diff --git a/src/api/types.ts b/src/api/types.ts
index 1ee7397..e376865 100644
--- a/src/api/types.ts
+++ b/src/api/types.ts
@@ -722,11 +722,11 @@ export type PhysicalExamQrcodeCreateResponse = CommonActionResult<string>;
  */
 export interface InputAddItemCombinationInfo {
   /** 体检组合项目代码 */
-  combination_item_code: string;
+  combination_item_code?: string | null;
   /** 体检组合项目价格 */
-  combination_item_price: number;
+  combination_item_price?: number | null;
   /** 折扣比例 */
-  discount_rate: number;
+  discount_rate?: number | null;
 }
 
 /**
@@ -1400,6 +1400,15 @@ export interface InputCustomSettlementApplyApprove {
   add_item_id?: string;
 }
 
+/**
+ * 体检加项自定义结算申请-加项组合项
+ */
+export interface OutputCustomSettlementApplyApproveItem {
+  combination_item_code?: string | null;
+  combination_item_price?: number | null;
+  discount_rate?: number | null;
+}
+
 /**
  * 体检加项自定义结算申请状态编辑出参
  */
@@ -1416,6 +1425,8 @@ export interface OutputCustomSettlementApplyApprove {
   apply_reason?: string;
   /** 折扣 */
   discount_ratio?: number | null;
+  /** 加项组合列表 */
+  listAddItemCombination?: OutputCustomSettlementApplyApproveItem[] | null;
 }
 
 /**
diff --git a/src/components/exam/ExamAddonPanel.tsx b/src/components/exam/ExamAddonPanel.tsx
index edc966d..5f2e526 100644
--- a/src/components/exam/ExamAddonPanel.tsx
+++ b/src/components/exam/ExamAddonPanel.tsx
@@ -2,6 +2,7 @@ import { useEffect, useMemo, useState, useRef, useCallback } from 'react';
 
 import type { ExamClient } from '../../data/mockData';
 import { searchPhysicalExamAddItem, getAddItemCustomerInfo, getChannelCompanyList, createNativePaymentQrcode, checkNativePaymentStatus, getAddItemBillPdf, getCustomSettlementApproveStatus, customSettlementApply, customSettlementApplyCancel } from '../../api';
+import type { InputAddItemCombinationInfo, OutputCustomSettlementApplyApproveItem } from '../../api/types';
 import { Button, Input } from '../ui';
 import { cls } from '../../utils/cls';
 import nozImage from '../../assets/image/noz.png';
@@ -97,6 +98,7 @@ export const ExamAddonPanel = ({ client, onGoToSign }: ExamAddonPanelProps) => {
     settlement_type?: number | null;
     discount_ratio?: number | null;
     add_item_id?: string | null;
+    listAddItemCombination?: OutputCustomSettlementApplyApproveItem[] | null;
   } | null>(null);
   const [customSettlementLoading, setCustomSettlementLoading] = useState(false);
   const [customSettlementType, setCustomSettlementType] = useState<1 | 2>(1); // 1-按比例折扣 2-自定义结算价
@@ -504,6 +506,7 @@ export const ExamAddonPanel = ({ client, onGoToSign }: ExamAddonPanelProps) => {
           settlement_type: (res.Data as any).settlement_type,
           discount_ratio: (res.Data as any).discount_ratio,
           add_item_id: currentAddItemId,
+          listAddItemCombination: res.Data.listAddItemCombination,
         };
 
         // 获取旧状态用于判断是否刚进入审核中
@@ -794,11 +797,7 @@ export const ExamAddonPanel = ({ client, onGoToSign }: ExamAddonPanelProps) => {
   const startPaymentPolling = (
     physical_exam_id: number,
     patient_id: number,
-    listAddItemCombination: Array<{
-      combination_item_code: string;
-      combination_item_price: number;
-      discount_rate: number;
-    }>,
+    listAddItemCombination: InputAddItemCombinationInfo[],
     pay_type: number,
     company_id: number,
     combinationItemCodes: string,
@@ -889,26 +888,32 @@ export const ExamAddonPanel = ({ client, onGoToSign }: ExamAddonPanelProps) => {
       const selectedItems = allAddons.filter((item) => selectedIds.has(item.id || item.name));
 
       // 构建加项组合项目信息列表
-      const listAddItemCombination = selectedItems
-        .map((item) => {
-          const combinationItemCode = item.combinationItemCode;
-          if (combinationItemCode === null || combinationItemCode === undefined) {
-            return null;
-          }
-          let combinationItemPrice = parseFloat(item.currentPrice || item.originalPrice || '0');
+      let listAddItemCombination: InputAddItemCombinationInfo[] = [];
 
-          // 如果自定义结算审核通过，传申请后的均价（按项平摊）
-          if (customSettlementStatus?.apply_status === 3 && typeof customSettlementStatus.final_settlement_price === 'number') {
-            combinationItemPrice = customSettlementStatus.final_settlement_price / selectedItems.length;
-          }
+      // 如果自定义结算审核通过，直接使用接口返回的项目列表
+      if (customSettlementStatus?.apply_status === 3 && customSettlementStatus.listAddItemCombination) {
+        listAddItemCombination = customSettlementStatus.listAddItemCombination.map((item: OutputCustomSettlementApplyApproveItem) => ({
+          combination_item_code: item.combination_item_code,
+          combination_item_price: item.combination_item_price,
+          discount_rate: item.discount_rate
+        }));
+      } else {
+        listAddItemCombination = selectedItems
+          .map((item) => {
+            const combinationItemCode = item.combinationItemCode;
+            if (combinationItemCode === null || combinationItemCode === undefined) {
+              return null;
+            }
+            const combinationItemPrice = parseFloat(item.currentPrice || item.originalPrice || '0');
 
-          return {
-            combination_item_code: String(combinationItemCode),
-            combination_item_price: combinationItemPrice,
-            discount_rate: discountRatio,
-          };
-        })
-        .filter((item): item is { combination_item_code: string; combination_item_price: number; discount_rate: number } => item !== null);
+            return {
+              combination_item_code: String(combinationItemCode),
+              combination_item_price: combinationItemPrice,
+              discount_rate: discountRatio,
+            } as InputAddItemCombinationInfo;
+          })
+          .filter((item): item is InputAddItemCombinationInfo => item !== null);
+      }
 
       if (listAddItemCombination.length === 0) {
         setPaymentMessage('缺少加项信息，请稍后重试');
@@ -919,6 +924,7 @@ export const ExamAddonPanel = ({ client, onGoToSign }: ExamAddonPanelProps) => {
       // 获取组合项目代码（用于生成二维码接口 & 生成加项单，多个加项逗号分隔）
       const combinationItemCodes = listAddItemCombination
         .map((item) => item.combination_item_code)
+        .filter(Boolean)
         .join(',');
 
       // 获取 patient_id（必须从接口返回的客户信息中获取）