cluster - 1 burns and plastic surgery sr.no package no … 1.12 burns post burn contracture...

Sr.No Package No Sub Speciality Procedure NamePre-Operative

Investigation Post Operative Investigation No of Follow up Package Rates Remarks

Speciality Code

PMJAYProcedure Code PMJAY

1 1.1 Burns 20% burns or scalds/burns over face (with or without grafting) Clinical Photograph Clinical Photograph 3 23000 S11 S1112001

2 1.2 Burns Up to 30% (with grafting) Clinical Photograph Clinical Photograph 3 34500 S11 S1112002

3 1.3 Burns upto-40% with Scalds (Conservative/ without grafting) Clinical Photograph Clinical Photograph 3 28750 S11 S1112003

4 1.4 Burns upto-40% Mixed Burns (with grafting) Clinical Photograph Clinical Photograph 3 40250 S11 S1100002

5 1.5 Burns upto-50% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 28750 S11 S1112004

6 1.6 Burns upto-50% Mixed Burns (with surgery grafting) Clinical Photograph Clinical Photograph 3 46000 S11 S1112005

7 1.7 Burns upto-60% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 46000 S11

8 1.8 Burns Up to-60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 57500 S11 S1100003

9 1.9 Burns Above 60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 63250 S11 S1100004

10 1.10 BurnsPost Burn Contracture surgeries for Functional Improvement(Package including

splints, pressure garments and physiotherapy), MildClinical Photograph Clinical Photograph 3 28175 S11 S1112006


splints, pressure garments and physiotherapy), ModerateClinical Photograph Clinical Photograph 3 34500 S11 S1112007


splints, pressure garments and physiotherapy), SevereClinical Photograph Clinical Photograph 3 40250 S11 S1112008

13 1.13 Plastic SurgeryReconstructive lower limb surgery following infection, Trauma, Tumors / Malignancy,

Developmental including diabetic foot – SEVEREClinical photograph Clinical photograph 4 48300 S11 S1012001

14 1.14 Plastic Surgery Abdominal wall reconstruction including post cancer excision. Clinical photograph Clinical photograph 4 40250 S11 S1012002

15 1.15 Plastic SurgeryReconstructive Micro surgery Replantation of hand, finger, thumb, arm, scalp etc

(Per finger 15000)Clinical photograph Clinical photograph 4 57500 S11 S1012003

Cluster - 1 BURNS AND PLASTIC SURGERY



Speciality Code


16 1.16 Plastic Surgery Reconstructive Micro surgery B) free tissue transfer Clinical photograph Clinical photograph 4 57500 S11 S1012004

17 1.17 Plastic Surgery Flap surgeries b) myocutaneous flap Clinical photograph Clinical photograph 4 40250 S11 S1012005

18 1.18 Plastic Surgery Flap surgeries c) osteo myocutaneous flap Clinical photograph Clinical photograph 4 40250 S11 S1012006

19 1.19 Plastic Surgery operation for vascularmalformation Clinical photograph Clinical photograph 4 34500 S11 S1012007

20 1.20 Plastic Surgery Ear Reconstruction for Microtia (stage-I) Clinical photograph Clinical photograph 4 28750 S11 S1012008

21 1.21 Plastic Surgery Ear Reconstruction for Microtia (stage-II) Clinical photograph Clinical photograph 4 34500 S11 S1012009

22 1.22 Plastic Surgery Ear Reconstruction for Microtia (stage-III) Clinical photograph Clinical photograph 4 40250 S11 S1012010

23 1.23 PLASTIC REPAIR Corrective Surgery for Congenital deformity of Upper Limb (Per Procedure) Clinical photograph Clinical photograph 4 20000 S11 S1012011

24 1.24 PLASTIC REPAIR Corrective Surgery for Craniosynostosis Clinical photograph Clinical photograph 4 50000 S11 S1012012

25 1.25Burns/Plastic

Surgery

% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns) - any % (not

requiring admission). Needs at least 5-6 dressing

Clinical photograph and

diagram with Rule of 9/ L

& B Chart for extent of

burns

Clinical photograph 7,000 S11 S1100001


Surgery

% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns): Upto 40 %;

Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed

necessary; Surgical procedures are required for deep burns that are not amenable to

heal with dressings alone.




burns



Surgery

% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns): 40 % - 60 %;







burns




Speciality Code



Surgery

% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns): > 60 %;







burns



Surgery

Electrical contact burns: Low voltage- without part of limb/limb loss; Includes % TBSA

skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical

procedures are required for deep burns that are not amenable to heal with dressings

alone.




burns



Surgery

Electrical contact burns: Low voltage- with part of limb/limb loss; Includes % TBSA



alone.




burns



Surgery

Electrical contact burns: High voltage- without part of limb/limb loss; Includes % TBSA



alone.




burns



Surgery

Electrical contact burns: High voltage- with part of limb/limb loss; Includes % TBSA



alone.




burns



Surgery

Chemical burns: Without significant facial scarring and/or loss of function; Includes %

TBSA skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical


alone.




burns



Surgery

Chemical burns: With significant facial scarring and/or loss of function; Includes %

TBSA skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical


alone.




burns




Speciality Code


35 1.35 Plastic Surgery Hemangioma – Sclerotherapy (under GA) Doppler/ MRI Clinical Photo 35,000 S10 S1000003

36 1.36 Plastic Surgery Hemangioma – Debulking/ Excision MRI Clinical Photo 35,000 S10 S1000004

37 1.37 Plastic SurgeryTissue Expander for disfigurement following burns/ trauma/ congenital deformity

(including cost of expander / implant)Clinical Photo Clinical Photo 50,000 S10 S1000005

38 1.38 Plastic Surgery Scalp avulsion reconstruction Clinical Photo Clinical Photo 50,000 S10 S1000006

39 1.39 Plastic Surgery NPWT (Inpatient only)(Per day Packege Amount) Clinical Photo Clinical Photo 2,000 per day S10 S1000007

40 1.40 Plastic Surgery Pressure Sore – Surgery Clinical Photo Clinical Photo 30,000 S10 S1000008


Surgery

Unspecified Surgical Package (Amount Capped @ 1,00,000rs per anum for

family,Package amount is Negotiable)Concern Investigation Concern Investigation 1,00,000 S11 U100



Speciality Code


42 2.1Intervention

CardiologyCAG (Coronary Angiography) 2D ECHO - 0 4025 S12 S1212001

43 2.2Intervention

CardiologyPeripheral/ Renal Angiography 2D ECHO - 0 4025 S12 S1212002

44 2.3Intervention

CardiologyCoronary Ballon Angioplasty CAG - 5 24150 S12 S1212003

45 2.4Intervention

CardiologyCath with Oxymetry 2D ECHO - 0 5520 S12 S1212004

46 2.5Intervention

CardiologyCath without Oxymetry 2D ECHO - 0 4428 S12 S1212005

47 2.6Intervention

CardiologyCheck Angiography 2D ECHO - 0 3335 S12 S1212006

48 2.7Intervention

CardiologyCoronary Angiography + Peripheral/ Renal Angiography 2D ECHO - 0 4025 S12 S1212007

49 2.10 Cardiology Renal/ Carotid /Peripheral Ballon Plasty (Unilateral) PAG - 5 23000

2.10 has been

modified tthen 2.8 &

2.9 can be included in

2.10

S12 S1212008

50 2.11Intervention

CardiologyAortic Stenting PAG - 5 60000

Rare case cover stent

may be permitted

after special

permission

S12 S1212009

51 2.12Intervention

CardiologyBallon Atrial Septectomy – BAS 2D ECHO - 0 16100 S12 S1200001

52 2.13Intervention

CardiologyIVC filter 0 - 0 50000

Different size and

types of filterS12 S1212010

53 2.14Intervention

CardiologyBi Ventricular Pacing - CRT ECG, ECHO, CAG

Bi-Ventricular Pacing - CRT Report,

ECG, ECHO, X-Ray Chest 0 2,90,000 S12 S1212011

54 2.15 AIntervention

CardiologyAICD - Automatic Implantable Cardiac Defibrillator (with device Single Chamber) ECG, ECHO, CAG

AICD- Automatic Implantable cardiac

Defibrillator (with device) report, ECG,

ECHO,X-Ray Chest

0 3,10,000

After special

Permission in very

Rare Case,as life

saving

S12 S1212012

Cluster - 2 CARDIOLOGY



Speciality Code


55 2.15 BIntervention

CardiologyAICD - Automatic Implantable Cardiac Defibrillator (with device Double Chamber) ECG, ECHO, CAG

AICD- Automatic Implantable cardiac

Defibrillator (with device) report, ECG,

ECHO, X-Ray Chest

0 4,12,000

After special

Permission in very

Rare Case,as life

saving

S12 S1212013

56 2.16Intervention

CardiologyCombo: AICD+Bi ventricular pacemaker (with device) ECG, ECHO

Combo: AICD+Bi ventricular pacemaker

(with device) report, ECG, ECHO, X-Ray

Chest

0 5,97,000

After

specialPermission in

very Rare Case,as life

saving

S12 S1212014

57 2.17Intervention

CardiologyPTCA - one stent (non-medicated) CAG X-Ray 5 62100 S12 S1212015

58 2.18Intervention

CardiologyPTCA - 2 stent (non-medicated) CAG X-Ray 5 85100 S12 S1212016

59 2.19Intervention

CardiologyBalloon Mitral Valvotomy – BMV 2D ECHO 2D ECHO 0 20000 S12 S1200003

60 2.20Intervention

CardiologyCoarctation dilatation – BDC 2D ECHO 2D ECHO, x-RAY 0 16000 S12 S1200012

61 2.21Intervention

CardiologyBalloon Pulmonary Valvotomy – BPV 2D ECHO 2D ECHO 0 16,100 S12 S1200004

62 2.22Intervention

CardiologyBalloon Aortic Valvotomy – BAV 2D ECHO 2D ECHO 0 16,100 S12 S1200002

63 2.23Intervention

CardiologyPeripheral Angioplasty withstent (non-medicated) 2D ECHO , ANGIOGRAM DOPPLER 5 50000 S12 S1212017

64 2.24Intervention

CardiologyRenal Angioplasty withstent (non-medicated) ANGIOGRAM DOPPLER , X-RAY 5 55000 S12 S1200008

65 2.25Intervention

CardiologyBoth side renal Angioplasty withstent (non-medicated) ANGIOGRAM DOPPLER , X-RAY 5 80000 S12 S1212018

66 2.26Intervention

CardiologyVertebral Angioplasty ANGIOGRAM DOPPLER 5 55000 S12 S1200005

67 2.27Intervention

CardiologyTemporary Pacemaker implantation CAG , ECG ECHO , X-RAY 0 4600 S12 S1200021

68 2.28Intervention

CardiologyPermanent pacemaker implantation (only VVI) including Pacemaker value CAG , ECG ECHO , X-RAY 0 63250 S12 S1212019

69 2.29Intervention

CardiologyPericardiocentesis 2D ECHO 2D ECHO 0 3450 S12 S1200020

70 2.30Intervention

CardiologyPDA Device Closure 2D ECHO 2D ECHO 0 50000 S12 S1200016

71 2.31Intervention

CardiologyASD Device Closure 2D ECHO 2D ECHO , X-RAY 0 92000 S12 S1200014

72 2.32Intervention

CardiologyVSD Device Closure 2D ECHO 2D ECHO , X-RAY 0 92000 S12 S1200015

73 2.33Intervention

CardiologyPDA Coil (one) insertion 2D ECHO 2D ECHO , X-RAY 0 13800 S12 S1200018

74 2.34Intervention

CardiologyPDA Multiple coil insertion 2D ECHO 2D ECHO , X-RAY 0 23000 S12 S1200017

75 2.35Intervention

CardiologyIVUS angiogram IVUS report 0 4,600 S12 S1212020

76 2.36Intervention

CardiologyEP study ECG, 2D Echo Clinical Photograph 0 11,308 S12 S1212021

77 2.37Intervention

CardiologyRF Ablation ECG, 2D Echo Clinical Photograph 0 16,100 S12 S1212022



Speciality Code


78 2.38Intervention

Cardiology3D Maping + Ablation ECG, 2D Echo Clinical Photograph 0 27313 S12 S1212023

79 2.39 Cardiology Medical treatment of Acute MI with Thrombolysis2D ECHO, CPKMB, ECG,

TROPONINE-T2D ECHO, ECG, LAB INVESTIGATION 0 17250 S12 S1200013

80 2.40 Cardiology Thrombolysis for peripheral ischemia ECG, 2D Echo 0 0 11,500 S12 S1200034

81 2.41Intervention

CardiologyRotablation+ PTCA CAG X-Ray 5 34500 S12 S1200031

82 2.42Intervention

CardiologyRotablation+ PTCA+ Stent X-Ray 5 80500 S12 S1200032

83 2.43Intervention

Cardiology Coiling (Coil clouser) 2D ECHO 2D ECHO,X-ray 5 20,000 S12 S1212024

84 2.44Intervention

CardiologyPost mi vsd closure 2D ECHO,ECG 2D ECHO,X-ray 5 92,000 S12 S1212025

85 2.45Intervention

CardiologyPTCA - one stent (medicated) CAG X-ray 5 72,000

Indication for DES

1)Diabetes

2)Lesion >18 mm in

length

S12 S1200024

86 2.46Intervention

CardiologyPTCA - 2 stent (medicated) CAG X-ray 5 108,000

Indication for DES

1)Diabetes

2)Lesion >18 mm in

length

S12 S1200025

87 2.47Intervention

CardiologyIABP 2D Echo 2D Echo - 15,000 S12 S1212026

88 2.48 Cardiology PDA stenting2D ECHO,Angiogram

report & stills40,000 S12 S1200019

89 2.49 Cardiology PTSMA CAG X-Ray 25,000 S12 S1200027

90 2.50 Cardiology Pulmonary artery stenting CAG X-Ray 40,000 S12 S1200028

91 2.51 Cardiology Pulmonary artery stenting (double) CAG X-Ray 65,000 S12 S1200029

92 2.52 Cardiology Right ventricular outflow tract (RVOT) stenting CAG X-Ray 40,000 S12 S1200030

93 2.53 Cardiology Bronchial artery Embolisation (for Haemoptysis)Chest x-Ray/CT

Scan,Serum Creatinine,HB

Chest x-Ray/CT Scan,Hb,Serum

Creatinine25,000 S12 S1200035

94 2.54 Cardiology Percutaneous Transluminal Tricuspid Commissurotormy (PTTC) 2D ECHO 2D ECHO 25,000 S12 S1200036

95 2.55 Cardiology Coiling - Pseudoaneurysms of Abdomen

CT,Serum

Creatinine,PT(Prothrombi

n Time),International

normalized ratio (INR)

CT,Serum Creatinine,PT(Prothrombin

Time),International normalized ratio

(INR)

55,000 S12 S1200037

96 2.56 Cardiology Embolization - Arteriovenous Malformation (AVM) in the Limbs

CT,Serum

Creatinine,PT(Prothrombi

n Time),International

normalized ratio (INR)

CT,Serum Creatinine,PT(Prothrombin

Time),International normalized ratio

(INR),HB

40,000 S12 S1200038

97 2.57 CardiologyCatheter directed Thrombolysis for: Deep vein thrombosis (DVT), Mesenteric

Thrombosis & Peripheral vesselsPT,S.Creatinine ,CT/MRI PT,S.Creatinine 50,000 S12 S1200039



Speciality Code


98 2.58 CardiologyUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


99 3.1 Cardiac CABG CAG Clinical Photograph 5 78200 S13 S1300001

100 3.2 Cardiac Re DO CABG CAG Clinical Photograph 5 83375 S13 S1312001

101 3.3 Cardiac CABG with IABP 2D ECHO , CAG Clinical Photograph 5 100625 S13 S1312002

102 3.4 Cardiac CABG with Aneurismal repair CAG Clinical Photograph 5 96025 S13 S1312003

103 3.5 Cardiac CABG with MV repair 2D ECHO , CAG Clinical Photograph 5 97750 S13 S1312004

104 3.6 Cardiac CABG with post MI VSD repair 2D ECHO , CAG Clinical Photograph 5 99475 S13 S1312030

105 3.7 Cardiac Open Mitral Valvotomy 2D ECHO 2D ECHO 5 78200 S13 S1300008

106 3.8 Cardiac Open Aortic Valvotomy 2D ECHO 2D ECHO , X-RAY 5 78200 S13 S1312005

107 3.9 Cardiac Open Pulmonary Valvotomy 2D ECHO 2D ECHO 5 80500 S13 S1300010

108 3.10 Cardiac Mitral Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300011

109 3.11 Cardiac Tricuspid Valve Repair 2D ECHO 2D ECHO , X-RAY 5 92000 S13 S1300012

110 3.12 Cardiac Mitral Valve Repair + Tricuspid Valve Repair 2D ECHO 2D ECHO , X-RAY 5 119600 S13 S1312006

111 3.13 Cardiac Aortic Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300013

Cluster - 3 CARDIO THORACIC SURGERY



Speciality Code


112 3.14 Cardiac Mitral Valve Replacement 2D ECHO 2D ECHO , X-RAY 5 120750

Bioprosthetic Valve in

special case like

,during pregnency

,Expecting Woman

,Old Age >70 yrs

S13 S1312007

113 3.15 Cardiac Aortic Valve Replacement 2D ECHO 3D ECHO , X-RAY 5 128800

Bioprosthetic Valve in

special case like

,during pregnency

,Expecting Woman

,Old Age >70 yrs

S13 S1312008

114 3.16 Cardiac Double Valve Replacement 2D ECHO 5D ECHO , X-RAY 5 152950 S13 S1312009

115 3.17 Cardiac Ross Procedure 2D ECHO 2D ECHO , X-RAY 5 120000 S13 S1300023

116 3.18 Cardiac ASD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300024

117 3.19 Cardiac VSD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300025

118 3.20 Cardiac AVSD/ AV Canal Defect 2D ECHO 2D ECHO , X-RAY 0 90850 S13 S1300026

119 3.21 Cardiac ICR for TOF 2D ECHO 2D ECHO , X-RAY 5 95000 S13 S1300027

120 3.22 Cardiac Pulmonary Valvotomy + RVOT Resection 2D ECHO 2D ECHO, X-RAY, clinical photograph 5 90850 S13 S1300028

121 3.23 Cardiac AP Window 2D ECHO 2D ECHO, X-RAY, clinical photograph 0 57500 S13 S1300029

122 3.24 Cardiac Surgery for HOCM 2D ECHO/TEE 2D ECHO, X-RAY, clinical photograph 0 90850 S13 S1300030

123 3.25 Cardiac Ebsteins 2D ECHO 2D ECHO, X-RAY, clinical photograph 0 90850 S13 S1300031



Speciality Code


124 3.26 Cardiac Fontan 2D ECHO 2D ECHO, X-RAY, clinical photograph 0 90850 S13 S1300032

125 3.27 Cardiac TAPVC 2D ECHO 2D ECHO , clinical photograph 0 90850 S13 S1300033

126 3.28 Cardiac Pulmonary Atresia with or without VSD 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 97750 S13 S1312010

127 3.29 Cardiac TGA 2D ECHO/Angio 2D ECHO , X-RAY, clinical photograph 0 97750 S13 S1312011

128 3.30 Cardiac Arterial Switch Operation 2D ECHO/Angio 2D ECHO , X-RAY, clinical photograph 0 86250 S13 S1300035

129 3.31 Cardiac ALCAPA - - 0 86250 S13

130 3.32 Cardiac Sennings 2D ECHO/Angio 2D ECHO , X-RAY, clinical photograph 0 74750 S13 S1300037

131 3.33 Cardiac Mustards 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 86250 S13 S1300038

132 3.34 Cardiac Pulmonary Conduit 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 105000 S13 S1312013

133 3.35 Cardiac Truncus Arteriosus Surgery 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 97750 S13 S1300039

134 3.36 Cardiac Root Replacement (Aortic Aneurysm/ Aortic Dissection) / Bental Procedure 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 130000 S13 S1300040

135 3.37 Cardiac Aortic Arch Replacement 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 38065 S13 S1300041

136 3.38 Cardiac Aortic Aneurysm Repair using CPB 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 125000 S13 S1300042

137 3.39 Cardiac Aortic Aneurysm Repair without using CPB 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 65000 S13 S1300043

138 3.40 Cardiac Pulmonary Embolectomy / Endarterectomy ABG, 2D ECHO, X-Ray 2D ECHO , X-RAY, clinical photograph 0 92000 S13 S1312014

139 3.41 Cardiac Surgery for Cardiac Tumour/ LA Myxoma/ RA Myxoma 2D ECHO 2D ECHO , X-RAY, clinical photograph 0 96600 S13 S1300045

140 3.42 Cardiac Closed Mitral Valvotomy 2D ECHO 2D ECHO , X-RAY 0 23000 S13 S1300009

141 3.43 Cardiac PDA Closure 2D ECHO 2D ECHO , X-RAY 5 23000 S13 S1300046



Speciality Code


142 3.44 Cardiac Coarctation Repair 2D ECHO, CAG Doppler 0 28750 S13 S1300047

143 3.45 Cardiac Coarctation Repair with graft 2D ECHO, CAG Doppler 0 36800 S13 S1300048

144 3.46 Cardiac BT Shunt (inclusives of grafts) 2D ECHO 2D ECHO, x-RAY 0 42000 S13 S1300049

145 3.47 Cardiac Glenn Shunt 2D ECHO 2D ECHO, x-RAY 0 57500 S13 S1300050

146 3.48 Cardiac Central Shunt 2D ECHO 2D ECHO, x-RAY 0 42000 S13 S1300051

147 3.49 Cardiac Aortic arch Anamolies 2D ECHO 2D ECHO, x-RAY 0 57500 S13 S1312016

148 3.50 Cardiac Pericardiectomy 2D ECHO 2D ECHO , X-RAY 0 34500 S13 S1300052

149 3.51 Cardiac Thoracoscopic surgery CT Chest X-Ray 0 40250 S13 S1312017

150 3.52 Cardiac Surgery without CPB CT Chest X-Ray 0 57500 S13 S1312018

151 3.53 Cardiac Surgery with CPB CT Chest X-Ray 0 57500 S13 S1312019

152 3.54 Thoracic Lobectomy CT-Chest , X-RAY Clinical Photograph , X-RAY 0 34500 S13 S1312020

153 3.55 Thoracic Pneumonectomy CT-Chest , X-RAY Clinical Photograph , X-RAY 0 46000 S13 S100219

154 3.56 Thoracic Pleurectomy CT-Chest , X-RAY Clinical Photograph , X-RAY 0 46000 S13 S1312022

155 3.57 Thoracic Decortication CT-Chest , X-RAY Clinical Photograph , X-RAY 0 51750 S13 S1312023

156 3.58 Thoracic Mediastinotomy CT-Chest , X-RAY Clinical Photograph , X-RAY 0 28750 S13 S1312024

157 3.59 Thoracic Pulmonary AV Fistula surgery Biopsy , CT , X-RAY Biopsy , Clinical Photograph , X-RAY 0 23000 S13 S1300053

158 3.60 Thoracic Lung Cyst CT-Chest , X-RAY Clinical Photograph , X-RAY 0 34500 S13 S1300054

159 3.61 Thoracic SOL mediastinum CT-Chest , X-RAY Clinical Photograph , X-RAY 0 51750 S13 S1300055



Speciality Code


160 3.62 Thoracic Surgical Correction of Bronchopleural Fistula. Biopsy , CT , X-RAY Biopsy , Clinical Photograph , X-RAY 0 34500 S13 S1512026

161 3.63 Thoracic Diaphragmatic Eventeration Barium Study, CT SCAN USG 0 46000 S13 S1300057

162 3.64 Thoracic Diaphragmatic HerniaBArium Study, X-RAY,

ENDOSCOPY, USGBIOPSY, CLINICAL PHOTOGRAPH 0 23000 S13 S1312025

163 3.65 Thoracic Oesophageal Diverticula /Achalasia Cardia Barium Study, CT SCAN USG 0 23000 S13 S1300058

164 3.66 Thoracic Diaphragmatic Injuries CT-Chest , X-RAY Clinical Photograph , X-RAY 0 23000 S13 S1300059

165 3.67 Thoracic Thoracotomy, Thoraco Abdominal Approach CT-Chest , X-RAY Clinical Photograph , X-RAY 0 34500 S13 S1300060

166 3.68 Thoracic Foreign Body Removal with scopeCT-Chest ,

BRONCHOSCOPYENDOSCOPY PICTURE 0 11500

post ix- endoscopy or

ct chestS13 S1300061

167 3.69 Thoracic Bronchial Repair Surgery for Injuries due to FBCT-Chest ,

BRONCHOSCOPYENDOSCOPY PICTURE 0 28750


ct chestS13 S1300062

168 3.70 ThoracicGastro StudyFollowed by Thoracotomy & Repairs for Oesophageal Injury for

Corrosive Injuries/FBGASTROSCOPY ENDOSCOPY PICTURE 0 16100


ct thoraxS13 S1312026

169 3.71 Thoracic Oesophageal tumour removalENDOSCOPY, X-RAY,

BARIUM STUDYBiopsy , Clinical Photograph , USG 0 28750 S13 S1312027

170 3.72 Thoracic OesophagectomyBiopsy , CT , Endoscopy ,

USGBiopsy , Clinical Photograph , USG 0 34500 S13 S100103

171 3.73 Thoracic Lung Injury repair CT-Chest , X-RAY Clinical Photograph , X-RAY 0 23000 S13 S1300063

172 3.74 Thoracic Diaphragmatic injury repair CT-Chest , X-RAY Clinical Photograph , X-RAY 0 28750 S13 S1312029

173 3.75 Thoracic Thyomectomy CT-Chest , X-RAY Clinical Photograph , X-RAY 0 28750 S13 S1300064

174 3.76 Cardiac CABG with Post MI Cardiac repair CAG, 2D Echo,ECG 2D Echo, X-ray 5 100000 S13 S1312030

175 3.77 Cardiac Tricuspid valve replacement 2D Echo 2D Echo, X-ray 5 115000 S13 S1312031

176 3.78 Cardiac Root enlargement with/ without graft 2D Echo 2D Echo, X-ray,Clinical Photograph 5 90000 S13 S1312032

177 3.79 Cardiac ICR 2D Echo 2D Echo, X-ray 5 90000 S13 S1312033



Speciality Code


178 3.80 Cardiac Double Switch Operation 2D ECHO 2D ECHO, X-Ray, Clinical Photograph 120,000 S13 S1300036

179 3.81 Cardiac Pulmonary Valve Replacement 2D ECHO Scar Photo,ECHO 120,000 S13 S1300065

180 3.82 Cardiac Intercostal Drainage and Management of ICD, Intercostal Block, Antibiotics &

PhysiotherapyPost Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 10,000 S13 S1300066

181 3.83 Cardiac Encysted Empyema/Pleural Effusion - Tubercular Post Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 10,000 S13 S1300067

182 3.84 Cardiac First rib Excision by transaxillary approach, Excision of cervical rib / fibrous band /

muscle by cervical approachPost Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 30,000 S13 S1300068

183 3.85 Cardiac Congenital Cystic Lesions Post Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 30,000 S13 S1300069

184 3.86 Cardiac Pulmonary Sequestration Resection Post Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 40,000 S13 S1300070

185 3.87 Cardiac Pulmonary artero venous malformation Post Op X-ray / CT Scan Post Op X-ray / CT Scan,Scar Photo 40,000 S13 S1300071

186 3.88 Cardiac Unspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per


Sr.No Package no Sub speciality Procedure namePre-Operative


Speciality Code


187 4.1 Vascular Patch Graft Angioplasty Regional angiogram Angiogram report, clinical Photograph 5 18400 S13 S100217

188 4.2 Vascular Femoropopliteal by pass procedure with graft (inclu. Graft) ANGIO Doppler 5 51750 S13 S1312035

189 4.3 Vascular Thromboembolectomy ANGIO Color Doppler 5 20700 S13 S1312036

190 4.4 Vascular Surgery for Arterial Aneursysm -Distal Abdominal AortaAngiogram/spiral CT

AngiogramColor Doppler 5 65000 S13 S1312037

191 4.5 Vascular Surgery for Arterial Aneursysm -Upper Abdominal AortaAngiogram/spiral CT


192 4.6 Vascular Surgery for Arterial Aneursysm –VertebralAngiogram/spiral CT


193 4.7 Vascular Intrathoracic Aneurysm (without graft)-Aneurysm not Requiring Bypass Techniques CT-Angio , Cath DOPPLER 5 74750 S13 S1300074

194 4.8 Vascular Intrathoracic Aneurysm (with graft) -Requiring Bypass Techniques CT-Angio , Cath DOPPLER 5 86250 S13 S1300075

Cluster - 4 CARDIO VASCULAR SURGERY



Speciality Code


195 4.9 Vascular Dissecting Aneurysms with CPB (inclu. Graft) CT-Angio , Cath DOPPLER 5 94,300 S13 S1312040

196 4.10 Vascular Dissecting Aneurysms without CPB (incl. graft) CT-Angio , Cath DOPPLER 5 86,250 S13 S1312041

197 4.11 Vascular Vascular Procedure – Major Vessels color Doppler/Angiogram Color Doppler 5 23000 S13 S1312042

198 4.12 Vascular Vascular Procedure – Minor Vessels color Doppler/Angiogram Color Doppler 5 20000 S13 S1312043

199 4.13 Vascular Surgery for Arterial Aneurysm Renal ArteryRenal arterial

Doppler,angiogramClinical Photograph 5 17250 S13 S1300076

200 4.14 Vascular Surgery for Arterial Aneurysm Carotid Carotid Doppler Clinical Photograph 5 17250 S13 S1312044

201 4.15 Vascular Surgery for Arterial Aneursysm Main Arteries of the Limb Peripheral Doppler Clinical Photograph 5 17250 S13 S1312045

202 4.16 Vascular Operations for Acquired Arteriovenous Fistual regional Angiogram Clinical Photograph 5 11500 S13 S1312046

203 4.17 Vascular Congenital Arterio Venous Fistula regional Angiogram Clinical Photograph 5 17250 S13 S1300077

204 4.18 Vascular Operations for Stenosis of Renal ArteriesRenal arterial

Doppler,angiogramClinical Photograph 5 23000 S13 S1300078

205 4.19 Vascular Peripheral Embolectomy without graftAngiogram/spiral CT

AngiogramColor Doppler 5 17,250 S13 S1312047

206 4.20 Vascular Aorto Billiac / Bifemoral bypass with Synthetic GraftAngiogram/spiral CT


207 4.21 Vascular Axillo bifemoral bypass with Synthetic GraftAngiogram/spiral CT


208 4.22 Vascular Femoro Distal Bypass with Vein GraftAngiogram/spiral CT


209 4.23 Vascular Femoro Distal Bypass with Synthetic GraftAngiogram/spiral CT


210 4.24 Vascular Axillo Brachial Bypass using with Synthetic GraftAngiogram/spiral CT


211 4.25 Vascular Brachio - Radial Bypass with Synthetic GraftAngiogram/spiral CT


212 4.26 Vascular Excision of Carotid body Tumor with vascular repairAngiogram/spiral CT




Speciality Code


213 4.27 Vascular Carotid artery bypass with Synthetic GraftAngiogram/spiral CT


214 4.28 Vascular Excision of Arterio Venous malformation – LargeSpiral CT Angiogram /MRI


215 4.29 Vascular Excision of Arterio Venous malformation – SmallSpiral CT Angiogram /MRI


216 4.30 Vascular Arterial Embolectomy Angiogram/colour Doppler Color Doppler/SBP/PVR 5 17,250 S13 S100150

217 4.31 Vascular D V T - IVC Filter color Doppler Plain X-ray abdomen 5 28750 S13 S1300088

218 4.32 Vascular Vascular TumorsAngiogram/Spiral CT


219 4.33 Vascular Small Arterial Aneurysms – RepairAngiogram/Spiral CT


220 4.34 Vascular Medium size arterial aneurysms – RepairAngiogram/Spiral CT


221 4.35 Vascular Medium size arterial aneurysms with synthetic graftAngiogram/Spiral CT


222 4.36 Vascular Carotid endarterectomy ANGIOGRAM X-RAY/DOPPLER 5 28750 S13 S1300089

223 4.37 Vascular Intrathoracic Aneurysm-Aneurysm not Requiring Bypass Techniques CT Angio, CATH Doppler 44,750 S13 S1300074

224 4.38 Vascular Intrathoracic Aneurysm-Requiring Bypass Techniques CT Angio, CATH Doppler 86,250 S13 S1300075

225 4.39 Vascular Aortic Angioplasty with two stents / Iliac angioplasty with stent Bilateral PAGAngioplasty stills showing Balloon &

post flow,Scar Photo90,000 S13 S1300090

226 4.40 Vascular Bilateral thrombo embolectomy

Duplex

ultrasound/Angiogram -

pre or intra operative

Scar Photo 30,000 S13 S1300091

227 4.41 Vascular Aorto-uni-iliac/uni-femoral bypass with synthetic graft

Angiogram/ Computed

Tomography Angiography

(3D-CTA)/Magnetic

Resonance Angiography

Duplex ultrasound,Scar Photo 70,000 S13 S1300092



Speciality Code


228 4.42 VascularUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


229 5.1 Urology Open Pyelolithotomy IVP , KUB , USGClinical Photograph , USG , X-RAY, urine

analysis2 15000 S7 S700028

230 5.2 Urology Open Nephrolithotomy IVP , KUB , USGClinical Photograph , USG , X-RAY, urine

analysis2 15000 S7 S700030

231 5.3 Urology Open Cystolithotomy IVP , KUB , USG Clinical Photograph , USG , X-RAY 2 10000 S7 S700060

232 5.4 Urology VVF Repair IVP , KUB , USGClinical Photograph , USG , voiding

cystogram3 23000 S7 S712001

233 5.5 Urology Pyeloplasty IVP , KUB , USGClinical Photograph , IVP/DTPA renal

scan3 23000 S7 S700016

234 5.6 Urology Cystolithotripsy IVP , KUB , USG Clinical Photograph , X-RAY 2 9775 S7 S700095

235 5.7 Urology PCNL (Percutaneous Nephro Lithotomy)IVP , KUB , USG, Spiral CT

KUB

Clinical Photograph , X-RAY KUB, USG

KUB2 23000 S7 S700025

236 5.8 Urology ESWL (Extra carporial shock-wave lithotripsy) IVP , KUB , USG X-RAY and USG KUB 2 8625 S7 S700026

237 5.9 Urology URSLIVP , KUB , USG, Spiral CT

KUBX-RAY KUB 2 10000 S7 S712002

238 5.10 Urology Nephrostomy (PCN) IVP , USG Clinical Photograph 0 5750 S7 S712003

239 5.11 Urology DJ stent (One side) IVP , USG X-RAY KUB 0 5750 S7 S712004

240 5.12 Urology Urethroplasty for Stricture Diseases-single stage RGU & MCU, UroflometryRGU & MCU, Uroflometry, Clinical

Photograph0 25000 S7 S712005

241 5.13 Urology Urethroplasty for Stricture Diseases-First Stage RGU & MCU, UroflometryRGU & MCU, Uroflometry, Clinical


Cluster - 5 GENITO URINARY SURGERY (RENAL)



Speciality Code


242 5.14 Urology Urethroplasty for Stricture Diseases-Second Stage RGU & MCU, UroflometryRGU & MCU, Uroflometry, Clinical


243 5.15 Urology Hypospadiasis(Adult) USG,Clinical Photograph Clinical Photograph, Uroflowmetry 3 20700 S7 S712007

244 5.16 Urology TURBT Biopsy , CT , USG, ECHO Biopsy , USG KUB 3 28750 S7 S700062

245 5.17 Urology TURP USG, Uroflometry, ECHO Biopsy , USG bladder and prostate 3 24150 S7 S700093

246 5.18 Urology Simple NephrectomyBiopsy , CT KUB , USG,

Renal ScanBiopsy , Clinical Photograph , USG 3 20700 S7 S700006

247 5.19 Urology Lap. Nephrectomy SimpleUSG, CT, ECHO, Renal

ScanBiopsy , Clinical Photograph , USG 3 20700 S7 S700007

248 5.20 Urology Lap. Nephrectomy Radical CT, KUB , USG, Renal Scan Biopsy , Clinical Photograph , USG 6 25300 S7 S700009

249 5.21 Urology Lap. Partial Nephrectomy CT, USG Biopsy , Clinical Photograph , USG 6 18527 S7 S700011

250 5.22Urology/

NephrologyRETROGRADE INTRARENAL SURGERY WITH LASER LITHOTRIPSY

CBC, S. CREATININE,

URINE R/M, URINE C/S,

PT/ APTT, X RAY KUB, IVP,

USG KUB

X RAY KUB, USG KUB 5 30000 S7 S712008

251 5.24Urology/

NephrologyHOLMIUM ENUCLEATION OF PROSTATE

CBC, S. CREATININE,

URINE R/M, URINE C/S, X

RAY KUB, USG KUB, S.

PSA, UROFLOWMETRY, S.

ELECTROLYTES

USG KUB, UROFLOWMETRY 5 30000 S7 S700094

252 5.30Urology/

NephrologyCHECK CYSTOSCOPY

CBC, S. CREATININE,

URINE R/M, USG KUB,

URINE CYTOLOGY

- 5 5750 S7 S700067

253 5.31Urology/

NephrologyCYSTOSCOPY + URINE SAMPLING + B/L RGP

CBC, S. CREATININE,


PT/ APTT, X RAY KUB, USG

KUB

- 5 9200 S7 S700057

254 5.41Urology/

NephrologyCOLOSTOMY & SUPRAPUBIC URINARY DIVERSION FOR PELVIC FRACTURE INJURY

CBC, S. CREATININE,

URINE R/M, USG KUB,

RGU + MCU

- 5 23000 S7 S712009



Speciality Code


255 5.45Urology/

NephrologySURGERY FOR URETHRORECTAL FISTULA

CBC, S. CREATININE,


USG KUB, RGU + MCU, CT

ABDOMEN

MCU 5 28750 S7 S712010

256 5.46Urology/

NephrologyOPEN SURGERY FOR COLOVESICAL FISTULA

CBC, S. CREATININE,


USG KUB, RGU + MCU, CT

ABDOMEN

MCU 5 34500 S7 S712011

257 5.54Urology/

NephrologyOPEN NEPHROURETERECTOMY WITH BLADDER CUFF EXCISION

CBC, S. CREATININE,

URINE C/S, X RAY KUB,

USG KUB, CECT

ABDOMEN, LFT, CHEST X

RAY, URINE CYTOLOTY

S. CREATININE, USG KUB, CHEST X RAY,

CT ABDOMEN5 34500 S7 S700014

258 5.55Urology/

NephrologyLAPAROSCOPIC NEPHROURETERECTOMY WITH BLADDER CUFF EXCISION

CBC, S. CREATININE,

URINE C/S, X RAY KUB,

USG KUB, CECT

ABDOMEN, LFT, CHEST X

RAY, URINE CYTOLOTY

S. CREATININE, USG KUB, CHEST X RAY,

CT ABDOMEN5 51750 S7 S700015

259 5.57Urology/

NephrologyOPEN URETEROCALICOSTOMY

CBC, S. CREATININE,


RAY KUB, IVP, USG KUB,

DIURETIC RENAL SCAN

USG KUB, DIURETIC RENAL SCAN 5 34500 S7 S700020

260 5.58Urology/

NephrologyLAPAROSCOPIC URETEROCALICOSTOMY

CBC, S. CREATININE,


RAY KUB, IVP, USG KUB,

DIURETIC RENAL SCAN

USG KUB, DIURETIC RENAL SCAN 5 40250 S7 S700021

261 5.59Urology/

NephrologyOPEN HEMINEPHRECTOMY FOR FUSION ANOMALY

CBC, S. CREATININE,


RAY KUB, CT IVU, USG

KUB, DIURETIC RENAL

SCAN

USG KUB 5 34500 S7 S712012



Speciality Code


262 5.60Urology/

NephrologyLAPROSCOPIC HEMINEPHRECTOMY FOR FUSION ANOMALY

CBC, S. CREATININE,



KUB, DIURETIC RENAL

SCAN

USG KUB 5 40250 S7 S712013

263 5.61Urology/

NephrologyOPEN ANATROPHIC NEPHROLITHOTOMY ( For Staghorn Stone)

CBC, S. CREATININE,



KUB

USG KUB, X RAY KUB, S. CREATININE 5 34500 S7 S712014

264 5.66Urology/

NephrologyOPEN URETERAL REIMPLANTATION FOR URETEROVAGINAL FISTULA

CBC, S. CREATININE,



USG KUB, MCU

USG KUB, DIURETIC IVP, MCU 5 34500 S7 S700044

265 5.67Urology/

NephrologyLAPAROSCOPIC URETERAL REIMPLANTATION FOR URETEROVAGINAL FISTULA

CBC, S. CREATININE,



USG KUB, MCU

USG KUB, DIURETIC IVP, MCU 5 46000 S7 S700046

266 5.68Urology/

NephrologyLAPAROSCOPIC VVF REPAIR

CBC, S. CREATININE,


IVP, USG KUB, MCU

MCU 5 43700 S7 S700085

267 5.71Urology/

NephrologyURETEROLYSIS FOR RETROPERITONEAL FIBROSIS

CBC, S. CREATININE,

URINE R/M, URINE C/S, CT

IVU, USG KUB

DIURETIC IVP 5 34500 S7 S712015

268 5.78Urology/

NephrologyOPEN RADICAL CYSTECTOMY WITH NEOBLADDER

CBC, S. CREATININE,

URINE CYTOLOGY, URINE

C/S,CT ABDOMEN, USG

KUB, CHEST X RAY

USG KUB, CT IVU, POUCHOGRAM 5 80500 S7 S700075

269 5.80Urology/

NephrologyOPEN RADICAL CYSTECTOMY WITH MAINZ 2 POUCH

CBC, S. CREATININE,

URINE CYTOLOGY, URINE

C/S,CT ABDOMEN, USG

KUB, CHEST X RAY,

COLONOSCOPY

CBC, S. CREATININE, ABG, USG

ABDOMEN, CT IVU, COLONOSCOPY5 57500 S7 S712016

270 5.82Urology/

NephrologyOPEN AUGMENTATION CYSTOPLASTY

CBC, S. CREATININE, MCU,

URINE C/S,CT ABDOMEN,

USG KUB, CHEST X RAY,

URINE AFB, IVP

MCU 5 57500 S7 S700089



Speciality Code


271 5.84Urology/

NephrologyOPEN BLADDER DIVERTICULECTOMY WITH URETERIC REIMPLANTATION

CBC, S. CREATININE,


USG KUB, MCU, DMSA

SCAN

MCU, DMSA RENAL SCAN 5 34500 S7 S700091

272 5.91Urology/

NephrologyOPEN ORCHIECTOMY (SIMPLE / RADICAL)

USG SCROTUM, DOPPLER

SCROTUM / AFP, LDH, B

HCG, CT ABDOMEN

AFP, LDH, B HCG, CT ABDOMEN 5 17250 S7 S712017

273 5.108Urology/

NephrologyOPEN ILEAL REPLACEMENT FOR URETERIC STRICTURE

CT IVU, MCU, URINE FOR

AFB, USG ABDOMENDIURETIC IVP 5 57500 S7 S712018

274 5.111Urology/

NephrologyOPEN BOARI FLAP

CT IVU, MCU, USG

ABDOMENMCU 5 28750 S7 S700052

275 5.124Urology/

NephrologyOPEN URETEROLYSIS

CBC, S. CREATININE,

URINE R/M, URINE C/S, CT

IVU, USG KUB

DIURETIC IVP 5 34500 S7 S712019

276 5.126Urology/

NephrologyOPEN COLOVAGINAL FISTULA REPAIR

CT ABDOMEN,

COLONOSCOPYBARIUM ENEMA 5 34500 S7 S712020

277 5.127Urology/

NephrologyURETHROVAGINAL FISTULA REPAIR

CBC, S. CREATININE,


IVP, USG KUB, MCU

MCU 5 34500 S7 S700087

278 5.135Urology/

NephrologyRADIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 6440 S7 S712022

279 5.136Urology/

NephrologyBRACHIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 8280 S7 S712023

280 5.142Urology/

Nephrology

MAINTENANCE HEMODIALYSIS (MHD) (WITH INJ. ERYTHROPOETINE WITH INJ. IRON)

–PER DIALYSIS.

CBC, S.CRETAIN, BL UREA,

S. Na+ /S.K+, HIV(ELLISA),

HCV (ELLISA), HBS Ag

(ELLISA)

- 0 2300 S7 S712024

281 5.143Interventional

Radiology

Permanent tunnelled catheter placement as substitute for AV fistula in long term

dialysis

Colour Doppler/

Peripheral AngiogramClinical Photograph 0 30,000 S7 S712025



Speciality Code



RadiologyEndovascular intervention for salvaging hemodialysis AV fistula

Colour Doppler/



RadiologySPC for atony bladder

Colour Doppler/


284 5.146 Urology Adrenalectomy-unilateral, open clinical notes,CT/MRI/USG Clinical photograph,USG 25,000 S7 S700001

285 5.147 Urology Adrenalectomy-unilateral, Laparoscopic clinical notes,CT/MRI/USG Clinical photograph,USG 30,000 S7 S700002

286 5.148 Urology Adrenalectomy-bilateral, open clinical notes,CT/MRI/USG Clinical photograph,USG 32,000 S7 S700003

287 5.149 Urology Adrenalectomy-biilateral, Laparoscopic clinical notes,CT/MRI/USG Clinical photograph,USG 40,000 S7 S700004

288 5.150 Urology Paraganglioma excision with liver mobilization clinical notes,CT/MRI/USG Clinical photograph,USG 50,000 S7 S700005

289 5.151 Urology Nephrectomy-Radical (Renal tumor) Open USG ,CT / MRI HPEE 25,000 S7 S700008

290 5.152 Urology Nephrectomy-Partial or Hemi, Open USG ,CT / MRI HPEE 30,000 S7 S700010

291 5.153 Urology Nephrectomy-Partial or Hemi, Laparoscopic USG ,CT / MRI HPEE 35,000 S7 S700011

292 5.154 Urology Nephro ureterectomy (Benign) Open Renal Scan(DTPA) HPEE 25,000 S7 S700012

293 5.155 Urology Nephro ureterectomy (Benign) Laparoscopic Renal Scan(DTPA) HPEE 30,000 S7 S700013

294 5.156 Urology Endopyelotomy (retrograde with laser/bugbee) USG,X Ray,IVP/CT USG 25,000 S7 S700018

295 5.157 Urology Endopyelotomy (antegrade with laser/bugbee) USG,X Ray,IVP/CT USG 28,000 S7 S700019

296 5.158 Urology Uretero-ureterostomy Open USG,X Ray,IVP/CT USG 25,000 S7 S700022



Speciality Code


297 5.159 Urology Uretero-ureterostomy Laparoscopic USG,X Ray,IVP/CT USG 35,000 S7 S700023

298 5.160 Urology Pyelolithotomy-Laparoscopic USG,X Ray,IVP/CT USG 30,000 S7 S700029

299 5.161 Urology Perinephric Abscess drainage (percutaneous) USG/CT USG 10,000 S7 S700032

300 5.162 Urology Perinephric Abscess drainage (Open) USG/CT USG 20,000 S7 S700033

301 5.163 Urology Renal Cyst deroofing or marsupialization-Open USG/CT USG 20,000 S7 S700034

302 5.164 Urology Renal Cyst deroofing or marsupialization-Laparoscopic USG/CT USG 30,000 S7 S700035

303 5.165 Urology Ureterolithotomy-Open USG,X Ray,IVP/CT Clinical photograph,USG 20,000 S7 S700037

304 5.166 Urology Ureterolithotomy-Laparoscopic USG,X Ray,IVP/CT Clinical photograph,USG 30,000 S7 S700038

305 5.167 Urology Ureterotomy (Cutaneous) USG,X Ray,IVP/CT Clinical photograph,USG 20,000 S7 S700042

306 5.168 Urology Endoureterotomy (laser/bugbee) USG,X Ray,IVP/CT Clinical photograph,USG 20,000 S7 S700043

307 5.169 Urology Uretero-vaginal/uterine fistula repair openUSG KUB,CT Urography/

MRI UrographyUSG 27,000 S7 S700048

308 5.170 Urology Uretero-vaginal/uterine fistula repair LaparoscopicUSG KUB,CT Urography/

MRI UrographyUSG 37,000 S7 S700049

309 5.171 Urology Boari flap for ureteric stricture, Laparoscopic USG,IVP/CT USG 40,000 S7 S700053

310 5.172 UrologyUreterocele incision including cystoscopy, ureteric catheterization, retrograde

pyelogramUSG,IVP/CT USG 15,000 S7 S700058

311 5.173 Urology Urachal Cyst excision -open USG,IVP/CT USG 15,000 S7 S700059

312 5.174 Urology Cystolithotomy-open, including cystoscopy USG,IVP/CT USG 15,000 S7 S700060

313 5.175 Urology Cystolithotripsy/Urethral Stone endoscopic, including cystoscopy USG,IVP/CT USG 15,000 S7 S700061



Speciality Code


314 5.176 Urology TUR-fulgration (Transurethral fulgration of the Bladder Tumor) USG/CT USG/HPEE 18,000 S7 S700063

315 5.177 Urology Bladder Neck incision-endoscopic

CBC, S. Cretanine, Urine-

R/M, USG KUB, Urine

Cytology

CLINICAL NOTES 15,000 S7 S700068

316 5.178 UrologyExtrophy Bladder repair including osteotomy if needed + epispadias repair + ureteric

reimplantClinical Photo Clinical Photo 50,000 S7 S700069

317 5.179 Urology Bladder injury repair (as an independent procedure with or without urethral injury) Clinical Photo Clinical Photo 20,000 S7 S700070

318 5.180 UrologyBladder injury repair with colostomy (as an independent procedure with or without

urethral injury)USG, Clinical Notes Clinical Photo 25,000 S7 S700072

319 5.181 Urology Partial Cystectomy-openclinical notes,CT

Scan/USG/MRI /MCUClinical Photo, HPEE 20,000 S7 S700073

320 5.182 Urology Partial Cystectomy-Laparoscopicclinical notes,CT


321 5.183 Urology Radical cystectomy with continent diversion-openclinical notes,CT


322 5.184 Urology Radical Cystectomy with Ileal Conduit-openclinical notes,CT


323 5.185 Urology Radical Cystectomy with ureterostomy-openclinical notes,CT


324 5.186 Urology Radical Cystectomy with ureterosigmoidostomy-openclinical notes,CT


325 5.187 Urology Other Cystectomiesclinical notes,CT


326 5.188 Urology Suprapubic Cystostomy - Open, as an independent procedureclinical notes,CT

Scan/USG/MRI Clinical Photo 10,000 S7 S700081

327 5.189 Urology Suprapubic Drainage - Closed/Trocarclinical notes,CT


328 5.190 Urology VVF/Uterovaginal Repair - Transvaginal approachclinical notes,CT

Scan/USG/MRI /IVPClinical Photo 25,000 S7 S700083

329 5.191 Urology VVF/Uterovaginal Repair - Abdominal,Openclinical notes,CT


330 5.192 Urology Hysterectomy as part of VVF/uterovaginal fistula repair (top-up)clinical notes,CT




Speciality Code


331 5.193 Urology Urethrovaginal fistula repairclinical notes,CT


332 5.194 Urology Y V Plasty of Bladder Neck/Bladder Neck Reconstructionclinical notes,CT

Scan/USG/MRIClinical Photo 20,000 S7 S700088

333 5.195 Urology Augmentation cystoplasty-openclinical notes,CT


334 5.196 Urology Augmentation cystoplasty-Laparoscopicclinical notes,CT


335 5.197 Urology Open simple prostatetctomy for BPHclinical notes,CT

Scan/USG/MRIClinical Photo 25,000 S7 S700092

336 5.198 Urology TURP-Transurethral Resection of the Prostate, BPH, Monopolar/Bipolar/Laser USG, Uroflowmetry HPEE, USG 25,000 S7 S700093

337 5.199 Urology TURP/Laser + Circumcision USG, Uroflowmetry HPEE, USG 30,000 S7 S700095

338 5.200 Urology TURP/Laser + Cystolithotripsy USG, Uroflowmetry HPEE, USG 30,000 S7 S700096

339 5.201 Urology TURP/Laser + Cystolithotomy-open USG, Uroflowmetry HPEE, USG 35,000 S7 S700097

340 5.202 Urology TURP/Laser + Orchidectomy USG, Uroflowmetry HPEE, USG 30,000 S7 S700098

341 5.203 Urology TURP/Laser + TURBT USG, Uroflowmetry HPEE, USG 30,000 S7 S700099

342 5.204 Urology TURP/Laser + URS with stone removal USG, Uroflowmetry HPEE, USG 40,000 S7 S700100

343 5.205 Urology TURP/Laser + VIU (visual internal Ureterotomy) USG, Uroflowmetry HPEE, USG 40,000 S7 S700101

344 5.206 Urology TURP/Laser + Hydrocele surgery USG, Uroflowmetry HPEE, USG 40,000 S7 S700102

345 5.207 Urology TURP/Laser + Hernioplasty USG, Uroflowmetry HPEE, USG 40,000 S7 S700103

346 5.208 Urology TURP/Laser + Urethral dilatation-non endoscopic USG, Uroflowmetry HPEE, USG 40,000 S7 S700104

347 5.209 Urology TURP/Laser + Urethral dilatation-endoscopic USG, Uroflowmetry HPEE, USG 40,000 S7 S700105

348 5.210 Urology Radical prostatectomy - laparoscopic USG HPEE, USG 70,000 S7 S700107



Speciality Code


349 5.211 Urology Transrectal Ultrasound guided prostate biopsy (minimum 12 core) USG HPEE, USG 10,000 S7 S700108

350 5.212 Urology Reduction of Paraphimosis Clinical Photo Clinical Photo 2,000 S7 S700109

351 5.213 Urology Excision of Urethral Caruncle Clinical Notes Clinical Photo 6,000 S7 S700110

352 5.214 Urology Meatoplasty Clinical Photo Clinical Photo 3,500 S7 S700111

353 5.215 Urology Meatotomy Clinical Photo Clinical Photo 3,500 S7 S700112

354 5.216 Urology Post Urethral Valve fulguration USG, MCU USG 10,000 S7 S700113

355 5.217 Urology Urethroplasty-End to endclinical notes,RGU/MCU/

UroflowmetryRGU/MCU 20,000 S7 S700114

356 5.218 Urology Urethroplasty-Transpubicclinical notes,RGU/MCU/

UroflowmetryRGU/MCU 30,000 S7 S700117

357 5.219 Urology Perineal Urethrostomy without closure USG, Clinical Notes Clinical Photo 20,000 S7 S700119

358 5.220 Urology Urethrorectal fistula repair Dye Study Clinical Notes 40,000 S7 S700120

359 5.221 Urology Urethral Dilatation-non endocopic as an independent procedure Clinical Notes Clinical Notes 2,000 S7 S700121

360 5.222 Urology Urethral Dilatation-endocopic as an independent procedure Clinical Notes Clinical Notes 5,000 S7 S700122

361 5.223 Urology Internal Ureterotomy including cystoscopy as an independent procedure clinical notes,RGU/MCU Clinical Notes 10,000 S7 S700123

362 5.224 Urology Orchiopexy-without laparoscopy, unilateral USG, Clinical Notes USG 15,000 S7 S700126

363 5.225 Urology Orchiopexy-without laparoscopy, bilateral USG, Clinical Notes USG 15,000 S7 S700127

364 5.226 Urology Orchiopexy-with laparoscopy, unilateral USG, Clinical Notes USG 30,000 S7 S700128

365 5.227 Urology Orchiopexy-with laparoscopy, bilateral USG, Clinical Notes USG 30,000 S7 S700129

366 5.228 Urology Stress incontinence surgery, open Clinical Notes Uroflowmetry 20,000 S7 S700130



Speciality Code


367 5.229 Urology Stress incontinence surgery, laparoscopic Clinical Notes Uroflowmetry 30,000 S7 S700131

368 5.230 Urology Stress incontinence surgery with slings Clinical Notes Uroflowmetry 35,000 S7 S700132

369 5.231 Urology Partial Penectomy Clinical Notes Clinical Notes 15,000 S7 S1512014

370 5.232 Urology Total Penectomy + Perineal Urethrostomy Clinical Notes Clinical Notes 20,000 S7 S700134

371 5.233 Urology Ilio-Inguinal lymphadenectomy-unilateral USG/FNAC HPEE 15,000 S7 S700135

372 5.234 Urology Ilio-Inguinal lymphadenectomy-bilateral USG/FNAC HPEE 25,000 S7 S700136

373 5.235 Urology Pelvic lymphadenectomy open, after prior cancer surgeryCT/MRI/USG pelvis,clinical

notesHPEE 25,000 S7 S700137

374 5.236 Urology Pelvic lymphadenectomy laparoscopic, after prior cancer surgeryCT/MRI/USG pelvis,clinical

notesHPEE 30,000 S7 S700138

375 5.237 Urology Orchiectomy-simple USG/CT Abdomen pelvis HPEE 10,000 S7 S700140

376 5.238 Urology Retroperitoneal lymph node dissection-LaparoscopicCT/MRI,USG Abdomen

pelvis,clinical notesHPEE 35,000 S7 S700143

377 5.239 Urology Infertility-Scrotal exploration unilateral Semen Analysis Clinical Notes/HPEE 10,000 S7 S700144

378 5.240 Urology Infertility-Scrotal exploration bilateral Semen Analysis Clinical Notes/HPEE 12,000 S7 S700145

379 5.241 Urology Infertility-Vasoepididymostomy, microsurgical, unilateral USG Vasography 15,000 S7 S700146

380 5.242 Urology Infertility-Vasoepididymostomy, microsurgical, bilateral USG Vasography 20,000 S7 S700147

381 5.243 Urology Varicocele-unilateral-non microsurgical Doppler Doppler 10,000 S7 S700148

382 5.244 Urology Varicocele-unilateral-microsurgical Doppler Doppler 12,000 S7 S700149

383 5.245 Urology Varicocele-bilateral-non microsurgical Doppler Doppler 15,000 S7 S700150

384 5.246 Urology Varicocele-bilateral-microsurgical Doppler Doppler 20,000 S7 S700151



Speciality Code


385 5.247 Urology Penile prosthesis insertion, Malleable (Indian implant) Clinincal History implant sticker 30,000 S7 S700152

386 5.248 Urology Priapism-aspiration/shunt Clinical Notes Clinical Notes 15,000 S7 S700153

387 5.249 Urology

Neurogenic bladder-Package for evaluation/investigation (catheter + ultrasound +

culture + RGU/ MCU) for 1 month (medicines - antibiotics). Follow up visit once in 3

months

Clinical assessment and

investigationsClinical Notes 7,500 S7 S700154

388 5.250 UrologyChronic prostatitis-Package for evaluation/investigation (ultrasound + culture +

prostate massage) for 1 month (medicines). Follow up visit once in 3 months



389 5.251 UrologyEmergency management of Ureteric stone - Package for evaluation/investigation

(ultrasound + culture) for 3 weeks (medicines).



390 5.252 Urology Emergency management of Hematuria (Package rete per day) Daily Urine- RM Clinical Notes 2,000 Package rete per day S7 S700157

391 5.253 Urology Emergency management of Acute retention of Urine (Package rete per day) Clinincal Notes/USG Clinical Notes 2,000 Package rete per day S7 S700158

392 5.254 UrologyAcute management of upper urinary tract trauma – conservative (Package rete per

day)USG/CT, Clinical History Clinical Notes 2,000 Package rete per day S7 S700159

393 5.255 Urology Urinary tract trauma – open surgery (exploratory) USG/CT, Clinical History Clinical Notes 20,000 S7 S700160

394 5.256 Urology Urinary tract trauma – Laparoscopy surgery USG/CT, Clinical History Clinical Notes 30,000 S7 S700161

395 5.257 Urology Pyeloplasty/pyeloureterostomy/pyelopyelostomy Open USG,X Ray,IVP/CT USG 25,000 S7 S700016

396 5.258 Urology Pyeloplasty/pyeloureterostomy/pyelopyelostomy Laparoscopic USG,X Ray,IVP/CT USG 30,000 S7 S700017

397 5.259 UrologyUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


398 6.1 Brain Craniotomy and Evacuation of Haematoma –Subdural CT Clinical Photograph 3 57040 S8 S812001

Cluster - 6 NEUROSURGERY/NEUROLOGY/INTERVENTIONAL NEURORADIOLOGY



Speciality Code


399 6.2 Brain Craniotomy and Evacuation of Haematoma – Extradural CT Clinical Photograph 3 51520 S8 S812002

400 6.3 Brain Excision of Brain Tumor Supratentorial- Parasagital CT Clinical Photograph 3 51750 S8 S812003

401 6.4 Brain Excision of Brain Tumor Supratentorial-Basal CT Clinical Photograph 3 51750 S8 S812004

402 6.5 Brain Excision of Brain Tumor - Brainstem CT Clinical Photograph 3 70000 S8 S812005

403 6.6 Brain Excision of Brain Tumor - C P Angle CT Clinical Photograph 3 50000 S8 S812006

404 6.7 Brain Excision of Brain Tumor Supratentorial & others CT Clinical Photograph 3 34500 S8 S800056

405 6.8 Brain Excision of Brain Tumors – Infratentorial MRI Clinical Photograph 3 110000 S8 S812007

406 6.9Brain / Spinal

(Endovascular)Intervention with coiling / embolisation procedures DSA DSA 3 85000 S8 S812008

407 6.10 Brain Ventriculoatrial /Ventriculoperitoneal/ Ventriculo-other Shunt CT Clinical Photograph 3 40000 S8 S812009

408 6.11 Brain Twist Drill Craniostomy CT Clinical Photograph 3 18630 S8 S800051

409 6.12 Brain Subdural Tapping CT Clinical Photograph 3 17020 S8 S812010

410 6.13 Brain Abscess Tapping Single CT Clinical Photograph 3 17250 S8 S800057

411 6.14 Brain Abscess Tapping multiple CT Clinical Photograph 3 23920 S8 S800058

412 6.15 Brain Meningo Encephalocele MRI Clinical Photograph 3 34270 S8 S812011

413 6.17 Brain C.S.F. Rhinorrhoea (Transcranial / Transnasal) CT Clinical Photograph 3 75000 S8 S812012

414 6.18 Brain Cranioplasty CT , Clinical Photograph Clinical Photograph 3 27830 S8 S812013

415 6.20 Brain Excision of Brain Abcess CT Clinical Photograph 3 28750 S8 S800059

416 6.21 Brain Aneurysm Clipping MRI Angio / DSA Clinical Photograph , X-RAY 3 34500 S8 S800060



Speciality Code



(Endovascular)Carotid angioplasty with stent ANGIOGRAM DOPPLER , X-RAY 3 60000 S8 S812014


(Endovascular)Carotid angioplasty without stent ANGIOGRAM DOPPLER , X-RAY 3 40000 S8 S812015

419 6.24 Brain External Ventricular Drainage (EVD) CT Clinical Photograph 3 28750 S8 S812016

420 6.25 Spinal Spinal Cord Tumours (extramedullary) MRI Biopsy , Clinical Photograph 3 34270 S8 S812017

421 6.26 Spinal Excision of Cervical Inter-Vertebral Discs MRI Clinical Photograph 3 34270 S8 S812018

422 6.27 Spinal Anterior Cervical Spine Surgery with fusion MRI Clinical Photograph 3 34270 S8 S812019

423 6.28 Spinal Anterio Lateral Decompression MRI Clinical Photograph 3 17250 S8 S812020

424 6.29 Spinal Laminectomy-Cervical/dorsal/lumbar MRI Clinical Photograph 3 34270 S8 S812021

425 6.30 Spinal Discectomy-Dorsal MRI Clinical Photograph 3 28520 S8 S812022

426 6.31 Spinal Discectomy-Lumbar MRI Clinical Photograph 3 28520 S8 S812023

427 6.32 Spinal Discectomy + cost of implant MRI Clinical Photograph 3 34270 S8 S812024

428 6.33 Spinal Spinal Intra Medullary Tumours MRI Biopsy , Clinical Photograph , X-RAY 3 68540 S8 S812025

429 6.34 Spinal Spina Bifida Surgery Major MRI Clinical Photograph , X-RAY 3 28750 S8 S812026

430 6.35 Spinal Spina Bifida Surgery Minor MRI Clinical Photograph , X-RAY 3 20700 S8 S812027

431 6.36 Brain / Spinal Stereotaxic Procedures (Framed / Frameless) CT/MRI Clinical Photograph 3 50000 S8 S800065


(Endovascular)Vertebral artery Stenting ANGIOGRAM DOPPLER 3 60000 S8 S812028

433 6.38 AAD Surgeries Transoral surgery and CV Junction (With Posterior Fixation) MRI , X-Ray Cerical Spine Clinical Photograph 3 125000 S8 S812029

434 6.39 AAD Surgeries Trans oral Surgery CT Biopsy , Clinical Photograph 3 39790 S8 S800071



Speciality Code


435 6.40 Brain Trans Sphenoidal Surgery CT, MRI Biopsy , Clinical Photograph 3 34040 S8 S812030

436 6.41 Brain RF Lesions for Trigminal Neuralgia MRI Clinical Photograph 3 28750 S8 S800050

437 6.44 Neuro muscular Muscle Biopsy with report EMG, NCV Biopsy 3 17250 S8 S800074

438 6.45 Brain MVD MRI Clinical Photograph 3 45000 S8 S812031

439 6.46 Neuro Surgery Nerve Biopsy with report EMG, NCV Biopsy 3 8625 S8 S812032

440 6.47 Neuro Surgery Nerve Decompression MRI Clinical Photograph 3 17250 S8 S800075

441 6.48 Neuro Surgery Peripheral Nerve Surgery Major EMG, NCV Clinical Photograph 3 34500 S8 S800076

442 6.49 Neuro Surgery Peripheral Nerve Surgery Minor EMG, NCV Clinical Photograph 3 17250 S8 S800077

443 6.50 C.V.JUNCTION POSTERIOR FIXATION ALONE

MRI SPINE +CT SPINE-

FLEXION/ EXTENTION/

NEUTRAL

X RAY SPINE 5 65000 S8 S812033

444 6.51 BRAIN SURGERY FOR ORBITAL TUMORS/PROPTOSIS MRI CONTRAST/ CECT CECT+BIOPSY REPORT 5 90000 S8 S812034

445 6.52 BRAIN+SPINE INFRATENTORIAL TUMOR WITH SPINAL EXTENSION MRI CONTRAST/ CECT CECT+BIOPSY REPORT 5 100000 S8 S812035

446 6.53 BRAINVASCULAR MALFORMATION SURGERY/Procedure

(SUPRATENTORIAL/INFRATENTORIAL)CTA/MRA/DSA CTA+BIOPSY 5 120000 S8 S812036

447 6.54 BRAIN EPILEPSY SURGERY-GRID INSERTION + LOCALISATION +SURGERY/Procedure MRI BRAIN (1.5/3 TESLA)

+VEEG +CT SCANCT BRAIN 5 110000 S8 S812037

448 6.55 BRAIN EPILEPSY SURGERY-LESIONECTOMYMRI BRAIN (1.5/3 TESLA)

+EEGCT BRAIN 5 60000 S8 S812038

449 6.56 BRAIN EPILEPSY SURGERY- ATL/AH FOR MTSMRI BRAIN (1.5/3 TESLA)

+EEGCT BRAIN 5 70000 S8 S812039

450 6.57 SKULL BONY TUMOR OF SKULL CECT CT BRAIN +BIOPSY REPORT 5 50000 S8 S812040

451 6.58 BRAIN ENDOSPIC BRAIN SURGERIES (DIAGNOSTIC) MRI BRAIN/CT BRAIN CT BRAIN 5 30000 S8 S812041



Speciality Code


452 6.59 BRAIN ENDOSPIC BRAIN SURGERIES (THIRD VENTRICULOSTOMY) MRI BRAIN/CT BRAIN CT BRAIN 5 45000 S8 S812042

453 6.60 BRAIN ENDOSPIC BRAIN SURGERY (AQUEDUCTOPLASTY) WITHOUT IMPLANT MRI BRAIN/ CT BRAIN CT BRAIN 5 50000 S8 S812043

454 6.61 BRAIN ENDOSPIC BRAIN SURGERY (AQUEDUCTOPLASTY) WITH IMPLANT MRI BRAIN/ CT BRAIN CT BRAIN 5 60000 S8 S812044

455 6.62 BRAIN ENDOSPIC BRAIN SURGERIES ( TUMOUR/CYST EXISION) MRI BRAIN/CT BRAIN CT BRAIN +BIOPSY 5 60000 S8 S812045

456 6.63 NERVE PAIN MANAGEMENT SURGERY (SYMPETHECTOMY/RHIZOTOMY) RELATED INVESTIGATIONS RELATED INVESTIGATIONS 3 40000 S8 S812046

457 6.64 C.V.JUNCTIONC V JUNCTION DECOMPRESSION (POSTERIOR) (ARNOLD-CHIARY MALFORMATION

AND OTHERS)

MRI CV JUNCTION + CT CV

JUNCTION-

FLEXION/EXTENTION/NEU

TRAL

X RAY SPINE 3 70000 S8 S812047

458 6.65 SKULL BONE FLAP REMOVAL CT BRAIN CT BRAIN 3 35000 S8 S812048

459 6.66 SPINE CORPECTOMY AND FIXATION CERVICAL/DORSAL/LUMBER(SINGLE LEVEL) MRI SPINE X RAY SPINE 5 65000 S8 S812049

460 6.67 SPINE CORPECTOMY AND FIXATION CERVICAL/DORSAL/LUMBER (MULTIPLE LEVEL) MRI SPINE X RAY SPINE 5 80000 S8 S812050

461 6.68 SPINE CERVICAL SPINE STABLISATION ANTERIOR MRI SPINE X RAY SPINE 5 60000 S8 S812051

462 6.69 SPINE CERVICAL SPINE STABLISATION-POSTERIOR MRI SPINE X RAY SPINE 5 60000 S8 S812052

463 6.70 SPINE CERVICAL SPINE STABLISATION-GLOBAL MRI SPINE X RAY SPNE 5 90000 S8 S812053

464 6.71 SPINE DL SPINE STABLISATION-ANTERTIOR MRI SPINE X RAY SPINE 5 60000 S8 S812054

465 6.72 A SPINE DL SPINE STABLISATION-POSTERIOR Level one MRI SPINE X RAY SPINE 5 50000 S8 S812055

466 6.72 B SPINE DL SPINE STABLISATION-POSTERIOR Level two MRI SPINE X RAY SPINE 5 60000 S8 S812055

467 6.73 A SPINE DL SPINE STABLISATION-GLOBAL (Anterior & Posterior combine) MRI SPINE X RAY SPINE 5 90000 S8 S812056

468 6.73 B SPINE DL SPINE STABLISATION-POSTERIOR Level three MRI SPINE X RAY SPINE 5 70000 S8 S812056

469 6.73 C SPINE DL SPINE STABLISATION-POSTERIOR Level four MRI SPINE X RAY SPINE 5 80000 S8 S812056



Speciality Code


470 6.74 SKULL CRANIOSYNOSTOSIS SURGERY MRI+3D CT BRAIN CT BRAIN 5 100000 S8 S800009

471 6.75 SPINE LAMINOPLASTY CERVICAL/DORSAL/LUMBER MRI SPINE X RAY SPINE 3 50000 S8 S812057

472 6.76 BRAINDIAGNOSTIC CEREBRAL/SPINAL ANGIOGRAPHY (DSA-DIGITAL SUBSTRACTION

ANGIOGRAPHY)CT BRAIN/MRI SPINE RELATED INVESTIGATIONS 0 12000 S8 S812058

473 6.77 SPINE ENDOSCOPIC SPINE SURGERY MRI SPINE X RAY SPINE 3 40000 S8 S812059

474 6.78 SPINE THECO-PERITONEAL SHUNT MRI BRAIN/CT BRAIN X RAY SPINE+CSF REPORT 3 30000 S8 S812060

475 6.79 BRAIN CRANIO-FACIAL RESECTIONMRI BRAIN/CT BRAIN

+FACECT BRAIN +FACE 5 90000 S8 S200050

476 6.80

BRAIN

REVASCULARISATI

ON

ST-MCA BYPASS/EC-ICA BYPASS CTA/MRA/DSA CTA 5 95000 S8 S812062

477 6.81 VASCULAR CAROTID LIGATION FOR CCF/GIANT ANEURYSM CTA/MRA/DSA CTA 5 30000 S8 S812063

478 6.82 BRAIN REEXPLORATION FOR DEBRIDEMENT/CSF LEAK/HAEMATOMA CT BRAIN CT BRAIN 3 25000 S8 S812064

479 6.83 REANIMATION FACIAL NERVE REANIMATIONCONCERNED

INVESTIGATIONSCONCERNED INVESTIGATIONS 5 40000 S8 S812065

480 6.84 SPINE TRANSPEDICULAR BIOPSY MRI SPINE CONTRAST X RAY SPINE +BIOPSY REPORT 1 25000 S8 S812066

481 6.85 SPINE VERTEBROPLASTY/KYPHOPLASTY MRI SPINE X RAY SPINE +BIOPSY REPORT 5 50000 S8 S812067

482 6.86 Brain Craniotomy and Evacuation of Haematoma - Intracranial Spontaneous / Traumatic NCCT BRAIN NCCT BRAIN 5 90000 S8 S812068

483 6.87 Brain Decompressive Craniectomy - For Infarct / Lesion with mass effect on brain NCCT BRAIN NCCT BRAIN 5 70000 S8 S812069

484 6.88 BRAIN SUPRATENTORIAL TUMOUR WITH INFRATENTORIAL TUMOR EXTENSIONMRI/CT BRAIN (WITH

CONTRAST)CECT+BIOPSY REPORT 5 100000 S8 S812070

485 6.89*MEDICAL

NEUROLOGYCONSERVATIVE MANAGEMENT (ISCHEMIC STROKE) CT brain plain,others MRI brain with angiography 5 week 60000

Payment fraction (

1st week-35%,2nd

week-25%,3rd week-

15%,4th week-

S8 M112001

486 6.90*MEDICAL

NEUROLOGYTHROMBOLYSIS WITH ACTILYSE FOR ISCHEMIC STROKE CT brain plain,others

Repeat CT brain after 24 hours,MRI

brain with angiography5 week 120000

Payment fraction (

1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

S8 M112002

487 6.91*MEDICAL

NEUROLOGY

INTRAPARENCHYMAL /SUBARACHNOID HEMMORRHAGE (CONSERVATIVE

MANAGEMENT)CT brain plain,others

Repeat CT brain plain , CT angiography

brain5 week 40000

Payment fraction (

1st week-35%,2nd

week-25%,3rd week-

15%,4th week-

S8 M112003



Speciality Code


488 6.92*MEDICAL

NEUROLOGYMENINGOENCEPHALITIS, OR/ AND EVD/VP shunt (CONSERVATIVE MANAGEMENT) CT brain plain,CSF ,others MRI brain with contrast 5 week 110000

Payment fraction (

1st week-35%,2nd

week-25%,3rd week-

15%,4th week-

10%,5th week-

10%,F/u-5%) of total

package rate

S8 M112004

489 6.93*MEDICAL

NEUROLOGYMYASTHENIA CRISIS MANAGEMENT BY PLASMAPHERESIS

Clinical diagnosis by

neurophysician OR

previously diagnosed case

Anyone of the following:repetitive

nerve stimulation,ACH-R antibody,Anti-

MUSK antibody

5 week 110000

Payment fraction (

1st week-35%,2nd

week-25%,3rd week-

15%,4th week-

10%,5th week-


package rate

S8 M112005

490 6.94*MEDICAL

NEUROLOGYMYASTHENIA CRISIS MANAGEMENT BY IV IMMUNOGLOBINS


neurophysician OR




MUSK antibody

5 week 200000

Payment fraction (

1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

S8 M112006

491 6.95*MEDICAL

NEUROLOGYGullian-barre syndrome management by plasmapheresis


neurophysicianCSF study, NCV/EMG 5 week 109627

Payment fraction (

1st week-35%,2nd

week-25%,3rd week-

15%,4th week-

10%,5th week-


package rate

S8 M112007

492 6.96*MEDICAL

NEUROLOGYGullian-barre syndrome management by Intravenous immunoglobulin


neurophysicianCSF study, NCV/EMG 5 week 200000

Payment fraction (

1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

S8 M112008

493 6.97 Neurology Anterior Encephalocele CT Brain/ MRI Brain CT Brain 50,000 S8 S800001

494 6.98 Neurology Burr hole CT Brain/ MRI Brain CT Brain 7,000 S8 S800002



Speciality Code


495 6.99 Neurology Burr hole with chronic Sub Dural Haematoma (including pre and post Op. CT) CT Brain/ MRI Brain CT Brain 20,000 S8 S800003

496 6.100 Neurology Carpal Tunnel Release including pre and post Op. MRI MRI, EMG/NCV - 10,000 S8 S800004

497 6.101 Neurology Cervical Ribs – BilateralX-Ray Cervical Spine/

Chest X-Ray, CT Scan

X-Ray Cervical Spine/ Chest X-Ray, CT

Scan35,000 S8 S800005

498 6.102 Neurology Cervical Ribs – UnilateralX-Ray Cervical Spine/

Chest X-Ray, CT Scan

X-Ray Cervical Spine/ Chest X-Ray, CT

Scan20,000 S8 S800006

499 6.103 Neurology Duroplasty - Endogenous CT Brain CT Brain 12,500 S8 S800010

500 6.104 Neurology Duroplasty - Exogenous(Implant cost is not iclluded in package rate) CT Brain Plain CT Brain 12,500

Implant cost will

added seperatly in

this package

S8 S800011

501 6.105 Neurology Haematoma (Child subdural) inclusive of General anaesthesia, pre and post Op. CT CT Brain CT Brain 50,000 S8 S800014

502 6.106 Neurology Laminectomy with Fusion and fixation MRI Spine X-Ray Spine. 50,000 S8 S800015

503 6.107 Neurology Laminectomy with Fusion MRI Spine X-Ray Spine. 40,000 S8 S800016

504 6.108 Neurology Local Neurectomy CT/MRI Clinical Photograph 16,000 S8 S800017

505 6.109 Neurology Meningocele – Anterior Brain , Spinal Cord MRI X Ray/ Post OP Operative Site 36,000 S8 S800019

506 6.110 Neurology Meningocele – Lumbar Brain , Spinal Cord MRI X Ray/ Post OP Operative Site 36,000 S8 S800020

507 6.111 Neurology Meningococcal – Occipital Clinical Photo/MRI/CT X Ray/ Post OP Operative Site 50,000 S8 S800021

508 6.112 Neurology Skull Traction MRI Spine X-Ray Spine. 8,000 S8 S800026

509 6.113 Neurology Spine - Canal Stenosis CT/MRI CT 40,000 S8 S800027

510 6.114 Neurology Spine - Extradural Haematoma MRI Spine X-Ray Spine. 30,000 S8 S800032

511 6.115 Neurology Spine - Extradural Haematoma with fixation MRI Spine X-Ray Spine. 40,000 S8 S800033

512 6.116 Neurology Spine - Intradural Haematoma MRI X-Ray Spine. 40,000 S8 S800036



Speciality Code


513 6.117 Neurology Spine - Intradural Haematoma with fixation MRI Spine X-Ray Spine. 50,000 S8 S800037

514 6.118 Neurology Spine - Intramedullar Tumour CT/MRI HPEE 50,000 S8 S800038

515 6.119 Neurology Spine - Intramedullar Tumour - fixation MRI Spine Biopsy , X-Ray Spin 60,000 S8 S800039

516 6.120 Neurology Brain Biopsy MRI Brain/ CT Brain Biopsy 15,000 S8 S800045

517 6.121 Neurology Cranial Nerve Anastomosis concecrned Investigation concecrned Investigation 32,000 S8 S800046

518 6.122 Neurology Depressed Fracture CT Brain CT Brain 40,000 S8 S800047

519 6.123 Neurology Peripheral Neurectomy (Trigeminal) MRI Biopsy 16,500 S8 S800049

520 6.124 Neurology Additonal clip for Aneurysm Clipping MRI ANGIO/DSA X Ray + Clinical Photo of Operative Site 15,000 S8 S800061

521 6.125 Neurology Cervical Disc Multiple level without Fusion MRI Spine X Ray + Clinical Photo of Operative Site 40,000 S8 S800068

522 6.126 Neurology Foramen Magnum Decompression CT/MRI X-Ray 45,000 S8 S800072

523 6.127 Neurology Arterio venous malformation (AVM) excision (whatever size and location) MRA/DSA Report X-Ray , Clinical Photo of Operative Site 50,000 S8 S800079

524 6.128 Neurology Scalp Arterio venous malformation (AVM) CT/MRI ANGIOHistoPatho Repot + Clinical Photo of

Operative Site25,000 S8 S800080

525 6.129 NeurologyGamma Knife radiosurgery (GKRS)/ SRS for tumours/ Arteriovenous malformation

(AVM)CT/MRI Clinical Photo 75,000 S8 S800083


Neuroradiology

Coil embolization for aneurysms (includes cost of first 3 coils + balloon and/ or stent if

used) 1 to 20 coils may be required as per need. DSA/CT/MRI ANGIO CT/MR ANGIO 1,00,000 S9 S900001


NeuroradiologyAdditional coil for coil embolization for aneurysms DSA/CT/MRI ANGIO CT/MR ANGIO 24,000 S9 S900002


NeuroradiologyDural AVMs/AVFs (per sitting) with glue DSA/CT/MR ANGIO CT/MR ANGIO 70,000 S9 S900003


NeuroradiologyDural AVMs/AVFs (per sitting) with onyx DSA/CT/MR ANGIO CT/MR ANGIO 1,50,000 S9 S900004



Speciality Code



Neuroradiology

Carotico-cavernous Fistula (CCF) embolization with coils. [includes 5 coils, guide

catheter, micro-catheter, micro-guidewire, general items]DSA/CT/MR ANGIO CT/MR ANGIO 1,50,000 S9 S900005


Neuroradiology

Carotid-cavernous Fistula (CCF) embolization with balloon (includes one balloon,

guide catheter, micro-catheter, micro-guidewire, general items)DSA/CT/MR ANGIO CT/MR ANGIO 75,000 S9 S900006


NeuroradiologyCerebral & Spinal AVM embolization (per sitting). Using Histoacryl DSA/CT/MR ANGIO CT/MR ANGIO 1,00,000 S9 S900007


NeuroradiologyParent vessel occlusion - Basic CT/MR ANGIO CT/MR ANGIO 30,000 S9 S900008


NeuroradiologyAdditonal coil for Parent Vessel Occlusion DSA/CT/MR ANGIO CT/MR ANGIO 24,000 S9 S900009


NeuroradiologyAdditonal balloon for Parent Vessel Occlusion DSA/CT/MR ANGIO CT/MR ANGIO 11,000 S9 S900010


NeuroradiologyBalloon test occlusion CT/MR ANGIO CT/MR ANGIO 70,000 S9 S900011


NeuroradiologyIntracranial balloon angioplasty with stenting DSA/CT/MR ANGIO CT/MR ANGIO 1,60,000 S9 S900012


NeuroradiologyIntracranial thrombolysis / clot retrieval DSA/CT/MR ANGIO CT/MR ANGIO 1,60,000 S9 S900013


NeuroradiologyPre-operative tumour embolization (per session) DSA/CT/MR ANGIO CT/MR ANGIO 40,000 S9 S900014

540 6.144 NeurologyUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


541 7.1Gastro Intestinal

TractOesophageal atresia –1.pure atresia- first stage(‘o’stomy & ‘G’stomy)

X-ray with infant feeding

tube or Dye studyClinical Photograph 3 23000 S14 S1412001


TractOesophageal atresia –2.pure atresia- second stage(oesaphageal replacement)

2D-ECHO, Dye study,

ultrasoundClinical Photograph 3 70000 S14 S1412002


Tract3.tracheo-oesphageal fistula(type c)

X-ray with infant feeding

tube or Dye studyClinical Photograph 3 40250 S14 S1412003


Tract4. H- type fistula Dye study, Bronchoscopy Clinical Photograph 0 40000 S14 S1412004

Cluster - 7 PAEDIATRIC SURGERY



Speciality Code



TractIntestinal Atresias & Obstructions X-RAY /CT Clinical Photograph 3 46000 S14 S1412005


TractBiliary Atresia HIDA scan Clinical Photograph 3 46000 S14 S1412006


TractCholedochal Cyst MRCP or CT scan Clinical Photograph 3 46000 S14 S1412007


TractDiaphragmatic Hernia USG/CT Clinical Photograph 0 40000 S14 S1312025


TractAnorectal Malformation1. Low ARM(male & female)

Invertogram or clinical

photographClinical Photograph 3 18400 S14 S1412008


Tract2.Intermediate & High variety a. Stage 1 colostomy

Invertogram or clinical

photographClinical Photograph 3 30000 S14 S1412009


Tractb. Stage two PSARP/Abdominoperineal Pull through

2-D ECHO, ULTRASOUND,

Dye StudyClinical Photograph 3 34500 S14 S1412010


Tractc. Stage three colostomy closure/ Ileostomy closure Clinical photograph Clinical Photograph 3 35000 S14 S1412011


Tract

ANORECTAL MALFORMATION.[Colostomy, iliostomy/ pouchostomy (first stage of

male/female ARM, cloaca, pouch colon or hirschsprung diease]Invertogram or clinical

photograph,Clinical Photograph 0 30000 S14 S1412012


TractSecond stage- PSARVUP/Abdominoperineal Pull through Definitive surgery

2-D ECHO, ULTRASOUND



TractThird stage- Colostomy / ileostomy closure

2-D ECHO, ULTRASOUND



TractHirschsprung's Disease- Single Stage Dye Study/ Rectal Biopsy

Clinical Photograph/Histopathological

Report3 60000 S14 S1412015


TractSecond stage-Definitive surgery Dye Study/ Rectal Biopsy

Clinical Photograph/Histopathological

Report3 57500 S14 S1412016

558 7.20 Thoracic Surgeries Empyema Thoracis X-Ray/CT Scan Clinical Photograph 3 40000 S14 S1412017

559 7.21GENITOURINARY

SurgeriesHYPOSPIDIAS- 1. SINGLE STAGE SURGERY Clinical Photograph Clinical Photograph 3 34500 S14 S1412018


SurgeriesHYPOSPIDIAS- 2.STAGED SURGERIES a) 1st Stage procedure Clinical Photograph Clinical Photograph 3 34500 S14 S1412019


Surgeriesa) 2nd Stage procedure Clinical Photograph Clinical Photograph 3 25300 S14 S1412020

562 7.24 Peadiatric Surgery EXSTROPHY BLADDER TOTAL CORRECTION1) SINGLE STAGE - 8 126500 S14 S1412021

563 7.25 Peadiatric Surgery EXSTROPHY BLADDER 2) FIRST STAGE BLADDER CLOSURE USG/ELECTROLYTES/MCU 8 100625 S14 S1412022



Speciality Code


564 7.26 Peadiatric Surgery EXSTROPHY BLADDER 3) SECOND STAGE BLADDER NECK RECONSTRUCTION - 8 60000 S14 S1412023

565 7.27 Peadiatric Surgery EXSTROPHY BLADDER 4) PRIMARY OR SECONDARY URETEROSIGMOIDOSTOMY - 8 86250 S14 S1412024

566 7.28 Peadiatric Surgery EPISPADIAS REPAIR 1) CONTINENT USG/MCU 5 40000 S14 S1412025

567 7.29 Peadiatric Surgery EPISPADIAS REPAIR 2) INCONTINENT (EPISPADIAS REPAIR +BNR) USG/MCU 5 51750 S14 S1412026

568 7.30 Gastrointestinal

NEC-operative-

1 Exploratory laparotomy+ repair of perforation X ray , USG same as above Clinical photo, X ray abd 4 48000 S14 S1412027

569 7.31 GastrointestinalSingle stage PSARP female ( Rectovestibular fistula/ anovestibular fistula/ vestibular

anus etc)

Clinical photograph, Xray

lumbosacral spine, USG

KUB, 2d echo, MCU

Clinical photgraph 4 50000 S14 S1412028

570 7.32 Gastrointestinal Duodenal atresia- Kimuras duodenoduodenostomy X ray abdomen Clinicl photograph 2 48000 S14 S1412029

571 7.33 Gastrointestinal Pyloric stenoses Ramstedts pyloromyotomy USG abdomen/dye study Clinical photograph 2 26000 S14 S1412030

572 7.34 Gastrointestinal GERD FundoplicationUpper gi scopy/ Upper GI

dye studyClinical photograph 2 35000 S14 S1400016

573 7.35 Genitourinary Posterior urethral valve- stabilization + cystoscopy+ puv fulguration & or vesicostomy

MCU, USG KUB, urine

analysis, Bl urea, ser

creatinine & S electrolyte

USG KUB, 4 30000 S14 S1412031

574 7.36 Brain Hydrocephalus in children- Ventriculoperitoneal shuntCt brain/ MRI Brain USG,

Fundus examinationClinical photograph, CSF report 4 25000 S14 S1412032

575 7.37 Genitourinary Vesicoureteric reflux, megaureter- ureteric reimplantation unilateral/bilateralMCU, USG KUB, Renal

scanClinical photo 4 40000 S14 S1412033

576 7.38 Abdomen Splenectomy for Thalessemia

Pediatrician advise for

splenectomy, Vaccinations

( pneumococcal),USG

Abdomen

Clinical photo 2 35000 S14 S1412034

577 7.39 Paediatric surgery Ankyloglossia Major Clinical Photo Clinical Photo 15,000 S14 S1400001

578 7.40 Paediatric surgery Ankyloglossia Minor Clinical Photo Clinical Photo 5,000 S14 S1400002

579 7.41 Paediatric surgery Hernia & Hydrocele USG clinical notes 20,000 S14 S1400003

580 7.42 Paediatric surgery Sacrococcygeal TeratomaCECT L-S Region, Clinical

Photo, Sputum AFBClinical Photo 20,000 S14 S1400004

581 7.43 Paediatric surgery Undescended Testis - Bilateral-Palp + Nonpalp USG Clinical Photo 15,000 S14 S1400005



Speciality Code


582 7.44 Paediatric surgery Undescended Testis - Bilateral Palpable USG Clinical Photo 15,000 S14 S1400006

583 7.45 Paediatric surgery Undescended Testis - Bilateral Non-Palpable USG Clinical Photo 20,000 S14 S1400007

584 7.46 Paediatric surgery Undescended Testis - Reexploration/ Second Stage USG Clinical Photo 20,000 S14 S1400008

585 7.47 Paediatric surgery Undescended Testis - Unilateral-Palpable USG Clinical Photo 15,000 S14 S1400009

586 7.48 Paediatric surgery Ano Rectal Malformation - Redo PullthroughClinical Photo, Distal

Cologram/ USG Dye StudyClinical Photo 15,000 S14 S1400014

587 7.49 Paediatric surgery Ano Rectal Malformation - TranspositionClinical Photo, Distal

Cologram/ USG Dye StudyClinical Photo 15,000 S14 S1400015

588 7.50 Paediatric surgery Duplication Cyst Excision CECT Abdomen Clinical Photo 20,000 S14 S1400017

589 7.51 Paediatric surgery Fecal Fistula ClosureClinical Photo, Operative

Details of Previous Surgery Clinical Photo 25,000 S14 S1400018

590 7.52 Paediatric surgery Gastrostomy + Esophagoscopy+ ThreadingX-Ray with Infant Feeding

Tube/ Dye StudyClinical Photo 20,000 S14 S1400019

591 7.53 Paediatric surgery GI Tumor Excision CECT, Clinical Photo Clinical Photo 30,000 S14 S1400020

592 7.54 Paediatric surgery Hirschsprung’s Disease - Retal Biopsy-Punch Barium Enema HPEE 10,000 S14 S1400023

593 7.55 Paediatric surgery Hirschsprung’s Disease - Retal Biopsy –Open Barium Enema HPEE 10,000 S14 S1400024

594 7.56 Paediatric surgery Hirschsprung’s Disease - Sphinecterotomy Barium Enema HPEE 15,000 S14 S1400025

595 7.57 Paediatric surgery Intussusception - Non –Operative Reduction in infants USG Abdomen USG 20,000 S14 S1400026

596 7.58 Paediatric surgery Intussusception – Operative in infantsUSG Abdomen, Clinical

PhotoClinical Photo 25,000 S14 S1400027

597 7.59 Paediatric surgery Ladds Procedure

X-Ray Abdomen Standing,

USG Abdomen/Barium

MEAL

Clinical Photo 30,000 S14 S1400028

598 7.60 Paediatric surgery Rectal Polypectomy - Sigmoiescopic (Ga) Sigmoidoscopic Picutre HPEE, Clinical Notes 8,000 S14 S1400029

599 7.61 Paediatric surgery Retro-Peritoneal Lymphangioma ExcisionCECT Abdomen, Clinical

PictureHPEE, Clinical Notes 25,000 S14 S1400030



Speciality Code


600 7.62 Paediatric surgery Congenital Lobar Emphysema CECT, X-Ray Chest X-Ray, Clinical Photo 25,000 S14 S1400032

601 7.63 Paediatric surgery Exomphalos/gastroschisis Clinical Photo Clinical Photo 25,000 S14 S1400033

602 7.64 Paediatric surgery Cleft Lip and Palate Surgery (per stage) Clinical Photo Clinical Photo 15,000 S14 S1400034

603 7.65 Paediatric surgeryUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per



InvestigationPost Operative Investigation No of Follow up Package Rates Remarks

Speciality Code


604 8.1 Polytrauma Nerve and tendon repair &/ Vascular repairNerve Conduction study,

CT scanClinical Photograph 3 23000 S6 S600001

605 8.2 Polytrauma Nerve & Tendon Repair &/ Vascular Repair (Grade-I& II)Nerve Conduction study,


606 8.3 Polytrauma Nerve & Tendon Repair &/ Vascular Repair (Grade-III)Nerve Conduction study,


607 8.4 Plastic Surgery Flap cover Surgery for wound in compound fractureCLINICAL PHOTOGRAPH, X-

RAYCLINICAL PHOTOGRAPH 3 23000 S6 S612003

608 8.5 PolytraumaOther Small bonefractures/K-wiring (To be covered along with other injuries only and

not as exclusive procedure)X-RAY X-RAY 3 10000 S6 S612004

609 8.6 PolytraumaSurgery for Patella fracture (To be covered along with other injuries only and not as

exclusive procedure)X-RAY X-RAY 3 15000 S6 S612005

610 8.7 Plastic Surgery Facial bone fractures (Facio-Maxillary Injuries)CLINICAL PHOTOGRAPH, X-

RAYCLINICAL PHOTOGRAPH, X-RAY 3 28750 S6 S612006

611 8.8Pelvic Bone

FracturesSurgical Correction of Pelvic bone fractures. X-RAY X-RAY 3 40000 S6 S612007

612 8.50 ORTHOJOINT RECONSTRUCTION (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND

NOT AS EXCLUSIVE PROCEDURE)

MRI , CLINICAL

PHOTOGRAPH, X-RAYCLINICAL PHOTOGRAPH, X-RAY 3 74750 S6 S612008

613 8.51 ORTHOELLIZAROV FIXATION,/ External Fixation (TO BE COVERED ALONG WITH OTHER

INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE)

CLINICAL PHOTOGRAPH, X-


614 8.52 ORTHOOPEN REDUCTION INTERNAL FIXATION- SMALL BONE (TO BE COVERED ALONG WITH

OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE)



615 8.53 ORTHOOPEN REDUCTION INTERNAL FIXATION- LARGE BONE (TO BE COVERED ALONG WITH




Cluster- 8 POLY-TRAUMA



Speciality Code


616 8.54 ORTHOOPEN REDUCTION OF SMALL JOINT(TO BE COVERED ALONG WITH OTHER INJURIES

ONLY AND NOT AS EXCLUSIVE PROCEDURE)



617 8.55 ORTHOOPEN REDUCTION WITH PHEMISTER GRAFTING (TO BE COVERED ALONG WITH




618 8.56 ORTHOPERCUTANEOUS- FIXATION OF FRACTURE (TO BE COVERED ALONG WITH OTHER




619 8.57 ORTHO

PREPATELLAR BURSA AND REPAIR OF MCL OF KNEE (TO BE COVERED ALONG WITH

OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE) stage A) Stage 1, B)

Stage 2

MRI, CLINICAL


620 8.58 ORTHORECONSTRUCTION OF ACL/PCL (TO BE COVERED ALONG WITH OTHER INJURIES ONLY

AND NOT AS EXCLUSIVE PROCEDURE) stage A) Stage 1, B) Stage 2

MRI, CLINICAL


621 8.60 ORTHOSHOULDER JACKET (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT

AS EXCLUSIVE PROCEDURE)



622 8.61 SURGERYRESECTION & ANASTOMOSIS OF INTESTINE (TO BE COVERED ALONG WITH OTHER



RAY, USG ABD, CT SCAN

ABD

CLINICAL PHOTOGRAPH, X-RAY 3 34500 S6 S612018

623 8.62 UROLOGYOPERATION FOR INJURY OF BLADDER (TO BE COVERED ALONG WITH OTHER




ABD


624 8.63 UROLOGYURETHRAL INJURY (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT

AS EXCLUSIVE PROCEDURE)



ABD


625 8.64 UROLOGYURETHRAL RECONSTRUCTION (TO BE COVERED ALONG WITH OTHER INJURIES ONLY

AND NOT AS EXCLUSIVE PROCEDURE)



ABD


626 8.66 SURGERYINTESTINAL RESECTION (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND




ABD


627 8.67 SURGERYSPLENECTOMY (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT AS

EXCLUSIVE PROCEDURE)



ABD




Speciality Code


628 8.70 SURGERYILIEOSIGMOIDOSTOMY (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND




ABD


629 8.73 OPHTHALMOLOGYPERFORATING SCLERA-CORNEAL INJURY (TO BE COVERED ALONG WITH OTHER




630 8.74 NEUROSURGERYDEPRESSED FRACTURE (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND



RAY, CT SCAN BRAINCLINICAL PHOTOGRAPH, X-RAY 3 40250 S6 S612026

631 8.76 NEUROSURGERYSKULL TRACTION (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT AS




632 8.77 NEUROSURGERYBURR HOLE (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT AS




633 8.78 NEUROSURGERYTEMPORAL BONE RESECTION (TO BE COVERED ALONG WITH OTHER INJURIES ONLY




634 8.79 NEUROSURGERYSKULL BASE SURGERY (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND




635 8.80 GYNAECOLOGYRUPTURE UTERUS, CLOSER AND REPAIR WITH TUBAL LIGATION (TO BE COVERED

ALONG WITH OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE)


RAY,CLINICAL PHOTOGRAPH, X-RAY 3 40250 S6 S612031

636 8.84THORACIC

SURGERY

THORACOPLASTY (TO BE COVERED ALONG WITH /Without OTHER INJURIES ONLY



RAY, CT SCAN THORAXCLINICAL PHOTOGRAPH, X-RAY 3 34500 S6 S612032

637 8.85 ORTHOWound management for compound fracture

(Any grade)Clinical Photograph, Xray Clinical Photograph, Xray 3 30000 S6 S612033

638 8.86 ORTHOEXTERNAL FIXATOR WITH SOFT TISSUE INJURY, SURGICAL MANAGEMENT, STG

COVERING FOR SMALL BONESClinical Photograph, Xray Clinical Photograph, Xray 3 50000 S6 S612034

639 8.87 ORTHOEXTERNAL FIXATOR WITH SOFT TISSUE INJURY, SURGICAL MANAGEMENT, STG

COVERING FOR LARGE BONESClinical Photograph, Xray Clinical Photograph, Xray 3 50000 S6 S612035

640 8.88 SPINE DEFORMITY SURGERY FOR SPINE (KYPHO/SCOLIOSIS) Clinical Photograph, Xray Clinical Photograph, Xray 3 150000 S6 S612036



Speciality Code


641 8.89 Polytrauma Plexus injury along with Vascular injury repair/ graft

Pre-op. Doppler

study,Nerve Conduction

study,CT

Post-op. Doppler study,Clinical photo

showing scar60,000 S6 S600002

642 8.90 Polytrauma Internal fixation with Flap cover Surgery for wound in compound fracturePRE OP CLINICAL

PICTURE,X-RAY/CT

Post- op. X-ray,Clinical Photograph

showing flap cover40,000 S6 S600003

643 8.91 Polytrauma Head injury requiring Facio-Maxillary Injury repairs & fixations (including implants) X-RAY/CTClinical photograph showing scar,Post-

op. X-ray35,000 S6 S600004

644 8.92 Polytrauma Internal fixation of Pelviacetabular fracture X-RAY/CTClinical photograph showing scar,Post-

op. X-ray40,000 S6 S600005

645 8.93 PolytraumaCraniotomy and evacuation of Haematoma – subdural/Extra dural along with fixation

of fracture of single long bonePre-op. X-ray,CT

Clinical photograph showing scar,Post-

op. X-ray/CT60,000 S6 S600006

646 8.94 PolytraumaCraniotomy and evacuation of Haematoma – subdural/Extra dural along with fixation

of fracture of 2 or more long bone.Pre-op. X-ray,CT


op. X-ray/CT75,000 S6 S600007

647 8.95 PolytraumaVisceral injury requiring surgical intervention along with fixation of fracture of single

long bone.Pre-op. X-ray,CT,USG


op. X-ray30,000 S6 S600008

648 8.96 PolytraumaVisceral injury requiring surgical intervention along with fixation of fracture of 2 or

more long bones.Pre-op. X-ray,CT,USG


op. X-ray45,000 S6 S600009

649 8.97 Polytrauma Chest injury with one fracture of long bone (with implants)Pre-op. X-ray of fracture ,

Chest Xray


op. X-ray35,000 S6 S600010

650 8.98 Polytrauma Chest injury with fracture of 2 or more long bonesPre-op. X-ray of fracture ,

Chest Xray


op. X-ray45,000 S6 S600011

651 8.99 Polytrauma Emergency tendons repair ± Peripheral Nerve repair/ reconstructive surgeryClinical report,electro-

diagnostic studies

Clinical Photographs with Graft site +

Showing scar,MRI30,000 S6 S600012

652 8.100 PolytraumaUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per


Sr.No Package No Sub-specialty Procedure namePre-operative

Investigation

Post-operative

InvestigationNo of Follow up Package Rates Remarks

Speciality Code


Cluster- 9 MEDICAL ONCOLOGY



Speciality Code


653 9.1* Breast Adriamycin/Cyclophosphamide (AC)

Biopsy with

immunohistochemistry,

Mammography, 2D Echo,

Chest X-ray, Sonography,

Bone scan, Blood

Investigations, clinical

Photograph

Clinical Photograph, Mammography,

chest X-ray4 to 6 months 4485 M5 M512001

654 9.2* Breast 5- Fluorouracil A-C (FAC)

Biopsy with




Bone scan, Blood


Photograph



655 9.3* Breast AC (AC then T)

Biopsy with




Bone scan, Blood


Photograph



656 9.4* Breast Paclitaxel

Biopsy with




Bone scan, Blood


Photograph


chest X-ray4 motnhs 11500 M5 M512004

657 9.5* Breast Cyclophosphamide/Methotrexate/5Fluorouracil (CMF)

Biopsy with




Bone scan, Blood


Photograph



658 9.6# Breast Tamoxifen tabs

Biopsy with




Bone scan, Blood


Photograph


chest X-ray4 to 5 years 109 M5 M512006



Speciality Code


659 9.7# Breast Aromatase Inhibitors

Biopsy with




Bone scan, Blood


Photograph


chest X-ray2 to 5 years 1150 M5 M512007

660 9.8*HER2 +ve Early

Breast Cancer

After 4 cycles of 9.3 package followed by Taxanes with GCSF, Herceptin with or

without Carboplatin

Biopsy with




Bone scan, Blood



chest X-ray

6 months to 1

year50000 M5 M512008

661 9.9* Cervical Cancer Weekly Cisplatin

Biopsy, USG,CT scan/MRI,

Chest X-ray, clinical

Photograph.

Clinical Photograph, USG,CT scan/MRI,

Chest X-ray.6 to 8 weeks 4025 M5 M512009

662 9.10* Vulval Cancer Cisplatin/5-FU



Photograph.


Chest X-ray.9200 M5 M512010

663 9.11* Vaginal Cancer Cisplatin/5-FU



Photograph.



664 9.12* Ovarian Cancer Carboplatin/Paclitaxel

Biopsy with


Chest X-ray, USG, CT scan,

CA 125, Cytology, clinical

Photograph

Clinical Photograph, Sonography, CT

scan, CA 125, chest x-ray.4 to 6 months 11500 M5 M512012

665 9.13* Ovarian Cancer Liposomal Doxorubicin & Gemcitabine

Biopsy with


Chest X-ray, USG, CT scan,

CA 125, Cytology, clinical

Photograph

Clinical Photograph, Sonography, CT

scan, CA 125, chest x-ray.4 to 6 months 13800 M5 M512013

666 9.14*Ovary Germ cell

TumorBleomycin /Etoposide/ Cisplatin (BEP)

Biopsy with


CT scan, USG, Chest x-ray,

Tumor markers, Clinical

Photograph, 2 D echo.

CT scan, USG, Chest x-ray, Tumor

markers, Clinical Photograph, 2 D echo.3 to 4 months 11270 M5 M512014

667 9.15*

Gestational

Trophoblast Ds.-

Lowrisk

Weekly Methotrexate

Biopsy, CT scan, USC,

Chest x-ray, Tumor

markers, MRI Brain,

Clinical Photograph.

CT scan, USC, Chest x-ray, Tumor

markers, MRI, clinical Photograph.3 to 4 months 863 M5 M512015



Speciality Code


668 9.16*

Gestational

Trophoblast Ds.-

Lowrisk

Actinomycin

Biopsy, CT scan, USG,

Chest x-ray, Tumor

markers, MRI, Brain,




669 9.17*

Gestational

Trophoblast Ds.-

Highrisk

Etoposide-Methotrexate-Actinomycin / Cyclophosphamide -Vincristine (EMA-CO)

Biopsy, CT scan, USG,

Chest x-ray, Tumor

markers, MRI Brain,




670 9.18* Testicular Cancer Bleomycin-Etoposide-Cisplatin (BEP)

Biopsy with



Tumor markers, Clinical

Photograph, 2 D echo.


markers, Clinical Photograph, 2 D echo.3 to 4 months 11040 M5 M512018

671 9.19* Testicular Cancer Taxanes, Ifosphamides, Vinblastine, Gemcitabine, Docetaxol, Platin

Biopsy with



Tumor markers, MRI

Brain, Clinical Photograph.


markers, MRI Brain, Clinical

Photograph.

3 to 4 months 16100 M5 M512019

672 9.20# Prostate Cancer Hormonal therapy

Biopsy, CT scan/MRI, USG,

x-ray, Tumor markers,

Bone scan, Clinical

Photograph.

CT scan/MRI, USG, x-ray, Tumor

markers, Bone scan, Clinical

Photograph.

1.5 to 2 years 4140 M5 M512020

673 9.21* Prostate Cancer Docetaxol + steriods with G-CSF


x-ray, Tumor markers,

Bone scan, Clinical

Photograph.

CT scan/MRI, USG, x-ray, Tumor

markers, Bone scan, Clinical

Photograph.

1.5 to 2 years 18400 M5 M512021

674 9.22* Bladder Cancer Weekly Cisplatin



Photograph.



675 9.23* Bladder Cancer Methotrexate Vinblastine Adriamycin Cyclophosphamide (MVAC)


x-ray, Urine cystology,


CT scan/MRI, USG, x-ray, Urine

cystology, Clinical Photograph.4 to 6 months 7130 M5 M512023

676 9.24* Bladder Cancer Gemcitabine/Carboplatin


x-ray, Urine cystology,


CT scan/MRI, USG, x-ray, Urine

cystology, Clinical Photograph.4 to 6 months 12880 M5 M512024



Speciality Code


677 9.25*

Lung cancer-Non-

small cell lung

cancer (NSCLC)

and SCLC

Platin/Etoposide

Biopsy with


CT scan, USG, x-ray,

Sonography, Bone scan,

MRI Brain PET-CT Scan.

CT scan, USG, x-ray, Sonography, Bone

scan, MRI Brain PET-CT Scan, Clinical

Photograph.

4 to 6 months 9430 M5 M512025

678 9.26*

Lung cancer-Non-

small cell lung

cancer (NSCLC)

Pemetrexed/ Platin Gemcitabine/ Platin Gefitinib

Biopsy with


CT scan, USG, x-ray,

Sonography, Bone scan,

MRI Brain PET-CT Scan.

CT scan, USG, x-ray, Sonography, Bone

scan, MRI Brain PET-CT Scan, Clinical

Photograph.

4 to 6 months 14950 M5 M512026

679 9.27* Esophageal Cancer Weekly Cisplatin/ Carboplatin Cisplatin-5FU Epirubicin/ Taxanes

Biopsy, CT scan, USG, x-

ray, Sonography,

Endoscopy.

Biopsy, CT scan, USG, x-ray,

Sonography, Endoscopy, Clinical

Photograph.

4 to 6 months 8625 M5 M512027

680 9.28* Gastric Cancer 5-FU -Leucovorin (McDonald Regimen), Epirubicin/Taxanes/Platin

Biopsy, CT scan, USG, x-

ray, Sonography,

Endoscopy.

Biopsy, CT scan, USG, x-ray,

Sonography, Endoscopy, Clinical

Photograph.

4 to 6 months 17250 M5 M512028

681 9.29* Colorectal Cancer Monthly 5-FUBiopsy, CT scan/MRI, x-

ray, Tumor marker-S. CEA

Biopsy, CT scan/MRI, x-ray, Tumor

marker-S. CEA, Clinical Photograph.4 to 6 months 5750 M5 M512029

682 9.30* Colorectal Cancer 5-Fluorouracil-Oxaliplatin -Leucovorin (FOLFOX) (Stage III only)Biopsy, CT scan/MRI, x-




683 9.31* Colorectal Cancer 5-FU, Irinotican, Leucovorin, (FOLFIRI) Capecitabine,Biopsy, CT scan/MRI, x-




684 9.32*Osteosarcoma

Bone TumorsCisplatin/Adriamycin + ifosmide (IAP)

Biopsy, CT scan, MRI scan,

x-ray, Bone scan, 2 D

Echo.

X-Ray, Clinical Photograph. 8 to 9 months 13800 M5 M512032

685 9.33*Lymphoma-

Hodgkin disease

Adriamycin/ Bleomycin/Vinblastine/ Dacarbazine (ABVD),

Cyclophosphamide/Vincristine/Prednisolone/Procarbazine (COPP).

Biopsy-


Serum biochemistry, Bone

marrow examination, CT

scan, x-ray, Sonography,

PET-CT Scan, 2 D Echo,

PFT.

Blood investigations & imaging-USG/CT

scan/PET-CT scan, Clinical Photograph6 to 8 months 6900 M5 M512033



Speciality Code


686 9.34* Lymphoma-NHL

Cyclophosphamide/Adriamycin/Vincristine/Prednisolone (CHOP), Rituximab,

Chlorambucil CVP (Cyclophosphamide/Vincristine,/Prednisolone), Bendamustine

Cladribone High dose Methotrexate/VCR/Procarbazine- Cytarabine

Biopsy-,




scan, x-ray, Sonography,

PET-CT, CSF cytology, MRI

brain/spine, Viral

markers,2 D Echo.

Blood investigations & imaging-USG/CT

scan/PET-CT scan, Clinical Photograph

4 months to 2

years13800 M5 M512034

687 9.35* Multiple Myeloma Vincristine, Adriamycin,Dexamethasone(VAD)

Hematology, Serum

biochemistry, Serum

Protein electrophoresis

and immunofixatation,

Bone marrow

examination, skeletal

survey & MRI Spine, 2 D

Echo.

Blood investigations, & Bone marrow

examination, X-Rays, Clinical

Photograph

2 to 5 years 5750 M5 M512035

688 9.36# Multiple Myeloma Thalidomide+Dexamethasone(Oral)

Hematology, Serum

biochemistry, Serum



Bone marrow


survey & MRI Spine, 2 D

Echo.


examination, Clinical Photograph2 to 5 years 4830 M5 M512036

689 9.37# Multiple Myeloma Melphalan -Prednisone (oral)

Hematology, Serum

biochemistry, Serum



Bone marrow




Photograph

2 to 5 years 2530 M5 M512037

690 9.38# Multiple Myeloma Bortezamib, Lenalinomide, Bisphosphonates, Autologus stem cell transplant

Hematology, Serum

biochemistry, Serum



Bone marrow




Photograph

2 to 5 years 13800 M5 M512038

691 9.39* Wilm's Tumor SIOP/NWTS regimen(Stages I - IV)USG/CT, biopsy with

Immunohistochemistry

Imaging USG/CT scan, Clinical

Photograph4 to 6 months 9775 M5 M512039

692 9.40*Hepatoblastoma

OperableCisplatin – Adriamycin

USG/CT, biopsy, Tumor

marker-AFP, 2D Echo.

USG/CT, Tumor marker, Clinical

Photograph.4 to 6 months 5175 M5 M512040



Speciality Code


693 9.41*Childhood B Cell

LymphomasVariable Regimen - MCP 841/BFM - 90, BFM-NHL, LMB 96, Rasburrycase

Hematology, Serum

biochemistry, CT Scan

whole body Or PET Scan,

Tissue biopsy with

immunochemistry/IPT,

Bone marrow

examination, CSF

Cytology.

Bone marrow examination, Imaging-

Studies, Clinical Photograph

6 months to 6.5

years16100 M5 M512041

694 9.42*Neuroblastoma (

Stages I-III )Variable Regimen Variable regimens, Autologous Stem Cell

CT, Biopsy-With

Immunohistochemistry,

Blood investigations,

MIBG scan, Bone marrow

examination.

Blood investigations & imaging-

USG/CT scan, MIBG scan, Clinical

Photograph

3 to 6 months 16100 M5 M512042

695 9.43* Retinoblastoma Carbo/Etoposide/Vincristine, Endoxan/vincristine/doxorubicin-platin/Etoposide

Biopsy, Blood

investigations, MRI Orbit

& Brain, CSF study, Bone

marrow examination,

Bone scan.

Ophthalmologic examination, Imaging-

Studies, Clinical Photograph

4 months to 1

year7130 M5 M512043

696 9.44* HistiocytosisVariable Regimen- LCH-III, Vinblastine + Prednisolone, 6MP, MTX, Cladribone,

Allergenic stem cell transplant.

Hematology, Biopsy,


marrow examination,

Chest X-Ray, skeletal

survey, MRI Brain,

Endocrine evaluation, HAL

typing & matching, serum

cyclosporine level.CSF

Cytology.

Blood investigations and imagine,

Clinical Photograph6 to 12 months 20700 M5 M512044

697 9.45*Rhabdomyosarco

maVincristine-Actinomycin-Cyclophosphamide (VAC) based chemo

Blood investigations,

Biopsy &


CT scan/MRI, Bone

marrow examination,

Bone scan.

Physical examination, Imagine MRI/CT

can, Clinical Photograph8 to 10 months 5750 M5 M512045



Speciality Code


698 9.46* Ewings sarcoma Variable Regimen- Endoxan/VCR/Doxorubicin-Ifosphamides/Etoposide.

X-Ray/CT Scan/MRI,

Biopsy &


Bone Scan, Bone marrow

examination, 2D Echo.

Physical examination, X-Ray/CT

scan/MRI, Clinical Photograph1 year 16100 M5 M512046

699 9.47*Acute Myeloid

LeukemiaInduction Phase

Hematology, Bone

marrow examination with

Immunophenotyping,

Conventional Cytogenetics

and FISH studies, MRI

Brain, X-Ray, 2D Echo.

Physical examination, Blood

investigations, Bone marrow

examination, Clinical Photograph

1 month 25300 M5 M512047

700 9.48*Acute Myeloid

LeukemiaConsolidation Phase

Hematology, Bone


Immunophenotyping,

Conventional Cytogenetics

and FISH studies, MRI

Brain, X-Ray, 2D Echo.




4 months 43700 M5 M512048

701 9.49*

Acute

Lymphoblastic

Leukemia

Induction phase 1st and 2nd months, MCP 841/BFM 90 protocol, Imatinib

Hematology, Bone


Immunophenotyping,

Cytogenetics and FISH

studies, CSF cytology, MRI

Brain, USG/CT scan.




1 to 2 months 71300 M5 M512049

702 9.50*

Acute

Lymphoblastic

Leukemia

3rd, 4th, 5th month-MCP 841/BFM 90 protocol, Imatinib, Allergenic stem cell

transplant

Hematology, Bone


Immunophenotyping,


studies, CSF cytology, MRI

Brain, USG/CT scan, 2D

Echo.




3 to 4 months 36800 M5 M512050

703 9.51*

Acute

Lymphoblastic

Leukemia

Maintenance- MCP 841/BFM 90 protocol, Imatinib

Hematology, Bone

marrow examination, FISH

study, CSF cytology.




2 years 4830 M5 M512051



Speciality Code


704 9.52* unlisted regimen Palliative ChemotherapyBiopsy. CT, USG, Blood

investigations

Blood investigations, USG/CT scan,

Clinical Photograph7130 M5 M512052

705 9.53*For Terminally ill

cancer patientPalliative and Supportive Therapy Biopsy , CT , USG Clinical Photograph 4830 M5 M512053

706 9.54*Colorectal Cancer

Stage 2& 3XELOX along with Adjuvant chemotherapy

CT scan Abdomen, Pelvis,

Tissue biopsy,

Photograph, Tummor

marker-S. CEA.

USG/CT/biopsy, Biochemical

investigations6 months 10120 M5 M512054

707 9.55*

Febrile

Neutropenia-

Highrisk-1

1ST Line iv antibiotics And other supportive therapy ( third generation

cephalosporin,aminoglycoside, Comnination of Beta Lactum with beta lactamase

inhibitor (Piperacillin-tazobactum), Vancomycin, Anti-Fun gals (azoles), G-CSF etc.,)

Blood C&S, Urine C&S,

Chest X-Ray, Tissue

Biopsy, CT scan.

USG/CT/biopsy, Biochemical

investigations.17250 M5 M512055

708 9.56*

Febrile

Neutropenia-

Highrisk-2

2nd line iv antibiotics and other supportive therapy(Carbapenems, Fourth generation

cephalosporins, Piperacillin, anti-fungal -azoles etc.,)

Blood C&S, Urine C&S,

Chest X-Ray, Tissue

Biopsy, CT scan.

USG/CT/biopsy, Blood investigations,

Blood Culture-sensitivity, X-Ray.48300 M5 M512056

709 9.57*

Relapsed

lymphoma- NHL

and HD

Ifosphamides /Platin /Etoposide (ICE), Cytarabine/ Platin/ Steroids (DHAP),

Autologous stem cell Transplant



scan, X-ray, Sonography,

PET-CT scan

Blood investigations & imaging-

USG/CT scan/PET-CT scan4-6 months 36800 M5 M512057

710 9.58* APML ATRA, Arsenic trioxide, Daunorubicin, Cytarabine 6 MP, methotrexate

Bone Marrow examination

with Immunophe-

notyping, Conventional

Cytogenetics and FISH/RT-

PCR studies, MRI Brain, X-

ray, 2 D echo, ECG

Bone marrow exam with RT-PCR study, 2 to 2.5 years 64400 M5 M512058

711 9.59* Paediatric AML BFM 93

Bone Marrow examination

with Immunophe-

notyping, Conventional


study, MRI Brain, CSF

cytology, X-ray, 2 D echo,

ECG

Physical exam, Blood investigations,

bone marrow exam (if clinically

indicated)

2-2.5 years 59800 M5 M512059

712 9.60*A CLL CVP - Cyclophosphamide, Vincristine, Steroids [CLL *]

Hematology, Serum

Biochemistry, Bone


Immunophe-notyping,

Lymph node biopsy with

IHC, USG/CT scan, 2 D

Echo


Imaging USG/CT scan5463 M5 M512060



Speciality Code


713 9.60*B CLL L +P -- Chlorambucil, Steroids [CLL *]

Hematology, Serum

Biochemistry, Bone


Immunophe-notyping,



Echo



714 9.60*C CLL Fludarabine, Cyclophosphamide, Rituximab (FCR) [CLL *]

Hematology, Serum

Biochemistry, Bone


Immunophe-notyping,



Echo



715 9.60*D CLL Rituximab [CLL *]

Hematology, Serum

Biochemistry, Bone


Immunophe-notyping,



Echo



716 9.60*E CLL Bendamustine [CLL *]

Hematology, Serum

Biochemistry, Bone


Immunophe-notyping,



Echo


Imaging USG/CT scan2-3 years 16387 M5 M512060

717 9.61# CML Blastic crisis Imatinib, Nilotinib, Dasatinib Allogeneic stem cell Transplant

Hematology with serum

biochemistry, Bone

marrow examination,

cytogenetic study, Ph by

FISH or RT-PCR, USG study


Bone marrow study, RT- PCR for BCR-

ABL

4600 M5 M512061

718 9.62A^ Aplastic Anaemia Aplastic Anaemia - ATG + Cyclosporine + Steroid

Hematology and serum

biochemistry, Bone

Marrow examination, viral

markers, IPT for PNH, HLA

typing & matching. S.

Cyclosporine level

Blood investigations 320000 M5 M512062



Speciality Code


719 9.62B^ Aplastic Anaemia Allogeneic stem cell Transplant

Hematology and serum

biochemistry, Bone

Marrow examination, viral

markers, IPT for PNH, HLA

typing & matching. S.

Cyclosporine level


720 9.63A^Myelodysplastic

syndromeMyelodysplastic syndrome - Lenalinomide Decitabine

Hematology, serum

biochemistry, Bone


cytogenetics, FISH study,


721 9.63B^Myelodysplastic

syndrome Allogeneic stem cell Transplant

Hematology, serum

biochemistry, Bone


cytogenetics, FISH study,


722 9.64^

Thalassemia/Haem

oglobinopathies

Sickle cell anaemia

Thalassemia/Haemoglobinopat hies Sickle cell anaemia - Allogeneic Bone Marrow

Transplant

Blood investigations Hb

electrophoresis ,HLA studyBlood investigations 780000 M5 M512066

723 9.65^

Congenital

condition

amenable to BMT

Congenital condition amenable to BMT - Allogeneic stem cell Transplant

Hematology, serum

biochemistry, Hb

electrophoresis , HLA

typing


724 9.66* Medulloblastoma Cisplatin/cyclophosphamide/VCR/Procarbazine, Lomustine

Hematology, Serum

biochemistry, RI brain &

spine, Biopsy


CSF cytology

Physical exam, MRI study 4-6 months 6900 M5 M512068

725 9.67^

Relapsed

Paediatric Solid

Tumours

Relapsed Paediatric Solid Tumor - Autologus stem cell transplant -Blood investigations and

Imaging,Blood investigations and Imaging, 780000 M5 M512069

726 9.68^A Palliative package Fixation of pathological fracture [Palliative package ^]Blood investigations and


727 9.68^B Palliative package Oesophageal Stenting /prosthesis- double [Palliative package ^]Blood investigations and




Speciality Code


728 9.68^C Palliative package Oesophageal Stenting/prosthesis- Single [Palliative package ^]Blood investigations and


729 9.68^D Palliative package Nerve blockage With Image / Nerve blockage Without Image [Palliative package ^]Blood investigations and


730 9.68^E Palliative packagePain killer / G-CSF/ Drainage – Biliary and urinary / Stenting – Biliary/ Stenting –

urinary / Nutritional supplement [Palliative package ^]

Blood investigations and


731 9.69* Anal Cancer MITOMYCIN, 5FUCXR , USG ABDOMEN, CT

AbdomenULTRASOUND 3 to 4 months 4600 M5 M512071

732 9.70* Head & Neck CISPLATIN WEEKLYChest X ray, CT/MRI,

BiopsyCT Scan Xrays 5 to 6 weeks 4140 M5 M512072

733 9.71* Head & Neck TPF (DOCETAXEL ,CISPLATIN , 5-FU) X ray, CT, MRI Biopsy CT Scan X-rays 2 to 3 months 16330 M5 M512073

734 9.72# Head & Neck CISPLATIN + MTX X ray, CT, MRI Biopsy CT Scan X-rays 2 to 3 months 4600 M5 M512074

735 9.73# HCC SORAFENIB ORALAFP , USG ABDOMEN, CT

Scan, Chest x rayUSG ABDOMEN 4 to 8 months 8280 M5 M512075

736 9.74# RCC SUNITINIBUSG, Biopsy, CT Scan,

Chest x rayUSG ABDOMEN 4 to 8 months 27600 M5 M512076

737 9.75* Brain Tumour Tenozolamide, Procarbazine, CCNU, Vincristine

MRI Brain, Biopsy with

Immunohistochemistry, X-

ray

MRI Brain, X-ay 6months 17480 M5 M512077

738 9.76*Sarcoma- soft

tissueCisplatin/ Adriamycin/ Ifosphamides

MRI, CT scan, Biopsy with

Immunohistochemistry, X-

ray

MRI, CT scan, X-ray 4 to 6 months 17250 M5 M512078

739 9.77*Hepatobilliary

tumorGemcitabine/ Oxaliplatin/ Capecitabine/ 5 FU

CT scan, Biopsy, Tumor

markers, X-ray,

Sonography

CT scan, Tumor markers, X-ray,

Sonography4 to 6 months 17480 M5 M512079



Speciality Code


740 9.78* Pancreatic cancer Gemcitabine/ Oxaliplatin/ Capecitabine/ 5 FU/Erlotinib

CT scan, Biopsy, Tumor

markers, X-ray,

Sonography

CT scan, Tumor markers, X-ray,

Sonography4 to 6 months 17480 M5 M512080

741 9.79*Endometrial

cancerWeekly Platin Paclitaxel/ Carboplatin

CT scan/MRI study, X-ray,

Biopsy, SonographyCT scan, X-ray, Sonography 4 to 6 months 4830 M5 M512081

742 9.80 OncologyPET Study (All Cancer for all oncology cluster diagnostic or staging in proven cancer

patient)

Biopsy report of proven

cancer of any past time

necessary for pre

authorisation

- - 15000 M5 M512082



Speciality Code


743 10.1Cobalt 60 external

beam radiotherapyRadical treatment Usg/x-ray/ct, biopsy

Clinical photograph, rt treatment

charts6 to 7 weeks 23000 M6 M612001


beam radiotherapyPalliative treatment Usg/x-ray/ct, biopsy


charts3 weeks 11500 M6 M612002


beam radiotherapyAdjuvent therapy Usg/x-ray/ct, biopsy



746 10.4 Linear accelerators Radical treatment with photons (linear accelarator) Usg/x-ray/ct, biopsyClinical photograph, rt treatment


747 10.5 Linear accelerators Palliative treatment with photons (linear accelarator) Usg/x-ray/ct, biopsyClinical photograph, rt treatment


748 10.6 Linear accelerators Adjuvant treatment with photons/electrons Usg/x-ray/ct, biopsyClinical photograph, rt treatment


749 10.7Brachytherapy-

intracavitary-iiIi. Hdr per application Usg/x-ray/ct, biopsy


charts

Weekly

application for 2

to 5 weeks

11500 M6 M612007

Cluster-10 RADIATION ONCOLOGY



Speciality Code


750 10.8Brachytherapy-

interstitial-iiIi. Hdr - one application and multiple dose fractions Usg/x-ray/ct, biopsy


charts5 days 11500 M6 M612008

751 10.9LA with multi leaf

collimatorRadical treatment with IMRT

USG/ X-ray/ CT/ MRI/

BiopsyUSG/ X-ray/ CT/ MRI/ Biopsy 6 to 7 weeks 95450 M6 M612009

752 10.10LA with multi leaf

collimatorRadical treatment with IGRT



753 10.15LA with some

accessoriesSRS (Stereotactic Radiosurgery)


BiopsyUSG/ X-ray/ CT/ MRI/ Biopsy 1 day 143750 M6 M612011

754 10.16LA with some

accessoriesSRT (Stereotactic Radiotherapy)


BiopsyUSG/ X-ray/ CT/ MRI/ Biopsy 6 weeks 143750 M6 M612012

755 10.17 Brain Tumour Gamma Knife / Cyber Knife CT CT 1 day 115000 M6 M612013

756 10.19Total Body

RadiationPre Bonemarrow/Stem Cell Transplant



757 10.20 Iodine Therapy Radio Iodine Therapy Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

chartsPer dose 15000 M6 M612015

758 10.21EBRT (External

Beam RT)SBRT (Sterotactic Beam RT) Usg,/x-ray,/ct,/biopsy


charts

Daily (5day x

week) 6 to 7

weeks

130000 M6 M612016

759 10.22 EBRT 3DCRT (3 Dimentional Conformal RT) Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts

Daily (5day x

week) 6 to 7

weeks

80000 M6 M612017



Speciality Code


760 10.23 EBRT Electron Boost Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 weeks 5000

Total 5 to 10 Fraction

of 200 Gray eachM6 M612018

761 10.24 EBRT Electron treatment curative Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment


762 10.25 EBRT Rapidarc/VMAT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment


763 10.26 Brachytherapy Intraluminal Brachytherapy in addition to EBRT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 weeks 11500

6.5 x 2

up to 55 GrayM6 M612021

764 10.27 Brachytherapy CT guided ICR (Intra Cavitory RT)in addition to EBRT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 weeks 16500 weekly upto 66 Gray M6 M612022

765 10.28 Brachytherapy CT guided Interstitial RT in addition to EBRT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 to 3 days 16500

6hourly two fraction

per day for two days M6 M612023

766 10.29 Brachytherapy MRI guided ICR in addition to EBRT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 weeks 16500 weekly upto 66 Gray M6 M612024

767 10.30 Brachytherapy MRI guided Interstial RT in addition to EBRT Usg,/x-ray,/ct,/biopsyClinical photograph, rt treatment

charts2 to 3 days 16500

6hourly two fraction

per day for two days M6 M612025

768 10.31Radiation

OncologyRespiratory Gating along with Linear Accelerator planning CT, Biopsy Clinical Photo, RT Chart 70,000 M6 M600009

769 10.32Radiation

OncologyTomotherapy(Radical/Adjuvant/Neoadjuvant) Blood test, CT, Biopsy Clinical Photo, RT Chart 75,000 M6 M600011



Speciality Code


770 11.2 Throat Microlaryngeal Surgery including Phonosurgery Biopsy, CT Scan/ MRI Biopsy 1 11500 S15 S1512001

Cluster-11 SURGICAL ONCOLOGY



Speciality Code


771 11.3 Throat Excision/ Hypopharynx of Tumors in Pharynx Biopsy, CT Scan/ MRI Clinical Photograph, biopsy 1 23000 S15 S1512002

772 11.4 Pancreas Distal Pancreatectomy CT , CA 19-9, PET Scan Clinical Photograph 1 55000 S15 S1512003

773 11.5 Pancreas Enucleation of Cyst CT, CA 19-9 Clinical Photograph 1 35000 S15 S1500030

774 11.6 Pancreas Whipples - any typeCT , ERCP, CA 19-9, PET

Scan, EUSClinical Photograph 1 75000 S15 S1512004

775 11.7 Spleen Splenectomy USG/CT Clinical Photograph , USG 1 30000 S15 S100132

776 11.8Genito Urinary

SystemRadical Nephrectomy

Biopsy , CT , IVP , KUB

,USGBiopsy , Clinical Photograph , USG 1 34500 S15 S1512006


SystemRadical Cystectomy




SystemOther cystectomies




SystemHigh Orchidectomy

CT Scan (Abdomen,

Pelvis), Biopsy, USG, CT

Scan Thorax

Biopsy , Clinical Photograph , USG 1 15000 S15 S1512009


SystemBilateral Orchidectomy

Biopsy , USG, Bone Scan,

Local X-rayBiopsy , Clinical Photograph , USG 1 11500 S15 S1512010


SystemTotal Penectomy

Biopsy, CT Scan

(Abdomen, Pelvis),Clinical

Photograph



SystemInguinal Block Dissection-one side

Biopsy , Clinical

phtograph, CT ScanBiopsy , Clinical Photograph , USG 1 8740 S15 S1512012


SystemRadical Prostatectomy

CT , KUB , USG, Bone Scan,

BiopsyBiopsy , Clinical Photograph , USG 1 60000 S15 S1512013


SystemPartial Penectomy

Biopsy, Clinical

Photograph, USG

Abdomen Pelvis


785 11.18 Gynaec Radical Hysterectomy Biopsy , CT , USG Biopsy , Clinical Photograph , USG 1 34500 S15 S1512015

786 11.19 Gynaec Surgery for Ca Ovary - early stage

CA 125, CEA, Biopsy/

cytology, aFP, ßHCG, LDH,

X-ray chest

Biopsy , Clinical Photograph , USG,

Tumor Marker1 23000 S15 S1512016



Speciality Code


787 11.20 Gynaec Surgery for Ca Ovary - advance stage

CA 125, CEA, Biopsy/

cytology, aFP, ßHCG, LDH,

X-ray chest

Biopsy , Clinical Photograph , USG,

Tumor Marker1 40000 S15 S1512017

788 11.21 Gynaec Vulvectomy Biopsy, Photograph Biopsy , Clinical Photograph , USG 1 17250 S15 S1512018

789 11.22 Breast Mastectomy - any type

Biopsy, X-rays,

Mammogram,

Photograph, USG, CT,

Bone scan

Biopsy , Clinical Photograph 1 25000 S15 S1512019

790 11.23 Breast Axillary Dissection

Biopsy, X-rays,

Mammogram,

Photograph, USG, CT,

Bone scan


791 11.24 Breast Wide excision

Biopsy, X-rays,

Mammogram,

Photograph, USG, CT


792 11.25 Ca.Rectum Abdomino Perineal Resection (APR) +SacrectomyCT/ Barium Meal Follow

throughClinical Photograph, biopsy 1 50000 S15 S1512021

793 11.26 Ca. Gall Bladder Radical Cholecystectomy CT , USG, PET Scan Biopsy , Clinical Photograph , USG 1 60000 S15 S1500031

794 11.27 Breast Wide excision + Reconstruction ( Pedicle flap)

CT/BMFT,

Colonoscopy,Biopsy, CEA,

PET Scan

Clinical Photograph, biopsy 1 25000 S15 S1512022

795 11.28 Lung Cancer Pneumonectomy

Biopsy, X-rays,

Mammogram,

Photograph, USG, CT


796 11.29 Lung Cancer Lobectomy

Biopsy, X-rays,

Mammogram,

Photograph, USG, CT


797 11.30 Lung Cancer DecorticationBiopsy , CT , X-RAY, PET

scan, CT brainBiopsy , Clinical Photograph , X-RAY 1 40000 S15 S1312023

798 11.31 Lung Cancer Surgical Correction of Bronchopleural Fistula.Biopsy , CT , X-RAY, PET

scan (SOS)Biopsy , Clinical Photograph , X-RAY 1 35000 S15 S1512026

799 11.32 Head &Neck Resection of Nasopharyngeal TumorBiopsy , CT , X-RAY, PET

scan, CT brainBiopsy , Clinical Photograph , X-RAY 1 50000 S15 S1500004



Speciality Code


800 11.33 Head &Neck Craniofacial resection of any type Biopsy , CT , X-RAY Biopsy , Clinical Photograph , X-RAY 1 90000 S15 S1512027

801 11.34 A Head &Neck Composite Resection ANY TYPE Biopsy, CT/MRI Biopsy , Clinical Photograph 1 41250 S15 S1512028

802 11.34 B Head &Neck PEDICLE FLAP Reconstruction Biopsy, CT/MRI Biopsy , Clinical Photograph 1 13750 S15 S1512028

803 11.35 Head &Neck Neck Dissection - any type CT/ MRI, Biopsy Biopsy , Clinical Photograph 1 32200 S15 S1512029

804 11.36 Head &Neck HemiglossectomyClinical Photograph/X-

Ray,USG/biopsy/CTClinical Photograph, biopsy 1 20700 S15 S1512030

805 11.37 Head &Neck Maxillectomy - any type

Biopsy , Clinical

Photograph , USG , X-RAY,

CT Scan


806 11.38 Head &Neck Thyroidectomy - any type

Biopsy , Clinical


MRI


807 11.39 Head &Neck Parotidectomy - any typex-ray of maxilla, CT/MRI,

biopsybiopsy and Clinical Photograph 1 20000 S15 S1512033

808 11.40 Head &Neck Laryngectomy - any type

Biopsy , Clinical


CT Scan


809 11.41 Head &Neck Laryngopharyngo Oesophagectomy

Biopsy , Clinical


CT Scan


810 11.42 Head &Neck Hemimandibulectomy

Biopsy , Clinical


CT Scan


811 11.43 Head &Neck Wide excision Any type

Biopsy , Clinical


CT Scan


812 11.44 Ca. Salivary Gland Submandibular Gland Excision

Biopsy , Clinical


OPG/CT scan




Speciality Code


813 11.45 Ca. Trachea Tracheal ResectionBiopsy , Clinical

Photograph , USG , X-RAYBiopsy , Clinical Photograph 1 50000 S15 S1500001

814 11.46 Ca. Trachea Sternotomy + Superior Mediastinal DissectionBiopsy , Clinical

Photograph , USG , X-RAYBiopsy , Clinical Photograph 1 45000 S15 S1500002

815 11.47 Ca. Parathyroid Parathyroidectomy Biopsy, CT, Bronchoscopy Clinical Photograph, biopsy 1 20700 S15 S1512039

816 11.48Ca. Gastro

Intestinal TractSmall bowel resection Biopsy, CT Clinical Photograph, biopsy 1 18400 S15 S1512040

817 11.49Ca. Gastro

Intestinal TractClosure of Ileostomy/ Colostomy

Biopsy , Clinical


Serum Parathormone


818 11.50 Spleen Radical Splenectomy CT , USG Biopsy , Clinical Photograph , USG 1 30000 S15 S1512042


SystemResection of Retroperitoneal Tumors

Barium meal test, CT

abdomen, biopsyBiopsy, clinical photograph 1 45000 S15 S1512043


SystemAbdominal wall tumor Resection USG, CT abdomen, biopsy BIOPSY, CLINICAL PHOTOGRAPH 1 35000 S15 S1500032


SystemResection with reconstruction USG, CT abdomen, biopsy BIOPSY, CLINICAL PHOTOGRAPH 1 20700 S15 S1500033


SystemOesophagectomy - any type

Biopsy , CT , Endoscopy

,USG, PET SCANBiopsy , Clinical Photograph , USG 1 60000 S15 S1512044


SystemGastrectomy - any type

Biopsy , CT , Endoscopy

,USG, PET SCANBiopsy , Clinical Photograph , USG 1 40000 S15 S1512045


SystemColectomy - any type

Biopsy , CT , Endoscopy ,

USG, CEABiopsy , Clinical Photograph , USG 1 40000 S15 S1512046


SystemAnterior Resection




SystemAbdominoperinial Resection





Speciality Code



SystemTriple Bypass




SystemOther GI Bypasses surgery any type (including pancreas)



829 11.62 Gynaec Radical Trachelectomy CT/MRI, Biopsy Clinical Photograph, biopsy 1 35000 S15 S1500043

830 11.63 Gynaec Radical vaginectomy CT, Biopsy Clinical Photograph, biopsy 1 26450 S15 S1500040

831 11.64 Gynaec Radical vaginectomy + Reconstruction CT, Biopsy Clinical Photograph, biopsy 1 45000 S15 S1500041

832 11.65 Gynaec-Ca.CervixRadical Hysterectomy +Bilateral Pelvic Lymph Node Dissection (BPLND) + Bilateral

Salpingo Ophorectomy (BSO) / Ovarian transpositionPap Smear / biopsy, CT Clinical Photograph, biopsy 1 45000 S15 S1500037

833 11.66 Gynaec-Ca.Cervix Anterior Exenteration (Gynaec) Pap Smear / biopsy, CT Clinical Photograph, biopsy 1 60000 S15 S1512050

834 11.67 Gynaec-Ca.Cervix Posterior Exenteration (Gynaec) Pap Smear / biopsy, CT Clinical Photograph, biopsy 1 50000 S15 S1512051

835 11.68 Gynaec-Ca.Cervix Total Pelvic Exenteration Pap Smear / biopsy, CT Clinical Photograph, biopsy 1 75000 S15 S1512052

836 11.69 Chest Chest wall resection for SOFT tissue bone tumorsBiopsy, CT Chest, Bone

ScanClinical Photograph, biopsy 1 9660 S15 S1512053

837 11.70 Chest Chest wall resection + ReconstructionBiopsy, CT Chest, Bone

ScanClinical Photograph, biopsy 1 30000 S15 S1500048

838 11.71Bone / soft tissue

tumorsLimb salvage surgery for Bone Tumors with modular Prosthesis

CT-Local part, CT

Chest,MRI, Bone ScanClinical Photograph, biopsy 1 75000 S15 S1500045


tumorsForequarter amputation Biopsy, CT Chest Clinical Photlograph/ X-Ray, biopsy 1 30000 S15 S1512054


tumorsHemipelvectomy

Biopsy, CT/MRI Pelvis, CT

Chest, PET scanClinical Photlograph/ X-Ray, biopsy 1 55000 S15 S1500046



Speciality Code



tumorsBone resection CT/MRI, Biopsy Clinical Photograph/X-ray, biopsy 1 30000 S15 S1512055

842 11.75 Renal Cell Cancer Partial Nephrectomy CT/Isotope renogram Clinical Photograph, biopsy 1 40000 S15 S1512056

843 11.76 Renal Cell Cancer Nephroureterectomy for Transitional Cell Carcinoma of renal pelvis (one side) CT, Biopsy Clinical Photograph, biopsy 1 46000 S15 S1512057

844 11.77 Testes cancer Retro Peritoneal Lymph Node Dissection(RPLND) (for Residual Disease)CT-Chest, CT.Abd+Pelvis,

Tumor markers, biopsyClinical Photograph, biopsy 1 60000 S15 S1512058

845 11.78 Tumours AdrenalectomyCT/MRI, Urinary

hormonesClinical Photograph, biopsy 1 45000 S15 S1512059

846 11.79 Testes cancer Urinary diversion biopsy, USG Scrotum Clinical Photograph, biopsy 1 40000 S15 S1512060

847 11.80 Testes cancer Retro Peritoneal Lymph Node Dissection RPLND as part of staging CT, biopsy Clinical Photograph, biopsy 1 23000 S15 S1512061

848 11.81Ca. Urinary

BladderAnterior Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT Clinical Photograph, biopsy 1 60000 S15 S1512062


BladderTotal Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT Clinical Photograph, biopsy 1 75000 S15 S1512063


BladderBilateral pelvic lymph Node Dissection(BPLND) CT, biopsy Clinical Photograph, biopsy 1 25000 S15 S1500042

851 11.84Thoracic and

MediastinumMediastinal tumor resection CT Clinical Photograph, biopsy 1 50000 S15 S1512064

852 11.85 Lung Lung metastatectomy of any typeCT, biopsy, Bone scan/

PET scanX-Ray, Biospy 1 35000 S15 S1512065

853 11.86 Lung Sleeve resection of Lung cancer.CT/ Bronchoscopy, biopsy,

PET scanX-Ray, Biospy 1 90000 S15 S1500027

854 11.87 Esophagus Oesophagectomy with Two field LymphadenectomyUGI Endoscopy, biopsy /

CTClinical Photograph, biopsy 1 80000 S15 S1500028



Speciality Code


855 11.88 Esophagus Oesophagectomy with Three field LymphadenectomyUGI Endoscopy, biopsy /

CTClinical Photograph, biopsy 1 80000 S15 S1500029

856 11.89 Palliative Surgeries Tracheostomy Clinical Photograph Clinical Photograph 1 5520 S15 S1500021

857 11.90 Palliative Surgeries Gastrostomy Clinical Photograph Clinical Photograph 1 15000 S15 S100064

858 11.91 Palliative Surgeries Jejunostomy Clinical Photograph Clinical Photograph 1 15000 S15 S100088

859 11.92 Palliative Surgeries Ileostomy Clinical Photograph Clinical Photograph 1 15000 S15 S100095

860 11.93 Palliative Surgeries Colostomy Clinical Photograph Clinical Photograph 1 15000 S15 S100018

861 11.94 Palliative Surgeries Suprapubic Cystostomy Clinical Photograph Clinical Photograph 1 10000 S15 S1512070

862 11.95 Palliative Surgeries Gastro JejunostomyUSG, CT SCAN, Clinical

PhotographClinical Photograph, biopsy 1 20000 S15 S1512071

863 11.96 Palliative Surgeries Ileotransverse BYPASSColostomy

CT SCAN, USG, Endoscopy,

Biopsy, Clinical

Photograph


864 11.97 Palliative Surgeries Substernal bypass

CT SCAN, USG, Endoscopy,

Biopsy, Clinical

Photograph


865 11.98 Reconstruction Myocutaneous / cutaneous flap Clinical Photograph Clinical Photograph 1 25000 S15 S1500005

866 11.99 Reconstruction Micro vascular reconstructionDoppler study, Clinical

PhotographClinical Photograph 1 45000 S15 S1500009

867 11.100Soft Tissue and

Bone TumorsWide excision - for soft tissue and bone tumors

Clinical Photograph,

biopsyClinical Photograph, biopsy 1 12650 S15 S1512073


Bone TumorsWide excision + Reconstruction for soft tissue and bone tumors


biopsyClinical Photograph, biopsy 1 25000 S15 S1512074


Bone TumorsAmputation for bone / soft tissue tumours (Major / Minor)


biopsyClinical Photograph, Biopsy 1 25000 S15 S1512075


SystemInguinal Block Dissection-both side

Biopsy, Clinical

Photograph, CT scanBiopsy, Clinical Photograph, USG 1 16100 S15 S1512076



Speciality Code


871 11.104 Ano-rectal Low Anterior resection OR Sphincter preserving surgery of any typeCT/ BMFT, Colonoscopy,

Biopsy, CEABiopsy, Clinical Photograph, USG 1 40000 S15 S1512077


SurgeryLaproscopic resection of any type

Barium meal test, CT

abdomen, biopsy,

Endoscopy, Tumor Marker

Biopsy, Clinical Photograph, USG 1 50000 S15 S1512078

873 11.106 Liver Hepatic surgery of any typeCT abdomen, biopsy,

Endoscopy, Tumor MarkerBiopsy, Clinical Photograph, USG 1 70000 S15 S1512079

874 11.107Lung &

OesophagusThoracoscopic and Laproscopic surgery of any type

CT abdomen, biopsy,

EndoscopyBiopsy, Clinical Photograph, USG 1 60000 S15 S1512080


SystemLaproscopic surgery for kidney & supra renal any type

CT abdomen, biopsy,

EndoscopyBiopsy, Clinical Photograph, USG 1 40000 S15 S1512081

876 11.109 Brain Tumour Brain tumours surgery of any type CT/ MRI, Biopsy CT, Photograph 1 55000 S15 S1512082

877 11.110Gynaec Body of

the uterusTAH + BSO + BLND + O.S.

Biopsy, CT scan, USG, CA

125CT, Biopsy, Photograph 1 45000 S15 S1512083

878 11.111 Bone & soft tissue Hind Quarter AmputationMRI, Bone scan & PET

scanCT, Biopsy, Photograph 1 40000 S15 S1512084

879 11.112 Bone & soft tissue Hip & Knee Disarticulation MRI Photograph 1 45000 S15 S1512085

880 11.113

Gynaec CIN Early

cancer of any

female organ

Radical Trachelectomy Cone Biopsy, Simple HysterectomyBiopsy, CT scan, USG, CA

125Biopsy, USG 1 40000 S15 S1512086

881 11.114

All System Pre

malignant and

Malignant Lesion

Laser Surgery Any type Usg,/x-ray,/ct,/biopsy clinical photograph 1 15000 S15 S1512087

882 11.115 Head & Neck Flap Cutting any typeUsg,/x-ray,/ct,/biopsy

previous procedure reportclinical photograph 1 5000 S15 S1512088

883 11.116 Head & Neck Eyeball enucleation Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512089

884 11.117For All Long term

ChemotherapyPICC (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 10000 S15 S1512090

885 11.118For All Long term

ChemotherapyPort Insertion (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512091

886 11.119 Palliative Surgeries ICD Tube Insertion Usg,/x-ray,/ct,/biopsy clinical photograph 0 1500 S15 S1512092



Speciality Code


887 11.120 Pancreas Wide Excision any type (Surgery other than Whipples) Usg,/x-ray,/ct,/biopsy clinical photograph 3 50000 S15 S1512093

888 11.121 Palliative Surgeries Drain Insertion any type Usg,/x-ray,/ct,/biopsy clinical photograph 0 1500 S15 S1512094

889 11.122Any Wound Gap

SurgeryResuturing

Usg,/x-ray,/ct,/biopsy

previous procedure reportclinical photograph 1 3000 S15 S1512095

890 11.123 Larynx Voice prosthesis Biopsy, CECT Invoice of prosthesis, scar photo 30,000 S15 S1500018

891 11.124 Skin Skin Tumours Wide Excision + ReconstructionBiopsy, Blood Routine

(CBC), CT Scanclinical photograph 25,000 S15 S1500038

892 11.125 Skin Skin Tumours AmputationBiopsy, Blood Routine

(CBC), CT Scanclinical photograph 25,000 S15 S1500039

893 11.126 Oncosurgery Unspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per family) Concern Investigation Concern Investigation 1,00,000 S15 U100


Investigation Post Operative Investigation No of Follow up

Package Rates

for Private

Hospitals

Package Rates for

Government

Hospitals

Speciality Code


894 14.1 Hip Replacement

Primary Hip replacement

(With Implant) Cemented THR

(Indian Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 1,00,000 50000 S5 S512001



(With Implant) Cemented THR

(Imported Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 1,20,000 70000 S5 S512002

896 14.3 Hip Replacement Primary Hip replacement

(With Implant) Uncemented THR (Indian Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 1,20,000 70000 S5 S512003



(With Implant) Uncemented THR

(Imported Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 1,30,000 85000 S5 S512004

898 14.5 Hip Replacement Revision Hip Replacement

(With Implant) All component Revision

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 3,00,000 2,25,000 S5 S512005


(With Implant) Acetabular Component with cage

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 2,00,000 1,30,000 S5 S512006

Cluster-14 PROCEDURES FOR KNEE & HIP REPLACEMENT



Speciality Code



(With Implant) Acetabular Component with pelvic Augments

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 2,50,000 1,80,000 S5 S512007


(With Implant) Stem Replacement

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY


X-RAY3 2,00,000 1,40,000 S5 S512008

902 14.9 Knee Replacement

Primary Knee Replacement

(With Implant) Metal Back

(Indian Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,

Bilateral Lower Limb

Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 1,10,000 65000 S5 S512009



(With Implant) Metal Back

(Imported Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,


Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 1,30,000 75000 S5 S512010



(With Implant) All Poly

(Indian Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,


Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 80000 45000 S5 S512011



(With Implant) All Poly

(Imported Implant)

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,


Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 90000 50000 S5 S512012

906 14.13 Knee Replacement Revision Knee Replacement for Long Stem without Augment

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,


Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 2,50,000 1,75,000 S5 S512013

907 14.14 Knee Replacement Revision Knee Replacement With Augment Support

Haematology, Serum

Biochemistry, Viral

markers, Clinical

Photograph, X-RAY,


Standing ORG/CT

scanogram

Clinical Photograph, X-RAY 3 3,00,000 2,25,000 S5 S512014

Cluster-15 ORGAN TRANSPLANT PACKAGES



Speciality Code




Speciality Code


908 15.1Kidney

transplantationKidney transplantation Laparoscopic Donor nephrectomy

Blood group, FBS, PPBS,

ELISA

USG ABDOMEN, Urine

R/M and C/S

CBC, RFT, LFT, Uric acid,

PTH, Lipid profile, Iron

profile, CMV IgG and IgM

BT, CT, PT, G6PD

2D Echocardiogram

Chest X Ray, ECG, DTPA

Renogram, PAP smear

(female)

CT Angiogram for kidney

vessel

RFT 60000 S17 S1712001

909 15.2 AKidney

transplantation

Open Kidney transplantation from living donor Part-1 Investigations

Blood group, HbA1C, FBS, PPBS, ELISA, HCV RNA Qualitative, CMV IgG and IgM

USG Abdomen,

Urine R/M and C/S

iPTH, Vit D, Uric Acid

BT,CT, PT, aPTT, G6PD level

Chest X Ray, ECG, 2D echocardiogram

Lipid Profile, Anticardiolipin Antibody, Lupus Anticoagulant, C3, C4, ANA, dsDNA,

pANCA, cANCA, USG Doppler Neck vessels

Usg Doppler Iliofemoral Vessels

MCU, Uroflowmetry

15000 S17 S1712002

910 15.2 BKidney

transplantation

Open Kidney transplantation from living donor Part-2 Investigations

HLA Typing

LCM, FCM

Single Antigen Qualitative

22500 S17 S1712003

911 15.2 CKidney

transplantation

Open Kidney transplantation from living donor Part-3 Investigation

Single Antigen Quantitative 22500 S17 S1712004

912 15.2 DKidney

transplantation

Open Kidney transplantation from living donor Part-4 Operative Part S. Creatinine, USG kidney graft,

Doppler study for graft240000 S17 S1712005



Speciality Code


913 15.3 AKidney

transplantation

Open Kidney transplantation from deceased donor Part-1 Investigations


USG Abdomen,

Urine R/M and C/S


BT, CT, PT, aPTT, G6PD level





MCU, Uroflowmetry

18000 S17 S1712006

914 15.3 BKidney

transplantation

Open Kidney transplantation from deceased donor Part-2 Investigations

HLA Typing

LCM, FCM


27000 S17 S1712007

915 15.3 CKidney

transplantation

Open Kidney transplantation from deceased donor Part=3 InvestigationSingle Antigen

Quantitative 27000 S17 S1712008

916 15.3 DKidney

transplantation

Open Kidney transplantation from deceased donor Part-4 Operative Part S. Creatinine, USG kidney graft,

Doppler study for graft288000 S17 S1712009

917 15.4 AKidney

transplantation

Open dual Kidney transplantation from deceased donor Part-1 Investigations

Blood group ,HbA1C, FBS, PPBS, ELISA, HCV RNA Qualitative, CMV IgG and IgM

USG Abdomen,

Urine R/M and C/S


BT,CT, PT,aPTT,. G6PD level



pANCA, cANCA,USG Doppler Neck vessels


MCU, Uroflowmetry

20000 S17 S1712010

918 15.4 BKidney

transplantation

Open dual Kidney transplantation from deceased donor Part-2 Investigations

HLA Typing

LCM, FCM


30000 S17 S1712011



Speciality Code


919 15.4 CKidney

transplantation

Open dual Kidney transplantation from deceased donor Part=3 Investigation

Single Antigen Quantitative30000 S17 S1712012

920 15.4 DKidney

transplantationOpen dual Kidney transplantation from deceased donor Part - 4 Operative Part

S. Creatinine, USG kidney graft,Doppler

for both kidney grafts320000 S17 S1712013

921 15.5Kidney

transplantationWound exploration for kidney graft nephrectomy

USG and Doppler study of

kidney allograftClinical photo, S. Creatinine 40000 S17 S1712014

922 15.6 AKidney

transplantation

Robotic kidney transplantation from living donor Part-1 Investigations


USG Abdomen,

Urine R/M and C/S







MCU, Uroflowmetry

22000 S17 S1712015

923 15.6 BKidney

transplantation

Robotic kidney transplantation from living donor Part-2 Investigations

HLA Typing

LCM, FCM


33000 S17 S1712016

924 15.6 CKidney

transplantation

Robotic kidney transplantation from living donor Part-3 Investigation


925 15.6 DKidney

transplantationRobotic kidney transplantation from living donor Part - 4 Operative Part S. Creatinine, USG kidney graft 352000 S17 S1712018



Speciality Code


926 15.7 AKidney

transplantation

Robotic kidney transplantation from deceased donor Part-1 Investigations

Blood group ,HbA1C, FBS, PPBS, ELISA, HCV RNA Qualitative, CMV IgG and IgM

USG Abdomen,

Urine R/M and C/S


BT,CT, PT,aPTT,. G6PD level





MCU, Uroflowmetry

23000 S17 S1712019

927 15.7 BKidney

transplantation

Robotic kidney transplantation from deceased donor Part-2 Investigations

HLA Typing

LCM, FCM


34500 S17 S1712020

928 15.7 CKidney

transplantation

Robotic kidney transplantation from deceased donor Part-3 Investigation

Single Antigen Quantitative 34500 S17 S1712021

929 15.7 DKidney

transplantationRobotic kidney transplantation from deceased donor Part - 4 Operative Part S. Creatinine, USG kidney graft 368000 S17 S1712022

930 15.8 AKidney

transplantation

Robotic dual kidney transplantation from deceased donor Part-1 Investigations


USG Abdomen,

Urine R/M and C/S







MCU, Uroflowmetry

24000 S17 S1712023

931 15.8 BKidney

transplantation

Robotic dual kidney transplantation from deceased donor Part-2 Investigations

HLA Typing

LCM, FCM


36000 S17 S1712024



Speciality Code


932 15.8 CKidney

transplantation

Robotic dual kidney transplantation from deceased donor Part-3 Investigation


933 15.8 DKidney

transplantationRobotic dual kidney transplantation from deceased donor Part-4 Operative Part

Clinical photograph, S. Creatinine, USG

kidney graft384000 S17 S1712026

934 15.9*Kidney

transplantation

Plasmapheresis for acute B cell rejection Albumin and Rituximab based protocol (

Rate is per sittings with limit of 4 sittings)

Single antigen qualitative

and quantitative, Flow

Cytometry, Kidney biospy

Single antigen qualitative and

quantitative, Flow Cytometry49,000

49,000* per sittings

with limit of 4 sittingsS17 S1712027

935 15.10Kidney

transplantation

Plasmapheresis for highly sensitized recipient Albumin and Rituximab based protocol

(rate is per sittings with limit of 4 sittings)

Single antigen qualitative

and quantitative, Flow

Cytometry

Single antigen qualitative and

quantitative, Flow Cytometry37,500

37,500* per sittings

with limit of 4 sittingsS17 S1712028

936 15.11Kidney

transplantation

Monthly investigations and immunosuppression from discharge after kidney

transplant Include Prednisolone ,Tacrolimus 4mg/day, Mycophenolate 360 or 500 mg

(4 tables) /day, Valgancyclovir 450 mg OD, Fluconazole 100mg OD, Sepmax OD (Rate

is per

CBC, RFT, RBS, Urine,

Graft Doppler, Tacrolimus

level

CBC, RFT, RBS, Urine, Graft Doppler,

Tacrolimus level(monthly)10,000

10,000* Rate per

monthS17 S1712029

937 15.12Kidney

transplantation

Monthly investigations and immunosuppression after kidney transplant Include

Prednisolone,Tacrolimus 4mg/day,Mycophenolate 360 or 500 mg (4 tables) /day,

Sepmax OD (Package Rate per month)

CBC, RFT, RBS, Urine CBC, RFT, RBS, Urine 5,000 * Rate per month S17 S1712030

938 15.13Kidney

transplantation

Treatment of Invasive fungal infection after kidney transplant Include Liposomal

Amphotericin 300MG /day(5mg/kg for 60 kg person) for 30 days and Surgical

debridement Hospital stay for 10 days ,ICU stay for 10 d (Rate per day with limit of

30 days)

Blood culture, CBC, RFT,

RBS, XR Chest, CT of organ

of invasion (plain) , Urine

Routine and culture,

Endoscopy for fluid and

reports, BAL charges

Blood culture, CBC, RFT, RBS, XR Chest,

CT Thorax12,000

* Rate per day with

limit of 30 daysS17 S1712031

939 15.14 AKidney

transplantation

CMV infection after kidney transplant Include IV gancyclovir 500 mg / Hospital stay

for 14 day, tab.Valgancyclovir 450 mg OD for 3-7 days

Kidney graft biopsy, CBC,

RFT, RBS, XR Chest, CT of

organ of invasion (Plain),


level, CMV DNA quantity,

BKV DNA quantity, Urine

routine and culture

CBC, RFT, RBS, XR Chest, Tacrolimus

level, CMV DNA quantity18000 S17 S1712032



Speciality Code


940 15.14 BKidney

transplantation


for 14 day, tab.Valgancyclovir 450 mg OD for 8-12 days







routine and culture



941 15.14 CKidney

transplantation


for 14 day, tab.Valgancyclovir 450 mg OD for 13 and above Days







routine and culture



942 15.15 AKidney

transplantation

Treatment for B cell rejection with Therapeutic Plasma exchange with ALBUMIN +IVIG

5 gm (4 sessions), Inj Rituximab 200 mg or Inj Boretezomib 2 mg (4 doses)

IV methyl prednisolone, Hospital stay for3-7 days

Single antigen quantity

Kidney graft biopsy , CBC

RFT, RBS, XR Chest, CT

Thorax,


level

CMV DNA quantity, BKV

DNA quantity, Urine CS

Single antigen quantity , CBC,

RFT, RBS, XR Chest,

Tacrolimus level,

CMV DNA quantity,

BKV DNA quantity

67500 S17 S1712035

943 15.15 BKidney

transplantation



IV methyl prednisolone, Hospital stay for 8-13 Days




Thorax,


level




RFT, RBS, XR Chest,

Tacrolimus level,

CMV DNA quantity,

BKV DNA quantity

135000 S17 S1712036

944 15.15 CKidney

transplantation



IV methyl prednisolone, Hospital stay for 13 Days abd above




Thorax,


level




RFT, RBS, XR Chest,

Tacrolimus level,

CMV DNA quantity,

BKV DNA quantity

225000 S17 S1712037



Speciality Code


945 15.16 AKidney

transplantation

Treatment for T cell rejection with thymoglobulin IV methyl prednisolone, IV

thymoglobulin 75 mg, Hospital stay for 3-7 days


Kidney graft biopsy, CBC


Thorax, Graft Doppler,

Tacrolimus level



CBC,

RFT, RBS, XR Chest,

Tacrolimus level,

CMV DNA quantity, BKV DNA quantity

39000 S17 S1712038

946 15.16 BKidney

transplantation


thymoglobulin 75 mg, Hospital stay for 8-12 days





Tacrolimus level



CBC,

RFT, RBS, XR Chest,

Tacrolimus level,


78000 S17 S1712039

947 15.16 CKidney

transplantation


thymoglobulin 75 mg, Hospital stay for 13 and above Days





Tacrolimus level



CBC,

RFT, RBS, XR Chest,

Tacrolimus level,


130000 S17 S1712040

948 15.17 AKidney

transplantation

Chest Infection after transplant with 10day ICU care with Ventilator, isolation ward

for 3-10 days


RBS

XR Chest, CT Thorax, Graft

Doppler

Tacrolimus level, CMV

DNA quantity, BKV DNA

quantity

Urine culture,

Bronchoscopy charges and

reports

Blood culture ,CBC,RFT,RBS

XR Chest,

CT Thorax,

Tacrolimus level,

Urine culture

75000 S17 S1712041

949 15.17 BKidney

transplantation


for 11-20 days


RBS


Doppler



quantity

Urine culture,


reports


XR Chest,

CT Thorax,

Tacrolimus level,

Urine culture

112500 S17 S1712042



Speciality Code


950 15.17 CKidney

transplantation


for 21 and above days


RBS


Doppler



quantity

Urine culture,


reports


XR Chest,

CT Thorax,

Tacrolimus level,

Urine culture

150000 S17 S1712043

951 15.18Kidney

transplantation

HEPATITIS C VIRUS TREAMENTInclude Sofosbuvir400+ledispasvir90mg OD for 3

months and HCVRNA quantity ( 3 times)

HCVRNA quantity, CBC,

RFT, LFT, Tacrolimus level

HCVRNA quantity, CBC,

LFT, RFT 10,500 * Rate per month S17 S1712044

952 15.19Kidney

transplantation

Yearly HEPATITIS B VIRUS TREATMENT Include ENTECAVIR 0.5 MG OD for 12 months,

HBVDNA quantity( 3 time)

HBVDNA quantity, CBC,

RFT, LFT, Tacrolimus levelHBVDNA quantity, CBC, LFT, RFT 2,200 * Rate per month S17 S1712045

953 15.20Kidney

transplantationMonthly once a day tacrolimus immunosuppression after kidney transplant

tacrolimus lvel, CBC, FRT,

LFR, RBS tacrolimus lvel, CBC, FRT, LFR, RBS 6,800 * Rate per month S17 S1712046

954 15.21Kidney

transplantationMonthly sirolimus immunosuppression after kidney transplant

Sirolimus LEVEL, CBC, LFT,

RFT, RBSSirolimus LEVEL, CBC, LFT, RFT, RBS 3,680 * Rate per month S17 S1712047

955 15.22Kidney

transplantationMonthly everolimus Immunosuppression after kidney transplant

Everolimus LEVEL, CBC,

LFT, RFT, RBSEverolimus LEVEL, CBC, LFT, RFT, RBS 9,000 * Rate per month S17 S1712048



Speciality Code


956 15.23 ALiver

transplantation

Living donor hepatectomy Part-1 Investigations

Blood group CBC, FBS, PPBS, Glycosylated Hemoglobin, Lipid profile, G6PD deficiency,

Uric acid, Serum Ceruloplasmin, 24 hours urinary copper, S. Creatinine, Blood urea,

LFT, aPTT, PT, INR, S. Calcium, S. Magnesium, S. Na, S. K, S. Alpha feto protein, S. CEA,

S. CA19-9, Stool for occult blood, Urine R/M, HIV ELISA, HCV ELISA, HBV DNA, Anti-

HBc antibody, CMV IgG and IgM, EBV, TORCH Complex, Varicella zoster IgG and IgM,

X-ray chest, USG abdomen, ECG, Pulmonary function test, 2D echocardiography,

NCCT abdomen

11250 S17 S1712049

957 15.23 BLiver

transplantation

Living donor hepatectomy Part-2 Investigations

CT triphasic angiography for celiac axis, CT Volumetry, MR cholengiography7500 S17 S1712050

958 15.23 CLiver

transplantationLiving donor hepatectomy Part-3 Operative Part

LFT, RFT, Lipid profile, ELISA, CT

volumetry131250 S17 S1712051

959 15.24 ALiver

transplantation

Liver transplantation from living donor Part-1 Investigations

Blood group, CBC, S. Creatinine, Blood urea, S. Na+, S. K+, S. Ca++, S. Mg++, FBS,

PPBS, Glycosylated hemoglobin, LFT, Urine R/M, 24 hours urinary proteins, 24 hours

urinary copper, S. Ammonia, Lipid profile, G6PD, D-dimer, S. Fibrinogen, PT, INR, a-

PTT, S. Iron, S. Ferritin, S. Transferrin, TIBC, S. Alfa feto protein, S. CEA, S. CA19-9,

Arterial blood gas study, HIV ELISA, HBsAg ELISA, Anti HBs antibody titer, HCV ELISA,

HCV RNA by PCR Assay, HBV DNA by PCR Assay, HEV antibody, TORCH complex, EBV

antibody titers, Varicella Zoster antibody titers, CMV IgG and IgM

8750 S17 S1712052



Speciality Code


960 15.24 BLiver

transplantation

Liver transplantation from living donor Part-2 Investigations

Protein C, Protein S, Antithrombin C, Homocysteine, Homocysteine, ANA, AMA,

ASMA, LKM1, IgG level, USG abdomen, Colour Doppler study for portal vein, X-ray

chest, ECG, Triphasic CT abdomen for celiac axis, Pulmonary function tests, 2D

echocardiography, Dobutamine stress echo., Coronary angiography, Arterial blood

gas analysis, Ascites fluid R/M, Ascites fluid culture, Pleural fluid R/M, TB PCR assay,

Vit D level, Vit. B12 level

17500 S17 S1712053

961 15.24 CLiver

transplantationLiver transplantation from living donor Part -3 Operative Part LFT, S. Creatinine, Clinical photograph 323750 S17 S1712054

962 15.25 ALiver

transplantation

Liver transplantation from deceased donor Part 1 Investigations








12500 S17 S1712055

963 15.25 BLiver

transplantation

Liver transplantation from deceased donor Part 2 Investigations







25000 S17 S1712056

964 15.25 CLiver

transplantation Liver transplantation from deceased donor Part - 3 Operative Part LFT, S. Creatinine 462500 S17 S1712057



Speciality Code


965 15.26 ALiver

transplantation

Split liver transplantation from deceased donor Part 1 Investigations








12500 S17 S1712058

966 15.26 BLiver

transplantation

Split liver transplantation from deceased donor Part 2 Investigations







25000 S17 S1712059

967 15.26 CLiver

transplantationSplit liver transplantation from deceased donor Part - 3 Operative Part LFT, S. Creatinine 462500 S17 S1712060

968 15.27 ALiver

transplantation

Dual lobe liver transplantation: One lobe from one living donor and other lobe from

other living donor (Two donor hepatectomy and one liver recipient surgery) DONOR

Ix Part-1 Investigations

Blood group CBC, FBS, PPBS, Glycosylated Hemoglobin, Lipid profile, G6PD deficiency,

Uric acid, Serum Ceruloplasmin, 24 hours urinary copper, S. Creatinine, Blood urea,

LFT, aPTT, PT, INR, S. Calcium, S. Magnesium, S. Na, S. K, S. Alpha feto protein, S. CEA,

S. CA19-9, Stool for occult blood, Urine R/M, HIV ELISA, HCV ELISA, HBV DNA, Anti-

HBc antibody, CMV IgG and IgM, EBV, TORCH Complex, Varicella zoster IgG and IgM,

X-ray chest, USG abdomen, ECG, Pulmonary function test, 2D echocardiography,

NCCT abdomen

30000 S17 S1712061



Speciality Code


969 15.27 BLiver

transplantation


other living donor (Two donor hepatectomy and one liver recipient surgery) DONOR

Ix Part-2 Investigations

CT triphasic angiography for celiac axis, CT Volumetry, MR cholengiography

30000 S17 S1712062

970 15.27 CLiver

transplantation


other living donor (Two donor hepatectomy and one liver recipient surgery)

Receipient Ix

Part-3 Investigations








30000 S17 S1712063

971 15.27 DLiver

transplantation



Receipient Ix Part-4 Investigations







LFT, RFT, Lipid profile, ELISA, CT

volumetry of both donors30000 S17 S1712064

972 15.27 ELiver

transplantation



Receipient Ix Part-5 Operativr Part for both Donor and recippient

1080000 S17 S1712065

973 15.28Liver

transplantationEmergency Exploratory laparotomy for liver donor ABG, USG abdomen USG abdomen 20000 S17 S1712066



Speciality Code


974 15.29Liver

transplantationEmergency Exploratory laparotomy for liver recipient ABG, USG abdomen USG abdomen 50000 S17 S1712067

975 15.30Liver

transplantationPost liver transplant Percutaneous Endoscopy guided gastrostomy (PEG) LFT, CBC Photograph 8000 S17 S1712068

976 15.31Liver

transplantationPost liver transplant incisional hernia repair (Prosthetic mesh) CT abdomen Clinical photograph, LFT 40000 for 7 days admission S17 S1712069

977 15.32Liver

transplantationLiver resection for HCC in Child-A cirrhosis

LFT, CECT, HRCT thorax,

Alfa fetoproteinLFT, CECT, Alfa fetoprotein 1,25,000 S17 S1712070

978 15.33Liver

transplantationRadiofrequency ablation (RFA) for HCC for Child-A, B and C cirrhosis

LFT, CECT, HRCT thorax,

Alfa fetoproteinLFT, CECT, Alfa fetoprotein 25,000 * Per session S17 S1712071

979 15.34Liver

transplantationTrans-jugular Intrahepatic Porto-Systemic Shunt procedure (TIPS)

LFT, S. Creatinine, PT, INR,

CBC, S. Ammonia, Doppler

portal vein, USG abdomen

X-ray abdomen, Doppler portal vein, S.

Creatinine1,50,000 S17 S1712072

980 15.35Liver

transplantationTrans-jugular liver allograft biopsy CBC, PT, LFT, S. Creatinine, X-ray chest, biopsy report 8000

(Including Procedure

and histopathology

charge)

S17 S1712073

981 15.36Liver

transplantationPercutaneous liver allograft biopsy CBC, PT, LFT, S. Creatinine, X-ray chest, biopsy report 5000

(Including Procedure

and histopathology

charge)

S17 S1712074

982 15.37Liver

transplantationPost liver transplant percutaneous transhepatic biliary drainage (PTBD)

LFT, MRCP, USG abdomen,

CBC, PTX-ray abdomen, USG abdomen, LFT 15000 S17 S1712075

983 15.38Liver

transplantationPost liver transplant roux en Y jejunojejunostomy and choledochojejunostomy


CBC, PTX-ray abdomen, USG abdomen, LFT 50000

(2 weeks of

hospitalization)S17 S1712076



Speciality Code


984 15.39Liver

transplantationPost liver transplant ERCP



985 15.40Liver

transplantationPost liver transplant ERCP with stenting



986 15.41 ALiver

transplantation

Monthly investigations and immunosuppression from day of discharge to 3 months

after liver transplant Include Prednisolone, Tacrolimus 4mg/day, Mycophenolate

upto 2 g /day, Valgancyclovir 450 mg ,Fluconazole 100mg/day, Septran 1 tablet once

a day For First Month

CBC, RFT, Na, K, LFT, RBS,

Tacrolimus level, USG liver

allograft

CBC, RFT, LFT, RBS, Tacrolimus level 41580 S17 S1712079

987 15.41 BLiver

transplantation




a day For Second Month



allograft


988 15.41 CLiver

transplantation




a day For Third Month



allograft


989 15.42Liver

transplantation

Monthly investigations and immunosuppression from 4-12 months after liver

transplant Include Prednisolone ,Tacrolimus 4mg/day, Mycophenolate upto 2 g / day

, Fluconazole 100mg/day, Septran 1 tablet once a day,

CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 4,200 *Rate per month S17 S1712082

990 15.43Liver

transplantation

Monthly investigations and immunosuppression (with everolimus)from 4-12 months

after liver transplant Include Prednisolone Tacrolimus 2 mg/day +Everolimus 1

mg/day, Mycophenolate upto 2 g /day Fluconazole 100mg/day, Septran 1 tablet once

a day

CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 7800 *Rate per month S17 S1712083



Speciality Code


991 15.44Liver

transplantation

Maintainence immunosuppresants and investigations after 12 months of liver

transplant(Calcineurin based ) Include Prednisolone, Tacrolimus 2mg/day

Mycophenolate upto 2 g /day


992 15.45Liver

transplantation

Maintainence immunosuppresants and investigations and for 12 months after liver

transplant (Calcineurin and mTOR based ) Include Prednisolone Tacrolimus 2 mg/day

Everolimus 1 mg/day, Mycophenolate upto 2 g/day


993 15.46Liver

transplantation

Invasive fungal infection after liver transplant Include Liposomal Amphotericin 5-10

mg/kg/day for 30 days and Surgical debridement, ICU stay for 10 days Hospital stay

for 21 days With Liposomal Amphotericin 300 mg/day

Fluid KOH preperation and

culture, CBC, RFT, LFT,

RBS, XR Chest, CT of organ

of invasion, Endoscopy

Blood culture, CBC, RFT, LFT, RBS, XR

Chest, CT Thorax3,75,000 S17 S1712086

994 15.47 ALiver

transplantation

CMV infection after liver transplant Include IV gancyclovir 500 mg / Hospital stay for

14 day, tab.Valgancyclovir 450 mg OD for 3-7 days

CBC,RFT, LFT, RBS, X-ray

Chest, CT Thorax, Graft

Doppler, Tacrolimus level,

CMV DNA quality and

quantity, Urine RM and

Culture

CBC, RFT, LFT, RBS, XR Chest,

Tacrolimus level, CMV DNA quantity19800 S17 S1712087

995 15.47 BLiver

transplantation


14 day, tab.Valgancyclovir 450 mg OD for 8-12 days




CMV DNA quality and


Culture



996 15.47 CLiver

transplantation


14 day, tab.Valgancyclovir 450 mg OD for 13 and above Days




CMV DNA quality and


Culture



997 15.48 ALiver

transplantationTreatment for T cell rejection IV methyl prednisolone IV, Hospital stay for 3-7 days

Liver graft biopsy, CBC,

LFT, RFT, RBS, XR Chest,


level, CMV DNA quality

and quantity





Speciality Code


998 15.48 BLiver

transplantationTreatment for T cell rejection IV methyl prednisolone IV, Hospital stay for 8-12 days





and quantity



999 15.48 CLiver

transplantation

Treatment for T cell rejection IV methyl prednisolone IV, Hospital stay for 13 and

above days





and quantity



1000 15.49 ALiver

transplantation

Treatment for T cell rejection with thymoglobulin IV methyl prednisolone ,IV

thymoglobulin 75 mg , Hospital stay for 15 d,Valgancyclovir 450 mg/day Fluconazole

100 mg/day for First month

Livergraft biopsy , CBC,

RFT, LFT, RBS, XR Chest,


level, CMV DNA quantity


level, CMV DNA quantity 80000 S17 S1712093

1001 15.49 BLiver

transplantation



100 mg/day for second month







1002 15.49 CLiver

transplantation



100 mg/day for 3rd month







1003 15.50 ALiver

transplantation

Chest Infection after transplant with 10day ICU care Include ICU stay , ICU ventilator ,

ICU medicine , isolation ward for 1 to 3 day

Blood culture , CBC , RFT,

LFT, RBS, XR Chest, CT



DNA quantity,

bronchoscopy charges and

reports

Blood culture , CBC, RFT, LFT, RBS, XR

Chest, CT Thorax, Tacrolimus level 75000 S17 S1712096



Speciality Code


1004 15.50 BLiver

transplantation


ICU medicine , isolation ward for 3 to 7 day





DNA quantity,


reports



1005 15.50 CLiver

transplantation


ICU medicine , isolation ward for 10 day or above





DNA quantity,


reports



1006 15.51Liver

Transplantation

Post-liver transplant Hepatitis C infectionIncludes sofosbuvir 400 mg/ day +

daclatasavir 60 mg/day + ribavirin 1000 mg/day

LFT, RFT, CBC, RBS, HCV

ELISA, HCV RNA quantity

LFT, RFT, CBC, RBS, HCV ELISA, HCV

RNA quantity30,000 *Rate per month S17 S1712099

1007 15.52Liver

Transplantation Post-liver transplant Hepatitis B infection Includes entecavir 0.5 mg /day

LFT, RFT, CBC, RBS, HBV

ELISA, HBV DNA quantity

LFT, RFT, CBC, RBS, HBV ELISA, HBV

DNA quantity4,000 *Rate per month S17 S1712100

1008 15.53Liver

Transplantation

Post-liver transplant Hepatitis B infection (entecavir resistant)Includes tenofovir 300

mg /day

LFT, RFT, CBC, RBS, HBV

ELISA, HBV DNA quantity

LFT, RFT, CBC, RBS, HBV ELISA, HBV

DNA quantity4,700 *Rate per month S17 S1712101

1009 15.54 APancreas

transplantation

Pancreas transplant Part-1 Investigations

Blood group, CBC, RFT, LFT, Thyroid Function Test, Calcium, S. Phosphorus, S. Vit D, S.

Uric Acid, Blood Sugar FaSTING, PPBS, HIV ELISA, HCV ELISA, HBSAgelisa, HCV RNA

quantitative, CMV IgG and IgM, Urine Routine and Micro, Urine Culture, USG

Abdomen, Chest XR, ECG, Lipid Profile, Anticardiolipid Ab, Lupus Anticoagulant, C3,

C4, P-ANCA, C-ANCA, ANA, DSDNA, PT INR, APTT, Pulmonary Function Test, ABG,

Doppler of Neck Vessels, Doppler of Iliofemoral Vessels, Uroflometry, MCU,

Urodynamic study

10000 S17 S1712102



Speciality Code


1010 15.54 BPancreas

transplantation

Pancreas transplant Part-2 Investigations

HLA Typing

LCM, FCM


40000 S17 S1712103

1011 15.54 CPancreas

transplantation

Pancreas transplant Part-3 Investigation

Single Antigen Quantitative, S. Amylase, S. lipase, C-Peptide, GAD Antibody, Plain CT

of Abdomen30000 S17 S1712104

1012 15.54 DPancreas

transplantationPancreas transplant Part - 4 Operative Part

Clinical photograph, blood sugar,

Doppler study for pancreas and kidney

graft, C-peptide

420000 S17 S1712105

1013 15.55Pancreas

transplantationExploratory laparotomy after pancreas transplant for abdominal wash ABG, USG abdomen USG abdomen 20000 S17 S1712106

1014 15.56Pancreas

transplantationExploratory laparotomy after pancreas transplant for pancreatectomy ABG, USG abdomen USG abdomen 50000 S17 S1712107



Speciality Code


1015 16.1 ENT Aural polypectomyclinical notes and

autoscopy examination4,000 S2 S200001

1016 16.2 ENT LabyrinthectomyCT temporal bone,CECT/

MRIHPEE 20,000 S2 S200002

1017 16.3 ENT Mastoidectomy X RAY,CT/MRI Clinical photo showing scar 12,500 S2 S200003

1018 16.4 ENT Mastoidectomy corticol modified/ radicalPTA , X-Ray

Mastoids,clinical notesClinical photo showing scar 11,500 S2 S200004

1019 16.5 ENT Mastoidectomy with tympanoplasty

clinical notes and

autoscopy

examination/CTSCAN/MRI

POST OP. SCOP

Y PICTURE16,000 S2 S200005

1020 16.6 ENT Myringoplasty PTA and IA PTA and IA 7,500 S2 S200006

Cluster - 16 ORTORINOLARYNGOLOGY



Speciality Code


1021 16.7 ENT Myringoplasty with OssiculoplastyPTA and IA,Endoscopy

Picture,clinical notesclinical notes 13,500 S2 S200007

1022 16.8 ENT Myringotomy – Bilateral clinical notesOperative notes with steps of

surgery,clinical notes6,000 S2 S200008

1023 16.9 ENT Myringotomy – Unilateral clinical notes

Operative notes with steps of

surgery,clinical notes,Endoscopy

Picture

3,500 S2 S200009

1024 16.10 ENT Myringotomy with Grommet - One ear PTA and IA Otoscopic findings 6,500 S2 S200010

1025 16.11 ENT Myrinogotomy with Grommet - Both ear PTA and IA Otoscopic findings 8,500 S2 S2000111026 16.12 ENT Ossiculoplasty PTA and IA Otoscopic findings 9,500 S2 S2000121027 16.13 ENT Partial amputation – Pinna PTA and IA Post op audiogram 4,000 S2 S200013

1028 16.14 ENTExcision of Pinna for Growths (Squamous/Basal) Injuries - Total Amputation &

Excision of External Auditory Meatus

CT/FNAC/HPE/CLINICAL

PHOTO

HPE/POST OP.

CLINICAL PHOTO8,000 S2 S200014

1029 16.15 ENT Excision of Pinna for Growths (Squamous/Basal) Injuries Total Amputation CT clinical notes,Histopathological report 6,500 S2 S200015

1030 16.16 ENT Stapedectomy PTA and IA Post op audiogram 10,000 S2 S200016

1031 16.17 ENT Tympanoplasty PTA and IA,clinical notesclinical notes,Clinical photo showing

scar9,000 S2 S200017

1032 16.18 ENT Vidian neurectomy – Micro clinical notes clinical notes 9,000 S2 S200018

1033 16.19 ENT Ear lobe repair - single (daycare) CLINICAL PHOTO POST.OP CLINICAL PHOTO 1,500 S2 S200019

1034 16.20 ENT Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin and Cartilage CLINICAL PHOTO POST.OP CLINICAL PHOTO 4,000 S2 S200020



Speciality Code


1035 16.21 ENT Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin Only CLINICAL PHOTO POST.OP CLINICAL PHOTO 2,500 S2 S200021

1036 16.22 ENT Pharyngectomy and reconstruction CT/MRI clinical notes 15,000 S2 S200022

1037 16.23 ENT Skull base surgery CT/MRI POST OPCLINICIAL PHOTO 37,000 S2 S200023

1038 16.24 ENT Total Amputation & Excision of External Auditory Meatus CLINICAL PHOTO POST.OP CLINICAL PHOTO 7,500 S2 S200024

1039 16.25 ENT Tympanotomy CLINICAL PHOTO POST.OP CLINICAL PHOTO 4,000 S2 S200025

1040 16.26 ENT Removal of foreign body from ear clinical notes clinical notes 3,000 S2 S200026

1041 16.27 ENT Aural polypectomy +Tympanoplasty PTA and IA clinical notes 10,000 S2 S200027

1042 16.28 ENT Ant. Ethmoidal artery ligation - open/ endoscopic CT/MRI POST.OP CLINICAL PHOTO 11,000 S2 S200028

1043 16.29 ENT Antrostomy – Bilateralclinical notes,CT/MRI,X-

Rayclinical notes,X Ray 8,500 S2 S200029

1044 16.30 ENT Antrostomy – Unilateral X RAY PNS CLINICAL NOTES 6,000 S2 S200030

1045 16.31 ENT Cryosurgery CLINICAL NOTES CLINICAL NOTES 3,000 S2 S200031

1046 16.32 ENT CSF Rhinorrhoea – Repair CT/MRI Clinical Photograph 14,000 S2 S200032

1047 16.33 ENT Septoplasty + FESS X RAY PNS/CT PNS CLINICAL PHOTO/HPE 11,500 S2 S200033

1048 16.34 ENT Ethmoidectomy – External X RAY PNS/CT PNS HPEE 11,500 S2 S200034

1049 16.35 ENT Fracture reduction nose with septal correctionX RAY/CT/MRI/CLINIAL

NOTESclinical notes,X Ray 8,000 S2 S200035

1050 16.36 ENT Fracture - setting maxilla X RAY PNS/CT PNS clinical notes,X Ray 8,000 S2 S200036



Speciality Code


1051 16.37 ENT Fracture - setting nasal bone X RAY PNS/CT PNS clinical notes,X Ray 5,000 S2 S200037

1052 16.38 ENT Functional Endoscopic Sinus (FESS) X RAY PNS/CT PNS clinical notes 11,000 S2 S200038

1053 16.39 ENT Intra Nasal Ethmoidectomy X RAY PNS/CT PNS clinical notes 5,000 S2 S200039

1054 16.40 ENT Rhinotomy – Lateral X RAY PNS/CT PNS clinical notes 7,500 S2 S200040

1055 16.41 ENT Nasal polypectomy – Bilateral X RAY PNS/CT PNS HPEE 9,000 S2 S200041

1056 16.42 ENT Nasal polypectomy – Unilateral X RAY PNS/CT PNS HPEE 6,000 S2 S200042

1057 16.43 ENT Turbinectomy Partial – Bilateral X RAY PNS/CT PNS clinical notes 3,000 S2 S200043

1058 16.44 ENT Turbinectomy Partial – Unilateral X RAY PNS/CT PNS clinical notes 2,000 S2 S200044

1059 16.45 ENT Radical fronto ethmo sphenodectomy clinical notes,CT/MRI HPEE 18,000 S2 S200045

1060 16.46 ENT Rhinoplasty CLINICAL PHOTO POST OP CLINICAL PHOTO 15,000 S2 S200046

1061 16.47 ENT SeptoplastyX RAY PNS/NASAL

ENDOSCOPYclinical notes 5,000 S2 S200047

1062 16.48 ENT Youngs operation NASAL ENDOSCOPY clinical notes 3,000 S2 S200048

1063 16.49 ENT Angiofibrom Excision CT PNS HPE 18,000 S2 S200049

1064 16.50 ENT Cranio-facial resection CT PNS CLINICAL PHOTO 22,500 S2 S200050

1065 16.51 ENT Endoscopic DCRX RAY PNS/SCOPY

EXAMINATIONENDOSCOPY PICTURE 7,000 S2 S200051

1066 16.52 ENT Endoscopic Hypophysectomy CT/MRI HPEE 21,000 S2 S200052

1067 16.53 ENT Intranasal Diathermy X RAY PNS clinical notes 3,000 S2 S200053

1068 16.54 ENT Rhinosporidiosis CT PNS ,HPE HPEE 5,000 S2 S200054

1069 16.55 ENT Septo-rhinoplasty CLINICAL PHOTO/CT PNS clinical notes 12,500 S2 S200055

1070 16.56 ENT Adeno Tonsillectomy X RAY NASOPHARYNX HPEE 8,000 S2 S200056

1071 16.57 ENT Adenoidectomy X RAY NASOPHARYNX HPEE 5,000 S2 S200057



Speciality Code


1072 16.58 ENT Arytenoidectomy CT clinical notes 10,000 S2 S200058

1073 16.59 ENT Choanal atresiaCT PNS/NASAL

ENDOSCOPYclinical notes 12,500 S2 S200059

1074 16.60 ENT Tonsillectomy + Myrinogotomy PTA/IA HPEE 10,000 S2 S200060

1075 16.61 ENT Pharyngeal diverticulum's – Excision CT/BARIUM STUDY HPEE 10,000 S2 S200061

1076 16.62 ENT Laryngectomy with block dissection CT/MRI HPEE 25,000 S2 S200062

1077 16.63 ENT Laryngofissure clinical notes clinical notes 5,000 S2 S200063

1078 16.64 ENT Laryngophayryngectomy clinical notes,CT/MRI HPEE 20,000 S2 S200064

1079 16.65 ENT Maxilla – Excision clinical notes,CT/MRI HPEE 12,500 S2 S200065

1080 16.66 ENT Oro Antral fistula CT/MRI CLINICAL NOTES 7,500 S2 S200066

1081 16.67 ENT Parapharyngeal – Exploration CT/MRI clinical notes 12,500 S2 S200067

1082 16.68 ENT Parapharyngeal Abscess – Drainage CT/MRI clinical notes 12,500 S2 S200068

1083 16.69 ENT Peritonsillor abscess under LA clinical notes Clinical NOTES 2,500 S2 S200069

1084 16.70 ENT Pharyngoplasty CT/MRI clinical notes 10,000 S2 S200070

1085 16.71 ENT Retro pharyngeal abscess – Drainage CLINICAL NOTES, X RAY/CT clinical notes 5,000 S2 S200071

1086 16.72 ENT Tonsillectomy + Styloidectomy X RAY ,CLINICAL NOTES CLINICAL NOTES 10,000 S2 S200072

1087 16.73 ENT Thyroglossal Fistula/ cyst – Excision USG/ X-RAY clinical notes 7,000 S2 S200073

1088 16.74 ENT Tonsillectomy – (Uni/ Bilateral) CLINICAL NOTES HPEE 7,500 S2 S200074

1089 16.75 ENT Total Parotidectomy USG,FNAC,CT/MRI HPEE 18,000 S2 S200075

1090 16.76 ENT Superficial Parotidectomy USG,FNAC,CT/MRI HPEE 12,000 S2 S200076

1091 16.77 ENT Uvulophanyngo Plasty clinical notes clinical notes 14,000 S2 S200077

1092 16.78 ENT Commondo Operation (glossectomy) CT /MRI ,BIOPSYHPEE,CLINICAL PHOTO

SHOWING SCAR17,500 S2 S200078

1093 16.79 ENT Excision of Branchial Cyst CT/USG CLINICAL NOTES 7,000 S2 S200079

1094 16.80 ENT Excision of Branchial Sinus CT/USG CLINICAL NOTES 7,000 S2 S200080



Speciality Code


1095 16.81 ENT Excision of Cystic Hygroma Major/ Extensive CLINICAL PHOTO/FNAC/CT HPEE 10,000 S2 S200081

1096 16.82 ENT Excision of Cystic Hygroma Minor CLINICAL PHOTO/FNAC/CT HPEE 5,000 S2 S200082

1097 16.83 ENT Excision of the Mandible SegmentalCLINICAL NOTES /X RAY

OPG.CLINICAL PHOTO 7,500 S2 S200083

1098 16.84 ENT Hemi-mandibulectomy with graft X RAY,BIOPSY/CT CLINICAL PHOTO 15,000 S2 S200084

1099 16.85 ENT Hemiglossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 6,000 S2 S200085

1100 16.86 ENT Palatopharyngoplasty CLINICAL NOTES CLINICAL NOTES 10,000 S2 S200086

1101 16.87 ENT Partial Glossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 5,000 S2 S200087

1102 16.88 ENT Ranula excisionCLINICAL NOTE,CLINICAL

PHOTOCLINICAL PHOTO 5,000 S2 S200088

1103 16.89 ENT Removal of Submandibular Salivary gland USG/FNAC HPEE 5,000 S2 S200089

1104 16.90 ENT Total Glossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 15,000 S2 S200090

1105 16.91 ENT Total Laryngectomy + Neck dissection BIOPSY,CT/MRI HPEE 25,000 S2 S200091

1106 16.92 ENT Laryngopharyngectomy with Gastric pull-up/ jejunal graft CLINICAL NOTES/BIOPSY/

CT/MRIHPEE 30,000 S2 S200092

1107 16.93 ENT Excision of CA cheek/ oral cavity + radial forearm flap BIOPSY,CT/MRI HPEE 30,000 S2 S200093

1108 16.94 ENT Excision of growth Jaw + free fibular flap reconstruction BIOPSY,CT/MRI HPEE 30,000 S2 S200094

1109 16.95 ENTUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


1110 17.1 Obs & Gyac Hysterectomy ± Salpingo-oophorectomyUSG, PRE OP, MINOR

PROFILE , HPEE OF D & CHPEE 20,000 S4 S400001

1111 17.2 Obs & Gyac Abdominal Myomectomy USG, Preop Minor Profile HPEE 16,000 S4 S400002

Cluster - 17 OBSTETRICS AND GYNAECOLOGY



Speciality Code


1112 17.3 Obs & Gyac Surgeries for Prolapse - Sling SurgeriesUSG, Clinical History Preop

minor profileUSG 16,000 S4 S400003

1113 17.4 Obs & Gyac Surgeries for Stress Incontinence 'Burch'

USG ( PVR) Clinical

History, Preop Minor

Profile

35,000 S4 S400004

1114 17.5 Obs & Gyac Hysterotomes - 2nd Trimester abortionsUSG, Indication for 2nd

trimester terminationUSG 5,000 S4 S400005

1115 17.6 Obs & Gyac Incisional Hernia Repair Clinical History Notes, USG Mesh Sticker Stapler ( If Used) 15,000 S4 S400006

1116 17.7 Obs & Gyac Radical Hysterectomy (Wertheims)USG, CT SCAN, Preop

Major Profile HPEE ReportHPEE 20,000 S4 S400007

1117 17.8 Obs & GyacLaparotomy and proceed for Ovarian Cancers. Omentomy with Bilateral Salpingo-

oophorectomy

USG, CT Scan, Tumer

Marker ( CA125), HPEE,

Preop Major Profile, X-Ray

Chest

HPEE 20,000 S4 S400008

1118 17.9 Obs & Gyac Non descent vaginal hysterectomyUSG/CT Scan, Clinical

History Notes, HPEE PreopHPEE Report Minor Profile 14,000 S4 S400009

1119 17.10 Obs & Gyac Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy

USG, Clinical History

Notes, HPEE Report Preop

Minor Profile

HPEE Report 16,000 S4 S400010

1120 17.11 Obs & Gyac Vaginal surgical repair for vesico-vaginal fistula

Clinical History Notes, RFT,

CT IVP ( KUB ), Preop

Minor Profile

Clinical Examination 10,000 S4 S400011

1121 17.12 Obs & Gyac SacrocolpopexyUSG, Preop.minor Profile,

Clinical History NotesClinical Examination 16,000 S4 S400012

1122 17.13 Obs & Gyac Repair for rectovaginal fitulasCT, Barium Encma, Preop

Minor ProfileClinical Examination 10,000 S4 S400013

1123 17.14 Obs & Gyac VaginoplastyUSG, Clinical Historm,

Preop Minor ProfileClinical Examination 10,000 S4 S400014

1124 17.15 Obs & Gyac LLETZ Colposcopy, Biopsy HPEE Report 15,000 S4 S400015



Speciality Code


1125 17.16 Obs & Gyac ColpotomyClinical Hiatory, USG

Preop, Minor ProfileHPEE Report 1,200 S4 S400016

1126 17.17 Obs & Gyac Dilation and Evacuation (D&E)USG, Clinical History,

Preop Minor ProfileNO 5,000 S4 S400017

1127 17.18 Obs & Gyac Cervical biopsy and PolypectomyUSG, Clinical History,

Minor ProfileHPEE 3,000 S4 S400018

1128 17.19 Obs & Gyac Bartholins Cyst Enucleation/ Incision drainageClinical History Notes

Preop Minor ProfileHPEE 3,000 S4 S400019

1129 17.20 Obs & Gyac Vulvectomy simpleHPEE, Clinical History

Preop Minor HistoryHPEE 17,250 S4 S400020

1130 17.21 Obs & Gyac Radical VulvectomyHPEE, CT, Clinical History

Preop Major ProfileHPEE 17,250 S4 S400021

1131 17.22 Obs & Gyac Diagnostic laparoscopyClinical History Preop

Minor ProfileCD, HPEE Report 11,000 S4 S400022

1132 17.23 Obs & Gyac Laparoscopic hysterectomy (TLH)USG / Ct, Clinical History,

Minor Preofile, HPEEHPEE / CD 20,000 S4 S400023

1133 17.24 Obs & Gyac Laparoscopic myomectomyUSG / Ct, Clinical History,

Minor Preofile, HPEEHPEE / CD 15,000 S4 S400024

1134 17.25 Obs & Gyac Laparoscopic cystectomy

USG / Ct, Clinical History,

Minor Preofile, HPEE ( CA -

125 )

HPEE / CD 15,000 S4 S400025

1135 17.26 Obs & Gyac Laparoscopic ovarotomyUSG / CT, Clinical History,

Minor Profile CA - 125HPEE / CD 10,000 S4 S400026

1136 17.27 Obs & Gyac Laparoscopic adhesiolysisUSG / CT, Clinical History,

Minor ProfileNO / CD 6,000 S4 S400027

1137 17.28 Obs & Gyac Laparoscopic tubal surgeries - salpingectomy, salpingotomyUSG / Clinical History

Preop Minor ProfileHPEE / CD 11,000 S4 S400028

1138 17.29 Obs & Gyac Drag hysteroscopyUSG, Clinical History,

Preop Minor ProfileCD 6,000 S4 S400029

1139 17.30 Obs & Gyac Hysteroscopic myomectomiesUSG, Clinical History,

Preop Minor ProfileCD , HPEE 6,000 S4 S400030

1140 17.31 Obs & Gyac Hysteroscopic adhesiolysisUSG, Clinical History,


1141 17.32 Obs & Gyac Hysteroscopic polypectomyUSG, Clinical History,

Preop Minor ProfileCD , HPEE 3,000 S4 S400032



Speciality Code


1142 17.33 Obs & Gyac Hysteroscopic IUCD removalUSG, Clinical History,


1143 17.34 Obs & Gyac Caesarian Delivery ANH Preop Minor Profile Birth Registration Form 9,000 S4 S400034

1144 17.35 Obs & Gyac Caesarian hysterectomy ANH Preop, Indicator HPEE 16,000 S4 S400035

1145 17.36 Obs & Gyac High risk delivery: Pre-mature delivery

ANC Profile, Clinical

History Notes, USG Preop,

Major Profile

Clinical History Notes in Details with

Tratment Given9,000 S4 S400036

1146 17.37 Obs & Gyac High risk delivery: Expected Gestation at delivery less than 35 weeks



Major Profile



1147 17.38 Obs & Gyac High risk delivery: Mothers with eclampsia or imminent eclampsia



Major Profile



1148 17.39 Obs & Gyac High risk delivery: Obstructed labour



Major Profile



1149 17.40 Obs & GyacHigh risk delivery: Major Fetal malformation requiring intervention immediately after

birth



Major Profile



1150 17.41 Obs & Gyac High risk delivery: Mothers with severe anaemia (<7 g/dL)



Major Profile



1151 17.42 Obs & Gyac

High risk delivery: Other maternal and fetal conditions as per guidelines-Such as Rh

haemolytic disease, uncontrolled diabetes, severe growth retardation etc that qualify

for high risk delivery etc.



Major Profile



1152 17.43 Obs & Gyac Manual removal of placentaClinical Notes, USG, Preop


1153 17.44 Obs & Gyac Laparotomy for ruptured ectopicUSG, Clinical History Preop

MinorHPEE 10,000 S4 S400044



Speciality Code


1154 17.45 Obs & Gyac MTP > 12 weeksUSG, Clinical History Preop

Minor, Consort FormNO 6,500 S4 S400045

1155 17.46 Obs & Gyac MTP upto 12 weeksUSG, Clinical History Preop

Minor, Consort FormNO 5,000 S4 S400046

1156 17.47 Obs & Gyac MTP upto 8 weeks

USG, Clinical History,

Preop Minor Profile,

Consort Form

NO 3,500 S4 S400047

1157 17.48 Obs & Gyac McDonald's stitch



Consort Form

NO 4,000 S4 S400048

1158 17.49 Obs & Gyac Shirodkar's stitch



Consort Form

NO 4,000 S4 S400049

1159 17.50 Obs & Gyac TuboplastyHSG, USG, Clinical History


1160 17.51 Obs & Gyac Laparotomy for broad ligament haematomaUSG, Minor Profile Clinical

HistoryNO 16,000 S4 S400051

1161 17.52 Obs & Gyac Trans-vaginal tape/ Trans-obturator tapeClinical History, USGPreop

MinorTVT / TUT Tape Sticker 5,000 S4 S400052

1162 17.53 Obs & Gyac Abdominal Perineal neo construction Cx + Uteria + VaginaUSG, HSG, Clinical History,

Preop MinorUSG 20,000 S4 S400053

1163 17.54 Obs & Gyac Ablation of Endometriotic Spot + AdhenolysisUSG / CT, Clinical History,

Preop Minor ProfileCD (if Laproscopy) 10,000 S4 S400054

1164 17.55 Obs & Gyac Ablation of Endometriotic Spot +SalpingostomyUSG / CT, Clinical History,


1165 17.56 Obs & Gyac Adhenolysis + Hernia - Ventral - Lipectomy/IncisionUSG / CT, Clinical History,


1166 17.57 Obs & Gyac Adhenolysis+ Ovarian CystectomyUSG / CT, Clinical History,


1167 17.58 Obs & Gyac Adhenolysis+ SalpingostomyUSG / CT, Clinical History,


1168 17.59 Obs & Gyac Broad Ligment Haemotoma drainageUSG / CT, Clinical History,




Speciality Code


1169 17.60 Obs & Gyac Brust abdomen repairClinical History, Minor

ProfileClincial Notes 14,000 S4 S400060

1170 17.61 Obs & Gyac Cone Biopsy CervixPap Smcar, Colposcopy


1171 17.62 Obs & Gyac Conventional TubectomyPreop Minor, Clinical

NotesHPEE 4,000 S4 S400062

1172 17.63 Obs & Gyac Cyst -Vaginal EnucleationClinical History Notes

Preop Minor / USGHPEE 3,000 S4 S400063

1173 17.64 Obs & Gyac Cyst-LabialClinical History Notes


1174 17.65 Obs & Gyac Cystocele - Anterior repairClinical History Notes


1175 17.66 Obs & Gyac Cystocele - Anterior Repair + Perineal Tear RepairClinical History Notes


1176 17.67 Obs & Gyac D&C (Dilatation &curretage) + Electro Cauterisation Cryo Surgery

Clinical History Notes

Preop Minor / USG + Pap

Smcar

HPEE 4,000 S4 S400067

1177 17.68 Obs & Gyac D&C (Dilatation&curretage)Clinical History USG, Preop

MinorHPEE 3,000 S4 S400068

1178 17.69 Obs & Gyac Diagnostic laparoscopy & hysteroscopy for infertilityClinical History USG, Preop

MinorCD , HPEE 5,000 S4 S400069

1179 17.70 Obs & Gyac Electro Cauterisation Cryo Surgery Pap Smcar, Clinical History NO 4,000 S4 S400070

1180 17.71 Obs & Gyac Exploration of abdominal haematoma (after laparotomy + LSCS)USG / CT, Clinical History


1181 17.72 Obs & Gyac Fractional CurretagePreop Minor Profile USG,

Clinical HistoryHPEE 4,000 S4 S400072

1182 17.73 Obs & Gyac Gaping Perineal wound secondary suturing/ episiotomy


Clinical History Notes,

Clinical Site photo

NO 2,500 S4 S400073

1183 17.74 Obs & Gyac HaematoColpo/Excision - Vaginal Septum USG / CT, Clinical History HPEE 5,000 S4 S400074



Speciality Code


1184 17.75 Obs & Gyac Hymenectomy& Repair of Hymen

Clinical History, USG

Clinical Site Photo, Preop

Minor Profile

HPEE 7,000 S4 S400075

1185 17.76 Obs & Gyac Amniocentesis AN Profile USG Triple 5,000 S4 S400076

1186 17.77 Obs & Gyac Chorionic villus sampling Electrophoresi 5,000 S4 S400077

1187 17.78 Obs & Gyac Cordocentesis 5,000 S4 S400078

1188 17.79 Obs & Gyac Intrauterine transfusions Clinical Treatment Notes, USG Plates 10,000 S4 S400079

1189 17.80 Obs & GyacUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


1190 18.1 Opthelmology Buckel Removal

History of Previous

Operation/ Discharge

Summary (RD)

Clinical Photo 5,000 S3 S300001

1191 18.2 Opthelmology Canaliculo Dacryocysto Rhinostomy Dacryocysto Graphy Clinical Photo 10,000 S3 S300002

1192 18.3 Opthelmology Capsulotomy (YAG) B-scan/clinical photo _ 1,500 S3 S300003

1193 18.4 Opthelmology Corneal Grafting clinical photo clinical photo 8,500 S3 S300004

1194 18.5 Opthelmology Prophylactic Cryoretinopexy- Closed retinal photo retinal photo 2,500 S3 S300005

1195 18.6 Opthelmology Cyclocryotherapy/Cyclophotocoagulation retinal photo retinal photo 3,000 S3 S300006

1196 18.7 Opthelmology Pterygium + ConjunctivalAutograft clinical photo Clinical Photo 9,000 S3 S300007

1197 18.8 Opthelmology Dacryocystectomy with implants Dacryocysto Graphy Clinical Photo,sticker of implant 10,000 S3 S300008

1198 18.9 Opthelmology Enucleation B-scan/clinical photo clinical photo 6,000 S3 S300009

1199 18.10 Opthelmology Enucleation with Implant B-scan/clinical photo Clinical Photo,sticker of implant 11,000 S3 S300010

1200 18.11 Opthelmology Exenteration MRI X RAY 15,000 S3 S300011

1201 18.12 Opthelmology

Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including

postoperative medications for 12 weeks (and wherever surgical or laser procedures

required for bleb augmentation and anterior chamber maintenance)

Visual field

report/tonometry/retinal

photo

clinical photo 10,000 S3 S300012

1202 18.13 Opthelmology Intraocular Foreign Body Removal from Anterior Segment B-scan/clinical photo clinical photo 4,000 S3 S300013

Cluster - 18 OPTHALMOLOGY



Speciality Code


1203 18.14 Opthelmology Intraocular Foreign Body Removal from Posterior Segment B-scan/clinical photo B-scan/clinical photo 20,000 S3 S300014

1204 18.15 Opthelmology Lensectomy /pediatric lens aspiration B-scan/clinical photo B-scan/clinical photo 9,000 S3 S300015

1205 18.16 Opthelmology Limbal Dermoid Removal clinical photo clinical photo 4,000 S3 S300016

1206 18.17 Opthelmology Surgical Membranectomy B-scan/clinical photo clinical photo 8,000 S3 S300017

1207 18.18 Opthelmology Perforating Corneo - Scleral Injury clinical photo clinical photo 10,000 S3 S300018

1208 18.19 Opthelmology Ptosis Surgery clinical photo clinical photo 10,000 S3 S300019

1209 18.20 Opthelmology IRIS Prolapse – Repair clinical photo clinical photo 4,000 S3 S300020

1210 18.21 Opthelmology Retinal Detachment Surgery retinal photo retinal photo 15,000 S3 S300021

1211 18.22 Opthelmology Small Tumour of Lid – Excision + Lid Reconstruction clinical photo clinical photo 10,000 S3 S300022

1212 18.23 Opthelmology Socket Reconstruction with amniotic membrane clinical photo clinical photo 8,000 S3 S300023

1213 18.24 Opthelmology Iridectomy – Laser clinical photo clinical photo 2,000 S3 S300024

1214 18.25 Opthelmology Iridectomy – Surgical clinical photo clinical photo 3,000 S3 S300025

1215 18.26 Opthelmology Iris cyst removal B-scan/clinical Notes clinical photo 2,500 S3 S300026

1216 18.27 Opthelmology Vitrectomy retinal photo retinal photo/CLINICAL PHOTO 7,500 S3 S300027

1217 18.28 Opthelmology Vitrectomy + Retinal Detachment surgery (pre-auth required) retinal photo retinal photo/CLINICAL PHOTO 17,500 S3 S300028

1218 18.29 Opthelmology Cataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech A-Scan implant sticker,clinical photo 7,500 S3 S300029

1219 18.30 Opthelmology Cataract with non-foldable IOL using SICS technique A-Scan implant sticker,clinical photo 5,000 S3 S300030

1220 18.31 OpthelmologyCataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech +

Glaucoma

A-Scan,field of

vision,tonometryimplant sticker,clinical photo 10,500 S3 S300031



Speciality Code


1221 18.32 Opthelmology Cataract with non-foldable IOL using SICS technique + GlaucomaA-Scan,field of

vision,tonometryimplant sticker,clinical photo 6,500 S3 S300032

1222 18.33 Opthelmology Conjunctival tumour excision + AMG clinical photo clinical photo 5,000 S3 S300033

1223 18.34 Opthelmology Entropion correction clinical photo clinical photo 4,000 S3 S300034

1224 18.35 Opthelmology Ectropion correction clinical photo clinical photo 5,000 S3 S300035

1225 18.36 Opthelmology Evisceration clinical photo/B -scan clinical photo 3,500 S3 S300036

1226 18.37 Opthelmology Laser for retinopathy (per sitting) retinal photo retinal photo 1,500 S3 S300037

1227 18.38 Opthelmology Lid tear clinical photo clinical photo 5,000 S3 S300038

1228 18.39 Opthelmology Orbitotomy B-Scan/MRI clinical photo 10,000 S3 S300039

1229 18.40 Opthelmology Squint correction (per muscle) clinical photo clinical photo 4,000 S3 S300040

1230 18.41 Opthelmology Anterior Chamber Reconstruction +Perforating corneo - Scleral Injury + IOL A-Scan,clinical photo clinical photo,IOL Sticker 11,500 S3 S300041

1231 18.42 Opthelmology PRP - Retinal Laser including 3 sittings retinal photo retinal photo 5,000 S3 S300042

1232 18.43 OpthelmologyUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


1233 19.1 General Surgery Adventious Burse – Excision USG/MRI 10,000 S1 S100001

1234 19.2 General Surgery Anterior Resection for CAUSG/Colonoscopy/CT/Bio

psyHPE 15,000 S1 S100002

1235 19.3 General Surgery Appendicectomy Clinical notes + USG HPE 10,000 S1 S100003

1236 19.4 General Surgery Appendicular Abscess – Drainage USG/CT HPE/USG 12,000 S1 S100004

1237 19.5 General Surgery Arteriovenous (AV) Malformation of Soft Tissue Tumour - Excision USG/Color droppler HPE/USG 15,000 S1 S100005

Cluster - 19 GENERAL SURGERY



Speciality Code


1238 19.6 General Surgery Bakers Cyst – Excision Clinical report/USG HPE/USG 6,000 S1 S100006

1239 19.7 General Surgery Bilateral Inguinal block dissection USG/CT/FNAC HPE 25,000 S1 S100007

1240 19.8 General Surgery Bleeding Ulcer - Gastrectomy & vagotomy USG/CT/HPE/OGD USG/HPE 25,000 S1 S100008

1241 19.9 General Surgery Bleeding Ulcer - Partial Gastrectomy USG/CT USG 25,000 S1 S100009

1242 19.10 General Surgery Block dissection Cervical Nodes CT scan/USG,FNAC HPE 10,000 S1 S100010

1243 19.11 General Surgery Branchial Fistula USG/CT HPE 14,000 S1 S100011

1244 19.12 General Surgery Breast Lump - Left – Excision USG/CT/FNAC HPE 6,500 S1 S100012

1245 19.13 General Surgery Breast Lump - Right – Excision USG/CT/FNAC HPE 6,500 S1 S100013

1246 19.14 General Surgery Branchial Cyst USG/CT HPE 10,000 S1 S100014

1247 19.15 General Surgery Bursa – Excision USG/Clinical Note HPE 4,000 S1 S100015

1248 19.16 General Surgery Bypass - Inoperable PancreasCT/MRI,USG,Tumor

MarkerHPE/USG 15,000 S1 S100016

1249 19.17 General Surgery Cervial Lymphnodes – Excision USG/FNAC HPE/USG 2,000 S1 S100017

1250 19.18 General Surgery Colostomy USG/CT/Xray/Loopogram HPE/USG,Clinical Photograph 10,000 S1 S100018

1251 19.19 General Surgery Cyst over Scrotum – Excision clinical notes/USG 2,000 S1 S100019

1252 19.20 General Surgery Cystic Mass – Excision clinical notes/USG 2,000 S1 S100020

1253 19.21 General Surgery Dermoid Cyst - Large – Excision USG/FNAC 4,000 S1 S100021

1254 19.22 General Surgery Dermoid Cyst - Small – Excision USG/FNAC 2,000 S1 S100022



Speciality Code


1255 19.23 General Surgery Drainage of Ischio Rectal Abscess clinical notes/USG 4,000 S1 S100023

1256 19.24 General Surgery Incision and Drainage of large Abscess clinical notes 4,000 S1 S100024

1257 19.25 General Surgery Drainage of Psoas Abscess USG/CT,clinical notes 7,500 S1 S100025

1258 19.26 General Surgery Drainage of Subdiaphramatic Abscess USG/CT,clinical notes 10,000 S1 S100026

1259 19.27 General Surgery Drainage Pericardial Effusion USG/CT,Echo 13,750 S1 S100027

1260 19.28 General Surgery Duodenal Diverticulum USG/CT/UGI 20,000 S1 S100028

1261 19.29 General Surgery Duodenal Jejunostomy USG/CT 20,000 S1 S100029

1262 19.30 General Surgery Duplication of Intestine Clinical report,CT HPE 18,000 S1 S100030

1263 19.31 General Surgery Hydrocele + Orchidectomy Clinical report,USG HPE 8,000 S1 S100031

1264 19.32 General Surgery Epidedectomy Clinical report,USG 8,000 S1 S100032

1265 19.33 General Surgery Epididymal Swelling –Excision USG/FNAC 6,000 S1 S100033

1266 19.34 General Surgery Epidymal Cyst Clinical report,USG 4,000 S1 S100034

1267 19.35 General Surgery Evacuation of Scrotal Hematoma Clinical report,USG 5,000 S1 S100035

1268 19.36 General Surgery Excision Benign Tumor -Small intestine USG/CT HPE 15,000 S1 S100036

1269 19.37 General Surgery Excision Bronchial SinusClinical

report,Broncoscopy/HRCTHPE 8,000 S1 S100037

1270 19.38 General Surgery Drainage of liver Abscess Clinical report,USG USG 8,000 S1 S100038

1271 19.39 General Surgery Excision Filarial Scrotum Clinical report,USG,PS 5,000 S1 S100039

1272 19.40 General Surgery Excision Mammary FistulaClinical

report,mammogramHPE 5,000 S1 S100040

1273 19.41 General Surgery Excision Meckel's Diverticulum USG/CT HPE 15,000 S1 S100041

1274 19.42 General Surgery Excision Pilonidal Sinus clinical notes 8,000 S1 S100042

1275 19.43 General Surgery Excision Small Intestinal Fistula USG/CT HPE 15,000 S1 S100043

1276 19.44 General Surgery Excision of Growth from Tongue only Biopsy,Clinical Note HPE 6,000 S1 S100044

1277 19.45 General Surgery Excision of Growth from Tongue with neck node dissection Biopsy,CT HPE 15,000 S1 S100045

1278 19.46 General Surgery Excision of Swelling in Right Cervical Region clinical notes 5,000 S1 S100046

1279 19.47 General Surgery Excision of Large Swelling in Hand clinical notes 3,000 S1 S100047

1280 19.48 General Surgery Excision of Small Swelling in Hand clinical notes 1,500 S1 S100048

1281 19.49 General Surgery Excision of Neurofibroma clinical notes HPE 3,000 S1 S100049



Speciality Code


1282 19.50 General Surgery Exicision of Sinus and Curettage clinical notes 5,000 S1 S100050

1283 19.51 General Surgery Fibroadenoma – Bilateral clinical notes HPE 8,000 S1 S100051

1284 19.52 General Surgery Fibrodenoma – Unilateral clinical notes HPE 7,000 S1 S100052

1285 19.53 General Surgery Fissurectomy clinical notes 8,000 S1 S100053

1286 19.54 General Surgery Fissurectomy and Haemorrhoidectomy clinical notes 12,000 S1 S100054

1287 19.55 General Surgery Eversion of Hydrocele Sac – Bilateral clinical notes 10,000 S1 S100055

1288 19.56 General Surgery Eversion of Hydrocele Sac – Unilateral clinical notes 5,000 S1 S100056

1289 19.57 General Surgery Fissurectomy with Sphincterotomy clinical notes Photograph of removed part of body 15,000 S1 S100057

1290 19.58 General Surgery Foreign Body Removal in Deep Region requiring GA Pre-op. X-ray 5,000 S1 S100058

1291 19.59 General Surgery Fundoplication Clinical report,OGD/CT USG 20,000 S1 S100059

1292 19.60 General Surgery G J Vagotomy/ Vagotomy + Pyloroplasty Clinical report HPE 15,000 S1 S100060

1293 19.61 General Surgery Ganglion - large – Excision Clinical report 3,000 S1 S100061

1294 19.62 General Surgery Ganglion - Small – Excision clinical notes 2,000 S1 S100062

1295 19.63 General Surgery Gastrojejunostomy Clinical notes + USG Clinical Photograph 15,000 S1 S100063

1296 19.64 General Surgery Gastrostomy Clinical notes + USG Clinical Photograph 15,000 S1 S100064

1297 19.65 General Surgery Graham's Operation for duodenal perforation X-ray abdomen/USG 15,000 S1 S100065

1298 19.66 General Surgery Granuloma – Excision Clinical report 2,000 S1 S100066

1299 19.67 General Surgery Haemangioma – Excision (large) Doppler 10,000 S1 S100067

1300 19.68 General Surgery Haemangioma – Excision (small) Doppler 5,000 S1 S100068

1301 19.69 General Surgery Haemorrhage of Small Intestine clinical notes 15,000 S1 S100069

1302 19.70 General Surgery Hepatic Resection (lobectomy) Clinical report,USG/CT HPE 20,000 S1 S100070

1303 19.71 General Surgery Hernia – Epigastric Clinical report USG,Mesh Sticker 11,000 S1 S100071

1304 19.72 General Surgery Hernia – Incisional Clinical report 15,000 S1 S100072

1305 19.73 General Surgery Hernia - Repair & release of obstruction Clinical report,X-ray 15,000 S1 S100073

1306 19.74 General Surgery Hernia – Umbilical Clinical report USG/CT 11,000 S1 S100074

1307 19.75 General Surgery Hernia – Femoral Clinical report/USG Mesh Sticker 10,000 S1 S100075

1308 19.76 General Surgery Hernioplasty – Inguinal Clinical report/USG Mesh Sticker 10,000 S1 S100076

1309 19.77 General Surgery Herniorraphy Clinical report 9,000 S1 S100077



Speciality Code


1310 19.78 General Surgery Hiatus Hernia – abdominal Clinical report,USG/OGD 15,000 S1 S100078

1311 19.79 General Surgery Hydatid Cyst of Liver Clinical report/USG HPE 12,500 S1 S100079

1312 19.80 General Surgery Hydrocele - Excision – Unilateral clinical notes 5,000 S1 S100080

1313 19.81 General Surgery Hydrocele - Excision – Bilateral Clinical report 10,000 S1 S100081

1314 19.82 General Surgery IlieoSigmoidostomy clinical notes 17,000 S1 S100082

1315 19.83 General Surgery Infected Bunion Foot – Excision clinical notes 4,000 S1 S100083

1316 19.84 General Surgery Inguinal Node (dissection) - Unilateral Clinical notes + USG HPE 10,000 S1 S100084

1317 19.85 General Surgery Intestinal perforation Clinical report,X-ray 12,500 S1 S100085

1318 19.86 General Surgery Intestinal Obstruction Clinical report,X-ray 12,500 S1 S100086

1319 19.87 General Surgery Intussusception Clinical report,X-ray 15,000 S1 S100087

1320 19.88 General Surgery Jejunostomy X-RAY/USG Clinical Photo 10,000 S1 S100088

1321 19.89 General Surgery Gastric Perforation Clinical report,X-ray/USG 15,000 S1 S100089

1322 19.90 General Surgery Intestinal Perforation (Resection Anastomosis) Clinical report,X-ray/USG 20,000 S1 S100090

1323 19.91 General Surgery Appendicular Perforation X-RAY/USG HPE 15,000 S1 S100091

1324 19.92 General Surgery Burst Abdomen Obstruction Clinical report 15,000 S1 S100092

1325 19.93 General Surgery Closure of Hollow Viscus Perforation Clinical notes + USG 15,000 S1 S100093

1326 19.94 General Surgery Laryngectomy & Pharyngeal Diverticulum (Throat) Clinical report,CT HPE 15,000 S1 S100094

1327 19.95 General Surgery Ileostomy clinical notes Clinical Photo 10,000 S1 S100095

1328 19.96 General Surgery Lipoma excision clinical notes 2,500 S1 S100096

1329 19.97 General Surgery Loop Colostomy Sigmoid clinical notes 12,000 S1 S100097

1330 19.98 General Surgery Mastectomyclinical

notes,MammogramHPE 12,000 S1 S100098

1331 19.99 General Surgery Mesenteric Cyst – Excision USG/ CT HPE 16,000 S1 S100099

1332 19.100 General Surgery Mesenteric Caval Anastomosis USG/ CT 15,000 S1 S100100

1333 19.101 General Surgery Microlaryngoscopic Surgery Clinical Note 15,000 S1 S100101

1334 19.102 General Surgery Oeshophagoscopy for foreign body removal Clinical Note Photo of removed foreign body 7,500 S1 S100102

1335 19.103 General Surgery Oesophagectomy CT HPE 17,500 S1 S100103

1336 19.104 General Surgery Portal Hypertension shunt surgery USG 18,000 S1 S100104

1337 19.105 General Surgery Pelvic Abscess - Open Drainage Clinical Note 10,000 S1 S100105

1338 19.106 General Surgery PancreaticoDuodenectomy CT HPE 25,000 S1 S100106

1339 19.107 General Surgery Distal Pancreatectomy with PancreaticoJejunostomy CT HPE 25,000 S1 S100107



Speciality Code


1340 19.108 General Surgery Papilloma Rectum – Excision clinical notes HPE 4,000 S1 S100108

1341 19.109 General Surgery Haemorroidectomy+ Fistulectomy clinical notes 10,000 S1 S100109

1342 19.110 General Surgery Growth in the Scalp – Excision clinical notes 4,000 S1 S100110

1343 19.111 General Surgery Porto Caval Anastomosis USG 15,000 S1 S100111

1344 19.112 General Surgery Pyeloroplasty USG 10,000 S1 S100112

1345 19.113 General Surgery Radical Mastectomy Mammogram,USG/X-ray HPE 10,000 S1 S100113

1346 19.114 General Surgery Radical Neck Dissection – Excision CT,Biopasy HPE 15,000 S1 S100114

1347 19.115 General Surgery Hernia – Spigelian USG 5,000 S1 S100115

1348 19.116 General Surgery Rectal Dilation clinical notes 2,000 S1 S100116

1349 19.117 General Surgery Prolapse of Rectal Mass – Excision clinical notes 10,000 S1 S100117

1350 19.118 General Surgery Rectopexy clinical notes 10,000 S1 S100118

1351 19.119 General Surgery Repair of Common Bile Duct USG 15,000 S1 S100119

1352 19.120 General Surgery Resection Anastomosis (Large Intestine) clinical notes 15,000 S1 S100120

1353 19.121 General Surgery Resection Anastomosis (Small Intestine) clinical notes 15,000 S1 S100121

1354 19.122 General Surgery Retroperitoneal Tumor – Excision USG/CT HPE 20,000 S1 S100122

1355 19.123 General Surgery Haemorroidectomy Clinical Notes 5,000 S1 S100123

1356 19.124 General Surgery Salivary Gland – Excision FNAC HPE 10,000 S1 S100124

1357 19.125 General Surgery Segmental Resection of Breast clinical notes 10,000 S1 S100125

1358 19.126 General Surgery Scrotal Swelling (Multiple) – Excision clinical notes,USG 5,000 S1 S100126

1359 19.127 General Surgery Sigmoid Diverticulum USG/ X-RAY 15,000 S1 S100127

1360 19.128 General Surgery Simple closure - Peptic perforation Clinical Note,X-ray 15,000 S1 S100128

1361 19.129 General Surgery Sinus – Excision clinical notes 5,000 S1 S100129

1362 19.130 General Surgery Soft Tissue Tumor (small) – Excision clinical notes HPE 5,000 S1 S100130

1363 19.131 General Surgery Soft Tissue Tumor (large) – Excision clinical notes,USG HPE 10,000 S1 S100131

1364 19.132 General Surgery Splenectomy clinical notes,USG HPE 25,000 S1 S100132

1365 19.133 General Surgery Submandibular Lymph node – Excision clinical notes,FNAC 5,000 S1 S100133

1366 19.134 General Surgery Submandibular Mass Excision + Reconstruction clinical notes,CT/FNAC HPE 20,000 S1 S100134

1367 19.135 General Surgery Swelling in foot (small) – Excision clinical notes 1,500 S1 S100135

1368 19.136 General Surgery Swelling in foot (large) – Excision clinical notes 3,500 S1 S100136

1369 19.137 General Surgery Coloectomy – Total USG/Colonoscopy HPE 20,000 S1 S100137



Speciality Code


1370 19.138 General Surgery Pharyngectomy& Reconstruction – Total CT/MRI HPE 20,000 S1 S100138

1371 19.139 General Surgery Tracheal Stenosis (End to end Anastamosis) (Throat) CT/MRI,Laryngoscopy 15,000 S1 S100139

1372 19.140 General Surgery Tracheoplasty (Throat) CT/USG 15,000 S1 S100140

1373 19.141 General Surgery Umbilical Sinus – Excision clinical notes 5,000 S1 S100141

1374 19.142 General Surgery Varicose Veins - Excision and Ligation Clinical notes,Doppler 10,000 S1 S100142

1375 19.143 General Surgery Vasovasostomy Clinical Note/USG 12,000 S1 S100143

1376 19.144 General Surgery Volvlous of Large Bowel Clinical Note/X-ray 25,000 S1 S100144

1377 19.145 General Surgery Cleft lip operation PRE OP CLINICAL PICTURE Clinical photograph 12,000 S1 S100145

1378 19.146 General Surgery Cleft palate repair (for each stage) PRE OP CLINICAL PICTURE Clinical photograph 12,000 S1 S100146

1379 19.147 General Surgery Cleft lip & palate operation (for each stage) PRE OP CLINICAL PICTURE Clinical photograph 15,000 S1 S100147

1380 19.148 General Surgery Aneurysm not Requiring Bypass Techniques t CT Angio CT Angio,Doppler 36,000 S1 S100148

1381 19.149 General Surgery Aneurysm Resection & Grafting CT Angio 36,000 S1 S100149

1382 19.150 General Surgery Arterial Embolectomy CT Angio/Color Doppler Doppler 17,250 S1 S100150

1383 19.151 General Surgery Carotid artery aneurysm repair Angiogram Color Doppler 17,250 S1 S100151

1384 19.152 General Surgery Carotid Body tumour - Excision Angiogram Color Doppler 20,000 S1 S100152

1385 19.153 General Surgery Cholecystectomy & Exploration of CBD USG/CT HPE 22,000 S1 S100153

1386 19.154 General Surgery Cholecystostomy USG/CT HPE 10,000 S1 S100154

1387 19.155 General Surgery Congential Arteriovenus Fistula (large) CT Angio/ Doppler 20,000 S1 S100155

1388 19.156 General Surgery Congential Arteriovenus Fistula (small) CT Angio/ Doppler 10,000 S1 S100156

1389 19.157 General Surgery Decortication (Pleurectomy) HRCT X-ray 20,000 S1 S100157

1390 19.158 General Surgery Dissecting Aneurysms CT Angio/ Cath Doppler 36,000 S1 S100158

1391 19.159 General Surgery Distal Abdominal Aorta repair Angiogram Color Doppler 36,000 S1 S100159

1392 19.160 General Surgery Estlander Operation (lip) Clinical Note 7,000 S1 S100160

1393 19.161 General Surgery Excision and Skin Graft of Venous Ulcer Clinical Note 15,000 S1 S100161

1394 19.162 General Surgery Excision of Parathyroid Adenoma/Carcinoma Biopsy,CT,Bronchoscopy Biopsy,Clinical Photograph 20,700 S1 S100162

1395 19.163 General Surgery Flap Reconstructive Surgery clinical notes 20,000 S1 S100163

1396 19.164 General Surgery Split thickness skin grafts – Small (< 4% TBSA) clinical notes Clinical Photograph 5,000 S1 S100164

1397 19.165 General Surgery Split thickness skin grafts – Medium (4 - 8% TBSA) clinical notes Clinical Photograph 10,000 S1 S100165

1398 19.166 General Surgery Split thickness skin grafts – Large (> 8% TBSA) clinical notes Clinical Photograph 15,000 S1 S100166

1399 19.167 General Surgery Free Grafts - Wolfe Grafts clinical notes Clinical Photograph 10,000 S1 S100167



Speciality Code


1400 19.168 General Surgery Hemi thyroidectomy USG/FNAC/TFT HPE 10,000 S1 S100168

1401 19.169 General Surgery Total thyroidectomy USG/FNAC/TFT HPE 20,000 S1 S100169

1402 19.170 General Surgery Laparoscopic Hernia Repair clinical notes Mesh Sticker 18,000 S1 S100170

1403 19.171 General Surgery Lap. Assisted left Hemi colectomy t USG HPE 25,000 S1 S100171

1404 19.172 General Surgery Lap. Assisted Right Hemi colectomy t USG HPE 25,000 S1 S100172

1405 19.173 General Surgery Lap. Assisted small bowel resection USG/CT HPE 15,000 S1 S100173

1406 19.174 General Surgery Lap. Assisted Total Colectomy USG/CT HPE 25,000 S1 S100174

1407 19.175 General Surgery Lap. Cholecystectomy & CBD exploration USG HPE 20,000 S1 S100175

1408 19.176 General Surgery Lap. For intestinal obstruction USG/CT,X-ray 15,000 S1 S100176

1409 19.177 General Surgery Lap. Hepatic resection USG/CT HPE 25,000 S1 S100177

1410 19.178 General Surgery Lap. Hydatid of liver surgery USG/CT HPE 20,000 S1 S100178

1411 19.179 General Surgery Laparoscopic Adhesinolysis Clinical notes + USG 15,000 S1 S100179

1412 19.180 General Surgery Laparoscopic Appendicectomy Clinical notes + USG HPE 18,000 S1 S100180

1413 19.181 General Surgery Laparoscopic Cholecystectomy USG HPE 15,000 S1 S100181

1414 19.182 General Surgery Laparoscopic cystogastrostomy USG 20,000 S1 S100182

1415 19.183 General Surgery Laparoscopic Gastrostomy USG/CT,Clinical note 12,000 S1 S100183

1416 19.184 General Surgery Laparoscopic Hiatus Hernia Repair OGD/USG 22,000 S1 S100184

1417 19.185 General Surgery Laparoscopic Pyloromyotomy OGD/USG 20,000 S1 S100185

1418 19.186 General Surgery Laparoscopic Rectopexy Clinical notes + USG 15,000 S1 S100186

1419 19.187 General Surgery Laparoscopic Spleenectomy Clinical notes + USG HPE 16,500 S1 S100187

1420 19.188 General Surgery Laparoscopic umbilical hernia repair Clinical notes + USG 15,000 S1 S100188

1421 19.189 General Surgery Laparoscopic ventral hernia repair Clinical notes + USG Mesh Sticker 20,000 S1 S100189

1422 19.190 General Surgery Laparotomy-peritonitis lavage and drainage Clinical notes + USG 10,000 S1 S100190

1423 19.191 General Surgery Ligation of Ankle Perforators Doppler 5,000 S1 S100191

1424 19.192 General Surgery Lymphatics Excision of Subcutaneous Tissues In Lymphoedema clinical notes,USG pelvis 10,000 S1 S100192

1425 19.193 General Surgery Repair of Main Arteries of the Limbs Clinical notes,Doppler 25,000 S1 S100193

1426 19.194 General Surgery Mediastinal Tumour CT Biopsy,Clinical photo showing scar 20,000 S1 S100194

1427 19.195 General Surgery Oesophagectomy for Carcinoma Oesophagus USG/CT,Biopsy HPE 25,000 S1 S100195

1428 19.196 General Surgery Operation for Bleeding Peptic Ulcer Clinical notes,OGD 15,000 S1 S100196

1429 19.197 General Surgery Operation for Carcinoma Lip – Vermilionectomy Clinical notes HPE 10,000 S1 S100197



Speciality Code


1430 19.198 General Surgery Operation for Carcinoma Lip - Wedge Excision and Vermilionectomy Clinical notes HPE 12,000 S1 S100198

1431 19.199 General Surgery Operation for Carcinoma Lip - Wedge-Excision Clinical notes HPE 10,000 S1 S100199

1432 19.200 General Surgery Appendicectomy - Appendicular Abscess – Drainage USG HPE 12,000 S1 S100200

1433 19.201 General Surgery Caecostomy Clinical notes + USG 10,000 S1 S100201

1434 19.202 General Surgery Closure of Colostomy Clinical notes 5,000 S1 S100202

1435 19.203 General Surgery Coccygeal Teratoma Excision USG/CT HPE 15,000 S1 S100203

1436 19.204 General Surgery Congenital Atresia & Stenosis of Small Intestine USG/CT 20,000 S1 S100204

1437 19.205 General Surgery CystoJejunostomy/or Cystogastrostomy clinical notes 20,000 S1 S100205

1438 19.206 General Surgery Drainage of perivertebral abscess Clinical notes + USG 10,000 S1 S100206

1439 19.207 General Surgery Hernia -hiatus-Transthoracicclinical notes,OGD/CHEST

X- ray25,000 S1 S100207

1440 19.208 General Surgery Intercostal drainage X-ray X-ray 2,000 S1 S100208

1441 19.209 General Surgery Operation for carcinoma lip- cheek advancement clinical notes HPE 12,000 S1 S100209

1442 19.210 General Surgery Thymectomy CT scan HPE 20,000 S1 S100210

1443 19.211 General Surgery Operation of Choledochal Cyst USG 15,000 S1 S100211

1444 19.212 General Surgery Operations for Acquired Arteriovenous Fistulaclinical

notes,Doppler/Angio15,000 S1 S100212

1445 19.213 General Surgery Operations for Replacement of Oesophagus by Colon clinical notes,OGD 25,000 S1 S100213

1446 19.214 General Surgery Hemodialysis per sitting RFT Serum Creatinine 2,300 S1 S100214

1447 19.215 General Surgery Parapharyngeal Tumour Excision USG,CT/FNAC HPE 20,000 S1 S100215

1448 19.216 General Surgery Partial/Subtotal Gastrectomy for Carcinoma OGD/CT HPE 22,000 S1 S100216

1449 19.217 General Surgery Patch Graft Angioplasty Angiography 20,000 S1 S100217

1450 19.218 General Surgery Pericardiostomy Clinical note,X-ray 30,000 S1 S100218

1451 19.219 General Surgery Pneumonectomy CT/Xray Clinical photo showing scar,X-ray 25,000 S1 S100219

1452 19.220 General Surgery Removal of Foreign Body from Trachea or Oesophagus clinical notes Photograph of removed foreign body 5,000 S1 S100220

1453 19.221 General Surgery Removal Tumours of Chest Wall USG/CT HPE 20,000 S1 S100221

1454 19.222 General Surgery Procedures Requiring Bypass Techniques Doopler/Angio 35,000 S1 S100222

1455 19.223 General Surgery Resection Enucleation of Adenoma (lung) HRCT HPE 10,000 S1 S100223

1456 19.224 General Surgery Rib Resection & Drainage X-ray/USG X-ray 10,000 S1 S100224

1457 19.225 General Surgery Skin Flaps - Rotation Flaps clinical notes 6,200 S1 S100225



Speciality Code


1458 19.226 General Surgery Splenectomy - For Trauma CT Angio Report HPE 20,000 S1 S100226

1459 19.227 General Surgery Surgery for Arterial Aneurism Spleen Artery Doopler/Angio 20,000 S1 S100227

1460 19.228 General Surgery Surgery for Arterial Aneurism –Vertebral Doopler/MR Angio 25,000 S1 S100228

1461 19.229 General Surgery Sympathetectomy – Cervical clinical notes 5,000 S1 S100229

1462 19.230 General Surgery Temporal Bone resection clinical notes 15,000 S1 S100230

1463 19.231 General Surgery Thorachostomy X-ray,clinical notes 10,000 S1 S100231

1464 19.232 General Surgery Thoracocentesis X-ray 1,500 S1 S100232

1465 19.233 General Surgery Thoracoplasty X-ray 20,000 S1 S100233

1466 19.234 General Surgery Thoracoscopic Decortication CT X-ray 25,000 S1 S100234

1467 19.235 General Surgery Thoracoscopic Hydatid Cyst excision CT X-ray 20,000 S1 S100235

1468 19.236 General Surgery Thoracoscopic Lobectomy CT X-ray 25,000 S1 S100236

1469 19.237 General Surgery Thoracoscopic Pneumonectomy CT X-ray 30,000 S1 S100237

1470 19.238 General Surgery Thoracoscopic Segmental Resection CT X-ray 25,000 S1 S100238

1471 19.239 General Surgery Thoracoscopic Sympathectomy CT X-ray 15,000 S1 S100239

1472 19.240 General Surgery Thrombendarterectomy CT/Angio 15,000 S1 S100240

1473 19.241 General Surgery Thorax (penetrating wounds) clinical notes,CT/X-ray X-ray 12,500 S1 S100241

1474 19.242 General Surgery Total Thyroidectomy and Block Dissection USG HPE 20,000 S1 S100242

1475 19.243 General Surgery Trendelenburg Operation Doppler 10,000 S1 S100243

1476 19.244 General Surgery Debridement of Ulcer-Leprosy clinical notes 5,000 S1 S100244

1477 19.245 General Surgery Tissue Reconstruction Flap Leprosy clinical notes 25,000 S1 S100245

1478 19.246 General Surgery Tendon Transfer-Leprosy clinical notes 25,000 S1 S100246

1479 19.247 General Surgery Adhenolysis + Appendicectomy USG HPE 20,000 S1 S100247

1480 19.248 General Surgery Hernia - Repair & release of obstruction+ Hernioplasty clinical notes 20,000 S1 S100248

1481 19.249 General Surgery Aspiration of cold Abscess of Lymphnode clinical notes HPE/Cytology 3,000 S1 S100249

1482 19.250 General Surgery Aspiration of Empyema X-ray Fluid-RM/CS 2,000 S1 S100250

1483 19.251 General Surgery AV Shunt for dialysisclinical note,Serum

CreatinineDoppler 6,000 S1 S100251

1484 19.252 General Surgery Peritoneal dialysis per sittingclinical notes,Serum

CreatinineSerum Creatinine 2,300 S1 S100252

1485 19.253 General Surgery Vasectomy clinical notes clinical notes 2,500 S1 S100253



Speciality Code


1486 19.254 General SurgeryUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


1487 20.1

Oral and

Maxillofacial

Surgery

Fixation of fracture of jaw with closed reduction (1 jaw) using wires - under LA OPG/CT Scan Clinical Photo 5,000 S16 S1600001

1488 20.2

Oral and

Maxillofacial

Surgery

Fixation of fracture of jaw with open reduction (1 jaw) and fixing of plates/ wire –

under GA OPG/CT Scan Clinical Photo 12,000 S16 S1600002

1489 20.3

Oral and

Maxillofacial

Surgery

Sequestrectomy OPG/CT Scan Clinical Photo 1,500 S16 S1600003

1490 20.4

Oral and

Maxillofacial

Surgery

TM joint ankylosis of both jaws - under GA OPG/CT Scan Clinical Photo 15,000 S16 S1600004

1491 20.5

Oral and

Maxillofacial

Surgery

Release of fibrous bands & grafting -in (OSMF) treatment under GA Clinical Photo Clinical Photo 3,000 S16 S1600005

1492 20.6

Oral and

Maxillofacial

Surgery

Extraction of impacted tooth under LA X-Ray Clinical Photo 500 S16 S1600006

1493 20.7

Oral and

Maxillofacial

Surgery

Cyst & tumour of Maxilla/mandible by enucleation/excision/marsupialization under

LA OPG/CT Scan/X-Ray Clinical Photo 2,500 S16 S1600007

1494 20.8

Oral and

Maxillofacial

Surgery

Mandible Tumour Resection and reconstruction/Cancer surgery OPG/CT Scan Clinical Photo 6,000 S16 S1600008

1495 20.9

Oral and

Maxillofacial

Surgery

Cleft lip and palate surgery (each stage) Clinical Photo Clinical Photo 15,000 S16 S1600009

1496 20.10

Oral and

Maxillofacial

Surgery

Unspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per




Speciality Code


1497 21.1 A General Medicine Acute gastroenteritis with moderate dehydration (admission type: Routine ward ) Clinical Notes clinical notes 1800

Government Reserve

(Package Amount per

day)

M1 M100001

21.1 B General Medicine Acute gastroenteritis with moderate dehydration (admission type: HDU ) Clinical Notes clinical notes 2700

Government Reserve

(Package Amount per

day)

M1 M100001

21.1 C General Medicine Acute gastroenteritis with moderate dehydration (admission type: ICU ,without

ventilator)Clinical Notes clinical notes 3600

Government Reserve

(Package Amount per

day)

M1 M100001

Cluster - 20 ORAL AND MAXILLO FACIAL SURGERY

Cluster - 21 GENERAL MEDICINE



Speciality Code


21.1 D General Medicine Acute gastroenteritis with moderate dehydration (admission type: ICU (with

ventilator )Clinical Notes clinical notes 4,500

Government Reserve

(Package Amount per

day)

M1 M100001

1498 21.2 A General Medicine Recurrent vomiting with dehydration (admission type: Routine ward )X-Ray abd.Standing /USG

Abd.Pelvis,clinical notesclinical notes 1800

Government Reserve

(Package Amount per

day)

M1 M100002

21.2 B General Medicine Recurrent vomiting with dehydration(admission type: HDU )X-Ray abd.Standing /USG


Government Reserve

(Package Amount per

day)

M1 M100002

21.2 C General Medicine Recurrent vomiting with dehydration(admission type: ICU ,without ventilator)X-Ray abd.Standing /USG


Government Reserve

(Package Amount per

day)

M1 M100002

21.2 D General Medicine Recurrent vomiting with dehydration(admission type: ICU (with ventilator )X-Ray abd.Standing /USG

Abd.Pelvis,clinical notesclinical notes 4,500

Government Reserve

(Package Amount per

day)

M1 M100002

1499 21.3 A General Medicine Dysentery (admission type: Routine ward ) Clinical Notes clinical notes 1800

Government Reserve

(Package Amount per

day)

M1 M100003

21.3 B General Medicine Dysentery(admission type: HDU ) Clinical Notes clinical notes 2700

Government Reserve

(Package Amount per

day)

M1 M100003

21.3 C General Medicine Dysentery(admission type: ICU ,without ventilator) Clinical Notes clinical notes 3600

Government Reserve

(Package Amount per

day)

M1 M100003

21.3 D General Medicine Dysentery(admission type: ICU (with ventilator ) Clinical Notes clinical notes 4,500

Government Reserve

(Package Amount per

day)

M1 M100003

1500 21.4 A General Medicine Renal colic (admission type: Routine ward ) X-Ray/USG clinical notes 1800Package Amount per

dayM1 M100004

21.4 B General Medicine Renal colic(admission type: HDU ) X-Ray/USG clinical notes 2700Package Amount per

dayM1 M100004

21.4 C General Medicine Renal colic(admission type: ICU ,without ventilator) X-Ray/USG clinical notes 3600Package Amount per

dayM1 M100004

21.4 D General Medicine Renal colic(admission type: ICU (with ventilator ) X-Ray/USG clinical notes 4,500Package Amount per

dayM1 M100004

1501 21.5 A General Medicine Acute bronchitis (admission type: Routine ward ) Chest X-Ray clinical notes 1800Package Amount per

dayM1 M100005



Speciality Code


21.5 B General Medicine Acute bronchitis(admission type: HDU ) Chest X-Ray clinical notes 2700Package Amount per

dayM1 M100005

21.5 C General Medicine Acute bronchitis(admission type: ICU ,without ventilator) Chest X-Ray clinical notes 3600Package Amount per

dayM1 M100005

21.5 D General Medicine Acute bronchitis(admission type: ICU (with ventilator ) Chest X-Ray clinical notes 4,500Package Amount per

dayM1 M100005

1502 21.6 A General Medicine Pneumothroax (admission type: Routine ward ) Chest X-Ray clinical notes 1800Package Amount per

dayM1 M100006

21.6 B General Medicine Pneumothroax(admission type: HDU ) Chest X-Ray clinical notes 2700Package Amount per

dayM1 M100006

21.6 C General Medicine Pneumothroax(admission type: ICU ,without ventilator) Chest X-Ray clinical notes 3600Package Amount per

dayM1 M100006

21.6 D General Medicine Pneumothroax(admission type: ICU (with ventilator ) Chest X-Ray clinical notes 4,500Package Amount per

dayM1 M100006

1503 21.7 A General Medicine Accelerated hypertension (admission type: Routine ward ) clinical notes,ECG clinical notes 1800Package Amount per

dayM1 M100007

21.7 B General Medicine Accelerated hypertension(admission type: HDU ) clinical notes,ECG clinical notes 2700Package Amount per

dayM1 M100007

21.7 C General Medicine Accelerated hypertension(admission type: ICU ,without ventilator) clinical notes,ECG clinical notes 3600Package Amount per

dayM1 M100007

21.7 D General Medicine Accelerated hypertension(admission type: ICU (with ventilator ) clinical notes,ECG clinical notes 4,500Package Amount per

dayM1 M100007

1504 21.8 A General Medicine Congestive heart failure (admission type: Routine ward )Chest X-Ray, 2 D Echo,

ECGclinical notes 1800

Package Amount per

dayM1 M100008

21.8 B General Medicine Congestive heart failure(admission type: HDU )Chest X-Ray, 2 D Echo,


Package Amount per

dayM1 M100008

21.8 C General Medicine Congestive heart failure(admission type: ICU ,without ventilator)Chest X-Ray, 2 D Echo,


Package Amount per

dayM1 M100008

21.8 D General Medicine Congestive heart failure(admission type: ICU (with ventilator )Chest X-Ray, 2 D Echo,

ECGclinical notes 4,500

Package Amount per

dayM1 M100008

1505 21.9 A General Medicine Severe anemia (admission type: Routine ward ) HB clinical notes 1800Package Amount per

dayM1 M100009

21.9 B General Medicine Severe anemia(admission type: HDU ) HB clinical notes 2700Package Amount per

dayM1 M100009

21.9 C General Medicine Severe anemia(admission type: ICU ,without ventilator) HB clinical notes 3600Package Amount per

dayM1 M100009

21.9 D General Medicine Severe anemia(admission type: ICU (with ventilator ) HB clinical notes 4,500Package Amount per

dayM1 M100009

1506 21.10 A General Medicine Diabetic ketoacidosis (admission type: Routine ward )FBS, PP2BS,HBA1C, Urine

Ketonsclinical notes 1800

Package Amount per

dayM1 M100010



Speciality Code


21.10 B General Medicine Diabetic ketoacidosis(admission type: HDU )FBS, PP2BS,HBA1C, Urine


Package Amount per

dayM1 M100010

21.10 C General Medicine Diabetic ketoacidosis(admission type: ICU ,without ventilator)FBS, PP2BS,HBA1C, Urine


Package Amount per

dayM1 M100010

21.10 D General Medicine Diabetic ketoacidosis(admission type: ICU (with ventilator )FBS, PP2BS,HBA1C, Urine

Ketonsclinical notes 4,500

Package Amount per

dayM1 M100010

1507 21.11 A General Medicine Acute febrile illness (admission type: Routine ward ) Fever Profile clinical notes 1800Package Amount per

dayM1 M100011

21.11 B General Medicine Acute febrile illness(admission type: HDU ) Fever Profile clinical notes 2700Package Amount per

dayM1 M100011

21.11 C General Medicine Acute febrile illness(admission type: ICU ,without ventilator) Fever Profile clinical notes 3600Package Amount per

dayM1 M100011

21.11 D General Medicine Acute febrile illness(admission type: ICU (with ventilator ) Fever Profile clinical notes 4,500Package Amount per

dayM1 M100011

1508 21.12 A General Medicine Acutre excaberation of COPD (admission type: Routine ward ) Chest X-Ray clinical notes 1800Package Amount per

dayM1 M100012

21.12 B General Medicine Acutre excaberation of COPD(admission type: HDU ) Chest X-Ray clinical notes 2700Package Amount per

dayM1 M100012

21.12 C General Medicine Acutre excaberation of COPD(admission type: ICU ,without ventilator) Chest X-Ray clinical notes 3600Package Amount per

dayM1 M100012

21.12 D General Medicine Acutre excaberation of COPD(admission type: ICU (with ventilator ) Chest X-Ray clinical notes 4,500Package Amount per

dayM1 M100012

1509 21.13 A General Medicine UTI (admission type: Routine ward )USG KUB, Urine routine

Microclinical notes 1800

Package Amount per

dayM1 M100013

21.13 B General Medicine UTI(admission type: HDU )USG KUB, Urine routine


Package Amount per

dayM1 M100013

21.13 C General Medicine UTI(admission type: ICU ,without ventilator)USG KUB, Urine routine


Package Amount per

dayM1 M100013

21.13 D General Medicine UTI(admission type: ICU (with ventilator )USG KUB, Urine routine

Microclinical notes 4,500

Package Amount per

dayM1 M100013

1510 21.14 A General Medicine Malaria (admission type: Routine ward ) PSMP clinical notes 1800Package Amount per

dayM1 M100014

21.14 B General Medicine Malaria(admission type: HDU ) PSMP clinical notes 2700Package Amount per

dayM1 M100014

21.14 C General Medicine Malaria(admission type: ICU ,without ventilator) PSMP clinical notes 3600Package Amount per

dayM1 M100014

21.14 D General Medicine Malaria(admission type: ICU (with ventilator ) PSMP clinical notes 4,500Package Amount per

dayM1 M100014

1511 21.15 A General Medicine Dengue fever (admission type: Routine ward ) NS, Antigen clinical notes 1800Package Amount per

dayM1 M100015



Speciality Code


21.15 B General Medicine Dengue fever(admission type: HDU ) NS, Antigen clinical notes 2700Package Amount per

dayM1 M100015

21.15 C General Medicine Dengue fever(admission type: ICU ,without ventilator) NS, Antigen clinical notes 3600Package Amount per

dayM1 M100015

21.15 D General Medicine Dengue fever(admission type: ICU (with ventilator ) NS, Antigen clinical notes 4,500Package Amount per

dayM1 M100015

1512 21.16 A General Medicine Chikungunya fever (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100016

21.16 B General Medicine Chikungunya fever(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100016

21.16 C General Medicine Chikungunya fever(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100016

21.16 D General Medicine Chikungunya fever(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100016

1513 21.17 A General Medicine Leptospirosis (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100017

21.17 B General Medicine Leptospirosis(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100017

21.17 C General Medicine Leptospirosis(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100017

21.17 D General Medicine Leptospirosis(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100017

1514 21.18 A General Medicine Enteric fever (admission type: Routine ward ) CBC, S. Widal clinical notes 1800Package Amount per

dayM1 M100018

21.18 B General Medicine Enteric fever(admission type: HDU ) CBC, S. Widal clinical notes 2700Package Amount per

dayM1 M100018

21.18 C General Medicine Enteric fever(admission type: ICU ,without ventilator) CBC, S. Widal clinical notes 3600Package Amount per

dayM1 M100018

21.18 D General Medicine Enteric fever(admission type: ICU (with ventilator ) CBC, S. Widal clinical notes 4,500Package Amount per

dayM1 M100018

1515 21.19 A General Medicine Pneumonia (admission type: Routine ward ) CBC, X-Ray Chest clinical notes 1800Package Amount per

dayM1 M100019

21.19 B General Medicine Pneumonia(admission type: HDU ) CBC, X-Ray Chest clinical notes 2700Package Amount per

dayM1 M100019

21.19 C General Medicine Pneumonia(admission type: ICU ,without ventilator) CBC, X-Ray Chest clinical notes 3600Package Amount per

dayM1 M100019

21.19 D General Medicine Pneumonia(admission type: ICU (with ventilator ) CBC, X-Ray Chest clinical notes 4,500Package Amount per

dayM1 M100019

1516 21.20 A General Medicine Acute excaberation of ILD (admission type: Routine ward ) Chest X-Ray clinical notes 1800Package Amount per

dayM1 M100020



Speciality Code


21.20 B General Medicine Acute excaberation of ILD(admission type: HDU ) Chest X-Ray clinical notes 2700Package Amount per

dayM1 M100020

21.20 C General Medicine Acute excaberation of ILD(admission type: ICU ,without ventilator) Chest X-Ray clinical notes 3600Package Amount per

dayM1 M100020

21.20 D General Medicine Acute excaberation of ILD(admission type: ICU (with ventilator ) Chest X-Ray clinical notes 4,500Package Amount per

dayM1 M100020

1517 21.21 A General Medicine Liver abscess (admission type: Routine ward )USG, Chest X-Ray, X-ray

Abdclinical notes 1800

Package Amount per

dayM1 M100021

21.21 B General Medicine Liver abscess(admission type: HDU )USG, Chest X-Ray, X-ray


Package Amount per

dayM1 M100021

21.21 C General Medicine Liver abscess(admission type: ICU ,without ventilator)USG, Chest X-Ray, X-ray


Package Amount per

dayM1 M100021

21.21 D General Medicine Liver abscess(admission type: ICU (with ventilator )USG, Chest X-Ray, X-ray

Abdclinical notes 4,500

Package Amount per

dayM1 M100021

1518 21.22 A General Medicine Acute viral hepatitis (admission type: Routine ward )USG ABD, Hepatits

Marker, HBSAG,NTHCVclinical notes 1800

Package Amount per

dayM1 M100022

21.22 B General Medicine Acute viral hepatitis(admission type: HDU )USG ABD, Hepatits


Package Amount per

dayM1 M100022

21.22 C General Medicine Acute viral hepatitis(admission type: ICU ,without ventilator)USG ABD, Hepatits


Package Amount per

dayM1 M100022

21.22 D General Medicine Acute viral hepatitis(admission type: ICU (with ventilator )USG ABD, Hepatits

Marker, HBSAG,NTHCVclinical notes 4,500

Package Amount per

dayM1 M100022

1519 21.23 A General Medicine Snake bite (admission type: Routine ward ) BT,CT,PT,APTT clinical notes 1800Package Amount per

dayM1 M100023

21.23 B General Medicine Snake bite(admission type: HDU ) BT,CT,PT,APTT clinical notes 2700Package Amount per

dayM1 M100023

21.23 C General Medicine Snake bite(admission type: ICU ,without ventilator) BT,CT,PT,APTT clinical notes 3600Package Amount per

dayM1 M100023

21.23 D General Medicine Snake bite(admission type: ICU (with ventilator ) BT,CT,PT,APTT clinical notes 4,500Package Amount per

dayM1 M100023

1520 21.24 A General Medicine Acute organophosphorus poisoning (admission type: Routine ward ) Anti Choline esterase clinical notes 1800Package Amount per

dayM1 M100024

21.24 B General Medicine Acute organophosphorus poisoning(admission type: HDU ) Anti Choline esterase clinical notes 2700Package Amount per

dayM1 M100024

21.24 C General Medicine Acute organophosphorus poisoning(admission type: ICU ,without ventilator) Anti Choline esterase clinical notes 3600Package Amount per

dayM1 M100024



Speciality Code


21.24 D General Medicine Acute organophosphorus poisoning(admission type: ICU (with ventilator ) Anti Choline esterase clinical notes 4,500Package Amount per

dayM1 M100024

1521 21.25 A General Medicine Other poisoning (admission type: Routine ward ) Clinical Notes clinical notes 1800Package Amount per

dayM1 M100025

21.25 B General Medicine Other poisoning(admission type: HDU ) Clinical Notes clinical notes 2700Package Amount per

dayM1 M100025

21.25 C General Medicine Other poisoning(admission type: ICU ,without ventilator) Clinical Notes clinical notes 3600Package Amount per

dayM1 M100025

21.25 D General Medicine Other poisoning(admission type: ICU (with ventilator ) Clinical Notes clinical notes 4,500Package Amount per

dayM1 M100025

1522 21.26 A General Medicine Pyrexia of unknown origin (admission type: Routine ward ) Fever Profile clinical notes 1800Package Amount per

dayM1 M100026

21.26 B General Medicine Pyrexia of unknown origin(admission type: HDU ) Fever Profile clinical notes 2700Package Amount per

dayM1 M100026

21.26 C General Medicine Pyrexia of unknown origin(admission type: ICU ,without ventilator) Fever Profile clinical notes 3600Package Amount per

dayM1 M100026

21.26 D General Medicine Pyrexia of unknown origin(admission type: ICU (with ventilator ) Fever Profile clinical notes 4,500Package Amount per

dayM1 M100026

1523 21.27 A General Medicine Pericardial/ Pleural tuberculosis (admission type: Routine ward )Chest X-Ray,

PL.TAPPING,AFBclinical notes 1800

Package Amount per

dayM1 M100027

21.27 B General Medicine Pericardial/ Pleural tuberculosis(admission type: HDU )Chest X-Ray,


Package Amount per

dayM1 M100027

21.27 C General Medicine Pericardial/ Pleural tuberculosis(admission type: ICU ,without ventilator)Chest X-Ray,


Package Amount per

dayM1 M100027

21.27 D General Medicine Pericardial/ Pleural tuberculosis(admission type: ICU (with ventilator )Chest X-Ray,

PL.TAPPING,AFBclinical notes 4,500

Package Amount per

dayM1 M100027

1524 21.28 A General Medicine Systematic lupus erythematosus (admission type: Routine ward )Clinical History/Concern

Investigationclinical notes 1800

Package Amount per

dayM1 M100028

21.28 B General Medicine Systematic lupus erythematosus(admission type: HDU )Clinical History/Concern


Package Amount per

dayM1 M100028

21.28 C General Medicine Systematic lupus erythematosus(admission type: ICU ,without ventilator)Clinical History/Concern


Package Amount per

dayM1 M100028

21.28 D General Medicine Systematic lupus erythematosus(admission type: ICU (with ventilator )Clinical History/Concern

Investigationclinical notes 4,500

Package Amount per

dayM1 M100028

1525 21.29 A General Medicine Vasculitis (admission type: Routine ward )Clinical History/Concern


Package Amount per

dayM1 M100029

21.29 B General Medicine Vasculitis(admission type: HDU )Clinical History/Concern


Package Amount per

dayM1 M100029

21.29 C General Medicine Vasculitis(admission type: ICU ,without ventilator)Clinical History/Concern


Package Amount per

dayM1 M100029



Speciality Code


21.29 D General Medicine Vasculitis(admission type: ICU (with ventilator )Clinical History/Concern

Investigationclinical notes 4,500

Package Amount per

dayM1 M100029

1526 21.30 A General Medicine Seizures (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100030

21.30 B General Medicine Seizures(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100030

21.30 C General Medicine Seizures(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100030

21.30 D General Medicine Seizures(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100030

1527 21.31 A General Medicine Bacterial/ fungal endocarditis (admission type: Routine ward ) 2 D Echo clinical notes 1800Package Amount per

dayM1 M100031

21.31 B General Medicine Bacterial/ fungal endocarditis(admission type: HDU ) 2 D Echo clinical notes 2700Package Amount per

dayM1 M100031

21.31 C General Medicine Bacterial/ fungal endocarditis(admission type: ICU ,without ventilator) 2 D Echo clinical notes 3600Package Amount per

dayM1 M100031

21.31 D General Medicine Bacterial/ fungal endocarditis(admission type: ICU (with ventilator ) 2 D Echo clinical notes 4,500Package Amount per

dayM1 M100031

1528 21.32 A General Medicine Acute inflammatory demyelinating polyneuropathy (admission type: Routine ward ) EMG,NCV,CSF,MRI clinical notes 1800Package Amount per

dayM1 M100032

21.32 B General Medicine Acute inflammatory demyelinating polyneuropathy(admission type: HDU ) EMG,NCV,CSF,MRI clinical notes 2700Package Amount per

dayM1 M100032

21.32 C General Medicine Acute inflammatory demyelinating polyneuropathy(admission type: ICU ,without

ventilator)EMG,NCV,CSF,MRI clinical notes 3600

Package Amount per

dayM1 M100032

21.32 D General Medicine Acute inflammatory demyelinating polyneuropathy(admission type: ICU (with

ventilator )EMG,NCV,CSF,MRI clinical notes 4,500

Package Amount per

dayM1 M100032

1529 21.33 A General Medicine Lung abscess/ Empyema (admission type: Routine ward ) Chest X-Ray, CT Thorax clinical notes 1800Package Amount per

dayM1 M100033

21.33 B General Medicine Lung abscess/ Empyema(admission type: HDU ) Chest X-Ray, CT Thorax clinical notes 2700Package Amount per

dayM1 M100033

21.33 C General Medicine Lung abscess/ Empyema(admission type: ICU ,without ventilator) Chest X-Ray, CT Thorax clinical notes 3600Package Amount per

dayM1 M100033

21.33 D General Medicine Lung abscess/ Empyema(admission type: ICU (with ventilator ) Chest X-Ray, CT Thorax clinical notes 4,500Package Amount per

dayM1 M100033

1530 21.34 A General Medicine Acute and chronic meningitis (admission type: Routine ward ) CSF,MRI Brain clinical notes 1800Package Amount per

dayM1 M100034

21.34 B General Medicine Acute and chronic meningitis(admission type: HDU ) CSF,MRI Brain clinical notes 2700Package Amount per

dayM1 M100034

21.34 C General Medicine Acute and chronic meningitis(admission type: ICU ,without ventilator) CSF,MRI Brain clinical notes 3600Package Amount per

dayM1 M100034



Speciality Code


21.34 D General Medicine Acute and chronic meningitis(admission type: ICU (with ventilator ) CSF,MRI Brain clinical notes 4,500Package Amount per

dayM1 M100034

1531 21.35 A General Medicine Viral encephalitis (admission type: Routine ward ) CSF, MRI clinical notes 1800Package Amount per

dayM1 M100035

21.35 B General Medicine Viral encephalitis(admission type: HDU ) CSF, MRI clinical notes 2700Package Amount per

dayM1 M100035

21.35 C General Medicine Viral encephalitis(admission type: ICU ,without ventilator) CSF, MRI clinical notes 3600Package Amount per

dayM1 M100035

21.35 D General Medicine Viral encephalitis(admission type: ICU (with ventilator ) CSF, MRI clinical notes 4,500Package Amount per

dayM1 M100035

1532 21.36 A General Medicine Persistent/ Chronic diarrohea (admission type: Routine ward ) Concern Investigation clinical notes 1800Package Amount per

dayM1 M100036

21.36 B General Medicine Persistent/ Chronic diarrohea(admission type: HDU ) Concern Investigation clinical notes 2700Package Amount per

dayM1 M100036

21.36 C General Medicine Persistent/ Chronic diarrohea(admission type: ICU ,without ventilator) Concern Investigation clinical notes 3600Package Amount per

dayM1 M100036

21.36 D General Medicine Persistent/ Chronic diarrohea(admission type: ICU (with ventilator ) Concern Investigation clinical notes 4,500Package Amount per

dayM1 M100036

1533 21.37 A General Medicine Acute and chronic pancreatitis (admission type: Routine ward ) USG ABD, CT clinical notes 1800Package Amount per

dayM1 M100037

21.37 B General Medicine Acute and chronic pancreatitis(admission type: HDU ) USG ABD, CT clinical notes 2700Package Amount per

dayM1 M100037

21.37 C General Medicine Acute and chronic pancreatitis(admission type: ICU ,without ventilator) USG ABD, CT clinical notes 3600Package Amount per

dayM1 M100037

21.37 D General Medicine Acute and chronic pancreatitis(admission type: ICU (with ventilator ) USG ABD, CT clinical notes 4,500Package Amount per

dayM1 M100037

1534 21.38 A General Medicine Visceral leishmaniasis (admission type: Routine ward ) IGM,Ab clinical notes 1800Package Amount per

dayM1 M100038

21.38 B General Medicine Visceral leishmaniasis(admission type: HDU ) IGM,Ab clinical notes 2700Package Amount per

dayM1 M100038

21.38 C General Medicine Visceral leishmaniasis(admission type: ICU ,without ventilator) IGM,Ab clinical notes 3600Package Amount per

dayM1 M100038

21.38 D General Medicine Visceral leishmaniasis(admission type: ICU (with ventilator ) IGM,Ab clinical notes 4,500Package Amount per

dayM1 M100038

1535 21.39 A General Medicine HIV with complications (admission type: Routine ward ) HIV clinical notes 1800Package Amount per

dayM1 M100039

21.39 B General Medicine HIV with complications(admission type: HDU ) HIV clinical notes 2700Package Amount per

dayM1 M100039

21.39 C General Medicine HIV with complications(admission type: ICU ,without ventilator) HIV clinical notes 3600Package Amount per

dayM1 M100039



Speciality Code


21.39 D General Medicine HIV with complications(admission type: ICU (with ventilator ) HIV clinical notes 4,500Package Amount per

dayM1 M100039

1536 21.40 A General Medicine Neuromuscular disorders (admission type: Routine ward ) EMG,NCV,MRI clinical notes 1800Package Amount per

dayM1 M100040

21.40 B General Medicine Neuromuscular disorders(admission type: HDU ) EMG,NCV,MRI clinical notes 2700Package Amount per

dayM1 M100040

21.40 C General Medicine Neuromuscular disorders(admission type: ICU ,without ventilator) EMG,NCV,MRI clinical notes 3600Package Amount per

dayM1 M100040

21.40 D General Medicine Neuromuscular disorders(admission type: ICU (with ventilator ) EMG,NCV,MRI clinical notes 4,500Package Amount per

dayM1 M100040

1537 21.41 A General Medicine Metabolic encephalopathy (admission type: Routine ward ) RFT,LFT,Uric acid, CBC clinical notes 1800Package Amount per

dayM1 M100041

21.41 B General Medicine Metabolic encephalopathy(admission type: HDU ) RFT,LFT,Uric acid, CBC clinical notes 2700Package Amount per

dayM1 M100041

21.41 C General Medicine Metabolic encephalopathy(admission type: ICU ,without ventilator) RFT,LFT,Uric acid, CBC clinical notes 3600Package Amount per

dayM1 M100041

21.41 D General Medicine Metabolic encephalopathy(admission type: ICU (with ventilator ) RFT,LFT,Uric acid, CBC clinical notes 4,500Package Amount per

dayM1 M100041

1538 21.42 A General Medicine Sickle cell Anemia (admission type: Routine ward )Sicklmg test, Electro

phoresisclinical notes 1800

Package Amount per

dayM1 M100042

21.42 B General Medicine Sickle cell Anemia(admission type: HDU )Sicklmg test, Electro


Package Amount per

dayM1 M100042

21.42 C General Medicine Sickle cell Anemia(admission type: ICU ,without ventilator)Sicklmg test, Electro


Package Amount per

dayM1 M100042

21.42 D General Medicine Sickle cell Anemia(admission type: ICU (with ventilator )Sicklmg test, Electro

phoresisclinical notes 4,500

Package Amount per

dayM1 M100042

1539 21.43 A General Medicine Poisonings with unstable vitals (admission type: Routine ward ) Gastic Levage clinical notes 1800Package Amount per

dayM1 M100043

21.43 B General Medicine Poisonings with unstable vitals(admission type: HDU ) Gastic Levage clinical notes 2700Package Amount per

dayM1 M100043

21.43 C General Medicine Poisonings with unstable vitals(admission type: ICU ,without ventilator) Gastic Levage clinical notes 3600Package Amount per

dayM1 M100043

21.43 D General Medicine Poisonings with unstable vitals(admission type: ICU (with ventilator ) Gastic Levage clinical notes 4,500Package Amount per

dayM1 M100043

1540 21.44 A General Medicine Type 1/2 respiratory failure (admission type: Routine ward ) ABG Analysis clinical notes 1800Package Amount per

dayM1 M100044

21.44 B General Medicine Type 1/2 respiratory failure(admission type: HDU ) ABG Analysis clinical notes 2700Package Amount per

dayM1 M100044

21.44 C General Medicine Type 1/2 respiratory failure(admission type: ICU ,without ventilator) ABG Analysis clinical notes 3600Package Amount per

dayM1 M100044



Speciality Code


21.44 D General Medicine Type 1/2 respiratory failure(admission type: ICU (with ventilator ) ABG Analysis clinical notes 4,500Package Amount per

dayM1 M100044

1541 21.45 A General Medicine Acute asthmatic attack (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100045

21.445 B General Medicine Acute asthmatic attack(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100045

21.45 C General Medicine Acute asthmatic attack(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100045

21.45 D General Medicine Acute asthmatic attack(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100045

1542 21.46 A General Medicine Acutre excaberation of ILD(admission type: Routine ward ) Chesr X-Ray(PA) clinical notes 1800Package Amount per

dayM1 M100020

21.46 B General Medicine Acutre excaberation of ILD(admission type: HDU ) Chesr X-Ray(PA) clinical notes 2700Package Amount per

dayM1 M100020

21.46 C General Medicine Acutre excaberation of ILD(admission type: ICU ,without ventilator) Chesr X-Ray(PA) clinical notes 3600Package Amount per

dayM1 M100020

21.46 D General Medicine Acutre excaberation of ILD(admission type: ICU (with ventilator ) Chesr X-Ray(PA) clinical notes 4,500Package Amount per

dayM1 M100020

1543 21.47 A General Medicine Severe pneumonia (admission type: Routine ward ) Chesr X-Ray(PA) clinical notes 1800Package Amount per

dayM1 M100047

21.47 B General Medicine Severe pneumonia(admission type: HDU ) Chesr X-Ray(PA) clinical notes 2700Package Amount per

dayM1 M100047

21.47 C General Medicine Severe pneumonia(admission type: ICU ,without ventilator) Chesr X-Ray(PA) clinical notes 3600Package Amount per

dayM1 M100047

21.47 D General Medicine Severe pneumonia(admission type: ICU (with ventilator ) Chesr X-Ray(PA) clinical notes 4,500Package Amount per

dayM1 M100047

1544 21.48 A General Medicine Acute gastroenteritis with severe dehydration (admission type: Routine ward ) Stool Culture clinical notes 1800Package Amount per

dayM1 M100048

21.48 B General Medicine Acute gastroenteritis with severe dehydration(admission type: HDU ) Stool Culture clinical notes 2700Package Amount per

dayM1 M100048

21.48 C General Medicine Acute gastroenteritis with severe dehydration(admission type: ICU ,without

ventilator)Stool Culture clinical notes 3600

Package Amount per

dayM1 M100048

21.48 D General Medicine Acute gastroenteritis with severe dehydration(admission type: ICU (with ventilator ) Stool Culture clinical notes 4,500Package Amount per

dayM1 M100048

1545 21.49 A General Medicine Hypertensive emergencies (admission type: Routine ward ) ECG, 2D Echo clinical notes 1800Package Amount per

dayM1 M100049

21.49 B General Medicine Hypertensive emergencies(admission type: HDU ) ECG, 2D Echo clinical notes 2700Package Amount per

dayM1 M100049

21.49 C General Medicine Hypertensive emergencies(admission type: ICU ,without ventilator) ECG, 2D Echo clinical notes 3600Package Amount per

dayM1 M100049



Speciality Code


21.49 D General Medicine Hypertensive emergencies(admission type: ICU (with ventilator ) ECG, 2D Echo clinical notes 4,500Package Amount per

dayM1 M100049

1546 21.50 A General Medicine Dengue hemorrhagic fever/Dengue shock syndrome (admission type: Routine ward ) Dengue NS1, IGM clinical notes 1800Package Amount per

dayM1 M100050

21.50 B General Medicine Dengue hemorrhagic fever/Dengue shock syndrome(admission type: HDU ) Dengue NS1, IGM clinical notes 2700Package Amount per

dayM1 M100050

21.50 C General Medicine Dengue hemorrhagic fever/Dengue shock syndrome(admission type: ICU ,without

ventilator)Dengue NS1, IGM clinical notes 3600

Package Amount per

dayM1 M100050

21.50 D General Medicine Dengue hemorrhagic fever/Dengue shock syndrome(admission type: ICU (with

ventilator )Dengue NS1, IGM clinical notes 4,500

Package Amount per

dayM1 M100050

1547 21.51 A General Medicine Complicated malaria (admission type: Routine ward ) CBC, RFT,LFT clinical notes 1800Package Amount per

dayM1 M100051

21.51 B General Medicine Complicated malaria(admission type: HDU ) CBC, RFT,LFT clinical notes 2700Package Amount per

dayM1 M100051

21.51 C General Medicine Complicated malaria(admission type: ICU ,without ventilator) CBC, RFT,LFT clinical notes 3600Package Amount per

dayM1 M100051

21.51 D General Medicine Complicated malaria(admission type: ICU ,without ventilator)(admission type: ICU

(with ventilator )CBC, RFT,LFT clinical notes 4,500

Package Amount per

dayM1 M100051

1548 21.52 A General Medicine Heat stroke (admission type: Routine ward ) CPK Total clinical notes 1800Package Amount per

dayM1 M100052

21.52 B General Medicine Heat stroke(admission type: HDU ) CPK Total clinical notes 2700Package Amount per

dayM1 M100052

21.52 C General Medicine Heat stroke(admission type: ICU ,without ventilator) CPK Total clinical notes 3600Package Amount per

dayM1 M100052

21.52 D General Medicine Heat stroke(admission type: ICU (with ventilator ) CPK Total clinical notes 4,500Package Amount per

dayM1 M100052

1549 21.53 A General Medicine Hyperosmolar Non-Ketotic coma (admission type: Routine ward ) ABGA,RBS clinical notes 1800Package Amount per

dayM1 M100053

21.53 B General Medicine Hyperosmolar Non-Ketotic coma(admission type: HDU ) ABGA,RBS clinical notes 2700Package Amount per

dayM1 M100053

21.53 C General Medicine Hyperosmolar Non-Ketotic coma(admission type: ICU ,without ventilator) ABGA,RBS clinical notes 3600Package Amount per

dayM1 M100053

21.53 D General Medicine Hyperosmolar Non-Ketotic coma(admission type: ICU (with ventilator ) ABGA,RBS clinical notes 4,500Package Amount per

dayM1 M100053

1550 21.54 A General Medicine Severe sepsis/Septic shock (admission type: Routine ward ) Blood Culture clinical notes 1800Package Amount per

dayM1 M100055

21.54 B General Medicine Severe sepsis/Septic shock(admission type: HDU ) Blood Culture clinical notes 2700Package Amount per

dayM1 M100055

21.54 C General Medicine Severe sepsis/Septic shock(admission type: ICU ,without ventilator) Blood Culture clinical notes 3600Package Amount per

dayM1 M100055



Speciality Code


21.54 D General Medicine Severe sepsis/Septic shock(admission type: ICU (with ventilator ) Blood Culture clinical notes 4,500Package Amount per

dayM1 M100055

1551 21.55 A General Medicine Upper GI bleeding (conservative) (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100056

21.55 B General Medicine Upper GI bleeding (conservative)(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100056

21.55 C General Medicine Upper GI bleeding (conservative)(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100056

21.55 D General Medicine Upper GI bleeding (conservative)(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100056

1552 21.56 A General Medicine Upper GI bleeding (endoscopic) (admission type: Routine ward ) Scopy clinical notes 1800Package Amount per

dayM1 M100057

21.56 B General Medicine Upper GI bleeding (endoscopic) Scopy clinical notes 2700Package Amount per

dayM1 M100057

21.56 C General Medicine Upper GI bleeding (endoscopic)(admission type: ICU ,without ventilator) Scopy clinical notes 3600Package Amount per

dayM1 M100057

21.56 D General Medicine Upper GI bleeding (endoscopic)(admission type: ICU (with ventilator ) Scopy clinical notes 4,500Package Amount per

dayM1 M100057

1553 21.57 A General Medicine Lower GI hemorrhage (admission type: Routine ward )Colonoscopy, USG Abd/

CTclinical notes 1800

Package Amount per

dayM1 M100058

21.57 B General Medicine Lower GI hemorrhage(admission type: HDU )Colonoscopy, USG Abd/


Package Amount per

dayM1 M100058

21.57 C General Medicine Lower GI hemorrhage(admission type: ICU ,without ventilator)Colonoscopy, USG Abd/


Package Amount per

dayM1 M100058

21.57 D General Medicine Lower GI hemorrhage(admission type: ICU (with ventilator )Colonoscopy, USG Abd/

CTclinical notes 4,500

Package Amount per

dayM1 M100058

1554 21.58 A General Medicine Immune mediated CNS disorders such as autoimmune encephalitis (admission type:

Routine ward )CSF,MRI clinical notes 1800

Package Amount per

dayM1 M100059

21.58 B General Medicine Immune mediated CNS disorders such as autoimmune encephalitis(admission type:

HDU )CSF,MRI clinical notes 2700

Package Amount per

dayM1 M100059

21.58 C General Medicine Immune mediated CNS disorders such as autoimmune encephalitis(admission type:

ICU ,without ventilator)CSF,MRI clinical notes 3600

Package Amount per

dayM1 M100059

21.58 D General Medicine Immune mediated CNS disorders such as autoimmune encephalitis(admission type:

ICU (with ventilator )CSF,MRI clinical notes 4,500

Package Amount per

dayM1 M100059

1555 21.59 A General Medicine Acute transverse myelitis (admission type: Routine ward ) MRI.CSF clinical notes 1800Package Amount per

dayM1 M100060

21.59 B General Medicine Acute transverse myelitis(admission type: HDU ) MRI.CSF clinical notes 2700Package Amount per

dayM1 M100060

21.59 C General Medicine Acute transverse myelitis(admission type: ICU ,without ventilator) MRI.CSF clinical notes 3600Package Amount per

dayM1 M100060



Speciality Code


21.59 D General Medicine Acute transverse myelitis(admission type: ICU (with ventilator ) MRI.CSF clinical notes 4,500Package Amount per

dayM1 M100060

1556 21.60 A General Medicine Hydrocephalus (admission type: Routine ward ) CT clinical notes 1800Package Amount per

dayM1 M100062

21.60 B General Medicine Hydrocephalus(admission type: HDU ) CT clinical notes 2700Package Amount per

dayM1 M100062

21.60 C General Medicine Hydrocephalus(admission type: ICU ,without ventilator) CT clinical notes 3600Package Amount per

dayM1 M100062

21.60 D General Medicine Hydrocephalus(admission type: ICU (with ventilator ) CT clinical notes 4,500Package Amount per

dayM1 M100062

1557 21.61 A General Medicine Cerebral sino-venous thrombosis (admission type: Routine ward ) MR Veno clinical notes 1800Package Amount per

dayM1 M100063

21.61 B General Medicine Cerebral sino-venous thrombosis(admission type: HDU ) MR Veno clinical notes 2700Package Amount per

dayM1 M100063

21.61 C General Medicine Cerebral sino-venous thrombosis(admission type: ICU ,without ventilator) MR Veno clinical notes 3600Package Amount per

dayM1 M100063

21.61 D General Medicine Cerebral sino-venous thrombosis(admission type: ICU (with ventilator ) MR Veno clinical notes 4,500Package Amount per

dayM1 M100063

1558 21.62 A General Medicine AKI/ renal failure(dialysis payable separately as an add on package for ) (admission

type: Routine ward )RFT, USG clinical notes 1800

Package Amount per

dayM1 M100064

21.62 B General Medicine AKI/ renal failure(dialysis payable separately as an add on package for )(admission

type: HDU )RFT, USG clinical notes 2700

Package Amount per

dayM1 M100064

21.62 C General Medicine AKI/ renal failure(dialysis payable separately as an add on package for )(admission

type: ICU ,without ventilator)RFT, USG clinical notes 3600

Package Amount per

dayM1 M100064

21.62 D General Medicine AKI/ renal failure(dialysis payable separately as an add on package for )(admission

type: ICU (with ventilator )RFT, USG clinical notes 4,500

Package Amount per

dayM1 M100064

1559 21.63 A General Medicine Status epilepticus (admission type: Routine ward ) MRI,CSF clinical notes 1800Package Amount per

dayM1 M100065

21.63 B General Medicine Status epilepticus(admission type: HDU ) MRI,CSF clinical notes 2700Package Amount per

dayM1 M100065

21.63 C General Medicine Status epilepticus(admission type: ICU ,without ventilator) MRI,CSF clinical notes 3600Package Amount per

dayM1 M100065

21.63 D General Medicine Status epilepticus(admission type: ICU (with ventilator ) MRI,CSF clinical notes 4,500Package Amount per

dayM1 M100065

1560 21.64 A General Medicine Status asthmaticus (admission type: Routine ward ) Clinical History clinical notes 1800Package Amount per

dayM1 M100066

21.64 B General Medicine Status asthmaticus(admission type: HDU ) Clinical History clinical notes 2700Package Amount per

dayM1 M100066

21.64 C General Medicine Status asthmaticus(admission type: ICU ,without ventilator) Clinical History clinical notes 3600Package Amount per

dayM1 M100066



Speciality Code


21.64 D General Medicine Status asthmaticus(admission type: ICU (with ventilator ) Clinical History clinical notes 4,500Package Amount per

dayM1 M100066

1561 21.65 A General Medicine Respiratory failure due to any cause (pneumonia, asthma, COPD, ARDS, foreign body,

poisoning, head injury etc.) (admission type: Routine ward )Concern Investigation clinical notes 1800

Package Amount per

dayM1 M100067

21.65 B General Medicine Respiratory failure due to any cause (pneumonia, asthma, COPD, ARDS, foreign body,

poisoning, head injury etc.)(admission type: HDU )Concern Investigation clinical notes 2700

Package Amount per

dayM1 M100067

21.65 C General Medicine Respiratory failure due to any cause (pneumonia, asthma, COPD, ARDS, foreign body,

poisoning, head injury etc.)(admission type: ICU ,without ventilator)Concern Investigation clinical notes 3600

Package Amount per

dayM1 M100067

21.65 D General Medicine Respiratory failure due to any cause (pneumonia, asthma, COPD, ARDS, foreign body,

poisoning, head injury etc.)(admission type: ICU (with ventilator )Concern Investigation clinical notes 4,500

Package Amount per

dayM1 M100067

1562 21.66 General Medicine

Blood and blood component transfusion (admission for a diagnostic procedure

leading to treatment requiring admission, e.g. bone marrow and bone biopsy,

endoscopy, liver biopsy, bronchoscopy, CT/MRI under GA, broncho-alveolar lavage,

lumbar puncture, muscle biopsy, pleural aspiration, ascitic tapping etc.)

Concern Investigation clinical notes 2,000Package Amount per

dayM1 M100068

1563 21.67 General Medicine Plasmapheresis - per session Concern Investigation clinical notes 2,000 M1 M100069

1564 21.68 General Medicine Haemodialysis/Peritoneal Dialysis - per session Concern Investigation clinical notes 2,300 M1 M100070

1565 21.69 General Medicine High end radiological diagnostic (CT, MRI, Imaging including nuclear imaging) - can

only be clubbed with medical package. Rs 5000 per annum limit to a familyclinical notes clinical notes 5,000

capped @ Rs 5000 per

annum for a familyM1 M100071

1566 21.70 General Medicine High end histopathology (Biopsies) and advanced serology investigations - can only be

clubbed with medical package. Rs 5000 per annum limit to a familyclinical notes clinical notes 5,000



1567 21.71 General Medicine CONSERVATIVE MANAGEMENT (ISCHEMIC STROKE) CT brain plain,others MRI brain with angiography

60000

(Payment fraction

( 1st week-

35%,2nd week-

25%,3rd week-

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


M1 M112001

1568 21.72 General Medicine THROMBOLYSIS WITH ACTILYSE FOR ISCHEMIC STROKE CT brain plain,othersRepeat CT brain after 24 hours,MRI

brain with angiography

120000

(Payment fraction

( 1st week-

50%,2nd week-

15%,3rd week-

10%,4th week-

10%,5th week-

10%,F/u-5%) of

total package

rate)

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


package rate)

M1 M112002

1569 21.73 General Medicine INTRAPARENCHYMAL /SUBARACHNOID HEMMORRHAGE (CONSERVATIVE

MANAGEMENT)CT brain plain,others

Repeat CT brain plain , CT angiography

brain

40000

(Payment fraction

( 1st week-

35%,2nd week-

25%,3rd week-

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


M1 M112003

1570 21.74 General Medicine MENINGOENCEPHALITIS, OR/ AND EVD/VP shunt (CONSERVATIVE MANAGEMENT) CT brain plain,CSF ,others MRI brain with contrast

110000

(Payment fraction

( 1st week-

35%,2nd week-

25%,3rd week-

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


M1 M112004



Speciality Code


1571 21.75 General Medicine MYASTHENIA CRISIS MANAGEMENT BY PLASMAPHERESIS


neurophysician OR




MUSK antibody

110000

(Payment fraction

( 1st week-

35%,2nd week-

25%,3rd week-

15%,4th week-

10%,5th week-

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


package rate)

M1 M112005

1572 21.76 General Medicine MYASTHENIA CRISIS MANAGEMENT BY IV IMMUNOGLOBINS


neurophysician OR




MUSK antibody

200000

(Payment fraction

( 1st week-

50%,2nd week-

15%,3rd week-

10%,4th week-

10%,5th week-

10%,F/u-5%) of

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


package rate)

M1 M112006

1573 21.77 General Medicine Gullian-barre syndrome management by plasmapheresisClinical diagnosis by

neurophysicianCSF study, NCV/EMG

109627

(Payment fraction

( 1st week-

35%,2nd week-

25%,3rd week-

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


M1 M112007

1574 21.78 General Medicine Gullian-barre syndrome management by Intravenous immunoglobulinClinical diagnosis by

neurophysicianCSF study, NCV/EMG 200000

( 1st week-50%,2nd

week-15%,3rd week-

10%,4th week-

10%,5th week-


M1 M112008



Speciality Code


1575 22.1 Mental Disorder Organic, including symptomatic, mental disorders (Admision Type -routine ward)Clinical assessment and

investigations

Clinical assessment& Report/ Mental

Status Examination 1,500

Government

Reserve,Package

amount is per Day

M8 M800001

1576 22.2 Mental DisorderMental and Behavioural disorders due to psychoactive substance use (Admision Type -

routine ward)


investigations



Government

Reserve,Package

amount is per Day

M8 M800002

1577 22.3 Mental Disorder Schizophrenia, schizotypal and delusional disorders (Admision Type -routine ward)Clinical assessment and

investigations



Government

Reserve,Package

amount is per Day

M8 M800003

1578 22.4 Mental Disorder Mood (affective) disorders (Admision Type -routine ward)Clinical assessment and

investigations


Status Examination/Related

Investigations

1,500

Government

Reserve,Package

amount is per Day

M8 M800004

1579 22.5 Mental Disorder Neurotic, stress-related and somatoform disorders (Admision Type -routine ward)Clinical assessment and

investigations



Investigations

1,500 M8 M800005

Cluster - 22 MENTAL DISORDER PACKAGES



Speciality Code


1580 22.6 Mental DisorderBehavioural syndromes associated with physiological disturbances and physical

factors (Admision Type -routine ward)


investigations



Investigations

1,500

Government

Reserve,Package

amount is per Day

M8 M800006

1581 22.7 Mental Disorder Mental retardation (Admision Type -routine ward)Clinical assessment and

investigations



Investigations

1,500

Government

Reserve,Package

amount is per Day

M8 M800007

1582 22.8 Mental Disorder Organic, including symptomatic, mental disorders (Admision Type -HDU)Clinical assessment and

investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800008

1583 22.9 Mental DisorderMental and Behavioural disorders due to psychoactive substance use (Admision Type -

HDU)


investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800009

1584 22.10 Mental Disorder Schizophrenia, schizotypal and delusional disorders (Admision Type -HDU)Clinical assessment and

investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800010

1585 22.11 Mental Disorder Mood (affective) disorders (Admision Type -HDU)Clinical assessment and

investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800011

1586 22.12 Mental Disorder Neurotic, stress-related and somatoform disorders (Admision Type -HDU)Clinical assessment and

investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800012

1587 22.13 Mental DisorderBehavioural syndromes associated with physiological disturbances and physical

factors (Admision Type -HDU)


investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800013



Speciality Code


1588 22.14 Mental Disorder Mental Retardation (Admision Type -HDU)Clinical assessment and

investigations



Investigations

2,500

Government

Reserve,Package

amount is per Day

M8 M800014

1589 22.15 Mental Disorder

Pre- Electro Convulsive Therapy (ECT) and Pre- Transcranial Magnetic Stimulation

(TMS) Package (Cognitive Tests, Complete Haemogram, Liver Function Test, Renal

Function Test, Serum Electrolytes, Electro Cardiogram (ECG), CT/MRI Brain,

Electroencephalogram, Thyroid Function Test, VDRL, HIV Test, Vitamin B12 levels,

Folate levels, Lipid Profile, Homocysteine levels)


investigations



Investigations

10,000 Government Reserve M8 M800015

1590 22.16 Mental Disorder Electro Convulsive Therapy (ECT) - per sessionClinical assessment and

investigations



Investigations


1591 22.17 Mental Disorder Transcranial Magnetic Stimulation (TMS) - per sessionClinical assessment and

investigations



Investigations




Speciality Code


1592 23.1Emergency Room

PackagesEmergency with stable cardiopulmonary status X Ray,ECG with report X Ray,ECG with report 1,000 M7 M700001


Packages

Emergency consultation: acute colic, high fever, cut, stitches, soft tissue injury, FB

removalBlood test clinical notes 1,000 M7 M700002


Packages

Single bone fracture plaster, nebulization for asthmatic attack, moderate

dehydration, hypoglycaemia in a diabetic, Dengue without complication, Syncope,

Food poisoning etc

Blood test clinical notes 1,000 M7 M700003


PackagesAnimal bites (Payment after completion of 5th dose) clinical notes Antirabies register/Stock register 1,700 M7 M700004



Speciality Code


Cluster - 23 EMERGENCY ROOM PACKAGES (Care Requiring Less Than 12 hrs Stay )

Cluster - 24 PEAEDIATRIC MEDICAL MANAGEMENT



Speciality Code


1596 24.1 A Pediatric Medicine Diarrhoea (admission type: Routine ward)clinical notes,Concern

Investigationsclinical notes,Concern Investigations 1,800 M2 M200001

24.1 B Pediatric Medicine Diarrhoea (admission type: HDU)clinical notes,Concern


24.1 C Pediatric Medicine Diarrhoea (admission type: ICU without ventilator)clinical notes,Concern


24.1 D Pediatric Medicine Diarrhoea (admission type: ICU (with ventilator))clinical notes,Concern


1597 24.2 A Pediatric Medicine Acute dysentery (admission type: Routine ward)clinical notes,Concern


24.2 B Pediatric Medicine Acute dysentery(admission type: HDU)clinical notes,Concern


24.2 C Pediatric Medicine Acute dysentery (admission type: ICU (without ventilator))clinical notes,Concern


24.2 D Pediatric Medicine Acute dysentery (admission type: ICU (with ventilator))clinical notes,Concern


1598 24.3 A Pediatric Medicine Pneumonia (admission type: Routine ward)clinical notes,Concern


24.3 B Pediatric Medicine Pneumonia (admission type: HDU)clinical notes,Concern


24.3 C Pediatric Medicine Pneumonia (admission type: ICU, without ventilator)clinical notes,Concern


24.3 D Pediatric Medicine Pneumonia (admission type: ICU, with ventilator)clinical notes,Concern


1599 24.4 A Pediatric Medicine Urinary tract infection (admission type: Routine ward)clinical notes,Concern


24.4 B Pediatric Medicine Urinary tract infection (admission type: HDU)clinical notes,Concern


24.4 C Pediatric Medicine Urinary tract infection (admission type: ICU, without ventilator)clinical notes,Concern




Speciality Code


24.4 D Pediatric Medicine Urinary tract infection (admission type: ICU, with ventilator)clinical notes,Concern


1600 24.5 A Pediatric Medicine Acute Exacerbation of asthma (admission type: Routine ward)clinical notes,Concern


24.5 B Pediatric Medicine Acute Exacerbation of asthma (admission type:HDU)clinical notes,Concern


24.5 C Pediatric Medicine Acute Exacerbation of asthma (admission type: ICU, without ventilator)clinical notes,Concern


24.5 D Pediatric Medicine Acute Exacerbation of asthma (admission type: ICU, with ventilator)clinical notes,Concern


1601 24.6 A Pediatric Medicine Acute glomerulonephritis (admission type: Routine ward)clinical notes,Concern


24.6 B Pediatric Medicine Acute glomerulonephritis (admission type: HDU)clinical notes,Concern


24.6 C Pediatric Medicine Acute glomerulonephritis (admission type: ICU, without ventilator)clinical notes,Concern


24.6 D Pediatric Medicine Acute glomerulonephritis (admission type: ICU, with ventilator)clinical notes,Concern


1602 24.7 A Pediatric Medicine Acute urticaria/ Anaphylaxis acute asthma (admission type: Routine ward)clinical notes,Concern


24.7 B Pediatric Medicine Acute urticaria/ Anaphylaxis acute asthma (admission type: HDU)clinical notes,Concern


24.7 C Pediatric Medicine Acute urticaria/ Anaphylaxis acute asthma (admission type: ICU, without ventilator)clinical notes,Concern


24.7 D Pediatric Medicine Acute urticaria/ Anaphylaxis acute asthma (admission type: ICU, with ventilator)clinical notes,Concern


1603 24.8 A Pediatric Medicine Poisonings with normal vital signs (admission type: Routine ward)clinical notes,Concern


24.8 B Pediatric Medicine Poisonings with normal vital signs (admission type: HDU)clinical notes,Concern


24.8 C Pediatric Medicine Poisonings with normal vital signs (admission type: ICU, without ventilator)clinical notes,Concern


24.8 D Pediatric Medicine Poisonings with normal vital signs (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1604 24.9 A Pediatric Medicine Febrile seizures/other seizures (admission type: Routine ward)clinical notes,Concern


24.9 B Pediatric Medicine Febrile seizures/other seizures (admission type: HDU)clinical notes,Concern


24.9 C Pediatric Medicine Febrile seizures/other seizures (admission type: ICU, without ventilator)clinical notes,Concern


24.9 D Pediatric Medicine Febrile seizures/other seizures (admission type: ICU, with ventilator)clinical notes,Concern


1605 24.10 A Pediatric Medicine Epileptic encephalopathy (admission type: Routine ward)clinical notes,Concern


24.10 B Pediatric Medicine Epileptic encephalopathy (admission type: HDU)clinical notes,Concern


24.10 C Pediatric Medicine Epileptic encephalopathy (admission type: ICU, without ventilator)clinical notes,Concern


24.10 D Pediatric Medicine Epileptic encephalopathy (admission type: ICU, with ventilator)clinical notes,Concern


1606 24.11 A Pediatric Medicine Optic neuritis (admission type: Routine ward)clinical notes,Concern


24.11 B Pediatric Medicine Optic neuritis (admission type: HDU)clinical notes,Concern


24.11 C Pediatric Medicine Optic neuritis (admission type: ICU, without ventilator)clinical notes,Concern


24.11 D Pediatric Medicine Optic neuritis (admission type: ICU, with ventilator)clinical notes,Concern


1607 24.12 A Pediatric Medicine Aseptic meningitis (admission type: Routine ward)clinical notes,Concern


24.12 B Pediatric Medicine Aseptic meningitis (admission type: HDU)clinical notes,Concern


24.12 C Pediatric Medicine Aseptic meningitis (admission type: ICU, without ventilator)clinical notes,Concern


24.12 D Pediatric Medicine Aseptic meningitis (admission type: ICU, with ventilator)clinical notes,Concern


1608 24.13 A Pediatric Medicine Trauma (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.13 B Pediatric Medicine Trauma (admission type: HDU)clinical notes,Concern


24.13 C Pediatric Medicine Trauma (admission type: ICU, without ventilator)clinical notes,Concern


24.13 D Pediatric Medicine Trauma (admission type: ICU, with ventilator)clinical notes,Concern


1609 24.14 A Pediatric Medicine Pyrexia of unexplained origin (admission type:Routine ward)clinical notes,Concern


24.14 B Pediatric Medicine Pyrexia of unexplained origin (admission type: HDU)clinical notes,Concern


24.14 C Pediatric Medicine Pyrexia of unexplained origin (admission type: ICU, without ventilator)clinical notes,Concern


24.14 D Pediatric Medicine Pyrexia of unexplained origin (admission type: ICU, with ventilator)clinical notes,Concern


1610 24.15 A Pediatric Medicine Chronic cough (admission type: Routine ward)clinical notes,Concern


24.15 B Pediatric Medicine Chronic cough (admission type: HDU)clinical notes,Concern


24.15 C Pediatric Medicine Chronic cough (admission type: ICU, without ventilator)clinical notes,Concern


24.15 D Pediatric Medicine Chronic cough (admission type: ICU, with ventilator)clinical notes,Concern


1611 24.16 A Pediatric Medicine Wheezing (admission type: Routine ward)clinical notes,Concern


24.16 B Pediatric Medicine Wheezing (admission type: HDU)clinical notes,Concern


24.16 C Pediatric Medicine Wheezing (admission type: ICU, without ventilator)clinical notes,Concern


24.16 D Pediatric Medicine Wheezing (admission type: ICU, with ventilator)clinical notes,Concern


1612 24.17 A Pediatric Medicine Unexplained seizures (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.17 B Pediatric Medicine Unexplained seizures (admission type: HDU)clinical notes,Concern


24.17 C Pediatric Medicine Unexplained seizures (admission type: ICU, without ventilator)clinical notes,Concern


24.17 D Pediatric Medicine Unexplained seizures (admission type: ICU, with ventilator)clinical notes,Concern


1613 24.18 A Pediatric MedicineGlobal developmental delay/ Intellectual disability of unknown etiology (admission

type: Routine ward)

clinical notes,Concern


24.18 B Pediatric MedicineGlobal developmental delay/ Intellectual disability of unknown etiology (admission

type: HDU)



24.18 C Pediatric MedicineGlobal developmental delay/ Intellectual disability of unknown etiology (admission

type: ICU, without ventilator



24.18 D Pediatric MedicineGlobal developmental delay/ Intellectual disability of unknown etiology (admission

type: ICU, with ventilator)



1614 24.19 A Pediatric Medicine Dysmorphic children (admission type: Routine ward)clinical notes,Concern


24.19 B Pediatric Medicine Dysmorphic children (admission type: HDU)clinical notes,Concern


24.19 C Pediatric Medicine Dysmorphic children (admission type: ICU, without ventilator)clinical notes,Concern


24.19 D Pediatric Medicine Dysmorphic children (admission type: ICU, with ventilator)clinical notes,Concern


1615 24.20 A Pediatric Medicine Rickets (admission type: Routine ward)clinical notes,Concern


24.20 B Pediatric Medicine Rickets (admission type: HDU)clinical notes,Concern


24.20 C Pediatric Medicine Rickets (admission type: ICU, without ventilator)clinical notes,Concern




Speciality Code


24.20 D Pediatric Medicine Rickets (admission type: ICU, with ventilator)clinical notes,Concern


1616 24.21 A Pediatric Medicine Unexplained severe anemia (admission type: Routine ward)clinical notes,Concern


24.21 B Pediatric Medicine Unexplained severe anemia (admission type: HDU)clinical notes,Concern


24.21 C Pediatric Medicine Unexplained severe anemia (admission type: ICU, without ventilator)clinical notes,Concern


24.21 D Pediatric Medicine Unexplained severe anemia (admission type: ICU, with ventilator)clinical notes,Concern


1617 24.22 A Pediatric Medicine Short stature (admission type: Routine ward)clinical notes,Concern


24.22 B Pediatric Medicine Short stature (admission type: HDU)clinical notes,Concern


24.22 C Pediatric Medicine Short stature (admission type: ICU, without ventilator)clinical notes,Concern


24.22 D Pediatric Medicine Short stature (admission type: ICU, with ventilator)clinical notes,Concern


1618 24.23 A Pediatric Medicine Musculoskeletal problems (admission type: Routine ward)clinical notes,Concern


24.23 B Pediatric Medicine Musculoskeletal problems (admission type: HDU)clinical notes,Concern


24.23 C Pediatric Medicine Musculoskeletal problems (admission type: ICU, without ventilator)clinical notes,Concern


24.23 D Pediatric Medicine Musculoskeletal problems (admission type: ICU, with ventilator)clinical notes,Concern


1619 24.24 A Pediatric Medicine Developmental and behavioral disorders (admission type: Routine ward)clinical notes,Concern


24.24 B Pediatric Medicine Developmental and behavioral disorders (admission type: HDU)clinical notes,Concern




Speciality Code


24.24 C Pediatric Medicine Developmental and behavioral disorders (admission type: ICU, without ventilator)clinical notes,Concern


24.24 D Pediatric Medicine Developmental and behavioral disorders (admission type: ICU, with ventilator)clinical notes,Concern


1620 24.25 A Pediatric Medicine Diabetic ketoacidosis (admission type: Routine ward)clinical notes,Concern


24.25 B Pediatric Medicine Diabetic ketoacidosis (admission type: HDU)clinical notes,Concern


24.25 C Pediatric Medicine Diabetic ketoacidosis (admission type: ICU, without ventilator)clinical notes,Concern


24.25 D Pediatric Medicine Diabetic ketoacidosis (admission type: ICU, with ventilator)clinical notes,Concern


1621 24.26 A Pediatric Medicine Nephrotic syndrome with peritonitis (admission type: Routine ward)clinical notes,Concern


24.26 B Pediatric Medicine Nephrotic syndrome with peritonitis (admission type: HDU)clinical notes,Concern


24.26 C Pediatric Medicine Nephrotic syndrome with peritonitis (admission type: ICU, without ventilator)clinical notes,Concern


24.26 D Pediatric Medicine Nephrotic syndrome with peritonitis (admission type: ICU, with ventilator)clinical notes,Concern


1622 24.27 A Pediatric Medicine Pyogenic meningitis (admission type: Routine ward)clinical notes,Concern


24.27 B Pediatric Medicine Pyogenic meningitis (admission type: HDU)clinical notes,Concern


24.27 C Pediatric Medicine Pyogenic meningitis (admission type: ICU, without ventilator)clinical notes,Concern


24.27 D Pediatric Medicine Pyogenic meningitis (admission type: ICU, with ventilator)clinical notes,Concern


1623 24.28 A Pediatric Medicine Persistent/ Chronic diarrhea (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.28 B Pediatric Medicine Persistent/ Chronic diarrhea (admission type: HDU)clinical notes,Concern


24.28 C Pediatric Medicine Persistent/ Chronic diarrhea (admission type: ICU, without ventilator)clinical notes,Concern


24.28 D Pediatric Medicine Persistent/ Chronic diarrhea (admission type: ICU, with ventilator)clinical notes,Concern


1624 24.29 A Pediatric Medicine Acute severe malnutrition (admission type: Routine ward)clinical notes,Concern


24.29 B Pediatric Medicine Acute severe malnutrition (admission type: HDU)clinical notes,Concern


24.29 C Pediatric Medicine Acute severe malnutrition (admission type: ICU, without ventilator)clinical notes,Concern


24.29 D Pediatric Medicine Acute severe malnutrition (admission type: ICU, with ventilator)clinical notes,Concern


1625 24.30 A Pediatric Medicine Dengue (admission type: Routine ward)clinical notes,Concern


24.30 B Pediatric Medicine Dengue (admission type: HDU)clinical notes,Concern


24.30 C Pediatric Medicine Dengue (admission type: ICU, without ventilator)clinical notes,Concern


24.30 D Pediatric Medicine Dengue (admission type: ICU, with ventilator)clinical notes,Concern


1626 24.31 A Pediatric Medicine Enteric fever (admission type: Routine ward)clinical notes,Concern


24.31 B Pediatric Medicine Enteric fever (admission type: HDU)clinical notes,Concern


24.31 C Pediatric Medicine Enteric fever (admission type: ICU, without ventilator)clinical notes,Concern


24.31 D Pediatric Medicine Enteric fever (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1627 24.32 A Pediatric Medicine Chikungunya (admission type: Routine ward)clinical notes,Concern


24.32 B Pediatric Medicine Chikungunya (admission type: HDU)clinical notes,Concern


24.32 C Pediatric Medicine Chikungunya (admission type: ICU, without ventilator)clinical notes,Concern


24.32 D Pediatric Medicine Chikungunya (admission type: ICU, with ventilator)clinical notes,Concern


1628 24.33 A Pediatric Medicine Acute hepatitis (admission type: Routine ward)clinical notes,Concern


24.33 B Pediatric Medicine Acute hepatitis (admission type: HDU)clinical notes,Concern


24.33 C Pediatric Medicine Acute hepatitis (admission type: ICU, without ventilator)clinical notes,Concern


24.33 D Pediatric Medicine Acute hepatitis (admission type: ICU, with ventilator)clinical notes,Concern


1629 24.34 A Pediatric Medicine Kala azar (admission type: Routine ward)clinical notes,Concern


24.34 B Pediatric Medicine Kala azar (admission type: HDU)clinical notes,Concern


24.34 C Pediatric Medicine Kala azar (admission type: ICU, without ventilator)clinical notes,Concern


24.34 D Pediatric Medicine Kala azar (admission type: ICU, with ventilator)clinical notes,Concern


1630 24.35 A Pediatric Medicine Tuberculosis (admission type: Routine ward)clinical notes,Concern


24.35 B Pediatric Medicine Tuberculosis (admission type: HDU)clinical notes,Concern


24.35 C Pediatric Medicine Tuberculosis (admission type: ICU, without ventilator)clinical notes,Concern


24.35 D Pediatric Medicine Tuberculosis (admission type: ICU, with ventilator)clinical notes,Concern


1631 24.36 A Pediatric Medicine HIV with complications (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.36 B Pediatric Medicine HIV with complications (admission type: HDU)clinical notes,Concern


24.36 C Pediatric Medicine HIV with complications (admission type: ICU, without ventilator)clinical notes,Concern


24.36 D Pediatric Medicine HIV with complications (admission type: ICU, with ventilator)clinical notes,Concern


1632 24.37 A Pediatric Medicine Infantile cholestasis (admission type: Routine ward)clinical notes,Concern


24.37 B Pediatric Medicine Infantile cholestasis (admission type: HDU)clinical notes,Concern


24.37 C Pediatric Medicine Infantile cholestasis (admission type: ICU, without ventilator)clinical notes,Concern


24.37 D Pediatric Medicine Infantile cholestasis (admission type: ICU, with ventilator)clinical notes,Concern


1633 24.38 A Pediatric Medicine Haemolytic uremic syndrome (admission type: Routine ward)clinical notes,Concern


24.38 B Pediatric Medicine Haemolytic uremic syndrome (admission type: HDU)clinical notes,Concern


24.38 C Pediatric Medicine Haemolytic uremic syndrome (admission type: ICU, without ventilator)clinical notes,Concern


24.38 D Pediatric Medicine Haemolytic uremic syndrome (admission type: ICU, with ventilator)clinical notes,Concern


1634 24.39 A Pediatric Medicine ITP (admission type: Routine down)clinical notes,Concern


24.39 B Pediatric Medicine ITP (admission type: HDU)clinical notes,Concern


24.39 C Pediatric Medicine ITP (admission type: ICU, without ventilator)clinical notes,Concern


24.39 D Pediatric Medicine ITP (admission type: ICU, with ventilator)clinical notes,Concern


1635 24.40 A Pediatric Medicine Juvenile myasthenia (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.40 B Pediatric Medicine Juvenile myasthenia (admission type: HDU)clinical notes,Concern


24.40 C Pediatric Medicine Juvenile myasthenia (admission type: ICU, without ventilator)clinical notes,Concern


24.40 D Pediatric Medicine Juvenile myasthenia (admission type: ICU, with ventilator)clinical notes,Concern


1636 24.41 A Pediatric Medicine Kawasaki Disease (admission type: Routine ward)clinical notes,Concern


24.41 B Pediatric Medicine Kawasaki Disease (admission type: HDU)clinical notes,Concern


24.41 C Pediatric Medicine Kawasaki Disease (admission type: ICU, without ventilator)clinical notes,Concern


24.41 D Pediatric Medicine Kawasaki Disease (admission type: ICU, with ventilator)clinical notes,Concern


1637 24.42 A Pediatric Medicine Persistent pneumonia (admission type: Routine ward)clinical notes,Concern


24.42 B Pediatric Medicine Persistent pneumonia (admission type: HDU)clinical notes,Concern


24.42 C Pediatric Medicine Persistent pneumonia (admission type: ICU, without ventilator)clinical notes,Concern


24.42 D Pediatric Medicine Persistent pneumonia (admission type: ICU, with ventilator)clinical notes,Concern


1638 24.43 A Pediatric Medicine Empyema (admission type: Routine ward)clinical notes,Concern




Speciality Code


24.43 B Pediatric Medicine Empyema (admission type: HDU)clinical notes,Concern


24.43 C Pediatric Medicine Empyema (admission type: ICU, without ventilator)clinical notes,Concern


24.43 D Pediatric Medicine Empyema (admission type: ICU, with ventilator)clinical notes,Concern


1639 24.44 A Pediatric Medicine Immune haemolytic anemia (admission type: Routine ward)clinical notes,Concern


24.44 B Pediatric Medicine Immune haemolytic anemia (admission type: HDU)clinical notes,Concern


24.44 C Pediatric Medicine Immune haemolytic anemia (admission type: ICU, without ventilator)clinical notes,Concern


24.44 D Pediatric Medicine Immune haemolytic anemia (admission type: ICU, with ventilator)clinical notes,Concern


1640 24.45 A Pediatric Medicine Cyanotic spells (admission type: Routine ward)clinical notes,Concern


24.45 B Pediatric Medicine Cyanotic spells (admission type: HDU)clinical notes,Concern


24.45 C Pediatric Medicine Cyanotic spells (admission type: ICU, without ventilator)clinical notes,Concern


24.45 D Pediatric Medicine Cyanotic spells (admission type: ICU, with ventilator)clinical notes,Concern


1641 24.46 A Pediatric Medicine Rheumatic fever (admission type: Routine ward)clinical notes,Concern


24.46 B Pediatric Medicine Rheumatic fever (admission type: HDU)clinical notes,Concern




Speciality Code


24.46 C Pediatric Medicine Rheumatic fever (admission type: ICU, without ventilator)clinical notes,Concern


24.46 D Pediatric Medicine Rheumatic fever (admission type: ICU, with ventilator)clinical notes,Concern


1642 24.47 A Pediatric Medicine Rheumatoid arthritis (admission type: Routine ward)clinical notes,Concern


24.47 B Pediatric Medicine Rheumatoid arthritis (admission type: HDU)clinical notes,Concern


24.47 C Pediatric Medicine Rheumatoid arthritis (admission type: ICU, without ventilator)clinical notes,Concern


24.47 D Pediatric Medicine Rheumatoid arthritis (admission type: ICU, with ventilator)clinical notes,Concern


1643 24.48 A Pediatric Medicine Encephalitis (admission type: Routine ward)clinical notes,Concern


24.48 B Pediatric Medicine Encephalitis (admission type: HDU)clinical notes,Concern


24.48 C Pediatric Medicine Encephalitis (admission type: ICU, without ventilator)clinical notes,Concern


24.48 D Pediatric Medicine Encephalitis (admission type: ICU, with ventilator)clinical notes,Concern


1644 24.49 A Pediatric Medicine Chronic meningitis (admission type: Routine ward)clinical notes,Concern


24.49 B Pediatric Medicine Chronic meningitis (admission type: HDU)clinical notes,Concern


24.49 C Pediatric Medicine Chronic meningitis (admission type: ICU, without ventilator)clinical notes,Concern


24.49 D Pediatric Medicine Chronic meningitis (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1645 24.50 A Pediatric MedicineIntracranial ring enhancing lesion with complication (neurocysticercosis,

tuberculoma) (admission type: Routine ward)



24.50 B Pediatric MedicineIntracranial ring enhancing lesion with complication (neurocysticercosis,

tuberculoma) (admission type: HDU)



24.50 C Pediatric MedicineIntracranial ring enhancing lesion with complication (neurocysticercosis,

tuberculoma) (admission type: ICU, without ventilator)



24.50 D Pediatric MedicineIntracranial ring enhancing lesion with complication (neurocysticercosis,

tuberculoma) (admission type: ICU, with ventilator)



1646 24.51 A Pediatric Medicine Refractory seizures (admission type: Routine ward)clinical notes,Concern


24.51 B Pediatric Medicine Refractory seizures (admission type: HDU)clinical notes,Concern


24.51 C Pediatric Medicine Refractory seizures (admission type: ICU, without ventilator)clinical notes,Concern


24.51 D Pediatric Medicine Refractory seizures (admission type: ICU, with ventilator)clinical notes,Concern


1647 24.52 A Pediatric Medicine Floppy infant (admission type: Routine ward)clinical notes,Concern


24.52 B Pediatric Medicine Floppy infant (admission type: HDU)clinical notes,Concern


24.52 C Pediatric Medicine Floppy infant (admission type: ICU, without ventilator)clinical notes,Concern


24.52 D Pediatric Medicine Floppy infant (admission type: ICU, with ventilator)clinical notes,Concern


1648 24.53 A Pediatric Medicine Acute neuroregression (admission type: Routine ward)clinical notes,Concern


24.53 B Pediatric Medicine Acute neuroregression (admission type: HDU)clinical notes,Concern




Speciality Code


24.53 C Pediatric Medicine Acute neuroregression (admission type: ICU, without ventilator)clinical notes,Concern


24.53 D Pediatric Medicine Acute neuroregression (admission type: ICU, with ventilator)clinical notes,Concern


1649 24.54 A Pediatric Medicine Neuromuscular disorders (admission type: Routine ward)clinical notes,Concern


24.54 B Pediatric Medicine Neuromuscular disorders (admission type: HDU)clinical notes,Concern


24.54 C Pediatric Medicine Neuromuscular disorders (admission type: ICU, without ventilator)clinical notes,Concern


24.54 D Pediatric Medicine Neuromuscular disorders (admission type: ICU, with ventilator)clinical notes,Concern


1650 24.55 A Pediatric Medicine Opsoclonus myoclonus syndrome (admission type: Routine ward)clinical notes,Concern


24.55 B Pediatric Medicine Opsoclonus myoclonus syndrome (admission type: HDU)clinical notes,Concern


24.55 C Pediatric Medicine Opsoclonus myoclonus syndrome (admission type: ICU, without ventilator)clinical notes,Concern


24.55 D Pediatric Medicine Opsoclonus myoclonus syndrome (admission type: ICU, with ventilator)clinical notes,Concern


1651 24.56 A Pediatric Medicine Acute ataxia (admission type: Routine ward)clinical notes,Concern


24.56 B Pediatric Medicine Acute ataxia (admission type: HDU)clinical notes,Concern


24.56 C Pediatric Medicine Acute ataxia (admission type: ICU, without ventilator)clinical notes,Concern


24.56 D Pediatric Medicine Acute ataxia (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1652 24.57 A Pediatric Medicine Steven Johnson syndrome (admission type: Routine ward)clinical notes,Concern


24.57 B Pediatric Medicine Steven Johnson syndrome (admission type: HDU)clinical notes,Concern


24.57 C Pediatric Medicine Steven Johnson syndrome (admission type: ICU, without ventilator)clinical notes,Concern


24.57 D Pediatric Medicine Steven Johnson syndrome (admission type: ICU, with ventilator)clinical notes,Concern


1653 24.58 A Pediatric Medicine Metabolic encephalopathy (admission type: Routine ward)clinical notes,Concern


24.58 B Pediatric Medicine Metabolic encephalopathy (admission type: HDU)clinical notes,Concern


24.58 C Pediatric Medicine Metabolic encephalopathy (admission type: ICU, without ventilator)clinical notes,Concern


24.58 D Pediatric Medicine Metabolic encephalopathy (admission type: ICU, with ventilator)clinical notes,Concern


1654 24.59 A Pediatric Medicine Ketogenic diet initiation in refractory epilepsy (admission type: Routine ward)clinical notes,Concern


24.59 B Pediatric Medicine Ketogenic diet initiation in refractory epilepsy (admission type: HDU)clinical notes,Concern


24.59 C Pediatric MedicineKetogenic diet initiation in refractory epilepsy (admission type: ICU, without

ventilator)



24.59 D Pediatric Medicine Ketogenic diet initiation in refractory epilepsy (admission type: ICU, with ventilator)clinical notes,Concern


1655 24.60 A Pediatric Medicine Inborn errors of metabolism (admission type: Routine ward)clinical notes,Concern


24.60 B Pediatric Medicine Inborn errors of metabolism (admission type: HDU)clinical notes,Concern




Speciality Code


24.60 C Pediatric Medicine Inborn errors of metabolism (admission type: ICU, without ventilator)clinical notes,Concern


24.60 D Pediatric Medicine Inborn errors of metabolism (admission type: ICU, with ventilator)clinical notes,Concern


1656 24.61 A Pediatric Medicine Wilson’s disease (admission type: Routine ward)clinical notes,Concern


24.61 B Pediatric Medicine Wilson’s disease (admission type: HDU)clinical notes,Concern


24.61 C Pediatric Medicine Wilson’s disease (admission type: ICU, without ventilator)clinical notes,Concern


24.61 D Pediatric Medicine Wilson’s disease (admission type: ICU, with ventilator)clinical notes,Concern


1657 24.62 A Pediatric Medicine Celiac disease (admission type: Routine ward)clinical notes,Concern


24.62 B Pediatric Medicine Celiac disease (admission type: HDU)clinical notes,Concern


24.62 C Pediatric Medicine Celiac disease (admission type: ICU, without ventilator)clinical notes,Concern


24.62 D Pediatric Medicine Celiac disease (admission type: ICU, with ventilator)clinical notes,Concern


1658 24.63 A Pediatric Medicine Unexplained jaundice (admission type: Routine ward)clinical notes,Concern


24.63 B Pediatric Medicine Unexplained jaundice (admission type: HDU)clinical notes,Concern


24.63 C Pediatric Medicine Unexplained jaundice (admission type: ICU, without ventilator)clinical notes,Concern


24.63 D Pediatric Medicine Unexplained jaundice (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1659 24.64 A Pediatric Medicine Unexplained hepatosplenomegaly (admission type: Routine ward)clinical notes,Concern


24.64 B Pediatric Medicine Unexplained hepatosplenomegaly (admission type: HDU)clinical notes,Concern


24.64 C Pediatric Medicine Unexplained hepatosplenomegaly (admission type: ICU, without ventilator)clinical notes,Concern


24.64 D Pediatric Medicine Unexplained hepatosplenomegaly (admission type: ICU, with ventilator)clinical notes,Concern


1660 24.65 A Pediatric Medicine Severe pneumonia (admission type: Routine ward)clinical notes,Concern


24.65 B Pediatric Medicine Severe pneumonia (admission type: HDU)clinical notes,Concern


24.65 C Pediatric Medicine Severe pneumonia (admission type: ICU, without ventilator)clinical notes,Concern


24.65 D Pediatric Medicine Severe pneumonia (admission type: ICU, with ventilator)clinical notes,Concern


1661 24.66 A Pediatric Medicine Severe exacerbation of asthma (admission type: Routine ward)clinical notes,Concern


24.66 B Pediatric Medicine Severe exacerbation of asthma (admission type: HDU)clinical notes,Concern


24.66 C Pediatric Medicine Severe exacerbation of asthma (admission type: ICU, without ventilator)clinical notes,Concern


24.66 D Pediatric Medicine Severe exacerbation of asthma (admission type: ICU, with ventilator)clinical notes,Concern


1662 24.67 A Pediatric Medicine Acute kidney injury (admission type: Routine ward)clinical notes,Concern


24.67 B Pediatric Medicine Acute kidney injury (admission type: HDU)clinical notes,Concern




Speciality Code


24.67 C Pediatric Medicine Acute kidney injury (admission type: ICU, without ventilator)clinical notes,Concern


24.67 D Pediatric Medicine Acute kidney injury (admission type: ICU, with ventilator)clinical notes,Concern


1663 24.68 A Pediatric Medicine Poisonings (admission type: Routine ward)clinical notes,Concern


24.68 B Pediatric Medicine Poisonings (admission type: HDU)clinical notes,Concern


24.68 C Pediatric Medicine Poisonings (admission type: ICU, without ventilator)clinical notes,Concern


24.68 D Pediatric Medicine Poisonings (admission type: ICU, with ventilator)clinical notes,Concern


1664 24.69 A Pediatric Medicine Serious trauma with unstable vitals (admission type: Routine ward)clinical notes,Concern


24.69 B Pediatric Medicine Serious trauma with unstable vitals (admission type: HDU)clinical notes,Concern


24.69 C Pediatric Medicine Serious trauma with unstable vitals (admission type: ICU, without ventilator)clinical notes,Concern


24.69 D Pediatric Medicine Serious trauma with unstable vitals (admission type: ICU, with ventilator)clinical notes,Concern


1665 24.70 A Pediatric Medicine Upper GI hemorrhage (admission type: Routine ward)clinical notes,Concern


24.70 B Pediatric Medicine Upper GI hemorrhage (admission type: HDU)clinical notes,Concern


24.70 C Pediatric Medicine Upper GI hemorrhage (admission type: ICU, without ventilator)clinical notes,Concern


24.70 D Pediatric Medicine Upper GI hemorrhage (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1666 24.71 A Pediatric Medicine Lower GI hemorrhage (admission type: Routine ward )clinical notes,Concern


24.71 B Pediatric Medicine Lower GI hemorrhage (admission type: HDU)clinical notes,Concern


24.71 C Pediatric Medicine Lower GI hemorrhage (admission type: ICU, without ventilator)clinical notes,Concern


24.71 D Pediatric Medicine Lower GI hemorrhage (admission type: ICU, with ventilator)clinical notes,Concern


1667 24.72 A Pediatric Medicine Acute abdomen (admission type: Routine ward)clinical notes,Concern


24.72 B Pediatric Medicine Acute abdomen (admission type: HDU)clinical notes,Concern


24.72 C Pediatric Medicine Acute abdomen (admission type: ICU, without ventilator)clinical notes,Concern


24.72 D Pediatric Medicine Acute abdomen (admission type: ICU, with ventilator)clinical notes,Concern


1668 24.73 A Pediatric Medicine Liver abscess (admission type: Routine ward)clinical notes,Concern


24.73 B Pediatric Medicine Liver abscess (admission type: HDU)clinical notes,Concern


24.73 C Pediatric Medicine Liver abscess (admission type: ICU, without ventilator)clinical notes,Concern


24.73 D Pediatric Medicine Liver abscess (admission type: ICU, with ventilator)clinical notes,Concern


1669 24.74 A Pediatric Medicine Complicated malaria (admission type: Routine ward)clinical notes,Concern


24.74 B Pediatric Medicine Complicated malaria (admission type: HDU)clinical notes,Concern




Speciality Code


24.74 C Pediatric Medicine Complicated malaria (admission type: ICU, without ventilator)clinical notes,Concern


24.74 D Pediatric Medicine Complicated malaria (admission type: ICU, with ventilator)clinical notes,Concern


1670 24.75 A Pediatric Medicine Severe dengue with shock (admission type: Routine ward)clinical notes,Concern


24.75 B Pediatric Medicine Severe dengue with shock (admission type: HDU)clinical notes,Concern


24.75 C Pediatric Medicine Severe dengue with shock (admission type: ICU, without ventilator)clinical notes,Concern


24.75 D Pediatric Medicine Severe dengue with shock (admission type: ICU, with ventilator)clinical notes,Concern


1671 24.76 A Pediatric Medicine Congestive cardiac failure (admission type: Routine ward)clinical notes,Concern


24.76 B Pediatric Medicine Congestive cardiac failure (admission type: HDU)clinical notes,Concern


24.76 C Pediatric Medicine Congestive cardiac failure (admission type: ICU, without ventilator)clinical notes,Concern


24.76 D Pediatric Medicine Congestive cardiac failure (admission type: ICU, with ventilator)clinical notes,Concern


1672 24.77 A Pediatric Medicine Brain abscess (admission type: Routine ward)clinical notes,Concern


24.77 B Pediatric Medicine Brain abscess (admission type: HDU)clinical notes,Concern


24.77 C Pediatric Medicine Brain abscess (admission type: ICU, without ventilator)clinical notes,Concern


24.77 D Pediatric Medicine Brain abscess (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1673 24.78 A Pediatric Medicine Acute encephalitic syndrome (admission type: Routine ward)clinical notes,Concern


24.78 B Pediatric Medicine Acute encephalitic syndrome (admission type: HDU)clinical notes,Concern


24.78 C Pediatric Medicine Acute encephalitic syndrome (admission type: ICU, without ventilator)clinical notes,Concern


24.78 D Pediatric Medicine Acute encephalitic syndrome (admission type: ICU, with ventilator)clinical notes,Concern


1674 24.79 A Pediatric Medicine Acute demyelinating myelopathy, (admission type: Routine ward)clinical notes,Concern


24.79 B Pediatric Medicine Acute demyelinating myelopathy, (admission type: HDU)clinical notes,Concern


24.79 C Pediatric Medicine Acute demyelinating myelopathy, (admission type: ICU, without ventilator)clinical notes,Concern


24.79 D Pediatric Medicine Acute demyelinating myelopathy, (admission type: ICU, with ventilator)clinical notes,Concern


1675 24.80 A Pediatric MedicineImmune mediated CNS disorders such as autoimmune encephalitis (admission type:

Routine ward)



24.80 B Pediatric MedicineImmune mediated CNS disorders such as autoimmune encephalitis (admission type:

HDU)



24.80 C Pediatric MedicineImmune mediated CNS disorders such as autoimmune encephalitis (admission type:

ICU, without ventilator)



24.80 D Pediatric MedicineImmune mediated CNS disorders such as autoimmune encephalitis (admission type:

ICU, with ventilator)



1676 24.81 A Pediatric Medicine Acute transverse myelitis (admission type: Routine ward)clinical notes,Concern


24.81 B Pediatric Medicine Acute transverse myelitis (admission type: HDU)clinical notes,Concern




Speciality Code


24.81 C Pediatric Medicine Acute transverse myelitis (admission type: ICU, without ventilator)clinical notes,Concern


24.81 D Pediatric Medicine Acute transverse myelitis (admission type: ICU, with ventilator)clinical notes,Concern


1677 24.82 A Pediatric Medicine Guillain Barre Syndrome (admission type: Routine ward)clinical notes,Concern


24.82 B Pediatric Medicine Guillain Barre Syndrome (admission type: HDU)clinical notes,Concern


24.82 C Pediatric Medicine Guillain Barre Syndrome (admission type: ICU, without ventilator)clinical notes,Concern


24.82 D Pediatric Medicine Guillain Barre Syndrome (admission type: ICU, with ventilator)clinical notes,Concern


1678 24.83 A Pediatric Medicine Hydrocephalus (admission type: Routine ward)clinical notes,Concern


24.83 B Pediatric Medicine Hydrocephalus (admission type:HDU)clinical notes,Concern


24.83 C Pediatric Medicine Hydrocephalus (admission type: ICU, without ventilator)clinical notes,Concern


24.83 D Pediatric Medicine Hydrocephalus (admission type: ICU, with ventilator)clinical notes,Concern


1679 24.84 A Pediatric Medicine Intracranial space occupying lesion (admission type: Routine ward)clinical notes,Concern


24.84 B Pediatric Medicine Intracranial space occupying lesion (admission type: HDU)clinical notes,Concern


24.84 C Pediatric Medicine Intracranial space occupying lesion (admission type: ICU, without ventilator)clinical notes,Concern


24.84 D Pediatric Medicine Intracranial space occupying lesion (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1680 24.85 A Pediatric Medicine Cerebral malaria (admission type: Routine ward)clinical notes,Concern


24.85 B Pediatric Medicine Cerebral malaria (admission type: HDU)clinical notes,Concern


24.85 C Pediatric Medicine Cerebral malaria (admission type: ICU, without ventilator)clinical notes,Concern


24.85 D Pediatric Medicine Cerebral malaria (admission type: ICU, with ventilator)clinical notes,Concern


1681 24.86 A Pediatric Medicine Acute ischemic stroke (admission type: Routine ward)clinical notes,Concern


24.86 B Pediatric Medicine Acute ischemic stroke (admission type: HDU)clinical notes,Concern


24.86 C Pediatric Medicine Acute ischemic stroke (admission type: ICU, without ventilator)clinical notes,Concern


24.86 D Pediatric Medicine Acute ischemic stroke (admission type: ICU, with ventilator)clinical notes,Concern


1682 24.87 A Pediatric Medicine Cerebral sino-venous thrombosis (admission type: Routine ward)clinical notes,Concern


24.87 B Pediatric Medicine Cerebral sino-venous thrombosis (admission type: HDU)clinical notes,Concern


24.87 C Pediatric Medicine Cerebral sino-venous thrombosis (admission type: ICU, without ventilator)clinical notes,Concern


24.87 D Pediatric Medicine Cerebral sino-venous thrombosis (admission type: ICU, with ventilator)clinical notes,Concern


1683 24.88 A Pediatric MedicineRespiratory failure due to any causes (pneumonia, asthma, foreign body, poisoning,

head injury etc.) (admission type: Routine ward)



24.88 B Pediatric MedicineRespiratory failure due to any causes (pneumonia, asthma, foreign body, poisoning,

head injury etc.) (admission type: HDU)





Speciality Code


24.88 C Pediatric MedicineRespiratory failure due to any causes (pneumonia, asthma, foreign body, poisoning,

head injury etc.) (admission type: ICU, without ventilator)



24.88 D Pediatric MedicineRespiratory failure due to any causes (pneumonia, asthma, foreign body, poisoning,

head injury etc.) (admission type: ICU, with ventilator)



1684 24.89 A Pediatric Medicine Acute transverse myelitis (admission type: Routine ward)clinical notes,Concern


24.89 B Pediatric Medicine Acute transverse myelitis (admission type: HDU)clinical notes,Concern


24.89 C Pediatric Medicine Acute transverse myelitis (admission type: ICU, without ventilator)clinical notes,Concern


24.89 D Pediatric Medicine Acute transverse myelitis (admission type: ICU, with ventilator)clinical notes,Concern


1685 24.90 A Pediatric Medicine Acute encephalitis –infectious/immune-mediated (admission type: Routine ward)clinical notes,Concern


24.90 B Pediatric Medicine Acute encephalitis –infectious/immune-mediated (admission type: HDU)clinical notes,Concern


24.90 C Pediatric MedicineAcute encephalitis –infectious/immune-mediated (admission type: ICU, without

ventilator)



24.90 D Pediatric MedicineAcute encephalitis –infectious/immune-mediated (admission type: ICU, with

ventilator)



1686 24.91 A Pediatric Medicine Convulsive & non convulsive status epilepticus (admission type: Routine ward)clinical notes,Concern


24.91 B Pediatric Medicine Convulsive & non convulsive status epilepticus (admission type: HDU)clinical notes,Concern


24.91 C Pediatric MedicineConvulsive & non convulsive status epilepticus (admission type: ICU, without

ventilator)



24.91 D Pediatric Medicine Convulsive & non convulsive status epilepticus (admission type: ICU, with ventilator)clinical notes,Concern




Speciality Code


1687 24.92 A Pediatric Medicine Cerebral herniation (admission type: Routine ward)clinical notes,Concern


24.92 B Pediatric Medicine Cerebral herniation (admission type: HDU)clinical notes,Concern


24.92 C Pediatric Medicine Cerebral herniation (admission type: ICU, without ventilator)clinical notes,Concern


24.92 D Pediatric Medicine Cerebral herniation (admission type: ICU, with ventilator)clinical notes,Concern


1688 24.93 A Pediatric Medicine Intracranial hemorrhage (admission type: Routine ward)clinical notes,Concern


24.93 B Pediatric Medicine Intracranial hemorrhage (admission type: HDU)clinical notes,Concern


24.93 C Pediatric Medicine Intracranial hemorrhage (admission type: ICU, without ventilator)clinical notes,Concern


24.93 D Pediatric Medicine Intracranial hemorrhage (admission type: ICU, with ventilator)clinical notes,Concern


1689 24.94 A Pediatric Medicine Hepatic encephalopathy (admission type: Rourine ward)clinical notes,Concern


24.94 B Pediatric Medicine Hepatic encephalopathy (admission type: HDU)clinical notes,Concern


24.94 C Pediatric Medicine Hepatic encephalopathy (admission type: ICU, without ventilator)clinical notes,Concern


24.94 D Pediatric Medicine Hepatic encephalopathy (admission type: ICU, with ventilator)clinical notes,Concern


1690 24.95 A Pediatric Medicine Complicated bacterial meningitis (admission type: Routine ward)clinical notes,Concern


24.95 B Pediatric Medicine Complicated bacterial meningitis (admission type: HDU)clinical notes,Concern




Speciality Code


24.95 C Pediatric Medicine Complicated bacterial meningitis (admission type: ICU, without ventilator)clinical notes,Concern


24.95 D Pediatric Medicine Complicated bacterial meningitis (admission type: ICU, with ventilator)clinical notes,Concern


1691 24.96 A Pediatric Medicine Raised intracranial pressure (admission type: routine ward)clinical notes,Concern


24.96 B Pediatric Medicine Raised intracranial pressure (admission type: HDU)clinical notes,Concern


24.96 C Pediatric Medicine Raised intracranial pressure (admission type: ICU, without ventilator)clinical notes,Concern


24.96 D Pediatric Medicine Raised intracranial pressure (admission type: ICU, with ventilator)clinical notes,Concern


1692 24.97 A Pediatric Medicine Hypertensive encephalopathy (admission type: Routind)clinical notes,Concern


24.97 B Pediatric Medicine Hypertensive encephalopathy (admission type: HDU)clinical notes,Concern


24.97 C Pediatric Medicine Hypertensive encephalopathy (admission type: ICU, without ventilator)clinical notes,Concern


24.97 D Pediatric Medicine Hypertensive encephalopathy (admission type: ICU, with ventilator)clinical notes,Concern


1693 24.98 Pediatric Medicine CRRT (per session)clinical notes,Concern




Speciality Code


1694 24.99 Pediatric Medicine

Blood and blood component transfusion up to a limit of 2 days(admission for a

diagnostic procedure leading to treatment requiring admission, e.g. bone marrow and

bone biopsy, endoscopy, liver biopsy, bronchoscopy, CT/MRI under GA, broncho-

alveolar lavage, lumbar puncture, muscle biopsy, FNAC, pleural aspiration, ascitic

tapping, neostigmine challenge test etc.)Package rate per Day


Investigationsclinical notes,Concern Investigations 1,500 Package rate per Day M2 M200099

1695 24.100 Pediatric MedicineBlood and blood component transfusion for indications like

Thalassemia/Hemoglobinopathies - upto a limit of 2 days,Package rate per Day


Investigationsclinical notes,Concern Investigations 1,500 Package rate per Day M2 M200100

1696 24.101 Pediatric MedicineHigh end radiological diagnostic (CT, MRI, Imaging including nuclear imaging) - can

only be clubbed with medical package.


Investigationsclinical notes,Concern Investigations 5,000



1697 24.102 Pediatric MedicineHigh end histopathology (Biopsies) and advanced serology investigations - can only be

clubbed with medical package.


Investigationsclinical notes,Concern Investigations 5,000





Speciality Code


1698 25.1 Neonatal

Basic neonatal care package (Rs. 500 per day, maximum 1500): Babies that can be

managed by side of mother in postnatal ward without requiring admission in

SNCU/NICU:

• Any newborn needing feeding support

• Babies requiring closer monitoring or short-term care for conditions like:

o Birth asphyxia (need for positive pressure ventilation; no HIE)

o Moderate jaundice requiring phototherapy

o Large for dates (>97 percentile) Babies

o Small for gestational age (less than 3rd centile) (Package rate is per day)

Blood sugar,Blood

group,Complete blood

count,Coombs test,others

as required,Concern

Investigaions

clinical notes,Concern Investigaions 500Capped Amount is

1500 for this PackageM3 M300001

Cluster - 25 NEO-NATAL PACKAGES



Speciality Code


1699 25.2 Neonatal

Special Neonatal Care Package (Rs. 3000 per day, maximum of 18000 - pre-auth after

4 days): Babies that required admission to SNCU or NICU:

Babies admitted for short term care for conditions like:

• Mild Respiratory Distress/tachypnea

• Mild encephalopathy

• Severe jaundice requiring intensive phototherapy

• Haemorrhagic disease of newborn

• Unwell baby requiring monitoring

• Some dehydration

• Hypoglycaemia

Mother's stay and food in the hospital for breastfeeding, family centred care and

(Kangaroo Mother Care) KMC is mandatory and included in the package rate

Blood sugar (Package rate

is per day)

Complete Blood Picture

Blood group

Bilirubin

Coombs Test

Chest X ray

CRP

Micro ESR

Blood Culture

Electrolytes

Renal function tests

Coagulation profile

Others as required

clinical notes,Concern Investigaions 3,000

Capped Amount is

18000 for this

Package

M3 M300002

1700 25.3 Neonatal

Intensive Neonatal Care Package (Rs. 5000 per day, maximum of Rs. 50,000 – pre-

auth is needed after 5 days) (Package rate is per day)

Babies with birthweight 1500-1799 g

or

Babies of any birthweight and at least one of the following conditions:

• Need for mechanical ventilation for less than 24 hours or non-invasive respiratory

support (CPAP, HFFNC)

• Sepsis / pneumonia without complications

• Hyperbilirubinemia requiring exchange transfusion

• Seizures

• Major congenital malformations (pre-surgical stabilization, not requiring

ventilation)

• Cholestasis significant enough requiring work up and in-hospital management

• Congestive heart failure or shock



Concern Investigaions clinical notes,Concern Investigaions 5,000

Capped Amount is

50000 for this

Package

M3 M300003



Speciality Code


1701 25.4 Neonatal

Advanced Neonatal Care Package (Rs. 6000 per day, maximum of Rs. 75,000 – pre-

auth is needed after 7 days) (Package rate is per day)

Babies with birthweight of 1200-1499 g

or

Babies of any birthweight with at least one of the following conditions:

• Any condition requiring invasive ventilation longer than 24 hours

• Hypoxic Ischemic encephalopathy requiring Therapeutic Hypothermia

• Cardiac rhythm disorders needing intervention (the cost of cardiac surgery or

implant will be covered under cardiac surgery packages)

• Sepsis with complications such as meningitis or bone and joint infection, DIC or

shock

• Renal failure requiring dialysis

• Inborn errors of metabolism




Capped Amount is

75000 for this

Package

M3 M300004

1702 25.5 Neonatal

Critical Care Neonatal Package (Rs. 7000 per day, maximum of Rs. 1,20,000 – pre-

auth after 10 days) (Package rate is per day)

Babies with birthweight of <1200 g

or

Babies of any birthweight with at least one of the following conditions:

• Severe Respiratory Failure requiring High Frequency Ventilation or inhaled Nitric

Oxide (iNO)

• Multisystem failure requiring multiple organ support including mechanical

ventilation and multiple inotropes

• Critical congenital heart disease




Capped Amount is

120000 for this

Package

M3 M300005

1703 25.6 Neonatal

Chronic Care Package (Rs. 3000 per day, maximum of Rs. 30,000): If the baby requires

stay beyond the upper limit of usual stay in Package no 0004 or 0005 for conditions

like severe BPD requiring respiratory support, severe NEC requiring prolonged TPN

support (Package rate is per day)


Investigaionsclinical notes,Concern Investigaions 3,000

Capped Amount is

30000 for this

Package

M3 M300006

1704 25.7 Neonatal High Risk Newborn Post Discharge Care Package (Protocol Driven)clinical notes,Concern

Investigaionsclinical notes,Concern Investigaions 2,400 M3 M300007

1705 25.8 Neonatal Laser Therapy for Retinopathy of Prematurity (Irrespective of no. of eyes affected) -

per session





Speciality Code


1706 25.9 Neonatal Advanced Surgery for Retinopathy of Prematurityclinical notes,Concern


1707 25.10 Neonatal Ventriculoperitoneal Shunt Surgery (VP) or Omaya Reservoir or External Drainage for

Hydrocephalus





Speciality Code


1708 26.1 Orthopeidc

AC joint reconstruction/ Stabilization/ Acromionplasty (Nonoperative management is

recommended for Rockwood type I and II injuries, whereas surgical reconstruction is

recommended for type IV and VI separations. The management for type III and V

injuries is more controversial and is determined on a case-by-case basis)

X Ray of Affected Limb,

MIR of ShoulderX Ray of Affected Limb 25,000 S5 S500001

1709 26.2 OrthopeidcAccessory bone – Excision (limbs) – congenital, Accessory digits sometime can be

removed X Ray of Affected Limb X Ray of Affected Limb 6,000 S5 S500002

1710 26.3 Orthopeidc Amputation - Below ElbowX Ray of Affected Limb,

clinical pictureX Ray of Affected Limb 15,000 S5 S500003

1711 26.4 Orthopeidc Amputation - Above ElbowX Ray of Affected Limb,


1712 26.5 Orthopeidc Amputation – one or more fingersX Ray of Affected Limb,


1713 26.6 Orthopeidc Amputation – WristX Ray of Affected Limb,


1714 26.7 Orthopeidc Amputation - one or more toes/ digitsX Ray of Affected Limb,


1715 26.8 Orthopeidc Amputation – Below KneeX Ray of Affected Limb,


1716 26.9 Orthopeidc Amputation – Above KneeX Ray of Affected Limb,


1717 26.10 Orthopeidc Foot & Hand Amputation (whole/ partial)X Ray of Affected Limb,


1718 26.11 Orthopeidc Disarticulation (hind & for quarter)Clinical and radiological

investigationClinical and radiological investigation 25,000 S5 S500011

1719 26.12 Orthopeidc Anterior Spine FixationClinical and radiological


1720 26.13 Orthopeidc Posterior Spine FixationClinical and radiological


Cluster - 26 ORTHOPEDICS



Speciality Code


1721 26.14 Orthopeidc Osteochondroma excision/ Excision of ExostosisClinical and radiological


1722 26.15 Orthopeidc Excision ArthoplastyClinical and radiological


1723 26.16 Orthopeidc Arthorotomy of any joint

X-Ray/USG/ MRI of

affected joints and clinical

photo , CBC

Clinical and radiological investigation 15,000 S5 S500016

1724 26.17 Orthopeidc Arthrodesis Ankle TripleClinical and radiological


1725 26.18 Orthopeidc Excision Arthoplasty of Femur headX-Ray, MRI of affected

joints , CBC, ESR, CRPPost-Operative X-Ray 22,500 S5 S500018

1726 26.19 Orthopeidc Bimalleolar Fracture FixationClinical and radiological


1727 26.20 Orthopeidc Bone Tumour Excision + reconstruction using implant (malignant/ benign)Clinical and radiological


1728 26.21 Orthopeidc Bone Tumour (malignant/ benign) curettage and bone graftingClinical and radiological


1729 26.22 OrthopeidcBone Tumour Excision (malignant/ benign) + Joint replacement (depending upon

type of joint and implant)

Clinical and radiological

investigationClinical and radiological investigation 1,50,000 S5 S500022

1730 26.23 Orthopeidc Clavicle fracture management - conservative (daycare) X- Ray of affected sights X- Ray of limb treated. 3,000 S5 S500023

1731 26.24 Orthopeidc Close Fixation - Hand BonesClinical and radiological

investigationX- Ray of limb treated. 4,000 S5 S500024

1732 26.25 Orthopeidc Close Fixation - Foot BonesX Ray of Affected Limb,

clinical pictureX- Ray of limb treated. 4,000 S5 S500025

1733 26.26 Orthopeidc Close Reduction - Small JointsX Ray of Affected Limb,


1734 26.27 Orthopeidc Closed Interlock Nailing + Bone Grafting – femurX Ray of Affected Limb,


1735 26.28 Orthopeidc Closed Interlocking IntermedullaryX Ray of Affected Limb,




Speciality Code


1736 26.29 Orthopeidc Closed Interlocking Tibia + Orif of Fracture FixationX Ray of Affected Limb,


1737 26.30 Orthopeidc Closed Reduction and Internal Fixation with K wireX Ray of Affected Limb,


1738 26.31 Orthopeidc Closed Reduction and Percutaneous Screw Fixation (neck femur)X Ray of Affected Limb,


1739 26.32 Orthopeidc Closed Reduction and Percutaneous PinningX Ray of Affected Limb,


1740 26.33 Orthopeidc Closed Reduction and Percutaneous NailingX Ray of Affected Limb,


1741 26.34 Orthopeidc Closed Reduction of the Hip (including hip Spika)X Ray of Affected Limb,


1742 26.35 OrthopeidcDebridement & Closure of Major injuries - contused lacerated wounds (anti-biotic +

dressing) - minimum of 3 sessions



1743 26.36 Orthopeidc Debridement & Closure of Minor injuriesX Ray of Affected Limb,


1744 26.37 Orthopeidc Closed reduction of dislocation (Knee/ Hip)X Ray of Affected Limb,


1745 26.38 Orthopeidc Closed reduction of dislocation (Shoulder/ Elbow)X Ray of Affected Limb,


1746 26.39 Orthopeidc Duputryen’s Contracture release + rehabilitation USG of Affected Hand clinical picture + USG 10,000 S5 S500039

1747 26.40 Orthopeidc Exploration and Ulnar nerve Repair X-Ray, UGS, RMG & NCV Post of USG 10,000 S5 S500040

1748 26.41 Orthopeidc External fixation - Long boneX Ray of Affected Limb,

clinical picturePost of X -Ray 15,000 S5 S500041

1749 26.42 Orthopeidc External fixation - Small boneX Ray of Affected Limb,


1750 26.43 Orthopeidc External fixation - PelvisX Ray of Affected Limb,


1751 26.44 Orthopeidc FasciotomyX Ray of Affected Limb,


1752 26.45 Orthopeidc Fixator with Joint ArthrolysisX Ray of Affected Limb,


1753 26.46 Orthopeidc Fracture - AcetabulumX Ray of Affected Limb,


1754 26.47 Orthopeidc Fracture - Fibula Internal FixationX Ray of Affected Limb,




Speciality Code


1755 26.48 OrthopeidcFracture - Hip Internal Fixation (Intertrochanteric Fracture with implant) +

rehabilitation



1756 26.49 Orthopeidc Fracture - Humerus Internal FixationX Ray of Affected Limb,


1757 26.50 Orthopeidc Fracture - Olecranon of UlnaX Ray of Affected Limb,


1758 26.51 Orthopeidc Fracture - Radius Internal FixationX Ray of Affected Limb,


1759 26.52 Orthopeidc Fracture - TIBIA Internal Fixation platingX Ray of Affected Limb,


1760 26.53 Orthopeidc Fracture - Ulna Internal FixationX Ray of Affected Limb,


1761 26.54 Orthopeidc Head Radius – ExcisionX Ray of Affected Limb,


1762 26.55 Orthopeidc High Tibial OsteotomyX Ray of Affected Limb,


1763 26.56 Orthopeidc Closed reduction + Hip SpicaX Ray of Affected Limb,


1764 26.57 Orthopeidc Internal Fixation Lateral EpicondyleX Ray of Affected Limb,


1765 26.58 Orthopeidc Internal Fixation of other Small Bones (metatarsals)X Ray of Affected Limb,


1766 26.59 Orthopeidc Limb LengtheningX Ray of Affected Limb,


1767 26.60 Orthopeidc Llizarov FixationX Ray of Affected Limb,


1768 26.61 Orthopeidc Multiple Tendon RepairClinical + Electro

Diagnostic studyClinical photographs showing scar 20,000 S5 S500061

1769 26.62 Orthopeidc Nerve Repair SurgeryClinical + Electro

Diagnostic study

Clinical photographs showing scar +

Electro Dignostic study15,000 S5 S500062

1770 26.63 Orthopeidc Nerve Transposition/Release/ NeurolysisClinical + Electro

Diagnostic study

Clinical photographs showing scar +

Electro Dignostic study8,000 S5 S500063

1771 26.64 Orthopeidc Open Reduction Internal Fixation (2 Small Bones)X Ray of Affected Limb,


1772 26.65 Orthopeidc Open Reduction Internal Fixation (Large Bone)X Ray of Affected Limb,


1773 26.66 Orthopeidc Open Reduction of CDHX Ray of Affected Limb,


1774 26.67 Orthopeidc Open Reduction of Small JointX Ray of Affected Limb,




Speciality Code


1775 26.68 Orthopeidc Open Reduction with bone grafting of nonunionX Ray of Affected Limb,


1776 26.69 Orthopeidc Osteotomy -Small BoneX Ray of Affected Limb,


1777 26.70 Orthopeidc Osteotomy -Long BoneX Ray of Affected Limb,


1778 26.71 Orthopeidc PatellectomyX Ray of Affected Limb,


1779 26.72 Orthopeidc Pelvic Osteotomy with fixation with plasterX Ray of Affected Limb,

clinical picturePost of X -Ray, Clinical photo 30,000 S5 S500072

1780 26.73 Orthopeidc Percutaneous - Fixation of FractureX Ray of Affected Limb,


1781 26.74 Orthopeidc Excision of BursaX Ray of Affected Limb,

clinical pictureRadiology Investigation 3,000 S5 S500074

1782 26.75 Orthopeidc Reconstruction of ACL/PCL with implant and braceClinical and radiological


1783 26.76 Orthopeidc Sequestrectomy of Long Bones + anti-biotics + dressingClinical and radiological


1784 26.77 Orthopeidc Tendo Achilles TenotomyX Ray of Affected Limb,

clinical pictureClinical and radiological investigation 5,000 S5 S500077

1785 26.78 Orthopeidc Tendon GraftingClinical and radiological


1786 26.79 Orthopeidc Tendon Release/ TenotomyClinical and radiological


1787 26.80 Orthopeidc TenolysisClinical and radiological


1788 26.81 Orthopeidc Tension Band Wiring PatellaClinical and radiological


1789 26.82 Orthopeidc Application of P.O.P. casts for Upper & Lower LimbsClinical and radiological


1790 26.83 Orthopeidc Application of P.O.P. Spikas& JacketsClinical and radiological


1791 26.84 Orthopeidc Application of Skeletal Tractions with pinClinical and radiological


1792 26.85 Orthopeidc Application of Skin TractionClinical and radiological




Speciality Code


1793 26.86 Orthopeidc Head radius - Excision + Fracture - Ulna Internal FixationClinical and radiological


1794 26.87 Orthopeidc External fixation - both bones of forearmsClinical and radiological


1795 26.88 Orthopeidc Fracture intercondylarHumerus + olecranon osteotomyClinical and radiological


1796 26.89 Orthopeidc Correction of club foot per castClinical and radiological


1797 26.90 Orthopeidc Arthroscopic Meniscus Repair/ MeniscectomyClinical and radiological


1798 26.91 Orthopeidc Bipolar Hemiarthroplasty (hip & shoulder)Clinical and radiological


1799 26.92 Orthopeidc Unipolar HemiarthroplastyClinical and radiological


1800 26.93 Orthopeidc Elbow replacementClinical and radiological


1801 26.94 Orthopeidc Arthrodesis of shoulderClinical and radiological


1802 26.95 Orthopeidc Arthrodesis of Knee (with implant)Clinical and radiological


1803 26.96 Orthopeidc Arthrodesis of Wrist (with implant)Clinical and radiological


1804 26.97 Orthopeidc Arthrodesis of Ankle (with implant)Clinical and radiological


1805 26.98 OrthopeidcUnspecified Surgical Package (Amount Capped @ 1,00,000rs per anum per


cluster - 1 burns and plastic surgery sr.no package no … 1.12 burns post burn contracture...

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