benefit packages of ayushman bharat - arogya …arogya.karnataka.gov.in/sast/details/benefit... ·...

Sl. no.Speciality

codePRocedure code Procedure name Rates Pre-op Investigation Post-op Investigation

1 S11 2A.S11.00001

2A.S11.00001 : % Total Body Surface Area Burns

(TBSA) (thermal/ scald/ flame burns) - any % (not

requiring admission). Needs at least 5-6 dressing

3500Clinical Photograph, Diagram with Rule

of 9 for extent of burnsClinical Photograph

S1 2A.S1.00040A 2A.S1.00040A : Excision Mammary Fistula - cross

speciality 5500 USG, Fistulogram Scar Photo, HPE Report

2 S16 2A.S16.00001 2A.S16.00001 : Fixation of fracture of jaw with closed

reduction (1 jaw) using wires - under LA2500 X Ray film with report X Ray film with report

3 S16 2A.S16.00006 2A.S16.00006 : Extraction of impacted tooth under

LA 250 X Ray film with report X Ray film with report

4 S16 2A.S16.00007 2A.S16.00007 : Cyst & tumour of Maxilla/mandible

by enucleation/excision/marsupialization under LA 1250

X Ray film with report,Clinical

Photograph,

X Ray film with report, Clinical

Photograph

5 S2 2A.S2.00001 2A.S2.00001 : Aural polypectomy 2000 Clinical photo Scar photo, HPE

6 S2 2A.S2.00003 2A.S2.00003 : Mastoidectomy 6250X-ray mastoid , Pure Tone Audiometry

Report X-Ray Mastoids, Scar photo

7 S2 2A.S2.00007 2A.S2.00007 : Myringoplasty with Ossiculoplasty 1750Pure Tone Audiometry Report and

Impedance Audiometry Report

Pure Tone Audiometry Report and


8 S2 2A.S2.00008 2A.S2.00008 : Myringotomy – Bilateral 3000 Pure Tone Audiometry Report Pure Tone Audiometry Report and


9 S2 2A.S2.00009 2A.S2.00009 : Myringotomy – Unilateral 1750 Pure Tone Audiometry Report Pure Tone Audiometry Report and


10 S2 2A.S2.00010 2A.S2.00010 : Myringotomy with Grommet - One ear 3250 Pure Tone Audiometry ReportPure Tone Audiometry Report and


11 S2 2A.S2.00011 2A.S2.00011 : Myrinogotomy with Grommet - Both

ear4250





12 S2 2A.S2.00013 2A.S2.00013 : Partial amputation – Pinna 2000 Clinical Photograph Clinical Photograph

13 S2 2A.S2.00017 2A.S2.00017 : Tympanoplasty 4500 CT Mastoid, Pure Tone Audiometry Pure Tone Audiometry Report

14 S2 2A.S2.00019 2A.S2.00019 : Ear lobe repair - single (daycare) 750 Clinical Photo, Clinical notes Scar Photograph

15 S2 2A.S2.00035 2A.S2.00035 : Fracture reduction nose with septal

correction4000 X-ray of the nasal bone Post-op X-ray with report

BENEFIT PACKAGES OF AYUSHMAN BHARAT - AROGYA KARNATAKA FOR GOVERNMENT HOSPITALS

SIMPLE SECONDARY CARE (RESTRICTED TO PUBLIC HEALTH INSTITUTION)

BURNS

CARDIOTHORACIC SURGERY

DENTAL AND ORAL AND MAXILLOFACIAL SURGERY

ENT

Sl. no.Speciality


16 S2 2A.S2.00038 2A.S2.00038 : Functional Endoscopic Sinus (FESS) 5500CT PNS , Direct Nasal Endoscopic Photo

graph, Clinical notes Endoscopy Photo

17 S2 2A.S2.00039 2A.S2.00039 : Intra Nasal Ethmoidectomy 2500 Clinical notes, CT PNS X-Ray

18 S2 2A.S2.00043 2A.S2.00043 : Turbinectomy Partial – Bilateral 1500 CT, Clinical Notes clinical notes

19 S2 2A.S2.00044 2A.S2.00044 : Turbinectomy Partial – Unilateral 1000 CT, Clinical Notes clinical notes

20 S2 2A.S2.00046 2A.S2.00046 : Rhinoplasty 7500 X- Ray, CT, Clinical Notes X Ray

21 S2 2A.S2.00047 2A.S2.00047 : Septoplasty 2500 X- Ray, CT, Clinical Notes Clinical Photograph

22 S2 2A.S2.00048 2A.S2.00048 : Youngs operation 1500 clinical notes clinical notes

23 S2 2A.S2.00049 2A.S2.00049 : Angiofibroma Excision 9000 Endoscopy Picture, CT, Clinical Notes Clinical photo showing scar

24 S2 2A.S2.00052 2A.S2.00052 : Endoscopic Hypophysectomy 10500 Clinical notes, CT/MRI clinical notes

25 S2 2A.S2.00053 2A.S2.00053 : Intranasal Diathermy 1500 clinical notes clinical notes

26 S2 2A.S2.00054 2A.S2.00054 : Rhinosporidiosis 3500 X Ray Nasopharynx film with report HPR

27 S2 2A.S2.00056 2A.S2.00056 : Adeno Tonsillectomy 4000 Clinical Photograph clinical Photograph

28 S2 2A.S2.00057 2A.S2.00057 : Adenoidectomy 2500 X-Ray Nasopharynx Clinical Photograph

29 S2 2A.S2.00071 2A.S2.00071 : Retro pharyngeal abscess – Drainage 2500 CT/MRI, Clinical photograph X-Ray

30 S2 2A.S2.00074 2A.S2.00074 : Tonsillectomy – (Uni/ Bilateral) 3750 Clinical Notes Procedure notes

31 S2 2A.S2.00076 2A.S2.00076 : Superficial Parotidectomy 6000Clinical notes, Biopsy, Clinical

Photograph, CT scan, CT/MRI

Histopathological report, Operative

notes with steps of surgery

32 S2 2A.S2.00079 2A.S2.00079 : Excision of Branchial Cyst 3500 Clinical notes & photo

Clinical photo showing scar, FNAC/

BIOPSY, Operative notes with steps

of surgery

33 S2 2A.S2.00080 2A.S2.00080 : Excision of Branchial Sinus 3500 Clinical notes & photo

Clinical photo showing scar, FNAC/


of surgery

34 S2 2A.S2.00086 2A.S2.00086 : Palatopharyngoplasty 5000 Clinical photo HPE Report, OT Notes

35 S2 2A.S2.00089 2A.S2.00089 : Removal of Submandibular Salivary

gland2500

Clinical Photograph , FNAC, Routine

Blood InvHPR , Clinical Photograph

36 M1 2A.M1.00001 2A.M1.00001 : Acute gastroenteritis with moderate

dehydration - routine ward 900

Relevant Hematological investigations,

Clinical notesTreatment notes

M1 2A.M1.00001A 2A.M1.00001A : Acute gastroenteritis with moderate

dehydration - HDU1350



M1 2A.M1.00001B 2A.M1.00001B : Acute gastroenteritis with moderate

dehydration - ICU without ventilator1800



M1 2A.M1.00001C 2A.M1.00001C : Acute gastroenteritis with moderate

dehydration - iCU with ventilator2250



37 M1 2A.M1.00003 2A.M1.00003 : Dysentery - routine ward 900Relevant Hematological investigations,


M1 2A.M1.00003A 2A.M1.00003A : Dysentery - HDU 1350Relevant Hematological investigations,


M1 2A.M1.00003B 2A.M1.00003B : Dysentery - ICU without ventilator 1800Relevant Hematological investigations,


GENERAL MEDICINE

Sl. no.Speciality


M1 2A.M1.00003C 2A.M1.00003C : Dysentery - ICU with ventilator 2250Relevant Hematological investigations,


38 M1 2A.M1.00004 2A.M1.00004 : Renal colic - routine ward 900 clinical notes clinical notes

M1 2A.M1.00004A 2A.M1.00004A : Renal colic - HDU 1350 clinical notes clinical notes

M1 2A.M1.00004B 2A.M1.00004B : Renal colic - ICU without ventilator 1800 clinical notes clinical notes

M1 2A.M1.00004C 2A.M1.00004C : Renal colic - ICU with ventilator 2250 clinical notes clinical notes

39 M1 2A.M1.00005 2A.M1.00005 : Acute bronchitis - routine ward 900 clinical notes clinical notes

M1 2A.M1.00005A 2A.M1.00005A : Acute bronchitis - HDU 1350 clinical notes clinical notes

M1 2A.M1.00005B 2A.M1.00005B : Acute bronchitis - ICU without

ventilator 1800 clinical notes clinical notes

M1 2A.M1.00005C 2A.M1.00005C : Acute bronchitis - iCU with


40 M1 2A.M1.00009 2A.M1.00009 : Severe anemia - routine ward 900 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009A 2A.M1.00009A : Severe anemia - HDU 1350 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009B 2A.M1.00009B : Severe anemia - ICU without

ventilator 1800 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009C 2A.M1.00009C : Severe anemia - ICU with ventilator 2250 clinical notes, HB% clinical notes, HB%

41 M1 2A.M1.00011 2A.M1.00011 : Acute febrile illness - routine ward 900 clinical notes clinical notes

M1 2A.M1.00011A 2A.M1.00011A : Acute febrile illness - HDU 1350 clinical notes clinical notes

M1 2A.M1.00011B 2A.M1.00011B : Acute febrile illness - ICU without


M1 2A.M1.00011C 2A.M1.00011C : Acute febrile illness - ICU with


42 M1 2A.M1.00013 2A.M1.00013 : UTI - routine ward 900 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013A 2A.M1.00013A : UTI - HDU 1350 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013B 2A.M1.00013B : UTI - ICU without ventilator 1800 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013C 2A.M1.00013C : UTI - ICU with ventilator 2250 clinical notes, Urine - C/S clinical notes

43 M1 2A.M1.00014 2A.M1.00014 : Malaria - routine ward 900clinical notes, Peripheral blood

examination reportclinical notes

M1 2A.M1.00014A 2A.M1.00014A : Malaria - HDU 1350clinical notes, Peripheral blood


M1 2A.M1.00014B 2A.M1.00014B : Malaria - ICU without ventilator 1800clinical notes, Peripheral blood


M1 2A.M1.00014C 2A.M1.00014C : Malaria - ICU with ventilator 2250clinical notes, Peripheral blood


44 M1 2A.M1.00015 2A.M1.00015 : Dengue fever - routine ward 900 clinical notes, Blood examination report clinical notes, Blood examination

M1 2A.M1.00015A 2A.M1.00015A : Dengue fever - HDU 1350 clinical notes, Blood examination report clinical notes, Blood examination

M1 2A.M1.00015B 2A.M1.00015B : Dengue fever - ICU without

ventilator 1800 clinical notes, Blood examination report

clinical notes, Blood examination

report

Sl. no.Speciality


M1 2A.M1.00015C 2A.M1.00015C : Dengue fever - ICU with ventilator 2250 clinical notes, Blood examination reportclinical notes, Blood examination

report

45 M1 2A.M1.00017 2A.M1.00017 : Leptospirosis - routine ward 900 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017A 2A.M1.00017A : Leptospirosis - HDU 1350 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017B 2A.M1.00017B : Leptospirosis - ICU without

ventilator 1800 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017C 2A.M1.00017C : Leptospirosis - ICU with ventilator 2250 clinical notes, Blood examination report clinical notes

46 M1 2A.M1.00018 2A.M1.00018 : Enteric fever - routine ward 900 clinical notes, Blood examination report clinical notes

M1 2A.M1.00018A 2A.M1.00018A : Enteric fever - HDU 1350 clinical notes, Blood examination report clinical notes

M1 2A.M1.00018B 2A.M1.00018B : Enteric fever - ICU without


M1 2A.M1.00018C 2A.M1.00018C : Enteric fever - ICU with ventilator 2250 clinical notes, Blood examination report clinical notes

47 M1 2A.M1.00019 2A.M1.00019 : Pneumonia - routine ward 900 clinical notes, X-ray clinical notes

M1 2A.M1.00019A 2A.M1.00019A : Pneumonia - HDU 1350 clinical notes, X-ray clinical notes

M1 2A.M1.00019B 2A.M1.00019B : Pneumonia - ICU without ventilator 1800 clinical notes, X-ray clinical notes

M1 2A.M1.00019C 2A.M1.00019C : Pneumonia - ICU with ventilator 2250 clinical notes, X-ray clinical notes

48 M1 2A.M1.00021 2A.M1.00021 : Liver abscess - routine ward 900 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen

M1 2A.M1.00021A 2A.M1.00021A : Liver abscess - HDU 1350 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen

M1 2A.M1.00021B 2A.M1.00021B : Liver abscess - ICU without

ventilator 1800 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen

M1 2A.M1.00021C 2A.M1.00021C : Liver abscess - ICU with ventilator 2250 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen

49 M1 2A.M1.00022 2A.M1.00022 : Acute viral hepatitis - routine ward 900 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022A 2A.M1.00022A : Acute viral hepatitis - HDU 1350 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022B 2A.M1.00022B : Acute viral hepatitis - ICU without

ventilator 1800 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022C 2A.M1.00022C : Acute viral hepatitis - ICU with

ventilator 2250 clinical notes, LFT clinical notes, LFT

50 M1 2A.M1.00026 2A.M1.00026 : Pyrexia of unknown origin - routine

ward 900 clinical notes, Blood examination report


report

M1 2A.M1.00026A 2A.M1.00026A : Pyrexia of unknown origin - HDU 1350 clinical notes, Blood examination reportclinical notes, Blood examination

report

M1 2A.M1.00026B 2A.M1.00026B : Pyrexia of unknown origin - ICU

without ventilator 1800 clinical notes, Blood examination report


report

M1 2A.M1.00026C 2A.M1.00026C : Pyrexia of unknown origin - ICU

with ventilator 2250 clinical notes, Blood examination report


report

51 M1 2A.M1.00027 2A.M1.00027 : Pericardial/ Pleural tuberculosis -

routine ward 900

clinical notes, Smear examination, X-ray

chestclinical notes, X-ray chest

Sl. no.Speciality


M1 2A.M1.00027A 2A.M1.00027A : Pericardial/ Pleural tuberculosis -

HDU1350



M1 2A.M1.00027B 2A.M1.00027B : Pericardial/ Pleural tuberculosis -

ICU without ventilator 1800



M1 2A.M1.00027C 2A.M1.00027C : Pericardial/ Pleural tuberculosis -

ICU with ventilator 2250



52 M1 2A.M1.00028 2A.M1.00028 : Systematic lupus erythematosus -

routine ward 900 clinical notes clinical notes

M1 2A.M1.00028A 2A.M1.00028A : Systematic lupus erythematosus -

HDU 1350 clinical notes clinical notes

M1 2A.M1.00028B 2A.M1.00028B : Systematic lupus erythematosus -

ICU without ventilator 1800 clinical notes clinical notes

M1 2A.M1.00028C 2A.M1.00028C : Systematic lupus erythematosus -

ICU with ventilator 2250 clinical notes clinical notes

53 M1 2A.M1.00029 2A.M1.00029 : Vasculitis - routine ward 900 clinical notes clinical notes

M1 2A.M1.00029A 2A.M1.00029A : Vasculitis - HDU 1350 clinical notes clinical notes

M1 2A.M1.00029B 2A.M1.00029B : Vasculitis - ICU without ventilator 1800 clinical notes clinical notes

M1 2A.M1.00029C 2A.M1.00029C : Vasculitis - ICU with ventilator 2250 clinical notes clinical notes

54 M1 2A.M1.00031 2A.M1.00031 : Bacterial/ fungal endocarditis -

routine ward 900 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031A 2A.M1.00031A : Bacterial/ fungal endocarditis -

HDU1350 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031B 2A.M1.00031B : Bacterial/ fungal endocarditis - ICU

without ventilator 1800 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031C 2A.M1.00031C : Bacterial/ fungal endocarditis - ICU

with ventilator 2250 clinical notes, X-ray /USG -chest clinical notes

55 M1 2A.M1.00036 2A.M1.00036 : Persistent/ Chronic diarrohea -

routine ward 900 Clinical notes Clinical notes

M1 2A.M1.00036A 2A.M1.00036A : Persistent/ Chronic diarrohea - HDU 1350 Clinical notes Clinical notes

M1 2A.M1.00036B 2A.M1.00036B : Persistent/ Chronic diarrohea - ICU

without ventilator 1800 Clinical notes Clinical notes

M1 2A.M1.00036C 2A.M1.00036C : Persistent/ Chronic diarrohea - ICU

with ventilator 2250 Clinical notes Clinical notes

56 M1 2A.M1.00037 2A.M1.00037 : Acute and chronic pancreatitis -

routine ward 900 clinical notes, Blood examination report


report

M1 2A.M1.00037A 2A.M1.00037A : Acute and chronic pancreatitis -

HDU 1350 clinical notes, Blood examination report


report

M1 2A.M1.00037B 2A.M1.00037B : Acute and chronic pancreatitis - ICU

without ventilator 1800 clinical notes, Blood examination report


report

M1 2A.M1.00037C 2A.M1.00037C : Acute and chronic pancreatitis - ICU

with ventilator 2250 clinical notes, Blood examination report


report

Sl. no.Speciality


57 M1 2A.M1.00040 2A.M1.00040 : Neuromuscular disorders - routine

ward 900 clinical notes clinical notes

M1 2A.M1.00040A 2A.M1.00040A : Neuromuscular disorders - HDU 1350 clinical notes clinical notes

M1 2A.M1.00040B 2A.M1.00040B : Neuromuscular disorders - ICU

without ventilator 1800 clinical notes clinical notes

M1 2A.M1.00040C 2A.M1.00040C : Neuromuscular disorders - ICU with


58 M1 2A.M1.00068

2A.M1.00068 : 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.)

1000 Blood group matching Clinical notes

59 M1 2A.M1.00071

2A.M1.00071 : High end radiological diagnostic (CT,

MRI, Imaging including nuclear imaging) - can only

be clubbed with medical package. Rs 5000 per

annum limit to a family

2500 Clincal notes Clincal notes

60 M1 2A.M1.00072

2A.M1.00072 : High end histopathology (Biopsies)

and advanced serology investigations - can only be

clubbed with medical package. Rs 5000 per annum

limit to a family

2500 Clincal notes Clincal notes

S1 2A.S1.00214A 2A.S1.00214A : Hemodialysis per sitting - cross

speciality 1000 ECHO, RFT, CBC RFT, CBC

S1 2A.S1.00252A 2A.S1.00252A : Peritoneal dialysis per sitting - cross

speciality 1000 Clinical notes, Serum Creatinine OT notes

61 S1 2A.S1.00001 2A.S1.00001 : Adventious Burse – Excision 5000 Clinical photo Scar photo

62 S1 2A.S1.00003 2A.S1.00003 : Appendicectomy 5000 Clinical notes, USG report OT note, scar photo, HPE Report

63 S1 2A.S1.00004 2A.S1.00004 : Appendicular Abscess – Drainage 6000 Clinical note, USG report OT note, scar photo

64 S1 2A.S1.00006 2A.S1.00006 : Bakers Cyst – Excision 3000 Clinical photo Scar photo

65 S1 2A.S1.00012 2A.S1.00012 : Breast Lump - Left – Excision 2500 USG/CT, Clinical notes OT note, HPE

66 S1 2A.S1.00013 2A.S1.00013 : Breast Lump - Right – Excision 3250 USG/CT, Clinical notes OT note, HPE

67 S1 2A.S1.00015 2A.S1.00015 : Bursa – Excision 2000 Clinical notes Scar photo

68 S1 2A.S1.00017 2A.S1.00017 : Cervial Lymphnodes – Excision 1000 USG/Biopsy/ FNAC USG, HPE Report

69 S1 2A.S1.00018 2A.S1.00018 : Colostomy 10000 Biopsy of the primary + CT Scan with Clinical Photograph of operated site

70 S1 2A.S1.00019 2A.S1.00019 : Cyst over Scrotum – Excision 1000 Clinical Photograph, USG OT notes, Scar photo

71 S1 2A.S1.00020 2A.S1.00020 : Cystic Mass – Excision 2000 X-ray/ CT, Clinical Photo Scar Photo

72 S1 2A.S1.00021 2A.S1.00021 : Dermoid Cyst - Large – Excision 2000 Clinical photo Scar photo

GENERAL SURGERY

Sl. no.Speciality


73 S1 2A.S1.00022 2A.S1.00022 : Dermoid Cyst - Small – Excision 1000 Clinical photo Scar photo

74 S1 2A.S1.00023 2A.S1.00023 : Drainage of Ischio Rectal Abscess 2000 clinical notes OT notes

75 S1 2A.S1.00024 2A.S1.00024 : Incision and Drainage of large Abscess 2000 Clinical notes, Clinical Photo OT notes, Clinical photo

76 S1 2A.S1.00025 2A.S1.00025 : Drainage of Psoas Abscess 3750 CT/USG , clinical notes, X-Ray of spine Clinical photo, OT notes

77 S1 2A.S1.00031 2A.S1.00031 : Hydrocele + Orchidectomy 4000 USG scrotum, Tumour markersClinical Photograph showing scar ( if

patient consents)+ HPE report

78 S1 2A.S1.00032 2A.S1.00032 : Epidedectomy 4000 Clinical notes + USG Clinical photo, OT notes

79 S1 2A.S1.00033 2A.S1.00033 : Epididymal Swelling –Excision 3000 Clinical notes + USG Clinical photo, OT notes

80 S1 2A.S1.00034 2A.S1.00034 : Epidymal Cyst 2000 Clinical notes + USG Clinical photo, OT notes

81 S1 2A.S1.00035 2A.S1.00035 : Evacuation of Scrotal Hematoma 2500 Clinical notes + USG Clinical photo, OT notes

82 S1 2A.S1.00038 2A.S1.00038 : Drainage of liver Abscess 4000 CT/USG - abdomen Clinical photo, OT notes

83 S1 2A.S1.00039 2A.S1.00039 : Excision Filarial Scrotum 2500 Clinical notes + USG Clinical photo, OT notes

84 S1 2A.S1.00040 2A.S1.00040 : Excision Mammary Fistula 2750 USG, Fistulogram Scar Photo, HPE Report

85 S1 2A.S1.00042 2A.S1.00042 : Excision Pilonidal Sinus 4000 Clinical photo OT notes, HPE

86 S1 2A.S1.00047 2A.S1.00047 : Excision of Large Swelling in Hand 1500 Clinical photo OT notes, HPE

87 S1 2A.S1.00048 2A.S1.00048 : Excision of Small Swelling in Hand 750 Clinical photo OT notes, HPE

88 S1 2A.S1.00049 2A.S1.00049 : Excision of Neurofibroma 1500 Clinical photo OT notes, HPE

89 S1 2A.S1.00050 2A.S1.00050 : Exicision of Sinus and Curettage 2500 Clinical photo, Sinogram OT notes, HPE

90 S1 2A.S1.00052 2A.S1.00052 : Fibrodenoma – Unilateral 3500 Clinical notes + USG HPE

91 S1 2A.S1.00053 2A.S1.00053 : Fissurectomy 4000 Clinical notes OT notes

92 S1 2A.S1.00054 2A.S1.00054 : Fissurectomy and

Haemorrhoidectomy6000 Clinical notes OT notes

93 S1 2A.S1.00055 2A.S1.00055 : Eversion of Hydrocele Sac – Bilateral 5000 Clinical Photograph, USG Clinical Notes

94 S1 2A.S1.00056 2A.S1.00056 : Eversion of Hydrocele Sac – Unilateral 2500 Clinical Photograph, USG Clinical Notes

95 S1 2A.S1.00060 2A.S1.00060 : G J Vagotomy/ Vagotomy +

Pyloroplasty7500 Biopsy , CT-Scan , Endoscopy , USG HPR, Clinical Photograph

96 S1 2A.S1.00061 2A.S1.00061 : Ganglion - large – Excision 1500 clinical photograph clinical photograph & Scar photo

97 S1 2A.S1.00062 2A.S1.00062 : Ganglion - Small – Excision 1000 clinical photograph clinical photograph & Scar photo

98 S1 2A.S1.00066 2A.S1.00066 : Granuloma – Excision 1000 clinical photograph Scar photo

99 S1 2A.S1.00067 2A.S1.00067 : Haemangioma – Excision (large) 5000 clinical photograph Doppler

100 S1 2A.S1.00069 2A.S1.00069 : Haemorrhage of Small Intestine 7500 Endoscopy/ CT Abdomen Clinical Photograph, HPE report

101 S1 2A.S1.00071 2A.S1.00071 : Hernia – Epigastric 5500 USG, Clinical NotesClinical Notes, Scar photo and OT

notes

102 S1 2A.S1.00072 2A.S1.00072 : Hernia – Incisional 7500 USG, Clinical PhotographClinical Notes, Scar photo and OT

notes

Sl. no.Speciality


103 S1 2A.S1.00074 2A.S1.00074 : Hernia – Umbilical 5500 USG, Clinical PhotographClinical Notes, Scar photo and OT

notes

104 S1 2A.S1.00075 2A.S1.00075 : Hernia – Femoral 5000 USG, Clinical NotesClinical Notes, Scar photo and OT

notes

105 S1 2A.S1.00076 2A.S1.00076 : Hernioplasty – Inguinal 5000 USG, Clinical PhotographClinical Notes, Scar photo and OT

notes

106 S1 2A.S1.00077 2A.S1.00077 : Herniorraphy 4500 USG, Clinical Photograph Clinical Notes, Scar photo and OT

107 S1 2A.S1.00080 2A.S1.00080 : Hydrocele - Excision – Unilateral 2500 Clinical Photograph Clinical Notes

108 S1 2A.S1.00081 2A.S1.00081 : Hydrocele - Excision – Bilateral 5000 Clinical Photograph Clinical Notes

109 S1 2A.S1.00083 2A.S1.00083 : Infected Bunion Foot – Excision 2000 Clinical Photograph Scar photograph

110 S1 2A.S1.00096 2A.S1.00096 : Lipoma excision 1250 Clinical Photo HPR, Scar photo

111 S1 2A.S1.00108 2A.S1.00108 : Papilloma Rectum – Excision 2000 CT Scan, Colonoscopy OT Notes / Post-op CT

112 S1 2A.S1.00110 2A.S1.00110 : Growth in the Scalp – Excision 2000 Biopsy, Clinical photo Scar photo

113 S1 2A.S1.00116 2A.S1.00116 : Rectal Dilatation 1000 Clinical notes Procedure Notes

114 S1 2A.S1.00118 2A.S1.00118 : Rectopexy 5000 Clinical Findings Procedure Notes

115 S1 2A.S1.00123 2A.S1.00123 : Haemorroidectomy 2500Clinical notes, Practoscopy findings,

Colonoscopy in elderlyOT Notes

116 S1 2A.S1.00126 2A.S1.00126 : Scrotal Swelling (Multiple) – Excision 2500 Clinical Photograph, USG OT notes, Scar photo

117 S1 2A.S1.00128 2A.S1.00128 : Simple closure - Peptic perforation 7500 Endoscopy , USG , X-Ray Abdomen-

Erect PostureScar photo, HPE

118 S1 2A.S1.00129 2A.S1.00129 : Sinus – Excision 2500 Sinogram Scar photo

119 S1 2A.S1.00130 2A.S1.00130 : Soft Tissue Tumor (small) – Excision 2500 Clinical notes, clinical photo Scar photo, HPE

120 S1 2A.S1.00132 2A.S1.00132 : Splenectomy 12500 CT/ MRI Scar photo

121 S1 2A.S1.00133 2A.S1.00133 : Submandibular Lymph node – Excision 2500 Clinical Photograph, HPE Scar Photo, HPE Report

122 S1 2A.S1.00135 2A.S1.00135 : Swelling in foot (small) – Excision 750 Clinical Photograph, X-ray Scar photo, HPE

123 S1 2A.S1.00136 2A.S1.00136 : Swelling in foot (large) – Excision 1750 Clinical Photograph, X-ray Scar photo, HPE

124 S1 2A.S1.00141 2A.S1.00141 : Umbilical Sinus – Excision 2500 Sinogram Scar photo

125 S1 2A.S1.00142 2A.S1.00142 : Varicose Veins - Excision and Ligation 5000 Venous Doppler Scar photo

126 S1 2A.S1.00154 2A.S1.00154 : Cholecystostomy 5000 Contrast X-ray, CT Clinical Photograph, HPE report

127 S1 2A.S1.00161 2A.S1.00161 : Excision and Skin Graft of Venous

Ulcer7500 Clinical notes Scar photo

128 S1 2A.S1.00169 2A.S1.00169 : Total thyroidectomy 10000 Clinical Photograph , USG , X-RAY Scar photo, HPE

129 S1 2A.S1.00191 2A.S1.00191 : Ligation of Ankle Perforators 5250 Doppler OT Notes

130 S1 2A.S1.00208 2A.S1.00208 : Intercostal drainage 4000 X-ray X-ray

131 S1 2A.S1.00214 2A.S1.00214 : Hemodialysis per sitting 1000 ECHO, RFT, CBC RFT, CBC

132 S1 2A.S1.00244 2A.S1.00244 : Debridement of Ulcer-Leprosy 2500 Clinical photo, x-ray Scar photo, X-Ray

133 S1 2A.S1.00248 2A.S1.00248 : Hernia - Repair & release of

obstruction+ Hernioplasty10000 USG

Clinical Notes, Scar photo and OT

notes

Sl. no.Speciality


134 S1 2A.S1.00249 2A.S1.00249 : Aspiration of cold Abscess of

Lymphnode1500 Clinical photo, x-ray chest Scar photo, HPE

135 S1 2A.S1.00250 2A.S1.00250 : Aspiration of Empyema 1000 Chest X-ray C&S Report, X-Ray

136 S1 2A.S1.00252 2A.S1.00252 : Peritoneal dialysis per sitting 1000 Clinical notes, Serum Creatinine OT notes

137 S1 2A.S1.00253 2A.S1.00253 : Vasectomy 1250 Clinical notes OT notes

138 M8 2A.M8.00001 2A.M8.00001 : Organic, including symptomatic,

mental disorders (routine ward)750 Clinical notes, CT brain Clinical notes, CT brain

139 M8 2A.M8.00002 2A.M8.00002 : Mental and Behavioural disorders

due to psychoactive substance use (routine ward)750 Clinical notes, CT brain Clinical notes, CT brain

140 M8 2A.M8.00003 2A.M8.00003 : Schizophrenia, schizotypal and

delusional disorders (routine ward)750 Clinical notes, CT brain Clinical notes, CT brain

141 M8 2A.M8.00004 2A.M8.00004 : Mood (affective) disorders (routine

ward)750 Clinical notes Clinical notes

142 M8 2A.M8.00009 2A.M8.00009 : Mental and Behavioural disorders

due to psychoactive substance use (HDU)1250 Clinical notes Clinical notes

143 M8 2A.M8.00010 2A.M8.00010 : Schizophrenia, schizotypal and

delusional disorders (HDU)1250 Clinical notes Clinical notes

144 M8 2A.M8.00012 2A.M8.00012 : Neurotic, stress-related and

somatoform disorders (HDU)1250 Clinical notes Clinical notes

145 M8 2A.M8.00013

2A.M8.00013 : Behavioural syndromes associated

with physiological disturbances and physical factors

(HDU)

1250 Clinical notes Clinical notes

146 M8 2A.M8.00014 2A.M8.00014 : Mental Retardation (HDU) 1250 Clinical notes Clinical notes

147 M2 2A.M2.00001 2A.M2.00001 : Diarrhoea - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00001A 2A.M2.00001A : Diarrhoea - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00001B 2A.M2.00001B : Diarrhoea - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00001C 2A.M2.00001C : Diarrhoea - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

148 M2 2A.M2.00002 2A.M2.00002 : Acute dysentery - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00002A 2A.M2.00002A : Acute dysentery - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00002B 2A.M2.00002B : Acute dysentery - ICU without

ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00002C 2A.M2.00002C : Acute dysentery - ICU with


149 M2 2A.M2.00003 2A.M2.00003 : Pneumonia - routine ward 900 Clinical Notes with relevant Treatment Notes

M2 2A.M2.00003A 2A.M2.00003A : Pneumonia - HDU 1350 Clinical Notes with relevant Treatment Notes

M2 2A.M2.00003B 2A.M2.00003B : Pneumonia - ICU without ventilator 1800Clinical Notes with relevant

investigationsTreatment Notes

M2 2A.M2.00003C 2A.M2.00003C : Pneumonia - ICU with ventilator 2250Clinical Notes with relevant


MENTAL DISORDER PACKAGES

NEONATAL AND PAEDIATRICS

Sl. no.Speciality


150 M2 2A.M2.00004 2A.M2.00004 : Urinary tract infection - routine ward 900Clinical Notes with relevant


M2 2A.M2.00004A 2A.M2.00004A : Urinary tract infection - HDU 1350 Clinical Notes with relevant Treatment Notes

M2 2A.M2.00004B 2A.M2.00004B : Urinary tract infection - ICU without

ventilator 1800

Clinical Notes with relevant


M2 2A.M2.00004C 2A.M2.00004C : Urinary tract infection - ICU with

ventilator 2250



151 M2 2A.M2.00006 2A.M2.00006 : Acute glomerulonephritis - routine

ward900 Clinical note with Lab reports Treatment note

M2 2A.M2.00006A 2A.M2.00006A : Acute glomerulonephritis - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00006B 2A.M2.00006B : Acute glomerulonephritis - ICU

without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00006C 2A.M2.00006C : Acute glomerulonephritis - ICU with


152 M2 2A.M2.00013 2A.M2.00013 : Trauma - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00013A 2A.M2.00013A : Trauma - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00013B 2A.M2.00013B : Trauma - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00013C 2A.M2.00013C : Trauma - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

153 M2 2A.M2.00014 2A.M2.00014 : Pyrexia of unexplained origin -

routine ward900 Clinical note with Lab reports Treatment note

M2 2A.M2.00014A 2A.M2.00014A : Pyrexia of unexplained origin -

HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00014B 2A.M2.00014B : Pyrexia of unexplained origin -

ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00014C 2A.M2.00014C : Pyrexia of unexplained origin -

ICU with ventilator 2250 Clinical note with Lab reports Treatment note

154 M2 2A.M2.00019 2A.M2.00019 : Dysmorphic children - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00019A 2A.M2.00019A : Dysmorphic children - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00019B 2A.M2.00019B : Dysmorphic children - ICU without


M2 2A.M2.00019C 2A.M2.00019C : Dysmorphic children - ICU with


155 M2 2A.M2.00020 2A.M2.00020 : Rickets - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00020A 2A.M2.00020A : Rickets - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00020B 2A.M2.00020B : Rickets - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00020C 2A.M2.00020C : Rickets - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

156 M2 2A.M2.00021 2A.M2.00021 : Unexplained severe anemia - routine


M2 2A.M2.00021A 2A.M2.00021A : Unexplained severe anemia - HDU 1350 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 2A.M2.00021B 2A.M2.00021B : Unexplained severe anemia - ICU


M2 2A.M2.00021C 2A.M2.00021C : Unexplained severe anemia - ICU

with ventilator 2250 Clinical note with Lab reports Treatment note

157 M2 2A.M2.00022 2A.M2.00022 : Short stature - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00022A 2A.M2.00022A : Short stature - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00022B 2A.M2.00022B : Short stature - ICU without


M2 2A.M2.00022C 2A.M2.00022C : Short stature - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

158 M2 2A.M2.00023 2A.M2.00023 : Musculoskeletal problems - routine


M2 2A.M2.00023A 2A.M2.00023A : Musculoskeletal problems - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00023B 2A.M2.00023B : Musculoskeletal problems - ICU


M2 2A.M2.00023C 2A.M2.00023C : Musculoskeletal problems - ICU


159 M2 2A.M2.00024 2A.M2.00024 : Developmental and behavioral

disorders - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00024A 2A.M2.00024A : Developmental and behavioral

disorders - HDU1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00024B 2A.M2.00024B : Developmental and behavioral

disorders - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00024C 2A.M2.00024C : Developmental and behavioral

disorders - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

160 M2 2A.M2.00028 2A.M2.00028 : Persistent/ Chronic diarrhea - routine


M2 2A.M2.00028A 2A.M2.00028A : Persistent/ Chronic diarrhea - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00028B 2A.M2.00028B : Persistent/ Chronic diarrhea - ICU


M2 2A.M2.00028C 2A.M2.00028C : Persistent/ Chronic diarrhea - ICU


161 M2 2A.M2.00029 2A.M2.00029 : Acute severe malnutrition - routine


M2 2A.M2.00029A 2A.M2.00029A : Acute severe malnutrition - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00029B 2A.M2.00029B : Acute severe malnutrition - ICU


M2 2A.M2.00029C 2A.M2.00029C : Acute severe malnutrition - ICU with


162 M2 2A.M2.00031 2A.M2.00031 : Enteric fever - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00031A 2A.M2.00031A : Enteric fever - HDU 1350 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 2A.M2.00031B 2A.M2.00031B : Enteric fever - ICU without


M2 2A.M2.00031C 2A.M2.00031C : Enteric fever - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

163 M2 2A.M2.00032 2A.M2.00032 : Chikungunya - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00032A 2A.M2.00032A : Chikungunya - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00032B 2A.M2.00032B : Chikungunya - ICU without


M2 2A.M2.00032C 2A.M2.00032C : Chikungunya - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

164 M2 2A.M2.00033 2A.M2.00033 : Acute hepatitis - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00033A 2A.M2.00033A : Acute hepatitis - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00033B 2A.M2.00033B : Acute hepatitis - ICU without


M2 2A.M2.00033C 2A.M2.00033C : Acute hepatitis - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

165 M2 2A.M2.00034 2A.M2.00034 : Kala azar - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00034A 2A.M2.00034A : Kala azar - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00034B 2A.M2.00034B : Kala azar - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00034C 2A.M2.00034C : Kala azar - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

166 M2 2A.M2.00038 2A.M2.00038 : Haemolytic uremic syndrome -

routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00038A 2A.M2.00038A : Haemolytic uremic syndrome - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00038B 2A.M2.00038B : Haemolytic uremic syndrome - ICU


M2 2A.M2.00038C 2A.M2.00038C : Haemolytic uremic syndrome - ICU


167 M2 2A.M2.00039 2A.M2.00039 : ITP - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00039A 2A.M2.00039A : ITP - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00039B 2A.M2.00039B : ITP - ICU without ventilator 1800 Clinical note with Lab reports Treatment note

M2 2A.M2.00039C 2A.M2.00039C : ITP - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

168 M2 2A.M2.00040 2A.M2.00040 : Juvenile myasthenia - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00040A 2A.M2.00040A : Juvenile myasthenia - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00040B 2A.M2.00040B : Juvenile myasthenia - ICU without


M2 2A.M2.00040C 2A.M2.00040C : Juvenile myasthenia - ICU with


169 M2 2A.M2.00041 2A.M2.00041 : Kawasaki Disease - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00041A 2A.M2.00041A : Kawasaki Disease - HDU 1350 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 2A.M2.00041B 2A.M2.00041B : Kawasaki Disease - ICU without


M2 2A.M2.00041C 2A.M2.00041C : Kawasaki Disease - ICU with


170 M2 2A.M2.00044 2A.M2.00044 : Immune haemolytic anemia - routine

ward 900



M2 2A.M2.00044A 2A.M2.00044A : Immune haemolytic anemia - HDU 1350Clinical Notes with relevant


M2 2A.M2.00044B 2A.M2.00044B : Immune haemolytic anemia - ICU

without ventilator 1800



M2 2A.M2.00044C 2A.M2.00044C : Immune haemolytic anemia - ICU

with ventilator 2250



171 M2 2A.M2.00045 2A.M2.00045 : Cyanotic spells - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00045A 2A.M2.00045A : Cyanotic spells - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00045B 2A.M2.00045B : Cyanotic spells - ICU without


M2 2A.M2.00045C 2A.M2.00045C : Cyanotic spells - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

172 M2 2A.M2.00046 2A.M2.00046 : Rheumatic fever - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00046A 2A.M2.00046A : Rheumatic fever - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00046B 2A.M2.00046B : Rheumatic fever - ICU without


M2 2A.M2.00046C 2A.M2.00046C : Rheumatic fever - ICU with


173 M2 2A.M2.00047 2A.M2.00047 : Rheumatoid arthritis - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00047A 2A.M2.00047A : Rheumatoid arthritis - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00047B 2A.M2.00047B : Rheumatoid arthritis - ICU without


M2 2A.M2.00047C 2A.M2.00047C : Rheumatoid arthritis - ICU with


174 M2 2A.M2.00054 2A.M2.00054 : Neuromuscular disorders - routine


M2 2A.M2.00054A 2A.M2.00054A : Neuromuscular disorders - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00054B 2A.M2.00054B : Neuromuscular disorders - ICU


M2 2A.M2.00054C 2A.M2.00054C : Neuromuscular disorders - ICU with


175 M2 2A.M2.00063 2A.M2.00063 : Unexplained jaundice - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00063A 2A.M2.00063A : Unexplained jaundice - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00063B 2A.M2.00063B : Unexplained jaundice - ICU without


Sl. no.Speciality


M2 2A.M2.00063C 2A.M2.00063C : Unexplained jaundice - ICU with


176 M2 2A.M2.00073 2A.M2.00073 : Liver abscess - routine ward 900 Clinical note with Lab reports Treatment note

M2 2A.M2.00073A 2A.M2.00073A : Liver abscess - HDU 1350 Clinical note with Lab reports Treatment note

M2 2A.M2.00073B 2A.M2.00073B : Liver abscess - ICU without


M2 2A.M2.00073C 2A.M2.00073C : Liver abscess - ICU with ventilator 2250 Clinical note with Lab reports Treatment note

177 M2 2A.M2.00100

2A.M2.00100 : Blood and blood component

transfusion for indications like

Thalassemia/Hemoglobinopathies - upto a limit of 2

days

750 Clinical note with Lab reports Treatment note

178 M2 2A.M2.00101

2A.M2.00101 : High end radiological diagnostic (CT,

MRI, Imaging including nuclear imaging) - can only

be clubbed with medical package.

2500 Clinical note CT/MRI report and film

179 M2 2A.M2.00102

2A.M2.00102 : High end histopathology (Biopsies)

and advanced serology investigations - can only be

clubbed with medical package.

2500 Clinical note HPE and Lab report

180 S14 2A.S14.00003 2A.S14.00003 : Hernia & Hydrocele 10000 X-ray abdomen or Ultrasound abdomen Scan Photography

181 S14 2A.S14.00005 2A.S14.00005 : Undescended Testis - Bilateral-Palp +

Nonpalp7500 Clinical examination Clinical examination

182 S14 2A.S14.00006 2A.S14.00006 : Undescended Testis - Bilateral

Palpable7500 USG and Clinical notes OT note

183 S14 2A.S14.00007 2A.S14.00007 : Undescended Testis - Bilateral Non-

Palpable10000 USG and Clinical notes OT note

184 S14 2A.S14.00029 2A.S14.00029 : Rectal Polypectomy - Sigmoiescopic

(Ga)4000 USG,CT report OT note and HPE report

M1 2A.M1.00001D 2A.M1.00001D : Acute gastroenteritis with moderate

dehydration - routine ward - cross speciality 900



M1 2A.M1.00001E 2A.M1.00001E : Acute gastroenteritis with moderate

dehydration - HDU - cross speciality 1350



M1 2A.M1.00001F 2A.M1.00001F : Acute gastroenteritis with moderate

dehydration - iCU with ventilator - cross speciality 2250



M1 2A.M1.00001G

2A.M1.00001G : Acute gastroenteritis with moderate

dehydration - ICU without ventilator - cross

speciality

1800Relevant Hematological investigations,


M1 2A.M1.00003D 2A.M1.00003D : Dysentery - routine ward - cross

speciality 900



Sl. no.Speciality


M1 2A.M1.00003E 2A.M1.00003E : Dysentery - HDU - cross speciality 1350Relevant Hematological investigations,


M1 2A.M1.00003F 2A.M1.00003F : Dysentery - ICU with ventilator -

cross speciality 2250



M1 2A.M1.00003G 2A.M1.00003G : Dysentery - ICU without ventilator -




M1 2A.M1.00005D 2A.M1.00005D : Acute bronchitis - routine ward -

cross speciality 900 clinical notes clinical notes

M1 2A.M1.00005E 2A.M1.00005E : Acute bronchitis - HDU - cross

speciality 1350 clinical notes clinical notes

M1 2A.M1.00005F 2A.M1.00005F : Acute bronchitis - iCU with

ventilator - cross speciality 2250 clinical notes clinical notes

M1 2A.M1.00005G 2A.M1.00005G : Acute bronchitis - ICU without


M1 2A.M1.00009D 2A.M1.00009D : Severe anemia - routine ward -

cross speciality 900 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009E 2A.M1.00009E : Severe anemia - HDU - cross

speciality 1350 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009F 2A.M1.00009F : Severe anemia - ICU with ventilator

- cross speciality 2250 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00009G 2A.M1.00009G : Severe anemia - ICU without

ventilator - cross speciality 1800 clinical notes, HB% clinical notes, HB%

M1 2A.M1.00011D 2A.M1.00011D : Acute febrile illness - routine ward -


M1 2A.M1.00011E 2A.M1.00011E : Acute febrile illness - HDU - cross

speciality 1350 clinical notes clinical notes

M1 2A.M1.00011F 2A.M1.00011F : Acute febrile illness - ICU with


M1 2A.M1.00011G 2A.M1.00011G : Acute febrile illness - ICU without


M1 2A.M1.00014 2A.M1.00014 : Malaria - routine ward - cross

speciality900

clinical notes, Peripheral blood


M1 2A.M1.00014A 2A.M1.00014A : Malaria - HDU - cross speciality 1350clinical notes, Peripheral blood


M1 2A.M1.00014B 2A.M1.00014B : Malaria - ICU without ventilator -




M1 2A.M1.00014C 2A.M1.00014C : Malaria - ICU with ventilator - cross

speciality2250



M1 2A.M1.00015C 2A.M1.00015C : Dengue fever - ICU with ventilator -

cross speciality 2250 clinical notes, Blood examination report


report

M1 2A.M1.00015E 2A.M1.00015E : Dengue fever - HDU - cross

speciality 1350 clinical notes, Blood examination report


report

M1 2A.M1.00015F 2A.M1.00015F : Dengue fever - ICU without

ventilator - cross speciality 1800 clinical notes, Blood examination report


report

Sl. no.Speciality


M1 2A.M1.00015G 2A.M1.00015G : Dengue fever - routine ward - cross

speciality 900 clinical notes, Blood examination report


report

M1 2A.M1.00017D 2A.M1.00017D : Leptospirosis - routine ward - cross

speciality900 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017E 2A.M1.00017E : Leptospirosis - HDU - cross

speciality1350 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017F 2A.M1.00017F : Leptospirosis - ICU without

ventilator - cross speciality1800 clinical notes, Blood examination report clinical notes

M1 2A.M1.00017G 2A.M1.00017G : Leptospirosis - ICU with ventilator -

cross speciality2250 clinical notes, Blood examination report clinical notes

M1 2A.M1.00022D 2A.M1.00022D : Acute viral hepatitis - routine ward -

cross speciality 900 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022E 2A.M1.00022E : Acute viral hepatitis - HDU - cross

speciality 1350 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022F 2A.M1.00022F : Acute viral hepatitis - ICU with

ventilator - cross speciality 2250 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00022G 2A.M1.00022G : Acute viral hepatitis - ICU without

ventilator - cross speciality 1800 clinical notes, LFT clinical notes, LFT

M1 2A.M1.00029D 2A.M1.00029D : Vasculitis - routine ward - HDU -


M1 2A.M1.00029E 2A.M1.00029E : Vasculitis - HDU - cross speciality 1350 clinical notes clinical notes

M1 2A.M1.00029F 2A.M1.00029F : Vasculitis - ICU with ventilator -

HDU - cross speciality 2250 clinical notes clinical notes

M1 2A.M1.00029G 2A.M1.00029G : Vasculitis - ICU without ventilator -


M1 2A.M1.00031D 2A.M1.00031D : Bacterial/ fungal endocarditis -

routine ward - cross speciality 900 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031E 2A.M1.00031E : Bacterial/ fungal endocarditis -

HDU - cross speciality 1350 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031F 2A.M1.00031F : Bacterial/ fungal endocarditis - ICU

with ventilator - cross speciality 2250 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00031G 2A.M1.00031G : Bacterial/ fungal endocarditis - ICU

without ventilator - cross speciality 1800 clinical notes, X-ray /USG -chest clinical notes

M1 2A.M1.00037D 2A.M1.00037D : Acute and chronic pancreatitis -

routine ward - cross speciality 900 clinical notes, Blood examination report


report

M1 2A.M1.00037E 2A.M1.00037E : Acute and chronic pancreatitis - ICU

without ventilator - cross speciality 1800 clinical notes, Blood examination report


report

M1 2A.M1.00037F 2A.M1.00037F : Acute and chronic pancreatitis - ICU

with ventilator - cross speciality 2250 clinical notes, Blood examination report


report

M1 2A.M1.00037G 2A.M1.00037G : Acute and chronic pancreatitis -

HDU - cross speciality1350 clinical notes, Blood examination report


report

Sl. no.Speciality


M1 2A.M1.00068A

2A.M1.00068A : 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.) - cross speciality

1000 Blood group matching Clinical notes

M1 2A.M1.00004BG 2A.M1.00004BG : Renal colic - ICU without ventilator

- cross speciality1800 clinical notes clinical notes

M1 2A.M1.00004D 2A.M1.00004D : Renal colic - routine ward - cross

speciality900 clinical notes clinical notes

M1 2A.M1.00004E 2A.M1.00004E : Renal colic - HDU - cross speciality 1350 clinical notes clinical notes

M1 2A.M1.00004F 2A.M1.00004F : Renal colic - ICU with ventilator -

cross speciality2250 clinical notes clinical notes

M1 2A.M1.00013D 2A.M1.00013D : UTI - routine ward - cross speciality 900 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013E 2A.M1.00013E : UTI - HDU - cross speciality 1350 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013F 2A.M1.00013F : UTI - ICU with ventilator - cross

speciality 2250 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00013G 2A.M1.00013G : UTI - ICU without ventilator - cross

speciality 1800 clinical notes, Urine - C/S clinical notes

M1 2A.M1.00027D 2A.M1.00027D : Pericardial/ Pleural tuberculosis -

routine ward - cross speciality900



M1 2A.M1.00027E 2A.M1.00027E : Pericardial/ Pleural tuberculosis -

HDU - cross speciality1350



M1 2A.M1.00027F 2A.M1.00027F : Pericardial/ Pleural tuberculosis -

ICU without ventilator - cross speciality1800



M1 2A.M1.00027G 2A.M1.00027G : Pericardial/ Pleural tuberculosis -

ICU with ventilator - cross speciality 2250



M1 2A.M1.00026D 2A.M1.00026D : Pyrexia of unknown origin -

routine ward - cross speciality900 clinical notes, Blood examination report


report

M1 2A.M1.00026E 2A.M1.00026E : Pyrexia of unknown origin - HDU -

cross speciality1350 clinical notes, Blood examination report


report

M1 2A.M1.00026F 2A.M1.00026F : Pyrexia of unknown origin - ICU with

ventilator - cross speciality2250 clinical notes, Blood examination report


report

M1 2A.M1.00026G 2A.M1.00026G : Pyrexia of unknown origin - ICU

without ventilator - cross speciality1800 clinical notes, Blood examination report


report

Sl. no.Speciality


M1 2A.M1.00028D 2A.M1.00028D : Systematic lupus erythematosus -

routine ward - cross speciality 900 clinical notes clinical notes

M1 2A.M1.00028E 2A.M1.00028E : Systematic lupus erythematosus -


M1 2A.M1.00028F 2A.M1.00028F : Systematic lupus erythematosus -

ICU with ventilator - cross speciality 2250 clinical notes clinical notes

M1 2A.M1.00028G 2A.M1.00028G : Systematic lupus erythematosus -

ICU without ventilator - cross speciality 1800 clinical notes clinical notes

185 S8 2A.S8.00004 2A.S8.00004 : Carpal Tunnel Release including pre

and post Op. MRI5000 MRI clinical photograph

186 S4 2A.S4.00001 2A.S4.00001 : Hysterectomy ± Salpingo-

oophorectomy10000 CT report and Film, Biopsy

Clinical Photograph showing scar +

HPE report

187 S4 2A.S4.00002 2A.S4.00002 : Abdominal Myomectomy 8000 Ultrasonography/ Tubal patency test HPE, OT notes

188 S4 2A.S4.00004 2A.S4.00004 : Surgeries for Stress Incontinence

'Burch'17500

APTT(activated partial thromboplastin

time) , Heamatocrit , PT (Prothrombin

time), Platelet Count , S.Fibrinogen Level

, USG

Clinical Photograph of Retroplacental

clots , USG

189 S4 2A.S4.00005 2A.S4.00005 : Hysterotomes - 2nd Trimester

abortions2500 USG and clinical notes Clinical note

190 S4 2A.S4.00006 2A.S4.00006 : Incisional Hernia Repair 7500 USG and clinical notes Clinical Photograph and OT note

191 S4 2A.S4.00007 2A.S4.00007 : Radical Hysterectomy (Wertheims) 10000 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

192 S4 2A.S4.00009 2A.S4.00009 : Non descent vaginal hysterectomy 7000Clinical notes and relevant lab

investigations HPR,OT notes

193 S4 2A.S4.00017 2A.S4.00017 : Dilation and Evacuation (D&E) 2500 USG and clinical notes OT note and HPE

194 S4 2A.S4.00018 2A.S4.00018 : Cervical biopsy and Polypectomy 1500 USG and clinical notes OT note and HPE

195 S4 2A.S4.00019 2A.S4.00019 : Bartholins Cyst Enucleation/ Incision

drainage1500 Clinical notes OT note

196 S4 2A.S4.00032 2A.S4.00032 : Hysteroscopic polypectomy 1500 USG and clinical notes OT note and HPE

197 S4 2A.S4.00033 2A.S4.00033 : Hysteroscopic IUCD removal 1500 X-ray,USG and Clinical note OT note

198 S4 2A.S4.00034 2A.S4.00034 : Caesarian Delivery 4500 USG and clinical notes OT Note

199 S4 2A.S4.00035 2A.S4.00035 : Caesarian hysterectomy 8000 USG and clinical notes OT note and HPE

200 S4 2A.S4.00045 2A.S4.00045 : MTP > 12 weeks 1500 USG and clinical notes Procedure Note

201 S4 2A.S4.00046 2A.S4.00046 : MTP upto 12 weeks 2500 USG and clinical notes Procedure Note

202 S4 2A.S4.00047 2A.S4.00047 : MTP upto 8 weeks 1750 USG and clinical notes Procedure Note

OBSTETRICS AND GYNAECOLOGY

NEUROSURGERY

Sl. no.Speciality


203 S4 2A.S4.00051 2A.S4.00051 : Laparotomy for broad ligament

haematoma8000 USG and clinical notes OT Note

204 S4 2A.S4.00054 2A.S4.00054 : Ablation of Endometriotic Spot +

Adhenolysis5000 USG and clinical notes OT Note

205 S4 2A.S4.00061 2A.S4.00061 : Cone Biopsy Cervix 500 USG and clinical notes OT note and HPE

206 S4 2A.S4.00062 2A.S4.00062 : Conventional Tubectomy 2000 Clinical note OT note

207 S4 2A.S4.00063 2A.S4.00063 : Cyst -Vaginal Enucleation 1500 Clinical note OT note and HPE

208 S4 2A.S4.00064 2A.S4.00064 : Cyst-Labial 1500 Clinical note OT note

209 S4 2A.S4.00067 2A.S4.00067 : D&C (Dilatation &curretage) + Electro

Cauterisation Cryo Surgery2000 USG and clinical notes OT Note

210 S4 2A.S4.00068 2A.S4.00068 : D&C (Dilatation&curretage) 1500 USG and clinical notes OT Note

211 S4 2A.S4.00072 2A.S4.00072 : Fractional Curretage 2000 USG and clinical notes OT Note and HPE

212 S4 2A.S4.00073 2A.S4.00073 : Gaping Perineal wound secondary

suturing/ episiotomy1250 Clinical note OT note

213 S4 2A.S4.00075 2A.S4.00075 : Hymenectomy& Repair of Hymen 3500 USG and clinical notes OT Note

214 S4 2A.S4.00076 2A.S4.00076 : Amniocentesis 2500 USG and clinical notesOT Note and Aminiotic fluid analysis

report

S15 2A.S15.00007A

2A.S15.00007A : Cyst & tumour of Maxilla/mandible

by enucleation/excision/marsupialization under LA -

cross speciality

1250X Ray film with report,Clinical

Photograph,


Photograph

215 S3 2A.S3.00001 2A.S3.00001 : Buckle Removal 2500 clinical notes Procedure notes

216 S3 2A.S3.00007 2A.S3.00007 : Pterygium + ConjunctivalAutograft 4500 Clinical Photograph Clinical Photograph

217 S3 2A.S3.00008 2A.S3.00008 : Dacryocystectomy with implants 5000 Sac Synrige Report Procedure notes

218 S3 2A.S3.00016 2A.S3.00016 : Limbal Dermoid Removal 2000Hematological and radiological

investigationsclinical notes

219 S3 2A.S3.00029 2A.S3.00029 : Cataract with foldable hydrophobic

acrylic IOL by Phaco emulsification tech3750 A Scan Report patient photograph

220 S3 2A.S3.00030 2A.S3.00030 : Cataract with non-foldable IOL using

SICS technique2500 A Scan Report Clinical Photograph

221 S3 2A.S3.00033 2A.S3.00033 : Conjunctival tumour excision + AMG 2500 Clinical Photograph Clinical notes

222 S3 2A.S3.00034 2A.S3.00034 : Entropion correction 2000 Clinical Photograph patient photograph

223 S3 2A.S3.00035 2A.S3.00035 : Ectropion correction 2500 Clinical Photograph patient photograph

224 S3 2A.S3.00036 2A.S3.00036 : Evisceration 1750 Clinical Photograph Clinical Photograph

225 S3 2A.S3.00038 2A.S3.00038 : Lid tear 2500 Clinical Photograph Clinical Photograph

OPTHALMOLOGY

ONCOLOGY

Sl. no.Speciality


226 S5 2A.S5.00001

2A.S5.00001 : 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)

12500 X-ray X-Ray, Scar photo

227 S5 2A.S5.00002

2A.S5.00002 : Accessory bone – Excision (limbs) –

congenital, Accessory digits sometime can be

removed

3000 X-ray, Clinical photo Scar photo, X-Ray

228 S5 2A.S5.00003 2A.S5.00003 : Amputation - Below Elbow 7500X-ray, clinical photo of the part, HPE for

tumoursScar photo, X-Ray, HPE for tumours

229 S5 2A.S5.00004 2A.S5.00004 : Amputation - Above Elbow 9000 X-ray X-ray

230 S5 2A.S5.00005 2A.S5.00005 : Amputation – one or more fingers 3000 X-ray Scar photo, X-Ray

231 S5 2A.S5.00006 2A.S5.00006 : Amputation – Wrist 7500 X-ray Scar photo, X-Ray

232 S5 2A.S5.00007 2A.S5.00007 : Amputation - one or more toes/ digits 3000 X-ray Scar photo, X-Ray

233 S5 2A.S5.00008 2A.S5.00008 : Amputation – Below Knee 7500X-ray, clinical photo of the part, HPE for


234 S5 2A.S5.00009 2A.S5.00009 : Amputation – Above Knee 10000 X-ray X-ray

235 S5 2A.S5.00010 2A.S5.00010 : Foot & Hand Amputation (whole/

partial)7500

X-ray, clinical photo of the part, HPE for


236 S5 2A.S5.00014 2A.S5.00014 : Osteochondroma excision/ Excision of

Exostosis5000 X-ray Scar photo, X-Ray

237 S5 2A.S5.00015 2A.S5.00015 : Excision Arthoplasty 7500 X-ray, CT/MRI Scar photo, X-Ray

238 S5 2A.S5.00016 2A.S5.00016 : Arthorotomy of any joint 7500 X-ray, Rountine Blood Inv. Biopsy X-Ray, Scar photo

239 S5 2A.S5.00017 2A.S5.00017 : Arthrodesis Ankle Triple 7500 X-RAY, Fluid Analysis/Biospy X-Ray, Scar photo

240 S5 2A.S5.00018 2A.S5.00018 : Excision Arthoplasty of Femur head 11250 X-ray, CT/MRI Scar photo, X-Ray

241 S5 2A.S5.00023 2A.S5.00023 : Clavicle fracture management -

conservative (daycare)1500 X-ray X-Ray

242 S5 2A.S5.00024 2A.S5.00024 : Close Fixation - Hand Bones 2000 X-ray X-Ray showing implant

243 S5 2A.S5.00025 2A.S5.00025 : Close Fixation - Foot Bones 2000 X-ray X-Ray showing implant

244 S5 2A.S5.00026 2A.S5.00026 : Close Reduction - Small Joints 2000 X-ray x-ray

245 S5 2A.S5.00029 2A.S5.00029 : Closed Interlocking Tibia + Orif of

Fracture Fixation15000 X-RAY/CT scan(If Required)

Post-operative X-ray, Clinical

Photograph showing scar

246 S5 2A.S5.00032 2A.S5.00032 : Closed Reduction and Percutaneous

Pinning7500 X Ray Scar photo, x-ray showing implant

247 S5 2A.S5.00034 2A.S5.00034 : Closed Reduction of the Hip

(including hip Spika)3500 X-ray Post-op X-ray, Scar photo

ORTHOPAEDICS

Sl. no.Speciality


248 S5 2A.S5.00036 2A.S5.00036 : Debridement & Closure of Minor

injuries1500 Clinical Notes + X-Rays Clinical Notes + X-Rays

249 S5 2A.S5.00037 2A.S5.00037 : Closed reduction of dislocation (Knee/

Hip)3000 X-ray X-ray, scar photo

250 S5 2A.S5.00038 2A.S5.00038 : Closed reduction of dislocation

(Shoulder/ Elbow)2500 X-ray

Patient Photo with Arthroscopic

incision

251 S5 2A.S5.00039 2A.S5.00039 : Duputryen’s Contracture release +

rehabilitation5000 clinical notes & photograph clinical notes & photograph

252 S5 2A.S5.00040 2A.S5.00040 : Exploration and Ulnar nerve Repair 5000Xray Films(if relevant)+ Clinical

Picture(Mandatory) + detail notesClinical photo showing Scar

253 S5 2A.S5.00042 2A.S5.00042 : External fixation - Small bone 5000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical


254 S5 2A.S5.00047 2A.S5.00047 : Fracture - Fibula Internal Fixation 5000 X-ray Scar photo, X-ray

255 S5 2A.S5.00050 2A.S5.00050 : Fracture - Olecranon of Ulna 5000 X-ray Scar photo, X-ray

256 S5 2A.S5.00051 2A.S5.00051 : Fracture - Radius Internal Fixation 5000 X-ray Scar photo, X-ray

257 S5 2A.S5.00052 2A.S5.00052 : Fracture - TIBIA Internal Fixation

plating8500 X-ray Scar photo, X-ray

258 S5 2A.S5.00053 2A.S5.00053 : Fracture - Ulna Internal Fixation 5000 X-ray Scar photo, X-ray

259 S5 2A.S5.00054 2A.S5.00054 : Head Radius – Excision 4000 X-ray Scar photo, X-ray

260 S5 2A.S5.00055 2A.S5.00055 : High Tibial Osteotomy 8500 Clinical photo, X-ray Scar photo, X-ray

261 S5 2A.S5.00056 2A.S5.00056 : Closed reduction + Hip Spica 3500 X-ray Clinical photo with spica, X-ray

262 S5 2A.S5.00057 2A.S5.00057 : Internal Fixation Lateral Epicondyle 5000 X-ray Scar photo, X-ray

263 S5 2A.S5.00058 2A.S5.00058 : Internal Fixation of other Small Bones

(metatarsals)5000 X-ray X-ray

264 S5 2A.S5.00063 2A.S5.00063 : Nerve Transposition/Release/

Neurolysis4000 Clinical Photograph Scar photo

265 S5 2A.S5.00067 2A.S5.00067 : Open Reduction of Small Joint 7500 X-ray Scar photo, X-ray

266 S5 2A.S5.00069 2A.S5.00069 : Osteotomy -Small Bone 8500 X-ray Scar photo, X-ray

267 S5 2A.S5.00070 2A.S5.00070 : Osteotomy -Long Bone 15000 X-ray Scar photo, X-ray

268 S5 2A.S5.00071 2A.S5.00071 : Patellectomy 4000 X-ray Scar photo, X-ray

269 S5 2A.S5.00073 2A.S5.00073 : Percutaneous - Fixation of Fracture 3500 X-ray X-ray

270 S5 2A.S5.00074 2A.S5.00074 : Excision of Bursa 1500 Clinical photo Scar photo

Sl. no.Speciality


271 S5 2A.S5.00076 2A.S5.00076 : Sequestrectomy of Long Bones + anti-

biotics + dressing12500 X-ray, Clinical photo X-ray

272 S5 2A.S5.00077 2A.S5.00077 : Tendo Achilles Tenotomy 2500 Clinical photo Clinical photo

273 S5 2A.S5.00079 2A.S5.00079 : Tendon Release/ Tenotomy 2500 Clinical photo Clinical photo

274 S5 2A.S5.00080 2A.S5.00080 : Tenolysis 2500 Clinical photo Clinical photo

275 S5 2A.S5.00081 2A.S5.00081 : Tension Band Wiring Patella 7500 X-ray Scar photo, X-ray

276 S5 2A.S5.00082 2A.S5.00082 : Application of P.O.P. casts for Upper &

Lower Limbs1500 X-ray Clinical photo, X-ray

277 S5 2A.S5.00083 2A.S5.00083 : Application of P.O.P. Spikas& Jackets 1750 X-ray Clinical photo, X-ray

278 S5 2A.S5.00084 2A.S5.00084 : Application of Skeletal Tractions with

pin1500 X-ray Clinical photo, X-ray

279 S5 2A.S5.00085 2A.S5.00085 : Application of Skin Traction 500 Clinical notes Clinical photo

280 S5 2A.S5.00086 2A.S5.00086 : Head radius - Excision + Fracture -

Ulna Internal Fixation10000 X-ray Scar photo, X-ray

281 S5 2A.S5.00089 2A.S5.00089 : Correction of club foot per cast 7500 Clinical photo Clinical photo with POP

282 S5 2A.S5.00098 2A.S5.00098 : Arthrodesis of shoulder 20000 X-ray Scar photo, X-ray

S8 2A.S8.00004A 2A.S8.00004A : Carpal Tunnel Release including pre

and post Op. MRI - cross speciality5000 MRI clinical photograph

S1 2A.S1.00244A 2A.S1.00244A : Debridement of Ulcer-Leprosy -

cross speciality 2500 Clinical photo, x-ray Scar photo, X-Ray

283 S7 2A.S7.00032 2A.S7.00032 : Perinephric Abscess drainage

(percutaneous)5000 USG Scar photo

284 S7 2A.S7.00067 2A.S7.00067 : Diagnostic Cystoscopy 2500 Clinical Notes Investigation Report

285 S7 2A.S7.00109 2A.S7.00109 : Reduction of Paraphimosis 750 Clinical Photograph Clinical Photograph

286 S7 2A.S7.00111 2A.S7.00111 : Meatoplasty 1750 Clinical photograph Operative photograph

287 S7 2A.S7.00112 2A.S7.00112 : Meatotomy 1750 Clinical photograph Operative photograph

288 S7 2A.S7.00121 2A.S7.00121 : Urethral Dilatation-non endocopic as

an independent procedure1000 CT Scan Clinical Photograph

289 S7 2A.S7.00140 2A.S7.00140 : Orchiectomy-simple 5000 USG scrotum, Tumour markersClinical Photograph showing scar ( if


290 S7 2A.S7.00148 2A.S7.00148 : Varicocele-unilateral-non

microsurgical5000 USG, Clinical photograph Clinical Photograph

291 S7 2A.S7.00149 2A.S7.00149 : Varicocele-unilateral-microsurgical 6000 USG, Clinical photograph Clinical Photograph

292 S7 2A.S7.00150 2A.S7.00150 : Varicocele-bilateral-non microsurgical 7500 USG, Clinical photograph Clinical Photograph

293 S7 2A.S7.00153 2A.S7.00153 : Priapism-aspiration/shunt 7500 CT/MRI/USG, clinical notes, Operative notes with steps of

surgery, clinical notes

294 S7 2A.S7.00159 2A.S7.00159 : Acute management of upper urinary

tract trauma – conservative1000 USG Doctors Note

UROLOGY

Sl. no.Speciality


295 S11 2B.S11.17058

2B.S11.17058 : Post Burn Contracture surgeries for

Functional Improvement involving only skin

(Package including splints,pressure garment and

physiotherapy- Moderate

22500 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

296 S13 2b.S13.00077 2b.S13.00077 : Operations for Congenital

Arteriovenous Fistula15000 CT Chest report Post Op X-ray,scar photo

S1 2B.S1.00005C 2B.S1.00005C : Arteriovenous (AV) Malformation of

Soft Tissue Tumour - Excision - cross speciality15000 Clinical Photograph Scar photo

S1 2B.S1.00143A 2B.S1.00143A : Vasovasostomy - cross speciality 11000Clinical notes (should have pre-op exam

of vasectomy site)Clinical photo

S1 2B.S1.00192A 2B.S1.00192A : Lymphatics Excision of Subcutaneous

Tissues In Lymphoedema - cross speciality 8000 Clinical Photograph Clinical Photograph

S13 2B.S13.00077A 2b.S13.00077A : Operations for Congenital

Arteriovenous Fistula - cross speciality 15000 CT Chest report Post Op X-ray,scar photo

S1 2B.S1.00005B 2B.S1.00005B : Arteriovenous (AV) Malformation of


S1 2B.S1.00011A 2B.S1.00011A : Branchial Fistula -cross speciality 14000 CT scan, Clinical Photograph clinical

S1 2B.S1.00027A 2B.S1.00027A : Drainage Pericardial Effusion - cross

speciality 11000 X -Ray, ECHO X -Ray film with report

S1 2B.S1.00037A 2B.S1.00037A : Excision Bronchial Sinus - cross

speciality 8000 USG/CT Clinical photo, OT notes

S1 2B.S1.00143B 2B.S1.00143B : Vasovasostomy - cross speciality 11000Clinical notes (should have pre-op exam


S1 2B.S1.00184A 2B.S1.00184A : Laparoscopic Hiatus Hernia Repair -

cross speciality 20000 UGI ENDOSCOPY Scar photo/ Intra op photo

S1 2B.S1.00206A 2B.S1.00206A : Drainage of perivertebral abscess -

cross speciality 7000 USG/ CT Scan Clinical Photograph

S1 2B.S1.00210A 2B.S1.00210A : Thymectomy - cross speciality 23000 USG Clinical Photograph

S1 2B.S1.00224B 2B.S1.00224B : Rib Resection & Drainage - cross

speciality7500 Chest X-ray, Clinical Photograph Clinical Photograph

S1 2B.S1.00232A 2B.S1.00232A : Thoracocentesis - cross speciality 1500 X-ray, CT X-ray

297 S16 2B.S16.00002

2B.S16.00002 : Fixation of fracture of jaw with open

reduction (1 jaw) and fixing of plates/ wire – under

GA

9000 X Ray film with report X Ray film with report

298 S16 2B.S16.00003 2B.S16.00003 : Sequestrectomy 1125 X Ray film with report X Ray film with report

COMPLEX SECONDARY CARE

BURNS



Sl. no.Speciality


299 S16 2B.S16.00004 2B.S16.00004 : TM joint ankylosis of both jaws -

under GA 11250 X Ray film with report X Ray film with report

300 S16 2B.S16.00005 2B.S16.00005 : Release of fibrous bands & grafting -

in (OSMF) treatment under GA 2250 Clinical notes 0

301 S16 2B.S16.00008 2B.S16.00008 : Mandible Tumour Resection and

reconstruction/Cancer surgery4500 X Ray film with report


Photograph

302 S16 2B.S16.17174 2B.S16.17174 : Drainage of parotid abscess 5250 X Ray film with reportX Ray film with report, Clinical

Photograph

S2 2B.S2.00029A 2B.S2.00029A : Antrostomy – Bilateral - cross

speciality 4875 CT PNS Clinical Photograph

S2 2B.S2.00030A 2B.S2.00030A : Antrostomy – Unilateral - cross

speciality 3375 CT PNS Clinical Photograph

S2 2B.S2.00066A 2B.S2.00066A : Oro Antral fistula - cross speciality 5625 Fistulogram/Clinical photograph Clinical Photograph

S2 2B.S2.00078A 2B.S2.00078A : Commondo Operation (glossectomy)

- cross speciality10500 CT Skull, HPE Clinical Photograph

S2 2B.S2.00083A 2B.S2.00083A : Excision of the Mandible Segmental -

cross speciality5625

X Ray film with report, Routine Blood

InvX Ray film with report

S2 2B.S2.00084A 2B.S2.00084A : Hemi-mandibulectomy with graft -


X Ray film with report, Routine Blood

InvX Ray film with report

S1 2B.S1.00044A 2B.S1.00044A : Excision of Growth from Tongue only

- cross speciality 4500 Clinical Photograph Scar Photo, HPE Report

S1 2B.S1.00124A 2B.S1.00124A : Salivary Gland – Excision - cross

speciality 7500 Clinical Photograph , FNAC, CT HPR , Scar Photograph

S1 2B.S1.00145B 2B.S1.00145B : Cleft lip operation - cross speciality 9000 Clinical Photograph Clinical Photograph

S1 2B.S1.00147B 2B.S1.00147B : Cleft lip & palate operation (for each

stage) - cross speciality11250 Clincal note and photograph OT note and clinical photograph

303 S2 2B.S2.00002 2B.S2.00002 : Labyrinthectomy 15000 Endoscopy Photo Endoscopy Photo

304 S2 2B.S2.00004 2B.S2.00004 : Mastoidectomy corticol modified/

radical6525

CT Temporal Bone , Pure Tone

Audiometry Report X-Ray Mastoids, Scar photo

305 S2 2B.S2.00005 2B.S2.00005 : Mastoidectomy with tympanoplasty 5625Pure Tone Audiometry Report, Clinical

notes

X-Ray Mastoids, Scar photo, Pure

Tone Audiometry Report

306 S2 2B.S2.00006 2B.S2.00006 : Myringoplasty 3750Pure Tone Audiometry Report, Clinical

notesPure Tone Audiometry Report

307 S2 2B.S2.00012 2B.S2.00012 : Ossiculoplasty 5625Pure Tone Audiometry Report and




308 S2 2B.S2.00014

2B.S2.00014 : Excision of Pinna for Growths

(Squamous/Basal) Injuries - Total Amputation &

Excision of External Auditory Meatus

6000 Clinical Photograph HPR/Clinical photograph

309 S2 2B.S2.00016 2B.S2.00016 : Stapedectomy 6000Pure Tone Audiometry Report and


Clinical Photograph With Piston ,

Pure Tone Audiometry Report

ENT

Sl. no.Speciality


310 S2 2B.S2.00021 2B.S2.00021 : Excision of Pinna for Growth

(Squamous/Basal/ Injuries) Skin Only1875 Clinical Photograph/ FNAC HPR/Clinical photograph

311 S2 2B.S2.00025 2B.S2.00025 : Tympanotomy 3000 Otoscopy, Clinical Notes Scar photo

312 S2 2B.S2.00027 2B.S2.00027 : Aural polypectomy +Tympanoplasty 7500 CT, Clinical Notes, Audiometry Procedure Notes, Scar Photo

313 S2 2B.S2.00028 2B.S2.00028 : Ant. Ethmoidal artery ligation - open/

endoscopic8250 CT PNS Clinical Photograph

314 S2 2B.S2.00029 2B.S2.00029 : Antrostomy – Bilateral 4875 CT PNS Clinical Photograph

315 S2 2B.S2.00030 2B.S2.00030 : Antrostomy – Unilateral 3375 CT PNS Clinical Photograph

316 S2 2B.S2.00031 2B.S2.00031 : Cryosurgery 2250 DNE Photo DNE Photo

317 S2 2B.S2.00033 2B.S2.00033 : Septoplasty + FESS 8625 CT/ MRI X-Ray

318 S2 2B.S2.00034 2B.S2.00034 : Ethmoidectomy – External 6900 CT/ MRI X-Ray

319 S2 2B.S2.00036 2B.S2.00036 : Fracture - setting maxilla 6000X Ray film with report with report with

reportPNSX Ray

320 S2 2B.S2.00041 2B.S2.00041 : Nasal polypectomy – Bilateral 6750 Clinical notes, CT PNS X-Ray

321 S2 2B.S2.00042 2B.S2.00042 : Nasal polypectomy – Unilateral 4500 Clinical notes, CT PNS X-Ray

322 S2 2B.S2.00051 2B.S2.00051 : Endoscopic DCR 5250 Lacrimal Syringing Report Clinical Photograph

323 S2 2B.S2.00055 2B.S2.00055 : Septo-rhinoplasty 4950 X Ray PNS , CT PNS Clinical Photograph

324 S2 2B.S2.00058 2B.S2.00058 : Arytenoidectomy 7500 CT-Scan / MRI Scan/Endo photoClinical Photograph, Endo Picture, X-

Ray

325 S2 2B.S2.00060 2B.S2.00060 : Tonsillectomy + Myrinogotomy 7500 Clinical Notes Procedure Notes

326 S2 2B.S2.00061 2B.S2.00061 : Pharyngeal diverticulum's – Excision 7500 USG Neck USG

327 S2 2B.S2.00062 2B.S2.00062 : Laryngectomy with block dissection 9000 CT Neck,USGX Ray film with report, Clinical

Photograph,HPE

328 S2 2B.S2.00063 2B.S2.00063 : Laryngofissure 2625 USG Neck USG

329 S2 2B.S2.00066 2B.S2.00066 : Oro Antral fistula 5625 Fistulogram/Clinical photograph Clinical Photograph, Procedure notes

330 S2 2B.S2.00068 2B.S2.00068 : Parapharyngeal Abscess – Drainage 5625 CT/MRI/ Clinical photograph Procedure notes

331 S2 2B.S2.00072 2B.S2.00072 : Tonsillectomy + Styloidectomy 9375 X-Ray Skull Lateral View X-Ray Skull Lateral View

332 S2 2B.S2.00073 2B.S2.00073 : Thyroglossal Fistula/ cyst – Excision 5250 Ultrasound Neck, Fistulogram HPR, X-Ray

333 S2 2B.S2.00077 2B.S2.00077 : Uvulophanyngo Plasty 10500 Polysomnography Clinical Photograph

334 S2 2B.S2.00078 2B.S2.00078 : Commondo Operation (glossectomy) 10500 CT Skull, HPE Clinical Photograph

335 S2 2B.S2.00082 2B.S2.00082 : Excision of Cystic Hygroma Minor 3750 Clinical notes & photo, USG/CT

Clinical photo showing scar, BIOPSY,

Operative notes with steps of surgery

& Clinical notes

336 S2 2B.S2.00083 2B.S2.00083 : Excision of the Mandible Segmental 5625 X Ray film Scar Photo, X Ray film

337 S2 2B.S2.00084 2B.S2.00084 : Hemi-mandibulectomy with graft 11250 X Ray film Scar Photo, X Ray film

Sl. no.Speciality


S1 2B.S1.00011B 2B.S1.00011B : Branchial Fistula -cross speciality 10500 CT scan, Clinical Photograph clinical

S1 2B.S1.00037A 2B.S1.00037A : Excision Bronchial Sinus - cross

speciality 6000 USG/CT Clinical photo, OT notes

S1 2B.S1.00094A 2B.S1.00094A : Laryngectomy & Pharyngeal

Diverticulum (Throat) - cross speciality 7500 CT Neck,USG Clinical Photograph,HPE

S1 2B.S1.00101A 2B.S1.00101A : Microlaryngoscopic Surgery - cross

speciality 9375 DL scopy findings

HPE, Clinical Notes, Intra-Op

Photograph

S1 2B.S1.00102B 2B.S1.00102B : Oeshophagoscopy for foreign body

removal - cross speciality 4500 Endoscopy/ X-Ray Clinical notes, endo picture

S1 2B.S1.00220B 2B.S1.00220B : Removal of Foreign Body from

Trachea or Oesophagus - cross speciality 1875 Clinical photo, endoscopy Procedure notes

S16 2B.S16.17174B 2B.S16.17174B : Drainage of parotid abscess - cross

speciality5250 X Ray film with report


Photograph

338 M1 2B.M1.00008 2B.M1.00008 : Congestive heart failure - routine

ward 1350



M1 2B.M1.00008A 2B.M1.00008A : Congestive heart failure - HDU 2025Clinical Notes with relevant


M1 2B.M1.00008B 2B.M1.00008B : Congestive heart failure - ICU




M1 2B.M1.00008C 2B.M1.00008C : Congestive heart failure - ICU with

ventilator 3375



339 M1 2B.M1.00010 2B.M1.00010 : Diabetic ketoacidosis - routine ward 1350Clinical Notes with relevant


M1 2B.M1.00010A 2B.M1.00010A : Diabetic ketoacidosis - HDU 2025Clinical Notes with relevant


M1 2B.M1.00010B 2B.M1.00010B : Diabetic ketoacidosis - ICU without

ventilator 2700



M1 2B.M1.00010C 2B.M1.00010C : Diabetic ketoacidosis - ICU with

ventilator 3375



340 M1 2B.M1.00033 2B.M1.00033 : Lung abscess/ Empyema - routine

ward 1350 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest

M1 2B.M1.00033A 2B.M1.00033A : Lung abscess/ Empyema - HDU 2025 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest

M1 2B.M1.00033B 2B.M1.00033B : Lung abscess/ Empyema - ICU

without ventilator 2700 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest

M1 2B.M1.00033C 2B.M1.00033C : Lung abscess/ Empyema - ICU with

ventilator 3375 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest

341 M1 2B.M1.00048 2B.M1.00048 : Acute gastroenteritis with severe

dehydration - routine ward 1350 Clinical notes Clinical notes

M1 2B.M1.00048A 2B.M1.00048A : Acute gastroenteritis with severe

dehydration - HDU 2025 Clinical notes Clinical notes

GENERAL MEDICINE

Sl. no.Speciality


M1 2B.M1.00048B 2B.M1.00048B : Acute gastroenteritis with severe

dehydration - ICU without ventilator 2700 Clinical notes Clinical notes

M1 2B.M1.00048C 2B.M1.00048C : Acute gastroenteritis with severe

dehydration - ICU with ventilator 3375 Clinical notes Clinical notes

342 M1 2B.M1.00057 2B.M1.00057 : Upper GI bleeding (endoscopic) -

routine ward 1350



M1 2B.M1.00057A 2B.M1.00057A : Upper GI bleeding (endoscopic) -

HDU 2025



M1 2B.M1.00057B 2B.M1.00057B : Upper GI bleeding (endoscopic) -




M1 2B.M1.00057C 2B.M1.00057C : Upper GI bleeding (endoscopic) -




343 M1 2B.M1.00061 2B.M1.00061 : Guillian Barre Syndrome - routine

ward 1350



M1 2B.M1.00061A 2B.M1.00061A : Guillian Barre Syndrome - HDU 2025Clinical Notes with relevant


M1 2B.M1.00061B 2B.M1.00061B : Guillian Barre Syndrome - ICU




M1 2B.M1.00061C 2B.M1.00061C : Guillian Barre Syndrome - ICU with

ventilator 3375



344 S1 2B.S1.00005 2B.S1.00005 : Arteriovenous (AV) Malformation of

Soft Tissue Tumour - Excision11250 Clinical Photograph Scar photo

345 S1 2B.S1.00009 2B.S1.00009 : Bleeding Ulcer - Partial Gastrectomy 18750 Endoscopy Scar photo, HPR

346 S1 2B.S1.00010 2B.S1.00010 : Block dissection Cervical Nodes 7500 Clinical photo, CT report Scar Photo, HPE Report

347 S1 2B.S1.00011 2B.S1.00011 : Branchial Fistula 10500 CT scan, Clinical Photograph clinical

348 S1 2B.S1.00026 2B.S1.00026 : Drainage of Subdiaphramatic Abscess 6000 USG/Clinical Notes Scar photo

349 S1 2B.S1.00027 2B.S1.00027 : Drainage Pericardial Effusion 8250 X -Ray, ECHO X -Ray film with report

350 S1 2B.S1.00028 2B.S1.00028 : Duodenal Diverticulum 11250 USG/CT Scan Scar Photo

351 S1 2B.S1.00029 2B.S1.00029 : Duodenal Jejunostomy 11250 USG Clinical Photo

352 S1 2B.S1.00030 2B.S1.00030 : Duplication of Intestine 12750 CT/ USG Scar Photo

353 S1 2B.S1.00036 2B.S1.00036 : Excision Benign Tumor -Small intestine 11250 CT/ USG HPE Report

354 S1 2B.S1.00037 2B.S1.00037 : Excision Bronchial Sinus 6000 USG/CT Clinical photo, OT notes

355 S1 2B.S1.00041 2B.S1.00041 : Excision Meckel's Diverticulum 11250 USG/ CT Scar Photo, HPE Report

356 S1 2B.S1.00043 2B.S1.00043 : Excision Small Intestinal Fistula 9000 USG/ CT Scar Photo

357 S1 2B.S1.00044 2B.S1.00044 : Excision of Growth from Tongue only 4500 Clinical Photograph Scar Photo, HPE Report

358 S1 2B.S1.00046 2B.S1.00046 : Excision of Swelling in Right Cervical

Region3000 FNAC/ Biopsy HPR

359 S1 2B.S1.00051 2B.S1.00051 : Fibroadenoma – Bilateral 6000 Biopsy/ FNAC, USG, HPR

GENERAL SURGERY

Sl. no.Speciality


360 S1 2B.S1.00057 2B.S1.00057 : Fissurectomy with Sphincterotomy 11250 Clinical notes Clinical Notes & OT Notes

361 S1 2B.S1.00058 2B.S1.00058 : Foreign Body Removal in Deep Region

requiring GA3750 X-Ray / Scopy report X-Ray / Scopy report

362 S1 2B.S1.00063 2B.S1.00063 : Gastrojejunostomy 11250 USG, Endoscopy Scar Photo

363 S1 2B.S1.00065 2B.S1.00065 : Graham's Operation for duodenal

perforation11250 X-ray abdomen/CT, USG USG, Scar Photo

364 S1 2B.S1.00073 2B.S1.00073 : Hernia - Repair & release of

obstruction11250 USG, Clinical Photograph

Clinical Notes, Scar photo and OT

notes

365 S1 2B.S1.00079 2B.S1.00079 : Hydatid Cyst of Liver 7500 CT/MRIClinical Photograph/ Scar photo, HPE

Report

366 S1 2B.S1.00082 2B.S1.00082 : IlieoSigmoidostomy 9750 CT Scan/ MRI Scar photo

367 S1 2B.S1.00086 2B.S1.00086 : Intestinal Obstruction 9375 X-Ray abdomen /CT /USG USG, Scar Photo

368 S1 2B.S1.00088 2B.S1.00088 : Jejunostomy 7500 USG Clinical Photo

369 S1 2B.S1.00089 2B.S1.00089 : Gastric Perforation 11250 X Ray abdomen/ CT Clinical/ Scar photo

370 S1 2B.S1.00090 2B.S1.00090 : Intestinal Perforation (Resection

Anastomosis)15000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo

371 S1 2B.S1.00091 2B.S1.00091 : Appendicular Perforation 9000 USG, Clinical Notes HPR , Clinical photograph

372 S1 2B.S1.00094 2B.S1.00094 : Laryngectomy & Pharyngeal

Diverticulum (Throat)7500 CT Neck,USG Clinical Photograph,HPE

373 S1 2B.S1.00095 2B.S1.00095 : Ileostomy 15000Biopsy of the primary + CT Scan with

filmClinical Photograph

374 S1 2B.S1.00097 2B.S1.00097 : Loop Colostomy Sigmoid 9000 CT/MRI , Endoscopy , USG Clinical photograph

375 S1 2B.S1.00098 2B.S1.00098 : Mastectomy 9000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report

376 S1 2B.S1.00099 2B.S1.00099 : Mesenteric Cyst – Excision 6750 USG/ CT Scan/ MRI Scar Photo, HPE Report

377 S1 2B.S1.00100 2B.S1.00100 : Mesenteric Caval Anastomosis 7500 CT abdomen/USG OT Notes, Intra-Op Photograph

378 S1 2B.S1.00101 2B.S1.00101 : Microlaryngoscopic Surgery 9375 DL scopy findingsHPE, Clinical Notes, Intra-Op

Photograph

379 S1 2B.S1.00102 2B.S1.00102 : Oeshophagoscopy for foreign body

removal4500 Endoscopy/ X-Ray Clinical notes, endo picture

380 S1 2B.S1.00105 2B.S1.00105 : Pelvic Abscess - Open Drainage 6000 USG Scar Photograph

381 S1 2B.S1.00107 2B.S1.00107 : Distal Pancreatectomy with

PancreaticoJejunostomy12750 CT/ MRI Scar photo

382 S1 2B.S1.00109 2B.S1.00109 : Haemorroidectomy+ Fistulectomy 7500Clinical notes, Practoscopy/

Colonoscopy findings, FistulogramOT Notes

383 S1 2B.S1.00111 2B.S1.00111 : Porto Caval Anastomosis 11250 CT/ MRI OT Notes / Post-op CT

384 S1 2B.S1.00119 2B.S1.00119 : Repair of Common Bile Duct 9375

CT/MRI Abdomen, Endoscopic

Retrograde Cholangio Pancreatography

(ERCP)

OT Notes

385 S1 2B.S1.00124 2B.S1.00124 : Salivary Gland – Excision 7500 Clinical Photograph , FNAC, CT HPR , Scar Photograph

386 S1 2B.S1.00127 2B.S1.00127 : Sigmoid Diverticulum 11250 CT/ MRI Scar photo

387 S1 2B.S1.00137 2B.S1.00137 : Colectomy – Total 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph

388 S1 2B.S1.00143 2B.S1.00143 : Vasovasostomy 8250Clinical notes (should have pre-op exam


Sl. no.Speciality


389 S1 2B.S1.00145 2B.S1.00145 : Cleft lip operation 9000 Clinical Photograph Scar Photograph

390 S1 2B.S1.00147 2B.S1.00147 : Cleft lip & palate operation (for each

stage)11250

Clincal note and photograph, CT Scan if

indicatedOT note and clinical photograph

391 S1 2B.S1.00153 2B.S1.00153 : Cholecystectomy & Exploration of

CBD10125 CT , LFT HPR, Clinical photograph

392 S1 2B.S1.00164 2B.S1.00164 : Split thickness skin grafts – Small (<

4% TBSA)3750 Clinical photograph Post-op photo

393 S1 2B.S1.00166 2B.S1.00166 : Split thickness skin grafts – Large (>

8% TBSA)11250 Clinical photograph Post-op photo

394 S1 2B.S1.00168 2B.S1.00168 : Hemi thyroidectomy 7500 FNAC , T F T , USG HPR , Clinical Photograph

395 S1 2B.S1.00170 2B.S1.00170 : Laparoscopic Hernia Repair 13500 USGClinical Notes, Scar photo and OT

notes

396 S1 2B.S1.00175 2B.S1.00175 : Lap. Cholecystectomy & CBD

exploration15000 CT , LFT HPR, Clinical photograph

397 S1 2B.S1.00176 2B.S1.00176 : Lap. For intestinal obstruction 11250 X-Ray abdomen /CT /USG USG, Scar Photo

398 S1 2B.S1.00177 2B.S1.00177 : Lap. Hepatic resection 18750 MRI/ CT Abdomen Scar Photo, HPE Report

399 S1 2B.S1.00178 2B.S1.00178 : Lap. Hydatid of liver surgery 13500 MRI/ CT Abdomen Scar Photo, HPE Report

400 S1 2B.S1.00180 2B.S1.00180 : Laparoscopic Appendicectomy 7500 MRI/ CT Scar Photo

401 S1 2B.S1.00181 2B.S1.00181 : Laparoscopic Cholecystectomy 9000 CT , LFT HPR, Clinical photograph

402 S1 2B.S1.00182 2B.S1.00182 : Laparoscopic cystogastrostomy 11250 USG/ CT Scan Clinical photograph

403 S1 2B.S1.00183 2B.S1.00183 : Laparoscopic Gastrostomy 7875 USG/ CT Scan Clinical photograph

404 S1 2B.S1.00184 2B.S1.00184 : Laparoscopic Hiatus Hernia Repair 15000 UGI ENDOSCOPY Scar photo/ Intra op photo

405 S1 2B.S1.00185 2B.S1.00185 : Laparoscopic Pyloromyotomy 9375 USG, Clinical notes Clinical Photograph

406 S1 2B.S1.00186 2B.S1.00186 : Laparoscopic Rectopexy 11250 Clinical Findings Clinical Findings

407 S1 2B.S1.00187 2B.S1.00187 : Laparoscopic Spleenectomy 9000 CT/ MRI Scar photo

408 S1 2B.S1.00188 2B.S1.00188 : Laparoscopic umbilical hernia repair 9000 USG, Clinical PhotographClinical Notes, Scar photo and OT

notes

409 S1 2B.S1.00189 2B.S1.00189 : Laparoscopic ventral hernia repair 15000 USG, Clinical PhotographClinical Notes, Scar photo and OT

notes

410 S1 2B.S1.00190 2B.S1.00190 : Laparotomy-peritonitis lavage and

drainage5250 USG/X Ray Scar photo

411 S1 2B.S1.00192 2B.S1.00192 : Lymphatics Excision of Subcutaneous

Tissues In Lymphoedema6000 Clinical Photograph Clinical Photograph

412 S1 2B.S1.00196 2B.S1.00196 : Operation for Bleeding Peptic Ulcer 11250 Endoscopy report. Scar photo, HPE

413 S1 2B.S1.00203 2B.S1.00203 : Coccygeal Teratoma Excision 11250 Clinical Photograph Clincial Notes, Scar photo

414 S1 2B.S1.00206 2B.S1.00206 : Drainage of perivertebral abscess 5250 USG/ CT Scan Clinical Photograph

415 S1 2B.S1.00210 2B.S1.00210 : Thymectomy 17250 USG Clinical Photograph

416 S1 2B.S1.00211 2B.S1.00211 : Operation of Choledochal Cyst 11250 CT/ USG HPE, Scar photo, USG

417 S1 2B.S1.00220 2B.S1.00220 : Removal of Foreign Body from

Trachea or Oesophagus1875 Clinical photo, endoscopy Procedure notes

Sl. no.Speciality


418 S1 2B.S1.00223 2B.S1.00223 : Resection Enucleation of Adenoma

(lung)7500 Clinical Photograph Clinical Photograph

419 S1 2B.S1.00224 2B.S1.00224 : Rib Resection & Drainage 5625 Chest X-ray, Clinical Photograph Clinical Photograph

420 S1 2B.S1.00226 2B.S1.00226 : Splenectomy - For Trauma 15000 CT/ MRI Scar photo

421 S1 2B.S1.00232 2B.S1.00232 : Thoracocentesis 1125 X-ray, CT X-ray

422 S1 2B.S1.00243 2B.S1.00243 : Trendelenburg Operation 7500 Clinical notes Clinical Photograph

423 S1 2B.S1.00245 2B.S1.00245 : Tissue Reconstruction Flap Leprosy 16500 Clinical Photograph Scar photo

424 S1 2B.S1.00246 2B.S1.00246 : Tendon Transfer-Leprosy 16500 Clinical Photograph, Clinical Notes Clinical Photograph

425 S1 2B.S1.17001

2B.S1.17001 : Endoscopic Retrograde Cholangio

Pancreatography (Endoscopic Retrograde Cholangio

Pancreatography (ERCP) with Interventions

3000 Liver function test (LFT), USG Liver function test (LFT), USG

426 S1 2B.S1.17002 2B.S1.17002 : Laproscopic Adrenalectomy 22500 CT Clinical Photograph

427 S1 2B.S1.17003 2B.S1.17003 : Gastro jejuno Colic Fistula 9375 USG Scar Photo

428 S1 2B.S1.17004

2B.S1.17004 : Endoscopic Retrograde Cholangio

Pancreatography (ERCP) (Endoscopic Retrograde

Cholangio – Pancreatography)

1688 LFT, USG USG

429 S1 2B.S1.17009 2B.S1.17009 : Upper GI Therapeutic(including

Varicose Intervention)1500 Endoscopy report. Procedure stills

S16 2B.S16.17174A 2B.S16.17174A : Drainage of parotid abscess - cross

speciality5250 X Ray film with report


Photograph

S2 2B.S2.00031A 2B.S2.00031A : Cryosurgery - cross speciality 2250 DNE Photo DNE Photo

430 M8 2B.M8.00005 2B.M8.00005 : Neurotic, stress-related and

somatoform disorders (routine ward)1125 Clinical notes Clinical notes

431 M8 2B.M8.00006

2B.M8.00006 : Behavioural syndromes associated

with physiological disturbances and physical factors

(routine ward)


432 M8 2B.M8.00007 2B.M8.00007 : Mental retardation (routine ward) 1125 Clinical notes Clinical notes

433 M8 2B.M8.00008 2B.M8.00008 : Organic, including symptomatic,

mental disorders (HDU)1875 Clinical notes Clinical notes

434 M8 2B.M8.00011 2B.M8.00011 : Mood (affective) disorders (HDU) 1875 Clinical notes Clinical notes

MENTAL DISORDER PACKAGES

Sl. no.Speciality


435 M8 2B.M8.00015

2B.M8.00015 : 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)

7500

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)

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)

436 M8 2B.M8.00016 2B.M8.00016 : Electro Convulsive Therapy (ECT) - per

session2250 Clinical notes Clinical notes

437 M8 2B.M8.00017 2B.M8.00017 : Transcranial Magnetic Stimulation

(TMS) - per session750 Clinical notes Clinical notes

438 M2 2B.M2.00008 2B.M2.00008 : Poisonings with normal vital signs -


M2 2B.M2.00008A 2B.M2.00008A : Poisonings with normal vital signs -


M2 2B.M2.00008B 2B.M2.00008B : Poisonings with normal vital signs -


M2 2B.M2.00008C 2B.M2.00008C : Poisonings with normal vital signs -


439 M2 2B.M2.00025 2B.M2.00025 : Diabetic ketoacidosis - routine ward 1350Clinical Notes with relevant


M2 2B.M2.00025A 2B.M2.00025A : Diabetic ketoacidosis - HDU 2025Clinical Notes with relevant


M2 2B.M2.00025B 2B.M2.00025B : Diabetic ketoacidosis - ICU without

ventilator 2700



M2 2B.M2.00025C 2B.M2.00025C : Diabetic ketoacidosis - ICU with

ventilator 3375



440 M2 2B.M2.00026 2B.M2.00026 : Nephrotic syndrome with peritonitis -

routine ward1350

Complete blood count (CBC), Renal

function test (RFT)


function test (RFT)

M2 2B.M2.00026A 2B.M2.00026A : Nephrotic syndrome with peritonitis

- HDU 2025


function test (RFT)


function test (RFT)

M2 2B.M2.00026B 2B.M2.00026B : Nephrotic syndrome with peritonitis

- ICU without ventilator 2700


function test (RFT)


function test (RFT)

M2 2B.M2.00026C 2B.M2.00026C : Nephrotic syndrome with peritonitis

- ICU with ventilator 3375


function test (RFT)


function test (RFT)

441 M2 2B.M2.00037 2B.M2.00037 : Infantile cholestasis - routine ward 1350Clinical Notes with relevant


M2 2B.M2.00037A 2B.M2.00037A : Infantile cholestasis - HDU 2025Clinical Notes with relevant


M2 2B.M2.00037B 2B.M2.00037B : Infantile cholestasis - ICU without

ventilator 2700



NEONATAL AND PAEDIATRICS SURGERIES

Sl. no.Speciality


M2 2B.M2.00037C 2B.M2.00037C : Infantile cholestasis - ICU with

ventilator 3375



442 M2 2B.M2.00043 2B.M2.00043 : Empyema - routine ward 1350 Clinical note with Lab reports Treatment note

M2 2B.M2.00043A 2B.M2.00043A : Empyema - HDU 2025 Clinical note with Lab reports Treatment note

M2 2B.M2.00043B 2B.M2.00043B : Empyema - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 2B.M2.00043C 2B.M2.00043C : Empyema - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

443 M2 2B.M2.00050

2B.M2.00050 : Intracranial ring enhancing lesion

with complication (neurocysticercosis, tuberculoma) -

routine ward

1350Clinical Notes with relevant


M2 2B.M2.00050A

2B.M2.00050A : Intracranial ring enhancing lesion


HDU



M2 2B.M2.00050B

2B.M2.00050B : Intracranial ring enhancing lesion


ICU without ventilator



M2 2B.M2.00050C

2B.M2.00050C : Intracranial ring enhancing lesion


ICU with ventilator



444 M2 2B.M2.00076 2B.M2.00076 : Congestive cardiac failure - routine

ward 1350



M2 2B.M2.00076A 2B.M2.00076A : Congestive cardiac failure - HDU 2025Clinical Notes with relevant


M2 2B.M2.00076B 2B.M2.00076B : Congestive cardiac failure - ICU




M2 2B.M2.00076C 2B.M2.00076C : Congestive cardiac failure - ICU with

ventilator 3375



445 M2 2B.M2.00099

2B.M2.00099 : 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.)

1125 Clinical note with Lab reports Treatment note and HPE report

446 M3 2B.M3.00009 2B.M3.00009 : Advanced Surgery for Retinopathy of

Prematurity11250 Fundoscopy Report Fundoscopy Report

447 S14 2B.S14.00009 2B.S14.00009 : Undescended Testis - Unilateral-

Palpable11250 USG,Clinical photo Nil

448 S14 2B.S14.00019 2B.S14.00019 : Gastrostomy + Esophagoscopy+

Threading15000 USG Clinical Photograph

Sl. no.Speciality


M1 2B.M1.00048D 2B.M1.00048D : Acute gastroenteritis with severe

dehydration - routine ward - Cross speciality1350 Clinical notes Clinical notes

M1 2B.M1.00048E 2B.M1.00048E : Acute gastroenteritis with severe

dehydration - HDU - Cross speciality2025 Clinical notes Clinical notes

M1 2B.M1.00048F 2B.M1.00048F : Acute gastroenteritis with severe

dehydration - ICU with ventilator - Cross speciality3375 Clinical notes Clinical notes

M1 2B.M1.00048G

2B.M1.00048G : Acute gastroenteritis with severe

dehydration - ICU without ventilator - Cross

speciality


S1 2B.S1.00030A 2B.S1.00030A : Duplication of Intestine - cross

speciality12750 CT/ USG Scar Photo

S1 2B.S1.00176A 2B.S1.00176A : Lap. For intestinal obstruction - cross

speciality 11250 X-Ray abdomen /CT /USG USG, Scar Photo

S1 2B.S1.00185A 2B.S1.00185A : Laparoscopic Pyloromyotomy - cross

speciality 9375 USG, Clinical notes Clinical Photograph

S1 2B.S1.00188A 2B.S1.00188A : Laparoscopic umbilical hernia repair -

cross speciality9000 USG Clinical Photograph

S1 2B.S1.00189A 2B.S1.00189A : Laparoscopic ventral hernia repair -


Clinical photograph , USG, Routine

Blood Inv Clinical photograph

449 S8 2B.S8.00015 2B.S8.00015 : Laminectomy with Fusion and fixation 37500 CT/MRI reportClinical Photographs showing scar +

X-ray-Lumbar Spine

450 S8 2B.S8.00018 2B.S8.00018 : Lumbar Disc including pre and post

Op. MRI22500 Clinical findings, MRI Report Clinical photograph showing scar

451 S8 2B.S8.00023 2B.S8.00023 : Micro discectomy – Lumbar 30000 Clinical findings, MRI Report Clinical photograph showing scar

452 S8 2B.S8.00029 2B.S8.00029 : Spine - Decompression & Fusion with

fixation37500 Clinical findings, MRI Report Post Op X-Ray Report and film

453 S8 2B.S8.00074 2B.S8.00074 : Muscle Biopsy with report 5250 Reports of relevant investigation HPE Report

S1 2B.S1.00005A 2B.S1.00005A : Arteriovenous (AV) Malformation of


454 S4 2B.S4.00003 2B.S4.00003 : Surgeries for Prolapse - Sling

Surgeries12000 Clinical Notes, USG OT Notes

455 S4 2B.S4.00010 2B.S4.00010 : Vaginal hysterectomy with anterior

and posterior colpoperineorrhaphy12000


Clinical notesOT Notes and HPE

456 S4 2B.S4.00013 2B.S4.00013 : Repair for rectovaginal fitulas 7500Clinical Notes, USG/KUB/Urology

opinionOT notes

457 S4 2B.S4.00020 2B.S4.00020 : Vulvectomy simple 11250 Clinical Notes, USG/CT/MRI OT Notes, HPE

458 S4 2B.S4.00022 2B.S4.00022 : Diagnostic laparoscopy 8250 USG Clinical Photograph

459 S4 2B.S4.00023 2B.S4.00023 : Laparoscopic hysterectomy (TLH) 15000Ultrasonography, X Ray, ECG, LFT,RFT,

FBS,PPBS, T3,T4,THSHPR,OT notes

NEUROSURGERY


Sl. no.Speciality


460 S4 2B.S4.00024 2B.S4.00024 : Laparoscopic myomectomy 9000 Ultrasonography/ Tubal patency test HPE, OT notes

461 S4 2B.S4.00025 2B.S4.00025 : Laparoscopic cystectomy 11250 USG, Routine investigations and CA 125 HPE

462 S4 2B.S4.00027 2B.S4.00027 : Laparoscopic adhesiolysis 4500 CT , X-Ray Abdomen HPR , Clinical photograph

463 S4 2B.S4.00044 2B.S4.00044 : Laparotomy for ruptured ectopic 7500Serum Beta HCG, USG, CBC, Routine

investigationOT notes

464 S4 2B.S4.00048 2B.S4.00048 : McDonald's stitch 3000 USG and clinical notes OT Note

465 S4 2B.S4.00049 2B.S4.00049 : Shirodkar's stitch 3000 Clinical Notes OT Notes

466 S4 2B.S4.00050 2B.S4.00050 : Tuboplasty 7125Ultrasonography, X Ray, ECG, LFT,RFT,

FBS,PPBS, T3,T4,THSOT Notes

467 S4 2B.S4.00056 2B.S4.00056 : Adhenolysis + Hernia - Ventral -

Lipectomy/Incision12000 USG and clinical notes OT Note

468 S4 2B.S4.00057 2B.S4.00057 : Adhenolysis+ Ovarian Cystectomy 7500 USG and clinical notes OT note and HPE

469 S4 2B.S4.00058 2B.S4.00058 : Adhenolysis+ Salpingostomy 7500 USG and clinical notes OT note and HPE

470 S4 2B.S4.00060 2B.S4.00060 : Brust abdomen repair 10500 USG and clinical notes OT note and HPE

471 S4 2B.S4.00065 2B.S4.00065 : Cystocele - Anterior repair 9000 USG and clinical notes OT Note

472 S4 2B.S4.00069 2B.S4.00069 : Diagnostic laparoscopy &

hysteroscopy for infertility3750 USG and clinical notes OT Note

473 S4 2B.S4.00071 2B.S4.00071 : Exploration of abdominal haematoma

(after laparotomy + LSCS)10500 USG and clinical notes OT Note and HPE

474 S4 2B.S4.00077 2B.S4.00077 : Chorionic villus sampling 3750USG, Lab investigation and clinical

notesOT Note and sampling report

475 S4 2B.S4.17015 2B.S4.17015 : Lap. Salphingo-oophorectomy 7500 USG, CA 125 HPE

476 S4 2B.S4.17016 2B.S4.17016 : Lap. Assisted Vaginal Hysterectomy

(LAVH)8625

Ultrasonography, X Ray, ECG, LFT,RFT,

FBS,PPBS, T3,T4,THS/ Endometrial

Biopsy/Cervical biopsy

HPR,OT notes

477 S15 2B.S15.00019 2B.S15.00019 : Total Thyroidectomy with central

compartment LN dissection15000 FNAC/CT/MRI report and Film


HPE report

S2 2B.S2.00078B 2B.S2.00078B : Commondo Operation (glossectomy)

- cross speciality10500 CT , Biopsy Clinical Photograph

S2 2B.S2.00083B 2B.S2.00083B : Excision of the Mandible Segmental -

cross speciality5625 X -Ray, CT , Biopsy X -Ray , Clinical photograph

S2 2B.S2.00084B 2B.S2.00084B : Hemi-mandibulectomy with graft -

cross speciality11250 CT , Biopsy Clinical photograph

S1 2B.S1.00010A 2B.S1.00010A : Block dissection Cervical Nodes -

cross speciality7500 Clinical photo, CT report Scar photo

S1 2B.S1.00036B 2B.S1.00036B : Excision Benign Tumor -Small

intestine - cross speciality 11250 CT/ USG HPE Report

S1 2B.S1.00046A 2B.S1.00046A : Excision of Swelling in Right Cervical

Region - cross speciality 3000 FNAC/ Biopsy HPR

ONCOLOGY

Sl. no.Speciality


S1 2B.S1.00051A 2B.S1.00051A : Fibroadenoma – Bilateral - cross

speciality6000 FNAC, USG, Routine Blood Inv HPR

S1 2B.S1.00088A 2B.S1.00088A : Jejunostomy - cross speciality 7500 USG Clinical Photo

S1 2B.S1.00094B 2B.S1.00094B : Laryngectomy & Pharyngeal

Diverticulum (Throat) - cross speciality 7500 CT Neck,USG Clinical Photograph,HPE

S1 2B.S1.00095A 2B.S1.00095A : Ileostomy - cross speciality 15000Biopsy of the primary + CT Scan with


S1 2B.S1.00097A 2B.S1.00097A : Loop Colostomy Sigmoid - cross

speciality 9000 CT/MRI , Endoscopy , USG Clinical photograph

S1 2B.S1.00098A 2B.S1.00098A : Mastectomy - cross speciality 9000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report

S1 2B.S1.00107A 2B.S1.00107A : Distal Pancreatectomy with

PancreaticoJejunostomy - cross speciality12750 CT/ MRI Scar photo

S1 2B.S1.00137A 2B.S1.00137A : Colectomy – Total - cross speciality 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph

S1 2B.S1.00168A 2B.S1.00168A : Hemi thyroidectomy - cross

speciality7500 FNAC , T F T , USG HPR , Clinical Photograph

S1 2B.S1.00177A 2B.S1.00177A : Lap. Hepatic resection - cross

speciality18750 MRI/ CT Abdomen Scar Photo, HPE Report

S1 2B.S1.00203A 2B.S1.00203A : Coccygeal Teratoma Excision - cross

speciality11250 Clinical Photograph Clincial Nortes, photo

S1 2B.S1.00223A 2B.S1.00223A : Resection Enucleation of Adenoma

(lung) - cross speciality7500 Clinical Photograph Clinical Photograph

S15 2B.S15.00008A 2B.S15.00008A : Mandible Tumour Resection and

reconstruction/Cancer surgery - cross speciality4500 X Ray film with report


Photograph

478 S3 2B.S3.00004 2B.S3.00004 : Corneal Grafting 6375 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes

479 S3 2B.S3.00005 2B.S3.00005 : Prophylactic Cryoretinopexy- Closed 1875 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes

480 S3 2B.S3.00010 2B.S3.00010 : Enucleation with Implant 6000 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes

481 S3 2B.S3.00012

2B.S3.00012 : 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)

825 Intraocular Pressure reading Clinical Photograph

482 S3 2B.S3.00013 2B.S3.00013 : Intraocular Foreign Body Removal

from Anterior Segment3000 B Scan Report Clinical Photograph

483 S3 2B.S3.00015 2B.S3.00015 : Lensectomy /pediatric lens aspiration 6750Slit lamp Examination report

&Fundoscopy Fundus Photograph

484 S3 2B.S3.00017 2B.S3.00017 : Surgical Membranectomy 6000 Indirect Opthalmoscopy report Fundus Photograph

OPTHALMOLOGY

Sl. no.Speciality


485 S3 2B.S3.00018 2B.S3.00018 : Perforating Corneo - Scleral Injury 4950 Clinical Photograph Scar photo

486 S3 2B.S3.00019 2B.S3.00019 : Ptosis Surgery 825 Clinical Photograph Clinical Photograph

487 S3 2B.S3.00020 2B.S3.00020 : IRIS Prolapse – Repair 3000 Slit lamp examination report Clinical Photograph

488 S3 2B.S3.00021 2B.S3.00021 : Retinal Detachment Surgery 11250 B Scan , Fundus Photograph Fundus Photograph

489 S3 2B.S3.00022 2B.S3.00022 : Small Tumour of Lid – Excision + Lid

Reconstruction7500 Clinical Photograph Clinical Photograph

490 S3 2B.S3.00023 2B.S3.00023 : Socket Reconstruction with amniotic

membrane6000 Clinical Photograph Clinical Photograph

491 S3 2B.S3.00025 2B.S3.00025 : Iridectomy – Surgical 2250 Clinical Note / slit lamp report Clinical Note / Slit lamp report

492 S3 2B.S3.00027 2B.S3.00027 : Vitrectomy 5625 B.Scan , Fundus Photograph Fundus Photograph

493 S3 2B.S3.00031 2B.S3.00031 : Cataract with foldable hydrophobic

acrylic IOL by Phaco emulsification tech + Glaucoma7875 A Scan Report Clinical Photograph

494 S3 2B.S3.00032 2B.S3.00032 : Cataract with non-foldable IOL using

SICS technique + Glaucoma4875 A Scan Report Clinical Photograph

495 S3 2B.S3.00037 2B.S3.00037 : Laser for retinopathy (per sitting) 1125 Fundoscopy Report Fundoscopy Report

496 S3 2B.S3.00039 2B.S3.00039 : Orbitotomy 4950 Clinical Photograph Clinical Photograph

497 S3 2B.S3.00040 2B.S3.00040 : Squint correction (per muscle) 3000 Clinical Photograph Clinical Photograph

498 S3 2B.S3.00041 2B.S3.00041 : Anterior Chamber Reconstruction

+Perforating corneo - Scleral Injury + IOL8625 Clinical Note / Slit lamp report Clinical Note / Slit lamp report

499 S3 2B.S3.00042 2B.S3.00042 : PRP - Retinal Laser including 3 sittings 3750 Fundoscopy Report Fundoscopy Report

500 S3 2B.S3.17010 2B.S3.17010 : Photocoagulation for Retinopathy for

3 sittings-Complete package1500 Fundoscopy Report Fundoscopy Report

501 S3 2B.S3.17011 2B.S3.17011 : Therapeutic Penetrating Keratoplasty 2475 Clinical Photo Clinical Photograph

502 S3 2B.S3.17012 2B.S3.17012 : Lamellar Keratoplasty 2475 Clinical Photo Clinical Photograph

503 S3 2B.S3.17013 2B.S3.17013 : Scleral Patch Graft 6000 Clinical Photograph Clinical Photograph

504 S3 2B.S3.17014 2B.S3.17014 : Glaucoma Filtering Surgery For

Paediatric Glaucoma6375 Intraocular Pressure reading Clinical Photograph

505 S5 2B.S5.00019 2B.S5.00019 : Bimalleolar Fracture Fixation 11250 X-ray Scar photo, X-Ray

506 S5 2B.S5.00021 2B.S5.00021 : Bone Tumour (malignant/ benign)

curettage and bone grafting15000 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE

507 S5 2B.S5.00027 2B.S5.00027 : Closed Interlock Nailing + Bone

Grafting – femur14250 X-ray, Rountine Blood Inv. Scar photo, x-ray

508 S5 2B.S5.00028 2B.S5.00028 : Closed Interlocking Intermedullary 13125 X-ray, Rountine Blood Inv. Scar photo, x-ray

509 S5 2B.S5.00030 2B.S5.00030 : Closed Reduction and Internal Fixation

with K wire4500 X-ray x-ray

510 S5 2B.S5.00031 2B.S5.00031 : Closed Reduction and Percutaneous

Screw Fixation (neck femur)11250 X-ray X-Ray showing implant

ORTHOPAEDICS

Sl. no.Speciality


511 S5 2B.S5.00033 2B.S5.00033 : Closed Reduction and Percutaneous

Nailing15000 X Ray Scar photo, x-ray showing implant

512 S5 2B.S5.00041 2B.S5.00041 : External fixation - Long bone 11250 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical


513 S5 2B.S5.00043 2B.S5.00043 : External fixation - Pelvis 11250 X Ray film with report X Ray film with report

514 S5 2B.S5.00045 2B.S5.00045 : Fixator with Joint Arthrolysis 15000 X-RAY Scar photo, X-RAY

515 S5 2B.S5.00048

2B.S5.00048 : Fracture - Hip Internal Fixation

(Intertrochanteric Fracture with implant) +

rehabilitation

12750 X-ray Scar photo, X-ray

516 S5 2B.S5.00049 2B.S5.00049 : Fracture - Humerus Internal Fixation 12750 X-ray Scar photo, X-ray

517 S5 2B.S5.00059 2B.S5.00059 : Limb Lengthening 11250 Clinical Photograph Scar Photo, Clinical Photograph

518 S5 2B.S5.00065 2B.S5.00065 : Open Reduction Internal Fixation

(Large Bone)15000 X-ray X-ray, scar photo, Invoice of implants

519 S5 2B.S5.00066 2B.S5.00066 : Open Reduction of CDH 22500 X-ray Scar photo, X-ray

520 S5 2B.S5.00068 2B.S5.00068 : Open Reduction with bone grafting of

nonunion15000 X-ray Scar photo, X-ray

521 S5 2B.S5.00075 2B.S5.00075 : Reconstruction of ACL/PCL with

implant and brace22500 MRI MRI

522 S5 2B.S5.00087 2B.S5.00087 : External fixation - both bones of

forearms18750 X-ray Clinical photo, X-ray

523 S5 2B.S5.00088 2B.S5.00088 : Fracture intercondylarHumerus +

olecranon osteotomy15000 X-ray Scar photo, X-ray

524 S5 2B.S5.00090 2B.S5.00090 : Arthroscopic Meniscus Repair/

Meniscectomy15000 MRI Report Scar photo, X-ray

525 S5 2B.S5.00094 2B.S5.00094 : Bipolar Hemiarthroplasty (hip &

shoulder)30000 X-ray Scar photo, X-ray

526 S5 2B.S5.00095 2B.S5.00095 : Unipolar Hemiarthroplasty 22500 X-ray Scar photo, X-ray

527 S5 2B.S5.00097 2B.S5.00097 : Elbow replacement 30000 X-ray Scar photo, X-ray

528 S5 2B.S5.00099 2B.S5.00099 : Arthrodesis of Knee (with implant) 30000 X-ray Clinical photo, X-ray

529 S5 2B.S5.00100 2B.S5.00100 : Arthrodesis of Wrist (with implant) 22500 X-ray Clinical photo, X-ray

530 S5 2B.S5.00101 2B.S5.00101 : Arthrodesis of Ankle (with implant) 22500 X-ray Clinical photo, X-ray

531 S5 2B.S5.17019 2B.S5.17019 : Maysers muscle pedicle graft for Non-

union fracture neck femur (orthroplasty)15000 X Ray film with report X Ray film with report

532 S5 2B.S5.17020 2B.S5.17020 : Facio-Maxillary Injury repairs &

fixations 3750 X-RAY/CT scan


post op. XRAY

533 S5 2B.S5.17021 2B.S5.17021 : Anterolateral Clearance For

Tuberculosis13500 MRI


Photograph

534 S5 2B.S5.17022 2B.S5.17022 : Posterior cruciate ligament (PCL)

Reconstruction13275 MRI MRI

Sl. no.Speciality


535 S5 2B.S5.17023 2B.S5.17023 : Blunt injury abdomen 7500 USG USG

S8 2B.S8.00015A 2B.S8.00015A : Laminectomy with Fusion and

fixation - cross speciality 37500 CT/MRI report

Clinical Photographs showing scar +

X-ray-Lumbar Spine

S8 2B.S8.00023A 2B.S8.00023A : Micro discectomy – Lumbar - cross

speciality 30000 Clinical findings, MRI Report Clinical photograph showing scar

S8 2B.S8.00029A 2B.S8.00029A : Spine - Decompression & Fusion

with fixation - cross speciality 37500 Clinical findings, MRI Report Post Op X-Ray Report and film

S8 2B.S8.00074A 2B.S8.00074A : Muscle Biopsy with report - cross

speciality5250 Reports of relevant investigation HPE Report

S1 2B.S1.00164B 2B.S1.00164B : Split thickness skin grafts – Small (<

4% TBSA) - - cross speciality3750 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

S1 2B.S1.00224A 2B.S1.00224A : Rib Resection & Drainage - cross

speciality5625 Chest X-ray, Clinical Photograph Clinical Photograph

S1 2B.S1.00246B 2B.S1.00246B : Tendon Transfer-Leprosy - - cross

speciality16500 Clinical Photograph, Clinical Notes Clinical Photograph

S5 2B.S5.00003A 2B.S5.00003A : Sequestrectomy - cross speciality 1125 X Ray film with report X Ray film with report

S1 2B.S1.00145A 2B.S1.00145A : Cleft lip operation - cross speciality 9000 Clinical Photograph Clinical Photograph

S1 2B.S1.00147A 2B.S1.00147A : Cleft lip & palate operation (for each

stage) - cross speciality11250 Clincal note and photograph OT note and clinical photograph

S1 2B.S1.00164A 2B.S1.00164A : Split thickness skin grafts – Small (<


S1 2B.S1.00166A 2B.S1.00166A : Split thickness skin grafts – Large (>


S1 2B.S1.00245A 2B.S1.00245A : Tissue Reconstruction Flap Leprosy -

cross speciality 16500 Clinical Photograph Scar photo

S1 2B.S1.00246A 2B.S1.00246A : Tendon Transfer-Leprosy - - cross

speciality16500 Clinical Photograph, Clinical Notes Clinical Photograph

536 S6 2B.S6.00005 2B.S6.00005 : Internal fixation of Pelviacetabular

fracture30000 X Ray film with report X Ray film with report, Scar Photo

S1 2B.S1.00009A 2B.S1.00009A : Bleeding Ulcer - Partial Gastrectomy -

cross speciality 18750 Endoscopy Scar photo, HPR

S1 2B.S1.00026A 2B.S1.00026A : Drainage of Subdiaphramatic

Abscess - cross speciality 6000 USG/Clinical Notes Scar photo

S1 2B.S1.00028A 2B.S1.00028A : Duodenal Diverticulum - cross

speciality 11250 USG/CT Scan Scar Photo

S1 2B.S1.00029A 2B.S1.00029A : Duodenal Jejunostomy - cross

speciality 11250 USG Clinical Photo

S1 2B.S1.00030B 2B.S1.00030B : Duplication of Intestine - cross

speciality12750 CT/ USG Scar Photo

PLASTIC AND RECONSTRUCTIVE SURGERY

POLYTRAUMA

SURGICAL GASTROENTEROLOGY

Sl. no.Speciality


S1 2B.S1.00036A 2B.S1.00036A : Excision Benign Tumor -Small

intestine - cross speciality 11250 CT/ USG HPE Report

S1 2B.S1.00041A 2B.S1.00041A : Excision Meckel's Diverticulum -

cross speciality 11250 USG/ CT Scar Photo, HPE Report

S1 2B.S1.00043A 2B.S1.00043A : Excision Small Intestinal Fistula -

cross speciality 9000 USG/ CT Scar Photo

S1 2B.S1.00063A 2B.S1.00063A : Gastrojejunostomy - cross speciality 11250 USG, Endoscopy Scar Photo

S1 2B.S1.00065A 2B.S1.00065A : Graham's Operation for duodenal

perforation - cross speciality 11250 X-ray abdomen/CT, USG USG, Scar Photo

S1 2B.S1.00079A 2B.S1.00079A : Hydatid Cyst of Liver - cross

speciality 7500 CT/MRI

Clinical Photograph/ Scar photo, HPE

Report

S1 2B.S1.00082A 2B.S1.00082A : IlieoSigmoidostomy - cross speciality 9750 CT Scan/ MRI Scar photo

S1 2B.S1.00088B 2B.S1.00088B : Jejunostomy - cross speciality 7500 USG Clinical Photo

S1 2B.S1.00090A 2B.S1.00090A : Intestinal Perforation (Resection

Anastomosis) - cross speciality 15000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo

S1 2B.S1.00095B 2B.S1.00095B : Ileostomy - cross speciality 15000Biopsy of the primary + CT Scan with


S1 2B.S1.00097B 2B.S1.00097B : Loop Colostomy Sigmoid - cross

speciality 9000 CT/MRI , Endoscopy , USG Clinical photograph

S1 2B.S1.00099A 2B.S1.00099A : Mesenteric Cyst – Excision 6750 USG/ CT Scan/ MRI Scar Photo, HPE Report

S1 2B.S1.00100A 2B.S1.00100A : Mesenteric Caval Anastomosis -

cross speciality 7500 CT abdomen/USG OT Notes, Intra-Op Photograph

S1 2B.S1.00102A 2B.S1.00102A : Oeshophagoscopy for foreign body

removal - cross speciality 4500 Endoscopy/ X-Ray Clinical notes, endo picture

S1 2B.S1.00107B 2B.S1.00107B : Distal Pancreatectomy with

PancreaticoJejunostomy - cross speciality12750 CT/ MRI Scar photo

S1 2B.S1.00111A 2B.S1.00111A : Porto Caval Anastomosis - Cross

speciality 11250 CT/ MRI OT Notes / Post-op CT

S1 2B.S1.00119A 2B.S1.00119A : Repair of Common Bile Duct 9375

CT/MRI Abdomen, Endoscopic

Retrograde Cholangio Pancreatography

(ERCP)

OT Notes

S1 2B.S1.00137B 2B.S1.00137B : Colectomy – Total - cross speciality 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph

S1 2B.S1.00175A 2B.S1.00175A : Lap. Cholecystectomy & CBD

exploration - cross speciality 15000 CT , LFT HPR, Clinical photograph

S1 2B.S1.00176B 2B.S1.00176B : Lap. For intestinal obstruction - cross

speciality 11250 X-Ray abdomen /CT /USG USG, Scar Photo

S1 2B.S1.00185B 2B.S1.00185B : Laparoscopic Pyloromyotomy - cross

speciality 9375 USG, Clinical notes Clinical Photograph

S1 2B.S1.00186A 2B.S1.00186A : Laparoscopic Rectopexy 11250 Clinical Findings Clinical Findings

S1 2B.S1.00220A 2B.S1.00220A : Removal of Foreign Body from

Trachea or Oesophagus - cross speciality 1875 Clinical photo, endoscopy Procedure notes

Sl. no.Speciality


S1 2B.S1.17001A

2B.S1.17001A : Endoscopic Retrograde Cholangio

Pancreatography (Endoscopic Retrograde Cholangio

Pancreatography (ERCP) with Interventions - cross

speciality

3000 Liver function test (LFT), USG Liver function test (LFT), USG

S1 2B.S1.17002A 2B.S1.17002A : Laproscopic Adrenalectomy - cross

speciality 22500 CT Clinical Photograph

S1 2B.S1.17003A 2B.S1.17003A : Gastro jejuno Colic Fistula - cross

speciality 9375 USG Scar Photo

S1 2B.S1.17004A

2B.S1.17004A : Endoscopic Retrograde Cholangio

Pancreatography (ERCP) (Endoscopic Retrograde

Cholangio – Pancreatography) - cross speciality

1688 LFT, USG USG

S1 2B.S1.17009A 2B.S1.17009A : Upper GI Therapeutic(including

Varicose Intervention) - cross speciality 1500 Endoscopy report. Procedure stills

S1 2B.S1.00058A 2B.S1.00058A : Foreign Body Removal in Deep

Region requiring GA - cross speciality 3750 X-Ray / Scopy report X-Ray / Scopy report

537 S7 2B.S7.00029 2B.S7.00029 : Pyelolithotomy-Laparoscopic 11250 USG Clinical Photograph

538 S7 2B.S7.00033 2B.S7.00033 : Perinephric Abscess drainage (Open) 5625 USG Scar photo

539 S7 2B.S7.00059 2B.S7.00059 : Urachal Cyst excision -open 11250 USG/CT KUB HPR

540 S7 2B.S7.00110 2B.S7.00110 : Excision of Urethral Caruncle 3750 Clinical Notes Clinical Photograph

541 S7 2B.S7.00127 2B.S7.00127 : Orchiopexy-without laparoscopy,

bilateral11250 USG Clinical Notes

542 S7 2B.S7.00135 2B.S7.00135 : Ilio-Inguinal lymphadenectomy-

unilateral11250 USG Scar photo

543 S7 2B.S7.00136 2B.S7.00136 : Ilio-Inguinal lymphadenectomy-

bilateral18750 USG Scar photo

544 S7 2B.S7.17039 2B.S7.17039 : Operation for Double Ureter 11813 IVP/CT KUB with Contrast Scar Photo

545 S7 2B.S7.17040 2B.S7.17040 : Pyelolithotomy 10125 IVP/CT KUB with Contrast Scar Photo

S1 2B.S1.17002B 2B.S1.17002B : Laproscopic Adrenalectomy - cross

speciality 22500 CT Clinical Photograph

UROLOGY

Sl. no.Speciality


546 S11 3A.S11.00006

3A.S11.00006 : Electrical contact burns: Low voltage-

with 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.

30000 Clinical Photograph Clinical Photograph

547 S11 3A.S11.00011

3A.S11.00011 : Post Burn Contracture surgeries for

Functional Improvement (Package including splints,

pressure garments, silicone-gel sheet and

physiotherapy): Excluding Neck contracture;

Contracture release with - Split thickness Skin Graft

(STSG) / Full Thickness Skin Graft (FTSG)/ Flap cover

is done for each joint with post-operative regular

dressings for STSG / FTSG / Flap cover.


548 S11 3A.S11.00012

3A.S11.00012 : Post Burn Contracture surgeries for

Functional Improvement (Package including splints,

pressure garments, silicone-gel sheet and

physiotherapy): Neck contracture; Contracture

release with - Split thickness Skin Graft (STSG) /

Full Thickness Skin Graft (FTSG)/ Flap cover is done

for each joint with post-operative regular dressings

for STSG / FTSG / Flap cover.


549 S12 3A.S12.00001 3A.S12.00001 : Balloon Atrial Septostomy 25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO

550 S12 3A.S12.00002 3A.S12.00002 : Balloon Aortic Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO

551 S12 3A.S12.00003 3A.S12.00003 : Balloon Mitral Valvotomy 30000 2D ECHO report 2D ECHO report + stills of ECHO

552 S12 3A.S12.00004 3A.S12.00004 : Balloon Pulmonary Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO

553 S12 3A.S12.00005 3A.S12.00005 : Vertebral Angioplasty with single

stent (medicated)55000 2D ECHO , ANGIOGRAM report & stills Post procedure Angio stills

554 S12 3A.S12.00006 3A.S12.00006 : Vertebral Angioplasty with double

stent(medicated)70000 2D ECHO , Angiogram Report & Stills Angiogram-DSA/MRA/CTA

555 S12 3A.S12.00007 3A.S12.00007 : Carotid angioplasty with stent

(medicated)130000

Angiogram report & Film showing the

lesion

Post procedure Angio stills + XRAY

+ Doppler

556 S12 3A.S12.00008 3A.S12.00008 : Renal Angioplasty with single stent

(medicated)65000

ECG, 2D ECHO, CAG stills showing

blocks & Reports

1.Angioplasty stills showing stents &

post Stent flow,2. Cartons of the

stents used approved by

FDA/CE/DCGI only

TERTIARY CARE BURNS

CARDIOLOGY

Sl. no.Speciality


557 S12 3A.S12.00009 3A.S12.00009 : Renal Angioplasty with double stent

(medicated)80000 2D ECHO , ANGIOGRAM report & stills Post procedure Angio stills

558 S12 3A.S12.00010 3A.S12.00010 : Peripheral Angioplasty with balloon 40000ECG, 2D ECHO, CAG stills showing

blocks & Reports




FDA/CE/DCGI only

559 S12 3A.S12.00011 3A.S12.00011 : Peripheral Angioplasty with stent

(medicated)50000

2D ECHO , ANGIOGRAM report & stills ,

ABIPost procedure Angio stills, ABI

560 S12 3A.S12.00012 3A.S12.00012 : Coarctation dilatation 25000 2D ECHO report 2D ECHO report + stills of ECHO

561 S12 3A.S12.00014 3A.S12.00014 : ASD Device Closure 88000 2D ECHO report 2D ECHO stills showing the device +

Report

562 S12 3A.S12.00015 3A.S12.00015 : VSD Device Closure 88000 2D ECHO report 2D ECHO stills showing the device +

Report

563 S12 3A.S12.00016 3A.S12.00016 : PDA Device Closure 80000 2D ECHO report 2D ECHO stills showing the device +

Report

564 S12 3A.S12.00017 3A.S12.00017 : PDA multiple Coil insertion 30000 2D ECHO report 2D ECHO stills showing the coil +

Report

565 S12 3A.S12.00018 3A.S12.00018 : PDA Coil (one) insertion 25000 2D ECHO report 2D ECHO stills showing the coil +

Report

566 S12 3A.S12.00019 3A.S12.00019 : PDA stenting 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

567 S12 3A.S12.00022

3A.S12.00022 : Permanent pacemaker implantation

(DDR) including Pacemaker value/pulse generator

replacement (DOUBLE CHAMBER)

120000ECG + Report by cardiologist +

Anigiogram report if doneX Ray showing the pacemaker in situ

568 S12 3A.S12.00023

3A.S12.00023 : Permanent pacemaker implantation

(VVI) including Pacemaker value/pulse generator

replacement (SINGLE CHAMBER)

75000ECG + Report by cardiologist +


569 S12 3A.S12.00024 3A.S12.00024 : PTCA - single stent (medicated,

inclusive of diagnostic angiogram)60000


blocks & Reports




FDA/CE/DCGI only

570 S12 3A.S12.00025 3A.S12.00025 : PTCA - double stent (medicated,

inclusive of diagnostic angiogram)85000


blocks & Reports




FDA/CE/DCGI only

571 S12 3A.S12.00026 3A.S12.00026 : PTCA - additonal stent (linked to

package no:0025)28849


blocks & Reports

Angioplasty stills showing stent &

post Stent flow

572 S12 3A.S12.00028 3A.S12.00028 : Pulmonary artery stenting 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

573 S12 3A.S12.00029 3A.S12.00029 : Pulmonary artery stenting (double) 65000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

Sl. no.Speciality


574 S12 3A.S12.00030 3A.S12.00030 : Right ventricular outflow tract (RVOT)

stenting50000 2D ECHO, Angiogram Report & Stills Post procedure Angio stills

575 S12 3A.S12.00031 3A.S12.00031 : Rotablation+ Balloon Angioplasty 45000 CAG Report with stills showing blocksCAG stills with balloon and stills with

post flow

576 S12 3A.S12.00032 3A.S12.00032 : Rotablation+ Balloon Angioplasty +

1 stent (medicated)100000 CAG Report with stills showing blocks

CAG stills with balloon and stills with

post flow

577 S12 3A.S12.00033 3A.S12.00033 : Rotablation+ Balloon Angioplasty +

2 stent (medicated)125000 CAG Report with stills showing blocks

CAG stills with balloon and stills with

post flow

578 S12 3A.S12.00034 3A.S12.00034 : Thrombolysis for peripheral ischemia 30000Peripheral Angiogram /Doppler Report

with StillsPost procedure Angio stills

579 S12 3A.S12.00035 3A.S12.00035 : Bronchial artery Embolisation (for

Haemoptysis)25000

Chest x-Ray/CT Scan, Hb, Serum

Creatinine


Creatinine

580 S12 3A.S12.00036 3A.S12.00036 : Percutaneous Transluminal Tricuspid

Commissurotormy (PTTC)25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO

581 S12 3A.S12.00037 3A.S12.00037 : Coiling - Pseudoaneurysms of

Abdomen55000

CT/MRI or Angiogram, Prothrombin

Time (PT), International normalized ratio

(INR) Hb, Serum Creatinine

CT, PT,INR, Hb, Serum Creatinine

582 S12 3A.S12.00038 3A.S12.00038 : Embolization - Arteriovenous

Malformation (AVM) in the Limbs40000 USG, CT PT, INR, Hb, Serum Creatinine

USG abd/CT PT,INR, Hb, Serum

Creatinine

583 S12 3A.S12.00039

3A.S12.00039 : Catheter directed Thrombolysis for:

Deep vein thrombosis (DVT), Mesenteric Thrombosis

& Peripheral vessels

50000

CT/MRI, Prothrombin Time (PT),

International normalized ratio (INR) Hb,

Serum Creatinine

CT/MRI, PT,INR, Hb, Serum

Creatinine

584 S12 3A.S12.17059 3A.S12.17059 : PTCA - one stent (non-medicated,

elective) *48000


blocks & Reports


post Stent flow

585 S12 3A.S12.17060 3A.S12.17060 : Renal Angioplasty with stent (non-

medicated) *55000 2D ECHO , ANGIOGRAM report & stills Post procedure Angio stills

586 S12 3A.S12.17061 3A.S12.17061 : Pulse Generator replacement 50000ECG + Report by cardiologist +


587 S12 3A.S12.17062 3A.S12.17062 : Septostomy 20000 2D ECHO report 2D ECHO report + stills of the ECHO

588 S12 3A.S12.17063 3A.S12.17063 : Intravascular ultrasound

(IVUS)/Fractional Flow Reserve (FFR)20000 Angiogram Report IVUS/FFR report

589 S12 3A.S12.17064 3A.S12.17064 : Electrophysiological Study (EP study) 10000 ECG with report + 2D ECHO report EP study report+ ECG

590 S12 3A.S12.17065 3A.S12.17065 : Radiofrequency Ablation (RF

Ablation)25000 ECG with report + 2D ECHO report RF ablation report +ECG

591 S12 3A.S12.17066 3A.S12.17066 : 3D Mapping + Ablation 50000 ECG with report + 2D ECHO report 3D mapping report+ECG with report

592 S12 3A.S12.17067 3A.S12.17067 : Rotablation+ PTCA (non-medicated

Stent )*63000 CAG Report with stills showing blocks

CAG stills with stents and stills with

post flow

Sl. no.Speciality


593 S12 3A.S12.17068 3A.S12.17068 : Rotablation+ PTCA (One Drug

Eluting Stent)*80000


blocks & Reports




FDA/CE/DCGI only

594 S12 3A.S12.17069 3A.S12.17069 : Venous stenting* 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

595 S12 3A.S12.17070 3A.S12.17070 : Coarctoplasty with stenting* 75000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

596 S12 3A.S12.17071 3A.S12.17071 : Paravalvular leak/ Ruptured sinus of

Valsalva aneurysm (RSOV)88000 2D ECHO Report

2D ECHO stills showing the device +

Report

597 S12 3A.S12.17072 3A.S12.17072 : Inferior Vena Cava (or IVC) Stenting 60000

USG, clotting Time (CT), Prothrombin


(INR), Hb, Serum Creatinine

USG, CT,PT,INR, Hb, Serum

Creatinine

598 S12 3A.S12.17087 3A.S12.17087 : Peripheral Angioplasty with stent

(non-medicated) *60000

2D ECHO , ANGIOGRAM report & stills ,

ABIPost procedure Angio stills, ABI

599 S12 3A.S12.17088 3A.S12.17088 : Carotid angioplasty with stent* 150000Angiogram report & Film showing the

lesion

Post procedure Angio stills + XRAY

+ Doppler

600 S13 3A.S13.00001 3A.S13.00001 : Coronary artery bypass grafting

(CABG)95000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo


(CABG) with Intra-aortic balloon pump (IABP)125000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo

602 S13 3A.S13.00003

3A.S13.00003 : Coronary artery bypass grafting

(CABG) + one mechanical Valve Replacement + Intra-

aortic balloon pump (IABP)

145000 2D ECHO with stills , CAG ReportPost op X Ray , 2D ECHO with stills,

scar photo


(CABG) with LV Aneurysmal repair95000 2D ECHO with stills , CAG Report

ECHO with stills,Post op X Ray ,scar

photo


(CABG) with Mitral Valve repair without ring95000 2D ECHO with stills , CAG Report

ECHO with stills,Post op X Ray ,scar

photo


(CABG) with Mitral Valve repair with ring125000 2D ECHO with stills , CAG Report

Post op X Ray , 2D ECHO with stills,

scar photo

606 S13 3A.S13.00007

3A.S13.00007 : Coronary artery bypass grafting

(CABG) with post MI Ventricular Septal Defect

(Ventricular Septal Defect) repair

120000 2D ECHO with stills , CAG ReportECHO with stills,Post op X Ray ,scar

photo

607 S13 3A.S13.00008 3A.S13.00008 : Open Mitral Valvotomy 80000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo

608 S13 3A.S13.00009 3A.S13.00009 : Closed Mitral Valvotomy 30000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +

Post Op X-ray,scar photo

609 S13 3A.S13.00010 3A.S13.00010 : Open Pulmonary Valvotomy 80000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo


Sl. no.Speciality


610 S13 3A.S13.00011 3A.S13.00011 : Mitral Valve Repair 80000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


611 S13 3A.S13.00012 3A.S13.00012 : Tricuspid Valve Repair 80000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


612 S13 3A.S13.00013 3A.S13.00013 : Aortic Valve Repair 80000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


613 S13 3A.S13.00014 3A.S13.00014 : Ring for any Valve Repair 20000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


614 S13 3A.S13.00015 3A.S13.00015 : Mitral Valve Replacement

(mechanical valve)130000 2D ECHO Report with stills

2D ECHO Report + stills of ECHO +


615 S13 3A.S13.00016 3A.S13.00016 : Mitral Valve Replacement (biological

valve)125000 2D ECHO Report with stills



616 S13 3A.S13.00017 3A.S13.00017 : Aortic Valve Replacement




617 S13 3A.S13.00018 3A.S13.00018 : Aortic Valve Replacement (biological

valve)125000 2D ECHO Report with stills



618 S13 3A.S13.00019 3A.S13.00019 : Tricuspid Valve Replacement




619 S13 3A.S13.00020 3A.S13.00020 : Tricuspid Valve Replacement

(biological valve)125000 2D ECHO Report with stills



620 S13 3A.S13.00021 3A.S13.00021 : Double Valve Replacement




621 S13 3A.S13.00022 3A.S13.00022 : Double Valve Replacement

(biological valve)155000 2D ECHO Report with stills



622 S13 3A.S13.00023 3A.S13.00023 : Ross Procedure 110000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


623 S13 3A.S13.00024 3A.S13.00024 : Atrial Septal Defect (ASD) 90000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


Sl. no.Speciality


624 S13 3A.S13.00025 3A.S13.00025 : Ventricular Septal Defect (VSD) 90000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


625 S13 3A.S13.00026 3A.S13.00026 : Atrioventricular septal defect/

Atrioventricular (AV) Canal Defect90000 2D ECHO Report with stills



626 S13 3A.S13.00027 3A.S13.00027 : Intracardiac repair (ICR) for Tetralogy

of Fallot (TOF)90000 2D ECHO Report with stills



627 S13 3A.S13.00028 3A.S13.00028 : Pulmonary Valvotomy + Right

Ventricular Outflow Tract (RVOT) Resection90000 2D ECHO Report with stills



628 S13 3A.S13.00029 3A.S13.00029 : Aortopulmonary Window (AP

Window)90000 2D ECHO Report with stills



629 S13 3A.S13.00030 3A.S13.00030 : Surgery for Hypertrophic Obstructive

Cardiomyopathy (HOCM)90000

2D ECHO/TEE Report + Chest Xray AP

view /Cardiac MRI



630 S13 3A.S13.00031 3A.S13.00031 : Ebsteins 90000 ECG, 2D ECHO Report2D ECHO Report + stills of ECHO +


631 S13 3A.S13.00032 3A.S13.00032 : Fontan 100000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


632 S13 3A.S13.00033 3A.S13.00033 : Total Anomalous Pulmonary Venous

Connection (TAPVC)120000 2D ECHO Report with stills



633 S13 3A.S13.00034 3A.S13.00034 : Any RV to PA conduit (Valved) 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


634 S13 3A.S13.00035 3A.S13.00035 : Arterial Switch Operation 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


635 S13 3A.S13.00036 3A.S13.00036 : Double Switch Operation 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


636 S13 3A.S13.00037 3A.S13.00037 : Sennings 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


637 S13 3A.S13.00038 3A.S13.00038 : Mustards 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


Sl. no.Speciality


638 S13 3A.S13.00039 3A.S13.00039 : Truncus Arteriosus Surgery 120000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


639 S13 3A.S13.00040 3A.S13.00040 : Root Replacement (Aortic Aneurysm/

Aortic Dissection) / Bental Procedure150000 2D ECHO Report with stills



640 S13 3A.S13.00041 3A.S13.00041 : Aortic Arch Replacement 150000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


641 S13 3A.S13.00042 3A.S13.00042 : Aortic Aneurysm Repair using

Cardiopulmonary bypass (CPB)90000 CT Angio Report Scar photo + Intra op photo

642 S13 3A.S13.00043 3A.S13.00043 : Aortic Aneurysm Repair without

using Cardiopulmonary bypass (CPB)75000 CT Angio Report Scar photo + Intra op photo

643 S13 3A.S13.00044 3A.S13.00044 : Pulmonary Embolectomy 150000 2D ECHO with stills + ABG report + CT

Chest report



644 S13 3A.S13.00046 3A.S13.00046 : Patent Ductus Arteriosus (PDA)

Closure30000 2D ECHO Report with stills


Post Op X-ray, scar photo

645 S13 3A.S13.00047 3A.S13.00047 : Coarctation Repair 30000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler

646 S13 3A.S13.00048 3A.S13.00048 : Coarctation Repair with interpostion

graft70000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler

647 S13 3A.S13.00049 3A.S13.00049 : Blalock–Thomas–Taussig (BT) Shunt

(inclusives of grafts)60000 2D ECHO Report with stills



648 S13 3A.S13.00050 3A.S13.00050 : Glenn Shunt (without

cardiopulmonary bypass)60000 2D ECHO Report with stills



649 S13 3A.S13.00051 3A.S13.00051 : Central Shunt 60000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


650 S13 3A.S13.00052 3A.S13.00052 : Pericardiectomy 50000 2D ECHO Report with stills2D ECHO Report + stills of ECHO +


651 S13 3A.S13.00053 3A.S13.00053 : Pulmonary AV Fistula surgery 45000 CT Chest report Post Op X-ray,scar photo

652 S13 3A.S13.00054 3A.S13.00054 : Lung Cyst 60000 CT Chest report Post Op X-ray,scar photo

653 S13 3A.S13.00055 3A.S13.00055 : Space-Occupying Lesion (SOL)

mediastinum60000 CT Chest report Post Op X-ray,scar photo

654 S13 3A.S13.00056 3A.S13.00056 : Surgical Correction of

Bronchopleural Fistula70000 CT Chest report



655 S13 3A.S13.00057 3A.S13.00057 : Diaphragmatic Eventeration 50000 CT Chest report2D ECHO Report + stills of ECHO +


Sl. no.Speciality


656 S13 3A.S13.00058 3A.S13.00058 : Oesophageal Diverticula /Achalasia

Cardia50000 Barium Study + CT Chest report



657 S13 3A.S13.00059 3A.S13.00059 : Diaphragmatic Injuries/Repair 35000 CT Chest report2D ECHO Report + stills of ECHO +


658 S13 3A.S13.00060 3A.S13.00060 : Thoracotomy, Thoraco Abdominal

Approach40000 CT Chest report Post Op X-ray,scar photo

659 S13 3A.S13.00062 3A.S13.00062 : Bronchial Repair Surgery for Injuries

due to FB40000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE

660 S13 3A.S13.00064 3A.S13.00064 : Thyomectomy 35000 CT Chest report X-RAY, scar photo

661 S13 3A.S13.00065 3A.S13.00065 : Pulmonary Valve Replacement 120000 2D ECHO Report2D ECHO Report + stills of ECHO +

post Op X-ray,scar photo

662 S13 3A.S13.00067 3A.S13.00067 : Encysted Empyema/Pleural Effusion -

Tubercular20000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

663 S13 3A.S13.00068

3A.S13.00068 : First rib Excision by transaxillary

approach, Excision of cervical rib / fibrous band /

muscle by cervical approach

40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

664 S13 3A.S13.00069 3A.S13.00069 : Congenital Cystic Lesions 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

665 S13 3A.S13.00070 3A.S13.00070 : Pulmonary Sequestration Resection 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

666 S13 3A.S13.00071 3A.S13.00071 : Pulmonary artero venous

malformation40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

667 S13 3A.S13.00074 3A.S13.00074 : Intrathoracic Aneurysm-Aneurysm

not Requiring Bypass Techniques65000 CT Angio Report Scar photo + Post op intra op photo

S13 3A.S13.00089A 3A.S13.00089A : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray


(CABG) with additional arterial graft*100000 2D ECHO , CAG Report

ECHO,Post op X Ray ,scar photo +

scar photo of graft area

669 S13 3A.S13.17090 3A.S13.17090 : Valve Replacement with Intra-aortic

balloon pump (IABP) *140000 2D ECHO Report with stills



670 S13 3A.S13.17091 3A.S13.17091 : Pulmonary Atresia with or without

Ventricular Septal Defect *105000 2D ECHO Report with stills



671 S13 3A.S13.17092 3A.S13.17092 : Pleurectomy 50000 CT Chest report Post Op X-ray,scar photo

672 S13 3A.S13.17093 3A.S13.17093 : Mediastinotomy 40000 CT Chest report Post Op X-ray,scar photo

673 S13 3A.S13.17094

3A.S13.17094 : Gastro Study Followed by

Thoracotomy & Repairs of Oesophageal Injury for

Corrosive Injuries/FB

50000 Gastroscopy Report ENDOSCOPY PICTURE, scar photo

674 S13 3A.S13.17095 3A.S13.17095 : Thorocotomy and resection of pluera

with Lung50000

Pre Op X-ray / CT Scan, Bronchoscopy

ReportPost Op X-ray / CT Scan ,scar photo

Sl. no.Speciality


675 S13 3A.S13.17096 3A.S13.17096 : Congenital Hypoplasia of the lung 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

676 S13 3A.S13.17097 3A.S13.17097 : Thoracotomy & Excision and fixation

of the Spine65000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo


(CABG) + Valve Replacement *115000 2D ECHO with stills , CAG Report

Post op X Ray , 2D ECHO with stills,

scar photo

678 S13 3A.S13.17100 3A.S13.17100 : Open Aortic Valvotomy * 80000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo

679 S13 3A.S13.17101

3A.S13.17101 : Aortic Aneurysm Repair without

using Cardiopulmonary bypass (CPB) with/without

graft*

70000 CT Angio Report Scar photo + Intra op photo

680 S13 3A.S13.17102 3A.S13.17102 : Lobectomy 70000 CT Chest report Post Op X-ray,scar photo

S6 3A.S6.17024B 3A.S6.17024B : Visceral injuries severe - cross

speciality60000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

S6 3A.S6.17025B 3A.S6.17025B : Chest injuries with ICD bilateral -

cross speciality11000 X-ray /ultra sound

Post-Operative chest X-ray with ICD

in situ

S6 3A.S6.17026B 3A.S6.17026B : Chest injuries with ICD + ICU - cross

speciality2000 X-ray /ultra sound


in situ

S6 3A.S6.17027B 3A.S6.17027B : Chest injuries with ICD + ICU +

Ventilator - cross speciality26600 X-ray /ultra sound


in situ

S8 3A.S8.00025B 3A.S8.00025B : Shunt (peritoneal, ventriculo-atrial/

peritoneal, theco peritoneal) - cross speciality 20000 CT report Clinical Photographs

S1 3A.S1.00078A 3A.S1.00078A : Hiatus Hernia – abdominal - cross

speciality40000 USG, UGI ENDOSCOPY Scar photo + Intra op photo

S1 3A.S1.00138B 3A.S1.00138B : Pharyngectomy& Reconstruction –

Total - cross specaility 12000 CT Neck, Biopsy HPE, CT Neck, Scar Photo

S1 3A.S1.00139A 3A.S1.00139A : Tracheal Stenosis (End to end

Anastamosis) (Throat) - cross speciality 15000 Bronchoscopy , CT Scar photo, Biopsy

S1 3A.S1.00140A 3A.S1.00140A : Tracheoplasty (Throat) - cross

speciality 40000 CT / Bronchoscopy report CT / Bronchoscopy report

S1 3A.S1.00149B 3A.S1.00149B : Aneurysm Resection & Grafting -

cross speciality 70000 CT Angio Report Scar photo + Intra op photo

S1 3A.S1.00150A 3A.S1.00150A : Arterial Embolectomy - cross

speciality10000 Arterial doppler Scar photo

S1 3A.S1.00151A 3A.S1.00151A : Carotid artery aneurysm repair -

cross speciality20000 2D ECHO Report with stills



S1 3A.S1.00152A 3A.S1.00152A : Carotid Body tumour - Excision -

cross speciality35000 Angiogram/spiral CT Angiogram reports

Stills showing the procedure

+Duplex scan, scar photo

S1 3A.S1.00157A 3A.S1.00157A : Decortication (Pleurectomy) - cross

speciality50000 CT Chest report Post Op X-ray,scar photo

Sl. no.Speciality


S1 3A.S1.00158A 3A.S1.00158A : Dissecting Aneurysms - cross

speciality 36000 2D ECHO Report with stills, Doppler



S1 3A.S1.00159A 3A.S1.00159A : Distal Abdominal Aorta repair - cross

speciality 36000 Angiogram/CTA/MRA Scar photo

S1 3A.S1.00194A 3A.S1.00194A : Mediastinal Tumour - cross speciality 50000 Biopsy/FNAC ,CT Clinical Photograph showing scar +

HPE report + XRAY Chest

S1 3A.S1.00195A 3A.S1.00195A : Oesophagectomy for Carcinoma

Oesophagus - cross speciality 50000 Biopsy , CT , Endoscopy reports HPE report, scar photo

S1 3A.S1.00207A 3A.S1.00207A : Hernia -hiatus-Transthoracic - cross

speciality 25000 UGI ENDOSCOPY Scar photo/ Intra op photo

S1 3A.S1.00218A 3A.S1.00218A : Pericardiostomy - cross speciality 10000 2D ECHO 2D ECHO Report + stills of ECHO +


S1 3A.S1.00219A 3A.S1.00219A : Pneumonectomy - cross speciality 60000 CT Chest report Post Op X-ray,scar photo

S1 3A.S1.00221A 3A.S1.00221A : Removal Tumours of Chest Wall -

cross speciality 40000 CT Chest, biopsy


HPE report

S1 3A.S1.00222A 3A.S1.00222A : Procedures Requiring Bypass

Techniques - cross speciality 35000 Angiogram Scar photo

S1 3A.S1.00231A 3A.S1.00231A : Thorachostomy - cross speciality 10000 Chest X Ray Chest X Ray

S1 3A.S1.00233A 3A.S1.00233A : Thoracoplasty - cross speciality 20000 X-ray, CT X-ray

S1 3A.S1.00234A 3A.S1.00234A : Thoracoscopic Decortication - cross

speciality 25000 Clinical Photograph Scar photo

S1 3A.S1.00235B 3A.S1.00235B : Thoracoscopic Hydatid Cyst excision -

cross speciality 20000 Chest X-ray / CT Scar photo, HPE

S1 3A.S1.00236A 3A.S1.00236A : Thoracoscopic Lobectomy - cross

speciality 25000 CT/MRI Scar photo, HPE

S1 3A.S1.00237A 3A.S1.00237A : Thoracoscopic Pneumonectomy -

cross speciality 30000 CT/MRI Scar photo, HPE

S1 3A.S1.00238A 3A.S1.00238A : Thoracoscopic Segmental Resection -

cross speciality 25000 CT/MRI Scar photo, HPE

S1 3A.S1.00239A 3A.S1.00239A : Thoracoscopic Sympathectomy -

cross speciality35000 CT Chest report


Post Op X-ray, photo of scar, port

insertion

S1 3A.S1.00241A 3A.S1.00241A : Thorax (penetrating wounds) -

CROSS SPECIALITY 12500 X-ray, Clinical photo Post-op clinical photo & X-Ray

Sl. no.Speciality


681 S13 3A.S13.00072 3A.S13.00072 : Thromboembolectomy (pre-auth not

required, usually done as emergency)30000 Duplex/Angio Report & stills Scar photo + Intra op photo

682 S13 3A.S13.00073 3A.S13.00073 : Surgery for Arterial Aneursysm -

Upper/Distal Abdominal Aorta90000 Duplex/Angio Report & stills Scar photo + Intra op photo

683 S13 3A.S13.00075 3A.S13.00075 : Intrathoracic Aneurysm-Requiring

Bypass Techniques110000 CT Angio Report Scar photo + Intra op photo

684 S13 3A.S13.00076 3A.S13.00076 : Surgery for Arterial Aneurysm Renal

Artery50000

Renal arterial Doppler, Angiogram with

stillsScar photo + Intra op photo

685 S13 3A.S13.00078 3A.S13.00078 : Operations for Stenosis of Renal

Arteries20000

Renal arterial Doppler,angiogram &

StillsDoppler Report + scar photo

686 S13 3A.S13.00079 3A.S13.00079 : Aorto Bi-lliac / Bi femoral /Axillo bi

femoral bypass with Synthetic Graft90000 Angiogram/spiral CT Angiogram reports

Stills showing the procedure with

graft + scar photo

687 S13 3A.S13.00080 3A.S13.00080 : Femoro Distal / Femoral - Femoral /

Femoral infra popliteal Bypass with Vein Graft50000 Angiogram/spiral CT Angiogram reports


graft +Duplex scan, scar photo

688 S13 3A.S13.00081 3A.S13.00081 : Femoro Distal / Femoral - Femoral /

Femoral infra popliteal Bypass with Synthetic Graft70000 Angiogram Report

Clinical Photographs Duplex, ABI,

scar photo

689 S13 3A.S13.00082 3A.S13.00082 : Axillo Brachial Bypass using with

Synthetic Graft50000 Angiogram/spiral CT Angiogram reports



690 S13 3A.S13.00083 3A.S13.00083 : Brachio - Radial Bypass with

Synthetic Graft40000 Angiogram/spiral CT Angiogram reports



691 S13 3A.S13.00084 3A.S13.00084 : Excision of body Tumor with vascular

repair40000 Angiogram report


graft + scar photo,

692 S13 3A.S13.00085 3A.S13.00085 : Carotid artery bypass with Synthetic

Graft60000 Angiogram/spiral CT Angiogram reports



693 S13 3A.S13.00086 3A.S13.00086 : Excision of Arterio Venous

malformation - Large50000 Angiogram/spiral CT Angiogram reports


graft + scar photo

694 S13 3A.S13.00087 3A.S13.00087 : Excision of Arterio Venous

malformation - Small30000 Angiogram/spiral CT Angiogram reports


graft + scar photo

695 S13 3A.S13.00088 3A.S13.00088 : Deep Vein Thrombosis (DVT) -

Inferior Vena Cava (IVC) filter65000 Color doppler

Plain X-ray abdomen showing the

filter

696 S13 3A.S13.00089 3A.S13.00089 : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray

697 S13 3A.S13.00090 3A.S13.00090 : Aortic Angioplasty with two stents /

Iliac angioplasty with stent Bilateral90000


blocks & Reports

Angioplasty stills showing Balloon &

post flow,scar photo

698 S13 3A.S13.00091 3A.S13.00091 : Bilateral thrombo embolectomy 40000 Duplex/Angio Report & stills Scar photo + Intra op photo

699 S13 3A.S13.00092 3A.S13.00092 : Aorto-uni-iliac/uni-femoral bypass

with synthetic graft75000 Angiogram/spiral CT Angiogram reports



CARDIOVASCULAR SURGERY

Sl. no.Speciality


700 S13 3A.S13.17103 3A.S13.17103 : Pericardiostomy without balloon 10000 2D ECHO report 2D ECHO report + stills of the ECHO

701 S13 3A.S13.17104 3A.S13.17104 : Carotid/other endarterectomy with

patch50000 Angiogram report


graft + scar photo

702 S13 3A.S13.17105 3A.S13.17105 : Aortic Angioplasty 40000ECG, 2D ECHO, CAG stills showing

blocks & Reports


post flow, scar photo

703 S13 3A.S13.17106 3A.S13.17106 : Aortic/ iliac Angioplasty with one

stent60000


blocks & Reports


post flow, scar photo

704 S13 3A.S13.17107 3A.S13.17107 : Aneurysm infra renal aorta /aorto

iliac(including graft)90000 ANGIO/ Spiral CT Angiogram Report Scar photo + Intra op photo

705 S13 3A.S13.17108 3A.S13.17108 : Aorto uni iliac/uni femoral bypass 70000

Angiogram/ Computed Tomography

Angiography (3D-CTA)/Magnetic

Resonance Angiography

Duplex scan, scar photo

706 S13 3A.S13.17109 3A.S13.17109 : Peripheral arterial aneurysms 50000 Angiogram Report & Stills Intra op photo

707 S13 3A.S13.17110

3A.S13.17110 : Aortic Aneurysm Repair using

Cardiopulmonary

bypass (CPB) including graft*

90000 CT Angio Report Scar photo + Intra op photo

S8 3A.S8.00025C 3A.S8.00025C : Shunt (peritoneal, ventriculo-atrial/


S1 3A.S1.00068A 3A.S1.00068A : Haemangioma – Excision (small) -

cross speciality 5000 clinical photograph Doppler

S1 3A.S1.00148A 3A.S1.00148A : Aneurysm not Requiring Bypass

Techniques - cross speciality 36000 CT Angio Report Scar photo + Post op intra op photo

S1 3A.S1.00149A 3A.S1.00149A : Aneurysm Resection & Grafting -

cross speciality 70000 CT Angio Report Scar photo + Intra op photo

S1 3A.S1.00150B 3A.S1.00150B : Arterial Embolectomy - cross

speciality10000 Arterial doppler Scar photo

S1 3A.S1.00151B 3A.S1.00151B : Carotid artery aneurysm repair -

cross speciality20000 2D ECHO Report with stills



S1 3A.S1.00155A 3A.S1.00155A : Congential Arteriovenus Fistula

(large) - cross speciality 20000 Arterial doppler, clinical photo Scar photo

S1 3A.S1.00156B 3A.S1.00156B : Congential Arteriovenus Fistula

(small) - cross speciality 10000 Arterial doppler, clinical photo Scar photo

S1 3A.S1.00158B 3A.S1.00158B : Dissecting Aneurysms - cross

speciality 36000 2D ECHO Report with stills, Doppler



S1 3A.S1.00159B 3A.S1.00159B : Distal Abdominal Aorta repair - cross

speciality 36000 Angiogram/CTA/MRA Scar photo

S1 3A.S1.00212A 3A.S1.00212A : Operations for Acquired

Arteriovenous Fistula - cross speciality 15000 Arterial doppler / MRA Scar photo

Sl. no.Speciality


S1 3A.S1.00217A 3A.S1.00217A : Patch Graft Angioplasty - cross

speciality 20000 Arterial Doppler Post Op Arterial Doppler, Scar photo

S1 3A.S1.00227A 3A.S1.00227A : Surgery for Arterial Aneurysm

Spleenic Artery - cross speciality 20000 CT Angio / MRA Scar photo

S1 3A.S1.00228A 3A.S1.00228A : Surgery for Arterial Aneurism

–Vertebral - cross speciality 25000 CT Angio / MRA Scar photo

S1 3A.S1.00240A 3A.S1.00240A : Thrombendarterectomy - cross

speciality 15000 Arterial doppler, CT Angio/MRA Scar photo

S10 3A.S10.00002A 3A.S10.00002A : Revascularization of limb/digit - -


CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

CXR, ECG,(X-ray of limb/digit)

Doppler study, Clinical photo and OT

note

S12 3A.S12.00029A 3A.S12.00029A : Pulmonary artery stenting (double)

- cross speciality65000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

S12 3A.S12.17069A 3A.S12.17069A : Venous stenting* - cross speciality 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

S1 3A.S1.00193A 3A.S1.00193A : Repair of Main Arteries of the Limbs -


Pre-operative Doppler study, CT

angio(Optional)+ Films+ detailed

Clinical notes

Post-operative Doppler study,

Clinical photo showing scar

708 S16 3A.S16.00009 3A.S16.00009 : Cleft lip and palate surgery (each

stage)11250 Clinical Photograph Clinical Photograph

S2 3A.S2.00085A 3A.S2.00085A : Hemiglossectomy - - cross speciality 18750CT/MRI report and Film if required/

Biopsy


HPE report

S2 3A.S2.00087A 3A.S2.00087A : Partial Glossectomy - cross

speciality18750

CT/MRI report and Film if required/

Biopsy


HPE report

S2 3A.S2.00088A 3A.S2.00088A : Ranula excision - cross speciality 18750CT/MRI report and Film if required/

Biopsy


HPE report

S2 3A.S2.00090A 3A.S2.00090A : Total Glossectomy - cross speciality 11250 CT Clinical photograph

S6 3A.S6.00004A

3A.S6.00004A : Head injury requiring Facio-Maxillary

Injury repairs & fixations (including implants) -

cross speciality

26250 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical


S8 3A.S8 .00050A 3A.S8 .00050A : R.F. Lesion for Trigeminal Neuralgia

- cross speciality11250 MRI Report CD of Procedure

S8 3A.S8.00049A 3A.S8.00049A : Peripheral Neurectomy (Trigeminal) -

cross speciality12375 MRI Report CD of Procedure

S1 3A.S1.00197B 3A.S1.00197B : Operation for Carcinoma Lip –

Vermilionectomy - cross speciality 7500 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00198A

3A.S1.00198A : Operation for Carcinoma Lip -

Wedge Excision and Vermilionectomy - cross

speciality

9000 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00199A 3A.S1.00199A : Operation for Carcinoma Lip -

Wedge-Excision - cross speciality 7500 Clinical photograph, HPE Scar photo, HPE


Sl. no.Speciality


S1 3A.S1.00209A 3A.S1.00209A : Operation for carcinoma lip- cheek

advancement - cross speciality 9000 Clinical photograph, HPE Scar photo, HPE

S14 3A.S14.00034A 3A.S14.00034A : Cleft Lip and Palate Surgery (per

stage) - cross speciality11250 Clinical Photograph Clinical Photograph

S15 3A.S15.00007A 3A.S15.00007A : Palatectomy- Soft palate - cross

speciality22500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

S15 3A.S15.00008A 3A.S15.00008A : Palatectomy- Hard palate - cross

speciality15000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

S15 3A.S15.00014A 3A.S15.00014A : Total Maxillectomy - - cross

speciality13500 CT report and Film, Biopsy


HPE report

709 S2 3A.S2.00015 3A.S2.00015 : Excision of Pinna for Growths

(Squamous/Basal) Injuries Total Amputation4875 Clinical Photograph HPR/Clinical photograph

710 S2 3A.S2.00018 3A.S2.00018 : Vidian neurectomy – Micro 6750 Clinical notes OT notes

711 S2 3A.S2.00020 3A.S2.00020 : Excision of Pinna for Growth

(Squamous/Basal/ Injuries) Skin and Cartilage3000 Clinical Photograph/ FNAC HPR/Clinical photograph

712 S2 3A.S2.00022 3A.S2.00022 : Pharyngectomy and reconstruction 11250 CT Neck HPE, Scar Photo

713 S2 3A.S2.00023 3A.S2.00023 : Skull base surgery 27750 CT-Scan / MRI Scan Clinical Photograph

714 S2 3A.S2.00024 3A.S2.00024 : Total Amputation & Excision of

External Auditory Meatus5625 Clinical photograph Scar photo HPE

715 S2 3A.S2.00032 3A.S2.00032 : CSF Rhinorrhoea – Repair 32250 CT report Clinical Photograph with Scar

716 S2 3A.S2.00040 3A.S2.00040 : Rhinotomy – Lateral 5625 clinical notes, CT/MRI clinical notes

717 S2 3A.S2.00050 3A.S2.00050 : Cranio-facial resection 52500 CT/MRI Report, Clinical Notes

CT report and film, Clinical

Photograph showing scar + HPE

report

718 S2 3A.S2.00059 3A.S2.00059 : Choanal atresia 9375 Clinical photo Clinical photo showing scar

719 S2 3A.S2.00064 3A.S2.00064 : Laryngophayryngectomy 15000 Clinical notes, CT/MRI clinical notes

720 S2 3A.S2.00065 3A.S2.00065 : Maxilla – Excision 9375 Clinical notes, CT/MRI Procedure notes

721 S2 3A.S2.00067 3A.S2.00067 : Parapharyngeal – Exploration 9375 CT/MRI Procedure notes

722 S2 3A.S2.00070 3A.S2.00070 : Pharyngoplasty 7500 CT/MRI Clinical notes

723 S2 3A.S2.00075 3A.S2.00075 : Total Parotidectomy 30000 FNAC,CT Clinical Photograph showing scar +

HPE report

724 S2 3A.S2.00081 3A.S2.00081 : Excision of Cystic Hygroma Major/

Extensive7500 Clinical notes & photo, USG/CT

Clinical photo showing scar, BIOPSY,

Operative notes with steps of surgery

& Clinical notes

725 S2 3A.S2.00085 3A.S2.00085 : Hemiglossectomy 18750 CT/MRI, Biopsy Clinical Photograph showing scar +

HPE report

726 S2 3A.S2.00087 3A.S2.00087 : Partial Glossectomy 18750 CT/MRI, Biopsy Clinical Photograph showing scar +

HPE report

727 S2 3A.S2.00088 3A.S2.00088 : Ranula excision 18750 CT/MRI, Biopsy Clinical Photograph showing scar +

HPE report

728 S2 3A.S2.00090 3A.S2.00090 : Total Glossectomy 11250 CT, Biopsy HPE Report

ENT

Sl. no.Speciality


729 S2 3A.S2.00091 3A.S2.00091 : Total Laryngectomy + Neck dissection 18750 CT, BiopsyBiopsy , Clinical Photograph, HPE

Report

730 S2 3A.S2.00092 3A.S2.00092 : Laryngopharyngectomy with Gastric

pull-up/ jejunal graft 22500 CT , Biopsy


HPE report

731 S2 3A.S2.00093 3A.S2.00093 : Excision of CA cheek/ oral cavity +

radial forearm flap22500 CT , Biopsy

Clinical photograph showing scar +

HPE report

732 S2 3A.S2.00094 3A.S2.00094 : Excision of growth Jaw + free fibular

flap reconstruction18750 CT , Biopsy


HPE report

S1 3A.S1.00045A 3A.S1.00045A : Excision of Growth from Tongue with

neck node dissection - cross speciality 11250 CT/MRI, Clinical Photo OT notes, HPE

S1 3A.S1.00114B 3A.S1.00114B : Radical Neck Dissection – Excision -


Clinical photo, Clinical notes & Biopsy/

CytologyScar photo & HPE

S1 3A.S1.00134B 3A.S1.00134B : Submandibular Mass Excision +

Reconstruction - Cross speciality18750

CT/MRI/USG report and Film if required/

Biopsy


HPE report

S1 3A.S1.00138A 3A.S1.00138A : Pharyngectomy& Reconstruction –

Total - cross specaility 9000 CT Neck, Biopsy HPE, CT Neck, Scar Photo

S1 3A.S1.00139B 3A.S1.00139B : Tracheal Stenosis (End to end

Anastamosis) (Throat) - cross speciality 11250 Bronchoscopy , CT Scar photo, Biopsy

S1 3A.S1.00140B 3A.S1.00140B : Tracheoplasty (Throat) - cross

speciality 30000 CT / Bronchoscopy report CT / Bronchoscopy report

S1 3A.S1.00146A 3A.S1.00146A : Cleft palate repair (for each stage) -

cross speciality 9000 Clinical photo Scar photo

S1 3A.S1.00152B 3A.S1.00152B : Carotid Body tumour - Excision -

cross speciality26250 Angiogram/spiral CT Angiogram reports

Stills showing the procedure


S1 3A.S1.00162B 3A.S1.00162B : Excision of Parathyroid

Adenoma/Carcinoma - cross speciality22500

CT Scan Functional scan/PTH

reports/USG


HPE report

S1 3A.S1.00215A 3A.S1.00215A : Parapharyngeal Tumour Excision -

cross speciality 8250 USG, CT Neck USG,HPE,Scar Photo

S10 3A.S10.00001A

3A.S10.00001A : Ear Pinna Reconstruction with

costal cartilage/ Prosthesis (including the cost of

prosthesis/implants). *If requiring multiple stages,

each stage will cost Rs. 30,000 provided the

operating surgeon demonstrates the photographic

results of previous stages. - cross speciality

2250 X-ray and clinical note OT note with clinical photograph of

stages

733 M1 3A.M1.00002 3A.M1.00002 : Recurrent vomiting with dehydration -

routine ward 1350



M1 3A.M1.00002A 3A.M1.00002A : Recurrent vomiting with

dehydration - HDU2025



M1 3A.M1.00002B 3A.M1.00002B : Recurrent vomiting with

dehydration - ICU without ventilator 2700



GENERAL MEDICINE

Sl. no.Speciality


M1 3A.M1.00002C 3A.M1.00002C : Recurrent vomiting with

dehydration - ICU with ventilator 3375



734 M1 3A.M1.00016 3A.M1.00016 : Chikungunya fever - routine ward 1350 clinical notes, Blood examination report clinical notes

M1 3A.M1.00016A 3A.M1.00016A : Chikungunya fever - HDU 2025 clinical notes, Blood examination report clinical notes

M1 3A.M1.00016B 3A.M1.00016B : Chikungunya fever - ICU without


M1 3A.M1.00016C 3A.M1.00016C : Chikungunya fever - ICU with


735 M1 3A.M1.00032 3A.M1.00032 : Acute inflammatory demyelinating

polyneuropathy - routine ward 1350 clinical notes clinical notes

M1 3A.M1.00032A 3A.M1.00032A : Acute inflammatory demyelinating

polyneuropathy - HDU2025 clinical notes clinical notes

M1 3A.M1.00032B 3A.M1.00032B : Acute inflammatory demyelinating

polyneuropathy - ICU without ventilator 2700 clinical notes clinical notes

M1 3A.M1.00032C 3A.M1.00032C : Acute inflammatory demyelinating

polyneuropathy - iCU with ventilator 3375 clinical notes clinical notes

736 M1 3A.M1.00034 3A.M1.00034 : Acute and chronic meningitis -

routine ward1350



M1 3A.M1.00034A 3A.M1.00034A : Acute and chronic meningitis - HDU 2025Clinical Notes with relevant


M1 3A.M1.00034B 3A.M1.00034B : Acute and chronic meningitis - ICU




M1 3A.M1.00034C 3A.M1.00034C : Acute and chronic meningitis - ICU




737 M1 3A.M1.00038 3A.M1.00038 : Visceral leishmaniasis - routine ward 1350 clinical notes, Blood examination reportclinical notes, Blood examination

report

M1 3A.M1.00038A 3A.M1.00038A : Visceral leishmaniasis - HDU 2025 clinical notes, Blood examination reportclinical notes, Blood examination

report

M1 3A.M1.00038B 3A.M1.00038B : Visceral leishmaniasis - ICU without



report

M1 3A.M1.00038C 3A.M1.00038C : Visceral leishmaniasis - ICU with



report

738 M1 3A.M1.00039 3A.M1.00039 : HIV with complications - routine

ward 1350 clinical notes, Blood examination report clinical notes

M1 3A.M1.00039A 3A.M1.00039A : HIV with complications - HDU 2025 clinical notes, Blood examination report clinical notes

M1 3A.M1.00039B 3A.M1.00039B : HIV with complications - ICU

without ventilator 2700 clinical notes, Blood examination report clinical notes

M1 3A.M1.00039C 3A.M1.00039C : HIV with complications - ICU with


Sl. no.Speciality


739 M1 3A.M1.00041 3A.M1.00041 : Metabolic encephalopathy - routine

ward 1350 clinical notes, CT clinical notes, CT

M1 3A.M1.00041A 3A.M1.00041A : Metabolic encephalopathy - HDU 2025 clinical notes, CT clinical notes, CT

M1 3A.M1.00041B 3A.M1.00041B : Metabolic encephalopathy - ICU

without ventilator 2700 clinical notes, CT clinical notes, CT

M1 3A.M1.00041C 3A.M1.00041C : Metabolic encephalopathy - ICU

with ventilator 3375 clinical notes, CT clinical notes, CT

740 M1 3A.M1.00042 3A.M1.00042 : Sickle cell Anemia - routine ward 1350 Clinical notes confirming digonosis clinical notes in relevant reports

M1 3A.M1.00042A 3A.M1.00042A : Sickle cell Anemia - HDU 2025 Clinical notes confirming digonosis clinical notes in relevant reports

M1 3A.M1.00042B 3A.M1.00042B : Sickle cell Anemia - ICU without

ventilator 2700 Clinical notes confirming digonosis clinical notes in relevant reports

M1 3A.M1.00042C 3A.M1.00042C : Sickle cell Anemia - ICU with

ventilator 3375 Clinical notes confirming digonosis clinical notes in relevant reports

741 M1 3A.M1.00043 3A.M1.00043 : Poisonings with unstable vitals -

routine ward 1350 Clinical notes Clinical notes

M1 3A.M1.00043A 3A.M1.00043A : Poisonings with unstable vitals -

HDU2025 Clinical notes Clinical notes

M1 3A.M1.00043B 3A.M1.00043B : Poisonings with unstable vitals - ICU


M1 3A.M1.00043C 3A.M1.00043C : Poisonings with unstable vitals - ICU


742 M1 3A.M1.00047 3A.M1.00047 : Severe pneumonia - routine ward 1350Clinical Notes with relevant

investigations, X-ray/USG of chestTreatment Notes

M1 3A.M1.00047A 3A.M1.00047A : Severe pneumonia- HDU 2025Clinical Notes with relevant


M1 3A.M1.00047B 3A.M1.00047B : Severe pneumonia - ICU without

ventilator 2700



M1 3A.M1.00047C 3A.M1.00047C : Severe pneumonia - ICU with

ventilator 3375



743 M1 3A.M1.00058 3A.M1.00058 : Lower GI hemorrhage - routine ward 1350 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI

M1 3A.M1.00058A 3A.M1.00058A : Lower GI hemorrhage - HDU 2025 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI

M1 3A.M1.00058B 3A.M1.00058B : Lower GI hemorrhage - ICU without

ventilator 2700 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI

M1 3A.M1.00058C 3A.M1.00058C : Lower GI hemorrhage - ICU with

ventilator 3375 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI

744 M1 3A.M1.00062 3A.M1.00062 : Hydrocephalus - routine ward 1350 CT Report CT Report, Scar Photo, X Ray

M1 3A.M1.00062A 3A.M1.00062A : Hydrocephalus - HDU 2025 CT Report CT Report, Scar Photo, X Ray

M1 3A.M1.00062B 3A.M1.00062B : Hydrocephalus - ICU without

ventilator 2700 CT Report CT Report, Scar Photo, X Ray

M1 3A.M1.00062C 3A.M1.00062C : Hydrocephalus - ICU with ventilator 3375 CT Report CT Report, Scar Photo, X Ray

Sl. no.Speciality


745 M1 3A.M1.00063 3A.M1.00063 : Cerebral sino-venous thrombosis -

routine ward 1350 Clinical notes, CT - brain Clinical notes, CT - brain

M1 3A.M1.00063A 3A.M1.00063A : Cerebral sino-venous thrombosis -

HDU2025 Clinical notes, CT - brain Clinical notes, CT - brain

M1 3A.M1.00063B 3A.M1.00063B : Cerebral sino-venous thrombosis -

ICU without ventilator 2700 Clinical notes, CT - brain Clinical notes, CT - brain

M1 3A.M1.00063C 3A.M1.00063C : Cerebral sino-venous thrombosis -

ICU with ventilator 3375 Clinical notes, CT - brain Clinical notes, CT - brain

746 M1 3A.M1.00069 3A.M1.00069 : Plasmapheresis - per session 1500 Blood examination Blood examination

747 M1 3A.M1.00070 3A.M1.00070 : Haemodialysis/Peritoneal Dialysis

(only for ARF) - per session1500



M2 3A.M2.00015D 3A.M2.00015D : Chronic cough - cross speciality -


M2 3A.M2.00015E 3A.M2.00015E : Chronic cough - cross speciality -

HDU2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00015F 3A.M2.00015F : Chronic cough - cross speciality -


M2 3A.M2.00015G 3A.M2.00015G : Chronic cough - cross speciality -


748 S1 3A.S1.00002 3A.S1.00002 : Anterior Resection for Ca 52500 Endoscopy, biopsy, CT report with film Clinical Photograph showing scar +

HPE report

749 S1 3A.S1.00007 3A.S1.00007 : Bilateral Inguinal block dissection 30000 Biopsy ReportsClinical Photograph showing scar +

HPE report

750 S1 3A.S1.00008 3A.S1.00008 : Bleeding Ulcer - Gastrectomy &

vagotomy18750 USG/CT, Clinical notes OT note

751 S1 3A.S1.00014 3A.S1.00014 : Branchial Cyst 7500 USG/CT Scar Photo, HPE Report

752 S1 3A.S1.00016 3A.S1.00016 : Bypass - Inoperable Pancreas 11250 USG/CT USG, Scar photo, HPE Report

753 S1 3A.S1.00045 3A.S1.00045 : Excision of Growth from Tongue with

neck node dissection11250 CT/MRI, Clinical Photo OT notes, HPE

754 S1 3A.S1.00059 3A.S1.00059 : Fundoplication 26250 Contrast X ray/endoscopy findings Clinical Photograph showing scar

755 S1 3A.S1.00064 3A.S1.00064 : Gastrostomy 11250 USG/ CT Scan Clinical photograph

756 S1 3A.S1.00068 3A.S1.00068 : Haemangioma – Excision (small) 3750 clinical photograph Doppler

757 S1 3A.S1.00070 3A.S1.00070 : Hepatic Resection (lobectomy) 15000 MRI/ CT Abdomen Scar Photo, HPE Report

758 S1 3A.S1.00078 3A.S1.00078 : Hiatus Hernia – abdominal 30000 UGI ENDOSCOPY Scar photo/ Intra op photo

759 S1 3A.S1.00084 3A.S1.00084 : Inguinal Node (dissection) - Unilateral 15000 Biopsy Reports/ Clinical PhotographClinical Photograph showing scar +

HPE report

760 S1 3A.S1.00087 3A.S1.00087 : Intussusception 11250 USG/CT , Clinical notes Scar photo

761 S1 3A.S1.00092 3A.S1.00092 : Burst Abdomen Obstruction 11250 Clinical Photograph, Clinical notesHPR , Scar photo & Clinical

Photograph,

762 S1 3A.S1.00103 3A.S1.00103 : Oesophagectomy 45000 Biopsy , CT , Endoscopy reports HPE report, scar photo

763 S1 3A.S1.00104 3A.S1.00104 : Portal Hypertension shunt surgery 37500 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar

GENERAL SURGERY

Sl. no.Speciality


764 S1 3A.S1.00106 3A.S1.00106 : PancreaticoDuodenectomy 18750CT-Scan , ERCP , ER Clinical Photograph ,

EndoscopyHPR , Scar Photograph

765 S1 3A.S1.00112 3A.S1.00112 : Pyeloroplasty 7500 USG, Clinical Notes Scar photo, HPE

766 S1 3A.S1.00113 3A.S1.00113 : Radical Mastectomy 7500 Mammography, HPE, CT Scan Scar photo & HPE

767 S1 3A.S1.00114 3A.S1.00114 : Radical Neck Dissection – Excision 11250Clinical photo, Clinical notes & Biopsy/


768 S1 3A.S1.00115 3A.S1.00115 : Hernia – Spigelian 3750 USGClinical Notes, Scar photo and OT

notes

769 S1 3A.S1.00117 3A.S1.00117 : Prolapse of Rectal Mass – Excision 7500 Clinical Findings Procedure Notes

770 S1 3A.S1.00120 3A.S1.00120 : Resection Anastomosis (Large

Intestine)11250 USG / CT Scan Scar photo, HPE

771 S1 3A.S1.00121 3A.S1.00121 : Resection Anastomosis (Small

Intestine)11250 USG / CT Scan Scar photo, HPE

772 S1 3A.S1.00122 3A.S1.00122 : Retroperitoneal Tumor – Excision 37500 CT abdomen with film, FNAC Clinical Photograph showing scar +

HPE report

773 S1 3A.S1.00125 3A.S1.00125 : Segmental Resection of Breast 7500 Mamography, FNAC, CT if indicated Scar photo, HPE

774 S1 3A.S1.00131 3A.S1.00131 : Soft Tissue Tumor (large) – Excision 26250Biopsy of the primary tumour + CT/MRI

with filmScar photo, HPE

775 S1 3A.S1.00134 3A.S1.00134 : Submandibular Mass Excision +

Reconstruction18750


Biopsy


HPE report

776 S1 3A.S1.00138 3A.S1.00138 : Pharyngectomy& Reconstruction –

Total9000 CT Neck, Biopsy HPE, CT Neck, Scar Photo

777 S1 3A.S1.00139 3A.S1.00139 : Tracheal Stenosis (End to end

Anastamosis) (Throat)11250 Bronchoscopy , CT Scar photo, Biopsy

778 S1 3A.S1.00140 3A.S1.00140 : Tracheoplasty (Throat) 30000 CT / Bronchoscopy report CT / Bronchoscopy report

779 S1 3A.S1.00146 3A.S1.00146 : Cleft palate repair (for each stage) 9000 Clinical photo Scar photo

780 S1 3A.S1.00148 3A.S1.00148 : Aneurysm not Requiring Bypass

Techniques 27000 CT Angio Report Scar photo + Post op intra op photo

781 S1 3A.S1.00149 3A.S1.00149 : Aneurysm Resection & Grafting 52500 CT Angio Report Scar photo + Intra op photo

782 S1 3A.S1.00150 3A.S1.00150 : Arterial Embolectomy 7500 Arterial doppler Scar photo

783 S1 3A.S1.00151 3A.S1.00151 : Carotid artery aneurysm repair 15000 Arterial doppler / CT Angio Scar photo

784 S1 3A.S1.00152 3A.S1.00152 : Carotid Body tumour - Excision 26250 Angiogram/Spiral CT Angiogram reportsStills showing the procedure


785 S1 3A.S1.00155 3A.S1.00155 : Congential Arteriovenus Fistula (large) 15000 Arterial doppler, clinical photo Scar photo

786 S1 3A.S1.00156 3A.S1.00156 : Congential Arteriovenus Fistula (small) 7500 Arterial doppler, clinical photo Scar photo

787 S1 3A.S1.00157 3A.S1.00157 : Decortication (Pleurectomy) 37500 CT Chest Post Op X-ray,scar photo

788 S1 3A.S1.00158 3A.S1.00158 : Dissecting Aneurysms 27000 2D ECHO Report with stills, Doppler2D ECHO Report + stills of ECHO +


789 S1 3A.S1.00159 3A.S1.00159 : Distal Abdominal Aorta repair 27000 Angiogram/CTA/MRA Scar photo

Sl. no.Speciality


790 S1 3A.S1.00160 3A.S1.00160 : Estlander Operation (lip) 5250 Clinical notes and photograph Scar photo

791 S1 3A.S1.00162 3A.S1.00162 : Excision of Parathyroid

Adenoma/Carcinoma22500


reports/USG


HPE report

792 S1 3A.S1.00163 3A.S1.00163 : Flap Reconstructive Surgery 22500 X-ray Films + detail notes Clinical photo showing Scar

793 S1 3A.S1.00165 3A.S1.00165 : Split thickness skin grafts – Medium (4

- 8% TBSA)7500 Clinical photograph Scar photo

794 S1 3A.S1.00167 3A.S1.00167 : Free Grafts - Wolfe Grafts 7500 Clinical photograph Scar photo

795 S1 3A.S1.00171 3A.S1.00171 : Lap. Assisted left Hemi colectomy t 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

796 S1 3A.S1.00172 3A.S1.00172 : Lap. Assisted Right Hemi colectomy t 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

797 S1 3A.S1.00173 3A.S1.00173 : Lap. Assisted small bowel resection 30000 CT, Biopsy Clinical Photograph showing scar +

HPE report

798 S1 3A.S1.00174 3A.S1.00174 : Lap. Assisted Total Colectomy 30000Colonocopy with film, biopsy, CT report

with film


HPE report

799 S1 3A.S1.00179 3A.S1.00179 : Laparoscopic Adhesinolysis 11250 MRI/ CT Abdomen Scar Photo, HPE Report

800 S1 3A.S1.00193 3A.S1.00193 : Repair of Main Arteries of the Limbs 7500

Pre-operative Doppler study, CT

angio(Optional)+ Films+ detailed

Clinical notes

Post-operative Doppler study,

Clinical photo showing scar

801 S1 3A.S1.00194 3A.S1.00194 : Mediastinal Tumour 37500 Biopsy/FNAC ,CT Clinical Photograph showing scar +


802 S1 3A.S1.00195 3A.S1.00195 : Oesophagectomy for Carcinoma

Oesophagus37500 Biopsy , CT , Endoscopy reports HPE report, scar photo

803 S1 3A.S1.00197 3A.S1.00197 : Operation for Carcinoma Lip –

Vermilionectomy7500 Clinical photograph, HPE Scar photo, HPE

804 S1 3A.S1.00198 3A.S1.00198 : Operation for Carcinoma Lip - Wedge

Excision and Vermilionectomy9000 Clinical photograph, HPE Scar photo, HPE

805 S1 3A.S1.00199 3A.S1.00199 : Operation for Carcinoma Lip - Wedge-

Excision7500 Clinical photograph, HPE Scar photo, HPE

806 S1 3A.S1.00200 3A.S1.00200 : Appendicectomy - Appendicular

Abscess – Drainage9000 Clinical notes, USG/ CT Scar photo, HPE

807 S1 3A.S1.00201 3A.S1.00201 : Caecostomy 7500 Clinical notes, USG/ CT Scar photo, HPE

808 S1 3A.S1.00202 3A.S1.00202 : Closure of Colostomy 22500 Colonoscopy, Biopsy Clinical Photograph showing scar

809 S1 3A.S1.00205 3A.S1.00205 : CystoJejunostomy/or

Cystogastrostomy15000 USG/ CT Scan Clinical photograph

810 S1 3A.S1.00207 3A.S1.00207 : Hernia -hiatus-Transthoracic 18750 UGI ENDOSCOPY Scar photo/ Intra op photo

811 S1 3A.S1.00209 3A.S1.00209 : Operation for carcinoma lip- cheek

advancement9000 Clinical photograph, HPE Scar photo, HPE

812 S1 3A.S1.00212 3A.S1.00212 : Operations for Acquired

Arteriovenous Fistula11250 Arterial doppler / MRA Scar photo

813 S1 3A.S1.00213 3A.S1.00213 : Operations for Replacement of

Oesophagus by Colon18750 Endoscopy, USG/CT Scar photo, HPE

814 S1 3A.S1.00215 3A.S1.00215 : Parapharyngeal Tumour Excision 8250 USG, CT Neck USG,HPE,Scar Photo

Sl. no.Speciality


815 S1 3A.S1.00216 3A.S1.00216 : Partial/Subtotal Gastrectomy for

Carcinoma37500 Endoscopy, biopsy, CT


HPE report

816 S1 3A.S1.00217 3A.S1.00217 : Patch Graft Angioplasty 15000 Arterial Doppler Post Op Arterial Doppler, Scar photo

817 S1 3A.S1.00218 3A.S1.00218 : Pericardiostomy 7500 2D ECHO 2D ECHO Report + stills of ECHO +


818 S1 3A.S1.00219 3A.S1.00219 : Pneumonectomy 45000 CT Chest Post Op X-ray,scar photo

819 S1 3A.S1.00221 3A.S1.00221 : Removal Tumours of Chest Wall 30000 CT Chest, biopsyClinical Photograph showing scar +

HPE report

820 S1 3A.S1.00222 3A.S1.00222 : Procedures Requiring Bypass

Techniques26250 Angiogram Scar photo

821 S1 3A.S1.00225 3A.S1.00225 : Skin Flaps - Rotation Flaps 4650 Clinical photo Scar photo

822 S1 3A.S1.00227 3A.S1.00227 : Surgery for Arterial Aneurysm Spleenic

Artery15000 CT Angio / MRA Scar photo

823 S1 3A.S1.00228 3A.S1.00228 : Surgery for Arterial Aneurism

–Vertebral18750 CT Angio / MRA Scar photo

824 S1 3A.S1.00229 3A.S1.00229 : Sympathetectomy – Cervical 3750 Clinical notes & Photo, Arterial doppler Scar photo

825 S1 3A.S1.00230 3A.S1.00230 : Temporal Bone resection 45000 CT/MRI, Biopsy Clinical Photograph showing scar +

HPE report

826 S1 3A.S1.00231 3A.S1.00231 : Thorachostomy 7500 Chest X Ray Chest X Ray

827 S1 3A.S1.00233 3A.S1.00233 : Thoracoplasty 15000 X-ray, CT X-ray

828 S1 3A.S1.00234 3A.S1.00234 : Thoracoscopic Decortication 18750 Clinical Photograph Scar photo

829 S1 3A.S1.00235 3A.S1.00235 : Thoracoscopic Hydatid Cyst excision 15000 Chest X-ray / CT Scar photo, HPE

830 S1 3A.S1.00236 3A.S1.00236 : Thoracoscopic Lobectomy 18750 CT/MRI Scar photo, HPE

831 S1 3A.S1.00237 3A.S1.00237 : Thoracoscopic Pneumonectomy 22500 CT/MRI Scar photo, HPE

832 S1 3A.S1.00238 3A.S1.00238 : Thoracoscopic Segmental Resection 18750 CT/MRI Scar photo, HPE

833 S1 3A.S1.00239 3A.S1.00239 : Thoracoscopic Sympathectomy 26250 CT Chest



insertion

834 S1 3A.S1.00240 3A.S1.00240 : Thrombendarterectomy 11250 Arterial doppler, CT Angio/MRA Scar photo

835 S1 3A.S1.00241 3A.S1.00241 : Thorax (penetrating wounds) 9375 X-ray, Clinical photo Post-op clinical photo & X-Ray

836 S1 3A.S1.00242 3A.S1.00242 : Total Thyroidectomy and Block

Dissection15000 Clinical Photograph , USG Scar photo, HPE

837 S1 3A.S1.00247 3A.S1.00247 : Adhenolysis + Appendicectomy 15000 MRI/ CT Abdomen Scar Photo, HPE Report

838 S1 3A.S1.17005 3A.S1.17005 : Prostate surgery (Code 3A.561) -

additional cost18750 CT report and Film, Biopsy Clinical Photograph, HPE report

839 S1 3A.S1.17006 3A.S1.17006 : Nephrectomy – partial (Code 3A.451)-

additional cost18750

CT report with film, Isotope renogram

if required

Clinical Photograph showing scar+

HPE report +USG Report

840 S1 3A.S1.17007 3A.S1.17007 : Low AR and APR (Code 3A.417,

3A.418) - additional cost18750

Endoscopy with film, biopsy, CT report

with film


HPE report

Sl. no.Speciality


841 S1 3A.S1.17008 3A.S1.17008 : Radical hysterectomy for Ca cervix and

Ca endometrium ( Code 3A.484)- additional cost15000 CT report and Film, Biopsy


HPE report

S10 3A.S10.00003A 3A.S10.00003A : Hemangioma – Sclerotherapy

(under GA) - cross speciality26250

CBC,RBS,RFT,S Electrolytes, HIV,

HbsAg,CXR, ECG MRI/MRAMRI/MRA

S10 3A.S10.00004A 3A.S10.00004A : Hemangioma – Debulking/ Excision

- cross speciality26250 CT report OT note,Scar photo

S10 3A.S10.00008A 3A.S10.00008A : Pressure Sore – Surgery - cross

speciality22500

CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,

CXR, ECG, Pus for C/S Clinical photo and OT note

S10 3A.S10.00009A 3A.S10.00009A : Diabetic Foot – Surgery - cross

speciality22500

CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

CXR, ECG, Pus for C/S, MRI/MRAMRI/MRA

S14 3A.S14.00016A 3A.S14.00016A : Anti GERD Surgery - Cross speciaity 7500 USG and Clinical notes OT Note

S2 3A.S2.00075A 3A.S2.00075A : Total Parotidectomy - - cross

speciality30000 FNAC,CT


HPE report

S2 3A.S2.00081A 3A.S2.00081A : Excision of Cystic Hygroma Major/

Extensive - cross speciality7500 Clinical notes & photo, USG/CT

Clinical photo showing scar, /


of surgery & Clinical notes

S6 3A.S6.17024A 3A.S6.17024A : Visceral injuries severe - cross

speciality45000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

S6 3A.S6.17025A 3A.S6.17025A : Chest injuries with ICD bilateral -

cross speciality8250 X-ray /ultra sound


in situ

S6 3A.S6.17026A 3A.S6.17026A : Chest injuries with ICD + ICU - cross

speciality1500 X-ray /ultra sound


in situ

S6 3A.S6.17027A 3A.S6.17027A : Chest injuries with ICD + ICU +

Ventilator - cross speciality19950 X-ray /ultra sound


in situ

S8 3A.S8.00075A 3A.S8.00075A : Nerve Decompression - cross

speciality15000 Nerve Conductions study Clinical Photographs showing scar

S8 3A.S8.00076A 3A.S8.00076A : Peripheral Nerve Surgery Major -


Nerve Conduction Velocity (Nerve

conduction velocity (NCV)) and

Electromyography (EMG) reports

Clinical Photographs showing scar

S8 3A.S8.00077B 3A.S8.00077B : Peripheral Nerve Surgery Minor -



conduction velocity (NCV) /



M4 3A.M4.00035A 3A.M4.00035A# : Bone tumors/soft tissue sarcomas

: surgery (inlcuding prosthesis) - cross speciality 176250

CT scan/MRI ,USG abdomen pelvis,

Clinical photograph

X-ray, CT Scan, Clinical photograph

Hemogram report

842 S9 3A.S9.00001

3A.S9.00001 : 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.

75000 ANGIOGRAM , MRI Angio Clinical Photograph

INTERVENTIONAL NEURORADIOLOGY

Sl. no.Speciality


843 S9 3A.S9.00002 3A.S9.00002 : Additional coil for coil embolization

for aneurysms 18000 ANGIOGRAM , MRI Angio Clinical Photograph

844 S9 3A.S9.00003 3A.S9.00003 : Dural AVMs/AVFs (per sitting) with

glue52500

Hematological and radiological

investigations, CT/MRI



845 S9 3A.S9.00004 3A.S9.00004 : Dural AVMs/AVFs (per sitting) with

onyx112500





846 S9 3A.S9.00005

3A.S9.00005 : Carotico-cavernous Fistula (CCF)

embolization with coils. [includes 5 coils, guide

catheter, micro-catheter, micro-guidewire, general

items]

112500Hematological and radiological




847 S9 3A.S9.00006

3A.S9.00006 : Carotid-cavernous Fistula (CCF)

embolization with balloon (includes one balloon,

guide catheter, micro-catheter, micro-guidewire,

general items)

56250Hematological and radiological




848 S9 3A.S9.00007 3A.S9.00007 : Cerebral & Spinal AVM embolization

(per sitting). Using Histoacryl75000 ANGIOGRAM , MRI Angio Clinical Photograph

849 S9 3A.S9.00008 3A.S9.00008 : Parent vessel occlusion - Basic 22500Hematological and radiological




850 S9 3A.S9.00009 3A.S9.00009 : Additonal coil for Parent Vessel

Occlusion18000





851 S9 3A.S9.00010 3A.S9.00010 : Additonal balloon for Parent Vessel

Occlusion8250





852 S9 3A.S9.00011 3A.S9.00011 : Balloon test occlusion 52500





853 S9 3A.S9.00012 3A.S9.00012 : Intracranial balloon angioplasty with

stenting120000

USG, clotting Time (CT), Prothrombin


(INR), Hb, Serum Creatinine

USG, CT,PT,INR, Hb, Serum

Creatinine

854 S9 3A.S9.00013 3A.S9.00013 : Intracranial thrombolysis / clot

retrieval120000

CT/MRI, Prothrombin Time (PT),

International normalized ratio (INR) Hb,

Serum Creatinine

CT/MRI, PT,INR, Hb, Serum

Creatinine

855 S9 3A.S9.00014 3A.S9.00014 : Pre-operative tumour embolization

(per session)30000


Creatinine


Creatinine

856 S9 3A.S9.00015 3A.S9.00015 : Vertebroplasty 30000Hematological and radiological




857 M2 3A.M2.00007 3A.M2.00007 : Acute urticaria/ Anaphylaxis acute

asthma - routine ward 1350 Clinical note with Lab reports Treatment note


Sl. no.Speciality


M2 3A.M2.00007A 3A.M2.00007A : Acute urticaria/ Anaphylaxis acute

asthma - HDU2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00007B 3A.M2.00007B : Acute urticaria/ Anaphylaxis acute

asthma - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 3A.M2.00007C 3A.M2.00007C : Acute urticaria/ Anaphylaxis acute

asthma - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

858 M2 3A.M2.00011 3A.M2.00011 : Optic neuritis - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00011A 3A.M2.00011A : Optic neuritis - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00011B 3A.M2.00011B : Optic neuritis - ICU without


M2 3A.M2.00011C 3A.M2.00011C : Optic neuritis - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

859 M2 3A.M2.00015 3A.M2.00015 : Chronic cough - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00015A 3A.M2.00015A : Chronic cough - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00015B 3A.M2.00015B : Chronic cough - ICU without


M2 3A.M2.00015C 3A.M2.00015C : Chronic cough - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

860 M2 3A.M2.00016 3A.M2.00016 : Wheezing - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00016A 3A.M2.00016A : Wheezing - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00016B 3A.M2.00016B : Wheezing - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 3A.M2.00016C 3A.M2.00016C : Wheezing - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

861 M2 3A.M2.00018

3A.M2.00018 : Global developmental delay/

Intellectual disability of unknown etiology - routine

ward


M2 3A.M2.00018A 3A.M2.00018A : Global developmental delay/

Intellectual disability of unknown etiology - HDU2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00018B

3A.M2.00018B : Global developmental delay/

Intellectual disability of unknown etiology - ICU

without ventilator


M2 3A.M2.00018C

3A.M2.00018C : Global developmental delay/

Intellectual disability of unknown etiology - ICU

with ventilator


862 M2 3A.M2.00036 3A.M2.00036 : HIV with complications - routine

ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00036A 3A.M2.00036A : HIV with complications - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00036B 3A.M2.00036B : HIV with complications - ICU


M2 3A.M2.00036C 3A.M2.00036C : HIV with complications - ICU with


Sl. no.Speciality


863 M2 3A.M2.00042 3A.M2.00042 : Persistent pneumonia - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00042A 3A.M2.00042A : Persistent pneumonia - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00042B 3A.M2.00042B : Persistent pneumonia - ICU without


M2 3A.M2.00042C 3A.M2.00042C : Persistent pneumonia - ICU with


864 M2 3A.M2.00049 3A.M2.00049 : Chronic meningitis - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00049A 3A.M2.00049A : Chronic meningitis - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00049B 3A.M2.00049B : Chronic meningitis - ICU without


M2 3A.M2.00049C 3A.M2.00049C : Chronic meningitis - ICU with


865 M2 3A.M2.00058 3A.M2.00058 : Metabolic encephalopathy - routine


M2 3A.M2.00058A 3A.M2.00058A : Metabolic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00058B 3A.M2.00058B : Metabolic encephalopathy - ICU


M2 3A.M2.00058C 3A.M2.00058C : Metabolic encephalopathy - ICU


866 M2 3A.M2.00061 3A.M2.00061 : Wilson’s disease - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00061A 3A.M2.00061A : Wilson’s disease - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00061B 3A.M2.00061B : Wilson’s disease - ICU without


M2 3A.M2.00061C 3A.M2.00061C : Wilson’s disease - ICU with


867 M2 3A.M2.00062 3A.M2.00062 : Celiac disease - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00062A 3A.M2.00062A : Celiac disease - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00062B 3A.M2.00062B : Celiac disease - ICU without


M2 3A.M2.00062C 3A.M2.00062C : Celiac disease - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

868 M2 3A.M2.00064 3A.M2.00064 : Unexplained hepatosplenomegaly -


M2 3A.M2.00064A 3A.M2.00064A : Unexplained hepatosplenomegaly -


M2 3A.M2.00064B 3A.M2.00064B : Unexplained hepatosplenomegaly -


M2 3A.M2.00064C 3A.M2.00064C : Unexplained hepatosplenomegaly -


869 M2 3A.M2.00065 3A.M2.00065 : Severe pneumonia - routine ward 1350 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 3A.M2.00065A 3A.M2.00065A : Severe pneumonia - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00065B 3A.M2.00065B : Severe pneumonia - ICU without


M2 3A.M2.00065C 3A.M2.00065C : Severe pneumonia - ICU with


870 M2 3A.M2.00066 3A.M2.00066 : Severe exacerbation of asthma -


M2 3A.M2.00066A 3A.M2.00066A : Severe exacerbation of asthma -


M2 3A.M2.00066B 3A.M2.00066B : Severe exacerbation of asthma - ICU


M2 3A.M2.00066C 3A.M2.00066C : Severe exacerbation of asthma - ICU


871 M2 3A.M2.00070 3A.M2.00070 : Upper GI hemorrhage - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00070A 3A.M2.00070A : Upper GI hemorrhage - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00070B 3A.M2.00070B : Upper GI hemorrhage - ICU


M2 3A.M2.00070C 3A.M2.00070C : Upper GI hemorrhage - ICU with


872 M2 3A.M2.00071 3A.M2.00071 : Lower GI hemorrhage - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00071A 3A.M2.00071A : Lower GI hemorrhage - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00071B 3A.M2.00071B : Lower GI hemorrhage - ICU without


M2 3A.M2.00071C 3A.M2.00071C : Lower GI hemorrhage - ICU with


873 M2 3A.M2.00072 3A.M2.00072 : Acute abdomen - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00072A 3A.M2.00072A : Acute abdomen - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00072B 3A.M2.00072B : Acute abdomen - ICU without


M2 3A.M2.00072C 3A.M2.00072C : Acute abdomen - ICU with


874 M2 3A.M2.00077 3A.M2.00077 : Brain abscess - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00077A 3A.M2.00077A : Brain abscess - HDU 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00077B 3A.M2.00077B : Brain abscess - ICU without


M2 3A.M2.00077C 3A.M2.00077C : Brain abscess - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

875 M2 3A.M2.00083 3A.M2.00083 : Hydrocephalus - routine ward 1350 Clinical examination Clinical examination

M2 3A.M2.00083A 3A.M2.00083A : Hydrocephalus - HDU 2025 Clinical examination Clinical examination

M2 3A.M2.00083B 3A.M2.00083B : Hydrocephalus - ICU without

ventilator 2700 Clinical examination Clinical examination

Sl. no.Speciality


M2 3A.M2.00083C 3A.M2.00083C : Hydrocephalus - ICU with ventilator 3375 Clinical examination Clinical examination

876 M2 3A.M2.00084 3A.M2.00084 : Intracranial space occupying lesion -


M2 3A.M2.00084A 3A.M2.00084A : Intracranial space occupying lesion -


M2 3A.M2.00084B 3A.M2.00084B : Intracranial space occupying lesion -


M2 3A.M2.00084C 3A.M2.00084C : Intracranial space occupying lesion -


877 M2 3A.M2.00087 3A.M2.00087 : Cerebral sino-venous thrombosis -


M2 3A.M2.00087A 3A.M2.00087A : Cerebral sino-venous thrombosis -


M2 3A.M2.00087B 3A.M2.00087B : Cerebral sino-venous thrombosis -


M2 3A.M2.00087C 3A.M2.00087C : Cerebral sino-venous thrombosis -


878 M3 3A.M3.00002

3A.M3.00002 : 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

2250 Clinical note and lab reports Treament note

Sl. no.Speciality


879 M3 3A.M3.00003

3A.M3.00003 : Intensive Neonatal Care Package (Rs.

5000 per day, maximum of Rs. 50,000 – pre-auth is

needed after 5 days)

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




package rate


Sl. no.Speciality


880 M3 3A.M3.00004

3A.M3.00004 : Advanced Neonatal Care Package (Rs.

6000 per day, maximum of Rs. 75,000 – pre-auth is

needed after 7 days):

Babies with birthweight of 1200-1499 g

or

Babies of any birthweight with at least one of the


• 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




package rate


881 M3 3A.M3.00005

3A.M3.00005 : Critical Care Neonatal Package (Rs.

7000 per day, maximum of Rs. 1,20,000 – pre-auth

after 10 days):

Babies with birthweight of <1200 g

or

Babies of any birthweight with at least one of the


• 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




package rate


Sl. no.Speciality


882 M3 3A.M3.00006

3A.M3.00006 : 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


883 M3 3A.M3.00007 3A.M3.00007 : High Risk Newborn Post Discharge

Care Package (Protocol Driven)1800 Clinical note and lab reports Treament note

884 M3 3A.M3.00008

3A.M3.00008 : Laser Therapy for Retinopathy of

Prematurity (Irrespective of no. of eyes affected) -

per session


885 M4 3A.M4.00009

3A.M4.00009 : Hodgkin Lymphoma (Favorable

group) (chemotherapy including diagnostics):

induction

52500 Lymphnode Biopsy, HPE, CT/MRI scanUSG abdomen pelvis,Chest x-ray,

CT/MRI scan

886 M4 3A.M4.00012 3A.M4.00012 : Hodgkin Lymphoma (unfavorable

group): chemotherapy including diagnostics82500 Lymphnode Biopsy, HPE, CT/MRI scan

USG abdomen pelvis,Chest x-ray,

CT/MRI scan

887 M4 3A.M4.00019 3A.M4.00019 : Retinoblastoma (Intraocular): surgery 75000 Haematology, Bone Marrow Aspitation/

Flow cytometry

Clinical Photograph, chemotherapy

drug batch number with bar code

888 M4 3A.M4.00026 3A.M4.00026 : Brain tumors: surgery 41250 MRI ReportClinical Photographs showing the

scar + HPE report

889 M4 3A.M4.00030 3A.M4.00030 : Wilms tumors: surgery 3750 CT report with film, biopsy/FNACClinical Photograph, chemotherapy


890 S14 3A.S14.00001 3A.S14.00001 : Ankyloglossia Major 11250 Clinical Photography Post-op photo

891 S14 3A.S14.00002 3A.S14.00002 : Ankyloglossia Minor 3750 Clinical Photography Post op photo

892 S14 3A.S14.00004 3A.S14.00004 : Sacrococcygeal Teratoma 15000 Clinical examination Clinical examination

893 S14 3A.S14.00008 3A.S14.00008 : Undescended Testis - Reexploration/

Second Stage18750 USG/OT notes of previous surgery Scar photo

894 S14 3A.S14.00010 3A.S14.00010 : Ano Rectal Malformation - Abd-

Perineal PSARP45000

Colostogram pic for males, Photo of

perineum region for femalesClinical Photograph showing scar

895 S14 3A.S14.00011 3A.S14.00011 : Ano Rectal Malformation – Anoplasty 15000 Clinical Note OT note

896 S14 3A.S14.00012 3A.S14.00012 : Ano Rectal Malformation – Cutback 22500 Photo of the perineum region Scar photo

897 S14 3A.S14.00013 3A.S14.00013 : Ano Rectal Malformation - PSARP 15000 Clinical Note OT note

898 S14 3A.S14.00014 3A.S14.00014 : Ano Rectal Malformation - Redo

Pullthrough11250 CT, USG report and Films OT note

899 S14 3A.S14.00015 3A.S14.00015 : Ano Rectal Malformation -

Transposition11250 CT, USG report and Films OT note

900 S14 3A.S14.00016 3A.S14.00016 : Anti GERD Surgery 7500 USG and Clinical notes OT Note

Sl. no.Speciality


901 S14 3A.S14.00017 3A.S14.00017 : Duplication Cyst Excision 15000 USG and Clinical notes OT Note

902 S14 3A.S14.00018 3A.S14.00018 : Fecal Fistula Closure 18750 USG and Clinical notes OT Note

903 S14 3A.S14.00020 3A.S14.00020 : GI Tumor Excision 22500 CT, USG report and Films OT note

904 S14 3A.S14.00021 3A.S14.00021 : Hirschsprung’s Disease - Myectomy 30000 Rectal biopsy/ X-Ray/Contast EnemaClinical photo showing scar +

Biopsy Report.

905 S14 3A.S14.00022 3A.S14.00022 : Hirschsprung’s Disease - Pull

Through15000 Rectal biopsy/ X-Ray/Contast Enema

Clinical photo showing scar +

Biopsy Report.

906 S14 3A.S14.00023 3A.S14.00023 : Hirschsprung’s Disease - Retal Biopsy-

Punch7500 Contrast Enema / Biopsy Clinical Photograph showing scar

907 S14 3A.S14.00024 3A.S14.00024 : Hirschsprung’s Disease - Retal Biopsy

–Open7500 Rectal biopsy/ X-Ray/Contast Enema

Clinical photo showing scar +

Biopsy Report.

908 S14 3A.S14.00025 3A.S14.00025 : Hirschsprung’s Disease -

Sphinecterotomy45000 Contrast Enema / Biopsy Clinical Photograph showing scar

909 S14 3A.S14.00026 3A.S14.00026 : Intussusception - Non –Operative

Reduction in infants13500 USG/Xray Post op USG, Post op X Ray

910 S14 3A.S14.00028 3A.S14.00028 : Ladds Procedure 22500 X-ray abdomen or Ultrasound abdomen Scan Photography

911 S14 3A.S14.00030 3A.S14.00030 : Retro-Peritoneal Lymphangioma

Excision18750 CT, USG report and Films OT note and HPE report

912 S14 3A.S14.00031 3A.S14.00031 : Congenital Diaphragmatic Hernia 82500 X-RayClinical Photograph showing

scar+Post op X ray

913 S14 3A.S14.00032 3A.S14.00032 : Congenital Lobar Emphysema 18750Clinical Notes with relevant


914 S14 3A.S14.00033 3A.S14.00033 : Exomphalos/gastroschisis 18750 CT, USG report and Films OT note

915 S14 3A.S14.00034 3A.S14.00034 : Cleft Lip and Palate Surgery (per

stage)11250 Clinical Photograph Clincal Photograph

916 S14 3A.S14.17111 3A.S14.17111 : Splenectomy - Child 33750 CT/ MRI CT/ MRI

917 S14 3A.S14.17112 3A.S14.17112 : Biliary Atresia 48750 CT Abdomen Clinical Photograph showing scar

918 S14 3A.S14.17113 3A.S14.17113 : Oesophageal Atresia 82500 X-Ray Clinical Photograph showing scar

919 S14 3A.S14.17114 3A.S14.17114 : Unilateral Inguinal Hernia- Age less

than 1 year11250 Clinical photograph, USG HPR, Clinical photograph

920 S14 3A.S14.17115 3A.S14.17115 : Urinary Diversion - Temporary 18750 MCU, USG Clinical Photograph showing scar

921 S14 3A.S14.17116 3A.S14.17116 : Urinary Diversion - Undiversion 26250 MCU, USG Clinical Photograph showing scar

922 S14 3A.S14.17117 3A.S14.17117 : Insertion of Chemo port 15000 Lab reports confirming cancer Clinical Photograph showing chemo

Port

923 S14 3A.S14.17118 3A.S14.17118 : Congenital Hydronephrosis

Open/Lap*37500 USG, Renal Isotope Scan Clinical Photograph showing scar

924 S14 3A.S14.17119 3A.S14.17119 : Anorectal Malformations Stage 3 33750 Clinical Photograph Clinical Photograph showing scar

925 S14 3A.S14.17120 3A.S14.17120 : Pyloromyotomy 26250 USG/Contrast X ray Clinical Photograph showing scar

926 S14 3A.S14.17121 3A.S14.17121 : Bladder Augumentation 60000 MCU/USG Clinical photo

927 S14 3A.S14.17122 3A.S14.17122 : Hypospadias Definitive Repair -

proximal penile45000

Clinical photo showing the meatal

openingNil

Sl. no.Speciality


928 S14 3A.S14.17123 3A.S14.17123 : Hypospadias Re-Do 30000Clinical photo showing the meatal

openingNil

929 S14 3A.S14.17124 3A.S14.17124 : Fistula Closure Hypospadiacs 15000 Clinical Photograph Nil

930 S14 3A.S14.17125 3A.S14.17125 : Faciomaxillary surgery 26250 X-RAY/CT scan Clinical Photograph showing scar +

post op. XRAY

931 S14 3A.S14.17132 3A.S14.17132 : Surgery for chronic pancreatitis 52500 CT/MRI Clinical Photograph showing scar

932 S14 3A.S14.17133 3A.S14.17133 : Omphalocele-Minor 30000 Clinical Photograph Clinical Photograph showing scar

933 S14 3A.S14.17134 3A.S14.17134 : Bilateral Inguinal Hernia for age < 1

year16875 Clinical Photograph Clinical Photograph showing scar

934 S14 3A.S14.17135 3A.S14.17135 : Meconium Aspiration syndrome 38175 Clinical notes confirming digonosis clinical notes in relevant reports

935 S14 3A.S14.17136 3A.S14.17136 : Meningo Encephalocele * 30000 MRI Report Post Op CT Report and film, Clinical

Photograph showing Scar

936 S14 3A.S14.17138 3A.S14.17138 : Unsescended Non palpable testis

stage 115000 USG abdomen Scar photo

937 S14 3A.S14.17139 3A.S14.17139 : Stent Removal 3750 X Ray Post op X Ray

938 S14 3A.S14.17141 3A.S14.17141 : Septicemia not requiring ventilation 36900 Clinical notes confirming digonosis clinical notes in relevant reports

939 S14 3A.S14.17142 3A.S14.17142 : Hypospadias Definitive Repair - mid

penile37500


openingNil

940 S14 3A.S14.17143 3A.S14.17143 : Hypospadias Definitive Repair - distal

penile30000


openingNil

941 S14 3A.S14.17144 3A.S14.17144 : VLBW not requiring ventilation 89925 Clinical notes confirming digonosis clinical notes in relevant reports

942 S14 3A.S14.17145 3A.S14.17145 : Respiratory distress syndrome 56663 Clinical notes confirming digonosis clinical notes in relevant reports

943 S14 3A.S14.17146 3A.S14.17146 : Hypospadias First Stage 22500 Clinical photo showing the meatal

openingNil

944 S14 3A.S14.17147 3A.S14.17147 : Asphyxia with convulsions 55050 Clinical notes confirming digonosis clinical notes in relevant reports

945 S14 3A.S14.17148 3A.S14.17148 : Meningomyelocele * 30000 CT reportPost Op CT Report and film, scar

photo

946 S14 3A.S14.17149 3A.S14.17149 : Laparotomy and excision of cyst (For

Paediatric benign abdominal cyst)22500 USG/CT Scar Photo, HPE Report

S7 3A.S7.00045A 3A.S7.00045A : Ureteric reimplantation-bilateral-

open - cross speciality 52500 MCU, USG Clinical Photograph showing scar

S7 3A.S7.00046A 3A.S7.00046A : Ureteric reimplantation-unilateral-

Laparoscopic - cross speciality 33750 MCU, USG Clinical Photograph showing scar

S7 3A.S7.00069A

3A.S7.00069A : Extrophy Bladder repair including

osteotomy if needed + epispadias repair + ureteric

reimplant - cross speciality

52500 MCU Clinical Photograph

S8 3A.S8.00025A 3A.S8.00025A : Shunt (peritoneal, ventriculo-atrial/


S8 3A.S8.17048A 3A.S8.17048A : Fetal Surgery for

Myelomeningocoele - cross speciality 56250 Ultrasound abdomen Ultrasound + scar photograph

Sl. no.Speciality


S1 3A.S1.00078B 3A.S1.00078B : Hiatus Hernia – abdominal - cross

speciality30000 USG, UGI ENDOSCOPY Scar photo + Intra op photo

S1 3A.S1.00087A 3A.S1.00087A : Intussusception - cross speciality 11250 USG/CT , Clinical notes Scar photo

S1 3A.S1.00112B 3A.S1.00112B : Pyeloroplasty - cross speciality 7500 USG, Clinical Notes Scar photo, HPE

S1 3A.S1.00157B 3A.S1.00157B : Decortication (Pleurectomy) - cross

speciality37500 CT Chest report Post Op X-ray,scar photo

S1 3A.S1.00219B 3A.S1.00219B : Pneumonectomy - cross speciality 45000 CT Chest report Post Op X-ray,scar photo

S1 3A.S1.00239B 3A.S1.00239B : Thoracoscopic Sympathectomy -

cross speciality26250 CT Chest report



insertion

M1 3A.M1.00002D 3A.M1.00002D : Recurrent vomiting with

dehydration - routine ward - cross speciality1350



M1 3A.M1.00002E 3A.M1.00002E : Recurrent vomiting with

dehydration - HDU - cross speciality2025



M1 3A.M1.00002F 3A.M1.00002F : Recurrent vomiting with

dehydration - ICU with ventilator - cross speciality2700



M1 3A.M1.00002G

3A.M1.00002G : Recurrent vomiting with

dehydration - ICU without ventilator - cross

speciality

3375Relevant Hematological investigations,


Sl. no.Speciality


947 S8 3A.S8.00001 3A.S8.00001 : Anterior Encephalocele 37500 MRI Report Post Op CT Report and film, Clinical


948 S8 3A.S8.00003 3A.S8.00003 : Burr hole with chronic Sub Dural

Haematoma (including pre and post Op. CT)15000 CT Report CT Report, Scar Photo

949 S8 3A.S8.00005 3A.S8.00005 : Cervical Ribs – Bilateral 26250 MRIX Ray film with report, Clinical

Photograph

950 S8 3A.S8.00006 3A.S8.00006 : Cervical Ribs – Unilateral 15000 MRIX Ray film with report, Clinical

Photograph

951 S8 3A.S8.00007 3A.S8.00007 : CranioPlasty - Endogenous graft 22500 CT report Post Op CT Report and film, Clinical

Photograph showing the scar

952 S8 3A.S8.00008 3A.S8.00008 : CranioPlasty - Exogenous graft

(inclusive of cost of implant)30000 CT report

Post Op CT Report and film, Clinical


953 S8 3A.S8.00009 3A.S8.00009 : Craniostenosis 37500 CT/MRI Report Post-op CT report and film

954 S8 3A.S8.00010 3A.S8.00010 : Duroplasty - Endogenous 9375 CT/MRI CT/MRI, scar Photo

955 S8 3A.S8.00011 3A.S8.00011 : Duroplasty - Exogenous 9375 CT/MRI CT/MRI, scar Photo

956 S8 3A.S8.00013 3A.S8.00013 : Haematoma - Brain (hypertensive) 37500 CT Report CT Report, Scar Photo, X Ray

957 S8 3A.S8.00014 3A.S8.00014 : Haematoma (Child subdural) inclusive

of General anaesthesia, pre and post Op. CT37500 CT Report CT Report, Scar Photo, X Ray

958 S8 3A.S8.00016 3A.S8.00016 : Laminectomy with Fusion 30000 Clinical findings, MRI Report photo showing scar

959 S8 3A.S8.00017 3A.S8.00017 : Local Neurectomy 12000 Clinical notes Scar photo

960 S8 3A.S8.00019 3A.S8.00019 : Meningocele – Anterior 27000 CT reportPost Op CT Report and film, scar

photo

961 S8 3A.S8.00020 3A.S8.00020 : Meningocele – Lumbar 27000 CT reportPost Op CT Report and film, scar

photo

962 S8 3A.S8.00021 3A.S8.00021 : Meningococcal – Occipital 37500 CT /MRI report CT report, Scar photo

963 S8 3A.S8.00022 3A.S8.00022 : Micro discectomy – Cervical 30000 Clinical findings, MRI Report Post Op X-ray, Clinical Photograph

showing scar

964 S8 3A.S8.00024 3A.S8.00024 : Brachial Plexus – Repair 20250 MRI X-RAY and clinical photograph

965 S8 3A.S8.00025 3A.S8.00025 : Shunt (peritoneal, ventriculo-atrial/

peritoneal, theco peritoneal)15000 CT report Clinical Photographs

966 S8 3A.S8.00026 3A.S8.00026 : Skull Traction 6000 CT report Clinical photograph

967 S8 3A.S8.00027 3A.S8.00027 : Spine - Canal Stenosis 30000 MRI report & film, Clinical findings Post Op X-Ray Report and film

968 S8 3A.S8.00028 3A.S8.00028 : Spine - Decompression & Fusion 30000 Clinical findings, MRI Report Post Op X-Ray Report and film

969 S8 3A.S8.00030 3A.S8.00030 : Spine - Extradural Tumour 22500 MRI Report Biopsy report + HPE Report + scar

photo

970 S8 3A.S8.00031 3A.S8.00031 : Spine - Extradural Tumour with

fixation33750 MRI Report

Biopsy report + HPE Report + scar

photo

971 S8 3A.S8.00032 3A.S8.00032 : Spine - Extradural Haematoma 22500 MRI Report scar photo

NEUROSURGERY

Sl. no.Speciality


972 S8 3A.S8.00033 3A.S8.00033 : Spine - Extradural Haematoma with

fixation30000 CT Report CT Report, Scar Photo, X Ray

973 S8 3A.S8.00034 3A.S8.00034 : Spine - Intradural Tumour 30000 MRI Report Biopsy report + HPE Report + scar

photo

974 S8 3A.S8.00035 3A.S8.00035 : Spine - Intradural Tumour with

fixation37500 CT Report CT Report, Scar Photo, X Ray & HPE

975 S8 3A.S8.00036 3A.S8.00036 : Spine - Intradural Haematoma 30000 MRI Report scar photo

976 S8 3A.S8.00037 3A.S8.00037 : Spine - Intradural Haematoma with

fixation37500 MRI Report scar photo

977 S8 3A.S8.00038 3A.S8.00038 : Spine - Intramedullar Tumour 30000 MRI ReportPost Op X-ray Report and film +

HPE report

978 S8 3A.S8.00039 3A.S8.00039 : Spine - Intramedullar Tumour -

fixation45000 MRI Report

Biopsy report + HPE Report + scar

photo

979 S8 3A.S8.00040 3A.S8.00040 : Trans Sphenoidal including pre and

post Op. MRI30000 CT/MRI Report HPE report

980 S8 3A.S8.00041 3A.S8.00041 : Tumours – Supratentorial 37500 CT report /MRI Clinical features


Photographs showing the scar +

HPE report

981 S8 3A.S8.00042 3A.S8.00042 : Tumours Meninges – Gocussa 37500 CT Histopathological report, CT

982 S8 3A.S8.00043 3A.S8.00043 : Tumours Meninges – Posterior 37500 CT report /MRI Clinical features



HPE report

983 S8 3A.S8.00044 3A.S8.00044 : Ventricular Puncture 11250 CT report Post Op CT Report and film, Clinical


984 S8 3A.S8.00045 3A.S8.00045 : Brain Biopsy 11250 CT report HPE, scar photo

985 S8 3A.S8.00046 3A.S8.00046 : Cranial Nerve Anastomosis 24000 CT Post Op CT Report and film,

986 S8 3A.S8.00047 3A.S8.00047 : Depressed Fracture 22500 CT reportClinical Photographs showing scar,

Post CT report and film

987 S8 3A.S8.00048 3A.S8.00048 : Nerve Biopsy excluding Hensens 7500




Clinical Photograph + HPE report

988 S8 3A.S8.00049 3A.S8.00049 : Peripheral Neurectomy (Trigeminal) 12375 MRI Report CD of Procedure

989 S8 3A.S8.00050 3A.S8.00050 : R.F. Lesion for Trigeminal Neuralgia 11250 MRI Report CD of Procedure

990 S8 3A.S8.00052 3A.S8.00052 : Excision of Brain TumorSupratentorial-

Parasagital60000 CT report /MRI Clinical features



HPE report


Basal 60000 CT report



HPE report

Sl. no.Speciality



Brainstem 60000 CT report



HPE report


C P Angle 37500 CT report /MRI Clinical features



HPE report

994 S8 3A.S8.00056 3A.S8.00056 : Excision of Brain

TumorSupratentorial& others 41250 CT report /MRI Clinical features



HPE report

995 S8 3A.S8.00057 3A.S8.00057 : Abscess Tapping single 11250 CT reportPost Op CT Report,film and scar

photo

996 S8 3A.S8.00060 3A.S8.00060 : Aneurysm Clipping including

angiogram82500 MRI/CT Angio / DSA report

Post Op CT Report and film, scar

photo

997 S8 3A.S8.00063 3A.S8.00063 : Spinal Fusion Procedure with implant 45000 Clinical findings, MRI Report

Post Op X-Ray Report and film, +

Showing scar + XRAY showing the

implants

998 S8 3A.S8.00064 3A.S8.00064 : Spina Bifida Surgery 30000 MRI Report Clinical Photographs showing scar

999 S8 3A.S8.00065 3A.S8.00065 : Stereotactic Lesioning 45000Neuro Psychologist report, Neurologist

report, MRI

Clinical Photographs showing scar ,

CT Brain report and film

1000 S8 3A.S8.00066 3A.S8.00066 : Posterior Cervical Discetomy without

implant 22500 MRI report Clinical Photographs showing scar

1001 S8 3A.S8.00067 3A.S8.00067 : Posterior Cervical Fusion with implant

(Lateral mass fixation) 45000 MRI report


X-ray - Cervical spine

1002 S8 3A.S8.00068 3A.S8.00068 : Cervical Disc Multiple level without

Fusion 26250 CT/MRI report


X-ray-Cervical Spine

1003 S8 3A.S8.00069 3A.S8.00069 : Thoracic/Lumbar Corpectomy with

fusion inclusive of implant 52500 MRI Report


X-ray Report and film showing the

implants

1004 S8 3A.S8.00070 3A.S8.00070 : Transoral surgery (Anterior) and CV

Junction (Posterior Sterlization)60000 MRI Report + XRAY Post Op X-ray report and film

1005 S8 3A.S8.00071 3A.S8.00071 : Trans oral Surgery 30000 CT report Post Op X-ray Report and film, HPE

report

1006 S8 3A.S8.00072 3A.S8.00072 : Foramen Magnum Decompression 33750 CT/MRI report Clinical Photographs showing scar

1007 S8 3A.S8.00073 3A.S8.00073 : Endoscopic CSF Rhinorrhea Repair 22500 CT/MRI report Clinical Photographs showing scar

1008 S8 3A.S8.00075 3A.S8.00075 : Nerve Decompression 15000 Nerve Conductions study Clinical Photographs showing scar

1009 S8 3A.S8.00076 3A.S8.00076 : Peripheral Nerve Surgery Major 33750





Sl. no.Speciality


1010 S8 3A.S8.00077 3A.S8.00077 : Peripheral Nerve Surgery Minor 11250





1011 S8 3A.S8.00078 3A.S8.00078 : Epilepsy Surgery 37500EEG, Neuro Psychologist report,

Neurologist report, CT/MRI

CT + Clinical Photographs showing

scar

1012 S8 3A.S8.00079 3A.S8.00079 : Arterio venous malformation (AVM)

excision (whatever size and location)75000 MRI Angio/DSA report CT report and film,scar photo

1013 S8 3A.S8.00080 3A.S8.00080 : Scalp Arterio venous malformation

(AVM) 18750 CT/MRI Report


HPE report

1014 S8 3A.S8.00081

3A.S8.00081 : Superficial Temporal Artery (STA):

middle cerebral artery (MCA) or (other EC - IC)

Bypass procedure

75000 MRI Angio/DSA report CT Report and film,scar photo

1015 S8 3A.S8.00082 3A.S8.00082 : Excision of Orbital Tumour 37500 CT/MRI Report

CT, Clinical Photograph showing

scar + HPE report, Post-op CT report

and film

1016 S8 3A.S8.00083

3A.S8.00083 : Gamma Knife radiosurgery (GKRS)/

SRS for tumours/ Arteriovenous malformation

(AVM)

56250 CT/MRI Report Clinical Photographs

1017 S8 3A.S8.17048 3A.S8.17048 : Fetal Surgery for Myelomeningocoele 56250 Ultrasound abdomen Ultrasound + scar photograph

1018 S8 3A.S8.17049 3A.S8.17049 : Excision of Brain Tumor Infratentorial-

C P Angle * 60000 CT report



HPE report

1019 S8 3A.S8.17050 3A.S8.17050 : Excision of Brain Tumor Supratentorial

& others *37500 CT report



HPE report

1020 S8 3A.S8.17051 3A.S8.17051 : Stereotaxic Procedures 18750 CT/ MRI reportPost Op CT Report and film + HPE

report

1021 S8 3A.S8.17052 3A.S8.17052 : Endoscopic venticulostomy 22500 CT reportClinical Photograph showing scar, DT

Brain film and report

1022 S8 3A.S8.17053 3A.S8.17053 : Anterior Cervical Discectomy Multiple

level with Implants*45000 Clinical findings, MRI Report

Photo showing the scar + XRAY

showing the implants

1023 S8 3A.S8.17054 3A.S8.17054 : Laminectomy-Cervical * 22500 Clinical findings, MRI Report photo showing scar

1024 S8 3A.S8.17055 3A.S8.17055 : Decompressive craniotomy 30000 CT reportClinical Photographs showing scar,

Post CT report and film

1025 S8 3A.S8.17057 3A.S8.17057 : MVD (Micro Vascular Decompression) 37500 MRI Report Clinical Photographs

1026 S8 3A.S8.00061 3A.S8.00061 : Additonal clip for Aneurysm Clipping 11250 MRI/CT Angio / DSA report Post Op CT Report and film, scar

photo

S9 3A.S9.00015A 3A.S9.00015A : Vertebroplasty - cross speciality 30000Hematological and radiological




M2 3A.M2.00077D 3A.M2.00077D : Brain abscess - cross speciality -


Sl. no.Speciality


M2 3A.M2.00077E 3A.M2.00077E : Brain abscess - cross speciality -


M2 3A.M2.00077F 3A.M2.00077F : Brain abscess - cross speciality -


M2 3A.M2.00077G 3A.M2.00077G : Brain abscess - cross speciality - -


M2 3A.M2.00083D 3A.M2.00083D : Hydrocephalus - cross speciality -

routine ward1350 CT Report CT Report, Scar Photo, X Ray

M2 3A.M2.00083E 3A.M2.00083E : Hydrocephalus - cross speciality -

HDU2025 CT Report CT Report, Scar Photo, X Ray

M2 3A.M2.00083F 3A.M2.00083F : Hydrocephalus - cross speciality -

ICU with ventilator 3375 CT Report CT Report, Scar Photo, X Ray

M2 3A.M2.00083G 3A.M2.00083G : Hydrocephalus - cross speciality -

ICU without ventilator 2700 CT Report CT Report, Scar Photo, X Ray

M2 3A.M2.00084D 3A.M2.00084D : Intracranial space occupying lesion -

cross speciality - routine ward 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00084E 3A.M2.00084E : Intracranial space occupying lesion -

cross speciality - HDU2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00084F 3A.M2.00084F : Intracranial space occupying lesion -

cross speciality - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

M2 3A.M2.00084G 3A.M2.00084G : Intracranial space occupying lesion -

cross speciality - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 3A.M2.00087D 3A.M2.00087D : Cerebral sino-venous thrombosis -

cross speciality - routine ward1350 Clinical notes, CT - brain Clinical notes, CT - brain

M2 3A.M2.00087E 3A.M2.00087E : Cerebral sino-venous thrombosis -

cross speciality - HDU 2025 Clinical notes, CT - brain Clinical notes, CT - brain

M2 3A.M2.00087F 3A.M2.00087F : Cerebral sino-venous thrombosis -

cross speciality - ICU with ventilator 3375 Clinical notes, CT - brain Clinical notes, CT - brain

M2 3A.M2.00087G 3A.M2.00087G : Cerebral sino-venous thrombosis -

cross speciality - ICU without ventilator 2700 Clinical notes, CT - brain Clinical notes, CT - brain

M4 3A.M4.00026A 3A.M4.00026A : Brain tumors: surgery - cross

speciality41250 MRI Report

Clinical Photographs showing the

scar + HPE report

S1 3A.S1.00230B 3A.S1.00230B : Temporal Bone resection - cross

speciality 45000 CT/MRI, Biopsy


HPE report

S10 3A.S10.00006A 3A.S10.00006A : Scalp avulsion reconstruction -


CBC,RBS,RFT,S Electrolytes, HIV,HbsAg,

CXR, ECG Clinical photo and OT note

S14 3A.S14.17136A 3A.S14.17136A : Meningo Encephalocele * - cross




S14 3A.S14.17148A 3A.S14.17148A : Meningomyelocele * - cross

speciality30000 CT report

Post Op CT Report and film, scar

photo

Sl. no.Speciality


S2 3A.S2.00023A 3A.S2.00023A : Skull base surgery - cross speciality 27750 CT-Scan / MRI Scan Clinical Photograph

S6 3A.S6.00001B 3A.S6.00001B : Nerve Plexus injuries, Tendon injury

repair/reconstruction/ Transfer - cross speciality37500

MRI + Xray Films(if relevant)+ Clinical


S6 3A.S6.00002A 3A.S6.00002A : Plexus injury along with Vascular

injury repair/ graft - cross speciality45000



S6 3A.S6.00004B

3A.S6.00004B : Head injury requiring Facio-Maxillary

Injury repairs & fixations (including implants) -

cross speciality



1027 S4 3A.S4.00008

3A.S4.00008 : Laparotomy and proceed for Ovarian

Cancers. Omentomy with Bilateral Salpingo-

oophorectomy

15000 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

1028 S4 3A.S4.00011 3A.S4.00011 : Vaginal surgical repair for vesico-

vaginal fistula7500

Clinical Notes, USG/KUB/Urology

opinionOT notes

1029 S4 3A.S4.00012 3A.S4.00012 : Sacrocolpopexy 12000 Clinical note,USG OT Note

1030 S4 3A.S4.00014 3A.S4.00014 : Vaginoplasty 7500 Clinical note OT Note

1031 S4 3A.S4.00015 3A.S4.00015 : LLETZ 11250 USG and clinical notes OT note and HPE

1032 S4 3A.S4.00016 3A.S4.00016 : Colpotomy 900 USG and clinical notes OT note

1033 S4 3A.S4.00021 3A.S4.00021 : Radical Vulvectomy 11250 USG and clinical notes OT note and HPE

1034 S4 3A.S4.00026 3A.S4.00026 : Laparoscopic ovarotomy 7500 USG and clinical notes OT note and HPE

1035 S4 3A.S4.00028 3A.S4.00028 : Laparoscopic tubal surgeries -

salpingectomy, salpingotomy8250 USG and clinical notes OT note and HPE

1036 S4 3A.S4.00029 3A.S4.00029 : Drag hysteroscopy 4500 USG and clinical notes OT note

1037 S4 3A.S4.00030 3A.S4.00030 : Hysteroscopic myomectomies 4500 USG and clinical notes OT note and HPE

1038 S4 3A.S4.00031 3A.S4.00031 : Hysteroscopic adhesiolysis 4500 USG and clinical notes OT note and HPE

1039 S4 3A.S4.00053 3A.S4.00053 : Abdominal Perineal neo construction

Cx + Uteria + Vagina15000 USG/CT, Lab report and clinical notes OT note

1040 S4 3A.S4.00055 3A.S4.00055 : Ablation of Endometriotic Spot

+Salpingostomy7500 USG and clinical notes OT Note

1041 S4 3A.S4.00066 3A.S4.00066 : Cystocele - Anterior Repair + Perineal

Tear Repair9750 USG and clinical notes OT Note

1042 S4 3A.S4.00070 3A.S4.00070 : Electro Cauterisation Cryo Surgery 3000 Clinical note OT Note, Clinical photograph

1043 S4 3A.S4.00074 3A.S4.00074 : HaematoColpo/Excision - Vaginal

Septum3750 USG and clinical notes OT Note and HPE

1044 S4 3A.S4.00078 3A.S4.00078 : Cordocentesis 3750 USG and clinical notes OT Note

1045 S4 3A.S4.00079 3A.S4.00079 : Intrauterine transfusions 7500 USG and clinical notes Procedure Note

S1 3A.S1.17008B

3A.S1.17008B : Radical hysterectomy for Ca cervix

and Ca endometrium ( Code 3A.484)- additional

cost - cross speciality


HPE report


Sl. no.Speciality


1046 M4 3A.M4.00004 3A.M4.00004 : Acute lymphoblastic leukemia:

radiation3750

Haematology, Bone Marrow Aspitation/

Flow cytometry

Photo with RT Machine , RT

treatment chart

1047 M4 3A.M4.00010 3A.M4.00010 : Hodgkin Lymphoma (Favorable

group): radiation7500 Hematology + Biopsy/FNAC report


treatment chart


group): radiation11250 Hematology + Biopsy/FNAC report


treatment chart

1049 M4 3A.M4.00018 3A.M4.00018 : Retinoblastoma (Intraocular):

radiation7500 Biopsy , CT report with film


treatment chart

1050 M4 3A.M4.00022 3A.M4.00022 : Retinoblastoma (extraocular):

radiation7500 Biopsy , CT report with film


treatment chart

1051 M4 3A.M4.00025 3A.M4.00025 : Brain tumors: radiation 22500 CT report /MRI Clinical featuresPhoto with RT Machine , RT

treatment chart

1052 M4 3A.M4.00029 3A.M4.00029 : Wilms tumors: radiation 3750 CT report with film, biopsy/FNACPhoto with RT Machine , RT

treatment chart

1053 M4 3A.M4.00034 3A.M4.00034 : Bone tumors/soft tissue sarcomas :

radiation18750 Biopsy , CT-Scan with film


treatment chart

1054 M4 3A.M4.00035 3A.M4.00035#: Bone tumors/soft tissue sarcomas :

surgery (inlcuding prosthesis)176250

CT scan/MRI ,Tumor board form, USG

abdomen pelvis, Clinical photograph

X-ray, CT Scan,Tumor Board form,

Clinical photograph Hemogram

report

1055 M6 3A.M6.00001 3A.M6.00001 : Cobalt 60 External Beam

Radiotherapy (Radical/Adjuvant / Neoadjuvant)15000 Biopsy/FNAC ,CT report and Film


treatment chart RT planning Data


Radiotherapy (Palliative)7500 CT report and Film, Biopsy



1057 M6 3A.M6.00003 3A.M6.00003 : Linear Accelerator External Beam

Radiotherapy (Palliative)15000 CT report and Film, Biopsy


treatment chart

1058 M6 3A.M6.00004

3A.M6.00004 : Linear Accelerator, External Beam

Radiotherapy 3D CRT/2D Planning

(Radical/Adjuvant/ Neoadjuvant)

37500 CT report and film, biopsy Photo with RT machine, RT treatment

chart

1059 M6 3A.M6.00005

3A.M6.00005 : Linear Accelerator, External Beam

Radiotherapy IMRT (Intensity Modulated

Radiotherapy) (Radical/Adjuvant/Neoadjuvant)

56250 CT report and Film, BiopsyPhoto with RT Machine , RT

treatment chart

1060 M6 3A.M6.00006

3A.M6.00006 : Linear Accelerator External Beam

Radiotherapy IGRT (Image Guided radiotherapy)

(Radical/Adjuvant/Neoadjuvent)

90000Photo with RT Machine , RT treatment

chart, CBCT machine log


treatment chart, CBCT machine log

1061 M6 3A.M6.00007 3A.M6.00007 : SRT(Stereota1036ic radiotherapy) 56250 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT


ONCOLOGY

Sl. no.Speciality


1062 M6 3A.M6.00008 3A.M6.00008 : SRS (Streotactic radiosurgery) 52500 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT


1063 M6 3A.M6.00009 3A.M6.00009 : Respiratory Gating along with Linear

Accelerator planning52500 ECHO, Chest X Ray, RFT, CBC, ABG



1064 M6 3A.M6.00010 3A.M6.00010 : Electron beam with Linear accelerator

(Radical)37500 Biopsy/FNAC ,CT report and Film


treatment chart

1065 M6 3A.M6.00011 3A.M6.00011 :

Tomotherapy(Radical/Adjuvant/Neoadjuvant)37500 CT report and film, biopsy

Photo with RT machine, RT treatment

chart

1066 M6 3A.M6.00012 3A.M6.00012 : Brachytherapy High Dose Radiation

(Intracavitory) - per fraction, maximum of 4 sessions3375 Biopsy/FNAC ,CT report and Film


treatment chart, RT planning data


(Interstitial) - for one application, multiple dose22500 CT/MRI report and Film, Biopsy




(Intraluminal) - per fraction, maximum 4 sessions3375 Biopsy/FNAC ,CT report and Film


treatment chart, RT planning data


Radiotherapy, Definitive, Neoadjuvant, Adjuvant15000 Biopsy/FNAC ,CT report and Film



1070 M6 3A.M6.17242 3A.M6.17242 : Brachytherapy/ Interstitial LDR ,

adjuvant11250 CT / MRI report with film, Biopsy



1071 M6 3A.M6.17243 3A.M6.17243 : Linear accelerator teletherapy,

Definitive+Tab Temozolamide41250 CT report and film, biopsy

Photo with RT machine, RT treatment

chart, RT planning data

1072 M6 3A.M6.17244

3A.M6.17244 : Linear accelerator teletherapy,

3DCRT, Definitive along with +concurrent Tab

Temozolamide along with RT

60000 CT report and Film, BiopsyPhoto with RT Machine , RT


1073 M6 3A.M6.17245 3A.M6.17245 : Linear accelerator (Photons)

teletherapy, Adjuvant37500 CT/MRI report and Film, Biopsy


treatment chart


Radiotherapy, Definitive15000 CT report and Film, Biopsy



1075 M6 3A.M6.17247 3A.M6.17247 : Radioiodine Treatment < 100

Millicuries15000 Biopsy/FNAC

Radioiodine original treatment chart

and Thyroid scan, Biopsy/HPE

1076 M6 3A.M6.17248 3A.M6.17248 : Radioiodine Treatment > 100

Millicuries22500 Biopsy/FNAC

Radioiodine original treatment chart

and Thyroid scan , Biopsy/HPE

Sl. no.Speciality


1077 M6 3A.M6.17249 3A.M6.17249 : Accelerated partial breast irradiation

(APBI) any type/ LINAC/3DCRT/IMRT37500

Biopsy/FNAC , Mammography/USG,

chest Xray


treatment chart

1078 M6 3A.M6.17250

3A.M6.17250 : Linear accelerator,Involved-Site

Radiotherapy (ISRT)/Involved field radiation therapy

(IFRT)/3DCRT/IMRT

18750 Hematology + Biopsy/FNAC reportPhoto with RT Machine , RT

treatment chart

1079 M6 3A.M6.17251 3A.M6.17251 : Linear accelerator, less than 20

fractions/3DCRT/IMRT18750 Hematology + Biopsy/FNAC report


treatment chart


3DCRT,IMRT,VMAT Adjuvant/Definitive 56250 Biopsy/FNAC ,CT report and Film


treatment chart

1081 M6 3A.M6.17253 3A.M6.17253 : Brachytherapy/ Interstitial HDR one

application, multiple doses Definitive/Boost22500 CT/MRI report and Film, Biopsy



1082 M6 3A.M6.17254 3A.M6.17254 : Cobalt 60 teletherapy, Palliative 7500 CT report and Film, BiopsyPhoto with RT Machine , RT



Palliative15000 CT report and Film, Biopsy


treatment chart

1084 S15 3A.S15.00001 3A.S15.00001 : Tracheal resection 13500 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

1085 S15 3A.S15.00002 3A.S15.00002 : Sternotomy with superior

mediastinal dissection9000 CT report and Film, Biopsy

Clinical Photograph showing the

scar + HPE report

1086 S15 3A.S15.00003 3A.S15.00003 : Substernal bypass 26250 Biopsy of the primary Clinical Photograph showing the

procedure/scar

1087 S15 3A.S15.00004 3A.S15.00004 : Resection of nasopharyngeal tumour 37500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

1088 S15 3A.S15.00005 3A.S15.00005 : Myocutaneous flap 18750 Biopsy of the primary Clinical Photograph showing scar

1089 S15 3A.S15.00006 3A.S15.00006 : Fasciocutaneous flap 11250X-ray Films + detail notes+ pre-op

clinical photoClinical photo showing Scar

1090 S15 3A.S15.00007 3A.S15.00007 : Palatectomy- Soft palate 22500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

1091 S15 3A.S15.00008 3A.S15.00008 : Palatectomy- Hard palate 15000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

1092 S15 3A.S15.00009 3A.S15.00009 : Microvascular reconstruction 33750 Biopsy of the primary Clinical Photograph showing scar

1093 S15 3A.S15.00010 3A.S15.00010 : Composite resection 37500 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

1094 S15 3A.S15.00011 3A.S15.00011 : Composite resection with

reconstruction(excluding microvascular)48750 CT report and Film, Biopsy


HPE report

1095 S15 3A.S15.00012 3A.S15.00012 : Neck dissection-selective 9000 Biopsy , USG/CT of neck with film Clinical Photograph showing scar +

HPE report

1096 S15 3A.S15.00013 3A.S15.00013 : Neck dissection-comprehensive 18750 Biopsy , USG/CT of neck with film Clinical Photograph showing scar +

HPE report

1097 S15 3A.S15.00014 3A.S15.00014 : Total Maxillectomy 13500 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

Sl. no.Speciality


1098 S15 3A.S15.00015 3A.S15.00015 : Radical Maxillectomy 30000 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

1099 S15 3A.S15.00016 3A.S15.00016 : Radical parotidectomy 18750 FNAC,CT Clinical Photograph showing scar +

HPE report

1100 S15 3A.S15.00017 3A.S15.00017 : Partial laryngectomy ( voice

preserving)15000 CT report and Film, Biopsy


HPE report

1101 S15 3A.S15.00018 3A.S15.00018 : Voice prosthesis 30000 CT report, Biopsy, +Photograph with AM Invoice of prosthesis, scar photo

1102 S15 3A.S15.00020

3A.S15.00020 : Total Thyroidectomy with central

compartment LN dissection with Lateral LN

dissection

18750 FNAC/CT/MRI report and FilmClinical Photograph showing scar +

HPE report

1103 S15 3A.S15.00022 3A.S15.00022 : Axillary dissection 11250Biopsy/FNAC , Mammography/USG,

chest Xray


HPE report

1104 S15 3A.S15.00023 3A.S15.00023 : Breast conserving surgery

(lumpectomy + axillary surgery)18750


chest Xray


HPE report

1105 S15 3A.S15.00024 3A.S15.00024 : Lung metastectomy- solitary 22500 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar +


1106 S15 3A.S15.00025 3A.S15.00025 : Lung metastectomy- multiple (<

four)37500 Biopsy/FNAC ,CT report and Film



1107 S15 3A.S15.00026 3A.S15.00026 : Lung metastectomy- multiple (>

four)45000 Biopsy/FNAC ,CT report and Film



1108 S15 3A.S15.00027 3A.S15.00027 : Sleeve resection of lung cancer 67500 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar +


1109 S15 3A.S15.00028 3A.S15.00028 : Oesophagectomy with two field

lymphadenectomy56250 Biopsy , CT , Endoscopy reports HPE report, scar photo

1110 S15 3A.S15.00029 3A.S15.00029 : Oesophagectomy with three field

lymphadenectomy67500 Biopsy , CT , Endoscopy reports Biopsy , CT , Endoscopy reports

1111 S15 3A.S15.00030 3A.S15.00030 : Enucleation of pancreatic neoplasm 18750 CT / MRI with film/IHC report Clinical Photograph showing scar +

HPE report

1112 S15 3A.S15.00031 3A.S15.00031 : Radical Cholecystectomy 45000 CT /MRI report and Film, biopsyClinical Photograph showing the scar

+ HPE report +USG Report

1113 S15 3A.S15.00032 3A.S15.00032 : Abdominal wall tumour resection 26250 CT abdomen report and Film Clinical Photograph showing scar +

HPE report

1114 S15 3A.S15.00033 3A.S15.00033 : Abdominal wall tumour resection

with reconstruction33750 CT abdomen report and Film


HPE report

1115 S15 3A.S15.00034 3A.S15.00034 : Oesophageal stenting including stent

cost30000 CT abdomen report and Film Stent invoice

1116 S15 3A.S15.00035 3A.S15.00035 : Triple bypass GI tract 30000 Biopsy , CT , Endoscopy Clinical Photograph showing scar +

HPE report

1117 S15 3A.S15.00036 3A.S15.00036 : Segmentectomy- hepatobiliary

system37500 CT /MRI report and Film

Clinical Photograph showing scar,

USG and HPE Report

Sl. no.Speciality


1118 S15 3A.S15.00037

3A.S15.00037 : Radical Hysterectomy + Bilateral

pelvic lymph node dissection + bilateral salpingo

ophorectomy (BSO)/ ovarian transposition


HPE report

1119 S15 3A.S15.00038 3A.S15.00038 : Skin Tumours Wide Excision +

Reconstruction37500

Biopsy of the primary tumour + CT/MRI

with film


HPE report

1120 S15 3A.S15.00039 3A.S15.00039 : Skin Tumours Amputation 18750Biopsy of the primary tumour + CT/MRI

with film


HPE report

1121 S15 3A.S15.00040 3A.S15.00040 : Radical Vaginectomy 30000 CT report and Film, Biopsy HPE report

1122 S15 3A.S15.00041 3A.S15.00041 : Radical Vaginectomy +

Reconstruction33750 CT report and Film, Biopsy HPE report

1123 S15 3A.S15.00042 3A.S15.00042 : Bilateral Pelvic Lymph Node

Dissection (BPLND)22500 CT report and Film, Biopsy


HPE report

1124 S15 3A.S15.00043 3A.S15.00043 : Radical Trachelectomy 30000 CT report and Film, Biopsy Clinical Photograph showing scar +

HPE report

1125 S15 3A.S15.00044 3A.S15.00044 : Vulvectomy with bilateral groin

dissection33750 Clinical Notes, USG/CT/MRI OT Notes, HPE

1126 S15 3A.S15.00045 3A.S15.00045 : Limb salvage surgery for bone tumor

with prosthesis56250

CT-Local part/MRI, CT Chest with film,

,Bone Scan report + Biopsy Report

Clinical Photograph XRAY Showing

prosthesis + HPE report

1127 S15 3A.S15.00046 3A.S15.00046 : Hemipelvectomy 48750 CT/MRI Pelvis with filmClinical Photograph showing scar /

HPE report + XRAY

1128 S15 3A.S15.00047 3A.S15.00047 : Sacral resection 45000 CT/MRI Pelvis with filmClinical Photograph showing scar /

HPE report + XRAY

1129 S15 3A.S15.00048 3A.S15.00048 : Chest wall resection with

reconstruction for soft tissue / bone tumors 30000 CT Chest with film, biopsy


HPE report

1130 S15 3A.S15.17150 3A.S15.17150 : Forequarter amputation 22500 CT-Local part/MRI with film + Biopsy

Report


HPE report

1131 S15 3A.S15.17151 3A.S15.17151 : Shoulder Girdle Resection 30000 CT-Local part including chest /MRI

report with film + Biopsy Report


HPE report

1132 S15 3A.S15.17152 3A.S15.17152 : Mastectomy +Axillary Dissection 18750Biopsy/FNAC , Mammography/USG,

chest Xray

HPE report, scar photo ( if patient

consents)

1133 S15 3A.S15.17153 3A.S15.17153 : Gastro Jejunostomy 22500Biopsy of the primary + CT Scan with

filmClinical photograph showing scar

1134 S15 3A.S15.17154 3A.S15.17154 : Ileotransverse Colostomy 22500Biopsy of the primary + CT Scan with

filmClinical photograph with scar

1135 S15 3A.S15.17155 3A.S15.17155 : Distal Pancreatectomy 45000 CT / MRI with film/IHC report Clinical Photograph showing scar +

HPE report

1136 S15 3A.S15.17156 3A.S15.17156 : Enucleation of Cyst 37500 CT report and Film Clinical Photograph showing scar +

HPE report

1137 S15 3A.S15.17157 3A.S15.17157 : Whipples surgery ( inclusive of

staplers)60000 CT / MRI/IHC


HPE report

1138 S15 3A.S15.17158 3A.S15.17158 : Hepatectomy (right or left) 63750 CT /MRI report and FilmClinical Photograph showing scar,

USG and HPE Report

Sl. no.Speciality


1139 S15 3A.S15.17159 3A.S15.17159 : Anterior Exenteration 52500 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+

HPE report

1140 S15 3A.S15.17160 3A.S15.17160 : Total Exenteration 56250 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+

HPE report

1141 S15 3A.S15.17161 3A.S15.17161 : Urinary diversion 30000 Biopsy, USG Scrotum report and FilmClinical Photograph showing scar,

post op USG

1142 S15 3A.S15.17162 3A.S15.17162 : Surgery for Ca Ovary - advance stage

with Mesenteric/Peritoneal/Omental Metastatsis45000 USG/CT Reports with film,CA 125


HPE report + USG report

1143 S15 3A.S15.17163 3A.S15.17163 : Microlaryngeal Surgery including

Phonosurgery8250 Clinical Photograph Clinical Photograph, HPE report

1144 S15 3A.S15.17164 3A.S15.17164 : Laryngectomy - any type, with neck

node dissection30000 CT report and Film, Biopsy


HPE report

1145 S15 3A.S15.17165 3A.S15.17165 : Laryngopharyngo Oesophagectomy 52500 Biopsy , CT , Endoscopy reports HPE report, scar photo

1146 S15 3A.S15.17166 3A.S15.17166 : GI Stenting including stent cost 30000 CT abdomen report and Film Stent invoice

1147 S15 3A.S15.17167 3A.S15.17167 : Composite Resection + Micro

vascular reconstruction60000 CT report and Film, Biopsy


HPE report

1148 S15 3A.S15.17168 3A.S15.17168 : Laser Surgery of Larynx 22500 Clinical Photograph

Photos with laser machine, CD of

procedure/intra op stills + HPE

report

1149 S15 3A.S15.17169 3A.S15.17169 : VATS/Laparoscopy ( for deep seated

biopsy)7500 CT report with film Scar Photo

1150 S15 3A.S15.17170 3A.S15.17170 : Abdominoperinial Resection 37500Endoscopy with film, biopsy, CT report

with film


HPE report

1151 S15 3A.S15.17171 3A.S15.17171 : Surgery for Ca Ovary - early stage 30000 USG/CT Reports with film,CA 125 Clinical Photograph showing scar +

HPE report + USG report

1152 S15 3A.S15.17172 3A.S15.17172 : Mastectomy +Axillary

Dissection+Defect Closure with Flap30000


chest Xray

HPE report, scar photo ( if patient

consents)

1153 S15 3A.S15.17173 3A.S15.17173 : Wide excision of lesion 18750CT/MRI report and Film if required,

Biopsy, clinical picture


HPE report

1154 M4 3A.M4.00001 3A.M4.00001 : Acute lymphoblastic leukemia

(chemotherapy including diagnostics): induction37500


Flow cytometry




(chemotherapy including diagnostics): consolidation37500


Flow cytometry




(chemotherapy including diagnostics): maintainence3750


Flow cytometry



1157 M4 3A.M4.00005 3A.M4.00005 : Acute lymphoblastic leukemia:

Supportive care/ rehabilitation 15000


Flow cytometry



Sl. no.Speciality


1158 M4 3A.M4.00006 3A.M4.00006 : Acute myeloid leukemia

(chemotherapy including diagnostics): induction56250


Flow cytometry



1159 M4 3A.M4.00007 3A.M4.00007 : Acute myeloid leukemia

(chemotherapy including diagnostics): consolidation 56250


Flow cytometry



1160 M4 3A.M4.00008 3A.M4.00008 : Acute myeloid leukemia: Supportive

care/ rehabilitation 22500 Haematology + Cytoflowmetry report


drug batch number with bar code,

treatment drug details in discharge

summary

1161 M4 3A.M4.00011 3A.M4.00011 : Hodgkin Lymphoma (Favorable

group): Supportive care/ rehabilitation 11250 Biopsy, CT




group): Supportive care/ rehabilitation 18750 Biopsy, CT




summary

1163 M4 3A.M4.00015 3A.M4.00015 : Non-Hodgkin Lymphoma:

chemotherapy including diagnostics112500

Lymphnode Biopsy,HPE, BMA with

biopsy, CT scan

Heamogram,Biochemestry,chest x-

ray, chemotherapy drug batch

number with bar code

1164 M4 3A.M4.00016 3A.M4.00016 : Non-Hodgkin Lymphoma: Supportive

care/ rehabilitation 37500 Biopsy, CT




summary


chemotherapy including diagnostics33750 Biopsy , CT report with film




supportive care/ rehabilitation15000 Biopsy , CT report with film




summary


chemotherapy including diagnostics82500 MRI of orbit and brain

Chest x-ray,USG abdomen

pelvis,BMA


supportive care/ rehabilitation26250 Biopsy , CT report with film



1169 M4 3A.M4.00024 3A.M4.00024 : Brain tumors: chemotherapy

including diagnostics30000 CT report /MRI Clinical features



Sl. no.Speciality


1170 M4 3A.M4.00027 3A.M4.00027 : Brain tumors: supportive care/

rehabilitation18750 CT report /MRI Clinical features



1171 M4 3A.M4.00028 3A.M4.00028 : Wilms tumors: chemotherapy

including diagnostics15000 CT report with film, biopsy/FNAC



1172 M4 3A.M4.00031 3A.M4.00031 : Histiocytosis: chemotherapy

including diagnostics37500

Skin Biopsy / Lymphnode Biopsy,USG

abdomen pelvisHeamogram,Biochemestry

1173 M4 3A.M4.00032 3A.M4.00032 : Histiocytosis: supportive care/

rehabilitation3750 Hematology + Biopsy/FNAC report




chemotherapy including diagnostics60000 Biopsy , CT-Scan with film




supportive care/ rehabilitation37500 Biopsy , CT-Scan with film



1176 M4 3A.M4.00037 3A.M4.00037 : Chronic Myeloid Leukemia :

chemotherapy including diagnostics4500


Flow cytometry


treatment chart

1177 M4 3A.M4.00038 3A.M4.00038 : Chronic Myeloid Leukemia :

supportive care/ rehabilitation75000

BMA report and Molecular analysis

report

Heamogram,Biochemestry, ,


summary

1178 M5 3A.M5.00001 3A.M5.00001 : Lymphoma, Non-Hodgkin’sR-CHOP

Regimen (per cycle) x 64500 Biopsy, CT report with film



1179 M5 3A.M5.00002 3A.M5.00002 : Multiple MyelomaBortezomib+

lenalidomide+ dexamethasone, per cycle x63750

Bone Marrow Aspiration Report, Serum

Protein electrophoresis, CRAB criteria



1180 M5 3A.M5.00003 3A.M5.00003 : Multiple MyelomaBortezomib+

cyclophosphamide+ dexamethasone, per cycle x 63750





1181 M5 3A.M5.00004 3A.M5.00004 : Multiple MyelomaMPT - melphalan,

thalidomide and prednisolone, per cycle x 93750





1182 M5 3A.M5.00005 3A.M5.00005 : Multiple MyelomaBortezomib +

dexamethasone, per cycle x 93750





1183 M5 3A.M5.00006

3A.M5.00006 : Multiple

MyelomaThalidomide+Dexamethasone(Oral)/

month - max 12 months

3750Bone Marrow Aspiration Report, Serum




1184 M5 3A.M5.00007

3A.M5.00007 : Colon Rectum5-Fluorouracil-

Oxaliplatin - Leucovorin (FOLFOX) - Max. 6 cycles

(Per cycle)

6000 CT report and Film, BiopsyChemotherapy drug batch number

with bar code

Sl. no.Speciality


1185 M5 3A.M5.00008

3A.M5.00008 : Bone Tumors/Osteosarcoma/

Hepatoblastoma -OperableCisplatin/carboplatin -

Adriamycin- max 6 cycles (Per cycle)

2250 Biopsy , CT-Scan with film Clinical Photograph, chemotherapy


1186 M5 3A.M5.00009

3A.M5.00009 : Lymphoma, Hodgkin'S Adriamycin

Bleomycin VinblastinDacarbazine (ABVD) - max 8

cycles (Per cycle) (Day 1 & Day 15)

7500 Biopsy, CTClinical Photograph, chemotherapy


1187 M5 3A.M5.00010 3A.M5.00010 : Cervix Cisplatin/Carboplatin (AUC2)

along with RT- max 6 cycles (Per cycle)3750 CT report and Film, Biopsy



1188 M5 3A.M5.00011 3A.M5.00011 : Neuroblastoma Stage I –IIIVariable

Regimen – Neuroblastoma - max 1 year (Per cycle)7500 CT report with film, biopsy/FNAC



1189 M5 3A.M5.00012

3A.M5.00012 : Wilm'sTumor SIOP/National Wilms

Tumour Study Group (NWTS) regimen(Stages I - V)-

max 6 months (Per month) - Wilm's tumour

5250 CT report with film, biopsy/FNACClinical Photograph, chemotherapy


1190 M5 3A.M5.00013 3A.M5.00013 : Colon - rectum Monthly 5-FU 3000 CT report and Film, BiopsyChemotherapy drug batch number

with bar code

1191 M5 3A.M5.00014 3A.M5.00014 : BreastPaclitaxel weekly x 12 weeks 3375Biopsy/FNAC , Mammography/USG,

chest Xray

Chemotherapy drug batch number

with bar code

1192 M5 3A.M5.00015

3A.M5.00015 : Breast

Cyclophosphamide/Methotrexate/5 Fluorouracil

(CMF) (Per cycle)

1125Biopsy/FNAC , Mammography/USG,

chest Xray


with bar code

1193 M5 3A.M5.00016 3A.M5.00016 : BreastTamoxifen tabs - maximum 12

cycles (Per month)75


chest Xray


with bar code

1194 M5 3A.M5.00017

3A.M5.00017 : Breast

Adriamycin/Cyclophosphamide (AC) – per cycle

(Maximum 4 cycles)


chest Xray


with bar code

1195 M5 3A.M5.00018 3A.M5.00018 : Breast5- Fluorouracil A-C (FAC) – per

cycle (Maximum 6 cycles)3750


chest Xray


with bar code

1196 M5 3A.M5.00019 3A.M5.00019 : BreastAC (AC Then Taxol) 3750Biopsy/FNAC , Mammography/USG,

chest Xray


with bar code

1197 M5 3A.M5.00020

3A.M5.00020 : Small Cell Lung Cancer

Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles

only)

5250 Biopsy/FNAC ,CT report and FilmChemotherapy drug batch number

with bar code

1198 M5 3A.M5.00021

3A.M5.00021 : Oncology oesophagusCisplatin + 5

FU(Neoadjuvant Chemotherapy)/Adjuvant (ADJ)-

per cycle (Max. of 6 cycles only)

2250Endoscopy with film, biopsy, CT report

with film


with bar code

Sl. no.Speciality


1199 M5 3A.M5.00022

3A.M5.00022 : Stomach Docetaxel +Oxaliplatin+5FU

20,000 per cycle for 4 cycles

CapOX- 10,000 per cycle for 8 cycles3000


with film


with bar code

1200 M5 3A.M5.00023

3A.M5.00023 : Breast Aromatase Inhibitors

(Anastazole/Letrozole/Exemestane) -

maximum 12 cycles (Per month)


chest Xray


with bar code

1201 M5 3A.M5.00024

3A.M5.00024 : Urinary Bladder Weekly

Cisplatin/Carboplatin- max 6 cycles with RT (Per

week)

1500 CT report and Film, Biopsy Clinical Photograph, chemotherapy


1202 M5 3A.M5.00025 3A.M5.00025 : Urinary Bladder Methotraxate

Vinblastin Adriamycin Cyclophosphamide (MVAC)3750 CT report and Film, Biopsy



1203 M5 3A.M5.00026 3A.M5.00026 : Retinoblastoma

Carbo/Etoposide/Vincristine-max 6 cycles (Per cycle)3000 Biopsy , CT report with film



1204 M5 3A.M5.00027 3A.M5.00027 : Febrile NeutropeniaIV antibiotics and

other supportive therapy (Per episode)22500 Haemogram for each episode

Clinical Photograph, Discharge

summary (with details of drugs

given)

1205 M5 3A.M5.00028 3A.M5.00028 : Vaginal/ Vulval Cancer Cisplastin/5-

FU2250

CT report and Film, Biopsy/Tumour

markers



1206 M5 3A.M5.00029 3A.M5.00029 : OvaryTaxol + Carboplatin-max 6

cycles (Per cycle)11250

CT report and Film, Biopsy/Tumour

markers



1207 M5 3A.M5.00030

3A.M5.00030 : Multiple MyelomaMelphalan -

Prednisone (oral) – per month (max 12 months) -

Ovarian CA, Bone CA





1208 M5 3A.M5.00031

3A.M5.00031 : Rectal Cancer Stage 2 And

3Gemcitabine +capecitabine-15,000 per cycle for 6

cycles


with bar code

1209 M5 3A.M5.00032 3A.M5.00032 : Multiple MyelomaZoledronic acid -

Max 12 cycles (Per month)1500

CT/PET /Bone scan/ Xray, Biopsy if

required


with bar code

1210 M5 3A.M5.00033

3A.M5.00033 : Gestational Trophoblast Ds. High

RiskEtoposide-Methotrexate-Actinomycin /

Cyclophosphamide -Vincristine (EMA-CO)-max 6

cycles (Per cycle)

7500 B HCG report,CT report and FilmClinical Photograph, chemotherapy


1211 M5 3A.M5.00034 3A.M5.00034 : Gestational Trophoblast Ds. Low Risk

Actinomycin- max 10 cycles (Per cycle)750 B HCG report,CT report and Film



1212 M5 3A.M5.00035 3A.M5.00035 : Gestational Trophoblast Ds. Low

RiskWeekly Methotrexate (Per week) max. 10 cycles750 B HCG report,CT report and Film



Sl. no.Speciality


1213 M5 3A.M5.00036 3A.M5.00036 : Ovary Germ Cell Tumour Bleomycin-

Etoposide-Cisplatin (BEP) - max cycles 4 (Per cycle)4500 CT report and Film, Biopsy



1214 M5 3A.M5.00037 3A.M5.00037 : Prostate Hormonal Therapy - Per

month2250

CT report and Film, Biopsy,PSA with

evidence of bone metastasis



1215 M5 3A.M5.00038

3A.M5.00038 : Testis Bleomycin-Etoposide-Cisplatin

(BEP) regimen for germ cell tumour - max cycles 4

(Per cycle)

7500 CT report and Film, BiopsyClinical Photograph, chemotherapy


1216 M5 3A.M5.00039

3A.M5.00039 : Acute Myeloid LeukemiaInduction

Phase, up to (Daunomycin and cytosine arabinoside

(3:7))75000


Flow cytometry



1217 M5 3A.M5.00040

3A.M5.00040 : Acute Myeloid

LeukemiaConsolidation Phase, up to (High dose

cytosine arabinoside – per cycle, max. of 3 to 4

cycles)

56250 Haematology, Bone Marrow Aspitation/

Flow cytometry



1218 M5 3A.M5.00041 3A.M5.00041 : Histocytosis Variable Regimen-

Histocyosis-max 1 year (Per month)6000 Biopsy , CT report with film



1219 M5 3A.M5.00042

3A.M5.00042 : Rhabdomyosarcoma Vincristine-

Actinomycin-Cyclophosphamide (VACTC) based

chemo - max 1 year (Per month) -

Rhabdomyosarcoma

4500 Biopsy , CT report with filmClinical Photograph, chemotherapy


1220 M5 3A.M5.00043 3A.M5.00043 : Ewing’s SarcomaVariable Regimen

Inv - Hematology, Biopsy – Payable4500 X-Ray,CT Scan with film, Biopsy



1221 M5 3A.M5.00044 3A.M5.00044 : Unlisted Regimen Palliative CT- Max

6 cycles (Per cycle)3750 CT/MRI , HPE report


with bar code

1222 M5 3A.M5.00045 3A.M5.00045 : Terminally Ill Palliative And

Supportive Therapy - Per month2250 CT/MRI , HPE report


with bar code

1223 M5 3A.M5.00046 3A.M5.00046 : Acute Lymphatic Leukemia

Maintenance Phase - Per month (x 24)3750


Flow cytometry


treatment chart

1224 M5 3A.M5.00047 3A.M5.00047 : Acute Lymphatic Leukemia Induction 37500 Haematology, Bone Marrow Aspitation/

Flow cytometry


treatment chart

1225 M5 3A.M5.00048 3A.M5.00048 : Acute Lymphatic Leukemia

Consolidation Phase37500


Flow cytometry



1226 M5 3A.M5.00049 3A.M5.00049 : Head and NeckTab Geftinib/Erlotinib-

Max 1 Year (Per month)2250 CT report and Film, Biopsy


with bar code

1227 M5 3A.M5.00050 3A.M5.00050 : Renal cell carcinoma Sunitinib/

Pazopanib (per day)1875


if required


with bar code

1228 M5 3A.M5.00051 3A.M5.00051 : Chronic myeloid leukemiaImatinib

(per month) x 5 years4500


Flow cytometry


treatment chart

Sl. no.Speciality


1229 M5 3A.M5.00052 3A.M5.00052 : Gall Bladder Cancer Gemcitabine +

cisplatin (per cycle) – for 6 cycles7500 CT report and Film, Biopsy



1230 M5 3A.M5.17176

3A.M5.17176 : Paclitaxel + Cisplatin / Carboplatin 2.

Gemcitabine D1 & D8 + Cisplatin / Carboplatin -

Max. 6 cycles only (Per cycle)

9000 Biopsy/FNAC ,CT report and FilmChemotherapy drug batch number

with bar code

1231 M5 3A.M5.17177

3A.M5.17177 : Pemetrexed +Carboplatin/Cisplatin

(Stage IIIB, IV Adenocarcinoma)- Max. 6 cycles only

(Per cycle)

11250 Biopsy/FNAC ,CT report and Film,Chemotherapy drug batch number

with bar code

1232 M5 3A.M5.17178

3A.M5.17178 : Cisplatin/Adriamycin+ifosmide (IAP)-

max 6 cycles (Per cycle) -Adj/Neo adjuvant/Palliative

(Osteosarcoma)

11250 Biopsy , CT-Scan with film Clinical Photograph, chemotherapy


1233 M5 3A.M5.17179 3A.M5.17179 : High Dose Methotrexate (MTX)- max

6 cycles (Per cycle)11250 Biopsy , CT-Scan with film



1234 M5 3A.M5.17180 3A.M5.17180 : IFS + ADR-max 6 cycles (Per cycle) -

Adj/Neo adjuvant/Palliative11250 Biopsy , CT-Scan with film



1235 M5 3A.M5.17181 3A.M5.17181 : Consolidation 1 to 4 phases(per

phase)- AML24750


Flow cytometry



1236 M5 3A.M5.17182 3A.M5.17182 : Adult ALL -Hyper CVAD/BFM - 4

cycles ( Each cycle= A + B)27000


Flow cytometry



1237 M5 3A.M5.17183 3A.M5.17183 : D'angelo's for CNS primary and

secondary lymphomas -(Max. 6 months) (Per month)15000 Haematology + Cytoflowmetry report



1238 M5 3A.M5.17184

3A.M5.17184 : Salvage CT - GDP (Gemcitabine -

Cisplatin- Dexamethasone)- Maximum 6 cycles (Per

cycle)

9000 Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy


1239 M5 3A.M5.17185

3A.M5.17185 : Salvage CT - ICE (Ifosfamide-

Carboplatin-Etoposide)- Maximum 6 cycles (Per

cycle)



1240 M5 3A.M5.17186

3A.M5.17186 : Salvage CT -DHAP (cytosine

arabinoside-cisplatin-dexamethasone) - Maximum 6

cycles (Per cycle)



1241 M5 3A.M5.17187 3A.M5.17187 : Second generation Tab TKI - max 12

cycles per year (Per month) - (Failure of Imatinib)4500

Hematology + FNAC report

/Cytogenetics/ BCR-ABL



1242 M5 3A.M5.17188 3A.M5.17188 : Bendamustine- max 6 cycles (Per

cycle) - CLL7500 Hematology + Biopsy/FNAC report



Sl. no.Speciality


1243 M5 3A.M5.17189

3A.M5.17189 : Bendamustine + Ritumaxib- 6-8

cycles (Per cycle) - CLL (Available only at select

centres)



1244 M5 3A.M5.17190 3A.M5.17190 : R-CHOP -max 6 cycles (Per cycle) 15000 Biopsy, CT report with filmClinical Photograph, chemotherapy


1245 M5 3A.M5.17191

3A.M5.17191 : Variable Regimen-Non

Lymphoblastic NHL, (Per cycle) max. 8

cycles.(Amount as per drug cost)



1246 M5 3A.M5.17192

3A.M5.17192 : Plasma cell Leukemia / Multiple

Myeloma - Thaladomide, Dexamethasone,

Bortezomib - max 6 cycles


Protein electrophoresis



1247 M5 3A.M5.17193 3A.M5.17193 : Carbo/Etoposide/Vincristine-max 6

cycles (Per cycle) - Retinoblastoma3750 Biopsy , CT report with film



1248 M5 3A.M5.17194 3A.M5.17194 : Variable Regimen- LCH-max 1 year

(Per month)(Amount as per drug cost)6000 Biopsy,IHC , CT report with film



1249 M5 3A.M5.17195 3A.M5.17195 : FEC (Epirubicin based)(Maximum 6

cycles) (Per cycle)6000


chest Xray


with bar code

1250 M5 3A.M5.17196

3A.M5.17196 : 1. TC Docetaxel +

Cyclophosphamide. 2. TAC Docetaxel + Doxorubicin

+ Cyclophosphamide. 3. Gemcitabine D1 & D8 +/-

Cisplatin/ Carboplatin - maximum 6 cycles (Per

cycle)


chest Xray


with bar code

1251 M5 3A.M5.17197

3A.M5.17197 : Capetabine (Day 1-14) - 6 cycles

(Palliative/Adjuvant); As Concurrent as RT sensitizor

with all RT

3000 CT/USG report and Film, Xray, BiopsyChemotherapy drug batch number

with bar code

1252 M5 3A.M5.17198 3A.M5.17198 : Variable Regimen maximum 6 cycles

(Per cycle) (Amount as per drug cost)6000 CT report and Film, Biopsy


with bar code

1253 M5 3A.M5.17199 3A.M5.17199 : Cisplatin/Carboplatin- 5FU (Per cycle)

-Oesophageal CA4500


with film


with bar code

1254 M5 3A.M5.17200 3A.M5.17200 : Epirubicin+Cisplatin+5FU (Per cycle) 6000Endoscopy with film, biopsy, CT report

with film


with bar code

1255 M5 3A.M5.17201 3A.M5.17201 : EOX (Epirubicin + Oxaloplatin +

Capcetabine) - Max 6 cycles9000


with film


with bar code

1256 M5 3A.M5.17202 3A.M5.17202 : Monthly 5-Fluorouracil(FU) (Per cycle)

-Colorectal cancer2250 CT report and Film, Biopsy


with bar code

1257 M5 3A.M5.17203 3A.M5.17203 : Imatinib -Max for 6 months (Per

month)3750 CT report and Film, Biopsy


with bar code

1258 M5 3A.M5.17204 3A.M5.17204 : Gemcitabine+Cisplatin(Day 1,Day 8 )-

max 6 cycles (Per cycle)7500 CT report and Film, Biopsy


with bar code

1259 M5 3A.M5.17205 3A.M5.17205 : Tab Sorafenib- max 12 months (Per



with bar code

Sl. no.Speciality


1260 M5 3A.M5.17206

3A.M5.17206 : Oxiplatin+Capecitabine- max. of 6

cycles for palliative only or 8 cycles for adjuvant (Per

cycle)

6000 CT/MRI with film, BiopsyChemotherapy drug batch number

with bar code

1261 M5 3A.M5.17207 3A.M5.17207 : Weekly Cisplatin/Carboplatin- max 6

cycles with RT (Per week)1500 CT report and Film, Biopsy


with bar code

1262 M5 3A.M5.17208

3A.M5.17208 :

Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vinblast

ine,Ifosphimide,Cisplatin(VeIP)- max cycles 4 (Per

cycle)

15000CT report and Film, Biopsy/Tumour

markers



1263 M5 3A.M5.17209 3A.M5.17209 : Cisplatin/Carboplatin (AUC2)- Max. of

6 cycles only (Per cycle)1500 CT report and Film, Biopsy



1264 M5 3A.M5.17210 3A.M5.17210 : Carboplatin/Paclitaxel-max 6 cycles

(Per cycle)9000 CT report and Film, Biopsy



1265 M5 3A.M5.17211 3A.M5.17211 : Weekly Methotrexate (Per week) max.

10 cycles750 B HCG report,CT report and Film



1266 M5 3A.M5.17212

3A.M5.17212 : Etoposide-Methotrexate-Actinomycin

/ Cyclophosphamide -Vincristine (EMA-CO)-max 6

cycles (Per cycle)

6000 B HCG report,CT report and FilmClinical Photograph, chemotherapy


1267 M5 3A.M5.17213 3A.M5.17213 : Variable Regimen (Amount as per

drug cost)- max 6 cycles (Per cycle)6000 CT report and Film, Biopsy



1268 M5 3A.M5.17214

3A.M5.17214 : Gemcitabine+ Carboplatin/

Liposomal Doxorubicin/ Albumin bound Paclitaxel (

Adjuvant), max 6 cycles



1269 M5 3A.M5.17215 3A.M5.17215 : Palliative CT- Max 6 cycles (Per cycle)

For Primary and secondary tumours6000 CT/USG report and Film, Xray, Biopsy


with bar code

1270 M5 3A.M5.17216 3A.M5.17216 : Zoledronic acid - Max 12 cycles (Per

month)2250

CT/PET /Bone scan/ Xray, Biopsy if

required


with bar code

1271 M5 3A.M5.17217 3A.M5.17217 : Tab Temozolemide for 6 months

(5days every month x 6 months)33750 CT report and Film, Biopsy

Pharmacy Bill/Invoice with batch no.

of the drug strip

1272 M5 3A.M5.17218 3A.M5.17218 : Growth Factor / Pegrafil (Per cycle)

(Maximum 4 cycles)1500


chest Xray


with bar code

1273 M5 3A.M5.17219 3A.M5.17219 : Cisplatin/Carboplatin (AUC2) along

with RT- max 6 cycles (Per cycle)1500 CT report and Film, Biopsy


with bar code

1274 M5 3A.M5.17220 3A.M5.17220 : Cisplatin + 5FU + Taxol/Docitaxel (

only hypopharynx)8250 CT report and Film, Biopsy


HPE report

1275 M5 3A.M5.17221 3A.M5.17221 : Palliative CT (Paclitaxel + Cisplatin or

5 FU + Cisplatin) - Max 6 cycles (Per cycle)6000 CT / USG report and Film, X ray, Biopsy


with bar code

Sl. no.Speciality


1276 M5 3A.M5.17222

3A.M5.17222 : Palliative CT 1. Docetaxel +

Cisplatin / Carboplatin. 2. Gemcitabine D1& D8 +

Cisplatin / Carboplatin - max 6 cycles (Per cycle)


with bar code

1277 M5 3A.M5.17223 3A.M5.17223 : Tab Sorefinib- max 12 months (Per

month)6000 CT/MRI report and Film, Biopsy


with bar code

1278 M5 3A.M5.17225

3A.M5.17225 : SIOP/NATIONAL WILMS TUMOUR

STUDY GROUP(NWTS) regimen(Stages I - V)- max 6

months (Per month) - Wilm's tumour

6000 CT report with film, biopsy/FNACClinical Photograph, chemotherapy


1279 M5 3A.M5.17226

3A.M5.17226 : Bleomycin-Etoposide-Cisplatin (BEP)

(Per cycle) - Germ cell tumours, extra gonadal

tumour



1280 M5 3A.M5.17227

3A.M5.17227 : Vincristine-Actinomycin-

Cyclophosphamide(Vact C) based chemo - max 1

year (Per cycle)- Rhabdomyosarcoma

6750 Biopsy , CT report with filmClinical Photograph, chemotherapy


1281 M5 3A.M5.17228

3A.M5.17228 : Cisplatin + 5 FU(Neoadjuvant

Chemotherapy)/Palliative - Max. of 4 cycles only (Per

cycle)


with bar code

1282 M5 3A.M5.17229

3A.M5.17229 : Bleomycin-Etoposide-Cisplatin (BEP)-

max cycles 4 (Per cycle) Germ cell tumours, extra

gonadal tumour

7500CT report and Film, Biopsy/Tumour

markers



1283 M5 3A.M5.17230 3A.M5.17230 : Tab Sorafenib-max 12 months (Per


Clinical Photograph,chemotherapy


1284 M5 3A.M5.17231 3A.M5.17231 : Tab Geftinib/Erlotinib-Max 1 Year

(Per month)4500 CT report and Film, Biopsy


with bar code

1285 M5 3A.M5.17232

3A.M5.17232 : Variable Regimen -Ewings Sarcoma-

max 17 cycles in 1 year (Per cycle)(Amount as per

drug cost)

7500 X-Ray,CT Scan with film, Biopsy Clinical Photograph, chemotherapy


1286 M5 3A.M5.17233 3A.M5.17233 : Induction/1st Phase-AML ( 2nd

Induction - permitted in adults only)37500


Flow cytometry



1287 M5 3A.M5.17234

3A.M5.17234 : Doxorubicin - Bleomycin - Vinblastine

Dacarbazine (DBVD)-max 6-8 cycles (Per cycle)

(Day1 & Day15) - Hodgkins Lymphoma

9000 Biopsy, CTClinical Photograph, chemotherapy


1288 M5 3A.M5.17235

3A.M5.17235 : Aromatase Inhibitors (

Anastazole/Letrozole/ Exemestane)- maximum 12

cycles (Per month)


chest Xray


with bar code

1289 M5 3A.M5.17236 3A.M5.17236 : Maintenance ( Paed and adults) - ALL

(Per month)2250


Flow cytometry



Sl. no.Speciality


1290 M5 3A.M5.17237 3A.M5.17237 : Imatinib Min 400 mg/day-max 12

cycles per year (Per month) - AML, CML3750

Hematology + FNAC report

/Cytogenetics/ BCR-ABL



1291 M5 3A.M5.17238 3A.M5.17238 : Paclitaxel/docetaxel(Maximum

4cycles) (Adjuvant) (Per cycle)6750


chest Xray


with bar code

1292 M5 3A.M5.17239

3A.M5.17239 : Carboplatin/cisplatin +

Paclitaxel/Docetaxel (Neoadjuvant Chemotherapy)-

Max. of 4 cycles only (Per cycle) -For stage III and

IVA

9000 Biopsy ReportsClinical Photograph showing scar +

HPE report

1293 M5 3A.M5.17240 3A.M5.17240 : Palliative CT- Max 6 cycles (Per cycle) 6000Biopsy/FNAC , Mammography/USG,

chest Xray


with bar code

S2 3A.S2.00085B 3A.S2.00085B : Hemiglossectomy - - cross speciality 18750 CT , Biopsy Clinical photograph

S2 3A.S2.00087B 3A.S2.00087B : Partial Glossectomy - cross speciality 18750 CT , Biopsy Clinical photograph

S2 3A.S2.00090B 3A.S2.00090B : Total Glossectomy - cross speciality 11250 CT , Biopsy Clinical photograph

S1 3A.S1.00002A 3A.S1.00002A : Anterior Resection for Ca - cross

speciality 52500 Endoscopy, biopsy, CT report with film


HPE report

S1 3A.S1.00007A 3A.S1.00007A : Bilateral Inguinal block dissection -

cross speciality 30000 Biopsy Reports


HPE report

S1 3A.S1.00016A 3A.S1.00016A : Bypass - Inoperable Pancreas - cross

speciality 11250 USG/CT USG, Scar photo, HPE Report

S1 3A.S1.00045B 3A.S1.00045B : Excision of Growth from Tongue with

neck node dissection - cross speciality 11250 CT/MRI, Clinical Photo OT notes, HPE

S1 3A.S1.00084A 3A.S1.00084A : Inguinal Node (dissection) -

Unilateral - cross speciality 15000 Biopsy Reports/ Clinical Photograph


HPE report

S1 3A.S1.00103A 3A.S1.00103A : Oesophagectomy - cross speciality 45000 Biopsy , CT , Endoscopy reports HPE report, scar photo

S1 3A.S1.00113A 3A.S1.00113A : Radical Mastectomy - cross speciality 7500 Mammography, HPE, CT Scan Scar photo & HPE

S1 3A.S1.00114A 3A.S1.00114A : Radical Neck Dissection – Excision -


Clinical photo, Clinical notes & Biopsy/


S1 3A.S1.00120A 3A.S1.00120A : Resection Anastomosis (Large

Intestine) - cross speciality 11250 USG / CT Scan Scar photo, HPE

S1 3A.S1.00121A 3A.S1.00121A : Resection Anastomosis (Small

Intestine) - cross speciality11250 USG / CT Scan Scar photo, HPE

S1 3A.S1.00122A 3A.S1.00122A : Retroperitoneal Tumor – Excision -

cross speciality 37500 CT abdomen with film, FNAC


HPE report

S1 3A.S1.00125A 3A.S1.00125A : Segmental Resection of Breast -

cross speciality 7500 Mamography, FNAC, CT if indicated Scar photo, HPE

S1 3A.S1.00131A 3A.S1.00131A : Soft Tissue Tumor (large) – Excision -


Biopsy of the primary tumour + CT/MRI

with filmScar photo, HPE

Sl. no.Speciality


S1 3A.S1.00134A 3A.S1.00134A : Submandibular Mass Excision +

Reconstruction - Cross speciality18750


Biopsy


HPE report

S1 3A.S1.00162A 3A.S1.00162A : Excision of Parathyroid

Adenoma/Carcinoma - cross speciality22500


reports/USG


HPE report

S1 3A.S1.00163A 3A.S1.00163A : Flap Reconstructive Surgery - cross

speciality 22500 X-ray Films + detail notes Clinical photo showing Scar

S1 3A.S1.00171A 3A.S1.00171A : Lap. Assisted left Hemi colectomy t -

cross speciality 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

S1 3A.S1.00172A 3A.S1.00172A : Lap. Assisted Right Hemi colectomy t

- cross speciality 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

S1 3A.S1.00173A 3A.S1.00173A : Lap. Assisted small bowel resection -

cross speciality 30000 CT, Biopsy


HPE report

S1 3A.S1.00174B 3A.S1.00174B : Lap. Assisted Total Colectomy - cross

speciality 30000

Colonocopy with film, biopsy, CT report

with film


HPE report

S1 3A.S1.00195B 3A.S1.00195B : Oesophagectomy for Carcinoma

Oesophagus - cross speciality 37500 Biopsy , CT , Endoscopy reports HPE report, scar photo

S1 3A.S1.00197A 3A.S1.00197A : Operation for Carcinoma Lip –

Vermilionectomy - cross speciality 7500 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00198B

3A.S1.00198B : Operation for Carcinoma Lip -

Wedge Excision and Vermilionectomy - cross

speciality

9000 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00199B 3A.S1.00199B : Operation for Carcinoma Lip -

Wedge-Excision - cross speciality 7500 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00202A 3A.S1.00202A : Closure of Colostomy - cross

speciality 22500 Colonoscopy, Biopsy Clinical Photograph showing scar

S1 3A.S1.00205A 3A.S1.00205A : CystoJejunostomy/or

Cystogastrostomy - cross speciality 15000 USG/ CT Scan Clinical photograph

S1 3A.S1.00209B 3A.S1.00209B : Operation for carcinoma lip- cheek

advancement - cross speciality 9000 Clinical photograph, HPE Scar photo, HPE

S1 3A.S1.00213A 3A.S1.00213A : Operations for Replacement of

Oesophagus by Colon - cross speciality 18750 Endoscopy, USG/CT Scar photo, HPE

S1 3A.S1.00215B 3A.S1.00215B : Parapharyngeal Tumour Excision -

cross speciality 8250 USG, CT Neck USG,HPE,Scar Photo

S1 3A.S1.00216B 3A.S1.00216B : Partial/Subtotal Gastrectomy for

Carcinoma - cross speciality 37500 Endoscopy, biopsy, CT


HPE report

S1 3A.S1.00230A 3A.S1.00230A : Temporal Bone resection - cross

speciality 45000 CT/MRI, Biopsy


HPE report

S1 3A.S1.00242A 3A.S1.00242A : Total Thyroidectomy and Block

Dissection - cross speciality 15000 Clinical Photograph , USG Scar photo, HPE

S1 3A.S1.17006A 3A.S1.17006A : Nephrectomy – partial (Code

3A.451)- additional cost - cross speciality 18750


if required



S1 3A.S1.17007A 3A.S1.17007A : Low AR and APR (Code 3A.417,

3A.418) - additional cost - cross speciality 18750


with film


HPE report

Sl. no.Speciality


S1 3A.S1.17008A

3A.S1.17008A : Radical hysterectomy for Ca cervix

and Ca endometrium ( Code 3A.484)- additional

cost - cross speciality


HPE report

S7 3A.S7.00141A3A.S7.00141A : Bilateral Orchidectomy for hormone

ablation11250

Biopsy Reports /PSA with evidence of

bone metastasis

Clinical Photograph showing scar ( if


M4 3A.M4.00026B 3A.M4.00026B : Brain tumors: surgery - cross


Clinical Photographs showing the

scar + HPE report

M4 3A.M4.00030A 3A.M4.00030A : Wilms tumors: surgery - cross

speciality3750 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report

1294 S3 3A.S3.00002 3A.S3.00002 : Canaliculo Dacryocysto Rhinostomy 7500 Clinical notes Procedure notes, sac syringe

1295 S3 3A.S3.00003 3A.S3.00003 : Capsulotomy (YAG) 1125 Clinical notes Clinical Photograph, Procedure notes

1296 S3 3A.S3.00006 3A.S3.00006 :

Cyclocryotherapy/Cyclophotocoagulation2250 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes

1297 S3 3A.S3.00009 3A.S3.00009 : Enucleation 4500 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes

1298 S3 3A.S3.00011 3A.S3.00011 : Exenteration 11250 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes

1299 S3 3A.S3.00014 3A.S3.00014 : Intraocular Foreign Body Removal

from Posterior Segment15000 B Scan Report Clinical Photograph

1300 S3 3A.S3.00024 3A.S3.00024 : Iridectomy – Laser 1500 Clinical Note / slit lamp report Clinical Note / Slit lamp report

1301 S3 3A.S3.00026 3A.S3.00026 : Iris cyst removal 1875 Clinical Note / slit lamp report Clinical Note / Slit lamp report

1302 S3 3A.S3.00028 3A.S3.00028 : Vitrectomy + Retinal Detachment

surgery (pre-auth required)13125 B.Scan , Fundus Photograph Fundus Photograph

S8 3A.S8.00082A 3A.S8.00082A : Excision of Orbital Tumour - cross

speciality37500 CT/MRI Report

CT, Clinical Photograph showing

scar + HPE report, Post-op CT report

and film

M2 3A.M2.00011D 3A.M2.00011D : Optic neuritis - routine ward - cross

speciality 1350 Clinical note with Lab reports Treatment note

M2 3A.M2.00011E 3A.M2.00011E : Optic neuritis - HDU - cross

speciality 2025 Clinical note with Lab reports Treatment note

M2 3A.M2.00011F 3A.M2.00011F : Optic neuritis - ICU without

ventilator - cross speciality 2700 Clinical note with Lab reports Treatment note

M2 3A.M2.00011G 3A.M2.00011G : Optic neuritis - ICU with ventilator -

cross speciality 3375 Clinical note with Lab reports Treatment note

M4 3A.M4.00019A 3A.M4.00019A : Retinoblastoma (Intraocular):

surgery - cross speciality 75000


Flow cytometry



1303 S5 3A.S5.00011 3A.S5.00011 : Disarticulation (hind & for quarter) 18750X-ray, clinical photo, CT, HPE for


OPTHALMOLOGY

ORTHOPAEDICS

Sl. no.Speciality


1304 S5 3A.S5.00012 3A.S5.00012 : Anterior Spine Fixation 26250 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo

1305 S5 3A.S5.00013 3A.S5.00013 : Posterior Spine Fixation 15000 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo

1306 S5 3A.S5.00020 3A.S5.00020 : Bone Tumour Excision +

reconstruction using implant (malignant/ benign)37500 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE

1307 S5 3A.S5.00022

3A.S5.00022 : Bone Tumour Excision (malignant/

benign) + Joint replacement (depending upon type

of joint and implant)

112500 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE

1308 S5 3A.S5.00046 3A.S5.00046 : Fracture - Acetabulum 19950 X-RAY/CT scan Clinical Photograph showing scar +

post op. XRAY

1309 S5 3A.S5.00060 3A.S5.00060 : Llizarov Fixation 19950 X-rayPost op X-ray, Pt photo with

applicator

1310 S5 3A.S5.00061 3A.S5.00061 : Multiple Tendon Repair 7500X-ray Films/ Clinical Picture + detail

notesClinical photo showing Scar

1311 S5 3A.S5.00062 3A.S5.00062 : Nerve Repair Surgery 11250 Clinical Photograph Clinical Photograph

1312 S5 3A.S5.00072 3A.S5.00072 : Pelvic Osteotomy with fixation with

plaster22500 X-ray photo with plaster, X-ray

1313 S5 3A.S5.00078 3A.S5.00078 : Tendon Grafting 15000Xray Films(if relevant)+ Clinical


1314 S5 3A.S5.00091 3A.S5.00091 : Total Hip Replacement (cemented) 45075 X-ray Post-op X-ray, Scar photo

1315 S5 3A.S5.00092 3A.S5.00092 : Total Hip Replacement (cementless) 51825 X-ray Post-op X-ray, Scar photo

1316 S5 3A.S5.00093 3A.S5.00093 : Total Hip Replacement (hybrid) 75000 X-ray Post-op X-ray, Scar photo

1317 S5 3A.S5.00096 3A.S5.00096 : Total Knee Replacement 48750 X-ray Post-op X-ray, Scar photo

S6 3A.S6.00001C 3A.S6.00001C : Nerve Plexus injuries, Tendon injury




S6 3A.S6.00002B 3A.S6.00002B : Plexus injury along with Vascular




S6 3A.S6.00003B

3A.S6.00003B : Internal fixation with Flap cover

Surgery for wound in compound fracture - cross

speciality



S8 3A.S8.00016A 3A.S8.00016A : Laminectomy with Fusion - cross

speciality 30000 Clinical findings, MRI Report photo showing scar

S8 3A.S8.00028A 3A.S8.00028A : Spine - Decompression & Fusion -

cross speciality 30000 Clinical findings, MRI Report Post Op X-Ray Report and film

S8 3A.S8.00075B 3A.S8.00075B : Nerve Decompression - cross

speciality15000 Nerve Conductions study Clinical Photographs showing scar

S8 3A.S8.00076B 3A.S8.00076B : Peripheral Nerve Surgery Major -






Sl. no.Speciality


S8 3A.S8.00077A 3A.S8.00077A : Peripheral Nerve Surgery Minor -






M4 3A.M4.00035B 3A.M4.00035B# : Bone tumors/soft tissue sarcomas :

surgery (inlcuding prosthesis) - cross speciality 176250

CT scan/MRI ,USG abdomen pelvis,

Clinical photograph

X-ray, CT Scan, Clinical photograph

Hemogram report

1318 S10 3A.S10.00001

3A.S10.00001 : Ear Pinna Reconstruction with costal

cartilage/ Prosthesis (including the cost of

prosthesis/implants). *If requiring multiple stages,

each stage will cost Rs. 30,000 provided the

operating surgeon demonstrates the photographic

results of previous stages.

22500 X-ray and clinical note OT note with clinical photograph of

stages

1319 S10 3A.S10.00002 3A.S10.00002 : Revascularization of limb/digit 18750CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

CXR, ECG,(X-ray of limb/digit)

Doppler study, Clinical photo and OT

note

1320 S10 3A.S10.00003 3A.S10.00003 : Hemangioma – Sclerotherapy (under

GA)26250

CBC,RBS,RFT,S Electrolytes, HIV,

HbsAg,CXR, ECG MRI/MRAMRI/MRA

1321 S10 3A.S10.00004 3A.S10.00004 : Hemangioma – Debulking/ Excision 26250CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,

CXR, ECG, MRI/MRAMRI/MRA

1322 S10 3A.S10.00005

3A.S10.00005 : Tissue Expander for disfigurement

following burns/ trauma/ congenital deformity

(including cost of expander / implant)

37500CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

CXR, ECG. Clinical photo and OT note

1323 S10 3A.S10.00006 3A.S10.00006 : Scalp avulsion reconstruction 37500CBC,RBS,RFT,S Electrolytes, HIV,HbsAg,

CXR, ECG Clinical photo and OT note

1324 S10 3A.S10.00007 3A.S10.00007 : NPWT (Inpatient only) 1500CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

CXR, ECG. Clinical photo and OT note

1325 S10 3A.S10.00008 3A.S10.00008 : Pressure Sore – Surgery 22500CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,

CXR, ECG, Pus for C/S Clinical photo and OT note

1326 S10 3A.S10.00009 3A.S10.00009 : Diabetic Foot – Surgery 22500

Clinical Photograph, CBC,RBS,RFT,S

Electrolytes, HIV, HbsAg,, CXR, ECG, Pus

for C/S, MRI/MRA

Post - op Photograph, MRI/MRA

S6 3A.S6.00001A 3A.S6.00001A : Nerve Plexus injuries, Tendon injury




S6 3A.S6.00003A

3A.S6.00003A : Internal fixation with Flap cover

Surgery for wound in compound fracture - cross

speciality



S1 3A.S1.00163B 3A.S1.00163B : Flap Reconstructive Surgery - cross

speciality 22500 X-ray Films + detail notes Clinical photo showing Scar

S1 3A.S1.00165A 3A.S1.00165A : Split thickness skin grafts – Medium

(4 - 8% TBSA) - cross speciality 7500 Clinical photograph Scar photo


Sl. no.Speciality


S1 3A.S1.00167A 3A.S1.00167A : Free Grafts - Wolfe Grafts - cross

speciality 7500 Clinical photograph Scar photo

S1 3A.S1.00225A 3A.S1.00225A : Skin Flaps - Rotation Flaps - cross

speciality4650 Clinical photo Scar photo

S6 3A.S6.00002C 3A.S6.00002C : Plexus injury along with Vascular




1327 S6 3A.S6.00001 3A.S6.00001 : Nerve Plexus injuries, Tendon injury

repair/reconstruction/ Transfer37500



1328 S6 3A.S6.00002 3A.S6.00002 : Plexus injury along with Vascular

injury repair/ graft45000



1329 S6 3A.S6.00003 3A.S6.00003 : Internal fixation with Flap cover

Surgery for wound in compound fracture30000 X-RAY/CT scan(If Required)



1330 S6 3A.S6.00004 3A.S6.00004 : Head injury requiring Facio-Maxillary

Injury repairs & fixations (including implants)26250 X-RAY/CT scan(If Required)



1331 S6 3A.S6.17024 3A.S6.17024 : Visceral injuries severe 45000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

1332 S6 3A.S6.17025 3A.S6.17025 : Chest injuries with ICD bilateral 8250 X-ray /ultra soundPost-Operative chest X-ray with ICD

in situ

1333 S6 3A.S6.17026 3A.S6.17026 : Chest injuries with ICD + ICU 15000 X-ray /ultra soundPost-Operative chest X-ray with ICD

in situ

1334 S6 3A.S6.17027 3A.S6.17027 : Chest injuries with ICD + ICU +

Ventilator19950 X-ray /ultra sound


in situ

1335 U1 3A.U1.00001 3A.U1.00001 : Unspecified Surgical Package 0

S1 3A.S1.00016B 3A.S1.00016B : Bypass - Inoperable Pancreas - cross

speciality 11250 USG/CT USG, Scar photo, HPE Report

S1 3A.S1.00059A 3A.S1.00059A : Fundoplication - cross speciality 26250 Contrast X ray/endoscopy findings Clinical Photograph showing scar

S1 3A.S1.00064A 3A.S1.00064A : Gastrostomy - cross speciality 11250 USG/ CT Scan Clinical photograph

S1 3A.S1.00070A 3A.S1.00070A : Hepatic Resection (lobectomy) -

cross speciality 15000 MRI/ CT Abdomen Scar Photo, HPE Report

S1 3A.S1.00087B 3A.S1.00087B : Intussusception - cross speciality 11250 USG/CT , Clinical notes Scar photo

S1 3A.S1.00104A 3A.S1.00104A : Portal Hypertension shunt surgery -

Cross speciality 37500 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar

S1 3A.S1.00106A 3A.S1.00106A : PancreaticoDuodenectomy - cross

speciality 18750

CT-Scan , ERCP , ER Clinical Photograph ,

EndoscopyHPR , Scar Photograph

S1 3A.S1.00112A 3A.S1.00112A : Pyeloroplasty - cross speciality 7500 USG, Clinical Notes Scar photo, HPE


POLYTRAUMA

Sl. no.Speciality


S1 3A.S1.00171B 3A.S1.00171B : Lap. Assisted left Hemi colectomy t -

cross speciality 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

S1 3A.S1.00172B 3A.S1.00172B : Lap. Assisted Right Hemi colectomy t

- cross speciality 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

S1 3A.S1.00174A 3A.S1.00174A : Lap. Assisted Total Colectomy - cross

speciality 30000

Colonocopy with film, biopsy, CT report

with film


HPE report

S1 3A.S1.00201A 3A.S1.00201A : Caecostomy - cross speciality 7500 Clinical notes, USG/ CT Scar photo, HPE

S1 3A.S1.00213B 3A.S1.00213B : Operations for Replacement of

Oesophagus by Colon - cross speciality 18750 Endoscopy, USG/CT Scar photo, HPE

S1 3A.S1.00216A 3A.S1.00216A : Partial/Subtotal Gastrectomy for

Carcinoma - cross speciality 37500 Endoscopy, biopsy, CT


HPE report

S1 3A.S1.00235A 3A.S1.00235A : Thoracoscopic Hydatid Cyst excision -

cross speciality 15000 Chest X-ray / CT Scar photo, HPE

S1 3A.S1.00247A 3A.S1.00247A : Adhenolysis + Appendicectomy -

cross speciality 15000 MRI/ CT Abdomen Scar Photo, HPE Report

1336 S7 3A.S7.00001 3A.S7.00001 : Adrenalectomy-unilateral, open 18750 CT/MRI report with film, Urinary

hormones


HPE report

1337 S7 3A.S7.00002 3A.S7.00002 : Adrenalectomy-unilateral,

Laparoscopic22500 USG Clinical Photograph

1338 S7 3A.S7.00003 3A.S7.00003 : Adrenalectomy-bilateral, open 24000 USG Clinical Photograph

1339 S7 3A.S7.00004 3A.S7.00004 : Adrenalectomy-biilateral,

Laparoscopic33750

CT/MRI report with film, Urinary

hormones


HPE report

1340 S7 3A.S7.00005 3A.S7.00005 : Paraganglioma excision with liver

mobilization37500 CT/MRI, clinical notes

Operative notes with steps of

surgery, Scar photo, HPE report

1341 S7 3A.S7.00006 3A.S7.00006 : Nephrectomy (Benign) Open 26250 USG, CT KUB /Isotope Renogram Scar & Specimen Photo +HPE report

1342 S7 3A.S7.00007 3A.S7.00007 : Nephrectomy (Benign) Laparoscopic 33750 USG & CT KUB /Isotope Renogram Scar Photo + HPE Report

1343 S7 3A.S7.00008 3A.S7.00008 : Nephrectomy-Radical (Renal tumor)

Open33750

Ultrasound abd /CT Scan abd with film,

Isotope Renogram if required


HPE report

1344 S7 3A.S7.00009 3A.S7.00009 : Nephrectomy-Radical (Renal tumor)

Laparoscopic22500

USG & CT KUB with Contrast / Isotope

RenogramScar Photo + HPE Report

1345 S7 3A.S7.00010 3A.S7.00010 : Nephrectomy-Partial or Hemi, Open 22500 USG & CT KUB with Contrast Scar Photo + HPE Report

1346 S7 3A.S7.00011 3A.S7.00011 : Nephrectomy-Partial or Hemi,

Laparoscopic45000

USG & CT KUB with Contrast / Isotope


1347 S7 3A.S7.00012 3A.S7.00012 : Nephro ureterectomy (Benign) Open 18750 IVP , USG USG

1348 S7 3A.S7.00013 3A.S7.00013 : Nephro ureterectomy (Benign)

Laparoscopic22500 IVP , USG USG

1349 S7 3A.S7.00014 3A.S7.00014 : Nephro ureterectomy with cuff of

bladder Open22500 IVP , USG USG

UROLOGY

Sl. no.Speciality


1350 S7 3A.S7.00015 3A.S7.00015 : Nephro ureterectomy with cuff of

bladder Laparoscopic33750


if required


HPE report

1351 S7 3A.S7.00016

3A.S7.00016 :

Pyeloplasty/pyeloureterostomy/pyelopyelostomy

Open

18750 USG & IVP/CT with Contrast Scar Photo

1352 S7 3A.S7.00017

3A.S7.00017 :

Pyeloplasty/pyeloureterostomy/pyelopyelostomy

Laparoscopic

30000 USG & IVP/CT with Contrast Scar Photo

1353 S7 3A.S7.00018 3A.S7.00018 : Endopyelotomy (retrograde with

laser/bugbee)18750 USG/IVP USG/IVP

1354 S7 3A.S7.00019 3A.S7.00019 : Endopyelotomy (antegrade with

laser/bugbee)21000 USG/IVP USG/IVP

1355 S7 3A.S7.00020 3A.S7.00020 : Ureterocalycostomy Open 22500 CT KUB with Contrast Scar Photo +X-Ray Kub

1356 S7 3A.S7.00021 3A.S7.00021 : Ureterocalycostomy Laparoscopic 26250 CT KUB with Contrast Scar Photo +X-Ray Kub

1357 S7 3A.S7.00022 3A.S7.00022 : Uretero-ureterostomy Open 18750 USG/IVP USG/IVP

1358 S7 3A.S7.00023 3A.S7.00023 : Uretero-ureterostomy Laparoscopic 26250 USG/IVP USG/IVP

1359 S7 3A.S7.00024 3A.S7.00024 : PCNL (Percutaneous

Nephrolithotomy) - Bilateral28500 CT KUB with Contrast/IVU Scar Photo +X-ray KUB

1360 S7 3A.S7.00025 3A.S7.00025 : PCNL (Percutaneous

Nephrolithotomy) - Unilateral18750 CT KUB with Contrast/IVU Scar Photo +X-ray KUB

1361 S7 3A.S7.00026 3A.S7.00026 : Extracoporeal shock-wave Lithotripsy

(SWL) stone, with or without stent (one side)6375 CT KUB with Contrast X-ray KUB/USG

1362 S7 3A.S7.00027 3A.S7.00027 : Extracoporeal shock-wave Lithotripsy

(SWL) stone, with or without stent (both sides)13500 CT KUB with Contrast X-ray KUB

1363 S7 3A.S7.00028 3A.S7.00028 : Pyelolithotomy-Open 27000 CT KUB with Contrast Scar Photo,X-Ray/USG KUB

1364 S7 3A.S7.00030 3A.S7.00030 : Nephrolithotomy-Open 27000 USG/X-ray KUB Scar Photo,X-Ray/USG KUB

1365 S7 3A.S7.00031 3A.S7.00031 : Anatrophic nephrolithotomy 33750 USG, CT KUB with Contrast Scar Photo +X-Ray Kub

1366 S7 3A.S7.00034 3A.S7.00034 : Renal Cyst deroofing or

marsupialization-Open15000 IVP , USG USG

1367 S7 3A.S7.00035 3A.S7.00035 : Renal Cyst deroofing or

marsupialization-Laparoscopic22500 IVP , USG USG

1368 S7 3A.S7.00036 3A.S7.00036 : Nephrostomy-percutaneous

ultrasound guided7500 USG Scar Photo With Nephrostomy Tube

1369 S7 3A.S7.00037 3A.S7.00037 : Ureterolithotomy-Open 22500 CT KUB with Contrast Scar Photo +X-Ray Kub

1370 S7 3A.S7.00038 3A.S7.00038 : Ureterolithotomy-Laparoscopic 26250 CT KUB with Contrast Scar Photo +X-Ray Kub

1371 S7 3A.S7.00039 3A.S7.00039 : Ureteroscopy+stone removal with

lithotripsy, lower ureter, unilateral15000 CT KUB X-ray KUB


lithotripsy, upper ureter, unilateral18750 CT KUB X-ray KUB

Sl. no.Speciality



lithotripsy, bilateral22500 CT KUB X-ray KUB

1374 S7 3A.S7.00042 3A.S7.00042 : Ureterotomy (Cutaneous) 15000 USG KUB/CT Scan/MRI Scan


surgery, X-ray KUB/USG KUB/CT,

Urography

1375 S7 3A.S7.00043 3A.S7.00043 : Endoureterotomy (laser/bugbee) 15000 USG KUB/CT Scan/MRI Scan


surgery, X-ray KUB/USG KUB/CT,

Urography

1376 S7 3A.S7.00044 3A.S7.00044 : Ureteric reimplantation-unilateral-

open28500 CT KUB/IVP/MCU Scar photo

1377 S7 3A.S7.00045 3A.S7.00045 : Ureteric reimplantation-bilateral-open 52500 MCU, USG Clinical Photograph showing scar

1378 S7 3A.S7.00046 3A.S7.00046 : Ureteric reimplantation-unilateral-

Laparoscopic33750 MCU, USG Clinical Photograph showing scar

1379 S7 3A.S7.00047 3A.S7.00047 : Ureteric reimplantation-bilateral-

Laparoscopic26250 MCU, USG Clinical Photograph showing scar

1380 S7 3A.S7.00048 3A.S7.00048 : Uretero-vaginal/uterine fistula repair

open20250 USG USG

1381 S7 3A.S7.00049 3A.S7.00049 : Uretero-vaginal/uterine fistula repair

Laparoscopic27750 USG USG

1382 S7 3A.S7.00050 3A.S7.00050 : Ureterolysis-open, for retroperitoneal

fibrosis (with or without omental wrapping)15000 MCU/IVP/CT Urography, clinical notes OT notes, Scar photo

1383 S7 3A.S7.00051

3A.S7.00051 : Ureterolysis-Laparoscopic, for

retroperitoneal fibrosis (with or without omental

wrapping)

22500 X-ray KUB/USG KUB/CT, Urography,

Clinical notesOT notes, Scar photo

1384 S7 3A.S7.00052 3A.S7.00052 : Boari flap for ureteric stricture, open 31500 CT KUB/IVP Clinical Picture, Scar Photo

1385 S7 3A.S7.00053 3A.S7.00053 : Boari flap for ureteric stricture,

Laparoscopic30000 CT KUB/IVP Clinical Picture, Scar Photo

1386 S7 3A.S7.00054 3A.S7.00054 : Ileal replacement for ureteric stricture 30000 IVP , USG , X-RAY Clinical Photograph

1387 S7 3A.S7.00055

3A.S7.00055 : DJ stent unilateral including

cystoscopy, ureteric catheterization, retrograde

pyelogram

5625 USG /X-ray KUB X-ray KUB

1388 S7 3A.S7.00056 3A.S7.00056 : DJ stent bilateral including cystoscopy,

ureteric catheterization, retrograde pyelogram7500 X-ray KUB & USG X-ray KUB & USG

1389 S7 3A.S7.00057

3A.S7.00057 : Ureteric sampling including


pyelogram

7500 USG USG

1390 S7 3A.S7.00058

3A.S7.00058 : Ureterocele incision including


pyelogram

11250 RGU , X-RAY Clinical Photograph

Sl. no.Speciality


1391 S7 3A.S7.00060 3A.S7.00060 : Cystolithotomy-open, including

cystoscopy13500 USG/X ray KUB Scar Photo,X-Ray/USG KUB

1392 S7 3A.S7.00061 3A.S7.00061 : Cystolithotripsy/Urethral Stone

endoscopic, including cystoscopy12750 X-ray KUB/USG X-ray KUB

1393 S7 3A.S7.00062 3A.S7.00062 : TURBT (Transurethral Resection of the

Bladder Tumor)22500 USG/CT KUB with Contrast

Cystoscopy Finding/ HPE Report, P.O

USG

1394 S7 3A.S7.00063 3A.S7.00063 : TUR-fulgration (Transurethral

fulgration of the Bladder Tumor)13500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1395 S7 3A.S7.00064

3A.S7.00064 : Intravesical BCG/Mitomycin 6

induction cycles (weekly for 6 weeks-total cost of 6

cycles)

9000 USG, HPE Case sheets

1396 S7 3A.S7.00065 3A.S7.00065 : Intravesical BCG/Mitomycin

maintenance for 12 doses (total cost of 12 doses)18000 USG, HPE Case sheets

1397 S7 3A.S7.00066 3A.S7.00066 : Post TURBT - Check Cystoscopy (Per

sitting) with or without cold-cup biopsy3750 USG & urine cytology Cystoscopy Finding, X-Ray KUB

1398 S7 3A.S7.00068 3A.S7.00068 : Bladder Neck incision-endoscopic 16875 USG & Uroflowmetry Uroflowmetry,ENDO Picture

1399 S7 3A.S7.00069

3A.S7.00069 : Extrophy Bladder repair including

osteotomy if needed + epispadias repair + ureteric

reimplant

52500 MCU Clinical Photograph

1400 S7 3A.S7.00070

3A.S7.00070 : Bladder injury repair (as an

independent procedure with or without urethral

injury)

15000 CT KUB Endo Picture/Operative Picture

1401 S7 3A.S7.00072

3A.S7.00072 : Bladder injury repair with colostomy

(as an independent procedure with or without

urethral injury)

18750 Clinical photograph Scar photo

1402 S7 3A.S7.00073 3A.S7.00073 : Partial Cystectomy-open 30000 CT KUB with Contrast Procedure Picture

1403 S7 3A.S7.00074 3A.S7.00074 : Partial Cystectomy-Laparoscopic 22500 CT KUB with Contrast Procedure Picture

1404 S7 3A.S7.00075 3A.S7.00075 : Radical cystectomy with neobladder-

open37500 CT KUB with Contrast Scar photo

1405 S7 3A.S7.00076 3A.S7.00076 : Radical cystectomy with continent

diversion-open37500 CT KUB with Contrast Scar photo

1406 S7 3A.S7.00077 3A.S7.00077 : Radical Cystectomy with Ileal Conduit-

open56250 CT report and Film, Biopsy


HPE report

1407 S7 3A.S7.00078 3A.S7.00078 : Radical Cystectomy with ureterostomy-

open26250 CT KUB with Contrast Scar photo

1408 S7 3A.S7.00079 3A.S7.00079 : Radical Cystectomy with

ureterosigmoidostomy-open26250 CT KUB with Contrast Scar photo

1409 S7 3A.S7.00080 3A.S7.00080 : Other Cystectomies 30000 CT report and Film, BiopsyClinical Photograph showing scar +

HPE report

1410 S7 3A.S7.00081 3A.S7.00081 : Suprapubic Cystostomy - Open, as an

independent procedure7500 Biopsy of the primary tumor

Clinical Photograph showing

procedure/scar

Sl. no.Speciality


1411 S7 3A.S7.00083 3A.S7.00083 : VVF/Uterovaginal Repair -

Transvaginal approach18750 CT KUB USG, Treating doctor note

1412 S7 3A.S7.00084 3A.S7.00084 : VVF/Uterovaginal Repair -

Abdominal,Open18750 CT KUB USG, Treating doctor note

1413 S7 3A.S7.00085 3A.S7.00085 : VVF/Uterovaginal Repair - Abdominal,

Laparoscopic30000 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram

1414 S7 3A.S7.00086 3A.S7.00086 : Hysterectomy as part of

VVF/uterovaginal fistula repair (top-up)3750 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram

1415 S7 3A.S7.00087 3A.S7.00087 : Urethrovaginal fistula repair 30000 USG/X ray KUB NIL

1416 S7 3A.S7.00088 3A.S7.00088 : Y V Plasty of Bladder Neck/Bladder

Neck Reconstruction15000 USG/MCU Clinical Photograph

1417 S7 3A.S7.00089 3A.S7.00089 : Augmentation cystoplasty-open 22500 USG Scar photo

1418 S7 3A.S7.00090 3A.S7.00090 : Augmentation cystoplasty-

Laparoscopic30000 USG Scar photo

1419 S7 3A.S7.00091 3A.S7.00091 : Open bladder diverticulectomy

with/without ureteric re-implantation22500 CT KUB Endo Picture/Operative Picture

1420 S7 3A.S7.00092 3A.S7.00092 : Open simple prostatetctomy for BPH 26250 USG, Uroflowmetry Scar Photo + HPE Report

1421 S7 3A.S7.00093 3A.S7.00093 : TURP-Transurethral Resection of the

Prostate, BPH, Monopolar/Bipolar/Laser22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1422 S7 3A.S7.00094 3A.S7.00094 : Holmium Laser Prostatectomy 30000 USG, Uroflowmetry Scar Photo + HPE Report

1423 S7 3A.S7.00095 3A.S7.00095 : TURP/Laser + Circumcision 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1424 S7 3A.S7.00096 3A.S7.00096 : TURP/Laser + Cystolithotripsy 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1425 S7 3A.S7.00097 3A.S7.00097 : TURP/Laser + Cystolithotomy-open 26250 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1426 S7 3A.S7.00098 3A.S7.00098 : TURP/Laser + Orchidectomy 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1427 S7 3A.S7.00099 3A.S7.00099 : TURP/Laser + TURBT 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1428 S7 3A.S7.00100 3A.S7.00100 : TURP/Laser + URS with stone removal 30000 CT KUB X-ray KUB

1429 S7 3A.S7.00101 3A.S7.00101 : TURP/Laser + VIU (visual internal

Ureterotomy)30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1430 S7 3A.S7.00102 3A.S7.00102 : TURP/Laser + Hydrocele surgery 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

1431 S7 3A.S7.00103 3A.S7.00103 : TURP/Laser + Hernioplasty 30000 USG/CT KUB,Uroflowmetry P.O USG

1432 S7 3A.S7.00104 3A.S7.00104 : TURP/Laser + Urethral dilatation-non

endoscopic30000 USG/CT KUB,Uroflowmetry P.O USG

1433 S7 3A.S7.00105 3A.S7.00105 : TURP/Laser + Urethral dilatation-

endoscopic30000 USG/CT KUB,Uroflowmetry P.O USG

1434 S7 3A.S7.00106 3A.S7.00106 : Radical prostatectomy - open 37500 CT report and Film, Biopsy Clinical Photograph, HPE report

1435 S7 3A.S7.00107 3A.S7.00107 : Radical prostatectomy - laparoscopic 56250 CT report and Film, Biopsy Clinical Photograph, HPE report

1436 S7 3A.S7.00108 3A.S7.00108 : Transrectal Ultrasound guided

prostate biopsy (minimum 12 core)4500 PSA,Transrectal USG HPE Report

1437 S7 3A.S7.00113 3A.S7.00113 : Post Urethral Valve fulguration 22500 MCU, USGClinical Photograph/Endoscopic

picture

Sl. no.Speciality


1438 S7 3A.S7.00114 3A.S7.00114 : Urethroplasty-End to end 33750 RGU Clinical notes

1439 S7 3A.S7.00115 3A.S7.00115 : Urethroplasty-Substitution-single

stage22500 RGU & MCU Scar photo,

1440 S7 3A.S7.00116 3A.S7.00116 : Urethroplasty-Substitution-two stage 18750 RGU & MCU Scar photo,

1441 S7 3A.S7.00117 3A.S7.00117 : Urethroplasty-Transpubic 22500 RGU Scar photo,

1442 S7 3A.S7.00118 3A.S7.00118 : Urethroplasty-two stage without

substitution22500 RGU Scar photo,

1443 S7 3A.S7.00119 3A.S7.00119 : Perineal Urethrostomy without closure 18750 RGU& MCU Scar photo,

1444 S7 3A.S7.00120 3A.S7.00120 : Urethrorectal fistula repair 30000 RGU& MCU Scar photo,

1445 S7 3A.S7.00122 3A.S7.00122 : Urethral Dilatation-endocopic as an

independent procedure3750 CT Scan Clinical Photograph

1446 S7 3A.S7.00123 3A.S7.00123 : Internal Ureterotomy including

cystoscopy as an independent procedure7500 USG Clinical Photograph

1447 S7 3A.S7.00124 3A.S7.00124 : Hypospadias repair-single stage 18750 Clinical Photograph Scar photo,

1448 S7 3A.S7.00125 3A.S7.00125 : Hypospadias repair-two or more stage 18750 Clinical Photograph Scar photo,

1449 S7 3A.S7.00126 3A.S7.00126 : Orchiopexy-without laparoscopy,

unilateral11250 USG Clinical Notes

1450 S7 3A.S7.00128 3A.S7.00128 : Orchiopexy-with laparoscopy,

unilateral22500 USG Clinical Notes

1451 S7 3A.S7.00129 3A.S7.00129 : Orchiopexy-with laparoscopy, bilateral 22500 USG Clinical Notes

1452 S7 3A.S7.00130 3A.S7.00130 : Stress incontinence surgery, open 15000 Clinical Notes Endo Picture / Operative Picture

1453 S7 3A.S7.00131 3A.S7.00131 : Stress incontinence surgery,

laparoscopic22500 Clinical Notes Endo Picture / Operative Picture

1454 S7 3A.S7.00132 3A.S7.00132 : Stress incontinence surgery with slings 33750 Clinical Notes Endo Picture / Operative Picture

1455 S7 3A.S7.00133 3A.S7.00133 : Partial Penectomy 11250 Biopsy ReportsClinical Photograph showing scar ( if


1456 S7 3A.S7.00134 3A.S7.00134 : Total Penectomy + Perineal

Urethrostomy18750 Biopsy Reports



1457 S7 3A.S7.00137 3A.S7.00137 : Pelvic lymphadenectomy open, after

prior cancer surgery18750 USG-KUB, HPE report Scar photo, HPE

1458 S7 3A.S7.00138 3A.S7.00138 : Pelvic lymphadenectomy laparoscopic,

after prior cancer surgery22500 USG-KUB, HPE report Scar photo, HPE

1459 S7 3A.S7.00139 3A.S7.00139 : Orchiectomy-High inguinal 11250 USG scrotum, Tumour markersClinical Photograph showing scar ( if


Sl. no.Speciality


1460 S7 3A.S7.00141 3A.S7.00141 : Bilateral Orchidectomy for hormone

ablation11250

Biopsy Reports /PSA with evidence of

bone metastasis



1461 S7 3A.S7.00142 3A.S7.00142 : Retroperitoneal lymph node

dissection-open18750 CT Scar photo

1462 S7 3A.S7.00143 3A.S7.00143 : Retroperitoneal lymph node

dissection-Laparoscopic60000 CT report and film, biopsy

Clinical photograph showing scar,

HPE report

1463 S7 3A.S7.00144 3A.S7.00144 : Infertility-Scrotal exploration unilateral 7500 USG/CT- Clinical Photograph Clinical Photograph

1464 S7 3A.S7.00145 3A.S7.00145 : Infertility-Scrotal exploration bilateral 9000 USG/CT- Clinical Photograph Clinical Photograph

1465 S7 3A.S7.00146 3A.S7.00146 : Infertility-Vasoepididymostomy,

microsurgical, unilateral11250 USG/CT- Clinical Photograph Clinical Photograph

1466 S7 3A.S7.00147 3A.S7.00147 : Infertility-Vasoepididymostomy,

microsurgical, bilateral15000 USG/CT- Clinical Photograph Clinical Photograph

1467 S7 3A.S7.00151 3A.S7.00151 : Varicocele-bilateral-microsurgical 15000 USG, Clinical photograph Clinical Photograph

1468 S7 3A.S7.00152 3A.S7.00152 : Penile prosthesis insertion, Malleable

(Indian implant)22500 CT/MRI/USG, clinical notes,


surgery, clinical notes

1469 S7 3A.S7.00154

3A.S7.00154 : Neurogenic bladder-Package for

evaluation/investigation (catheter + ultrasound +

culture + RGU/ MCU) for 1 month (medicines -

antibiotics). Follow up visit once in 3 months

5625 USG/CTX-Ray, catheter + ultrasound +

culture + RGU/ MCU

1470 S7 3A.S7.00155

3A.S7.00155 : Chronic prostatitis-Package for

evaluation/investigation (ultrasound + culture +

prostate massage) for 1 month (medicines). Follow

up visit once in 3 months

1875 USGultrasound + culture + prostate

massage - Reports

1471 S7 3A.S7.00156

3A.S7.00156 : Emergency management of Ureteric

stone - Package for evaluation/investigation

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

2625 USG Ultrasound + culture Report

1472 S7 3A.S7.00157 3A.S7.00157 : Emergency management of Hematuria 1500 USG Doctors Note

1473 S7 3A.S7.00161 3A.S7.00161 : Urinary tract trauma – Laparoscopy

surgery22500 clinical notes, CT/MRI/USG - pelvis Operative notes with steps of surgery

1474 S7 3A.S7.17041 3A.S7.17041 : Lap. Nephrectomy Radical 37500USG & CT KUB with Contrast / Isotope


1475 S7 3A.S7.17042 3A.S7.17042 : Retrograde Intra Renal surgery (RIRS

with laser) – for renal and PUJ calculi*37500 CT KUB with Contrast

C ARM Picture with Patient Details, X-

ray KUB/USG

1476 S7 3A.S7.17043 3A.S7.17043 : URSL* (Inclusive of stent) 16875 CT KUB X-ray KUB

1477 S7 3A.S7.17044 3A.S7.17044 : URSL-LASER* 18750 CT KUBX-ray KUB, Purchase Voucher for

Laser machine

1478 S7 3A.S7.17045 3A.S7.17045 : Hypospadiasis(Adult)* 26250 Clinical Photograph Scar photo,

Sl. no.Speciality


1479 S7 3A.S7.17046 3A.S7.17046 : Visual Internal Urethrotomy 9000 USG & RGU Uroflowmetry/ENDO PICTURE

M4 3A.M4.00030B 3A.M4.00030B : Wilms tumors: surgery - cross

speciality3750 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report

S1 3A.S1.00122B 3A.S1.00122B : Retroperitoneal Tumor – Excision -

cross speciality 37500 CT abdomen with film, FNAC


HPE report

S1 3A.S1.17005A 3A.S1.17005A : Prostate surgery (Code 3A.561) -

additional cost - Cross speciality 18750 CT report and Film, Biopsy Clinical Photograph, HPE report

S1 3A.S1.17006B 3A.S1.17006B : Nephrectomy – partial (Code

3A.451)- additional cost - cross speciality 18750


if required



Sl. no.Speciality


1480 S11 4A.S11.00002


(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.



1481 S11 4A.S11.00003


(TBSA) (thermal/ scald/ flame burns): 40 % - 60 %;







1482 S11 4A.S11.00004


(TBSA) (thermal/ scald/ flame burns): > 60 %;







1483 S11 4A.S11.00005

4A.S11.00005 : Electrical contact burns: Low voltage-

without part of limb/limb loss; Includes % TBSA skin




dressings alone.


1484 S11 4A.S11.00007

4A.S11.00007 : Electrical contact burns: High voltage-

without part of limb/limb loss; Includes % TBSA skin




dressings alone.


1485 S11 4A.S11.00008

4A.S11.00008 : Electrical contact burns: High voltage-

with part of limb/limb loss; Includes % TBSA skin




dressings alone.


EMERGENCY CAREBURNS

Sl. no.Speciality


1486 S11 4A.S11.00009

4A.S11.00009 : 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 procedures are

required for deep burns that are not amenable to

heal with dressings alone.


1487 S11 4A.S11.00010

4A.S11.00010 : 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 procedures are

required for deep burns that are not amenable to

heal with dressings alone.


1488 S12 4A.S12.00013 4A.S12.00013 : Medical treatment of Acute MI with

Thrombolysis /Stuck Valve Thrombolysis15000

2D ECHO, CPKMB,CAG, ECG with report,

TROPONINE-T reports

2D ECHO, ECG, LAB INVESTIGATION

(Trop T report)

1489 S12 4A.S12.00020 4A.S12.00020 : Pericardiocentesis 10000 2D ECHO report 2D ECHO report

1490 S12 4A.S12.00021 4A.S12.00021 : Temporary Pacemaker implantation 10000 ECG + Report by cardiologist X Ray showing the pacemaker in situ

1491 S12 4A.S12.00027 4A.S12.00027 : PTSMA 30000ECG, 2D ECHO, CAG stills showing

blocks & Reports


post flow

1492 S12 4A.S12.17073

4A.S12.17073 : PTCA - one stent (non-medicated,

emergency, inclusive of angiogram) at the same

admission.*

48000ECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing stents &

post Stent flow

1493 S12 4A.S12.17074

4A.S12.17074 : PTCA - one Drug Eluting stent (


admission. *


blocks & Reports




FDA/CE/DCGI only

1494 S12 4A.S12.17075

4A.S12.17075 : PTCA - two bare metal stents ( non-

medicated, emergency, inclusive of angiogram) at

the same admission. *


blocks & Reports


post Stent flow

1495 S12 4A.S12.17076

4A.S12.17076 : PTCA - two Drug Eluting stents (


admission. *


blocks & Reports

Angioplasty stills showing stents &

post Stent flow

1496 S12 4A.S12.17077 4A.S12.17077 : Arrythmias 7000 CAG CAG

1497 S12 4A.S12.17078 4A.S12.17078 : Stuck valve with Thrombolysis 20000 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC

1498 S12 4A.S12.17079 4A.S12.17079 : Medical management of unstable

angina/non STS7500 ECG,ECHO,Cardiac Enzymes, RFT, CBC ECG, RFT, CBC

1499 S12 4A.S12.17080 4A.S12.17080 : Cardiac failure 7500 ECG,ECHO,Chest X-ray, RFT, CBC ECHO, CHEST X RAY, RFT, CBC

1500 S12 4A.S12.17081 4A.S12.17081 : Emergency dialysis for cardiac

conditions15000 ECHO, RFT, CBC RFT, CBC

1501 S12 4A.S12.17082 4A.S12.17082 : ICU with ventilator with dialysis 15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY RFT,RFT, CBC, ABG

CARDIOLOGY

Sl. no.Speciality


1502 S12 4A.S12.17083 4A.S12.17083 : Acute respiratory distress - ventilator

support15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY, RFT, CBC, ABG

1503 S12 4A.S12.17084 4A.S12.17084 : Pulmonary edema 10000 ECG, ECHO,Chest X Ray, RFT, CBC, ABG ECHO, CHEST X RAY, RFT, CBC, ABG

1504 S12 4A.S12.17085 4A.S12.17085 : Laryngoscopy / Bronchoscopy with

dilatation of trachea with gum elastic bogie5000 CT / Bronchoscopy report CT / Bronchoscopy report

1505 S12 4A.S12.17086 4A.S12.17086 : Pericardiostomy with balloon 20000 2D ECHO report 2D ECHO report + stills of the ECHO

1506 S13 4A.S13.00045 4A.S13.00045 : Surgery for Cardiac Tumour/ Left

Atrial (LA) Myxoma/ Right Atrial (RA) Myxoma95000 2D ECHO with stills + CT Chest report



1507 S13 4A.S13.00061 4A.S13.00061 : Foreign Body Removal with scope 20000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE

1508 S13 4A.S13.00063 4A.S13.00063 : Lung Injury repair 50000 CT Chest report X-RAY, scar photo

1509 S13 4A.S13.00066

4A.S13.00066 : Intercostal Drainage and

Management of ICD, Intercostal Block, Antibiotics &

Physiotherapy

15000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

1510 S13 4A.S13.17098 4A.S13.17098 : Management of Mediastinitis /

mediastinal bleeding40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

S13 4A.S13.17098A 4A.S13.17098A : Management of Mediastinitis /

mediastinal bleeding40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

S6 4A.S6.00010B 4A.S6.00010B : Chest injury with one fracture of long

bone (with implants) - cross speciality 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

S6 4A.S6.00011B 4A.S6.00011B : Chest injury with fracture of 2 or

more long bones - cross speciality 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

S6 4A.S6.17029B 4A.S6.17029B : Inter costal drainage (icd) one side -

cross speciality 8000 X-ray X-ray

S6 4A.S6.17030B 4A.S6.17030B : Inter costal drainage

(icd)bilateral (flail chest) - cross speciality 11000 X-ray X-ray

S6 4A.S6.17031B

4A.S6.17031B : Inter costal drainage

(icd)bilateral (flail chest) with icu stay - cross

speciality

12000 X-ray X-ray

S6 4A.S6.17032B

4A.S6.17032B : Inter costal drainage

(icd)bilateral (flail chest) with icu stay with ventilator -

cross speciality

14000 X-ray X-ray

S1 4A.S1.00251A 4A.S1.00251A : AV Shunt for dialysis - cross

speciality 7500 Duplex

Clinical photos showing the AV

fistula

S1 4A.S1.00251B 4A.S1.00251B : AV Shunt for dialysis - cross



fistula

1511 M7 4A.M7.00001 4A.M7.00001 : Emergency with stable

cardiopulmonary status 750 Clincal notes, Chest X-ray/CT Clincal notes, Chest X-ray/CT

EMERGENCY ROOM


Sl. no.Speciality


1512 M7 4A.M7.00002 4A.M7.00002 : Emergency consultation: acute colic,

high fever, cut, stitches, soft tissue injury, FB removal750 Clincal notes Clincal notes

1513 M7 4A.M7.00003

4A.M7.00003 : Single bone fracture plaster,

nebulization for asthmatic attack, moderate

dehydration, hypoglycaemia in a diabetic, Dengue

without complication, Syncope, Food poisoning etc

750X Ray film with report, clinical note,

Blood examination

X Ray film with report, clinical note,

Blood examination

1514 M7 4A.M7.00004 4A.M7.00004 : Animal bites (Payment after

completion of 5th dose)1275 Clinical examination Clinical examination

1515 S2 4A.S2.00026 4A.S2.00026 : Removal of foreign body from ear 488 Clinical Photograph, Otoscopic findings Procedure Notes

1516 S2 4A.S2.00037 4A.S2.00037 : Fracture - setting nasal bone 3750X Ray film with report with report with

reportPNSX Ray

1517 S2 4A.S2.00045 4A.S2.00045 : Radical fronto ethmo sphenodectomy 11625 X-Ray PNS,CT scan of sinuses CT scan of sinuses

1518 S2 4A.S2.00069 4A.S2.00069 : Peritonsillor abscess under LA 1125 Clinical Photograph Clinical Photograph

S13 4A.S13.00061A 4A.S13.00061A : Foreign Body Removal with scope -

cross speciality15000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE

1519 M7 4A.M7.17256 4A.M7.17256 : Drowning 3000 Clinical Notes Clinical Notes

1520 M7 4A.M7.17257 4A.M7.17257 : Injuries caused while operating

agricultural equipments3000 Clinical Notes Clinical Notes

1521 M1 4A.M1.00006 4A.M1.00006 : Pneumothroax - routine ward 1350Clinical Notes with relevant


M1 4A.M1.00006A 4A.M1.00006A : Pneumothroax - HDU 2025Clinical Notes with relevant


M1 4A.M1.00006B 4A.M1.00006B : Pneumothroax - ICU without

ventilator 2700



M1 4A.M1.00006C 4A.M1.00006C : Pneumothroax - ICU with ventilator 3375Clinical Notes with relevant


1522 M1 4A.M1.00007 4A.M1.00007 : Accelerated hypertension - routine

ward 1350



M1 4A.M1.00007A 4A.M1.00007A : Accelerated hypertension - HDU 2025Clinical Notes with relevant


M1 4A.M1.00007B 4A.M1.00007B : Accelerated hypertension - ICU




M1 4A.M1.00007C 4A.M1.00007C : Accelerated hypertension - ICU with

ventilator 3375



1523 M1 4A.M1.00012 4A.M1.00012 : Acutre excaberation of COPD -

routine ward 1350



ENT

GENERAL EMERGENCY

GENERAL MEDICINE

Sl. no.Speciality


M1 4A.M1.00012A 4A.M1.00012A : Acutre excaberation of COPD - HDU 2025Clinical Notes with relevant


M1 4A.M1.00012B 4A.M1.00012B : Acutre excaberation of COPD - ICU




M1 4A.M1.00012C 4A.M1.00012C : Acutre excaberation of COPD - ICU




1524 M1 4A.M1.00020 4A.M1.00020 : Acute excaberation of ILD - routine

ward 1350 clinical notes, USG abdomen clinical notes

M1 4A.M1.00020A 4A.M1.00020A : Acute excaberation of ILD - HDU 2025 clinical notes, USG abdomen clinical notes

M1 4A.M1.00020B 4A.M1.00020B : Acute excaberation of ILD - ICU

without ventilator 2700 clinical notes, USG abdomen clinical notes

M1 4A.M1.00020C 4A.M1.00020C : Acute excaberation of ILD - ICU with

ventilator 3375 clinical notes, USG abdomen clinical notes

1525 M1 4A.M1.00023 4A.M1.00023 : Snake bite - routine ward 1350 Clinical notes, photo of bite mark Treatment Notes

M1 4A.M1.00023A 4A.M1.00023A : Snake bite - HDU 2025 Clinical notes, photo of bite mark Treatment Notes

M1 4A.M1.00023B 4A.M1.00023B : Snake bite - ICU without ventilator 2700 Clinical notes, photo of bite mark Treatment Notes

M1 4A.M1.00023C 4A.M1.00023C : Snake bite - ICU with ventilator 3375 Clinical notes, photo of bite mark Treatment Notes

1526 M1 4A.M1.00024 4A.M1.00024 : Acute organophosphorus poisoning -

routine ward 1350



M1 4A.M1.00024A 4A.M1.00024A : Acute organophosphorus poisoning

- HDU2025



M1 4A.M1.00024B 4A.M1.00024B : Acute organophosphorus poisoning

- ICU without ventilator 2700



M1 4A.M1.00024C 4A.M1.00024C : Acute organophosphorus poisoning

- ICU with ventilator 3375



1527 M1 4A.M1.00025 4A.M1.00025 : Other poisoning - routine ward 1350Clinical Notes with relevant


M1 4A.M1.00025A 4A.M1.00025A : Other poisoning - HDU 2025Clinical Notes with relevant


M1 4A.M1.00025B 4A.M1.00025B : Other poisoning - ICU without

ventilator 2700



M1 4A.M1.00025C 4A.M1.00025C : Other poisoning - ICU with

ventilator 3375



1528 M1 4A.M1.00030 4A.M1.00030 : Seizures - routine ward 1350 EEG EEG

M1 4A.M1.00030A 4A.M1.00030A : Seizures - HDU 2025 EEG EEG

M1 4A.M1.00030B 4A.M1.00030B : Seizures - ICU without ventilator 2700 EEG EEG

M1 4A.M1.00030C 4A.M1.00030C : Seizures - ICU with ventilator 3375 EEG EEG

1529 M1 4A.M1.00035 4A.M1.00035 : Viral encephalitis - routine ward 1350 Clinical notes, CT Clinical notes, CT

M1 4A.M1.00035A 4A.M1.00035A : Viral encephalitis - HDU 2025 Clinical notes, CT Clinical notes, CT

Sl. no.Speciality


M1 4A.M1.00035B 4A.M1.00035B : Viral encephalitis - ICU without

ventilator 2700 Clinical notes, CT Clinical notes, CT

M1 4A.M1.00035C 4A.M1.00035C : Viral encephalitis - ICU with

ventilator 3375 Clinical notes, CT Clinical notes, CT

1530 M1 4A.M1.00044 4A.M1.00044 : Type 1/2 respiratory failure - routine

ward 1350



M1 4A.M1.00044A 4A.M1.00044A : Type 1/2 respiratory failure - HDU 2025Clinical Notes with relevant


M1 4A.M1.00044B 4A.M1.00044B : Type 1/2 respiratory failure - ICU




M1 4A.M1.00044C 4A.M1.00044C : Type 1/2 respiratory failure - ICU




1531 M1 4A.M1.00045 4A.M1.00045 : Acute asthmatic attack - routine ward 1350Clinical Notes with relevant


M1 4A.M1.00045A 4A.M1.00045A : Acute asthmatic attack - HDU 2025Clinical Notes with relevant


M1 4A.M1.00045B 4A.M1.00045B : Acute asthmatic attack - ICU




M1 4A.M1.00045C 4A.M1.00045C : Acute asthmatic attack - ICU with

ventilator 3375



1532 M1 4A.M1.00046 4A.M1.00046 : Acutre excaberation of COPD 0Clinical Notes with relevant


1533 M1 4A.M1.00049 4A.M1.00049 : Hypertensive emergencies - routine

ward 1350 Clinical notes Clinical notes

M1 4A.M1.00049A 4A.M1.00049A : Hypertensive emergencies - HDU 2025 Clinical notes Clinical notes

M1 4A.M1.00049B 4A.M1.00049B : Hypertensive emergencies - ICU


M1 4A.M1.00049C 4A.M1.00049C : Hypertensive emergencies - ICU


1534 M1 4A.M1.00050 4A.M1.00050 : Dengue hemorrhagic fever/Dengue

shock syndrome - routine ward 1350 clinical notes, Blood examination report


report

M1 4A.M1.00050A 4A.M1.00050A : Dengue hemorrhagic fever/Dengue

shock syndrome - HDU2025 clinical notes, Blood examination report


report

M1 4A.M1.00050B 4A.M1.00050B : Dengue hemorrhagic fever/Dengue

shock syndrome - ICU without ventilator 2700 clinical notes, Blood examination report


report

M1 4A.M1.00050C 4A.M1.00050C : Dengue hemorrhagic fever/Dengue

shock syndrome - ICU with ventilator 3375 clinical notes, Blood examination report


report

1535 M1 4A.M1.00051 4A.M1.00051 : Complicated malaria - routine ward 1350Clinical Notes with relevant


M1 4A.M1.00051A 4A.M1.00051A : Complicated malaria - HDU 2025Clinical Notes with relevant


Sl. no.Speciality


M1 4A.M1.00051B 4A.M1.00051B : Complicated malaria - ICU without

ventilator 2700



M1 4A.M1.00051C 4A.M1.00051C : Complicated malaria - ICU with

ventilator 3375



1536 M1 4A.M1.00052 4A.M1.00052 : Heat stroke - routine ward 1350Clinical Notes with relevant


M1 4A.M1.00052A 4A.M1.00052A : Heat stroke - HDU 2025Clinical Notes with relevant


M1 4A.M1.00052B 4A.M1.00052B : Heat stroke - ICU without ventilator 2700Clinical Notes with relevant


M1 4A.M1.00052C 4A.M1.00052C : Heat stroke - ICU with ventilator 3375Clinical Notes with relevant


1537 M1 4A.M1.00053 4A.M1.00053 : Hyperosmolar Non-Ketotic coma -

routine ward 1350



M1 4A.M1.00053A 4A.M1.00053A : Hyperosmolar Non-Ketotic coma -

HDU2025



M1 4A.M1.00053B 4A.M1.00053B : Hyperosmolar Non-Ketotic coma -




M1 4A.M1.00053C 4A.M1.00053C : Hyperosmolar Non-Ketotic coma -




1538 M1 4A.M1.00054 4A.M1.00054 : Cerebrovascular accident - routine

ward 1350



M1 4A.M1.00054A 4A.M1.00054A : Cerebrovascular accident - HDU 2025Clinical Notes with relevant


M1 4A.M1.00054B 4A.M1.00054B : Cerebrovascular accident - ICU




M1 4A.M1.00054C 4A.M1.00054C : Cerebrovascular accident - ICU with

ventilator 3375



1539 M1 4A.M1.00055 4A.M1.00055 : Severe sepsis/Septic shock - routine

ward 1350



M1 4A.M1.00055A 4A.M1.00055A : Severe sepsis/Septic shock - HDU 2025Clinical Notes with relevant


M1 4A.M1.00055B 4A.M1.00055B : Severe sepsis/Septic shock - ICU




M1 4A.M1.00055C 4A.M1.00055C : Severe sepsis/Septic shock - ICU




1540 M1 4A.M1.00056 4A.M1.00056 : Upper GI bleeding (conservative) -

routine ward 1350



M1 4A.M1.00056A 4A.M1.00056A : Upper GI bleeding (conservative) -

HDU 2025



M1 4A.M1.00056B 4A.M1.00056B : Upper GI bleeding (conservative) -




M1 4A.M1.00056C 4A.M1.00056C : Upper GI bleeding (conservative) -




Sl. no.Speciality


1541 M1 4A.M1.00059 4A.M1.00059 : Immune mediated CNS disorders

such as autoimmune encephalitis - routine ward 1350 Clinical notes Clinical notes

M1 4A.M1.00059A 4A.M1.00059A : Immune mediated CNS disorders

such as autoimmune encephalitis - HDU2025 Clinical notes Clinical notes

M1 4A.M1.00059B

4A.M1.00059B : Immune mediated CNS disorders

such as autoimmune encephalitis - ICU without

ventilator


M1 4A.M1.00059C

4A.M1.00059C : Immune mediated CNS disorders

such as autoimmune encephalitis - ICU with

ventilator


1542 M1 4A.M1.00060 4A.M1.00060 : Acute transverse myelitis - routine

ward 1350 Clinical notes Clinical notes

M1 4A.M1.00060A 4A.M1.00060A : Acute transverse myelitis - HDU 2025 Clinical notes Clinical notes

M1 4A.M1.00060B 4A.M1.00060B : Acute transverse myelitis - ICU


M1 4A.M1.00060C 4A.M1.00060C : Acute transverse myelitis - ICU with

ventilator 3375 Clinical notes Clinical notes

1543 M1 4A.M1.00064

4A.M1.00064 : AKI/ renal failure(dialysis payable

separately as an add on package for ) - routine

ward



M1 4A.M1.00064A 4A.M1.00064A : AKI/ renal failure(dialysis payable

separately as an add on package for ) - HDU2025



M1 4A.M1.00064B

4A.M1.00064B : AKI/ renal failure(dialysis payable

separately as an add on package for ) - - ICU

without ventilator



M1 4A.M1.00064C

4A.M1.00064C : AKI/ renal failure(dialysis payable

separately as an add on package for ) - - ICU with

ventilator



1544 M1 4A.M1.00065 4A.M1.00065 : Status epilepticus - routine ward 1350 Clinical Notes Clinical Notes

M1 4A.M1.00065A 4A.M1.00065A : Status epilepticus - HDU 2025 Clinical Notes Clinical Notes

M1 4A.M1.00065B 4A.M1.00065B : Status epilepticus - ICU without

ventilator 2700 Clinical Notes Clinical Notes

M1 4A.M1.00065C 4A.M1.00065C : Status epilepticus - ICU with


1545 M1 4A.M1.00066 4A.M1.00066 : Status asthmaticus - routine ward 1350 Clinical Notes Clinical Notes

M1 4A.M1.00066A 4A.M1.00066A : Status asthmaticus - HDU 2025 Clinical Notes Clinical Notes

M1 4A.M1.00066B 4A.M1.00066B : Status asthmaticus - ICU without


Sl. no.Speciality


M1 4A.M1.00066C 4A.M1.00066C : Status asthmaticus - ICU with


1546 M1 4A.M1.00067

4A.M1.00067 : Respiratory failure due to any cause

(pneumonia, asthma, COPD, ARDS, foreign body,

poisoning, head injury etc.) - routine ward

1350 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest

M1 4A.M1.00067A

4A.M1.00067A : Respiratory failure due to any cause


poisoning, head injury etc.) - HDU


M1 4A.M1.00067B

4A.M1.00067B : Respiratory failure due to any cause


poisoning, head injury etc.) - ICU without ventilator


M1 4A.M1.00067C

4A.M1.00067C : Respiratory failure due to any cause


poisoning, head injury etc.) - ICU with ventilator


1547 S1 4A.S1.00085 4A.S1.00085 : Intestinal perforation 6750 X-Ray of abdomen/CT (Upright position) Scar photo

1548 S1 4A.S1.00093 4A.S1.00093 : Closure of Hollow Viscus Perforation 9375 X Ray abdomen ,USG Scar photo

1549 S1 4A.S1.00144 4A.S1.00144 : Volvlous of Large Bowel 18750 CT Scan Scar photo

1550 S1 4A.S1.00204 4A.S1.00204 : Congenital Atresia & Stenosis of Small

Intestine82500 USG/ CT OT Notes, Scar Photo

1551 S1 4A.S1.00251 4A.S1.00251 : AV Shunt for dialysis 5625 DuplexClinical photos showing the AV

fistula

S6 4A.S6.00008A

4A.S6.00008A : Visceral injury requiring surgical

intervention along with fixation of fracture of single

long bone. - cross speciality

22500 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

S6 4A.S6.17029A 4A.S6.17029A : Inter costal drainage (icd) one side -

cross speciality 6000 X-ray X-ray

S6 4A.S6.17030A 4A.S6.17030A : Inter costal drainage

(icd)bilateral (flail chest) - cross speciality 8250 X-ray X-ray

S6 4A.S6.17031A

4A.S6.17031A : Inter costal drainage

(icd)bilateral (flail chest) with icu stay - cross

speciality

9000 X-ray X-ray

S6 4A.S6.17032A

4A.S6.17032A : Inter costal drainage

(icd)bilateral (flail chest) with icu stay with ventilator -

cross speciality

10500 X-ray X-ray

S6 4A.S6.17033A 4A.S6.17033A : Blunt injury abdomen with icu stay -

cross speciality 9000 USG USG

GENERAL SURGERY

Sl. no.Speciality


S6 4A.S6.17034A 4A.S6.17034A : Supra pubic cystostomy in fracture

pelvis - cross speciality 6000 X-ray X-ray

S6 4A.S6.00009A

4A.S6.00009A : Visceral injury requiring surgical

intervention along with fixation of fracture of 2 or

more long bones. - cross speciality


1552 M2 4A.M2.00005 4A.M2.00005 : Acute Exacerbation of asthma -

routine ward1350



M2 4A.M2.00005A 4A.M2.00005A : Acute Exacerbation of asthma -

HDU2025



M2 4A.M2.00005B 4A.M2.00005B : Acute Exacerbation of asthma - ICU




M2 4A.M2.00005C 4A.M2.00005C : Acute Exacerbation of asthma - ICU




1553 M2 4A.M2.00009 4A.M2.00009 : Febrile seizures/other seizures -


M2 4A.M2.00009A 4A.M2.00009A : Febrile seizures/other seizures -


M2 4A.M2.00009B 4A.M2.00009B : Febrile seizures/other seizures - ICU


M2 4A.M2.00009C 4A.M2.00009C : Febrile seizures/other seizures - ICU


1554 M2 4A.M2.00010 4A.M2.00010 : Epileptic encephalopathy - routine


M2 4A.M2.00010A 4A.M2.00010A : Epileptic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00010B 4A.M2.00010B : Epileptic encephalopathy - ICU


M2 4A.M2.00010C 4A.M2.00010C : Epileptic encephalopathy - ICU with


1555 M2 4A.M2.00012 4A.M2.00012 : Aseptic meningitis - routine ward 1350Clinical Notes with relevant


M2 4A.M2.00012A 4A.M2.00012A : Aseptic meningitis - HDU 2025Clinical Notes with relevant


M2 4A.M2.00012B 4A.M2.00012B : Aseptic meningitis - ICU without

ventilator 2700



M2 4A.M2.00012C 4A.M2.00012C : Aseptic meningitis - ICU with

ventilator 3375



1556 M2 4A.M2.00017 4A.M2.00017 : Unexplained seizures - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00017A 4A.M2.00017A : Unexplained seizures - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00017B 4A.M2.00017B : Unexplained seizures - ICU without



Sl. no.Speciality


M2 4A.M2.00017C 4A.M2.00017C : Unexplained seizures - ICU with


1557 M2 4A.M2.00027 4A.M2.00027 : Pyogenic meningitis - routine ward 1350Clinical Notes with relevant


M2 4A.M2.00027A 4A.M2.00027A : Pyogenic meningitis - HDU 2025Clinical Notes with relevant


M2 4A.M2.00027B 4A.M2.00027B : Pyogenic meningitis - ICU without

ventilator 2700



M2 4A.M2.00027C 4A.M2.00027C : Pyogenic meningitis - ICU with

ventilator 3375



1558 M2 4A.M2.00030 4A.M2.00030 : Dengue - routine ward 1350 CBC

M2 4A.M2.00030A 4A.M2.00030A : Dengue - HDU 2025 CBC

M2 4A.M2.00030B 4A.M2.00030B : Dengue - ICU without ventilator 2700 CBC

M2 4A.M2.00030C 4A.M2.00030C : Dengue - ICU with ventilator 3375 CBC

1559 M2 4A.M2.00035 4A.M2.00035 : Tuberculosis - routine ward 1350 CBC, CT CBC,CT

M2 4A.M2.00035A 4A.M2.00035A : Tuberculosis - HDU 2025 CBC, CT CBC,CT

M2 4A.M2.00035B 4A.M2.00035B : Tuberculosis - ICU without ventilator 2700 CBC, CT CBC,CT

M2 4A.M2.00035C 4A.M2.00035C : Tuberculosis - ICU with ventilator 3375 CBC, CT CBC,CT

1560 M2 4A.M2.00048 4A.M2.00048 : Encephalitis - routine ward 1350 CT CT

M2 4A.M2.00048A 4A.M2.00048A : Encephalitis - HDU 2025 CT CT

M2 4A.M2.00048B 4A.M2.00048B : Encephalitis - ICU without ventilator 2700 CT CT

M2 4A.M2.00048C 4A.M2.00048C : Encephalitis - ICU with ventilator 3375 CT CT

1561 M2 4A.M2.00051 4A.M2.00051 : Refractory seizures - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00051A 4A.M2.00051A : Refractory seizures - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00051B 4A.M2.00051B : Refractory seizures - ICU without


M2 4A.M2.00051C 4A.M2.00051C : Refractory seizures - ICU with


1562 M2 4A.M2.00052 4A.M2.00052 : Floppy infant - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00052A 4A.M2.00052A : Floppy infant - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00052B 4A.M2.00052B : Floppy infant - ICU without


M2 4A.M2.00052C 4A.M2.00052C : Floppy infant - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

1563 M2 4A.M2.00053 4A.M2.00053 : Acute neuroregression - routine


M2 4A.M2.00053A 4A.M2.00053A : Acute neuroregression - HDU 2025 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 4A.M2.00053B 4A.M2.00053B : Acute neuroregression - ICU without


M2 4A.M2.00053C 4A.M2.00053C : Acute neuroregression - ICU with


1564 M2 4A.M2.00055 4A.M2.00055 : Opsoclonus myoclonus syndrome -


M2 4A.M2.00055A 4A.M2.00055A : Opsoclonus myoclonus syndrome -


M2 4A.M2.00055B 4A.M2.00055B : Opsoclonus myoclonus syndrome -


M2 4A.M2.00055C 4A.M2.00055C : Opsoclonus myoclonus syndrome -


1565 M2 4A.M2.00056 4A.M2.00056 : Acute ataxia - routine ward 1350 Clinical examination Clinical examination

M2 4A.M2.00056A 4A.M2.00056A : Acute ataxia - HDU 2025 Clinical examination Clinical examination

M2 4A.M2.00056B 4A.M2.00056B : Acute ataxia - ICU without


M2 4A.M2.00056C 4A.M2.00056C : Acute ataxia - ICU with ventilator 3375 Clinical examination Clinical examination

1566 M2 4A.M2.00057 4A.M2.00057 : Steven Johnson syndrome - routine


M2 4A.M2.00057A 4A.M2.00057A : Steven Johnson syndrome - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00057B 4A.M2.00057B : Steven Johnson syndrome - ICU


M2 4A.M2.00057C 4A.M2.00057C : Steven Johnson syndrome - ICU


1567 M2 4A.M2.00059 4A.M2.00059 : Ketogenic diet initiation in refractory

epilepsy - routine ward1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00059A 4A.M2.00059A : Ketogenic diet initiation in

refractory epilepsy - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00059B 4A.M2.00059B : Ketogenic diet initiation in

refractory epilepsy - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 4A.M2.00059C 4A.M2.00059C : Ketogenic diet initiation in

refractory epilepsy - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

1568 M2 4A.M2.00060 4A.M2.00060 : Inborn errors of metabolism - routine


M2 4A.M2.00060A 4A.M2.00060A : Inborn errors of metabolism - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00060B 4A.M2.00060B : Inborn errors of metabolism - ICU


M2 4A.M2.00060C 4A.M2.00060C : Inborn errors of metabolism - ICU


Sl. no.Speciality


1569 M2 4A.M2.00067 4A.M2.00067 : Acute kidney injury - routine ward 1350CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine

R/E, LFT,Lipid Profile

CBC,RFT,USG

Abd,HIV,HBsAg,HCV,Urine R/E,

LFT,Lipid Profile

M2 4A.M2.00067A 4A.M2.00067A : Acute kidney injury - HDU 2025CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine


CBC,RFT,USG


LFT,Lipid Profile

M2 4A.M2.00067B 4A.M2.00067B : Acute kidney injury - ICU without

ventilator 2700

CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine


CBC,RFT,USG


LFT,Lipid Profile

M2 4A.M2.00067C 4A.M2.00067C : Acute kidney injury - ICU with

ventilator 3375



CBC,RFT,USG


LFT,Lipid Profile

1570 M2 4A.M2.00068 4A.M2.00068 : Poisonings - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00068A 4A.M2.00068A : Poisonings - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00068B 4A.M2.00068B : Poisonings - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

M2 4A.M2.00068C 4A.M2.00068C : Poisonings - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

1571 M2 4A.M2.00069 4A.M2.00069 : Serious trauma with unstable vitals -

routine ward1350 X-ray

M2 4A.M2.00069A 4A.M2.00069A : Serious trauma with unstable vitals -

HDU2025 X-ray

M2 4A.M2.00069B 4A.M2.00069B : Serious trauma with unstable vitals -

ICU without ventilator 2700 X-ray

M2 4A.M2.00069C 4A.M2.00069C : Serious trauma with unstable vitals -

ICU with ventilator 3375 X-ray

1572 M2 4A.M2.00074 4A.M2.00074 : Complicated malaria - routine ward 1350Clinical Notes with relevant


M2 4A.M2.00074A 4A.M2.00074A : Complicated malaria - HDU 2025Clinical Notes with relevant


M2 4A.M2.00074B 4A.M2.00074B : Complicated malaria - ICU without

ventilator 2700



M2 4A.M2.00074C 4A.M2.00074C : Complicated malaria - ICU with

ventilator 3375



1573 M2 4A.M2.00075 4A.M2.00075 : Severe dengue with shock - routine


M2 4A.M2.00075A 4A.M2.00075A : Severe dengue with shock - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00075B 4A.M2.00075B : Severe dengue with shock - ICU


M2 4A.M2.00075C 4A.M2.00075C : Severe dengue with shock - ICU


1574 M2 4A.M2.00078 4A.M2.00078 : Acute encephalitic syndrome -


Sl. no.Speciality


M2 4A.M2.00078A 4A.M2.00078A : Acute encephalitic syndrome - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00078B 4A.M2.00078B : Acute encephalitic syndrome - ICU


M2 4A.M2.00078C 4A.M2.00078C : Acute encephalitic syndrome - ICU


1575 M2 4A.M2.00079 4A.M2.00079 : Acute demyelinating myelopathy -


M2 4A.M2.00079A 4A.M2.00079A : Acute demyelinating myelopathy, -


M2 4A.M2.00079B 4A.M2.00079B : Acute demyelinating myelopathy, -


M2 4A.M2.00079C 4A.M2.00079C : Acute demyelinating myelopathy, -


1576 M2 4A.M2.00080 4A.M2.00080 : Immune mediated CNS disorders

such as autoimmune encephalitis - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00080A 4A.M2.00080A : Immune mediated CNS disorders

such as autoimmune encephalitis - HDU2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00080B

4A.M2.00080B : Immune mediated CNS disorders

such as autoimmune encephalitis - ICU without

ventilator


M2 4A.M2.00080C

4A.M2.00080C : Immune mediated CNS disorders

such as autoimmune encephalitis - ICU with

ventilator


1577 M2 4A.M2.00081 4A.M2.00081 : Acute transverse myelitis - routine


M2 4A.M2.00081A 4A.M2.00081A : Acute transverse myelitis - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00081B 4A.M2.00081B : Acute transverse myelitis - ICU


M2 4A.M2.00081C 4A.M2.00081C : Acute transverse myelitis - ICU with


1578 M2 4A.M2.00082 4A.M2.00082 : Guillain Barre Syndrome - routine

ward 1350 Clinical examination Clinical examination

M2 4A.M2.00082A 4A.M2.00082A : Guillain Barre Syndrome - HDU 2025 Clinical examination Clinical examination

M2 4A.M2.00082B 4A.M2.00082B : Guillain Barre Syndrome - ICU

without ventilator 2700 Clinical examination Clinical examination

M2 4A.M2.00082C 4A.M2.00082C : Guillain Barre Syndrome - ICU with


1579 M2 4A.M2.00085 4A.M2.00085 : Cerebral malaria - routine ward 1350 CBC, CT CBC, CT

M2 4A.M2.00085A 4A.M2.00085A : Cerebral malaria - HDU 2025 CBC, CT CBC, CT

Sl. no.Speciality


M2 4A.M2.00085B 4A.M2.00085B : Cerebral malaria - ICU without

ventilator 2700 CBC, CT CBC, CT

M2 4A.M2.00085C 4A.M2.00085C : Cerebral malaria - ICU with

ventilator 3375 CBC, CT CBC, CT

1580 M2 4A.M2.00086 4A.M2.00086 : Acute ischemic stroke - routine ward 1350Clinical Notes with relevant


M2 4A.M2.00086A 4A.M2.00086A : Acute ischemic stroke - HDU 2025Clinical Notes with relevant


M2 4A.M2.00086B 4A.M2.00086B : Acute ischemic stroke - ICU without

ventilator 2700



M2 4A.M2.00086C 4A.M2.00086C : Acute ischemic stroke - ICU with

ventilator 3375



1581 M2 4A.M2.00088

4A.M2.00088 : Respiratory failure due to any causes

(pneumonia, asthma, foreign body, poisoning, head

injury etc.) - routine ward



M2 4A.M2.00088A

4A.M2.00088A : Respiratory failure due to any

causes (pneumonia, asthma, foreign body,

poisoning, head injury etc.) - HDU



M2 4A.M2.00088B

4A.M2.00088B : Respiratory failure due to any


poisoning, head injury etc.) - ICU without ventilator



M2 4A.M2.00088C

4A.M2.00088C : Respiratory failure due to any


poisoning, head injury etc.) - ICU with ventilator



1582 M2 4A.M2.00089 4A.M2.00089 : Acute transverse myelitis 0 Clinical note with Lab reports Treatment note

1583 M2 4A.M2.00090 4A.M2.00090 : Acute encephalitis

–infectious/immune-mediated - routine ward1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00090A 4A.M2.00090A : Acute encephalitis

–infectious/immune-mediated - HDU2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00090B

4A.M2.00090B : Acute encephalitis

–infectious/immune-mediated - ICU without

ventilator


M2 4A.M2.00090C 4A.M2.00090C : Acute encephalitis

–infectious/immune-mediated - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

1584 M2 4A.M2.00091 4A.M2.00091 : Convulsive & non convulsive status

epilepticus - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00091A 4A.M2.00091A : Convulsive & non convulsive status

epilepticus - HDU2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00091B 4A.M2.00091B : Convulsive & non convulsive status

epilepticus - ICU without ventilator 2700 Clinical note with Lab reports Treatment note

Sl. no.Speciality


M2 4A.M2.00091C 4A.M2.00091C : Convulsive & non convulsive status

epilepticus - ICU with ventilator 3375 Clinical note with Lab reports Treatment note

1585 M2 4A.M2.00092 4A.M2.00092 : Cerebral herniation - routine ward 1350 Clinical note with Lab reports Treatment note

M2 4A.M2.00092A 4A.M2.00092A : Cerebral herniation - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00092B 4A.M2.00092B : Cerebral herniation - ICU without


M2 4A.M2.00092C 4A.M2.00092C : Cerebral herniation - ICU with


1586 M2 4A.M2.00093 4A.M2.00093 : Intracranial hemorrhage - routine

ward 1350



M2 4A.M2.00093A 4A.M2.00093A : Intracranial hemorrhage - HDU 2025Clinical Notes with relevant


M2 4A.M2.00093B 4A.M2.00093B : Intracranial hemorrhage - ICU




M2 4A.M2.00093C 4A.M2.00093C : Intracranial hemorrhage - ICU with

ventilator 3375



1587 M2 4A.M2.00094 4A.M2.00094 : Hepatic encephalopathy - routine


M2 4A.M2.00094A 4A.M2.00094A : Hepatic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00094B 4A.M2.00094B : Hepatic encephalopathy - ICU


M2 4A.M2.00094C 4A.M2.00094C : Hepatic encephalopathy - ICU with


1588 M2 4A.M2.00095 4A.M2.00095 : Complicated bacterial meningitis -


M2 4A.M2.00095A 4A.M2.00095A : Complicated bacterial meningitis -


M2 4A.M2.00095B 4A.M2.00095B : Complicated bacterial meningitis -


M2 4A.M2.00095C 4A.M2.00095C : Complicated bacterial meningitis -


1589 M2 4A.M2.00096 4A.M2.00096 : Raised intracranial pressure - routine


M2 4A.M2.00096A 4A.M2.00096A : Raised intracranial pressure - HDU 2025 Clinical note with Lab reports Treatment note

M2 4A.M2.00096B 4A.M2.00096B : Raised intracranial pressure - ICU


M2 4A.M2.00096C 4A.M2.00096C : Raised intracranial pressure - ICU


1590 M2 4A.M2.00097 4A.M2.00097 : Hypertensive encephalopathy -


Sl. no.Speciality


M2 4A.M2.00097A 4A.M2.00097A : Hypertensive encephalopathy -


M2 4A.M2.00097B 4A.M2.00097B : Hypertensive encephalopathy - ICU


M2 4A.M2.00097C 4A.M2.00097C : Hypertensive encephalopathy - ICU


1591 M2 4A.M2.00098 4A.M2.00098 : CRRT (per session) 6000 Clinical note with Lab reports Treatment note

1592 M2 4A.M2.17175 4A.M2.17175 : Medical Management of Acute Renal

Failure With Dialysis in Paediatric patients1125 CBC, RFT CBC, RFT

1593 M3 4A.M3.00001

4A.M3.00001 : 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)


1594 M3 4A.M3.00010

4A.M3.00010 : Ventriculoperitoneal Shunt Surgery

(VP) or Omaya Reservoir or External Drainage for

Hydrocephalus

20250 CT Report CT Report, Scar Photo, X Ray

1595 S14 4A.S14.00027 4A.S14.00027 : Intussusception – Operative in

infants22500 USG OT notes

1596 S14 4A.S14.17126 4A.S14.17126 : Airway Reconstruction for benign

conditions37500 Endoscopic Picture OT notes

1597 S14 4A.S14.17127 4A.S14.17127 : Anorectal Malformations Stage 1 26250 USG OT notes

1598 S14 4A.S14.17128 4A.S14.17128 : Paediatric intestinal obstruction

>1month48750 USG OT notes

1599 S14 4A.S14.17129 4A.S14.17129 : Laparotomy for peritonitis 37500 USG OT notes, Scar Picture

1600 S14 4A.S14.17130 4A.S14.17130 : Omphalocele-Major/Gastroschisis 52500 USG OT notes

1601 S14 4A.S14.17131 4A.S14.17131 : Exstropy Bladder Stage 1 60000 USG OT notes

1602 S14 4A.S14.17137 4A.S14.17137 : Bronchoscospy for foreign body

removal18750 X Ray OT Notes/ X Ray

1603 S14 4A.S14.17140 4A.S14.17140 : Bowel resection and anastomosis 41250 USG OT notes

Sl. no.Speciality


S1 4A.S1.00204A 4A.S1.00204A : Congenital Atresia & Stenosis of

Small Intestine - cross speciality 82500 USG/ CT OT Notes, Scar Photo

1604 S8 4A.S8.00002 4A.S8.00002 : Burr hole 13500 CT Report CT Report, Scar Photo

1605 S8 4A.S8.00012 4A.S8.00012 : Haematoma - Brain (head injuries)

(including pre and post Op. CT)45000 CT Report , X Ray

OT Notes, CT Report, Clinical

Photograph

1606 S8 4A.S8.00051 4A.S8.00051 : Twist Drill Craniostomy 11250 CT report Film and scar photo

1607 S8 4A.S8.00058 4A.S8.00058 : Abscess Tapping multiple 15000 CT reportPost Op CT Report,film and scar

photo

1608 S8 4A.S8.00059 4A.S8.00059 : Excision of Brain Abscess 37500 CT report Post Op CT Report and film, Clinical


1609 S8 4A.S8.00062 4A.S8.00062 : External Ventricular Drainage (EVD)

including antibiotics11250 CT report



1610 S8 4A.S8.17056 4A.S8.17056 : Craniotomy and Evacuation of

Haematoma -Extradural *37500 CT Report CT Report, Scar Photo, X Ray

S6 4A.S6.00006A

4A.S6.00006A : Craniotomy and evacuation of

Haematoma – subdural/Extra dural along with

fixation of fracture of single long bone - cross

speciality

45000 CT Report , X RayOT Notes, CT Report, Clinical

Photograph

S6 4A.S6.00007A

4A.S6.00007A : Craniotomy and evacuation of


fixation of fracture of 2 or more long bone. - cross

speciality


Photograph

S6 4A.S6.00012A

4A.S6.00012A : Emergency tendons repair ±

Peripheral Nerve repair/ reconstructive surgery -

cross speciality

22500 X-ray Films/ Clinical Picture Clinical photo showing Scar

S6 4A.S6.17036A 4A.S6.17036A : Head injury with icu (conservative)) -

cross speciality5250 CT Clinical photo with treatment notes

S6 4A.S6.17037A 4A.S6.17037A : Head injury with icu stay (with

ventilator)11250 CT Clinical photo with treatment notes

S6 4A.S6.17038A 4A.S6.17038A : Head injury with minimal surgical

intervention - cross speciality 18750 CT

Clinical/scar photo with treatment

notes

1611 S4 4A.S4.00036 4A.S4.00036 : High risk delivery: Pre-mature delivery 6750 USG and clinical notes Delivery note/OT note

1612 S4 4A.S4.00037 4A.S4.00037 : High risk delivery: Expected Gestation

at delivery less than 35 weeks6750 USG and clinical notes Delivery note/OT note

1613 S4 4A.S4.00038 4A.S4.00038 : High risk delivery: Mothers with

eclampsia or imminent eclampsia6750 USG and clinical notes Delivery note/OT note

1614 S4 4A.S4.00039 4A.S4.00039 : High risk delivery: Obstructed labour 6750 USG and clinical notes Delivery note/OT note

NEUROSURGERY


Sl. no.Speciality


1615 S4 4A.S4.00040

4A.S4.00040 : High risk delivery: Major Fetal

malformation requiring intervention immediately

after birth

6750 USG and clinical notes Delivery note/OT note

1616 S4 4A.S4.00041 4A.S4.00041 : High risk delivery: Mothers with severe

anaemia (<7 g/dL)6750 USG, Lab report and clinical notes Delivery note/OT note

1617 S4 4A.S4.00042

4A.S4.00042 : 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.

6750 USG, Lab report and clinical notes Delivery note/OT note

1618 S4 4A.S4.00043 4A.S4.00043 : Manual removal of placenta 3188 Clinical Notes/USG Clinical Notes

1619 S4 4A.S4.00052 4A.S4.00052 : Trans-vaginal tape/ Trans-obturator

tape11250

APTT(activated partial thromboplastin

time) , Heamatocrit , PT (Prothrombin

time), Platelet Count , S.Fibrinogen Level

, USG

Clinical Photograph of Retroplacental

clots , USG

1620 S4 4A.S4.00059 4A.S4.00059 : Broad Ligment Haemotoma drainage 5738 Clinical Notes, Ultrasonography OT Notes

1621 S4 4A.S4.17017

4A.S4.17017 : Abruptio-Placenta With Coagulation

Defects( Disseminated Intravascular Coagulation

(DiC))

18750

Arterial Blood Gas (ABG),APTT(activated

partial thromboplastin

time),CHE,LFT,RFT,Haematocrit, platelet

count, S fibrogen

Biochemical investigations

1622 S4 4A.S4.17018 4A.S4.17018 : Perforation of Uterus after D/E

laprotomy and closure9563 Clinical Notes, Ultrassonography OT Notes

1623 S15 4A.S15.00021 4A.S15.00021 : Tracheostomy 3750 Clinical photo Clinical photo

1624 M5 4A.M5.17224 4A.M5.17224 : IV antibiotics and other supportive

therapy For Febrile Neutropenia (Per episode)7500 Haemogram for each episode

Clinical Photograph, Discharge

summary (with details of drugs

given)

1625 S5 4A.S5.00035

4A.S5.00035 : Debridement & Closure of Major

injuries - contused lacerated wounds (anti-biotic +

dressing) - minimum of 3 sessions

5250 Clinical Notes + X-Rays Clinical Notes + X-Rays

1626 S5 4A.S5.00044 4A.S5.00044 : Fasciotomy 11250complete blood count,clinical

photographScar photo

1627 S5 4A.S5.00064 4A.S5.00064 : Open Reduction Internal Fixation (2

Small Bones)9000 X-ray X-ray

S6 4A.S6.00008C

4A.S6.00008C : Visceral injury requiring surgical




S6 4A.S6.00010A 4A.S6.00010A : Chest injury with one fracture of long

bone (with implants) - cross speciality 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

ONCOLOGY

ORTHOPAEDICS

Sl. no.Speciality


S6 4A.S6.00011A 4A.S6.00011A : Chest injury with fracture of 2 or

more long bones - cross speciality 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

S6 4A.S6.00012C

4A.S6.00012C : Emergency tendons repair ±


cross speciality


S6 4A.S6.17028B 4A.S6.17028B : Deglove injury of extremities - cross

speciality 9000

complete blood count,clinical

photograph, X ray of affected partScar photo

S6 4A.S6.00009C

4A.S6.00009C : Visceral injury requiring surgical




S6 4A.S6.00012B

4A.S6.00012B : Emergency tendons repair ±


cross speciality


S6 4A.S6.17028A 4A.S6.17028A : Deglove injury of extremities - cross

speciality 9000

complete blood count,clinical


1628 S6 4A.S6.00006

4A.S6.00006 : Craniotomy and evacuation of


fixation of fracture of single long bone


Photograph

1629 S6 4A.S6.00007

4A.S6.00007 : Craniotomy and evacuation of


fixation of fracture of 2 or more long bone.


Photograph

1630 S6 4A.S6.00008

4A.S6.00008 : Visceral injury requiring surgical


long bone.


1631 S6 4A.S6.00009

4A.S6.00009 : Visceral injury requiring surgical


more long bones.


1632 S6 4A.S6.00010 4A.S6.00010 : Chest injury with one fracture of long

bone (with implants)26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

1633 S6 4A.S6.00011 4A.S6.00011 : Chest injury with fracture of 2 or more

long bones26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY

1634 S6 4A.S6.00012 4A.S6.00012 : Emergency tendons repair ±

Peripheral Nerve repair/ reconstructive surgery22500 X-ray Films/ Clinical Picture Clinical photo showing Scar

1635 S6 4A.S6.17028 4A.S6.17028 : Deglove injury of extremities 9000complete blood count,clinical


1636 S6 4A.S6.17029 4A.S6.17029 : Inter costal drainage (icd) one side 6000 X-ray X-ray

1637 S6 4A.S6.17030 4A.S6.17030 : Inter costal drainage (icd)bilateral (flail

chest)8250 X-ray X-ray


chest) with icu stay9000 X-ray X-ray


POLYTRAUMA

Sl. no.Speciality



chest) with icu stay with ventilator10500 X-ray X-ray

1640 S6 4A.S6.17033 4A.S6.17033 : Blunt injury abdomen with icu stay 9000 USG USG

1641 S6 4A.S6.17034 4A.S6.17034 : Supra pubic cystostomy in fracture

pelvis 6000 X-ray X-ray

1642 S6 4A.S6.17035 4A.S6.17035 : Spine injuries - with ct/mri 5250 CT/MRI CT/MRI

1643 S6 4A.S6.17036 4A.S6.17036 : Head injury with icu (conservative)) 5250 CT Clinical photo with treatment notes

1644 S6 4A.S6.17037 4A.S6.17037 : Head injury with icu stay (with

ventilator)11250 CT Clinical photo with treatment notes

1645 S6 4A.S6.17038 4A.S6.17038 : Head injury with minimal surgical

intervention18750 CT

Clinical/scar photo with treatment

notes

S1 4A.S1.00085A 4A.S1.00085A : Intestinal perforation - cross

speciality 6750 X-Ray of abdomen/CT (Upright position) Scar photo

S1 4A.S1.00093A 4A.S1.00093A : Closure of Hollow Viscus Perforation -

cross speciality 9375 X Ray abdomen ,USG Scar photo

S1 4A.S1.00144A 4A.S1.00144A : Volvlous of Large Bowel - cross

speciality 18750 CT Scan Scar photo

S6 4A.S6.00008B

4A.S6.00008B : Visceral injury requiring surgical




S6 4A.S6.17033B 4A.S6.17033B : Blunt injury abdomen with icu stay -

cross speciality 9000 USG USG

S6 4A.S6.00009B

4A.S6.00009B : Visceral injury requiring surgical




1646 S7 4A.S7.00071

4A.S7.00071 : Bladder injury repair (only to be used

if done as a part of ongoing laparotomy/other

surgery)

15000Endoscopy with film, biopsy, CT report

with film


HPE report

1647 S7 4A.S7.00082 4A.S7.00082 : Suprapubic Drainage - Closed/Trocar 1500 RGU,MCU RGU,MCU

1648 S7 4A.S7.00158 4A.S7.00158 : Emergency management of Acute

retention of Urine1500 USG Doctors Note + X-ray

1649 S7 4A.S7.00160 4A.S7.00160 : Urinary tract trauma – open surgery

(exploratory)7500



CBC,RFT,USG


LFT,Lipid Profile

UROLOGY


Sl. no.Speciality


1650 S7 4A.S7.17047

4A.S7.17047 : Acutekidney injury with hemodialysis,

inclusive of pre-op inv,post -op inv,procedure

cost,ICU/wards stay,and medication for 15 days

18750CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine


CBC,RFT,USG


LFT,Lipid Profile

S1 4A.S1.00251C 4A.S1.00251C : AV Shunt for dialysis - cross



fistula

S6 4A.S6.17034B 4A.S6.17034B : Supra pubic cystostomy in fracture

pelvis - cross speciality 6000 X-ray X-ray

Note:

• Empanelled hospitals should upload basic investigations conducted in each patient - routine investigations like haemotology, bio-chemical, histopathological, micro biological, radiological

films and reports and USG reports for arriving at the diagnosis and clinical notes, provisional diagnosis, planned treatment procedure, and the code selected from the procedure list mandatorily

for preauthorization

• Procedures mentioned as cross speciality can be done by specialities under which they have been included in addition to the main speciality.

• Codes mentioned as * are sub procedures which are a part of the main procedure. Case specific procedure to be selected accordingly and cannot be clubbed with the main procedure.

• Scar photos or certain clinical photographs which involves patient private parts need not be furnished at the time of preauth/claims.

3A.M4.00035#, 3A.M4.00035A#, 3A.M4.00035B# - Bone tumors/soft tissue sarcomas : surgery (inlcuding prosthesis) - Comprehensive package includes surgery, invoice, irradiation and mega

prothesis/custom made prothesis. The code is designed for limb salvage in sarcoma cases which are detected early and have a good prognosis. The design is for neo-adjuvant chemotherapy to

reduce the activity, local irradiation followed by surgical excision of the tumour. The CAD of the prosthesis requires sometime and normally being taken on the second stage of surgery. The

approvals are to be given in staged manner with the first approval for neo-adjuvant chemotherapy with appropriate drugs and the cost as per the chemo packages of AB-ArK, second for the

local irradiation as per the cost per cycle of irradiation factored in the packages, third for the surgical excision of the tumour as per the surgical package and fourth for the implantation of mega

prosthesis or custom designed prosthesis as per the cost within the limit of package and finally the follow of treatment of chemo, radio and follow up treatment. The treatment packages are

provided under code - 3A.M4.00033, 3A.M4.00034, 3A.S15.00045 & 3A.M4.00036. The whole package should not exceed the rates prescribed under 3A.M4.00035, 3A.M4.00035A,

3A.M4.00035B

3A.M6.00006 : Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) (Radical/Adjuvant/Neoadjuvent) - Hospitals needs to produce AERB Certificate of Linear

Acceleration, Cone Beam CT fitted in machine or tracking device with variable. Package includes planning and execution. Additional CBCT report log print to be submitted during claim

submission.

Oncology codes where in supportive care/rehabilitation is mentioned: Comprehensive package which includes treatment for Neutropenia, septicaemia and nutritional support along with

antibiotics, oral supplements with counselling. In case of relapse CT is recommended.

benefit packages of ayushman bharat - arogya …arogya.karnataka.gov.in/sast/details/benefit... ·...

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