government hospitals package rate list...lft,rft, fbs,ppbs, t3,t4,ths, endometrial biopsy , cervical...

Sl. No Procedure Name

Arogya

Karnataka

Code

Package

Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations

1 Sequestrectomy 2B.1 7313 2435 X Ray film with report X Ray film with report

2 Drainage of parotid abscess 2B.2 5250 2982 X Ray film with report X Ray film with report, Clinical Photograph

3 Fixation of fracture of jaw including implants 2B.3 7500 2321 X Ray film with report X Ray film with report

4 Tumour excision 2B.4 5625 2436X Ray film with report,Clinical

Photograph,X Ray film with report, Clinical Photograph

5 Excision of mandible 2B.5 9000 61 X Ray film with report X Ray film with report, Clinical Photograph

6 Repair of parotid duct 2B.6 11250 39 X Ray film with report X Ray film with report, Clinical Photograph

7 Condylectomy 2B.7 1125 NA X Ray film with report X Ray film with report, Clinical Photograph

8 Fistula closure 2B.8 263 2313 X Ray film with report X Ray film with report, Clinical Photograph

9 Treatment of malocclusion through wiring 2B.9 6000 2447X Ray film with report,Clinical

Photograph,Clinical Photograph

10 Peadiatric caries (Full mouth) 2B.10 3750 NAX Ray film with report,Clinical

Photograph,X Ray film with report/Clinical Photograph

11 Management of puerperal sepsis 2B.11 4125 NA

Ultrasonography, X Ray, ECG,

LFT,RFT, FBS,PPBS,

T3,T4,THS,Routine investigation

Clinical Notes

12 Threatened rupture Uterus With Tubectomy 2B.13 8438 737 Clinical Notes OT notes

13 Lap. Salphingo-oophorectomy 2B.14 7500 688 USG, CA 125 HPE

14 Lap. Assisted Vaginal Hysterectomy (LAVH) 2B.15 8625 710


LFT,RFT, FBS,PPBS, T3,T4,THS/

Endometrial Biopsy/Cervical biopsy

HPR,OT notes

15 Lap. Total Abdominal Hysterectomy 2B.16 8625 711Ultrasonography, X Ray, ECG,

LFT,RFT, FBS,PPBS, T3,T4,THSHPR,OT notes

16Vaginal Hysterectomy With Pelvic Floor Repair

(Cystocele, Rectocele & Perineorraphy)2B.17 11250 709


LFT,RFT, FBS,PPBS, T3,T4,THS,

Endometrial biopsy , Cervical biopsy

Ultrasonography

17 Laparoscopic Ovarian Cystectomy 2B.18 6000 685 USG, Routine investigations and CA 125 HPE

Government hospitals package rate list

Complex Secondary Healthcare TreatmentsDENTAL

OBSTETRICS AND GYNAECOLOGY


Arogya

Karnataka

Code

Package


18 Laparoscopic Ectopic Resection 2B.19 9450 804Serum Beta HCG, USG, CBC, Routine

investigationOT notes

19 Laparoscopic Myomectomy 2B.20 9000 717 Ultrasonography/ Tubal patency test HPE, OT notes

20 Laparoscopic Sling Operations 2B.21 10425 712 Clinical Notes, USG OT Notes

21Vesico vaginal Fistula/recto vaginal fistula-

Repair2B.22 10500 775

Clinical Notes, USG/KUB/Urology

opinionOT notes

22 Tuboplasty 2B.23 7125 741Ultrasonography, X Ray, ECG,

LFT,RFT, FBS,PPBS, T3,T4,THSOT Notes

23 Vulvectomy 2B.24 6750 770 Clinical Notes, USG/CT/MRI OT Notes, HPE

24 Shirodhkar Mc. Donalds stitch 2B.25 2100 824 Clinical Notes OT Notes

25Gestational [pregnancy-induced] hypertension

with significant proteinuria2B.26 563/day 2601

Clinical Notes with relevant

investigationsTreatment Notes

26 Low Forceps/Vaccum delivery 2B.27 4125 791, 790 Clinical Notes Delivery notes

27Chest injuries with intercostal drainage (ICD)

unilateral2B.28 6000 16 17 X-ray X-ray

28 Amputation-Forearm 2B.29 13500 911 X-ray X-ray

29 Amputation-Wrist Axillary Node Dissection 2B.30 9000 912 X-ray X-ray

30 Amputation-Arm 2B.31 13500 930 X-ray X-ray

31 Amputation-Thigh 2B.32 15000 929 X-ray X-ray

32Maysers muscle pedicle graft for Non-union

fracture neck femur (orthroplasty)2B.33 15000 1027 X Ray film with report X Ray film with report

33 Facio-Maxillary Injury repairs & fixations 2B.34 11250 2401 X-RAY/CT scan Clinical Photograph showing scar + post op.

XRAY

34 Decompression and Stabilization with Steffiplate 2B.35 15000 1015 X Ray film with report X Ray film with report

35 Harrington Instrumentation 2B.36 11250 1066 X Ray film with report X Ray film with report

36 Leg Lengthening 2B.37 11250 1044 Clinical Photograph Scar Photo, Clinical Photograph

37 Nerve Transplant/Release 2B.38 10125 955 Clinical Photograph, MRI, Clinical Notes Clinical Photograph showing scar

38

Simple frame -Single bone-

femur,tibia,humerus,radius including six schanz

pins,1 rod and 6 clamps implant

2B.39 15750 1061 X Ray film with report X Ray film with report, Scar Photo

ORTHOPAEDICS


Arogya

Karnataka

Code

Package


39Pelvis/transarticular including implants

Procedure 2B.40 13800 2385 X Ray film with report X Ray film with report, Scar Photo

40 Soft Tissue Reconstruction Procedures For Joints 2B.41 5400 980 MRI Clinical photograph

41Anterior instrumentations + Cage fixations

including implants procedure 2B.42 22500 1006 X-ray X-ray

42 Anterolateral Clearance For Tuberculosis 2B.43 13500 1001 MRI X Ray film with report, Clinical Photograph

43 Cervical Rib Excision 2B.44 10725 64 MRI X Ray film with report, Clinical Photograph

44 Long bone (two) external/internal fixation 2B.45 22500

1032,1029,862

,863,864,1073,

1061, 1051

X-RAY/CT scan(If Required) Post-operative X-ray, Clinical Photograph

showing scar

45 Pelvic injuries external/Internal fixation 2B.46 15000 2385 X Ray film with report X Ray film with report

46Arthroscopic Anterior cruciate ligament (ACL)

Reconstruction2B.47 14250 971 MRI MRI

47Posterior cruciate ligament (PCL)

Reconstruction2B.48 13275 972 MRI MRI

48 Discectomy-Dorso Lumbar 2B.49 19110 1902 Clinical findings, MRI Report Clinical photograph showing scar

49 Discectomy-Lumbar 2B.50 18600 1902 Clinical findings, MRI Report Clinical photograph showing scar

50 Lumbar Laminectomy (no discectomy) 2B.51 13500 1857 CT/MRI reportClinical Photographs showing scar + X-ray-

Lumbar Spine

51Closed fracture reduction under anaesthesia for

first and additional fracture2B.52 3000 858, 859 X-ray X-ray, scar photo

52Simple/compound fracture with internal/external

fixation along with implants 2B.53 15750 1051 X-ray X-ray, scar photo, Invoice of implants

53 Blunt injury abdomen 2B.54 7500 NA USG USG

54 Surgery for GI Bleeding Ulcers 2B.55 15000 1152 Endoscopy Endoscopy Picture

55 Lap. Adhesiolysis 2B.56 9750 1257 CT , X-Ray Abdomen HPR , Clinical photograph

56 Resection & Anastomosis Of Small Intestine 2B.57 13500 113 CT , X-Ray Abdomen HPR , Clinical photograph

57Operations For Recurrent Intestinal Obstruction

(Noble Plication Other)2B.58 11250 112 CT-Contrast HPR , Clinical photograph

SURGICAL GASTRO ENTEROLOGY


Arogya

Karnataka

Code

Package


58Upper GI Therapeutic(including Varicose

Intervention)2B.59 1500 2844 Endoscopy Endoscopy

59

Endoscopic Retrograde Cholangio

Pancreatography (Endoscopic Retrograde

Cholangio Pancreatography (ERCP) with

Interventions

2B.60 3000 1224 Liver function test (LFT), USG Liver function test (LFT), USG

60 Plane / Anterior Vitrectomy 2B.61 3675 491 Slit lamp findings Clinical notes

61Vitrectomy - Membrane Peeling - Endolaser -

Silicon oil or Gas - with or without belt buckling2B.62 9000 492 Indirect Opthalmoscopy report

62 Vitrectomy - Membrane Peeling- Endolaser 2B.63 9375 493 Indirect Opthalmoscopy report Fundus Photograph

63 Vitrectomy Plus Silicon Oil Or Gas 2B.64 9375 494 Indirect Opthalmoscopy report Clinical Photograph

64 Removal Of Silicon Oil Or Gas 2B.65 2625 495 B Scan, Fundus Photograph B Scan, Fundus Photograph

65 Scleral buckle procedure for retinal detachment 2B.66 7500 497 B Scan , Fundus Photograph Fundus Photograph

66 Intraocular foreign body removal with vitrectomy 2B.67 5775 528 B Scan Report Clinical Photograph

67 Socket Reconstruction 2B.68 4125 507 Clinical Photograph Clinical Photograph

68 Dermis Fat Graft 2B.69 3675 508 Clinical Photograph Clinical Photograph

69 Orbitotomy 2B.70 4950 509 Clinical Photograph Clinical Photograph

70 Decompression/Excision of optic nerve lesions 2B.71 10125 511, 1893 CT , MRI Clinical Photograph

71 Proptosis,orbitotomy 2B.72 6000 1889, 509 CT/MRI Clinical Photograph

72

Paediatric Opthalmic treatment---

Photocoagulation For Retinopathy Of

Prematurity upto 3 sittings (complete package)

2B.73 6375 499 Fundoscopy Report Fundoscopy Report

73Photocoagulation for Retinopathy for 3 sittings-

Complete package2B.74 1500 498 Fundoscopy Report Clinical Photograph

74 Laser treatment for Retinopathy one sitting 2B.75 990 498 Fundoscopy Report Clinical Photograph

75Pan retinal photocoagulation (PRP)/ FOCAL /

GRID / YAG /Laser per eye for one sitting 2B.76 750 498 Fundoscopy Report Clinical Photograph

OPHTHALMOLOGY


Arogya

Karnataka

Code

Package


76PRP / FOCAL / GRID / YAG / Laser per eye for

three sitting2B.77 2250 498 Fundoscopy Report Clinical Photograph

77PRP / FOCAL / GRID / YAG / Laser for both

eyes one sitting2B.78 2250 498 Fundoscopy Report Clinical Photograph

78PRP / FOCAL / GRID / YAG /Laser for both

eyes three sitting 2B.79 6750 498 Fundoscopy Report Clinical Photograph

79 Radial Keratotomy 2B.80 3375 533 Refratcive power Refratcive power

80Cauterisation of ulcer/subconjuctival injection -

both eye2B.81 225 538 Clinical Photograph Clinical Photograph

81Cauterisation of ulcer/subconjuctival injection -

One eye2B.82 150 539 Clinical Photograph Clinical Photograph

82Anterior Chamber Reconstruction +Cataract –

Unilateral2B.83 6563 519, 503 Clinical Note / slit lamp report Clinical Note / slit lamp report

83 Trabeculectomy + Vitrectomy 2B.84 6300 624, 491 Clinical Note / Slit lamp report Clinical Note / Slit lamp report

84Anterior Chamber Reconstruction +Perforating

Corneo - Scleral Injury2B.85 6900 519, 488 Clinical Note / Slit lamp report Clinical Note / Slit lamp report

85 Therapeutic Penetrating Keratoplasty 2B.86 2475 484 B Scan Report Clinical Photograph

86 Lamellar Keratoplasty 2B.87 2475 560 B Scan Report Clinical Photograph

87 Corneal Patch Graft 2B.88 3750 485 Clinical Photograph Clinical Photograph

88 Scleral Patch Graft 2B.89 6000 NA Clinical Photograph Clinical Photograph

89 Double Z-Plasty 2B.90 3000 486 Clinical Photograph Clinical Photograph

90Cataract surgery with anterior vitrectomy with

Intraocular Lens (IOL) 2B.91 2625 503, 491 A Scan Report Clinical Photograph

91 Enucleation (Incl. of implant) 2B.92 6000 609 CT Skull , Clinical Photograph , Orbit Clinical Photograph

92 Rectus Muscle Surgery (Single) 2B.93 4125 513 Clinical Photograph Clinical Photograph

93 Rectus Muscle Surgery (Two/Three) 2B.94 8250 515 Clinical Photograph Clinical Photograph

94 Oblique Muscle 2B.95 8250 514 Clinical Photograph Clinical Photograph

95 Lid Reconstruction Surgery 2B.96 3375 516 Clinical Photograph Clinical Photograph

96 Ptosis 2B.97 825 600 Clinical Photograph Clinical Photograph

97 Trabeculectomy (Glaucoma surgery) 2B.98 2475 624 Intraocular Pressure reading Clinical Photograph

98DCR ( Dacryocystorhinostomy)

Endoscopic/Laser2B.99 5625 566 Lacrimal Syringing Report Clinical Photograph


Arogya

Karnataka

Code

Package


99Paediatric Cataract Surgery (Phacoemulsification-

Iol Under General Anaesthesia)2B.100 7800 505

Slit lamp Examination report

&Fundoscopy Fundus Photograph

100Glaucoma Filtering Surgery For Paediatric

Glaucoma2B.101 6375 506 Intraocular Pressure reading Clinical Photograph

101Scleral fixation Intraocular Lens (IOL) with

cataract surgery2B.102 6000 654 A Scan Report Clinical Photograph

102Pupilloplasty with cataract surgery with

Intraocular Lens (IOL)2B.103 4500 680 A Scan Report Clinical Photograph

103 Iridodyalisis repair 2B.104 4500 657 Slit lamp examination report Clinical Photograph

104 Iridodyalisis repair with Intraocular Lens (IOL) 2B.105 6750 657, 680 Slit lamp examination report Clinical Photograph

105 Repair of globe rupture 2B.106 7500 NA Slit lamp examination report Clinical Photograph

106 Iridectomy 2B.107 6375 535 Clinical Note / slit lamp report Clinical Note / Slit lamp report

107Pterygium + Conjunctival Autograft +Glaucoma

surgery (trabeculectomy)2B.108 5363 525, 624 Clinical Photograph Clinical Photograph

108Abscess Drainage of Lid +Cryoretinopexy -

Closed2B.109 3938 517 Clinical Photograph Clinical Photograph


Arogya

Karnataka

Code

Package


109 Operation for Double Ureter 2B.110 11813 1730 IVP/CT KUB with Contrast Scar Photo

110 Pyelolithotomy 2B.111 10125 1572 IVP/CT KUB with Contrast Scar Photo

111 Excision of Urethral Caruncle 2B.112 3750 834 Clinical Notes Clinical Photograph

112 Urachal Cyst 2B.113 3000 1629 USG/CT KUB HPR

113 Acute tubulo-interstitial nephritis 2B.114 563/day 2609Clinical Notes with relevant


114 Styloidectomy - Both side 2B.115 5625 458X Ray Skull Lateral View film with

report X Ray Skull Lateral View film with report

115 Styloidectomy - One side 2B.116 5625 459X Ray Skull Lateral View film with


116 Tonsillectomy + Styloidectomy 2B.117 9375 460X Ray Skull Lateral View film with


117 Rhinosporosis 2B.118 5250 455 X Ray Nasopharynx film with report HPR

118 Septo-rhinoplasty 2B.119 4950 456 X Ray PNS film with report Clinical Photograph

119 Laryngofissure 2B.120 2625 399 USG Neck USG

120 Parotidectomy - Conservative 2B.121 525040, 41, 42,

1987USG HPR

121

Excision of Pinna for Growths (Squamous/Basal)

Injuries - Total Amputation & Excision of

External Auditory Meatus and Reconstruction

2B.122 6375 385, 387, 388 Clinical Photograph HPR/Clinical photograph

122 Oro Antral fistula 2B.123 7500 414 Fistulogram/Clinical photograph Clinical Photograph

123 Commando Operation ( glossectomy) 2B.124 1050047, 49, 48,

1985, 1986CT Skull, HPE Clinical Photograph

124 Cortical Mastoidectomy 2B.125 4688 362, 363X-ray manastoidis , Pure Tone

Audiometry Report X-Ray Mastoids

125 Radical / Modified Radical Mastoidectomy 2B.126 6525 363CT Temporal Bone , Pure Tone

Audiometry Report X-Ray Mastoids

126 Myringoplasty 2B.127 3750 367 Pure Tone Audiometry Report, Pure Tone Audiometry Report

127 Ossiculoplasty 2B.128 5625 373Pure Tone Audiometry Report and

Impedance Audiometry Report

Pure Tone Audiometry Report and Impedance

Audiometry Report

UROLOGY

ENT


Arogya

Karnataka

Code

Package


128 Myringotomy - Bilateral 2B.129 1875 369Pure Tone Audiometry Report and



Audiometry Report

129 Myringotomy - Unilateral 2B.130 1425 370Pure Tone Audiometry Report and



Audiometry Report

130 Myringotomy with Grommet - One ear 2B.131 2325 371Pure Tone Audiometry Report and



Audiometry Report

131 Myrinogotomy with Grommet - Both ear 2B.132 2813 372Pure Tone Audiometry Report and



Audiometry Report

132 Stapedectomy 2B.133 6000 378Pure Tone Audiometry Report and


Clinical Photograph With Piston , Pure Tone

Audiometry Report

133Functional Endoscopic Sinus Surgery (FESS)

Unilateral2B.134 6900 437, 464

CT PNS , Direct Nasal Endoscopic Photo

graph Endoscopy Photo

134Functional Endoscopic Sinus Surgery (FESS)

Bilateral2B.135 9000 437, 464

CT PNS , Direct Nasal Endoscopic Photo

graph Endoscopy Photo

135 Excision Of Benign Tumour Nose 2B.136 4688 320CT PNS , Direct Nasal Endoscopic Photo

graphHPE

136 Microlaryngeal Surgery 2B.137 8250 397 Endoscopy Photo Endoscopy Photo

137 Phono Surgery For Vocal Cord Paralysis 2B.138 14063 398 CT-Scan / MRI Scan/Endo photo Clinical Photograph, Endo Picture

138 Uvulo-Palato-Pharyngoplasty. 2B.139 8250 405 Polysomnography Clinical Photograph

139 Partial amputation and reconstruction of Pinna 2B.140 2250 374 Clinical Photograph Clinical Photograph

140 Tympanoplasty+ Ossiculoplasty 2B.141 6000 376, 373CT Mastoid, Pure Tone Audiometry

ReportPure Tone Audiometry Report

141 Ant. Ethmoidal artery ligation 2B.142 9270 434 CT PNS Clinical Photograph

142 Antrostomy – Bilateral 2B.143 4875 429 CT PNS Clinical Photograph

143 Antrostomy – Unilateral 2B.144 3375 430 CT PNS Clinical Photograph

144 Caldwell - luc – Bilateral 2B.145 6000 431 CT PNS Clinical Photograph

145 Caldwell - luc- Unilateral 2B.146 3450 432 CT PNS Clinical Photograph

146 Cryosurgery(Nose) 2B.147 5400 435 DNE Photo DNE Photo

147Septoplasty + Functional endoscopic sinus

surgery (FESS) / polypectomy2B.148 7875 437

X Ray film with report with report with

reportPNSEndo Picture, HPR

148 Ethmoidectomy - External 2B.149 6900 439, 450 CT PNS Endo Picture, HPR


Arogya

Karnataka

Code

Package


149 Fracture - setting maxilla 2B.150 6563

2281,2282,

2283, 2284,

2285, 2286,

2287

X Ray film with report with report with

reportPNSX Ray PNS

150 Pharyngeal diverticulum's – Excision 2B.151 9000 413 USG Neck USG

151 Excision of Cystic Hygroma 2B.152 4500 73, 74, 75 USG HPR

152 Microlaryngoscopic Surgery 2B.153 9375 397 DL scopy findings HPE, Clinical Notes, Scar Photo

153Laryngectomy & Pharyngeal Diverticulum

(Throat)2B.154 7500 413 CT Neck,USG

X Ray film with report, Clinical

Photograph,HPE

154 Laryngectomy with Block Dissection (Throat) 2B.155 9000 68 CT Neck,USGX Ray film with report, Clinical

Photograph,HPE

155 Drainage of Subdiaphramatic Abscess 2B.156 6000 287 USG/Clinical Notes Scar photo

156 Duplication of Intestine 2B.157 12750 125 USG Scar Photo

157 Mesenteric Caval Anastomosis 2B.158 7500 310 CT abdomen/USG OT NOtes

158 Endoscopic mucosal resection 2B.159 1163 1201 Clinical Notes Investigation Report

159 Duodenal stricture dilation 2B.160 743 1212 Clinical Notes Investigation Report

160 Colonic stenting 2B.161 1875 1220 Clinical Notes Investigation Report

161 Endoscopic sphincterotomy 2B.162 1800 1226 Clinical Notes Investigation Report

162 Common bile duct (CBD) stricture dilatation 2B.163 4388 1228 CT CT

163 Biliary stenting (plastic and metallic) 2B.164 3600 1229 Clinical Notes Investigation Report

164 Endoscopic cysto gastrostomy 2B.165 6038 1235 Clinical Notes Investigation Report

165 Balloon dilatation of papilla 2B.166 4650 1236 Clinical Notes Investigation Report

166 Parotid Duct Repair 2B.167 5625 39 Silography, Routine Blood Inv Silography

167 Parathyroidectomy 2B.168 10125 34 USG, Routine Blood Investigations HPR , Clinical photograph

168 Lap. Hiatus Hernia Repair Abdominal 2B.169 15000 214 Clinical photograph, Routine Blood Inv Clinical photograph

169 Rare Hernias (Spigalion,Obuturator,Sciatic) 2B.170 11250 215USG Abdomen , UGI Endoscopy,

Routine Blood Inv. Endoscopy picture

170Arteriovenous (AV) Malformation of Soft Tissue

Tumour - Excision2B.171 15000 274 Clinical Photograph Scar photo

171Distal Pancrcatectomy with Pancreatico

Jejunostomy2B.172 12750 1192, 1194 USG Scar photo

172 Diverticulectomy 2B.173 11250 1491 USG Scar photo

GENERAL SURGERY


Arogya

Karnataka

Code

Package


173 Lap. Hydatid of liver surgery 2B.174 13500 174 USG Clinical Photograph

174 Laproscopic Adrenalectomy 2B.175 22500 38 USG Clinical Photograph

175 Laproscopic Appendicectomy 2B.176 7500 194 USG USG

176 Laproscopic Colostomy 2B.177 12750 NA USG Clinical Photograph

177 Laproscopic cystogastrostomy 2B.178 11250 183 USG Clinical Photograph

178 Laproscopic donor Nephrectomy 2B.179 22500 1577 CT CT

179 Laproscopic Gastrostomy 2B.180 7875 90 USG Clinical Photograph

180 Laproscopic Pyelolithotomy 2B.181 11250 1573 USG Clinical Photograph

181 Laproscopic Pyloromyotomy 2B.182 9375 89 USG Clinical Photograph

182 Laproscopic Spleenectomy 2B.183 9000 1142 USG Clinical Photograph

183 Laproscopic Thyroidectomy 2B.184 9000 27 USG Clinical Photograph

184 Laproscopic umbilical hernia repair 2B.185 9000 208 USG Clinical Photograph

185 Laproscopic ureterolithotomy 2B.186 10500 1758 USG Clinical Photograph

186 Laprotomy-peritonitis lavage and drainage 2B.187 5250 827 USG/X Ray Scar photo

187 Ligation of Ankle Perforators 2B.188 7875 333 Doppler OT Notes

188Lymphatics Excision of Subcutaneous Tissues In

Lymphoedema2B.189 6000 2241 Clinical Photograph Clinical Photograph

189 Coccygeal Teratoma Excision 2B.190 11475 1566 Clinical Photograph Clincial Nortes, photo

190 Drainage of perinephric abscess 2B.191 5625 1652 USG Scar photo

191 Thorax ( penetrating wounds) 2B.192 7500 1412 X Ray film with report Clinical Photograph

192 Trendelenburg Operation 2B.193 7875 332 Clinical notes Clinical Photograph

193 Fibroadenoma Breast - Multiple 2B.194 4875 293, 294 FNAC, USG, Routine Blood Inv HPR

194 Lap. Rectopexy 2B.195 13500 150 Clinical photograph Clinical photograph

195 Hemimandibulectomy 2B.196 8250 60X Ray film with report, Routine Blood

InvX Ray film with report

196 Segmental Mandible Excision 2B.197 11250 61X Ray film with report, Routine Blood

InvX Ray film with report

197 Lap. Ventral And Scar Hernia (Non incl. Mesh) 2B.198 13500 209Clinical photograph , USG, Routine

Blood Inv Clinical photograph

198 Lap. Inguinal Hernia Repair (Non incl. Mesh)-

Unilateral2B.199 11250 220, 1523

Clinical photograph , USG, Routine

Blood InvClinical photograph

199 Appendicular Perforation 2B.200 9000 195 USG, Routine Blood Inv HPR , Clinical photograph

200 Duodenal / Gastric Perforation 2B.201 15000 92, 93 USG, Routine Blood Inv HPR , Clinical photograph


Arogya

Karnataka

Code

Package


201Resection & Anastomosis Of Small

Intestine(includes ileostomy)2B.202 8438 113 Endoscopy , USG , X-Ray Abdomen HPR , Clinical photograph

202 Colectomy(Right,Left,SubTotal) includes

colostomy2B.203 12750 130 Endoscopy , USG , X-Ray Abdomen HPR , Clinical photograph

203 Lap.Cholecystectomy 2B.204 9000 177 CT , LFT , USG HPR, Clinical photograph , USG

204 Cholecystectomy & Exploration Cbd 2B.205 10125 178 CT , LFT , USG HPR, Clinical photograph , USG

205 Ileostomy 2B.206 13125 1165, 1166 Biopsy , Endoscopy , USG Clinical photograph

206 Colostomy Closure 2B.207 9375 132 Barium , CT , Endoscopy , USG Clinical photograph

207 Bleeding Ulcer - Gastrectomy 2B.208 15000 88 Endoscopy Scar photo, HPR

208 Drainage Pericardial Effusion 2B.209 8250 2733, 2723 X Ray film with report X Ray film with report

209 Duodenal Diverticulum 2B.210 11250 94 USG/CT Scan Scar Photo

210 Excision Benign Tumor -Small intestine 2B.211 11250 117 USG HPE Report

211 Excision Mammary Fistula 2B.212 4125 233 USG Scar Photo

212 Excision Meckel's Diverticulum 2B.213 11250 118 USG Scar Photo

213 Excision Small Intestinal Fistulla 2B.214 9000 116 USG Scar Photo

214 Gastro jejuno Colic Fistula 2B.215 9375 96 USG Scar Photo

215 Gastrotomy 2B.216 11250 90 USG Clinical Photograph

216 Ilieo Sigmoidostomy 2B.217 9750 138 USG Scar photo

217 Intestinal Perforation (Resection Anastomosis) 2B.218 22500 110 Erect abdomen X Ray/CT Abdomen OT Notes

218 Anorectoplasty 2B.219 10500 152 Clinical Notes OT Notes

219 Oesophagus Portal Hypertension 2B.220 13500 108 USG/MRI OT notes

220 Pelvic Abscess - Open Drainage 2B.221 6000 288 USG Scar Picture

221 Repair of Common Bile Duct 2B.222 9375 na

CT/MRI Abdomen, Endoscopic

Retrograde Cholangio Pancreatography

(ERCP)

OT Notes

222 Abbe Operation 2B.223 5625 51 Clinical photograph Clinical photograph

223 Lap. For intestinal obstruction 2B.224 18750 121 USG Clinical Photograph

224 Lap. Hepatic resection 2B.225 22500 1187 USG Clinical Photograph

225 Drainage of perivertebral abscess 2B.226 5250 2982 USG Clinical Photograph

226 Splenorenal Anastomosis 2B.227 15000 190 CT Abdomen Clinical Notes

227 Thorachostomy 2B.228 7875 2381 Chest X Ray film with report Chest X Ray film with report

228 Thoracoplasty 2B.229 22500 2106 Chest X Ray film with report Chest X Ray film with report


Arogya

Karnataka

Code

Package


229 Cleft lip and palate 2B.230 75002289, 2290,

1461, 1463Clinical Photograph Clinical Photograph

230 Simple mastectomy 2B.231 6750 66 Biopsy ,Clinical Photograph ,

Mammography, FNAC USGBiopsy ,Clinical Photograph

231 Branchial Fistula/Sinus 2B.232 9750 57, 58 CT scan clinical

232 Caecopexy 2B.233 9750 140 USG Scar photo

233 Cavernostomy 2B.234 9750 1764 USG/CT Scan Scar Photo

234 Colocystoplasty 2B.235 11250 133 USG Scar photo

235 Drainage of Peripheral Gastric Abscess 2B.236 6000 285 USG/Clinical Notes Scar photo

236 Duodenal Jejunostomy 2B.237 11250 107 Barrium,USG/CT Scan Scar Photo

237 Excision of Small Growth from Tongue 2B.238 1125 55 Clinical Photograph Clinical Photograph

238 Excision of Swelling in Right Cervial Region 2B.239 3000 65 FNAC HPR

239 Facial Decompression 2B.240 11250 360 EMG, Galvanic Stimulation EMG

240 Gastrojejunostomy 2B.241 11250 86 USG,barrium ( vagotomy to be repeted) Scar Photo, HPE

241 Graham's Operation 2B.242 9375 303 X-ray abdomen/CT, USG USG, Scar Photo

242 Hydatid Cyst of Liver 2B.243 7500 170 USG Scar photo

243 Mesenteric Cyst - Excision 2B.244 6750 309 USG Scar photo

244 Oeshophagoscopy for foreign body removal 2B.245 4500 311 Endoscopy Clinical notes, endo picture

245 Thyroplasty 2B.246 8250 33 CT/MRI Clinical Photograph, OT Notes

246 Vasco Vasostomy 2B.247 8250 256Clinical notes (should have pre-op exam

of vasectomy site)Clinical photo

247 Warren's Shunt 2B.248 11250 191 Endoscopy Endoscopic picture

248 Thymectomy 2B.249 17250 1411 USG Clinical Photograph

249 Resection Enucleation of Adenoma 2B.250 5625 1755 Clinical Photograph Clinical Photograph

250 Rib Resection & Drainage 2B.251 5625 1406 Clinical Photograph Clinical Photograph

251 Tissue Reconstruction Flap Leprosy 2B.252 16500 2362 Clinical Photograph Clinical Photograph

252 Tendon Transfer-Leprosy 2B.253 16500 2961 Clinical Photograph, Clinical Notes Clinical Photograph

253 Bronchial Cyst 2B.254 3750 31 X-ray, CT 0

254 Cystic Mass - Excision 2B.255 3000 280 X-ray, CT 0

255 Splenectomy 2B.256 17250 193 USG Scar photo

256 Removal of Foreign Body from Trachea 2B.257 1875 1204 Clinical phto, endoscopy Clinical phto

257 Thoracocentesis 2B.258 900 1407 X-ray, CT X-ray

258 Urtheral Dilatation 2B.259 375 2961 CT Scan Clinical Photograph


Arogya

Karnataka

Code

Package


259 Varicose veins - injection 2B.260 375 13 Clincial photo Clincial photo

260 cleft lip 2B.261 1875 1461, 2251 Clinical Photograph Clinical Photograph

261 Lung abscess /Empema 2B.262 563/day 2773Clinical Notes with relevant


262 Pneumothorax 2B.263 563/day 2774, Clinical Notes with relevant


263 Porto Caval Anastomosis 2B.264 37500 171 CT 0

264 Acute Pneumonia-/ consolidation Bacterial 2B.265 563/day

2594, 2596,

2598, 2599,

2783



265Gestational [pregnancy-induced] hypertension

without significant proteinuria2B.266 563/day 2600



266 Interstitial lung diseases 2B.267 563/day 2772Clinical Notes with relevant


267Lower respiratory tract infection (LRTI)

management2B.268 563/day 2783



268 Endocarditis 2B.269 563/day2612, 2682,

2724




Arogya

Karnataka

Code

Package


269Conservative management ICU stay with

ventilator 2B.270 2625 2562



270 Epiduro-fluroscopy Adhesiolysis (3 days stay) 2B.271 563/day 818Clinical Notes with relevant


271 Upper GI bleeding ( endoscopic treatment) 2B.272 563/day 1153Clinical Notes with relevant


272

Medical Management of Steroid Resistant

Nephrotic Syndrome Complicated Or Resistant

in Paediatric patients

2B.273 563/day 2643Complete blood count (CBC), Renal

function test (RFT)

Complete blood count (CBC), Renal function test

(RFT)

273 Torticollis release 2B.274 9375 1561 X-ray X-ray

274 Tennis elbow release 2B.275 4500 NA Clinical photograph Clinical photograph of wound

275

Medical Management of Acute Broncho Lobar

pneumonia With Empyema/ Pleural Effusion in

Paediatric patients

2B.276 563/day 2637Clinical Notes with relevant


276

Medical Management of Acute Broncho Lobar

pneumonia With Pyo Pneumothorax in

Paediatric patient



277Medical Management of Auto immune

hemolytic anemia in Paediatric patient2B.278 563/day 2702



278

Medical Management of Congenital Heart

Disease With Congestive Cardiac Failure in

Paediatric patients



279Medical Management of Diphtheria in Paediatric

patient2B.280 563/day 2699



280Medical Management of Enteric Fever

Complicated in Paediatric patient2B.281 563/day 2625



281Medical Management of Guillian-Barre

Syndrome2B.282 563/day 2679



282Medical Management of Neuro Tuberculosis in

Paediatric patient2B.283 563/day 2626



283Medical Management of Stroke Syndrome in





Arogya

Karnataka

Code

Package


284

Medical Management of Urinary Tract Infection

With Complications Like Pyelonephritis And

Renal Failure in Paediatric patient



285Medical Management of Viral Myocarditis in




286 Neonatal Cholestasis 2B.287 563/day 1513Clinical Notes with relevant


287 Severe Pancratitis 2B.288 563/day 2893Clinical Notes with relevant


288 Control of diabetic ketoacidosis 2B.289 11250 2629Clinical Notes with relevant


289Neonatal jaundice management due to other

excessive haemolysis2B.290 563/day 2610



290Neonatal jaundice management from other and

unspecified causes2B.291 563/day 2611



291Medical Management of Acquired Heart Disease

With Congestive Cardiac Failure2B.292 1125/day 2688



292Small Area grafting (upto 10% of body area )

Medium Area grafting (upto 10% to 20%)2B.293 22500 2350 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

293Large Area grafting (greater than 10% > 20% of

body area)2B.294 22500 2350 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

294

Post Burn Contracture surgeries for Functional

Improvement (Package including splints,

pressure garments and physiotherapy)- Mild

2B.295 15000 2370 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

295

Post Burn Contracture surgeries for Functional

Improvement involving only skin (Package

including splints,pressure garment and

physiotherapy- Moderate

2B.296 22500 2370 CBC/Electrolytes/RFJ, Clincal photo Post-op photo

296 Muscle Biopsy with report 2B.297 7500 343 Reports of relevant investigation HPE Report

297 Diagnostic Laproscopy 2B.298 3000 NA USG Scar photo

298 Three phase whole body Bone Scan 2B.299 2325 NA Clinical Notes Investigation Report


Arogya

Karnataka

Code

Package


299 Sclerotherapy of oesophageal varices 2B.300 1875 NA Clinical Notes Investigation Report

300 Pyloric balloon dilatation 2B.301 1800 NA Clinical Notes Investigation Report

301 Mechanical lithotripsy of CBD stones 2B.302 6000 NA Clinical Notes Investigation Report

302 Cystoscopy with Retrograde Catheter -Unilateral 2B.303 1950 NA Clinical Notes Investigation Report

303 Cystoscopy with Retrograde Catheter - Bilateral 2B.304 2475 NA Clinical Notes Investigation Report

304 Cystoscopy Diagnostic 2B.305 1200 NA Clinical Notes Investigation Report

305 Cystoscopy with Bladder Biopsy 2B.306 1500 NA Clinical Notes Investigation Report

306 USG guided intervention - nephrostomy 2B.307 600 NA Clinical Notes Investigation Report

307

Endoscopic Retrograde Cholangio

Pancreatography (ERCP) (Endoscopic

Retrograde Cholangio – Pancreatography)

2B.308 1688 NA LFT, USG USG


Arogya

Karnataka

Code

Package


308

Post Burn Contracture surgeries for functional

improvement involving soft tissue and

bone(Package including splints, pressure

garments and phsiotherapy)

- Severe*

3A.1 52500 2370 Clinical Photograph Clinical Photograph

BF1 Post Burns Follow up - 1 3A.BF1 NA



309 PTCA - one stent (non-medicated, elective) * 3A.2 48000 1287ECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing stent & post Stent

flow

310 PTCA - 2 stent (non-medicated) * 3A.3 55000 1288ECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing stents & post Stent

flow

311PTCA - one stent (Drug Eluting Stent , elective)

*3A.4 60000 1287

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

312PTCA - Two stent (Drug Eluting Stents ,

elective) *3A.5 85000 1288


blocks & Reports



FDA/CE/DCGI only

313 Balloon Mitral Valvotomy * 3A.6 30000 1262 2D ECHO report 2D ECHO report + stills of ECHO

314 Balloon Pulmonary Valvotomy 3A.7 25000 1263 2D ECHO report 2D ECHO report + stills of ECHO

315 Balloon Aortic Valvotomy* 3A.8 25000 1258 2D ECHO report 2D ECHO report + stills of ECHO

316 Coarctation dilatation* 3A.9 25000 1425 2D ECHO report 2D ECHO report + stills of ECHO

317Peripheral Angioplasty with stent (non-

medicated) *3A.10 60000 1367

2D ECHO , ANGIOGRAM report &

stills , ABIPost procedure Angio stills, ABI

318 Renal Angioplasty with stent (non-medicated) * 3A.11 55000 13652D ECHO , ANGIOGRAM report &

stills Post procedure Angio stills

319Both sided renal Angioplasty with stent (non-

medicated) *3A.12 80000 1365


stills Post procedure Angio stills

Teritary Healthcare TreatmentsBURNS

POST BURNS FOLLOWUP

CARDIOLOGY


Arogya

Karnataka

Code

Package


320 Vertebral Angioplasty (non-medicated) * 3A.13 55000 1315 2D ECHO , ANGIOGRAM report &

stillsPost procedure Angio stills

321

Permanent pacemaker implantation (only VVI

single chamber) including Pacemaker

value/pulse generator replacement

3A.14 75000 1310ECG + Report by cardiologist +

Anigiogram report if doneX Ray showing the pacemaker in situ

322

Permanent pacemaker implantation (DDR, dual

chamber) including Pacemaker value/pulse

generator replacement

3A.15 120000 1309ECG + Report by cardiologist +


323 Pulse Generator replacement 3A.16 50000 NAECG + Report by cardiologist +


324 Septostomy 3A.17 20000 1271, 1418 2D ECHO report 2D ECHO report + stills of the ECHO

325 PDA Device Closure * 3A.18 80000 1280 2D ECHO report 2D ECHO stills showing the device + Report

326 ASD Device Closure * 3A.19 88000 1272, 1275 2D ECHO report 2D ECHO stills showing the device + Report

327 Ventricular Septal Defect Device Closure * 3A.20 88000

1279, 1280,

1281, 1282,

1283

2D ECHO report 2D ECHO stills showing the device + Report

328 PDA Coil (one) insertion 3A.21 25000 1281 2D ECHO report 2D ECHO stills showing the coil + Report

329 PDA Multiple coil insertion 3A.22 30000 1282 2D ECHO report 2D ECHO stills showing the coil + Report

330Intravascular ultrasound (IVUS)/Fractional Flow

Reserve (FFR)3A.23 20000 1442 Angiogram Report IVUS/FFR report

331 Electrophysiological Study (EP study) 3A.24 10000 1427 ECG with report + 2D ECHO report EP study report+ ECG

332 Radiofrequency Ablation (RF Ablation) 3A.25 25000 1863 ECG with report + 2D ECHO report RF ablation report +ECG

333 3D Mapping + Ablation 3A.26 50000 NA ECG with report + 2D ECHO report 3D mapping report+ECG with report

334 Rotablation+ PTCA (non-medicated Stent )* 3A.27 63000 1421 CAG Report with stills showing blocks CAG stills with stents and stills with post flow

335 Rotablation+ PTCA (One Drug Eluting Stent)* 3A.28 80000 1421ECG, 2D ECHO, CAG stills showing

blocks & Reports



FDA/CE/DCGI only

336 Rotablation+ Balloon Angioplasty 3A.29 45000 1421 CAG Report with stills showing blocks CAG stills with balloon and stills with post flow


Arogya

Karnataka

Code

Package


337 Peripheral Angioplasty with balloon * 3A.30 40000 1366ECG, 2D ECHO, CAG stills showing

blocks & Reports



FDA/CE/DCGI only

338 Renal Angioplasty with stent (Drug Eluting ) * 3A.31 65000 1365ECG, 2D ECHO, CAG stills showing

blocks & Reports



FDA/CE/DCGI only

339 Venous stenting* 3A.32 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

340 PDA stenting* 3A.33 50000 1279 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

341 Coarctoplasty with stenting* 3A.34 75000 1323 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

342 Right ventricular outflow tract (RVOT) stenting 3A.35 50000 NA 2D ECHO, Angiogram Report & Stills Post procedure Angio stills

343 Pulmonary artery stenting 3A.36 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

344Vertebral Angioplasty (non-medicated) - with

stent3A.37 70000 NA 2D ECHO , Angiogram Report & Stills Angiogram-DSA/MRA/CTA

345Paravalvular leak/ Ruptured sinus of Valsalva

aneurysm (RSOV)3A.38 88000 1374 2D ECHO Report 2D ECHO stills showing the device + Report

346 Carotid angioplasty with stent* 3A.39 150000 1441Angiogram report & Film showing the

lesion Post procedure Angio stills + XRAY + Doppler

347 Coronary artery bypass grafting (CABG) * 3A.40 95000 1295 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo

348Coronary artery bypass grafting (CABG) with

additional arterial graft*3A.41 100000 NA 2D ECHO , CAG Report

ECHO,Post op X Ray ,scar photo + scar photo of

graft area


Intra-aortic balloon pump (IABP) *3A.42 125000 1293 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo

350Coronary artery bypass grafting (CABG) +

Valve Replacement *3A.43 115000 1296 2D ECHO with stills , CAG Report Post op X Ray , 2D ECHO with stills, scar photo

351

Coronary artery bypass grafting (CABG) +

Valve Replacement + Intra-aortic balloon pump

(IABP) *

3A.44 145000 1296 2D ECHO with stills , CAG Report Post op X Ray , 2D ECHO with stills, scar photo

CARDIO THORACIC SURGERY


Arogya

Karnataka

Code

Package



Aneurysmal repair *3A.45 95000 1294 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo


Mitral Valve repair *3A.46 95000 1296 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo

354

Coronary artery bypass grafting (CABG) with

post MI Ventricular Septal Defect (Ventricular

Septal Defect) repair with IABP*

3A.47 120000 NA 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo

355 Open Mitral Valvotomy * 3A.48 80000 1262 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo

356 Open Aortic Valvotomy * 3A.49 80000 1266 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo

357 Open Pulmonary Valvotomy * 3A.50 80000 1263 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo

358 Closed Mitral Valvotomy * 3A.51 30000 1259 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

359 Mitral Valve Repair * 3A.52 80000 1262 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

360 Tricuspid Valve Repair * 3A.53 80000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

361 Aortic Valve Repair * 3A.54 80000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

362 Ring for any Valve Repair * 3A.55 20000 1264 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

363 Mitral Valve Replacement * 3A.56 130000 1269 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

364 Aortic Valve Replacement * 3A.57 130000 1266 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

365 Pulmonary Valve Replacement* 3A.58 120000 1263 2D ECHO Report2D ECHO Report + stills of ECHO + post Op X-

ray,scar photo

366 Tricuspid Valve Replacement * 3A.59 130000 1270 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

367Valve Replacement with Intra-aortic balloon

pump (IABP) *3A.60 140000 1266 2D ECHO Report with stills

2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo


Arogya

Karnataka

Code

Package


368 Double Valve Replacement * 3A.61 150000 1265 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

369 Ross Procedure * 3A.62 110000 1261 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

370 Atrial septal defect (ASD) * 3A.63 90000 1272 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

371 Ventricular Septal Defect (VSD) * 3A.64 90000 1273 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

372

Atrioventricular septal defect (AVentricular

Septal Defect)/ Atrioventricular (AV) Canal

Defect *

3A.65 90000 1272 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

373 Intracardiac repair (ICR) for Tetralogy of Fallot

(TOF) *3A.66 90000 1277 2D ECHO Report with stills


ray,scar photo

374Pulmonary Valvotomy + Right Ventricular

Outflow Tract (RVOT) Resection *3A.67 90000 1263 2D ECHO Report with stills


ray,scar photo

375 Aortopulmonary Window (AP Window) * 3A.68 90000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

376Surgery for Hypertrophic Obstructive

Cardiomyopathy (HOCM) *3A.69 90000 NA

2D ECHO/TEE Report + Chest Xray AP

view /Cardiac MRI


ray,scar photo

377 Ebsteins * 3A.70 90000 NA ECG, 2D ECHO Report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

378 Fontan * 3A.71 100000 1416 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

379Total Anomalous Pulmonary Venous Connection

(TAPVC) *3A.72 120000 1278 2D ECHO Report with stills


ray,scar photo

380Pulmonary Atresia with or without Ventricular

Septal Defect *3A.73 105000 NA 2D ECHO Report with stills


ray,scar photo

381Transposition of the great arteries (TGA) -

Arterial Switch Operation*3A.74 120000 1284, 1285 2D ECHO Report with stills


ray,scar photo

382 Double Switch Operation * 3A.75 120000 1414 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

383 Sennings * 3A.76 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo


Arogya

Karnataka

Code

Package


384 Mustards * 3A.77 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

385 Rastelli procedure -Pulmonary Conduit * 3A.78 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

386 Truncus Arteriosus Surgery * 3A.79 120000 1325 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

387Root Replacement (Aortic Aneurysm/ Aortic

Dissection) / Bental Procedure *3A.80 150000 1325 2D ECHO Report with stills


ray,scar photo

388 Aortic Arch Replacement* 3A.81 150000 1342 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

389

Aortic Aneurysm Repair without using

Cardiopulmonary bypass (CPB) with/without

graft*

3A.82 70000 1342 CT Angio Report Scar photo + Intra op photo

390Aortic Aneurysm Repair using Cardiopulmonary

bypass (CPB) with/without graft*3A.83 90000 1339 CT Angio Report Scar photo + Intra op photo

391Intrathoracic Aneurysm (without graft)-

Aneurysm not Requiring Bypass Techniques*3A.84 65000 1324 CT Angio Report Scar photo + Post op intra op photo

392 Pulmonary Embolectomy / Endarterectomy* 3A.85 150000 1317 2D ECHO with stills + ABG report +

CT Chest report


ray,scar photo

393 Patent Ductus Arteriosus (PDA) Closure 3A.86 30000 1280 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray, scar photo

394 Coarctation Repair* 3A.87 30000 1322 2D ECHO with stills + CAG report Doppler report + Stills of Doppler

395 Coarctation Repair with graft * 3A.88 70000 1328 2D ECHO with stills + CAG report Doppler report + Stills of Doppler

396Blalock–Thomas–Taussig (BT) Shunt

(inclusives of grafts)3A.89 60000 1417 2D ECHO Report with stills


ray,scar photo

397 Glenn Shunt 3A.90 60000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

398 Central Shunt 3A.91 60000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

399 Pericardiectomy 3A.92 50000 1299 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo


Arogya

Karnataka

Code

Package


400 Thoracoscopic surgery 3A.93 35000 1408 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray, photo of scar, port insertion

401 Pericardiostomy Surgery 3A.94 10000 1298 2D ECHO report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

402 Thyomectomy 3A.95 35000 1411 CT Chest report X-RAY, scar photo

403 Lobectomy 3A.96 70000 1390 CT Chest report Post Op X-ray,scar photo

404 Pneumonectomy 3A.97 60000 1391 CT Chest report Post Op X-ray,scar photo

405 Pleurectomy 3A.98 50000 NA CT Chest report Post Op X-ray,scar photo

406 Decortication 3A.99 50000 1397 CT Chest report Post Op X-ray,scar photo

407 Mediastinotomy 3A.100 40000 NA CT Chest report Post Op X-ray,scar photo

408 Pulmonary AV Fistula surgery 3A.101 45000 NA CT Chest report Post Op X-ray,scar photo

409 Lung Cyst 3A.102 60000 1389 CT Chest report Post Op X-ray,scar photo

410 Space-Occupying Lesion (SOL) mediastinum 3A.103 60000 1395 CT Chest report Post Op X-ray,scar photo

411 Surgical Correction of Bronchopleural Fistula. 3A.104 70000 1398 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

412 Diaphragmatic Eventeration 3A.105 50000 1401 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

413 Oesophageal Diverticula /Achalasia Cardia 3A.106 50000 1387 Barium Study + CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

414 Diaphragmatic Injuries/Repair 3A.107 35000 1402 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray,scar photo

415 Thoracotomy, Thoraco Abdominal Approach 3A.108 40000 1388 CT Chest report Post Op X-ray,scar photo

416Bronchial Repair Surgery for Injuries due to

Foreign body3A.109 40000 1394 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE

417

Gastro Study Followed by Thoracotomy &

Repairs of Oesophageal Injury for Corrosive

Injuries/FB

3A.110 50000 1388 Gastroscopy Report ENDOSCOPY PICTURE, scar photo

418 Oesophageal tumour removal 3A.111 50000 NA Endoscopy Report + Biopsy Report Biopsy report, scar photo

419 Oesophagectomy 3A.112 60000 1994, 2015 Biopsy , CT , Endoscopy reports Biopsy report, scar photo

420Encysted Empyema/Pleural Effusion -

Tubercular3A.113 20000 1393 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan


Arogya

Karnataka

Code

Package


421

First rib Excision by transaxillary approach

Excision of cervical rib / fibrous band / muscle

by cervical approach

3A.114 40000 64 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

422 Thorocotomy and resection of pluera with Lung 3A.115 50000 1404Pre Op X-ray / CT Scan, Bronchoscopy

ReportPost Op X-ray / CT Scan ,scar photo

423Tracheoplasty and introduction of montegomary

T-tube (Tracheal stenting)3A.116 40000 80 CT / Bronchoscopy report CT / Bronchoscopy report

424 Congenital Hypoplasia of the lung 3A.117 40000 Na Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

425 Congenital Cystic Lesions 3A.118 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

426 Pulmonary Sequestration 3A.119 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

427 Pulmonary artero venous malformation 3A.120 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

428Thoracotomy & Excision and fixation of the

Spine3A.121 65000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

429 Hiatus Hernia Repair 3A.122 40000 212, 213 USG, UGI ENDOSCOPY Scar photo + Intra op photo

430Intrathoracic Aneurysm (with graft) -Requiring

Bypass Techniques*3A.123 110000 1324, 1329 CT Angio Report Scar photo + Intra op photo

Rotablation+ Balloon Angioplasty 3A.29 45000 1421 CAG Report with stills showing blocks CAG stills with balloon and stills with post flow

Peripheral Angioplasty with stent (non-

medicated) *3A.10 60000 1367


stills , ABIPost procedure Angio stills, ABI

431 Pericardiostomy without balloon 3A.124 10000 1298 2D ECHO report 2D ECHO report + stills of the ECHO

432 Thromboembolectomy - unilat singular 3A.125 300001318, 1316,

1317, 1319Duplex/Angio Report & stills Scar photo + Intra op photo

433 Thromboembolectomy - bilat /multi level 3A.126 400001318, 1316,

1317, 1319Duplex/Angio Report & stills Scar photo + Intra op photo

434Aortic Aneurysm Repair without using

Cardiopulmonary bypass (CPB) including graft*3A.127 70000 1342 CT Angio Report Scar photo + Intra op photo

435Aortic Aneurysm Repair using Cardiopulmonary

bypass (CPB) including graft*3A.128 90000 1339 CT Angio Report Scar photo + Intra op photo

436Surgery for Arterial Aneursysm -Abdominal

aorta3A.129 90000 1333 Duplex/Angio Report & stills Scar photo + Intra op photo

CARDIO VASCULAR SURGERY


Arogya

Karnataka

Code

Package


437 Surgery for Arterial Aneurysm Renal Artery 3A.130 50000 1372Renal arterial Doppler, Angiogram with

stillsScar photo + Intra op photo

438 Operations for Stenosis of Renal Arteries 3A.131 20000 1373Renal arterial Doppler,angiogram &

StillsDoppler Report + scar photo

439Femoropopliteal by pass procedure with graft

(inclu. Graft)3A.132 70000 1349 Angiogram Report Clinical Photographs Duplex, ABI, scar photo

440Aorto Bi lliac / Bi femoral /Axillo bi femoral

bypass with Synthetic Graft3A.133 90000 1351 Angiogram/spiral CT Angiogram reports

Stills showing the procedure with graft + scar

photo

441Femoro Distal / Femoro-popliteal/ Femoral infra

popliteal Bypass with Vein Graft3A.134 50000 1354 Angiogram/spiral CT Angiogram reports

Stills showing the procedure with graft +Duplex

scan, scar photo

442

Carotid- carotid/Carotid- Subclavian/ Femoro

Distal / Femoral - Femoral / Femoral infra

popliteal Bypass with Synthetic Graft

3A.135 75000 1354 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex

scan, scar photo

443

Axillo Brachial Bypass using Synthetic

Graft/Brachial Artery to Auxillary Vein/Basilic

Vein grafting using PTFE graft

3A.136 50000 1355 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex

scan, scar photo

444 Brachio - Radial Bypass (with vein) 3A.137 40000 1356 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex

scan, scar photo

445Excision of Carotid body Tumor with / without

vascular repair3A.138 35000 1379 Angiogram/spiral CT Angiogram reports

Stills showing the procedure +Duplex scan, scar

photo

446 Carotid artery bypass with Synthetic Graft 3A.139 60000 1337 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex

scan, scar photo

447Excision of Arterio Venous malformation -

Large3A.140 50000 1330 Angiogram/spiral CT Angiogram reports


photo

448Excision of Arterio Venous malformation -

Small (Congenital/Acquired)3A.141 30000 1331 Angiogram/spiral CT Angiogram reports


photo

449 Carotid/other peripheral endarterectomy 3A.142 40000 1926 Angiogram reportStills showing the procedure with graft + scar

photo,

450 Carotid/other endarterectomy with patch 3A.143 50000 1926 Angiogram reportStills showing the procedure with graft + scar

photo

451 Aortic Angioplasty 3A.144 40000 NaECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing Balloon & post flow,

scar photo


Arogya

Karnataka

Code

Package


452 Aortic/ iliac Angioplasty with one stent 3A.145 60000 naECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing Balloon & post flow,

scar photo

453Aortic Angioplasty with two stents / Iliac

angioplasty with stent Bilateral3A.146 90000 na


blocks & Reports

Angioplasty stills showing Balloon & post

flow,scar photo

454

Deep Vein Thrombosis (DVT) - Inferior Vena

Cava (IVC) filter (Recurrent DVD - (includes

removal of filter)

3A.147 65000 1332 Color doppler Plain X-ray abdomen showing the filter

455Aneurysm infra renal aorta /aorto iliac(including

graft)3A.148 90000 1325 ANGIO/ Spiral CT Angiogram Report Scar photo + Intra op photo

456 Aorto uni iliac/uni femoral bypass 3A.149 70000 1350

Angiogram/ Computed Tomography

Angiography (3D-CTA)/Magnetic

Resonance Angiography

Duplex scan, scar photo

457 Peripheral arterial aneurysms 3A.150 50000 1369, 1370 Angiogram Report & Stills Intra op photo

First rib Excision by transaxillary approach

Excision of cervical rib / fibrous band / muscle

by cervical approach

3A.114 40000 64 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo

Venous stenting* 3A.32 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills

458 Bronchial artery Embolisation (for Haemoptysis) 3A.151 25000 2904Chest x-Ray/CT Scan, Hb, Serum

CreatinineChest x-Ray/CT Scan, Hb, Serum Creatinine

459Percutaneous Transluminal Tricuspid

Commissurotormy (PTTC)3A.152 25000 NA 2D ECHO report with stills 2D ECHO report + stills of the ECHO

460 Balloon Atrial Septostomy 3A.153 25000 1271 2D ECHO report with stills 2D ECHO report + stills of the ECHO

461 Coiling - Pseudoaneurysms of Abdomen 3A.154 55000 NA

CT/MRI or Angiogram, Prothrombin

Time (PT), International normalized ratio

(INR) Hb, Serum Creatinine

CT, PT,INR, Hb, Serum Creatinine

462Embolisation - Arteriovenous Malformation

(AVM) in the Limbs3A.155 40000 1897 USG, CT PT, INR, Hb, Serum Creatinine USG abd/CT PT,INR, Hb, Serum Creatinine

463

Catheter directed Thrombolysis for: Deep vein

thrombosis (DVT), Mesenteric Thrombosis &

Peripheral vessels*

3A.156 50000 2739

CT/MRI, Prothrombin Time (PT),

International normalized ratio (INR) Hb,

Serum Creatinine

CT/MRI, PT,INR, Hb, Serum Creatinine

CARDIOLOGY/ CVS/ INTERVENTIONAL RADIOLOGICAL THERAPEAUTIC PROCEDURE


Arogya

Karnataka

Code

Package


464 Inferior Vena Cava (or IVC) Stenting 3A.157 60000 NA

USG, clotting Time (CT), Prothrombin

Time (PT), International normalized ratio

(INR), Hb, Serum Creatinine

USG, CT,PT,INR, Hb, Serum Creatinine

Pericardiostomy without balloon 3A.124 10000 1298 2D ECHO report 2D ECHO report + stills of the ECHO

CVSF1 Post Cardiac surgery Followup-1 3A.CVSF1 #N/A NA





465 Open Pyelolithotomy* 3A.158 27000 1572 CT KUB with Contrast Scar Photo,X-Ray/USG KUB

466 Open Nephrolithotomy* 3A.159 27000 1569 USG/X-ray KUB Scar Photo,X-Ray/USG KUB

467 Pyeloplasty* 3A.160 30000 1581 USG & IVP/CT with Contrast Scar Photo

468PCNL (Percutaneous Nephro Lithotomy)*

(Inclusive of stent)3A.161 28500 1636 CT KUB with Contrast/IVU Scar Photo +X-ray KUB

469 Nephrostomy (PCN)* 3A.162 7500 1571 USG Scar Photo With Nephrostomy Tube

470 Simple Nephrectomy 3A.163 26250 1530 USG, CT KUB /Isotope Renogram Scar & Specimen Photo +HPE report

471 Lap. Nephrectomy Simple 3A.164 33750 1585, 1530 USG & CT KUB /Isotope Renogram Scar Photo + HPE Report

472 Lap. Nephrectomy Radical 3A.165 37500 2042, 1530USG & CT KUB with Contrast / Isotope

RenogramScar Photo + HPE Report

473 Lap. Partial Nephrectomy 3A.166 45000 1584USG & CT KUB with Contrast / Isotope

RenogramScar Photo + HPE Report

474 Open partial Nephrectomy 3A.167 37500 2041 USG & CT KUB with Contrast Scar Photo + HPE Report

475Open Anatrophic Nephrolithotomy ( For

Staghorn Stone)3A.168 33750 1574 USG, CT KUB with Contrast Scar Photo +X-Ray Kub

POST CARDIO SURGERY FOLLOW-UP

GENITO URINARY


Arogya

Karnataka

Code

Package


476Retrograde Intra Renal surgery (RIRS with

laser) – for renal and PUJ calculi*3A.169 37500 1593 CT KUB with Contrast

C ARM Picture with Patient Details, X-ray

KUB/USG

477 URSL* (Inclusive of stent) 3A.170 168751594, 1738,

1739, 1740CT KUB X-ray KUB

478 DJ stent (One side) 3A.171 5625 1651 USG /X-ray KUB X-ray KUB

479 URSL-LASER* 3A.172 187501594, 1741,

1742, 1743CT KUB

X-ray KUB, Purchase Voucher for Laser

machine

480 DJ stent (Bilateral) 3A.173 7500 1651 X-ray KUB & USG X-ray KUB & USG

481 Ureterolithotomy-Open* 3A.174 22500 1601 CT KUB with Contrast Scar Photo +X-Ray Kub

482 Ureterolithotomy-LAP* 3A.175 26250 1601 CT KUB with Contrast Scar Photo +X-Ray Kub

483 Open Boari Flap-Uretaric stricture 3A.176 315001600, 1601,

257CT KUB/IVP Clinical Picture, Scar Photo

484 Open Ureteral Reimplantation (Unilateral) 3A.177 28500 1597 ,1599 CT KUB/IVP/MCU Scar photo

485 Deflux for VUR* 3A.178 37500 1599 USG,MCU Post -op MCU

486 Ureterocoele incision 3A.179 18750 1805 IVU/CT ENDO Picture With patient details

487 TURP 3A.180 22500 1654 USG/CT KUB,Uroflowmetry HPE Report,P.O USG

488 Open Prostatectomy 3A.181 26250 1656 USG, Uroflowmetry Scar Photo + HPE Report

489 Bladder Neck Incision 3A.182 16875 1628 USG & Uroflowmetry Uroflowmetry,ENDO Picture

490 TRUS biopsy of prostate 3A.183 4500 1821 PSA,Transrectal USG HPE Report

491 Open Cystolithotomy 3A.184 13500 1610 USG/X ray KUB Scar Photo,X-Ray/USG KUB

492 UVF/VVF Repair* 3A.185 30000 774, 775, 777 USG/X ray KUB NIL

493 Cystolithotripsy 3A.186 127501606, 1608,

1609X-ray KUB/USG X-ray KUB

494 TURBT 3A.187 22500 1613 USG/CT KUB with Contrast Cystoscopy Finding/ HPE Report, P.O USG

495 Laparoscopic VVF Repair 3A.188 30000 773 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram

496 Bladder Augmentation 3A.189 31500 1539 USG , Cystogram/MCU Scar Photo, Post OP Cystogram

497 Post TURBT BCG (Per Cycle Per Week) 3A.190 750 1707, 1708 HPE report Endo Picture

498 Post TURBT Check Cystoscopy (Per Sitting) 3A.191 3750 no code USG & urine cytology Cystoscopy Finding, X-Ray KUB

499 Partial cystectomy* 3A.192 30000 1630 CT KUB with Contrast Procedure Picture

500 Bladder diverticulectomy -open/lap* 3A.193 22500 1615 CT KUB Endo Picture/Operative Picture

501Urethroplasty for Stricture Diseases-single

stage*3A.194 33750 1634, 1635 RGU Scar photo,


Arogya

Karnataka

Code

Package


502 Urethroplasty for Stricture Diseases-First Stage 3A.195 22500 1637 RGU & MCU Scar photo,

503Urethroplasty for Stricture Diseases-Second

Stage*3A.196 18750 1638 RGU & MCU Scar photo,

504 Hypospadiasis(Adult)* 3A.197 26250 1544, Clinical Photograph Scar photo,

505 Hypospadiasis(Adult) First Stage 3A.198 18750 1545 Clinical Photograph Scar photo,

506 Hypospadiasis(Adult) Second Stage 3A.199 18750 1546 Clinical Photograph Scar photo,

507 Perineal Urethrostomy 3A.200 18750 1632 RGU& MCU Scar photo,

508 Visual Internal Urethrotomy 3A.201 9000 1633, 1670 USG & RGU Uroflowmetry/ENDO PICTURE

509 Open Orchidectomy (Simple / Radical) 3A.202 15000 235 USG Scrotum SCAR PHOTO , HPE report

510Repair of stress incontinence - lap or open colpo

suspension* 3A.203 33750 752, 753, 754 Clinical Notes Endo Picture / Operative Picture

511 Adenoma Excision- Adrenals 3A.204 9000 1457, 1755 X-ray nasopharynx Clinical photograph

512 ESWL (Extra carporial shock-wave lithotripsy)* 3A.205 6375 1704 CT KUB with Contrast X-ray KUB/USG

513ESWL (Extra corporial shock-wave lithotripsy)

above 1 cm to 2 cm- Single Side*3A.206 13500 1704 CT KUB with Contrast X-ray KUB

514 Renal biopsy – Percutaneous 3A.207 5625 NACBC,RFT, USG ABD,

HIV,HBsAg,HCV,Urine R/EHPR

GUF1 Post Genito Urinary Follow up-1 3A.GUF1 #N/A NA



POST GENITO URINARY FOLLOW-UP


Arogya

Karnataka

Code

Package


515 Supraglottoplasty 3A.208 18750 NA Endoscopy photo/CT Clinical Photograph showing scar / endoscopy

picture

516 Esophageal substitution surgery 3A.209 82500 1484 Contrast X ray/endoscopy findings, Clinical Photograph showing scar

517 Thoracic Duplication cyst 3A.210 37500 1389, 1396 CT, Chest X ray Biopsy Report.

518 Thoracic Wall defects Correction 3A.211 45000 1473 CT/MRI, X ray Clinical Photograph

519 Omphalocele-Minor 3A.212 30000 1476, 1478 Clinical Photograph Clinical Photograph showing scar

520 Splenectomy - Child 3A.213 33750 189, 192, 193 Hemogram,USG Clinical Photograph showing scar

521 Shunt surgery for portal hypertension 3A.214 37500 108, 191 USC/CT/MRI Clinical Photograph showing scar

522 Surgery for chronic pancreatitis 3A.215 52500 NA CT/MRI Clinical Photograph showing scar

523 Colostomy formation 3A.216 15000 136, 137 X-Ray Clinical Photograph showing scar

524 Biliary Atresia 3A.217 48750 1513 CT Abdomen Clinical Photograph showing scar

525Excision of choledochal cyst with hepatic

jejunostomy3A.218 63750 1514 USG/CT/MRCP Scar photo,HPE Report

526 Oesophageal Atresia 3A.219 82500 1481 X-Ray Clinical Photograph showing scar

527 Diaphragmatic Hernia - Paed 3A.220 82500 1529, 220 X-Ray Clinical Photograph showing scar+Post op X ray

528 Unilateral Inguinal Hernia- Age less than 1 year 3A.221 11250 219, 220 Clinical photograph, USG Clinical Photograph showing scar

529 Bilateral Inguinal Hernia for age < 1 year 3A.222 16875 218 Clinical Photograph Clinical Photograph showing scar

530 Ureteric Reimplantations Bilateral * 3A.223 52500 1536 MCU, USG Clinical Photograph showing scar

531 Ureteric Reimplantations Unilateral * 3A.224 33750 1536, 1597 MCU, USG Clinical Photograph showing scar

532 Exstropy Bladder Stage 2 3A.225 52500 1536, 1597 MCU Clinical Photograph

533 Urinary Diversion - Temporary 3A.226 18750 2044 MCU, USG Clinical Photograph showing scar

534 Urinary Diversion - Permanent 3A.227 33750 2044 MCU, USG Clinical Photograph showing scar

535 Urinary Diversion - Undiversion 3A.228 26250 2044 MCU, USG Clinical Photograph showing scar

536 Continence Stage 1 (Epispadias) 3A.229 30000 1547Clinical photo showing the meatal

openingNil

537Stage 2 Incontinence for epispadias including

bladder neck repair3A.230 30000 1647, 1648 USG/MCU Clinical Photograph

538 Insertion of Hickman Catheter 3A.231 7500 1346, 1347 Lab reports confirming cancer Clinical Photograph showing catheter

539 Insertion of Chemo port 3A.232 15000 1346, 1347 Lab reports confirming cancer Clinical Photograph showing chemo Port

540 Congenital Hydronephrosis Open/Lap* 3A.233 37500 1535 USG, Renal Isotope Scan Clinical Photograph showing scar

NEONATAL AND PAEDIATRIC SURGERY


Arogya

Karnataka

Code

Package


541 Feminising genitoplasty 3A.234 41250 1558 Clinical Photograph Clinical Photograph showing scar

542 Undescended Testis (Palpable) 3A.235 11250 1549 USG,Clinical photo Nil

543 Unsescended Non palpable testis stage 1 3A.236 15000 NA USG abdomen Scar photo

544Undescended Non palpable testis stage 2

(definitve repair)3A.237 18750 NA USG/OT notes of previous surgery Scar photo

545 Anorectal Malformations Definite Repair 3A.238 45000

1510, 1494

(multiple

codes)

Colostogram pic for males, Photo of

perineum region for femalesClinical Photograph showing scar

546 Anorectal Malformations Stage 3 3A.239 33750

1499, 1501,

1502

(multiple

code)

Clinical Photograph Clinical Photograph showing scar

547 Anorectal malformation- Low variant 3A.240 22500

152, 1506,

(Multiple

codes)

Photo of the perineum region Scar photo

548 Hirschsprungs Disease stage 1 3A.241 30000

1496, 1495,

1501 (Multiple

codes)

Rectal biopsy/ X-Ray/Contast Enema Clinical photo showing scar + Biopsy Report.

549Hirschsprungs Disease stage 2/Definitive Repair

(Including Staplers)3A.242 45000

1511, 1507

(Multiple

coddes)

Contrast Enema / Biopsy Clinical Photograph showing scar

550 Heller's Cardiomyotomy with fundoplication 3A.243 37500 89 Contrast X ray/endoscopy findings Clinical Photograph showing scar

551 Simple Fundoplication 3A.244 26250 1154 Contrast X ray/endoscopy findings Clinical Photograph showing scar

552 Intussusception pneumatic/hydrostatic reduction 3A.245 13500 108 USG/Xray Post op USG, Post op X Ray

553 Pyloromyotomy 3A.246 26250 89 USG/Contrast X ray Clinical Photograph showing scar

554 Bladder Augumentation 3A.247 60000 1539 MCU/USG Clinical photo

555 Hypospadias First Stage 3A.248 22500 1545 Clinical photo showing the meatal

openingNil

556 Hypospadias Definitive Repair - proximal penile 3A.249 45000 1544 Clinical photo showing the meatal

openingNil

557 Hypospadias Definitive Repair - mid penile 3A.250 37500 1544, Clinical photo showing the meatal

openingNil


Arogya

Karnataka

Code

Package


558 Hypospadias Definitive Repair - distal penile 3A.251 30000 1544, 1546 Clinical photo showing the meatal

openingNil

559 Hypospadias Re-Do 3A.252 30000 NA Clinical photo showing the meatal

openingNil

560 Fistula Closure Hypospadiacs 3A.253 15000 NA Clinical Photograph Nil

561Cystoscopic fulguration of posterior urethral

valves3A.254 22500 1770 MCU, USG Clinical Photograph/Endoscopic picture

562 Stent Removal 3A.255 3750 1703 X Ray Post op X Ray

563Laparotomy and excision of cyst (For Paediatric

benign abdominal cyst)3A.256 22500 320 USG/CT Scar Photo, HPE Report

564 Polydactly (One finger) 3A.257 15000 2324 Clinical photo Clinical photo

565 Club hands Stage 1 / Club Foot 3A.258 300002394, 1088,

2324Clinical photo Clinical photo

566 Club hands Stage 2 3A.259 300002394, 1088,


567 Syndactly 3A.260 187502394, 1088,


568 Meningo Encephalocele * 3A.261 30000 1850 MRI Report Post Op CT Report and film, Clinical

Photograph showing Scar

569 Meningomyelocele * 3A.262 30000 1837, 1838 CT report Post Op CT Report and film, scar photo

570 Faciomaxillary surgery 3A.263 262501931, 2321,

2322X-RAY/CT scan

Clinical Photograph showing scar + post op.

XRAY

571 Respiratory distress syndrome 3A.264 56663 NA Clinical notes confirming digonosis clinical notes in relevant reports

572 Meconium Aspiration syndrome 3A.265 38175 NA Clinical notes confirming digonosis clinical notes in relevant reports

573 Septicemia not requiring ventilation 3A.266 36900 2693, 2695 Clinical notes confirming digonosis clinical notes in relevant reports

574 VLBW not requiring ventilation 3A.267 89925 2658, 2661 Clinical notes confirming digonosis clinical notes in relevant reports

575Neonatal jaundice requiring exchange

transfusion3A.268 23438 2610, 2611 Clinical notes confirming digonosis clinical notes in relevant reports

576 Asphyxia with convulsions 3A.269 55050 2650 Clinical notes confirming digonosis clinical notes in relevant reports

577Cochlear Implant Surgery excluding

implant(Including AV therapy)3A.270 97500 2406 Clinical notes confirming digonosis clinical notes in relevant reports

578Thalessemia/Sickle Cell anaemia (Quaterly per

child per year)3A.271 18750 NA Clinical notes confirming digonosis clinical notes in relevant reports

Decortication 3A.99 37500 1397 CT Chest report Post Op X-ray,scar photo


Arogya

Karnataka

Code

Package


Hiatus Hernia Repair 3A.122 30000 212, 213 USG, UGI ENDOSCOPY Scar photo + Intra op photo

Lobectomy 3A.96 52500 1390 CT Chest report Post Op X-ray,scar photo

Pneumonectomy 3A.97 45000 1391 CT Chest report Post Op X-ray,scar photo

Thoracoscopic surgery 3A.93 26250 1408 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-

ray, photo of scar, port insertion

579Transoral surgery /Anterior/ Posterior/CV

Junction (with Stabilization)3A.272 60000 1884 MRI Report + XRAY Post Op X-ray report and film

580 Trans oral Surgery 3A.273 22500 1884 CT report Post Op X-ray Report and film, HPE report

581 RF Lesions for Trigminal Neuralgia 3A.274 11250 NA MRI Report CD of Procedure

582 Foramen Magnum Decompression 3A.275 33750 1956 CT/MRI report Clinical Photographs showing scar

583 Endoscopic CSF Rhinorrhea Repair 3A.276 33750 1937 CT/MRI report Clinical Photographs showing scar

584 Fetal Surgery for Myelomeningocoele 3A.277 56250 NA Ultrasound abdomen Ultrasound + scar photograph

585 Nerve Biopsy with report 3A.278 7500 1914

Nerve Conduction Velocity (Nerve

conduction velocity (NCV)) and

Electromyography (EMG) reports

Clinical Photograph + HPE report

586 Neuroblastoma 3A.279 30000 1456, 2148 Biopsy, CT Clinical photograph

587 Nerve Decompression 3A.280 15000 360, 1922 Nerve Conductions study Clinical Photographs showing scar

588 Peripheral Nerve Surgery Major 3A.281 33750 1868

Nerve Conduction Velocity (Nerve

conduction velocity (NCV)) and

Electromyography (EMG) reports

Clinical Photographs showing scar

589 Carotid Endarterectomy 3A.282 33750 1926 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray

590 Stereotactic Lesioning 3A.283 45000 1888Neuro Psychologist report, Neurologist

report, MRI

Clinical Photographs showing scar , CT Brain

report and film

591 Epilepsy Surgery 3A.284 37500 1939EEG, Neuro Psychologist report,

Neurologist report, CT/MRICT + Clinical Photographs showing scar

592 CTS 3A.285 7500 1954 Nerve Conductions study Clinical Photographs showing scar

Neuro Surgery - Atlanto Axial Dislocation (AAD)

NEUROSURGERY - GENERAL NEUROSURGERY


Arogya

Karnataka

Code

Package


593 Guillain Barre Syndrome 3A.286 56250 NANerve conduction studies report,

confirmed by Neurologist

Photo of patient with venouscathetor in situ,

photo of plasma filters with number and patient's

name , bills for purchase of plasma filters,

albumin and fresh flozen plasma, viral markers

report - Hbs antigen, HIV 1 & 2, Anti - HCV

antibodies


Arogya

Karnataka

Code

Package


594Excision of Brain Tumor Supratentorial-

Parasagital *3A.287 60000 1842 CT report /MRI Clinical features

Post Op CT Report and film, Clinical

Photographs showing the scar + HPE report

595 Excision of Brain Tumor Supratentorial-Basal * 3A.288 60000 1839 CT reportPost Op CT Report and film, Clinical


596Excision of Brain Tumor Supratentorial-

Brainstem *3A.289 60000 1839 CT report



597Excision of Brain Tumor Infratentorial-C P

Angle * 3A.290 60000 1841 CT report



598Excision of Brain Tumor Supratentorial & others

*3A.291 37500 1842 CT report



599 Excision of Brain Tumors -Subtentorial * 3A.292 41250 1846 MRI ReportClinical Photographs showing the scar + HPE

report

600 Abscess Tapping Single 3A.293 11250 1831 CT report Post Op CT Report,film and scar photo

601 C.S.F. Rhinorrhoea 3A.294 32250 1852 CT report Clinical Photograph with Scar

602 Cranioplasty 3A.295 22500 1847 CT report Post Op CT Report and film, Clinical

Photograph showing the scar

603 Aneurysm Clipping * 3A.296 82500 1872 MRI/CT Angio / DSA report Post Op CT Report and film, scar photo

604 Stereotaxic Procedures 3A.297 18750 1888 CT/ MRI report Post Op CT Report and film + HPE report

605 Trans Sphenoidal Surgery -Routine/Endoscopic 3A.298 30000 1871 CT/MRI Report HPE report

606 MVD (Micro Vascular Decompression) 3A.299 37500 NA MRI Report Clinical Photographs

607Arterio venous malformation (AVM) excision

(whatever size and location) */ Cavernoma3A.300 75000 1330, 1331 MRI Angio/DSA report CT report and film,scar photo

608

Superficial Temporal Artery (STA): middle

Cerebral Artery (MCA) or (Other EC : IC)

Bypass Procedure

3A.301 75000 NA MRI Angio/DSA report CT Report and film,scar photo

NEURO-SURGERY BRAIN


Arogya

Karnataka

Code

Package


609 Endoscopic venticulostomy 3A.302 22500 1851 CT reportClinical Photograph showing scar, DT Brain film

and report

610 Endoscopic colloid cyst excision 3A.303 37500 NA CT reportClinical Photograph showing scar, Post CT

report and film

611 Endoscopic Tumour Removal 3A.304 375001839, 1840,

1841, 1842 CT report

Clinical Photograph showing scar + HPE, Post-

op CT report and film

612 Excision of Orbital Tumour* 3A.305 37500 1971 CT/MRI ReportCT, Clinical Photograph showing scar + HPE

report, Post-op CT report and film

613 Cranio Facial Resection 3A.306 52500 2071 CT/MRI ReportCT report and film, Clinical Photograph showing

scar + HPE report

614 Elevation/Excision of depressed fracture 3A.307 22500 1953 CT reportClinical Photographs showing scar, Post CT

report and film

615 Decompressive craniotomy 3A.308 30000 1830 CT reportClinical Photographs showing scar, Post CT

report and film

616 Craniostenosis 3A.309 37500 1899 CT/MRI Report Post-op CT report and film

617Gamma Knife radiosurgery (GKRS)/SRS for

Tumours/Arteriovenous malformation (AVM)3A.310 56250 1962, 1963 CT/MRI Report Clinical Photographs

618 Scalp Arteriovenous malformation (AVM) 3A.311 18750 1973 CT/MRI Report Clinical Photograph showing scar + HPE report

619 Skull lesion including cranioplasty 3A.312 30000 1847 CT/MRI ReportClinical Photograph showing scar + HPE report

+ Xray - Skull

620 Skull Lesion without Cranioplasty 3A.313 18750 1847 CT/MRI ReportClinical Photograph showing scar + HPE report

+ Xray - Skull

621 Cranioplasty with mesh 3A.314 30000 1847 CT report Post Op CT Report and film, Clinical


Carotid angioplasty with stent* 3A.39 112500 1441Angiogram report & Film showing the

lesion Post procedure Angio stills + XRAY + Doppler

Meningo Encephalocele * 3A.261 30000 1850 MRI Report Post Op CT Report and film, Clinical


622 Spinal Cord Tumours* 3A.315 33750 1858 MRI Report Biopsy report + HPE Report + scar photo

623 Anterior Cervical Discectomy Single level * 3A.316 22500 1881 Clinical findings, MRI Report Post Op X-ray, Clinical Photograph showing

scar

NEURO-SURGERY SPINE


Arogya

Karnataka

Code

Package


624Anterior Cervical Discectomy Multiple level

with Implants*3A.317 45000 1887 Clinical findings, MRI Report

Photo showing the scar + XRAY showing the

implants

625 Laminectomy-Cervical * 3A.318 22500 1925 Clinical findings, MRI Report photo showing scar

626 Spinal Fusion Procedure + cost of implant * 3A.319 45000 1006, 1883 Clinical findings, MRI ReportPost Op X-Ray Report and film, + Showing scar

+ XRAY showing the implants

627 Spinal Intra Medullary Tumours* 3A.320 30000 1859 MRI Report Post Op X-ray Report and film + HPE report

628 Spina Bifida Surgery Major * 3A.321 30000 1861, 1862 MRI Report Clinical Photographs showing scar

629Corpectomy for Spinal Fixation + cost of implant

*3A.322 52500 1882 MRI Report

Clinical Photographs showing scar + X-ray

Report and film showing the implants

630 Posterior Cervical Discetomy without implant * 3A.323 22500 1891, 1881 MRI report Clinical Photographs showing scar

631Posterior Cervical Fusion with implant (Lateral

mass fixation) *3A.324 45000 1887 MRI report

Clinical Photographs showing scar + X-ray -

Cervical spine

632 Theco Peritoneal Shunt 3A.325 15000 1854 CT report Clinical Photographs

633 Cervical Disc Multiple level without Fusion 3A.326 26250 1881 CT/MRI reportClinical Photographs showing scar + X-ray-

Cervical Spine

634Thoracic/Lumbar Corpectomy with fusion

inclusive of implant /Trans thoracic *3A.327 52500 1881 CT/MRI Clinical Photographs showing scar + Xray

635Spinal Fusion Procedure + cost of implant * Cost

of next + Multiple level3A.328 52500 1883 Clinical findings, MRI Report

Post Op X-Ray Report and film, + Showing scar

+ XRAY showing the implants

Meningomyelocele * 3A.262 30000 1837, 1838 CT report Post Op CT Report and film, scar photo

NSBF1 Post Brain surgery Follow up-1 3A.NSBF1 #N/A NA




NSSF1 Post Spine surgery Follow up-1 3A.NSSF1 #N/A NA

POST NEURO SURGERY FOLLOW-UP


Arogya

Karnataka

Code

Package




636 Lung metastatectomy - solitary 3A.329 22500 1997 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +

XRAY Chest

637 Lung metastatectomy - Multiple 3A.330 37500 1998 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +

XRAY Chest

638 Sleeve resection of Lung cancer 3A.331 67500 1999 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +

XRAY Chest

639 Mediastinal tumor resection 3A.332 37500 2003 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +

XRAY Chest

640 VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo

641Linear accelerator teletherapy,

3DCRT,IMRT,VMAT Adjuvant/Definitive 3A.334 56250 2227, 2228 Biopsy/FNAC ,CT report and Film Photo with RT Machine , RT treatment chart

642Brachytherapy - Intraluminal HDR per fraction

(max 4 session)3A.335 3375 2226 Biopsy/FNAC ,CT report and Film

Photo with RT Machine , RT treatment chart,

RT planning data

643 Definitive, Adjuvant, SRS/SRT 3A.336 56250 2229 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT treatment chart RT

planning Data

644Cobalt 60 External Beam Radiotherapy,

Definitive, Neoadjuvant, Adjuvant3A.337 15000 2221 Biopsy/FNAC ,CT report and Film

Photo with RT Machine , RT treatment chart RT

planning Data

645Cisplatin/Etoposide (IIIB)- Max. 6 cycles only

(Per cycle)3A.338 5250 2175 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code

646

Paclitaxel + Cisplatin / Carboplatin 2.

Gemcitabine D1 & D8 + Cisplatin / Carboplatin -

Max. 6 cycles only (Per cycle)

3A.339 9000 2178 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code

647

Pemetrexed +Carboplatin/Cisplatin (Stage IIIB,

IV Adenocarcinoma)- Max. 6 cycles only (Per

cycle)

3A.340 11250 2179 Biopsy/FNAC ,CT report and Film, Chemotherapy drug batch number with bar code

648Variable Regimen maximum 6 cycles (Per

cycle)(Amount as per drug cost)3A.341 6000 2177 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code

Lobectomy 3A.96 52500 1390 CT Chest report Post Op X-ray,scar photo

ONCOLOGY - LUNGS


Arogya

Karnataka

Code

Package


Pneumonectomy 3A.97 45000 1391 CT Chest report Post Op X-ray,scar photo

Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data

Growth Factor / Pegrafil (Per cycle)

(Maximum 4 cycles)3A.514 1500 2163, 2165

Biopsy/FNAC , Mammography/USG,

chest XrayChemotherapy drug batch number with bar code

Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart

Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,


Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if

requiredChemotherapy drug batch number with bar code

Tab Geftinib/Erlotinib-Max 1 Year (Per month) 3A.554 4500 2176, 2177 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

649Limb salvage surgery for Bone Tumors with

Prosthesis3A.342 56250 2079

CT-Local part/MRI, CT Chest with film,

,Bone Scan report + Biopsy Report

Clinical Photograph XRAY Showing prosthesis

+ HPE report

650 Forequarter amputation 3A.343 22500 2083 CT-Local part/MRI with film + Biopsy

Report Clinical Photograph showing scar+ HPE report

651 Shoulder Girdle Resection 3A.344 30000 2081 CT-Local part including chest /MRI

report with film + Biopsy ReportClinical Photograph showing scar + HPE report

652 Hemipelvectomy 3A.345 48750 2084 CT/MRI Pelvis with filmClinical Photograph showing scar / HPE report +

XRAY

653 Sacral Resection 3A.346 45000 2082 CT/MRI Pelvis with filmClinical Photograph showing scar / HPE report +

XRAY

654Wide excision - for skin, soft tissue and bone

tumors - minor3A.347 11250 2091 Biopsy of the primary tumour Clinical Photograph showing scar + HPE report

655Wide excision - for skin, soft tissue and bone

tumors - Major3A.348 22500 2091 Biopsy of the primary tumour Clinical Photograph showing scar + HPE report

656Wide excision + Reconstruction for soft tissue

and bone tumors3A.349 37500 2092

Biopsy of the primary tumour + CT/MRI

with filmClinical Photograph showing scar + HPE report

657Amputation for bone / soft tissue tumours

(Minor)3A.350 18750 2080



ONCOLOGY - SKIN/BONE AND SOFT TISSUE


Arogya

Karnataka

Code

Package


658Amputation for bone / soft tissue tumours

(Major)3A.351 26250 2080



659Chest wall resection for SOFT tissue bone

tumors3A.352 30000 2005 CT Chest with film, biopsy Clinical Photograph showing scar + HPE report

660 Chest wall resection + Reconstruction 3A.353 30000 2006 CT Chest with film, biopsy Clinical Photograph showing scar + HPE report

661Linear accelerator teletherapy, Definitive,

Neoadjuvant, Adjuvant 3DCRT/IMRT3A.354 37500

2222,

2224,2227,222

8

CT report and film, biopsy Photo with RT machine, RT treatment chart

662

Cisplatin/Adriamycin+ifosmide (IAP)- max 6

cycles (Per cycle) -Adj/Neo adjuvant/Palliative

(Osteosarcoma)

3A.355 11250 2136 Biopsy , CT-Scan with film Clinical Photograph, chemotherapy drug batch

number with bar code

663 High Dose Methotrexate (MTX)- max 6 cycles

(Per cycle)3A.356 11250 2168 Biopsy , CT-Scan with film

Clinical Photograph, chemotherapy drug batch


664

Variable Regimen -Ewings Sarcoma- max 17

cycles in 1 year (Per cycle)(Amount as per drug

cost)

3A.357 7500 2137 X-Ray,CT Scan with film, Biopsy Clinical Photograph, chemotherapy drug batch


665IFS + ADR-max 6 cycles (Per cycle) -Adj/Neo

adjuvant/Palliative3A.358 11250 2136 Biopsy , CT-Scan with film




planning Data

Brachytherapy/ Interstitial HDR one application,

multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy


planning Data


(Maximum 4 cycles)3A.514 1500 2163, 2165








Cobalt 60 External Beam Radiotherapy,

Definitive3A.545 15000 2219, 2221 CT report and Film, Biopsy


planning Data


Arogya

Karnataka

Code

Package


666Induction/1st Phase-AML ( 2nd Induction -

permitted in adults only)3A.359 37500 2155

Haematology, Bone Marrow Aspitation/

Flow cytometry



667 Consolidation 1 to 4 phases(per phase)- AML 3A.360 24750 2157 Haematology, Bone Marrow Aspitation/

Flow cytometry



668Induction, Intensification & Consolidation / ALL

and Lymphoblastic NHL3A.361 75000

2159, 2160,

2162


Flow cytometry



669CNS directed therapy - RT/CT (10 fractions)

(CT- for age below 3 years; all others -RT)3A.362 11250

2222,2223,222

4,Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart

670Maintenance ( Paed and adults) - ALL (Per

month)3A.363 2250 2158,


Flow cytometry



671Adult ALL -Hyper CVAD/BFM - 4 cycles (

Each cycle= A + B)3A.364 27000 NA


Flow cytometry



672D'angelo's for CNS primary and secondary

lymphomas -(Max. 6 months) (Per month)3A.365 15000 NA Haematology + Cytoflowmetry report



673Salvage CT - GDP (Gemcitabine - Cisplatin-

Dexamethasone)- Maximum 6 cycles (Per cycle)3A.366 9000 2181 Hematology + Biopsy/FNAC report



674Salvage CT - ICE (Ifosfamide-Carboplatin-

Etoposide)- Maximum 6 cycles (Per cycle)3A.367 11250 2149 Hematology + Biopsy/FNAC report



675

Salvage CT -DHAP (cytosine arabinoside-

cisplatin-dexamethasone) - Maximum 6 cycles

(Per cycle)

3A.368 18750 NA Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch


676Imatinib Min 400 mg/day-max 12 cycles per year

(Per month) - AML, CML3A.369 3750 2196

Hematology + FNAC report

/Cytogenetics/ BCR-ABL



677Second generation Tab TKI - max 12 cycles per

year (Per month) - (Failure of Imatinib)3A.370 4500 NA

Hematology + FNAC report

/Cytogenetics/ BCR-ABL



678 Bendamustine- max 6 cycles (Per cycle) - CLL 3A.371 7500 2193 Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch


679Bendamustine + Ritumaxib- 6-8 cycles (Per

cycle) - CLL (Available only at select centres)3A.372 15000 2199 Hematology + Biopsy/FNAC report



ONCOLOGY - BLOOD - PAEDIATRICS AND OTHERS


Arogya

Karnataka

Code

Package


680

Doxorubicin - Bleomycin - Vinblastine

Dacarbazine (DBVD)-max 6-8 cycles (Per cycle)

(Day1 & Day15) - Hodgkins Lymphoma

3A.373 9000 2137 Biopsy, CTClinical Photograph, chemotherapy drug batch


681

Cyclophosphamide - Doxorubicin Vincristine -

Prednisone (CHOP)- max 8 cycles (Per cycle) -

NHL/Lymphoma

3A.374 4500 2138 Biopsy, CT report with filmClinical Photograph, chemotherapy drug batch


682 R-CHOP -max 6 cycles (Per cycle) 3A.375 15000 2188 Biopsy, CT report with filmClinical Photograph, chemotherapy drug batch


683

Variable Regimen-Non Lymphoblastic NHL,

(Per cycle) max. 8 cycles.(Amount as per drug

cost)

3A.376 15000 2147 Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch


684Linear accelerator, less than 20

fractions/3DCRT/IMRT3A.377 18750 2224 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart

685

Cobalt 60 External Beam Radiotherapy,Involved-

Site Radiotherapy (ISRT)/Involved Field

Radiation Therapy (IFRT)

3A.378 11250 2221 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart

686

Linear accelerator,Involved-Site Radiotherapy

(ISRT)/Involved field radiation therapy

(IFRT)/3DCRT/IMRT

3A.379 18750 2221 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart

687Vincristine, Adriamycin, Dexamethasone(VAD)-

cycle max 6 cycles - Multiple myeloma3A.380 3750 2141

Bone Marrow Aspiration Report, Serum

Protein electrophoresis, CRAB criteria



688Thalidomide+Dexamethasone(Oral)-/month max

12 months - Multiple myeloma3A.381 3000 2142





689Melphalan -Prednisone (oral)-Month max 12

months -- Multiple myeloma3A.382 1125 2143





690

Plasma cell Leukemia / Multiple Myeloma -

Thaladomide, Dexamethasone, Bortezomib -

max 6 cycles

3A.383 15000 2142Bone Marrow Aspiration Report, Serum

Protein electrophoresis




Arogya

Karnataka

Code

Package


691

Zoledronic acid along with Adjuvant

Chemotherapy of AS-I- Maximum 12 cycles (

Bone metastasis)

3A.384 2250 2166 Bone Marrow Aspiration ReportClinical Photograph, chemotherapy drug batch


692

SIOP/NATIONAL WILMS TUMOUR STUDY

GROUP(NWTS) regimen(Stages I - V)- max 6

months (Per month) - Wilm's tumour

3A.385 6000 2144 CT report with film, biopsy/FNACClinical Photograph, chemotherapy drug batch


693Variable Regimen-Neuroblastoma- max 1 year

(Per cycle)(Amount as per drug cost)3A.386 7500 2148 CT report with film, biopsy/FNAC



694Carbo/Etoposide/Vincristine-max 6 cycles (Per

cycle) - Retinoblastoma3A.387 3750 2149 Biopsy , CT report with film



695Variable Regimen- LCH-max 1 year (Per

month)(Amount as per drug cost)3A.388 6000 2147 Biopsy,IHC , CT report with film



696

Vincristine-Actinomycin-

Cyclophosphamide(Vact C) based chemo - max

1 year (Per cycle)- Rhabdomyosarcoma

3A.389 6750 2153 Biopsy , CT report with filmClinical Photograph, chemotherapy drug batch


697 Palliative and Supportive Therapy (Per month) 3A.390 2250 2165 Biopsy , CT report with film Clinical Photograph

698Salvage CT- max 6 cycles ( Per cycle) only

paediatrics3A.391 9000 NA Hematology + Biopsy/FNAC report




(Maximum 4 cycles)3A.514 1500 2163, 2165





VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo

699 Mastectomy +Axillary Dissection 3A.392 18750 2089Biopsy/FNAC , Mammography/USG,

chest Xray HPE report, scar photo ( if patient consents)

700Mastectomy +Axillary Dissection+Defect

Closure with Flap3A.393 30000 2089 2090


chest Xray HPE report, scar photo ( if patient consents)

701 Axillary Dissection 3A.394 11250 2011Biopsy/FNAC , Mammography/USG,

chest XrayClinical Photograph showing scar + HPE report

ONCOLOGY - BREAST


Arogya

Karnataka

Code

Package


702 Breast Conserving Surgery 3A.395 18750 228Biopsy/FNAC , Mammography/USG,

chest XrayClinical Photograph showing scar + HPE report

703 Bilateral oophorectomy 3A.396 18750 687ERPR positive report, Biopsy of CA

breastHPE report

704Accelerated partial breast irradiation (APBI) any

type/ LINAC/3DCRT/IMRT3A.397 37500

2222, 2228,

2224


chest XrayPhoto with RT Machine , RT treatment chart

7055- Fluorouracil A-C (FAC)(Maximum 6 cycles)

(Per cycle)3A.398 3750 2150



706 AC (Maximum 4 cycles) (Per cycle) 3A.399 3750 2127Biopsy/FNAC , Mammography/USG,


707FEC (Epirubicin based)(Maximum 6 cycles) (Per

cycle)3A.400 6000 2150



708Paclitaxel/docetaxel(Maximum 4cycles)

(Adjuvant) (Per cycle)3A.401 6750 2139, 2201



709Cyclophosphamide/Methotrexate/5Fluorouracil

(CMF) (Per cycle)3A.402 1125 2151



710

1. TC Docetaxel + Cyclophosphamide. 2. TAC

Docetaxel + Doxorubicin + Cyclophosphamide.

3. Gemcitabine D1 & D8 +/- Cisplatin/

Carboplatin - maximum 6 cycles (Per cycle)

3A.403 90002127,2182,

2145, 2150



711Tamoxifen tabs- maximum 12 cycles (Per

month)3A.404 75 2164



712Aromatase Inhibitors ( Anastazole/Letrozole/

Exemestane)- maximum 12 cycles (Per month)3A.405 675 2171



713 Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,


714Variable Regimen - maximum 6 cycles (Per

cycle) (Amount as per drug cost)3A.407 6000 2150, 2127



715 Paclitaxel weekly x 12 weeks 3A.408 3375 2139Biopsy/FNAC , Mammography/USG,



planning Data


Arogya

Karnataka

Code

Package





planning Data


(Maximum 4 cycles)3A.514 1500 2163, 2165






Definitive, Adjuvant, SRS/SRT 3A.336 56250 2229 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT treatment chart RT

planning Data




planning Data

716

Capetabine (Day 1-14) - 6 cycles

(Palliative/Adjuvant); As Concurrent as RT

sensitizor with all RT

3A.409 3000 2187 CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code

717Variable Regimen maximum 6 cycles (Per

cycle) (Amount as per drug cost)3A.410 6000

2180, 2181,

2182, 2184CT report and Film, Biopsy Chemotherapy drug batch number with bar code

718Oesophagectomy with Two field

Lymphadenectomy3A.411 56250 2016

UGI Endoscopy with film, biopsy, CT

report with film Clinical Photograph showing scar+ HPE report

719Oesophagectomy with Three field

Lymphadenectomy3A.412 67500 2017

UGI Endoscopy with film, biopsy, CT

report with film Clinical Photograph showing scar+ HPE report

720 Gastrectomy - any type 3A.413 37500 2019Endoscopy with film, biopsy, CT report


721 Small bowel resection 3A.414 30000 2022 CT/ X ray with film , biopsy Clinical Photograph showing scar + HPE report

722 Closure of Ileostomy/ Colostomy 3A.415 22500 2028 2029 Colonoscopy with film, Biopsy Clinical Photograph showing scar

723 Colectomy - any type 3A.416 30000 2023Endoscopy with film, biopsy, CT report

with film Clinical Photograph showing scar + HPE report

724 Anterior Resection ( inclusive of staplers) 3A.417 52500 2031Endoscopy with film, biopsy, CT report


725 Abdominoperinial Resection 3A.418 37500 2030Endoscopy with film, biopsy, CT report


ONCOLOGY - GI TRACT AND OESOPHAGUS


Arogya

Karnataka

Code

Package


726 Feeding procedure(Gastrostromy/Jejunostomy) 3A.419 15000 2027 2020 Biopsy of the primary tumor Clinical Photograph of operated site

727 Ileostomy 3A.420 15000 2026Biopsy of the primary + CT Scan with

filmClinical Photograph of operated site

728 Colostomy 3A.421 15000 2025Biopsy of the primary + CT Scan with

filmClinical Photograph of operated site

729 Gastro Jejunostomy 3A.422 22500 2021Biopsy of the primary + CT Scan with

filmClinical photograph showing scar

730 Ileotransverse Colostomy 3A.423 22500 2024Biopsy of the primary + CT Scan with

filmClinical photograph with scar

731 Distal Pancreatectomy 3A.424 45000 2036 CT / MRI with film/IHC report Clinical Photograph showing scar + HPE report

732 Enucleation of Cyst 3A.425 37500 1190 CT report and Film Clinical Photograph showing scar + HPE report

733 Whipples surgery ( inclusive of staplers) 3A.426 60000 1197 CT / MRI/IHC Clinical Photograph showing scar + HPE report

734 Radical Cholecystectomy 3A.427 45000 2034 CT /MRI report and Film, biopsyClinical Photograph showing the scar + HPE

report +USG Report

735 Resection of Retroperitoneal Tumors 3A.428 37500 2040 CT abdomen with film, FNAC Clinical Photograph showing scar + HPE report

736 Abdominal wall tumor Resection 3A.429 26250 2038 CT abdomen report and Film Clinical Photograph showing scar + HPE report

737Abdominal wall Resection with

reconstruction/mesh3A.430 33750 2039 CT abdomen report and Film Clinical Photograph showing scar + HPE report

738 GI Stenting including stent cost 3A.431 30000 1205 CT abdomen report and Film Stent invoice

739 Triple Bypass -GI Tract 3A.432 30000 1191 Biopsy , CT , Endoscopy Clinical Photograph showing scar + HPE report

740 Hepatectomy (right or left) 3A.433 63750 1180 1181 CT /MRI report and FilmClinical Photograph showing scar, USG and HPE

Report

741 Segmentectomy-Hepato Billiary System 3A.434 37500 1179 CT /MRI report and FilmClinical Photograph showing scar, USG and HPE

Report

742 Substernal bypass 3A.435 26250 2018 Biopsy of the primary Clinical Photograph showing the procedure/scar


Arogya

Karnataka

Code

Package


743

Linear accelerator teletherapy, Definitive,

3DCRT/IMRT - for inoperable oesophagus

cancer without metastsis.

3A.436 56250 2228 2227 CT report and film, biopsy Photo with RT machine, RT treatment chart

744Cisplatin/Carboplatin- 5FU (Per cycle) -

Oesophageal CA3A.437 4500 2128

Endoscopy with film, biopsy, CT report

with filmChemotherapy drug batch number with bar code

745 Epirubicin+Cisplatin+5FU (Per cycle) 3A.438 6000 2128Endoscopy with film, biopsy, CT report


746

Hepatoblastoma - Variable regime, max 6 cycles

(per cycle) as per drug cost

cisplatin/carboplatin+adriamycin

3A.439 3750 2146 CT scan, Tumour markers Chemotherapy drug batch number with bar code

747

Docetaxel+Cisplatin+5FU OR Capcetabine +

Oxaloplatin (Neoadjuvant Chemotherapy

maximum 3 cycles/pallative maximum 6 cycles)

(Per cycle)

3A.440 7500 2186Endoscopy with film, biopsy, CT report


748EOX (Epirubicin + Oxaloplatin + Capcetabine) -

Max 6 cycles3A.441 9000 2180



749Monthly 5-Fluorouracil(FU) (Per cycle) -

Colorectal cancer3A.442 2250 2132 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

750

5-Fluorouracil-Oxaliplatin -Leucovorin

(FOLFOX)- Day 1 and 2; Max. 12 cycles for

adjuvant (Per cycle) -Colorectal cancer

3A.443 6000 2134 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

751

5-Fluorouracil-Oxaliplatin -Leucovorin

(FOLFOX)- Day 1 and 2; Max. 6 cycles for

palliative (Per cycle) -Colorectal cancer


752 Imatinib -Max for 6 months (Per month) 3A.445 3750 2183 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

753Gemcitabine+Cisplatin(Day 1,Day 8 )-max 6

cycles (Per cycle)3A.446 7500 2182 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

754 Tab Sorafenib- max 12 months (Per month) 3A.447 6000 2205 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

755

Oxiplatin+Capecitabine- max. of 6 cycles for

palliative only or 8 cycles for adjuvant (Per

cycle)

3A.448 6000 5 CT/MRI with film, Biopsy Chemotherapy drug batch number with bar code


Arogya

Karnataka

Code

Package


756

Second line palliative CT - FOLFERI (Day 1, 2

every 14 days) max 6 cycles OR CAPIRI (

Capcetabine D1 -14, Irinotecam D1, D8)

(Metastatic, after failure of CAPOX,

Capcetabine)

3A.449 7500 NA CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code


planning Data


(Maximum 4 cycles)3A.514 1500 2163, 2165









Linear accelerator teletherapy, Definitive,


2222,

2224,2227,222

8

CT report and film, biopsy Photo with RT machine, RT treatment chart

Brachytherapy - Intraluminal HDR per fraction



RT planning data


Definitive, Neoadjuvant, Adjuvant3A.337 15000 2221 Biopsy/FNAC ,CT report and Film


planning Data

757 Radical Nephrectomy - Open/Lap * 3A.450 33750 2042Ultrasound abd /CT Scan abd with film,

Isotope Renogram if required Clinical Photograph showing scar + HPE report

758 Partial Nephrectomy 3A.451 41250 2041 CT report with film, Isotope renogram if

required

Clinical Photograph showing scar+ HPE report

+USG Report

759Nephro- ureterectomy for Transitional Cell

Carcinoma of renal pelvis (one side)3A.452 33750 2043

CT report with film, Isotope renogram if

requiredClinical Photograph showing scar+ HPE report

760 Radical Cystectomy with Ileal conduit * 3A.453 56250 2047 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

ONCOLOGY - GENITO URINARY SURGERY


Arogya

Karnataka

Code

Package


761 Other cystectomies * 3A.454 30000 2046 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

762 High Orchidectomy * 3A.455 11250 2049 USG scrotum, Tumour markersClinical Photograph showing scar ( if patient

consents)+ HPE report

763 Bilateral Orchidectomy * 3A.456 11250 2102Biopsy Reports /PSA with evidence of

bone metastasis

Clinical Photograph showing scar ( if patient


764 Partial Penectomy * 3A.457 11250 2051 Biopsy ReportsClinical Photograph showing scar ( if patient


765 Total Penectomy * 3A.458 18750 2097 Biopsy ReportsClinical Photograph showing scar ( if patient


766 Inguinal Block Dissection-one side * 3A.459 15000 2115 2012 Biopsy Reports Clinical Photograph showing scar + HPE report

767 Inguinal Block Dissection-Bilateral 3A.460 30000 2116 Biopsy Reports Clinical Photograph showing scar + HPE report

768Radical Prostatectomy with Bilateral pelvic

lymph Node Dissection(BPLND) *3A.461 56250 2048 CT report and Film, Biopsy Clinical Photograph, HPE report

769 Anterior Exenteration 3A.462 52500 2109 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+ HPE report

770 Total Exenteration 3A.463 56250 2110 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+ HPE report

771 Suprapubic Cystostomy 3A.464 7500 2045 Biopsy of the primary tumor Clinical Photograph showing procedure/scar

772 Urinary diversion 3A.465 30000 2044 Biopsy, USG Scrotum report and Film Clinical Photograph showing scar, post op USG

773 Adrenalectomy * 3A.466 33750 1980 1981 CT/MRI report with film, Urinary

hormonesClinical Photograph showing scar+ HPE report

774Retro Peritoneal Lymph Node

Dissection(RPLND)3A.467 60000 2013 CT report and film, biopsy Clinical photograph showing scar, HPE report

775 Linear accelerator teletherapy, 3DCRT 3A.468 56250 2228 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart, RT

planning Data

776IMRT/VMAT/SBRT (Radical radiation alone

for prostate) 3A.469 67500 2227 CT report and Film, Biopsy

Photo with RT Machine , RT treatment chart, RT

planning Data

777Linear accelerator, Curative less than 20

fractions3A.470 15000 2224

CT report and Film, Biopsy/Tumour

markersPhoto with RT Machine , RT treatment chart


Arogya

Karnataka

Code

Package


778Weekly Cisplatin/Carboplatin- max 6 cycles with

RT (Per week)3A.471 1500 2133 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

779Gemcitabine+ Cisplatin(Day 1,Day 8)(Palliative

/Adjuvant)-max 6 cycles (Per cycle)3A.472 7500 2182 CT report and Film, Biopsy



780 Hormonal therapy with Abiratarone- monthly 3A.473 6000 2126CT report and Film, Biopsy,PSA with

evidence of bone metastasis



781Hormone therapy - Bicalutamide -50mg OD

monthly (per month)3A.474 3750 2126

CT report and Film, Biopsy,PSA with

evidence of bone metastasis



782 Carboplatin(AUC more than 5) (Per cycle) 3A.475 3750 2145 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch


783

Bleomycin-Etoposide-Cisplatin (BEP)- max

cycles 4 (Per cycle) Germ cell tumours, extra

gonadal tumour

3A.476 7500 2175CT report and Film, Biopsy/Tumour

markers



784

Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vi

nblastine,Ifosphimide,Cisplatin(VeIP)- max

cycles 4 (Per cycle)

3A.477 15000 2200CT report and Film, Biopsy/Tumour

markers



785 Tab Sorafenib-max 12 months (Per month) 3A.478 6000 2205 CT report and Film, Biopsy Clinical Photograph,chemotherapy drug batch


786Palliative CT - (5FU + Cisplatin/Carboplatin) -

Max 6 cycles (Per cycle)3A.479 4500 2128 CT/USG report and Film, Xray, Biopsy



787Palliative CT-Docetaxel- Max 6 cycles (Per

cycle)3A.480 6750 2201 CT/USG report and Film, Xray, Biopsy



788

Variable Regimen maximum 6 cycles (Per

cycle)MVAC- Mitomycin, Vincristine,

Adriamycin, Cyclophosphamide

3A.481 6000 2140 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch


789

Urinary bladder CA- Gemcitabine/Cisplatin as

radio sensitizer weekly - max 8 weeks - (cost per

week)

3A.482 1500 2182 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch



planning Data




planning Data


Arogya

Karnataka

Code

Package



(Maximum 4 cycles)3A.514 1500 2163, 2165







Arogya

Karnataka

Code

Package


790 Radical Trachelectomy 3A.483 30000 2056 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

791

Radical Hysterectomy +Bilateral Pelvic Lymph

Node Dissection (BPLND) + Bilateral Salpingo

Ophorectomy (BSO) / Ovarian transposition

3A.484 37500 2060 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

792 Anterior / Posterior Exenteration (Gynaec) 3A.485 52500 2061 2062 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

793 Total Pelvic Exenteration 3A.486 56250 2063 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

794 Bilateral pelvic lymph Node Dissection(BPLND) 3A.487 22500 2105 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

795 Surgery for Ca Ovary - early stage 3A.488 30000 2052 USG/CT Reports with film,CA 125 Clinical Photograph showing scar + HPE report

+ USG report

796Surgery for Ca Ovary - advance stage with

Mesenteric/Peritoneal/Omental Metastatsis3A.489 45000 2055 USG/CT Reports with film,CA 125

Clinical Photograph showing scar + HPE report

+ USG report

797 Radical vaginectomy 3A.490 30000 2065 CT report and Film, Biopsy HPE report

798 Radical vaginectomy + Reconstruction 3A.491 33750 2066 CT report and Film, Biopsy HPE report

799 Vulvectomy 3A.492 22500 2067 Biopsy Reports HPE report

800Linear accelerator teletherapy,Definitive,


2222 2224

2228 2227CT report and film, biopsy Photo with RT machine, RT treatment chart

801 Brachytherapy/ Interstitial LDR , adjuvant 3A.494 11250 2225 CT / MRI report with film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data

802Cisplatin/Carboplatin (AUC2)- Max. of 6 cycles

only (Per cycle)3A.495 1500 2145 CT report and Film, Biopsy



803 Carboplatin/Paclitaxel-max 6 cycles (Per cycle) 3A.496 9000 2145 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch


804Bleomycin-Etoposide-Cisplatin (BEP) (Per

cycle) - Germ cell tumours, extra gonadal tumour3A.497 7500 2156 CT report and Film, Biopsy



805 Weekly Methotrexate (Per week) max. 10 cycles 3A.498 750 2168 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch


ONCOLOGY - GYNAECOLOGY


Arogya

Karnataka

Code

Package


806 Actinomycin- max 10 cycles (Per cycle) 3A.499 750 2172 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch


807

Etoposide-Methotrexate-Actinomycin /

Cyclophosphamide -Vincristine (EMA-CO)-max

6 cycles (Per cycle)

3A.500 6000 2174 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch


808Variable Regimen (Amount as per drug cost)-

max 6 cycles (Per cycle)3A.501 6000 2163 2165 CT report and Film, Biopsy



809

Gemcitabine+ Carboplatin/ Liposomal

Doxorubicin/ Albumin bound Paclitaxel (

Adjuvant), max 6 cycles

3A.502 9000 2182 CT report and Film, BiopsyClinical Photograph, chemotherapy drug batch



planning Data




planning Data


(Maximum 4 cycles)3A.514 1500 2163, 2165









Brachytherapy - Intraluminal HDR per fraction



RT planning data




planning Data

810 X Knife, Gamma Knife, Cyber knife 3A.503 67500 1962 1963 CT/MRI report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data


Definitive+Tab Temozolomide along with RT 3A.504 26250

2220

2219,2198CT report and Film, Biopsy Photo with RT Machine , RT treatment chart

ONCOLOGY - BRAIN AND SPINE


Arogya

Karnataka

Code

Package


812 Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data

813Linear accelerator teletherapy, Definitive+Tab

Temozolamide3A.506 41250

2224,2222,219

8, CT report and film, biopsy

Photo with RT machine, RT treatment chart, RT

planning data

814

Linear accelerator teletherapy, 3DCRT,

Definitive along with +concurrent Tab

Temozolamide along with RT

3A.507 60000 2228, 2198, CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data

815

Linear accelerator teletherapy, IMRT /VMAT,

Definitive along with +concurrent Tab

Temozolamide along with RT.

3A.508 78750 2227, 2198 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT

planning Data

816 Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart

817Palliative CT- Max 6 cycles (Per cycle) For

Primary and secondary tumours3A.510 6000 2163 CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code

818 Variable regimen - Max 6 cycles (Per cycle) 3A.511 6000 2163 2165 CT/MRI , HPE report Chemotherapy drug batch number with bar code

819 Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if


820Tab Temozolemide for 6 months (5days every

month x 6 months)3A.513 33750 2198 CT report and Film, Biopsy

Pharmacy Bill/Invoice with batch no. of the drug

strip

821Growth Factor / Pegrafil (Per cycle)

(Maximum 4 cycles)3A.514 1500 2163, 2165



822 Tracheal Resection and anastomosis 3A.515 13500 1996 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

823 Sternotomy + Superior Mediastinal Dissection 3A.516 9000 2004 CT report and Film, Biopsy Clinical Photograph showing the scar + HPE

report

824 Microlaryngeal Surgery including Phonosurgery 3A.517 8250 397, 398 Clinical Photograph Clinical Photograph, HPE report

825 Resection of Nasopharyngeal Tumor 3A.518 37500 1991 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

826 Myocutaneous / cutaneous flap 3A.519 18750 2093 Biopsy of the primary Clinical Photograph showing scar

827 Palatectomy 3A.520 22500 1989 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report

828 Micro vascular reconstruction 3A.521 33750 2008 Biopsy of the primary Clinical Photograph showing scar

ONCOLOGY - HEAD AND NECK


Arogya

Karnataka

Code

Package


829 Temporal bone resection (Any Type) 3A.522 45000 2074 CT/MRI report and Film, Biopsy Clinical Photograph showing scar + HPE report

830 Composite Resection 3A.523 37500 2094, 2076 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

831 Composite Resection and Reconstruction 3A.524 48750 2094 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

832Composite Resection + Micro vascular

reconstruction3A.525 60000 2094 2008 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

833 Neck Dissection - any type 3A.526 18750 2009 Biopsy , USG/CT of neck with film Clinical Photograph showing scar + HPE report

834 Hemiglossectomy 3A.527 18750 1985CT/MRI report and Film if required/

Biopsy Clinical Photograph showing scar + HPE report

835 Maxillectomy 3A.528 30000 2070 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

836 Parotidectomy 3A.529 30000 1987 FNAC,CT Clinical Photograph showing scar + HPE report

837Laryngectomy - any type, with neck node

dissection3A.530 30000 1993 2009 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

838 Voice Prosthesis 3A.531 30000 NA CT report, Biopsy, +Photograph with AM Invoice of prosthesis, scar photo

839 Laryngopharyngo Oesophagectomy 3A.532 52500 1994 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

840 Hemimandibulectomy 3A.533 18750 2068 CT report and Film if required/ Biopsy Clinical Photograph showing scar + HPE report

841 Wide excision of lesion 3A.534 18750 2101CT/MRI report and Film if required,

Biopsy, clinical pictureClinical Photograph showing scar + HPE report

842 Thyroidectomy any type 3A.535 18750 1978 FNAC/CT/MRI report and Film Clinical Photograph showing scar + HPE report

843 Laser Surgery of Larynx 3A.536 22500 NA Clinical PhotographPhotos with laser machine, CD of procedure/intra

op stills + HPE report

844 Submandibular Gland Excision 3A.537 18750 1988CT/MRI/USG report and Film if

required/ BiopsyClinical Photograph showing scar + HPE report

845 Parathyroidectomy 3A.538 22500 1979CT Scan Functional scan/PTH

reports/USGClinical Photograph showing scar + HPE report


Arogya

Karnataka

Code

Package


846 Pharyngectomy & Reconstruction - Total 3A.539 9000 71 CT Neck,USG HPE, X Ray Neck, Scar Photo

847 Parapharyngeal Tumour Excision 3A.540 8250 403 USG, CT Neck USG,HPE,Scar Photo

848Linear accelerator (Photons) teletherapy,

Adjuvant3A.541 37500 2224 CT/MRI report and Film, Biopsy Photo with RT Machine , RT treatment chart

849Linear accelerator teletherapy 3DCRT,

Definitive, Adjuvant 3A.542 56250 2228 CT/MRI report and Film, Biopsy


planning Data

850Linear accelerator teletherapy IMRT /VMAT,

Definitive, Adjuvant3A.543 75000 2227 CT/MRI report and Film, Biopsy


planning Data

851Brachytherapy/ Interstitial HDR one application,



planning Data




planning Data

853 Radioiodine Treatment < 100 Millicuries 3A.546 15000 NA Biopsy/FNACRadioiodine original treatment chart and Thyroid

scan, Biopsy/HPE

854 Radioiodine Treatment > 100 Millicuries 3A.547 22500 NA Biopsy/FNACRadioiodine original treatment chart and Thyroid

scan , Biopsy/HPE

855Cisplatin/Carboplatin (AUC2) along with RT-

max 6 cycles (Per cycle)3A.548 1500 2173, 2202 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

856

Carboplatin/cisplatin + Paclitaxel/Docetaxel

(Neoadjuvant Chemotherapy)-Max. of 4 cycles

only (Per cycle) -For stage III and IVA


857

Cisplatin + 5 FU(Neoadjuvant

Chemotherapy)/Palliative - Max. of 4 cycles only

(Per cycle)

3A.550 45002128, 2130,

2135CT report and Film, Biopsy Chemotherapy drug batch number with bar code

858Cisplatin + 5FU + Taxol/Docitaxel ( only

hypopharynx)3A.551 8250 2184 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

859Palliative CT (Paclitaxel + Cisplatin or 5 FU +

Cisplatin) - Max 6 cycles (Per cycle)3A.552 6000 2163 CT / USG report and Film, X ray, Biopsy Chemotherapy drug batch number with bar code

860

Palliative CT 1. Docetaxel + Cisplatin /

Carboplatin. 2. Gemcitabine D1& D8 + Cisplatin

/ Carboplatin - max 6 cycles (Per cycle)



Arogya

Karnataka

Code

Package


861 Tab Geftinib/Erlotinib-Max 1 Year (Per month) 3A.554 4500 2176, 2177 CT report and Film, Biopsy Chemotherapy drug batch number with bar code

862 Tab Sorefinib- max 12 months (Per month) 3A.555 6000 2205 CT/MRI report and Film, Biopsy Chemotherapy drug batch number with bar code


planning Data


(Maximum 4 cycles)3A.514 1500 2163, 2165




863 Prostate surgery (Code 3A.561) - additional cost 3A.556 18750 NA CT report and Film, Biopsy Clinical Photograph, HPE report

864Nephrectomy – partial (Code 3A.451)-

additional cost3A.557 18750 NA

CT report with film, Isotope renogram if

required

Clinical Photograph showing scar+ HPE report

+USG Report

865Low AR and APR (Code 3A.417, 3A.418) -

additional cost3A.558 18750 NA



866Radical hysterectomy for CA cervix and CA

endometrium ( Code 3A.484)- additional cost3A.559 15000 NA CT report and Film, Biopsy Clinical Photograph showing scar + HPE report

OF1 Post Oncology Follow up-1 3A.OF1 #N/A NA

OF2 Post Oncology Follow up-2 3A.OF2 #N/A NA

OF3a Post Oncology Follow up-3 3A.OF3a #N/A NA

OF3b Post Oncology Follow up-3 with CECT 3A.OF3b #N/A NA

867 Tendon injury requiring repair moderate 3A.560 75002231,989,968,

965, 960

X-ray Films/ Clinical Picture + detail

notesClinical photo showing Scar

868 Tendon injury requiring repair major 3A.561 15000 967968Xray Films(if relevant)+ Clinical

Picture(Mandatory) + detail notesClinical photo showing Scar

869 Nerve injuries minor 3A.562 11250

2231,

953,1868,1904

,

Xray Films(if relevant)+ Clinical


ROBOTIC SURGERY - ALLOWED IN SELECTED CENTRES ONLY

POST ONCOLOGY FOLLOW-UP

POLYTRAUMA


Arogya

Karnataka

Code

Package


870 Nerve injuries major 3A.563 15000952, 954, 955,

1931

Xray Films(if relevant)+ Clinical


871 Nerve plexus injuries 3A.564 375001000 , 1866 ,

1867

MRI + Xray Films(if relevant)+ Clinical


872 Vascular peripheral/minor injuries 3A.565 7500 2231,

Pre-operative Doppler study, CT

angio(Optional)+ Films+ detailed

Clinical notes

Post-operative Doppler study, Clinical photo

showing scar


Arogya

Karnataka

Code

Package


873 Vascular central/severe injuries(major) 3A.566 37500 2231Pre-operative Doppler study+ CT

Angio(optional) + detailed Clinical notes

Post-operative Doppler study, Clinical photo

showing scar

874 Flap surgery (Simple) 3A.567 11250 2542X-ray Films + detail notes+ pre-op

clinical photoClinical photo showing Scar

875 Complex flap surgery 3A.568 22500 2364, 2365 X-ray Films + detail notes Clinical photo showing Scar

876 Visceral injuries moderate 3A.569 30000 610 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

877 Visceral injuries severe 3A.570 45000 510611 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

878 Chest injuries with ICD bilateral 3A.571 82502002, 1471,

2977X-ray /ultra sound Post-Operative chest X-ray with ICD in situ

879 Chest injuries with ICD + ICU 3A.572 15000 2391, 2398 , X-ray /ultra sound Post-Operative chest X-ray with ICD in situ

880 Chest injuries with ICD + ICU + Ventilator 3A.573 19950 2398 , X-ray /ultra sound Post-Operative chest X-ray with ICD in situ

881 Acetabular definitive treatment 3A.574 19950 1036, X-RAY/CT scan Clinical Photograph showing scar + post op.

XRAY

882Illizarov/Orthofix/hybrid external fixator

application3A.575 19950

2961, 1125,

1061 X-ray Post op X-ray, Pt photo with applicator

883 Skin Grafting Major- Injuries(Add on code) 3A.576 135002352, 2354,

961X-ray X-ray + post-operative scar photo

884

Arthroscopic BANKARTS Repair for recurrent

dislocation of shoulder (without cost of suture

anchors)**

3A.577 12450 986 X-ray Patient Photo with Arthroscopic incision

885

Total knee replacement(Unilateral) Procedure +

Impant including cement cost. Incase of bilateral

in same sitting only implant cost will be paid. In

case of next sitting 50% of procedure cost &

implant will be paid.**

3A.578 48750 942, 949, 950 X-ray Post-op X-ray, Scar photo

886Total hip replacement Uncemented

implant(Procedure cost + implant cost)**3A.579 51825 947, 948 X-ray Post-op X-ray, Scar photo

887Total hip replacement cemented

implant((Procedure cost + implant cost)**3A.580 45075 947, 948 X-ray Post-op X-ray, Scar photo


Arogya

Karnataka

Code

Package


888Total hip replacement Hybrid ((Procedure cost +

implant cost)**3A.581 75000 947, 948 X-ray Post-op X-ray, Scar photo

* Procedures requiring Follow Up as per Annexure 3

** Super speciality procedures that shall be restricted to PHIs and Medical colleges (Public & Private)


Arogya

Karnataka

Code

Package


889 Second degree burns - Thermal (16% to 30%) 4A.1 18750 2263, 2264Clinical Photograph, Diagram with Rule

of 9 for extent of burnsClinical Photograph

890 Second degree burns - Thermal (30% to 50%) 4A.2 375002249, 2250,

2242, 2243

Clinical Photograph, Diagram with Rule


891 Between 50% to 60% Burns - Thermal 4A.3 52500 2244, 2245Clinical Photograph, Diagram with Rule


892 More than 60% Burns - Thermal 4A.4 75000 2245Clinical Photograph, Diagram with Rule


893Chemical Burns/Acid Burns (Moderate )

(Grafting not required)4A.5 22500 537 Clinical Photograph Clinical Photograph

894 Chemical Burns (Severe) 4A.6 56250 537 Clinical Photograph Clinical Photograph

895 Electrical Burns(Moderate) 4A.7 22500 2255 Clinical Photograph Clinical Photograph

896 Electrical Burns(Severe) 4A.8 52500 2255 Clinical Photograph Clinical Photograph

897Any degree burn with inhalational injury, with

72 hours ventilator support4A.9 45000 2857 Clinical Photo Clinical photograph

898 Coronary Balloon Angioplasty/PTSMA* 4A.10 30000 2961ECG, 2D ECHO, CAG stills showing

blocks & ReportsAngioplasty stills showing Balloon & post flow

899PTCA - one stent (non-medicated, emergency,

inclusive of angiogram) at the same admission.*4A.11 48000 1286, 1287


blocks & Reports


flow

900PTCA - one Drug Eluting stent ( emergency,

inclusive of angiogram) at the same admission. *4A.12 60000 1286, 1287


blocks & Reports



FDA/CE/DCGI only

901

PTCA - two bare metal stents ( non-medicated,

emergency, inclusive of angiogram) at the same

admission. *

4A.13 55000 1288, 1289ECG, 2D ECHO, CAG stills showing

blocks & Reports

Angioplasty stills showing stent & post Stent

flow

902PTCA - two Drug Eluting stents ( emergency,

inclusive of angiogram) at the same admission. *4A.14 85000 1288, 1289


blocks & Reports


flow

Emergency procedures TERTIARY EMERGENCY

BURNS

CARDIOLOGY


Arogya

Karnataka

Code

Package


903Medical treatment of Acute MI with

Thrombolysis4A.15 15000 2720

2D ECHO, CPKMB,CAG, ECG with

report, TROPONINE-T reports

2D ECHO, ECG, LAB INVESTIGATION

(Trop T report)

904 Arrythmias 4A.16 7000 2725, 2726 CAG CAG

905 Stuck valve with Thrombolysis 4A.17 20000 1960 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC

906Medical management of unstable angina/non

STS4A.18 7500 2730, 2731

ECG,ECHO,Cardiac Enzymes, RFT,

CBCECG, RFT, CBC

907 Cardiac failure 4A.19 75002670, 2672,

2674ECG,ECHO,Chest X-ray, RFT, CBC ECHO, CHEST X RAY, RFT, CBC

908 CVA secondary to Cardiac conditions 4A.20 100001337, 2603,

2604

ECHO, CT Brain/ MRI Brain,, RFT,

CBCPT/INR, RFT, CBC

909 Emergency dialysis for cardiac conditions 4A.21 15000 1791, 1792 ECHO, RFT, CBC RFT, CBC

910 ICU with ventilator with dialysis 4A.22 15000 2646 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY RFT,RFT, CBC, ABG

911 Acute respiratory distress - ventilator support 4A.23 15000 2560, 2561 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY, RFT, CBC, ABG

912 Pulmonary edema 4A.24 10000 2732ECG, ECHO,Chest X Ray, RFT, CBC,

ABGECHO, CHEST X RAY, RFT, CBC, ABG

913Laryngoscopy / Bronchoscopy with dilatation of

trachea with gum elastic bogie4A.25 5000 NA CT / Bronchoscopy report CT / Bronchoscopy report

914Intercostal Drainage and Management of ICD,

Intercostal Block, Antibiotics & Physiotherapy4A.26 15000 1407 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

915 Temporary Pacemaker implantation 4A.27 10000 1307, 1308 ECG + Report by cardiologist X Ray showing the pacemaker in situ

916 Creation of AV fistula for dialysis 4A.28 7500 1346, 1347 Duplex Clinical photos showing the AV fistula

917 Pericardiostomy with balloon 4A.29 20000 1298 2D ECHO report 2D ECHO report + stills of the ECHO

918 Pericardiocentesis 4A.30 10000 1297 2D ECHO report 2D ECHO report

919 Thrombolysis for peripheral ischemia 4A.31 30000 1960Peripheral Angiogram /Doppler Report

with StillsPost procedure Angio stills

920 Foreign Body Removal with scope 4A.32 20000 296 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE

921Surgery for Cardiac Tumour/ Left Atrial (LA)

Myxoma/ Right Atrial (RA) Myxoma4A.33 95000 1300 2D ECHO with stills + CT Chest report


ray,scar photo

922 Lung Injury repair 4A.34 50000 1394 CT Chest report X-RAY, scar photo

CARDIO THORACIC SURGERY


Arogya

Karnataka

Code

Package


923Management of Mediastinitis / mediastinal

bleeding4A.35 40000 1395 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan


Arogya

Karnataka

Code

Package


924Hemodialysis for acutekidney injury (intiation

phase)4A.36 3750

1789, 1791,

1792

CBC,RFT,USG

Abd,HIV,HBsAg,HCV,Urine R/E

CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine

R/E

925 Subsequent Hemodialysis - per session 4A.37 7501789, 1791,

1792RFT, Urine R/E RFT, Urine R/E

926

Acutekidney injury without hemodialysis,

inclusive of pre-op inv,post -op inv,procedure

cost,wards stay,and medication for 10 days

4A.38 7500 2644, 2646,

CBC,RFT,USG

Abd,HIV,HBsAg,HCV,Urine R/E,

LFT,Lipid Profile


R/E, LFT,Lipid Profile

927

Acutekidney injury with hemodialysis, inclusive

of pre-op inv,post -op inv,procedure

cost,ICU/wards stay,and medication for 15 days

4A.39 18750 2645

CBC,RFT,USG

Abd,HIV,HBsAg,HCV,Urine R/E,

LFT,Lipid Profile


R/E, LFT,Lipid Profile

928 Trochar SPC FOR ARU/Acute Urethral injury 4A.40 1500 1606 RGU,MCU RGU,MCU

929 Reduction of Paraphimosis 4A.41 1125 248 Clinical Photograph Clinical Photograph

930 Bronchoscospy for foreign body removal 4A.42 18750428, 1405,

1565X Ray OT Notes/ X Ray

931 Airway Reconstruction for benign conditions 4A.43 37500 1458 Endoscopic Picture OT notes

932 Anorectal Malformations Stage 1 4A.44 26250 1501, 1495 USG OT notes

933 Neonatal Intestinal Atresias 4A.45 82500 1490 USG OT Notes, Scar Photo

934 Paediatric intestinal obstruction >1month 4A.46 48750 112 USG OT notes

935 Laparotomy for peritonitis 4A.47 37500 1488, 1489 USG OT notes, Scar Picture

936 Omphalocele-Major/Gastroschisis 4A.48 52500 1478, 1479 USG OT notes

937 Intussusception operative reduction 4A.49 22500 1493 USG OT notes

938 Bowel resection and anastomosis 4A.50 41250 88 USG OT notes

939 Exstropy Bladder Stage 1 4A.51 60000 1605 USG OT notes

940Craniotomy and Evacuation of Haematoma -

Subdural *4A.52 45000 1828 CT Report , X Ray OT Notes, CT Report, Clinical Photograph

941Craniotomy and Evacuation of Haematoma -

Extradural *4A.53 37500 1829 CT Report CT Report, Scar Photo, X Ray

NEUROSURGERY

GENITO URINARY

NEONATAL AND PAEDIATRIC SURGERY


Arogya

Karnataka

Code

Package


942 Ventriculoatrial /Ventriculoperitoneal Shunt 4A.54 20250 1947 CT Report CT Report, Scar Photo, X Ray

943 Subdural Tapping/Burr 4A.55 13500 1824 CT Report CT Report, Scar Photo

944 Twist Drill Craniostomy 4A.56 11250 1823 CT report Film and scar photo

945 Abscess Tapping multiple 4A.57 15000 1826 CT report Post Op CT Report,film and scar photo

946 Excision of Brain Abcess 4A.58 37500 1831, 1832 CT report Post Op CT Report and film, Clinical


947 External Ventricular Drainage (EVD) 4A.59 11250 1855 CT report Post Op CT Report and film, Clinical


948 IV antibiotics and other supportive therapy For

Febrile Neutropenia (Per episode)4A.60 7500 2169 Haemogram for each episode

Clinical Photograph, Discharge summary (with

details of drugs given)

949 Exploratomy laparotomy 4A.61 15000 346Endoscopy with film, biopsy, CT report


950 Electric Shock 4A.62 3000 2255 Clinical Notes Clinical Notes

951 Peritonsillor abscess under LA 4A.63 1125 420 Clinical Photograph Clinical Photograph

952 Removal of foreign body from Ear 4A.64 488 393 Clinical Photograph, Otoscopic findings Clinical Photograph

953 Fracture reduction of nasal bone 4A.65 3750 2279 X Ray Nasal Bones film with reportPost op X Ray Nasal Bone film with report ,

clinical photo

954 Removal of foreign body from Nose 4A.66 488 466Clinical findings/ X Ray nose lateral

view film with report Clinical photograph

955 Drowning 4A.67 3000 NA Clinical Notes Clinical Notes

956 Bullgore Injury 4A.68 3000 NA Clinical Notes Clinical Notes

957Injuries caused while operating agricultural

equipments4A.69 3000 NA Clinical Notes Clinical Notes

958 Acute meningitis - fungal 4A.70 563/day 2753Clinical Notes with relevant


959 Acute meningitis - pyogenic 4A.71 563/day 2752Clinical Notes with relevant


ONCOLOGY

SECONDARY EMERGENCY PROCEDURES

BURNS

ENT

GENERAL EMERGENCY

GENERAL MEDICINE


Arogya

Karnataka

Code

Package


960Acute Myocardial infarction ( conservative

management)4A.72 563/day 2720



961 Acute renal failure 4A.73 563/day 2745Clinical Notes with relevant


962Acute renal failure ( plus dialysis ) -

maintenance dialysis4A.74 563/day 2745, 2748



963 Acute respiratory failure ( including ventilator ) 4A.75 2625/day 2776Clinical Notes with relevant


964 Intracerebral haemorrhage (ICU) 4A.76 563/day 1976Clinical Notes with relevant


965 Mngt of Hemorrhagic Stroke/Strokes 4A.77 563/day 2604Clinical Notes with relevant


966Subarachnoid haemorrhage (ICU) - Conservative

management 4A.78 563/day 2602



967 Acute Exarcebation of COPD 4A.79 563/day 2854Clinical Notes with relevant


968 Acute Hypertension - medical management 4A.80 563/day 2592, 2621Clinical Notes with relevant


969 Asthma Acute Status 4A.81 563/day 2856, 2668Clinical Notes with relevant


970 Chicken pox- complicated 4A.82 563/day NAClinical Notes with relevant


971 COPD+ Respiratory Failure 4A.83 563/day 2558, 2557Clinical Notes with relevant


972 Food poisoning 4A.84 563/day NAClinical Notes with relevant


973 Heat stroke 4A.85 563/day NAClinical Notes with relevant


974 Malaria - complicated 4A.86 563/day 2566Clinical Notes with relevant


975 Management of Pneumothorax 4A.87 563/day 2638Clinical Notes with relevant


976 Scorpion sting 4A.88 563/day 2675Clinical Notes with relevant



Arogya

Karnataka

Code

Package


977 Transforaminal Block 4A.89 563/day NAClinical Notes with relevant


978 Upper GI bleeding ( conservative) 4A.90 563/day 2901Clinical Notes with relevant


979 Control of diabetic ketoacidosis 4A.91 563/day 2629Clinical Notes with relevant


980 Cerebral infarction 4A.92 563/day 2604Clinical Notes with relevant


981 Emphysema Acute Exacerbation 4A.93 563/day 2608Clinical Notes with relevant


982 Mngt of Ischemic Strokes 4A.94 563/day 2762Clinical Notes with relevant


983 Dengue haemorrhagic fever 4A.95 563/day 2585Clinical Notes with relevant


984Dengue h'agic fever ( plus packed cell

transfusion)4A.96 563/day 2585



985 Hyper Osmolar Non Ketotic Coma 4A.97 563/day NAClinical Notes with relevant


986 Meningitis 4A.98 563/day 2613, 2624Clinical Notes with relevant


987Other Coagulation disorders ( plus blood

tranfusion units costs)4A.99 563/day 2569



988 Septic shock 4A.100 563/day 2562Clinical Notes with relevant


989 Septicemia 4A.101 563/day 2661, 2662Clinical Notes with relevant


990 Viral meningitis 4A.102 563/day 2613Clinical Notes with relevant


991 Accidental orgono phosphorus poisoining 4A.103 563/day 2563Clinical Notes with relevant


992 Acute asthamic attack 4A.104 563/day 2856Clinical Notes with relevant


993 Status epilepsy 4A.105 563/day 2764 Clinical Notes Clinical Notes

994 Staus asthamaticus 4A.106 563/day 2856 Clinical Notes Clinical Notes


Arogya

Karnataka

Code

Package


995 TB Meningitis 4A.107 563/day 2565Clinical Notes with relevant

investigationsClinical Notes with relevant investigations

996 Tetanus 4A.108 563/day 2622Clinical notes confirming

diagnosis,spatula test

997 Snake bite 4A.109 7875/day 2687 Clinical notes, photo of bite mark

998Medical Management of Cerebral Malaria

(Falciparum)4A.110 563/day 2566, 2692 CBC, CT CBC, CT

999

Medical Management of Convulsive

Disorders/Status Epilepticus (Fits)in Paediatric

patient

4A.111 563/day 2684, 2632 EEG EEG

1000Medical Management of Encephalitis /

Encephalopathy in Paediatric patient4A.112 563/day 2631 CT CT

1001Medical Management of Neuro Tuberculosis

With Ventilation in Paediatric patient4A.113 563/day 2626 CBC, CT CBC,CT

1002 Multi System Organ Failure 4A.114 563/day 2680, 2564 CBC, CT CBC,CT

1003 Kerosene Ingestion 4A.115 563/day NAClinical Notes with relevant


1004Suspected Dengue Shock Syndrome With

Thrombocytopenia4A.116 563/day 2585 CBC

1005Medical Management of Acute Renal Failure in

Paediatric patient4A.117 563/day 2644 CBC, RFT CBC, RFT

1006Medical Management of Acute Renal Failure

With Dialysis in Paediatric patients4A.118 1125/day 2645 CBC, RFT CBC, RFT

1007 Acute Stridor/Foreign Body Obstruction 4A.119 563/day NA X-ray X-ray

1008 Radical fronto ethmo sphenodectomy 4A.120 11625 446 X-Ray PNS,CT scan of sinuses CT scan of sinuses

1009 Instestinal perforation 4A.121 6750 110 X-Ray of abdomen/CT (Upright position) Scar photo

1010 Intestinal Obstruction 4A.122 6750 112X-Ray abdomen /CT , Complete Blood

Count,USGUSG, Scar Photo

1011 Intussusception 4A.123 9375 1493USG/CT , Clinical history and physical

examination notesScar photo

GENERAL PAEDIATRICS

GENERAL SURGERY


Arogya

Karnataka

Code

Package


1012 Gastric Perforation 4A.124 9375 92, 93 X Ray abdomen ,USG Scar photo

1013 Eclampsia With Complications 4A.125 11250 810 Ultrasonography, Cinical NotesClinical Photograph,Ultrasonography, Clinical

Notes

1014Eclampsia With Complications Requiring

Ventilatory Support4A.126 21000 810 Ultrasonography Ultrasonography

1015Abruptio-Placenta With Coagulation Defects(

Disseminated Intravascular Coagulation (DiC))4A.127 18750 792

Arterial Blood Gas

(ABG),APTT(activated partial

thromboplastin

time),CHE,LFT,RFT,Haematocrit,

platelet count, S fibrogen

Biochemical investigations

1016Tension free Vaginal Tape (TVT) Repair (Stress

Urine Incontinence) {Non incl. implant}4A.128 11250 753

APTT(activated partial thromboplastin

time) , Heamatocrit , PT (Prothrombin

time), Platelet Count , S.Fibrinogen Level

, USG

Clinical Photograph of Retroplacental clots ,

USG

1017 Open Ectopic Gestation 4A.129 11250 803Serum Beta HCG, USG, CBC, Routine

investigationOT notes

1018 Manual Removal of Placenta 4A.130 3188 NA Clinical Notes/USG Clinical Notes

1019

Emergency Casearean delivery - To be provided

in private hospital only when a PHI in same

taluka does not has the medical capability.

4A.131 5175 787Clinical photograph,Clinical notes

confirming emergencyScar photo

1020 Repair of post coital tear, perineal injury 4A.132 2063 823 Clinical Notes Clinical Notes

1021 Laprotomy for ectopic repture 4A.133 9563 745, 746 Clinical Notess, USG OT Notes, HPE

1022Perforation of Uterus after D/E laprotomy and

closure4A.134 9563 728 Clinical Notes, Ultrassonography OT Notes

1023 Broad Ligment Haemotoma drainage 4A.135 5738 828 Clinical Notes, Ultrasonography OT Notes

1024 Perforating corneo - Scleral Injury 4A.136 4950 488 Scar photo

1025 Acid and alkali burns 4A.137 563 537 Clinical photograph,Rule of 9 Scar photo

1026 Deglove injury of extremities 4A.138 9000 2360, 2390complete blood count,clinical

photograph, X ray of affected partScar photo

OBSTETRICS AND GYNAECOLOGY

OPHTHALMOLOGY

POLYTRAUMA - RTA


Arogya

Karnataka

Code

Package


1027 Inter costal drainage (icd) one side 4A.139 60001406, 2002,

2977, 17X-ray X-ray

1028 Inter costal drainage (icd)bilateral (flail chest) 4A.140 82501406, 2002,

2977, 17X-ray X-ray

1029Inter costal drainage (icd)bilateral (flail chest)

with icu stay4A.141 9000

1406, 2002,

2977, 17X-ray X-ray

1030Inter costal drainage (icd)bilateral (flail chest)

with icu stay with ventilator4A.142 10500

1406, 2002,

2977, 17X-ray X-ray

1031 Blunt injury abdomen with icu stay 4A.143 9000 NA USG USG

1032 Supra pubic cystostomy in fracture pelvis 4A.144 6000 1734, 2045 X-ray X-ray

1033 Immobilization for suspected spine injuries 4A.145 1500 1013 X-ray, CT X-ray, CT

1034 Spine injuries - with ct/mri 4A.146 5250 1013 CT/MRI CT/MRI

1035 Tracheostomy 4A.147 3750 1995 Clinical photo Clinical photo

1036 Head injury with icu (conservative)) 4A.148 5250 NA CT

1037 Head injury with icu stay (with ventilator) 4A.149 11250 NA CT

1038 Head injury with minimal surgical intervention 4A.150 18750 NA CT

1039RTA injuries associated with burns

(conservative management)4A.151 3000 2360 HB, Clinical photo

1040Simple/Compound fracture with fixator along

with implants for bones of Foot & Hand4A.152 9000

2364, 2383,

2386X-ray X-ray

1041 ICU stay other than head injury 4A.153 3000 2392, 2393 X-ray

1042Fasciotomy of upper and lower limb for

compartment syndrome4A.154 11250 956, 957, 958 complete blood count,clinical photograph Scar photo

* Procedures requiring Follow Up as per Annexure 3

POLYTRAUMA

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