suvarna arogya suraksha trust - healthsprint.comsast.gov.in/home/details/rbsk package list.pdf ·...
TRANSCRIPT
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
1 9
9 : Post Burn Contracture surgeries for Functional
Improvement (Package including splints, pressure
garments and physiotherapy)- Mild*
20000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
2 12 12 : Second degree burns (16% to 30%) 25000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
3 13 13 : Second degree burns (30% to 50%) 50000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
REVISED BENEFIT PACKAGES OF 7 and 13 (Tertiary and Secondary)SPECIALITIES for
Rastriya Bala Swastya Karyakram Scheme, 2017
Government of Karnataka
SUVARNA AROGYA SURAKSHA TRUST(Department of Health & Family Welfare)
BMTC, TTMC ‘A Block’ 4th Floor, Shanthi Nagar, K.H. Road, Bangalore
Phone: 080-22536200, Fax: 080-22536221 E-mail: [email protected]
SAST Toll free call centre numbers 1800-425-8330 and 1800-425-2646.
Burns
Note: Changes have been made in the package rates, pre-op and post-op investigations
Procedure marked with * has Follow-up care. Please check the follow up package list for details.
Emergency codes
Emergency codes are available under all specialities, for life saving treatment within 48 hours. For these, hospital
can select emergency option from drop down list online while applying for preauth.
For any other procedures that require emergency treatment, hospital can call the emergency phone number for
approval.
Laparoscopic Surgery is allowed for Codes under the schemes for all surgery codes. Package amount will be
given for surgery - whether it is done open or lap.
Clinical Photograph with Arogyamithra is mandatory with preauth and claim documents. Photo with SAMCO
will be accepted in specific cases only.
BENEFIT PACKAGES FOR CROSS-SPECIALITY PROCEDURES
Cross Speciality facility is available only if the hospital is empanelled for the particular
For Oncology, please refer to the guidelines for specific codes (SAST website)
RBSK Tertiary care Benefit Package List
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
4 16 16 : Between 50% to 60% Burns 70000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
5 17 17 : More than 60% Burns 100000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
6 18
18 : Post Burn Contracture surgeries for Functional
Improvement involving only skin (Package including
splints,pressure garment and physiotherapy-
Moderate*
40000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
7 19
19 : Post Burn Contracture surgeries for functional
improvement involving soft tissue and bone(Package
including splints, pressure garments and phsiotherapy)
- Severe*
70000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
8 20 20 : Electrical Burns(Moderate) 30000 Clinical Photograph Clinical Photograph
9 21 21 : Electrical Burns(Severe) 70000 Clinical Photograph Clinical Photograph
10 2222 : Chemical Burns(Moderate ) (Grafting not
required)30000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
11 23 23 : Chemical Burns (Severe) 75000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
12 24 24 : Second degree burns (upto 15%) 15000
Clinical Photograph, Diagram
with Rule of 9 for extent of
burns
Clinical Photograph
13 2525 : Any degree burn with inhalational injury, with 72
hours ventilator support60000 Clinical Photo Clinical photograph
14 26 26 : Small Area grafting (less than 5% of body area ) 30000 Clinical Photo Scar Photo
15 2727 : Large Area grafting (greater than 5 % of body
area)40000 Clinical Photo Scar Photo
16 105 105 : Balloon Mitral Valvotomy * 30000 2D ECHO report 2D ECHO report + stills of
ECHO
17 106 106 : Coarctation dilatation* 25000 2D ECHO report 2D ECHO report + stills of
ECHO
18 107 107 : Balloon Pulmonary Valvotomy 25000 2D ECHO report 2D ECHO report + stills of
ECHO
19 108 108 : Balloon Aortic Valvotomy* 25000 2D ECHO report 2D ECHO report + stills of
ECHO
20 112 112 : Vertebral Angioplasty (non-medicated) * 55000 2D ECHO , ANGIOGRAM
report & stills Post procedure Angio stills
21 113 113 : Temporary Pacemaker implantation 10000 ECG + Report by cardiologist X Ray showing the pacemaker
in situ
22 114
114 : Permanent pacemaker implantation (only VVI
single chamber) including Pacemaker value/pulse
generator replacement
75000ECG + Report by cardiologist +
Anigiogram report if done
X Ray showing the pacemaker
in situ
23 115 115 : Pericardiocentesis 10000 2D ECHO report 2D ECHO report
24 116 116 : Septostomy 20000 2D ECHO report 2D ECHO report + stills of the
ECHO
25 117 117 : Pericardiostomy without balloon 10000 2D ECHO report 2D ECHO report + stills of the
ECHO
26 118 118 : Pericardiostomy with balloon 20000 2D ECHO report 2D ECHO report + stills of the
ECHO
27 119 119 : PDA Device Closure * 80000 2D ECHO report 2D ECHO stills showing the
device + Report
28 120 120 : ASD Device Closure * 88000 2D ECHO report 2D ECHO stills showing the
device + Report
29 121 121 : Ventricular Septal Defect Device Closure * 88000 2D ECHO report 2D ECHO stills showing the
device + Report
30 122 122 : PDA Coil (one) insertion 25000 2D ECHO report 2D ECHO stills showing the
coil + Report
31 123 123 : PDA Multiple coil insertion 30000 2D ECHO report 2D ECHO stills showing the
coil + Report
32 138 138 : Open Mitral Valvotomy * 80000 2D ECHO Report with stills2D ECHO Report + stills of
ECHO,scar photo
33 139 139 : Open Aortic Valvotomy * 80000 2D ECHO Report with stills2D ECHO Report + stills of
ECHO,scar photo
34 140 140 : Open Pulmonary Valvotomy * 80000 2D ECHO Report with stills2D ECHO Report + stills of
ECHO,scar photo
35 141 141 : Mitral Valve Repair * 80000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
Cardiology
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
36 142 142 : Tricuspid Valve Repair * 80000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
37 143 143 : Aortic Valve Repair * 80000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
38 144 144 : Ring for any Valve Repair * 20000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
39 145 145 : Mitral Valve Replacement * 130000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
40 146 146 : Aortic Valve Replacement * 130000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
41 147 147 : Tricuspid Valve Replacement * 130000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
42 148148 : Valve Replacement with Intra-aortic balloon
pump (IABP) *140000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
43 150 150 : Ross Procedure * 110000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
44 151 151 : Atrial septal defect (ASD) * 90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
45 152 152 : Ventricular Septal Defect (VSD) * 90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
46 153153 : Atrioventricular septal defect (AVentricular
Septal Defect)/ Atrioventricular (AV) Canal Defect *90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
47 154154 : Intracardiac repair (ICR) for Tetralogy of Fallot
(TOF) *90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
48 155155 : Pulmonary Valvotomy + Right Ventricular
Outflow Tract (RVOT) Resection *90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
49 156 156 : Aortopulmonary Window (AP Window) * 90000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
50 158 158 : Ebsteins * 90000 ECG, 2D ECHO Report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
51 159 159 : Fontan * 100000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
52 160160 : Total Anomalous Pulmonary Venous Connection
(TAPVC) *120000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
53 161161 : Pulmonary Atresia with or without Ventricular
Septal Defect *105000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
54 162162 : Transposition of the great arteries (TGA) -Arterial
Switch Operation*120000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
55 164 164 : Double Switch Operation * 120000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
56 167 167 : Rastelli procedure -Pulmonary Conduit * 120000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
57 168 168 : Truncus Arteriosus Surgery * 120000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
58 169169 : Root Replacement (Aortic Aneurysm/ Aortic
Dissection) / Bental Procedure *150000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
59 170 170 : Aortic Arch Replacement* 150000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
60 172172 : Aortic Aneurysm Repair without using
Cardiopulmonary bypass (CPB) with/without graft*70000 CT Angio Report Scar photo + Intra op photo
61 174174 : Surgery for Cardiac Tumour/ Left Atrial (LA)
Myxoma/ Right Atrial (RA) Myxoma95000
2D ECHO with stills + CT
Chest report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
62 175 175 : Closed Mitral Valvotomy * 30000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
63 176 176 : Patent Ductus Arteriosus (PDA) Closure 30000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray, scar
photo
64 177 177 : Coarctation Repair* 30000 2D ECHO with stills + CAG
report
Doppler report + Stills of
Doppler
65 179 179 : Coarctation Repair with graft * 70000 2D ECHO with stills + CAG
report
Doppler report + Stills of
Doppler
66 180180 : Blalock–Thomas–Taussig (BT) Shunt (inclusives of
grafts)60000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
67 181 181 : Glenn Shunt 60000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
68 182 182 : Central Shunt 60000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
69 184 184 : Pericardiectomy 50000 2D ECHO Report with stills
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
70 185 185 : Thoracoscopic surgery 35000 CT Chest report
2D ECHO Report + stills of
ECHO + Post Op X-ray, photo
of scar, port insertion
71 186 186 : Pericardiostomy Surgery 10000 2D ECHO report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
72 189 189 : Lobectomy 70000 CT Chest report Post Op X-ray,scar photo
73 190 190 : Pneumonectomy 60000 CT Chest report Post Op X-ray,scar photo
74 191 191 : Pleurectomy 50000 CT Chest report Post Op X-ray,scar photo
75 192 192 : Decortication 50000 CT Chest report Post Op X-ray,scar photo
76 194 194 : Pulmonary AV Fistula surgery 45000 CT Chest report Post Op X-ray,scar photo
77 195 195 : Lung Cyst 60000 CT Chest report Post Op X-ray,scar photo
78 196 196 : Space-Occupying Lesion (SOL) mediastinum 60000 CT Chest report Post Op X-ray,scar photo
79 197 197 : Surgical Correction of Bronchopleural Fistula. 70000 CT Chest report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
80 198 198 : Diaphragmatic Eventeration 50000 CT Chest report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
81 200 200 : Oesophageal Diverticula /Achalasia Cardia 50000Barium Study + CT Chest
report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
82 201 201 : Diaphragmatic Injuries/Repair 35000 CT Chest report
2D ECHO Report + stills of
ECHO + Post Op X-ray,scar
photo
83 202 202 : Thoracotomy, Thoraco Abdominal Approach 40000 CT Chest report Post Op X-ray,scar photo
84 203 203 : Foreign Body Removal with scope 20000CT Chest report +
Bronchoscopy report ENDOSCOPY PICTURE
85 204204 : Bronchial Repair Surgery for Injuries due to
Foreign body40000
CT Chest report +
Bronchoscopy report ENDOSCOPY PICTURE
86 205205 : Gastro Study Followed by Thoracotomy &
Repairs of Oesophageal Injury for Corrosive Injuries/FB50000 Gastroscopy Report
ENDOSCOPY PICTURE, scar
photo
87 206 206 : Oesophageal tumour removal 50000Endoscopy Report + Biopsy
Report Biopsy report, scar photo
88 207 207 : Oesophagectomy 60000 Biopsy , CT , Endoscopy
reports Biopsy report, scar photo
89 208 208 : Lung Injury repair 50000 CT Chest report X-RAY, scar photo
90 210 210 : Thyomectomy 35000 CT Chest report X-RAY, scar photo
91 220220 : Aortic Aneurysm Repair using Cardiopulmonary
bypass (CPB) with/without graft*90000 CT Angio Report Scar photo + Intra op photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
92 230
230 : Carotid- carotid/Carotid- Subclavian/ Femoro
Distal / Femoral - Femoral / Femoral infra popliteal
Bypass with Synthetic Graft
75000Angiogram/spiral CT
Angiogram reports
Stills showing the procedure
with graft +Duplex scan, scar
photo
93 235 235 : Excision of Arterio Venous malformation - Large 50000Angiogram/spiral CT
Angiogram reports
Stills showing the procedure
with graft + scar photo
94 236236 : Excision of Arterio Venous malformation - Small
(Congenital/Acquired)30000
Angiogram/spiral CT
Angiogram reports
Stills showing the procedure
with graft + scar photo
95 238 238 : Carotid/other peripheral endarterectomy 40000 Angiogram report Stills showing the procedure
with graft + scar photo,
96 264 264 : Aortic Angioplasty 40000ECG, 2D ECHO, CAG stills
showing blocks & Reports
Angioplasty stills showing
Balloon & post flow, scar
photo
97 266266 : Aortic Angioplasty with two stents / Iliac
angioplasty with stent Bilateral90000
ECG, 2D ECHO, CAG stills
showing blocks & Reports
Angioplasty stills showing
Balloon & post flow,scar
photo
98 271271 : Aneurysm infra renal aorta /aorto iliac(including
graft)90000
ANGIO/ Spiral CT Angiogram
Report Scar photo + Intra op photo
99 274 274 : Creation of AV fistula for dialysis 7500 Duplex Clinical photos showing the
AV fistula
100 276 276 : PDA stenting* 50000 2D ECHO , Angiogram Report
& Stills Post procedure Angio stills
101 277 277 : Coarctoplasty with stenting* 75000 2D ECHO , Angiogram Report
& Stills Post procedure Angio stills
102 278 278 : Right ventricular outflow tract (RVOT) stenting 50000 2D ECHO, Angiogram Report
& Stills Post procedure Angio stills
103 279 279 : Pulmonary artery stenting 50000 2D ECHO , Angiogram Report
& Stills Post procedure Angio stills
104 281281 : Paravalvular leak/ Ruptured sinus of Valsalva
aneurysm (RSOV)88000 2D ECHO Report
2D ECHO stills showing the
device + Report
105 282 282 : Pulmonary Valve Replacement* 120000 2D ECHO Report
2D ECHO Report + stills of
ECHO + post Op X-ray,scar
photo
106 283283 : Intercostal Drainage and Management of ICD,
Intercostal Block, Antibiotics & Physiotherapy15000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
107 284284 : Management of Mediastinitis / mediastinal
bleeding40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
108 285 285 : Encysted Empyema/Pleural Effusion - Tubercular 20000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
109 286
286 : First rib Excision by transaxillary approach
Excision of cervical rib / fibrous band / muscle by
cervical approach
40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar
photo
110 287 287 : Thorocotomy and resection of pluera with Lung 50000Pre Op X-ray / CT Scan,
Bronchoscopy Report
Post Op X-ray / CT Scan ,scar
photo
111 289289 : Laryngoscopy / Bronchoscopy with dilatation of
trachea with gum elastic bogie5000 CT / Bronchoscopy report CT / Bronchoscopy report
112 290290 : Tracheoplasty and introduction of montegomary
T-tube (Tracheal stenting)40000 CT / Bronchoscopy report CT / Bronchoscopy report
113 291 291 : Congenital Hypoplasia of the lung 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar
photo
114 292 292 : Congenital Cystic Lesions 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar
photo
115 293 293 : Pulmonary Sequestration 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar
photo
116 294 294 : Pulmonary artero venous malformation 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar
photo
117 296 296 : Bronchial artery Embolisation (for Haemoptysis) 25000Chest x-Ray/CT Scan, Hb,
Serum Creatinine
Chest x-Ray/CT Scan, Hb,
Serum Creatinine
118 298 298 : Balloon Atrial Septostomy 25000 2D ECHO report with stills2D ECHO report + stills of the
ECHO
119 299 299 : Coiling - Pseudoaneurysms of Abdomen 55000
CT/MRI or Angiogram,
Prothrombin Time (PT),
International normalized ratio
(INR) Hb, Serum Creatinine
CT, PT,INR, Hb, Serum
Creatinine
120 576 576 : Hiatus Hernia Repair 40000 USG, UGI ENDOSCOPY Scar photo + Intra op photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
121 1003 1003 : Inferior Vena Cava (or IVC) Stenting 60000
USG, clotting Time (CT),
Prothrombin Time (PT),
International normalized ratio
(INR), Hb, Serum Creatinine
USG, CT,PT,INR, Hb, Serum
Creatinine
122 1006
1006 : Permanent pacemaker implantation (DDR, dual
chamber) including Pacemaker value/pulse generator
replacement
120000ECG + Report by cardiologist +
Anigiogram report if done
X Ray showing the pacemaker
in situ
123 1007 1007 : Pulse Generator replacement 50000ECG + Report by cardiologist +
Anigiogram report if done
X Ray showing the pacemaker
in situ
124 1010 1010 : Thromboembolectomy - bilat /multi level 40000 Duplex/Angio Report & stills Scar photo + Intra op photo
125 10111011 : Surgery for Arterial Aneursysm -Abdominal
aorta90000 Duplex/Angio Report & stills Scar photo + Intra op photo
126 1015 1015 : Arrhymias 7000 ECG,ECHO, PT/INR, RFT, CBC ECG, PT/INR, RFT, CBC
127 1016 1016 : Stuck valve with Thrombolysis 20000 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC
128 1018 1018 : Cardiac failure 7500ECG,ECHO,Chest X-ray, RFT,
CBCECHO, CHEST X RAY, RFT, CBC
129 1019 1019 : CVA secondary to Cardiac conditions 10000ECHO, CT Brain/ MRI Brain,,
RFT, CBCPT/INR, RFT, CBC
130 1020 1020 : Emergency dialysis for cardiac conditions 15000 ECHO, RFT, CBC RFT, CBC
131 1021 1021 : ICU with ventilator with dialysis 15000ECHO, Chest X Ray, RFT, CBC,
ABG
CHEST X RAY RFT,RFT, CBC,
ABG
132 1022 1022 : Acute respiratory distress - ventilator support 15000ECHO, Chest X Ray, RFT, CBC,
ABGCHEST X RAY, RFT, CBC, ABG
133 1023 1023 : Pulmonary edema 10000ECG, ECHO,Chest X Ray, RFT,
CBC, ABG
ECHO, CHEST X RAY, RFT,
CBC, ABG
134 301 301 : Oesophageal Atresia 110000 X-Ray Clinical Photograph showing
scar
135 302 302 : Diaphragmatic Hernia - Paed 110000 X-Ray Clinical Photograph showing
scar+Post op X ray
136 303 303 : Neonatal Intestinal Atresias 110000 X-Ray Clinical Photograph showing
scar
137 304 304 : Biliary Atresia 65000 CT AbdomenClinical Photograph showing
scar
138 305 305 : Anorectal Malformations Stage 1 35000 Photo of perineal regionClinical photo showing
Colostomy
139 306 306 : Anorectal Malformations Definite Repair 60000
Colostogram pic for males,
Photo of perineum region for
females
Clinical Photograph showing
scar
140 307 307 : Anorectal Malformations Stage 3 45000 Clinical PhotographClinical Photograph showing
scar
141 308 308 : Hirschsprungs Disease stage 1 40000 Rectal biopsy/ X-Ray/Contast
Enema
Clinical photo showing scar +
Biopsy Report.
142 309309 : Hirschsprungs Disease stage 2/Definitive Repair
(Including Staplers)60000 Contrast Enema / Biopsy
Clinical Photograph showing
scar
143 310 310 : Omphalocele-Major/Gastroschisis 70000 Clinical PhotographClinical Photograph showing
scar
144 311 311 : Omphalocele-Minor 40000 Clinical PhotographClinical Photograph showing
scar
145 312 312 : Splenectomy - Child 45000 Hemogram,USG Clinical Photograph showing
scar
146 313 313 : Congenital Hydronephrosis Open/Lap 50000 USG, Renal Isotope ScanClinical Photograph showing
scar
147 314 314 : Ureteric Reimplantations Bilateral 70000 MCU, USGClinical Photograph showing
scar
148 315 315 : Ureteric Reimplantations Unilateral 45000 MCU, USGClinical Photograph showing
scar
149 316 316 : Exstropy Bladder Stage 1 80000 USG, clinical photo Clinical Photograph
150 317 317 : Exstropy Bladder Stage 2 70000 MCU Clinical Photograph
151 318 318 : Urinary Diversion - Temporary 25000 MCU, USGClinical Photograph showing
scar
152 319 319 : Urinary Diversion - Permanent 45000 MCU, USGClinical Photograph showing
scar
153 320 320 : Urinary Diversion - Undiversion 35000 MCU, USGClinical Photograph showing
scar
154 321 321 : Continence Stage 1 (Epispadias) 40000Clinical photo showing the
meatal openingNil
Paediatric and Neonatal Surgery
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
155 323 323 : Bladder Augumentation 80000 MCU/USG Clinical photo
156 324 324 : Thoracic Duplication cyst 50000 CT, Chest X ray Biopsy Report.
157 325 325 : Thoracic Wall defects Correction 60000 CT/MRI, X ray Clinical Photograph
158 326 326 : Hypospadias First Stage 30000 Clinical photo showing the
meatal openingNil
159 327 327 : Hypospadias Re-Do 40000 Clinical photo showing the
meatal openingNil
160 328 328 : Insertion of Hickman Catheter 10000 Lab reports confirming cancer Clinical Photograph showing
catheter
161 329 329 : Insertion of Chemo port 20000 Lab reports confirming cancer Clinical Photograph showing
chemo Port
162 330 330 : Shunt surgery for portal hypertension 50000 USC/CT/MRIClinical Photograph showing
scar
163 331 331 : Airway Reconstruction for benign conditions 50000 Endoscopy photo/CT Clinical Photograph, X ray
164 332 332 : Supraglottoplasty 25000 Endoscopy photo/CT Clinical Photograph showing
scar / endoscopy picture
165 334 334 : Heller's Cardiomyotomy with fundoplication 50000Contrast X ray/endoscopy
findings
Clinical Photograph showing
scar
166 335 335 : Esophageal substitution surgery 110000Contrast X ray/endoscopy
findings,
Clinical Photograph showing
scar
167 336 336 : Colostomy formation 20000 X-Ray Clinical Photograph showing
scar
168 337 337 : Colostomy closure 30000 Clinical PhotographClinical Photograph showing
scar
169 338 338 : Feminising genitoplasty 55000 Clinical PhotographClinical Photograph showing
scar
170 339 339 : Pyloromyotomy 35000 USG/Contrast X rayClinical Photograph showing
scar
171 340340 : Cystoscopic fulguration of posterior urethral
valves30000 MCU, USG
Clinical
Photograph/Endoscopic
picture
172 341 341 : Bronchoscospy for foreign body removal 25000 X Ray Clinical Photograph, X ray
173 342 342 : Intussusception pneumatic/hydrostatic reduction 18000 USG/Xray Post op USG, Post op X Ray
174 343 343 : Intussusception operative reduction 30000 USGClinical Photograph showing
scar
175 344 344 : Bowel resection and anastomosis 55000 Xray/CT scanClinical Photograph showing
scar
176 345 345 : Laparotomy for peritonitis 50000 Xray/USG/CTClinical Photograph showing
scar
177 346 346 : Surgery for chronic pancreatitis 70000 CT/MRIClinical Photograph showing
scar
178 347 347 : Inguinal Hernia- Age less than 1 year 15000 Clinical PhotographClinical Photograph showing
scar
179 348 348 : Undescended Testis (Palpable) 15000 USG,Clinical photo Nil
180 349 349 : Paediatric intestinal obstruction >1month 65000 x ray abdomen /USG scar photo
181 350350 : Excision of choledochal cyst with hepatic
jejunostomy85000 USG/CT/MRCP Scar photo,HPE Report
182 351 351 : Bilateral Inguinal Hernia for age < 1 year 22500 Clinical PhotographClinical Photograph showing
scar
183 352352 : Stage 2 Incontinence for epispadias including
bladder neck repair40000 USG/MCU Clinical Photograph
184 353 353 : Unsescended Non palpable testis stage 1 20000 USG abdomen Scar photo
185 354354 : Undescended Non palpable testis stage 2
(definitve repair)25000
USG/OT notes of previous
surgeryScar photo
186 355 355 : Anorectal malformation- Low variant 30000 Photo of the perineum region Scar photo
187 356 356 : Simple Fundoplication 35000Contrast X ray/endoscopy
findings
Clinical Photograph showing
scar
188 357 357 : Hypospadias Definitive Repair - distal penile 40000 Clinical photo showing the
meatal openingNil
189 358 358 : Hypospadias Definitive Repair - mid penile 50000 Clinical photo showing the
meatal openingNil
190 359 359 : Hypospadias Definitive Repair - proximal penile 60000 Clinical photo showing the
meatal openingNil
191 360 360 : Fistula Closure Hypospadiacs 20000 Clinical Photograph Nil
192 361 361 : Syndactly 25000 Clinical photo Clinical photo
193 362 362 : Stent Removal 5000 X Ray Post op X Ray
194 364364 : Laparotomy and excision of cyst (For Paediatric
benign abdominal cyst)30000 USG/CT Scar Photo, HPE Report
195 365 365 : Polydactly (One finger) 20000 Clinical photo Clinical photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
196 366 366 : Club hands Stage 1 40000 Clinical photo Clinical photo
197 367 367 : Club hands Stage 2 40000 Clinical photo Clinical photo
198 368368 : Thalessemia/Sickle Cell anaemia (Quaterly per
child per year, per quarter Rs 25000 )25000
Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
199 369 369 : Respiratory distress syndrome 75550Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
200 370 370 : Meconium Aspiration syndrome 50900Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
201 371 371 : Septicemia not requiring ventilation 49200Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
202 372 372 : VLBW not requiring ventilation 119900Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
203 373 373 : Neonatal jaundice 22450Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
204 374374 : Neonatal jaundice requiring exchange
transfusion31250
Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
205 375 375 : Asphyxia with convulsions 73400Clinical notes confirming
diagnosis
Clinical Notes and relevant
Post op reports
206 401401 : Craniotomy and Evacuation of Haematoma -
Subdural *60000 CT report
Post Op CT Report and film,
Clinical Photograph showing
scar
207 402402 : Craniotomy and Evacuation of Haematoma -
Extradural *50000 CT report
Post Op CT Report and film,
Clinical Photograph showing
scar
208 403403 : Excision of Brain Tumor Supratentorial-
Parasagital *80000
CT report /MRI Clinical
features
Post Op CT Report and film,
Clinical Photographs showing
the scar + HPE report
209 404 404 : Excision of Brain Tumor Supratentorial-Basal * 80000 CT report
Post Op CT Report and film,
Clinical Photographs showing
the scar + HPE report
210 405405 : Excision of Brain Tumor Supratentorial-Brainstem
*80000 CT report
Post Op CT Report and film,
Clinical Photographs showing
the scar + HPE report
211 406 406 : Excision of Brain Tumor Infratentorial-C P Angle * 80000 CT report
Post Op CT Report and film,
Clinical Photographs showing
the scar + HPE report
212 407 407 : Excision of Brain Tumor Supratentorial & others * 50000 CT report
Post Op CT Report and film,
Clinical Photographs showing
the scar + HPE report
213 408 408 : Excision of Brain Tumors -Subtentorial * 55000 MRI Report Clinical Photographs showing
the scar + HPE report
214 411 411 : Ventriculoatrial /Ventriculoperitoneal Shunt 27000 CT report Post Op CT Report,film and
scar photo, X-ray
215 413 413 : Subdural Tapping/Burr 18000 CT report Post Op CT Report,film and
scar photo
216 414 414 : Abscess Tapping Single 15000 CT report Post Op CT Report,film and
scar photo
217 415 415 : Abscess Tapping multiple 20000 CT report Post Op CT Report,film and
scar photo
218 416 416 : Meningo Encephalocele * 40000 MRI Report
Post Op CT Report and film,
Clinical Photograph showing
Scar
219 417 417 : Meningomyelocele * 40000 CT report Post Op CT Report and film,
scar photo
220 418 418 : C.S.F. Rhinorrhoea 43000 CT report Clinical Photograph with Scar
221 419 419 : Cranioplasty 30000 CT report
Post Op CT Report and film,
Clinical Photograph showing
the scar
222 421 421 : Excision of Brain Abcess 50000 CT report
Post Op CT Report and film,
Clinical Photograph showing
the scar
223 425 425 : External Ventricular Drainage (EVD) 15000 CT report
Post Op CT Report and film,
Clinical Photograph showing
Scar
Neuro Surgery
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
224 426 426 : Spinal Cord Tumours* 45000 MRI Report Biopsy report + HPE Report +
scar photo
225 428 428 : Anterior Cervical Discectomy Single level * 30000 Clinical findings, MRI Report Post Op X-ray, Clinical
Photograph showing scar
226 429429 : Anterior Cervical Discectomy Multiple level with
Implants (procedure 30000+ Implants 20000) *60000 Clinical findings, MRI Report
Photo showing the scar +
XRAY showing the implants
227 436 436 : Spinal Intra Medullary Tumours* 40000 MRI Report Post Op X-ray Report and
film + HPE report
228 437 437 : Spina Bifida Surgery Major * 40000 MRI Report Clinical Photographs showing
scar
229 439 439 : Stereotaxic Procedures 25000 CT/ MRI report Post Op CT Report and film +
HPE report
230 441441 : Transoral surgery /Anterior/ Posterior/CV
Junction (with Stabilization)80000 MRI Report + XRAY Post Op X-ray report and film
231 442 442 : Trans oral Surgery 30000 CT report Post Op X-ray Report and
film, HPE report
232 443 443 : Trans Sphenoidal Surgery -Routine/Endoscopic 40000 CT/MRI Report HPE report
233 444 444 : RF Lesions for Trigminal Neuralgia 15000 MRI Report CD of Procedure
234 448 448 : Muscle Biopsy with report 10000
Nerve Conduction Velocity
(Nerve conduction velocity
(NCV)) and Electromyography
(EMG) reports
Clinical Photograph + HPE
report
235 449 449 : MVD (Micro Vascular Decompression) 50000 MRI Report Clinical Photographs
236 450 450 : Nerve Biopsy with report 10000
Nerve Conduction Velocity
(Nerve conduction velocity
(NCV)) and Electromyography
(EMG) reports
Clinical Photograph + HPE
report
237 451 451 : Nerve Decompression 20000 Nerve Conductions studyClinical Photographs showing
scar
238 453 453 : Peripheral Nerve Surgery Major 45000
Nerve Conduction Velocity
(Nerve conduction velocity
(NCV)) and Electromyography
(EMG) reports
Clinical Photographs showing
scar
239 457457 : Arterio venous malformation (AVM) excision
(whatever size and location) */ Cavernoma100000 MRI Angio/DSA report
CT report and film,scar
photo
240 459 459 : Endoscopic venticulostomy 30000 CT report Clinical Photograph showing
scar, DT Brain film and report
241 460 460 : Endoscopic colloid cyst excision 50000 CT report Clinical Photograph showing
scar, Post CT report and film
242 461 461 : Endoscopic Tumour Removal 50000 CT report
Clinical Photograph showing
scar + HPE, Post-op CT report
and film
243 462 462 : Excision of Orbital Tumour* 50000 CT/MRI Report
CT, Clinical Photograph
showing scar + HPE report,
Post-op CT report and film
244 463 463 : Cranio Facial Resection 70000 CT/MRI Report
CT report and film, Clinical
Photograph showing scar +
HPE report
245 464 464 : Elevation/Excision of depressed fracture 30000 CT report Clinical Photographs showing
scar, Post CT report and film
246 465 465 : Decompressive craniotomy 40000 CT report Clinical Photographs showing
scar, Post CT report and film
247 466 466 : Craniostenosis 50000 CT/MRI Report Post-op CT report and film
248 467467 : Gamma Knife radiosurgery (GKRS)/SRS for
Tumours/Arteriovenous malformation (AVM)75000 CT/MRI Report Clinical Photographs
249 468 468 : Scalp Arteriovenous malformation (AVM) 25000 CT/MRI Report Clinical Photograph showing
scar + HPE report
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
250 469 469 : Skull lesion including cranioplasty 40000 CT/MRI Report
Clinical Photograph showing
scar + HPE report + Xray -
Skull
251 470 470 : Skull Lesion without Cranioplasty 25000 CT/MRI Report
Clinical Photograph showing
scar + HPE report + Xray -
Skull
252 471 471 : Foramen Magnum Decompression 45000 CT/MRI report Clinical Photographs showing
scar
253 472 472 : Posterior Cervical Discetomy without implant * 30000 MRI report Clinical Photographs showing
scar
254 473473 : Posterior Cervical Fusion with implant (Lateral
mass fixation) *60000 MRI report
Clinical Photographs showing
scar + X-ray - Cervical spine
255 474 474 : Theco Peritoneal Shunt 20000 CT report Clinical Photographs
256 475 475 : Endoscopic CSF Rhinorrhea Repair 45000 CT/MRI report Clinical Photographs showing
scar
257 476 476 : Lumbar Laminectomy (no discectomy) * 30000 CT/MRI report Clinical Photographs showing
scar + X-ray-Lumbar Spine
258 477 477 : Cervical Disc Multiple level without Fusion 35000 CT/MRI report Clinical Photographs showing
scar + X-ray-Cervical Spine
259 478 478 : Fetal Surgery for Myelomeningocoele 75000 Ultrasound abdomen Ultrasound + scar
photograph
260 479479 : Thoracic/Lumbar Corpectomy with fusion
inclusive of implant /Trans thoracic *70000 CT/MRI
Clinical Photographs showing
scar + Xray
261 480 480 : Carotid Endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
262 481 481 : Stereotactic Lesioning 60000Neuro Psychologist report,
Neurologist report, MRI
Clinical Photographs showing
scar , CT Brain report and film
263 482 482 : Epilepsy Surgery 50000
EEG, Neuro Psychologist
report, Neurologist report,
CT/MRI
CT + Clinical Photographs
showing scar
264 483 483 : Cranioplasty with mesh 40000 CT report
Post Op CT Report and film,
Clinical Photograph showing
the scar
265 485 485 : Carpal Tunnel System (CTS) 10000 Nerve Conductions studyClinical Photographs showing
scar
266 486 486 : Guillain Barre Syndrome 75000
Nerve 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
267 502502 : 5- Fluorouracil A-C (FAC)(Maximum 6 cycles) (Per
cycle)5000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
268 503 503 : AC (Maximum 4 cycles) (Per cycle) 5000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
269 504504 : FEC (Epirubicin based)(Maximum 6 cycles) (Per
cycle)8000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
270 505505 : Paclitaxel/docetaxel(Maximum 4cycles)
(Adjuvant) (Per cycle)9000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
271 506506 : Cyclophosphamide/Methotrexate/5Fluorouracil
(CMF) (Per cycle)1500
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
272 507 507 : Tamoxifen tabs- maximum 12 cycles (Per month) 100
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
273 508
508 : Aromatase Inhibitors (
Anastazole/Letrozole/Exemestane)-maximum 12
cycles (Per month)
900
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
Oncology
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
274 509509 : Cisplatin/Carboplatin (AUC2) along with RT- max
6 cycles (Per cycle)2000 CT report and Film, Biopsy
Chemotherapy drug batch
number with bar code
275 512 512 : Carboplatin/Paclitaxel-max 6 cycles (Per cycle) 12000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
276 513513 : Bleomycin-Etoposide-Cisplatin (BEP) (Per cycle) -
Germ cell tumours, extra gonadal tumour10000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
277 514 514 : Weekly Methotrexate (Per week) max. 10 cycles 1000B HCG report,CT report and
Film
Clinical Photograph,
chemotherapy drug batch
number with bar code
278 515 515 : Actinomycin- max 10 cycles (Per cycle) 1000B HCG report,CT report and
Film
Clinical Photograph,
chemotherapy drug batch
number with bar code
279 516
516 : Etoposide-Methotrexate-Actinomycin /
Cyclophosphamide -Vincristine (EMA-CO)-max 6 cycles
(Per cycle)
8000B HCG report,CT report and
Film
Clinical Photograph,
chemotherapy drug batch
number with bar code
280 517517 : Bleomycin-Etoposide-Cisplatin (BEP)- max cycles
4 (Per cycle) Germ cell tumours, extra gonadal tumour10000
CT report and Film,
Biopsy/Tumour markers
Clinical Photograph,
chemotherapy drug batch
number with bar code
281 518 518 : Hormonal therapy - maximum monthly 6 months 15000
CT report and Film, Biopsy,PSA
with evidence of bone
metastasis
Clinical Photograph,
chemotherapy drug batch
number with bar code
282 519519 : Weekly Cisplatin/Carboplatin- max 6 cycles with
RT (Per week)2000 CT report and Film, Biopsy
Chemotherapy drug batch
number with bar code
283 521
521 : Carboplatin/cisplatin + Paclitaxel/Docetaxel
(Neoadjuvant Chemotherapy)-Max. of 4 cycles only
(Per cycle) -For stage III and IVA
12000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
284 522
522 : Cisplatin + 5 FU(Neoadjuvant
Chemotherapy)/Palliative - Max. of 4 cycles only (Per
cycle)
6000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
285 525525 : Cisplatin/Etoposide (IIIB)- Max. 6 cycles only (Per
cycle)7000
Biopsy/FNAC ,CT report and
Film
Chemotherapy drug batch
number with bar code
286 527527 : Cisplatin/Carboplatin- 5FU (Per cycle) -
Oesophageal CA6000
Endoscopy with film, biopsy,
CT report with film
Chemotherapy drug batch
number with bar code
287 529529 : Monthly 5-Fluorouracil(FU) (Per cycle) -
Colorectal cancer3000 CT report and Film, Biopsy
Chemotherapy drug batch
number with bar code
288 531
531 : 5-Fluorouracil-Oxaliplatin -Leucovorin (FOLFOX)-
Day 1 and 2; Max. 12 cycles for adjuvant (Per cycle) -
Colorectal cancer
8000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
289 532
532 : Cisplatin/Adriamycin+ifosmide (IAP)- max 6
cycles (Per cycle) -Adj/Neo adjuvant/Palliative
(Osteosarcoma)
15000 Biopsy , CT-Scan with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
290 533
533 : Doxorubicin - Bleomycin - Vinblastine
Dacarbazine (DBVD)-max 6-8 cycles (Per cycle) (Day1
& Day15) - Hodgkins Lymphoma
12000 Biopsy, CT
Clinical Photograph,
chemotherapy drug batch
number with bar code
291 534
534 : Cyclophosphamide - Doxorubicin Vincristine -
Prednisone (CHOP)- max 8 cycles (Per cycle) -
NHL/Lymphoma
6000 Biopsy, CT report with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
292 535535 : Vincristine, Adriamycin, Dexamethasone(VAD)-
cycle max 6 cycles - Multiple myeloma5000
Bone Marrow Aspiration
Report, Serum Protein
electrophoresis, CRAB criteria
Clinical Photograph,
chemotherapy drug batch
number with bar code
293 536536 : Thalidomide+Dexamethasone(Oral)-/month max
12 months - Multiple myeloma4000
Bone Marrow Aspiration
Report, Serum Protein
electrophoresis, CRAB criteria
Clinical Photograph,
chemotherapy drug batch
number with bar code
294 537537 : Melphalan -Prednisone (oral)-Month max 12
months -- Multiple myeloma1500
Bone Marrow Aspiration
Report, Serum Protein
electrophoresis, CRAB criteria
Clinical Photograph,
chemotherapy drug batch
number with bar code
295 538
538 : SIOP/NATIONAL WILMS TUMOUR STUDY
GROUP(NWTS) regimen(Stages I - V)- max 6 months
(Per month) - Wilm's tumour
8000CT report with film,
biopsy/FNAC
Clinical Photograph,
chemotherapy drug batch
number with bar code
296 540540 : Variable Regimen-Non Lymphoblastic NHL, (Per
cycle) max. 8 cycles.(Amount as per drug cost)20000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
297 541541 : Variable Regimen-Neuroblastoma- max 1 year
(Per cycle)(Amount as per drug cost)10000
CT report with film,
biopsy/FNAC
Clinical Photograph,
chemotherapy drug batch
number with bar code
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
298 542542 : Carbo/Etoposide/Vincristine-max 6 cycles (Per
cycle) - Retinoblastoma5000 Biopsy , CT report with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
299 543543 : Variable Regimen- LCH-max 1 year (Per
month)(Amount as per drug cost)8000
Biopsy,IHC , CT report with
film
Clinical Photograph,
chemotherapy drug batch
number with bar code
300 544
544 : Vincristine-Actinomycin-Cyclophosphamide(Vact
C) based chemo - max 1 year (Per cycle)-
Rhabdomyosarcoma
9000 Biopsy , CT report with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
301 545545 : Variable Regimen -Ewings Sarcoma- max 17
cycles in 1 year (Per cycle)(Amount as per drug cost)10000
X-Ray,CT Scan with film,
Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
302 546 546 : Paclitaxel weekly x 12 weeks 4500
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
303 550550 : Induction, Intensification & Consolidation / ALL
and Lymphoblastic NHL100000
Haematology, Bone Marrow
Aspitation/ Flow cytometry
Clinical Photograph,
chemotherapy drug batch
number with bar code
304 552552 : Maintenance ( Paed and adults) - ALL (Per
month)3000
Haematology, Bone Marrow
Aspitation/ Flow cytometry
Clinical Photograph,
chemotherapy drug batch
number with bar code
305 556 556 : Palliative and Supportive Therapy (Per month) 3000 Biopsy , CT report with film Clinical Photograph
306 558
558 : Zoledronic acid along with Adjuvant
Chemotherapy of AS-I- Maximum 12 cycles ( Bone
metastasis)
3000Bone Marrow Aspiration
Report
Clinical Photograph,
chemotherapy drug batch
number with bar code
307 559559 : Growth Factor / Pegrafil (Per cycle) (Maximum 4
cycles)2000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
308 561 561 : X Knife, Gamma Knife, Cyber knife 90000CT/MRI report and Film,
Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
309 562562 : Cobalt 60 External Beam Radiotherapy, Definitive
Neoadjuvant, Adjuvant20000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
310 563 563 : Cobalt 60 teletherapy, Palliative 10000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
311 565
565 : Linear accelerator teletherapy,
Conventional,Definitive, Neoadjuvant, Adjuvant
3DCRT/IMRT
50000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart, RT planning
Data
312 566 566 : Linear accelerator teletherapy, Palliative 20000 CT report and Film, BiopsyPhoto with RT Machine , RT
treatment chart
313 567567 : Linear accelerator teletherapy IMRT /VMAT,
Definitive, Adjuvant ((RT planning cost 20000/-)100000
CT/MRI report and Film,
Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
314 568568 : Linear accelerator teletherapy 3DCRT, Definitive,
Adjuvant (RT planning cost 15000/-)75000
CT/MRI report and Film,
Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
315 569 569 : Definitive, Adjuvant, SRS/SRT 75000Biopsy/FNAC ,CT report and
Film
Photo with RT Machine , RT
treatment chart RT planning
Data
316 571571 : Brachytherapy - Intraluminal HDR per fraction
(max 4 session)4500
Biopsy/FNAC ,CT report and
Film
Photo with RT Machine , RT
treatment chart, RT planning
data
317 572 572 : Brachytherapy/ Interstitial LDR , adjuvant 15000CT / MRI report with film,
Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
318 573573 : Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost30000
CT/MRI report and Film,
Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
319 574 574 : Radioiodine Treatment < 100 Millicuries 20000 Biopsy/FNAC
Radioiodine original
treatment chart and Thyroid
scan, Biopsy/HPE
320 575 575 : Radioiodine Treatment > 100 Millicuries 30000 Biopsy/FNAC
Radioiodine original
treatment chart and Thyroid
scan , Biopsy/HPE
321 578 578 : Microlaryngeal Surgery including Phonosurgery 12000 Clinical Photograph Clinical Photograph, HPE
report
322 580 580 : Distal Pancreatectomy 60000 CT / MRI with film/IHC report Clinical Photograph showing
scar + HPE report
323 581 581 : Enucleation of Cyst 50000 CT report and Film Clinical Photograph showing
scar + HPE report
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
324 582 582 : Whipples surgery ( inclusive of staplers) 80000 CT / MRI/IHC Clinical Photograph showing
scar + HPE report
325 583 583 : Splenectomy 35000CT /USG report and Film,
biopsy
Clinical Photograph showing
scar + HPE report + USG
report
326 584 584 : Radical Nephrectomy - Open/Lap * 45000
Ultrasound abd /CT Scan abd
with film, Isotope Renogram
if required
Clinical Photograph showing
scar + HPE report
327 585 585 : Radical Cystectomy with Ileal conduit * 75000 CT report and Film, BiopsyClinical Photograph showing
scar + HPE report
328 586 586 : Other cystectomies * 40000 CT report and Film, BiopsyClinical Photograph showing
scar + HPE report
329 587 587 : High Orchidectomy * 15000 USG scrotum, Tumour
markers
Clinical Photograph showing
scar ( if patient consents)+
HPE report
330 588 588 : Bilateral Orchidectomy * 15000Biopsy Reports /PSA with
evidence of bone metastasis
Clinical Photograph showing
scar ( if patient consents)+
HPE report
331 590 590 : Total Penectomy * 25000 Biopsy Reports
Clinical Photograph showing
scar ( if patient consents)+
HPE report
332 591 591 : Inguinal Block Dissection-one side * 20000 Biopsy Reports Clinical Photograph showing
scar + HPE report
333 593 593 : Partial Penectomy * 15000 Biopsy Reports
Clinical Photograph showing
scar ( if patient consents)+
HPE report
334 602 602 : Pneumonectomy 80000Biopsy/FNAC ,CT report and
Film
Clinical Photograph showing
scar + HPE report + XRAY
Chest
335 603 603 : Lobectomy 50000Biopsy/FNAC ,CT report and
Film
Clinical Photograph showing
scar + HPE report + XRAY
Chest
336 606 606 : Resection of Nasopharyngeal Tumor 50000CT/MRI report and Film,
Biopsy
Clinical Photograph, HPE
report
337 607 607 : Palatectomy 30000CT/MRI report and Film,
Biopsy
Clinical Photograph, HPE
report
338 608 608 : Temporal bone resection (Any Type) 60000CT/MRI report and Film,
Biopsy
Clinical Photograph showing
scar + HPE report
339 611 611 : Composite Resection 50000 CT report and Film, Biopsy Clinical Photograph showing
scar + HPE report
340 612 612 : Neck Dissection - any type 25000Biopsy , USG/CT of neck with
film
Clinical Photograph showing
scar + HPE report
341 622 622 : Laser Surgery of Larynx 30000 Clinical Photograph
Photos with laser machine,
CD of procedure/intra op
stills + HPE report
342 623 623 : Submandibular Gland Excision 25000CT/MRI/USG report and Film if
required/ Biopsy
Clinical Photograph showing
scar + HPE report
343 624 624 : Tracheal Resection 50000 CT report and Film, Biopsy Clinical Photograph showing
scar + HPE report
344 625 625 : Sternotomy + Superior Mediastinal Dissection 55000 CT report and Film, Biopsy Clinical Photograph showing
the scar + HPE report
345 626 626 : Parathyroidectomy 30000CT Scan Functional scan/PTH
reports/USG
Clinical Photograph showing
scar + HPE report
346 627 627 : Small bowel resection 40000 CT/ X ray with film , biopsy Clinical Photograph showing
scar + HPE report
347 628 628 : Closure of Ileostomy/ Colostomy 30000 Colonoscopy with film, Biopsy Clinical Photograph showing
scar
348 630 630 : Radical Cholecystectomy 60000 CT /MRI report and Film,
biopsy
Clinical Photograph showing
the scar + HPE report +USG
Report
349 632 632 : Resection of Retroperitoneal Tumors 50000 CT abdomen with film, FNAC Clinical Photograph showing
scar + HPE report
350 633 633 : Abdominal wall tumor Resection 35000 CT abdomen report and Film Clinical Photograph showing
scar + HPE report
351 634634 : Abdominal wall Resection with
reconstruction/mesh45000 CT abdomen report and Film
Clinical Photograph showing
scar + HPE report
352 635 635 : Bilateral pelvic lymph Node Dissection(BPLND) 30000 CT report and Film, Biopsy Clinical Photograph showing
scar + HPE report
353 638 638 : Anterior Resection ( inclusive of staplers) 70000Endoscopy with film, biopsy,
CT report with film
Clinical Photograph showing
scar + HPE report
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
354 652 652 : Chest wall resection for SOFT tissue bone tumors 40000 CT Chest with film, biopsyClinical Photograph showing
scar + HPE report
355 653 653 : Chest wall resection + Reconstruction 40000 CT Chest with film, biopsyClinical Photograph showing
scar + HPE report
356 654654 : Limb salvage surgery for Bone Tumors with
Prosthesis75000
CT-Local part/MRI, CT Chest
with film, ,Bone Scan report +
Biopsy Report
Clinical Photograph XRAY
Showing prosthesis + HPE
report
357 655 655 : Forequarter amputation 30000 CT-Local part/MRI with film +
Biopsy Report
Clinical Photograph showing
scar+ HPE report
358 656 656 : Shoulder Girdle Resection 40000
CT-Local part including chest
/MRI report with film +
Biopsy Report
Clinical Photograph showing
scar + HPE report
359 657 657 : Hemipelvectomy 65000 CT/MRI Pelvis with filmClinical Photograph showing
scar / HPE report + XRAY
360 658 658 : Sacral Resection 60000 CT/MRI Pelvis with filmClinical Photograph showing
scar / HPE report + XRAY
361 660 660 : Partial Nephrectomy 55000 CT report with film, Isotope
renogram if required
Clinical Photograph showing
scar+ HPE report +USG Report
362 663 663 : Adrenalectomy * 45000 CT/MRI report with film,
Urinary hormones
Clinical Photograph showing
scar+ HPE report
363 664 664 : Urinary diversion 40000 Biopsy, USG Scrotum report
and Film
Clinical Photograph showing
scar, post op USG
364 665665 : Retro Peritoneal Lymph Node Dissection RPLND
as part of staging20000 CT report and Film, Biopsy
Clinical Photograph showing
scar+ HPE report
365 666 666 : Anterior Exenteration 70000 Cystoscopy, biopsy, CT report
and Film
Clinical Photograph showing
scar+ HPE report
366 667 667 : Total Exenteration 75000 Cystoscopy, biopsy, CT report
and Film
Clinical Photograph showing
scar+ HPE report
367 669 669 : Mediastinal tumor resection 50000Biopsy/FNAC ,CT report and
Film
Clinical Photograph showing
scar + HPE report + XRAY
Chest
368 670 670 : Lung metastatectomy - solitary 30000Biopsy/FNAC ,CT report and
Film
Clinical Photograph showing
scar + HPE report + XRAY
Chest
369 671 671 : Lung metastatectomy - Multiple 50000Biopsy/FNAC ,CT report and
Film
Clinical Photograph showing
scar + HPE report + XRAY
Chest
370 675 675 : Tracheostomy 5000 Clinical Photograph showing
the procedure/scar
371 676 676 : Feeding procedure(Gastrostromy/Jejunostomy) 20000 Biopsy of the primary tumorClinical Photograph of
operated site
372 678 678 : Ileostomy 20000Biopsy of the primary + CT
Scan with film
Clinical Photograph of
operated site
373 679 679 : Colostomy 20000Biopsy of the primary + CT
Scan with film
Clinical Photograph of
operated site
374 680 680 : Suprapubic Cystostomy 10000 Biopsy of the primary tumorClinical Photograph showing
procedure/scar
375 681 681 : Gastro Jejunostomy 30000Biopsy of the primary + CT
Scan with film
Clinical photograph showing
scar
376 682 682 : Ileotransverse Colostomy 30000Biopsy of the primary + CT
Scan with filmClinical photograph with scar
377 683 683 : Substernal bypass 35000 Biopsy of the primary Clinical Photograph showing
the procedure/scar
378 684 684 : Myocutaneous / cutaneous flap 25000 Biopsy of the primary Clinical Photograph showing
scar
379 685 685 : Micro vascular reconstruction 45000 Biopsy of the primary Clinical Photograph showing
scar
380 686686 : Wide excision - for skin, soft tissue and bone
tumors - minor15000 Biopsy of the primary tumour
Clinical Photograph showing
scar + HPE report
381 687687 : Wide excision + Reconstruction for soft tissue
and bone tumors50000
Biopsy of the primary tumour
+ CT/MRI with film
Clinical Photograph showing
scar + HPE report
382 688688 : Amputation for bone / soft tissue tumours
(Minor)25000
Biopsy of the primary tumour
+ CT/MRI with film
Clinical Photograph showing
scar + HPE report
383 689 689 : VATS/Laparoscopy ( for deep seated biopsy) 10000 CT report with film Scar Photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
384 691
691 : Cobalt 60 External Beam Radiotherapy,
Definitive+Tab Temozolomide along with RT
(20000+15000=35000)
35000 CT report and Film, BiopsyPhoto with RT Machine , RT
treatment chart
385 692692 : Linear accelerator teletherapy, Conventional,
Definitive+Tab Temozolamide (40000+15000=55000)55000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart
386 693
693 : Linear accelerator teletherapy, 3DCRT, Definitive
along with +concurrent Tab Temozolamide along with
RT (65000+15000=80000) RT Planning Cost-15000/-
80000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
387 694
694 : Linear accelerator teletherapy, IMRT /VMAT,
Definitive along with +concurrent Tab Temozolamide
along with RT (90000+15000=105000) out of 90,000/-
RT planning cost is 20,000/-
105000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart RT planning
Data
388 695695 : Tab Temozolemide for 6 months (5days every
month x 6 months)45000 CT report and Film, Biopsy
Pharmacy Bill/Invoice with
batch no. of the drug strip
389 696 696 : Composite Resection and Reconstruction 65000 CT report and Film, Biopsy Clinical Photograph showing
scar + HPE report
390 698
698 : Palliative CT 1. Docetaxel + Cisplatin /
Carboplatin. 2. Gemcitabine D1& D8 + Cisplatin /
Carboplatin - max 6 cycles (Per cycle)
10000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
391 699 699 : Voice Prosthesis 40000CT report, Biopsy,
+Photograph with AM
Invoice of prosthesis, scar
photo
392 703703 : Variable Regimen - maximum 6 cycles (Per cycle)
(Amount as per drug cost)8000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
393 706706 : Pemetrexed +Carboplatin/Cisplatin (Stage IIIB, IV
Adenocarcinoma)- Max. 6 cycles only (Per cycle)15000
Biopsy/FNAC ,CT report and
Film,
Chemotherapy drug batch
number with bar code
394 707 707 : Tab Geftinib/Erlotinib-Max 1 Year (Per month) 6000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
395 708708 : Variable Regimen maximum 6 cycles (Per
cycle)(Amount as per drug cost)8000
Biopsy/FNAC ,CT report and
Film
Chemotherapy drug batch
number with bar code
396 709
709 : Linear accelerator teletherapy,
3DCRT,IMRT,VMAT Adjuvant/Definitive (RT planning
cost 15000/-)
75000Biopsy/FNAC ,CT report and
Film
Photo with RT Machine , RT
treatment chart
397 710 710 : Epirubicin+Cisplatin+5FU (Per cycle) 8000Endoscopy with film, biopsy,
CT report with film
Chemotherapy drug batch
number with bar code
398 711
711 : Docetaxel+Cisplatin+5FU OR Capcetabine +
Oxaloplatin (Neoadjuvant Chemotherapy maximum 3
cycles/pallative maximum 6 cycles) (Per cycle)
10000Endoscopy with film, biopsy,
CT report with film
Chemotherapy drug batch
number with bar code
399 712 712 : Imatinib -Max for 6 months (Per month) 5000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
400 713713 : Gemcitabine+Cisplatin(Day 1,Day 8 )-max 6
cycles (Per cycle)10000 CT report and Film, Biopsy
Chemotherapy drug batch
number with bar code
401 714 714 : GI Stenting including stent cost 40000 CT abdomen report and Film Stent invoice
402 715 715 : Tab Sorefinib- max 12 months (Per month) 8000CT/MRI report and Film,
Biopsy
Chemotherapy drug batch
number with bar code
403 716 716 : Inguinal Block Dissection-Bilateral 40000 Biopsy Reports Clinical Photograph showing
scar + HPE report
404 717717 : Gemcitabine+ Cisplatin(Day 1,Day 8)(Palliative
/Adjuvant)-max 6 cycles (Per cycle)10000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
405 718 718 : Palliative CT- Max 6 cycles (Per cycle) 8000CT/USG report and Film, Xray,
Biopsy
Chemotherapy drug batch
number with bar code
406 719 719 : Zoledronic acid - Max 12 cycles (Per month) 3000CT/PET /Bone scan/ Xray,
Biopsy if required
Chemotherapy drug batch
number with bar code
407 720 720 : Inguinal Block Dissection-Bilateral 40000 Biopsy Reports Clinical Photograph showing
scar+ HPE report
408 721 721 : Carboplatin(AUC more than 5) (Per cycle) 5000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
409 722
722 :
Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vinblastin
e,Ifosphimide,Cisplatin(VeIP)- max cycles 4 (Per cycle)
20000CT report and Film,
Biopsy/Tumour markers
Clinical Photograph,
chemotherapy drug batch
number with bar code
410 723 723 : Linear accelerator, Curative less than 20 fractions 20000CT report and Film,
Biopsy/Tumour markers
Photo with RT Machine , RT
treatment chart
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
411 724724 : Variable Regimen (Amount as per drug cost)-
max 6 cycles (Per cycle)8000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
412 726726 : Amputation for bone / soft tissue tumours
(Major)35000
Biopsy of the primary tumour
+ CT/MRI with film
Clinical Photograph showing
scar + HPE report
413 727727 : High Dose Methotrexate (MTX)- max 6 cycles
(Per cycle)15000 Biopsy , CT-Scan with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
414 728728 : IFS + ADR-max 6 cycles (Per cycle) -Adj/Neo
adjuvant/Palliative15000 Biopsy , CT-Scan with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
415 734 734 : Consolidation 1 to 4 phases(per phase)- AML 33000 Haematology, Bone Marrow
Aspitation/ Flow cytometry
Clinical Photograph,
chemotherapy drug batch
number with bar code
416 737737 : D'angelo's for CNS primary and secondary
lymphomas -(Max. 6 months) (Per month)20000
Haematology +
Cytoflowmetry report
Clinical Photograph,
chemotherapy drug batch
number with bar code
417 738738 : Salvage CT -DHAP (cytosine arabinoside-cisplatin-
dexamethasone) - Maximum 6 cycles (Per cycle)25000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
418 739739 : Imatinib Min 400 mg/day-max 12 cycles per year
(Per month) - AML, CML5000
Hematology + FNAC report
/Cytogenetics/ BCR-ABL
Clinical Photograph,
chemotherapy drug batch
number with bar code
419 740 740 : Bendamustine- max 6 cycles (Per cycle) - CLL 10000 Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
420 741741 : Linear accelerator, less than 20
fractions/3DCRT/IMRT25000
Hematology + Biopsy/FNAC
report
Photo with RT Machine , RT
treatment chart
421 742
742 : Cobalt 60 External Beam Radiotherapy,Involved-
Site Radiotherapy (ISRT)/Involved Field Radiation
Therapy (IFRT)
15000Hematology + Biopsy/FNAC
report
Photo with RT Machine , RT
treatment chart
422 743743 : IV antibiotics and other supportive therapy For
Febrile Neutropenia (Per episode)10000 Haemogram for each episode
Clinical Photograph,
Discharge summary (with
details of drugs given)
423 744744 : Oxiplatin+Capecitabine- max. of 6 cycles for
palliative only or 8 cycles for adjuvant (Per cycle)8000 CT/MRI with film, Biopsy
Chemotherapy drug batch
number with bar code
424 748
748 : Linear accelerator,Involved-Site Radiotherapy
(ISRT)/Involved field radiation therapy
(IFRT)/3DCRT/IMRT
25000Hematology + Biopsy/FNAC
report
Photo with RT Machine , RT
treatment chart
425 749 749 : Variable regimen - Max 6 cycles (Per cycle) 8000 CT/MRI , HPE reportChemotherapy drug batch
number with bar code
426 750750 : Composite Resection + Micro vascular
reconstruction80000 CT report and Film, Biopsy
Clinical Photograph showing
scar + HPE report
427 751751 : Linear accelerator (Photons) teletherapy,
Adjuvant50000
CT/MRI report and Film,
Biopsy
Photo with RT Machine , RT
treatment chart
428 752752 : Cisplatin + 5FU + Taxol/Docitaxel ( only
hypopharynx) :11000 CT report and Film, Biopsy
Clinical Photograph showing
scar + HPE report
429 753753 : Palliative CT (Paclitaxel + Cisplatin or 5 FU +
Cisplatin) - Max 6 cycles (Per cycle)8000
CT / USG report and Film, X
ray, Biopsy
Chemotherapy drug batch
number with bar code
430 754 754 : Bilateral oophorectomy 25000ERPR positive report, Biopsy
of CA breastHPE report
431 755
755 : 1. TC Docetaxel + Cyclophosphamide. 2. TAC
Docetaxel + Doxorubicin + Cyclophosphamide. 3.
Gemcitabine D1 & D8 +/- Cisplatin/ Carboplatin -
maximum 6 cycles (Per cycle)
12000
Biopsy/FNAC ,
Mammography/USG, chest
Xray
Chemotherapy drug batch
number with bar code
432 756
756 : Paclitaxel + Cisplatin / Carboplatin 2.
Gemcitabine D1 & D8 + Cisplatin / Carboplatin -Max. 6
cycles only (Per cycle)
12000Biopsy/FNAC ,CT report and
Film
Chemotherapy drug batch
number with bar code
433 757 757 : Exploratomy laparotomy 20000Endoscopy with film, biopsy,
CT report with film
Clinical Photograph showing
scar + HPE report
434 758
758 : Linear accelerator teletherapy,
Conventional,Definitive, 3DCRT/IMRT - for inoperable
oesophagus cancer without metastsis.(RT planning
cost 15000/-)
75000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart, RT planning
Data
435 759759 : Hepatoblastoma - Variable regime, max 6 cycles
(per cycle) as per drug cost5000 CT scan, Tumour markers
Chemotherapy drug batch
number with bar code
436 760760 : EOX (Epirubicin + Oxaloplatin + Capcetabine) -
Max 6 cycles12000
Endoscopy with film, biopsy,
CT report with film
Chemotherapy drug batch
number with bar code
437 761
761 : 5-Fluorouracil-Oxaliplatin -Leucovorin (FOLFOX)-
Day 1 and 2; Max. 6 cycles for palliative (Per cycle) -
Colorectal cancer
10000 CT report and Film, BiopsyChemotherapy drug batch
number with bar code
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
438 762
762 : 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)
10000CT/USG report and Film, Xray,
Biopsy
Chemotherapy drug batch
number with bar code
439 763
763 : Capetabine (Day 1-14) - 6 cycles
(Palliative/Adjuvant); As Concurrent as RT sensitizor
with all RT
4000CT/USG report and Film, Xray,
Biopsy
Chemotherapy drug batch
number with bar code
440 764764 : Linear accelerator teletherapy, 3DCRT (RT
planning 15000/)75000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart, RT planning
Data
441 765765 : IMRT/VMAT/SBRT (Radical radiation alone for
prostate) (RT Planning 20000/)90000 CT report and Film, Biopsy
Photo with RT Machine , RT
treatment chart, RT planning
Data
442 766 766 : Hormonal therapy with Abiratarone- monthly 8000
CT report and Film, Biopsy,PSA
with evidence of bone
metastasis
Clinical Photograph,
chemotherapy drug batch
number with bar code
443 767767 : Hormone therapy - Bicalutamide -50mg OD
monthly (per month)5000
CT report and Film, Biopsy,PSA
with evidence of bone
metastasis
Clinical Photograph,
chemotherapy drug batch
number with bar code
444 768768 : Palliative CT - (5FU + Cisplatin/Carboplatin) - Max
6 cycles (Per cycle)6000
CT/USG report and Film, Xray,
Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
445 769 769 : Palliative CT-Docetaxel- Max 6 cycles (Per cycle) 9000CT/USG report and Film, Xray,
Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
446 770
770 : Variable Regimen maximum 6 cycles (Per
cycle)MVAC- Mitomycin, Vincristine, Adriamycin,
Cyclophosphamide (Amount as per drug cost- max
8000)
8000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
447 771771 : Urinary bladder CA- Gemcitabine/Cisplatin as
radio sensitizer weekly - max 8 weeks - (cost per week)2000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
448 772
772 : Gemcitabine+ Carboplatin/ Liposomal
Doxorubicin/ Albumin bound Paclitaxel ( Adjuvant),
max 6 cycles
12000 CT report and Film, Biopsy
Clinical Photograph,
chemotherapy drug batch
number with bar code
449 773773 : Wide excision - for skin, soft tissue and bone
tumors - Major30000 Biopsy of the primary tumour
Clinical Photograph showing
scar + HPE report
450 774774 : CNS directed therapy - RT/CT (10 fractions) (CT-
for age below 3 years; all others -RT)15000
Hematology + Biopsy/FNAC
report
Photo with RT Machine , RT
treatment chart
451 776776 : Salvage CT - GDP (Gemcitabine - Cisplatin-
Dexamethasone)- Maximum 6 cycles (Per cycle)12000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
452 777777 : Salvage CT - ICE (Ifosfamide-Carboplatin-
Etoposide)- Maximum 6 cycles (Per cycle)15000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
453 778778 : Second generation Tab TKI - max 12 cycles per
year (Per month) - (Failure of Imatinib)6000
Hematology + FNAC report
/Cytogenetics/ BCR-ABL
Clinical Photograph,
chemotherapy drug batch
number with bar code
454 779779 : Bendamustine + Ritumaxib- 6-8 cycles (Per cycle) -
CLL (Available only at select centres)20000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
455 780 780 : R-CHOP -max 6 cycles (Per cycle) 20000 Biopsy, CT report with film
Clinical Photograph,
chemotherapy drug batch
number with bar code
456 781
781 : Plasma cell Leukemia / Multiple Myeloma -
Thaladomide, Dexamethasone, Bortezomib - max 6
cycles
20000
Bone Marrow Aspiration
Report, Serum Protein
electrophoresis
Clinical Photograph,
chemotherapy drug batch
number with bar code
457 782782 : Salvage CT- max 6 cycles ( Per cycle) only
paediatrics12000
Hematology + Biopsy/FNAC
report
Clinical Photograph,
chemotherapy drug batch
number with bar code
458 822 822 : Tendon injury requiring repair moderate 10000X-ray Films/ Clinical Picture +
detail notesClinical photo showing Scar
459 823 823 : Tendon injury requiring repair major 20000
Xray Films(if relevant)+
Clinical Picture(Mandatory) +
detail notes
Clinical photo showing Scar
460 824 824 : Nerve injuries minor 15000
Xray Films(if relevant)+
Clinical Picture(Mandatory) +
detail notes
Clinical photo showing Scar
polytrauma
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
461 825 825 : Nerve injuries major 20000
Xray Films(if relevant)+
Clinical Picture(Mandatory) +
detail notes
Clinical photo showing Scar
462 827 827 : Vascular peripheral/minor injuries 10000
Pre-operative Doppler study,
CT angio(Optional)+ Films+
detailed Clinical notes
Post-operative Doppler study,
Clinical photo showing scar
463 828 828 : Vascular central/severe injuries(major) 50000
Pre-operative Doppler study+
CT Angio(optional) + detailed
Clinical notes
Post-operative Doppler study,
Clinical photo showing scar
464 829 829 : Flap surgery (Simple) 15000X-ray Films + detail notes+ pre-
op clinical photoClinical photo showing Scar
465 830 830 : Complex flap surgery 30000 X-ray Films + detail notes Clinical photo showing Scar
466 831 831 : Long bone external fixation 25000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical
Photograph showing scar
467 832 832 : Long bone internal fixation 25000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical
Photograph showing scar
468 833 833 : Long bone (two) external/internal fixation 40000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical
Photograph showing scar
469 834 834 : Small bones external fixation 15000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical
Photograph showing scar
470 835 835 : Small bones internal fixation 15000 X-RAY/CT scan(If Required) Post-operative X-ray, Clinical
Photograph showing scar
471 836 836 : Facio-Maxillary Injury repairs & fixations 35000 X-RAY/CT scan Clinical Photograph showing
scar + post op. XRAY
472 837 837 : Visceral injuries moderate 40000Pre-op. of X-ray/CT scan /
Ultra sound
Post-Operative X-ray, scar
photo
473 838 838 : Visceral injuries severe 60000Pre-op. of X-ray/CT scan /
Ultra sound
Post-Operative X-ray, scar
photo
474 839 839 : Chest injuries with ICD unilateral 8000 X-ray /ultra soundPost-Operative chest X-ray
with ICD in situ
475 840 840 : Chest injuries with ICD bilateral 11000 X-ray /ultra soundPost-Operative chest X-ray
with ICD in situ
476 841 841 : Chest injuries with ICD + ICU 20000 X-ray /ultra soundPost-Operative chest X-ray
with ICD in situ
477 842 842 : Chest injuries with ICD + ICU + Ventilator 35000 X-ray /ultra soundPost-Operative chest X-ray
with ICD in situ
478 843 843 : Pelvic injuries external/Internal fixation 35000 X-RAY/CT scan Clinical Photograph showing
scar + post op. XRAY
479 844 844 : Acetabular definitive treatment 50000 X-RAY/CT scan Clinical Photograph showing
scar + post op. XRAY
480 845 845 : Dislocation /fracture Closed Reduction 4000 X-Ray Films + detail notes Post Reduction XRAY
481 846 846 : Bone grafting for any procedure 15000 X-ray Scar photo
482 847847 : Fasciotomy of upper and lower limb for
compartment syndrome15000 X-ray Scar photo, Post op X-ray
483 848848 : Illizarov/Orthofix/hybrid external fixator
application75000 X-ray
Post op X-ray, Pt photo with
applicator
484 849 849 : Arthroscopic ACL Reconstruction 55000 MRI Report & Film X-ray LCD
485 850 850 : PCL Reconstruction 55000 MRI Report & Film X-ray LCD
486 851 851 : Skin Grafting Minor - injuries(Add on code) 10000 Scar photoX-ray + post-operative scar
photo
487 852 852 : Skin Grafting Major- Injuries(Add on code) 20000 X-rayX-ray + post-operative scar
photo
488 853 853 : Implant Removal(Minor) 3000 X-ray Scar photo
489 854 854 : Implant Removal (Major) 12000 X-ray Scar photo
490 855855 : Arthroscopic BANKARTS Repair for recurrent
dislocation of shoulder75000 X-ray
Patient Photo with
Arthroscopic incision
491 856 856 : Curettage for osteomyelitis 15000 X-ray Scar photo
492 861861 : Maysers muscle pedicle graft for Non-union
fracture neck femur (orthroplasty)30000 X-ray Post-op X-ray, Scar photo
493 862 862 : Synovectomy 15000Clinical notes confirming
diagnosis Scar Photo
494 863 863 : Arthrodesis Minor joint 8000 X-ray Scar photo
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
495 864 864 : Arthrodesis Major Joint 15000 X-ray Scar photo
496 865 865 : Osteotomy Minor 15000 X-ray Scar photo
497 866 866 : Osteotomy Major 25000 X-ray Scar photo
498 901 901 : Open Pyelolithotomy* 36000 CT KUB with Contrast Scar Photo,X-Ray/USG KUB
499 902 902 : Open Nephrolithotomy* 36000 USG/X-ray KUB Scar Photo,X-Ray/USG KUB
500 903 903 : Open Cystolithotomy 18000 USG/X ray KUB Scar Photo,X-Ray/USG KUB
501 905 905 : Pyeloplasty* 40000 USG & IVP/CT with Contrast Scar Photo
502 906 906 : Cystolithotripsy 17000 X-ray KUB/USG X-ray KUB
503 907 907 : PCNL (Percutaneous Nephro Lithotomy)* 38000 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
504 908 908 : ESWL (Extra carporial shock-wave lithotripsy)* 12000 CT KUB with Contrast X-ray KUB/USG
505 909 909 : URSL* 22500 CT KUB X-ray KUB
506 910 910 : Nephrostomy (PCN)* 10000 USGScar Photo With
Nephrostomy Tube
507 911 911 : DJ stent (One side) 7500 USG /X-ray KUB X-ray KUB
508 912 912 : Urethroplasty for Stricture Diseases-single stage* 45000 RGU Scar photo,
509 913 913 : Urethroplasty for Stricture Diseases-First Stage 30000 RGU & MCU Scar photo,
510 914914 : Urethroplasty for Stricture Diseases-Second
Stage*25000 RGU & MCU Scar photo,
511 918 918 : Simple Nephrectomy 35000USG, CT KUB /Isotope
Renogram
Scar & Specimen Photo +HPE
report
512 919 919 : Lap. Nephrectomy Simple 45000USG & CT KUB /Isotope
RenogramScar Photo + HPE Report
513 920 920 : Lap. Nephrectomy Radical 50000USG & CT KUB with Contrast /
Isotope RenogramScar Photo + HPE Report
514 921 921 : Lap. Partial Nephrectomy 60000USG & CT KUB with Contrast /
Isotope RenogramScar Photo + HPE Report
515 922 922 : Laparoscopic Vvf Repair 40000 Cystoscopy,CECT KUB/ IVPClinical Photograph/
Cystogram
516 923 923 : URSL-Laser* 25000 CT KUBX-ray KUB, Purchase Voucher
for Laser machine
517 924 924 : DJ Stent (Bilateral) 10000 X-ray KUB & USG X-ray KUB & USG
518 927 927 : Open Partial Nephrectomy 50000 USG & CT KUB with Contrast Scar Photo + HPE Report
519 928928 : Open Anatrophic Nephrolithotomy ( For Staghorn
Stone)45000 USG, CT KUB with Contrast Scar Photo +X-Ray Kub
520 929 929 : Ureterolithotomy-Open* 30000 CT KUB with Contrast Scar Photo +X-Ray Kub
521 930 930 : Ureterolithotomy-Lap* 35000 CT KUB with Contrast Scar Photo +X-Ray Kub
522 936 936 : Perineal Urethrostomy 25000 RGU& MCU Scar photo,
523 937 937 : Open Orchidectomy (Simple / Radical) 20000 USG Scrotum SCAR PHOTO , HPE report
524 938 938 : Visual Internal Urethrotomy 12000 USG & RGU Uroflowmetry/ENDO PICTURE
525 939 939 : Meatoplasty 15000 USG , Uroflometry,RGU ENDO PICTURE
526 943943 : Eswl (Extra Corporial Shock-Wave Lithotripsy)
Above 1 Cm To 2 Cm- Single Side*18000 CT KUB with Contrast X-ray KUB
527 946 946 : Varicocoele - unilateral 15000Scrotal Doppler Ultra Sound
ScanOperative Picture
528 947 947 : Varicocoele - bilateral 20000Scrotal Doppler Ultra Sound
ScanOperative Picture
529 948 948 : Deflux for VUR* 50000 USG,MCU Post -op MCU
530 949 949 : Partial cystectomy* 40000 CT KUB with Contrast Procedure Picture
531 950 950 : Ureterocoele incision 25000 IVU/CTENDO Picture With patient
details
532 952 952 : Bladder diverticulectomy -open/lap* 30000 CT KUBEndo Picture/Operative
Picture
533 954954 : Hemodialysis for acutekidney injury (intiation
phase)5000
CBC,RFT, USG
ABD,HIV,HBsAg,HCV,Urine R/ERFT,Urine R/E
534 955 955 : Subsequent Hemodialysis - per session 1000 RFT,Urine R/E RFT,Urine R/E
535 956 956 : Renal biopsy – Percutaneous 7500CBC,RFT, USG ABD,
HIV,HBsAg,HCV,Urine R/EHPR
Genito Urinary Surgery
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
536 957
957 : Acutekidney injury without hemodialysis,
inclusive of pre-op inv,post -op inv,procedure
cost,wards stay,and medication for 10 days
10000
CBC,RFT, USG ABD,
HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile
RFT,Urine R/E
537 958
958 : Acutekidney injury with hemodialysis, inclusive
of pre-op inv,post -op inv,procedure cost,ICU/wards
stay,and medication for 15 days
25000
CBC,RFT, USG ABD,
HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile
RFT,Urine R/E
538 959 959 : Trochar SPC FOR ARU/Acute Urethral injury 2000 RGU,MCU RGU,MCU
Sl.NoProcedure
Code Procedure
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
1 3001 Fistulectomy 8500 pre op Xary film Post op xray film
2 3002 Fixation of fracture of jaw 15000 pre op Xary film Post op xray film
3 3003 Sequestrectomy 9750 pre op Xary film Post op xray film
4 3004 Tumour excision 7500Pre op Xray,Clinical photo, Post op xray, clinical photo
5 3005 Apisectomy including LA 800Preop xray Post op xray, clinical photo
6 3006 Complicated Ext. per Tooth including LA 300 Pre op xray Post op xray
7 3007 Cyst under LA (Large) 600 Pre op xray Post op xray
8 3008 Cyst under LA (Small) 450 Pre op xray Post op xray
9 3009 Extraction of tooth including LA 125 Pre op xray Post op xray
10 3010 Flap operation per Tooth 500Pre op xray Post op xray, clinical photo
11 3011 Fracture wiring including LA 1000 Pre op xray Post op xray
12 3012 Gingivectomy per Tooth 300Pre op xray, clinical photo Post op xray, clinical photo
13 3013 Impacted Tooth including LA 800 Pre op xray Post op xray
14 3014 Drainage of parotid abscess 7000 Pre op xray Post op xray
15 3015 Excision of mandible 12000 Pre op xray Post op xray
16 3016 Repair of parotid duct 18000 Pre op xray Post op xray
17 3017 Abscess incision 350 Pre op xray Post op xray
18 3018 Alveolectomy per tooth 300 Pre op xray Post op xray
19 3019 Apical Curettage per tooth 400 Pre op xray Post op xray
20 3020 Condylectomy 2000 Pre op xray Post op xray
21 3021 Fistula closure 500 Pre op xray Post op xray
22 3022 Gingivectomy full mouth 2000 Pre op xray Post op xray
23 3023 Fracture Jaws closed reduction 1000 Pre op xray Post op xray
24 3024 Frenectomy 300 Pre op xray Post op xray
25 3025 Osteotomy 1500 Pre op xray Post op xray
26 3026 Pericoronotomy 500Pre op xray, clinical photo Post op xray, clinical photo
27 3027 Pulpotomy 450 Pre op xray Post op xray
28 3028 Segmental resection of jaw 1500 Pre op xray Post op xray
29 3029 Treatment of malocclusion through wiring 10000Pre op xray, clinical photo Post op xray, clinical photo
30 3030 Treatment Nursing bottle caries (Full mouth) 5000 Pre op xray Post op xray
31 3031 Complete denture 2500 Clinical photo, Xray clinical photo
32 3032 Removable partial denture 150 Pre op xray Post clinical photo graph
33 3033 Restoration of teeth per tooth 200 Pre op xray Post op xray
34 3034Treatment of gums through scaling (three sittings
)450
pre clinical photograph Post clinical photo graph
35 3035 Root canal treatment per tooth 1200 Pre op xray Post op xray
36 3036 Metal crown per cap 500Pre op xray, clinical photo Post op xray, clinical photo
37 3037 Ceramic crown per cap 1000Pre op xray, clinical photo Post op xray, clinical photo
38 3101 Fenestration 10000 X Ray PNS OT Notes
39 3102 Myringoplasty with Ossiculoplasty 20000 X Ray Mastoid OT Notes
40 3103 Vidian neurectomy - Micro 12000 Clinical notes OT Notes
41 3104Excision of Pinna for Growth (Squamous/Basal/
Injuries) Skin Only2500
Clinical Photo Scar Photo
42 3105 Total amputation of Pinna 3000 Clinical Photo Scar Photo
43 3106 Tympanotomy 3000 X Ray Mastoid OT Notes
44 3107 Aural polypectomy +Tympanoplasty 13000 X Ray Mastoid OT Notes
45 3108 Ant. Ethmoidal artery ligation 15000 Clinical Notes OT Notes
46 3109 Antrostomy – Unilateral 4500 Clinical Notes, X Ray PNS OT Notes
47 3110 Cryosurgery (Nose) 8000 X Ray PNS OT Notes
RBSK SECONDARY CARE PROCEDURE LIST
Dental
ENT
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
48 3111 Ethmoidectomy - External 15000 X Ray PNS OT Notes
49 3112 Fracture reduction nose with septal correction 8000X Ray Nasal Bones OT Notes
50 3113 Radical fronto ethmo sphenodectomy 16000 CT PNS OT Notes
51 3114 Trans Antral Ethmoidectomy 12000 CT PNS OT Notes
52 3115 Endoscopic Hypophysectomy 16500 CT PNS OT Notes
53 3116 Intranasal Diathermy 2500 X Ray PNS OT Notes
54 3117 Lateral Rhinotomy 1500 Clinical Notes OT Notes
55 3118 Rhinoplasty 20000 Clinical Photo OT Notes
56 3119 Excision of Pharyngeal Diverticulum 10000 Endoscopic Picture OT Notes
57 3120 Excision of Cystic Hygroma Minor 5000 USG Neck OT Notes
58 3121 Cheek Advancement 12000 Clinical photo OT Notes
59 3122 Myringotomy - Bilateral 4000 Clinical Notes OT Notes
60 3123 Myringotomy - Unilateral 2500 Clinical Notes OT Notes
61 3124 Myringotomy with Grommet - One ear 5000 Clinical Notes OT Notes
62 3125 Myrinogotomy with Grommet - Both ear 6000 Clinical Notes OT Notes
63 3126 Removal of foreign body from Ear 800 Clinical Notes OT Notes
64 3127 Septoplasty 5000 X Ray PNS OT Notes
65 3128Functional Endoscopic Sinus Surgery (FESS)
Unilateral8000
Endoscopic Picture, CT OT Notes
66 3129Functional Endoscopic Sinus Surgery (FESS)
Bilateral10000
Endoscopic Picture, CT OT Notes
67 3130 Excision Of Benign Tumour Nose 6250 Clinical Note, X Ray PNS OT Notes, HPE
68 3131 Turbinectomy - Bilateral 5000 X Ray PNS OT Notes
69 3132 Turbinectomy - Unilateral 3000 X Ray PNS OT Notes
70 3133 Removal of foreign body from Nose 800 X Ray PNS OT Notes
71 3134 Tonsillectomy 6250Clinical Notes, Blood Count OT Notes
72 3135 Adenoidectomy 3500 X ray Posterior Pharynx OT Notes
73 3136 Release of Tongue tie 2000 Clinical Notes OT Notes
74 3137 Thyroglossal Cyst /Fistula - Excision 7500 Clinical Notes OT Notes
75 3138 Excision of Branchial Cyst /Sinus 7500 Clinical Notes OT Notes
76 3139 Ranula excision 6250Clinical Notes, X RayNeck
(Lateral View ) OT Notes
77 3201 Appendicular Abscess - Drainage 9000 USG, Blood Count HPE, Scar photo
78 3202 Bakers Cyst - Excision 6000X Ray, Clinical photograph Scar Photo
79 3203 Bursa - Excision 8500 Clinical photo Scar Photo
80 3204 Carbuncle 5000 Blood Sugar, Blood Count Scar Photo
81 3205 Cervial Lymphnode - Excision biopsy 2500 Blood Count, BSR HPE
82 3207 Dorsal Slit and Reduction of Paraphimosis 2500 Blood Count OT Notes
83 3208 Epidydectomy 12000 Blood Count OT Notes
84 3209 Evacuation of Scrotal Hematoma 5000 Blood Count,USG OT Notes
85 3211 Excision Mammary Fistula 10000 Sono-mammography Scar Photo
86 3212 Fibro Lipoma of Spermatic cord with Excision 2500Blood Count, USG OT Notes, Scar photo
87 3213 Fulguration 5000 Blood Count Endo Pic
88 3214 Ganglion - Excision 5000 Blood Count Clinical photograph
89 3215 Granuloma - Excision 4000 Blood Count Scar Photo
90 3216 Infected Bunion Foot - Excision 5000 X Ray foot, Blood Count Scar Photo
91 3218 Closure of Hollow Viscus Perforation 15000USG/CT, X Ray erect
abdomen Scar Photo
92 3219 Anorectoplasty 18000 USG/CT, X Ray Scar Photo
93 3220 Mesenteric Cyst - Excision 9000 CT/USG Scar Photo
94 3221 Pelvic Abscess - Open Drainage 8000 USG, Blood Count Scar Photo
95 3222 Papilloma Rectum - Excision 3500 Clinical Notes HPE
96 3223 Rectal Dilation 4500 Clinical Notes
97 3227 Excision and Skin Graft of Venous Ulcer 15000 Clinical Photo Scar Photo
98 3228 Free Grafts - Small Area 10% 7000 Clinical Photo Scar Photo
99 3229 Free Grafts -Medium Area 10-20% 9000 Clinical Photo Scar Photo
100 3230 Free Grafts - Large Area > 20% 12000 Clinical Photo Scar Photo
101 3231Lymphatics Excision of Subcutaneous Tissues In
Lymphoedema10000
Clinical Photo Scar Photo
102 3233 Peritoneal dialysis with shunt 2500Clinical Notes, BUN, Serum
Creatinine Procedure Notes
103 3234 Rib Resection & Drainage 10000 X Ray Xray, Scar Photo
104 3235 Skin Flaps - Rotation Flaps 6000 Clinical Photo Scar Photo
105 3236 Trendelenburg Operation for varicose veins 12000 Clinical Photo Scar Photo
General Surgery
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
106 3237 Tissue Reconstruction Flap Leprosy 25000 Clinical Photo Scar Photo
107 3238 Tendon Transfer-Leprosy 25000 Clinical Photo Scar Photo
108 3239 Hydrocele - Excision - Bilateral 10000 USG Scar Photo
109 3240 Hydrocele - Excision - unilateral 8000 USG Scar Photo
110 3241 Cyst Excision 5000 Clinical Photo Scar Photo
111 3242 Wound Debridement 3000 Clinical Photo Scar Photo
112 3243 Haemorrhoidectomy / Haemorrhoidopexy 6000 Clinical Photo OT Notes
113 3244 Fistulectomy 10000 Clinical Notes OT Notes
114 3245 Excision Pilonidal Sinus 10000 Clinical Photo OT Notes
115 3246 Prolapse of Rectal Mass - Excision 10000 Clinical Photo OT Notes
116 3247 Rectal polyp 7500 Clinical Notes OT Notes
117 3248 Rectopexy 22000 Clinical Notes OT Notes
118 3250 Circumcision (Children) 2000 Clinical Notes OT Notes
119 3251 Enucleation of Superficial Lipoma 1500 Clinical Notes OT Notes
120 3252 Excision Of Submandibular Salivary Gland 8000 Clinical Notes Scar Photo
121 3253 Rare Hernias (Spigalion,Obuturator,Sciatic) 15000 USG Scar Photo
122 3254 Umbilical Hernia ( incl. Mesh) 14000 USG Scar Photo
123 3255 Ventral And Scar Hernia ( Incl. Mesh) ,open/Lap 14000USG Scar Photo
124 3256Inguinal Hernia Repair ( incl. Mesh)-Unilateral,
Open/Lap12000
USG OT Notes
125 3301 Bartholin abscess I & D 2500 Clinical Notes OT Notes
126 3302 Bartholin cyst removal 3000 Clinical Notes OT Notes
127 3303 Cervical Polypectomy 3500 Clinical Notes OT Notes
128 3304 Ovarian Cystectomy 15000 Clinical Notes, USG OT Notes, Scar photo
129 3305 Excision - Vaginal Septum 5000 Clinical Notes OT Notes
130 3306 Hymenectomy & Repair of Hymen 8000 Clinical Notes OT Notes
131 3309 Laprotomy - Failed exploratory laproscopy 13000 USG, Clinical Notes OT Notes, Scar photo
132 3310Abdominal perineal neo construction
Cx+Uterus+Vagina15000
USG, Clinical Notes OT Notes, Scar photo
133 3311 Examination under anaesthesia 2500 Clinical Notes OT Notes
134 3312 Excision of urethral caruncle 2750 Clinical Notes OT Notes
135 3402 Fimbriolysis 8000 USG OT Notes, Scar photo
136 3403 Uterine septum 10000 USG OT Notes,Scar photo
137 3501 Polypectomy 10000 USG HPE
138 3502 Uterine Synechia - Cutting 10000 USG Scar photo
139 3601 Cryoretinopexy - Closed 4000 Clinical Notes OT Notes
140 3602 Cyst- Excision 4000 Clinical Notes OT Notes
141 3603 Dacryocystectomy 8000 Clinical Notes OT Notes
142 3604 Endoscopic Optic Nerve Decompression 7500 Clinical Notes,CT OT Notes
143 3605 Endoscopic Optic Orbital Decompression 12000 Clinical Notes,CT OT Notes
144 3606 Exentration- Eyeball, Orbital bones 12000 Clinical Notes,CT OT Notes
145 3607 Intraocular Foreign Body Removal 10000 Clinical Notes OT Notes
146 3608 Lensectomy 12000 Clinical Notes OT Notes
147 3609 Perforating corneo - Scleral Injury 8000 Clinical Notes OT Notes
148 3610 Retinal Detachment Surgery 6000 Clinical Notes OT Notes
149 3611 Tumours of IRIS 3500 Clinical Notes OT Notes
150 3612 Juvenile Cataract with IOL- Unilateral 8000 Clinical Notes OT Notes
151 3613 Juvenile Cataract with IOL- Bilateral 12000 Clinical Notes OT Notes
152 3614 ERG (Electro retinal gram) 825 OT Notes
153 3615 Lid tear 5000 Clinical Notes OT Notes
154 3616 Orbitotomy 12000 Clinical Notes OT Notes
155 3617 Squint correction 12000 Clinical notes OT Notes
156 3618 Pterigium + Conjunctival Autograft 12000 Clinical notes OT Notes
157 3619 Anterior Chamber Reconstruction 8000 Clinical notes OT Notes
158 3620 Trabecullectomy 7700 Clinical notes OT Notes
159 3621 Therapeutic Penetrating Keratoplasty 10000 Clinical notes OT Notes
160 3622 Lamellar Keratoplasty 10000 Clinical notes OT Notes
161 3623 Corneal Patch Graft 8000 Clinical notes OT Notes
162 3624 Scleral Patch Graft 8000 Clinical notes OT Notes
163 3625 Penetrating Keratoplasty 12000 Clinical notes OT Notes
164 3626 Double Z-Plasty 6000 Clinical notes OT Notes
165 3627 Amniotic Membrane Graft 6000 Clinical notes OT Notes
166 3628 Plane / Anterior Vitrectomy 6000 Clinical notes OT Notes
167 3629 Vitrectomy - Membrane Peeling- Endolaser 12000 Clinical notes OT Notes
Endoscopic Procedures
OBG
Hysteroscopic Procedures
Opthalmology
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
168 3630 Vitrectomy Plus Silicon Oil Or Gas 12000 Clinical notes OT Notes
169 3631 Removal Of Silicon Oil Or Gas 3500 Clinical notes OT Notes
170 3632 Scleral buckle procedure for retinal detachment 12000Clinical notes OT Notes
171 3633 Intraocular Foreign body removal 15000 Clinical notes OT Notes
172 3634 Socket Reconstruction 7500 Clinical notes OT Notes
173 3635 Dermis Fat Graft 7500 Clinical notes OT Notes
174 3636 Enucleation (non. Incl. implant) 10000 Clinical notes OT Notes
175 3637 Evisceration (non incl. implant) 7000 Clinical notes OT Notes
176 3638 Decompression/Excision of optic nerve lesions 20000Clinical notes OT Notes
177 3639 Proptosis 8000 Clinical notes OT Notes
178 3640 Rectus Muscle Surgery(Single) 12000 Clinical notes OT Notes
179 3641 Rectus Muscle Surgery(Two/Three) 16000 Clinical notes OT Notes
180 3642 Oblique Muscle for squint correction 8000 Clinical notes OT Notes
181 3643 Lid Reconstruction Surgery 15000 Clinical notes OT Notes
182 3644 Ptosis 6000 Clinical notes OT Notes
183 3645 Pterygium 5000 Clinical notes OT Notes
184 3646 Entropion correction 7000 Clinical notes OT Notes
185 3647 DCR ( Dacryocystorhinostomy) Endoscopic/Laser 15000Clinical notes OT Notes
186 3648 Cautersation of ulcer / subconjuctival injection 250Clinical notes OT Notes
187 3649 Acid and alkali burns (Including medical tests) 1000Clinical notes OT Notes
188 3650 Ectropion Correction 10000 Clinical notes OT Notes
189 3651
Pediatric Opthalmic treatment---
Photocoagulation For Retinopathy Of Prematurity
* 3 sittings (complete package)
9000
Clinical notes OT Notes
190 3652Laser treatment for Retinopathy one sitting per
eye1500
Clinical notes OT Notes
191 3653ROP (Retinopathy of prematurity)- Laser (LA)/per
sitting 1500 Clinical notes OT Notes
192 3654ROP (Retinopathy of prematurity)- Laser (GA)/Per
sitting 6000 Clinical notes OT Notes
193 3655PRP / FOCAL / GRID / YAG / LASER per eye per
sitting1500
Clinical notes OT Notes
194 3656 Intra Vitreal Injection Trimcialone 4000 Clinical notes OT Notes
195 3657 Intra Vitreal Injection Avastin 8000 Clinical notes OT Notes
196 3658 Lacrimal Probing under GA 9000 Clinical notes OT Notes
197 3659 Anterior Chamber Wash(includes GA charge) 6000 Clinical notes OT Notes
198 3660 Sling surgery for ptosis under general anesthesia 13000Clinical notes OT Notes
199 3661 Scleral fixation with IOL 10000 Clinical notes OT Notes
200 3662 Pupilloplasty 6000 Clinical notes OT Notes
201 3663 Iridodyalisis repair 7000 Clinical notes OT Notes
202 3664 Iridodyalisis repair with IOL 15000 Clinical notes OT Notes
203 3665 Repair of globe rupture 15000 Clinical notes OT Notes
204 3701 Tube Plaster (or plaster cylinder) 1500 X Ray Xray
205 3702 Two bones (CRIF) Incl. Implant 28000 X Ray Xray
206 3703 Meniscectomy 10000 X Ray Xray
207 3704
Elbow reconstruction (Double plating + Tension
band) (ORIF) including locking and non locking
plates (18000+8000)
26000
X Ray Xray
208 3705 Dequervains release 7800 Clinical Photo OT Notes
209 3706 Trigger finger release 4000 Clinical Notes OT Notes
210 3707 Excision of radial head/lateral end clavicle 12000 X Ray Xray
211 3708 Tennis elbow release 6000 Clinical Photo OT Notes
212 3709 Tendon transfers multiple (ankle / wrist) 15000 Clinical Photo OT Notes
213 3801 Anal Dilatation (upto 5 sittings), Per Sitting 1000 Clinical Note OT notes
214 3802 Supra Pubic Drainage - Open 6000 Clinical Note Scar photo
215 3803 Inguinal Hernia (Congenital Hydrocele) > 1 year 10000USG Scar photo
216 3804 Cleft Lip 10000 Clinical Photo Scar photo
217 3805 Cleft Palate 15000 Clinical Photo Scar photo
218 3806Hemangioma Excision (Small Hemangioma with
Age restriction)10000
Clinical Note Scar photo
Orthopaedics
Paediatric Surgeries
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
219 3807 Scrotal Transposition Repair 20000 USG Scar photo
220 3808 Laparoscopic Varicocele Ligation 22000 USG Scar photo
221 3809 Liver biopsy 5500 Clinical Note HPE
222 3810 Endoscopy-upper GI (Diagnostic ) 1250 Clinical Note Endoscopic findings
223 3811 Endoscopy-upper GI (Therapeutic) 3000 Clinical Note Endoscopic findings
224 3812 Endocopy-lower GI 2500 Clinical Note Endoscopic findings
225 3813 Diagnostic laparoscopy 12500 USG Scar photo
226 3814 Torticollis release 12500 Clinical Note Scar photo
227 3901 Adenoma Parathyroid - Excision 28000 Clinical note, USG/CT HPE
228 3902 Thyroid Adenoma Resection Enucleation 25000 Clinical note, USG HPE, Scar photo
229 4001 Dormia Extraction of Calculus 8000 USG OT Notes
230 4002 Urethral dilatation per sitting 5000 Clinical Note OT Notes
231 4003 Haemodialysis per sitting 3000 Clinical Note Clinical Note
232 4101MRI Major (Brain, Whole Spine,PelvisAbdomen,
Chest) - Without Contrast3000
NIL NIL
233 4102MRI Major (Brain, Spine,PelvisAbdomen, Chest) -
With Contrast4000
NIL NIL
234 4103MRI Minor (Extremities, Cervical, Lumbar,
Thoracic) - Without Contrast3000
NIL NIL
235 4104MRI Minor (Extremities, Cervical, Lumbar,
Thoracic) - With Contrast4000
NIL NIL
236 4119 Mammography (Single side with USG) 600 NIL NIL
237 4120 Mammography (Both sides with USG) 1200 NIL NIL
238 4121 Pulmonary function test 600 NIL NIL
239 4122 Urodynamic Study (Cystometry) 500 NIL NIL
240 4123
CT Scan (Brain, Whole Spine, Cervical Spine,
Lumbar, Chest, Abdomen, Neck - Without
Contrast
2000
NIL NIL
241 4124CT Scan (Brain, Whole Spine, Cervical Spine,
Lumbar, Chest, Abdomen, Neck - With Contrast2750
NIL NIL
242 4125 C.T. Chest (HRCT) - Without Contrast 2500 NIL NIL
243 4126 C.T. Chest (HRCT) - with Contrast 3250 NIL NIL
244 4139 C.T. Scan Limbs - Without Contrast 2800 NIL NIL
245 4140 C.T. Scan Limbs - with Contrast 3550 NIL NIL
246 4141 C.T. Scan of Para Nasal Sinus - Without Contrast 1400NIL NIL
247 4142 C.T. Scan of Para Nasal Sinus - with Constrast 2150NIL NIL
248 4143 Whole Blood per unit 1500 NIL NIL
249 4144 Platelets per unit 800 NIL NIL
250 4145 Plasma per unit 900 NIL NIL
251 4146 Packed cells per unit 1500 NIL NIL
2524147 Investgations for cochlear Implants (includes
CT,MRI & Related Audiology Tests)
10000NIL NIL
253 4201 General Ward :Unspecified 750/day NIL NIL
254 4202
ICU-designated air conditioned space, with
Standard ICU bed, equipment for the constant
monitoring for vitals, emergency crash cart/tray,
defibrillator, ventilators, suction pumps, bedside
oxygen facility.
3500/day
NIL NIL
255 4203 Organo phosphorus poisoining 3750Clinical Notes with relevant
investigationsTreatment Notes
256 4204 Acid peptic disease 750Clinical Notes with relevant
investigationsTreatment Notes
257 4205Acute and subacute endocarditis(ICU charges
when needed)7500
Clinical Notes with relevant
investigationsTreatment Notes
258 4206 Acute asthamatic attack 2250Clinical Notes with relevant
investigationsTreatment Notes
259 4207 Acute colitis 2250Clinical Notes with relevant
investigationsTreatment Notes
260 4208Acute diarrhea with severe dehydration ( grade 2
and above)1500
Clinical Notes with relevant
investigationsTreatment Notes
Investigations
General Medicine
Endocrine
Urology
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
261 4209 Acute diarrohea with moderate dehydration 750Clinical Notes with relevant
investigationsTreatment Notes
262 4210 Acute Exarcebation of COPD 4500Clinical Notes with relevant
investigationsTreatment Notes
263 4211 Acute hepatitis A 7500Clinical Notes with relevant
investigationsTreatment Notes
264 4212 Acute hepatitis B 7500Clinical Notes with relevant
investigationsTreatment Notes
265 4213 Acute Hypertension - medical management 2250Clinical Notes with relevant
investigationsTreatment Notes
266 4214 Acute meningitis - fungal 5250Clinical Notes with relevant
investigationsTreatment Notes
267 4215 Acute meningitis - pyogenic 5250Clinical Notes with relevant
investigationsTreatment Notes
268 4216 Acute otitis media 1500Clinical Notes with relevant
investigationsTreatment Notes
269 4217 Acute Pancreatitis 5250Clinical Notes with relevant
investigationsTreatment Notes
270 4218 Acute Pneumonia 3750Clinical Notes with relevant
investigationsTreatment Notes
271 4219 Acute renal colitis 2250Clinical Notes with relevant
investigationsTreatment Notes
272 4220 Acute renal failure 7500Clinical Notes with relevant
investigationsTreatment Notes
273 4221 Acute renal failure ( plus dialysis ) 5250Clinical Notes with relevant
investigationsTreatment Notes
274 4222 Acute respiratory failure 5250Clinical Notes with relevant
investigationsTreatment Notes
275 4223 Acute tubulo-interstitial nephritis 5250Clinical Notes with relevant
investigationsTreatment Notes
276 4224 Acute urinary infection 2250Clinical Notes with relevant
investigationsTreatment Notes
277 4225 Amoebiasis 2250Clinical Notes with relevant
investigationsTreatment Notes
278 4226 Amoebic abscess - liver 3750Clinical Notes with relevant
investigationsTreatment Notes
279 4227Anemia – Severe Hb less than 6 gm/dl ( plus blood
transfusion units )3750
Clinical Notes with relevant
investigationsTreatment Notes
280 4228 Status Asthamaticus 3750Clinical Notes with relevant
investigationsTreatment Notes
281 4229 Bronchiectasis 5250Clinical Notes with relevant
investigationsTreatment Notes
282 4230 Bronchitis, not specified as acute or chronic 5250Clinical Notes with relevant
investigationsTreatment Notes
283 4231 Chicken pox- complicated 2250Clinical Notes with relevant
investigationsTreatment Notes
284 4232 Chronic otitis media 3750Clinical Notes with relevant
investigationsTreatment Notes
285 4233 Chronic pancreatitis 3750Clinical Notes with relevant
investigationsTreatment Notes
286 4234 Chronic viral hepatitis 7500Clinical Notes with relevant
investigationsTreatment Notes
287 4235 Conjunctivitis (bacterial) 2250Clinical Notes with relevant
investigationsTreatment Notes
288 4236 Control of diabetic ketoacidosis 2250Clinical Notes with relevant
investigationsTreatment Notes
289 4101Dog Bite subject to completion of 5 injections plus
dressing2500
Clinical Notes with relevant
investigationsTreatment Notes
290 4102 Snake bite ( poisionous) 10500Clinical Notes with relevant
investigationsTreatment Notes
291 4237 Dengue fever 2250Clinical Notes with relevant
investigationsTreatment Notes
292 4238 Dengue haemorrhagic fever 7500Clinical Notes with relevant
investigationsTreatment Notes
293 4239 Dysfunctional uterine bleeding 5250Clinical Notes with relevant
investigationsTreatment Notes
294 4240 Emphysema Acute Exacerbation 2250Clinical Notes with relevant
investigationsTreatment Notes
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
295 4241 Enteric fever 3750Clinical Notes with relevant
investigationsTreatment Notes
296 4242 Filariasis 1500Clinical Notes with relevant
investigationsTreatment Notes
297 4243 Food poisoning 2250Clinical Notes with relevant
investigationsTreatment Notes
298 4244 Heat stroke 2250Clinical Notes with relevant
investigationsTreatment Notes
299 4245 Hemiplegia / quadriplegia 11250Clinical Notes with relevant
investigationsTreatment Notes
300 4246 Herpes Simplex 5250Clinical Notes with relevant
investigationsTreatment Notes
301 4247 Hyper Osmolar Non Ketotic Coma 3000Clinical Notes with relevant
investigationsTreatment Notes
302 4248Insulin-dependent diabetes mellitus-Acute
episode2250
Clinical Notes with relevant
investigationsTreatment Notes
303 4249 Interstial lung diseases 3000Clinical Notes with relevant
investigationsTreatment Notes
304 4250 Leprosy Reaction & Neuritis (T1R & T2R) 7500Clinical Notes with relevant
investigationsTreatment Notes
305 4251 Leprosy Ulcer Care With Stay 7500Clinical Notes with relevant
investigationsTreatment Notes
306 4252 Leptospirosis 5250Clinical Notes with relevant
investigationsTreatment Notes
307 4253 Localised cellulilits 2250Clinical Notes with relevant
investigationsTreatment Notes
308 4254 LRTI management 3000Clinical Notes with relevant
investigationsTreatment Notes
309 4255 Lung abscess /Empema 3000Clinical Notes with relevant
investigationsTreatment Notes
310 4256 Malaria - complicated 3750Clinical Notes with relevant
investigationsTreatment Notes
311 4257 Malaria - uncomplicated 2250Clinical Notes with relevant
investigationsTreatment Notes
312 4258 Malnutrition-related diabetes mellitus 3750Clinical Notes with relevant
investigationsTreatment Notes
313 4259 Management of Pneumothorax 3750Clinical Notes with relevant
investigationsTreatment Notes
314 4260 Measles - complicated 5250Clinical Notes with relevant
investigationsTreatment Notes
315 4261 Measles - uncomplicated 1500Clinical Notes with relevant
investigationsTreatment Notes
316 4262 Meningitis 5250Clinical Notes with relevant
investigationsTreatment Notes
317 4263 Myalgia 1500Clinical Notes with relevant
investigationsTreatment Notes
318 4264Neonatal jaundice due to other excessive
haemolysis5250
Clinical Notes with relevant
investigationsTreatment Notes
319 4265Neonatal jaundice from other and unspecified
causes5250
Clinical Notes with relevant
investigationsTreatment Notes
320 4266 Nephrotic syndrome 2250Clinical Notes with relevant
investigationsTreatment Notes
321 4267 Non-insulin-dependent diabetes mellitus 2250Clinical Notes with relevant
investigationsTreatment Notes
322 4268 Orchititis 1500Clinical Notes with relevant
investigationsTreatment Notes
323 4269 Other acute viral hepatitis 7500Clinical Notes with relevant
investigationsTreatment Notes
324 4270 Other nontraumatic intracranial haemorrhage 7500Clinical Notes with relevant
investigationsTreatment Notes
325 4271 Peripheral neuritis/ neuropathy 3750Clinical Notes with relevant
investigationsTreatment Notes
326 4272PUO Management(would include fevers -
viral/bacterial/fungal/infestation, etc)5250
Clinical Notes with relevant
investigationsTreatment Notes
327 4273Respiratory tuberculosis, bacteriologically and
histologically confirmed7500
Clinical Notes with relevant
investigationsTreatment Notes
328 4274 Scabies 1500Clinical Notes with relevant
investigationsTreatment Notes
Sl. No.Procedure
CodeProcedure Name
Package rates (in
Rs.)Pre-op Investigations Post-op Investigations
329 4275 Scorpion sting 1500Clinical Notes with relevant
investigationsTreatment Notes
330 4276 Septic shock 3750Clinical Notes with relevant
investigationsTreatment Notes
331 4277 Septicemia (Add-on Procedure) 7500Clinical Notes with relevant
investigationsTreatment Notes
332 4278 Status epilepsy 3750Clinical Notes with relevant
investigationsTreatment Notes
333 4279 Systenuc Lupus Erythematosis 3750Clinical Notes with relevant
investigationsTreatment Notes
334 4280 TB – pulmonary 3750Clinical Notes with relevant
investigationsTreatment Notes
335 4281 TB Meningitis 5250Clinical Notes with relevant
investigationsTreatment Notes
336 4282 Tetanus 5250Clinical Notes with relevant
investigationsTreatment Notes
337 4283 Tonsillitis 2250Clinical Notes with relevant
investigationsTreatment Notes
338 4284 Trachoma 2250Clinical Notes with relevant
investigationsTreatment Notes
339 4285 Typhoid and paratyphoid fevers 5250Clinical Notes with relevant
investigationsTreatment Notes
340 4286 Unspecified diabetes mellitus 2250Clinical Notes with relevant
investigationsTreatment Notes
341 4287 Urethritis 3750Clinical Notes with relevant
investigationsTreatment Notes
342 4288 URI 2250Clinical Notes with relevant
investigationsTreatment Notes
343 4289 Vasculits 2250Clinical Notes with relevant
investigationsTreatment Notes
344 4290 Viral and other specified intestinal infections 2250Clinical Notes with relevant
investigationsTreatment Notes
345 4291 Vitamin A deficiency 5250Clinical Notes with relevant
investigationsTreatment Notes