Benefit Packages (Private)

BENEFIT PACKAGES OF AYUSHMAN BHARAT - AROGYA KARNATAKA FOR PRIVATE HOSPITALS
Speciality
Sl. no. Procedure code Procedure name Rates Pre-op Post-op
code
COMPLEX SECONDARY CARE
BURNS
2B.S11.17058 : Post Burn Contracture surgeries for
Functional Improvement involving only skin (Package
1 S11 2B.S11.17058 30000 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
including splints,pressure garment and physiotherapy-
Moderate
CARDIOTHORACIC SURGERY
2B.S13.00077 : Operations for Congenital Arteriovenous
2 S13 2B.S13.00077 15000 CT Chest report Post Op X-ray,scar photo
Fistula
2B.S1.00005C : Arteriovenous (AV) Malformation of Soft
S1 2B.S1.00005C 15000 Clinical Photograph Scar photo
Tissue Tumour - Excision - cross speciality
Clinical notes (should have pre-op
S1 2B.S1.00143A 2B.S1.00143A : Vasovasostomy - cross speciality 11000 Clinical photo
exam of vasectomy site)
2B.S1.00192A : Lymphatics Excision of Subcutaneous
S1 2B.S1.00192A 8000 Clinical Photograph Clinical Photograph
Tissues In Lymphoedema
2b.S13.00077A : Operations for Congenital
S13 2B.S13.00077A 15000 CT Chest report Post Op X-ray,scar photo
Arteriovenous Fistula
2B.S1.00005B : Arteriovenous (AV) Malformation of Soft
S1 2B.S1.00005B 15000 Clinical Photograph Scar photo
S1 2B.S1.00011A 2B.S1.00011A : Branchial Fistula -cross speciality 14000 CT scan, Clinical Photograph clinical
2B.S1.00027A : Drainage Pericardial Effusion - cross
S1 2B.S1.00027A 11000 X -Ray, ECHO X -Ray film with report
speciality
USG/CT Clinical photo, OT notes
S1 2B.S1.00037A 2B.S1.00037A : Excision Bronchial Sinus - cross speciality 8000

S1 2B.S1.00143B 2B.S1.00143B : Vasovasostomy - cross speciality 11000 Clinical photo
2B.S1.00184A : Laparoscopic Hiatus Hernia Repair - cross
S1 2B.S1.00184A 20000 UGI ENDOSCOPY Scar photo/ Intra op photo
speciality
2B.S1.00206A : Drainage of perivertebral abscess - cross
S1 2B.S1.00206A 7000 USG/ CT Scan Clinical Photograph
speciality
S1 2B.S1.00210A 2B.S1.00210A : Thymectomy - cross speciality 23000 USG Clinical Photograph
2B.S1.00224B : Rib Resection & Drainage - cross
S1 2B.S1.00224B 7500 Chest X-ray, Clinical Photograph Clinical Photograph
speciality
S1 2B.S1.00232A 2B.S1.00232A : Thoracocentesis - cross speciality 1500 X-ray, CT X-ray
DENTAL AND ORAL AND MAXILLOFACIAL SURGERY
2B.S16.00002 : Fixation of fracture of jaw with open

3 S16 2B.S16.00002 12000 X Ray film with report X Ray film with report
reduction (1 jaw) and fixing of plates/ wire – under GA
4 S16 2B.S16.00003 2B.S16.00003 : Sequestrectomy 1500 X Ray film with report X Ray film with report
2B.S16.00004 : TM joint ankylosis of both jaws - under
GA
Speciality
code
2B.S16.00005 : Release of fibrous bands & grafting -in
6 S16 2B.S16.00005 3000 Clinical notes 0
(OSMF) treatment under GA
2B.S16.00008 : Mandible Tumour Resection and X Ray film with report, Clinical
7 S16 2B.S16.00008 6000 X Ray film with report
reconstruction/Cancer surgery Photograph
X Ray film with report, Clinical
8 S16 2B.S16.17174 2B.S16.17174 : Drainage of parotid abscess 7000 X Ray film with report
Photograph
S2 2B.S2.00029A 2B.S2.00029A : Antrostomy – Bilateral - cross speciality 6500 CT PNS Clinical Photograph
S2 2B.S2.00030A 2B.S2.00030A : Antrostomy – Unilateral - cross speciality 4500 CT PNS Clinical Photograph
S2 2B.S2.00066A 2B.S2.00066A : Oro Antral fistula - cross speciality 7500 Fistulogram/Clinical photograph Clinical Photograph
2B.S2.00078A : Commondo Operation (glossectomy) -
S2 2B.S2.00078A 14000 CT Skull, HPE Clinical Photograph
cross speciality
2B.S2.00083A : Excision of the Mandible Segmental - X Ray film with report, Routine Blood
S2 2B.S2.00083A 7500 X Ray film with report
cross speciality Inv
2B.S2.00084A : Hemi-mandibulectomy with graft - cross X Ray film with report, Routine Blood
speciality Inv
S1 2B.S1.00044A 2B.S1.00044A : Excision of Growth from Tongue only 6000 Clinical Photograph Scar Photo, HPE Report
S1 2B.S1.00124A 2B.S1.00124A : Salivary Gland – Excision - cross speciality 10000 Clinical Photograph , FNAC, CT HPR , Scar Photograph
S1 2B.S1.00145B 2B.S1.00145B : Cleft lip operation - cross speciality 12000 Clinical Photograph Clinical Photograph
2B.S1.00147B : Cleft lip & palate operation (for each

S1 2B.S1.00147B 15000 Clincal note and photograph OT note and clinical photograph
stage) - cross speciality
ENT
9 S2 2B.S2.00002 2B.S2.00002 : Labyrinthectomy 20000 Endoscopy Photo Endoscopy Photo
CT Temporal Bone , Pure Tone
10 S2 2B.S2.00004 2B.S2.00004 : Mastoidectomy corticol modified/ radical 8700 X-Ray Mastoids, Scar photo
Audiometry Report
Pure Tone Audiometry Report, X-Ray Mastoids, Scar photo, Pure Tone
11 S2 2B.S2.00005 2B.S2.00005 : Mastoidectomy with tympanoplasty 7500
Clinical notes Audiometry Report
Pure Tone Audiometry Report,
12 S2 2B.S2.00006 2B.S2.00006 : Myringoplasty 5000 Pure Tone Audiometry Report
Clinical notes
Pure Tone Audiometry Report and Pure Tone Audiometry Report and
13 S2 2B.S2.00012 2B.S2.00012 : Ossiculoplasty 7500
Impedance Audiometry Report Impedance Audiometry Report
2B.S2.00014 : Excision of Pinna for Growths

14 S2 2B.S2.00014 (Squamous/Basal) Injuries - Total Amputation & Excision 8000 Clinical Photograph HPR/Clinical photograph
of External Auditory Meatus
Pure Tone Audiometry Report and Clinical Photograph With Piston , Pure
15 S2 2B.S2.00016 2B.S2.00016 : Stapedectomy 8000
Impedance Audiometry Report Tone Audiometry Report
2B.S2.00021 : Excision of Pinna for Growth

16 S2 2B.S2.00021 2500 Clinical Photograph/ FNAC HPR/Clinical photograph
(Squamous/Basal/ Injuries) Skin Only
Speciality
code
17 S2 2B.S2.00025 2B.S2.00025 : Tympanotomy 4000 Otoscopy, Clinical Notes Scar photo
18 S2 2B.S2.00027 2B.S2.00027 : Aural polypectomy +Tympanoplasty 10000 CT, Clinical Notes, Audiometry Procedure Notes, Scar Photo
2B.S2.00028 : Ant. Ethmoidal artery ligation - open/
19 S2 2B.S2.00028 11000 CT PNS Clinical Photograph
endoscopic
20 S2 2B.S2.00029 2B.S2.00029 : Antrostomy – Bilateral 6500 CT PNS Clinical Photograph
21 S2 2B.S2.00030 2B.S2.00030 : Antrostomy – Unilateral 4500 CT PNS Clinical Photograph
22 S2 2B.S2.00031 2B.S2.00031 : Cryosurgery 3000 DNE Photo DNE Photo
23 S2 2B.S2.00033 2B.S2.00033 : Septoplasty + FESS 11500 CT/ MRI X-Ray
24 S2 2B.S2.00034 2B.S2.00034 : Ethmoidectomy – External 9200 CT/ MRI X-Ray
X Ray film with report with report
25 S2 2B.S2.00036 2B.S2.00036 : Fracture - setting maxilla 8000 X Ray
with reportPNS
26 S2 2B.S2.00041 2B.S2.00041 : Nasal polypectomy – Bilateral 9000 Clinical notes, CT PNS X-Ray
27 S2 2B.S2.00042 2B.S2.00042 : Nasal polypectomy – Unilateral 6000 Clinical notes, CT PNS X-Ray
28 S2 2B.S2.00051 2B.S2.00051 : Endoscopic DCR 7000 Lacrimal Syringing Report Clinical Photograph
29 S2 2B.S2.00055 2B.S2.00055 : Septo-rhinoplasty 6600 X Ray PNS , CT PNS Clinical Photograph
Clinical Photograph, Endo Picture, X-
30 S2 2B.S2.00058 2B.S2.00058 : Arytenoidectomy 10000 CT-Scan / MRI Scan/Endo photo
Ray
31 S2 2B.S2.00060 2B.S2.00060 : Tonsillectomy + Myrinogotomy 10000 Clinical Notes Procedure Notes
32 S2 2B.S2.00061 2B.S2.00061 : Pharyngeal diverticulum's – Excision 10000 USG Neck USG
33 S2 2B.S2.00062 2B.S2.00062 : Laryngectomy with block dissection 12000 CT Neck,USG
Photograph,HPE
34 S2 2B.S2.00063 2B.S2.00063 : Laryngofissure 3500 USG Neck USG
35 S2 2B.S2.00066 2B.S2.00066 : Oro Antral fistula 7500 Fistulogram/Clinical photograph Clinical Photograph, Procedure notes
36 S2 2B.S2.00068 2B.S2.00068 : Parapharyngeal Abscess – Drainage 7500 CT/MRI/ Clinical photograph Procedure notes
37 S2 2B.S2.00072 2B.S2.00072 : Tonsillectomy + Styloidectomy 12500 X-Ray Skull Lateral View X-Ray Skull Lateral View
38 S2 2B.S2.00073 2B.S2.00073 : Thyroglossal Fistula/ cyst – Excision 7000 Ultrasound Neck, Fistulogram HPR, X-Ray
39 S2 2B.S2.00077 2B.S2.00077 : Uvulophanyngo Plasty 14000 Polysomnography Clinical Photograph
40 S2 2B.S2.00078 2B.S2.00078 : Commondo Operation (glossectomy) 14000 CT Skull, HPE Clinical Photograph
Clinical photo showing scar, BIOPSY,

41 S2 2B.S2.00082 2B.S2.00082 : Excision of Cystic Hygroma Minor 5000 Clinical notes & photo, USG/CT Operative notes with steps of surgery
& Clinical notes
42 S2 2B.S2.00083 2B.S2.00083 : Excision of the Mandible Segmental 7500 X Ray film Scar Photo, X Ray film
43 S2 2B.S2.00084 2B.S2.00084 : Hemi-mandibulectomy with graft 15000 X Ray film Scar Photo, X Ray film
S1 2B.S1.00011B 2B.S1.00011B : Branchial Fistula -cross speciality 14000 CT scan, Clinical Photograph clinical
USG/CT Clinical photo, OT notes
S1 2B.S1.00037A 2B.S1.00037A : Excision Bronchial Sinus - cross speciality 8000
2B.S1.00094A : Laryngectomy & Pharyngeal Diverticulum

S1 2B.S1.00094A 10000 CT Neck,USG Clinical Photograph,HPE
(Throat) - cross speciality
2B.S1.00101A : Microlaryngoscopic Surgery - cross HPE, Clinical Notes, Intra-Op
S1 2B.S1.00101A 12500 DL scopy findings
speciality Photograph
2B.S1.00102B : Oeshophagoscopy for foreign body
S1 2B.S1.00102B 6000 Endoscopy/ X-Ray Clinical notes, endo picture
removal - cross speciality
Speciality
code
2B.S1.00220B : Removal of Foreign Body from Trachea or
S1 2B.S1.00220B 2500 Clinical photo, endoscopy Procedure notes
Oesophagus - cross speciality
2B.S16.17174B : Drainage of parotid abscess - cross X Ray film with report, Clinical
S16 2B.S16.17174B 7000 X Ray film with report
GENERAL MEDICINE
Clinical Notes with relevant
44 M1 2B.M1.00008 2B.M1.00008 : Congestive heart failure - routine ward 1800 Treatment Notes
investigations
M1 2B.M1.00008A 2B.M1.00008A : Congestive heart failure - HDU 2700 Treatment Notes
investigations
2B.M1.00008B : Congestive heart failure - ICU without Clinical Notes with relevant
M1 2B.M1.00008B 3600 Treatment Notes
ventilator investigations
2B.M1.00008C : Congestive heart failure - ICU with Clinical Notes with relevant
M1 2B.M1.00008C 4500 Treatment Notes
45 M1 2B.M1.00010 2B.M1.00010 : Diabetic ketoacidosis - routine ward 1800 Treatment Notes
investigations
M1 2B.M1.00010A 2B.M1.00010A : Diabetic ketoacidosis - HDU 2700 Treatment Notes
investigations
2B.M1.00010B : Diabetic ketoacidosis - ICU without Clinical Notes with relevant
2B.M1.00010C : Diabetic ketoacidosis - ICU with Clinical Notes with relevant
clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
46 M1 2B.M1.00033 2B.M1.00033 : Lung abscess/ Empyema - routine ward 1800
M1 2B.M1.00033A 2B.M1.00033A : Lung abscess/ Empyema - HDU 2700 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
2B.M1.00033B : Lung abscess/ Empyema - ICU without clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
M1 2B.M1.00033B 3600
ventilator
2B.M1.00033C : Lung abscess/ Empyema - ICU with clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
M1 2B.M1.00033C 4500
ventilator
2B.M1.00048 : Acute gastroenteritis with severe Clinical notes Clinical notes
47 M1 2B.M1.00048 1800
dehydration - routine ward
2B.M1.00048A : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048A 2700
dehydration - HDU
2B.M1.00048B : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048B 3600
dehydration - ICU without ventilator
2B.M1.00048C : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048C 4500
dehydration - ICU with ventilator
2B.M1.00057 : Upper GI bleeding (endoscopic) - routine Clinical Notes with relevant
48 M1 2B.M1.00057 1800 Treatment Notes
ward investigations
M1 2B.M1.00057A 2B.M1.00057A : Upper GI bleeding (endoscopic) - HDU 2700 Treatment Notes
investigations
2B.M1.00057B : Upper GI bleeding (endoscopic) - ICU Clinical Notes with relevant
without ventilator investigations
2B.M1.00057C : Upper GI bleeding (endoscopic) - ICU Clinical Notes with relevant
with ventilator investigations
Speciality
code
49 M1 2B.M1.00061 2B.M1.00061 : Guillian Barre Syndrome - routine ward 1800 Treatment Notes
investigations
M1 2B.M1.00061A 2B.M1.00061A : Guillian Barre Syndrome - HDU 2700 Treatment Notes
investigations
2B.M1.00061B : Guillian Barre Syndrome - ICU without Clinical Notes with relevant
2B.M1.00061C : Guillian Barre Syndrome - ICU with Clinical Notes with relevant
GENERAL SURGERY
2B.S1.00005 : Arteriovenous (AV) Malformation of Soft
50 S1 2B.S1.00005 15000 Clinical Photograph Scar photo
Tissue Tumour - Excision
51 S1 2B.S1.00009 2B.S1.00009 : Bleeding Ulcer - Partial Gastrectomy 25000 Endoscopy Scar photo, HPR
52 S1 2B.S1.00010 2B.S1.00010 : Block dissection Cervical Nodes 10000 Clinical photo, CT report Scar Photo, HPE Report
53 S1 2B.S1.00011 2B.S1.00011 : Branchial Fistula 14000 CT scan, Clinical Photograph clinical
54 S1 2B.S1.00026 2B.S1.00026 : Drainage of Subdiaphramatic Abscess 8000 USG/Clinical Notes Scar photo
55 S1 2B.S1.00027 2B.S1.00027 : Drainage Pericardial Effusion 11000 X -Ray, ECHO X -Ray film with report
56 S1 2B.S1.00028 2B.S1.00028 : Duodenal Diverticulum 15000 USG/CT Scan Scar Photo
57 S1 2B.S1.00029 2B.S1.00029 : Duodenal Jejunostomy 15000 USG Clinical Photo
58 S1 2B.S1.00030 2B.S1.00030 : Duplication of Intestine 17000 CT/ USG Scar Photo
59 S1 2B.S1.00036 2B.S1.00036 : Excision Benign Tumor -Small intestine 15000 CT/ USG HPE Report
60 S1 2B.S1.00037 2B.S1.00037 : Excision Bronchial Sinus 8000 USG/CT Clinical photo, OT notes
61 S1 2B.S1.00041 2B.S1.00041 : Excision Meckel's Diverticulum 15000 USG/ CT Scar Photo, HPE Report
62 S1 2B.S1.00043 2B.S1.00043 : Excision Small Intestinal Fistula 12000 USG/ CT Scar Photo
63 S1 2B.S1.00044 2B.S1.00044 : Excision of Growth from Tongue only 6000 Clinical Photograph Scar Photo, HPE Report
2B.S1.00046 : Excision of Swelling in Right Cervical
64 S1 2B.S1.00046 4000 FNAC/ Biopsy HPR
Region
65 S1 2B.S1.00051 2B.S1.00051 : Fibroadenoma – Bilateral 8000 Biopsy/ FNAC, USG, HPR
66 S1 2B.S1.00057 2B.S1.00057 : Fissurectomy with Sphincterotomy 15000 Clinical notes Clinical Notes & OT Notes
2B.S1.00058 : Foreign Body Removal in Deep Region
67 S1 2B.S1.00058 5000 X-Ray / Scopy report X-Ray / Scopy report
requiring GA
68 S1 2B.S1.00063 2B.S1.00063 : Gastrojejunostomy 15000 USG, Endoscopy Scar Photo
2B.S1.00065 : Graham's Operation for duodenal
69 S1 2B.S1.00065 15000 X-ray abdomen/CT, USG USG, Scar Photo
perforation
70 S1 2B.S1.00073 2B.S1.00073 : Hernia - Repair & release of obstruction 15000 USG, Clinical Photograph Clinical Notes, Scar photo and OT notes
Clinical Photograph/ Scar photo, HPE

71 S1 2B.S1.00079 2B.S1.00079 : Hydatid Cyst of Liver 10000 CT/MRI
Report
72 S1 2B.S1.00082 2B.S1.00082 : IlieoSigmoidostomy 13000 CT Scan/ MRI Scar photo
73 S1 2B.S1.00086 2B.S1.00086 : Intestinal Obstruction 12500 X-Ray abdomen /CT /USG USG, Scar Photo
74 S1 2B.S1.00088 2B.S1.00088 : Jejunostomy 10000 USG Clinical Photo
75 S1 2B.S1.00089 2B.S1.00089 : Gastric Perforation 15000 X Ray abdomen/ CT Clinical/ Scar photo
Speciality
code
2B.S1.00090 : Intestinal Perforation (Resection
76 S1 2B.S1.00090 20000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo
Anastomosis)
77 S1 2B.S1.00091 2B.S1.00091 : Appendicular Perforation 12000 USG, Clinical Notes HPR , Clinical photograph
2B.S1.00094 : Laryngectomy & Pharyngeal Diverticulum
78 S1 2B.S1.00094 10000 CT Neck,USG Clinical Photograph,HPE
(Throat)
Biopsy of the primary + CT Scan with
79 S1 2B.S1.00095 2B.S1.00095 : Ileostomy 20000 Clinical Photograph
film
80 S1 2B.S1.00097 2B.S1.00097 : Loop Colostomy Sigmoid 12000 CT/MRI , Endoscopy , USG Clinical photograph
81 S1 2B.S1.00098 2B.S1.00098 : Mastectomy 12000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report
82 S1 2B.S1.00099 2B.S1.00099 : Mesenteric Cyst – Excision 9000 USG/ CT Scan/ MRI Scar Photo, HPE Report
83 S1 2B.S1.00100 2B.S1.00100 : Mesenteric Caval Anastomosis 10000 CT abdomen/USG OT Notes, Intra-Op Photograph
HPE, Clinical Notes, Intra-Op
84 S1 2B.S1.00101 2B.S1.00101 : Microlaryngoscopic Surgery 12500 DL scopy findings
Photograph
2B.S1.00102 : Oeshophagoscopy for foreign body
85 S1 2B.S1.00102 6000 Endoscopy/ X-Ray Clinical notes, endo picture
removal
86 S1 2B.S1.00105 2B.S1.00105 : Pelvic Abscess - Open Drainage 8000 USG Scar Photograph
2B.S1.00107 : Distal Pancreatectomy with
87 S1 2B.S1.00107 17000 CT/ MRI Scar photo
PancreaticoJejunostomy
Clinical notes, Practoscopy/

88 S1 2B.S1.00109 2B.S1.00109 : Haemorroidectomy+ Fistulectomy 10000 OT Notes
Colonoscopy findings, Fistulogram
89 S1 2B.S1.00111 2B.S1.00111 : Porto Caval Anastomosis 15000 CT/ MRI OT Notes / Post-op CT
CT/MRI Abdomen, Endoscopic
90 S1 2B.S1.00119 2B.S1.00119 : Repair of Common Bile Duct 12500 Retrograde Cholangio OT Notes
Pancreatography (ERCP)
91 S1 2B.S1.00124 2B.S1.00124 : Salivary Gland – Excision 10000 Clinical Photograph , FNAC, CT HPR , Scar Photograph
92 S1 2B.S1.00127 2B.S1.00127 : Sigmoid Diverticulum 15000 CT/ MRI Scar photo
93 S1 2B.S1.00137 2B.S1.00137 : Colectomy – Total 17000 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
94 S1 2B.S1.00143 2B.S1.00143 : Vasovasostomy 11000 Clinical photo
95 S1 2B.S1.00145 2B.S1.00145 : Cleft lip operation 12000 Clinical Photograph Scar Photograph
Clincal note and photograph, CT Scan
96 S1 2B.S1.00147 2B.S1.00147 : Cleft lip & palate operation (for each stage) 15000 OT note and clinical photograph
if indicated
97 S1 2B.S1.00153 2B.S1.00153 : Cholecystectomy & Exploration of CBD 13500 CT , LFT HPR, Clinical photograph
2B.S1.00164 : Split thickness skin grafts – Small (< 4%

98 S1 2B.S1.00164 5000 Clinical photograph Post-op photo
TBSA)
2B.S1.00166 : Split thickness skin grafts – Large (> 8%
99 S1 2B.S1.00166 15000 Clinical photograph Post-op photo
TBSA)
100 S1 2B.S1.00168 2B.S1.00168 : Hemi thyroidectomy 10000 FNAC , T F T , USG HPR , Clinical Photograph
101 S1 2B.S1.00170 2B.S1.00170 : Laparoscopic Hernia Repair 18000 USG Clinical Notes, Scar photo and OT notes
Speciality
code
102 S1 2B.S1.00175 2B.S1.00175 : Lap. Cholecystectomy & CBD exploration 20000 CT , LFT HPR, Clinical photograph
103 S1 2B.S1.00176 2B.S1.00176 : Lap. For intestinal obstruction 15000 X-Ray abdomen /CT /USG USG, Scar Photo
104 S1 2B.S1.00177 2B.S1.00177 : Lap. Hepatic resection 25000 MRI/ CT Abdomen Scar Photo, HPE Report
105 S1 2B.S1.00178 2B.S1.00178 : Lap. Hydatid of liver surgery 18000 MRI/ CT Abdomen Scar Photo, HPE Report
106 S1 2B.S1.00180 2B.S1.00180 : Laparoscopic Appendicectomy 10000 MRI/ CT Scar Photo
107 S1 2B.S1.00181 2B.S1.00181 : Laparoscopic Cholecystectomy 12000 CT , LFT HPR, Clinical photograph
108 S1 2B.S1.00182 2B.S1.00182 : Laparoscopic cystogastrostomy 15000 USG/ CT Scan Clinical photograph
109 S1 2B.S1.00183 2B.S1.00183 : Laparoscopic Gastrostomy 10500 USG/ CT Scan Clinical photograph
110 S1 2B.S1.00184 2B.S1.00184 : Laparoscopic Hiatus Hernia Repair 20000 UGI ENDOSCOPY Scar photo/ Intra op photo
111 S1 2B.S1.00185 2B.S1.00185 : Laparoscopic Pyloromyotomy 12500 USG, Clinical notes Clinical Photograph
112 S1 2B.S1.00186 2B.S1.00186 : Laparoscopic Rectopexy 15000 Clinical Findings Clinical Findings
113 S1 2B.S1.00187 2B.S1.00187 : Laparoscopic Spleenectomy 12000 CT/ MRI Scar photo
114 S1 2B.S1.00188 2B.S1.00188 : Laparoscopic umbilical hernia repair 12000 USG, Clinical Photograph Clinical Notes, Scar photo and OT notes
115 S1 2B.S1.00189 2B.S1.00189 : Laparoscopic ventral hernia repair 20000 USG, Clinical Photograph Clinical Notes, Scar photo and OT notes
2B.S1.00190 : Laparotomy-peritonitis lavage and

116 S1 2B.S1.00190 7000 USG/X Ray Scar photo
drainage
2B.S1.00192 : Lymphatics Excision of Subcutaneous
117 S1 2B.S1.00192 8000 Clinical Photograph Clinical Photograph
Tissues In Lymphoedema
118 S1 2B.S1.00196 2B.S1.00196 : Operation for Bleeding Peptic Ulcer 15000 Endoscopy report. Scar photo, HPE
119 S1 2B.S1.00203 2B.S1.00203 : Coccygeal Teratoma Excision 15000 Clinical Photograph Clincial Notes, Scar photo
120 S1 2B.S1.00206 2B.S1.00206 : Drainage of perivertebral abscess 7000 USG/ CT Scan Clinical Photograph
121 S1 2B.S1.00210 2B.S1.00210 : Thymectomy 23000 USG Clinical Photograph
122 S1 2B.S1.00211 2B.S1.00211 : Operation of Choledochal Cyst 15000 CT/ USG HPE, Scar photo, USG
2B.S1.00220 : Removal of Foreign Body from Trachea or
123 S1 2B.S1.00220 2500 Clinical photo, endoscopy Procedure notes
Oesophagus
124 S1 2B.S1.00223 2B.S1.00223 : Resection Enucleation of Adenoma (lung) 10000 Clinical Photograph Clinical Photograph
Speciality
code
125 S1 2B.S1.00224 2B.S1.00224 : Rib Resection & Drainage 7500 Chest X-ray, Clinical Photograph Clinical Photograph
126 S1 2B.S1.00226 2B.S1.00226 : Splenectomy - For Trauma 20000 CT/ MRI Scar photo
127 S1 2B.S1.00232 2B.S1.00232 : Thoracocentesis 1500 X-ray, CT X-ray
128 S1 2B.S1.00243 2B.S1.00243 : Trendelenburg Operation 10000 Clinical notes Clinical Photograph
129 S1 2B.S1.00245 2B.S1.00245 : Tissue Reconstruction Flap Leprosy 22000 Clinical Photograph Scar photo
130 S1 2B.S1.00246 2B.S1.00246 : Tendon Transfer-Leprosy 22000 Clinical Photograph, Clinical Notes Clinical Photograph
2B.S1.17001 : Endoscopic Retrograde Cholangio

131 S1 2B.S1.17001 Pancreatography (Endoscopic Retrograde Cholangio 4000 Liver function test (LFT), USG Liver function test (LFT), USG
Pancreatography (ERCP) with Interventions
132 S1 2B.S1.17002 2B.S1.17002 : Laproscopic Adrenalectomy 30000 CT Clinical Photograph

133 S1 2B.S1.17003 2B.S1.17003 : Gastro jejuno Colic Fistula 12500 USG Scar Photo
2B.S1.17004 : Endoscopic Retrograde Cholangio
134 S1 2B.S1.17004 Pancreatography (ERCP) (Endoscopic Retrograde 2250 LFT, USG USG
Cholangio – Pancreatography)
2B.S1.17009 : Upper GI Therapeutic(including Varicose
135 S1 2B.S1.17009 2000 Endoscopy report. Procedure stills
Intervention)
2B.S16.17174A : Drainage of parotid abscess - cross X Ray film with report, Clinical
S2 2B.S2.00031A 2B.S2.00031A : Cryosurgery - cross speciality 3000 DNE Photo DNE Photo
MENTAL DISORDER PACKAGES
2B.M8.00005 : Neurotic, stress-related and somatoform Clinical notes Clinical notes
136 M8 2B.M8.00005 1500
disorders (routine ward)
2B.M8.00006 : Behavioural syndromes associated with Clinical notes Clinical notes
137 M8 2B.M8.00006 physiological disturbances and physical factors (routine 1500
ward)
138 M8 2B.M8.00007 2B.M8.00007 : Mental retardation (routine ward) 1500 Clinical notes Clinical notes
2B.M8.00008 : Organic, including symptomatic, mental Clinical notes Clinical notes
139 M8 2B.M8.00008 2500
disorders (HDU)
140 M8 2B.M8.00011 2B.M8.00011 : Mood (affective) disorders (HDU) 2500 Clinical notes Clinical notes
Complete Haemogram, Liver Complete Haemogram, Liver Function
2B.M8.00015 : Pre- Electro Convulsive Therapy (ECT) and Function Test, Renal Function Test, Test, Renal Function Test, Serum
Pre- Transcranial Magnetic Stimulation (TMS) Package Serum Electrolytes, Electro Electrolytes, Electro Cardiogram (ECG),
(Cognitive Tests, Complete Haemogram, Liver Function Cardiogram (ECG), CT/MRI Brain, CT/MRI Brain, Electroencephalogram,
141 M8 2B.M8.00015 Test, Renal Function Test, Serum Electrolytes, Electro 10000 Electroencephalogram, Thyroid Thyroid Function Test, VDRL, HIV Test,
Cardiogram (ECG), CT/MRI Brain, Electroencephalogram, Function Test, VDRL, HIV Test, Vitamin B12 levels, Folate levels, Lipid
Thyroid Function Test, VDRL, HIV Test, Vitamin B12 Vitamin B12 levels, Folate levels, Lipid Profile, Homocysteine levels)
levels, Folate levels, Lipid Profile, Homocysteine levels) Profile, Homocysteine levels)
2B.M8.00016 : Electro Convulsive Therapy (ECT) - per Clinical notes Clinical notes
142 M8 2B.M8.00016 3000
session
2B.M8.00017 : Transcranial Magnetic Stimulation (TMS) - Clinical notes Clinical notes
143 M8 2B.M8.00017 1000
per session
Speciality
code
NEONATAL AND PAEDIATRICS SURGERIES
2B.M2.00008 : Poisonings with normal vital signs -
144 M2 2B.M2.00008 1800 Clinical note with Lab reports Treatment note
routine ward
2B.M2.00008A : Poisonings with normal vital signs -
M2 2B.M2.00008A 2700 Clinical note with Lab reports Treatment note
HDU
2B.M2.00008B : Poisonings with normal vital signs - ICU
M2 2B.M2.00008B 3600 Clinical note with Lab reports Treatment note
without ventilator
2B.M2.00008C : Poisonings with normal vital signs - ICU
M2 2B.M2.00008C 4500 Clinical note with Lab reports Treatment note
with ventilator
145 M2 2B.M2.00025 2B.M2.00025 : Diabetic ketoacidosis - routine ward 1800 Treatment Notes
investigations
M2 2B.M2.00025A 2B.M2.00025A : Diabetic ketoacidosis - HDU 2700 Treatment Notes
investigations
2B.M2.00025B : Diabetic ketoacidosis - ICU without Clinical Notes with relevant
2B.M2.00025C : Diabetic ketoacidosis - ICU with Clinical Notes with relevant
2B.M2.00026 : Nephrotic syndrome with peritonitis - Complete blood count (CBC), Renal Complete blood count (CBC), Renal
146 M2 2B.M2.00026 1800
routine ward function test (RFT) function test (RFT)
2B.M2.00026A : Nephrotic syndrome with peritonitis - Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026A 2700
HDU function test (RFT) function test (RFT)
2B.M2.00026B : Nephrotic syndrome with peritonitis - Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026B 3600
ICU without ventilator function test (RFT) function test (RFT)
2B.M2.00026C : Nephrotic syndrome with peritonitis - Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026C 4500
ICU with ventilator function test (RFT) function test (RFT)
147 M2 2B.M2.00037 2B.M2.00037 : Infantile cholestasis - routine ward 1800 Treatment Notes
investigations
M2 2B.M2.00037A 2B.M2.00037A : Infantile cholestasis - HDU 2700 Treatment Notes
investigations
2B.M2.00037B : Infantile cholestasis - ICU without Clinical Notes with relevant
M2 2B.M2.00037C 2B.M2.00037C : Infantile cholestasis - ICU with ventilator 4500 Treatment Notes
investigations
148 M2 2B.M2.00043 2B.M2.00043 : Empyema - routine ward 1800 Clinical note with Lab reports Treatment note
M2 2B.M2.00043A 2B.M2.00043A : Empyema - HDU 2700 Clinical note with Lab reports Treatment note
M2 2B.M2.00043B 2B.M2.00043B : Empyema - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 2B.M2.00043C 2B.M2.00043C : Empyema - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
2B.M2.00050 : Intracranial ring enhancing lesion with
149 M2 2B.M2.00050 complication (neurocysticercosis, tuberculoma) - routine 1800 Treatment Notes
investigations
ward
2B.M2.00050A : Intracranial ring enhancing lesion with Clinical Notes with relevant
M2 2B.M2.00050A 2700 Treatment Notes
complication (neurocysticercosis, tuberculoma) - HDU investigations
Speciality
code
2B.M2.00050B : Intracranial ring enhancing lesion with
M2 2B.M2.00050B complication (neurocysticercosis, tuberculoma) - ICU 3600 Treatment Notes
investigations
without ventilator
2B.M2.00050C : Intracranial ring enhancing lesion with
M2 2B.M2.00050C complication (neurocysticercosis, tuberculoma) - ICU 4500 Treatment Notes
investigations
with ventilator
150 M2 2B.M2.00076 2B.M2.00076 : Congestive cardiac failure - routine ward 1800 Treatment Notes
investigations
M2 2B.M2.00076A 2B.M2.00076A : Congestive cardiac failure - HDU 2700 Treatment Notes
investigations
2B.M2.00076B : Congestive cardiac failure - ICU without Clinical Notes with relevant
2B.M2.00076C : Congestive cardiac failure - ICU with Clinical Notes with relevant
2B.M2.00099 : Blood and blood component transfusion

up to a limit of 2 days(admission for a diagnostic
procedure leading to treatment requiring admission, e.g.
bone marrow and bone biopsy, endoscopy, liver biopsy,
151 M2 2B.M2.00099 1500 Clinical note with Lab reports Treatment note and HPE report
bronchoscopy, CT/MRI under GA, broncho-alveolar
lavage, lumbar puncture, muscle biopsy, FNAC, pleural
aspiration, ascitic tapping, neostigmine challenge test
etc.)
2B.M3.00009 : Advanced Surgery for Retinopathy of

152 M3 2B.M3.00009 15000 Fundoscopy Report Fundoscopy Report
Prematurity
153 S14 2B.S14.00009 2B.S14.00009 : Undescended Testis - Unilateral-Palpable 15000 USG,Clinical photo Nil
2B.S14.00019 : Gastrostomy + Esophagoscopy+

154 S14 2B.S14.00019 20000 USG Clinical Photograph
Threading
2B.M1.00048D : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048D 1800
dehydration - routine ward - Cross speciality
2B.M1.00048E : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048E 2700
dehydration - HDU - Cross speciality
2B.M1.00048F : Acute gastroenteritis with severe Clinical notes Clinical notes
M1 2B.M1.00048F 4500
dehydration - ICU with ventilator - Cross speciality
Clinical notes Clinical notes
2B.M1.00048G : Acute gastroenteritis with severe
M1 2B.M1.00048G 3600
dehydration - ICU without ventilator - Cross speciality
S1 2B.S1.00030A 2B.S1.00030A : Duplication of Intestine - cross speciality 17000 CT/ USG Scar Photo
2B.S1.00176A : Lap. For intestinal obstruction - cross

S1 2B.S1.00176A 15000 X-Ray abdomen /CT /USG USG, Scar Photo
speciality
2B.S1.00185A : Laparoscopic Pyloromyotomy - cross
S1 2B.S1.00185A 12500 USG, Clinical notes Clinical Photograph
speciality
Speciality
code
2B.S1.00188A : Laparoscopic umbilical hernia repair -
S1 2B.S1.00188A 12000 USG Clinical Photograph
cross speciality
2B.S1.00189A : Laparoscopic ventral hernia repair - Clinical photograph , USG, Routine
S1 2B.S1.00189A 20000 Clinical photograph
cross speciality Blood Inv
NEUROSURGERY
Clinical Photographs showing scar + X-
155 S8 2B.S8.00015 2B.S8.00015 : Laminectomy with Fusion and fixation 50000 CT/MRI report
ray-Lumbar Spine
2B.S8.00018 : Lumbar Disc including pre and post Op.
156 S8 2B.S8.00018 30000 Clinical findings, MRI Report Clinical photograph showing scar
MRI
157 S8 2B.S8.00023 2B.S8.00023 : Micro discectomy – Lumbar 40000 Clinical findings, MRI Report Clinical photograph showing scar
2B.S8.00029 : Spine - Decompression & Fusion with
158 S8 2B.S8.00029 50000 Clinical findings, MRI Report Post Op X-Ray Report and film
fixation
159 S8 2B.S8.00074 2B.S8.00074 : Muscle Biopsy with report 7000 Reports of relevant investigation HPE Report
2B.S1.00005A : Arteriovenous (AV) Malformation of Soft
S1 2B.S1.00005A 15000 Clinical Photograph Scar photo
OBSTETRICS AND GYNAECOLOGY
160 S4 2B.S4.00003 2B.S4.00003 : Surgeries for Prolapse - Sling Surgeries 16000 Clinical Notes, USG OT Notes
2B.S4.00010 : Vaginal hysterectomy with anterior and Relevant Hematological

161 S4 2B.S4.00010 16000 OT Notes and HPE
posterior colpoperineorrhaphy investigations, Clinical notes
Clinical Notes, USG/KUB/Urology
162 S4 2B.S4.00013 2B.S4.00013 : Repair for rectovaginal fitulas 10000 OT notes
opinion
163 S4 2B.S4.00020 2B.S4.00020 : Vulvectomy simple 15000 Clinical Notes, USG/CT/MRI OT Notes, HPE
164 S4 2B.S4.00022 2B.S4.00022 : Diagnostic laparoscopy 11000 USG Clinical Photograph
Ultrasonography, X Ray, ECG, LFT,RFT,
165 S4 2B.S4.00023 2B.S4.00023 : Laparoscopic hysterectomy (TLH) 20000 HPR,OT notes
FBS,PPBS, T3,T4,THS
166 S4 2B.S4.00024 2B.S4.00024 : Laparoscopic myomectomy 12000 Ultrasonography/ Tubal patency test HPE, OT notes
USG, Routine investigations and CA

167 S4 2B.S4.00025 2B.S4.00025 : Laparoscopic cystectomy 15000 HPE
125
168 S4 2B.S4.00027 2B.S4.00027 : Laparoscopic adhesiolysis 6000 CT , X-Ray Abdomen HPR , Clinical photograph
Serum Beta HCG, USG, CBC, Routine
169 S4 2B.S4.00044 2B.S4.00044 : Laparotomy for ruptured ectopic 10000 OT notes
investigation
170 S4 2B.S4.00048 2B.S4.00048 : McDonald's stitch 4000 USG and clinical notes OT Note
171 S4 2B.S4.00049 2B.S4.00049 : Shirodkar's stitch 4000 Clinical Notes OT Notes
172 S4 2B.S4.00050 2B.S4.00050 : Tuboplasty 9500 OT Notes
FBS,PPBS, T3,T4,THS
2B.S4.00056 : Adhenolysis + Hernia - Ventral -
173 S4 2B.S4.00056 16000 USG and clinical notes OT Note
Lipectomy/Incision
174 S4 2B.S4.00057 2B.S4.00057 : Adhenolysis+ Ovarian Cystectomy 10000 USG and clinical notes OT note and HPE
175 S4 2B.S4.00058 2B.S4.00058 : Adhenolysis+ Salpingostomy 10000 USG and clinical notes OT note and HPE
176 S4 2B.S4.00060 2B.S4.00060 : Brust abdomen repair 14000 USG and clinical notes OT note and HPE
177 S4 2B.S4.00065 2B.S4.00065 : Cystocele - Anterior repair 12000 USG and clinical notes OT Note
Speciality
code
2B.S4.00069 : Diagnostic laparoscopy & hysteroscopy for
178 S4 2B.S4.00069 5000 USG and clinical notes OT Note
infertility
2B.S4.00071 : Exploration of abdominal haematoma
179 S4 2B.S4.00071 14000 USG and clinical notes OT Note and HPE
(after laparotomy + LSCS)
USG, Lab investigation and clinical
180 S4 2B.S4.00077 2B.S4.00077 : Chorionic villus sampling 5000 OT Note and sampling report
notes
181 S4 2B.S4.17015 2B.S4.17015 : Lap. Salphingo-oophorectomy 10000 USG, CA 125 HPE

182 S4 2B.S4.17016 2B.S4.17016 : Lap. Assisted Vaginal Hysterectomy (LAVH) 11500 FBS,PPBS, T3,T4,THS/ Endometrial HPR,OT notes
Biopsy/Cervical biopsy
ONCOLOGY
2B.S15.00019 : Total Thyroidectomy with central Clinical Photograph showing scar +
183 S15 2B.S15.00019 20000 FNAC/CT/MRI report and Film
compartment LN dissection HPE report
2B.S2.00078B : Commondo Operation (glossectomy) -
S2 2B.S2.00078B 14000 CT , Biopsy Clinical Photograph
cross speciality
2B.S2.00083B : Excision of the Mandible Segmental -
S2 2B.S2.00083B 7500 X -Ray, CT , Biopsy X -Ray , Clinical photograph
cross speciality
2B.S2.00084B : Hemi-mandibulectomy with graft - cross
S2 2B.S2.00084B 15000 CT , Biopsy Clinical photograph
speciality
2B.S1.00010A : Block dissection Cervical Nodes - cross Clinical photo, CT report Scar photo
S1 2B.S1.00010A 10000
speciality
2B.S1.00036B : Excision Benign Tumor -Small intestine -
S1 2B.S1.00036B 15000 CT/ USG HPE Report
cross speciality
2B.S1.00046A : Excision of Swelling in Right Cervical
S1 2B.S1.00046A 4000 FNAC/ Biopsy HPR
Region - cross speciality
2B.S1.00051A : Fibroadenoma – Bilateral - cross
S1 2B.S1.00051A 8000 FNAC, USG, Routine Blood Inv HPR
speciality
S1 2B.S1.00088A 2B.S1.00088A : Jejunostomy - cross speciality 10000 USG Clinical Photo
2B.S1.00094B : Laryngectomy & Pharyngeal Diverticulum
S1 2B.S1.00094B 10000 CT Neck,USG Clinical Photograph,HPE
(Throat) - cross speciality
S1 2B.S1.00095A 2B.S1.00095A : Ileostomy - cross speciality 20000 Clinical Photograph
film
2B.S1.00097A : Loop Colostomy Sigmoid - cross
S1 2B.S1.00097A 12000 CT/MRI , Endoscopy , USG Clinical photograph
speciality
S1 2B.S1.00098A 2B.S1.00098A : Mastectomy - cross speciality 12000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report
2B.S1.00107A : Distal Pancreatectomy with

S1 2B.S1.00107A 17000 CT/ MRI Scar photo
PancreaticoJejunostomy - cross speciality
S1 2B.S1.00137A 2B.S1.00137A : Colectomy – Total - cross speciality 17000 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
S1 2B.S1.00168A 2B.S1.00168A : Hemi thyroidectomy - cross speciality 10000 FNAC , T F T , USG HPR , Clinical Photograph
S1 2B.S1.00177A 2B.S1.00177A : Lap. Hepatic resection - cross speciality 25000 MRI/ CT Abdomen Scar Photo, HPE Report
Speciality
code
2B.S1.00203A : Coccygeal Teratoma Excision - cross
S1 2B.S1.00203A 15000 Clinical Photograph Clincial Nortes, photo
speciality
2B.S1.00223A : Resection Enucleation of Adenoma (lung)
S1 2B.S1.00223A 10000 Clinical Photograph Clinical Photograph
- cross speciality
2B.S15.00008A : Mandible Tumour Resection and X Ray film with report, Clinical
reconstruction/Cancer surgery - cross speciality Photograph
OPTHALMOLOGY
184 S3 2B.S3.00004 2B.S3.00004 : Corneal Grafting 8500 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
185 S3 2B.S3.00005 2B.S3.00005 : Prophylactic Cryoretinopexy- Closed 2500 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
186 S3 2B.S3.00010 2B.S3.00010 : Enucleation with Implant 8000 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
2B.S3.00012 : Glaucoma Surgery (Trabeculectomy only)

with or without Mitomycin C, including postoperative
187 S3 2B.S3.00012 medications for 12 weeks (and wherever surgical or laser 1100 Intraocular Pressure reading Clinical Photograph
procedures required for bleb augmentation and anterior
chamber maintenance)
2B.S3.00013 : Intraocular Foreign Body Removal from

188 S3 2B.S3.00013 4000 B Scan Report Clinical Photograph
Anterior Segment
Slit lamp Examination report
189 S3 2B.S3.00015 2B.S3.00015 : Lensectomy /pediatric lens aspiration 9000 Fundus Photograph
&Fundoscopy
190 S3 2B.S3.00017 2B.S3.00017 : Surgical Membranectomy 8000 Indirect Opthalmoscopy report Fundus Photograph
191 S3 2B.S3.00018 2B.S3.00018 : Perforating Corneo - Scleral Injury 6600 Clinical Photograph Scar photo
192 S3 2B.S3.00019 2B.S3.00019 : Ptosis Surgery 1100 Clinical Photograph Clinical Photograph
193 S3 2B.S3.00020 2B.S3.00020 : IRIS Prolapse – Repair 4000 Slit lamp examination report Clinical Photograph
194 S3 2B.S3.00021 2B.S3.00021 : Retinal Detachment Surgery 15000 B Scan , Fundus Photograph Fundus Photograph
2B.S3.00022 : Small Tumour of Lid – Excision + Lid
Reconstruction
2B.S3.00023 : Socket Reconstruction with amniotic
membrane
197 S3 2B.S3.00025 2B.S3.00025 : Iridectomy – Surgical 3000 Clinical Note / slit lamp report Clinical Note / Slit lamp report
198 S3 2B.S3.00027 2B.S3.00027 : Vitrectomy 7500 B.Scan , Fundus Photograph Fundus Photograph
2B.S3.00031 : Cataract with foldable hydrophobic acrylic

199 S3 2B.S3.00031 10500 A Scan Report Clinical Photograph
IOL by Phaco emulsification tech + Glaucoma
2B.S3.00032 : Cataract with non-foldable IOL using SICS

200 S3 2B.S3.00032 6500 A Scan Report Clinical Photograph
technique + Glaucoma
201 S3 2B.S3.00037 2B.S3.00037 : Laser for retinopathy (per sitting) 1500 Fundoscopy Report Fundoscopy Report
202 S3 2B.S3.00039 2B.S3.00039 : Orbitotomy 6600 Clinical Photograph Clinical Photograph
203 S3 2B.S3.00040 2B.S3.00040 : Squint correction (per muscle) 4000 Clinical Photograph Clinical Photograph
2B.S3.00041 : Anterior Chamber Reconstruction
204 S3 2B.S3.00041 11500 Clinical Note / Slit lamp report Clinical Note / Slit lamp report
+Perforating corneo - Scleral Injury + IOL
Speciality
code
205 S3 2B.S3.00042 2B.S3.00042 : PRP - Retinal Laser including 3 sittings 5000 Fundoscopy Report Fundoscopy Report
2B.S3.17010 : Photocoagulation for Retinopathy for 3

206 S3 2B.S3.17010 2000 Fundoscopy Report Fundoscopy Report
sittings-Complete package
207 S3 2B.S3.17011 2B.S3.17011 : Therapeutic Penetrating Keratoplasty 3300 Clinical Photo Clinical Photograph
208 S3 2B.S3.17012 2B.S3.17012 : Lamellar Keratoplasty 3300 Clinical Photo Clinical Photograph
209 S3 2B.S3.17013 2B.S3.17013 : Scleral Patch Graft 8000 Clinical Photograph Clinical Photograph
2B.S3.17014 : Glaucoma Filtering Surgery For Paediatric
210 S3 2B.S3.17014 8500 Intraocular Pressure reading Clinical Photograph
Glaucoma
ORTHOPAEDICS
211 S5 2B.S5.00019 2B.S5.00019 : Bimalleolar Fracture Fixation 15000 X-ray Scar photo, X-Ray
2B.S5.00021 : Bone Tumour (malignant/ benign)
212 S5 2B.S5.00021 20000 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
curettage and bone grafting
2B.S5.00027 : Closed Interlock Nailing + Bone Grafting –
213 S5 2B.S5.00027 19000 X-ray, Rountine Blood Inv. Scar photo, x-ray
femur
214 S5 2B.S5.00028 2B.S5.00028 : Closed Interlocking Intermedullary 17500 X-ray, Rountine Blood Inv. Scar photo, x-ray
2B.S5.00030 : Closed Reduction and Internal Fixation
215 S5 2B.S5.00030 6000 X-ray x-ray
with K wire
2B.S5.00031 : Closed Reduction and Percutaneous Screw
216 S5 2B.S5.00031 15000 X-ray X-Ray showing implant
Fixation (neck femur)
2B.S5.00033 : Closed Reduction and Percutaneous
217 S5 2B.S5.00033 20000 X Ray Scar photo, x-ray showing implant
Nailing
Post-operative X-ray, Clinical
218 S5 2B.S5.00041 2B.S5.00041 : External fixation - Long bone 15000 X-RAY/CT scan(If Required)
Photograph showing scar
219 S5 2B.S5.00043 2B.S5.00043 : External fixation - Pelvis 15000 X Ray film with report X Ray film with report
220 S5 2B.S5.00045 2B.S5.00045 : Fixator with Joint Arthrolysis 20000 X-RAY Scar photo, X-RAY
2B.S5.00048 : Fracture - Hip Internal Fixation

221 S5 2B.S5.00048 17000 X-ray Scar photo, X-ray
(Intertrochanteric Fracture with implant) + rehabilitation
222 S5 2B.S5.00049 2B.S5.00049 : Fracture - Humerus Internal Fixation 17000 X-ray Scar photo, X-ray
223 S5 2B.S5.00059 2B.S5.00059 : Limb Lengthening 15000 Clinical Photograph Scar Photo, Clinical Photograph
2B.S5.00065 : Open Reduction Internal Fixation (Large
224 S5 2B.S5.00065 20000 X-ray X-ray, scar photo, Invoice of implants
Bone)
225 S5 2B.S5.00066 2B.S5.00066 : Open Reduction of CDH 30000 X-ray Scar photo, X-ray
2B.S5.00068 : Open Reduction with bone grafting of
nonunion
2B.S5.00075 : Reconstruction of ACL/PCL with implant
227 S5 2B.S5.00075 30000 MRI MRI
and brace
228 S5 2B.S5.00087 2B.S5.00087 : External fixation - both bones of forearms 25000 X-ray Clinical photo, X-ray
2B.S5.00088 : Fracture intercondylarHumerus +

olecranon osteotomy
2B.S5.00090 : Arthroscopic Meniscus Repair/
230 S5 2B.S5.00090 20000 MRI Report Scar photo, X-ray
Meniscectomy
Speciality
code
231 S5 2B.S5.00094 2B.S5.00094 : Bipolar Hemiarthroplasty (hip & shoulder) 40000 X-ray Scar photo, X-ray
232 S5 2B.S5.00095 2B.S5.00095 : Unipolar Hemiarthroplasty 30000 X-ray Scar photo, X-ray
233 S5 2B.S5.00097 2B.S5.00097 : Elbow replacement 40000 X-ray Scar photo, X-ray
234 S5 2B.S5.00099 2B.S5.00099 : Arthrodesis of Knee (with implant) 40000 X-ray Clinical photo, X-ray
235 S5 2B.S5.00100 2B.S5.00100 : Arthrodesis of Wrist (with implant) 30000 X-ray Clinical photo, X-ray
236 S5 2B.S5.00101 2B.S5.00101 : Arthrodesis of Ankle (with implant) 30000 X-ray Clinical photo, X-ray
2B.S5.17019 : Maysers muscle pedicle graft for Non-
union fracture neck femur (orthroplasty)
Clinical Photograph showing scar +
238 S5 2B.S5.17020 2B.S5.17020 : Facio-Maxillary Injury repairs & fixations 5000 X-RAY/CT scan
post op. XRAY
239 S5 2B.S5.17021 2B.S5.17021 : Anterolateral Clearance For Tuberculosis 18000 MRI
Photograph
2B.S5.17022 : Posterior cruciate ligament (PCL)
240 S5 2B.S5.17022 17700 MRI MRI
Reconstruction
241 S5 2B.S5.17023 2B.S5.17023 : Blunt injury abdomen 10000 USG USG
2B.S8.00015A : Laminectomy with Fusion and fixation - Clinical Photographs showing scar + X-
S8 2B.S8.00015A 50000 CT/MRI report
cross speciality ray-Lumbar Spine
2B.S8.00023A : Micro discectomy – Lumbar - cross
S8 2B.S8.00023A 40000 Clinical findings, MRI Report Clinical photograph showing scar
speciality
2B.S8.00029A : Spine - Decompression & Fusion with
S8 2B.S8.00029A 50000 Clinical findings, MRI Report Post Op X-Ray Report and film
fixation - cross speciality
2B.S8.00074A : Muscle Biopsy with report - cross
S8 2B.S8.00074A 7000 Reports of relevant investigation HPE Report
speciality
2B.S1.00164B : Split thickness skin grafts – Small (< 4%
S1 2B.S1.00164B 5000 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
TBSA) - - cross speciality
2B.S1.00224A : Rib Resection & Drainage - cross
S1 2B.S1.00224A 7500 Chest X-ray, Clinical Photograph Clinical Photograph
speciality
2B.S1.00246B : Tendon Transfer-Leprosy - - cross
S1 2B.S1.00246B 22000 Clinical Photograph, Clinical Notes Clinical Photograph
speciality
S5 2B.S5.00003A 2B.S5.00003A : Sequestrectomy - cross speciality 1500 X Ray film with report X Ray film with report
PLASTIC AND RECONSTRUCTIVE SURGERY
S1 2B.S1.00145A 2B.S1.00145A : Cleft lip operation - cross speciality 12000 Clinical Photograph Clinical Photograph
2B.S1.00147A : Cleft lip & palate operation (for each

S1 2B.S1.00147A 15000 Clincal note and photograph OT note and clinical photograph
stage) - cross speciality
2B.S1.00164A : Split thickness skin grafts – Small (< 4%
S1 2B.S1.00164A 5000 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
2B.S1.00166A : Split thickness skin grafts – Large (> 8%
S1 2B.S1.00166A 15000 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
2B.S1.00245A : Tissue Reconstruction Flap Leprosy -
S1 2B.S1.00245A 22000 Clinical Photograph Scar photo
cross speciality
2B.S1.00246A : Tendon Transfer-Leprosy - - cross
S1 2B.S1.00246A 22000 Clinical Photograph, Clinical Notes Clinical Photograph
speciality
Speciality
code
POLYTRAUMA
242 S6 2B.S6.00005 2B.S6.00005 : Internal fixation of Pelviacetabular fracture 40000 X Ray film with report X Ray film with report, Scar Photo
SURGICAL GASTROENTEROLOGY
2B.S1.00009A : Bleeding Ulcer - Partial Gastrectomy -
S1 2B.S1.00009A 25000 Endoscopy Scar photo, HPR
cross speciality
2B.S1.00026A : Drainage of Subdiaphramatic Abscess -
S1 2B.S1.00026A 8000 USG/Clinical Notes Scar photo
cross speciality
S1 2B.S1.00028A 2B.S1.00028A : Duodenal Diverticulum - cross speciality 15000 USG/CT Scan Scar Photo
S1 2B.S1.00029A 2B.S1.00029A : Duodenal Jejunostomy - cross speciality 15000 USG Clinical Photo
S1 2B.S1.00030B 2B.S1.00030B : Duplication of Intestine - cross speciality 17000 CT/ USG Scar Photo
2B.S1.00036A : Excision Benign Tumor -Small intestine -

S1 2B.S1.00036A 15000 CT/ USG HPE Report
cross speciality
2B.S1.00041A : Excision Meckel's Diverticulum - cross
S1 2B.S1.00041A 15000 USG/ CT Scar Photo, HPE Report
speciality
2B.S1.00043A : Excision Small Intestinal Fistula - cross
S1 2B.S1.00043A 12000 USG/ CT Scar Photo
speciality
S1 2B.S1.00063A 2B.S1.00063A : Gastrojejunostomy - cross speciality 15000 USG, Endoscopy Scar Photo
2B.S1.00065A : Graham's Operation for duodenal

S1 2B.S1.00065A 15000 X-ray abdomen/CT, USG USG, Scar Photo
perforation - cross speciality
Clinical Photograph/ Scar photo, HPE
S1 2B.S1.00079A 2B.S1.00079A : Hydatid Cyst of Liver - cross speciality 10000 CT/MRI
Report
S1 2B.S1.00082A 2B.S1.00082A : IlieoSigmoidostomy - cross speciality 13000 CT Scan/ MRI Scar photo
S1 2B.S1.00088B 2B.S1.00088B : Jejunostomy - cross speciality 10000 USG Clinical Photo

2B.S1.00090A : Intestinal Perforation (Resection
S1 2B.S1.00090A 20000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo
Anastomosis) - cross speciality
S1 2B.S1.00095B 2B.S1.00095B : Ileostomy - cross speciality 20000 Clinical Photograph
film
Speciality
code
S1 2B.S1.00097B 2B.S1.00097B : Loop Colostomy Sigmoid - cross speciality 12000 CT/MRI , Endoscopy , USG Clinical photograph
S1 2B.S1.00099A 2B.S1.00099A : Mesenteric Cyst – Excision 9000 USG/ CT Scan/ MRI Scar Photo, HPE Report
2B.S1.00100A : Mesenteric Caval Anastomosis - cross
S1 2B.S1.00100A 10000 CT abdomen/USG OT Notes, Intra-Op Photograph
speciality
2B.S1.00102A : Oeshophagoscopy for foreign body
S1 2B.S1.00102A 6000 Endoscopy/ X-Ray Clinical notes, endo picture
removal - cross speciality
2B.S1.00107B : Distal Pancreatectomy with
S1 2B.S1.00107B 17000 CT/ MRI Scar photo
PancreaticoJejunostomy - cross speciality
2B.S1.00111A : Porto Caval Anastomosis - Cross
S1 2B.S1.00111A 15000 CT/ MRI OT Notes / Post-op CT
speciality
CT/MRI Abdomen, Endoscopic
S1 2B.S1.00119A 2B.S1.00119A : Repair of Common Bile Duct 12500 Retrograde Cholangio OT Notes
Pancreatography (ERCP)
S1 2B.S1.00137B 2B.S1.00137B : Colectomy – Total - cross speciality 17000 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
2B.S1.00175A : Lap. Cholecystectomy & CBD exploration
S1 2B.S1.00175A 20000 CT , LFT HPR, Clinical photograph
- cross speciality
2B.S1.00176B : Lap. For intestinal obstruction - cross
S1 2B.S1.00176B 15000 X-Ray abdomen /CT /USG USG, Scar Photo
speciality
2B.S1.00185B : Laparoscopic Pyloromyotomy - cross
S1 2B.S1.00185B 12500 USG, Clinical notes Clinical Photograph
speciality
S1 2B.S1.00186A 2B.S1.00186A : Laparoscopic Rectopexy 15000 Clinical Findings Clinical Findings
2B.S1.00220A : Removal of Foreign Body from Trachea
S1 2B.S1.00220A 2500 Clinical photo, endoscopy Procedure notes
or Oesophagus - cross speciality
2B.S1.17001A : Endoscopic Retrograde Cholangio
Pancreatography (Endoscopic Retrograde Cholangio
S1 2B.S1.17001A 4000 Liver function test (LFT), USG Liver function test (LFT), USG
Pancreatography (ERCP) with Interventions - cross
speciality
2B.S1.17002A : Laproscopic Adrenalectomy - cross
S1 2B.S1.17002A 30000 CT Clinical Photograph
speciality
2B.S1.17003A : Gastro jejuno Colic Fistula - cross
S1 2B.S1.17003A 12500 USG Scar Photo
speciality
2B.S1.17004A : Endoscopic Retrograde Cholangio
S1 2B.S1.17004A Pancreatography (ERCP) (Endoscopic Retrograde 2250 LFT, USG USG
Cholangio – Pancreatography) - cross speciality
2B.S1.17009A : Upper GI Therapeutic(including Varicose
S1 2B.S1.17009A 2000 Endoscopy report. Procedure stills
Intervention) - cross speciality
2B.S1.00058A : Foreign Body Removal in Deep Region
S1 2B.S1.00058A 5000 X-Ray / Scopy report X-Ray / Scopy report
requiring GA - cross speciality
UROLOGY
243 S7 2B.S7.00029 2B.S7.00029 : Pyelolithotomy-Laparoscopic 15000 USG Clinical Photograph
244 S7 2B.S7.00033 2B.S7.00033 : Perinephric Abscess drainage (Open) 7500 USG Scar photo
245 S7 2B.S7.00059 2B.S7.00059 : Urachal Cyst excision -open 15000 USG/CT KUB HPR
246 S7 2B.S7.00110 2B.S7.00110 : Excision of Urethral Caruncle 5000 Clinical Notes Clinical Photograph
Speciality
code
247 S7 2B.S7.00127 2B.S7.00127 : Orchiopexy-without laparoscopy, bilateral 15000 USG Clinical Notes
248 S7 2B.S7.00135 2B.S7.00135 : Ilio-Inguinal lymphadenectomy-unilateral 15000 USG Scar photo
249 S7 2B.S7.00136 2B.S7.00136 : Ilio-Inguinal lymphadenectomy-bilateral 25000 USG Scar photo
250 S7 2B.S7.17039 2B.S7.17039 : Operation for Double Ureter 15750 IVP/CT KUB with Contrast Scar Photo
251 S7 2B.S7.17040 2B.S7.17040 : Pyelolithotomy 13500 IVP/CT KUB with Contrast Scar Photo
2B.S1.17002B : Laproscopic Adrenalectomy - cross
S1 2B.S1.17002B 30000 CT Clinical Photograph
speciality
Speciality
code
TERTIARY CARE
BURNS
3A.S11.00006 : Electrical contact burns: Low voltage-
with part of limb/limb loss; Includes % TBSA skin
grafted, flap cover, follow-up dressings etc. as deemed
252 S11 3A.S11.00006 40000 Clinical Photograph Clinical Photograph
necessary; Surgical procedures are required for deep
burns that are not amenable to heal with dressings
alone.
3A.S11.00011 : Post Burn Contracture surgeries for

Functional Improvement (Package including splints,
pressure garments, silicone-gel sheet and
physiotherapy): Excluding Neck contracture; Contracture
release with - Split thickness Skin Graft (STSG) / Full
Thickness Skin Graft (FTSG)/ Flap cover is done for each
joint with post-operative regular dressings for STSG /
FTSG / Flap cover.
3A.S11.00012 : Post Burn Contracture surgeries for

Functional Improvement (Package including splints,
pressure garments, silicone-gel sheet and
physiotherapy): Neck contracture; Contracture release
with - Split thickness Skin Graft (STSG) /
Full Thickness Skin Graft (FTSG)/ Flap cover is done for
each joint with post-operative regular dressings for
STSG / FTSG / Flap cover.
CARDIOLOGY
255 S12 3A.S12.00001 3A.S12.00001 : Balloon Atrial Septostomy 25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO
256 S12 3A.S12.00002 3A.S12.00002 : Balloon Aortic Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO
257 S12 3A.S12.00003 3A.S12.00003 : Balloon Mitral Valvotomy 30000 2D ECHO report 2D ECHO report + stills of ECHO
258 S12 3A.S12.00004 3A.S12.00004 : Balloon Pulmonary Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO
3A.S12.00005 : Vertebral Angioplasty with single stent 2D ECHO , ANGIOGRAM report &
259 S12 3A.S12.00005 55000 Post procedure Angio stills
(medicated) stills
3A.S12.00006 : Vertebral Angioplasty with double 2D ECHO , Angiogram Report & Stills
260 S12 3A.S12.00006 70000 Angiogram-DSA/MRA/CTA
stent(medicated)
3A.S12.00007 : Carotid angioplasty with stent Angiogram report & Film showing Post procedure Angio stills + XRAY +
261 S12 3A.S12.00007 130000
(medicated) the lesion Doppler
1.Angioplasty stills showing stents &

3A.S12.00008 : Renal Angioplasty with single stent ECG, 2D ECHO, CAG stills showing
262 S12 3A.S12.00008 65000 post Stent flow,2. Cartons of the stents
(medicated) blocks & Reports
used approved by FDA/CE/DCGI only
3A.S12.00009 : Renal Angioplasty with double stent 2D ECHO , ANGIOGRAM report &
(medicated) stills
Speciality
code

ECG, 2D ECHO, CAG stills showing
264 S12 3A.S12.00010 3A.S12.00010 : Peripheral Angioplasty with balloon 40000 post Stent flow,2. Cartons of the stents
blocks & Reports
3A.S12.00011 : Peripheral Angioplasty with stent 2D ECHO , ANGIOGRAM report &

265 S12 3A.S12.00011 50000 Post procedure Angio stills, ABI
(medicated) stills , ABI
266 S12 3A.S12.00012 3A.S12.00012 : Coarctation dilatation 25000 2D ECHO report 2D ECHO report + stills of ECHO
2D ECHO stills showing the device +
267 S12 3A.S12.00014 3A.S12.00014 : ASD Device Closure 88000 2D ECHO report
Report
268 S12 3A.S12.00015 3A.S12.00015 : VSD Device Closure 88000 2D ECHO report
Report
269 S12 3A.S12.00016 3A.S12.00016 : PDA Device Closure 80000 2D ECHO report
Report
2D ECHO stills showing the coil +
270 S12 3A.S12.00017 3A.S12.00017 : PDA multiple Coil insertion 30000 2D ECHO report
Report
2D ECHO stills showing the coil +
271 S12 3A.S12.00018 3A.S12.00018 : PDA Coil (one) insertion 25000 2D ECHO report
Report
2D ECHO , Angiogram Report &
272 S12 3A.S12.00019 3A.S12.00019 : PDA stenting 50000 Post procedure Angio stills
Stills
3A.S12.00022 : Permanent pacemaker implantation

ECG + Report by cardiologist +
273 S12 3A.S12.00022 (DDR) including Pacemaker value/pulse generator 120000 X Ray showing the pacemaker in situ
Anigiogram report if done
replacement (DOUBLE CHAMBER)
3A.S12.00023 : Permanent pacemaker implantation (VVI)

274 S12 3A.S12.00023 including Pacemaker value/pulse generator replacement 75000 X Ray showing the pacemaker in situ
(SINGLE CHAMBER)

3A.S12.00024 : PTCA - single stent (medicated, inclusive ECG, 2D ECHO, CAG stills showing
of diagnostic angiogram) blocks & Reports

3A.S12.00025 : PTCA - double stent (medicated, inclusive ECG, 2D ECHO, CAG stills showing
of diagnostic angiogram) blocks & Reports
3A.S12.00026 : PTCA - additonal stent (linked to package ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent & post
277 S12 3A.S12.00026 28849
no:0025) blocks & Reports Stent flow
278 S12 3A.S12.00028 3A.S12.00028 : Pulmonary artery stenting 50000 Post procedure Angio stills
Stills
279 S12 3A.S12.00029 3A.S12.00029 : Pulmonary artery stenting (double) 65000 Post procedure Angio stills
Stills
3A.S12.00030 : Right ventricular outflow tract (RVOT) 2D ECHO, Angiogram Report & Stills
stenting
Speciality
code
CAG stills with balloon and stills with
281 S12 3A.S12.00031 3A.S12.00031 : Rotablation+ Balloon Angioplasty 45000 CAG Report with stills showing blocks
post flow
3A.S12.00032 : Rotablation+ Balloon Angioplasty + 1 CAG stills with balloon and stills with
282 S12 3A.S12.00032 100000 CAG Report with stills showing blocks
stent (medicated) post flow
3A.S12.00033 : Rotablation+ Balloon Angioplasty + 2 CAG stills with balloon and stills with
stent (medicated) post flow
Peripheral Angiogram /Doppler
284 S12 3A.S12.00034 3A.S12.00034 : Thrombolysis for peripheral ischemia 30000 Post procedure Angio stills
Report with Stills
3A.S12.00035 : Bronchial artery Embolisation (for Chest x-Ray/CT Scan, Hb, Serum Chest x-Ray/CT Scan, Hb, Serum
285 S12 3A.S12.00035 25000
Haemoptysis) Creatinine Creatinine
3A.S12.00036 : Percutaneous Transluminal Tricuspid
286 S12 3A.S12.00036 25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO
Commissurotormy (PTTC)
CT/MRI or Angiogram, Prothrombin

287 S12 3A.S12.00037 3A.S12.00037 : Coiling - Pseudoaneurysms of Abdomen 55000 Time (PT), International normalized CT, PT,INR, Hb, Serum Creatinine
ratio (INR) Hb, Serum Creatinine
3A.S12.00038 : Embolization - Arteriovenous USG abd/CT PT,INR, Hb, Serum

288 S12 3A.S12.00038 40000 USG, CT PT, INR, Hb, Serum Creatinine
Malformation (AVM) in the Limbs Creatinine
3A.S12.00039 : Catheter directed Thrombolysis for: Deep CT/MRI, Prothrombin Time (PT),
289 S12 3A.S12.00039 vein thrombosis (DVT), Mesenteric Thrombosis & 50000 International normalized ratio (INR) CT/MRI, PT,INR, Hb, Serum Creatinine
Peripheral vessels Hb, Serum Creatinine
3A.S12.17059 : PTCA - one stent (non-medicated, ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent & post
290 S12 3A.S12.17059 48000
elective) * blocks & Reports Stent flow
3A.S12.17060 : Renal Angioplasty with stent (non- 2D ECHO , ANGIOGRAM report &
medicated) * stills
292 S12 3A.S12.17061 3A.S12.17061 : Pulse Generator replacement 50000 X Ray showing the pacemaker in situ
293 S12 3A.S12.17062 3A.S12.17062 : Septostomy 20000 2D ECHO report 2D ECHO report + stills of the ECHO
3A.S12.17063 : Intravascular ultrasound (IVUS)/Fractional

294 S12 3A.S12.17063 20000 Angiogram Report IVUS/FFR report
Flow Reserve (FFR)
295 S12 3A.S12.17064 3A.S12.17064 : Electrophysiological Study (EP study) 10000 ECG with report + 2D ECHO report EP study report+ ECG
296 S12 3A.S12.17065 3A.S12.17065 : Radiofrequency Ablation (RF Ablation) 25000 ECG with report + 2D ECHO report RF ablation report +ECG
297 S12 3A.S12.17066 3A.S12.17066 : 3D Mapping + Ablation 50000 ECG with report + 2D ECHO report 3D mapping report+ECG with report
3A.S12.17067 : Rotablation+ PTCA (non-medicated Stent CAG stills with stents and stills with
)* post flow

3A.S12.17068 : Rotablation+ PTCA (One Drug Eluting ECG, 2D ECHO, CAG stills showing
Stent)* blocks & Reports
Speciality
code
2D ECHO , Angiogram Report & Stills
300 S12 3A.S12.17069 3A.S12.17069 : Venous stenting* 50000 Post procedure Angio stills

301 S12 3A.S12.17070 3A.S12.17070 : Coarctoplasty with stenting* 75000 Post procedure Angio stills
Stills
3A.S12.17071 : Paravalvular leak/ Ruptured sinus of 2D ECHO stills showing the device +
302 S12 3A.S12.17071 88000 2D ECHO Report
Valsalva aneurysm (RSOV) Report
USG, clotting Time (CT), Prothrombin

303 S12 3A.S12.17072 3A.S12.17072 : Inferior Vena Cava (or IVC) Stenting 60000 Time (PT), International normalized USG, CT,PT,INR, Hb, Serum Creatinine
ratio (INR), Hb, Serum Creatinine
3A.S12.17087 : Peripheral Angioplasty with stent (non- 2D ECHO , ANGIOGRAM report &
304 S12 3A.S12.17087 60000 Post procedure Angio stills, ABI
medicated) * stills , ABI
Angiogram report & Film showing Post procedure Angio stills + XRAY +
305 S12 3A.S12.17088 3A.S12.17088 : Carotid angioplasty with stent* 150000
the lesion Doppler
306 S13 3A.S13.00001 3A.S13.00001 : Coronary artery bypass grafting (CABG) 95000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
3A.S13.00002 : Coronary artery bypass grafting (CABG)

307 S13 3A.S13.00002 125000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
with Intra-aortic balloon pump (IABP)
3A.S13.00003 : Coronary artery bypass grafting (CABG) +
Post op X Ray , 2D ECHO with stills,
308 S13 3A.S13.00003 one mechanical Valve Replacement + Intra-aortic 145000 2D ECHO with stills , CAG Report
scar photo
balloon pump (IABP)
3A.S13.00004 : Coronary artery bypass grafting (CABG) ECHO with stills,Post op X Ray ,scar
309 S13 3A.S13.00004 95000 2D ECHO with stills , CAG Report
with LV Aneurysmal repair photo
3A.S13.00005 : Coronary artery bypass grafting (CABG) ECHO with stills,Post op X Ray ,scar
with Mitral Valve repair without ring photo
3A.S13.00006 : Coronary artery bypass grafting (CABG) Post op X Ray , 2D ECHO with stills,
with Mitral Valve repair with ring scar photo
3A.S13.00007 : Coronary artery bypass grafting (CABG)
ECHO with stills,Post op X Ray ,scar
312 S13 3A.S13.00007 with post MI Ventricular Septal Defect (Ventricular 120000 2D ECHO with stills , CAG Report
photo
Septal Defect) repair
2D ECHO Report + stills of ECHO,scar
313 S13 3A.S13.00008 3A.S13.00008 : Open Mitral Valvotomy 80000 2D ECHO Report with stills
photo
2D ECHO Report + stills of ECHO +
314 S13 3A.S13.00009 3A.S13.00009 : Closed Mitral Valvotomy 30000 2D ECHO Report with stills
Post Op X-ray,scar photo
315 S13 3A.S13.00010 3A.S13.00010 : Open Pulmonary Valvotomy 80000 2D ECHO Report with stills
photo
316 S13 3A.S13.00011 3A.S13.00011 : Mitral Valve Repair 80000 2D ECHO Report with stills
317 S13 3A.S13.00012 3A.S13.00012 : Tricuspid Valve Repair 80000 2D ECHO Report with stills
318 S13 3A.S13.00013 3A.S13.00013 : Aortic Valve Repair 80000 2D ECHO Report with stills
Speciality
code
319 S13 3A.S13.00014 3A.S13.00014 : Ring for any Valve Repair 20000 2D ECHO Report with stills
3A.S13.00015 : Mitral Valve Replacement (mechanical 2D ECHO Report + stills of ECHO +
320 S13 3A.S13.00015 130000 2D ECHO Report with stills
valve) Post Op X-ray,scar photo
3A.S13.00016 : Mitral Valve Replacement (biological 2D ECHO Report + stills of ECHO +
3A.S13.00017 : Aortic Valve Replacement (mechanical 2D ECHO Report + stills of ECHO +
3A.S13.00018 : Aortic Valve Replacement (biological 2D ECHO Report + stills of ECHO +
3A.S13.00019 : Tricuspid Valve Replacement (mechanical 2D ECHO Report + stills of ECHO +
3A.S13.00020 : Tricuspid Valve Replacement (biological 2D ECHO Report + stills of ECHO +
3A.S13.00021 : Double Valve Replacement (mechanical 2D ECHO Report + stills of ECHO +
3A.S13.00022 : Double Valve Replacement (biological 2D ECHO Report + stills of ECHO +
328 S13 3A.S13.00023 3A.S13.00023 : Ross Procedure 110000 2D ECHO Report with stills
329 S13 3A.S13.00024 3A.S13.00024 : Atrial Septal Defect (ASD) 90000 2D ECHO Report with stills
330 S13 3A.S13.00025 3A.S13.00025 : Ventricular Septal Defect (VSD) 90000 2D ECHO Report with stills
3A.S13.00026 : Atrioventricular septal defect/ 2D ECHO Report + stills of ECHO +
Atrioventricular (AV) Canal Defect Post Op X-ray,scar photo
3A.S13.00027 : Intracardiac repair (ICR) for Tetralogy of 2D ECHO Report + stills of ECHO +
Fallot (TOF) Post Op X-ray,scar photo
3A.S13.00028 : Pulmonary Valvotomy + Right Ventricular 2D ECHO Report + stills of ECHO +
Outflow Tract (RVOT) Resection Post Op X-ray,scar photo
334 S13 3A.S13.00029 3A.S13.00029 : Aortopulmonary Window (AP Window) 90000 2D ECHO Report with stills
3A.S13.00030 : Surgery for Hypertrophic Obstructive 2D ECHO/TEE Report + Chest Xray 2D ECHO Report + stills of ECHO +
335 S13 3A.S13.00030 90000
Cardiomyopathy (HOCM) AP view /Cardiac MRI Post Op X-ray,scar photo
336 S13 3A.S13.00031 3A.S13.00031 : Ebsteins 90000 ECG, 2D ECHO Report
337 S13 3A.S13.00032 3A.S13.00032 : Fontan 100000 2D ECHO Report with stills
3A.S13.00033 : Total Anomalous Pulmonary Venous 2D ECHO Report + stills of ECHO +
Connection (TAPVC) Post Op X-ray,scar photo
339 S13 3A.S13.00034 3A.S13.00034 : Any RV to PA conduit (Valved) 120000 2D ECHO Report with stills
340 S13 3A.S13.00035 3A.S13.00035 : Arterial Switch Operation 120000 2D ECHO Report with stills
Speciality
code
341 S13 3A.S13.00036 3A.S13.00036 : Double Switch Operation 120000 2D ECHO Report with stills
342 S13 3A.S13.00037 3A.S13.00037 : Sennings 120000 2D ECHO Report with stills
343 S13 3A.S13.00038 3A.S13.00038 : Mustards 120000 2D ECHO Report with stills
344 S13 3A.S13.00039 3A.S13.00039 : Truncus Arteriosus Surgery 120000 2D ECHO Report with stills
3A.S13.00040 : Root Replacement (Aortic Aneurysm/ 2D ECHO Report + stills of ECHO +
Aortic Dissection) / Bental Procedure Post Op X-ray,scar photo
346 S13 3A.S13.00041 3A.S13.00041 : Aortic Arch Replacement 150000 2D ECHO Report with stills
3A.S13.00042 : Aortic Aneurysm Repair using
347 S13 3A.S13.00042 90000 CT Angio Report Scar photo + Intra op photo
Cardiopulmonary bypass (CPB)
3A.S13.00043 : Aortic Aneurysm Repair without using
Cardiopulmonary bypass (CPB)
2D ECHO with stills + ABG report + 2D ECHO Report + stills of ECHO +
349 S13 3A.S13.00044 3A.S13.00044 : Pulmonary Embolectomy 150000
CT Chest report Post Op X-ray,scar photo
350 S13 3A.S13.00046 3A.S13.00046 : Patent Ductus Arteriosus (PDA) Closure 30000 2D ECHO Report with stills
Post Op X-ray, scar photo
351 S13 3A.S13.00047 3A.S13.00047 : Coarctation Repair 30000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
352 S13 3A.S13.00048 3A.S13.00048 : Coarctation Repair with interpostion graft 70000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
3A.S13.00049 : Blalock–Thomas–Taussig (BT) Shunt 2D ECHO Report + stills of ECHO +

(inclusives of grafts) Post Op X-ray,scar photo
3A.S13.00050 : Glenn Shunt (without cardiopulmonary 2D ECHO Report + stills of ECHO +
bypass) Post Op X-ray,scar photo
355 S13 3A.S13.00051 3A.S13.00051 : Central Shunt 60000 2D ECHO Report with stills
356 S13 3A.S13.00052 3A.S13.00052 : Pericardiectomy 50000 2D ECHO Report with stills
357 S13 3A.S13.00053 3A.S13.00053 : Pulmonary AV Fistula surgery 45000 CT Chest report Post Op X-ray,scar photo
358 S13 3A.S13.00054 3A.S13.00054 : Lung Cyst 60000 CT Chest report Post Op X-ray,scar photo
3A.S13.00055 : Space-Occupying Lesion (SOL)
359 S13 3A.S13.00055 60000 CT Chest report Post Op X-ray,scar photo
mediastinum
3A.S13.00056 : Surgical Correction of Bronchopleural 2D ECHO Report + stills of ECHO +
360 S13 3A.S13.00056 70000 CT Chest report
Fistula Post Op X-ray,scar photo
361 S13 3A.S13.00057 3A.S13.00057 : Diaphragmatic Eventeration 50000 CT Chest report
362 S13 3A.S13.00058 3A.S13.00058 : Oesophageal Diverticula /Achalasia Cardia 50000 Barium Study + CT Chest report
363 S13 3A.S13.00059 3A.S13.00059 : Diaphragmatic Injuries/Repair 35000 CT Chest report
Speciality
code
3A.S13.00060 : Thoracotomy, Thoraco Abdominal
364 S13 3A.S13.00060 40000 CT Chest report Post Op X-ray,scar photo
Approach
3A.S13.00062 : Bronchial Repair Surgery for Injuries due CT Chest report + Bronchoscopy
365 S13 3A.S13.00062 40000 ENDOSCOPY PICTURE
to FB report
366 S13 3A.S13.00064 3A.S13.00064 : Thyomectomy 35000 CT Chest report X-RAY, scar photo
367 S13 3A.S13.00065 3A.S13.00065 : Pulmonary Valve Replacement 120000 2D ECHO Report
post Op X-ray,scar photo
3A.S13.00067 : Encysted Empyema/Pleural Effusion -
368 S13 3A.S13.00067 20000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
Tubercular
3A.S13.00068 : First rib Excision by transaxillary
369 S13 3A.S13.00068 approach, Excision of cervical rib / fibrous band / muscle 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
by cervical approach
370 S13 3A.S13.00069 3A.S13.00069 : Congenital Cystic Lesions 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
371 S13 3A.S13.00070 3A.S13.00070 : Pulmonary Sequestration Resection 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
372 S13 3A.S13.00071 3A.S13.00071 : Pulmonary artero venous malformation 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
3A.S13.00074 : Intrathoracic Aneurysm-Aneurysm not

373 S13 3A.S13.00074 65000 CT Angio Report Scar photo + Post op intra op photo
Requiring Bypass Techniques
3A.S13.17089 : Coronary artery bypass grafting (CABG) ECHO,Post op X Ray ,scar photo + scar
374 S13 3A.S13.17089 100000 2D ECHO , CAG Report
with additional arterial graft* photo of graft area
3A.S13.17090 : Valve Replacement with Intra-aortic 2D ECHO Report + stills of ECHO +
balloon pump (IABP) * Post Op X-ray,scar photo
3A.S13.17091 : Pulmonary Atresia with or without 2D ECHO Report + stills of ECHO +
Ventricular Septal Defect * Post Op X-ray,scar photo
377 S13 3A.S13.17092 3A.S13.17092 : Pleurectomy 50000 CT Chest report Post Op X-ray,scar photo
378 S13 3A.S13.17093 3A.S13.17093 : Mediastinotomy 40000 CT Chest report Post Op X-ray,scar photo
3A.S13.17094 : Gastro Study Followed by Thoracotomy

379 S13 3A.S13.17094 50000 Gastroscopy Report ENDOSCOPY PICTURE, scar photo
& Repairs of Oesophageal Injury for Corrosive Injuries/FB
3A.S13.17095 : Thorocotomy and resection of pluera Pre Op X-ray / CT Scan,

380 S13 3A.S13.17095 50000 Post Op X-ray / CT Scan ,scar photo
with Lung Bronchoscopy Report
381 S13 3A.S13.17096 3A.S13.17096 : Congenital Hypoplasia of the lung 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
3A.S13.17097 : Thoracotomy & Excision and fixation of

382 S13 3A.S13.17097 65000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
the Spine
3A.S13.17099 : Coronary artery bypass grafting (CABG) + Post op X Ray , 2D ECHO with stills,
Valve Replacement * scar photo
384 S13 3A.S13.17100 3A.S13.17100 : Open Aortic Valvotomy * 80000 2D ECHO Report with stills
photo
3A.S13.17101 : Aortic Aneurysm Repair without using

Cardiopulmonary bypass (CPB) with/without graft*
Speciality
code
386 S13 3A.S13.17102 3A.S13.17102 : Lobectomy 70000 CT Chest report Post Op X-ray,scar photo
Pre-op. of X-ray/CT scan / Ultra
S6 3A.S6.17024B 3A.S6.17024B : Visceral injuries severe - cross speciality 60000 Post-Operative X-ray, scar photo
sound
3A.S6.17025B : Chest injuries with ICD bilateral - cross Post-Operative chest X-ray with ICD in
S6 3A.S6.17025B 11000 X-ray /ultra sound
speciality situ
3A.S6.17026B : Chest injuries with ICD + ICU - cross Post-Operative chest X-ray with ICD in
speciality situ
3A.S6.17027B : Chest injuries with ICD + ICU + Ventilator Post-Operative chest X-ray with ICD in
- cross speciality situ
3A.S8.00025B : Shunt (peritoneal, ventriculo-atrial/

S8 3A.S8.00025B 20000 CT report Clinical Photographs
peritoneal, theco peritoneal) - cross speciality
3A.S1.00078A : Hiatus Hernia – abdominal - cross

S1 3A.S1.00078A 40000 USG, UGI ENDOSCOPY Scar photo + Intra op photo
speciality
3A.S1.00138B : Pharyngectomy& Reconstruction – Total -
S1 3A.S1.00138B 12000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
cross specaility
3A.S1.00139A : Tracheal Stenosis (End to end
S1 3A.S1.00139A 15000 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat) - cross speciality
S1 3A.S1.00140A 3A.S1.00140A : Tracheoplasty (Throat) - cross speciality 40000 CT / Bronchoscopy report CT / Bronchoscopy report
3A.S1.00149B : Aneurysm Resection & Grafting - cross

S1 3A.S1.00149B 70000 CT Angio Report Scar photo + Intra op photo
speciality
S1 3A.S1.00150A 3A.S1.00150A : Arterial Embolectomy - cross speciality 10000 Arterial doppler Scar photo
3A.S1.00151A : Carotid artery aneurysm repair - cross 2D ECHO Report + stills of ECHO +
S1 3A.S1.00151A 20000 2D ECHO Report with stills
speciality Post Op X-ray,scar photo
3A.S1.00152A : Carotid Body tumour - Excision - cross Angiogram/spiral CT Angiogram Stills showing the procedure +Duplex
S1 3A.S1.00152A 35000
speciality reports scan, scar photo
3A.S1.00157A : Decortication (Pleurectomy) - cross
S1 3A.S1.00157A 50000 CT Chest report Post Op X-ray,scar photo
speciality
S1 3A.S1.00158A 3A.S1.00158A : Dissecting Aneurysms - cross speciality 36000 2D ECHO Report with stills, Doppler
3A.S1.00159A : Distal Abdominal Aorta repair - cross
S1 3A.S1.00159A 36000 Angiogram/CTA/MRA Scar photo
speciality
S1 3A.S1.00194A 3A.S1.00194A : Mediastinal Tumour - cross speciality 50000 Biopsy/FNAC ,CT
HPE report + XRAY Chest
3A.S1.00195A : Oesophagectomy for Carcinoma
S1 3A.S1.00195A 50000 Biopsy , CT , Endoscopy reports HPE report, scar photo
3A.S1.00207A : Hernia -hiatus-Transthoracic - cross
S1 3A.S1.00207A 25000 UGI ENDOSCOPY Scar photo/ Intra op photo
speciality
S1 3A.S1.00218A 3A.S1.00218A : Pericardiostomy - cross speciality 10000 2D ECHO
S1 3A.S1.00219A 3A.S1.00219A : Pneumonectomy - cross speciality 60000 CT Chest report Post Op X-ray,scar photo
Speciality
code
3A.S1.00221A : Removal Tumours of Chest Wall - cross Clinical Photograph showing scar +
S1 3A.S1.00221A 40000 CT Chest, biopsy
speciality HPE report
3A.S1.00222A : Procedures Requiring Bypass Techniques
S1 3A.S1.00222A 35000 Angiogram Scar photo
- cross speciality
S1 3A.S1.00231A 3A.S1.00231A : Thorachostomy - cross speciality 10000 Chest X Ray Chest X Ray
S1 3A.S1.00233A 3A.S1.00233A : Thoracoplasty - cross speciality 20000 X-ray, CT X-ray
3A.S1.00234A : Thoracoscopic Decortication - cross
S1 3A.S1.00234A 25000 Clinical Photograph Scar photo
speciality
3A.S1.00235B : Thoracoscopic Hydatid Cyst excision -
S1 3A.S1.00235B 20000 Chest X-ray / CT Scar photo, HPE
cross speciality
3A.S1.00236A : Thoracoscopic Lobectomy - cross
S1 3A.S1.00236A 25000 CT/MRI Scar photo, HPE
speciality
3A.S1.00237A : Thoracoscopic Pneumonectomy - cross
speciality
3A.S1.00238A : Thoracoscopic Segmental Resection -
cross speciality
3A.S1.00239A : Thoracoscopic Sympathectomy - cross
S1 3A.S1.00239A 35000 CT Chest report Post Op X-ray, photo of scar, port
speciality
insertion
3A.S1.00241A : Thorax (penetrating wounds) - CROSS
S1 3A.S1.00241A 12500 X-ray, Clinical photo Post-op clinical photo & X-Ray
SPECIALITY
S13 3A.S13.00089A 3A.S13.00089A : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
CARDIOVASCULAR SURGERY
3A.S13.00072 : Thromboembolectomy (pre-auth not
387 S13 3A.S13.00072 30000 Duplex/Angio Report & stills Scar photo + Intra op photo
required, usually done as emergency)
3A.S13.00073 : Surgery for Arterial Aneursysm -
388 S13 3A.S13.00073 90000 Duplex/Angio Report & stills Scar photo + Intra op photo
Upper/Distal Abdominal Aorta
3A.S13.00075 : Intrathoracic Aneurysm-Requiring Bypass
Techniques
3A.S13.00076 : Surgery for Arterial Aneurysm Renal Renal arterial Doppler, Angiogram
390 S13 3A.S13.00076 50000 Scar photo + Intra op photo
Artery with stills
Renal arterial Doppler,angiogram &
391 S13 3A.S13.00078 3A.S13.00078 : Operations for Stenosis of Renal Arteries 20000 Doppler Report + scar photo
Stills
3A.S13.00079 : Aorto Bi-lliac / Bi femoral /Axillo bi Angiogram/spiral CT Angiogram Stills showing the procedure with graft
392 S13 3A.S13.00079 90000
femoral bypass with Synthetic Graft reports + scar photo
3A.S13.00080 : Femoro Distal / Femoral - Femoral / Angiogram/spiral CT Angiogram Stills showing the procedure with graft
393 S13 3A.S13.00080 50000
Femoral infra popliteal Bypass with Vein Graft reports +Duplex scan, scar photo
3A.S13.00081 : Femoro Distal / Femoral - Femoral / Clinical Photographs Duplex, ABI, scar
394 S13 3A.S13.00081 70000 Angiogram Report
Femoral infra popliteal Bypass with Synthetic Graft photo
3A.S13.00082 : Axillo Brachial Bypass using with Angiogram/spiral CT Angiogram Stills showing the procedure with graft
395 S13 3A.S13.00082 50000
Synthetic Graft reports +Duplex scan, scar photo
3A.S13.00083 : Brachio - Radial Bypass with Synthetic Angiogram/spiral CT Angiogram Stills showing the procedure with graft
396 S13 3A.S13.00083 40000
Graft reports +Duplex scan, scar photo
Speciality
code
3A.S13.00084 : Excision of body Tumor with vascular Stills showing the procedure with graft
397 S13 3A.S13.00084 40000 Angiogram report
repair + scar photo,
Angiogram/spiral CT Angiogram Stills showing the procedure with graft
398 S13 3A.S13.00085 3A.S13.00085 : Carotid artery bypass with Synthetic Graft 60000
reports +Duplex scan, scar photo
3A.S13.00086 : Excision of Arterio Venous malformation - Angiogram/spiral CT Angiogram Stills showing the procedure with graft
399 S13 3A.S13.00086 50000
Large reports + scar photo
3A.S13.00087 : Excision of Arterio Venous malformation - Angiogram/spiral CT Angiogram Stills showing the procedure with graft
400 S13 3A.S13.00087 30000
Small reports + scar photo
3A.S13.00088 : Deep Vein Thrombosis (DVT) - Inferior
401 S13 3A.S13.00088 65000 Color doppler Plain X-ray abdomen showing the filter
Vena Cava (IVC) filter
402 S13 3A.S13.00089 3A.S13.00089 : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
3A.S13.00090 : Aortic Angioplasty with two stents / Iliac ECG, 2D ECHO, CAG stills showing Angioplasty stills showing Balloon &
403 S13 3A.S13.00090 90000
angioplasty with stent Bilateral blocks & Reports post flow,scar photo
404 S13 3A.S13.00091 3A.S13.00091 : Bilateral thrombo embolectomy 40000 Duplex/Angio Report & stills Scar photo + Intra op photo
3A.S13.00092 : Aorto-uni-iliac/uni-femoral bypass with Angiogram/spiral CT Angiogram Stills showing the procedure with graft
405 S13 3A.S13.00092 75000
synthetic graft reports +Duplex scan, scar photo
406 S13 3A.S13.17103 3A.S13.17103 : Pericardiostomy without balloon 10000 2D ECHO report 2D ECHO report + stills of the ECHO
Stills showing the procedure with graft

407 S13 3A.S13.17104 3A.S13.17104 : Carotid/other endarterectomy with patch 50000 Angiogram report
+ scar photo
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing Balloon &
408 S13 3A.S13.17105 3A.S13.17105 : Aortic Angioplasty 40000
blocks & Reports post flow, scar photo
409 S13 3A.S13.17106 3A.S13.17106 : Aortic/ iliac Angioplasty with one stent 60000
blocks & Reports post flow, scar photo
3A.S13.17107 : Aneurysm infra renal aorta /aorto
410 S13 3A.S13.17107 90000 ANGIO/ Spiral CT Angiogram Report Scar photo + Intra op photo
iliac(including graft)
Angiogram/ Computed Tomography

411 S13 3A.S13.17108 3A.S13.17108 : Aorto uni iliac/uni femoral bypass 70000 Angiography (3D-CTA)/Magnetic Duplex scan, scar photo
Resonance Angiography
412 S13 3A.S13.17109 3A.S13.17109 : Peripheral arterial aneurysms 50000 Angiogram Report & Stills Intra op photo
3A.S13.17110 : Aortic Aneurysm Repair using
413 S13 3A.S13.17110 Cardiopulmonary 90000 CT Angio Report Scar photo + Intra op photo
bypass (CPB) including graft*
3A.S8.00025C : Shunt (peritoneal, ventriculo-atrial/

S8 3A.S8.00025C 20000 CT report Clinical Photographs
3A.S1.00068A : Haemangioma – Excision (small) - cross

S1 3A.S1.00068A 5000 clinical photograph Doppler
speciality
3A.S1.00148A : Aneurysm not Requiring Bypass
S1 3A.S1.00148A 36000 CT Angio Report Scar photo + Post op intra op photo
Techniques - cross speciality
3A.S1.00149A : Aneurysm Resection & Grafting - cross
S1 3A.S1.00149A 70000 CT Angio Report Scar photo + Intra op photo
speciality
Speciality
code
S1 3A.S1.00150B 3A.S1.00150B : Arterial Embolectomy - cross speciality 10000 Arterial doppler Scar photo
3A.S1.00151B : Carotid artery aneurysm repair - cross 2D ECHO Report + stills of ECHO +
S1 3A.S1.00151B 20000 2D ECHO Report with stills
speciality Post Op X-ray,scar photo
3A.S1.00155A : Congential Arteriovenus Fistula (large) -
S1 3A.S1.00155A 20000 Arterial doppler, clinical photo Scar photo
cross speciality
3A.S1.00156B : Congential Arteriovenus Fistula (small) -
S1 3A.S1.00156B 10000 Arterial doppler, clinical photo Scar photo
cross speciality
S1 3A.S1.00158B 3A.S1.00158B : Dissecting Aneurysms - cross speciality 36000 2D ECHO Report with stills, Doppler
3A.S1.00159B : Distal Abdominal Aorta repair - cross
S1 3A.S1.00159B 36000 Angiogram/CTA/MRA Scar photo
speciality
3A.S1.00212A : Operations for Acquired Arteriovenous
S1 3A.S1.00212A 15000 Arterial doppler / MRA Scar photo
Fistula - cross speciality
S1 3A.S1.00217A 3A.S1.00217A : Patch Graft Angioplasty - cross speciality 20000 Arterial Doppler Post Op Arterial Doppler, Scar photo
3A.S1.00227A : Surgery for Arterial Aneurysm Spleenic

S1 3A.S1.00227A 20000 CT Angio / MRA Scar photo
Artery - cross speciality
3A.S1.00228A : Surgery for Arterial Aneurism –Vertebral -
S1 3A.S1.00228A 25000 CT Angio / MRA Scar photo
cross speciality
S1 3A.S1.00240A 3A.S1.00240A : Thrombendarterectomy - cross speciality 15000 Arterial doppler, CT Angio/MRA Scar photo
CBC,RBS,RFT,S Electrolytes, HIV,

3A.S10.00002A : Revascularization of limb/digit - - cross Doppler study, Clinical photo and OT
S10 3A.S10.00002A 25000 HbsAg,, CXR, ECG,(X-ray of
speciality note
limb/digit)
3A.S12.00029A : Pulmonary artery stenting (double) - 2D ECHO , Angiogram Report &
S12 3A.S12.00029A 65000 Post procedure Angio stills
cross speciality Stills
2D ECHO , Angiogram Report & Stills
S12 3A.S12.17069A 3A.S12.17069A : Venous stenting* - cross speciality 50000 Post procedure Angio stills
DENTAL AND ORAL AND MAXILLOFACIAL SURGERY
414 S16 3A.S16.00009 3A.S16.00009 : Cleft lip and palate surgery (each stage) 15000 Clinical Photograph Clinical Photograph
CT/MRI report and Film if required/ Clinical Photograph showing scar +

S2 3A.S2.00085A 3A.S2.00085A : Hemiglossectomy - - cross speciality 25000
Biopsy HPE report
S2 3A.S2.00087A 3A.S2.00087A : Partial Glossectomy - cross speciality 25000
Biopsy HPE report
S2 3A.S2.00088A 3A.S2.00088A : Ranula excision - cross speciality 25000
Biopsy HPE report
S2 3A.S2.00090A 3A.S2.00090A : Total Glossectomy - cross speciality 15000 CT Clinical photograph
3A.S6.00004A : Head injury requiring Facio-Maxillary

S6 3A.S6.00004A Injury repairs & fixations (including implants) - cross 35000 X-RAY/CT scan(If Required)
speciality
Speciality
code
3A.S8 .00050A : R.F. Lesion for Trigeminal Neuralgia -
S8 3A.S8 .00050A 15000 MRI Report CD of Procedure
cross speciality
3A.S8.00049A : Peripheral Neurectomy (Trigeminal) -
S8 3A.S8.00049A 16500 MRI Report CD of Procedure
cross speciality
3A.S1.00197B : Operation for Carcinoma Lip –
S1 3A.S1.00197B 10000 Clinical photograph, HPE Scar photo, HPE
Vermilionectomy - cross speciality
3A.S1.00198A : Operation for Carcinoma Lip - Wedge

S1 3A.S1.00198A 12000 Clinical photograph, HPE Scar photo, HPE
Excision and Vermilionectomy - cross speciality
3A.S1.00199A : Operation for Carcinoma Lip - Wedge-

Excision - cross speciality
3A.S1.00209A : Operation for carcinoma lip- cheek
advancement - cross speciality
3A.S14.00034A : Cleft Lip and Palate Surgery (per stage)
S14 3A.S14.00034A 15000 Clinical Photograph Clinical Photograph
- cross speciality
3A.S15.00007A : Palatectomy- Soft palate - cross
S15 3A.S15.00007A 30000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
speciality
3A.S15.00008A : Palatectomy- Hard palate - cross
S15 3A.S15.00008A 20000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
speciality
S15 3A.S15.00014A 3A.S15.00014A : Total Maxillectomy - - cross speciality 18000 CT report and Film, Biopsy
HPE report
ENT
3A.S2.00015 : Excision of Pinna for Growths
415 S2 3A.S2.00015 6500 Clinical Photograph HPR/Clinical photograph
(Squamous/Basal) Injuries Total Amputation
416 S2 3A.S2.00018 3A.S2.00018 : Vidian neurectomy – Micro 9000 Clinical notes OT notes
3A.S2.00020 : Excision of Pinna for Growth
417 S2 3A.S2.00020 4000 Clinical Photograph/ FNAC HPR/Clinical photograph
(Squamous/Basal/ Injuries) Skin and Cartilage
418 S2 3A.S2.00022 3A.S2.00022 : Pharyngectomy and reconstruction 15000 CT Neck HPE, Scar Photo
419 S2 3A.S2.00023 3A.S2.00023 : Skull base surgery 37000 CT-Scan / MRI Scan Clinical Photograph
3A.S2.00024 : Total Amputation & Excision of External
420 S2 3A.S2.00024 7500 Clinical photograph Scar photo HPE
Auditory Meatus
421 S2 3A.S2.00032 3A.S2.00032 : CSF Rhinorrhoea – Repair 43000 CT report Clinical Photograph with Scar
422 S2 3A.S2.00040 3A.S2.00040 : Rhinotomy – Lateral 7500 clinical notes, CT/MRI clinical notes
CT report and film, Clinical Photograph

423 S2 3A.S2.00050 3A.S2.00050 : Cranio-facial resection 70000 CT/MRI Report, Clinical Notes
showing scar + HPE report
424 S2 3A.S2.00059 3A.S2.00059 : Choanal atresia 12500 Clinical photo Clinical photo showing scar
425 S2 3A.S2.00064 3A.S2.00064 : Laryngophayryngectomy 20000 Clinical notes, CT/MRI clinical notes
426 S2 3A.S2.00065 3A.S2.00065 : Maxilla – Excision 12500 Clinical notes, CT/MRI Procedure notes
427 S2 3A.S2.00067 3A.S2.00067 : Parapharyngeal – Exploration 12500 CT/MRI Procedure notes
428 S2 3A.S2.00070 3A.S2.00070 : Pharyngoplasty 10000 CT/MRI Clinical notes
429 S2 3A.S2.00075 3A.S2.00075 : Total Parotidectomy 40000 FNAC,CT
HPE report
Speciality
code
Clinical photo showing scar, BIOPSY,
3A.S2.00081 : Excision of Cystic Hygroma Major/
430 S2 3A.S2.00081 10000 Clinical notes & photo, USG/CT Operative notes with steps of surgery
Extensive
& Clinical notes
431 S2 3A.S2.00085 3A.S2.00085 : Hemiglossectomy 25000 CT/MRI, Biopsy
HPE report
432 S2 3A.S2.00087 3A.S2.00087 : Partial Glossectomy 25000 CT/MRI, Biopsy
HPE report
433 S2 3A.S2.00088 3A.S2.00088 : Ranula excision 25000 CT/MRI, Biopsy
HPE report
434 S2 3A.S2.00090 3A.S2.00090 : Total Glossectomy 15000 CT, Biopsy HPE Report
Biopsy , Clinical Photograph, HPE
435 S2 3A.S2.00091 3A.S2.00091 : Total Laryngectomy + Neck dissection 25000 CT, Biopsy
Report
3A.S2.00092 : Laryngopharyngectomy with Gastric pull- Clinical Photograph showing scar +
436 S2 3A.S2.00092 30000 CT , Biopsy
up/ jejunal graft HPE report
3A.S2.00093 : Excision of CA cheek/ oral cavity + radial Clinical photograph showing scar +
437 S2 3A.S2.00093 30000 CT , Biopsy
forearm flap HPE report
3A.S2.00094 : Excision of growth Jaw + free fibular flap Clinical Photograph showing scar +
438 S2 3A.S2.00094 25000 CT , Biopsy
reconstruction HPE report
3A.S1.00045A : Excision of Growth from Tongue with OT notes, HPE
S1 3A.S1.00045A 15000
neck node dissection - cross speciality CT/MRI, Clinical Photo
3A.S1.00114B : Radical Neck Dissection – Excision - cross Clinical photo, Clinical notes &
S1 3A.S1.00114B 15000 Scar photo & HPE
speciality Biopsy/ Cytology
3A.S1.00134B : Submandibular Mass Excision + CT/MRI/USG report and Film if Clinical Photograph showing scar +
S1 3A.S1.00134B 25000
Reconstruction - Cross speciality required/ Biopsy HPE report
3A.S1.00138A : Pharyngectomy& Reconstruction – Total -
S1 3A.S1.00138A 12000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
cross specaility
3A.S1.00139B : Tracheal Stenosis (End to end
S1 3A.S1.00139B 15000 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat) - cross speciality
S1 3A.S1.00140B 3A.S1.00140B : Tracheoplasty (Throat) - cross speciality 40000 CT / Bronchoscopy report CT / Bronchoscopy report
3A.S1.00146A : Cleft palate repair (for each stage) -

S1 3A.S1.00146A 12000 Clinical photo Scar photo
cross speciality
3A.S1.00152B : Carotid Body tumour - Excision - cross Angiogram/spiral CT Angiogram Stills showing the procedure +Duplex
S1 3A.S1.00152B 35000
speciality reports scan, scar photo
3A.S1.00162B : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
S1 3A.S1.00162B 30000
Adenoma/Carcinoma - cross speciality reports/USG HPE report
3A.S1.00215A : Parapharyngeal Tumour Excision - cross
S1 3A.S1.00215A 11000 USG, CT Neck USG,HPE,Scar Photo
speciality
Speciality
code
3A.S10.00001A : Ear Pinna Reconstruction with costal

cartilage/ Prosthesis (including the cost of
prosthesis/implants). *If requiring multiple stages, each OT note with clinical photograph of
S10 3A.S10.00001A 3000 X-ray and clinical note
stage will cost Rs. 30,000 provided the operating stages
surgeon demonstrates the photographic results of
previous stages. - cross speciality
GENERAL MEDICINE
3A.M1.00002 : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
439 M1 3A.M1.00002 1800
routine ward investigations, Clinical notes
3A.M1.00002A : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002A 2700
HDU investigations, Clinical notes
3A.M1.00002B : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002B 3600
ICU without ventilator investigations, Clinical notes
3A.M1.00002C : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002C 4500
ICU with ventilator investigations, Clinical notes
clinical notes, Blood examination clinical notes
440 M1 3A.M1.00016 3A.M1.00016 : Chikungunya fever - routine ward 1800
report
M1 3A.M1.00016A 3A.M1.00016A : Chikungunya fever - HDU 2700
report
3A.M1.00016B : Chikungunya fever - ICU without clinical notes, Blood examination clinical notes
M1 3A.M1.00016B 3600
ventilator report
M1 3A.M1.00016C 3A.M1.00016C : Chikungunya fever - ICU with ventilator 4500
report
3A.M1.00032 : Acute inflammatory demyelinating clinical notes clinical notes
441 M1 3A.M1.00032 1800
polyneuropathy - routine ward
3A.M1.00032A : Acute inflammatory demyelinating clinical notes clinical notes
M1 3A.M1.00032A 2700
polyneuropathy - HDU
clinical notes clinical notes
3A.M1.00032B : Acute inflammatory demyelinating
M1 3A.M1.00032B 3600
polyneuropathy - ICU without ventilator
clinical notes clinical notes

3A.M1.00032C : Acute inflammatory demyelinating
M1 3A.M1.00032C 4500
polyneuropathy - iCU with ventilator
3A.M1.00034 : Acute and chronic meningitis - routine Clinical Notes with relevant
442 M1 3A.M1.00034 1800 Treatment Notes
ward investigations
M1 3A.M1.00034A 3A.M1.00034A : Acute and chronic meningitis - HDU 2700 Treatment Notes
investigations
3A.M1.00034B : Acute and chronic meningitis - ICU Clinical Notes with relevant
M1 3A.M1.00034B 3600 Treatment Notes
3A.M1.00034C : Acute and chronic meningitis - ICU with Clinical Notes with relevant
M1 3A.M1.00034C 4500 Treatment Notes
clinical notes, Blood examination clinical notes, Blood examination report
443 M1 3A.M1.00038 3A.M1.00038 : Visceral leishmaniasis - routine ward 1800
report
Speciality
code
M1 3A.M1.00038A 3A.M1.00038A : Visceral leishmaniasis - HDU 2700
report
3A.M1.00038B : Visceral leishmaniasis - ICU without clinical notes, Blood examination clinical notes, Blood examination report
M1 3A.M1.00038B 3600
ventilator report
3A.M1.00038C : Visceral leishmaniasis - ICU with clinical notes, Blood examination clinical notes, Blood examination report
M1 3A.M1.00038C 4500
ventilator report
444 M1 3A.M1.00039 3A.M1.00039 : HIV with complications - routine ward 1800
report
M1 3A.M1.00039A 3A.M1.00039A : HIV with complications - HDU 2700
report
3A.M1.00039B : HIV with complications - ICU without clinical notes, Blood examination clinical notes
M1 3A.M1.00039B 3600
ventilator report
3A.M1.00039C : HIV with complications - ICU with clinical notes, Blood examination clinical notes
M1 3A.M1.00039C 4500
ventilator report
clinical notes, CT clinical notes, CT
445 M1 3A.M1.00041 3A.M1.00041 : Metabolic encephalopathy - routine ward 1800
M1 3A.M1.00041A 3A.M1.00041A : Metabolic encephalopathy - HDU 2700 clinical notes, CT clinical notes, CT
3A.M1.00041B : Metabolic encephalopathy - ICU clinical notes, CT clinical notes, CT
M1 3A.M1.00041B 3600
without ventilator
3A.M1.00041C : Metabolic encephalopathy - ICU with clinical notes, CT clinical notes, CT
M1 3A.M1.00041C 4500
ventilator
446 M1 3A.M1.00042 3A.M1.00042 : Sickle cell Anemia - routine ward 1800 Clinical notes confirming digonosis clinical notes in relevant reports
M1 3A.M1.00042A 3A.M1.00042A : Sickle cell Anemia - HDU 2700 Clinical notes confirming digonosis clinical notes in relevant reports
3A.M1.00042B : Sickle cell Anemia - ICU without

M1 3A.M1.00042B 3600 Clinical notes confirming digonosis clinical notes in relevant reports
ventilator
M1 3A.M1.00042C 3A.M1.00042C : Sickle cell Anemia - ICU with ventilator 4500 Clinical notes confirming digonosis clinical notes in relevant reports
3A.M1.00043 : Poisonings with unstable vitals - routine

447 M1 3A.M1.00043 1800 Clinical notes Clinical notes
ward
M1 3A.M1.00043A 3A.M1.00043A : Poisonings with unstable vitals - HDU 2700 Clinical notes Clinical notes
3A.M1.00043B : Poisonings with unstable vitals - ICU

M1 3A.M1.00043B 3600 Clinical notes Clinical notes
without ventilator
3A.M1.00043C : Poisonings with unstable vitals - ICU
M1 3A.M1.00043C 4500 Clinical notes Clinical notes
with ventilator
448 M1 3A.M1.00047 3A.M1.00047 : Severe pneumonia - routine ward 1800 Treatment Notes
investigations, X-ray/USG of chest
M1 3A.M1.00047A 3A.M1.00047A : Severe pneumonia- HDU 2700 Treatment Notes
3A.M1.00047B : Severe pneumonia - ICU without Clinical Notes with relevant
ventilator investigations, X-ray/USG of chest
Speciality
code
M1 3A.M1.00047C 3A.M1.00047C : Severe pneumonia - ICU with ventilator 4500 Treatment Notes
clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
449 M1 3A.M1.00058 3A.M1.00058 : Lower GI hemorrhage - routine ward 1800
M1 3A.M1.00058A 3A.M1.00058A : Lower GI hemorrhage - HDU 2700 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
3A.M1.00058B : Lower GI hemorrhage - ICU without clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
M1 3A.M1.00058B 3600
ventilator
3A.M1.00058C : Lower GI hemorrhage - ICU with clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
M1 3A.M1.00058C 4500
ventilator
450 M1 3A.M1.00062 3A.M1.00062 : Hydrocephalus - routine ward 1800 CT Report CT Report, Scar Photo, X Ray
M1 3A.M1.00062A 3A.M1.00062A : Hydrocephalus - HDU 2700 CT Report CT Report, Scar Photo, X Ray
M1 3A.M1.00062B 3A.M1.00062B : Hydrocephalus - ICU without ventilator 3600 CT Report CT Report, Scar Photo, X Ray
M1 3A.M1.00062C 3A.M1.00062C : Hydrocephalus - ICU with ventilator 4500 CT Report CT Report, Scar Photo, X Ray
3A.M1.00063 : Cerebral sino-venous thrombosis -

451 M1 3A.M1.00063 1800 Clinical notes, CT - brain Clinical notes, CT - brain
routine ward
M1 3A.M1.00063A 3A.M1.00063A : Cerebral sino-venous thrombosis - HDU 2700 Clinical notes, CT - brain Clinical notes, CT - brain
3A.M1.00063B : Cerebral sino-venous thrombosis - ICU

M1 3A.M1.00063B 3600 Clinical notes, CT - brain Clinical notes, CT - brain
without ventilator
3A.M1.00063C : Cerebral sino-venous thrombosis - ICU
M1 3A.M1.00063C 4500 Clinical notes, CT - brain Clinical notes, CT - brain
with ventilator
452 M1 3A.M1.00069 3A.M1.00069 : Plasmapheresis - per session 2000 Blood examination Blood examination
3A.M1.00070 : Haemodialysis/Peritoneal Dialysis (only Clinical Notes with relevant
for ARF) - per session investigations
3A.M2.00015D : Chronic cough - cross speciality -
M2 3A.M2.00015D 1800 Clinical note with Lab reports Treatment note
routine ward
M2 3A.M2.00015E 3A.M2.00015E : Chronic cough - cross speciality - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00015F : Chronic cough - cross speciality - ICU

M2 3A.M2.00015F 4500 Clinical note with Lab reports Treatment note
with ventilator
3A.M2.00015G : Chronic cough - cross speciality - ICU
M2 3A.M2.00015G 3600 Clinical note with Lab reports Treatment note
without ventilator
GENERAL SURGERY
454 S1 3A.S1.00002 3A.S1.00002 : Anterior Resection for Ca 70000 Endoscopy, biopsy, CT report with film
HPE report
455 S1 3A.S1.00007 3A.S1.00007 : Bilateral Inguinal block dissection 40000 Biopsy Reports
HPE report
USG/CT, Clinical notes OT note
456 S1 3A.S1.00008 3A.S1.00008 : Bleeding Ulcer - Gastrectomy & vagotomy 25000
457 S1 3A.S1.00014 3A.S1.00014 : Branchial Cyst 10000 USG/CT Scar Photo, HPE Report
458 S1 3A.S1.00016 3A.S1.00016 : Bypass - Inoperable Pancreas 15000 USG/CT USG, Scar photo, HPE Report
Speciality
code
3A.S1.00045 : Excision of Growth from Tongue with neck OT notes, HPE
459 S1 3A.S1.00045 15000
node dissection CT/MRI, Clinical Photo
460 S1 3A.S1.00059 3A.S1.00059 : Fundoplication 35000 Contrast X ray/endoscopy findings Clinical Photograph showing scar
461 S1 3A.S1.00064 3A.S1.00064 : Gastrostomy 15000 USG/ CT Scan Clinical photograph

462 S1 3A.S1.00068 3A.S1.00068 : Haemangioma – Excision (small) 5000 clinical photograph Doppler
463 S1 3A.S1.00070 3A.S1.00070 : Hepatic Resection (lobectomy) 20000 MRI/ CT Abdomen Scar Photo, HPE Report
464 S1 3A.S1.00078 3A.S1.00078 : Hiatus Hernia – abdominal 40000 UGI ENDOSCOPY Scar photo/ Intra op photo
465 S1 3A.S1.00084 3A.S1.00084 : Inguinal Node (dissection) - Unilateral 20000 Biopsy Reports/ Clinical Photograph
HPE report
466 S1 3A.S1.00087 3A.S1.00087 : Intussusception 15000 USG/CT , Clinical notes Scar photo
467 S1 3A.S1.00092 3A.S1.00092 : Burst Abdomen Obstruction 15000 Clinical Photograph, Clinical notes HPR , Scar photo & Clinical Photograph,
468 S1 3A.S1.00103 3A.S1.00103 : Oesophagectomy 60000 Biopsy , CT , Endoscopy reports HPE report, scar photo
469 S1 3A.S1.00104 3A.S1.00104 : Portal Hypertension shunt surgery 50000 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar
CT-Scan , ERCP , ER Clinical
470 S1 3A.S1.00106 3A.S1.00106 : PancreaticoDuodenectomy 25000 HPR , Scar Photograph
Photograph , Endoscopy
471 S1 3A.S1.00112 3A.S1.00112 : Pyeloroplasty 10000 USG, Clinical Notes Scar photo, HPE
472 S1 3A.S1.00113 3A.S1.00113 : Radical Mastectomy 10000 Mammography, HPE, CT Scan Scar photo & HPE
Clinical photo, Clinical notes &
473 S1 3A.S1.00114 3A.S1.00114 : Radical Neck Dissection – Excision 15000 Scar photo & HPE
Biopsy/ Cytology
474 S1 3A.S1.00115 3A.S1.00115 : Hernia – Spigelian 5000 USG Clinical Notes, Scar photo and OT notes
475 S1 3A.S1.00117 3A.S1.00117 : Prolapse of Rectal Mass – Excision 10000 Clinical Findings Procedure Notes
476 S1 3A.S1.00120 3A.S1.00120 : Resection Anastomosis (Large Intestine) 15000 USG / CT Scan Scar photo, HPE
477 S1 3A.S1.00121 3A.S1.00121 : Resection Anastomosis (Small Intestine) 15000 USG / CT Scan Scar photo, HPE

478 S1 3A.S1.00122 3A.S1.00122 : Retroperitoneal Tumor – Excision 50000 CT abdomen with film, FNAC
HPE report
479 S1 3A.S1.00125 3A.S1.00125 : Segmental Resection of Breast 10000 Mamography, FNAC, CT if indicated Scar photo, HPE
Biopsy of the primary tumour +

480 S1 3A.S1.00131 3A.S1.00131 : Soft Tissue Tumor (large) – Excision 35000 Scar photo, HPE
CT/MRI with film
3A.S1.00134 : Submandibular Mass Excision + CT/MRI/USG report and Film if Clinical Photograph showing scar +
481 S1 3A.S1.00134 25000
Reconstruction required/ Biopsy HPE report
482 S1 3A.S1.00138 3A.S1.00138 : Pharyngectomy& Reconstruction – Total 12000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
3A.S1.00139 : Tracheal Stenosis (End to end

483 S1 3A.S1.00139 15000 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat)
484 S1 3A.S1.00140 3A.S1.00140 : Tracheoplasty (Throat) 40000 CT / Bronchoscopy report CT / Bronchoscopy report
485 S1 3A.S1.00146 3A.S1.00146 : Cleft palate repair (for each stage) 12000 Clinical photo Scar photo
3A.S1.00148 : Aneurysm not Requiring Bypass
486 S1 3A.S1.00148 36000 CT Angio Report Scar photo + Post op intra op photo
Techniques
Speciality
code
487 S1 3A.S1.00149 3A.S1.00149 : Aneurysm Resection & Grafting 70000 CT Angio Report Scar photo + Intra op photo
488 S1 3A.S1.00150 3A.S1.00150 : Arterial Embolectomy 10000 Arterial doppler Scar photo
489 S1 3A.S1.00151 3A.S1.00151 : Carotid artery aneurysm repair 20000 Arterial doppler / CT Angio Scar photo
Angiogram/Spiral CT Angiogram Stills showing the procedure +Duplex
490 S1 3A.S1.00152 3A.S1.00152 : Carotid Body tumour - Excision 35000
reports scan, scar photo
491 S1 3A.S1.00155 3A.S1.00155 : Congential Arteriovenus Fistula (large) 20000 Arterial doppler, clinical photo Scar photo
492 S1 3A.S1.00156 3A.S1.00156 : Congential Arteriovenus Fistula (small) 10000 Arterial doppler, clinical photo Scar photo
493 S1 3A.S1.00157 3A.S1.00157 : Decortication (Pleurectomy) 50000 CT Chest Post Op X-ray,scar photo
494 S1 3A.S1.00158 3A.S1.00158 : Dissecting Aneurysms 36000 2D ECHO Report with stills, Doppler
495 S1 3A.S1.00159 3A.S1.00159 : Distal Abdominal Aorta repair 36000 Angiogram/CTA/MRA Scar photo
496 S1 3A.S1.00160 3A.S1.00160 : Estlander Operation (lip) 7000 Clinical notes and photograph Scar photo
3A.S1.00162 : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
497 S1 3A.S1.00162 30000
Adenoma/Carcinoma reports/USG HPE report
498 S1 3A.S1.00163 3A.S1.00163 : Flap Reconstructive Surgery 30000 X-ray Films + detail notes Clinical photo showing Scar
3A.S1.00165 : Split thickness skin grafts – Medium (4 -
499 S1 3A.S1.00165 10000 Clinical photograph Scar photo
8% TBSA)
500 S1 3A.S1.00167 3A.S1.00167 : Free Grafts - Wolfe Grafts 10000 Clinical photograph Scar photo
501 S1 3A.S1.00171 3A.S1.00171 : Lap. Assisted left Hemi colectomy t 25000 CT , colonoscopy , USG USG, Scar Photo, HPE
502 S1 3A.S1.00172 3A.S1.00172 : Lap. Assisted Right Hemi colectomy t 25000 CT , colonoscopy , USG USG, Scar Photo, HPE

503 S1 3A.S1.00173 3A.S1.00173 : Lap. Assisted small bowel resection 40000 CT, Biopsy
HPE report
Colonocopy with film, biopsy, CT Clinical Photograph showing scar +
504 S1 3A.S1.00174 3A.S1.00174 : Lap. Assisted Total Colectomy 40000
report with film HPE report
505 S1 3A.S1.00179 3A.S1.00179 : Laparoscopic Adhesinolysis 15000 MRI/ CT Abdomen Scar Photo, HPE Report
Pre-operative Doppler study, CT
Post-operative Doppler study, Clinical
506 S1 3A.S1.00193 3A.S1.00193 : Repair of Main Arteries of the Limbs 10000 angio(Optional)+ Films+ detailed
photo showing scar
Clinical notes
507 S1 3A.S1.00194 3A.S1.00194 : Mediastinal Tumour 50000 Biopsy/FNAC ,CT
3A.S1.00195 : Oesophagectomy for Carcinoma
508 S1 3A.S1.00195 50000 Biopsy , CT , Endoscopy reports HPE report, scar photo
Oesophagus
3A.S1.00197 : Operation for Carcinoma Lip –
509 S1 3A.S1.00197 10000 Clinical photograph, HPE Scar photo, HPE
Vermilionectomy
3A.S1.00198 : Operation for Carcinoma Lip - Wedge
Excision and Vermilionectomy
3A.S1.00199 : Operation for Carcinoma Lip - Wedge-
Excision
3A.S1.00200 : Appendicectomy - Appendicular Abscess –
512 S1 3A.S1.00200 12000 Clinical notes, USG/ CT Scar photo, HPE
Drainage
513 S1 3A.S1.00201 3A.S1.00201 : Caecostomy 10000 Clinical notes, USG/ CT Scar photo, HPE
Speciality
code
514 S1 3A.S1.00202 3A.S1.00202 : Closure of Colostomy 30000 Colonoscopy, Biopsy Clinical Photograph showing scar
515 S1 3A.S1.00205 3A.S1.00205 : CystoJejunostomy/or Cystogastrostomy 20000 USG/ CT Scan Clinical photograph
516 S1 3A.S1.00207 3A.S1.00207 : Hernia -hiatus-Transthoracic 25000 UGI ENDOSCOPY Scar photo/ Intra op photo
3A.S1.00209 : Operation for carcinoma lip- cheek
advancement
3A.S1.00212 : Operations for Acquired Arteriovenous
518 S1 3A.S1.00212 15000 Arterial doppler / MRA Scar photo
Fistula
3A.S1.00213 : Operations for Replacement of
519 S1 3A.S1.00213 25000 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon
520 S1 3A.S1.00215 3A.S1.00215 : Parapharyngeal Tumour Excision 11000 USG, CT Neck USG,HPE,Scar Photo
521 S1 3A.S1.00216 3A.S1.00216 : Partial/Subtotal Gastrectomy for Carcinoma 50000 Endoscopy, biopsy, CT
HPE report
522 S1 3A.S1.00217 3A.S1.00217 : Patch Graft Angioplasty 20000 Arterial Doppler Post Op Arterial Doppler, Scar photo

523 S1 3A.S1.00218 3A.S1.00218 : Pericardiostomy 10000 2D ECHO
524 S1 3A.S1.00219 3A.S1.00219 : Pneumonectomy 60000 CT Chest Post Op X-ray,scar photo
525 S1 3A.S1.00221 3A.S1.00221 : Removal Tumours of Chest Wall 40000 CT Chest, biopsy
HPE report
526 S1 3A.S1.00222 3A.S1.00222 : Procedures Requiring Bypass Techniques 35000 Angiogram Scar photo
527 S1 3A.S1.00225 3A.S1.00225 : Skin Flaps - Rotation Flaps 6200 Clinical photo Scar photo
3A.S1.00227 : Surgery for Arterial Aneurysm Spleenic
528 S1 3A.S1.00227 20000 CT Angio / MRA Scar photo
Artery
529 S1 3A.S1.00228 3A.S1.00228 : Surgery for Arterial Aneurism –Vertebral 25000 CT Angio / MRA Scar photo
Clinical notes & Photo, Arterial

530 S1 3A.S1.00229 3A.S1.00229 : Sympathetectomy – Cervical 5000 Scar photo
doppler
531 S1 3A.S1.00230 3A.S1.00230 : Temporal Bone resection 60000 CT/MRI, Biopsy
HPE report
532 S1 3A.S1.00231 3A.S1.00231 : Thorachostomy 10000 Chest X Ray Chest X Ray
533 S1 3A.S1.00233 3A.S1.00233 : Thoracoplasty 20000 X-ray, CT X-ray
534 S1 3A.S1.00234 3A.S1.00234 : Thoracoscopic Decortication 25000 Clinical Photograph Scar photo
535 S1 3A.S1.00235 3A.S1.00235 : Thoracoscopic Hydatid Cyst excision 20000 Chest X-ray / CT Scar photo, HPE
536 S1 3A.S1.00236 3A.S1.00236 : Thoracoscopic Lobectomy 25000 CT/MRI Scar photo, HPE
537 S1 3A.S1.00237 3A.S1.00237 : Thoracoscopic Pneumonectomy 30000 CT/MRI Scar photo, HPE
538 S1 3A.S1.00238 3A.S1.00238 : Thoracoscopic Segmental Resection 25000 CT/MRI Scar photo, HPE
539 S1 3A.S1.00239 3A.S1.00239 : Thoracoscopic Sympathectomy 35000 CT Chest Post Op X-ray, photo of scar, port
insertion
540 S1 3A.S1.00240 3A.S1.00240 : Thrombendarterectomy 15000 Arterial doppler, CT Angio/MRA Scar photo
541 S1 3A.S1.00241 3A.S1.00241 : Thorax (penetrating wounds) 12500 X-ray, Clinical photo Post-op clinical photo & X-Ray
Speciality
code
542 S1 3A.S1.00242 3A.S1.00242 : Total Thyroidectomy and Block Dissection 20000 Clinical Photograph , USG Scar photo, HPE
543 S1 3A.S1.00247 3A.S1.00247 : Adhenolysis + Appendicectomy 20000 MRI/ CT Abdomen Scar Photo, HPE Report
3A.S1.17005 : Prostate surgery (Code 3A.561) -
544 S1 3A.S1.17005 25000 CT report and Film, Biopsy Clinical Photograph, HPE report
additional cost
3A.S1.17006 : Nephrectomy – partial (Code 3A.451)- CT report with film, Isotope Clinical Photograph showing scar+ HPE
545 S1 3A.S1.17006 25000
additional cost renogram if required report +USG Report
3A.S1.17007 : Low AR and APR (Code 3A.417, 3A.418) - Endoscopy with film, biopsy, CT Clinical Photograph showing scar +
546 S1 3A.S1.17007 25000
additional cost report with film HPE report
3A.S1.17008 : Radical hysterectomy for Ca cervix and Ca Clinical Photograph showing scar +
547 S1 3A.S1.17008 20000 CT report and Film, Biopsy
endometrium ( Code 3A.484)- additional cost HPE report
3A.S10.00003A : Hemangioma – Sclerotherapy (under CBC,RBS,RFT,S Electrolytes, HIV,

S10 3A.S10.00003A 35000 MRI/MRA
GA) - cross speciality HbsAg,CXR, ECG MRI/MRA
3A.S10.00004A : Hemangioma – Debulking/ Excision - CT report OT note,Scar photo
S10 3A.S10.00004A 35000
cross speciality
3A.S10.00008A : Pressure Sore – Surgery - cross CBC,RBS,RFT,S Electrolytes, HIV,
S10 3A.S10.00008A 30000 Clinical photo and OT note
speciality HbsAg, CXR, ECG, Pus for C/S
3A.S10.00009A : Diabetic Foot – Surgery - cross
S10 3A.S10.00009A 30000 HbsAg,, CXR, ECG, Pus for C/S, MRI/MRA
speciality
MRI/MRA
S14 3A.S14.00016A 3A.S14.00016A : Anti GERD Surgery - Cross speciaity 10000 USG and Clinical notes OT Note

S2 3A.S2.00075A 3A.S2.00075A : Total Parotidectomy - - cross speciality 40000 FNAC,CT
HPE report
Clinical photo showing scar, / BIOPSY,
3A.S2.00081A : Excision of Cystic Hygroma Major/
S2 3A.S2.00081A 10000 Clinical notes & photo, USG/CT Operative notes with steps of surgery
Extensive - cross speciality
& Clinical notes
S6 3A.S6.17024A 3A.S6.17024A : Visceral injuries severe - cross speciality 60000 Post-Operative X-ray, scar photo
sound
3A.S6.17025A : Chest injuries with ICD bilateral - cross Post-Operative chest X-ray with ICD in
S6 3A.S6.17025A 11000 X-ray /ultra sound
speciality situ
3A.S6.17026A : Chest injuries with ICD + ICU - cross Post-Operative chest X-ray with ICD in
speciality situ
3A.S6.17027A : Chest injuries with ICD + ICU + Post-Operative chest X-ray with ICD in
Ventilator - cross speciality situ
S8 3A.S8.00075A 3A.S8.00075A : Nerve Decompression - cross speciality 20000 Nerve Conductions study Clinical Photographs showing scar
Nerve Conduction Velocity (Nerve

3A.S8.00076A : Peripheral Nerve Surgery Major - cross
S8 3A.S8.00076A 45000 conduction velocity (NCV)) and Clinical Photographs showing scar
speciality
Electromyography (EMG) reports
Speciality
code

3A.S8.00077B : Peripheral Nerve Surgery Minor - cross
S8 3A.S8.00077B 15000 conduction velocity (NCV) / Clinical Photographs showing scar
speciality
3A.M4.00035A# : Bone tumors/soft tissue sarcomas :

M4 3A.M4.00035A 235000 CT scan/MRI ,USG abdomen pelvis, X-ray, CT Scan, Clinical photograph
surgery (inlcuding prosthesis) - cross speciality
Clinical photograph Hemogram report
Pre-operative Doppler study, CT
3A.S1.00193A : Repair of Main Arteries of the Limbs - Post-operative Doppler study, Clinical
S1 3A.S1.00193A 10000 angio(Optional)+ Films+ detailed
cross speciality photo showing scar
Clinical notes
INTERVENTIONAL NEURORADIOLOGY
3A.S9.00001 : Coil embolization for aneurysms (includes

548 S9 3A.S9.00001 cost of first 3 coils + balloon and/ or stent if used) 1 to 100000 ANGIOGRAM , MRI Angio Clinical Photograph
20 coils may be required as per need.
3A.S9.00002 : Additional coil for coil embolization for

549 S9 3A.S9.00002 24000 ANGIOGRAM , MRI Angio Clinical Photograph
aneurysms
Hematological and radiological Hematological and radiological
550 S9 3A.S9.00003 3A.S9.00003 : Dural AVMs/AVFs (per sitting) with glue 70000
investigations, CT/MRI investigations, CT/MRI
551 S9 3A.S9.00004 3A.S9.00004 : Dural AVMs/AVFs (per sitting) with onyx 150000
3A.S9.00005 : Carotico-cavernous Fistula (CCF)

552 S9 3A.S9.00005 embolization with coils. [includes 5 coils, guide catheter, 150000
micro-catheter, micro-guidewire, general items]
3A.S9.00006 : Carotid-cavernous Fistula (CCF)

553 S9 3A.S9.00006 embolization with balloon (includes one balloon, guide 75000
catheter, micro-catheter, micro-guidewire, general items)
3A.S9.00007 : Cerebral & Spinal AVM embolization (per

554 S9 3A.S9.00007 100000 ANGIOGRAM , MRI Angio Clinical Photograph
sitting). Using Histoacryl
555 S9 3A.S9.00008 3A.S9.00008 : Parent vessel occlusion - Basic 30000

556 S9 3A.S9.00009 3A.S9.00009 : Additonal coil for Parent Vessel Occlusion 24000 Time (PT), International normalized CT, PT,INR, Hb, Serum Creatinine

3A.S9.00010 : Additonal balloon for Parent Vessel
557 S9 3A.S9.00010 11000 Time (PT), International normalized CT, PT,INR, Hb, Serum Creatinine
Occlusion
Speciality
code

558 S9 3A.S9.00011 3A.S9.00011 : Balloon test occlusion 70000 Time (PT), International normalized CT, PT,INR, Hb, Serum Creatinine
USG, clotting Time (CT), Prothrombin

3A.S9.00012 : Intracranial balloon angioplasty with
559 S9 3A.S9.00012 1,60,000 Time (PT), International normalized USG, CT,PT,INR, Hb, Serum Creatinine
stenting
ratio (INR), Hb, Serum Creatinine
CT/MRI, Prothrombin Time (PT),

560 S9 3A.S9.00013 3A.S9.00013 : Intracranial thrombolysis / clot retrieval 1,60,000 International normalized ratio (INR) CT/MRI, PT,INR, Hb, Serum Creatinine
Hb, Serum Creatinine
3A.S9.00014 : Pre-operative tumour embolization (per Chest x-Ray/CT Scan, Hb, Serum Chest x-Ray/CT Scan, Hb, Serum
561 S9 3A.S9.00014 40000
session) Creatinine Creatinine
562 S9 3A.S9.00015 3A.S9.00015 : Vertebroplasty 40000
3A.M2.00007 : Acute urticaria/ Anaphylaxis acute
563 M2 3A.M2.00007 1800 Clinical note with Lab reports Treatment note
asthma - routine ward
3A.M2.00007A : Acute urticaria/ Anaphylaxis acute
M2 3A.M2.00007A 2700 Clinical note with Lab reports Treatment note
asthma - HDU
3A.M2.00007B : Acute urticaria/ Anaphylaxis acute
M2 3A.M2.00007B 3600 Clinical note with Lab reports Treatment note
asthma - ICU without ventilator
3A.M2.00007C : Acute urticaria/ Anaphylaxis acute
M2 3A.M2.00007C 4500 Clinical note with Lab reports Treatment note
asthma - ICU with ventilator
564 M2 3A.M2.00011 3A.M2.00011 : Optic neuritis - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00011A 3A.M2.00011A : Optic neuritis - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00011B 3A.M2.00011B : Optic neuritis - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00011C 3A.M2.00011C : Optic neuritis - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
565 M2 3A.M2.00015 3A.M2.00015 : Chronic cough - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00015A 3A.M2.00015A : Chronic cough - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00015B 3A.M2.00015B : Chronic cough - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00015C 3A.M2.00015C : Chronic cough - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
566 M2 3A.M2.00016 3A.M2.00016 : Wheezing - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00016A 3A.M2.00016A : Wheezing - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00016B 3A.M2.00016B : Wheezing - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00016C 3A.M2.00016C : Wheezing - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
3A.M2.00018 : Global developmental delay/ Intellectual

disability of unknown etiology - routine ward
3A.M2.00018A : Global developmental delay/ Intellectual

disability of unknown etiology - HDU
Speciality
code
3A.M2.00018B : Global developmental delay/ Intellectual

disability of unknown etiology - ICU without ventilator
3A.M2.00018C : Global developmental delay/ Intellectual

disability of unknown etiology - ICU with ventilator
568 M2 3A.M2.00036 3A.M2.00036 : HIV with complications - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00036A 3A.M2.00036A : HIV with complications - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00036B : HIV with complications - ICU without
ventilator
3A.M2.00036C : HIV with complications - ICU with
ventilator
569 M2 3A.M2.00042 3A.M2.00042 : Persistent pneumonia - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00042A 3A.M2.00042A : Persistent pneumonia - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00042B : Persistent pneumonia - ICU without
ventilator
3A.M2.00042C : Persistent pneumonia - ICU with
ventilator
570 M2 3A.M2.00049 3A.M2.00049 : Chronic meningitis - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00049A 3A.M2.00049A : Chronic meningitis - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00049B : Chronic meningitis - ICU without
ventilator
M2 3A.M2.00049C 3A.M2.00049C : Chronic meningitis - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
571 M2 3A.M2.00058 3A.M2.00058 : Metabolic encephalopathy - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00058A 3A.M2.00058A : Metabolic encephalopathy - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00058B : Metabolic encephalopathy - ICU
without ventilator
3A.M2.00058C : Metabolic encephalopathy - ICU with
ventilator
572 M2 3A.M2.00061 3A.M2.00061 : Wilson’s disease - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00061A 3A.M2.00061A : Wilson’s disease - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00061B 3A.M2.00061B : Wilson’s disease - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00061C 3A.M2.00061C : Wilson’s disease - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
573 M2 3A.M2.00062 3A.M2.00062 : Celiac disease - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00062A 3A.M2.00062A : Celiac disease - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00062B 3A.M2.00062B : Celiac disease - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00062C 3A.M2.00062C : Celiac disease - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
Speciality
code
3A.M2.00064 : Unexplained hepatosplenomegaly -
routine ward
M2 3A.M2.00064A 3A.M2.00064A : Unexplained hepatosplenomegaly - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00064B : Unexplained hepatosplenomegaly - ICU

without ventilator
3A.M2.00064C : Unexplained hepatosplenomegaly - ICU
with ventilator
575 M2 3A.M2.00065 3A.M2.00065 : Severe pneumonia - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00065A 3A.M2.00065A : Severe pneumonia - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00065B : Severe pneumonia - ICU without
ventilator
M2 3A.M2.00065C 3A.M2.00065C : Severe pneumonia - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
3A.M2.00066 : Severe exacerbation of asthma - routine

ward
M2 3A.M2.00066A 3A.M2.00066A : Severe exacerbation of asthma - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00066B : Severe exacerbation of asthma - ICU

without ventilator
3A.M2.00066C : Severe exacerbation of asthma - ICU
with ventilator
577 M2 3A.M2.00070 3A.M2.00070 : Upper GI hemorrhage - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00070A 3A.M2.00070A : Upper GI hemorrhage - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00070B : Upper GI hemorrhage - ICU without
ventilator
3A.M2.00070C : Upper GI hemorrhage - ICU with
ventilator
578 M2 3A.M2.00071 3A.M2.00071 : Lower GI hemorrhage - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00071A 3A.M2.00071A : Lower GI hemorrhage - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00071B : Lower GI hemorrhage - ICU without
ventilator
3A.M2.00071C : Lower GI hemorrhage - ICU with
ventilator
579 M2 3A.M2.00072 3A.M2.00072 : Acute abdomen - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00072A 3A.M2.00072A : Acute abdomen - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00072B 3A.M2.00072B : Acute abdomen - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00072C 3A.M2.00072C : Acute abdomen - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
580 M2 3A.M2.00077 3A.M2.00077 : Brain abscess - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00077A 3A.M2.00077A : Brain abscess - HDU 2700 Clinical note with Lab reports Treatment note
Speciality
code
M2 3A.M2.00077B 3A.M2.00077B : Brain abscess - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00077C 3A.M2.00077C : Brain abscess - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
581 M2 3A.M2.00083 3A.M2.00083 : Hydrocephalus - routine ward 1800 Clinical examination Clinical examination
M2 3A.M2.00083A 3A.M2.00083A : Hydrocephalus - HDU 2700 Clinical examination Clinical examination
M2 3A.M2.00083B 3A.M2.00083B : Hydrocephalus - ICU without ventilator 3600 Clinical examination Clinical examination
M2 3A.M2.00083C 3A.M2.00083C : Hydrocephalus - ICU with ventilator 4500 Clinical examination Clinical examination
3A.M2.00084 : Intracranial space occupying lesion -

routine ward
3A.M2.00084A : Intracranial space occupying lesion -
HDU
3A.M2.00084B : Intracranial space occupying lesion - ICU
without ventilator
3A.M2.00084C : Intracranial space occupying lesion - ICU
with ventilator
3A.M2.00087 : Cerebral sino-venous thrombosis -
routine ward
M2 3A.M2.00087A 3A.M2.00087A : Cerebral sino-venous thrombosis - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00087B : Cerebral sino-venous thrombosis - ICU

without ventilator
3A.M2.00087C : Cerebral sino-venous thrombosis - ICU
with ventilator
3A.M3.00002 : Special Neonatal Care Package (Rs. 3000

per day, maximum of 18000 - pre-auth after 4 days):
Babies that required admission to SNCU or NICU:
Babies admitted for short term care for conditions like:
• Mild Respiratory Distress/tachypnea
• Mild encephalopathy
• Severe jaundice requiring intensive phototherapy
584 M3 3A.M3.00002 3000 Clinical note and lab reports Treament note
• Haemorrhagic disease of newborn
• Unwell baby requiring monitoring
• Some dehydration
• Hypoglycaemia
Mother's stay and food in the hospital for breastfeeding,
family centred care and (Kangaroo Mother Care) KMC is
mandatory and included in the package rate
Speciality
code
3A.M3.00003 : Intensive Neonatal Care Package (Rs.
5000 per day, maximum of Rs. 50,000 – pre-auth is
needed after 5 days)
Babies with birthweight 1500-1799 g
or
Babies of any birthweight and at least one of the
following conditions:
• Need for mechanical ventilation for less than 24 hours

or non-invasive respiratory support (CPAP, HFFNC)
• Sepsis / pneumonia without complications
• Hyperbilirubinemia requiring exchange transfusion

• Seizures
• Major congenital malformations (pre-surgical
stabilization, not requiring ventilation)
Speciality
code
3A.M3.00004 : Advanced Neonatal Care Package (Rs.
6000 per day, maximum of Rs. 75,000 – pre-auth is
needed after 7 days):
Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one of the
• Any condition requiring invasive ventilation longer
than 24 hours
• Hypoxic Ischemic encephalopathy requiring

Therapeutic Hypothermia
• Cardiac rhythm disorders needing intervention (the

cost of cardiac surgery or implant will be covered under
cardiac surgery packages)
• Sepsis with complications such as meningitis or bone

and joint infection, DIC or shock
Speciality
code
3A.M3.00005 : Critical Care Neonatal Package (Rs. 7000

per day, maximum of Rs. 1,20,000 – pre-auth after 10
days):
Babies with birthweight of <1200 g
or
Babies of any birthweight with at least one of the
• Severe Respiratory Failure requiring High Frequency

Ventilation or inhaled Nitric Oxide (iNO)
• Multisystem failure requiring multiple organ support
including mechanical ventilation and multiple inotropes
• Critical congenital heart disease
Mother's stay and food in the hospital for breastfeeding,
family centred care and (Kangaroo Mother Care) KMC is
mandatory and included in the package rate
3A.M3.00006 : Chronic Care Package (Rs. 3000 per day,

maximum of Rs. 30,000): If the baby requires stay
beyond the upper limit of usual stay in Package no 0004
or 0005 for conditions like severe BPD requiring
respiratory support, severe NEC requiring prolonged
TPN support
3A.M3.00007 : High Risk Newborn Post Discharge Care
Package (Protocol Driven)
3A.M3.00008 : Laser Therapy for Retinopathy of
590 M3 3A.M3.00008 Prematurity (Irrespective of no. of eyes affected) - per 1500 Clinical note and lab reports Treament note
session
3A.M4.00009 : Hodgkin Lymphoma (Favorable group) USG abdomen pelvis,Chest x-ray,

591 M4 3A.M4.00009 70000 Lymphnode Biopsy, HPE, CT/MRI scan
(chemotherapy including diagnostics): induction CT/MRI scan
3A.M4.00012 : Hodgkin Lymphoma (unfavorable group): USG abdomen pelvis,Chest x-ray,

592 M4 3A.M4.00012 1,10,000 Lymphnode Biopsy, HPE, CT/MRI scan
chemotherapy including diagnostics CT/MRI scan
Haematology, Bone Marrow Clinical Photograph, chemotherapy

593 M4 3A.M4.00019 3A.M4.00019 : Retinoblastoma (Intraocular): surgery 100000
Aspitation/ Flow cytometry drug batch number with bar code
Clinical Photographs showing the scar

594 M4 3A.M4.00026 3A.M4.00026 : Brain tumors: surgery 55000 MRI Report
+ HPE report
Speciality
code
Clinical Photograph, chemotherapy

595 M4 3A.M4.00030 3A.M4.00030 : Wilms tumors: surgery 5000 CT report with film, biopsy/FNAC
drug batch number with bar code
596 S14 3A.S14.00001 3A.S14.00001 : Ankyloglossia Major 15000 Clinical Photography Post-op photo
597 S14 3A.S14.00002 3A.S14.00002 : Ankyloglossia Minor 5000 Clinical Photography Post op photo
598 S14 3A.S14.00004 3A.S14.00004 : Sacrococcygeal Teratoma 20000 Clinical examination Clinical examination
3A.S14.00008 : Undescended Testis - Reexploration/
599 S14 3A.S14.00008 25000 USG/OT notes of previous surgery Scar photo
Second Stage
3A.S14.00010 : Ano Rectal Malformation - Abd-Perineal Colostogram pic for males, Photo of
600 S14 3A.S14.00010 60000 Clinical Photograph showing scar
PSARP perineum region for females
601 S14 3A.S14.00011 3A.S14.00011 : Ano Rectal Malformation – Anoplasty 20000 Clinical Note OT note
602 S14 3A.S14.00012 3A.S14.00012 : Ano Rectal Malformation – Cutback 30000 Photo of the perineum region Scar photo
603 S14 3A.S14.00013 3A.S14.00013 : Ano Rectal Malformation - PSARP 20000 Clinical Note OT note
3A.S14.00014 : Ano Rectal Malformation - Redo
604 S14 3A.S14.00014 15000 CT, USG report and Films OT note
Pullthrough
605 S14 3A.S14.00015 3A.S14.00015 : Ano Rectal Malformation - Transposition 15000 CT, USG report and Films OT note
606 S14 3A.S14.00016 3A.S14.00016 : Anti GERD Surgery 10000 USG and Clinical notes OT Note
607 S14 3A.S14.00017 3A.S14.00017 : Duplication Cyst Excision 20000 USG and Clinical notes OT Note
608 S14 3A.S14.00018 3A.S14.00018 : Fecal Fistula Closure 25000 USG and Clinical notes OT Note
609 S14 3A.S14.00020 3A.S14.00020 : GI Tumor Excision 30000 CT, USG report and Films OT note
Clinical photo showing scar + Biopsy
610 S14 3A.S14.00021 3A.S14.00021 : Hirschsprung’s Disease - Myectomy 40000 Rectal biopsy/ X-Ray/Contast Enema
Report.
Clinical photo showing scar + Biopsy
611 S14 3A.S14.00022 3A.S14.00022 : Hirschsprung’s Disease - Pull Through 20000 Rectal biopsy/ X-Ray/Contast Enema
Report.
3A.S14.00023 : Hirschsprung’s Disease - Retal Biopsy-
612 S14 3A.S14.00023 10000 Contrast Enema / Biopsy Clinical Photograph showing scar
Punch
3A.S14.00024 : Hirschsprung’s Disease - Retal Biopsy Clinical photo showing scar + Biopsy
613 S14 3A.S14.00024 10000 Rectal biopsy/ X-Ray/Contast Enema
–Open Report.
614 S14 3A.S14.00025 3A.S14.00025 : Hirschsprung’s Disease - Sphinecterotomy 60000 Contrast Enema / Biopsy Clinical Photograph showing scar
3A.S14.00026 : Intussusception - Non –Operative

615 S14 3A.S14.00026 18000 USG/Xray Post op USG, Post op X Ray
Reduction in infants
X-ray abdomen or Ultrasound
616 S14 3A.S14.00028 3A.S14.00028 : Ladds Procedure 30000 Scan Photography
abdomen
617 S14 3A.S14.00030 3A.S14.00030 : Retro-Peritoneal Lymphangioma Excision 25000 CT, USG report and Films OT note and HPE report
Clinical Photograph showing scar+Post

618 S14 3A.S14.00031 3A.S14.00031 : Congenital Diaphragmatic Hernia 110000 X-Ray
op X ray
619 S14 3A.S14.00032 3A.S14.00032 : Congenital Lobar Emphysema 25000 Treatment Notes
investigations
620 S14 3A.S14.00033 3A.S14.00033 : Exomphalos/gastroschisis 25000 CT, USG report and Films OT note
Speciality
code
621 S14 3A.S14.00034 3A.S14.00034 : Cleft Lip and Palate Surgery (per stage) 15000 Clinical Photograph Clincal Photograph
622 S14 3A.S14.17111 3A.S14.17111 : Splenectomy - Child 45000 CT/ MRI CT/ MRI
623 S14 3A.S14.17112 3A.S14.17112 : Biliary Atresia 65000 CT Abdomen Clinical Photograph showing scar
624 S14 3A.S14.17113 3A.S14.17113 : Oesophageal Atresia 110000 X-Ray Clinical Photograph showing scar
3A.S14.17114 : Unilateral Inguinal Hernia- Age less than
625 S14 3A.S14.17114 15000 Clinical photograph, USG HPR, Clinical photograph
1 year
626 S14 3A.S14.17115 3A.S14.17115 : Urinary Diversion - Temporary 25000 MCU, USG Clinical Photograph showing scar
627 S14 3A.S14.17116 3A.S14.17116 : Urinary Diversion - Undiversion 35000 MCU, USG Clinical Photograph showing scar
Clinical Photograph showing chemo
628 S14 3A.S14.17117 3A.S14.17117 : Insertion of Chemo port 20000 Lab reports confirming cancer
Port
629 S14 3A.S14.17118 3A.S14.17118 : Congenital Hydronephrosis Open/Lap* 50000 USG, Renal Isotope Scan Clinical Photograph showing scar
630 S14 3A.S14.17119 3A.S14.17119 : Anorectal Malformations Stage 3 45000 Clinical Photograph Clinical Photograph showing scar
631 S14 3A.S14.17120 3A.S14.17120 : Pyloromyotomy 35000 USG/Contrast X ray Clinical Photograph showing scar
632 S14 3A.S14.17121 3A.S14.17121 : Bladder Augumentation 80000 MCU/USG Clinical photo
3A.S14.17122 : Hypospadias Definitive Repair - proximal Clinical photo showing the meatal
633 S14 3A.S14.17122 60000 Nil
penile opening
Clinical photo showing the meatal
634 S14 3A.S14.17123 3A.S14.17123 : Hypospadias Re-Do 40000 Nil
opening
635 S14 3A.S14.17124 3A.S14.17124 : Fistula Closure Hypospadiacs 20000 Clinical Photograph Nil
636 S14 3A.S14.17125 3A.S14.17125 : Faciomaxillary surgery 35000 X-RAY/CT scan
post op. XRAY
637 S14 3A.S14.17132 3A.S14.17132 : Surgery for chronic pancreatitis 70000 CT/MRI Clinical Photograph showing scar
638 S14 3A.S14.17133 3A.S14.17133 : Omphalocele-Minor 40000 Clinical Photograph Clinical Photograph showing scar
639 S14 3A.S14.17134 3A.S14.17134 : Bilateral Inguinal Hernia for age < 1 year 22500 Clinical Photograph Clinical Photograph showing scar
640 S14 3A.S14.17135 3A.S14.17135 : Meconium Aspiration syndrome 50900 Clinical notes confirming digonosis clinical notes in relevant reports
Post Op CT Report and film, Clinical

641 S14 3A.S14.17136 3A.S14.17136 : Meningo Encephalocele * 40000 MRI Report
Photograph showing Scar
642 S14 3A.S14.17138 3A.S14.17138 : Unsescended Non palpable testis stage 1 20000 USG abdomen Scar photo
643 S14 3A.S14.17139 3A.S14.17139 : Stent Removal 5000 X Ray Post op X Ray
644 S14 3A.S14.17141 3A.S14.17141 : Septicemia not requiring ventilation 49200 Clinical notes confirming digonosis clinical notes in relevant reports
3A.S14.17142 : Hypospadias Definitive Repair - mid Clinical photo showing the meatal
645 S14 3A.S14.17142 50000 Nil
penile opening
3A.S14.17143 : Hypospadias Definitive Repair - distal Clinical photo showing the meatal
646 S14 3A.S14.17143 40000 Nil
penile opening
647 S14 3A.S14.17144 3A.S14.17144 : VLBW not requiring ventilation 119900 Clinical notes confirming digonosis clinical notes in relevant reports
648 S14 3A.S14.17145 3A.S14.17145 : Respiratory distress syndrome 75550 Clinical notes confirming digonosis clinical notes in relevant reports
Speciality
code
Clinical photo showing the meatal
649 S14 3A.S14.17146 3A.S14.17146 : Hypospadias First Stage 30000 Nil
opening
650 S14 3A.S14.17147 3A.S14.17147 : Asphyxia with convulsions 73400 Clinical notes confirming digonosis clinical notes in relevant reports
651 S14 3A.S14.17148 3A.S14.17148 : Meningomyelocele * 40000 CT report Post Op CT Report and film, scar photo
3A.S14.17149 : Laparotomy and excision of cyst (For

652 S14 3A.S14.17149 30000 USG/CT Scar Photo, HPE Report
Paediatric benign abdominal cyst)
3A.S7.00045A : Ureteric reimplantation-bilateral-open -
S7 3A.S7.00045A 70000 MCU, USG Clinical Photograph showing scar
cross speciality
3A.S7.00046A : Ureteric reimplantation-unilateral-
S7 3A.S7.00046A 45000 MCU, USG Clinical Photograph showing scar
Laparoscopic - cross speciality
3A.S7.00069A : Extrophy Bladder repair including
S7 3A.S7.00069A osteotomy if needed + epispadias repair + ureteric 70000 MCU Clinical Photograph
reimplant - cross speciality
3A.S8.00025A : Shunt (peritoneal, ventriculo-atrial/

S8 3A.S8.00025A 20000 CT report Clinical Photographs
3A.S8.17048A : Fetal Surgery for Myelomeningocoele -

S8 3A.S8.17048A 75000 Ultrasound abdomen Ultrasound + scar photograph
cross speciality
3A.S1.00078B : Hiatus Hernia – abdominal - cross
S1 3A.S1.00078B 40000 USG, UGI ENDOSCOPY Scar photo + Intra op photo
speciality
S1 3A.S1.00087A 3A.S1.00087A : Intussusception - cross speciality 15000 USG/CT , Clinical notes Scar photo
S1 3A.S1.00112B 3A.S1.00112B : Pyeloroplasty - cross speciality 10000 USG, Clinical Notes Scar photo, HPE
3A.S1.00157B : Decortication (Pleurectomy) - cross
S1 3A.S1.00157B 50000 CT Chest report Post Op X-ray,scar photo
speciality
S1 3A.S1.00219B 3A.S1.00219B : Pneumonectomy - cross speciality 60000 CT Chest report Post Op X-ray,scar photo
3A.S1.00239B : Thoracoscopic Sympathectomy - cross
S1 3A.S1.00239B 35000 CT Chest report Post Op X-ray, photo of scar, port
speciality
insertion
3A.M1.00002D : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002D 1800
routine ward - cross speciality investigations, Clinical notes
3A.M1.00002E : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002E 2700
HDU - cross speciality investigations, Clinical notes
3A.M1.00002F : Recurrent vomiting with dehydration - Relevant Hematological Treatment notes
M1 3A.M1.00002F 3600
ICU with ventilator - cross speciality investigations, Clinical notes
Relevant Hematological Treatment notes
3A.M1.00002G : Recurrent vomiting with dehydration -
M1 3A.M1.00002G 4500 investigations, Clinical notes
ICU without ventilator - cross speciality
NEUROSURGERY
653 S8 3A.S8.00001 3A.S8.00001 : Anterior Encephalocele 50000 MRI Report
3A.S8.00003 : Burr hole with chronic Sub Dural
654 S8 3A.S8.00003 20000 CT Report CT Report, Scar Photo
Haematoma (including pre and post Op. CT)
Speciality
code
655 S8 3A.S8.00005 3A.S8.00005 : Cervical Ribs – Bilateral 35000 MRI
Photograph
656 S8 3A.S8.00006 3A.S8.00006 : Cervical Ribs – Unilateral 20000 MRI
Photograph

657 S8 3A.S8.00007 3A.S8.00007 : CranioPlasty - Endogenous graft 30000 CT report
Photograph showing the scar
3A.S8.00008 : CranioPlasty - Exogenous graft (inclusive Post Op CT Report and film, Clinical
658 S8 3A.S8.00008 40000 CT report
of cost of implant) Photograph showing the scar
659 S8 3A.S8.00009 3A.S8.00009 : Craniostenosis 50000 CT/MRI Report Post-op CT report and film
660 S8 3A.S8.00010 3A.S8.00010 : Duroplasty - Endogenous 12500 CT/MRI CT/MRI, scar Photo
661 S8 3A.S8.00011 3A.S8.00011 : Duroplasty - Exogenous 12500 CT/MRI CT/MRI, scar Photo
662 S8 3A.S8.00013 3A.S8.00013 : Haematoma - Brain (hypertensive) 50000 CT Report CT Report, Scar Photo, X Ray
3A.S8.00014 : Haematoma (Child subdural) inclusive of

663 S8 3A.S8.00014 50000 CT Report CT Report, Scar Photo, X Ray
General anaesthesia, pre and post Op. CT
664 S8 3A.S8.00016 3A.S8.00016 : Laminectomy with Fusion 40000 Clinical findings, MRI Report photo showing scar
665 S8 3A.S8.00017 3A.S8.00017 : Local Neurectomy 16000 Clinical notes Scar photo
666 S8 3A.S8.00019 3A.S8.00019 : Meningocele – Anterior 36000 CT report Post Op CT Report and film, scar photo
667 S8 3A.S8.00020 3A.S8.00020 : Meningocele – Lumbar 36000 CT report Post Op CT Report and film, scar photo
668 S8 3A.S8.00021 3A.S8.00021 : Meningococcal – Occipital 50000 CT /MRI report CT report, Scar photo
Post Op X-ray, Clinical Photograph
669 S8 3A.S8.00022 3A.S8.00022 : Micro discectomy – Cervical 40000 Clinical findings, MRI Report
showing scar
670 S8 3A.S8.00024 3A.S8.00024 : Brachial Plexus – Repair 27000 MRI X-RAY and clinical photograph
3A.S8.00025 : Shunt (peritoneal, ventriculo-atrial/
671 S8 3A.S8.00025 20000 CT report Clinical Photographs
peritoneal, theco peritoneal)
672 S8 3A.S8.00026 3A.S8.00026 : Skull Traction 8000 CT report Clinical photograph
673 S8 3A.S8.00027 3A.S8.00027 : Spine - Canal Stenosis 40000 MRI report & film, Clinical findings Post Op X-Ray Report and film
674 S8 3A.S8.00028 3A.S8.00028 : Spine - Decompression & Fusion 40000 Clinical findings, MRI Report Post Op X-Ray Report and film
Biopsy report + HPE Report + scar
675 S8 3A.S8.00030 3A.S8.00030 : Spine - Extradural Tumour 30000 MRI Report
photo
676 S8 3A.S8.00031 3A.S8.00031 : Spine - Extradural Tumour with fixation 45000 MRI Report
photo
677 S8 3A.S8.00032 3A.S8.00032 : Spine - Extradural Haematoma 30000 MRI Report scar photo
678 S8 3A.S8.00033 3A.S8.00033 : Spine - Extradural Haematoma with fixation 40000 CT Report CT Report, Scar Photo, X Ray

679 S8 3A.S8.00034 3A.S8.00034 : Spine - Intradural Tumour 40000 MRI Report
photo
680 S8 3A.S8.00035 3A.S8.00035 : Spine - Intradural Tumour with fixation 50000 CT Report CT Report, Scar Photo, X Ray & HPE
Speciality
code
681 S8 3A.S8.00036 3A.S8.00036 : Spine - Intradural Haematoma 40000 MRI Report scar photo
3A.S8.00037 : Spine - Intradural Haematoma with
682 S8 3A.S8.00037 50000 MRI Report scar photo
fixation
Post Op X-ray Report and film + HPE
683 S8 3A.S8.00038 3A.S8.00038 : Spine - Intramedullar Tumour 40000 MRI Report
report
684 S8 3A.S8.00039 3A.S8.00039 : Spine - Intramedullar Tumour - fixation 60000 MRI Report
photo
3A.S8.00040 : Trans Sphenoidal including pre and post
685 S8 3A.S8.00040 40000 CT/MRI Report HPE report
Op. MRI
686 S8 3A.S8.00041 3A.S8.00041 : Tumours – Supratentorial 50000 CT report /MRI Clinical features Photographs showing the scar + HPE
report
687 S8 3A.S8.00042 3A.S8.00042 : Tumours Meninges – Gocussa 50000 CT Histopathological report, CT
688 S8 3A.S8.00043 3A.S8.00043 : Tumours Meninges – Posterior 50000 CT report /MRI Clinical features Photographs showing the scar + HPE
report
689 S8 3A.S8.00044 3A.S8.00044 : Ventricular Puncture 15000 CT report
690 S8 3A.S8.00045 3A.S8.00045 : Brain Biopsy 15000 CT report HPE, scar photo
691 S8 3A.S8.00046 3A.S8.00046 : Cranial Nerve Anastomosis 32000 CT Post Op CT Report and film,
Clinical Photographs showing scar,
692 S8 3A.S8.00047 3A.S8.00047 : Depressed Fracture 30000 CT report
Post CT report and film

693 S8 3A.S8.00048 3A.S8.00048 : Nerve Biopsy excluding Hensens 10000 conduction velocity (NCV)) and Clinical Photograph + HPE report
694 S8 3A.S8.00049 3A.S8.00049 : Peripheral Neurectomy (Trigeminal) 16500 MRI Report CD of Procedure
695 S8 3A.S8.00050 3A.S8.00050 : R.F. Lesion for Trigeminal Neuralgia 15000 MRI Report CD of Procedure
3A.S8.00052 : Excision of Brain TumorSupratentorial-
696 S8 3A.S8.00052 80000 CT report /MRI Clinical features Photographs showing the scar + HPE
Parasagital
report
697 S8 3A.S8.00053 80000 CT report Photographs showing the scar + HPE
Basal
report
Brainstem
report
3A.S8.00055 : Excision of Brain TumorSupratentorial-C P
Angle
report
3A.S8.00056 : Excision of Brain TumorSupratentorial&
others
report
Speciality
code
701 S8 3A.S8.00057 3A.S8.00057 : Abscess Tapping single 15000 CT report Post Op CT Report,film and scar photo
Post Op CT Report and film, scar

702 S8 3A.S8.00060 3A.S8.00060 : Aneurysm Clipping including angiogram 110000 MRI/CT Angio / DSA report
photo
Post Op X-Ray Report and film, +
703 S8 3A.S8.00063 3A.S8.00063 : Spinal Fusion Procedure with implant 60000 Clinical findings, MRI Report Showing scar + XRAY showing the
implants
704 S8 3A.S8.00064 3A.S8.00064 : Spina Bifida Surgery 40000 MRI Report Clinical Photographs showing scar
Neuro Psychologist report, Clinical Photographs showing scar , CT
705 S8 3A.S8.00065 3A.S8.00065 : Stereotactic Lesioning 60000
Neurologist report, MRI Brain report and film
3A.S8.00066 : Posterior Cervical Discetomy without
706 S8 3A.S8.00066 30000 MRI report Clinical Photographs showing scar
implant
3A.S8.00067 : Posterior Cervical Fusion with implant Clinical Photographs showing scar + X-
707 S8 3A.S8.00067 60000 MRI report
(Lateral mass fixation) ray - Cervical spine
708 S8 3A.S8.00068 3A.S8.00068 : Cervical Disc Multiple level without Fusion 35000 CT/MRI report
ray-Cervical Spine
3A.S8.00069 : Thoracic/Lumbar Corpectomy with fusion
709 S8 3A.S8.00069 70000 MRI Report ray Report and film showing the
inclusive of implant
implants
3A.S8.00070 : Transoral surgery (Anterior) and CV
710 S8 3A.S8.00070 80000 MRI Report + XRAY Post Op X-ray report and film
Junction (Posterior Sterlization)
Post Op X-ray Report and film, HPE
711 S8 3A.S8.00071 3A.S8.00071 : Trans oral Surgery 40000 CT report
report
712 S8 3A.S8.00072 3A.S8.00072 : Foramen Magnum Decompression 45000 CT/MRI report Clinical Photographs showing scar
713 S8 3A.S8.00073 3A.S8.00073 : Endoscopic CSF Rhinorrhea Repair 30000 CT/MRI report Clinical Photographs showing scar
714 S8 3A.S8.00075 3A.S8.00075 : Nerve Decompression 20000 Nerve Conductions study Clinical Photographs showing scar

715 S8 3A.S8.00076 3A.S8.00076 : Peripheral Nerve Surgery Major 45000 conduction velocity (NCV)) and Clinical Photographs showing scar

716 S8 3A.S8.00077 3A.S8.00077 : Peripheral Nerve Surgery Minor 15000 conduction velocity (NCV) / Clinical Photographs showing scar
EEG, Neuro Psychologist report,

717 S8 3A.S8.00078 3A.S8.00078 : Epilepsy Surgery 50000 CT + Clinical Photographs showing scar
Neurologist report, CT/MRI
3A.S8.00079 : Arterio venous malformation (AVM)
718 S8 3A.S8.00079 100000 MRI Angio/DSA report CT report and film,scar photo
excision (whatever size and location)
719 S8 3A.S8.00080 3A.S8.00080 : Scalp Arterio venous malformation (AVM) 25000 CT/MRI Report
HPE report
3A.S8.00081 : Superficial Temporal Artery (STA): middle

720 S8 3A.S8.00081 100000 MRI Angio/DSA report CT Report and film,scar photo
cerebral artery (MCA) or (other EC - IC) Bypass procedure
Speciality
code
CT, Clinical Photograph showing scar
721 S8 3A.S8.00082 3A.S8.00082 : Excision of Orbital Tumour 50000 CT/MRI Report + HPE report, Post-op CT report and
film
3A.S8.00083 : Gamma Knife radiosurgery (GKRS)/ SRS

722 S8 3A.S8.00083 75000 CT/MRI Report Clinical Photographs
for tumours/ Arteriovenous malformation (AVM)
723 S8 3A.S8.17048 3A.S8.17048 : Fetal Surgery for Myelomeningocoele 75000 Ultrasound abdomen Ultrasound + scar photograph

3A.S8.17049 : Excision of Brain Tumor Infratentorial-C P
Angle *
report
3A.S8.17050 : Excision of Brain Tumor Supratentorial &
others *
report
Post Op CT Report and film + HPE
726 S8 3A.S8.17051 3A.S8.17051 : Stereotaxic Procedures 25000 CT/ MRI report
report
Clinical Photograph showing scar, DT
727 S8 3A.S8.17052 3A.S8.17052 : Endoscopic venticulostomy 30000 CT report
Brain film and report
3A.S8.17053 : Anterior Cervical Discectomy Multiple level Photo showing the scar + XRAY
728 S8 3A.S8.17053 60000 Clinical findings, MRI Report
with Implants* showing the implants
729 S8 3A.S8.17054 3A.S8.17054 : Laminectomy-Cervical * 30000 Clinical findings, MRI Report photo showing scar
Clinical Photographs showing scar,
730 S8 3A.S8.17055 3A.S8.17055 : Decompressive craniotomy 40000 CT report
Post CT report and film
731 S8 3A.S8.17057 3A.S8.17057 : MVD (Micro Vascular Decompression) 50000 MRI Report Clinical Photographs
Post Op CT Report and film, scar

732 S8 3A.S8.00061 3A.S8.00061 : Additonal clip for Aneurysm Clipping 15000 MRI/CT Angio / DSA report
photo
S9 3A.S9.00015A 3A.S9.00015A : Vertebroplasty - cross speciality 40000
3A.M2.00077D : Brain abscess - cross speciality - routine
ward
M2 3A.M2.00077E 3A.M2.00077E : Brain abscess - cross speciality - HDU 2700 Clinical note with Lab reports Treatment note
3A.M2.00077F : Brain abscess - cross speciality - ICU

with ventilator
3A.M2.00077G : Brain abscess - cross speciality - - ICU
without ventilator
3A.M2.00083D : Hydrocephalus - cross speciality -
M2 3A.M2.00083D 1800 CT Report CT Report, Scar Photo, X Ray
routine ward
M2 3A.M2.00083E 3A.M2.00083E : Hydrocephalus - cross speciality - HDU 2700 CT Report CT Report, Scar Photo, X Ray
3A.M2.00083F : Hydrocephalus - cross speciality - ICU

M2 3A.M2.00083F 4500 CT Report CT Report, Scar Photo, X Ray
with ventilator
Speciality
code
3A.M2.00083G : Hydrocephalus - cross speciality - ICU
M2 3A.M2.00083G 3600 CT Report CT Report, Scar Photo, X Ray
without ventilator
3A.M2.00084D : Intracranial space occupying lesion -
cross speciality - routine ward
3A.M2.00084E : Intracranial space occupying lesion -
M2 3A.M2.00084E 2700 Clinical note with Lab reports Treatment note
cross speciality - HDU
3A.M2.00084F : Intracranial space occupying lesion -
cross speciality - ICU with ventilator
3A.M2.00084G : Intracranial space occupying lesion -
cross speciality - ICU without ventilator
3A.M2.00087D : Cerebral sino-venous thrombosis -
M2 3A.M2.00087D 1800 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - routine ward
3A.M2.00087E : Cerebral sino-venous thrombosis -
M2 3A.M2.00087E 2700 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - HDU
3A.M2.00087F : Cerebral sino-venous thrombosis -
M2 3A.M2.00087F 4500 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - ICU with ventilator
3A.M2.00087G : Cerebral sino-venous thrombosis -
M2 3A.M2.00087G 3600 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - ICU without ventilator
M4 3A.M4.00026A 3A.M4.00026A : Brain tumors: surgery - cross speciality 55000 MRI Report
+ HPE report
S1 3A.S1.00230B 3A.S1.00230B : Temporal Bone resection - cross speciality 60000 CT/MRI, Biopsy
HPE report
3A.S10.00006A : Scalp avulsion reconstruction - cross CBC,RBS,RFT,S Electrolytes,
S10 3A.S10.00006A 50000 Clinical photo and OT note
speciality HIV,HbsAg, CXR, ECG
3A.S14.17136A : Meningo Encephalocele * - cross Post Op CT Report and film, Clinical
S14 3A.S14.17136A 40000 MRI Report
speciality Photograph showing Scar
S14 3A.S14.17148A 3A.S14.17148A : Meningomyelocele * - cross speciality 40000 CT report Post Op CT Report and film, scar photo
S2 3A.S2.00023A 3A.S2.00023A : Skull base surgery - cross speciality 37000 CT-Scan / MRI Scan Clinical Photograph
3A.S6.00001B : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001B 50000 Clinical photo showing Scar
repair/reconstruction/ Transfer - cross speciality Picture(Mandatory) + detail notes
3A.S6.00002A : Plexus injury along with Vascular injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002A 60000 Clinical photo showing Scar
repair/ graft - cross speciality Picture(Mandatory) + detail notes
3A.S6.00004B : Head injury requiring Facio-Maxillary

S6 3A.S6.00004B Injury repairs & fixations (including implants) - cross 35000 X-RAY/CT scan(If Required)
speciality
3A.S4.00008 : Laparotomy and proceed for Ovarian
733 S4 3A.S4.00008 Cancers. Omentomy with Bilateral Salpingo- 20000 CT report and Film, Biopsy
HPE report
oophorectomy
Speciality
code
3A.S4.00011 : Vaginal surgical repair for vesico-vaginal Clinical Notes, USG/KUB/Urology
734 S4 3A.S4.00011 10000 OT notes
fistula opinion
735 S4 3A.S4.00012 3A.S4.00012 : Sacrocolpopexy 16000 Clinical note,USG OT Note
736 S4 3A.S4.00014 3A.S4.00014 : Vaginoplasty 10000 Clinical note OT Note
737 S4 3A.S4.00015 3A.S4.00015 : LLETZ 15000 USG and clinical notes OT note and HPE
738 S4 3A.S4.00016 3A.S4.00016 : Colpotomy 1200 USG and clinical notes OT note
739 S4 3A.S4.00021 3A.S4.00021 : Radical Vulvectomy 15000 USG and clinical notes OT note and HPE
740 S4 3A.S4.00026 3A.S4.00026 : Laparoscopic ovarotomy 10000 USG and clinical notes OT note and HPE
3A.S4.00028 : Laparoscopic tubal surgeries -
741 S4 3A.S4.00028 11000 USG and clinical notes OT note and HPE
salpingectomy, salpingotomy
742 S4 3A.S4.00029 3A.S4.00029 : Drag hysteroscopy 6000 USG and clinical notes OT note
743 S4 3A.S4.00030 3A.S4.00030 : Hysteroscopic myomectomies 6000 USG and clinical notes OT note and HPE
744 S4 3A.S4.00031 3A.S4.00031 : Hysteroscopic adhesiolysis 6000 USG and clinical notes OT note and HPE
3A.S4.00053 : Abdominal Perineal neo construction Cx +
745 S4 3A.S4.00053 20000 USG/CT, Lab report and clinical notes OT note
Uteria + Vagina
3A.S4.00055 : Ablation of Endometriotic Spot
746 S4 3A.S4.00055 10000 USG and clinical notes OT Note
+Salpingostomy
3A.S4.00066 : Cystocele - Anterior Repair + Perineal Tear
747 S4 3A.S4.00066 13000 USG and clinical notes OT Note
Repair
748 S4 3A.S4.00070 3A.S4.00070 : Electro Cauterisation Cryo Surgery 4000 Clinical note OT Note, Clinical photograph
749 S4 3A.S4.00074 3A.S4.00074 : HaematoColpo/Excision - Vaginal Septum 5000 USG and clinical notes OT Note and HPE
750 S4 3A.S4.00078 3A.S4.00078 : Cordocentesis 5000 USG and clinical notes OT Note
751 S4 3A.S4.00079 3A.S4.00079 : Intrauterine transfusions 10000 USG and clinical notes Procedure Note
3A.S1.17008B : Radical hysterectomy for Ca cervix and
S1 3A.S1.17008B Ca endometrium ( Code 3A.484)- additional cost - cross 20000 CT report and Film, Biopsy
HPE report
speciality
Speciality
code
ONCOLOGY
Haematology, Bone Marrow Photo with RT Machine , RT treatment
752 M4 3A.M4.00004 3A.M4.00004 : Acute lymphoblastic leukemia: radiation 5000
Aspitation/ Flow cytometry chart
3A.M4.00010 : Hodgkin Lymphoma (Favorable group): Photo with RT Machine , RT treatment
753 M4 3A.M4.00010 10000 Hematology + Biopsy/FNAC report
radiation chart
3A.M4.00013 : Hodgkin Lymphoma (unfavorable group): Photo with RT Machine , RT treatment
radiation chart
Photo with RT Machine , RT treatment
755 M4 3A.M4.00018 3A.M4.00018 : Retinoblastoma (Intraocular): radiation 10000 Biopsy , CT report with film
chart
756 M4 3A.M4.00022 3A.M4.00022 : Retinoblastoma (extraocular): radiation 10000 Biopsy , CT report with film
chart
757 M4 3A.M4.00025 3A.M4.00025 : Brain tumors: radiation 30000 CT report /MRI Clinical features
chart
758 M4 3A.M4.00029 3A.M4.00029 : Wilms tumors: radiation 5000 CT report with film, biopsy/FNAC
chart
3A.M4.00034 : Bone tumors/soft tissue sarcomas : Photo with RT Machine , RT treatment
759 M4 3A.M4.00034 25000 Biopsy , CT-Scan with film
radiation chart
3A.M4.00035# : Bone tumors/soft tissue sarcomas :

760 M4 3A.M4.00035 235000 CT scan/MRI ,Tumor board form, USG X-ray, CT Scan,Tumor Board form,
surgery (inlcuding prosthesis)
abdomen pelvis, Clinical photograph Clinical photograph Hemogram report
3A.M6.00001 : Cobalt 60 External Beam Radiotherapy Photo with RT Machine , RT treatment
761 M6 3A.M6.00001 20000 Biopsy/FNAC ,CT report and Film
(Radical/Adjuvant / Neoadjuvant) chart RT planning Data
3A.M6.00002 : Cobalt 60 External Beam Radiotherapy Photo with RT Machine , RT treatment
762 M6 3A.M6.00002 10000 CT report and Film, Biopsy
(Palliative) chart RT planning Data
3A.M6.00003 : Linear Accelerator External Beam Photo with RT Machine , RT treatment
Radiotherapy (Palliative) chart
3A.M6.00004 : Linear Accelerator, External Beam
Photo with RT machine, RT treatment
764 M6 3A.M6.00004 Radiotherapy 3D CRT/2D Planning (Radical/Adjuvant/ 50000 CT report and film, biopsy
chart
Neoadjuvant)
3A.M6.00005 : Linear Accelerator, External Beam
765 M6 3A.M6.00005 Radiotherapy IMRT (Intensity Modulated Radiotherapy) 75000 CT report and Film, Biopsy
chart
(Radical/Adjuvant/Neoadjuvant)
3A.M6.00006 : Linear Accelerator External Beam
Photo with RT Machine , RT Photo with RT Machine , RT treatment
766 M6 3A.M6.00006 Radiotherapy IGRT (Image Guided radiotherapy) 120000
treatment chart, CBCT machine log chart, CBCT machine log
(Radical/Adjuvant/Neoadjuvent)
767 M6 3A.M6.00007 3A.M6.00007 : SRT(Stereota1036ic radiotherapy) 75000 Biopsy/FNAC ,CT report and Film
chart RT planning Data
768 M6 3A.M6.00008 3A.M6.00008 : SRS (Streotactic radiosurgery) 70000 Biopsy/FNAC ,CT report and Film
3A.M6.00009 : Respiratory Gating along with Linear Photo with RT Machine , RT treatment
769 M6 3A.M6.00009 70000 ECHO, Chest X Ray, RFT, CBC, ABG
Accelerator planning chart RT planning Data
3A.M6.00010 : Electron beam with Linear accelerator Photo with RT Machine , RT treatment
(Radical) chart
Speciality
code
3A.M6.00011 : Photo with RT machine, RT treatment
771 M6 3A.M6.00011 50000 CT report and film, biopsy
Tomotherapy(Radical/Adjuvant/Neoadjuvant) chart
3A.M6.00012 : Brachytherapy High Dose Radiation Photo with RT Machine , RT treatment

(Intracavitory) - per fraction, maximum of 4 sessions chart, RT planning data

773 M6 3A.M6.00013 30000 CT/MRI report and Film, Biopsy
(Interstitial) - for one application, multiple dose chart RT planning Data

(Intraluminal) - per fraction, maximum 4 sessions chart, RT planning data
3A.M6.17241 : Cobalt 60 External Beam Radiotherapy, Photo with RT Machine , RT treatment

Definitive, Neoadjuvant, Adjuvant chart RT planning Data
776 M6 3A.M6.17242 3A.M6.17242 : Brachytherapy/ Interstitial LDR , adjuvant 15000 CT / MRI report with film, Biopsy
3A.M6.17243 : Linear accelerator teletherapy, Photo with RT machine, RT treatment
777 M6 3A.M6.17243 55000 CT report and film, biopsy
Definitive+Tab Temozolamide chart, RT planning data
3A.M6.17244 : Linear accelerator teletherapy, 3DCRT,
778 M6 3A.M6.17244 Definitive along with +concurrent Tab Temozolamide 80000 CT report and Film, Biopsy
along with RT
3A.M6.17245 : Linear accelerator (Photons) teletherapy, Photo with RT Machine , RT treatment
Adjuvant chart
3A.M6.17246 : Cobalt 60 External Beam Radiotherapy, Photo with RT Machine , RT treatment
Definitive chart RT planning Data
Radioiodine original treatment chart

781 M6 3A.M6.17247 3A.M6.17247 : Radioiodine Treatment < 100 Millicuries 20000 Biopsy/FNAC
and Thyroid scan, Biopsy/HPE
Radioiodine original treatment chart

782 M6 3A.M6.17248 3A.M6.17248 : Radioiodine Treatment > 100 Millicuries 30000 Biopsy/FNAC
and Thyroid scan , Biopsy/HPE
3A.M6.17249 : Accelerated partial breast irradiation Biopsy/FNAC , Mammography/USG, Photo with RT Machine , RT treatment
783 M6 3A.M6.17249 50000
(APBI) any type/ LINAC/3DCRT/IMRT chest Xray chart
3A.M6.17250 : Linear accelerator,Involved-Site
784 M6 3A.M6.17250 Radiotherapy (ISRT)/Involved field radiation therapy 25000 Hematology + Biopsy/FNAC report
chart
(IFRT)/3DCRT/IMRT
3A.M6.17251 : Linear accelerator, less than 20 Photo with RT Machine , RT treatment
fractions/3DCRT/IMRT chart
3A.M6.17252 : Linear accelerator teletherapy, Photo with RT Machine , RT treatment
3DCRT,IMRT,VMAT Adjuvant/Definitive chart
3A.M6.17253 : Brachytherapy/ Interstitial HDR one Photo with RT Machine , RT treatment
application, multiple doses Definitive/Boost chart RT planning Data
788 M6 3A.M6.17254 3A.M6.17254 : Cobalt 60 teletherapy, Palliative 10000 CT report and Film, Biopsy
Speciality
code
789 M6 3A.M6.17255 3A.M6.17255 : Linear accelerator teletherapy, Palliative 20000 CT report and Film, Biopsy
chart
790 S15 3A.S15.00001 3A.S15.00001 : Tracheal resection 18000 CT report and Film, Biopsy
HPE report
3A.S15.00002 : Sternotomy with superior mediastinal Clinical Photograph showing the scar
dissection + HPE report
Clinical Photograph showing the
792 S15 3A.S15.00003 3A.S15.00003 : Substernal bypass 35000 Biopsy of the primary
procedure/scar
793 S15 3A.S15.00004 3A.S15.00004 : Resection of nasopharyngeal tumour 50000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
794 S15 3A.S15.00005 3A.S15.00005 : Myocutaneous flap 25000 Biopsy of the primary Clinical Photograph showing scar
X-ray Films + detail notes+ pre-op
795 S15 3A.S15.00006 3A.S15.00006 : Fasciocutaneous flap 15000 Clinical photo showing Scar
clinical photo
796 S15 3A.S15.00007 3A.S15.00007 : Palatectomy- Soft palate 30000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
797 S15 3A.S15.00008 3A.S15.00008 : Palatectomy- Hard palate 20000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
798 S15 3A.S15.00009 3A.S15.00009 : Microvascular reconstruction 45000 Biopsy of the primary Clinical Photograph showing scar
799 S15 3A.S15.00010 3A.S15.00010 : Composite resection 50000 CT report and Film, Biopsy
HPE report
3A.S15.00011 : Composite resection with Clinical Photograph showing scar +
reconstruction(excluding microvascular) HPE report
801 S15 3A.S15.00012 3A.S15.00012 : Neck dissection-selective 12000 Biopsy , USG/CT of neck with film
HPE report
802 S15 3A.S15.00013 3A.S15.00013 : Neck dissection-comprehensive 25000 Biopsy , USG/CT of neck with film
HPE report
803 S15 3A.S15.00014 3A.S15.00014 : Total Maxillectomy 18000 CT report and Film, Biopsy
HPE report
804 S15 3A.S15.00015 3A.S15.00015 : Radical Maxillectomy 40000 CT report and Film, Biopsy
HPE report
805 S15 3A.S15.00016 3A.S15.00016 : Radical parotidectomy 25000 FNAC,CT
HPE report
806 S15 3A.S15.00017 3A.S15.00017 : Partial laryngectomy ( voice preserving) 20000 CT report and Film, Biopsy
HPE report
CT report, Biopsy, +Photograph with
807 S15 3A.S15.00018 3A.S15.00018 : Voice prosthesis 40000 Invoice of prosthesis, scar photo
AM
3A.S15.00020 : Total Thyroidectomy with central Clinical Photograph showing scar +

808 S15 3A.S15.00020 25000 FNAC/CT/MRI report and Film
compartment LN dissection with Lateral LN dissection HPE report
Biopsy/FNAC , Mammography/USG, Clinical Photograph showing scar +

809 S15 3A.S15.00022 3A.S15.00022 : Axillary dissection 15000
chest Xray HPE report
3A.S15.00023 : Breast conserving surgery (lumpectomy Biopsy/FNAC , Mammography/USG, Clinical Photograph showing scar +
810 S15 3A.S15.00023 25000
+ axillary surgery) chest Xray HPE report
811 S15 3A.S15.00024 3A.S15.00024 : Lung metastectomy- solitary 30000 Biopsy/FNAC ,CT report and Film
Speciality
code
812 S15 3A.S15.00025 3A.S15.00025 : Lung metastectomy- multiple (< four) 50000 Biopsy/FNAC ,CT report and Film
813 S15 3A.S15.00026 3A.S15.00026 : Lung metastectomy- multiple (> four) 60000 Biopsy/FNAC ,CT report and Film
814 S15 3A.S15.00027 3A.S15.00027 : Sleeve resection of lung cancer 90000 Biopsy/FNAC ,CT report and Film
3A.S15.00028 : Oesophagectomy with two field
815 S15 3A.S15.00028 75000 Biopsy , CT , Endoscopy reports HPE report, scar photo
lymphadenectomy
3A.S15.00029 : Oesophagectomy with three field
816 S15 3A.S15.00029 90000 Biopsy , CT , Endoscopy reports Biopsy , CT , Endoscopy reports
lymphadenectomy
817 S15 3A.S15.00030 3A.S15.00030 : Enucleation of pancreatic neoplasm 25000 CT / MRI with film/IHC report
HPE report
Clinical Photograph showing the scar +
818 S15 3A.S15.00031 3A.S15.00031 : Radical Cholecystectomy 60000 CT /MRI report and Film, biopsy
HPE report +USG Report
819 S15 3A.S15.00032 3A.S15.00032 : Abdominal wall tumour resection 35000 CT abdomen report and Film
HPE report
3A.S15.00033 : Abdominal wall tumour resection with Clinical Photograph showing scar +
820 S15 3A.S15.00033 45000 CT abdomen report and Film
821 S15 3A.S15.00034 3A.S15.00034 : Oesophageal stenting including stent cost 40000 CT abdomen report and Film Stent invoice

822 S15 3A.S15.00035 3A.S15.00035 : Triple bypass GI tract 40000 Biopsy , CT , Endoscopy
HPE report
Clinical Photograph showing scar, USG
823 S15 3A.S15.00036 3A.S15.00036 : Segmentectomy- hepatobiliary system 50000 CT /MRI report and Film
and HPE Report
3A.S15.00037 : Radical Hysterectomy + Bilateral pelvic
824 S15 3A.S15.00037 lymph node dissection + bilateral salpingo ophorectomy 50000 CT report and Film, Biopsy
HPE report
(BSO)/ ovarian transposition
3A.S15.00038 : Skin Tumours Wide Excision + Biopsy of the primary tumour + Clinical Photograph showing scar +
825 S15 3A.S15.00038 50000
Reconstruction CT/MRI with film HPE report
Biopsy of the primary tumour + Clinical Photograph showing scar +
826 S15 3A.S15.00039 3A.S15.00039 : Skin Tumours Amputation 25000
CT/MRI with film HPE report
827 S15 3A.S15.00040 3A.S15.00040 : Radical Vaginectomy 40000 CT report and Film, Biopsy HPE report
828 S15 3A.S15.00041 3A.S15.00041 : Radical Vaginectomy + Reconstruction 45000 CT report and Film, Biopsy HPE report
3A.S15.00042 : Bilateral Pelvic Lymph Node Dissection Clinical Photograph showing scar +
(BPLND) HPE report
830 S15 3A.S15.00043 3A.S15.00043 : Radical Trachelectomy 40000 CT report and Film, Biopsy
HPE report
831 S15 3A.S15.00044 3A.S15.00044 : Vulvectomy with bilateral groin dissection 45000 Clinical Notes, USG/CT/MRI OT Notes, HPE
CT-Local part/MRI, CT Chest with

3A.S15.00045 : Limb salvage surgery for bone tumor Clinical Photograph XRAY Showing
832 S15 3A.S15.00045 75000 film, ,Bone Scan report + Biopsy
with prosthesis prosthesis + HPE report
Report
Speciality
code
Clinical Photograph showing scar / HPE
833 S15 3A.S15.00046 3A.S15.00046 : Hemipelvectomy 65000 CT/MRI Pelvis with film
report + XRAY
Clinical Photograph showing scar / HPE
834 S15 3A.S15.00047 3A.S15.00047 : Sacral resection 60000 CT/MRI Pelvis with film
report + XRAY
3A.S15.00048 : Chest wall resection with reconstruction Clinical Photograph showing scar +
835 S15 3A.S15.00048 40000 CT Chest with film, biopsy
for soft tissue / bone tumors HPE report
CT-Local part/MRI with film + Clinical Photograph showing scar+
836 S15 3A.S15.17150 3A.S15.17150 : Forequarter amputation 30000
Biopsy Report HPE report
CT-Local part including chest /MRI Clinical Photograph showing scar +

837 S15 3A.S15.17151 3A.S15.17151 : Shoulder Girdle Resection 40000
report with film + Biopsy Report HPE report
Biopsy/FNAC , Mammography/USG, HPE report, scar photo ( if patient

838 S15 3A.S15.17152 3A.S15.17152 : Mastectomy +Axillary Dissection 25000
chest Xray consents)
839 S15 3A.S15.17153 3A.S15.17153 : Gastro Jejunostomy 30000 Clinical photograph showing scar
film
840 S15 3A.S15.17154 3A.S15.17154 : Ileotransverse Colostomy 30000 Clinical photograph with scar
film
841 S15 3A.S15.17155 3A.S15.17155 : Distal Pancreatectomy 60000 CT / MRI with film/IHC report
HPE report
842 S15 3A.S15.17156 3A.S15.17156 : Enucleation of Cyst 50000 CT report and Film
HPE report
843 S15 3A.S15.17157 3A.S15.17157 : Whipples surgery ( inclusive of staplers) 80000 CT / MRI/IHC
HPE report
Clinical Photograph showing scar, USG
844 S15 3A.S15.17158 3A.S15.17158 : Hepatectomy (right or left) 85000 CT /MRI report and Film
and HPE Report
Cystoscopy, biopsy, CT report and Clinical Photograph showing scar+
845 S15 3A.S15.17159 3A.S15.17159 : Anterior Exenteration 70000
Film HPE report
Cystoscopy, biopsy, CT report and Clinical Photograph showing scar+
846 S15 3A.S15.17160 3A.S15.17160 : Total Exenteration 75000
Film HPE report
Clinical Photograph showing scar, post
847 S15 3A.S15.17161 3A.S15.17161 : Urinary diversion 40000 Biopsy, USG Scrotum report and Film
op USG
3A.S15.17162 : Surgery for Ca Ovary - advance stage Clinical Photograph showing scar +
848 S15 3A.S15.17162 60000 USG/CT Reports with film,CA 125
with Mesenteric/Peritoneal/Omental Metastatsis HPE report + USG report
3A.S15.17163 : Microlaryngeal Surgery including

849 S15 3A.S15.17163 11000 Clinical Photograph Clinical Photograph, HPE report
Phonosurgery
3A.S15.17164 : Laryngectomy - any type, with neck node Clinical Photograph showing scar +
dissection HPE report
851 S15 3A.S15.17165 3A.S15.17165 : Laryngopharyngo Oesophagectomy 70000 Biopsy , CT , Endoscopy reports HPE report, scar photo
852 S15 3A.S15.17166 3A.S15.17166 : GI Stenting including stent cost 40000 CT abdomen report and Film Stent invoice
3A.S15.17167 : Composite Resection + Micro vascular Clinical Photograph showing scar +
Speciality
code
Photos with laser machine, CD of

854 S15 3A.S15.17168 3A.S15.17168 : Laser Surgery of Larynx 30000 Clinical Photograph
procedure/intra op stills + HPE report
3A.S15.17169 : VATS/Laparoscopy ( for deep seated

855 S15 3A.S15.17169 10000 CT report with film Scar Photo
biopsy)
Endoscopy with film, biopsy, CT Clinical Photograph showing scar +
856 S15 3A.S15.17170 3A.S15.17170 : Abdominoperinial Resection 50000
report with film HPE report
857 S15 3A.S15.17171 3A.S15.17171 : Surgery for Ca Ovary - early stage 40000 USG/CT Reports with film,CA 125
HPE report + USG report
3A.S15.17172 : Mastectomy +Axillary Dissection+Defect Biopsy/FNAC , Mammography/USG, HPE report, scar photo ( if patient
858 S15 3A.S15.17172 40000
Closure with Flap chest Xray consents)
CT/MRI report and Film if required, Clinical Photograph showing scar +
859 S15 3A.S15.17173 3A.S15.17173 : Wide excision of lesion 25000
Biopsy, clinical picture HPE report
3A.M4.00001 : Acute lymphoblastic leukemia Haematology, Bone Marrow Clinical Photograph, chemotherapy
860 M4 3A.M4.00001 50000
(chemotherapy including diagnostics): induction Aspitation/ Flow cytometry drug batch number with bar code
861 M4 3A.M4.00002 50000
(chemotherapy including diagnostics): consolidation Aspitation/ Flow cytometry drug batch number with bar code
862 M4 3A.M4.00003 5000
(chemotherapy including diagnostics): maintainence Aspitation/ Flow cytometry drug batch number with bar code
3A.M4.00005 : Acute lymphoblastic leukemia: Supportive Haematology, Bone Marrow Clinical Photograph, chemotherapy
863 M4 3A.M4.00005 20000
care/ rehabilitation Aspitation/ Flow cytometry drug batch number with bar code
3A.M4.00006 : Acute myeloid leukemia (chemotherapy Haematology, Bone Marrow Clinical Photograph, chemotherapy
864 M4 3A.M4.00006 75000
including diagnostics): induction Aspitation/ Flow cytometry drug batch number with bar code
3A.M4.00007 : Acute myeloid leukemia (chemotherapy Haematology, Bone Marrow Clinical Photograph, chemotherapy
865 M4 3A.M4.00007 75000
including diagnostics): consolidation Aspitation/ Flow cytometry drug batch number with bar code

3A.M4.00008 : Acute myeloid leukemia: Supportive care/ drug batch number with bar code,
866 M4 3A.M4.00008 30000 Haematology + Cytoflowmetry report
rehabilitation treatment drug details in discharge
summary
3A.M4.00011 : Hodgkin Lymphoma (Favorable group): Clinical Photograph, chemotherapy

867 M4 3A.M4.00011 15000 Biopsy, CT
Supportive care/ rehabilitation drug batch number with bar code

3A.M4.00014 : Hodgkin Lymphoma (unfavorable group): drug batch number with bar code,
868 M4 3A.M4.00014 25000 Biopsy, CT
Supportive care/ rehabilitation treatment drug details in discharge
summary
Speciality
code
Heamogram,Biochemestry,chest x-ray,
3A.M4.00015 : Non-Hodgkin Lymphoma: chemotherapy Lymphnode Biopsy,HPE, BMA with
869 M4 3A.M4.00015 1,50,000 chemotherapy drug batch number with
including diagnostics biopsy, CT scan
bar code
3A.M4.00016 : Non-Hodgkin Lymphoma: Supportive drug batch number with bar code,
870 M4 3A.M4.00016 50000 Biopsy, CT
care/ rehabilitation treatment drug details in discharge
summary
3A.M4.00017 : Retinoblastoma (Intraocular): Clinical Photograph, chemotherapy

871 M4 3A.M4.00017 45000 Biopsy , CT report with film
chemotherapy including diagnostics drug batch number with bar code

3A.M4.00020 : Retinoblastoma (Intraocular): supportive drug batch number with bar code,
care/ rehabilitation treatment drug details in discharge
summary
3A.M4.00021 : Retinoblastoma (extraocular):
873 M4 3A.M4.00021 110000 MRI of orbit and brain Chest x-ray,USG abdomen pelvis,BMA
chemotherapy including diagnostics
3A.M4.00023 : Retinoblastoma (extraocular): supportive Clinical Photograph, chemotherapy

care/ rehabilitation drug batch number with bar code
3A.M4.00024 : Brain tumors: chemotherapy including Clinical Photograph, chemotherapy

875 M4 3A.M4.00024 40000 CT report /MRI Clinical features
diagnostics drug batch number with bar code
3A.M4.00027 : Brain tumors: supportive care/ Clinical Photograph, chemotherapy

876 M4 3A.M4.00027 25000 CT report /MRI Clinical features
rehabilitation drug batch number with bar code
3A.M4.00028 : Wilms tumors: chemotherapy including Clinical Photograph, chemotherapy

877 M4 3A.M4.00028 20000 CT report with film, biopsy/FNAC
diagnostics drug batch number with bar code
3A.M4.00031 : Histiocytosis: chemotherapy including Skin Biopsy / Lymphnode Biopsy,USG

878 M4 3A.M4.00031 50000 Heamogram,Biochemestry
diagnostics abdomen pelvis
3A.M4.00032 : Histiocytosis: supportive care/ Clinical Photograph, chemotherapy

rehabilitation drug batch number with bar code
3A.M4.00033 : Bone tumors/soft tissue sarcomas : Clinical Photograph, chemotherapy

chemotherapy including diagnostics drug batch number with bar code
3A.M4.00036 : Bone tumors/soft tissue sarcomas : Clinical Photograph, chemotherapy

supportive care/ rehabilitation drug batch number with bar code
3A.M4.00037 : Chronic Myeloid Leukemia : Haematology, Bone Marrow Photo with RT Machine , RT treatment
882 M4 3A.M4.00037 6000
chemotherapy including diagnostics Aspitation/ Flow cytometry chart
3A.M4.00038 : Chronic Myeloid Leukemia : supportive BMA report and Molecular analysis Heamogram,Biochemestry, , treatment
883 M4 3A.M4.00038 1,00,000
care/ rehabilitation report drug details in discharge summary
Speciality
code
3A.M5.00001 : Lymphoma, Non-Hodgkin’sR-CHOP Clinical Photograph, chemotherapy

884 M5 3A.M5.00001 6000 Biopsy, CT report with film
Regimen (per cycle) x 6 drug batch number with bar code
Bone Marrow Aspiration Report,

3A.M5.00002 : Multiple MyelomaBortezomib+ Clinical Photograph, chemotherapy
885 M5 3A.M5.00002 5000 Serum Protein electrophoresis, CRAB
lenalidomide+ dexamethasone, per cycle x6 drug batch number with bar code
criteria
3A.M5.00003 : Multiple MyelomaBortezomib+ Clinical Photograph, chemotherapy
cyclophosphamide+ dexamethasone, per cycle x 6 drug batch number with bar code
criteria
3A.M5.00004 : Multiple MyelomaMPT - melphalan, Clinical Photograph, chemotherapy
thalidomide and prednisolone, per cycle x 9 drug batch number with bar code
criteria
3A.M5.00005 : Multiple MyelomaBortezomib + Clinical Photograph, chemotherapy
dexamethasone, per cycle x 9 drug batch number with bar code
criteria
3A.M5.00006 : Multiple Bone Marrow Aspiration Report,
889 M5 3A.M5.00006 MyelomaThalidomide+Dexamethasone(Oral)/ month - 5000 Serum Protein electrophoresis, CRAB
max 12 months criteria
3A.M5.00007 : Colon Rectum5-Fluorouracil-Oxaliplatin - Chemotherapy drug batch number

Leucovorin (FOLFOX) - Max. 6 cycles (Per cycle) with bar code
3A.M5.00008 : Bone Tumors/Osteosarcoma/

891 M5 3A.M5.00008 Hepatoblastoma -OperableCisplatin/carboplatin - 3000 Biopsy , CT-Scan with film
Adriamycin- max 6 cycles (Per cycle)
3A.M5.00009 : Lymphoma, Hodgkin'S Adriamycin
892 M5 3A.M5.00009 Bleomycin VinblastinDacarbazine (ABVD) - max 8 cycles 10000 Biopsy, CT
(Per cycle) (Day 1 & Day 15)
3A.M5.00010 : Cervix Cisplatin/Carboplatin (AUC2) along Clinical Photograph, chemotherapy

with RT- max 6 cycles (Per cycle) drug batch number with bar code
3A.M5.00011 : Neuroblastoma Stage I –IIIVariable Clinical Photograph, chemotherapy

894 M5 3A.M5.00011 10000 CT report with film, biopsy/FNAC
Regimen – Neuroblastoma - max 1 year (Per cycle) drug batch number with bar code
3A.M5.00012 : Wilm'sTumor SIOP/National Wilms

895 M5 3A.M5.00012 Tumour Study Group (NWTS) regimen(Stages I - V)- max 7000 CT report with film, biopsy/FNAC
6 months (Per month) - Wilm's tumour
Chemotherapy drug batch number
896 M5 3A.M5.00013 3A.M5.00013 : Colon - rectum Monthly 5-FU 4000 CT report and Film, Biopsy
with bar code
Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
897 M5 3A.M5.00014 3A.M5.00014 : BreastPaclitaxel weekly x 12 weeks 4500
chest Xray with bar code
3A.M5.00015 : Breast
898 M5 3A.M5.00015 Cyclophosphamide/Methotrexate/5 Fluorouracil (CMF) 1500
(Per cycle)
Speciality
code
3A.M5.00016 : BreastTamoxifen tabs - maximum 12 Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
899 M5 3A.M5.00016 100
cycles (Per month) chest Xray with bar code
3A.M5.00017 : Breast Adriamycin/Cyclophosphamide Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number

900 M5 3A.M5.00017 3000
(AC) – per cycle (Maximum 4 cycles) chest Xray with bar code
3A.M5.00018 : Breast5- Fluorouracil A-C (FAC) – per Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
901 M5 3A.M5.00018 5000
cycle (Maximum 6 cycles) chest Xray with bar code
902 M5 3A.M5.00019 3A.M5.00019 : BreastAC (AC Then Taxol) 5000
3A.M5.00020 : Small Cell Lung Cancer Chemotherapy drug batch number

Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles only) with bar code
3A.M5.00021 : Oncology oesophagusCisplatin + 5

Endoscopy with film, biopsy, CT Chemotherapy drug batch number
904 M5 3A.M5.00021 FU(Neoadjuvant Chemotherapy)/Adjuvant (ADJ)- per 3000
report with film with bar code
cycle (Max. of 6 cycles only)
3A.M5.00022 : Stomach Docetaxel +Oxaliplatin+5FU

20,000 per cycle for 4 cycles Endoscopy with film, biopsy, CT Chemotherapy drug batch number
905 M5 3A.M5.00022 4000
CapOX- 10,000 per cycle for 8 cycles report with film with bar code
3A.M5.00023 : Breast Aromatase Inhibitors

906 M5 3A.M5.00023 (Anastazole/Letrozole/Exemestane) - maximum 900
12 cycles (Per month)
3A.M5.00024 : Urinary Bladder Weekly Clinical Photograph, chemotherapy

Cisplatin/Carboplatin- max 6 cycles with RT (Per week) drug batch number with bar code
3A.M5.00025 : Urinary Bladder Methotraxate Vinblastin Clinical Photograph, chemotherapy

Adriamycin Cyclophosphamide (MVAC) drug batch number with bar code
3A.M5.00026 : Retinoblastoma Clinical Photograph, chemotherapy

Carbo/Etoposide/Vincristine-max 6 cycles (Per cycle) drug batch number with bar code
3A.M5.00027 : Febrile NeutropeniaIV antibiotics and Clinical Photograph, Discharge

910 M5 3A.M5.00027 30000 Haemogram for each episode
other supportive therapy (Per episode) summary (with details of drugs given)
CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy

911 M5 3A.M5.00028 3A.M5.00028 : Vaginal/ Vulval Cancer Cisplastin/5-FU 3000
markers drug batch number with bar code
3A.M5.00029 : OvaryTaxol + Carboplatin-max 6 cycles CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy
912 M5 3A.M5.00029 15000
(Per cycle) markers drug batch number with bar code
3A.M5.00030 : Multiple MyelomaMelphalan -Prednisone Bone Marrow Aspiration Report,

913 M5 3A.M5.00030 (oral) – per month (max 12 months) - Ovarian CA, Bone 1500 Serum Protein electrophoresis, CRAB
CA criteria
Speciality
code
3A.M5.00031 : Rectal Cancer Stage 2 And 3Gemcitabine Chemotherapy drug batch number
+capecitabine-15,000 per cycle for 6 cycles with bar code
3A.M5.00032 : Multiple MyelomaZoledronic acid - Max CT/PET /Bone scan/ Xray, Biopsy if Chemotherapy drug batch number
915 M5 3A.M5.00032 2000
12 cycles (Per month) required with bar code
3A.M5.00033 : Gestational Trophoblast Ds. High
RiskEtoposide-Methotrexate-Actinomycin / Clinical Photograph, chemotherapy
916 M5 3A.M5.00033 10000 B HCG report,CT report and Film
Cyclophosphamide -Vincristine (EMA-CO)-max 6 cycles drug batch number with bar code
(Per cycle)
3A.M5.00034 : Gestational Trophoblast Ds. Low Risk Clinical Photograph, chemotherapy

Actinomycin- max 10 cycles (Per cycle) drug batch number with bar code
3A.M5.00035 : Gestational Trophoblast Ds. Low Clinical Photograph, chemotherapy

RiskWeekly Methotrexate (Per week) max. 10 cycles drug batch number with bar code
3A.M5.00036 : Ovary Germ Cell Tumour Bleomycin- Clinical Photograph, chemotherapy

Etoposide-Cisplatin (BEP) - max cycles 4 (Per cycle) drug batch number with bar code
CT report and Film, Biopsy,PSA with Clinical Photograph, chemotherapy

920 M5 3A.M5.00037 3A.M5.00037 : Prostate Hormonal Therapy - Per month 3000
evidence of bone metastasis drug batch number with bar code
3A.M5.00038 : Testis Bleomycin-Etoposide-Cisplatin

921 M5 3A.M5.00038 (BEP) regimen for germ cell tumour - max cycles 4 (Per 10000 CT report and Film, Biopsy
cycle)
3A.M5.00039 : Acute Myeloid LeukemiaInduction Phase,

922 M5 3A.M5.00039 up to (Daunomycin and cytosine arabinoside (3:7)) 100000
3A.M5.00040 : Acute Myeloid LeukemiaConsolidation

923 M5 3A.M5.00040 Phase, up to (High dose cytosine arabinoside – per cycle, 75000
max. of 3 to 4 cycles)
3A.M5.00041 : Histocytosis Variable Regimen- Clinical Photograph, chemotherapy

Histocyosis-max 1 year (Per month) drug batch number with bar code
3A.M5.00042 : Rhabdomyosarcoma Vincristine-

925 M5 3A.M5.00042 Actinomycin-Cyclophosphamide (VACTC) based chemo - 6000 Biopsy , CT report with film
max 1 year (Per month) - Rhabdomyosarcoma
3A.M5.00043 : Ewing’s SarcomaVariable Regimen Inv - Clinical Photograph, chemotherapy

926 M5 3A.M5.00043 6000 X-Ray,CT Scan with film, Biopsy
Hematology, Biopsy – Payable drug batch number with bar code
3A.M5.00044 : Unlisted Regimen Palliative CT- Max 6 Chemotherapy drug batch number
927 M5 3A.M5.00044 5000 CT/MRI , HPE report
cycles (Per cycle) with bar code
Speciality
code
3A.M5.00045 : Terminally Ill Palliative And Supportive Chemotherapy drug batch number
928 M5 3A.M5.00045 3000 CT/MRI , HPE report
Therapy - Per month with bar code
3A.M5.00046 : Acute Lymphatic Leukemia Maintenance Haematology, Bone Marrow Photo with RT Machine , RT treatment
929 M5 3A.M5.00046 5000
Phase - Per month (x 24) Aspitation/ Flow cytometry chart
Haematology, Bone Marrow Photo with RT Machine , RT treatment
930 M5 3A.M5.00047 3A.M5.00047 : Acute Lymphatic Leukemia Induction 50000
Aspitation/ Flow cytometry chart
3A.M5.00048 : Acute Lymphatic Leukemia Consolidation Haematology, Bone Marrow Clinical Photograph, chemotherapy
931 M5 3A.M5.00048 50000
Phase Aspitation/ Flow cytometry drug batch number with bar code
3A.M5.00049 : Head and NeckTab Geftinib/Erlotinib-Max Chemotherapy drug batch number

1 Year (Per month) with bar code
3A.M5.00050 : Renal cell carcinoma Sunitinib/ Pazopanib CT report with film, Isotope Chemotherapy drug batch number
933 M5 3A.M5.00050 2500
(per day) renogram if required with bar code
3A.M5.00051 : Chronic myeloid leukemiaImatinib (per Haematology, Bone Marrow Photo with RT Machine , RT treatment
934 M5 3A.M5.00051 6000
month) x 5 years Aspitation/ Flow cytometry chart
3A.M5.00052 : Gall Bladder Cancer Gemcitabine + Clinical Photograph, chemotherapy

cisplatin (per cycle) – for 6 cycles drug batch number with bar code
3A.M5.17176 : Paclitaxel + Cisplatin / Carboplatin 2.

936 M5 3A.M5.17176 Gemcitabine D1 & D8 + Cisplatin / Carboplatin -Max. 6 12000 Biopsy/FNAC ,CT report and Film
with bar code
cycles only (Per cycle)
3A.M5.17177 : Pemetrexed +Carboplatin/Cisplatin (Stage Chemotherapy drug batch number

937 M5 3A.M5.17177 15000 Biopsy/FNAC ,CT report and Film,
IIIB, IV Adenocarcinoma)- Max. 6 cycles only (Per cycle) with bar code
3A.M5.17178 : Cisplatin/Adriamycin+ifosmide (IAP)- max

938 M5 3A.M5.17178 6 cycles (Per cycle) -Adj/Neo adjuvant/Palliative 15000 Biopsy , CT-Scan with film
(Osteosarcoma)
3A.M5.17179 : High Dose Methotrexate (MTX)- max 6 Clinical Photograph, chemotherapy

cycles (Per cycle) drug batch number with bar code
3A.M5.17180 : IFS + ADR-max 6 cycles (Per cycle) - Clinical Photograph, chemotherapy

Adj/Neo adjuvant/Palliative drug batch number with bar code
3A.M5.17181 : Consolidation 1 to 4 phases(per phase)- Haematology, Bone Marrow Clinical Photograph, chemotherapy
941 M5 3A.M5.17181 33000
AML Aspitation/ Flow cytometry drug batch number with bar code
3A.M5.17182 : Adult ALL -Hyper CVAD/BFM - 4 cycles ( Haematology, Bone Marrow Clinical Photograph, chemotherapy
942 M5 3A.M5.17182 36000
Each cycle= A + B) Aspitation/ Flow cytometry drug batch number with bar code
3A.M5.17183 : D'angelo's for CNS primary and Clinical Photograph, chemotherapy

943 M5 3A.M5.17183 20000 Haematology + Cytoflowmetry report
secondary lymphomas -(Max. 6 months) (Per month) drug batch number with bar code
Speciality
code
3A.M5.17184 : Salvage CT - GDP (Gemcitabine -
944 M5 3A.M5.17184 Cisplatin- Dexamethasone)- Maximum 6 cycles (Per 12000 Hematology + Biopsy/FNAC report
cycle)
3A.M5.17185 : Salvage CT - ICE (Ifosfamide-Carboplatin- Clinical Photograph, chemotherapy

Etoposide)- Maximum 6 cycles (Per cycle) drug batch number with bar code
3A.M5.17186 : Salvage CT -DHAP (cytosine arabinoside-

946 M5 3A.M5.17186 cisplatin-dexamethasone) - Maximum 6 cycles (Per 25000 Hematology + Biopsy/FNAC report
cycle)
3A.M5.17187 : Second generation Tab TKI - max 12 Hematology + FNAC report Clinical Photograph, chemotherapy
947 M5 3A.M5.17187 6000
cycles per year (Per month) - (Failure of Imatinib) /Cytogenetics/ BCR-ABL drug batch number with bar code
3A.M5.17188 : Bendamustine- max 6 cycles (Per cycle) - Clinical Photograph, chemotherapy

CLL drug batch number with bar code
3A.M5.17189 : Bendamustine + Ritumaxib- 6-8 cycles Clinical Photograph, chemotherapy

(Per cycle) - CLL (Available only at select centres) drug batch number with bar code

950 M5 3A.M5.17190 3A.M5.17190 : R-CHOP -max 6 cycles (Per cycle) 20000 Biopsy, CT report with film
3A.M5.17191 : Variable Regimen-Non Lymphoblastic Clinical Photograph, chemotherapy

NHL, (Per cycle) max. 8 cycles.(Amount as per drug cost) drug batch number with bar code
3A.M5.17192 : Plasma cell Leukemia / Multiple Myeloma

Bone Marrow Aspiration Report, Clinical Photograph, chemotherapy
952 M5 3A.M5.17192 - Thaladomide, Dexamethasone, Bortezomib - max 6 20000
Serum Protein electrophoresis drug batch number with bar code
cycles
3A.M5.17193 : Carbo/Etoposide/Vincristine-max 6 cycles Clinical Photograph, chemotherapy

(Per cycle) - Retinoblastoma drug batch number with bar code
3A.M5.17194 : Variable Regimen- LCH-max 1 year (Per Clinical Photograph, chemotherapy

954 M5 3A.M5.17194 8000 Biopsy,IHC , CT report with film
month)(Amount as per drug cost) drug batch number with bar code
3A.M5.17195 : FEC (Epirubicin based)(Maximum 6 cycles) Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
955 M5 3A.M5.17195 8000
(Per cycle) chest Xray with bar code
3A.M5.17196 : 1. TC Docetaxel + Cyclophosphamide. 2.

TAC Docetaxel + Doxorubicin + Cyclophosphamide. 3. Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
956 M5 3A.M5.17196 12000
Gemcitabine D1 & D8 +/- Cisplatin/ Carboplatin - chest Xray with bar code
maximum 6 cycles (Per cycle)
3A.M5.17197 : Capetabine (Day 1-14) - 6 cycles

957 M5 3A.M5.17197 (Palliative/Adjuvant); As Concurrent as RT sensitizor with 4000 CT/USG report and Film, Xray, Biopsy
with bar code
all RT
Speciality
code
3A.M5.17198 : Variable Regimen maximum 6 cycles (Per Chemotherapy drug batch number
cycle) (Amount as per drug cost) with bar code
3A.M5.17199 : Cisplatin/Carboplatin- 5FU (Per cycle) - Endoscopy with film, biopsy, CT Chemotherapy drug batch number
959 M5 3A.M5.17199 6000
Oesophageal CA report with film with bar code
Endoscopy with film, biopsy, CT Chemotherapy drug batch number
960 M5 3A.M5.17200 3A.M5.17200 : Epirubicin+Cisplatin+5FU (Per cycle) 8000
report with film with bar code
3A.M5.17201 : EOX (Epirubicin + Oxaloplatin + Endoscopy with film, biopsy, CT Chemotherapy drug batch number
961 M5 3A.M5.17201 12000
Capcetabine) - Max 6 cycles report with film with bar code
3A.M5.17202 : Monthly 5-Fluorouracil(FU) (Per cycle) - Chemotherapy drug batch number
Colorectal cancer with bar code
963 M5 3A.M5.17203 3A.M5.17203 : Imatinib -Max for 6 months (Per month) 5000 CT report and Film, Biopsy
with bar code
3A.M5.17204 : Gemcitabine+Cisplatin(Day 1,Day 8 )-max Chemotherapy drug batch number
6 cycles (Per cycle) with bar code
3A.M5.17205 : Tab Sorafenib- max 12 months (Per Chemotherapy drug batch number
month) with bar code
3A.M5.17206 : Oxiplatin+Capecitabine- max. of 6 cycles Chemotherapy drug batch number

966 M5 3A.M5.17206 8000 CT/MRI with film, Biopsy
for palliative only or 8 cycles for adjuvant (Per cycle) with bar code
3A.M5.17207 : Weekly Cisplatin/Carboplatin- max 6 Chemotherapy drug batch number

cycles with RT (Per week) with bar code
3A.M5.17208 :
968 M5 3A.M5.17208 Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vinblastine,If 20000
osphimide,Cisplatin(VeIP)- max cycles 4 (Per cycle)
3A.M5.17209 : Cisplatin/Carboplatin (AUC2)- Max. of 6 Clinical Photograph, chemotherapy

cycles only (Per cycle) drug batch number with bar code
3A.M5.17210 : Carboplatin/Paclitaxel-max 6 cycles (Per Clinical Photograph, chemotherapy

cycle) drug batch number with bar code
3A.M5.17211 : Weekly Methotrexate (Per week) max. 10 Clinical Photograph, chemotherapy

cycles drug batch number with bar code
3A.M5.17212 : Etoposide-Methotrexate-Actinomycin /
972 M5 3A.M5.17212 Cyclophosphamide -Vincristine (EMA-CO)-max 6 cycles 8000 B HCG report,CT report and Film
(Per cycle)
3A.M5.17213 : Variable Regimen (Amount as per drug Clinical Photograph, chemotherapy

cost)- max 6 cycles (Per cycle) drug batch number with bar code
3A.M5.17214 : Gemcitabine+ Carboplatin/ Liposomal

974 M5 3A.M5.17214 Doxorubicin/ Albumin bound Paclitaxel ( Adjuvant), max 12000 CT report and Film, Biopsy
6 cycles
Speciality
code
3A.M5.17215 : Palliative CT- Max 6 cycles (Per cycle) For Chemotherapy drug batch number
975 M5 3A.M5.17215 8000 CT/USG report and Film, Xray, Biopsy
Primary and secondary tumours with bar code
3A.M5.17216 : Zoledronic acid - Max 12 cycles (Per CT/PET /Bone scan/ Xray, Biopsy if Chemotherapy drug batch number
976 M5 3A.M5.17216 3000
month) required with bar code
3A.M5.17217 : Tab Temozolemide for 6 months (5days Pharmacy Bill/Invoice with batch no. of
every month x 6 months) the drug strip
3A.M5.17218 : Growth Factor / Pegrafil (Per cycle) Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
978 M5 3A.M5.17218 2000
(Maximum 4 cycles) chest Xray with bar code
3A.M5.17219 : Cisplatin/Carboplatin (AUC2) along with Chemotherapy drug batch number
RT- max 6 cycles (Per cycle) with bar code
3A.M5.17220 : Cisplatin + 5FU + Taxol/Docitaxel ( only Clinical Photograph showing scar +
hypopharynx) HPE report
3A.M5.17221 : Palliative CT (Paclitaxel + Cisplatin or 5 FU CT / USG report and Film, X ray, Chemotherapy drug batch number
981 M5 3A.M5.17221 8000
+ Cisplatin) - Max 6 cycles (Per cycle) Biopsy with bar code
3A.M5.17222 : Palliative CT 1. Docetaxel + Cisplatin /
982 M5 3A.M5.17222 Carboplatin. 2. Gemcitabine D1& D8 + Cisplatin / 10000 CT report and Film, Biopsy
with bar code
Carboplatin - max 6 cycles (Per cycle)
983 M5 3A.M5.17223 3A.M5.17223 : Tab Sorefinib- max 12 months (Per month) 8000 CT/MRI report and Film, Biopsy
with bar code
3A.M5.17225 : SIOP/NATIONAL WILMS TUMOUR STUDY
984 M5 3A.M5.17225 GROUP(NWTS) regimen(Stages I - V)- max 6 months 8000 CT report with film, biopsy/FNAC
(Per month) - Wilm's tumour
3A.M5.17226 : Bleomycin-Etoposide-Cisplatin (BEP) (Per Clinical Photograph, chemotherapy

cycle) - Germ cell tumours, extra gonadal tumour drug batch number with bar code
3A.M5.17227 : Vincristine-Actinomycin-
986 M5 3A.M5.17227 Cyclophosphamide(Vact C) based chemo - max 1 year 9000 Biopsy , CT report with film
(Per cycle)- Rhabdomyosarcoma
3A.M5.17228 : Cisplatin + 5 FU(Neoadjuvant
987 M5 3A.M5.17228 Chemotherapy)/Palliative - Max. of 4 cycles only (Per 6000 CT report and Film, Biopsy
with bar code
cycle)
3A.M5.17229 : Bleomycin-Etoposide-Cisplatin (BEP)- max
988 M5 3A.M5.17229 cycles 4 (Per cycle) Germ cell tumours, extra gonadal 10000
tumour
Clinical Photograph,chemotherapy
989 M5 3A.M5.17230 3A.M5.17230 : Tab Sorafenib-max 12 months (Per month) 8000 CT report and Film, Biopsy
3A.M5.17231 : Tab Geftinib/Erlotinib-Max 1 Year (Per Chemotherapy drug batch number

month) with bar code
3A.M5.17232 : Variable Regimen -Ewings Sarcoma- max Clinical Photograph, chemotherapy

991 M5 3A.M5.17232 10000 X-Ray,CT Scan with film, Biopsy
17 cycles in 1 year (Per cycle)(Amount as per drug cost) drug batch number with bar code
Speciality
code
3A.M5.17233 : Induction/1st Phase-AML ( 2nd Induction - Haematology, Bone Marrow Clinical Photograph, chemotherapy
992 M5 3A.M5.17233 50000
permitted in adults only) Aspitation/ Flow cytometry drug batch number with bar code
3A.M5.17234 : Doxorubicin - Bleomycin - Vinblastine

993 M5 3A.M5.17234 Dacarbazine (DBVD)-max 6-8 cycles (Per cycle) (Day1 & 12000 Biopsy, CT
Day15) - Hodgkins Lymphoma
3A.M5.17235 : Aromatase Inhibitors (
994 M5 3A.M5.17235 Anastazole/Letrozole/ Exemestane)- maximum 12 cycles 900
(Per month)
3A.M5.17236 : Maintenance ( Paed and adults) - ALL (Per Haematology, Bone Marrow Clinical Photograph, chemotherapy
995 M5 3A.M5.17236 3000
month) Aspitation/ Flow cytometry drug batch number with bar code
3A.M5.17237 : Imatinib Min 400 mg/day-max 12 cycles Hematology + FNAC report Clinical Photograph, chemotherapy
996 M5 3A.M5.17237 5000
per year (Per month) - AML, CML /Cytogenetics/ BCR-ABL drug batch number with bar code
3A.M5.17238 : Paclitaxel/docetaxel(Maximum 4cycles) Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number

997 M5 3A.M5.17238 9000
(Adjuvant) (Per cycle) chest Xray with bar code
3A.M5.17239 : Carboplatin/cisplatin +
998 M5 3A.M5.17239 Paclitaxel/Docetaxel (Neoadjuvant Chemotherapy)-Max. 12000 Biopsy Reports
HPE report
of 4 cycles only (Per cycle) -For stage III and IVA

999 M5 3A.M5.17240 3A.M5.17240 : Palliative CT- Max 6 cycles (Per cycle) 8000
S2 3A.S2.00085B 3A.S2.00085B : Hemiglossectomy - - cross speciality 25000 CT , Biopsy Clinical photograph
S2 3A.S2.00087B 3A.S2.00087B : Partial Glossectomy - cross speciality 25000 CT , Biopsy Clinical photograph
S2 3A.S2.00090B 3A.S2.00090B : Total Glossectomy - cross speciality 15000 CT , Biopsy Clinical photograph
3A.S1.00002A : Anterior Resection for Ca - cross Clinical Photograph showing scar +

S1 3A.S1.00002A 70000 Endoscopy, biopsy, CT report with film
3A.S1.00007A : Bilateral Inguinal block dissection - cross Clinical Photograph showing scar +
S1 3A.S1.00007A 40000 Biopsy Reports
3A.S1.00016A : Bypass - Inoperable Pancreas - cross
S1 3A.S1.00016A 15000
speciality USG/CT USG, Scar photo, HPE Report
3A.S1.00045B : Excision of Growth from Tongue with OT notes, HPE
S1 3A.S1.00045B 15000
neck node dissection - cross speciality CT/MRI, Clinical Photo
3A.S1.00084A : Inguinal Node (dissection) - Unilateral - Clinical Photograph showing scar +
S1 3A.S1.00084A 20000 Biopsy Reports/ Clinical Photograph
cross speciality HPE report
S1 3A.S1.00103A 3A.S1.00103A : Oesophagectomy - cross speciality 60000 Biopsy , CT , Endoscopy reports HPE report, scar photo
S1 3A.S1.00113A 3A.S1.00113A : Radical Mastectomy - cross speciality 10000 Mammography, HPE, CT Scan Scar photo & HPE
3A.S1.00114A : Radical Neck Dissection – Excision - cross Clinical photo, Clinical notes &
S1 3A.S1.00114A 15000 Scar photo & HPE
speciality Biopsy/ Cytology
Speciality
code
3A.S1.00120A : Resection Anastomosis (Large Intestine) -
S1 3A.S1.00120A 15000 USG / CT Scan Scar photo, HPE
cross speciality
3A.S1.00121A : Resection Anastomosis (Small Intestine) -
S1 3A.S1.00121A 15000 USG / CT Scan Scar photo, HPE
cross speciality
3A.S1.00122A : Retroperitoneal Tumor – Excision - cross Clinical Photograph showing scar +
S1 3A.S1.00122A 50000 CT abdomen with film, FNAC
3A.S1.00125A : Segmental Resection of Breast - cross
S1 3A.S1.00125A 10000 Mamography, FNAC, CT if indicated Scar photo, HPE
speciality
3A.S1.00131A : Soft Tissue Tumor (large) – Excision - Biopsy of the primary tumour +
S1 3A.S1.00131A 35000 Scar photo, HPE
cross speciality CT/MRI with film
3A.S1.00134A : Submandibular Mass Excision + CT/MRI/USG report and Film if Clinical Photograph showing scar +
S1 3A.S1.00134A 25000
Reconstruction - Cross speciality required/ Biopsy HPE report
3A.S1.00162A : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
S1 3A.S1.00162A 30000
Adenoma/Carcinoma - cross speciality reports/USG HPE report
3A.S1.00163A : Flap Reconstructive Surgery - cross
S1 3A.S1.00163A 30000 X-ray Films + detail notes Clinical photo showing Scar
speciality
3A.S1.00171A : Lap. Assisted left Hemi colectomy t -
S1 3A.S1.00171A 25000 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00172A : Lap. Assisted Right Hemi colectomy t -
S1 3A.S1.00172A 25000 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00173A : Lap. Assisted small bowel resection - Clinical Photograph showing scar +
S1 3A.S1.00173A 40000 CT, Biopsy
cross speciality HPE report
3A.S1.00174B : Lap. Assisted Total Colectomy - cross Colonocopy with film, biopsy, CT Clinical Photograph showing scar +
S1 3A.S1.00174B 40000
speciality report with film HPE report
3A.S1.00195B : Oesophagectomy for Carcinoma
S1 3A.S1.00195B 50000 Biopsy , CT , Endoscopy reports HPE report, scar photo
3A.S1.00197A : Operation for Carcinoma Lip –
Vermilionectomy - cross speciality
3A.S1.00198B : Operation for Carcinoma Lip - Wedge

Excision and Vermilionectomy - cross speciality
3A.S1.00199B : Operation for Carcinoma Lip - Wedge-

Excision - cross speciality
S1 3A.S1.00202A 3A.S1.00202A : Closure of Colostomy - cross speciality 30000 Colonoscopy, Biopsy Clinical Photograph showing scar
3A.S1.00205A : CystoJejunostomy/or Cystogastrostomy -

S1 3A.S1.00205A 20000 USG/ CT Scan Clinical photograph
cross speciality
3A.S1.00209B : Operation for carcinoma lip- cheek
advancement - cross speciality
3A.S1.00213A : Operations for Replacement of
S1 3A.S1.00213A 25000 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon - cross speciality
3A.S1.00215B : Parapharyngeal Tumour Excision - cross
S1 3A.S1.00215B 11000 USG, CT Neck USG,HPE,Scar Photo
speciality
Speciality
code
3A.S1.00216B : Partial/Subtotal Gastrectomy for Clinical Photograph showing scar +
S1 3A.S1.00216B 50000 Endoscopy, biopsy, CT
Carcinoma - cross speciality HPE report
S1 3A.S1.00230A 3A.S1.00230A : Temporal Bone resection - cross speciality 60000 CT/MRI, Biopsy
HPE report
3A.S1.00242A : Total Thyroidectomy and Block
S1 3A.S1.00242A 20000 Clinical Photograph , USG Scar photo, HPE
Dissection - cross speciality
3A.S1.17006A : Nephrectomy – partial (Code 3A.451)- CT report with film, Isotope Clinical Photograph showing scar+ HPE
S1 3A.S1.17006A 25000
additional cost - cross speciality renogram if required report +USG Report
3A.S1.17007A : Low AR and APR (Code 3A.417, 3A.418) - Endoscopy with film, biopsy, CT Clinical Photograph showing scar +
S1 3A.S1.17007A 25000
additional cost - cross speciality report with film HPE report
3A.S1.17008A : Radical hysterectomy for Ca cervix and
S1 3A.S1.17008A Ca endometrium ( Code 3A.484)- additional cost - cross 20000 CT report and Film, Biopsy
HPE report
speciality
M4 3A.M4.00026B 3A.M4.00026B : Brain tumors: surgery - cross speciality 55000 MRI Report
+ HPE report
M4 3A.M4.00030A 3A.M4.00030A : Wilms tumors: surgery - cross speciality 5000 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report
3A.S7.00141A : Bilateral Orchidectomy for hormone Biopsy Reports /PSA with evidence Clinical Photograph showing scar ( if
S7 3A.S7.00141A 15000
ablation of bone metastasis patient consents)+ HPE report
OPTHALMOLOGY
1000 S3 3A.S3.00002 3A.S3.00002 : Canaliculo Dacryocysto Rhinostomy 10000 Clinical notes Procedure notes, sac syringe
1001 S3 3A.S3.00003 3A.S3.00003 : Capsulotomy (YAG) 1500 Clinical notes Clinical Photograph, Procedure notes
1002 S3 3A.S3.00006 3A.S3.00006 : Cyclocryotherapy/Cyclophotocoagulation 3000 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
1003 S3 3A.S3.00009 3A.S3.00009 : Enucleation 6000 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
1004 S3 3A.S3.00011 3A.S3.00011 : Exenteration 15000 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
3A.S3.00014 : Intraocular Foreign Body Removal from

1005 S3 3A.S3.00014 20000 B Scan Report Clinical Photograph
Posterior Segment
1006 S3 3A.S3.00024 3A.S3.00024 : Iridectomy – Laser 2000 Clinical Note / slit lamp report Clinical Note / Slit lamp report
1007 S3 3A.S3.00026 3A.S3.00026 : Iris cyst removal 2500 Clinical Note / slit lamp report Clinical Note / Slit lamp report
3A.S3.00028 : Vitrectomy + Retinal Detachment surgery
1008 S3 3A.S3.00028 17500 B.Scan , Fundus Photograph Fundus Photograph
(pre-auth required)
CT, Clinical Photograph showing scar
3A.S8.00082A : Excision of Orbital Tumour - cross
S8 3A.S8.00082A 50000 CT/MRI Report + HPE report, Post-op CT report and
speciality
film
M2 3A.M2.00011D 3A.M2.00011D : Optic neuritis - routine ward 1800 Clinical note with Lab reports Treatment note
M2 3A.M2.00011E 3A.M2.00011E : Optic neuritis - HDU 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00011F 3A.M2.00011F : Optic neuritis - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 3A.M2.00011G 3A.M2.00011G : Optic neuritis - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
Speciality
code
3A.M4.00019A : Retinoblastoma (Intraocular): surgery - Haematology, Bone Marrow Clinical Photograph, chemotherapy
M4 3A.M4.00019A 100000
cross speciality Aspitation/ Flow cytometry drug batch number with bar code
ORTHOPAEDICS
X-ray, clinical photo, CT, HPE for
1009 S5 3A.S5.00011 3A.S5.00011 : Disarticulation (hind & for quarter) 25000 Scar photo, X-Ray, HPE for tumours
tumours
1010 S5 3A.S5.00012 3A.S5.00012 : Anterior Spine Fixation 35000 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo
1011 S5 3A.S5.00013 3A.S5.00013 : Posterior Spine Fixation 20000 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo
3A.S5.00020 : Bone Tumour Excision + reconstruction
1012 S5 3A.S5.00020 50000 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
using implant (malignant/ benign)
3A.S5.00022 : Bone Tumour Excision (malignant/
1013 S5 3A.S5.00022 benign) + Joint replacement (depending upon type of 150000 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
joint and implant)
1014 S5 3A.S5.00046 3A.S5.00046 : Fracture - Acetabulum 26600 X-RAY/CT scan
post op. XRAY
1015 S5 3A.S5.00060 3A.S5.00060 : Llizarov Fixation 26600 X-ray Post op X-ray, Pt photo with applicator
X-ray Films/ Clinical Picture + detail

1016 S5 3A.S5.00061 3A.S5.00061 : Multiple Tendon Repair 10000 Clinical photo showing Scar
notes
1017 S5 3A.S5.00062 3A.S5.00062 : Nerve Repair Surgery 15000 Clinical Photograph Clinical Photograph
1018 S5 3A.S5.00072 3A.S5.00072 : Pelvic Osteotomy with fixation with plaster 30000 X-ray photo with plaster, X-ray
Xray Films(if relevant)+ Clinical

1019 S5 3A.S5.00078 3A.S5.00078 : Tendon Grafting 20000 Clinical photo showing Scar
Picture(Mandatory) + detail notes
1020 S5 3A.S5.00091 3A.S5.00091 : Total Hip Replacement (cemented) 60100 X-ray Post-op X-ray, Scar photo
1021 S5 3A.S5.00092 3A.S5.00092 : Total Hip Replacement (cementless) 69100 X-ray Post-op X-ray, Scar photo
1022 S5 3A.S5.00093 3A.S5.00093 : Total Hip Replacement (hybrid) 100000 X-ray Post-op X-ray, Scar photo
1023 S5 3A.S5.00096 3A.S5.00096 : Total Knee Replacement 65000 X-ray Post-op X-ray, Scar photo
3A.S6.00001C : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001C 50000 Clinical photo showing Scar
3A.S6.00002B : Plexus injury along with Vascular injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002B 60000 Clinical photo showing Scar
3A.S6.00003B : Internal fixation with Flap cover Surgery Post-operative X-ray, Clinical
S6 3A.S6.00003B 40000 X-RAY/CT scan(If Required)
for wound in compound fracture - cross speciality Photograph showing scar
3A.S8.00016A : Laminectomy with Fusion - cross

S8 3A.S8.00016A 40000 Clinical findings, MRI Report photo showing scar
speciality
3A.S8.00028A : Spine - Decompression & Fusion - cross
S8 3A.S8.00028A 40000 Clinical findings, MRI Report Post Op X-Ray Report and film
speciality
S8 3A.S8.00075B 3A.S8.00075B : Nerve Decompression - cross speciality 20000 Nerve Conductions study Clinical Photographs showing scar
Speciality
code

3A.S8.00076B : Peripheral Nerve Surgery Major - cross
S8 3A.S8.00076B 45000 conduction velocity (NCV)) and Clinical Photographs showing scar
speciality

3A.S8.00077A : Peripheral Nerve Surgery Minor - cross
S8 3A.S8.00077A 15000 conduction velocity (NCV) / Clinical Photographs showing scar
speciality
3A.M4.00035B# : Bone tumors/soft tissue sarcomas :

M4 3A.M4.00035B 235000 CT scan/MRI ,USG abdomen pelvis, X-ray, CT Scan, Clinical photograph
surgery (inlcuding prosthesis) - cross speciality
Clinical photograph Hemogram report
3A.S10.00001 : Ear Pinna Reconstruction with costal
cartilage/ Prosthesis (including the cost of
prosthesis/implants). *If requiring multiple stages, each OT note with clinical photograph of
1024 S10 3A.S10.00001 30000 X-ray and clinical note
stage will cost Rs. 30,000 provided the operating stages
surgeon demonstrates the photographic results of
previous stages.
Doppler study, Clinical photo and OT
1025 S10 3A.S10.00002 3A.S10.00002 : Revascularization of limb/digit 25000 HbsAg,, CXR, ECG,(X-ray of
note
limb/digit)
1026 S10 3A.S10.00003 3A.S10.00003 : Hemangioma – Sclerotherapy (under GA) 35000 MRI/MRA
HbsAg,CXR, ECG MRI/MRA
1027 S10 3A.S10.00004 3A.S10.00004 : Hemangioma – Debulking/ Excision 35000 MRI/MRA
HbsAg, CXR, ECG, MRI/MRA
3A.S10.00005 : Tissue Expander for disfigurement
1028 S10 3A.S10.00005 following burns/ trauma/ congenital deformity 50000 CBC,RBS,RFT,S Electrolytes, HIV, Clinical photo and OT note
(including cost of expander / implant) HbsAg,, CXR, ECG.
CBC,RBS,RFT,S Electrolytes,
1029 S10 3A.S10.00006 3A.S10.00006 : Scalp avulsion reconstruction 50000 Clinical photo and OT note
HIV,HbsAg, CXR, ECG
1030 S10 3A.S10.00007 3A.S10.00007 : NPWT (Inpatient only) 2000 Clinical photo and OT note
HbsAg,, CXR, ECG.
1031 S10 3A.S10.00008 3A.S10.00008 : Pressure Sore – Surgery 30000 Clinical photo and OT note
HbsAg, CXR, ECG, Pus for C/S
Clinical Photograph, CBC,RBS,RFT,S

1032 S10 3A.S10.00009 3A.S10.00009 : Diabetic Foot – Surgery 30000 Post - op Photograph, MRI/MRA
Electrolytes, HIV, HbsAg,, CXR, ECG,
Pus for C/S, MRI/MRA
3A.S6.00001A : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001A 50000 Clinical photo showing Scar
3A.S6.00003A : Internal fixation with Flap cover Surgery Post-operative X-ray, Clinical
S6 3A.S6.00003A 40000 X-RAY/CT scan(If Required)
for wound in compound fracture - cross speciality Photograph showing scar
Speciality
code
3A.S1.00163B : Flap Reconstructive Surgery - cross
S1 3A.S1.00163B 30000 X-ray Films + detail notes Clinical photo showing Scar
speciality
3A.S1.00165A : Split thickness skin grafts – Medium (4 -
S1 3A.S1.00165A 10000 Clinical photograph Scar photo
8% TBSA) - cross speciality
3A.S1.00167A : Free Grafts - Wolfe Grafts - cross
S1 3A.S1.00167A 10000 Clinical photograph Scar photo
speciality
3A.S1.00225A : Skin Flaps - Rotation Flaps - cross
S1 3A.S1.00225A 6200 Clinical photo Scar photo
speciality
3A.S6.00002C : Plexus injury along with Vascular injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002C 60000 Clinical photo showing Scar
POLYTRAUMA
3A.S6.00001 : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
1033 S6 3A.S6.00001 50000 Clinical photo showing Scar
repair/reconstruction/ Transfer Picture(Mandatory) + detail notes
3A.S6.00002 : Plexus injury along with Vascular injury MRI + Xray Films(if relevant)+ Clinical
1034 S6 3A.S6.00002 60000 Clinical photo showing Scar
repair/ graft Picture(Mandatory) + detail notes
3A.S6.00003 : Internal fixation with Flap cover Surgery Post-operative X-ray, Clinical
1035 S6 3A.S6.00003 40000 X-RAY/CT scan(If Required)
for wound in compound fracture Photograph showing scar
3A.S6.00004 : Head injury requiring Facio-Maxillary Post-operative X-ray, Clinical

1036 S6 3A.S6.00004 35000 X-RAY/CT scan(If Required)
Injury repairs & fixations (including implants) Photograph showing scar

1037 S6 3A.S6.17024 3A.S6.17024 : Visceral injuries severe 60000 Post-Operative X-ray, scar photo
sound
Post-Operative chest X-ray with ICD in
1038 S6 3A.S6.17025 3A.S6.17025 : Chest injuries with ICD bilateral 11000 X-ray /ultra sound
situ
1039 S6 3A.S6.17026 3A.S6.17026 : Chest injuries with ICD + ICU 20000 X-ray /ultra sound
situ
1040 S6 3A.S6.17027 3A.S6.17027 : Chest injuries with ICD + ICU + Ventilator 26600 X-ray /ultra sound
situ
SURGICAL GASTROENTEROLOGY AND UNSPECIFIED PACKAGE
1041 U1 3A.U1.00001 3A.U1.00001 : Unspecified Surgical Package 0
3A.S1.00016B : Bypass - Inoperable Pancreas - cross
S1 3A.S1.00016B 15000
speciality USG/CT USG, Scar photo, HPE Report
S1 3A.S1.00059A 3A.S1.00059A : Fundoplication - cross speciality 35000 Contrast X ray/endoscopy findings Clinical Photograph showing scar
S1 3A.S1.00064A 3A.S1.00064A : Gastrostomy - cross speciality 15000 USG/ CT Scan Clinical photograph
3A.S1.00070A : Hepatic Resection (lobectomy) - cross
S1 3A.S1.00070A 20000 MRI/ CT Abdomen Scar Photo, HPE Report
speciality
S1 3A.S1.00087B 3A.S1.00087B : Intussusception - cross speciality 15000 USG/CT , Clinical notes Scar photo
3A.S1.00104A : Portal Hypertension shunt surgery -
S1 3A.S1.00104A 50000 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar
Cross speciality
Speciality
code
3A.S1.00106A : PancreaticoDuodenectomy - cross CT-Scan , ERCP , ER Clinical
S1 3A.S1.00106A 25000 HPR , Scar Photograph
speciality Photograph , Endoscopy
S1 3A.S1.00112A 3A.S1.00112A : Pyeloroplasty - cross speciality 10000 USG, Clinical Notes Scar photo, HPE
3A.S1.00171B : Lap. Assisted left Hemi colectomy t -
S1 3A.S1.00171B 25000 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00172B : Lap. Assisted Right Hemi colectomy t -
S1 3A.S1.00172B 25000 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00174A : Lap. Assisted Total Colectomy - cross Colonocopy with film, biopsy, CT Clinical Photograph showing scar +
S1 3A.S1.00174A 40000
speciality report with film HPE report
S1 3A.S1.00201A 3A.S1.00201A : Caecostomy - cross speciality 10000 Clinical notes, USG/ CT Scar photo, HPE
3A.S1.00213B : Operations for Replacement of
S1 3A.S1.00213B 25000 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon - cross speciality
3A.S1.00216A : Partial/Subtotal Gastrectomy for Clinical Photograph showing scar +
S1 3A.S1.00216A 50000 Endoscopy, biopsy, CT
Carcinoma - cross speciality HPE report
3A.S1.00235A : Thoracoscopic Hydatid Cyst excision -
S1 3A.S1.00235A 20000 Chest X-ray / CT Scar photo, HPE
cross speciality
3A.S1.00247A : Adhenolysis + Appendicectomy - cross
S1 3A.S1.00247A 20000 MRI/ CT Abdomen Scar Photo, HPE Report
speciality
UROLOGY
CT/MRI report with film, Urinary Clinical Photograph showing scar+ HPE
1042 S7 3A.S7.00001 3A.S7.00001 : Adrenalectomy-unilateral, open 25000
hormones report
1043 S7 3A.S7.00002 3A.S7.00002 : Adrenalectomy-unilateral, Laparoscopic 30000 USG Clinical Photograph
1044 S7 3A.S7.00003 3A.S7.00003 : Adrenalectomy-bilateral, open 32000 USG Clinical Photograph

CT/MRI report with film, Urinary Clinical Photograph showing scar+ HPE
1045 S7 3A.S7.00004 3A.S7.00004 : Adrenalectomy-biilateral, Laparoscopic 45000
hormones report
3A.S7.00005 : Paraganglioma excision with liver Operative notes with steps of surgery,
1046 S7 3A.S7.00005 50000 CT/MRI, clinical notes
mobilization Scar photo, HPE report
1047 S7 3A.S7.00006 3A.S7.00006 : Nephrectomy (Benign) Open 35000 USG, CT KUB /Isotope Renogram Scar & Specimen Photo +HPE report
1048 S7 3A.S7.00007 3A.S7.00007 : Nephrectomy (Benign) Laparoscopic 45000 USG & CT KUB /Isotope Renogram Scar Photo + HPE Report
Ultrasound abd /CT Scan abd with Clinical Photograph showing scar +
1049 S7 3A.S7.00008 3A.S7.00008 : Nephrectomy-Radical (Renal tumor) Open 45000
film, Isotope Renogram if required HPE report
3A.S7.00009 : Nephrectomy-Radical (Renal tumor) USG & CT KUB with Contrast /

1050 S7 3A.S7.00009 30000 Scar Photo + HPE Report
Laparoscopic Isotope Renogram
1051 S7 3A.S7.00010 3A.S7.00010 : Nephrectomy-Partial or Hemi, Open 30000 USG & CT KUB with Contrast Scar Photo + HPE Report
3A.S7.00011 : Nephrectomy-Partial or Hemi, USG & CT KUB with Contrast /
1052 S7 3A.S7.00011 60000 Scar Photo + HPE Report
Laparoscopic Isotope Renogram
1053 S7 3A.S7.00012 3A.S7.00012 : Nephro ureterectomy (Benign) Open 25000 IVP , USG USG
3A.S7.00013 : Nephro ureterectomy (Benign)
1054 S7 3A.S7.00013 30000 IVP , USG USG
Laparoscopic
Speciality
code
3A.S7.00014 : Nephro ureterectomy with cuff of bladder
1055 S7 3A.S7.00014 30000 IVP , USG USG
Open
3A.S7.00015 : Nephro ureterectomy with cuff of bladder CT report with film, Isotope Clinical Photograph showing scar+ HPE
1056 S7 3A.S7.00015 45000
Laparoscopic renogram if required report
3A.S7.00016 :
1057 S7 3A.S7.00016 25000 USG & IVP/CT with Contrast Scar Photo
Pyeloplasty/pyeloureterostomy/pyelopyelostomy Open
3A.S7.00017 :
1058 S7 3A.S7.00017 Pyeloplasty/pyeloureterostomy/pyelopyelostomy 40000 USG & IVP/CT with Contrast Scar Photo
Laparoscopic
3A.S7.00018 : Endopyelotomy (retrograde with
1059 S7 3A.S7.00018 25000 USG/IVP USG/IVP
laser/bugbee)
3A.S7.00019 : Endopyelotomy (antegrade with
1060 S7 3A.S7.00019 28000 USG/IVP USG/IVP
laser/bugbee)
1061 S7 3A.S7.00020 3A.S7.00020 : Ureterocalycostomy Open 30000 CT KUB with Contrast Scar Photo +X-Ray Kub
1062 S7 3A.S7.00021 3A.S7.00021 : Ureterocalycostomy Laparoscopic 35000 CT KUB with Contrast Scar Photo +X-Ray Kub
1063 S7 3A.S7.00022 3A.S7.00022 : Uretero-ureterostomy Open 25000 USG/IVP USG/IVP
1064 S7 3A.S7.00023 3A.S7.00023 : Uretero-ureterostomy Laparoscopic 35000 USG/IVP USG/IVP
3A.S7.00024 : PCNL (Percutaneous Nephrolithotomy) -
1065 S7 3A.S7.00024 38000 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
Bilateral
3A.S7.00025 : PCNL (Percutaneous Nephrolithotomy) -
1066 S7 3A.S7.00025 25000 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
Unilateral
3A.S7.00026 : Extracoporeal shock-wave Lithotripsy

1067 S7 3A.S7.00026 8500 CT KUB with Contrast X-ray KUB/USG
(SWL) stone, with or without stent (one side)
3A.S7.00027 : Extracoporeal shock-wave Lithotripsy

1068 S7 3A.S7.00027 18000 CT KUB with Contrast X-ray KUB
(SWL) stone, with or without stent (both sides)
1069 S7 3A.S7.00028 3A.S7.00028 : Pyelolithotomy-Open 36000 CT KUB with Contrast Scar Photo,X-Ray/USG KUB
1070 S7 3A.S7.00030 3A.S7.00030 : Nephrolithotomy-Open 36000 USG/X-ray KUB Scar Photo,X-Ray/USG KUB
1071 S7 3A.S7.00031 3A.S7.00031 : Anatrophic nephrolithotomy 45000 USG, CT KUB with Contrast Scar Photo +X-Ray Kub
3A.S7.00034 : Renal Cyst deroofing or marsupialization-
1072 S7 3A.S7.00034 20000 IVP , USG USG
Open
3A.S7.00035 : Renal Cyst deroofing or marsupialization-
1073 S7 3A.S7.00035 30000 IVP , USG USG
Laparoscopic
3A.S7.00036 : Nephrostomy-percutaneous ultrasound
1074 S7 3A.S7.00036 10000 USG Scar Photo With Nephrostomy Tube
guided
1075 S7 3A.S7.00037 3A.S7.00037 : Ureterolithotomy-Open 30000 CT KUB with Contrast Scar Photo +X-Ray Kub
1076 S7 3A.S7.00038 3A.S7.00038 : Ureterolithotomy-Laparoscopic 35000 CT KUB with Contrast Scar Photo +X-Ray Kub
3A.S7.00039 : Ureteroscopy+stone removal with
1077 S7 3A.S7.00039 20000 CT KUB X-ray KUB
lithotripsy, lower ureter, unilateral
lithotripsy, upper ureter, unilateral
Speciality
code
lithotripsy, bilateral
Operative notes with steps of surgery,

1080 S7 3A.S7.00042 3A.S7.00042 : Ureterotomy (Cutaneous) 20000 USG KUB/CT Scan/MRI Scan
X-ray KUB/USG KUB/CT, Urography
Operative notes with steps of surgery,

1081 S7 3A.S7.00043 3A.S7.00043 : Endoureterotomy (laser/bugbee) 20000 USG KUB/CT Scan/MRI Scan
X-ray KUB/USG KUB/CT, Urography
1082 S7 3A.S7.00044 3A.S7.00044 : Ureteric reimplantation-unilateral-open 38000 CT KUB/IVP/MCU Scar photo
1083 S7 3A.S7.00045 3A.S7.00045 : Ureteric reimplantation-bilateral-open 70000 MCU, USG Clinical Photograph showing scar
3A.S7.00046 : Ureteric reimplantation-unilateral-

1084 S7 3A.S7.00046 45000 MCU, USG Clinical Photograph showing scar
Laparoscopic
3A.S7.00047 : Ureteric reimplantation-bilateral-
1085 S7 3A.S7.00047 35000 MCU, USG Clinical Photograph showing scar
Laparoscopic
1086 S7 3A.S7.00048 3A.S7.00048 : Uretero-vaginal/uterine fistula repair open 27000 USG USG
3A.S7.00049 : Uretero-vaginal/uterine fistula repair

1087 S7 3A.S7.00049 37000 USG USG
Laparoscopic
3A.S7.00050 : Ureterolysis-open, for retroperitoneal

1088 S7 3A.S7.00050 20000 MCU/IVP/CT Urography, clinical notes OT notes, Scar photo
fibrosis (with or without omental wrapping)
3A.S7.00051 : Ureterolysis-Laparoscopic, for

X-ray KUB/USG KUB/CT, Urography,
1089 S7 3A.S7.00051 retroperitoneal fibrosis (with or without omental 30000 OT notes, Scar photo
Clinical notes
wrapping)
1090 S7 3A.S7.00052 3A.S7.00052 : Boari flap for ureteric stricture, open 42000 CT KUB/IVP Clinical Picture, Scar Photo
3A.S7.00053 : Boari flap for ureteric stricture,
1091 S7 3A.S7.00053 40000 CT KUB/IVP Clinical Picture, Scar Photo
Laparoscopic
1092 S7 3A.S7.00054 3A.S7.00054 : Ileal replacement for ureteric stricture 40000 IVP , USG , X-RAY Clinical Photograph
3A.S7.00055 : DJ stent unilateral including cystoscopy,

1093 S7 3A.S7.00055 7500 USG /X-ray KUB X-ray KUB
ureteric catheterization, retrograde pyelogram
3A.S7.00056 : DJ stent bilateral including cystoscopy,

1094 S7 3A.S7.00056 10000 X-ray KUB & USG X-ray KUB & USG
3A.S7.00057 : Ureteric sampling including cystoscopy,

1095 S7 3A.S7.00057 10000 USG USG
3A.S7.00058 : Ureterocele incision including cystoscopy,

1096 S7 3A.S7.00058 15000 RGU , X-RAY Clinical Photograph
Speciality
code
1097 S7 3A.S7.00060 3A.S7.00060 : Cystolithotomy-open, including cystoscopy 18000 USG/X ray KUB Scar Photo,X-Ray/USG KUB
3A.S7.00061 : Cystolithotripsy/Urethral Stone

1098 S7 3A.S7.00061 17000 X-ray KUB/USG X-ray KUB
endoscopic, including cystoscopy
3A.S7.00062 : TURBT (Transurethral Resection of the Cystoscopy Finding/ HPE Report, P.O
1099 S7 3A.S7.00062 30000 USG/CT KUB with Contrast
Bladder Tumor) USG
3A.S7.00063 : TUR-fulgration (Transurethral fulgration of
1100 S7 3A.S7.00063 18000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
the Bladder Tumor)
3A.S7.00064 : Intravesical BCG/Mitomycin 6 induction

1101 S7 3A.S7.00064 12000 USG, HPE Case sheets
cycles (weekly for 6 weeks-total cost of 6 cycles)
3A.S7.00065 : Intravesical BCG/Mitomycin maintenance

1102 S7 3A.S7.00065 24000 USG, HPE Case sheets
for 12 doses (total cost of 12 doses)
3A.S7.00066 : Post TURBT - Check Cystoscopy (Per
1103 S7 3A.S7.00066 5000 USG & urine cytology Cystoscopy Finding, X-Ray KUB
sitting) with or without cold-cup biopsy
1104 S7 3A.S7.00068 3A.S7.00068 : Bladder Neck incision-endoscopic 22500 USG & Uroflowmetry Uroflowmetry,ENDO Picture
3A.S7.00069 : Extrophy Bladder repair including
1105 S7 3A.S7.00069 osteotomy if needed + epispadias repair + ureteric 70000 MCU Clinical Photograph
reimplant
3A.S7.00070 : Bladder injury repair (as an independent

1106 S7 3A.S7.00070 20000 CT KUB Endo Picture/Operative Picture
procedure with or without urethral injury)
3A.S7.00072 : Bladder injury repair with colostomy (as an

1107 S7 3A.S7.00072 25000 Clinical photograph Scar photo
independent procedure with or without urethral injury)
1108 S7 3A.S7.00073 3A.S7.00073 : Partial Cystectomy-open 40000 CT KUB with Contrast Procedure Picture
1109 S7 3A.S7.00074 3A.S7.00074 : Partial Cystectomy-Laparoscopic 30000 CT KUB with Contrast Procedure Picture
1110 S7 3A.S7.00075 3A.S7.00075 : Radical cystectomy with neobladder-open 50000 CT KUB with Contrast Scar photo
3A.S7.00076 : Radical cystectomy with continent

1111 S7 3A.S7.00076 50000 CT KUB with Contrast Scar photo
diversion-open
1112 S7 3A.S7.00077 3A.S7.00077 : Radical Cystectomy with Ileal Conduit-open 75000 CT report and Film, Biopsy
HPE report
3A.S7.00078 : Radical Cystectomy with ureterostomy-
open
3A.S7.00079 : Radical Cystectomy with
ureterosigmoidostomy-open
1115 S7 3A.S7.00080 3A.S7.00080 : Other Cystectomies 40000 CT report and Film, Biopsy
HPE report
3A.S7.00081 : Suprapubic Cystostomy - Open, as an Clinical Photograph showing
1116 S7 3A.S7.00081 10000 Biopsy of the primary tumor
independent procedure procedure/scar
3A.S7.00083 : VVF/Uterovaginal Repair - Transvaginal
1117 S7 3A.S7.00083 25000 CT KUB USG, Treating doctor note
approach
Speciality
code
3A.S7.00084 : VVF/Uterovaginal Repair -
1118 S7 3A.S7.00084 25000 CT KUB USG, Treating doctor note
Abdominal,Open
3A.S7.00085 : VVF/Uterovaginal Repair - Abdominal,
1119 S7 3A.S7.00085 40000 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram
Laparoscopic
3A.S7.00086 : Hysterectomy as part of VVF/uterovaginal
1120 S7 3A.S7.00086 5000 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram
fistula repair (top-up)
1121 S7 3A.S7.00087 3A.S7.00087 : Urethrovaginal fistula repair 40000 USG/X ray KUB NIL
3A.S7.00088 : Y V Plasty of Bladder Neck/Bladder Neck
1122 S7 3A.S7.00088 20000 USG/MCU Clinical Photograph
Reconstruction
1123 S7 3A.S7.00089 3A.S7.00089 : Augmentation cystoplasty-open 30000 USG Scar photo
1124 S7 3A.S7.00090 3A.S7.00090 : Augmentation cystoplasty-Laparoscopic 40000 USG Scar photo
3A.S7.00091 : Open bladder diverticulectomy

1125 S7 3A.S7.00091 30000 CT KUB Endo Picture/Operative Picture
with/without ureteric re-implantation
1126 S7 3A.S7.00092 3A.S7.00092 : Open simple prostatetctomy for BPH 35000 USG, Uroflowmetry Scar Photo + HPE Report
3A.S7.00093 : TURP-Transurethral Resection of the
Prostate, BPH, Monopolar/Bipolar/Laser
1128 S7 3A.S7.00094 3A.S7.00094 : Holmium Laser Prostatectomy 40000 USG, Uroflowmetry Scar Photo + HPE Report
1129 S7 3A.S7.00095 3A.S7.00095 : TURP/Laser + Circumcision 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1130 S7 3A.S7.00096 3A.S7.00096 : TURP/Laser + Cystolithotripsy 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1131 S7 3A.S7.00097 3A.S7.00097 : TURP/Laser + Cystolithotomy-open 35000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1132 S7 3A.S7.00098 3A.S7.00098 : TURP/Laser + Orchidectomy 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1133 S7 3A.S7.00099 3A.S7.00099 : TURP/Laser + TURBT 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1134 S7 3A.S7.00100 3A.S7.00100 : TURP/Laser + URS with stone removal 40000 CT KUB X-ray KUB
3A.S7.00101 : TURP/Laser + VIU (visual internal

Ureterotomy)
1136 S7 3A.S7.00102 3A.S7.00102 : TURP/Laser + Hydrocele surgery 40000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1137 S7 3A.S7.00103 3A.S7.00103 : TURP/Laser + Hernioplasty 40000 USG/CT KUB,Uroflowmetry P.O USG
3A.S7.00104 : TURP/Laser + Urethral dilatation-non
1138 S7 3A.S7.00104 40000 USG/CT KUB,Uroflowmetry P.O USG
endoscopic
3A.S7.00105 : TURP/Laser + Urethral dilatation-
1139 S7 3A.S7.00105 40000 USG/CT KUB,Uroflowmetry P.O USG
endoscopic
1140 S7 3A.S7.00106 3A.S7.00106 : Radical prostatectomy - open 50000 CT report and Film, Biopsy Clinical Photograph, HPE report
1141 S7 3A.S7.00107 3A.S7.00107 : Radical prostatectomy - laparoscopic 75000 CT report and Film, Biopsy Clinical Photograph, HPE report
3A.S7.00108 : Transrectal Ultrasound guided prostate

1142 S7 3A.S7.00108 6000 PSA,Transrectal USG HPE Report
biopsy (minimum 12 core)
1143 S7 3A.S7.00113 3A.S7.00113 : Post Urethral Valve fulguration 30000 MCU, USG Clinical Photograph/Endoscopic picture
1144 S7 3A.S7.00114 3A.S7.00114 : Urethroplasty-End to end 45000 RGU Clinical photo
1145 S7 3A.S7.00115 3A.S7.00115 : Urethroplasty-Substitution-single stage 30000 RGU & MCU Scar photo,
Speciality
code
1146 S7 3A.S7.00116 3A.S7.00116 : Urethroplasty-Substitution-two stage 25000 RGU & MCU Scar photo,
1147 S7 3A.S7.00117 3A.S7.00117 : Urethroplasty-Transpubic 30000 RGU Scar photo,

3A.S7.00118 : Urethroplasty-two stage without
1148 S7 3A.S7.00118 30000 RGU Scar photo,
substitution
1149 S7 3A.S7.00119 3A.S7.00119 : Perineal Urethrostomy without closure 25000 RGU& MCU Scar photo,
1150 S7 3A.S7.00120 3A.S7.00120 : Urethrorectal fistula repair 40000 RGU& MCU Scar photo,
3A.S7.00122 : Urethral Dilatation-endocopic as an
1151 S7 3A.S7.00122 5000 CT Scan Clinical Photograph
independent procedure
3A.S7.00123 : Internal Ureterotomy including cystoscopy
1152 S7 3A.S7.00123 10000 USG Clinical Photograph
as an independent procedure
1153 S7 3A.S7.00124 3A.S7.00124 : Hypospadias repair-single stage 25000 Clinical Photograph Scar photo,
1154 S7 3A.S7.00125 3A.S7.00125 : Hypospadias repair-two or more stage 25000 Clinical Photograph Scar photo,
1155 S7 3A.S7.00126 3A.S7.00126 : Orchiopexy-without laparoscopy, unilateral 15000 USG Clinical Notes
1156 S7 3A.S7.00128 3A.S7.00128 : Orchiopexy-with laparoscopy, unilateral 30000 USG Clinical Notes
1157 S7 3A.S7.00129 3A.S7.00129 : Orchiopexy-with laparoscopy, bilateral 30000 USG Clinical Notes
1158 S7 3A.S7.00130 3A.S7.00130 : Stress incontinence surgery, open 20000 Clinical Notes Endo Picture / Operative Picture
1159 S7 3A.S7.00131 3A.S7.00131 : Stress incontinence surgery, laparoscopic 30000 Clinical Notes Endo Picture / Operative Picture
1160 S7 3A.S7.00132 3A.S7.00132 : Stress incontinence surgery with slings 45000 Clinical Notes Endo Picture / Operative Picture
Clinical Photograph showing scar ( if

1161 S7 3A.S7.00133 3A.S7.00133 : Partial Penectomy 15000 Biopsy Reports
patient consents)+ HPE report
1162 S7 3A.S7.00134 3A.S7.00134 : Total Penectomy + Perineal Urethrostomy 25000 Biopsy Reports
3A.S7.00137 : Pelvic lymphadenectomy open, after prior
1163 S7 3A.S7.00137 25000 USG-KUB, HPE report Scar photo, HPE
cancer surgery
3A.S7.00138 : Pelvic lymphadenectomy laparoscopic,
1164 S7 3A.S7.00138 30000 USG-KUB, HPE report Scar photo, HPE
after prior cancer surgery
1165 S7 3A.S7.00139 3A.S7.00139 : Orchiectomy-High inguinal 15000 USG scrotum, Tumour markers
3A.S7.00141 : Bilateral Orchidectomy for hormone Biopsy Reports /PSA with evidence Clinical Photograph showing scar ( if
1166 S7 3A.S7.00141 15000
ablation of bone metastasis patient consents)+ HPE report
3A.S7.00142 : Retroperitoneal lymph node dissection-
1167 S7 3A.S7.00142 25000 CT Scar photo
open
3A.S7.00143 : Retroperitoneal lymph node dissection- Clinical photograph showing scar, HPE
1168 S7 3A.S7.00143 80000 CT report and film, biopsy
Laparoscopic report
1169 S7 3A.S7.00144 3A.S7.00144 : Infertility-Scrotal exploration unilateral 10000 USG/CT- Clinical Photograph Clinical Photograph
Speciality
code
1170 S7 3A.S7.00145 3A.S7.00145 : Infertility-Scrotal exploration bilateral 12000 USG/CT- Clinical Photograph Clinical Photograph
3A.S7.00146 : Infertility-Vasoepididymostomy,
1171 S7 3A.S7.00146 15000 USG/CT- Clinical Photograph Clinical Photograph
microsurgical, unilateral
3A.S7.00147 : Infertility-Vasoepididymostomy,
1172 S7 3A.S7.00147 20000 USG/CT- Clinical Photograph Clinical Photograph
microsurgical, bilateral
1173 S7 3A.S7.00151 3A.S7.00151 : Varicocele-bilateral-microsurgical 20000 USG, Clinical photograph Clinical Photograph
3A.S7.00152 : Penile prosthesis insertion, Malleable Operative notes with steps of surgery,
1174 S7 3A.S7.00152 30000 CT/MRI/USG, clinical notes,
(Indian implant) clinical notes
3A.S7.00154 : Neurogenic bladder-Package for
evaluation/investigation (catheter + ultrasound + culture X-Ray, catheter + ultrasound + culture
1175 S7 3A.S7.00154 7500 USG/CT
+ RGU/ MCU) for 1 month (medicines - antibiotics). + RGU/ MCU
Follow up visit once in 3 months
3A.S7.00155 : Chronic prostatitis-Package for
evaluation/investigation (ultrasound + culture + ultrasound + culture + prostate
1176 S7 3A.S7.00155 2500 USG
prostate massage) for 1 month (medicines). Follow up massage - Reports
visit once in 3 months
3A.S7.00156 : Emergency management of Ureteric stone
1177 S7 3A.S7.00156 - Package for evaluation/investigation (ultrasound + 3500 USG Ultrasound + culture Report
culture) for 3 weeks (medicines).
1178 S7 3A.S7.00157 3A.S7.00157 : Emergency management of Hematuria 2000 USG Doctors Note
1179 S7 3A.S7.00161 3A.S7.00161 : Urinary tract trauma – Laparoscopy surgery 30000 clinical notes, CT/MRI/USG - pelvis Operative notes with steps of surgery
USG & CT KUB with Contrast /

1180 S7 3A.S7.17041 3A.S7.17041 : Lap. Nephrectomy Radical 50000 Scar Photo + HPE Report
Isotope Renogram
3A.S7.17042 : Retrograde Intra Renal surgery (RIRS with C ARM Picture with Patient Details, X-
1181 S7 3A.S7.17042 50000 CT KUB with Contrast
laser) – for renal and PUJ calculi* ray KUB/USG
1182 S7 3A.S7.17043 3A.S7.17043 : URSL* (Inclusive of stent) 22500 CT KUB X-ray KUB
X-ray KUB, Purchase Voucher for Laser
1183 S7 3A.S7.17044 3A.S7.17044 : URSL-LASER* 25000 CT KUB
machine
1184 S7 3A.S7.17045 3A.S7.17045 : Hypospadiasis(Adult)* 35000 Clinical Photograph Scar photo,
1185 S7 3A.S7.17046 3A.S7.17046 : Visual Internal Urethrotomy 12000 USG & RGU Uroflowmetry/ENDO PICTURE
M4 3A.M4.00030B 3A.M4.00030B : Wilms tumors: surgery - cross speciality 5000 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report
3A.S1.00122B : Retroperitoneal Tumor – Excision - cross Clinical Photograph showing scar +

S1 3A.S1.00122B 50000 CT abdomen with film, FNAC
3A.S1.17005A : Prostate surgery (Code 3A.561) -
S1 3A.S1.17005A 25000 CT report and Film, Biopsy Clinical Photograph, HPE report
additional cost - Cross speciality
3A.S1.17006B : Nephrectomy – partial (Code 3A.451)- CT report with film, Isotope Clinical Photograph showing scar+ HPE
S1 3A.S1.17006B 25000
additional cost - cross speciality renogram if required report +USG Report
Speciality
code
EMERGENCY CARE
BURNS
4A.S11.00002 : % Total Body Surface Area Burns (TBSA)
(thermal/ scald/ flame burns): Upto 40 %; Includes %
TBSA skin grafted, flap cover, follow-up dressings etc. as Clinical Photograph, Diagram with
1186 S11 4A.S11.00002 25000 Clinical Photograph
deemed necessary; Surgical procedures are required for Rule of 9 for extent of burns
deep burns that are not amenable to heal with dressings
alone.
(thermal/ scald/ flame burns): 40 % - 60 %; Includes %
TBSA skin grafted, flap cover, follow-up dressings etc. as Clinical Photograph, Diagram with
alone.
(thermal/ scald/ flame burns): > 60 %; Includes % TBSA
skin grafted, flap cover, follow-up dressings etc. as Clinical Photograph, Diagram with
alone.
4A.S11.00005 : Electrical contact burns: Low voltage-
without part of limb/limb loss; Includes % TBSA skin
alone.
4A.S11.00007 : Electrical contact burns: High voltage-
without part of limb/limb loss; Includes % TBSA skin
1190 S11 4A.S11.00007 50000
alone. Clinical Photograph Clinical Photograph
4A.S11.00008 : Electrical contact burns: High voltage-
with part of limb/limb loss; Includes % TBSA skin
alone.
4A.S11.00009 : Chemical burns: Without significant facial
scarring and/or loss of function; Includes % TBSA skin
alone.
Speciality
code
4A.S11.00010 : Chemical burns: With significant facial
scarring and/or loss of function; Includes % TBSA skin
alone.
CARDIOLOGY
4A.S12.00013 : Medical treatment of Acute MI with 2D ECHO, CPKMB,CAG, ECG with 2D ECHO, ECG, LAB INVESTIGATION
1194 S12 4A.S12.00013 15000
Thrombolysis /Stuck Valve Thrombolysis report, TROPONINE-T reports (Trop T report)
1195 S12 4A.S12.00020 4A.S12.00020 : Pericardiocentesis 10000 2D ECHO report 2D ECHO report
1196 S12 4A.S12.00021 4A.S12.00021 : Temporary Pacemaker implantation 10000 ECG + Report by cardiologist X Ray showing the pacemaker in situ
1197 S12 4A.S12.00027 4A.S12.00027 : PTSMA 30000
blocks & Reports post flow
4A.S12.17073 : PTCA - one stent (non-medicated,
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stents &
1198 S12 4A.S12.17073 emergency, inclusive of angiogram) at the same 48000
blocks & Reports post Stent flow
admission.*
4A.S12.17074 : PTCA - one Drug Eluting stent ( 1.Angioplasty stills showing stents &
ECG, 2D ECHO, CAG stills showing
1199 S12 4A.S12.17074 emergency, inclusive of angiogram) at the same 60000 post Stent flow,2. Cartons of the stents
blocks & Reports
admission. * used approved by FDA/CE/DCGI only
4A.S12.17075 : PTCA - two bare metal stents ( non-

ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent & post
1200 S12 4A.S12.17075 medicated, emergency, inclusive of angiogram) at the 55000
blocks & Reports Stent flow
same admission. *
4A.S12.17076 : PTCA - two Drug Eluting stents (
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stents &
1201 S12 4A.S12.17076 emergency, inclusive of angiogram) at the same 85000
blocks & Reports post Stent flow
admission. *
1202 S12 4A.S12.17077 4A.S12.17077 : Arrythmias 7000 CAG CAG
1203 S12 4A.S12.17078 4A.S12.17078 : Stuck valve with Thrombolysis 20000 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC
4A.S12.17079 : Medical management of unstable
1204 S12 4A.S12.17079 7500 ECG,ECHO,Cardiac Enzymes, RFT, CBC ECG, RFT, CBC
angina/non STS
1205 S12 4A.S12.17080 4A.S12.17080 : Cardiac failure 7500 ECG,ECHO,Chest X-ray, RFT, CBC ECHO, CHEST X RAY, RFT, CBC
1206 S12 4A.S12.17081 4A.S12.17081 : Emergency dialysis for cardiac conditions 15000 ECHO, RFT, CBC RFT, CBC
1207 S12 4A.S12.17082 4A.S12.17082 : ICU with ventilator with dialysis 15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY RFT,RFT, CBC, ABG
4A.S12.17083 : Acute respiratory distress - ventilator
1208 S12 4A.S12.17083 15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY, RFT, CBC, ABG
support
ECG, ECHO,Chest X Ray, RFT, CBC,
1209 S12 4A.S12.17084 4A.S12.17084 : Pulmonary edema 10000 ECHO, CHEST X RAY, RFT, CBC, ABG
ABG
4A.S12.17085 : Laryngoscopy / Bronchoscopy with
1210 S12 4A.S12.17085 5000 CT / Bronchoscopy report CT / Bronchoscopy report
dilatation of trachea with gum elastic bogie
1211 S12 4A.S12.17086 4A.S12.17086 : Pericardiostomy with balloon 20000 2D ECHO report 2D ECHO report + stills of the ECHO
Speciality
code
4A.S13.00045 : Surgery for Cardiac Tumour/ Left Atrial 2D ECHO with stills + CT Chest 2D ECHO Report + stills of ECHO +
1212 S13 4A.S13.00045 95000
(LA) Myxoma/ Right Atrial (RA) Myxoma report Post Op X-ray,scar photo
CT Chest report + Bronchoscopy
1213 S13 4A.S13.00061 4A.S13.00061 : Foreign Body Removal with scope 20000 ENDOSCOPY PICTURE
report
1214 S13 4A.S13.00063 4A.S13.00063 : Lung Injury repair 50000 CT Chest report X-RAY, scar photo
4A.S13.00066 : Intercostal Drainage and Management of

ICD, Intercostal Block, Antibiotics & Physiotherapy
4A.S13.17098 : Management of Mediastinitis /

mediastinal bleeding
4A.S13.17098A : Management of Mediastinitis /
S13 4A.S13.17098A 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
mediastinal bleeding
4A.S6.00010B : Chest injury with one fracture of long
S6 4A.S6.00010B 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants) - cross speciality
4A.S6.00011B : Chest injury with fracture of 2 or more
S6 4A.S6.00011B 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
long bones - cross speciality
4A.S6.17029B : Inter costal drainage (icd) one side -
S6 4A.S6.17029B 8000 X-ray X-ray
cross speciality
4A.S6.17030B : Inter costal drainage (icd)bilateral (flail
S6 4A.S6.17030B 11000 X-ray X-ray
chest) - cross speciality

S6 4A.S6.17031B 12000 X-ray X-ray
chest) with icu stay - cross speciality

S6 4A.S6.17032B 14000 X-ray X-ray
chest) with icu stay with ventilator - cross speciality
S1 4A.S1.00251A 4A.S1.00251A : AV Shunt for dialysis - cross speciality 7500 Duplex Clinical photos showing the AV fistula
S1 4A.S1.00251B 4A.S1.00251B : AV Shunt for dialysis - cross speciality 7500 Duplex Clinical photos showing the AV fistula
EMERGENCY ROOM
4A.M7.00001 : Emergency with stable cardiopulmonary
1217 M7 4A.M7.00001 1000 Clincal notes, Chest X-ray/CT Clincal notes, Chest X-ray/CT
status
4A.M7.00002 : Emergency consultation: acute colic, high

1218 M7 4A.M7.00002 1000 Clincal notes Clincal notes
fever, cut, stitches, soft tissue injury, FB removal
4A.M7.00003 : Single bone fracture plaster, nebulization

for asthmatic attack, moderate dehydration, X Ray film with report, clinical note, X Ray film with report, clinical note,
1219 M7 4A.M7.00003 1000
hypoglycaemia in a diabetic, Dengue without Blood examination Blood examination
complication, Syncope, Food poisoning etc
4A.M7.00004 : Animal bites (Payment after completion Clinical examination Clinical examination
1220 M7 4A.M7.00004 1700
of 5th dose)
ENT
Speciality
code
Clinical Photograph, Otoscopic
1221 S2 4A.S2.00026 4A.S2.00026 : Removal of foreign body from ear 650 Procedure Notes
findings
X Ray film with report with report
1222 S2 4A.S2.00037 4A.S2.00037 : Fracture - setting nasal bone 5000 X Ray
with reportPNS
1223 S2 4A.S2.00045 4A.S2.00045 : Radical fronto ethmo sphenodectomy 15500 X-Ray PNS,CT scan of sinuses CT scan of sinuses
1224 S2 4A.S2.00069 4A.S2.00069 : Peritonsillor abscess under LA 1500 Clinical Photograph Clinical Photograph
4A.S13.00061A : Foreign Body Removal with scope - CT Chest report + Bronchoscopy
S13 4A.S13.00061A 20000 ENDOSCOPY PICTURE
cross speciality report
GENERAL EMERGENCY
1225 M7 4A.M7.17256 4A.M7.17256 : Drowning 4000 Clinical Notes Clinical Notes
4A.M7.17257 : Injuries caused while operating
1226 M7 4A.M7.17257 4000 Clinical Notes Clinical Notes
agricultural equipments
GENERAL MEDICINE
1227 M1 4A.M1.00006 4A.M1.00006 : Pneumothroax - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00006A 4A.M1.00006A : Pneumothroax - HDU 2700 Treatment Notes
investigations
M1 4A.M1.00006B 4A.M1.00006B : Pneumothroax - ICU without ventilator 3600 Treatment Notes
investigations
M1 4A.M1.00006C 4A.M1.00006C : Pneumothroax - ICU with ventilator 4500 Treatment Notes
investigations
1228 M1 4A.M1.00007 4A.M1.00007 : Accelerated hypertension - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00007A 4A.M1.00007A : Accelerated hypertension - HDU 2700 Treatment Notes
investigations
4A.M1.00007B : Accelerated hypertension - ICU without Clinical Notes with relevant
4A.M1.00007C : Accelerated hypertension - ICU with Clinical Notes with relevant
4A.M1.00012 : Acutre excaberation of COPD - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00012A 4A.M1.00012A : Acutre excaberation of COPD - HDU 2700 Treatment Notes
investigations
4A.M1.00012B : Acutre excaberation of COPD - ICU Clinical Notes with relevant
4A.M1.00012C : Acutre excaberation of COPD - ICU with Clinical Notes with relevant
clinical notes, USG abdomen clinical notes
1230 M1 4A.M1.00020 4A.M1.00020 : Acute excaberation of ILD - routine ward 1800
M1 4A.M1.00020A 4A.M1.00020A : Acute excaberation of ILD - HDU 2700 clinical notes, USG abdomen clinical notes
4A.M1.00020B : Acute excaberation of ILD - ICU without clinical notes, USG abdomen clinical notes
M1 4A.M1.00020B 3600
ventilator
Speciality
code
4A.M1.00020C : Acute excaberation of ILD - ICU with clinical notes, USG abdomen clinical notes
M1 4A.M1.00020C 4500
ventilator
1231 M1 4A.M1.00023 4A.M1.00023 : Snake bite - routine ward 1800 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023A 4A.M1.00023A : Snake bite - HDU 2700 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023B 4A.M1.00023B : Snake bite - ICU without ventilator 3600 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023C 4A.M1.00023C : Snake bite - ICU with ventilator 4500 Clinical notes, photo of bite mark Treatment Notes
4A.M1.00024 : Acute organophosphorus poisoning - Clinical Notes with relevant
routine ward investigations
4A.M1.00024A : Acute organophosphorus poisoning - Clinical Notes with relevant
M1 4A.M1.00024A 2700 Treatment Notes
HDU investigations
4A.M1.00024B : Acute organophosphorus poisoning - Clinical Notes with relevant
ICU without ventilator investigations
4A.M1.00024C : Acute organophosphorus poisoning - Clinical Notes with relevant
ICU with ventilator investigations
1233 M1 4A.M1.00025 4A.M1.00025 : Other poisoning - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00025A 4A.M1.00025A : Other poisoning - HDU 2700 Treatment Notes
investigations
M1 4A.M1.00025B 4A.M1.00025B : Other poisoning - ICU without ventilator 3600 Treatment Notes
investigations
M1 4A.M1.00025C 4A.M1.00025C : Other poisoning - ICU with ventilator 4500 Treatment Notes
investigations
1234 M1 4A.M1.00030 4A.M1.00030 : Seizures - routine ward 1800 EEG EEG
M1 4A.M1.00030A 4A.M1.00030A : Seizures - HDU 2700 EEG EEG
M1 4A.M1.00030B 4A.M1.00030B : Seizures - ICU without ventilator 3600 EEG EEG
M1 4A.M1.00030C 4A.M1.00030C : Seizures - ICU with ventilator 4500 EEG EEG
1235 M1 4A.M1.00035 4A.M1.00035 : Viral encephalitis - routine ward 1800 Clinical notes, CT Clinical notes, CT
M1 4A.M1.00035A 4A.M1.00035A : Viral encephalitis - HDU 2700 Clinical notes, CT Clinical notes, CT
4A.M1.00035B : Viral encephalitis - ICU without Clinical notes, CT Clinical notes, CT
M1 4A.M1.00035B 3600
ventilator
Clinical notes, CT Clinical notes, CT
M1 4A.M1.00035C 4A.M1.00035C : Viral encephalitis - ICU with ventilator 4500
4A.M1.00044 : Type 1/2 respiratory failure - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00044A 4A.M1.00044A : Type 1/2 respiratory failure - HDU 2700 Treatment Notes
investigations
4A.M1.00044B : Type 1/2 respiratory failure - ICU Clinical Notes with relevant
4A.M1.00044C : Type 1/2 respiratory failure - ICU with Clinical Notes with relevant
1237 M1 4A.M1.00045 4A.M1.00045 : Acute asthmatic attack - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00045A 4A.M1.00045A : Acute asthmatic attack - HDU 2700 Treatment Notes
investigations
Speciality
code
4A.M1.00045B : Acute asthmatic attack - ICU without Clinical Notes with relevant
4A.M1.00045C : Acute asthmatic attack - ICU with Clinical Notes with relevant
1238 M1 4A.M1.00046 4A.M1.00046 : Acutre excaberation of COPD 0 Treatment Notes
investigations
1239 M1 4A.M1.00049 4A.M1.00049 : Hypertensive emergencies - routine ward 1800
M1 4A.M1.00049A 4A.M1.00049A : Hypertensive emergencies - HDU 2700 Clinical notes Clinical notes
4A.M1.00049B : Hypertensive emergencies - ICU Clinical notes Clinical notes
M1 4A.M1.00049B 3600
without ventilator
4A.M1.00049C : Hypertensive emergencies - ICU with Clinical notes Clinical notes
M1 4A.M1.00049C 4500
ventilator
4A.M1.00050 : Dengue hemorrhagic fever/Dengue shock clinical notes, Blood examination clinical notes, Blood examination report
1240 M1 4A.M1.00050 1800
syndrome - routine ward report
4A.M1.00050A : Dengue hemorrhagic fever/Dengue clinical notes, Blood examination clinical notes, Blood examination report
M1 4A.M1.00050A 2700
shock syndrome - HDU report
4A.M1.00050B : Dengue hemorrhagic fever/Dengue
M1 4A.M1.00050B 3600 report
shock syndrome - ICU without ventilator

4A.M1.00050C : Dengue hemorrhagic fever/Dengue
M1 4A.M1.00050C 4500 report
shock syndrome - ICU with ventilator

1241 M1 4A.M1.00051 4A.M1.00051 : Complicated malaria - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00051A 4A.M1.00051A : Complicated malaria - HDU 2700 Treatment Notes
investigations
4A.M1.00051B : Complicated malaria - ICU without Clinical Notes with relevant
4A.M1.00051C : Complicated malaria - ICU with Clinical Notes with relevant
1242 M1 4A.M1.00052 4A.M1.00052 : Heat stroke - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00052A 4A.M1.00052A : Heat stroke - HDU 2700 Treatment Notes
investigations
M1 4A.M1.00052B 4A.M1.00052B : Heat stroke - ICU without ventilator 3600 Treatment Notes
investigations
M1 4A.M1.00052C 4A.M1.00052C : Heat stroke - ICU with ventilator 4500 Treatment Notes
investigations
4A.M1.00053 : Hyperosmolar Non-Ketotic coma - Clinical Notes with relevant
M1 4A.M1.00053A 4A.M1.00053A : Hyperosmolar Non-Ketotic coma - HDU 2700 Treatment Notes
investigations
Speciality
code
4A.M1.00053B : Hyperosmolar Non-Ketotic coma - ICU Clinical Notes with relevant
4A.M1.00053C : Hyperosmolar Non-Ketotic coma - ICU Clinical Notes with relevant
1244 M1 4A.M1.00054 4A.M1.00054 : Cerebrovascular accident - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00054A 4A.M1.00054A : Cerebrovascular accident - HDU 2700 Treatment Notes
investigations
4A.M1.00054B : Cerebrovascular accident - ICU without Clinical Notes with relevant
4A.M1.00054C : Cerebrovascular accident - ICU with Clinical Notes with relevant
1245 M1 4A.M1.00055 4A.M1.00055 : Severe sepsis/Septic shock - routine ward 1800 Treatment Notes
investigations
M1 4A.M1.00055A 4A.M1.00055A : Severe sepsis/Septic shock - HDU 2700 Treatment Notes
investigations
4A.M1.00055B : Severe sepsis/Septic shock - ICU Clinical Notes with relevant
4A.M1.00055C : Severe sepsis/Septic shock - ICU with Clinical Notes with relevant
4A.M1.00056 : Upper GI bleeding (conservative) - Clinical Notes with relevant
M1 4A.M1.00056A 4A.M1.00056A : Upper GI bleeding (conservative) - HDU 2700 Treatment Notes
investigations
4A.M1.00056B : Upper GI bleeding (conservative) - ICU Clinical Notes with relevant
4A.M1.00056C : Upper GI bleeding (conservative) - ICU Clinical Notes with relevant
4A.M1.00059 : Immune mediated CNS disorders such as Clinical notes Clinical notes
1247 M1 4A.M1.00059 1800
autoimmune encephalitis - routine ward
4A.M1.00059A : Immune mediated CNS disorders such Clinical notes Clinical notes
M1 4A.M1.00059A 2700
as autoimmune encephalitis - HDU
4A.M1.00059B : Immune mediated CNS disorders such
M1 4A.M1.00059B 3600
as autoimmune encephalitis - ICU without ventilator

4A.M1.00059C : Immune mediated CNS disorders such
M1 4A.M1.00059C 4500
as autoimmune encephalitis - ICU with ventilator

1248 M1 4A.M1.00060 4A.M1.00060 : Acute transverse myelitis - routine ward 1800
M1 4A.M1.00060A 4A.M1.00060A : Acute transverse myelitis - HDU 2700 Clinical notes Clinical notes
4A.M1.00060B : Acute transverse myelitis - ICU without Clinical notes Clinical notes
M1 4A.M1.00060B 3600
ventilator
Speciality
code
4A.M1.00060C : Acute transverse myelitis - ICU with Clinical notes Clinical notes
M1 4A.M1.00060C 4500
ventilator
4A.M1.00064 : AKI/ renal failure(dialysis payable Clinical Notes with relevant

separately as an add on package for ) - routine ward investigations
4A.M1.00064A : AKI/ renal failure(dialysis payable Clinical Notes with relevant

M1 4A.M1.00064A 2700 Treatment Notes
separately as an add on package for ) - HDU investigations
4A.M1.00064B : AKI/ renal failure(dialysis payable
M1 4A.M1.00064B separately as an add on package for ) - - ICU without 3600 Treatment Notes
investigations
ventilator
4A.M1.00064C : AKI/ renal failure(dialysis payable
M1 4A.M1.00064C separately as an add on package for ) - - ICU with 4500 Treatment Notes
investigations
ventilator
1250 M1 4A.M1.00065 4A.M1.00065 : Status epilepticus - routine ward 1800 Clinical Notes Clinical Notes
M1 4A.M1.00065A 4A.M1.00065A : Status epilepticus - HDU 2700 Clinical Notes Clinical Notes
4A.M1.00065B : Status epilepticus - ICU without
M1 4A.M1.00065B 3600 Clinical Notes Clinical Notes
ventilator
M1 4A.M1.00065C 4A.M1.00065C : Status epilepticus - ICU with ventilator 4500 Clinical Notes Clinical Notes
1251 M1 4A.M1.00066 4A.M1.00066 : Status asthmaticus - routine ward 1800 Clinical Notes Clinical Notes
M1 4A.M1.00066A 4A.M1.00066A : Status asthmaticus - HDU 2700 Clinical Notes Clinical Notes
4A.M1.00066B : Status asthmaticus - ICU without
M1 4A.M1.00066B 3600 Clinical Notes Clinical Notes
ventilator
M1 4A.M1.00066C 4A.M1.00066C : Status asthmaticus - ICU with ventilator 4500 Clinical Notes Clinical Notes
4A.M1.00067 : Respiratory failure due to any cause

1252 M1 4A.M1.00067 (pneumonia, asthma, COPD, ARDS, foreign body, 1800 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - routine ward
4A.M1.00067A : Respiratory failure due to any cause
M1 4A.M1.00067A (pneumonia, asthma, COPD, ARDS, foreign body, 2700 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - HDU
4A.M1.00067B : Respiratory failure due to any cause

M1 4A.M1.00067B (pneumonia, asthma, COPD, ARDS, foreign body, 3600 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - ICU without ventilator
4A.M1.00067C : Respiratory failure due to any cause

M1 4A.M1.00067C (pneumonia, asthma, COPD, ARDS, foreign body, 4500 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - ICU with ventilator
GENERAL SURGERY
X-Ray of abdomen/CT (Upright
1253 S1 4A.S1.00085 4A.S1.00085 : Intestinal perforation 9000 Scar photo
position)
1254 S1 4A.S1.00093 4A.S1.00093 : Closure of Hollow Viscus Perforation 12500 X Ray abdomen ,USG Scar photo
1255 S1 4A.S1.00144 4A.S1.00144 : Volvlous of Large Bowel 25000 CT Scan Scar photo
Speciality
code
4A.S1.00204 : Congenital Atresia & Stenosis of Small
1256 S1 4A.S1.00204 110000 USG/ CT OT Notes, Scar Photo
Intestine
1257 S1 4A.S1.00251 4A.S1.00251 : AV Shunt for dialysis 7500 Duplex Clinical photos showing the AV fistula
4A.S6.00008A : Visceral injury requiring surgical

S6 4A.S6.00008A intervention along with fixation of fracture of single long 30000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
bone. - cross speciality
4A.S6.17029A : Inter costal drainage (icd) one side -
S6 4A.S6.17029A 8000 X-ray X-ray
cross speciality
4A.S6.17030A : Inter costal drainage (icd)bilateral (flail
S6 4A.S6.17030A 11000 X-ray X-ray
chest) - cross speciality

S6 4A.S6.17031A 12000 X-ray X-ray
chest) with icu stay - cross speciality

S6 4A.S6.17032A 14000 X-ray X-ray
chest) with icu stay with ventilator - cross speciality
4A.S6.17033A : Blunt injury abdomen with icu stay -

S6 4A.S6.17033A 12000 USG USG
cross speciality
4A.S6.17034A : Supra pubic cystostomy in fracture
S6 4A.S6.17034A 8000 X-ray X-ray
pelvis - cross speciality
4A.S6.00009A : Visceral injury requiring surgical
S6 4A.S6.00009A intervention along with fixation of fracture of 2 or more 45000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
long bones. - cross speciality
4A.M2.00005 : Acute Exacerbation of asthma - routine Clinical Notes with relevant
ward investigations
M2 4A.M2.00005A 4A.M2.00005A : Acute Exacerbation of asthma - HDU 2700 Treatment Notes
investigations
4A.M2.00005B : Acute Exacerbation of asthma - ICU Clinical Notes with relevant
4A.M2.00005C : Acute Exacerbation of asthma - ICU with Clinical Notes with relevant
4A.M2.00009 : Febrile seizures/other seizures - routine
ward
M2 4A.M2.00009A 4A.M2.00009A : Febrile seizures/other seizures - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00009B : Febrile seizures/other seizures - ICU

without ventilator
4A.M2.00009C : Febrile seizures/other seizures - ICU
with ventilator
1260 M2 4A.M2.00010 4A.M2.00010 : Epileptic encephalopathy - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00010A 4A.M2.00010A : Epileptic encephalopathy - HDU 2700 Clinical note with Lab reports Treatment note
Speciality
code
4A.M2.00010B : Epileptic encephalopathy - ICU without
ventilator
4A.M2.00010C : Epileptic encephalopathy - ICU with
ventilator
1261 M2 4A.M2.00012 4A.M2.00012 : Aseptic meningitis - routine ward 1800 Treatment Notes
investigations
M2 4A.M2.00012A 4A.M2.00012A : Aseptic meningitis - HDU 2700 Treatment Notes
investigations
4A.M2.00012B : Aseptic meningitis - ICU without Clinical Notes with relevant
M2 4A.M2.00012C 4A.M2.00012C : Aseptic meningitis - ICU with ventilator 4500 Treatment Notes
investigations
1262 M2 4A.M2.00017 4A.M2.00017 : Unexplained seizures - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00017A 4A.M2.00017A : Unexplained seizures - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00017B : Unexplained seizures - ICU without
ventilator
4A.M2.00017C : Unexplained seizures - ICU with
ventilator
1263 M2 4A.M2.00027 4A.M2.00027 : Pyogenic meningitis - routine ward 1800 Treatment Notes
investigations
M2 4A.M2.00027A 4A.M2.00027A : Pyogenic meningitis - HDU 2700 Treatment Notes
investigations
4A.M2.00027B : Pyogenic meningitis - ICU without Clinical Notes with relevant
4A.M2.00027C : Pyogenic meningitis - ICU with Clinical Notes with relevant
1264 M2 4A.M2.00030 4A.M2.00030 : Dengue - routine ward 1800 CBC
M2 4A.M2.00030A 4A.M2.00030A : Dengue - HDU 2700 CBC
M2 4A.M2.00030B 4A.M2.00030B : Dengue - ICU without ventilator 3600 CBC
M2 4A.M2.00030C 4A.M2.00030C : Dengue - ICU with ventilator 4500 CBC
1265 M2 4A.M2.00035 4A.M2.00035 : Tuberculosis - routine ward 1800 CBC, CT CBC,CT
M2 4A.M2.00035A 4A.M2.00035A : Tuberculosis - HDU 2700 CBC, CT CBC,CT
M2 4A.M2.00035B 4A.M2.00035B : Tuberculosis - ICU without ventilator 3600 CBC, CT CBC,CT
M2 4A.M2.00035C 4A.M2.00035C : Tuberculosis - ICU with ventilator 4500 CBC, CT CBC,CT

1266 M2 4A.M2.00048 4A.M2.00048 : Encephalitis - routine ward 1800 CT CT
M2 4A.M2.00048A 4A.M2.00048A : Encephalitis - HDU 2700 CT CT
M2 4A.M2.00048B 4A.M2.00048B : Encephalitis - ICU without ventilator 3600 CT CT
M2 4A.M2.00048C 4A.M2.00048C : Encephalitis - ICU with ventilator 4500 CT CT

1267 M2 4A.M2.00051 4A.M2.00051 : Refractory seizures - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00051A 4A.M2.00051A : Refractory seizures - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00051B : Refractory seizures - ICU without
ventilator
Speciality
code
M2 4A.M2.00051C 4A.M2.00051C : Refractory seizures - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
1268 M2 4A.M2.00052 4A.M2.00052 : Floppy infant - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00052A 4A.M2.00052A : Floppy infant - HDU 2700 Clinical note with Lab reports Treatment note
M2 4A.M2.00052B 4A.M2.00052B : Floppy infant - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 4A.M2.00052C 4A.M2.00052C : Floppy infant - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
1269 M2 4A.M2.00053 4A.M2.00053 : Acute neuroregression - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00053A 4A.M2.00053A : Acute neuroregression - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00053B : Acute neuroregression - ICU without
ventilator
4A.M2.00053C : Acute neuroregression - ICU with
ventilator
4A.M2.00055 : Opsoclonus myoclonus syndrome -
routine ward
M2 4A.M2.00055A 4A.M2.00055A : Opsoclonus myoclonus syndrome - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00055B : Opsoclonus myoclonus syndrome - ICU

without ventilator
4A.M2.00055C : Opsoclonus myoclonus syndrome - ICU
with ventilator
1271 M2 4A.M2.00056 4A.M2.00056 : Acute ataxia - routine ward 1800 Clinical examination Clinical examination
M2 4A.M2.00056A 4A.M2.00056A : Acute ataxia - HDU 2700 Clinical examination Clinical examination
M2 4A.M2.00056B 4A.M2.00056B : Acute ataxia - ICU without ventilator 3600 Clinical examination Clinical examination
M2 4A.M2.00056C 4A.M2.00056C : Acute ataxia - ICU with ventilator 4500 Clinical examination Clinical examination
1272 M2 4A.M2.00057 4A.M2.00057 : Steven Johnson syndrome - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00057A 4A.M2.00057A : Steven Johnson syndrome - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00057B : Steven Johnson syndrome - ICU without
ventilator
4A.M2.00057C : Steven Johnson syndrome - ICU with
ventilator
4A.M2.00059 : Ketogenic diet initiation in refractory
epilepsy - routine ward
4A.M2.00059A : Ketogenic diet initiation in refractory
epilepsy - HDU
4A.M2.00059B : Ketogenic diet initiation in refractory
epilepsy - ICU without ventilator
4A.M2.00059C : Ketogenic diet initiation in refractory
epilepsy - ICU with ventilator
4A.M2.00060 : Inborn errors of metabolism - routine
ward
Speciality
code
M2 4A.M2.00060A 4A.M2.00060A : Inborn errors of metabolism - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00060B : Inborn errors of metabolism - ICU

without ventilator
4A.M2.00060C : Inborn errors of metabolism - ICU with
ventilator
CBC,RFT,USG CBC,RFT,USG
1275 M2 4A.M2.00067 4A.M2.00067 : Acute kidney injury - routine ward 1800 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile LFT,Lipid Profile
M2 4A.M2.00067A 4A.M2.00067A : Acute kidney injury - HDU 2700 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
4A.M2.00067B : Acute kidney injury - ICU without
M2 4A.M2.00067B 3600 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
ventilator
M2 4A.M2.00067C 4A.M2.00067C : Acute kidney injury - ICU with ventilator 4500 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
1276 M2 4A.M2.00068 4A.M2.00068 : Poisonings - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00068A 4A.M2.00068A : Poisonings - HDU 2700 Clinical note with Lab reports Treatment note
M2 4A.M2.00068B 4A.M2.00068B : Poisonings - ICU without ventilator 3600 Clinical note with Lab reports Treatment note
M2 4A.M2.00068C 4A.M2.00068C : Poisonings - ICU with ventilator 4500 Clinical note with Lab reports Treatment note
4A.M2.00069 : Serious trauma with unstable vitals -
1277 M2 4A.M2.00069 1800 X-ray
routine ward
4A.M2.00069A : Serious trauma with unstable vitals -
M2 4A.M2.00069A 2700 X-ray
HDU
4A.M2.00069B : Serious trauma with unstable vitals -
M2 4A.M2.00069B 3600 X-ray
ICU without ventilator
4A.M2.00069C : Serious trauma with unstable vitals -
M2 4A.M2.00069C 4500 X-ray
ICU with ventilator
1278 M2 4A.M2.00074 4A.M2.00074 : Complicated malaria - routine ward 1800 Treatment Notes
investigations
M2 4A.M2.00074A 4A.M2.00074A : Complicated malaria - HDU 2700 Treatment Notes
investigations
4A.M2.00074B : Complicated malaria - ICU without Clinical Notes with relevant
M2 4A.M2.00074C 4A.M2.00074C : Complicated malaria - ICU with ventilator 4500 Treatment Notes
investigations
1279 M2 4A.M2.00075 4A.M2.00075 : Severe dengue with shock - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00075A 4A.M2.00075A : Severe dengue with shock - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00075B : Severe dengue with shock - ICU without
ventilator
Speciality
code
4A.M2.00075C : Severe dengue with shock - ICU with
ventilator
4A.M2.00078 : Acute encephalitic syndrome - routine
ward
M2 4A.M2.00078A 4A.M2.00078A : Acute encephalitic syndrome - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00078B : Acute encephalitic syndrome - ICU

without ventilator
4A.M2.00078C : Acute encephalitic syndrome - ICU with
ventilator
4A.M2.00079 : Acute demyelinating myelopathy -
routine ward
M2 4A.M2.00079A 4A.M2.00079A : Acute demyelinating myelopathy, - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00079B : Acute demyelinating myelopathy, - ICU

without ventilator
4A.M2.00079C : Acute demyelinating myelopathy, - ICU
with ventilator
4A.M2.00080 : Immune mediated CNS disorders such as
autoimmune encephalitis - routine ward
4A.M2.00080A : Immune mediated CNS disorders such
as autoimmune encephalitis - HDU
4A.M2.00080B : Immune mediated CNS disorders such

as autoimmune encephalitis - ICU without ventilator
4A.M2.00080C : Immune mediated CNS disorders such

as autoimmune encephalitis - ICU with ventilator
1283 M2 4A.M2.00081 4A.M2.00081 : Acute transverse myelitis - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00081A 4A.M2.00081A : Acute transverse myelitis - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00081B : Acute transverse myelitis - ICU without
ventilator
4A.M2.00081C : Acute transverse myelitis - ICU with
ventilator
1284 M2 4A.M2.00082 4A.M2.00082 : Guillain Barre Syndrome - routine ward 1800 Clinical examination Clinical examination
M2 4A.M2.00082A 4A.M2.00082A : Guillain Barre Syndrome - HDU 2700 Clinical examination Clinical examination
4A.M2.00082B : Guillain Barre Syndrome - ICU without
M2 4A.M2.00082B 3600 Clinical examination Clinical examination
ventilator
4A.M2.00082C : Guillain Barre Syndrome - ICU with
M2 4A.M2.00082C 4500 Clinical examination Clinical examination
ventilator
1285 M2 4A.M2.00085 4A.M2.00085 : Cerebral malaria - routine ward 1800 CBC, CT CBC, CT
M2 4A.M2.00085A 4A.M2.00085A : Cerebral malaria - HDU 2700 CBC, CT CBC, CT
Speciality
code
M2 4A.M2.00085B 4A.M2.00085B : Cerebral malaria - ICU without ventilator 3600 CBC, CT CBC, CT
M2 4A.M2.00085C 4A.M2.00085C : Cerebral malaria - ICU with ventilator 4500 CBC, CT CBC, CT

1286 M2 4A.M2.00086 4A.M2.00086 : Acute ischemic stroke - routine ward 1800 Treatment Notes
investigations
M2 4A.M2.00086A 4A.M2.00086A : Acute ischemic stroke - HDU 2700 Treatment Notes
investigations
4A.M2.00086B : Acute ischemic stroke - ICU without Clinical Notes with relevant
4A.M2.00086C : Acute ischemic stroke - ICU with Clinical Notes with relevant
4A.M2.00088 : Respiratory failure due to any causes
1287 M2 4A.M2.00088 (pneumonia, asthma, foreign body, poisoning, head 1800 Treatment Notes
investigations
injury etc.) - routine ward
4A.M2.00088A : Respiratory failure due to any causes
M2 4A.M2.00088A (pneumonia, asthma, foreign body, poisoning, head 2700 Treatment Notes
investigations
injury etc.) - HDU
4A.M2.00088B : Respiratory failure due to any causes

M2 4A.M2.00088B (pneumonia, asthma, foreign body, poisoning, head 3600 Treatment Notes
investigations
injury etc.) - ICU without ventilator
4A.M2.00088C : Respiratory failure due to any causes

M2 4A.M2.00088C (pneumonia, asthma, foreign body, poisoning, head 4500 Treatment Notes
investigations
injury etc.) - ICU with ventilator
1288 M2 4A.M2.00089 4A.M2.00089 : Acute transverse myelitis 0 Clinical note with Lab reports Treatment note
4A.M2.00090 : Acute encephalitis –infectious/immune-
mediated - routine ward
4A.M2.00090A : Acute encephalitis –infectious/immune-
mediated - HDU
4A.M2.00090B : Acute encephalitis –infectious/immune-

mediated - ICU without ventilator
4A.M2.00090C : Acute encephalitis –infectious/immune-

mediated - ICU with ventilator
4A.M2.00091 : Convulsive & non convulsive status

epilepticus - routine ward
4A.M2.00091A : Convulsive & non convulsive status
epilepticus - HDU
4A.M2.00091B : Convulsive & non convulsive status
epilepticus - ICU without ventilator
4A.M2.00091C : Convulsive & non convulsive status
epilepticus - ICU with ventilator
Speciality
code
1291 M2 4A.M2.00092 4A.M2.00092 : Cerebral herniation - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00092A 4A.M2.00092A : Cerebral herniation - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00092B : Cerebral herniation - ICU without
ventilator
M2 4A.M2.00092C 4A.M2.00092C : Cerebral herniation - ICU with ventilator 4500 Clinical note with Lab reports Treatment note

1292 M2 4A.M2.00093 4A.M2.00093 : Intracranial hemorrhage - routine ward 1800 Treatment Notes
investigations
M2 4A.M2.00093A 4A.M2.00093A : Intracranial hemorrhage - HDU 2700 Treatment Notes
investigations
4A.M2.00093B : Intracranial hemorrhage - ICU without Clinical Notes with relevant
4A.M2.00093C : Intracranial hemorrhage - ICU with Clinical Notes with relevant
1293 M2 4A.M2.00094 4A.M2.00094 : Hepatic encephalopathy - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00094A 4A.M2.00094A : Hepatic encephalopathy - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00094B : Hepatic encephalopathy - ICU without
ventilator
4A.M2.00094C : Hepatic encephalopathy - ICU with
ventilator
4A.M2.00095 : Complicated bacterial meningitis -
routine ward
M2 4A.M2.00095A 4A.M2.00095A : Complicated bacterial meningitis - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00095B : Complicated bacterial meningitis - ICU

without ventilator
4A.M2.00095C : Complicated bacterial meningitis - ICU
with ventilator
1295 M2 4A.M2.00096 4A.M2.00096 : Raised intracranial pressure - routine ward 1800 Clinical note with Lab reports Treatment note
M2 4A.M2.00096A 4A.M2.00096A : Raised intracranial pressure - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00096B : Raised intracranial pressure - ICU
without ventilator
4A.M2.00096C : Raised intracranial pressure - ICU with
ventilator
4A.M2.00097 : Hypertensive encephalopathy - routine
ward
M2 4A.M2.00097A 4A.M2.00097A : Hypertensive encephalopathy - HDU 2700 Clinical note with Lab reports Treatment note
4A.M2.00097B : Hypertensive encephalopathy - ICU

without ventilator
4A.M2.00097C : Hypertensive encephalopathy - ICU with
ventilator
Speciality
code
1297 M2 4A.M2.00098 4A.M2.00098 : CRRT (per session) 8000 Clinical note with Lab reports Treatment note
4A.M2.17175 : Medical Management of Acute Renal
1298 M2 4A.M2.17175 1500 CBC, RFT CBC, RFT
Failure With Dialysis in Paediatric patients
4A.M3.00001 : Basic neonatal care package (Rs. 500 per
day, maximum 1500): Babies that can be managed by
side of mother in postnatal ward without requiring
admission in SNCU/NICU:
• Any newborn needing feeding support
• Babies requiring closer monitoring or short-term care
for conditions like:
o Birth asphyxia (need for positive pressure ventilation;
no HIE)
o Moderate jaundice requiring phototherapy
o Large for dates (>97 percentile) Babies
o Small for gestational age (less than 3rd centile)
4A.M3.00010 : Ventriculoperitoneal Shunt Surgery (VP)
1300 M3 4A.M3.00010 or Omaya Reservoir or External Drainage for 27000 CT Report CT Report, Scar Photo, X Ray
Hydrocephalus
1301 S14 4A.S14.00027 4A.S14.00027 : Intussusception – Operative in infants 30000 USG OT notes
4A.S14.17126 : Airway Reconstruction for benign

1302 S14 4A.S14.17126 50000 Endoscopic Picture OT notes
conditions
1303 S14 4A.S14.17127 4A.S14.17127 : Anorectal Malformations Stage 1 35000 USG OT notes
1304 S14 4A.S14.17128 4A.S14.17128 : Paediatric intestinal obstruction >1month 65000 USG OT notes
1305 S14 4A.S14.17129 4A.S14.17129 : Laparotomy for peritonitis 50000 USG OT notes, Scar Picture
1306 S14 4A.S14.17130 4A.S14.17130 : Omphalocele-Major/Gastroschisis 70000 USG OT notes
1307 S14 4A.S14.17131 4A.S14.17131 : Exstropy Bladder Stage 1 80000 USG OT notes
1308 S14 4A.S14.17137 4A.S14.17137 : Bronchoscospy for foreign body removal 25000 X Ray OT Notes/ X Ray
1309 S14 4A.S14.17140 4A.S14.17140 : Bowel resection and anastomosis 55000 USG OT notes
4A.S1.00204A : Congenital Atresia & Stenosis of Small
S1 4A.S1.00204A 110000 USG/ CT OT Notes, Scar Photo
Intestine - cross speciality
NEUROSURGERY
1310 S8 4A.S8.00002 4A.S8.00002 : Burr hole 18000 CT Report CT Report, Scar Photo
4A.S8.00012 : Haematoma - Brain (head injuries) OT Notes, CT Report, Clinical
1311 S8 4A.S8.00012 60000 CT Report , X Ray
(including pre and post Op. CT) Photograph
1312 S8 4A.S8.00051 4A.S8.00051 : Twist Drill Craniostomy 15000 CT report Film and scar photo
1313 S8 4A.S8.00058 4A.S8.00058 : Abscess Tapping multiple 20000 CT report Post Op CT Report,film and scar photo

1314 S8 4A.S8.00059 4A.S8.00059 : Excision of Brain Abscess 50000 CT report
Photograph showing the scar
Speciality
code
4A.S8.00062 : External Ventricular Drainage (EVD) Post Op CT Report and film, Clinical
1315 S8 4A.S8.00062 15000 CT report
including antibiotics Photograph showing Scar
4A.S8.17056 : Craniotomy and Evacuation of
1316 S8 4A.S8.17056 50000 CT Report CT Report, Scar Photo, X Ray
Haematoma -Extradural *
4A.S6.00006A : Craniotomy and evacuation of

OT Notes, CT Report, Clinical
S6 4A.S6.00006A Haematoma – subdural/Extra dural along with fixation of 60000 CT Report , X Ray
Photograph
fracture of single long bone - cross speciality
4A.S6.00007A : Craniotomy and evacuation of

S6 4A.S6.00007A Haematoma – subdural/Extra dural along with fixation of 75000 CT Report , X Ray
Photograph
fracture of 2 or more long bone. - cross speciality
4A.S6.00012A : Emergency tendons repair ± Peripheral

S6 4A.S6.00012A 30000 X-ray Films/ Clinical Picture Clinical photo showing Scar
Nerve repair/ reconstructive surgery - cross speciality
4A.S6.17036A : Head injury with icu (conservative)) -

S6 4A.S6.17036A 7000 CT Clinical photo with treatment notes
cross speciality
S6 4A.S6.17037A 4A.S6.17037A : Head injury with icu stay (with ventilator) 15000 CT Clinical photo with treatment notes
4A.S6.17038A : Head injury with minimal surgical Clinical/scar photo with treatment
S6 4A.S6.17038A 25000 CT
intervention - cross speciality notes
1317 S4 4A.S4.00036 4A.S4.00036 : High risk delivery: Pre-mature delivery 9000 USG and clinical notes Delivery note/OT note
4A.S4.00037 : High risk delivery: Expected Gestation at

1318 S4 4A.S4.00037 9000 USG and clinical notes Delivery note/OT note
delivery less than 35 weeks
4A.S4.00038 : High risk delivery: Mothers with eclampsia
1319 S4 4A.S4.00038 9000 USG and clinical notes Delivery note/OT note
or imminent eclampsia
1320 S4 4A.S4.00039 4A.S4.00039 : High risk delivery: Obstructed labour 9000 USG and clinical notes Delivery note/OT note
4A.S4.00040 : High risk delivery: Major Fetal
1321 S4 4A.S4.00040 malformation requiring intervention immediately after 9000 USG and clinical notes Delivery note/OT note
birth
4A.S4.00041 : High risk delivery: Mothers with severe
1322 S4 4A.S4.00041 9000 USG, Lab report and clinical notes Delivery note/OT note
anaemia (<7 g/dL)
4A.S4.00042 : High risk delivery: Other maternal and

fetal conditions as per guidelines-Such as Rh haemolytic
1323 S4 4A.S4.00042 9000 USG, Lab report and clinical notes Delivery note/OT note
disease, uncontrolled diabetes, severe growth
retardation etc that qualify for high risk delivery etc.
1324 S4 4A.S4.00043 4A.S4.00043 : Manual removal of placenta 4250 Clinical Notes/USG Clinical Notes
Speciality
code
APTT(activated partial
thromboplastin time) , Heamatocrit , Clinical Photograph of Retroplacental
1325 S4 4A.S4.00052 4A.S4.00052 : Trans-vaginal tape/ Trans-obturator tape 15000
PT (Prothrombin time), Platelet Count clots , USG
, S.Fibrinogen Level , USG
1326 S4 4A.S4.00059 4A.S4.00059 : Broad Ligment Haemotoma drainage 7650 Clinical Notes, Ultrasonography OT Notes
Arterial Blood Gas

(ABG),APTT(activated partial
4A.S4.17017 : Abruptio-Placenta With Coagulation
1327 S4 4A.S4.17017 25000 thromboplastin Biochemical investigations
Defects( Disseminated Intravascular Coagulation (DiC))
time),CHE,LFT,RFT,Haematocrit,
platelet count, S fibrogen
4A.S4.17018 : Perforation of Uterus after D/E laprotomy
1328 S4 4A.S4.17018 12750 Clinical Notes, Ultrassonography OT Notes
and closure
ONCOLOGY
1329 S15 4A.S15.00021 4A.S15.00021 : Tracheostomy 5000 Clinical photo Clinical photo
4A.M5.17224 : IV antibiotics and other supportive Clinical Photograph, Discharge

1330 M5 4A.M5.17224 10000 Haemogram for each episode
therapy For Febrile Neutropenia (Per episode) summary (with details of drugs given)
ORTHOPAEDICS
4A.S5.00035 : Debridement & Closure of Major injuries -
1331 S5 4A.S5.00035 contused lacerated wounds (anti-biotic + dressing) - 7000 Clinical Notes + X-Rays Clinical Notes + X-Rays
minimum of 3 sessions
complete blood count,clinical
1332 S5 4A.S5.00044 4A.S5.00044 : Fasciotomy 15000 Scar photo
photograph
4A.S5.00064 : Open Reduction Internal Fixation (2 Small
1333 S5 4A.S5.00064 12000 X-ray X-ray
Bones)
4A.S6.00008C : Visceral injury requiring surgical
S6 4A.S6.00008C intervention along with fixation of fracture of single long 30000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
4A.S6.00010A : Chest injury with one fracture of long
S6 4A.S6.00010A 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants) - cross speciality
4A.S6.00011A : Chest injury with fracture of 2 or more
S6 4A.S6.00011A 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
long bones - cross speciality
4A.S6.00012C : Emergency tendons repair ± Peripheral

S6 4A.S6.00012C 30000 X-ray Films/ Clinical Picture Clinical photo showing Scar
4A.S6.17028B : Deglove injury of extremities - cross complete blood count,clinical

S6 4A.S6.17028B 12000 Scar photo
speciality photograph, X ray of affected part
4A.S6.00009C : Visceral injury requiring surgical

S6 4A.S6.00009C intervention along with fixation of fracture of 2 or more 45000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
Speciality
code
4A.S6.00012B : Emergency tendons repair ± Peripheral

S6 4A.S6.00012B 30000 X-ray Films/ Clinical Picture Clinical photo showing Scar
4A.S6.17028A : Deglove injury of extremities - cross complete blood count,clinical

S6 4A.S6.17028A 12000 Scar photo
speciality photograph, X ray of affected part
POLYTRAUMA
4A.S6.00006 : Craniotomy and evacuation of
1334 S6 4A.S6.00006 Haematoma – subdural/Extra dural along with fixation of 60000 CT Report , X Ray
Photograph
fracture of single long bone
4A.S6.00007 : Craniotomy and evacuation of
1335 S6 4A.S6.00007 Haematoma – subdural/Extra dural along with fixation of 75000 CT Report , X Ray
Photograph
fracture of 2 or more long bone.
4A.S6.00008 : Visceral injury requiring surgical
1336 S6 4A.S6.00008 intervention along with fixation of fracture of single long 30000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
bone.
4A.S6.00009 : Visceral injury requiring surgical
1337 S6 4A.S6.00009 intervention along with fixation of fracture of 2 or more 45000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
long bones.
4A.S6.00010 : Chest injury with one fracture of long
1338 S6 4A.S6.00010 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants)
4A.S6.00011 : Chest injury with fracture of 2 or more
1339 S6 4A.S6.00011 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
long bones
4A.S6.00012 : Emergency tendons repair ± Peripheral
1340 S6 4A.S6.00012 30000 X-ray Films/ Clinical Picture Clinical photo showing Scar
Nerve repair/ reconstructive surgery
complete blood count,clinical

1341 S6 4A.S6.17028 4A.S6.17028 : Deglove injury of extremities 12000 Scar photo
photograph, X ray of affected part
1342 S6 4A.S6.17029 4A.S6.17029 : Inter costal drainage (icd) one side 8000 X-ray X-ray
4A.S6.17030 : Inter costal drainage (icd)bilateral (flail
1343 S6 4A.S6.17030 11000 X-ray X-ray
chest)
1344 S6 4A.S6.17031 12000 X-ray X-ray
chest) with icu stay

1345 S6 4A.S6.17032 14000 X-ray X-ray
chest) with icu stay with ventilator
1346 S6 4A.S6.17033 4A.S6.17033 : Blunt injury abdomen with icu stay 12000 USG USG
1347 S6 4A.S6.17034 4A.S6.17034 : Supra pubic cystostomy in fracture pelvis 8000 X-ray X-ray
1348 S6 4A.S6.17035 4A.S6.17035 : Spine injuries - with ct/mri 7000 CT/MRI CT/MRI
Speciality
code
1349 S6 4A.S6.17036 4A.S6.17036 : Head injury with icu (conservative)) 7000 CT Clinical photo with treatment notes
1350 S6 4A.S6.17037 4A.S6.17037 : Head injury with icu stay (with ventilator) 15000 CT Clinical photo with treatment notes
4A.S6.17038 : Head injury with minimal surgical Clinical/scar photo with treatment
1351 S6 4A.S6.17038 25000 CT
intervention notes
SURGICAL GASTROENTEROLOGY
X-Ray of abdomen/CT (Upright
S1 4A.S1.00085A 4A.S1.00085A : Intestinal perforation - cross speciality 9000 Scar photo
position)
4A.S1.00093A : Closure of Hollow Viscus Perforation -
S1 4A.S1.00093A 12500 X Ray abdomen ,USG Scar photo
cross speciality
S1 4A.S1.00144A 4A.S1.00144A : Volvlous of Large Bowel - cross speciality 25000 CT Scan Scar photo
4A.S6.00008B : Visceral injury requiring surgical

S6 4A.S6.00008B intervention along with fixation of fracture of single long 30000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
4A.S6.17033B : Blunt injury abdomen with icu stay -
S6 4A.S6.17033B 12000 USG USG
cross speciality
4A.S6.00009B : Visceral injury requiring surgical
S6 4A.S6.00009B intervention along with fixation of fracture of 2 or more 45000 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
UROLOGY
4A.S7.00071 : Bladder injury repair (only to be used if Endoscopy with film, biopsy, CT Clinical Photograph showing scar +
1352 S7 4A.S7.00071 20000
done as a part of ongoing laparotomy/other surgery) report with film HPE report
1353 S7 4A.S7.00082 4A.S7.00082 : Suprapubic Drainage - Closed/Trocar 2000 RGU,MCU RGU,MCU
4A.S7.00158 : Emergency management of Acute

1354 S7 4A.S7.00158 2000 USG Doctors Note + X-ray
retention of Urine
4A.S7.00160 : Urinary tract trauma – open surgery
1355 S7 4A.S7.00160 10000 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
(exploratory)
Speciality
code
4A.S7.17047 : Acutekidney injury with hemodialysis, CBC,RFT,USG CBC,RFT,USG

1356 S7 4A.S7.17047 inclusive of pre-op inv,post -op inv,procedure 25000 Abd,HIV,HBsAg,HCV,Urine R/E, Abd,HIV,HBsAg,HCV,Urine R/E,
cost,ICU/wards stay,and medication for 15 days LFT,Lipid Profile LFT,Lipid Profile
S1 4A.S1.00251C 4A.S1.00251C : AV Shunt for dialysis - cross speciality 7500 Duplex Clinical photos showing the AV fistula
4A.S6.17034B : Supra pubic cystostomy in fracture

S6 4A.S6.17034B 8000 X-ray X-ray
pelvis - cross speciality
Note:
• Empanelled hospitals should upload basic investigations conducted in each patient - routine investigations like haemotology, bio-chemical, histopathological, micro biological, radiological films
and reports and USG reports for arriving at the diagnosis and clinical notes, provisional diagnosis, planned treatment procedure, and the code selected from the procedure list mandatorily for
preauthorization
• Procedures mentioned as cross speciality can be done by specialities under which they have been included in addition to the main speciality.
• Codes mentioned as * are sub procedures which are a part of the main procedure. Case specific procedure to be selected accordingly and cannot be clubbed with the main procedure.
• Scar photos or certain clinical photographs which involves patient private parts need not be furnished at the time of preauth/claims.
3A.M4.00035#, 3A.M4.00035A#, 3A.M4.00035B# - Bone tumors/soft tissue sarcomas : surgery (inlcuding prosthesis) - Comprehensive package includes surgery, invoice, irradiation and mega
prothesis/custom made prothesis. The code is designed for limb salvage in sarcoma cases which are detected early and have a good prognosis. The design is for neo-adjuvant chemotherapy to
reduce the activity, local irradiation followed by surgical excision of the tumour. The CAD of the prosthesis requires sometime and normally being taken on the second stage of surgery. The
approvals are to be given in staged manner with the first approval for neo-adjuvant chemotherapy with appropriate drugs and the cost as per the chemo packages of AB-ArK, second for the local
irradiation as per the cost per cycle of irradiation factored in the packages, third for the surgical excision of the tumour as per the surgical package and fourth for the implantation of mega prosthesis
or custom designed prosthesis as per the cost within the limit of package and finally the follow of treatment of chemo, radio and follow up treatment. The treatment packages are provided under
code - 3A.M4.00033, 3A.M4.00034, 3A.S15.00045 & 3A.M4.00036. The whole package should not exceed the rates prescribed under 3A.M4.00035, 3A.M4.00035A, 3A.M4.00035B
3A.M6.00006 : Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) (Radical/Adjuvant/Neoadjuvent) - Hospitals needs to produce AERB Certificate of Linear
Acceleration, Cone Beam CT fitted in machine or tracking device with variable. Package includes planning and execution. Additional CBCT report log print to be submitted during claim submission.
Oncology codes where in supportive care/rehabilitation is mentioned: Comprehensive package which includes treatment for Neutropenia, septicaemia and nutritional support along with
antibiotics, oral supplements with counselling. In case of relapse CT is recommended.

Benefit Packages (Private)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Benefit Packages (Private)

Uploaded by

Copyright:

Available Formats

BENEFIT PACKAGES OF AYUSHMAN BHARAT - AROGYA KARNATAKA FOR PRIVATE HOSPITALS

Clinical notes (should have pre-op

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

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

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

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

Clinical photo showing scar, BIOPSY,

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

Clinical Photograph/ Scar photo, HPE

Clinical notes, Practoscopy/

2B.S1.00164 : Split thickness skin grafts – Small (< 4%

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

2B.S1.17001 : Endoscopic Retrograde Cholangio

132 S1 2B.S1.17002 2B.S1.17002 : Laproscopic Adrenalectomy 30000 CT Clinical Photograph

2B.M2.00099 : Blood and blood component transfusion

2B.M3.00009 : Advanced Surgery for Retinopathy of

2B.S14.00019 : Gastrostomy + Esophagoscopy+

2B.S1.00176A : Lap. For intestinal obstruction - cross

2B.S4.00010 : Vaginal hysterectomy with anterior and Relevant Hematological

USG, Routine investigations and CA

Ultrasonography, X Ray, ECG, LFT,RFT,

2B.S1.00107A : Distal Pancreatectomy with

2B.S3.00012 : Glaucoma Surgery (Trabeculectomy only)

2B.S3.00013 : Intraocular Foreign Body Removal from

2B.S3.00031 : Cataract with foldable hydrophobic acrylic

2B.S3.00032 : Cataract with non-foldable IOL using SICS

2B.S3.17010 : Photocoagulation for Retinopathy for 3

2B.S5.00048 : Fracture - Hip Internal Fixation

2B.S5.00088 : Fracture intercondylarHumerus +

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

2B.S1.00036A : Excision Benign Tumor -Small intestine -

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

S1 2B.S1.00088B 2B.S1.00088B : Jejunostomy - cross speciality 10000 USG Clinical Photo

248 S7 2B.S7.00135 2B.S7.00135 : Ilio-Inguinal lymphadenectomy-unilateral 15000 USG Scar photo

249 S7 2B.S7.00136 2B.S7.00136 : Ilio-Inguinal lymphadenectomy-bilateral 25000 USG Scar photo

3A.S11.00011 : Post Burn Contracture surgeries for

3A.S11.00012 : Post Burn Contracture surgeries for

1.Angioplasty stills showing stents &

1.Angioplasty stills showing stents &

3A.S12.00011 : Peripheral Angioplasty with stent 2D ECHO , ANGIOGRAM report &

3A.S12.00022 : Permanent pacemaker implantation

3A.S12.00023 : Permanent pacemaker implantation (VVI)

1.Angioplasty stills showing stents &

1.Angioplasty stills showing stents &

CT/MRI or Angiogram, Prothrombin

3A.S12.00038 : Embolization - Arteriovenous USG abd/CT PT,INR, Hb, Serum

3A.S12.17063 : Intravascular ultrasound (IVUS)/Fractional

1.Angioplasty stills showing stents &

2D ECHO , Angiogram Report &

USG, clotting Time (CT), Prothrombin

3A.S13.00002 : Coronary artery bypass grafting (CABG)

3A.S13.00049 : Blalock–Thomas–Taussig (BT) Shunt 2D ECHO Report + stills of ECHO +

3A.S13.00074 : Intrathoracic Aneurysm-Aneurysm not

3A.S13.17094 : Gastro Study Followed by Thoracotomy

3A.S13.17095 : Thorocotomy and resection of pluera Pre Op X-ray / CT Scan,

3A.S13.17097 : Thoracotomy & Excision and fixation of

3A.S13.17101 : Aortic Aneurysm Repair without using

3A.S8.00025B : Shunt (peritoneal, ventriculo-atrial/

3A.S1.00078A : Hiatus Hernia – abdominal - cross

3A.S1.00149B : Aneurysm Resection & Grafting - cross

Stills showing the procedure with graft

Angiogram/ Computed Tomography

3A.S8.00025C : Shunt (peritoneal, ventriculo-atrial/