2 If admitted in This includes bed charges (HDU/SNCU), Nursing and boarding charges,
HDU/SNCU Surgeons, Anesthetists, Medical Practitioner, Consultants fees, Anesthesia,
Blood, Oxygen, O.T. Charges, Medicines and Drugs, X-Ray and Diagnostic
Tests etc. during stay in HDU/SNCU
3 If admitted in This includes bed charges ICU/NICU), Nursing and boarding charges,
ICU/NICU(without Surgeons, Anesthetists, Medical Practitioner, Consultants fees, Anesthesia,
Ventilation) Blood, Oxygen, O.T. Charges, Medicines and Drugs, X-Ray and Diagnostic
Tests etc. during stay in ICU/NICU
4 If admitted in This includes bed charges (ICU/NICU with ventilator), Nursing and boarding
ICU/NICU(withVentilati charges, Surgeons, Anesthetists, Medical Practitioner, Consultants fees,
on) Anesthesia, Blood, Oxygen, O.T. Charges, Medicines and Drugs, X-Ray and
Diagnostic Tests etc. during stay in ICU/NICU with ventilation
5 Surgical Procedures in This includesbed charges (General ward), Nursing and boarding charges,
General Ward ( not Surgeons, Anaesthetists, Medical Practitioner, Consultants fees, Anaesthesia,
specified in packages) Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances, Medicines and
Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests etc.
Expenses incurred for diagnostic test and medicines upto 3 days before the
admission of the patient and cost of diagnostic test and medicine upto 5 days of
the discharge from the hospital for the same ailment / surgery will also be the
part of package. The package should cover the entire cost of treatment of the
patient from date of reporting (3 day Pre hospitalisation) to his discharge from
hospital and 5 days after discharge and any complication while in hospital,
making the transaction truly cashless to the patient.
Recommended Rate
Rs 750/per day
Rs 1250/per day
Rs 1500/per day
Rs 2000/per day
Package Cost
INDEX
Sl.No Speciality Code System
S1 GENERAL SURGERY
S2 ENT
S OPTHALMOLOGY
S4 GYNAECOLOGY
S5 ORTHOPAEDICS
S6 POLY TRAUMA
S7 UROLOGY
S8 NEURO SURGERY
S9 INTERVENTIONAL RADIOLOGY
S10 PLASTIC & RECONSTRUCTIVE SURGERY
S11 BURNS
S12 CARDIOLOGY
S13 CV &CT
S14 PAEDIATRICS SURGERY
S15 SURGICAL ONCOLOGY
S16 ORAL &MAXILLOFACIAL SURGERY
M1 GENERAL MEDICINE
M2 PAEDIATRICS MEDICINE
M3 NEONATOLOGY
M4 PAEDIATRICS ONCOLOGY
M5 MEDICAL ONCOLOGY
M6 RADIATION ONCOLOGY
M7 EMERGENCY ROOM MANAGEMENT
M8 MENTAL DISORDER
M9 UNSPECIFIED PROCEDURE
Package
Amount Preaut Average Govt
h length of Reser
Require Stay ved
Speci Packa d or (Includin Proce
alty ge Not Mandatory investigations for pre- Post-Op investigations for g Days in dure
code Code Package Name (Y/N) auth claims submission ICU) (Y/N)
Excision of Growth from Tongue with neck 15,000 Procedure Note with
S1 00045 node dissection N Discharge Summary 4 N
Operation for Carcinoma Lip - Wedge Excision 12,000 Procedure Note with
S1 00198 and Vermilionectomy N Discharge Summary 6 N
Congenital Atresia & Stenosis of Small 20,000 Admission note with relevant Procedure Note with
S1 00204 Intestine Y investigation result report Discharge Summary 5 N
Fibro Lipoma of Spermatic with Lord Excision 7,000 Procedure Note with
S1 N Discharge Summary 3 N
Laparoscopic Inguinal Hernia - Bilateral 18,000 Admission note with relevant Procedure Note with
S1 Y investigation result report Discharge Summary 2 N
Laparoscopic Inguinal hernia - Unilateral 14,000 Admission note with relevant Procedure Note with
S1 Y investigation result report Discharge Summary 2 N
Laparoscopic Anterior resection
Admission note with relevant
80000 investigation result report Procedure Note with
S1 Y including USG/CT/Biopsy Discharge Summary 3 Y
Laparoscopic APR
Admission note with relevant
70000 investigation result report Procedure Note with
S1 Y including USG/CT/Biopsy Discharge Summary 3 Y
Laparoscopic Cardiomyotomy
Admission note with relevant
50000 investigation result report Procedure Note with
S1 Y including USG/CT/UGI Discharge Summary 3 Y
Laparoscopic deroofing cyst
Admission note with relevant
20000 investigation result report Procedure Note with
S1 Y including USG/CT Discharge Summary 2 N
Laparoscopic fundoplication
Admission note with relevant
70000 investigation result report Procedure Note with
S1 Y including USG/CT/UGI Discharge Summary 3 Y
Laparoscopic Hernia Repair-other
than ventral,inguinal &hiatus 18,000 Admission note with relevant Procedure Note with
S1 Y investigation result report Discharge Summary 2 N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
ENT
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Opthalmology
Package name
Average
length
Preauth of Stay Govt Medical
Specia Require Post-Op (Includin Reserved (M) or
lty Package Package d or Not Mandatory investigations investigations for g Days in Procedur Surgical
code Code Amount (Y/N) for pre-auth claims submission ICU) e (Y/N) (S)
Buckle Removal
Procedure Note with
S3 00001 7,500 N Discharge Summary D N S
Canaliculo Dacryocysto Rhinostomy
Procedure Note with
S3 00002 10,000 N Discharge Summary 1 N S
Capsulotomy (YAG)
Procedure Note with
S3 00003 2,225 N Discharge Summary D N S
Corneal Grafting
Procedure Note with
S3 00004 6,000 N Discharge Summary D N S
Prophylactic Cryoretinopexy- Closed
Procedure Note with
S3 00005 5,675 N Discharge Summary 1 N S
Cyclocryotherapy/Cyclophotocoagulatio
n
Procedure Note with
S3 00006 4,025 N Discharge Summary D N S
Pterygium + ConjunctivalAutograft
Procedure Note with
S3 00007 7,500 N Discharge Summary D N S
Dacryocystectomy with implants
Procedure Note with
S3 00008 11,000 N Discharge Summary D N S
Enucleation
Procedure Note with
SS 00009 5,000 N Discharge Summary 1 N S
Enucleation with Implant
Procedure Note with
S3 00010 7,500 N Discharge Summary 1 N S
Exenteration
Procedure Note with
S3 00011 7,500 N Discharge Summary D N S
Glaucoma Surgery (Trabeculectomy
only) with or without Mitomycin C,
including postoperative medications for
12 weeks (and wherever surgical or laser
procedures required for bleb
augmentation and anterior chamber
maintenance)
Procedure Note with
S3 00012 10,000 N Discharge Summary 1 N S
Intraocular Foreign Body Removal from
Anterior Segment
Procedure Note with
S3 00013 4,000 N Discharge Summary D N S
Intraocular Foreign Body Removal from
Posterior Segment
Procedure Note with
S3 00014 20,000 N Discharge Summary 1 N S
Lensectomy /pediatric lens aspiration
Procedure Note with
S3 00015 9,000 N Discharge Summary D N S
Limbal Dermoid Removal
Procedure Note with
S3 00016 4,000 N Discharge Summary D N S
Surgical Membranectomy
Procedure Note with
S3 00017 8,000 N Discharge Summary D N S
Perforating Corneo - Scleral Injury
Procedure Note with
S3 00018 10,000 N Discharge Summary 2 N S
Ptosis Surgery
Procedure Note with
S3 00019 10,000 N Discharge Summary D N S
IRIS Prolapse – Repair
Procedure Note with
S3 00020 5,600 N Discharge Summary D N S
Retinal Detachment Surgery
Procedure Note with
S3 00021 15,000 N Discharge Summary 2 N S
Small Tumour of Lid – Excision + Lid
Reconstruction
Procedure Note with
S3 00022 5,000 N Discharge Summary D N S
Socket Reconstruction with amniotic
membrane
Procedure Note with
S3 00023 8,000 N Discharge Summary 1 N S
Iridectomy – Laser
Procedure Note with
S3 00024 2,000 N Discharge Summary D N S
Iridectomy – Surgical
Procedure Note with
S3 00025 3,000 N Discharge Summary D N S
Iris cyst removal
2300 Procedure Note with
S3 00026 N Discharge Summary D N S
Vitrectomy
Procedure Note with
SS 00027 7,500 N Discharge Summary 1 N S
Vitrectomy + Retinal Detachment
surgery (pre-auth required)
Procedure Note with
S3 00028 17,500 N Discharge Summary 1 N S
Cataract with foldable hydrophobic
acrylic IOL by Phaco emulsification tech
Procedure Note with
S3 00029 7,500 N Discharge Summary D N S
Cataract with non-foldable IOL using
SICS technique
Procedure Note with
S3 00030 5,750 N Discharge Summary D N S
Cataract with foldable hydrophobic
acrylic IOL by Phaco emulsification tech
+ Glaucoma Procedure Note with
S3 00031 15,000 N Discharge Summary D N S
Cataract with non-foldable IOL using
SICS technique + Glaucoma
Procedure Note with
S3 00032 12,500 N Discharge Summary D N S
Conjunctival tumour excision + AMG
Procedure Note with
S3 00033 5,000 N Discharge Summary D N S
Entropion correction
Procedure Note with
S3 00034 4,000 N Discharge Summary D N S
Ectropion correction
Procedure Note with
S3 00035 5,000 N Discharge Summary D N S
Evisceration
Procedure Note with
SS 00036 3,500 N Discharge Summary D N S
Laser for retinopathy (per sitting)
Procedure Note with
S3 00037 1,500 N Discharge Summary D N S
Lid tear
Procedure Note with
S3 00038 3,500 N Discharge Summary D N S
Orbitotomy
Procedure Note with
SS 00039 10,000 N Discharge Summary 1 N S
Squint correction (per muscle)
Procedure Note with
S3 00040 4,000 N Discharge Summary D N S
Anterior Chamber Reconstruction
+Perforating corneo - Scleral Injury + IOL
Procedure Note with
S3 00041 11,500 N Discharge Summary 2N S
PRP - Retinal Laser including 3 sittings
Procedure Note with
S3 00042 5,000 N Discharge Summary D N S
Abscess Drainage of Lid
575 Procedure Note with
S3 N Discharge Summary D N S
Acid and alkali burns
Procedure Note with
S3 1,300 N Discharge Summary D N S
ALT-Argon laser trabeculoplasty
Procedure Note with
S3 1,725 N Discharge Summary D N S
Amniotic Membrane grafting
Procedure Note with
S3 2725 N Discharge Summary D N S
Argon/diode laser for Retinal
Detachment
Procedure Note with
S3 1,300 N Discharge Summary D N S
Bandage Contact Lenses for Corneal
perforation
Procedure Note with
S3 575 N Discharge Summary D N S
Canaliculoplasty
Procedure Note with
S3 2500 N Discharge Summary D N S
Cataract – Unilateral-ECCE.
4250 Procedure Note with
S3 N Discharge Summary D N S
Cauterisation of ulcer/subconjuctival
injection - both eye 250 Procedure Note with
S3 N Discharge Summary D N S
Cauterisation of ulcer/subconjuctival
injection - One eye 125 Procedure Note with
S3 N Discharge Summary D N S
Chalazion - both eye
750 Procedure Note with
S3 N Discharge Summary D N S
Chalazion - one eye
600 Procedure Note with
S3 N Discharge Summary D N S
Collagen crosslinking (UV radiation Kerat
Procedure Note with
S3 2500 N Discharge Summary D N S
Corneal Foreign Body Removal
Procedure Note with
S3 500 N Discharge Summary D N S
Dacryocystorhinostomy(DCR)-plain
3300 Procedure Note with
S3 N Discharge Summary D N S
DALK-Deep AnteriorLamellar
Keratoplasty 19000 Procedure Note with
S3 N Discharge Summary 2N S
DSAEK Descement's stripping automated
endothelial keratoplasty 18000 Procedure Note with
S3 N Discharge Summary 2N S
Ectropion Correction -one lid
2500 Procedure Note with
S3 N Discharge Summary D N S
Entropion correction -one lid
2000 Procedure Note with
S3 N Discharge Summary D N S
Epicantuhus correction
2500 Procedure Note with
S3 N Discharge Summary D N S
Epiliation
300 Procedure Note with
S3 N Discharge Summary D N S
ERG/EOG/VEP
1500 Procedure Note with
S3 N Discharge Summary D N S
Fracture Orbital repair
10500 Procedure Note with
S3 N Discharge Summary 2N S
Glaucoma Surgery with valve
Procedure Note with
S3 10,000 N Discharge Summary 1N S
Injection Botulinum for
Blepharospasm,Squint,etc 3000 Procedure Note with
S3 N Discharge Summary D N S
Intravitreal Injection of Antibiotics
3500 Procedure Note with
S3 N Discharge Summary D N S
Iris cyst removal
Procedure Note with
S3 2,500 N Discharge Summary D N S
Keratoplasty
9125 Procedure Note with
S3 N Discharge Summary 1N S
Keratoprosthesis Stage 1&2
15000 Procedure Note with
S3 N Discharge Summary 2N S
Optic Nerve Decompression
10000 Procedure Note with
S3 N Discharge Summary 1N S
Orbital Decompression
10000 Procedure Note with
S3 N Discharge Summary 1N S
Orbital Abscess I&D
4000 Procedure Note with
S3 N Discharge Summary D N S
Probing and syringing of Lacrimal sac
Unilateral/bilateralunder GA 2000 Procedure Note with
S3 N Discharge Summary D N S
Pterygium (Day care)
1500 Procedure Note with
S3 N Discharge Summary D N S
Ptosis Surgery -fasanella servat
procedure-one lid 3000 Procedure Note with
S3 N Discharge Summary D N S
Ptosis Surgery -LPS resection -one lid
7000 Procedure Note with
S3 N Discharge Summary 1N S
Silicon Oil removal Surgery
Procedure Note with
S3 3000 N Discharge Summary D N S
Telecanthus correction
5800 Procedure Note with
S3 N Discharge Summary 1N S
Tumours of IRIS
4450 Procedure Note with
S3 N Discharge Summary 1N S
UV radiation for cross linkig for
Keratoconus 2250 Procedure Note with
S3 N Discharge Summary D N S
YAG Laser capsulotomy
Procedure Note with
S3 1,500 N Discharge Summary D N S
Gynecology
Package name Average
length
of Stay
(Includi
ng Days
Preaut in ICU) Govt
h Reserv
Requir ed
Speci ed or Proced
alty Package Package Not Post-Op investigations ure
code Code Amount (Y/N) Mandatory investigations for pre-auth for claims submission (Y/N)
Hysterectomy -abdominal/vaginal± Salpingo- 5
oophorectomy
Admission note with relevant Procedure Note with
S4 00001 20000 Y investigation result report including USG Discharge Summary N
Abdominal Myomectomy 5
Procedure Note with
S4 00002 16000 N Discharge Summary N
Surgeries for Prolapse - Sling Surgeries 5
Procedure Note with
S4 00003 16000 N Discharge Summary N
Surgeries for Stress Incontinence 'Burch' 5
Admission note with relevant Procedure Note with
S4 00004 35000 Y investigation result report Discharge Summary N
Hysterotomes - 2nd Trimester abortions D
Procedure Note with
S4 00005 5000 N Discharge Summary N
Incisional Hernia Repair 3
Procedure Note with
00006 15,000 N Discharge Summary
Radical Hysterectomy (Wertheims) 5
Admission note with relevant
investigation result report including USG Procedure Note with
S4 00007 25000 Y and Biopsy Discharge Summary N
Laparotomy and proceed for Ovarian 5
Cancers. Omentomy with Bilateral Salpingo- Admission note with relevant
oophorectomy investigation result report including USG Procedure Note with
S4 00008 20,000 Y and Biopsy Discharge Summary N
Non descent vaginal hysterectomy 4
Procedure Note with
S4 00009 14000 N Discharge Summary N
Vaginal hysterectomy with anterior and 5
posterior colpoperineorrhaphy
Admission note with relevant Procedure Note with
S4 00010 22000 Y investigation result report including USG Discharge Summary N
Sacrocolpopexy 3
Procedure Note with
S4 00012 16000 N Discharge Summary N
Repair for rectovaginal fitulas 3
Procedure Note with
S4 00013 16000 N Discharge Summary N
Vaginoplasty 3
Procedure Note with
S4 00014 10000 N Discharge Summary N
LLETZ 3
Procedure Note with
S4 00015 15000 N Discharge Summary N
Colpotomy D
Procedure Note with
S4 00016 1500 N Discharge Summary N
Dilation and Evacuation (D&E) D
Procedure Note with
S4 00017 5100 N Discharge Summary N
Cervical biopsy and Polypectomy D
Procedure Note with
S4 00018 4500 N Discharge Summary N
Bartholins Cyst Enucleation/ Incision D
drainage Procedure Note with
S4 00019 3000 N Discharge Summary N
Vulvectomy simple 3
Procedure Note with
S4 00020 15000 N Discharge Summary N
Radical Vulvectomy 3
Admission note with relevant
investigation result report including Procedure Note with
S4 00021 17000 Y Biopsy Discharge Summary N
Diagnostic laparoscopy 1
Procedure Note with
S4 00022 11000 N Discharge Summary N
Laparoscopic hysterectomy (TLH) 2
Admission note with relevant Procedure Note with
S4 00023 25000 Y investigation result report including USG Discharge Summary N
Laparoscopic myomectomy 2
Admission note with relevant Procedure Note with
S4 00024 17000 Y investigation result report including USG Discharge Summary N
Laparoscopic cystectomy 2
Admission note with relevant Procedure Note with
S4 00025 15000 Y investigation result report including USG Discharge Summary N
Laparoscopic ovarotomy 2
Admission note with relevant Procedure Note with
S4 00026 12000 Y investigation result report including USG Discharge Summary N
Laparoscopic adhesiolysis 1
Procedure Note with
S4 00027 6000 N Discharge Summary N
Laparoscopic tubal surgeries - salpingectomy, 2
salpingotomy Procedure Note with
S4 00028 12500 N Discharge Summary N
Drag hysteroscopy 1
Procedure Note with
S4 00029 6000 N Discharge Summary N
Hysteroscopic myomectomies 1
Procedure Note with
S4 00030 6000 N Discharge Summary N
Hysteroscopic adhesiolysis 1
Procedure Note with
S4 00031 6000 N Discharge Summary N
Hysteroscopic polypectomy 1
Procedure Note with
S4 00032 8050 N Discharge Summary N
Hysteroscopic IUCD removal 1
Procedure Note with
S4 00033 3000 N Discharge Summary N
Caesarian Delivery 5
Procedure Note with
S4 00034 12000 N Discharge Summary N
Caesarian hysterectomy 5
Procedure Note with
S4 00035 22000 N Discharge Summary N
High risk delivery: Pre-mature delivery Procedure Note with
3
S4 00036 9000 N Discharge Summary N
High risk delivery: Expected Gestation at 3
delivery less than 35 weeks Procedure Note with
S4 00037 9000 N Discharge Summary N
High risk delivery: Mothers with 3
eclampsia or imminent eclampsia Procedure Note with
S4 00038 10000 N Discharge Summary N
High risk delivery: Obstructed labour- 3
forceps/vacuum delivery Procedure Note with
S4 00039 10000 N Discharge Summary N
High risk delivery: Major Fetal 3
malformation requiring intervention
immediately after birth Procedure Note with
S4 00040 10000 N Discharge Summary N
High risk delivery: Mothers with severe 3
anaemia (<7 g/dL) Procedure Note with
S4 00041 9,000 N Discharge Summary N
High risk delivery: Other maternal and 3
fetal conditions as per guidelines-Such as
Rh haemolytic disease, uncontrolled
diabetes, severe growth retardation etc Procedure Note with
S4 00042 that qualify for high risk delivery etc. 10000 N Discharge Summary N
Manual removal of placenta 1
Procedure Note with
S4 00043 5000 N Discharge Summary N
Laparotomy for ruptured ectopic 3
Procedure Note with
S4 00044 14000 N Discharge Summary N
MTP > 12 weeks 1
Procedure Note with
S4 00045 6500 N Discharge Summary N
MTP upto 12 weeks 1
Procedure Note with
S4 00046 5000 N Discharge Summary N
MTP upto 8 weeks 1
Procedure Note with
S4 00047 3500 N Discharge Summary N
McDonald's stitch D
Procedure Note with
S4 00048 5000 N Discharge Summary N
Shirodkar's stitch D
Procedure Note with
S4 00049 4000 N Discharge Summary N
Tuboplasty 2
Procedure Note with
S4 00050 10000 N Discharge Summary N
Laparotomy for broad ligament haematoma 3
Admission note with relevant Procedure Note with
S4 00051 16000 Y investigation result report including USG Discharge Summary N
Trans-vaginal tape/ Trans-obturator tape D
Procedure Note with
S4 00052 5000 N Discharge Summary N
Abdominal Perineal neo construction Cx + 5
Uteria + Vagina Admission note with relevant
investigation result report including USG Procedure Note with
S4 00053 20000 Y and Biopsy Discharge Summary N
Ablation of Endometriotic Spot + 2
Adhenolysis Procedure Note with
S4 00054 10000 N Discharge Summary N
Ablation of Endometriotic Spot 2
+Salpingostomy Procedure Note with
S4 00055 10000 N Discharge Summary N
Adhenolysis + Hernia - Ventral - 2
Lipectomy/Incision Procedure Note with
S4 00056 16000 N Discharge Summary N
Adhenolysis+ Ovarian Cystectomy 2
Procedure Note with
S4 00057 10000 N Discharge Summary N
Adhenolysis+ Salpingostomy 2
Procedure Note with
S4 00058 10000 N Discharge Summary N
Broad Ligment Haemotoma drainage 2
Procedure Note with
S4 00059 10000 N Discharge Summary N
Brust abdomen repair 3
Procedure Note with
00060 15000 N Discharge Summary
Cone Biopsy Cervix 1
Procedure Note with
S4 00061 1500 N Discharge Summary N
Conventional Tubectomy 1
Procedure Note with
S4 00062 4000 N Discharge Summary N
Cyst -Vaginal Enucleation D
Procedure Note with
S4 00063 3000 N Discharge Summary N
Cyst-Labial D
Procedure Note with
S4 00064 3000 N Discharge Summary N
Cystocele - Anterior repair 3
Procedure Note with
S4 00065 12000 N Discharge Summary N
Cystocele - Anterior Repair + Perineal Tear 3
Repair Procedure Note with
S4 00066 14000 N Discharge Summary N
D&C (Dilatation &curretage) + Electro D
Cauterisation Cryo Surgery Procedure Note with
S4 00067 4000 N Discharge Summary N
D&C (Dilatation&curretage) D
Procedure Note with
S5 00068 3000 N Discharge Summary N
Electro Cauterisation Cryo Surgery D
Procedure Note with
S4 00070 4000 N Discharge Summary N
Exploration of abdominal haematoma (after 3
laparotomy + LSCS) Admission note with relevant Procedure Note with
S4 00071 14000 Y investigation result report Discharge Summary N
Fractional Curretage D
Procedure Note with
S4 00072 4000 N Discharge Summary N
Gaping Perineal wound secondary suturing/ 1
episiotomy Procedure Note with
S4 00073 2500 N Discharge Summary N
HaematoColpo/Excision - Vaginal Septum 1
Procedure Note with
S4 00074 5000 N Discharge Summary N
Hymenectomy& Repair of Hymen 1
Procedure Note with
S4 00075 7000 N Discharge Summary N
Amniocentesis D
Procedure Note with
S4 00076 5000 N Discharge Summary N
Chorionic villus sampling D
Procedure Note with
S4 00077 5000 N Discharge Summary N
Cordocentesis D
Procedure Note with
S4 00078 5000 N Discharge Summary N
Intrauterine transfusions D
Procedure Note with
S4 00079 10000 N Discharge Summary N
1
Ablation of Endometrium Procedure Note with
S4 5750 N Discharge Summary N
1
Cervical Tear Procedure Note with
S4 5000 N Discharge Summary N
1
Destructive operation Procedure Note with
S4 6000 N Discharge Summary N
D
Procedure Note with
S4 Foreign Body retrieval from vagina 3000 N Discharge Summary N
3
Fothergill's operation Admission note with relevant Procedure Note with
S4 17000 Y investigation result report Discharge Summary N
D
Fractional Curretage Procedure Note with
S4 4000 N Discharge Summary N
2
Hysteroscopic Tubal Cannulation Procedure Note with
S4 15000 N Discharge Summary N
3
Admission note with relevant
Hysterotomy -Tumors removal investigation result report including Procedure Note with
S4 17000 Y Biopsy Discharge Summary N
3
Laparotomy -failed laproscopy to explore Admission note with relevant Procedure Note with
S4 14000 Y investigation result report Discharge Summary N
3
Laparotomy for ectopic pregnancy Procedure Note with
S4 12000 N Discharge Summary N
3
Laparotomy to explore for IUCD perforation Procedure Note with
S4 14000 N Discharge Summary N
2
Normal Vaginal delivery Procedure Note with
S4 7000 N Discharge Summary N
Normal Vaginal delivery with 3rd /4th 3
Procedure Note with
S4 degree Perineal Tear Repair 8000 N Discharge Summary N
3
Ovarian Cystectomy Procedure Note with
S4 17000 N Discharge Summary N
3
Admission note with relevant Procedure Note with
S4 Ovarian Cystectomy in Pregnancy 18000 Y investigation result report including USG Discharge Summary N
2
Ovariectomy/Oophorectomy Procedure Note with
S4 11520 N Discharge Summary N
Perforation of Uterus after D&C-laparotomy 3
Procedure Note with
S4 and closure 15725 N Discharge Summary N
D
Perineal Tear Repair Procedure Note with
S4 2200 N Discharge Summary N
3
Prolapse Uterus - Manchester Admission note with relevant Procedure Note with
S4 15000 Y investigation result report Discharge Summary N
3
Prolapse Uterus -L forts Admission note with relevant Procedure Note with
S4 15000 Y investigation result report Discharge Summary N
1
Pyometra Dilation Procedure Note with
S4 5000 N Discharge Summary N
D
Repair of post coital tear, perineal injury Procedure Note with
S4 3500 N Discharge Summary N
3
Rupture Uterus and repair with tubal ligation Procedure Note with
S4 20000 N Discharge Summary N
1
Uterine Synechia - Cutting Procedure Note with
S4 8625 N Discharge Summary N
D
Vaginal Tear -Repair Procedure Note with
S4 3600 N Discharge Summary N
2
Vulval Tumors - Removal Procedure Note with
S4 6000 N Discharge Summary N
3
Salpingo-Oophorectomy Procedure Note with
S4 11500 N Discharge Summary N
Capped amount
(pacakge cannot
Medical be used more Reserved
(M) or than the for Trust
Surgical mentioned Payment
(S) monetary limit) (Y/N)
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
Orthopaedics
Preaut
h
Requir Average
ed or length of Govt
Not Stay Reserve
Speci (Y/N) (Including d
alty Package Package Mandatory investigations Post-Op investigations for Days in Procedu
code Code Package name Amount for pre-auth claims submission ICU) re (Y/N)
25,000
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
s N
Poly Trauma
Craniotomy and evacuation of Haematoma Admission note with relevant Procedure Note with Discharge
– subdural/Extra dural along with fixation of investigation result report Summary including Post operative
S6 00006 fracture of single long bone 60,000 Y including radiological report radiological report 5-10 days N
Craniotomy and evacuation of Haematoma Admission note with relevant Procedure Note with Discharge
– subdural/Extra dural along with fixation of investigation result report Summary including Post operative
S6 00007 fracture of 2 or more long bone. 75,000 Y including radiological report radiological report 5-10 days N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
Urology
Post-Op
investigations for
claims submission
Packag
e Code
Preaut Average Govt
h length of Reser
Requir Stay ved
Spec ed or (Includin Proce
ialty Package Not g Days in dure
code Package name Amount (Y/N) Mandatory investigations for pre-auth ICU) (Y/N)
Procedure Note
Admission note with relevant with Discharge
00001 investigation result report including Summary
S7 Adrenalectomy-unilateral, open 25000 Y CT/MRI/USG 5 N
Procedure Note
Admission note with relevant with Discharge
00002 investigation result report including Summary
S7 Adrenalectomy-unilateral, Laparoscopic 30000 Y CT/MRI/USG 2 N
Procedure Note
Admission note with relevant with Discharge
00003 investigation result report including Summary
S7 Adrenalectomy-bilateral, open 32000 Y CT/MRI/USG 5 N
Procedure Note
Admission note with relevant with Discharge
00004 investigation result report including Summary
S7 Adrenalectomy-biilateral, Laparoscopic 40000 Y CT/MRI/USG 2 N
Procedure Note
Admission note with relevant with Discharge
00005 investigation result report including Summary
S7 Paraganglioma excision with liver mobilization 50000 Y CT/MRI/USG 5 N
Procedure Note
Admission note with relevant with Discharge
00006 investigation result report including Summary
S7 Nephrectomy (Benign) Open 30000 Y CT/MRI/ USG/KUB/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00007 investigation result report including Summary
S7 Nephrectomy (Benign) Laparoscopic 35000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00008 investigation result report including Summary
S7 Nephrectomy-Radical (Renal tumor) Open 35000 Y CT/MRI/ USG/KUB/Urography/HP 5 N
Procedure Note
Admission note with relevant with Discharge
00009 investigation result report including Summary
S7 Nephrectomy-Radical (Renal tumor) Laparoscopic 40000 Y CT/MRI/ USG/KUB/Urography/HP 2 N
Procedure Note
Admission note with relevant with Discharge
00010 investigation result report including Summary
S7 Nephrectomy-Partial or Hemi, Open 25000 Y CT/MRI/ USG/KUB/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00011 investigation result report including Summary
S7 Nephrectomy-Partial or Hemi, Laparoscopic 30000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00012 investigation result report including Summary
S7 Nephro ureterectomy (Benign) Open 31000 Y CT/MRI/ USG/KUB/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00013 investigation result report including Summary
S7 Nephro ureterectomy (Benign) Laparoscopic 36000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00014 investigation result report including Summary
S7 Nephro ureterectomy with cuff of bladder Open 35000 Y CT/MRI/ USG/KUB/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00015 Nephro ureterectomy with cuff of bladder investigation result report including Summary
S7 Laparoscopic 40000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00016 Pyeloplasty/pyeloureterostomy/pyelopyelostomy investigation result report including Summary
S7 Open 25000 Y CT/MRI/ USG/KUB/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00017 Pyeloplasty/pyeloureterostomy/pyelopyelostomy investigation result report including Summary
S7 Laparoscopic 30000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00018 investigation result report including Summary
S7 Endopyelotomy (retrograde with laser/bugbee) 25000 Y CT/MRI/ USG/KUB/Urography 1 N
Procedure Note
Admission note with relevant with Discharge
00019 investigation result report including Summary
S7 Endopyelotomy (antegrade with laser/bugbee) 28000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00020 investigation result report including Summary
S7 Ureterocalycostomy Open 25000 Y CT/MRI/ USG/KUB/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00021 investigation result report including Summary
S7 Ureterocalycostomy Laparoscopic 30000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00022 investigation result report including Summary
S7 Uretero-ureterostomy Open 25000 Y CT/MRI/ USG/KUB/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00023 investigation result report including Summary
S7 Uretero-ureterostomy Laparoscopic 35000 Y CT/MRI/ USG/KUB/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00024 investigation result report including Summary
S7 PCNL (Percutaneous Nephrolithotomy) - Bilateral 40000 Y CT/MRI/ USG/KUB/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00025 investigation result report including Summary
S7 PCNL (Percutaneous Nephrolithotomy) - Unilateral 25000 Y CT/MRI/ USG/KUB/Urography 3 N
Procedure Note
with Discharge D (up to
00026 Extracoporeal shock-wave Lithotripsy (ESWL) 3
Summary
S7 stone, with or without stent (one side) 13000 N sittings) N
Procedure Note
with Discharge D (up to
00027 Extracoporeal shock-wave Lithotripsy (ESWL) 3
Summary
S7 stone, with or without stent (both sides) 22750 N sittings) N
Procedure Note
Admission note with relevant with Discharge
00028 investigation result report including CT/ Summary
S7 Pyelolithotomy-Open 20000 Y USG/KUB/IVP 3 N
Procedure Note
Admission note with relevant with Discharge
00029 investigation result report including CT/ Summary
S7 Pyelolithotomy-Laparoscopic 30000 Y USG/KUB/IVP 2 N
Procedure Note
Admission note with relevant with Discharge
00030 investigation result report including CT/ Summary
S7 Nephrolithotomy-Open 20000 Y USG/KUB/IVP 3 N
Procedure Note
Admission note with relevant with Discharge
00031 investigation result report including CT/ Summary
S7 Anatrophic nephrolithotomy 30000 Y USG/KUB/IVP 5 N
Procedure Note
00032 with Discharge
Summary
S7 Perinephric Abscess drainage (percutaneous) 10000 N 2 N
Procedure Note
00033 with Discharge
Summary
S7 Perinephric Abscess drainage (Open) 20000 N 3 N
Procedure Note
Admission note with relevant with Discharge
00034 investigation result report including Summary
S7 Renal Cyst deroofing or marsupialization-Open 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00035 Renal Cyst deroofing or marsupialization- investigation result report including Summary
S7 Laparoscopic 30000 Y radiological/USG report 3 N
Procedure Note
00036 with Discharge
Summary
S7 Nephrostomy-percutaneous ultrasound guided 11925 N D N
Procedure Note
Admission note with relevant with Discharge
00037 investigation result report including Summary
S7 Ureterolithotomy-Open 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00038 investigation result report including Summary
S7 Ureterolithotomy-Laparoscopic 30000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00039 Ureteroscopy+stone removal with lithotripsy, investigation result report including Summary
S7 lower ureter, unilateral 20000 Y radiological/USG report 1 N
Procedure Note
Admission note with relevant with Discharge
00040 Ureteroscopy+stone removal with lithotripsy, investigation result report including Summary
S7 upper ureter, unilateral 25000 Y radiological/USG report 1 N
Procedure Note
Admission note with relevant with Discharge
00041 Ureteroscopy+stone removal with lithotripsy, investigation result report including Summary
S7 bilateral 30000 Y radiological/USG report 1 N
Procedure Note
Admission note with relevant with Discharge
00042 investigation result report including Summary
S7 Ureterotomy (Cutaneous) 20000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00043 investigation result report including Summary
S7 Endoureterotomy (laser/bugbee) 20000 Y radiological/USG report 1 N
Procedure Note
Admission note with relevant with Discharge
00044 investigation result report including Summary
S7 Ureteric reimplantation-unilateral-open 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00045 investigation result report including Summary
S7 Ureteric reimplantation-bilateral-open 25000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00046 investigation result report including Summary
S7 Ureteric reimplantation-unilateral-Laparoscopic 30000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00047 investigation result report including Summary
S7 Ureteric reimplantation-bilateral-Laparoscopic 35000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00048 investigation result report including Summary
S7 Uretero-vaginal/uterine fistula repair open 27000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00049 investigation result report including Summary
S7 Uretero-vaginal/uterine fistula repair Laparoscopic 37000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00050 Ureterolysis-open, for retroperitoneal fibrosis investigation result report including Summary
S7 (with or without omental wrapping) 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00051 Ureterolysis-Laparoscopic, for retroperitoneal investigation result report including Summary
S7 fibrosis (with or without omental wrapping) 30000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00052 investigation result report including Summary
S7 Boari flap for ureteric stricture, open 30000 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00053 investigation result report including Summary
S7 Boari flap for ureteric stricture, Laparoscopic 40000 Y radiological/USG report/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00054 investigation result report including Summary
S7 Ileal replacement for ureteric stricture 40000 Y radiological/USG report/Urography 5 N
Procedure Note
00055 DJ stent unilateral including cystoscopy, ureteric with Discharge
Summary
S7 catheterization, retrograde pyelogram 10000 N D N
Procedure Note
00056 DJ stent bilateral including cystoscopy, ureteric with Discharge
Summary
S7 catheterization, retrograde pyelogram 12000 N D N
Procedure Note
00057 Ureteric sampling including cystoscopy, ureteric with Discharge
Summary
S7 catheterization, retrograde pyelogram 10,000 N D N
Procedure Note
00058 Ureterocele incision including cystoscopy, ureteric with Discharge
Summary
S7 catheterization, retrograde pyelogram 15000 N 1 N
Procedure Note
00059 with Discharge
Summary
S7 Urachal Cyst excision -open 15000 N 2 N
Procedure Note
00060 with Discharge
Summary
S7 Cystolithotomy-open, including cystoscopy 15000 N 2 N
Procedure Note
00061 Cystolithotripsy/Urethral Stone endoscopic, with Discharge
Summary
S7 including cystoscopy 15000 N 1 N
Procedure Note
Admission note with relevant with Discharge
00062 TURBT (Transurethral Resection of the Bladder investigation result report including Summary
S7 Tumor) 25000 Y radiological/USG report/HP 2 N
Procedure Note
Admission note with relevant with Discharge
00063 TUR-fulgration (Transurethral fulgration of the investigation result report including Summary
S7 Bladder Tumor) 18000 Y radiological/USG report/HP 2 N
Procedure Note
00064 Intravesical BCG/Mitomycin 6 induction cycles with Discharge
Summary
S7 (weekly for 6 weeks-total cost of 6 cycles) 12000 N D N
Procedure Note
Admission note with relevant with Discharge
00065 Intravesical BCG/Mitomycin maintenance for 12 investigation result report including Summary
S7 doses (total cost of 12 doses) 24000 Y radiological/USG report D N
Procedure Note
00066 Post TURBT - Check Cystoscopy (Per sitting) with with Discharge
Summary
S7 or without cold-cup biopsy 10000 N D N
Procedure Note
00067 with Discharge
Summary
S7 Diagnostic Cystoscopy 5000 N D N
Procedure Note
00068 with Discharge
Summary
S7 Bladder Neck incision-endoscopic 15000 N 1 N
Procedure Note
Admission note with relevant with Discharge
00069 Extrophy Bladder repair including osteotomy if investigation result report including Summary
S7 needed + epispadias repair + ureteric reimplant 50000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00070 Bladder injury repair (as an independent investigation result report including Summary
S7 procedure with or without urethral injury) 20000 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00071 Bladder injury repair (only to be used if done as a investigation result report including Summary
S7 part of ongoing laparotomy/other surgery) 10000 Y radiological/USG report/Urography 2 N
Procedure Note
Bladder injury repair with colostomy (as an Admission note with relevant with Discharge
00072 independent procedure with or without urethral investigation result report including Summary
S7 injury) 25000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00073 investigation result report including Summary
S7 Partial Cystectomy-open 20000 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00074 investigation result report including Summary
S7 Partial Cystectomy-Laparoscopic 30000 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00075 investigation result report including Summary
S7 Radical cystectomy with neobladder-open 50000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00076 investigation result report including Summary
S7 Radical cystectomy with continent diversion-open 50000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00077 investigation result report including Summary
S7 Radical Cystectomy with Ileal Conduit-open 50000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00078 investigation result report including Summary
S7 Radical Cystectomy with ureterostomy-open 35000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00079 Radical Cystectomy with ureterosigmoidostomy- investigation result report including Summary
S7 open 35000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00080 investigation result report including Summary
S7 Other Cystectomies 30000 Y radiological/USG report/Urography 2 N
Procedure Note
00081 Suprapubic Cystostomy - Open, as an independent with Discharge
Summary
S7 procedure 10000 N D N
Procedure Note
00082 with Discharge
Summary
S7 Suprapubic Drainage - Closed/Trocar 5000 N D N
Procedure Note
Admission note with relevant with Discharge
00083 investigation result report including Summary
S7 VVF/Uterovaginal Repair - Transvaginal approach 25000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00084 investigation result report including Summary
S7 VVF/Uterovaginal Repair - Abdominal,Open 25000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00085 VVF/Uterovaginal Repair - Abdominal, investigation result report including Summary
S7 Laparoscopic 30000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00087 investigation result report including Summary
S7 Urethrovaginal fistula repair 30000 Y radiological/USG report/IVP 3 N
Procedure Note
Admission note with relevant with Discharge
00088 Y V Plasty of Bladder Neck/Bladder Neck investigation result report including Summary
S7 Reconstruction 20000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00089 investigation result report including Summary
S7 Augmentation cystoplasty-open 30000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00090 investigation result report including Summary
S7 Augmentation cystoplasty-Laparoscopic 40000 Y radiological/USG report/Urography 2 N
Procedure Note
Admission note with relevant with Discharge
00091 Open bladder diverticulectomy with/without investigation result report including Summary
S7 ureteric re-implantation 25000 Y radiological/USG report/IVP 3 N
Procedure Note
Admission note with relevant with Discharge
00092 investigation result report including Summary
S7 Open simple prostatetctomy for BPH 25000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00093 TURP-Transurethral Resection of the Prostate, investigation result report including Summary
S7 BPH, Monopolar/Bipolar/Laser 25000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00094 investigation result report including Summary
S7 Holmium Laser Prostatectomy 40000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00095 investigation result report including Summary
S7 TURP/Laser + Circumcision 26000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00096 investigation result report including Summary
S7 TURP/Laser + Cystolithotripsy 35000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00097 investigation result report including Summary
S7 TURP/Laser + Cystolithotomy-open 32000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00098 investigation result report including Summary
S7 TURP/Laser + Orchidectomy 28000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00099 investigation result report including Summary
S7 TURP/Laser + TURBT 30000 Y radiological/USG report/HP 2 N
Procedure Note
Admission note with relevant with Discharge
00100 investigation result report including Summary
S7 TURP/Laser + URS with stone removal 31000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00101 investigation result report including Summary
S7 TURP/Laser + VIU (visual internal Ureterotomy) 30000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00102 investigation result report including Summary
S7 TURP/Laser + Hydrocele surgery 28000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00103 investigation result report including Summary
S7 TURP/Laser + Hernioplasty 30000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00104 investigation result report including Summary
S7 TURP/Laser + Urethral dilatation-non endoscopic 26000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00105 investigation result report including Summary
S7 TURP/Laser + Urethral dilatation-endoscopic 27500 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00106 investigation result report including Summary
S7 Radical prostatectomy - open 50000 Y radiological/USG report/HP 5 N
Procedure Note
Admission note with relevant with Discharge
00107 investigation result report including Summary
S7 Radical prostatectomy - laparoscopic 70000 Y radiological/USG report/HP 2 N
Procedure Note
00108 Transrectal Ultrasound guided prostate biopsy with Discharge
Summary
S7 (minimum 12 core) 10000 N 1 N
Procedure Note
00109 with Discharge
Summary
S7 Reduction of Paraphimosis 2000 N D N
Procedure Note
00110 with Discharge
Summary
S7 Excision of Urethral Caruncle 6000 N 1 N
Procedure Note
00111 with Discharge
Summary
S7 Meatoplasty 3500 N 1 N
Procedure Note
00112 with Discharge
Summary
S7 Meatotomy 3500 N 1 N
Procedure Note
00113 with Discharge
Summary
S7 Post Urethral Valve fulguration 10275 N 1 N
Procedure Note
Admission note with relevant with Discharge
00114 investigation result report including Summary
S7 Urethroplasty-End to end 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00115 investigation result report including Summary
S7 Urethroplasty-Substitution-single stage 30000 Y radiological/USG report/RGU 3 N
Procedure Note
Admission note with relevant with Discharge
00116 investigation result report including Summary
S7 Urethroplasty-Substitution-two stage 35000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00117 investigation result report including Summary
S7 Urethroplasty-Transpubic 30000 Y radiological/USG report/RGU 5 N
Procedure Note
Admission note with relevant with Discharge
00118 investigation result report including Summary
S7 Urethroplasty-two stage without substitution 30000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
00119 investigation result report including Summary
S7 Perineal Urethrostomy without closure 20000 Y radiological/USG report 2 N
Procedure Note
Admission note with relevant with Discharge
00120 investigation result report including Summary
S7 Urethrorectal fistula repair 40000 Y radiological/USG report 5 N
Procedure Note
00121 Urethral Dilatation-non endocopic as an with Discharge
Summary
S7 independent procedure 2000 N D N
Procedure Note
00122 Urethral Dilatation-endocopic as an independent with Discharge
Summary
S7 procedure 5000 N D N
Procedure Note
00123 Internal Ureterotomy including cystoscopy as an with Discharge
Summary
S7 independent procedure 10000 N 1 N
Procedure Note
Admission note with relevant with Discharge
00124 investigation result report including Summary
S7 Hypospadias repair-single stage 20000 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
00125 investigation result report including Summary
S7 Hypospadias repair-two or more stage 30000 Y radiological/USG report/Urography 3 N
Procedure Note
00126 with Discharge
Summary
S7 Orchiopexy-without laparoscopy, unilateral 10000 N 2 N
Procedure Note
00127 with Discharge
Summary
S7 Orchiopexy-without laparoscopy, bilateral 15000 N 2 N
Procedure Note
00128 with Discharge
Admission note with relevant Summary
S7 Orchiopexy-with laparoscopy, unilateral 20000 Y investigation result report 2 N
Procedure Note
00129 with Discharge
Admission note with relevant Summary
S7 Orchiopexy-with laparoscopy, bilateral 25000 Y investigation result report 2 N
Procedure Note
Admission note with relevant with Discharge
00130 investigation result report including Summary
S7 Stress incontinence surgery, open 20000 Y radiological/USG report/Urography 4 N
Procedure Note
Admission note with relevant with Discharge
00131 investigation result report including Summary
S7 Stress incontinence surgery, laparoscopic 30000 Y radiological/USG report/Urography 4 N
Procedure Note
Admission note with relevant with Discharge
00132 investigation result report including Summary
S7 Stress incontinence surgery with slings 35000 Y radiological/USG report/Urography 3 N
Procedure Note
00133 with Discharge
Admission note with relevant Summary
S7 Partial Penectomy 15000 Y investigation result report 2 N
Procedure Note
00134 with Discharge
Admission note with relevant Summary
S7 Total Penectomy + Perineal Urethrostomy 20000 Y investigation result report 2 N
Procedure Note
00135 with Discharge
Admission note with relevant Summary
S7 Ilio-Inguinal lymphadenectomy-unilateral 15000 Y investigation result report 3 N
Procedure Note
00136 with Discharge
Admission note with relevant Summary
S7 Ilio-Inguinal lymphadenectomy-bilateral 25000 Y investigation result report 3 N
Procedure Note
Admission note with relevant with Discharge
00137 Pelvic lymphadenectomy open, after prior cancer investigation result report including Summary
S7 surgery 25000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
00138 Pelvic lymphadenectomy laparoscopic, after prior investigation result report including Summary
S7 cancer surgery 30000 Y radiological/USG report 3 N
Procedure Note
00139 with Discharge
Summary
S7 Orchiectomy-High inguinal 12000 N 2 N
Procedure Note
00140 with Discharge
Summary
Orchiectomy-simple 10,000 N 2 N
Procedure Note
00142 with Discharge
Admission note with relevant Summary
S7 Retroperitoneal lymph node dissection-open 25000 Y investigation result report 3 N
Procedure Note
00143 Retroperitoneal lymph node dissection- with Discharge
Admission note with relevant Summary
S7 Laparoscopic 35000 Y investigation result report 2 N
Procedure Note
00148 with Discharge
Summary
S7 Varicocele-unilateral-non microsurgical 10000 N 1 N
Procedure Note
00149 with Discharge
Admission note with relevant Summary
S7 Varicocele-unilateral-microsurgical 12000 Y investigation result report 1 N
Procedure Note
00150 with Discharge
Summary
S7 Varicocele-bilateral-non microsurgical 15000 N 1 N
Procedure Note
00151 with Discharge
Admission note with relevant Summary
S7 Varicocele-bilateral-microsurgical 20000 Y investigation result report 1 N
Procedure Note
00152 Penile prosthesis insertion, Malleable (Indian with Discharge
Admission note with relevant Summary
S7 implant) 30000 Y investigation result report 3 N
Procedure Note
00153 with Discharge
Summary
S7 Priapism-aspiration/shunt 15000 N 2 N
Procedure Note
with Discharge
Summary
00154 Neurogenic bladder-Package for
evaluation/investigation (catheter + ultrasound +
culture + RGU/ MCU) for 1 month (medicines -
S7 antibiotics). Follow up visit once in 3 months 7500 N D N
Procedure Note
with Discharge
Summary
00155 Chronic prostatitis-Package for
evaluation/investigation (ultrasound + culture +
prostate massage) for 1 month (medicines). Follow
S7 up visit once in 3 months 2500 N D N
Procedure Note
with Discharge
00156 Emergency management of Ureteric stone - Summary
Package for evaluation/investigation (ultrasound +
S7 culture) for 3 weeks (medicines). 3500 N D N
Procedure Note
00157 with Discharge
Summary
S7 Emergency management of Hematuria 750 N D N
Procedure Note
00158 Emergency management of Acute retention of with Discharge
Summary
S7 Urine 750 N D N
Procedure Note
00159 Acute management of upper urinary tract trauma with Discharge
Summary
S7 – conservative 750 N D N
Procedure Note
Admission note with relevant with Discharge
00160 investigation result report including Summary
S7 Urinary tract trauma – open surgery (exploratory) 20000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
00161 investigation result report including Summary
S7 Urinary tract trauma – Laparoscopy surgery 30000 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
ANDERSON HYNES PYELOPLASTY 15000 investigation result report including Summary
S7 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
BILATERAL NEPHROURETECTOMY (NATIVE) 20000 investigation result report including Summary
S7 Y radiological/USG report 3 N
Procedure Note
BIOPSY OF BLADDER (CYSTOSCOPIC) 6000 with Discharge
Summary
S7 N 1 N
Procedure Note
Bladder Tumour (Fulguration) with Discharge
Summary
S7 5000 N 1 N
Procedure Note
CAECO CYSTOPLASTY 12000 with Discharge
Summary
S7 N 3 N
Procedure Note
CIRCUMCISION -medically indicated 2950 with Discharge
Summary
S7 N D N
Procedure Note
CLOSURE OF URETHRAL FISTULA 10000 with Discharge
Summary
S7 N 2 N
Procedure Note
Correction of Exstrophy of Bladder with Discharge
Admission note with relevant Summary
S7 20000 Y investigation result report 3 N
Procedure Note
Admission note with relevant with Discharge
Cysto Gastrostomy investigation result report including Summary
S7 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
Cysto Jejunostomy investigation result report including Summary
S7 20000 Y radiological/USG report 3 N
Procedure Note
Cystolitholapaxy with Discharge
Summary
S7 10000 N 3 N
Procedure Note
Admission note with relevant with Discharge
CYSTOPLASTY 20000 investigation result report including Summary
S7 Y radiological/USG report 3 N
Procedure Note
DILATATION OF STRICTURE URETHRA UNDER G.A. 3000 with Discharge
Summary
S7 N D N
Procedure Note
DIVERTICULECTOMY 18000 with Discharge
Summary
S7 N 3 N
Procedure Note
Dormia Extraction of Calculus with Discharge
Summary
S7 7000 N 1 N
S7 Drainage of Perinepheric Abscess 10000 N N
Procedure Note
ENDOSCOPIC TEFLON INJECT 4000 with Discharge
Summary
S7 N D N
Procedure Note
EPIDIDYMECTOMY 8500 with Discharge
Summary
S7 N 2 N
Procedure Note
Exploration of Epididymis (Unsuccesful Vaso with Discharge
vasostomy) Summary
S7 8475 N 2 N
Procedure Note
EXPLORATORY SCROTOTOMY 6200 with Discharge
Summary
S7 N 2 N
Procedure Note
Hypospadias Repair and Orchiopexy with Discharge
Summary
S7 18300 N N
Procedure Note
Admission note with relevant with Discharge
Internal Urethrotomy investigation result report including Summary
S7 10000 radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
LAPROSCOPIC OPERATION FOR VARICOCELE 14500 investigation result report including Summary
S7 radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
Lithotripsy investigation result report including Summary
S7 12500 radiological/USG report 2 N
Nephropexy Procedure Note
Admission note with relevant with Discharge
investigation result report including Summary
S7 15000 radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
Open Resection of Bladder Neck investigation result report including Summary
S7 12000 radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
Operation for Cyst of Kidney investigation result report including Summary
S7 15000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
Operation for Double Ureter investigation result report including Summary
S7 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
Operation for ectopic ureter investigation result report including Summary
S7 20000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
OPERATIONS FOR HYDRONEPHROSIS 16000 investigation result report including Summary
S7 Y radiological/USG report 3 N
Procedure Note
PALOMO’S BILATERAL 10000 with Discharge
Admission note with relevant Summary
S7 investigation result report 3 N
Procedure Note
PALOMO’S UNILATERAL 6000 with Discharge
Admission note with relevant Summary
S7 investigation result report 3 N
Procedure Note
Admission note with relevant with Discharge
Retroperitoneal Fibrosis investigation result report including Summary
S7 29800 Y radiological/USG report 5 N
Procedure Note
RETROPERITONEOSCOPIC OPERATION FOR Admission note with relevant with Discharge
25000 investigation result report including
HYDERONEPHROSIS Summary
S7 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
RETROPERITONEOSCOPIC PYELOLITHOTOMY 25200 investigation result report including Summary
S7 Y radiological/USG report/Urography 5 N
Procedure Note
RETROPERITONEOSCOPIC SURGERY FOR RENAL Admission note with relevant with Discharge
19700 investigation result report including
CYST Summary
S7 Y radiological/USG report/Urography 3 N
Procedure Note
Admission note with relevant with Discharge
RETROPERITONEOSCOPIC URETEROLITHOTOMY 25000 investigation result report including Summary
S7 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
RETROPERITONEOSCOPY NEPHRECTOMY 35000 investigation result report including Summary
S7 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
RETROPERITONEOSCOPY PARTIAL NEPHRECTOMY 30000 investigation result report including Summary
S7 Y radiological/USG report/Urography 5 N
Procedure Note
Admission note with relevant with Discharge
Retropubic Prostatectomy investigation result report including Summary
S7 16950 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
Stricture Urethra investigation result report including Summary
S7 9000 radiological/Urography 1 N
Procedure Note
TESTICULAR BIOPSY 4000 with Discharge
Admission note with relevant Summary
S7 investigation result report D N
Procedure Note
Admission note with relevant with Discharge
Trans Vesical Prostatectomy investigation result report including Summary
S7 18000 radiological/USG report 3 N
Procedure Note
Transurethral Fulguration with Discharge
Admission note with relevant Summary
S7 5000 investigation result report 1 N
Procedure Note
Admission note with relevant with Discharge
TURP + Fissurectomy investigation result report including Summary
S7 28000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
TURP + Fistulectomy investigation result report including Summary
S7 28000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
TURP + Haemorrhoidectomy investigation result report including Summary
S7 30000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
TURP + Herniorraphy investigation result report including Summary
S7 30000 Y radiological/USG report N
Procedure Note
Admission note with relevant with Discharge
TURP + Nephrectomy investigation result report including Summary
S7 35000 Y radiological/USG report 5 N
Procedure Note
Admission note with relevant with Discharge
TURP + Urethrolithotomy investigation result report including Summary
S7 30000 Y radiological/USG report 3 N
Procedure Note
Admission note with relevant with Discharge
TURP + URS investigation result report including Summary
S7 27000 Y radiological/USG report N
TURP/Laser + Orchidectomy Procedure Note
Admission note with relevant with Discharge
investigation result report including Summary
S7 27500 Y radiological/USG report N
Procedure Note
URETERIC CATHETERISATION 1700 with Discharge
Summary
S7 N D N
Procedure Note
Admission note with relevant with Discharge
URETERO-COLIC ANASTOMOSIS 20000 investigation result report including Summary
S7 Y radiological/USG report 3 N
Procedure Note
URS Extraction of Stone - Bilateral with Discharge
Summary
S7 17025 N 2 N
Procedure Note
URS Extraction of Stone - Unilateral with Discharge
Summary
S7 11850 N 2 N
Procedure Note
URS extraction with DJ stenting-Bilateral with Discharge
Summary
S7 18500 N 2 N
Procedure Note
URS extraction with DJ stenting-Unilateral with Discharge
Summary
S7 13000 N 2 N
Procedure Note
URS extraction with ESWL-Bilateral with Discharge
Summary
S7 20000 N 2 N
Procedure Note
URS extraction with ESWL-Unilateral with Discharge
Summary
S7 15000 N 2 N
Procedure Note
URS with DJ Stenting With ESWL-Unilateral with Discharge
Summary
S7 17025 N 2 N
Procedure Note
VASOVASOSTOMY 11700 with Discharge
Summary
S7 N 2 N
Procedure Note
Vesico Ureteric Reflux - Unilateral with Discharge
Summary
S7 15000 N 3 N
Procedure Note
Vesico ureteric Reflux - Bilateral with Discharge
Summary
S7 20000 N 3 N
Procedure Note
VIU (Visual Internal Urethrotomy ) with Discharge
Summary
S7 8400 N 2 N
Procedure Note
VIU + Cystolithopexy with Discharge
Summary
S7 15000 N 3 N
Procedure Note
VIU + Hydrocelectomy with Discharge
Summary
S7 17100 N 3 N
Procedure Note
VIU and Meatoplasty with Discharge
Summary
S7 10200 N 3 N
Capped
amount
(pacakge
Medi cannot be
cal used more
(M) than the
or mentione Reserved
Surgi d for Trust
cal monetary Payment
(S) limit) (Y/N)
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
M N
M N
M N
M N
M N
M N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
Neuro Surgery
Average Govt
length of Reserv
Spec Preauth Stay ed Medical
ialty Packa Require (Including Proced (M) or
cod ge Package d or Not Mandatory investigations for Post-Op investigations Days in ure Surgical
e Code Package name Amount (Y/N) pre-auth for claims submission ICU) (Y/N) (S)
Burr hole with chronic Sub Dural Admission note with relevant
Haematoma (including pre and post Op. investigation result report Procedure Note with
S8 00003 CT) Y including CT/MRI Report of Brain Discharge Summary 3 N S
Gamma Knife radiosurgery (GKRS)/ SRS for Admission note with relevant
tumours/ Arteriovenous malformation investigation result report Procedure Note with
S8 00083 (AVM) Y including CT/MRI Report of Brain Discharge Summary 5 N S
5000 Procedure Note with
S8 Brain mapping N Discharge Summary 1 N S
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Interventional Radiology
Package name
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
S N
Plastic & Reconstructive Surgery
S N
S N
S N
S N
S N
S N
S N
S N
S N
Burns
Preaut
h
Spec Packa Package Requir Mandatory investigations Post-Op investigations
ialty ge Package name Amount ed or for pre-auth for claims submission
code Code Not
(Y/N)
D N S N
10-14 days N S N
10-14 days N S N
Cardiology
Average
length of
Preauth Stay
Spec Packa Required (Includin
ialty ge Package or Not Mandatory investigations for Post-Op investigations for g Days in
code Code Package name Amount (Y/N) pre-auth claims submission ICU)
25,000 Y
Admission note with relevant
investigation result report
including ColourDoppler ECHO Procedure Note with Discharge
S12 00001 Balloon Atrial Septostomy report Summary with procedure report 2
35000 Y
Admission note with relevant
investigation result report
including ColourDoppler ECHO Procedure Note with Discharge
S12 00002 Balloon Aortic Valvotomy report Summary with procedure report 2
40000 Y
Admission note with relevant
investigation result report
including ColourDoppler ECHO Procedure Note with Discharge
S12 00003 Balloon Mitral Valvotomy report Summary with procedure report 2
35000 Y
Admission note with relevant
investigation result report
including ColourDoppler ECHO Procedure Note with Discharge
S12 00004 Balloon Pulmonary Valvotomy report Summary with procedure report 2
60000 Y
Procedure Note with Discharge
Admission note with relevant Summary with procedure report
Vertebral Angioplasty with single stent investigation result report and bar code sticker of the
S12 00005 (medicated) including angiogram Stent. 2
90000 Y
Procedure Note with Discharge
Admission note with relevant Summary with procedure report
Vertebral Angioplasty with double investigation result report and bar code sticker of the
S12 00006 stent(medicated) including angiogram Stent. 2
130000 Y
Procedure Note with Discharge
Admission note with relevant Summary with procedure report
investigation result report and bar code sticker of the
S12 00007 Carotid angioplasty with stent (medicated) including angiogram Stent. 3
60000 Y
Procedure Note with Discharge
Admission note with relevant Summarywith procedure note
Renal Angioplasty with single stent investigation result report and bar code sticker of the
S12 00008 (medicated) including angiogram Stent. 2
90000 Y
Procedure Note with Discharge
Admission note with relevant Summarywith procedure report
Renal Angioplasty with double stent investigation result report and bar code sticker of the
S12 00009 (medicated) including angiogram Stent. 2
25000 Y
CARDIAC RESYNCHRONISATION THERAPY Admission note with relevant Procedure Note with Discharge
[CRT] investigation result Summary including procedure
reportincluding ECHO and ECG note and bar code of
S12 report consumables. 5
Coarctoplasty with stenting 45000 Y
ELECTROPHYSIOLOGICAL STUDY Admission note with relevant Procedure Note with Discharge
investigation result report Summary including procedure
S12 including ECG/Holter report report 1
15000 N
IMPLANTABLE CARDIAC DEFIBRILLATOR [ICD] Admission note with relevant Procedure Note with Discharge
investigation result report including procedure report and
S12 including ECHO and ECG report bar code of consumables 5
PERIPHERAL ANGIOGRAM INCLUDING 6000 D
S12 CAROTID, FOUR VESSEL ANGIOGRAM Clinical note /ECG Procedure report D
60000 Y
PERCUTANEOUS SEPTAL MYOCARDIAL Admission note with relevant Procedure Note with Discharge
ABLATION REQUIRING PPI investigation result report Summary including procedure
including colour doppler note and bar code of
S12 ECHO/ECG report consumables. 3
35000 Y
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N M N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
Y S N
N S N
N S N
N S N
N S N
Y S N
N S N
N S N
N S N
N S N
N S N
Cardio Vascular & Cardio Thoracic Surgery
Preaut
h
Requir
Spec ed or
ialty Packag Package Not Mandatory investigations for pre-
code e Code Package name Amount (Y/N) auth
Coronary artery bypass grafting (CABG) + one Admission note with relevant
mechanical Valve Replacement + Intra-aortic balloon investigation result report
S13 00003 pump (IABP) 175000 Y including CAG/ECHO report
Coronary artery bypass grafting (CABG) with post MI Admission note with relevant
Ventricular Septal Defect (Ventricular Septal Defect) investigation result report
S13 00007 repair 125000 Y including CAG/ECHO report
Admission note with relevant
investigation result including
ECHO report /CAG report if >40
S13 00008 Open Mitral Valvotomy 75000 Y years
Aorto Bi lliac / Bi femoral /Axillo bi femoral bypass Admission note with relevant
with (single) Synthetic Graft investigation result report
including CT Angiogram/ Doppler
S13 50000 Y report
Oesophageal tumour excision and follow up care Admission note with relevant
(open preferred) investigation result including
ECHO report /CAG report if >40
S13 60000 Y years
Capped
amount
(pacakge
Average Govt cannot be
length Reser used more
of Stay ved Medica than the
(Includi Proce l (M) or mentioned Reserved for
ng Days dure Surgica monetary Trust Payment
Post-Op investigations for claims submission in ICU) (Y/N) l (S) limit) (Y/N)
Average
length of
Stay
Preauth (Including
Required Mandatory Days in
Specialt Package Package or Not investigations for Post-Op investigations for intensive
y code Code Package name Amount (Y/N) pre-auth claims submission care units)
Procedure Note with
S14 00001 Ankyloglossia Major 15000 N Discharge Summary 3
Procedure Note with
S14 00002 Ankyloglossia Minor 5000 N Discharge Summary 2
Procedure Note with
S14 00003 Hernia & Hydrocele B/L 15000 N Discharge Summary 3
Procedure Note with
S14 00004 Sacrococcygeal Teratoma 20000 N Discharge Summary 5
Procedure Note with
S14 00005 Undescended Testis - Bilateral-Palp /Nonpalp 20,000 N Discharge Summary 5
Procedure Note with
S14 00008 Undescended Testis - Reexploration/ Second Stage 20,000 N Discharge Summary 5
Undescended Testis - Unilateral-Palpable/non Procedure Note with
S14 00009 palpable 15,000 N Discharge Summary 5
Procedure Note with
S14 00010 Ano Rectal Malformation - Abd-Perineal PSARP 20000 N Discharge Summary 5
Procedure Note with
S14 00011 Ano Rectal Malformation – Anoplasty 20000 N Discharge Summary 5
Procedure Note with
S14 00012 Ano Rectal Malformation – Cutback 7500 N Discharge Summary 3
Procedure Note with
S14 00013 Ano Rectal Malformation - PSARP 22000 N Discharge Summary 5
Procedure Note with
S14 00014 Ano Rectal Malformation - Redo Pullthrough 15000 N Discharge Summary 3
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
N S N
Surgical Oncology
Average
length of
Stay
(Includin
Preauth g Days in
Spec Required intensive
ialty Packag Package or Not Mandatory investigations for Post-Op investigations for care
code e Code Package name Amount (Y/N) pre-auth claims submission units)
Radical Hysterectomy + Bilateral pelvic lymph node Admission note with relevant
dissection + bilateral salpingo ophorectomy (BSO)/ investigation result report Procedure Note with
S15 00037 ovarian transposition 50,000 Y including CECT/Biopsy report Discharge Summary 5 to 7
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Y S N
Oral & Maxillofacial Surgery
Special Packag Preauth Mandatory Post-Op investigations for claims Average Govt
ty code e Code Required investigations submission length of Reserved
or Not for pre-auth Stay Procedure
(Y/N) (Including (Y/N)
Days in
intensive
care units)
Package
Package name Amount
S
S
S
S
S
S
S
S
S
Capped amount
(pacakge cannot
be used more Reserved
than the for Trust
mentioned Payment
monetary limit) (Y/N)
N
N
N
N
N
N
N
N
N
General Medicine
Specia Package Package name Package Amount per day (drop down) for Preauth Mandatory
lty Code admission type: Routine General ward (Rs Require investigations for pre-
code 750/ HDU (Rs 1250)/ ICU (without ventilator) d or Not auth
(Rs 1500)/ ICU (with ventilator)(Rs 2000) (Y/N)
M1 00071 High end radiological diagnostic (CT& MRI) - can only capped @ Rs 5000 per annum for a family Y Admission note with
be clubbed with medical package. Rs 5000 per annum relevant investigation
limit to a family result report
M1 00072 High end histopathology (Biopsies) and advanced capped @ Rs 5000 per annum for a family Y Admission note with
serology investigations - can only be clubbed with relevant investigation
medical package. Rs 5000 per annum limit to a family result report
M1 GENERAL MEDICINE-Any ailments can be admitted in the The minimum number of days needed has to Admission note with
respective ward as per the decision of the treating be blocked first,depending on the needs it can relevant investigation
Doctor,but has to be supported with substantiative be enhanced by providing the supportive result report
documents. documents
M1 Acute disseminated Encephalomyelities ,Multiple In addition cost of the drug-IV Methyl Y Admission note with
Sclerosis,Auto immune encephalities,longitudinally Prednisolone/Immunoglobulin if needed can relevant investigation
extensive myelities ,Acute Transverse Myelitis,Guillian be claimed using the template attached, along result report and the
Barre Syndrome with utilise Plasmapheresis package ,if template for additional
needed. request
M1 GENERAL MEDICINE-Acute Stroke In addition if Chemical Thrombolectomy is Y Admission note with
indicated cost of the drug can be claimed relevant investigation
using the template result report and the
template for additional
request
M1 GENERAL MEDICINE-Neuro muscular weakness due to In addition IV Immunoglobulin if needed can Y Admission note with
immune based diseases like AIDP,Myasthenia and be claimed using the template attached, along relevant investigation
CIDP with/without haemodynamic compromise with utilise Plasmapheresis package ,if result report and the
autonomic disturbance needed. template for additional
request
M1 GENERAL MEDICINE-Meningitis/Encephalitis- In addition the drugs needed exclusively for Y Admission note with
Bacterial/Fungal/Viral the care of the infection if needed can be relevant investigation
claimed using the template attached result report and the
template for additional
request
M1 GENERAL MEDICINE-Neck In addition the cost of Inj Botulinum toxin if Y Admission note with
dystonia/Blepharospasm/Hemifacial spasam /Writers needed can be claimed using the template relevant investigation
crampwhich needs treatment with Inj Botulinum toxin attached result report and the
template for additional
request
M1 APD with Cycler initiation and continuous dialysis for 5 days 15000 Y Admission note with
relevant investigation
result report
M1 KIDNEY BIOPSY (NEEDLE AND LIGHT MICROSCOPY) 4000 Y Admission note with
relevant investigation
result report
M1 Permanent Catheter ( double cuffed permeath )insertion 12500 Y Admission note with
alone relevant investigation
result report
M1 RENAL TRANSPLANTATION with conventional 150000 Y Admission note with
immunosupressant relevant investigation
result including
Biopsy/CT abdomen
report
Preauth
Required Mandatory
Specialty Package or Not investigations for pre-
code Code Package name (Y/N) auth
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00001 Diarrhoea N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00002 Acute dysentery N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00003 Pneumonia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00004 Urinary tract infection N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00005 Acute Exacerbation of asthma N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00006 Acute glomerulonephritis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00007 Acute urticaria/ Anaphylaxis acute asthma N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00008 Poisonings with normal vital signs N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00009 Febrile seizures/other seizures N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00010 Epileptic encephalopathy N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00011 Optic neuritis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00012 Aseptic meningitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00013 Trauma N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00014 Pyrexia of unexplained origin N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00015 Chronic cough N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00016 Wheezing N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00017 Unexplained seizures N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
Global developmental delay/ Intellectual disability of relevant investigation
M2 00018 unknown etiology N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00019 Dysmorphic children N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00020 Rickets N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00021 Unexplained severe anemia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00022 Short stature N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00023 Musculoskeletal problems N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00024 Developmental and behavioral disorders N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00025 Diabetic ketoacidosis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00026 Nephrotic syndrome with peritonitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00027 Pyogenic meningitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00028 Persistent/ Chronic diarrhea N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00029 Acute severe malnutrition N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00030 Dengue N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00031 Enteric fever N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00032 Chikungunya N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00033 Acute hepatitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00034 Kala azar N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00035 Tuberculosis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00036 HIV with complications N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00037 Infantile cholestasis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00038 Haemolytic uremic syndrome N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00039 ITP N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00040 Juvenile myasthenia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00041 Kawasaki Disease N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00042 Persistent pneumonia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00043 Empyema N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00044 Immune haemolytic anemia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00045 Cyanotic spells N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00046 Rheumatic fever N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00047 Rheumatoid arthritis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00048 Encephalitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00049 Chronic meningitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
Intracranial ring enhancing lesion with complication relevant investigation
M2 00050 (neurocysticercosis, tuberculoma) N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00051 Refractory seizures N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00052 Floppy infant N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00053 Acute neuroregression N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00054 Neuromuscular disorders N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00055 Opsoclonus myoclonus syndrome N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00056 Acute ataxia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00057 Steven Johnson syndrome N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00058 Metabolic encephalopathy N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00059 Ketogenic diet initiation in refractory epilepsy N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00060 Inborn errors of metabolism N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00061 Wilson’s disease N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00062 Celiac disease N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00063 Unexplained jaundice N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00064 Unexplained hepatosplenomegaly N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00065 Severe pneumonia N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00066 Severe exacerbation of asthma N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00067 Acute kidney injury N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00068 Poisonings N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00069 Serious trauma with unstable vitals N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00070 Upper GI hemorrhage N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00071 Lower GI hemorrhage N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00072 Acute abdomen N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00073 Liver abscess N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00074 Complicated malaria N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00075 Severe dengue with shock N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00076 Congestive cardiac failure N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00077 Brain abscess N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00078 Acute encephalitic syndrome N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00079 Acute demyelinating myelopathy, N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
Immune mediated CNS disorders such as autoimmune relevant investigation
M2 00080 encephalitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00081 Acute transverse myelitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00082 Guillain Barre Syndrome N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00083 Hydrocephalus N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00084 Intracranial space occupying lesion N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00085 Cerebral malaria N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00086 Acute ischemic stroke N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00087 Cerebral sino-venous thrombosis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
Respiratory failure due to any causes (pneumonia, relevant investigation
M2 00088 asthma, foreign body, poisoning, head injury etc.) N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00089 Acute transverse myelitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00090 Acute encephalitis –infectious/immune-mediated N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00091 Convulsive & non convulsive status epilepticus N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00092 Cerebral herniation N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00093 Intracranial hemorrhage N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00094 Hepatic encephalopathy N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00095 Complicated bacterial meningitis N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00096 Raised intracranial pressure N result report
The minimum number of days has to be
blocked first,depending on the needs it
can be enhanced providing the
supportive documents Admission note with
relevant investigation
M2 00097 Hypertensive encephalopathy N result report
High end radiological diagnostic (CT, MRI, Imaging Admission note with
including nuclear imaging) - can only be clubbed capped @ Rs 5000 per annum for a relevant investigation
M2 00101 with medical package. family Y result report
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Neonatology
Preauth
Required
Package or Not
Package name Amount (Y/N)
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: 500/ day
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)
N
M3 00002 Special Neonatal Care Package (Rs. 2500 per day, maximum of 15000 - pre-auth after 4
days): Babies that required admission to SNCU or NICU
Babies admitted for short term care for conditions like:
• Mild Respiratory Distress/tachypnea
• Mild encephalopathy
• Severe jaundice requiring intensive phototherapy
• Haemorrhagic disease of newborn
• Unwell baby requiring monitoring
• Some dehydration
• Hypoglycaemia
Mother's stay in the hospital for breastfeeding, family centred care and (Kangaroo
Mother Care) KMC is mandatory and included in the package rate
2500/day Y
M3 00003 Intensive Neonatal Care Package (Rs. 4000 per day, maximum of Rs. 40,000 – 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)
4000/day Y
is needed after 7 days):
M3 00004 Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one of the following conditions:
• Any condition requiring invasive ventilation longer than 24 hours
• Cardiac rhythm disorders needing intervention (the cost of cardiac surgery or implant
will be covered under cardiac surgery packages)
• Sepsis with complications such as meningitis or bone and joint infection, DIC or shock
• Renal failure requiring dialysis
or
Babies of any birthweight with at least one of the following conditions:
• Severe Respiratory Failure requiring High Frequency Ventilation or inhaled Nitric Oxide
(iNO)
• Multisystem failure requiring multiple organ support including mechanical ventilation
and multiple inotropes
• Critical congenital heart disease
Mother's stay in the hospital for breastfeeding, family centred care and (Kangaroo
Mother Care) KMC is mandatory and included in the package rate
6000/day Y
M3 00006 Chronic Care Package (Rs. 2500 per day, maximum of Rs. 25,000): 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
2500/day Y
M3 00008
Laser Therapy for Retinopathy of Prematurity (Irrespective of no. of eyes affected) 1,500 Y
M3 00009
Advanced Surgery for Retinopathy of Prematurity 15,000 Y
M3 00010
Ventriculoperitoneal Shunt Surgery (VP) or Omaya Reservoir or External Drainage 5,000 Y
onatology
Medical
Average length of Stay (M) or
Mandatory investigations for pre- Post-Op investigations (Including Days in Govt Reserved Surgical
auth for claims submission intensive care units) Procedure (Y/N) (S)
<5 Days N
N
N
N
N
N
N
cccccccccccccc
cccccccccccccccccccccccccc
Paediatrics Oncology
Average
Preauth length of Stay
Require (Including Govt
d or Days in Reserved
Specialt Packag Package Not Mandatory investigations Post-Op investigations for intensive care Procedure
y code e Code Package name Amount (Y/N) for pre-auth claims submission units) (Y/N)
Hodgkin Lymphoma
(unfavorable group): Clinical note including Chemotherapy drug batch
chemotherapy including Clinical assessment and number with bar code and the
M3 00012 diagnostics 70,000 Y result of Biopsy/CT bill of the medicines Y
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
M N
Preauth
Speci Required
alty Package Package or Not Mandatory investigations Post-Op investigations for claims
code Code Site Package name Amount (Y/N) for pre-auth submission
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Y M
Radiation Oncology
Preauth
Special Required
ty Package Package or Not Mandatory investigations for pre- Post-Op investigations for
code Code Package name Amount (Y/N) auth claims submission
Linear Accelerator External Beam Radiotherapy IGRT Clinical note including Clinical
(Image Guided radiotherapy) assessment and result of relevant
M6 00006 (Radical/Adjuvant/Neoadjuvent) 120,000 Y investigations including CT/Biopsy Clinical assessment
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Y M N
Emergency Room Management
Average length
Preauth of Stay
Speci Required Mandatory Post-Op (Including Days
alty Package Package or Not investigations for investigations for in intensive care
code Code Package name Amount (Y/N) pre-auth claims submission units)
N M N
N M/S N
N M/S N
N M/S N
Mental Disorder
7 to 21 days N M N
7 to 21 days N M N
7 to 21 days N M N
7 to 21 days N M N
7 to 21 days N M N
7 to 21 days N M N
7 to 21 days N M N
5 to 10 days N M N
5 to 10 days N M N
5 to 10 days N M N
5 to 10 days N M N
5 to 10 days N M N
5 to 10 days N M N
5 to 10 days N M N
N M N
N M N
N M N
Unspecified Procedures
Decided by SHA N