AnnexA MedicalCaseRates

List of Medical Case Rates (Updated February 2017)
FIRST CASE RATE

ICD 10 CODE DESCRIPTION GROUP Professional Health Care
Case Rate
Fee Institution Fee
P91.3 Neonatal cerebral irritability ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.4 Neonatal cerebral depression ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.6 Hypoxic ischaemic encephalopathy of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.8 Other specified disturbances of cerebral status of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.9 Disturbance of cerebral status of newborn, unspecified ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
Peritonsillar abscess; Abscess of tonsil; Peritonsillar
J36 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
cellulitis; Quinsy
Other diseases of larynx; Abscess of larynx; Cellulitis of
larynx; Disease NOS of larynx; Necrosis of larynx;
J38.7 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
Pachyderma of larynx; Perichondritis of larynx; Ulcer of
larynx
Retropharyngeal and parapharyngeal abscess;
Peripharyngeal abscess
Other abscess of pharynx; Cellulitis of pharynx;
Nasopharyngeal abscess
Other diseases of pharynx; Cyst of pharynx or nasopharynx;
Oedema of pharynx or nasopharynx
J85.1 Abscess of lung with pneumonia ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J85.2 Abscess of lung without pneumonia; Abscess of lung NOS ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J85.3 Abscess of mediastinum ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000

J86.0 Pyothorax with fistula ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
Pyothorax without fistula; Abscess of pleura; Abscess of
thorax; Empyema; Pyopneumothorax
A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae ACUTE GASTROENTERITIS 6,000 1,800 4,200
A00.1 Cholera due to Vibrio cholerae 01, biovar eltor ACUTE GASTROENTERITIS 6,000 1,800 4,200
A00.9 Cholera, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200
Shigellosis due to Shigella dysenteriae; Group A shigellosis
A03.0 ACUTE GASTROENTERITIS 6,000 1,800 4,200
[Shiga-Kruse dysentery]
A03.1 Shigellosis due to Shigella flexneri;Group B shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.2 Shigellosis due to Shigella boydii; Group C shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.3 Shigellosis due to Shigella sonnei; Group D shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.8 Other shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.9 Shigellosis, unspecified; ; Bacillary dysentery NOS ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.0 Enteropathogenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.1 Enterotoxigenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.2 Enteroinvasive Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.3 Enterohaemorrhagic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.4 Other intestinal Escherichia coli infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.5 Campylobacter enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.6 Enteritis due to Yersinia enterocolitica ACUTE GASTROENTERITIS 6,000 1,800 4,200
Enterocolitis due to Clostridium difficile; Foodborne
A04.7 intoxication by Clostridium difficile; Pseudomembranous ACUTE GASTROENTERITIS 6,000 1,800 4,200
colitis
A04.8 Other specified bacterial intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
Bacterial intestinal infection, unspecified. Bacterial enteritis
NOS
A05.0 Foodborne staphylococcal intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
Foodborne Clostridium perfringens [Clostridium welchii]
A05.2 intoxication. Enteritis necroticans. ACUTE GASTROENTERITIS 6,000 1,800 4,200
Pig-bel
A05.3 Foodborne Vibrio parahaemolyticus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.4 Foodborne Bacillus cereus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.8 Other specified bacterial foodborne intoxications ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.9 Bacterial foodborne intoxication, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.0 Balantidiasis; Balantidial dysentery ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.1 Giardiasis [lambliasis] ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.2 Cryptosporidiosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
Isosporiasis; Infection due to Isospora belli and Isospora
hominis; Intestinal coccidiosis; Isosporosis
Other specified protozoal intestinal diseases; Intestinal
trichomoniasis; Sarcocystosis; Sarcosporidiosis
Protozoal intestinal disease, unspecified;Flagellate
A07.9 diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal ACUTE GASTROENTERITIS 6,000 1,800 4,200
dysentery
A08.0 Rotaviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
Acute gastroenteropathy due to Norovirus; Noroviral
enteritis; Small round structured virus enteritis
A08.2 Adenoviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.3 Other viral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
Viral intestinal infection, unspecified; Viral enteritis NOS;

Viral gastroenteritis NOS; Viral gastroenteropathy NOS
A08.5 Other specified intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
Page 1 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Infectious diarrhea
Infectious diarrhea with no dehydration
Other and unspecified gastroenteritis and colitis of
infectious origin
Gastroenteritis and colitis of unspecified origin; Neonatal

diarrhoea NOS
K52.0 Gastroenteritis and colitis due to radiation ACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.1 Toxic gastroenteritis and colitis ACUTE GASTROENTERITIS 6,000 1,800 4,200
Allergic and dietetic gastroenteritis and colitis; Food
K52.2 ACUTE GASTROENTERITIS 6,000 1,800 4,200
hypersensitivity gastroenteritis or colitis
Other specified noninfective gastroenteritis and colitis;
Eosinophilic gastritis or gastroenteritis
Noninfective gastroenteritis and colitis, unspecified;

Diarrhoea specified as noninfective, or NOS in countries
where the conditions can be presumed to be of
noninfectious origin; Enteritis specified as noninfective, or
NOS in countries where the conditions can be presumed to
be of noninfectious origin; Ileitis specified as noninfective,
or NOS in countries where the conditions can be presumed
to be noninfectious origin; Jejunitis specified as
noninfective, or NOS in countries where the conditions can
be presumed to be noninfectious origin; Sigmoiditis
pecified as noninfective, or NOS in countries where the
conditions can be presumed to be noninfectious origin
K58.0 Irritable bowel syndrome with diarrhoea ACUTE GASTROENTERITIS 6,000 1,800 4,200
Acute renal failure with tubular necrosis; Tubular necrosis

N17.0 ACUTE RENAL FAILURE 19,300 5,790 13,510
NOS; Acute Tubular necrosis ; Renal Tubular necrosis
Acute renal failure with acute cortical necrosis; Cortical

N17.1 necrosis NOS; Acute Cortical necrosis ; Renal Cortical ACUTE RENAL FAILURE 19,300 5,790 13,510
necrosis
Acute renal failure with medullary necrosis; Medullary
N17.2 papillary necrosis, NOS; Acute medullary papillary necrosis; ACUTE RENAL FAILURE 19,300 5,790 13,510
Renal medullary papillary necrosis
N17.8 Other acute renal failure ACUTE RENAL FAILURE 19,300 5,790 13,510
N17.9 Acute renal failure, unspecified; ACUTE RENAL FAILURE 19,300 5,790 13,510
Renal failure following abortion and ectopic and molar

O08.4 pregnancy; Oliguria Acute renal failure; Oliguria renal ACUTE RENAL FAILURE 19,300 5,790 13,510
shutdown; Oliguria renal tubular necrosis; Oliguria Uraemia
Adult respiratory distress syndrome; Adult hyaline

J80 ADULT RESPIRATORY DISTRESS SYNDROME 32,000 9,600 22,400
membrane disease
T78.1 Other adverse food reactions, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340
T78.3 Angioneurotic oedema; Giant urticaria; Quinke's oedema ALLERGIC REACTIONS 6,200 1,860 4,340
Allergy, unspecified; Allergic reaction NOS; Hypersensitivity

T78.4 ALLERGIC REACTIONS 6,200 1,860 4,340
NOS; Idiosyncracy NOS
T78.8 Other adverse effects, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340
T78.9 Adverse effect, unspecified ALLERGIC REACTIONS 6,200 1,860 4,340
Unspecified adverse effect of drug or medicament; Adverse

effect of correct drug or medicament properly
administered; Allergic reactiion to correct drug or
T88.7 medicament properly administered; Hypersensitivity to ALLERGIC REACTIONS 6,200 1,860 4,340
correct drug or medicament properly administered;
Idiosyncracy to correct drug or medicament properly
administered; Drug: hypersensitivity NOS; reaction NOS
A06.4+ K77.0* Amoebic liver abscess; Hepatic amoebiasis AMOEBIASIS, HEPATIC 10,000 3,000 7,000
Acute amoebic dysentery; Acute amoebiasis; Intestinal
A06.0 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
amoebiasis NOS
A06.1 Chronic intestinal amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.2 Amoebic nondysenteric colitis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.3 Amoeboma of intestine; Amoeboma NOS AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.7 Cutaneous amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
Amoebic infection of other sites
A06.8 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
Amoebic Appendicitis; Amoebic balanitis (N51.2*)
E85.8 Other amyloidosis; Localized amyloidosis AMYLOIDOSIS 11,100 3,330 7,770
T78.0 Anaphylactic shock due to adverse food reaction ANAPHYLACTIC SHOCK 7,600 2,280 5,320
Anaphylactic shock, unspecified; Allergic shock NOS;
T78.2 ANAPHYLACTIC SHOCK 7,600 2,280 5,320
Anaphylactic reaction NOS; Anaphylaxis NOS
Anaphylactic shock due to adverse effect of correct drug or
T88.6 ANAPHYLACTIC SHOCK 7,600 2,280 5,320
medicament properly administered
Iron deficiency anaemia secondary to blood loss (chronic);
D50.0 ANEMIA 10,000 3,000 7,000
Posthaemorrhagic anaemia (chronic)
Page 2 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Sideropenic dysphagia; Kelly-Paterson syndrome; Plummer-
D50.1 ANEMIA 10,000 3,000 7,000
Vinson syndrome
D50.8 Other iron deficiency anaemias ANEMIA 10,000 3,000 7,000
D50.9 Iron deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000
Vitamin B12 deficiency anaemia due to intrinsic factor
deficiency; Addison Anaemia; Biermer Anaemia;
D51.0 Congenital Pernicious Anaemia; Congenital intrinsic factor ANEMIA 10,000 3,000 7,000
deficiency
Pernicious anemia
D51.8 Other vitamin B12 deficiency anaemias ANEMIA 10,000 3,000 7,000
D51.9 Vitamin B12 deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000
Drug-induced folate deficiency anaemia
D52.1 Use additional external cause code (Chapter XX), if desired ANEMIA 10,000 3,000 7,000
to identify drug
Folate deficiency anaemia, unspecified; Folic acid deficiency
D52.9 ANEMIA 10,000 3,000 7,000
anaemia NOS
Protein deficiency anaemia; Amino-acid deficiency
D53.0 ANEMIA 10,000 3,000 7,000
anaemia; Orotaciduric anaemia
Other megaloblastic anaemias, not elsewhere classified;
D53.1 ANEMIA 10,000 3,000 7,000
Megaloblastic anaemia NOS
D53.2 Scorbutic anaemia ANEMIA 10,000 3,000 7,000
Other specified nutritional anaemias; Anaemia associated
with deficiency of copper; Anaemia associated with
D53.8 ANEMIA 10,000 3,000 7,000
deficiency of molybdenum; Anaemia associated with
deficiency of zinc
D53.9 Nutritional anaemia, unspecified; Simple chronic anaemia ANEMIA 10,000 3,000 7,000
Anaemia due to glucose-6-phosphate dehydrogenase

D55.0 [G6PD] deficiency; Favism; ANEMIA 10,000 3,000 7,000
G6PD deficiency anaemia
Anaemia due to other disorders of glutathione metabolism;
Anaemia due to enzyme deficiencies, except G6PD, related
D55.1 to the hexose monophosphate [HMP] shunt pathway; ANEMIA 10,000 3,000 7,000
Anaemia due to haemolytic nonspherocytic hereditary,
type I
Anaemia due to disorders of glycolytic enzymes;
Haemolytic nonspherocytic hereditary Anaemia, type II;
D55.2 Hexokinase deficiency Anaemia; Pyruvate kinase [PK] ANEMIA 10,000 3,000 7,000
deficiency Anaemia; Triose-phosphate isomerase deficiency
Anaemia
D55.8 Other anaemias due to enzyme disorders ANEMIA 10,000 3,000 7,000
D55.9 Anaemia due to enzyme disorder, unspecified ANEMIA 10,000 3,000 7,000
Thalassaemia, unspecified
Mediterranean anaemia; Mediterranean anaemia with
D56.9 other haemoglobinopathy; Thalassaemia minor with other ANEMIA 10,000 3,000 7,000
haemoglobinopathy; Thalassaemia mixed with other
haemoglobinopathy;
D57.0 Sickle-cell anaemia with crisis; Hb-SS disease with crisis ANEMIA 10,000 3,000 7,000
Sickle-cell anaemia without crisis; Sickle-cell anaemia NOS;
D57.1 ANEMIA 10,000 3,000 7,000
Sickle-cell disease NOS ; Sickle-cell disorder NOS
D57.3 Sickle-cell trait; Hb-S trait ; Heterozygous Haemoglobin S ANEMIA 10,000 3,000 7,000
D57.8 Other sickle-cell disorders ANEMIA 10,000 3,000 7,000

Hereditary spherocytosis; Acholuric (familial) jaundice;
D58.0 Congenital (spherocytic) haemolytic icterus; Minkowski- ANEMIA 10,000 3,000 7,000
Chauffard syndrome
Hereditary elliptocytosis; Congenital Elliptocytosis;
D58.1 ANEMIA 10,000 3,000 7,000
Congenital Ovalocytosis; Hereditary Ovalocytosis
Other haemoglobinopathies; Abnormal haemoglobin NOS;

Congenital Heinz body anaemia; Hb-C Disease; Hb-C
D58.2 ANEMIA 10,000 3,000 7,000
Disease; Hb-D Disease; Hb-E Disease; Haemoglobinopathy
NOS; Unstable haemoglobin haemolytic disease
Other specified hereditary haemolytic anaemias;

D58.8 ANEMIA 10,000 3,000 7,000
Stomatocytosis
Hereditary haemolytic anaemia, unspecified; Acquired
D58.9 ANEMIA 10,000 3,000 7,000
haemolytic anaemia
D59.0 Drug-induced autoimmune haemolytic anaemia ANEMIA 10,000 3,000 7,000
Other autoimmune haemolytic anaemias; Autoimmune

haemolytic disease, cold type; (Autoimmune haemolytic
disease, warm type; Chronic cold haemagglutinin disease;
D59.1 ANEMIA 10,000 3,000 7,000
Cold agglutinin disease; Cold agglutinin haemoglobinuria;
Secondary symptomatic Haemolytic anaemia, cold type;
Secondary symptomatic Haemolytic anaemia, warm type;
Page 3 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Drug-induced nonautoimmune haemolytic anaemia; Drug-
D59.2 ANEMIA 10,000 3,000 7,000
induced enzyme deficiency anaemia
Other nonautoimmune haemolytic anaemias; Mechanical
D59.4 Haemolytic anaemia; Microangiopathic Haemolytic ANEMIA 10,000 3,000 7,000
anaemia; Toxic Haemolytic anaemia
Paroxysmal nocturnal haemoglobinuria [Marchiafava-
D59.5 ANEMIA 10,000 3,000 7,000
Micheli]
Haemoglobinuria due to haemolysis from other external

D59.6 causes; Haemoglobinuria from exertion; Haemoglobinuria ANEMIA 10,000 3,000 7,000
march; Haemoglobinuria paroxysmal cold
D59.8 Other acquired haemolytic anaemias ANEMIA 10,000 3,000 7,000

Acquired haemolytic anaemia, unspecified; Chronic
D59.9 ANEMIA 10,000 3,000 7,000
Idiopathic haemolytic anaemia
D60.1 Transient acquired pure red cell aplasia ANEMIA 10,000 3,000 7,000
Constitutional aplastic anaemia; Congenital Pure red cell
Aplasia; Pure red cell Aplasia of infants; Primary Pure red
D61.0 cell Aplasia; Blackfan-Diamond syndrome; Familial ANEMIA 10,000 3,000 7,000
hypoplastic anaemia; Fanconi's anaemia; Pancytopenia
with malformations
D61.1 Drug-induced aplastic anaemia ANEMIA 10,000 3,000 7,000
D61.2 Aplastic anaemia due to other external agents ANEMIA 10,000 3,000 7,000
D61.3 Idiopathic aplastic anaemia ANEMIA 10,000 3,000 7,000
D61.8 Other specified aplastic anaemias ANEMIA 10,000 3,000 7,000
Aplastic anaemia, unspecified; Hypoplastic anaemia NOS;
D61.9 ANEMIA 10,000 3,000 7,000
Medullary hypoplasia; Panmyelophthisis
D62 Acute posthaemorrhagic anaemia ANEMIA 10,000 3,000 7,000
D63.0* Anaemia in neoplastic disease ANEMIA 10,000 3,000 7,000
D63.8* Anaemia in other chronic diseases classified elsewhere ANEMIA 10,000 3,000 7,000
Hereditary sideroblastic anaemia; Sex-linked hypochromic
D64.0 ANEMIA 10,000 3,000 7,000
sideroblastic anaemia
D64.1 Secondary sideroblastic anaemia due to disease ANEMIA 10,000 3,000 7,000
D64.2 Secondary sideroblastic anaemia due to drugs and toxins ANEMIA 10,000 3,000 7,000
Other sideroblastic anaemias; Sideroblastic anaemia NOS;

D64.3 ANEMIA 10,000 3,000 7,000
pyridoxine-responsive NEC Sideroblastic anaemia
Other specified anaemias; Infantile pseudoleukaemia;

D64.8 ANEMIA 10,000 3,000 7,000
Leukoerythroblastic anaemia
Anaemia, unspecified
D64.9 ANEMIA 10,000 3,000 7,000
Severe anemia
M00.16 Pneumococcal arthritis and polyarthritis, Lower leg ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.19 Pneumococcal arthritis and polyarthritis, Site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
Other streptococcal arthritis and polyarthritis, Site

M00.29 ARTHRITIS INFECTIOUS 9,700 2,910 6,790
unspecified
Arthritis and polyarthritis due to other specified bacterial
agents upper arm
Pyogenic arthritis, unspecified; Infective arthritis NOS
multiple sites
shoulder region
forearm
hand
pelvic region and thigh
lower leg
ankle and foot
other sites
site unspecified
M02.39 Reiter's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M06.19 Adult-onset Still's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
Juvenile arthritis with systemic onset; Still's disease NOS
site unspecified
M02.99 Reactive arthropathy, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Seropositive rheumatoid arthritis, unspecified, site
M05.99 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
unspecified
M06.01 Seronegative rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.09 Seronegative rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.36 Rheumatoid nodule, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.45 Inflammatory polyarthropathy, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Page 4 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M06.49 Inflammatory polyarthropathy, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.81 Other specified rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.86 Other specified rheumatoid arthritis, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.87 Other specified rheumatoid arthritis, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.89 Other specified rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.90 Rheumatoid arthritis, unspecified, multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.91 Rheumatoid arthritis, unspecified, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.93 Rheumatoid arthritis, unspecified, forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.94 Rheumatoid arthritis, unspecified, hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.95 Rheumatoid arthritis, unspecified, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.96 Rheumatoid arthritis, unspecified, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.97 Rheumatoid arthritis, unspecified, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.98 Rheumatoid arthritis, unspecified, other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.99 Rheumatoid arthritis, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis
with or without rheumatoid factor lower leg

with or without rheumatoid factor ankle and foot

with or without rheumatoid factor site unspecified
M08.19 Juvenile ankylosing spondylitis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.86 Other juvenile arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.89 Other juvenile arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.91 Juvenile arthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.96 Juvenile arthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.99 Juvenile arthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.00 Idiopathic gout; Gouty bursitis; Primary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Idiopathic gout; Gouty bursitis; Primary gout;

Urate tophus of heart shoulder region
Urate tophus of heart upper arm
M10.03 Idiopathic gout; Gouty bursitis; Primary gout forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Urate tophus of heart hand
Idiopathic gout; Gouty bursitis; Primary gout;Urate tophus
of heart pelvic region and thigh
M10.06 Idiopathic gout; Gouty bursitis; Primary gout lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Urate tophus of heart ankle and foot
Urate tophus of heart other sites
Urate tophus of heart site unspecified
M10.10 Lead-induced gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.29 Drug-induced gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.30 Gout due to impairment of renal function multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.36 Gout due to impairment of renal function lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.39 Gout due to impairment of renal function site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.40 Other secondary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.49 Other secondary gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.90 Gout, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.91 Gout, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.92 Gout, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.93 Gout, unspecified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.94 Gout, unspecified hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.96 Gout, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.97 Gout, unspecified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.98 Gout, unspecified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.99 Gout, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.89 Other specified crystal arthropathies site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.90 Crystal arthropathy, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.99 Crystal arthropathy, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.26 Villonodular synovitis (pigmented) lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.39 Palindromic rheumatism site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.50 Traumatic arthropathy multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.52 Traumatic arthropathy upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.53 Traumatic arthropathy forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.54 Traumatic arthropathy hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.55 Traumatic arthropathy pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.56 Traumatic arthropathy lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Page 5 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M12.57 Traumatic arthropathy ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.58 Traumatic arthropathy other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.59 Traumatic arthropathy site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Other specific arthropathies, not elsewhere classified;
Transient arthropathy lower leg
Other specific arthropathies, not elsewhere classified;
Transient arthropathy site unspecified
M13.00 Polyarthritis, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.01 Polyarthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.02 Polyarthritis, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.06 Polyarthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.09 Polyarthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.13 Monoarthritis, not elsewhere classified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.16 Monoarthritis, not elsewhere classified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.17 Monoarthritis, not elsewhere classified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.18 Monoarthritis, not elsewhere classified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.80 Other specified arthritis; Allergic arthritis multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.81 Other specified arthritis; Allergic arthritis shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Other specified arthritis; Allergic arthritis pelvic region and

thigh
M13.86 Other specified arthritis; Allergic arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.87 Other specified arthritis; Allergic arthritis ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.88 Other specified arthritis; Allergic arthritis other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.89 Other specified arthritis; Allergic arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.90 Arthritis, unspecified; Arthropathy NOS multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.91 Arthritis, unspecified; Arthropathy NOS shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.92 Arthritis, unspecified; Arthropathy NOS upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.93 Arthritis, unspecified; Arthropathy NOS forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.94 Arthritis, unspecified; Arthropathy NOS hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Arthritis, unspecified; Arthropathy NOS pelvic region and
thigh
M13.96 Arthritis, unspecified; Arthropathy NOS lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.97 Arthritis, unspecified; Arthropathy NOS ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.98 Arthritis, unspecified; Arthropathy NOS other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.99 Arthritis, unspecified; Arthropathy NOS site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Chikungunya virus disease; Chikungunya (haemorrhagic)

A92.0 ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
fever
A92.1 O'nyong-nyong fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
Venezuelan equine fever; Venezuelan equine encephalitis;

A92.2 ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
Venezuelan encephalomyelitis virus disease
A92.8 Other specified mosquito-borne viral fevers ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A93.1 Sandfly fever; Pappataci fever; Phlebotomus fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
Other specified arthropod-borne viral fevers; Piry virus

A93.8 disease; Severe fever with thrombocytopenia syndrome ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
[SFTS]; Vesicular stomatitis virus disease [Indiana fever]
Unspecified arthropod-borne viral fever; Unspecified

arthropod-borne viral fever; Arboviral fever NOS; Arbovirus
A94 ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
infection NOS
Acute hemorrhagic fever
M15.0 Primary generalized (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900
M15.2 Bouchard's nodes (with arthropathy) ARTHROSIS 7,000 2,100 4,900
M15.3 Secondary multiple arthrosis; Post-traumatic polyarthrosis ARTHROSIS 7,000 2,100 4,900
M15.4 Erosive (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900

M15.8 Other polyarthrosis ARTHROSIS 7,000 2,100 4,900
M15.9 Polyarthrosis, unspecified; Generalized osteoarthritis NOS ARTHROSIS 7,000 2,100 4,900
M16.0 Primary coxarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900

Other primary coxarthrosis; Primary coxarthrosis NOS;
M16.1 ARTHROSIS 7,000 2,100 4,900
Primary coxarthrosis unilateral
M16.2 Coxarthrosis resulting from dysplasia, bilateral ARTHROSIS 7,000 2,100 4,900
Other dysplastic coxarthrosis; Dysplastic coxarthrosis NOS;
M16.3 ARTHROSIS 7,000 2,100 4,900
Dysplastic coxarthrosis unilateral
M16.9 Coxarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900
M17.0 Primary gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900
Other primary gonarthrosis; Primary gonarthrosis NOS;
M17.1 ARTHROSIS 7,000 2,100 4,900
Primary gonarthrosis unilateral
M17.2 Post-traumatic gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900
Page 6 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other post-traumatic gonarthrosis; Post-traumatic

M17.3 ARTHROSIS 7,000 2,100 4,900
gonarthrosis NOS; Post-traumatic gonarthrosis unilateral
Other secondary gonarthrosis; Secondary gonarthrosis

M17.5 ARTHROSIS 7,000 2,100 4,900
NOS; Secondary gonarthrosis unilateral
M17.9 Gonarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900
M18.0 Primary arthrosis of first carpometacarpal joints, bilateral ARTHROSIS 7,000 2,100 4,900
M18.9 Arthrosis of first carpometacarpal joint, unspecified ARTHROSIS 7,000 2,100 4,900
Primary arthrosis of other joints; Primary arthrosis
M19.00 ARTHROSIS 7,000 2,100 4,900
NOSmultiple sites
M19.02 ARTHROSIS 7,000 2,100 4,900
NOSupper arm
M19.05 ARTHROSIS 7,000 2,100 4,900
NOSpelvic region and thigh
M19.06 ARTHROSIS 7,000 2,100 4,900
NOSlower leg
M19.08 ARTHROSIS 7,000 2,100 4,900
NOSother sites
Primary arthrosis of other joints; Primary arthrosis NOSsite
M19.09 ARTHROSIS 7,000 2,100 4,900
unspecified
Post-traumatic arthrosis of other joints; Post-traumatic
M19.10 ARTHROSIS 7,000 2,100 4,900
arthrosis NOS multiple sites
M19.11 ARTHROSIS 7,000 2,100 4,900
arthrosis NOS shoulder region
M19.12 ARTHROSIS 7,000 2,100 4,900
arthrosis NOS upper arm
M19.19 ARTHROSIS 7,000 2,100 4,900
arthrosis NOS site unspecified
Other secondary arthrosis; Secondary arthrosis NOS
M19.21 ARTHROSIS 7,000 2,100 4,900
shoulder region
Other secondary arthrosis; Secondary arthrosis NOS site
M19.29 ARTHROSIS 7,000 2,100 4,900
unspecified
M19.81 Other specified arthrosis shoulder region ARTHROSIS 7,000 2,100 4,900
M19.86 Other specified arthrosis lower leg ARTHROSIS 7,000 2,100 4,900
M19.87 Other specified arthrosis ankle and foot ARTHROSIS 7,000 2,100 4,900
M19.88 Other specified arthrosis other sites ARTHROSIS 7,000 2,100 4,900
M19.89 Other specified arthrosis site unspecified ARTHROSIS 7,000 2,100 4,900
M19.90 Arthrosis, unspecified multiple sites ARTHROSIS 7,000 2,100 4,900
M19.91 Arthrosis, unspecified shoulder region ARTHROSIS 7,000 2,100 4,900
M19.92 Arthrosis, unspecified upper arm ARTHROSIS 7,000 2,100 4,900
M19.93 Arthrosis, unspecified forearm ARTHROSIS 7,000 2,100 4,900
M19.94 Arthrosis, unspecified hand ARTHROSIS 7,000 2,100 4,900
M19.95 Arthrosis, unspecified pelvic region and thigh ARTHROSIS 7,000 2,100 4,900
M19.96 Arthrosis, unspecified lower leg ARTHROSIS 7,000 2,100 4,900
M19.97 Arthrosis, unspecified ankle and foot ARTHROSIS 7,000 2,100 4,900
M19.98 Arthrosis, unspecified other sites ARTHROSIS 7,000 2,100 4,900
Arthrosis, unspecified site unspecified
M19.99 ARTHROSIS 7,000 2,100 4,900
Osteoarthritis
Predominantly allergic asthma; Allergic bronchitis NOS;
Allergic rhinitis with asthma; Atopic asthma; Extrinsic
J45.00 ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
allergic asthma; Hay fever with asthma; in Acute
Exacerbation
Nonallergic asthma; Idiosyncratic asthma; Intrinsic
J45.10 ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
nonallergic asthma, in Acute Exacerbation
J45.80 Mixed asthma, in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J45.90 Bronchial Asthma in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J46 Status asthmaticus; Acute severe asthma ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
Pulmonary collapse; Atelectasis; Collapse of lung; Brock's
J98.1 ATELECTASIS 13,800 4,140 9,660
syndrome
Panniculitis affecting regions of neck and back occipito-
M54.01 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
atlanto-axial region
Panniculitis affecting regions of neck and back lumbar
region
Panniculitis affecting regions of neck and back sacral and
sacrococcygeal region
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
Multiple sites in spine
occipito-atlanto-axial region
Page 7 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
cervical region
thoracic region
thoracolumbar region
lumbar region
lumbosacral region
sacral and sacrococcygeal region
site unspecified
M54.2 Cervicalgia BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.20 Cervicalgia Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.22 Cervicalgia cervical region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.26 Cervicalgia lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.3 Sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.30 Sciatica Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.31 Sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.35 Sciatica thoracolumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.36 Sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.37 Sciatica lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.38 Sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.39 Sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.4 Lumbago with sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.41 Lumbago with sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.44 Lumbago with sciatica thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.46 Lumbago with sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.48 Lumbago with sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.49 Lumbago with sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.5 Low back pain; Loin pain; Low back strain; Lumbago NOS BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
Low back pain; Loin pain; Low back strain; Lumbago NOS
Multiple sites in spine
occipito-atlanto-axial region
cervical region
M54.84 Other dorsalgia thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.88 Other dorsalgia sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
Dorsalgia, unspecified; Backache NOS occipito-atlanto-axial
region
Dorsalgia, unspecified; Backache NOS cervicothoracic
region
M54.96 Dorsalgia, unspecified; Backache NOS lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.97 Dorsalgia, unspecified; Backache NOS lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
Dorsalgia, unspecified; Backache NOS sacral and

M54.99 Dorsalgia, unspecified; Backache NOS site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
N31.0 Uninhibited neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300
N31.1 Reflex neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300
Flaccid neuropathic bladder, not elsewhere classified;
Atonic Motor Neuropathic bladder; Sensory Atonic Motor
N31.2 BLADDER DYSFUNCTION 9,000 2,700 6,300
Neuropathic bladder; Autonomous Neuropathic bladder ;
Nonreflex Neuropathic bladder
N31.8 Other neuromuscular dysfunction of bladder BLADDER DYSFUNCTION 9,000 2,700 6,300
Neuromuscular dysfunction of bladder, unspecified;
Neurogenic bladder dysfunction NOS
Page 8 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
N32.9 Bladder disorder, unspecified BLADDER DYSFUNCTION 9,000 2,700 6,300
N39.3 Stress incontinence BLADDER DYSFUNCTION 9,000 2,700 6,300
Other specified urinary incontinence; Overflow
incontinence, Reflex incontinence, Urge incontinence
R32 Unspecified urinary incontinence; Enuresis NOS BLADDER DYSFUNCTION 9,000 2,700 6,300
Botulism; Classical foodborne intoxication due to
A05.1 BOTULISM 4,800 1,440 3,360
Clostridium botulinum
Compression of brain; [compression, Herniation] of brain
G93.5 BRAIN HERNIATION 22,400 6,720 15,680
(stem)
Inflammatory disorders of breast; Acute abscess of non

puerperal areola; Acute abscess nonpuerperal breast;
Chronic abscess of nonpuerperal areola; Chronic abscess of
N61 nonpuerperal breast; Carbuncle of breast; Acute mastitis BREAST INFECTIONS 7,900 2,370 5,530
nonpuerperal, NOS; Acute mastitis nonpuerperal, infective;
subacute mastitis nonpuerperal, NOS; subacute mastitis
nonpuerpural, infective
Infection of nipple associated with childbirth; Gestational

O91.0 BREAST INFECTIONS 7,900 2,370 5,530
abscess of nipple; Puerperal abscess of nipple
Abscess of breast associated with childbirth; Mammary

abscess gestational or puerperal; Purulent mastitis
gestational or puerperal; Subareolar abscess gestational or
puerperal
Nonpurulent mastitis associated with childbirth;
Lymphangitis of breast gestational or puerperal; Mastitis
O91.2 NOS gestational or puerperal; Interstitial mastitis BREAST INFECTIONS 7,900 2,370 5,530
gestational or puerperal; Parenchymatous mastitis
gestational or puerperal
O92.0 Retracted nipple associated with childbirth BREAST INFECTIONS 7,900 2,370 5,530
Cracked nipple associated with childbirth; Fissure of nipple,
gestational or puerperal
C50.0 Malignant neoplasm of Nipple and areola, breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.1 Malignant neoplasm of Central portion of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.2 Malignant neoplasm of Upper-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.3 Malignant neoplasm of Lower-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.4 Malignant neoplasm of Upper-outer quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.6 Malignant neoplasm of Axillary tail of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.8 Malignant neoplasm of Overlapping lesion of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.9 Malignant neoplasm of Breast, unspecified BREAST MALIGNANCY 11,800 3,540 8,260
L10.0 Pemphigus vulgaris BULLOUS DISORDERS 12,000 3,600 8,400
L10.1 Pemphigus vegetans BULLOUS DISORDERS 12,000 3,600 8,400
L10.2 Pemphigus foliaceus BULLOUS DISORDERS 12,000 3,600 8,400
L10.4 Pemphigus erythematosus; Senear-Usher syndrome BULLOUS DISORDERS 12,000 3,600 8,400
L10.8 Other pemphigus BULLOUS DISORDERS 12,000 3,600 8,400
L10.9 Pemphigus, unspecified BULLOUS DISORDERS 12,000 3,600 8,400
L11.0 Acquired keratosis follicularis BULLOUS DISORDERS 12,000 3,600 8,400
L11.1 Transient acantholytic dermatosis [Grover] BULLOUS DISORDERS 12,000 3,600 8,400
L11.9 Acantholytic disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400
L12.0 Bullous pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400
Cicatricial pemphigoid; Benign mucous membrane
L12.1 BULLOUS DISORDERS 12,000 3,600 8,400
pemphigoid
Chronic bullous disease of childhood; Juvenile dermatitis
L12.2 BULLOUS DISORDERS 12,000 3,600 8,400
herpetiformis
L12.3 Acquired epidermolysis bullosa BULLOUS DISORDERS 12,000 3,600 8,400
L12.8 Other pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400
L13.0 Dermatitis herpetiformis; Duhring's disease BULLOUS DISORDERS 12,000 3,600 8,400
L13.1 Subcorneal pustular dermatitis; Sneddon-Wilkinson disease BULLOUS DISORDERS 12,000 3,600 8,400
L13.9 Bullous disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400

T20.4 Corrosion of unspecified degree of head and neck BURN A 8,500 2,550 5,950
T21.0 Burn of unspecified degree of trunk BURN A 8,500 2,550 5,950
T21.2 Burn of second degree of trunk BURN A 8,500 2,550 5,950
T21.5 Corrosion of first degree of trunk BURN A 8,500 2,550 5,950
T21.6 Corrosion of second degree of trunk BURN A 8,500 2,550 5,950
Burn of second degree of shoulder and upper limb, except
T22.2 BURN A 8,500 2,550 5,950
wrist and hand
Corrosion of first degree of shoulder and upper limb,
T22.5 BURN A 8,500 2,550 5,950
except wrist and hand
Corrosion of second degree of shoulder and upper limb,
T22.6 BURN A 8,500 2,550 5,950
except wrist and hand
T23.2 Burn of second degree of wrist and hand BURN A 8,500 2,550 5,950
T23.4 Corrosion of unspecified degree of wrist and hand BURN A 8,500 2,550 5,950
Burn of second degree of hip and lower limb, except ankle
T24.2 BURN A 8,500 2,550 5,950
and foot
Page 9 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Corrosion of first degree of hip and lower limb, except
T24.5 BURN A 8,500 2,550 5,950
ankle and foot
Corrosion of second degree of hip and lower limb, except
T24.6 BURN A 8,500 2,550 5,950
ankle and foot
T25.2 Burn of second degree of ankle and foot BURN A 8,500 2,550 5,950
T25.5 Corrosion of first degree of ankle and foot BURN A 8,500 2,550 5,950
T26.0 Burn of eyelid and periocular area BURN A 8,500 2,550 5,950
T26.4 Burn of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950
T26.9 Corrosion of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950
T27.3 Burn of respiratory tract, part unspecified BURN A 8,500 2,550 5,950
T27.7 Corrosion of respiratory tract, part unspecified BURN A 8,500 2,550 5,950
T28.9 Corrosion of other and unspecified internal organs BURN A 8,500 2,550 5,950
Burns of multiple regions, no more than first-degree burns
T29.1 BURN A 8,500 2,550 5,950
mentioned
Burn of unspecified body region, unspecified degree; Burn
T30.0 BURN A 8,500 2,550 5,950
NOS
Burn of second degree, body region unspecified; Secodn-
T30.2 BURN A 8,500 2,550 5,950
degree burn NOS
Burn of third degree, body region unspecified; Third-degree
T30.3 BURN A 8,500 2,550 5,950
burn NOS
Corrosion of unspecified body region, unspecified degree;
T30.4 BURN A 8,500 2,550 5,950
Corrosion NOS
Corrosion of first degree, body region unspecified; First-
T30.5 BURN A 8,500 2,550 5,950
degree corrosion NOS
Corrosion of second degree, body region unspecified;
T30.6 BURN A 8,500 2,550 5,950
Second-degree corrosion NOS
Corrosion of third degree, body region unspecified; Thrid-
T30.7 BURN A 8,500 2,550 5,950
degree corrosion NOS
T31.0 Burns involving less than 10% of body surface BURN A 8,500 2,550 5,950
T31.1 Burns involving 10-19% of body surface BURN A 8,500 2,550 5,950
T32.0 Corrosions involving less than 10% of body surface BURN A 8,500 2,550 5,950
T32.1 Corrosions involving 10-19% of body surface BURN A 8,500 2,550 5,950
T34.1 Frostbite with tissue necrosis of neck BURN A 8,500 2,550 5,950
Superficial frostbite involving multiple body regions;
T35.0 BURN A 8,500 2,550 5,950
Multiple superficial frosbite NOS
Frostbite with tissue necrosis involving multiple body
T35.1 BURN A 8,500 2,550 5,950
regions; Multiple frosbite with tissue necrosis NOS
T20.2 Burn of second degree of head and neck BURN B 10,600 3,180 7,420
T20.3 Burn of third degree of head and neck BURN B 10,600 3,180 7,420
T20.6 Corrosion of second degree of head and neck BURN B 10,600 3,180 7,420
Burn of third degree of shoulder and upper limb, except
T22.3 BURN B 10,600 3,180 7,420
wrist and hand
T23.3 Burn of third degree of wrist and hand BURN B 10,600 3,180 7,420
T23.6 Corrosion of second degree of wrist and hand BURN B 10,600 3,180 7,420
T23.7 Corrosion of third degree of wrist and hand BURN B 10,600 3,180 7,420
Burn of third degree of hip and lower limb, except ankle
T24.3 BURN B 10,600 3,180 7,420
and foot
Corrosion of third degree of hip and lower limb, except
T24.7 BURN B 10,600 3,180 7,420
ankle and foot
T25.3 Burn of third degree of ankle and foot BURN B 10,600 3,180 7,420
T26.1 Burn of cornea and conjunctival sac BURN B 10,600 3,180 7,420
T26.2 Burn with resulting rupture and destruction of eyeball BURN B 10,600 3,180 7,420
T26.3 Burn of other parts of eye and adnexa BURN B 10,600 3,180 7,420
T26.6 Corrosion of cornea and conjunctival sac BURN B 10,600 3,180 7,420
T27.0 Burn of larynx and trachea BURN B 10,600 3,180 7,420
T27.2 Burn of other parts of respiratory tract; Thoracic cavity BURN B 10,600 3,180 7,420
T28.0 Burn of mouth and pharynx BURN B 10,600 3,180 7,420
T28.1 Burn of oesophagus BURN B 10,600 3,180 7,420
T28.2 Burn of other parts of alimentary tract BURN B 10,600 3,180 7,420
T28.3 Burn of internal genitourinary organs BURN B 10,600 3,180 7,420
T28.5 Corrosion of mouth and pharynx BURN B 10,600 3,180 7,420
T28.6 Corrosion of oesophagus BURN B 10,600 3,180 7,420
T28.7 Corrosion of other parts of alimentary tract BURN B 10,600 3,180 7,420
T28.8 Corrosion of internal genitourinary organs BURN B 10,600 3,180 7,420
Burns of multiple regions, no more than second-degree
T29.2 BURN B 10,600 3,180 7,420
burns mentioned
Burns of multiple regions, at least one burn of third degree
T29.3 BURN B 10,600 3,180 7,420
mentioned
Corrosions of multiple regions, no more than second-
T29.6 BURN B 10,600 3,180 7,420
degree corrosions mentioned
T31.2 Burns involving 20-29% of body surface BURN B 10,600 3,180 7,420
T32.2 Corrosions involving 20-29% of body surface BURN B 10,600 3,180 7,420
Page 10 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Frostbite with tissue necrosis of other and unspecified

T34.9 sites; Frosbite with tissue necrosis NOS; Frosbite with tissue BURN B 10,600 3,180 7,420
of leg NOS; Frosbite with tissue necrosis of trunk NOS
T21.3 Burn of third degree of trunk BURN C 16,100 4,830 11,270

T31.6 Burns involving 60-69% of body surface BURN C 16,100 4,830 11,270
T31.9 Burns involving 90% or more of body surface BURN C 16,100 4,830 11,270
T32.9 Corrosions involving 90% or more of body surface BURN C 16,100 4,830 11,270
I47.0 Re-entry ventricular arrhythmia CARDIAC ARRHYTHMIA 12,200 3,660 8,540
Supraventricular tachycardia; Atrial Paroxysmal
tachycardia; Atrioventricular [AV] Paroxysmal tachycardia;
I47.1 CARDIAC ARRHYTHMIA 12,200 3,660 8,540
Junctional Paroxysmal tachycardia; Nodal Paroxysmal
tachycardia
I47.2 Ventricular tachycardia CARDIAC ARRHYTHMIA 12,200 3,660 8,540
Paroxysmal tachycardia, unspecified; Bouveret (-Hoffmann)
syndrome
I48 Atrial fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.0 Ventricular fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.1 Atrial premature depolarization; Atrial premature beats CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.2 Junctional premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540

I49.3 Ventricular premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540
Other and unspecified premature depolarization; Ectopic
I49.4 beats; Extrasystoles; Extrasystolic arrhythmias; Premature CARDIAC ARRHYTHMIA 12,200 3,660 8,540
beats NOS; Premature contractions
I49.5 Sick sinus syndrome; Tachycardia-bradycardia syndrome CARDIAC ARRHYTHMIA 12,200 3,660 8,540
Other specified cardiac arrhythmias; Brugada syndrome;

Long QT syndrome; coronary sinus rhythm disorder;
ectopic rhythm disorder; nodal rhythm disorder
I49.9 Cardiac arrhythmia, unspecified; Cardiac arrhythmia NOS CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I42.0 Dilated cardiomyopathy; Congestive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380

Obstructive hypertrophic cardiomyopathy; Hypertrophic
I42.1 CARDIOMYOPATHY 13,400 4,020 9,380
subaortic stenosis
Other hypertrophic cardiomyopathy; Nonobstructive
hypertrophic cardiomyopathy
Endomyocardial (eosinophilic) disease; Endomyocardial

(tropical) fibrosis; Löffler's endocarditis
I42.4 Endocardial fibroelastosis; Congenital cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380

I42.5 Other restrictive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.6 Alcoholic cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.7 Cardio myopathy due to drugs and other external agents CARDIOMYOPATHY 13,400 4,020 9,380
I42.8 Other cardiomyopathies CARDIOMYOPATHY 13,400 4,020 9,380

Cardio myopathy, unspecified; Primary cardiomyopathy
NOS; Secondary cardiomyopathy NOS
CARDIOVASCULAR COMPLICATIONS IN THE
P29.0 Neonatal cardiac failure 22,700 6,810 15,890
NEWBORN
P29.1 Neonatal cardiac dysrhythmia 22,700 6,810 15,890
NEWBORN
P29.2 Neonatal hypertension 22,700 6,810 15,890
NEWBORN
P29.4 Transient myocardial ischaemia of newborn 22,700 6,810 15,890
NEWBORN
Other cardiovascular disorders originating in the perinatal CARDIOVASCULAR COMPLICATIONS IN THE
P29.8 22,700 6,810 15,890
period NEWBORN
Cauda equina syndrome; Neurogenic bladder due to cauda
G83.4 equina syndrome CAUDA EQUINA SYNDROME 8,800 2,640 6,160
Excludes: cord bladder NOS (G95.8)
A46 Erysipelas CELLULITIS 9,600 2,880 6,720
A48.0 Gas gangrene; Clostridial cellulitis; Clostridial myonecrosis CELLULITIS 9,600 2,880 6,720
Cellulitis of finger and toe; Infection of nail; Onychia;

L03.0 CELLULITIS 9,600 2,880 6,720
Paronychia; Perionychia
Cellulitis of other parts of limb, Axilla; Cellulitis of
L03.1 CELLULITIS 9,600 2,880 6,720
Hip;Cellulitis of Shoulder
L03.2 Cellulitis of face CELLULITIS 9,600 2,880 6,720
Cellulitis of trunk;Cellulitis of Abdominal wall;Cellulitis of
L03.3 Back [any part]; Cellulitis of Chest wall;Cellulitis of CELLULITIS 9,600 2,880 6,720
Groin;Cellulitis of Perineum;Cellulitis of Umbilicus
Cellulitis of other sites; Cellulitis of Head [any part, except
L03.8 CELLULITIS 9,600 2,880 6,720
face];Cellulitis of Scalp
Page 11 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
L03.9 Cellulitis, unspecified CELLULITIS 9,600 2,880 6,720
L98.3 Eosinophilic cellulitis [Wells] CELLULITIS 9,600 2,880 6,720
Spastic cerebral palsy; Congenital spastic paralysis
G80.0 CEREBRAL PALSY 9,500 2,850 6,650
(cerebral); Spastic tetraplegic cerebral palsy
G80.1 Spastic diplegia; Spastic cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650
Infantile hemiplegia
G80.2 CEREBRAL PALSY 9,500 2,850 6,650
Spastic hemiplegic cerebral palsy
Dyskinetic cerebral palsy; Athetoid cerebral palsy; Dystonic
G80.3 CEREBRAL PALSY 9,500 2,850 6,650
cerebral palsy
G80.4 Ataxic cerebral palsy CEREBRAL PALSY 9,500 2,850 6,650
Other infantile cerebral palsy; Mixed cerebral palsy
G80.8 CEREBRAL PALSY 9,500 2,850 6,650
syndromes
G80.9 Infantile cerebral palsy, unspecified; Cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650
Primary biliary cirrhosis; Chronic nonsupparative

K74.3 CHOLANGITIS 13,200 3,960 9,240
destructive cholangitis
Calculus of bile duct with cholangitis; Any condition listed in
K80.3 CHOLANGITIS 13,200 3,960 9,240
K80.5 with cholangitis
Calculus of gallbladder with acute cholecystitis; Any
K80.0 condition listed in K80.2 with acute cholecystitis CHOLECYSTITIS 11,300 3,390 7,910
Acute cholecystitis with cholelithiasis
Calculus of gallbladder with other cholecystitis; Any
K80.1 condition listed in K80.2 with chronic cholecystitis; CHOLECYSTITIS 11,300 3,390 7,910
Cholecystitis with cholelithiasis NOS
Calculus of bile duct with cholecystitis; Any condition listed
K80.4 CHOLECYSTITIS 11,300 3,390 7,910
in K80.5 with cholecystitis (with cholangitis)
Acute cholecystitis; Abscess of gallbladder without calculus;

Angiocholecystitis without calculus; Acute emphysematous
cholecystitis without calculus; Gangrenous cholecystitis
K81.0 CHOLECYSTITIS 11,300 3,390 7,910
without calculus; Supparative cholecystitis without
calculus; Empyema of gallbladder without calculus;
Gangrene of gallbladder without calculus
K81.1 Chronic cholecystitis CHOLECYSTITIS 11,300 3,390 7,910

K81.8 Other cholecystitis CHOLECYSTITIS 11,300 3,390 7,910
Q90.0 Trisomy 21, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q90.2 Trisomy 21, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q90.9 Down's syndrome, unspecified; Trisomy 21 NOS CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.0 Trisomy 18, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.2 Trisomy 18, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.3 Edwards' syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.7 Patau's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q92.9 Trisomy and partial trisomy of autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Whole chromosome monosomy, mosaicism (mitotic
Q93.1 CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
nondisjunction)
Q93.2 Chromosome replaced with ring or dicentric CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Deletion of short arm of chromosome 5; Cri-du-chat
syndrome
Other deletions of part of a chromosome; Angelman
syndrome
Q93.7 Deletions with other complex rearrangements CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.9 Deletion from autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q95.9 Balanced rearrangement and structural marker, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q96.9 Turner's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890

Sex chromosome abnormality, female phenotype,
unspecified
Q98.4 Klinefelter's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q99.2 Fragile X chromosome; Fragile X syndrome CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q99.8 Other specified chromosome abnormalities CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
N18.0 End stage renal disease CHRONIC KIDNEY DISEASE N/A N/A N/A
Chronic kidney disease, stage 5
Chronic uraemia
End stage kidney disease:
• in allograft failure
• NOS
• on dialysis
• without dialysis or transplant
N18.5 CHRONIC KIDNEY DISEASE 14,500 4,350 10,150
Renal retinitis+(H32.8*)
Uraemic:
• apoplexia+(I68.8*)
• dementia+(F02.8*)
• neuropathy+(G63.8*)
• paralysis+(G99.8*)
• pericarditis+(I32.8*)
N18.8 Other chronic renal failure CHRONIC KIDNEY DISEASE N/A N/A N/A
Page 12 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Chronic renal failure
N18.9 CHRONIC KIDNEY DISEASE 14,500 4,350 10,150
Chronic kidney disease, unspecified
Unspecified renal failure
N19 Unspecified kidney failure CHRONIC KIDNEY DISEASE 14,500 4,350 10,150
Renal insufficiency NOS
Chronic obstructive/ asthmatic/ emphysematous

J44.0 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
pulmonary disease with acute lower respiratory infection
Chronic obstructive/ asthmatic/ emphysematous

J44.1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
pulmonary disease with acute exacerbation, unspecified
Chronic asthmatic (obstructive) bronchitis NOS; Chronic

J44.8 emphysematous bronchitis NOS; Chronic obstructive CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
bronchitis NOS
Chronic obstructive pulmonary disease, unspecified;
J44.9 Chronic obstructive airway disease NOS; Chronic CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
obstructive lung disease NOS
Cleft hard palate, bilateral; Bilateral fissure of hard palate;
Q35.0 CLEFT LIP AND PALATE 7,800 2,340 5,460
Bilateral palatoschisis of hard palate
Q35.1 Cleft hard palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.3 Cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.5 Cleft hard palate with cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.7 Cleft uvula CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.8 Cleft palate, unspecified, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.9 Cleft palate, unspecified CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.0 Cleft lip, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.1 Cleft lip, median CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.9 Cleft lip, unilateral; Cleft lip NOS CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.0 Cleft hard palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Cleft hard palate with unilateral cleft lip; Cleft hard palate
with cleft lip NOS
Q37.2 Cleft soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Cleft soft palate with unilateral cleft lip; Cleft soft palate
with cleft lip NOS
Q37.4 Cleft hard and soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Cleft hard and soft palate with unilateral cleft lip; Cleft hard
and soft palate with cleft lip NOS
Q37.8 Unspecified cleft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Unspecified cleft palate with unilateral cleft lip; Cleft palate
with cleft lip NOS
F01.0 Vascular dementia of acute onset COGNITIVE DYSFUNCTION 8,200 2,460 5,740
R41.0 Disorientation, unspecified; Confusion NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740
R41.3 Other amnesia; Amnesia NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740
Senility; Old age without mention of psychosis; Senescence
R54 without mention of psychosis; Senile asthenia; Senile COGNITIVE DYSFUNCTION 8,200 2,460 5,740
debility
COMPLICATIONS OF BENIGN NEOPLASMS OF
D34 Benign neoplasm of thyroid gland 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.0 Benign neoplasm of Adrenal gland 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.1 Benign neoplasm of Parathyroid gland 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.2 Benign neoplasm of Pituitary gland 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.3 Benign neoplasm of Craniopharyngeal duct 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.4 Benign neoplasm of Pineal gland 12,000 3,600 8,400
ENDOCRINE GLANDS
D35.9 Benign neoplasm of Endocrine gland, unspecified 12,000 3,600 8,400
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D16.0 Benign neoplasm of Scapula and long bones of upper limb 10,500 3,150 7,350
BONES
D16.1 Benign neoplasm of Short bones of upper limb 10,500 3,150 7,350
BONES
D16.2 Benign neoplasm ofLong bones of lower limb 10,500 3,150 7,350
BONES
D16.3 Benign neoplasm of Short bones of lower limb 10,500 3,150 7,350
BONES
Benign neoplasm of Bones of skull and face; Benign
D16.4 neoplasm of Superior Maxilla; Benign neoplasm of Orbital 10,500 3,150 7,350
BONES
bone
D16.5 Benign neoplasm of Lower jaw bone 10,500 3,150 7,350
BONES
D16.6 Benign neoplasm of Vertebral column 10,500 3,150 7,350
BONES
D16.7 Benign neoplasm of Ribs, sternum and clavicle 10,500 3,150 7,350
BONES
Page 13 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
D16.8 Benign neoplasm of Pelvic bones, sacrum and coccyx 10,500 3,150 7,350
BONES
Benign neoplasm of Bone and articular cartilage, COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D16.9 10,500 3,150 7,350
unspecified BONES
Benign neoplasm of Caecum;Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D12.0 8,700 2,610 6,090
Ileocaecal valve DIGESTIVE SYSTEM
D12.1 Benign neoplasm of Appendix 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign neoplasm of Transverse colon; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D12.3 8,700 2,610 6,090
Hepatic flexure; Benign neoplasm of Splenic flexure DIGESTIVE SYSTEM

D12.4 Benign neoplasm of Descending colon 8,700 2,610 6,090
DIGESTIVE SYSTEM
D12.5 Benign neoplasm of Sigmoid colon 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign neoplasm of Colon, unspecified; Adenomatosis of
D12.6 colon; Benign neoplasm of Large intestine NOS; Hereditary 8,700 2,610 6,090
DIGESTIVE SYSTEM
Polyposis of colon
Benign neoplasm of Rectosigmoid junction; Adenomatosis
D12.7 of colon; Benign neoplasm of Large intestine NOS; 8,700 2,610 6,090
DIGESTIVE SYSTEM
Hereditary Polyposis of colon
D12.8 Benign neoplasm of Rectum 8,700 2,610 6,090
DIGESTIVE SYSTEM
D12.9 Benign neoplasm of Anus and anal canal 8,700 2,610 6,090
DIGESTIVE SYSTEM
D13.0 Benign neoplasm of Oesophagus 8,700 2,610 6,090
DIGESTIVE SYSTEM
D13.1 Benign neoplasm of Stomach 8,700 2,610 6,090
DIGESTIVE SYSTEM
D13.2 Benign neoplasm of Duodenum 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign neoplasm of Other and unspecified parts of small COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D13.3 8,700 2,610 6,090
intestine DIGESTIVE SYSTEM
Benign neoplasm of Liver; Benign neoplasm of Intrahepatic COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D13.4 8,700 2,610 6,090
bile ducts DIGESTIVE SYSTEM
D13.5 Benign neoplasm of Extrahepatic bile ducts 8,700 2,610 6,090
DIGESTIVE SYSTEM
D13.6 Benign neoplasm of Pancreas 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign neoplasm of Endocrine pancreas; Benign neoplasm
D13.7 of Islet cell tumour; Benign neoplasm of Islets of 8,700 2,610 6,090
DIGESTIVE SYSTEM
Langerhans
Benign neoplasm of Ill-defined sites within the digestive

D13.9 system; Benign neoplasm of Digestive system NOS; Benign 8,700 2,610 6,090
DIGESTIVE SYSTEM
neoplasm of Intestine NOS; Benign neoplasm of Spleen

D17.5 Benign lipomatous neoplasm of intra-abdominal organs 8,700 2,610 6,090
DIGESTIVE SYSTEM
D17.6 Benign lipomatous neoplasm of spermatic cord 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign lipomatous neoplasm of other sites; Benign
D17.7 lipomatous neoplasm of Peritoneum; Benign lipomatous 8,700 2,610 6,090
DIGESTIVE SYSTEM
neoplasm of Retroperitoneum
D20.0 Benign neoplasm of of soft tissue of Retroperitoneum 8,700 2,610 6,090
DIGESTIVE SYSTEM
D20.1 Benign neoplasm of of soft tissue of Peritoneum 8,700 2,610 6,090
DIGESTIVE SYSTEM
Benign neoplasm of Connective and other soft tissue of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D21.4 8,700 2,610 6,090
abdomen DIGESTIVE SYSTEM
D25.0 Submucous leiomyoma of uterus 9,600 2,880 6,720
FEMALE GENITAL TRACT
D25.1 Intramural leiomyoma of uterus 9,600 2,880 6,720
D25.2 Subserosal leiomyoma of uterus 9,600 2,880 6,720
D25.9 Leiomyoma of uterus, unspecified 9,600 2,880 6,720
D26.0 Other Benign neoplasm of Cervix uteri 9,600 2,880 6,720
D26.1 Other Benign neoplasm of Corpus uteri 9,600 2,880 6,720
D26.7 Other Benign neoplasm of Other parts of uterus 9,600 2,880 6,720
D26.9 Other Benign neoplasm of Uterus, unspecified 9,600 2,880 6,720
D27 Benign neoplasm of ovary 9,600 2,880 6,720
Page 14 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
D28.0 Benign neoplasm of Vulva 9,600 2,880 6,720
D28.1 Benign neoplasm of Vagina 9,600 2,880 6,720
Benign neoplasm of Uterine tubes and ligaments; Benign
neoplasm of Fallopian Tubes; Benign neoplasm of Uterine COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D28.2 9,600 2,880 6,720
Broad Ligament; Benign neoplasm of Uterine round FEMALE GENITAL TRACT
ligament
D28.7 Benign neoplasm of Other specified female genital organs 9,600 2,880 6,720
D28.9 Benign neoplasm of Female genital organ, unspecified 9,600 2,880 6,720
D29.0 Benign neoplasm of Penis 7,700 2,310 5,390
MALE GENITAL TRACT
D29.1 Benign neoplasm of Prostate 7,700 2,310 5,390
MALE GENITAL TRACT
D29.2 Benign neoplasm of Testis 7,700 2,310 5,390
MALE GENITAL TRACT
Benign neoplasm of Scrotum; Benign neoplasm of Skin of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D29.4 7,700 2,310 5,390
scrotum MALE GENITAL TRACT
D32.0 Benign neoplasm of Cerebral meninges 14,800 4,440 10,360
NERVOUS SYSTEM
D32.1 Benign neoplasm of Spinal meninges 14,800 4,440 10,360
NERVOUS SYSTEM
Benign neoplasm of Meninges, unspecified; Meningioma COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D32.9 14,800 4,440 10,360
NOS NERVOUS SYSTEM
Benign neoplasm of Brain, supratentorial; Benign neoplasm
of Cerebral ventricle; Benign neoplasm of Cerebrum;
D33.0 Benign neoplasm of Frontal lobe; Benign neoplasm of 14,800 4,440 10,360
NERVOUS SYSTEM
Occipital lobe; Benign neoplasm of Parietal lobe; Benign
neoplasm of Temporal lobe
Benign neoplasm of Brain, infratentorial; Benign neoplasm
D33.1 of Brain stem; Benign neoplasm of Cerebellum; Benign 14,800 4,440 10,360
NERVOUS SYSTEM
neoplasm of Fourth ventricle
D33.2 Benign neoplasm of Brain, unspecified 14,800 4,440 10,360
NERVOUS SYSTEM
Benign neoplasm of Cranial nerves; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D33.3 14,800 4,440 10,360
Olfactory bulb NERVOUS SYSTEM
D33.4 Benign neoplasm of Spinal cord 14,800 4,440 10,360
NERVOUS SYSTEM
Benign neoplasm of Other specified parts of central COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D33.7 14,800 4,440 10,360
nervous system NERVOUS SYSTEM
Benign neoplasm of Central nervous system, unspecified; COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D33.9 14,800 4,440 10,360
Central Nervous system NOS NERVOUS SYSTEM
Benign neoplasm of Peripheral nerves and autonomic COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D36.1 14,800 4,440 10,360
nervous system NERVOUS SYSTEM
Benign neoplasm of Lip; Benign neoplasm of frenulum of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D10.0 Lip; Benign neoplasm of Inner aspect of lip; Benign ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
neoplasm of Mucosa of Lip; Vermilion border of Lip GLANDS
Benign neoplasm of Tongue;Benign neoplasm of Lingual
D10.1 ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
tonsil
GLANDS
Benign neoplasm of Other and unspecified parts of mouth;
Benign neoplasm of Minor salivary gland NOS
GLANDS
Benign neoplasm of Nasopharynx; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D10.6 Pharyngeal tonsil; Benign neoplasm of Posterior margin of ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
septum and choanae GLANDS
D10.7 Benign neoplasm of Hypopharynx ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
GLANDS
D10.9 Benign neoplasm of Pharynx, unspecified ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
GLANDS
D11.0 Benign neoplasm of Parotid gland ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
GLANDS
Benign neoplasm of Other major salivary glands; sublingual;
submandibular
GLANDS
D11.9 Benign neoplasm of Major salivary gland, unspecified ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
GLANDS
Benign neoplasm of Larynx; Benign neoplasm of
suprahyoid portion of Epiglottis
GLANDS
Page 15 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
D14.2 Benign neoplasm of Trachea ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650
GLANDS
D30.0 Benign neoplasm of Kidney 8,300 2,490 5,810
URINARY SYSTEM
D30.1 Benign neoplasm of Renal pelvis 8,300 2,490 5,810
URINARY SYSTEM
Benign neoplasm of Bladder; Benign neoplasm of Urethral
D30.3 orifice of bladder; Benign neoplasm of ureteric orifice of 8,300 2,490 5,810
URINARY SYSTEM
bladder
D30.4 Benign neoplasm of Urethra 8,300 2,490 5,810
URINARY SYSTEM
Benign neoplasm of Urinary organ, unspecified; Benign COMPLICATIONS OF BENIGN NEOPLASMS OF THE
D30.9 8,300 2,490 5,810
neoplasm of Urinary system NOS URINARY SYSTEM
Cardiac septal defect, acquired; Acquired atrial septal
I51.0 defect old; Acquired auricular septal defect old ; Acquired COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
ventricular septal defect old
I51.1 Rupture of chordae tendineae, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.2 Rupture of papillary muscle, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
Intra cardiac thrombosis, not elsewhere classified; Old
I51.3 Apical thrombosis; Old Atrial thrombosis; Old Auricular COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
thrombosis; Old Venticular thrombosis
Myocarditis, unspecified; Myocardial fibrosis; Myocarditis
I51.4 COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
NOS; Chronic interstitial myocarditis
Myocardial degeneration; Fatty Degeneration of heart or
I51.5 myocardium fatty; Senile Degeneration of heart or COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
myocardium; Myocardial disease
Other ill-defined heart diseases; Acute carditis; Chronic
I51.8 COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
Carditis; Acute pancarditis; Chronic pancarditis
COMPLICATIONS OF HEMANGIOMA AND
D18.0 Haemangioma, any site; Angioma NOS 9,000 2,700 6,300
LYMPHANGIOMA
COMPLICATIONS OF HEMANGIOMA AND
D18.1 Lymphangioma, any site 9,000 2,700 6,300
LYMPHANGIOMA
COMPLICATIONS OF INTRATHORACIC BENIGN
D14.3 Benign neoplasm of Bronchus and lung 10,100 3,030 7,070
NEOPLASMS
D14.4 Benign neoplasm of Respiratory system, unspecified 10,100 3,030 7,070
NEOPLASMS
D15.0 Benign neoplasm of Thymus 10,100 3,030 7,070
NEOPLASMS
D15.1 Benign neoplasm of Heart 10,100 3,030 7,070
NEOPLASMS
D15.2 Benign neoplasm of Mediastinum 10,100 3,030 7,070
NEOPLASMS
D15.9 Benign neoplasm of Intrathoracic organ, unspecified 10,100 3,030 7,070
NEOPLASMS
D17.4 Benign lipomatous neoplasm of intrathoracic organs 10,100 3,030 7,070
NEOPLASMS
Benign neoplasm of Connective and other soft tissue of
thorax; Benign neoplasm of Connective and other soft
D21.3 tissue of Axilla; Benign neoplasm of Connective and other 10,100 3,030 7,070
NEOPLASMS
soft tissue of Diaphragm; Benign neoplasm of Connective
and other soft tissue of Great vessels
COMPLICATIONS OF SEXUALLY TRANSMITTED
A52.1 Late Symptomatic neurosyphilis; Tabes dorsalis 5,500 1,650 3,850
DISEASES
Neurosyphilis, unspecified; Syphilitic Gumma of central

A52.3 nervous system NOS; Late Syphilis of central nervous 5,500 1,650 3,850
DISEASES
system NOS; Syphiloma of central nervous system NOS

A52.7 Other symptomatic late syphilis 5,500 1,650 3,850
DISEASES
Latent syphilis, unspecified as early or late; Latent syphilis COMPLICATIONS OF SEXUALLY TRANSMITTED
A53.0 5,500 1,650 3,850
NOS; Positive serological reaction for syphilis DISEASES
Gonococcal infection of lower genitourinary tract with
A54.1 periurethral and accessory gland abscess; Gonococcal 5,500 1,650 3,850
DISEASES
Bartholin's gland abscess
Gonococcal Pelviperitonitis and other gonococcal COMPLICATIONS OF SEXUALLY TRANSMITTED
A54.2 5,500 1,650 3,850
genitourinary infections DISEASES
Other gonococcal infections: COMPLICATIONS OF SEXUALLY TRANSMITTED
A54.8 5,500 1,650 3,850
Gonococcal septicaemia; Gonococcal skin lesions DISEASES
Chlamydial lymphogranuloma (venereum); Climatic or
A55 tropical bubo ; Durand-Nicolas-Favre disease; Esthiomene; 5,500 1,650 3,850
DISEASES
Lymphogranuloma inguinale
Chlamydial infection of pelviperitoneum and other COMPLICATIONS OF SEXUALLY TRANSMITTED
A56.1 5,500 1,650 3,850
genitourinary organs; DISEASES
A59 Trichomoniasis 5,500 1,650 3,850
DISEASES
T79.0 Air embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
Page 16 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
T79.1 Fat embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.2 Traumatic secondary and recurrent haemorrhage COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.3 Post-traumatic wound infection, not elsewhere classified COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
Traumatic shock; immediate shock following injury;

T79.4 COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
Delayed shock following injury
Traumatic anuria; Crush syndrome; Renal failure following
crushing
Traumatic ischaemia of muscle; Compartment syndrome;
Volkmann's ischaemic contracture
T79.7 Traumatic subcutaneous emphysema COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.8 Other early complications of trauma COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
Congenital adrenogenital disorders associated with enzyme

E25.0 deficiency; Congenital adrenal hyperplasia; 21-Hydroxylase CONGENITAL ANDROGENITAL DISORDER 7,800 2,340 5,460
deficiency; Salt-losing congenital adrenal hyperplasia
P61.2 Anaemia of prematurity CONGENITAL ANEMIA 15,200 4,560 10,640

P61.3 Congenital anaemia from fetal blood loss CONGENITAL ANEMIA 15,200 4,560 10,640
Other congenital anaemias, not elsewhere classified;
P61.4 CONGENITAL ANEMIA 15,200 4,560 10,640
Congenital anaemia NOS
Congenital dyserythropoietic anaemia; Congenital
D64.4 CONGENITAL BLOOD DISORDERS 4,000 1,200 2,800
Dyshaematopoietic anaemia
D74.0 Congenital methaemoglobinaemia CONGENITAL BLOOD DISORDERS 4,000 1,200 2,800
Q80.2 Lamellar ichthyosis; Collodion baby CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q80.9 Congenital ichthyosis, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.2 Epidermolysis bullosa dystrophica CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.8 Other epidermolysis bullosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.9 Epidermolysis bullosa, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.0 Hereditary lymphoedema CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.2 Mastocytosis; Urticaria pigmentosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.3 Incontinentia pigmenti CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.4 Ectodermal dysplasia (anhidrotic) CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Other specified congenital malformations of skin; Abnormal
palmar creases; Accessory skin tags; Benign familial
Q82.8 pemphigus [Hailey-Hailey]; Cutis laxa (hyperelastica); CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Dermatoglyphic anomalies; Inherited keratosis palmaris et
plantaris; Keratosis follicula
Other specified congenital malformations of integument;
Q84.8 CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Aplasia cutis congenita
CONGENITAL DISORDERS OF THE FEMALE GENITAL
Q50.1 Developmental ovarian cyst 9,300 2,790 6,510
TRACT
Other congenital malformations of ovary; Accessory ovary; CONGENITAL DISORDERS OF THE FEMALE GENITAL
Q50.3 9,300 2,790 6,510
Congenital malformation of ovary NOS; Ovarian streak TRACT

Q50.4 Embryonic cyst of fallopian tube; Fimbrial cyst 9,300 2,790 6,510
TRACT
Embryonic cyst of broad ligament; Cyst epoophoron; CONGENITAL DISORDERS OF THE FEMALE GENITAL
Q50.5 9,300 2,790 6,510
Gartner's duct Cyst; Parovarian Cyst TRACT
Other congenital malformations of fallopian tube and

broad ligament; Absence of fallopian tube or broad
Q50.6 ligament; Accessory of fallopian tube or broad ligament; 9,300 2,790 6,510
TRACT
Atresia of fallopian tube or broad ligament; Congenital
malformation of fallopian tube or broad ligament NOS
Agenesis and aplasia of uterus; Congenital absence of CONGENITAL DISORDERS OF THE FEMALE GENITAL
Q51.0 9,300 2,790 6,510
uterus TRACT
Q51.9 Congenital malformation of uterus and cervix, unspecified 9,300 2,790 6,510
TRACT
CONGENITAL DISORDERS OF THE
Q65.6 Unstable hip; Dislocatable hip; Subluxatable hip 5,300 1,590 3,710
MUSCULOSKELETAL SYSTEM
Q67.3 Plagiocephaly 5,300 1,590 3,710
Other congenital deformities of skull, face and jaw;
Depressions in skull; Deviation of nasal septum, congenital; CONGENITAL DISORDERS OF THE
Q67.4 5,300 1,590 3,710
Hemifacial atrophy or hypertrophy; Squashed or bent nose, MUSCULOSKELETAL SYSTEM
congenital
Q67.6 Pectus excavatum; Congenital funnel chest 5,300 1,590 3,710
Q67.7 Pectus carinatum; Congenital pigeon chest 5,300 1,590 3,710
Congenital deformity of sternocleidomastoid muscle;
Congenital, sternomastoid torticollis; Contracture of CONGENITAL DISORDERS OF THE
Q68.0 5,300 1,590 3,710
sternocleidomastoid muscle; Sternomastoid tumour, MUSCULOSKELETAL SYSTEM
congenital
Congenital scoliosis due to congenital bony malformation;
Q76.3 Hemivertebra fusion or failure of segmentation with 5,300 1,590 3,710
scoliosis
Page 17 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Q78.0 Osteogenesis imperfecta; Fragilitas ossium 5,300 1,590 3,710
Q78.2 Osteopetrosis; Albers-Schönberg syndrome 5,300 1,590 3,710
Q78.8 Other specified osteochondrodysplasias; Osteopoikilosis 5,300 1,590 3,710
Osteochondrodysplasia, unspecified; Chondrodystrophy CONGENITAL DISORDERS OF THE
Q78.9 5,300 1,590 3,710
NOS; Osteodystrophy NOS MUSCULOSKELETAL SYSTEM
Other congenital malformation syndromes with other CONGENITAL DISORDERS OF THE
Q87.5 5,300 1,590 3,710
skeletal changes MUSCULOSKELETAL SYSTEM
Atresia of oesophagus without fistula; Atresia of
Q39.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
oesophagus NOS
Atresia of oesophagus with tracheo-oesophageal fistula;

Atresia of oesophagus with broncho-oesophageal fistula
Congenital tracheo-oesophageal fistula without atresia;

Congenital tracheo-oesophageal fistula NOS
Q39.6 Diverticulum of oesophagus; Oesophageal pouch CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q39.9 Congenital malformation of oesophagus, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Congenital hypertrophic pyloric stenosis; Congenital or
infantile constriction of pylorus; Congenital or infantile
Q40.0 hypertrophy of pylorus; Congenital or infantile spasm of CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
pylorus; Congenital or infantile stenosis of pylorus;
Congenital or infantile stricture of pylorus
Congenital hiatus hernia; Displacement of cardia through
oesophageal hiatus
Other specified congenital malformations of stomach;

Congenital displacement of stomach; Congenital
diverticulum of stomach; Congenital hourglass stomach;
Duplication of stomach; Megalogastria; Microgastria
Congenital malformation of upper alimentary tract,

Q40.9 unspecified; Congenital anomaly NOS of upper alimentary CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
tract; Congenital deformity NOS of upper alimentary tract
Q41.0 Congenital absence, atresia and stenosis of duodenum CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Congenital absence, atresia and stenosis of jejunum; Apple
peel syndrome; Imperforate jejunum
Q41.2 Congenital absence, atresia and stenosis of ileum CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Congenital absence, atresia and stenosis of small intestine,
Q41.9 part unspecified; Congenital absence, atresia and stenosis CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
of intestine NOS
Congenital absence, atresia and stenosis of rectum with
fistula
Congenital absence, atresia and stenosis of rectum without
fistula; Imperforate rectum
Q42.2 Congenital absence, atresia and stenosis of anus with fistula CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Congenital absence, atresia and stenosis of anus without

fistula; Imperforate anus
Congenital absence, atresia and stenosis of large intestine,
part unspecified
Meckel's diverticulum; Persistent omphalomesenteric duct;
Persistent vitelline duct
Hirschsprung's disease; Aganglionosis; Congenital
(aganglionic) megacolon
Other congenital functional disorders of colon; Congenital
dilatation of colon
Congenital malformations of intestinal fixation; Congenital
anomalous omental adhesions [bands] ; Congenital
peritoneal adhesions [bands]; Jackson's membrane;
Q43.3 Malrotation of colon; Failure of rotation of caecum and CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
colon; Incomplete rotation of caecum and colon;
Insufficient rotation of caecum and colon; Universal
mesentery
Q43.4 Duplication of intestine CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.5 Ectopic anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.6 Congenital fistula of rectum and anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.7 Persistent cloaca; Cloaca NOS CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Other specified congenital malformations of intestine;
Congenital blind loop syndrome; Congenital diverticulitis,
colon; Congenital diverticulum, intestine; Dolichocolon;
Megaloappendix; Megaloduodenum;
Microcolon; Transposition of appendix; Transposition of
colon; Transposition of intestine
Q43.9 Congenital malformation of intestine, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Page 18 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Agenesis, aplasia and hypoplasia of gallbladder; Congenital
absence of gallbladder
Other congenital malformations of gallbladder; Congenital

malformation of gallbladder NOS; Intrahepatic gallbladder
Q44.2 Atresia of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.3 Congenital stenosis and stricture of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.4 Choledochal cyst CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Other congenital malformations of bile ducts; Accessory

Q44.5 hepatic duct; Congenital malformation of bile duct NOS; CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Biliary duct Duplication; Cystic duct Duplication
Q44.6 Cystic disease of liver; Fibrocystic disease of liver CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Other congenital malformations of liver; Accessory liver;

Q44.7 Alagille's syndrome; Congenital absence of liver; Congenital CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
hepatomegaly; Congenital malformation of liver NOS
Agenesis, aplasia and hypoplasia of pancreas; Congenital

absence of pancreas
Other specified congenital malformations of digestive
system; Absence of alimentary tract NOS, complete;
Q45.8 Absence of alimentary tract NOS, partial; Duplication of CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
digestive organs NOS; Malposition, congenital of digestive
organs NOS
Congenital malformation of digestive system, unspecified;

Q45.9 Congenital anomaly NOS of digestive system ; Congenital CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
deformity NOS of digestive system
Q79.0 Congenital diaphragmatic hernia CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Other congenital malformations of diaphragm; Absence of
Q79.1 diaphragm; Congenital malformation of diaphragm NOS; CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Eventration of diaphragm
Q79.2 Exomphalos; Omphalocele CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.3 Gastroschisis CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.4 Prune belly syndrome CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.5 Other congenital malformations of abdominal wall CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q20.0 Common arterial trunk; Persistent truncus arteriosus CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.1 Double outlet right ventricle; Taussig-Bing syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.2 Double outlet left ventricle CONGENITAL HEART DISEASES 11,600 3,480 8,120
Discordant ventriculoarterial connection;
Q20.3 Dextrotransposition of aorta; Transposition of great vessels CONGENITAL HEART DISEASES 11,600 3,480 8,120
(complete)
Double inlet ventricle; Common ventricle; Cor triloculare
Q20.4 CONGENITAL HEART DISEASES 11,600 3,480 8,120
biatriatum; Single ventricle
Discordant atrioventricular connection; Corrected

transposition; Laevotransposition; Ventricular inversion
Congenital malformation of cardiac chambers and

connections, unspecified
Q21.0 Ventricular septal defect CONGENITAL HEART DISEASES 11,600 3,480 8,120
Atrial septal defect; Coronary sinus defect; Patent or
Q21.1 persistent foramen ovale; Patent or persistent ostium CONGENITAL HEART DISEASES 11,600 3,480 8,120
secundum defect (type II); Sinus venosus defect
Atrioventricular septal defect; Common atrioventricular
Q21.2 canal; Endocardial cushion defect; Ostium primum atrial CONGENITAL HEART DISEASES 11,600 3,480 8,120
septal defect (type I)
Tetralogy of Fallot; Ventricular septal defect with
Q21.3 pulmonary stenosis or atresia, dextroposition of aorta and CONGENITAL HEART DISEASES 11,600 3,480 8,120
hypertrophy of right ventricle.
Aortopulmonary septal defect; Aortic septal defect;
Aortopulmonary window
Other congenital malformations of cardiac septa;
Eisenmenger's defect; Pentalogy of Fallot
Congenital malformation of cardiac septum, unspecified;
Septal (heart) defect NOS
Q22.0 Pulmonary valve atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.1 Congenital pulmonary valve stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Congenital pulmonary valve insufficiency; Congenital
pulmonary valve regurgitation
Q22.4 Congenital tricuspid stenosis; Tricuspid atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.5 Ebstein's anomaly CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.6 Hypoplastic right heart syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.8 Other congenital malformations of tricuspid valve CONGENITAL HEART DISEASES 11,600 3,480 8,120
Congenital stenosis of aortic valve; Congenital aortic
atresia; Congenital aortic stenosis
Congenital insufficiency of aortic valve; Bicuspid aortic
valve; Congenital aortic insufficiency
Page 19 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Q23.2 Congenital mitral stenosis; Congenital mitral atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.3 Congenital mitral insufficiency CONGENITAL HEART DISEASES 11,600 3,480 8,120
Hypoplastic left heart syndrome; Atresia, or marked
hypoplasia of aortic orifice or valve, with hypoplasia of
Q23.4 ascending aorta and defective development of left ventricle CONGENITAL HEART DISEASES 11,600 3,480 8,120
(with mitral valve stenosis or
atresia).
Q23.8 Other congenital malformations of aortic and mitral valves CONGENITAL HEART DISEASES 11,600 3,480 8,120
Congenital malformation of aortic and mitral valves,

unspecified
Q24.0 Dextrocardia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.2 Cor triatriatum CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.3 Pulmonary infundibular stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.4 Congenital subaortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Malformation of coronary vessels; Congenital coronary
(artery) aneurysm
Q24.6 Congenital heart block CONGENITAL HEART DISEASES 11,600 3,480 8,120
Other specified congenital malformations of heart;

Congenital diverticulum of left ventricle; Congenital
malformation of myocardium; Congenital malformation of
pericardium; Malposition of heart; Uhl's disease
Congenital malformation of heart, unspecified; Congenital

anomaly NOS of heart; Congenital disease NOS of heart
Patent ductus arteriosus; Patent ductus Botallo; Persistent

ductus arteriosus
Coarctation of aorta; Preductal coarctation of aorta;
Postductal coarctation of aorta
Q25.2 Atresia of aorta CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.3 Stenosis of aorta; Supravalvular aortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Other congenital malformations of aorta; Absence of aorta;
Aplasia of aorta; Congenital aneurysm of aorta; Congenital
dilatation of aorta; Aneurysm of sinus of valsalva (rupture);
Double aortic arch [vascular ring or aorta]; Hypoplasia of
aorta; Persistent convolutions of aortic arch; Persistent
right aortic arch
Q25.5 Atresia of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.6 Stenosis of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120
Other congenital malformations of pulmonary artery;
aberrant pulmonary artery; agenesis of pulmonary artery;
Q25.7 aneurysm, congenital of pulmonary artery; anomaly of CONGENITAL HEART DISEASES 11,600 3,480 8,120
pulmonary artery; hypoplasia of pulmonary artery;
pulmonary arteriovenous aneurysm
Q25.8 Other congenital malformations of great arteries CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.9 Congenital malformation of great arteries, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120
Congenital stenosis of vena cava; Congenital stenosis of
Q26.0 inferior vena cava; Congenital stenosis of superior vena CONGENITAL HEART DISEASES 11,600 3,480 8,120
cava
Q26.2 Total anomalous pulmonary venous connection CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.4 Anomalous pulmonary venous connection, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120
Other congenital malformations of great veins; Absence of

inferior vena cava ; Absence of superior vena cava ; Azygos
continuation of inferior vena cava; Persistent left posterior
cardinal vein; Scimitar syndrome
Congenital malformation of great vein, unspecified;

Q26.9 Anomaly of inferior vena cava NOS; Anomaly of superior CONGENITAL HEART DISEASES 11,600 3,480 8,120
vena cava NOS
Congenital iodine-deficiency syndrome, neurological type;
E00.0 CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
Endemic cretinism, neurological type
Congenital hypothyroidism with diffuse goitre; Nontoxic
E03.0 congenital Goitre NOS; Nontoxic ongenital CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
parenchymatous Goitre
Congenital hypothyroidism without goitre; Aplasia of
E03.1 thyroid (with myxoedema); Congenital atrophy of thyroid; CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
Congenital hypothyroidism NOS
Anencephaly; Acephaly; Acrania; Amyelencephaly; CONGENITAL MALFORMATIONS OF THE
Q00.0 13,000 3,900 9,100
Hemicephaly; Hemicephaly BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
Q01.0 Frontal encephalocele 13,000 3,900 9,100
BRAIN/NERVOUS SYSTEM
Q01.1 Nasofrontal encephalocele 13,000 3,900 9,100
Q01.2 Occipital encephalocele 13,000 3,900 9,100
Page 20 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Q01.8 Encephalocele of other sites 13,000 3,900 9,100
Q02 Microcephaly; Hydromicrocephaly; Micrencephalon 13,000 3,900 9,100
Malformations of aqueduct of Sylvius; Anomaly of
Q03.0 aqueduct of sylvius; Obstruction, congenital of aqueduct of 13,000 3,900 9,100
sylvius; Stenosis of aqueduct of sylvius
Atresia of foramina of Magendie and Luschka; Dandy- CONGENITAL MALFORMATIONS OF THE
Q03.1 13,000 3,900 9,100
Walker syndrome BRAIN/NERVOUS SYSTEM
Congenital malformations of corpus callosum; Agenesis of CONGENITAL MALFORMATIONS OF THE
Q04.0 13,000 3,900 9,100
corpus callosum BRAIN/NERVOUS SYSTEM
Q04.2 Holoprosencephaly 13,000 3,900 9,100
Other reduction deformities of brain; Absence of part of

brain; Agenesis of part of brain; Aplasia of part of brain; CONGENITAL MALFORMATIONS OF THE
Q04.3 13,000 3,900 9,100
Hypoplasia of part of brain ; Agyria; Hydranencephaly; BRAIN/NERVOUS SYSTEM
Lissencephaly; Microgyria; Pachygyria

Q04.4 Septo-optic dysplasia 13,000 3,900 9,100
Q04.6 Congenital cerebral cysts; Porencephaly; Schizencephaly 13,000 3,900 9,100
Other specified congenital malformations of brain; CONGENITAL MALFORMATIONS OF THE
Q04.8 13,000 3,900 9,100
Macrogyria BRAIN/NERVOUS SYSTEM
Congenital malformation of brain, unspecified; Congenital

anomaly NOS of brain; Congenital deformity NOS of brain; CONGENITAL MALFORMATIONS OF THE
Q04.9 13,000 3,900 9,100
Congenital disease of lesion NOS of brain; Congenital BRAIN/NERVOUS SYSTEM
multiple anomalis NOS of brain
Thoracic spina bifida with hydrocephalus; Dorsal spina

Q05.1 bifida with hydrocephalus; Thoracolumbar spina bifida with 13,000 3,900 9,100
hydrocephalus
Lumbar spina bifida with hydrocephalus; Lumbosacral spina CONGENITAL MALFORMATIONS OF THE
Q05.2 13,000 3,900 9,100
bifida with hydrocephalus BRAIN/NERVOUS SYSTEM
Q05.4 Unspecified spina bifida with hydrocephalus 13,000 3,900 9,100
Thoracic spina bifida without hydrocephalus; Dorsal NOS CONGENITAL MALFORMATIONS OF THE
Q05.6 13,000 3,900 9,100
spina bifida; Thoracolumbar NOS spina bifida BRAIN/NERVOUS SYSTEM
Lumbar spina bifida without hydrocephalus; Lumbosacral CONGENITAL MALFORMATIONS OF THE
Q05.7 13,000 3,900 9,100
spina bifida NOS BRAIN/NERVOUS SYSTEM
Q05.8 Sacral spina bifida without hydrocephalus 13,000 3,900 9,100
Q05.9 Spina bifida, unspecified 13,000 3,900 9,100
Q06.0 Amyelia 13,000 3,900 9,100
Q06.2 Diastematomyelia 13,000 3,900 9,100
Q06.4 Hydromyelia; Hydrorachis 13,000 3,900 9,100
Q06.8 Other specified congenital malformations of spinal cord 13,000 3,900 9,100
Congenital malformation of spinal cord, unspecified;

Congenital anomaly NOS of spinal cord or meninges; CONGENITAL MALFORMATIONS OF THE
Q06.9 13,000 3,900 9,100
Congenital deformity NOS of spinal cord or meninges; BRAIN/NERVOUS SYSTEM
Congenital disease or lesion NOS of spinal cord or meninges

Q07.0 Arnold-Chiari syndrome 13,000 3,900 9,100
Congenital malformation of nervous system, unspecified;
Congenital anomaly NOS of nervous system; Congenital CONGENITAL MALFORMATIONS OF THE
Q07.9 13,000 3,900 9,100
deformity NOS of nervous system; Congenital disease or BRAIN/NERVOUS SYSTEM
lesion NOS of nervous system
Q74.3 Arthrogryposis multiplex congenita 13,000 3,900 9,100
Craniosynostosis; Acrocephaly; ]Imperfect fusion of skull; CONGENITAL MALFORMATIONS OF THE
Q75.0 13,000 3,900 9,100
Oxycephaly; Trigonocephaly BRAIN/NERVOUS SYSTEM
Q75.1 Craniofacial dysostosis; Crouzon's disease 13,000 3,900 9,100
Q75.2 Hypertelorism 13,000 3,900 9,100
Mandibulofacial dysostosis; Franceschetti Syndrome; CONGENITAL MALFORMATIONS OF THE
Q75.4 13,000 3,900 9,100
Treacher Collins Syndrome BRAIN/NERVOUS SYSTEM
Other specified congenital malformations of skull and face
Q75.8 bones; Absence of skull bone, congenital; Congenital 13,000 3,900 9,100
deformity of forehead; Platybasia
Page 21 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Congenital malformation of skull and face bones,
Q75.9 unspecified; Congenital anomaly of face bones NOS; 13,000 3,900 9,100
Congenital anomaly of skull NOS
Q76.0 Spina bifida occulta 13,000 3,900 9,100
Other congenital malformations of spine, not associated

with scoliosis; Congenital absence of vertebra unspecified
or not associated with scoliosis; Congenital fusion of spine
unspecified or not associated with scoliosis; Congenital
kyphosis unspecified or not associated with scoliosis;
Congenital lordosis unspecified or not associated with
scoliosis; Congenital malformation of lumbosacral joint
Q76.4 unspecified or not associated with scoliosis; Congenital 13,000 3,900 9,100
malformation of lumbosacral region unspecified or not
associated with scoliosis; Hemivertebra unspecified or not
associated with scoliosis; Malformation of spine
unspecified or not associated with scoliosis;
Platyspondylisis unspecified or not associated with
scoliosis; Supernumerary vertebra unspecified or nor
associated with scoliosis
CONGENITAL MALFORMATIONS OF THE LOWER

Q32.0 Congenital tracheomalacia 21,700 6,510 15,190
RESPIRATORY TRACT
Other congenital malformations of bronchus; Absence of

bronchus; Agenesis of bronchus; Atresia of bronchus; CONGENITAL MALFORMATIONS OF THE LOWER
Q32.4 21,700 6,510 15,190
Congenital malformation NOS of bronchus; Diverticulum of RESPIRATORY TRACT
bronchus; Congenital malformations of lung] of bronchus
Congenital cystic lung; Congenital honeycomb lung;

Q33.0 Congenital cystic lung disease; Congenital polycystic lung 21,700 6,510 15,190
RESPIRATORY TRACT
disease
Q33.2 Sequestration of lung 21,700 6,510 15,190
RESPIRATORY TRACT
Q33.3 Agenesis of lung; Absence of lung, lobe 21,700 6,510 15,190
RESPIRATORY TRACT
Q33.4 Congenital bronchiectasis 21,700 6,510 15,190
RESPIRATORY TRACT
Q33.6 Hypoplasia and dysplasia of lung 21,700 6,510 15,190
RESPIRATORY TRACT
Q34.1 Congenital cyst of mediastinum 21,700 6,510 15,190
RESPIRATORY TRACT
Other specified congenital malformations of respiratory CONGENITAL MALFORMATIONS OF THE LOWER
Q34.8 21,700 6,510 15,190
system; Atresia of nasopharynx RESPIRATORY TRACT
Congenital malformation of respiratory system,
Q34.9 unspecified; Congenital absence of respiratory organ ; 21,700 6,510 15,190
RESPIRATORY TRACT
Congenital anomaly NOS of respiratory organ
Choanal atresia; Absence of anterior nares; Absence of
CONGENITAL MALFORMATIONS OF THE NOSE,
Q30.0 posterior nares; congenital stenosis of anterior nares; 11,000 3,300 7,700
UPPER RESPIRATORY TRACT
Congenital stenosis of posterior nares
Agenesis and underdevelopment of nose; Congenital CONGENITAL MALFORMATIONS OF THE NOSE,
Q30.1 11,000 3,300 7,700
absence of nose UPPER RESPIRATORY TRACT
Q30.2 Fissured, notched and cleft nose 11,000 3,300 7,700
Q31.3 Laryngocele 11,000 3,300 7,700
Q31.5 Congenital laryngomalacia 11,000 3,300 7,700
Other congenital malformations of larynx; Absence of

cricoid cartilage, epiglottis, glottis, larynx or thyroid
cartilage; Agenesis of cricoid cartilage, epiglottis, glottis,
Q31.8 larynx or thyroid cartilage; Atresia of cricoid cartilage, 11,000 3,300 7,700
epiglottis, glottis, larynx or thyroid cartilage; Cleft thyroid
cartilage; Congenital stenosis of larynx NEC; Fissure of
epiglottis; Posterior cleft of cricoid cartilage

Q31.9 Congenital malformation of larynx, unspecified 11,000 3,300 7,700
CONGENITAL MALFORMATIONS OF THE ORAL
Q38.2 Macroglossia 4,000 1,200 2,800
CAVITY
Congenital malformations of palate, not elsewhere
CONGENITAL MALFORMATIONS OF THE ORAL
Q38.5 classified; Absence of uvula; Congenital malformation of 4,000 1,200 2,800
CAVITY
palate NOS; High arched palate
Other congenital malformations of mouth; Congenital CONGENITAL MALFORMATIONS OF THE ORAL
Q38.6 4,000 1,200 2,800
malformation of mouth NOS CAVITY
Other congenital malformations of pharynx; Congenital CONGENITAL MALFORMATIONS OF THE ORAL
Q38.8 4,000 1,200 2,800
malformation of pharynx NOS CAVITY
Q12.2 Coloboma of lens CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Page 22 of 127
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Case Rate
Fee Institution Fee
Q12.4 Spherophakia CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Other congenital corneal malformations; Congenital
Q13.4 malformation of cornea NOS; CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Microcornea; Peter's anomaly
Congenital malformation of vitreous humour; Congenital
Q14.0 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
vitreous opacity
Congenital malformation of retina; Congenital retinal
aneurysm
Congenital malformation of posterior segment of eye,
unspecified
Congenital glaucoma; Buphthalmos; Glaucoma of newborn;

Hydrophthalmos; Keratoglobus, congenital, with glaucoma;
Macrocornea with glaucoma; Macrophthalmos in
congenital glaucoma; Megalocornea with glaucoma
Q15.8 Other specified congenital malformations of eye CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Congenital malformation of eye, unspecified; Congenital

anomaly NOS of eye; Congenital deformity NOS of eye
P96.0 Congenital renal failure; Uraemia of newborn CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.0 Renal agenesis, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.1 Renal agenesis, bilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.2 Renal agenesis, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.3 Renal hypoplasia, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.5 Renal hypoplasia, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.6 Potter's syndrome CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Congenital single renal cyst; Congenital cyst of kidney;
Q61.0 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Single cyst of kidney
Polycystic kidney, autosomal recessive; Polycystic kidney,
infantile type
Polycystic kidney, autosomal dominant; Polycystic kidney,
adult type
Q61.3 Polycystic kidney, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.4 Renal dysplasia CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.5 Medullary cystic kidney; Sponge kidney NOS CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Other cystic kidney diseases; Fibrocystic kidney; Fibrocystic
renal degeneration or disease
Cystic kidney disease, unspecified; Meckel-Gruber
syndrome
Q62.0 Congenital hydronephrosis CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q62.7 Congenital vesico-uretero-renal reflux CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.0 Accessory kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.1 Lobulated, fused and horseshoe kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Ectopic kidney; Congenital displaced kidney; Malrotation of
kidney
Q63.3 Hyperplastic and giant kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Other specified congenital malformations of kidney;
Congenital renal calculi
Early cutaneous congenital syphilis: , Early mucocutaneous
congenital syphilis, Early visceral congenital syphilis; Early
congenital syphilitic laryngitis; Early congenital syphilitic
A50.0 oculopathy; Early congenital syphilitic CONGENITAL SYPHILIS 12,800 3,840 8,960
osteochondropathy; Early congenital syphilitic pharyngitis;
Early congenital syphilitic pneumonia; Early congenital
syphilitic rhinitis
Early congenital syphilis, unspecified; Congenital syphilis
A50.2 CONGENITAL SYPHILIS 12,800 3,840 8,960
NOS less than two years after birth.
Late congenital neurosyphilis [juvenile neurosyphilis];

A50.4 Dementia paralytica juvenilis; Juvenile general paresis ; CONGENITAL SYPHILIS 12,800 3,840 8,960
Juvenile tabes dorsalis; Juvenile taboparetic neurosyphilis
Other late congenital syphilis, symptomatic; Syphilitic

A50.5 CONGENITAL SYPHILIS 12,800 3,840 8,960
saddle nose
A50.9 Congenital syphilis, unspecified CONGENITAL SYPHILIS 12,800 3,840 8,960
Atresia and stenosis of ureter; Congenital occlusion of
ureter; Congenital occlusion of ureteropelvic junction;
Q62.1 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Congenital occlusion of ureterovesical orifice; Impervious
ureter
Q62.2 Congenital megaloureter; Congenital dilatation of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Other obstructive defects of renal pelvis and ureter;

Congenital ureterocele
Q62.5 Duplication of ureter; Accessory of ureter, Double of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Page 23 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malposition of ureter; Deviation of ureter or ureteric
orifice; Displacement of ureter or ureteric orifice; Ectopic of
ureter or ureteric orifice; Implantation, anomalous of
ureter or ureteric orifice
Exstrophy of urinary bladder; Ectopia vesicae; Extroversion
of bladder
Q64.2 Congenital posterior urethral valves CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Other atresia and stenosis of urethra and bladder neck;

Congenital bladder neck obstruction; Congenital stricture of
urethra; Congenital stricture of urinary meatus; Congenital
stricture of vesicourethral orifice; Impervious urethra
Malformation of urachus; Cyst of urachus; Patent urachus;

Prolapse of urachus
Other congenital malformations of bladder and urethra;

Accessory bladder; Accessory urethra; Congenital hernia of
bladder; Congenital malformation of bladder or urethra
Q64.7 NOS; Congenital prolapse of bladder (mucosa); Congenital CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
prolapse of urethra; Congenital prolapse of urinary meatus;
Congenital prolapse of urethrorectal fistula; Double
urethra; Double urinary meatus
Q64.8 Other specified congenital malformations of urinary system CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Congenital malformation of urinary system, unspecified;

Q64.9 Congenital anomaly NOS of urinary system; Congenital CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
deformity NOS of urinary system
Q27.1 Congenital renal artery stenosis CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Peripheral arteriovenous malformation; Arteriovenous
Q27.3 CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
aneurysm
Other specified congenital malformations of peripheral
vascular system; Aberrant subclavian artery; Absence of
Q27.8 artery or vein NEC; Atresia of artery or vein NEC; Congenital CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
aneurysm (peripheral); Congenital stricture, artery;
Congenital varix
Congenital malformation of peripheral vascular system,
Q27.9 CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
unspecified; Anomaly of artery or vein NOS
Arteriovenous malformation of precerebral vessels;
Q28.0 Congenital arteriovenous precerebral aneurysm CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
(nonruptured)
Other malformations of precerebral vessels; Congenital
Q28.1 malformation of precerebral vessels NOS; Congenital CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
precerebral aneurysm (nonruptured)
Arteriovenous malformation of cerebral vessels;

Q28.2 Arteriovenous malformation of brain NOS; CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Congenital arteriovenous cerebral aneurysm (nonruptured)
Other malformations of cerebral vessels; Congenital

Q28.3 cerebral aneurysm, nonruptured; Congenital malformation CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
of cerebral vessels NOS
M30.0 Polyarteritis nodosa CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Polyarteritis with lung involvement [Churg-Strauss]; Allergic
M30.1 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
granulomatous angiitis
M30.2 Juvenile polyarteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M30.3 Mucocutaneous lymph node syndrome [Kawasaki] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Other conditions related to polyarteritis nodosa;
Polyangiitis overlap syndrome
M31.0 Hypersensitivity angiitis; Goodpasture's syndrome CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Thrombotic microangiopathy; Thrombotic
thrombocytopenic purpura
M31.2 Lethal midline granuloma CONNECTIVE TISSUE DISEASES N/A N/A N/A
Wegener's granulomatosis; Necrotizing respiratory
granulomatosis
M31.4 Aortic arch syndrome [Takayasu] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.6 Other giant cell arteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Other specified necrotizing vasculopathies;
Hypocomplementaemic vasculitis
M31.9 Necrotizing vasculopathy, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.0 Juvenile dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.1 Other dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.2 Polymyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.9 Dermatopolymyositis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M34.0 Progressive systemic sclerosis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
CR(E)ST syndrome; Combination of calcinosis, Raynaud's
M34.1 phenomenon, (o)esophageal dysfunction, CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
sclerodactyly, telangiectasia
M34.2 Systemic sclerosis induced by drugs and chemicals CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Page 24 of 127
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Case Rate
Fee Institution Fee
M34.9 Systemic sclerosis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.0 Sicca syndrome [SJÖGREN] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.1 Other overlap syndromes; Mixed connective tissue disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.2 Behçet's disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

M35.3 Polymyalgia rheumatica CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.4 Diffuse (eosinophilic) fasciitis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.8 Other specified systemic involvement of connective tissue CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Systemic involvement of connective tissue, unspecified;

M35.9 Systemic Autoimmune disease NOS; Collagen (vascular) CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
disease NOS
Trigeminal neuralgia; Syndrome of paroxysmal facial pain;
G50.0 CRANIAL NERVE DISORDER 7,400 2,220 5,180
Tic douloureux
G50.8 Other disorders of trigeminal nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.0 Bell's palsy; Facial palsy CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.1 Geniculate ganglionitis CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.3 Clonic hemifacial spasm CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.4 Facial myokymia CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.8 Other disorders of facial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.9 Disorder of facial nerve, unspecified CRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.0 Disorders of olfactory nerve; Disorder of 1st cranial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
Disorders of glossopharyngeal nerve; Disorder of 9th

cranial nerve; Glossopharyngeal neuralgia
Disorders of vagus nerve; Disorder of pneumogastric [10th]
nerve
G52.7 Disorders of multiple cranial nerves; Polyneuritis cranialis CRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.8 Disorders of other specified cranial nerves CRANIAL NERVE DISORDER 7,400 2,220 5,180
Optic neuritis; Optic neuropathy, except ischaemic; Optic
H46 CRANIAL NERVE DISORDER 7,400 2,220 5,180
papillitis; Retrobulbar neuritis NOS
Disorders of optic nerve, not elsewhere classified;
H47.0 Compression of optic nerve; Haemorrhage in optic nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
sheath; Ischaemic optic neuropathy
Acute obstructive laryngitis [croup]; Obstructive laryngitis
J05.0 CROUP 8,200 2,460 5,740
NOS
Pituitary-dependent Cushing's disease; Overproduction of

E24.0 CUSHING'S SYNDROME 9,500 2,850 6,650
pituitary ACTH; Pituitary-dependent hyperadrenocorticism
E24.1 Nelson's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650

E24.2 Drug-induced Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.3 Ectopic ACTH syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.8 Other Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.9 Cushing's syndrome, unspecified CUSHING'S SYNDROME 9,500 2,850 6,650
E84.0 Cystic fibrosis with pulmonary manifestations CYSTIC FIBROSIS 7,300 2,190 5,110
E84.1 Cystic fibrosis with intestinal manifestations CYSTIC FIBROSIS 7,300 2,190 5,110
Cystic fibrosis with other manifestations; Cystic fibrosis with
E84.8 CYSTIC FIBROSIS 7,300 2,190 5,110
combined manifestations
E84.9 Cystic fibrosis, unspecified CYSTIC FIBROSIS 7,300 2,190 5,110
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
G30.0 Alzheimer's disease with early onset 10,000 3,000 7,000
SYSTEM
G30.1 Alzheimer's disease with late onset 10,000 3,000 7,000
SYSTEM
G30.8 Other Alzheimer's disease 10,000 3,000 7,000
SYSTEM
G30.9+F00.9* Dementia in alzheimer's disease, unspecified 10,000 3,000 7,000
SYSTEM
Circumscribed brain atrophy; Pick's disease; Progressive DEGENERATIVE DISEASES OF CENTRAL NERVOUS
G31.0 10,000 3,000 7,000
isolated aphasia SYSTEM
G31.1 Senile degeneration of brain, not elsewhere classified 10,000 3,000 7,000
SYSTEM
Degeneration of nervous system due to alcohol; Alcoholic

cerebellar ataxia; Alcoholic cerebellar degeneration; DEGENERATIVE DISEASES OF CENTRAL NERVOUS
G31.2 10,000 3,000 7,000
Alcoholic cerebral degeneration; Alcoholic encephalopathy; SYSTEM
Dysfunction of autonomic nervous system due to alcohol
Other specified degenerative diseases of nervous system;

Grey-matter degeneration [Alpers]; Lewy body (ies) DEGENERATIVE DISEASES OF CENTRAL NERVOUS
G31.8 10,000 3,000 7,000
dementia; Lewy body (ies) disease; Subacute necrotizing SYSTEM
encephalopathy [Leigh]
Other specified degenerative disorders of nervous system DEGENERATIVE DISEASES OF CENTRAL NERVOUS
G32.8* 10,000 3,000 7,000
in diseases classified elsewhere SYSTEM
Multiple sclerosis; Multiple sclerosis NOS; Multiple

DEMYELINATING DISEASE OF CENTRAL NERVOUS
G35 sclerosis of brain stem; Multiple sclerosis of cord; Multiple 11,600 3,480 8,120
SYSTEM
sclerosis, disseminated; Multiple sclerosis, generalized
Page 25 of 127
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Case Rate
Fee Institution Fee
Neuromyelitis optica [Devic]; Demyelination in optic DEMYELINATING DISEASE OF CENTRAL NERVOUS
G36.0 11,600 3,480 8,120
neuritis SYSTEM
Acute and subacute haemorrhagic leukoencephalitis DEMYELINATING DISEASE OF CENTRAL NERVOUS
G36.1 11,600 3,480 8,120
[Hurst] SYSTEM
G36.8 Other specified acute disseminated demyelination 11,600 3,480 8,120
SYSTEM
G36.9 Acute disseminated demyelination, unspecified 11,600 3,480 8,120
SYSTEM
G37.0 Diffuse sclerosis; Periaxial encephalitis; Schilder's disease 11,600 3,480 8,120
SYSTEM
G37.1 Central demyelination of corpus callosum 11,600 3,480 8,120
SYSTEM
G37.2 Central pontine myelinolysis 11,600 3,480 8,120
SYSTEM
Acute transverse myelitis in demyelinating disease of DEMYELINATING DISEASE OF CENTRAL NERVOUS
G37.3 11,600 3,480 8,120
central nervous system; Acute transverse myelitis NOS SYSTEM
G37.4 Subacute necrotizing myelitis 11,600 3,480 8,120
SYSTEM
Other specified demyelinating diseases of central nervous DEMYELINATING DISEASE OF CENTRAL NERVOUS
G37.8 11,600 3,480 8,120
system SYSTEM
Demyelinating disease of central nervous system,
G37.9 unspecified 11,600 3,480 8,120
SYSTEM
Brain sclerosis
Dengue without warning signs: Dengue fever (DF) Dengue
A97.0 haemorrhagic fever Grades 1 and 2; Dengue haemorrhagic DENGUE FEVER 10,000 3,000 7,000
fever without warning signs
Dengue with warning sings; Dengue haemorrhagic fever
A97.1 DENGUE FEVER 10,000 3,000 7,000
with warning signs
Severe Dengue; Severe Dengue fever; Severe Dengue
A97.2 DENGUE, SEVERE 16,000 4,800 11,200
haemorrhagic fever
E23.2 Diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070
N25.1 Nephrogenic diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070
Insulin-dependent diabetes mellitus with coma; Brittle

diabetes (mellitus) with coma; Juvenile-onset diabetes
E10.0 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
(mellitus) withcoma ; Ketosis-prone diabetes (mellitus)
with coma; Type I diabetes (mellitus) with coma;
Insulin-dependent diabetes mellitus with acididosis/

ketoacidosis without mention of coma; Diabetic acididosis
without mention of coma; Diabetic ketoacidosis without
mention of coma;
Non-insulin-dependent diabetes mellitus with coma;

Nonobese diabetes (mellitus) With coma ; Obese diabetes
mellitus With coma ; Adult-onset diabetes mellitus With
E11.0 coma ; Maturity-onset diabetes mellitus With coma ; DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
Nonketotic diabetes mellitus With coma; Stable diabetes
mellitus with coma; Type II diabetes mellitus with coma;
Non-insulin-dependent diabetes of the young
Non-insulin-dependent diabetes mellitus with ketoacidosis

without mention of coma; ; Nonobese diabetes (mellitus)
With ketoacidosis without mention of coma; Obese
diabetes mellitus With ketoacidosis without mention of
coma; Adult-onset diabetes mellitus without mention of
coma; Maturity-onset diabetes mellitus without mention of
coma; Nonketotic diabetes mellitus without mention of
coma; Stable diabetes mellitus without mention of coma;
Type II diabetes mellitus without mention of coma; Non-
insulin-dependent diabetes of the young
Malnutrition-related diabetes mellitus with coma; Insulin-

dependent malnutrition-related diabetes mellitus with
coma ; Non-insulin-dependent malnutrition-related
diabetes mellitus with coma
E13.0 Other specified diabetes mellitus with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
Other specified diabetes mellitus with acididosis/
ketoacidosis without mention of coma
E14.0 Unspecified diabetes mellitus; diabetes NOS with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
Unspecified diabetes mellitus; diabetes NOS with
acididosis/ ketoacidosis without mention of coma
Insulin-dependent diabetes mellitus with Diabetic DIABETES MELLITUS WITH COMPLICATIONS
E10.5 12,600 3,780 8,820
gangrene/ ulcer OTHER THAN COMA AND KETOSIS
Insulin-dependent diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS
E10.6 12,600 3,780 8,820
complications OTHER THAN COMA AND KETOSIS
Insulin-dependent diabetes mellitus with multiple DIABETES MELLITUS WITH COMPLICATIONS
E10.7 12,600 3,780 8,820
Page 26 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Insulin-dependent diabetes mellitus with unspecified DIABETES MELLITUS WITH COMPLICATIONS
E10.8 12,600 3,780 8,820
Non-insulin-dependent diabetes mellitus with Diabetic

gangrene/ ulcer; Nonobese diabetes (mellitus) with
Diabetic gangrene/ ulcer; Obese diabetes mellitus with
Diabetic gangrene/ ulcer; Adult-onset diabetes mellitus
with Diabetic gangrene/ ulcer; Maturity -onset diabetes DIABETES MELLITUS WITH COMPLICATIONS
E11.5 12,600 3,780 8,820
mellitus with Diabetic gangrene/ulcer; Nonketotic diabetes OTHER THAN COMA AND KETOSIS
mellitus with Diabetic gangrene/ulcer; Stable diabetes
mellitus with diabetic gangrene/ulcer; Type II diabetes
mellitus with diabetic gangrene/ulcer; Non-insulin-
dependent diabetes of the young
Non-insulin-dependent diabetes mellitus with other DIABETES MELLITUS WITH COMPLICATIONS

E11.6 12,600 3,780 8,820
specified complications OTHER THAN COMA AND KETOSIS
Non-insulin-dependent diabetes mellitus with multiple
complications ; Nonobese diabetes (mellitus) With
DIABETES MELLITUS WITH COMPLICATIONS
E11.7 multiple complications ; Obese diabetes mellitus With 12,600 3,780 8,820
OTHER THAN COMA AND KETOSIS
multiple complications ; Adult-onset diabetes mellitus
With multiple complications ; Matur
Malnutrition-related diabetes mellitus with Diabetic
gangrene/ ulcer; Insulin-dependent malnutrition-related
E12.5 diabetes mellitus with Diabetic gangrene/ ulcer; Non- 12,600 3,780 8,820
insulin-dependent malnutrition-related diabetes mellitus
with Diabetic gangrene/ ulcer
Malnutrition-related diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS
E12.6 12,600 3,780 8,820
Malnutrition-related diabetes mellitus with unspecified

complications; Insulin-dependent malnutrition-related
E12.8 diabetes mellitus with unspecified complications; Non- 12,600 3,780 8,820
insulin-dependent malnutrition-related diabetes mellitus
with unspecified complications
Other specified diabetes mellitus with Diabetic gangrene/ DIABETES MELLITUS WITH COMPLICATIONS
E13.5 12,600 3,780 8,820
ulcer OTHER THAN COMA AND KETOSIS
Other specified diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS
E13.6 12,600 3,780 8,820
Unspecified diabetes mellitus; diabetes NOS with Diabetic DIABETES MELLITUS WITH COMPLICATIONS
E14.5 12,600 3,780 8,820
gangrene/ ulcer OTHER THAN COMA AND KETOSIS
Unspecified diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS
E14.6 12,600 3,780 8,820
Unspecified diabetes mellitus; diabetes NOS with multiple DIABETES MELLITUS WITH COMPLICATIONS
E14.7 12,600 3,780 8,820
Pharyngeal diphtheria; Diphtheritic membranous angina;
A36.0 DIPHTHERIA 8,700 2,610 6,090
Tonsillar diphtheria
A36.3 Cutaneous diphtheria DIPHTHERIA 8,700 2,610 6,090
A36.9 Diphtheria, unspecified DIPHTHERIA 8,700 2,610 6,090
Agranulocytosis; Agranulocytic angina; Infantile genetic
agranulocytosis; Kostmann's disease;
Neutropenia NOS; Congenital Neutropenia; Cyclic DISEASES OF BLOOD AND BLOOD FORMING
D70 12,100 3,630 8,470
Neutropenia; Drug-induced Neutropenia; Periodic ORGANS
Neutropenia; Primary Splenic Neutropenia; Toxic
Neutropenia; Neutropenic splenomegaly
Functional disorders of polymorphonuclear neutrophils;
Cell membrane receptor complex [CR3] defect; Chronic
DISEASES OF BLOOD AND BLOOD FORMING
D71 (childhood) granulomatous disease; 12,100 3,630 8,470
ORGANS
Congenital dysphagocytosis; Progressive septic
granulomatosis; Other disorders of white blood cells
Genetic anomalies of leukocytes; Alder Granulation

Anomaly or Syndrome; Alder Granulocyte Anomaly or
Syndrome; May-Hegglin Granulation Anomaly or
D72.0 Syndrome; May-Hegglin Granulocyte Anomaly or 12,100 3,630 8,470
ORGANS
Syndrome; Pelger-Huët Granulocyte Anomaly or
Syndrome; Hereditary leukocytic: hypersegmentation,;
hyposegmentation ; Hereditary leukomelanopathy
Other specified disorders of white blood cells; Lymphocytic

Leukaemoid reaction; Monocytic Leukaemoid reaction;
D72.8 Myelocytic Leukaemoid reaction; Leukocytosis; 12,100 3,630 8,470
ORGANS
Symptomatic Lymphocytosis; Lymphopenia; Symptomatic
Monocytosis;Plasmacytosis

D73.2 Chronic congestive splenomegaly 12,100 3,630 8,470
ORGANS
D73.3 Abscess of spleen 12,100 3,630 8,470
ORGANS
Page 27 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
D73.4 Cyst of spleen 12,100 3,630 8,470
ORGANS
Infarction of spleen; Nontraumatic Splenic rupture; Torsion DISEASES OF BLOOD AND BLOOD FORMING
D73.5 12,100 3,630 8,470
of spleen ORGANS
Other diseases of spleen; Fibrosis of spleen NOS; DISEASES OF BLOOD AND BLOOD FORMING
D73.8 12,100 3,630 8,470
Perisplenitis; Splenitis NOS ORGANS
D74.9 Methaemoglobinaemia, unspecified 12,100 3,630 8,470
ORGANS
Familial erythrocytosis; Benign Polycythaemia; Familial DISEASES OF BLOOD AND BLOOD FORMING
D75.0 12,100 3,630 8,470
Polycythaemia ORGANS
Secondary polycythaemia; Acquired Polycythaemia due to
erythropoietin; Acquired Polycythaemia due to fall in
plasma volume; Acquired Polycythaemia due to high DISEASES OF BLOOD AND BLOOD FORMING
D75.1 12,100 3,630 8,470
altitude; Acquired Polycythaemia due to stress; Emotional ORGANS
Polycythaemia; Hypoxaemic Polycythaemia; nephrogenous
Polycythaemia; relative Polycythaemia
D75.2 Essential thrombocytosis 12,100 3,630 8,470
ORGANS
D75.8 Other specified diseases of blood and blood-forming organs 12,100 3,630 8,470
ORGANS
D76.0 Langerhans' cell histiocytosis, not elsewhere classified 12,100 3,630 8,470
ORGANS
Haemophagocytic lymphohistiocytosis; Eosinophilic
D76.1 granuloma; Hand-Schüller-Christian disease; Chronic 12,100 3,630 8,470
ORGANS
Histiocytosis X
D76.2 Haemophagocytic syndrome, infection-associated 12,100 3,630 8,470
ORGANS
Other histiocytosis syndromes; Reticulohistiocytoma (giant-
D76.3 cell); Sinus histiocytosis with massive lymphadenopathy; 12,100 3,630 8,470
ORGANS
Xanthogranuloma
Oesophagitis; Abscess of oesophagus; Oesophagitis NOS;
K20 DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Chemical oesophagitis; Peptic oesophagitis
K22.0 Achalasia of cardia; Achalasia NOS; Cardiospasm DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Ulcer of oesophagus; Erosion of oesophagus; Ulcer of

oesophagus NOS; Ulcer of oesophagus due to ingestion of
K22.1 chemicals; Ulcer of oesophagus due to ingestion of drugs DISEASES OF ESOPHAGUS 8,300 2,490 5,810
and medicaments; Fungal ulcer of oesophagus; Peptic ulcer
of oesophagus; Ulcerative oesophagitis
Oesophageal obstruction; Oesophageal web (acquired);

K22.2 Compression of oesophagus; Constriction of oesophagus; DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Stenosis of oesophagus; Stricture of oesophagus
K22.3 Perforation of oesophagus; Rupture of oesophagus DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Dyskinesia of oesophagus; Corksrew oesophagus; Diffuse
K22.4 DISEASES OF ESOPHAGUS 8,300 2,490 5,810
oesophageal spasm; Spasm of oesophagus
Gastro-oesophageal laceration-haemorrhage syndrome;
Mallory-Weiss syndrome
K22.7 Barrett's esophagus; Barret's disease; Barett's syndrome DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Other specified diseases of oesophagus; Haemorrhage of

oesophagus NOS
K22.9 Disease of oesophagus, unspecified DISEASES OF ESOPHAGUS 8,300 2,490 5,810
Cellulitis of external ear; Cellulitis of auricle; Cellulitis of
H60.1 DISEASES OF EXTERNAL EAR 9,000 2,700 6,300
external auditory canal
H60.2 Malignant otitis externa DISEASES OF EXTERNAL EAR 9,000 2,700 6,300
Other infective otitis externa; diffuse Otitis externa ;
Haemorrhagic Otitis externa ; Swimmer's ear
Cholesteatoma of external ear; Keratosis obturans of
external ear (canal)
H83.0 Labyrinthitis DISEASES OF INNER EAR 6,200 1,860 4,340
H83.8 Other specified diseases of inner ear DISEASES OF INNER EAR 6,200 1,860 4,340
Obstruction of Eustachian tube; Compression of
H68.1 Eustachian tube; Stenosis of Eustachian tube; Stricture of DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Eustachian tube
H69.9 Eustachian tube disorder, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Acute mastoiditis; Abscess of mastoid; Empyema of
H70.0 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
mastoid
H70.1 Chronic mastoiditis; Caries of mastoid; Fistula of mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Petrositis; Acute inflammation of petrous bone; Chronic

H70.2 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
inflammation of petrous bone
H70.8 Other mastoiditis and related conditions DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.9 Mastoiditis, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Page 28 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Cholesteatoma of middle ear; Cholesteatoma tympani;
Perforation of tympanic membrane; Persistent post-
H71 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
traumatic perforation of ear drum; Postinflammatory
perforation of ear drum
H73.0 Acute myringitis; Acute tympanitis; Bullous myringitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.1 Chronic myringitis; Chronic tympanitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.8 Other specified disorders of tympanic membrane DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.9 Disorder of tympanic membrane, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H74.8 Other specified disorders of middle ear and mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H74.9 Disorder of middle ear and mastoid, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Developmental odontogenic cysts; Dentigerous cyst;
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K09.0 Eruption Cyst; Follicular cyst; Gingival cyst; Lateral 8,300 2,490 5,810
AND JAW
periodontal cyst; Primordial cyst; Keratocyst
Developmental (nonodontogenic) cysts of oral region; Cyst

K09.1 of globulomaxillary; Cyst of incisive canal; Cyst of median 8,300 2,490 5,810
AND JAW
palatal; Cyst of nasopalatine; Cyst of palatine papilla
Other cysts of jaw; Cyst of jaw NOS; Aneurysmal cyst of DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K09.2 8,300 2,490 5,810
jaw; Haemorrhagic cyst of jaw; Traumatic cyst of jaw AND JAW
Other cysts of oral region, not elsewhere classified;

Dermoid cyst of mouth; Epidermoid cyst of mouth; DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K09.8 8,300 2,490 5,810
Lymphoepithelial cyst of mouth; Epstein's pearl; AND JAW
Nasoalveolar cyst; Nasolabial cyst
K09.9 Cyst of oral region, unspecified 8,300 2,490 5,810
AND JAW
Developmental disorders of jaws; Latent bone cyst of jaw; DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K10.0 8,300 2,490 5,810
Stafne's cyst; Torus mandibularis; Torus palatinus AND JAW
K10.1 Giant cell granuloma, central; Giant cell granuloma NOS 8,300 2,490 5,810
AND JAW
Inflammatory conditions of jaws; Acute osteitis of jaw;

Chronic osteitis of jaw; Supparative osteitis of jaw; Acute
neonatal osteomyelitis of jaw; Chronic neonatal
osteomyelitis of jaw; Supparative neonatal osteomyelitis of DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K10.2 8,300 2,490 5,810
jaw; Acute osteoradionecrosis of jaw; chronic AND JAW
osteoradionecrosis of jaw; Suppurative osteoradionecrosis
of jaw; Acute periostitis of jaw; Chronic periortitis of jaw;
Suppurative periortitis of jaw; Sequestrum, of jaw bone

K10.3 Alveolitis of jaws; Alveolar osteitis; Dry socket 8,300 2,490 5,810
AND JAW
Other specified diseases of jaws; Cherubism of jaw;
K10.8 Exostosis of jaw; Fibrous dysplasia of jaw; Unilateral 8,300 2,490 5,810
AND JAW
condylar hyperplasia; Unilateral condylar hypoplasia
K11.2 Sialoadenitis 8,300 2,490 5,810
AND JAW
K11.3 Abscess of salivary gland 8,300 2,490 5,810
AND JAW
K11.4 Fistula of salivary gland 8,300 2,490 5,810
AND JAW
Sialolithiasis; Calculus of salivary gland or duct; Stone of DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K11.5 8,300 2,490 5,810
salivary gland or duct AND JAW
Mucocele of salivary gland; Mucous extravasation cyst of
K11.6 salivary gland; Mucous retention cyst of salivary gland; 8,300 2,490 5,810
AND JAW
Ranula
Other diseases of salivary glands; Benign lymphoepithelial
lesion of salivary gland; Mikulicz' disease; Necrotizing DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K11.8 8,300 2,490 5,810
sialometaplasia; Sialectasia; Stenosis of salivary duct; AND JAW
Stricture of salivary duct
K11.9 Disease of salivary gland, unspecified; Sialoadenopathy NOS 8,300 2,490 5,810
AND JAW
Cellulitis and abscess of mouth; Cellulitis of floor of mouth; DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K12.2 8,300 2,490 5,810
Submandibular abscess AND JAW
Granuloma and granuloma-like lesions of oral mucosa;
Eosinophilic granuloma of oral mucosa; Granuloma DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K13.4 8,300 2,490 5,810
pyogenicum of oral mucosa; Verrucous xanthoma of oral AND JAW
mucosa
Other and unspecified lesions of oral mucosa; Focal oral DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
K13.7 8,300 2,490 5,810
mucinosis AND JAW
K31.1 Adult hypertrophic pyloric stenosis; Pyloric stenosis NOS DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.2 Hourglass stricture and stenosis of stomach DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.3 Pylorospasm, not elsewhere classified DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.4 Gastric diverticulum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
Obstruction of duodenum; Constriction of duodenum;
K31.5 Stenosis of duodenum; Stricture of duodenum; Chronic DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
duodenal ileus
Page 29 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Fistula of stomach and duodenum; Gastrocolic fistula;
K31.6 DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
Gastrojejunocolic fistula
K31.7 Polyp of stomach and duodenum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
Other specified diseases of stomach and duodenum;
K31.8 Achlorhydria; Gastroptosis; Hourglass contraction of DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
stomach
DISEASES OF THE GALLBLADDER AND BILIARY
K74.4 Secondary biliary cirrhosis 9,800 2,940 6,860
TRACT
K74.5 Biliary cirrhosis, unspecified 9,800 2,940 6,860
TRACT
Calculus of gallbladder without cholecystitis;

Cholecystolithiasis unspecified or without cholecystitis;
Cholelithiasis unspecified or without cholecystitis;
K80.2 Recurrent colic of gallbladder unspecified or without 9,800 2,940 6,860
TRACT
cholecystitis; Impacted gallstone of cystic duct unspecified
or without cholecystitis; impacted gallstone of gallbladder
unspecified or without cholecystitis
Calculus of bile duct without cholangitis or cholecystitis;

Choledocholithiasis unspecified or without cholangitis or
cholecystitis; Impacted gallstone of bile duct NOS
unspecified or without cholangitis or cholecystitis;
Impacted gallstone of common duct unspecified or without DISEASES OF THE GALLBLADDER AND BILIARY
K80.5 9,800 2,940 6,860
cholangitis or cholecystitis; Impacted gallstone of hepatic TRACT
duct unspecified or without cholangitis or cholecystitis;
Hepatic cholelithiasis unspecified or without cholangitisor
cholecystitis; Hepatic recurrent colic unspecified or without
cholangitis or cholecystitis

K80.8 Other cholelithiasis 9,800 2,940 6,860
TRACT
Obstruction of gallbladder; Occlusion of cystic duct of
gallbladder without calculus; Stenosis of cystic duct or DISEASES OF THE GALLBLADDER AND BILIARY
K82.0 9,800 2,940 6,860
gallbladder without calculus; Stricture of cystic duct or TRACT
gallbladder without calculus
K82.1 Hydrops of gallbladder; Mucocele of gallbladder 9,800 2,940 6,860
TRACT
Perforation of gallbladder; Rupture of cystic duct or DISEASES OF THE GALLBLADDER AND BILIARY
K82.2 9,800 2,940 6,860
gallbladder TRACT
Fistula of gallbladder; Cholecystocolic fistula; DISEASES OF THE GALLBLADDER AND BILIARY
K82.3 9,800 2,940 6,860
Cholecystoduodenal fistula TRACT
K82.4 Cholesterolosis of gallbladder; Strawberry gallbladder 9,800 2,940 6,860
TRACT
Other specified diseases of gallbladder; Adhesions of cystic
duct or gallbladder; Atrophy of cystic duct or gallbladder;
Cyst of cystic duct or gallbladder; Dyskinesia of cystic duct DISEASES OF THE GALLBLADDER AND BILIARY
K82.8 9,800 2,940 6,860
or gallbladder; Hypertrophy of cystic duct or gallbladder; TRACT
Nonfunctioning of cystic duct or gallbladder; Ulcer of cystic
duct or gallbladder
Cholangitis; Cholangitis NOS; Ascending cholangitis;
Primary cholangitis; Recurrent cholangitis; Sclerosing DISEASES OF THE GALLBLADDER AND BILIARY
K83.0 9,800 2,940 6,860
cholangitis; Secondary cholangitis; Stenosing cholangitis; TRACT
Suppurative cholangitis
Obstruction of bile duct; Occlusion of bile duct without
K83.1 calculus; Stenosis of bile duct without calculus; Stricture of 9,800 2,940 6,860
TRACT
bile duct without calculus
K83.3 Fistula of bile duct; Choledochoduodenal fistula 9,800 2,940 6,860
TRACT
K83.4 Spasm of sphincter of Oddi 9,800 2,940 6,860
TRACT
K83.5 Biliary cyst 9,800 2,940 6,860
TRACT
Other specified diseases of biliary tract; Adhesions of bile
K83.8 duct; Atrophy of bile duct; Hypertrophy of bile duct; Ulcer 9,800 2,940 6,860
TRACT
of bile duct
Acute pancreatitis; Abscess of pancreas; Acute necrosis of

pancreas; Infective necrosis of pancreas; Pancreatitis NOS;
K85 DISEASES OF THE PANCREAS 12,600 3,780 8,820
Acute recurrent pancreatitis; Haemorrhagic pancreatitis;
Subacute pancreatitis; Supparative pancreatitis
K85.0 Idiopathic acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.1 Biliary acute pancreatitis; Gallstone pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.2 Alcohol-induced acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.8 Other acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.9 Acute pancreatitis, unspecified; Other diseases of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.0 Alcohol-induced chronic pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
Page 30 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other chronic pancreatitis; Chronic pancreatitis NOS;
K86.1 Infectious chronic pancreatitis; Recurrent chronic DISEASES OF THE PANCREAS 12,600 3,780 8,820
pancreatitis; Relapsing chronic pancreatitis
K86.2 Cyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.3 Pseudocyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
Other specified diseases of pancreas; Atrophy of pancreas;

Calculus of pancreas; Cirrhosis of pancreas; Fibrosis of
K86.8 DISEASES OF THE PANCREAS 12,600 3,780 8,820
pancreas; Pancreatic infantilism; Pancreatic necrosis NOS;
Aseptic pancreatic necrosis; Fat necrosis of pancreas
Other specified diseases of pulmonary vessels; Rupture of

I28.8 pulmonary vessel; Stenosis of pulmonary vessel; Stricture DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
of pulmonary vessel
Dissection of aorta [anypart]; Dissecting aneurysm of aorta
I71.0 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
(ruptured) [any part]
Aortic aneurysm of unspecified site without mention of
I71.9 rupture; Aneurysm of aorta; Dilatation of aorta; Hyaline DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
necrosis of aorta
Embolism and thrombosis of abdominal aorta; Aortic
bifurcation syndrome; Leriche's syndrome
Embolism and thrombosis of other and unspecified parts of
aorta
I74.2 Embolism and thrombosis of arteries of upper extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.3 Embolism and thrombosis of arteries of lower extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
Embolism and thrombosis of arteries of extremities,

unspecified; Peripheral arterial embolism
I74.5 Embolism and thrombosis of iliac artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.8 Embolism and thrombosis of other arteries DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.9 Embolism and thrombosis of unspecified artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.4 Coeliac artery compression syndrome DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.6 Arteritis, unspecified; Aortitis NOS; Endarteritis NOS DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.8 Other specified disorders of arteries and arterioles DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I85.0 Oesophageal varices with bleeding DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
Compression of vein; Stricture of vein; Inferior Vena cava
syndrome; Superior vena cava syndrome
Disseminated chorioretinal inflammation; Disseminated
H30.1 chorioretinitis; Disseminated choroiditis; Disseminated DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
retinitis; Disseminated retinochoroiditis
H30.8 Other chorioretinal inflammations; Harada's disease DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
Choroidal haemorrhage and rupture; Choroidal
H31.3 DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
haemorrhage NOS; Choroidal haemorrhage expulsive
M80.0 Postmenopausal osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M80.1 Postoophorectomy osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Postsurgical malabsorption osteoporosis with pathological

M80.3 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
fracture
M81.0 Postmenopausal osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.08 Postmenopausal osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.1 Postoophorectomy osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.4 Drug-induced osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.40 Drug-induced osteoporosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.55 Idiopathic osteoporosis Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.58 Idiopathic osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.6 Localized osteoporosis [Lequesne] DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.8 Other osteoporosis; Senile osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Other osteoporosis; Senile osteoporosis Other, head,
neck,ribs,skull,trunk,vertebral column
M81.89 Other osteoporosis; Senile osteoporosis Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.9 Osteoporosis, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.95 Osteoporosis, Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.98 Osteoporosis, Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Adult osteomalacia due to malabsorption; Postsurgical
malabsorption osteomalacia in adults
M83.4 Aluminium bone disease DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.8 Other adult osteomalacia DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.87 Other adult osteomalacia Ankle and foot DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.89 Other adult osteomalacia Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.9 Adult osteomalacia, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.99 Adult osteomalacia, unspecified Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.0 Fibrous dysplasia (monostotic) DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.1 Skeletal fluorosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.2 Hyperostosis of skull DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.5 Aneurysmal bone cyst DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Page 31 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M85.55 Aneurysmal bone cyst Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.6 Other cyst of bone DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.63 Other cyst of bone Forearm DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.65 Other cyst of bone Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Other specified disorders of bone density and structure;
Hyperostosis of bones, except skull
Other specified disorders of bone density and structure;
Hyperostosis of bones, except skull Other
M89.38 Hypertrophy of bone Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Other sphingolipidosis; Fabry(-Anderson) Disease; Gaucher
Disease; Krabbe Disease; Niemann-Pick Disease; Faber's
E75.2 DISORDER OF LIPID STORAGE 8,100 2,430 5,670
syndrome; Metachromatic leukodystrophy; Sulfatase
deficiency
Neuronal ceroid lipofuscinosis; Batten Disease;
E75.4 Bielschowsky-Jansky Disease; Kufs Disease; pielmeyer-Vogt DISORDER OF LIPID STORAGE 8,100 2,430 5,670
Disease
Other lipid storage disorders; Cerebrotendinous
E75.5 cholesterosis [van Bogaert-Scherer-Epstein]; Wolman's DISORDER OF LIPID STORAGE 8,100 2,430 5,670
disease
E75.6 Lipid storage disorder, unspecified DISORDER OF LIPID STORAGE 8,100 2,430 5,670
N95.0 Postmenopausal bleeding DISORDERS ASSOCIATED WITH MENOPAUSE 6,000 1,800 4,200
Primary hyperaldosteronism; Conn's syndrome;
E26.0 Primary aldosteronism due to adrenal hyperplasia DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
(bilateral)
E26.1 Secondary hyperaldosteronism DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E26.8 Other hyperaldosteronism; Bartter's syndrome DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
Hyperaldosteronism, unspecified; Other disorders of
E26.9 DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
adrenal gland
Primary adrenocortical insufficiency; Addison's disease;
Autoimmune adrenalitis
E27.2 Addisonian crisis; Adrenal crisis; Adrenocortical crisis DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.3 Drug-induced adrenocortical insufficiency DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
Other and unspecified adrenocortical insufficiency; Adrenal
E27.4 haemorrhage; Adrenal infarction; DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
Adrenocortical insufficiency NOS; Hypoaldosteronism
Other specified disorders of adrenal gland; Abnormality of
cortisol-binding globulin
E70.0 Classical phenylketonuria DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E70.1 Other hyperphenylalaninaemias DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Disorders of tyrosine metabolism; Alkaptonuria;

E70.2 DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Hypertyrosinaemia; Ochronosis; Tyrosinaemia; Tyrosinosis
Albinism; OcularAlbinism; Oculocutaneous Albinism

E70.3 Chediak(-Steinbrinck)-Higashi Syndrome; Cross Syndrome; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Hermansky-Pudlak Syndrome
Other disorders of aromatic amino-acid metabolism;
E70.8 Disorders of histidine metabolism; Disorders of tryptophan DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
metabolism
E71.0 Maple-syrup-urine disease DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Other disorders of branched-chain amino-acid metabolism;
Hyperleucine-isoleucinaemia; Hypervalinaemia; Isovaleric
acidaemia;
Methylmalonic acidaemia; Propionic acidaemia
Disorders of fatty-acid metabolism; Adrenoleukodystrophy
E71.3 [Addison-Schilder]; Muscle carnitine palmityltransferase DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
deficiency
Disorders of amino-acid transport; Cystinosis; Cystinuria;
E72.0 Fanconi(-de Toni)(-Debré) syndrome; Hartnup's disease; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Lowe's syndrome
Disorders of urea cycle metabolism; Argininaemia;
E72.2 Argininosuccinic aciduria; Citrullinaemia; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
Hyperammonaemia
Disorders of lysine and hydroxylysine metabolism / Glutaric
aciduria; Hydroxylysinaemia; Hyperlysinaemia
Disorders of glycine metabolism;
Hyperhydroxyprolinaemia; Hyperprolinaemia (type I) ,
Hyperprolinaemia type II; Non-ketotic hyperglycinaemia;
Sarcosinaemia
E73.0 Congenital lactase deficiency DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
Glycogen storage disease; Cardiac glycogenosis; Andersen

Disease; Cori Disease; Forbes Disease; Hers Disease;
E74.0 DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
McArdle Disease; Pompe Disease; Tauri Disease; von
Gierke Disease; Liver phosphorylase deficiency
Disorders of fructose metabolism; Essential fructosuria;

E74.1 Fructose-1,6-diphosphatase deficiency; Hereditary fructose DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
intolerance
Page 32 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Disorders of galactose metabolism; Galactokinase
deficiency; Galactosaemia
Other disorders of intestinal carbohydrate absorption;
Glucose-galactose malabsorption; Sucrase deficiency
Other specified disorders of carbohydrate
E74.8 metabolism/Essential pentosuria; Oxalosis; Oxaluria; Renal DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
glycosuria
E77.8 Other disorders of glycoprotein metabolism DISORDERS OF GLYCOPROTEIN METABOLISM 10,600 3,180 7,420
Mucopolysaccharidosis, type I; Hurler Syndrome; Hurler- DISORDERS OF GLYCOSAMINOGLYCAN
E76.0 10,900 3,270 7,630
Scheie Syndrome; Scheie Syndrome METABOLISM
DISORDERS OF GLYCOSAMINOGLYCAN
E76.1 Mucopolysaccharidosis, type II; Hunter's syndrome 10,900 3,270 7,630
METABOLISM
Other mucopolysaccharidoses; ß-Glucuronidase deficiency;

Mucopolysaccharidosis, type III; Mucopolysaccharidosis IV,
Mucopolysaccharidosis VI, Mucopolysaccharidosis VII;
E76.2 Mild Maroteaux-Lamy Syndrome; Severe Maroteaux-Lamy 10,900 3,270 7,630
METABOLISM
Syndrome; Morquio-like Syndrome; Morquio-classic
syndrome; Sanfilippo type B syndrome; Sanfilippo type C
syndrome; Sanfilippo type D syndrome
E76.3 Mucopolysaccharidosis, unspecified 10,900 3,270 7,630
METABOLISM
E76.8 Other disorders of glucosaminoglycan metabolism 10,900 3,270 7,630
METABOLISM
Pure hypercholesterolaemia; Familial

hypercholesterolaemia; Fredrickson's
E78.0 hyperlipoproteinaemia, type Iia; DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
Hyperbetalipoproteinaemia; Hyperlipidaemia, group A; Low-
density-lipoprotein-type [LDL] hyperlipoproteinaemia
Pure hyperglyceridaemia; Endogenous hyperglyceridaemia;

Fredrickson's hyperlipoproteinaemia, type IV;
E78.1 Hyperlipidaemia, group B; Hyperprebetalipoproteinaemia'; DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
Very-low-density-lipoprotein-type [VLDL]
hyperlipoproteinaemia
Mixed hyperlipidaemia; Broad- or floating-

betalipoproteinaemia; Fredrickson's
hyperlipoproteinaemia, type IIb; Fredrickson's
E78.2 hyperlipoproteinaemia type III; Hyperbetalipoproteinaemia DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
with prebetalipoproteinaemia; Hypercholesterolaemia with
endogenous hyperglyceridaemia; Hyperlipidaemia, group C;
Tubero-eruptive xanthoma; Xanthoma tuberosum
Hyperchylomicronaemia; Fredrickson's
hyperlipoproteinaemia, type I; Fredrickson's
E78.3 DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
hyperlipoproteinaemia, type V; Hyperlipidaemia, group D;
Mixed hyperglyceridaemia
E78.4 Other hyperlipidaemia; Familial combined hyperlipidaemia DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
Lipoprotein deficiency; Abetalipoproteinaemia;

High-density lipoprotein deficiency;
E78.6 Hypoalphalipoproteinaemia; Familial DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
Hypobetalipoproteinaemia; Lecithin cholesterol
acyltransferase deficiency; Tangier disease
E78.8 Other disorders of lipoprotein metabolism DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
Disorders of copper metabolism; Menkes' kinky hair
E83.0 DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
disease; Menkes' steely hair disease; Wilson's disease
E83.1 Disorders of iron metabolism; Haemochromatosis DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.2 Disorders of zinc metabolism; Acrodermatitis enteropathica DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
Disorders of phosphorus metabolism; Acid phosphatase

deficiency; Familial hypophosphataemia;
Hypophosphatasia; Vitamin-D-resistant osteomalacia;
Vitamin-D-resistant rickets
Disorders of magnesium metabolism; Hypermagnesaemia;
Hypomagnesaemia
Disorders of calcium metabolism; Familial hypocalciuric
hypercalcaemia; Idiopathic hypercalciuria
E83.8 Other disorders of mineral metabolism DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
Acute inflammation of orbit; Abscess of orbit;Cellulitis of
H05.0 orbit; Osteomyelitis of orbit; Periostitis of orbit, Tenonitis of DISORDERS OF ORBIT 9,500 2,850 6,650
orbit
Exophthalmic conditions; Displacement of globe (lateral)
H05.2 DISORDERS OF ORBIT 9,500 2,850 6,650
NOS; Haemorrhage of orbit; Oedema of orbit
Page 33 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Hereditary erythropoietic porphyria; Congenital DISORDERS OF PORPHYRIN AND BILIRUBIN

E80.0 9,800 2,940 6,860
erythropoietic porphyria; Erythropoietic protoporphyria METABOLISM
Other porphyria; Hereditary coproporphyria DISORDERS OF PORPHYRIN AND BILIRUBIN

E80.2 9,800 2,940 6,860
Porphyria NOS; Acute intermittent (hepatic) Porphyria METABOLISM
DISORDERS OF PORPHYRIN AND BILIRUBIN
E80.4 Gilbert's syndrome 9,800 2,940 6,860
METABOLISM
DISORDERS OF PORPHYRIN AND BILIRUBIN
E80.5 Crigler-Najjar syndrome 9,800 2,940 6,860
METABOLISM
Other disorders of bilirubin metabolism; Dubin-Johnson DISORDERS OF PORPHYRIN AND BILIRUBIN
E80.6 9,800 2,940 6,860
syndrome; Rotor's syndrome METABOLISM
Other disorders of purine and pyrimidine metabolism; DISORDERS OF PURINE AND PYRIMIDINE
E79.8 7,000 2,100 4,900
Hereditary xanthinuria METABOLISM
E20.0 Idiopathic hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E20.8 Other hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E20.9 Hypoparathyroidism, unspecified; Parathyroid tetany DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
Primary hyperparathyroidism; Hyperplasia of parathyroid;
E21.0 Osteitis fibrosa cystica generalisata [von Recklinghausen's DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
disease of bone]
E21.4 Other specified disorders of parathyroid gland DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E21.5 Disorder of parathyroid gland, unspecified DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
Syndrome of inappropriate secretion of antidiuretic
E22.2 DISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260
hormone
Hypopituitarism; Fertile eunuch syndrome;

Hypogonadotropic hypogonadism; Idiopathic growth
hormone deficiency; Isolated deficiency of gonadotropin;
Isolated deficiency of growth hormone; Isolated deficiency
E23.0 of pituitary hormone; Kallmann's syndrome; Loraine-Levi DISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260
short stature; Necrosis of pituitary gland(postpartum);
Panhypopituitarism; Pituitary cachexia; Pituitary
insufficiency NOS; Pituitary short stature; Sheehan's
syndrome; Simmond's disease
H43.0 Vitreous prolapse DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
H43.1 Vitreous haemorrhage DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
Purulent endophthalmitis; Panophthalmitis; Vitreous
H44.0 DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
abscess
Other endophthalmitis; Parasitic endophthalmitis NOS;
Sympathetic uveitis
Degenerated conditions of globe; Absolute glaucoma;
Atrophy of globe; Phthisis bulbi
Disseminated intravascular coagulation [defibrination
syndrome]; Acquired Afibrinogenaemia; Consumption
D65 coagulopathy; Diffuse or disseminated intravascular DISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400
coagulation [DIC] ; Acquired Fibrinolytic haemorrhage;
Fibrinolytic Purpura; Purpura fulminans;
Disseminated intravascular coagulation of fetus and
P60 DISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400
newborn; Defibrination syndrome of fetus or newborn
M42.1 Adult osteochondrosis of spine DORSOPATHIES 7,600 2,280 5,320
M43.02 Spondylolysis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.03 Spondylolysis cervicothoracic region DORSOPATHIES 7,600 2,280 5,320
M43.04 Spondylolysis thoracic region DORSOPATHIES 7,600 2,280 5,320
M43.06 Spondylolysis lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.07 Spondylolysis lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M43.09 Spondylolysis site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.10 Spondylolisthesis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320
M43.12 Spondylolisthesis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.15 Spondylolisthesis thoracolumbar region DORSOPATHIES 7,600 2,280 5,320
M43.16 Spondylolisthesis lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.17 Spondylolisthesis lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M43.18 Spondylolisthesis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M43.19 Spondylolisthesis site unspecified DORSOPATHIES 7,600 2,280 5,320
Other fusion of spine; Ankylosis of spinal joint cervical
M43.22 DORSOPATHIES 7,600 2,280 5,320
region
Other fusion of spine; Ankylosis of spinal joint lumbar
M43.26 DORSOPATHIES 7,600 2,280 5,320
region
Other fusion of spine; Ankylosis of spinal joint lumbosacral
M43.27 DORSOPATHIES 7,600 2,280 5,320
region
Other fusion of spine; Ankylosis of spinal joint site
M43.29 DORSOPATHIES 7,600 2,280 5,320
unspecified
M43.42 Other recurrent atlantoaxial subluxation cervical region DORSOPATHIES 7,600 2,280 5,320
M43.49 Other recurrent atlantoaxial subluxation site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.60 Torticollis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320

M43.62 Torticollis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.64 Torticollis thoracic region DORSOPATHIES 7,600 2,280 5,320
M43.66 Torticollis lumbar region DORSOPATHIES 7,600 2,280 5,320
Page 34 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M43.68 Torticollis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M43.69 Torticollis site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.8 Other specified deforming dorsopathies DORSOPATHIES 7,600 2,280 5,320
M43.82 Other specified deforming dorsopathies cervical region DORSOPATHIES 7,600 2,280 5,320
Other specified deforming dorsopathies thoracolumbar
M43.85 DORSOPATHIES 7,600 2,280 5,320
region
M43.86 Other specified deforming dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.87 Other specified deforming dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320
Other specified deforming dorsopathies sacral and

M43.88 DORSOPATHIES 7,600 2,280 5,320
M43.89 Other specified deforming dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320
Deforming dorsopathy, unspecified; Curvature of spine

M43.9 DORSOPATHIES 7,600 2,280 5,320
NOS
M43.94 DORSOPATHIES 7,600 2,280 5,320
NOS thoracic region
M43.95 DORSOPATHIES 7,600 2,280 5,320
NOS thoracolumbar region
M43.96 DORSOPATHIES 7,600 2,280 5,320
NOS lumbar region
M43.97 DORSOPATHIES 7,600 2,280 5,320
NOS lumbosacral region
M43.99 DORSOPATHIES 7,600 2,280 5,320
NOS site unspecified
Cervicocranial syndrome; Posterior cervical sympathetic
M53.0 DORSOPATHIES 7,600 2,280 5,320
syndrome
M53.1 Cervicobrachial syndrome DORSOPATHIES 7,600 2,280 5,320
M53.12 Cervicobrachial syndrome cervical region DORSOPATHIES 7,600 2,280 5,320
M53.19 Cervicobrachial syndrome site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.2 Spinal instabilities DORSOPATHIES 7,600 2,280 5,320
M53.22 Spinal instabilities cervical region DORSOPATHIES 7,600 2,280 5,320
M53.24 Spinal instabilities thoracic region DORSOPATHIES 7,600 2,280 5,320
M53.26 Spinal instabilities lumbar region DORSOPATHIES 7,600 2,280 5,320
M53.27 Spinal instabilities lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M53.28 Spinal instabilities sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M53.29 Spinal instabilities site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.3 Coccygodynia DORSOPATHIES 7,600 2,280 5,320
M53.38 Coccygodynia sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M53.8 Other specified dorsopathies DORSOPATHIES 7,600 2,280 5,320
M53.86 Other specified dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320
M53.87 Other specified dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M53.89 Other specified dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.9 Dorsopathy, unspecified DORSOPATHIES 7,600 2,280 5,320
M53.92 Dorsopathy, unspecified cervical region DORSOPATHIES 7,600 2,280 5,320
M53.95 Dorsopathy, unspecified thoracolumbar region DORSOPATHIES 7,600 2,280 5,320
M54 Dorsalgia DORSOPATHIES 7,600 2,280 5,320
Drowning and nonfatal submersion; Immersion; Swimmer's
T75.1 DROWNING 7,100 2,130 4,970
cramp
O00.0 Abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
Tubal pregnancy; Fallopian pregnancy; Rupture of fallopian
O00.1 ECTOPIC PREGNANCY 7,800 2,340 5,460
tube due to pregnancy; Tubal abortion
O00.2 Ovarian pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
Other ectopic pregnancy; Cervical pregnancy; Cornual

O00.8 ECTOPIC PREGNANCY 7,800 2,340 5,460
pregnancy; Intraligamentous pregnancy; Mural pregnancy
O00.9 Ectopic pregnancy, unspecified ECTOPIC PREGNANCY 7,800 2,340 5,460

O36.7 Maternal care for viable fetus in abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
Effects of lightning; Shock from lightning; Struck by
T75.0 ELECTRICAL SHOCK 5,400 1,620 3,780
lightning NOS
Effects of electric current; Electrocution; Shock from
T75.4 ELECTRICAL SHOCK 5,400 1,620 3,780
electric current
MacLeod's syndrome; Unilateral emphysema; Unilateral
J43.0 EMPHYSEMA 11,400 3,420 7,980
transparency of lung
J43.1 Panlobular emphysema; Panacinar emphysema EMPHYSEMA 11,400 3,420 7,980
J43.2 Centrilobular emphysema EMPHYSEMA 11,400 3,420 7,980
J43.8 Other emphysema EMPHYSEMA 11,400 3,420 7,980
Emphysema, unspecified; Lung emphysema NOS;
Pulmonary emphysema NOS; Bullous lung emphysema;
J43.9 Bullous pulmonary emphysema; Vesicular lung EMPHYSEMA 11,400 3,420 7,980
emphysema; Vesucular pulmonary emphysema;
Emphysematous bleb
J98.2 Interstitial emphysema; Mediastinal emphysema EMPHYSEMA 11,400 3,420 7,980
J98.3 Compensatory emphysema EMPHYSEMA 11,400 3,420 7,980
Human immunodeficiency virus [HIV] disease resulting in
B22.0 encephalopathy; Human immunodeficiency virus [HIV] ENCEPHALOPATHY 22,200 6,660 15,540
dementia
Page 35 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
G92 Toxic encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540
G93.1 Anoxic brain damage, not elsewhere classified ENCEPHALOPATHY 22,200 6,660 15,540
I67.4 Hypertensive encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540
N80.0 Endometriosis of uterus; Adenomyosis ENDOMETRIOSIS 7,700 2,310 5,390
N80.1 Endometriosis of ovary ENDOMETRIOSIS 7,700 2,310 5,390
N80.2 Endometriosis of fallopian tube ENDOMETRIOSIS 7,700 2,310 5,390
N80.3 Endometriosis of pelvic peritoneum ENDOMETRIOSIS 7,700 2,310 5,390
N80.4 Endometriosis of rectovaginal septum and vagina ENDOMETRIOSIS 7,700 2,310 5,390
N80.5 Endometriosis of intestine ENDOMETRIOSIS 7,700 2,310 5,390
N80.8 Other endometriosis; Endometriosis of thorax ENDOMETRIOSIS 7,700 2,310 5,390
N80.9 Endometriosis, unspecified ENDOMETRIOSIS 7,700 2,310 5,390
J05.1 Acute epiglottitis; Epiglottitis NOS EPIGLOTTITIS 9,700 2,910 6,790
Localization-related focal idiopathic epilepsy and epileptic

syndromes with seizures of localized onset; Localization-
related partial idiopathic epilepsy and epileptic syndromes
G40.0 EPILEPSY 7,800 2,340 5,460
with seizures of localized onset; Benign childhood epilepsy
with centrotemporal EEG spikes;Childhood epilepsy with
occipital EEG paroxysms
Localization-related focal symptomatic epilepsy and

epileptic syndromes with simple partial seizures;
Localization-related partial symptomatic epilepsy and
G40.1 EPILEPSY 7,800 2,340 5,460
epileptic syndromes with simple partial seizures; Attacks
without alteration of consciousness ; Simple partial seizures
developing into secondarily generalized seizures
Localization-related focal symptomatic epilepsy and

epileptic syndromes with complex partial seizures;
Localization-related partial symptomatic epilepsy and
G40.2 epileptic syndromes with complex partial seizures; Attacks EPILEPSY 7,800 2,340 5,460
with alteration of consciousness, often with automatisms.
Complex partial seizures developing into secondarily
generalized seizures
Generalized idiopathic epilepsy and epileptic syndromes;

Benign myoclonic epilepsy in infancy; Benign familial
neonatal convulsions; Childhood absence epilepsy
[pyknolepsy]; Epilepsy with grand mal seizures on
awakening; Juvenile absence epilepsy; Juvenile absence
G40.3 EPILEPSY 7,800 2,340 5,460
epilepsy; Juvenile myoclonic epilepsy impulsive petit mal);
Nonspecific atonic epileptic seizures; Nonspecific clonic
epileptic seizures; Nonspecific myoclonic epileptic seizures;
nonspecific tonic epileptic seizures; Nonspecific tonic-clonic
epileptic seizures
Other generalized epilepsy and epileptic syndromes;

Epilepsy with myoclonic absences; Epilepsy with myoclonic-
G40.4 astatic seizures; Infantile spasms; Lennox-Gastaut EPILEPSY 7,800 2,340 5,460
syndrome; Salaam attacks; Symptomatic early myoclonic;
Encephalopathy; West's syndrome
Special epileptic syndromes; Epilepsia partialis continua

[Kozhevnikof]; Epileptic seizures related to alcohol;
G40.5 Epileptic seizures related to drugs; Epileptic seizures related EPILEPSY 7,800 2,340 5,460
to hormonal changes; Epileptic seizures related to sleep
deprivation; Epileptic seizures related to stress
G40.6 Grand mal seizures, unspecified (with or without petit mal) EPILEPSY 7,800 2,340 5,460
G40.7 Petit mal, unspecified, without grand mal seizures EPILEPSY 7,800 2,340 5,460
Other epilepsy; Epilepsies and epileptic syndromes

G40.8 EPILEPSY 7,800 2,340 5,460
undetermined as to whether they are focal or generalized
Epilepsy, unspecified; Epileptic convulsions NOS; Epileptic

G40.9 EPILEPSY 7,800 2,340 5,460
fits NOS; Epileptic seizures NOS
G21.0 Malignant neuroleptic syndrome EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.1 Other drug-induced secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.8 Other secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.9 Secondary parkinsonism, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
Hallervorden-Spatz disease; Pigmentary pallidal

G23.0 EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
degeneration
Progressive supranuclear ophthalmoplegia [Steele-
G23.1 EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
Richardson-Olszewski]
Page 36 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other specified degenerative diseases of basal ganglia;
G23.8 Calcification of basal ganglia; Neurogenic orthostatic EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
hypotension [Shy-Drager}
G23.9 Degenerative disease of basal ganglia, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.0 Carcinomatous neuromyopathy in Drug-induced dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.1 Idiopathic familial dystonia; Idiopathic dystonia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.3 Spasmodic torticollis EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.4 Idiopathic orofacial dystonia; Orofacial dyskinesia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.8 Other dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.9 Dystonia, unspecified; Dyskinesia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.3 Myoclonus; Drug-induced myoclonus EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.5 Other chorea; Chorea NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
Other specified extrapyramidal and movement disorders;

G25.8 Akathisia (drug-induced) (treatment-induced) Restless legs EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
syndrome; Stiff-man syndrome
G25.9 Extrapyramidal and movement disorder, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
R56.0 Febrile convulsions FEBRILE SEIZURES 7,000 2,100 4,900

Other and unspecified convulsions; Fit NOS; Seizure
R56.8 FEBRILE SEIZURES 7,000 2,100 4,900
(convulsive) NOS
P92.1 Regurgitation and rumination in newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.2 Slow feeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.4 Overfeeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.8 Other feeding problems of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.9 Feeding problem of newborn, unspecified FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
R50.9 Fever, unspecified; Hyperpyrexia NOS; Pyrexia NOS FEVER OF UNKNOWN ORIGIN 7,000 2,100 4,900
Hyperosmolality and hypernatraemia; Sodium [Na] excess;
E87.0 FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
Sodium [Na] overload
E87.1 Hypo-osmolality and hyponatraemia FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
Acidosis; Acidosis NOS; Lactic Acidosis; Metabolic Acidosis;
Respiratory Acidosis
Alkalosis; Alkalosis NOS; Metabolic Alkalosis; Respiratory
Alkalosis
E87.4 Mixed disorder of acid-base balance FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
Hyperkalaemia; Potassium [K] excess; Potassium [K]
overload
E87.6 Hypokalaemia; Potassium [K] deficiency FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.7 Fluid overload FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
Other disorders of electrolyte and fluid balance, not
elsewhere classified; Electrolyte imbalance NOS;
E87.8 Hyperchloraemia; Hypochloraemia; Other metabolic FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
disorders
Electrolyte abnormality
Fracture of thoracic vertebra; Fracture of thoracic spine
S22.00 FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
NOS (closed)
S22.10 Multiple fractures of thoracic spine (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.2 Fracture of sternum FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.20 Fracture of sternum (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.3 Fracture of rib FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.30 Fracture of rib (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.31 Fracture of rib (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.4 Multiple fractures of ribs FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.40 Multiple fractures of ribs (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.41 Multiple fractures of ribs (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.80 Fracture of other parts of bony thorax (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.90 Fracture of bony thorax, part unspecified (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
J85.0 Gangrene and necrosis of lung GANGRENE 13,200 3,960 9,240
Pyoderma gangrenosum; Dermatitis gangrenosa;
L88 GANGRENE 13,200 3,960 9,240
Phagedenic pyoderma
R02 Gangrene, not elsewhere classified GANGRENE 13,200 3,960 9,240
Gastro-oesophageal reflux disease with oesophagitis;
K21.0 GASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270
Reflux oesophagitis
Gastro-oesophageal reflux disease without oesophagitis;
K21.9 GASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270
Oesophageal reflux NOS
GASTROINTESTINAL DISORDERS OF THE
P76.0 Meconium plug syndrome 11,700 3,510 8,190
NEWBORN
P76.1 Transitory ileus of newborn 11,700 3,510 8,190
NEWBORN
Page 37 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
P76.8 Other specified intestinal obstruction of newborn 11,700 3,510 8,190
NEWBORN
P76.9 Intestinal obstruction of newborn, unspecified 11,700 3,510 8,190
NEWBORN
P77 Necrotizing enterocolitis of fetus and newborn 11,700 3,510 8,190
NEWBORN
P78.0 Perinatal intestinal perforation; Meconium peritonitis 11,700 3,510 8,190
NEWBORN
Neonatal haematemesis and melaena due to swallowed GASTROINTESTINAL DISORDERS OF THE
P78.2 11,700 3,510 8,190
maternal blood NEWBORN
P78.3 Noninfective neonatal diarrhoea 11,700 3,510 8,190
NEWBORN
Other specified perinatal digestive system disorders; GASTROINTESTINAL DISORDERS OF THE
P78.8 11,700 3,510 8,190
Congenital cirrhosis of liver; Peptic ulcer of newborn NEWBORN
P78.9 Perinatal digestive system disorder, unspecified 11,700 3,510 8,190
NEWBORN
H40.0 Glaucoma suspect; Ocular hypertension GLAUCOMA 6,500 1,950 4,550
Primary open-angle glaucoma; primary capsular with
pseudoexfoliation of lens glaucoma; Residual stage capsular
with pseudoexfoliation of lens; Primary chronic simple
H40.1 glaucoma; Residual stage chronic simple glaucoma; Primary GLAUCOMA 6,500 1,950 4,550
low-tension glaucoma; Residual low tension glaucoma;
Primary pigmentary glaucoma; Residual pigmentary
glaucoma
Primary angle-closure glaucoma; Primary acute angle-
closure glaucoma ; Acute residual stage angle-closure
glaucoma ; Primary chronic angle-closure glaucoma ;
H40.2 GLAUCOMA 6,500 1,950 4,550
Residual stage chronic angle-closure glaucoma; Primary
intermittent angle-cloure glaucoma; Residual intermittent
angle-closure glaucoma
H40.3 Glaucoma secondary to eye trauma GLAUCOMA 6,500 1,950 4,550
H40.4 Glaucoma secondary to eye inflammation GLAUCOMA 6,500 1,950 4,550
H40.5 Glaucoma secondary to other eye disorders GLAUCOMA 6,500 1,950 4,550
H40.8 Other glaucoma GLAUCOMA 6,500 1,950 4,550
H40.9 Glaucoma, unspecified GLAUCOMA 6,500 1,950 4,550
Acute nephritic syndrome including Acute glomerular

N00.0 disease, Acute glomerulonephritis, Acute nephritis, Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
renal disease NOS, with Minor glomerular abnormality

disease, Acute glomerulonephritis, Acute nephritis, Acute
N00.1 renal disease NOS, with Focal and segmental glomerular GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
lesions (with focal and segmental hyalinosis; focal and
segmental sclerosis) & Focal glomerulonephritis

N00.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
renal disease NOS with Diffuse membranous
glomerulonephritis
renal disease NOS with Diffuse mesangial proliferative
glomerulonephritis
renal disease NOS with Diffuse endocapillary proliferative
glomerulonephritis

N00.5 renal disease NOS with Diffuse mesangiocapillary GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
glomerulonephritis (Membranoproliferative
glomerulonephritis, types 1 and 3, or NOS)

renal disease NOS with Diffuse crescentic
glomerulonephritis (Extracpillary glomerulonephritis)
renal disease NOS with Other (Proliferative
glomerulonephritis NOS)
N00.9 disease, Acute glomerulonephritis, Acute nephritis, Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
renal disease NOS, Unspecified renal biopsy
Page 38 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Rapidly progressive nephritic syndrome; rapidly progressive

N01.0 glomerular disease; rapidly progressive glomerulonephritis; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
rapidly progressive nephritis, Minor glomerular abnormality

glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Focal and segmental
glomerular lesions
rapidly progressive nephritis, Diffuse mesangial
proliferative glomerulonephritis
rapidly progressive nephritis, Diffuse mesangiocapillary
glomerulonephritis

rapidly progressive nephritis, other

rapidly progressive nephritis, Unspecified
Recurrent and persistent haematuria including Benign

familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Minor glomerular abnormality
with Focal and segmental glomerular lesions
with Diffuse membranous glomerulonephritis

with Diffuse mesangiocapillary glomerulonephritis

N02.8 childhood; Haematuria with morphological lesion specified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
with other (Proliferative glomerulonephritis NOS)
IgA Nephropathy

with Unspecified renal biopsy
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Minor glomerular
abnormality
chronic renal disease NOS, with Focal and segmental
glomerular lesions
chronic renal disease NOS, withDiffuse membranous
glomerulonephritis
chronic renal disease NOS, with Diffuse mesangial
chronic renal disease NOS, with Diffuse endocapillary
chronic renal disease NOS, with Diffuse mesangiocapillary
glomerulonephritis
Page 39 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
chronic renal disease NOS, with Diffuse crescentic
glomerulonephritis
chronic renal disease NOS, with Other (Proliferative
glomerulonephritis NOS)

N03.9 disease, Chronic glomerulonephritis, Chronic nephritis, GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
chronic renal disease NOS, with Unspecified renal biopsy
Nephrotic syndrome: Minor glomerular abnormality;

Minimal change lesion
Nephrotic syndrome: Focal and segmental glomerular
N04.1 lesions; Focal and segmental hyalinosis; Focal and GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
segmental sclerosis; Focal glomerulonephritis
Nephrotic syndrome: Diffuse membranous
glomerulonephritis
Nephrotic syndrome: Diffuse mesangial proliferative
glomerulonephritis
Nephrotic syndrome: Diffuse endocapillary proliferative
glomerulonephritis
Nephrotic syndrome: Diffuse mesangiocapillary
N04.5 glomerulonephritis; Membranoproliferative GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
glomerulonephritis, types 1 and 3, or NOS
Nephrotic syndrome: Diffuse crescentic glomerulonephritis;
Extracapillary glomerulonephritis
N04.8 Nephrotic syndrome: Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.9 Nephrotic syndrome:Unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Unspecified nephritic syndrome including Glomerular

N05.0 disease, Glomerulonephritis, Nephritis NOS with Minor GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
glomerular abnormality, minimal change lesion
disease, Glomerulonephritis, Nephritis NOS with Focal and
N05.1 segmental glomerular lesions (with focal and segmental GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis
N05.2 disease, Glomerulonephritis, Nephritis NOS with Diffuse GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
membranous glomerulonephritis
mesangial proliferative glomerulonephritis
endocapillary proliferative glomerulonephritis
disease, Glomerulonephritis, Nephritis NOS with Diffuse
N05.5 mesangiocapillary glomerulonephritis, GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
disease, Glomerulonephritis, Nephritis NOS with Dense
deposit disease
Membranoproliferative glomerulonephritis, type 2
disease, Glomerulonephritis, Nephritis NOS with Diffuse
crescentic glomerulonephritis, Extracapillary
glomerulonephritis

N05.8 disease, Glomerulonephritis, Nephritis NOS with Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
(Proliferative glomerulonephritis NOS)

N05.9 disease, Glomerulonephritis, Nephritis NOS with GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Unspecified renal biopsy
Isolated proteinuria with specified morphological lesion
N06.0 with morphological lesion specified with Minor glomerular GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
abnormality
N06.8 with Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
(Proliferative glomerulonephritis NOS)
with Unspecified renal biopsy
Page 40 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Hereditary nephropathy, not elsewhere classified with
Minor glomerular abnormality
Focal and segmental glomerular lesions (with focal and
segmental hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis
Diffuse membranous glomerulonephritis
Diffuse mesangial proliferative glomerulonephritis
Diffuse mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
Unspecified renal biopsy
Acute tubulo-interstitial nephritis; pyelonephritis; Acute
N10 infectious interstitial nephritis; Acute pyelitis; Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
pyelonephritis
Chronic tubulo-interstitial nephritis, unspecified; Chronic
N11.9 interstitial nephritis NOS; Chronic pyelitis NOS; Chronic GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
pyelonephritis NOS
Tubulo-interstitial nephritis, not specified as acute or
N12 chronic; Interstitial nephritis NOS; Pyelitis NOS; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Pyelonephritis NOS
N14.0 Analgesic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Nephropathy induced by other drugs, medicaments and

biological substances
Nephropathy induced by unspecified drug, medicament or
biological substance
N14.4 Toxic nephropathy, not elsewhere classified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N15.0 Balkan nephropathy; Balkan endemic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N15.8 Other specified renal tubulo-interstitial diseases GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Renal tubulo-interstitial disease, unspecified; Infection of

kidney NOS
N39.1 Persistent proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N39.2 Orthostatic proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Derangement of meniscus due to old tear or injury; Old

M23.20 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
bucket-handle tear multiple sites
M23.21 bucket-handle tear Anterior cruciate ligament or Anterior HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
horn of medial meniscus
M23.22 bucket-handle tear Posterior cruciate ligament or Posterior HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
horn of medial meniscus

bucket-handle tear Posterior horn of lateral meniscus
M23.46 Loose body in knee Other and unspecified lateral meniscus HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.5 Chronic instability of knee HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Other internal derangements of knee; Laxity of ligament of
knee; Snapping knee multiple sites
M23.9 Internal derangement of knee, unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Internal derangement of knee, unspecified Anterior
cruciate ligament or Anterior horn of medial meniscus
M24.08 Loose body in joint other sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.1 Other articular cartilage disorders HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Disorder of ligament; Instability secondary to old ligament
injury; Ligamentous laxity NOS
M24.4 Recurrent dislocation and subluxation of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Recurrent dislocation and subluxation of joint shoulder
region
M24.50 Contracture of joint multiple sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.54 Contracture of joint hand HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.56 Contracture of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.6 Ankylosis of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.65 Ankylosis of joint pelvic region and thigh HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.66 Ankylosis of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.69 Ankylosis of joint site unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.7 Protrusio acetabuli HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Page 41 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other specific joint derangements, not elsewhere classified;
Irritable hip other sites
G43.0 Migraine without aura [common migraine] HEADACHE SYNDROMES 5,500 1,650 3,850
Migraine with aura [classical migraine]; Migraine aura
without headache; Migraine, basilar; Migraine equivalents;
G43.1 Familial hemiplegic Migraine; Migraine with acute-onset HEADACHE SYNDROMES 5,500 1,650 3,850
aura; Migraine with prolonged aura; Migraine with typical
aura
G43.2 Status migrainosus HEADACHE SYNDROMES 5,500 1,650 3,850
G43.3 Complicated migraine HEADACHE SYNDROMES 5,500 1,650 3,850
Other migraine; Ophthalmoplegic migraine; Retinal
G43.8 HEADACHE SYNDROMES 5,500 1,650 3,850
migraine
G43.9 Migraine, unspecified HEADACHE SYNDROMES 5,500 1,650 3,850
Cluster headache syndrome; Chronic paroxysmal
G44.0 hemicrania; Chronic cluster headache; Episodic Cluster HEADACHE SYNDROMES 5,500 1,650 3,850
headache
Vascular headache, not elsewhere classified; Vascular
headache NOS
Tension-type headache; Chronic tension-type headache;

Episodic tension headache; Tension headache NOS
G44.3 Chronic post-traumatic headache HEADACHE SYNDROMES 5,500 1,650 3,850

G44.4 Drug-induced headache, not elsewhere classified HEADACHE SYNDROMES 5,500 1,650 3,850
G44.8 Other specified headache syndromes HEADACHE SYNDROMES 5,500 1,650 3,850
R51 Headache; Facial pain NOS HEADACHE SYNDROMES 5,500 1,650 3,850
Atrioventricular block, complete; Complete heart block
I44.2 HEART CONDUCTION DISORDERS 12,300 3,690 8,610
NOS; Third-degree block
Other and unspecified atrioventricular block;
Atrioventricular block NOS
I44.4 Left anterior fascicular block HEART CONDUCTION DISORDERS 12,300 3,690 8,610
Other specified heart blockl; Sinoatrial NOS; Sinoauricular
block
Pre-excitation syndrome; Anomalous atrioventicular
excitation; Atrioventricular conduction, accelerated;
I45.6 Atrioventicular conduction, accesory; Atrioventicular HEART CONDUCTION DISORDERS 12,300 3,690 8,610
conduction pre-excitation; Lown-Ganong-Levine syndrome;
Wolff-Parkinson-White syndrome
Other specified conduction disorder; Atrioventricular [AV]
dissociation; Interference dissociation
Heart conduction disorders, unspecified; Heart block NOS;
Stokes-Adams syndrome
Rheumatic heart disease, unspecified; Rheumatic carditis;
I09.9 HEART FAILURE 15,700 4,710 10,990
Rheumatic heart failure
Congestive heart failure; Congestive heart disease; Right
I50.0 HEART FAILURE 15,700 4,710 10,990
venticular failure (secondary to left heart failure)
Left ventricular failure; Acute oedema of lung with mention
of heart disease NOS or heart failure; Acute pulmonary
oedema with mention of heart disease NOS or heart failure;
I50.1 HEART FAILURE 15,700 4,710 10,990
Cardiac asthma with mention of heart disease NOS or heart
failure; Left heart failure with mention of heart disease NOS
or heart failure
Heart failure, unspecified; Cardiac, heart or myocardial
I50.9 HEART FAILURE 15,700 4,710 10,990
failure NOS
Mitral (valve) insufficiency; Incompetence mitral valve NOS

I34.0 or of specified cause, except rheumatic; Regurgitation HEART VALVE DISORDERS 8,400 2,520 5,880
mitral valve NOS or of specified cause, except rheumatic
I34.1 Mitral (valve) prolapse; Floppy mitral valve syndrome HEART VALVE DISORDERS 8,400 2,520 5,880
I34.2 Nonrheumatic mitral (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
I34.8 Other nonrheumatic mitral heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I34.9 Nonrheumatic mitral valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I35.0 Aortic (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
Aortic (valve) insufficiency; Incompetence Aortic valve NOS

I35.1 or of specified cause, except rheumatic; Aortic valve HEART VALVE DISORDERS 8,400 2,520 5,880
regurgitation NOS or of specified cause, except rheumatic
I35.2 Aortic (valve) stenosis with insufficiency HEART VALVE DISORDERS 8,400 2,520 5,880
I35.8 Other aortic heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I35.9 Aortic valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I36.0 Nonrheumatic tricuspid (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
Nonrheumatic tricuspid (valve) insufficiency; Incompetence
tricuspid valve of specified cause, except rheumatic;
I36.1 HEART VALVE DISORDERS 8,400 2,520 5,880
Tricuspid valve regurgitation of specified cause, except
rheumatic
I36.8 Other nonrheumatic tricuspid valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I36.9 Nonrheumatic tricuspid valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I37.0 Pulmonary valve stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
Page 42 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Pulmonary valve insufficiency; Incompetence pulmonary
valve NOS or specified cause, except rheumatic; Pulmonary
I37.1 HEART VALVE DISORDERS 8,400 2,520 5,880
valve regurgitation NOS or of specified cause, except
rheumatic
I37.8 Other pulmonary heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I37.9 Pulmonary valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
Heat stroke and sunstroke; Heat apoplexy; Heat pyrexia;
T67.0 HEAT EXHAUSTION 6,500 1,950 4,550
Siriasis; Thermoplegia
T67.1 Heat syncope; Heat collapse HEAT EXHAUSTION 6,500 1,950 4,550
T67.2 Heat cramp HEAT EXHAUSTION 6,500 1,950 4,550
Heat exhaustion, anhydrotic; Heat prostration due to water
depletion
Heat exhaustion due to salt depletion; Heat prostation due
to salt (and water) depletion
T67.5 Heat exhaustion, unspecified; Heat prostration NOS HEAT EXHAUSTION 6,500 1,950 4,550
T67.9 Effect of heat and light, unspecified HEAT EXHAUSTION 6,500 1,950 4,550
M25.00 Haemarthrosis multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.01 Haemarthrosis shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.05 Haemarthrosis pelvic region and thigh HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.06 Haemarthrosis lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.07 Haemarthrosis ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.08 Haemarthrosis other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.09 Haemarthrosis site unspecified HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.38 Other instability of joint other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.40 Effusion of joint multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.41 Effusion of joint shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.46 Effusion of joint lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.47 Effusion of joint ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
D59.3 Haemolytic-uraemic syndrome HEMOLYTIC UREMIC SYNDROME 20,200 6,060 14,140
Delayed or excessive haemorrhage following abortion and
HEMORRHAGE IN PREGNANCY AND POST
O08.1 ectopic and molar pregnancy; Afibrinogenaemia; 7,000 2,100 4,900
PARTUM PERIOD
Defibrination syndrome; Intravascular coagulation
Third-stage haemorrhage; Haemorrhage associated with
O72.0 retained, trapped or adherent placenta; Retained placenta 7,000 2,100 4,900
PARTUM PERIOD
NOS
Other immediate postpartum haemorrhage; Haemorrhage
O72.1 following delivery of placenta; Postpartum atomic 7,000 2,100 4,900
PARTUM PERIOD
haemorrhage NOS
Delayed and secondary postpartum haemorrhage;
Haemorrhage associated with retained portions of placenta HEMORRHAGE IN PREGNANCY AND POST
O72.2 7,000 2,100 4,900
or membranes; Retained products of concepcion NOS, PARTUM PERIOD
following delivery
Postpartum coagulation defects; Afibrinogenaemia HEMORRHAGE IN PREGNANCY AND POST
O72.3 7,000 2,100 4,900
postpartum; Fibrinolysis postpartum PARTUM PERIOD
Retained placenta without haemorrhage; Placenta accreta HEMORRHAGE IN PREGNANCY AND POST
O73.0 7,000 2,100 4,900
without haemorrhage PARTUM PERIOD
Retained portions of placenta and membranes without
O73.1 haemorrhage; Retained products of conception following 7,000 2,100 4,900
PARTUM PERIOD
delivery, without haemorrhage
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
P50.0 Fetal blood loss from vasa praevia 7,800 2,340 5,460
THE NEWBORN
P50.1 Fetal blood loss from ruptured cord 7,800 2,340 5,460
THE NEWBORN
P50.2 Fetal blood loss from placenta 7,800 2,340 5,460
THE NEWBORN
P50.9 Fetal blood loss, unspecified; Fetal haemorrhage NOS 7,800 2,340 5,460
THE NEWBORN
P51.9 Umbilical haemorrhage of newborn, unspecified 7,800 2,340 5,460
THE NEWBORN
Haemorrhagic disease of fetus and newborn; Vitamin K HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
P53 7,800 2,340 5,460
deficiency of newborn THE NEWBORN
P54.0 Neonatal haematemesis 7,800 2,340 5,460
THE NEWBORN
P54.2 Neonatal rectal haemorrhage 7,800 2,340 5,460
THE NEWBORN
P54.3 Other neonatal gastrointestinal haemorrhage 7,800 2,340 5,460
THE NEWBORN
P54.4 Neonatal adrenal haemorrhage 7,800 2,340 5,460
THE NEWBORN
Neonatal cutaneous haemorrhage; Bruising in fetus or
newborn; Ecchymoses in fetus or newborn; Petechiae in HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
P54.5 7,800 2,340 5,460
fetus or newborn; Superficial haematomata in fetus or THE NEWBORN
newborn
P54.6 Neonatal vaginal haemorrhage; Pseudomenses 7,800 2,340 5,460
THE NEWBORN
P54.8 Other specified neonatal haemorrhages 7,800 2,340 5,460
THE NEWBORN
Page 43 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
P54.9 Neonatal haemorrhage, unspecified 7,800 2,340 5,460
THE NEWBORN
P55.0 Rh isoimmunization of fetus and newborn 7,800 2,340 5,460
THE NEWBORN
P55.1 ABO isoimmunization of fetus and newborn 7,800 2,340 5,460
THE NEWBORN
P55.8 Other haemolytic diseases of fetus and newborn 7,800 2,340 5,460
THE NEWBORN
P55.9 Haemolytic disease of fetus and newborn, unspecified 7,800 2,340 5,460
THE NEWBORN
Transient neonatal thrombocytopenia; neonatal
thrombocytopenia due to exchange transfusion; Neonatal
P61.0 thrombocytopenia due to idiophatic maternal 7,800 2,340 5,460
THE NEWBORN
thrombocytopenia; Neonatal thrombocytopenia due to
isoimmunization
P61.1 Polycythaemia neonatorum 7,800 2,340 5,460
THE NEWBORN
P61.5 Transient neonatal neutropenia 7,800 2,340 5,460
THE NEWBORN
P61.6 Other transient neonatal disorders of coagulation 7,800 2,340 5,460
THE NEWBORN
P61.8 Other specified perinatal haematological disorders 7,800 2,340 5,460
THE NEWBORN
P61.9 Perinatal haematological disorder, unspecified 7,800 2,340 5,460
THE NEWBORN
Hereditary factor VIII deficiency; Deficiency factor VIII (with
D66 functional defect); Haemophilia NOS; Haemophilia A; HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
Classical Haemophilia
Hereditary factor IX deficiency; Christmas disease; Factor IX

D67 Deficiency (with functional defect); Plasma thromboplastin HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
component [PTC] Deficiency; Haemophilia B
Von Willebrand's disease; Angiohaemophilia; Factor VIII

D68.0 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
deficiency with vascular defect; Vascular haemophilia
Hereditary factor XI deficiency; Haemophilia C Plasma

thromoplastin antecedent [PTA] deficiency
Hereditary deficiency of other clotting factors; Congenital

afibrinogenaemia; AC globulin Deficiency; Proaccelerin
Deficiency; Deficiency of factor I [fibrinogen]; Deficiency of
factor II [prothrombin]; Deficiency of factor V [labile];
Deficiency of factor VII [stable]; Deficiency of factor X
[Stuart-Prower]; Deficiency of XII [hageman]; XIII [fibrin-
stabilizing]; Congenital dysfibrinogenaemia;
Hypoproconvertinaemia; Owren's disease
Haemorrhagic disorder due to circulating anticoagulants;

Haemorrhage during long term use of anticoagulants;
D68.3 Hyperheparinaemia; Increase in antithrombin; Increase in HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
anti-VIIIa; Increase in anti-Ixa; Increase in anti-Xa; Increase
in anti-Xia
Acquired coagulation factor deficiency; Deficiency of
D68.4 coagulation factor due to liver disease; Deficiency of HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
coagulation factor due to vitamin K deficiency
Other specified coagulation defects; Presence of systemic
lupus erythematosus [SLE] inhibitor
D68.9 Coagulation defect, unspecified HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
Allergic purpura; Anaphylactoid Purpura; Henoch(-
Schönlein) Purpura; Nonthrombocytopenic Purpura;
Haemorrhagic Purpura; Idiopathic Purpura; Vascular
Purpura; AllergicVasculitis
Qualitative platelet defects; Bernard-Soulier [giant platelet]
syndrome; Glanzmann's disease; Grey platelet syndrome;
Haemorrhagic Thromboasthenia; Hereditary
Thromboasthenia; Thrombocytopathy ;
Other nonthrombocytopenic purpura; Purpura NOS; Senile
Purpura; Simplex Purpura
D69.3 Idiopathic thrombocytopenic purpura; Evans' syndrome HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
Other specified haemorrhagic conditions; Hereditary

Capillary fragility; Vascular pseudohaemophilia
Alcoholic hepatic failure; Alcoholic hepatic failure NOS;
Acute alcoholic hepatic failure; Chronic alcoholic hepatic
K70.4 HEPATIC FAILURE 20,600 6,180 14,420
failure; Subacute alcoholic hepatic failure; Alcoholic hepatic
failure with or without hepatic coma
Acute and subacute hepatic failure
Acute hepatitis
Page 44 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
K72.1 Chronic hepatic failure HEPATIC FAILURE 20,600 6,180 14,420
Hepatic failure, unspecified
Liver necrosis
O01.0 Classical hydatidiform mole; Complete hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620
O01.1 Incomplete and partial hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620
Hydatidiform mole, unspecified; Trophoblastic disease
O01.9 HYDATIDIFORM MOLE 6,600 1,980 4,620
NOS; Vesicular mole NOS
G91.0 Communicating hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.1 Obstructive hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.2 Normal-pressure hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.3 Post-traumatic hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
G91.8 Other hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.9 Hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
Q03.8 Other congenital hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
Q03.9 Congenital hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
P56.0 Hydrops fetalis due to isoimmunization HYDROPS FETALIS 7,400 2,220 5,180
Hydrops fetalis due to other and unspecified haemolytic
P56.9 HYDROPS FETALIS 7,400 2,220 5,180
disease
Hydrops fetalis not due to haemolytic disease; Hydrops
P83.2 HYDROPS FETALIS 7,400 2,220 5,180
fetalis NOS
I10.1 Hypertension, stage 2 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
Hypertension
I10.9 Essential hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
Malignant hypertension
Hypertensive heart disease with (congestive) heart failure;
I11.0 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
Hypertensive heart failure
Hypertensive heart disease without (congestive) heart
failure; Hypertensive heart disease NOS
Hypertensive renal disease with renal failure; Hypertensive
renal failure
Hypertensive renal disease without renal failure;
Hypertensive renal disease NOS
Hypertensive heart and renal disease with (congestive)
heart failure
I13.1 Hypertensive heart and renal disease with renal failure HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
Hypertensive heart and renal disease with both
(congestive) heart failure and renal failure
I13.9 Hypertensive heart and renal disease, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.0 Renovascular hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.1 Hypertension secondary to other renal disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.2 Hypertension secondary to endocrine disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.8 Other secondary hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.9 Secondary hypertension, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
Thyrotoxicosis with diffuse goitre; Exophthalmic or toxic
E05.0 HYPERTHYROIDISM 8,500 2,550 5,950
goitre NOS; Graves' disease; Toxic diffuse goitre
Thyrotoxicosis with toxic single thyroid nodule;
Thyrotoxicosis with toxic uninodular goitre
Thyrotoxicosis with toxic multinodular goitre; Toxic nodular
goitre NOS
Thyroid nodules with hyperthyroidism
Toxic thyroid nodules
E05.3 Thyrotoxicosis from ectopic thyroid tissue HYPERTHYROIDISM 8,500 2,550 5,950
E05.4 Thyrotoxicosis factitia HYPERTHYROIDISM 8,500 2,550 5,950
E05.5 Thyroid crisis or storm HYPERTHYROIDISM 8,500 2,550 5,950
Other thyrotoxicosis; Overproduction of thyroid-stimulating
hormone
Thyrotoxicosis, unspecified; Hyperthyroidism NOS;
Thyroiditis
E01.0 Iodine-deficiency-related diffuse (endemic) goitre HYPOTHYROIDISM 8,100 2,430 5,670
Iodine-deficiency-related multinodular (endemic) goitre;
E01.1 HYPOTHYROIDISM 8,100 2,430 5,670
Iodine-deficiency-related nodular goitre
E01.2 Iodine-deficiency-related (endemic) goitre, unspecified HYPOTHYROIDISM 8,100 2,430 5,670
Other iodine-deficiency-related thyroid disorders and allied

conditions; Acquired iodine-deficiency hypothyroidism NOS
E02 Subclinical iodine-deficiency hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670

Hypothyroidism due to medicaments and other exogenous
substances
E03.5 Myxoedema coma HYPOTHYROIDISM 8,100 2,430 5,670
E03.8 Other specified hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670
E03.9 Hypothyroidism, unspecified; HYPOTHYROIDISM 8,100 2,430 5,670
Hereditary hypogammaglobulinaemia; Autosomal recessive
agammaglobulinaemia (Swiss type); X-linked
D80.0 IMMUNODEFICIENCY 11,600 3,480 8,120
agammaglobulinaemia [Bruton] (with growth hormone
deficiency)
D80.2 Selective deficiency of immunoglobulin A [IgA] IMMUNODEFICIENCY 11,600 3,480 8,120
Page 45 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
D80.7 Transient hypogammaglobulinaemia of infancy IMMUNODEFICIENCY 11,600 3,480 8,120
Other immunodeficiencies with predominantly antibody
defects; Kappa light chain deficiency
Immunodeficiency with predominantly antibody defects,
unspecified
Severe combined immunodeficiency [SCID] with low T- and
B-cell numbers
Major histocompatibility complex class I deficiency; Bare
lymphocyte syndrome
Combined immunodeficiency, unspecified; Severe
combined immunodeficiency disorder [SCID] NOS
Wiskott-Aldrich syndrome; Immunodeficiency with
thrombocytopenia and eczema
Di George's syndrome; Pharyngeal pouch syndrome;
D82.1 Thymic alymphoplasia; Thymic aplasia or hypoplasia with IMMUNODEFICIENCY 11,600 3,480 8,120
immunodeficiency
Immunodeficiency following hereditary defective response

to Epstein-Barr virus; X-linked lymphoproliferative disease
D82.4 Hyperimmunoglobulin E [IgE] syndrome IMMUNODEFICIENCY 11,600 3,480 8,120

Immunodeficiency associated with major defect,
unspecified
Common variable immunodeficiency with predominant

abnormalities of B-cell numbers and function
Common variable immunodeficiency with predominant

immunoregulatory T-cell disorders
D83.9 Common variable immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D84.8 Other specified immunodeficiencies IMMUNODEFICIENCY 11,600 3,480 8,120
D84.9 Immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D86.1 Sarcoidosis of lymph nodes IMMUNODEFICIENCY 11,600 3,480 8,120
Sarcoidosis of other and combined sites; Uveoparotid fever
[Heerfordt]
D86.9 Sarcoidosis, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
Polyclonal hypergammaglobulinaemia; Benign
D89.0 hypergammaglobulinaemic purpura; Polyclonal IMMUNODEFICIENCY 11,600 3,480 8,120
gammopathy NOS
Cryoglobulinaemia; Essential Cryoglobulinaemia; Idiopathic

Cryoglobulinaemia; Mixed Cryoglobulinaemia; Primary
Cryoglobulinaemia; Secondary Cryoglobulinaemia;
Cryoglobulinaemic purpura; Cryoglobulinaemic vasculitis
D89.2 Hypergammaglobulinaemia, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120

Other specified disorders involving the immune
mechanism, not elsewhere classified
Disorder involving the immune mechanism, unspecified;
Immune disease NOS
Leukoplakia of penis; Balanitis xerotica obliterans; Kraurosis INFLAMMATION/INFECTION OF THE MALE
N48.0 9,000 2,700 6,300
of penis GENITAL TRACT
INFLAMMATION/INFECTION OF THE MALE
N48.1 Balanoposthitis; Balanitis 9,000 2,700 6,300
GENITAL TRACT
Other inflammatory disorders of penis; Abscess of corpus

cavernosum and penis; Boil of corpus cavernosum and
N48.2 penis; Carbuncle of corpus cavernosum and penis; Cellulitis 9,000 2,700 6,300
GENITAL TRACT
of corpus cavernosum and penis; Cavernitis (penis) of
corpus cavernosum and penis

N48.5 Ulcer of penis 9,000 2,700 6,300
GENITAL TRACT
Induratio penis plastica; Peyronie's disease; Plastic INFLAMMATION/INFECTION OF THE MALE
N48.6 9,000 2,700 6,300
induration of penis GENITAL TRACT
N49.0 Inflammatory disorders of seminal vesicle; Vesiculitis NOS 9,000 2,700 6,300
GENITAL TRACT
Inflammatory disorders of spermatic cord, tunica vaginalis INFLAMMATION/INFECTION OF THE MALE
N49.1 9,000 2,700 6,300
and vas deferens; Vasitis GENITAL TRACT
N49.2 Inflammatory disorders of scrotum 9,000 2,700 6,300
GENITAL TRACT
Inflammatory disorders of other specified male genital
N49.8 organs; Inflammation of multiple sites in male genital 9,000 2,700 6,300
GENITAL TRACT
organs
Inflammatory disorder of unspecified male genital organ;
Abscess of unspecified male genital organ; Boil of
N49.9 unspecified male genital organ; Carbuncle of unspecified 9,000 2,700 6,300
GENITAL TRACT
male genital organ; Cellulitis of unspecified male genital
organ
Page 46 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Crohn's disease of small intestine; Crohn's disease [regional
enteritis] of duodenum; Crohn's disease [regional enteritis]
K50.0 INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
of ileum; Crohn's disease [regional enteritis] of jejunum;
Regional ileitis; Terminal ileitis
Crohn's disease of large intestine; Granulomatous colitis;

Regional colitis; Crohn's disease [regional enteritis] of
colon; Crohn's disease [regional enteritis] of large bowel;
Crohn's disease [regional enteritis] of rectum
Other Crohn's disease; Crohn's disease of both small and

large intestine
Crohn's disease [regional enteritis], unspecified; Crohn's
K50.9 disease NOS; Regional enteritis NOS; Granulomatous INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
enteritis NOS
K51.0 Ulcerative (chronic) enterocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.1 Ulcerative (chronic) ileocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.2 Ulcerative (chronic) proctitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.3 Ulcerative (chronic) rectosigmoiditis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.5 Mucosal proctocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.8 Other ulcerative colitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.9 Ulcerative colitis, unspecified; Ulcerative enteritis NOS INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
Acute disseminated encephalitis; Postimmunization INFLAMMATORY DISEASE OF THE CENTRAL
G04.0 21,600 6,480 15,120
[Encephalitis; Postimmunization Encephalomyelitis NERVOUS SYSTEM
INFLAMMATORY DISEASE OF THE CENTRAL
G04.1 Tropical spastic paraplegia 21,600 6,480 15,120
NERVOUS SYSTEM
Bacterial meningoencephalitis and meningomyelitis, not INFLAMMATORY DISEASE OF THE CENTRAL
G04.2 21,600 6,480 15,120
elsewhere classified NERVOUS SYSTEM
Other encephalitis, myelitis and encephalomyelitis; INFLAMMATORY DISEASE OF THE CENTRAL
G04.8 21,600 6,480 15,120
Postinfectious encephalitis and encephalomyelitis NOS NERVOUS SYSTEM
Encephalitis, myelitis and encephalomyelitis, unspecified; INFLAMMATORY DISEASE OF THE CENTRAL
G04.9 21,600 6,480 15,120
Ventriculitis (cerebral) NOS NERVOUS SYSTEM
Encephalitis, myelitis and encephalomyelitis in other INFLAMMATORY DISEASE OF THE CENTRAL
G05.8* 21,600 6,480 15,120
diseases classified elsewhere NERVOUS SYSTEM
Intracranial and intraspinal abscess and grauloma in INFLAMMATORY DISEASE OF THE CENTRAL
G07* 21,600 6,480 15,120
diseases classified elsewhere NERVOUS SYSTEM
Intracranial and intraspinal phlebitis and thrombophlebitis;
Septic [embolism, endophlebitis, phlebitis, INFLAMMATORY DISEASE OF THE CENTRAL
G08 21,600 6,480 15,120
thrombophlebitis, thrombosis] of intracranial or intraspinal NERVOUS SYSTEM
venous sinuses and veins
Measles complicated by encephalitis; Encephalitis, myelitis INFLAMMATORY DISEASE OF THE CENTRAL

B05.0+ G05.1* 21,600 6,480 15,120
and encephalomyelitis in viral diseases classified elsewhere NERVOUS SYSTEM
I30.0 Acute nonspecific idiopathic pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
Infective pericarditis; Pneumococcal pericarditis; Purulent

I30.1 pericarditis; Staphylococcal pericarditis; Streptococcal INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
pericarditis; Viral pericarditis; Pyopericarditis
I30.8 Other forms of acute pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I30.9 Acute pericarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
Chronic adhesive pericarditis; Accretio cordis; Adherent

I31.0 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
pericardium; Adhesive mediastinopericarditis
Chronic constrictive pericarditis; Concretio cordis;

Pericardial calcification
Acute and subacute infective endocarditis; Acute bacterial

endocarditis; Subacute bacterial endocarditis; Acute
infective endocarditis NOS; Subacute infective endocarditis
NOS; Acute lenta endocarditis; Subacute lenta endocarditis;
Acute malignant endocarditis; Subacute malignant
endocarditis; Acute septic endocarditis; Subacute septic
endocarditis; Acute ulcerative endocarditis; Subacute
ulcerative endocarditis
Acute endocarditis, unspecified; Endocarditis, acute or

I33.9 subacute; Myoendocarditis, acute or subacute; INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
Periendocarditis, acute or subacute
Endocarditis, valve unspecified; Chronic Endocarditis NOS;

Valvular incompetence of unspecified valve NOS or of
specified cause, except rheumatic or congenital; Valvular
insufficiency of unspecified valve NOS or of specified cause,
except rheumatic or congenital; Valvular regurgitation of
I38 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
unspecified valve NOS or of specified cause, except
rheumatic or congenital; Valvular stenosis of unspecified
valve NOS or of specified cause, except rheumatic or
congenital; Chronic valvulitis of unspecified valve NOS or of
specified cause, except rheumatic or congenital
Page 47 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
I40.0 Infective myocarditis; Septic myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.1 Isolated myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.8 Other acute myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.9 Acute myocarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
Influenza due to identified zoonotic or pandemic influenza
virus; Influenza caused by influenza virus strains of special
J09 INFLUENZA 6,600 1,980 4,620
epidemiological importance with an animal-human or inter-
human transimission
Influenza with pneumonia, seasonal influenza virus
J10.0 identified; Influenzal (broncho)pneumonia, other influenza INFLUENZA 6,600 1,980 4,620
virus identified
Influenza with other respiratory manifestations, seasonal
influenza virus identified; Influenza; Influenzal acute upper
respiratory infection, seasonal influenza virus identified;
J10.1 Influenzal laryngitis, seasonal influenza virus identified; INFLUENZA 6,600 1,980 4,620
Influenzal pharyngitis, seasonal influenza virus identified;
Influenzal pleural effusion, seasonal influenza virus
identified
Influenza with other manifestations, seasonal influenza

virus identified; Encephalopathy due to influenza, seasonal
J10.8 influenza virus identified; Influenzal gastroenteritis, INFLUENZA 6,600 1,980 4,620
seasonal influenza virus identified; Influenzal myocarditis
(acute), seasonal influenza virus identified
Influenza with pneumonia, virus not identified; Influenzal

J11.0 (broncho) pneumonia, unspecified or specific virus not INFLUENZA 6,600 1,980 4,620
identified
Influenza with other respiratory manifestations, virus not
identified; Influenza NOS; Influenzal Acute upper
respiratory infection, unspecified or specific virus not
J11.1 identified; Influenzal laryngitis, unspecified or specific virus INFLUENZA 6,600 1,980 4,620
not identified; Influenzal pharyngitis, unspecified or specific
virus not identified; Influenzal pleural effusion, unspecified
or specific virus not identified
Influenza with other manifestations, virus not identified;

Encephalopathy due to influenza, unspecified or specific
J11.8 virus not identified; Influenzal gastroentiritis, unspecified or INFLUENZA 6,600 1,980 4,620
specific virus not identified; Acute influenzal myocarditis,
unspecified or specific virus not identified
J11.8+ I41.1* Influenzal myocarditis (acute), virus not identified INFLUENZA 6,600 1,980 4,620
INJURIES DUE TO ENVIRONMENTAL AND OTHER
T66 Unspecified effects of radiation 9,300 2,790 6,510
EXTERNAL FACTORS CAUSES
T67.6 Heat fatigue, transient 9,300 2,790 6,510
T67.8 Other effects of heat and light 9,300 2,790 6,510
T68 Hypothermia 9,300 2,790 6,510
T69.0 Immersion hand and foot; Trench foot 9,300 2,790 6,510
T69.9 Effect of reduced temperature, unspecified 9,300 2,790 6,510
Otitic barotrauma; Aero-otitis media; Effects of change in
T70.0 ambient atmospheric pressure or water pressure on ears/ 9,300 2,790 6,510
on sinuses
Other and unspecified effects of high altitude; Alpine
T70.2 sickness; Anoxia due to high altitude; Barotrauma NOS; 9,300 2,790 6,510
Hypobaropathy; Mountain sickness
Caisson disease [decompression sickness]; Compressed-air INJURIES DUE TO ENVIRONMENTAL AND OTHER
T70.3 9,300 2,790 6,510
disease; Diver's palsy or paralysis EXTERNAL FACTORS CAUSES
Effects of high-pressure fluids; Traumatic jet injection INJURIES DUE TO ENVIRONMENTAL AND OTHER
T70.4 9,300 2,790 6,510
(industrial) EXTERNAL FACTORS CAUSES
Other effects of air pressure and water pressure; Blast INJURIES DUE TO ENVIRONMENTAL AND OTHER
T70.8 9,300 2,790 6,510
injury syndrome EXTERNAL FACTORS CAUSES
T70.9 Effect of air pressure and water pressure, unspecified 9,300 2,790 6,510
Effects of vibration; Pneumatic hammer syndrome; INJURIES DUE TO ENVIRONMENTAL AND OTHER
T75.2 9,300 2,790 6,510
Traumatic vasospastic syndrome; Vertigo from infrasound EXTERNAL FACTORS CAUSES
Other specified injuries due to environmental and other

T75.8 external factors causes; Effects of abnormal gravitation [G] 9,300 2,790 6,510
forces; Effects of weightlessness
S14.0 Concussion and oedema of cervical spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880
S34.0 Concussion and oedema of lumbar spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880
Page 48 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
INJURIES TO THE MUSCLES AND TENDONS AND
S16 Injury of muscle and tendon at neck level 7,200 2,160 5,040
JOINTS
Injury of muscle and tendon of abdomen, lower back and INJURIES TO THE MUSCLES AND TENDONS AND
S39.0 7,200 2,160 5,040
pelvis JOINTS
Dislocation of shoulder joint; Dislocation of Glenohumeral INJURIES TO THE MUSCLES AND TENDONS AND
S43.0 7,200 2,160 5,040
joint JOINTS
Sprain and strain of shoulder joint; sprain and strain of
S43.4 Coracohumeral (ligament); Sprain and strain of Rotator cuff 7,200 2,160 5,040
JOINTS
capsule
Sprain and strain of acromioclavicular joint; sprain and INJURIES TO THE MUSCLES AND TENDONS AND
S43.5 7,200 2,160 5,040
strain of Acromioclavicular ligament JOINTS
Sprain and strain of other and unspecified parts of shoulder INJURIES TO THE MUSCLES AND TENDONS AND
S43.7 7,200 2,160 5,040
girdle; Sprain and strain of shoulder girdle NOS JOINTS

S46.0 Injury of tendon of the rotator cuff of shoulder 7,200 2,160 5,040
JOINTS
S46.1 Injury of muscle and tendon of long head of biceps 7,200 2,160 5,040
JOINTS
S46.2 Injury of muscle and tendon of other parts of biceps 7,200 2,160 5,040
JOINTS
Injury of multiple muscles and tendons at shoulder and INJURIES TO THE MUSCLES AND TENDONS AND
S46.7 7,200 2,160 5,040
upper arm level JOINTS
Injury of other muscles and tendons at shoulder and upper INJURIES TO THE MUSCLES AND TENDONS AND
S46.8 7,200 2,160 5,040
arm level JOINTS
Injury of unspecified muscle and tendon at shoulder and INJURIES TO THE MUSCLES AND TENDONS AND
S46.9 7,200 2,160 5,040
upper arm level JOINTS
S53.4 Sprain and strain of elbow 7,200 2,160 5,040
JOINTS
Injury of flexor muscle and tendon of thumb at forearm INJURIES TO THE MUSCLES AND TENDONS AND
S56.0 7,200 2,160 5,040
level JOINTS
Injury of long flexor muscle and tendon of other finger(s) at INJURIES TO THE MUSCLES AND TENDONS AND
S56.1 7,200 2,160 5,040
forearm level JOINTS
S56.2 Injury of other flexor muscle and tendon at forearm level 7,200 2,160 5,040
JOINTS
Injury of extensor or abductor muscles and tendons of INJURIES TO THE MUSCLES AND TENDONS AND
S56.3 7,200 2,160 5,040
thumb at forearm level JOINTS
Sprain and strain of wrist; Sprain and strain of Carpal joint;
S63.5 Sprain and strain of Radiocarpal joint; Sprain and strain of 7,200 2,160 5,040
JOINTS
Radiocarpal ligament
Sprain and strain of finger(s); Sprain and strain of
Interphalangeal joint, hand; Sprain and strain INJURIES TO THE MUSCLES AND TENDONS AND
S63.6 7,200 2,160 5,040
Metacarpophalangeal joint; Sprain and strain of Phalanx, JOINTS
hand; Sprain and strain of Thumb
S63.7 Sprain and strain of other and unspecified parts of hand 7,200 2,160 5,040
JOINTS
Injury of flexor muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND
S66.1 7,200 2,160 5,040
and hand level JOINTS
Injury of extensor muscle and tendon of other finger at INJURIES TO THE MUSCLES AND TENDONS AND
S66.3 7,200 2,160 5,040
wrist and hand level JOINTS
Injury of intrinsic muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND
S66.5 7,200 2,160 5,040
and hand level JOINTS
Injury of multiple flexor muscles and tendons at wrist and INJURIES TO THE MUSCLES AND TENDONS AND
S66.6 7,200 2,160 5,040
hand level JOINTS
S66.8 Injury of other muscles and tendons at wrist and hand level 7,200 2,160 5,040
JOINTS
Injury of unspecified muscle and tendon at wrist and hand INJURIES TO THE MUSCLES AND TENDONS AND
S66.9 7,200 2,160 5,040
level JOINTS
S73.1 Sprain and strain of hip 7,200 2,160 5,040
JOINTS
Injury of quadriceps muscle and tendon; injury of Patellar INJURIES TO THE MUSCLES AND TENDONS AND
S76.1 7,200 2,160 5,040
ligament (tendon) JOINTS
S76.2 Injury of adductor muscle and tendon of thigh 7,200 2,160 5,040
JOINTS
Injury of muscle and tendon of the posterior muscle group INJURIES TO THE MUSCLES AND TENDONS AND
S76.3 7,200 2,160 5,040
at thigh level JOINTS
Injury of other and unspecified muscles and tendons at INJURIES TO THE MUSCLES AND TENDONS AND
S76.4 7,200 2,160 5,040
thigh level JOINTS
Sprain and strain involving fibular collateral ligament of
S83.4 knee; Sprain and strain involving tibial collateral ligament of 7,200 2,160 5,040
JOINTS
knee
Sprain and strain involving anterior cruciate ligament of
S83.5 knee; Sprain and strain involving posterior cruciate 7,200 2,160 5,040
JOINTS
ligament of knee
Sprain and strain of other and unspecified parts of knee; INJURIES TO THE MUSCLES AND TENDONS AND
S83.6 7,200 2,160 5,040
Tibiofibular joint and ligament, superior JOINTS
S86.8 Injury of other muscles and tendons at lower leg level 7,200 2,160 5,040
JOINTS
Page 49 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
S86.9 Injury of unspecified muscle and tendon at lower leg level 7,200 2,160 5,040
JOINTS
Sprain and strain of ankle including Calcaneofibular

S93.4 (ligament), Deltoid (ligament), Internal collateral (ligament), 7,200 2,160 5,040
JOINTS
Talofibular (ligament), Tibiofibular , distal (ligament)
Sprain and strain of toe(s) including Interphalangeal INJURIES TO THE MUSCLES AND TENDONS AND
S93.5 7,200 2,160 5,040
(joint(s), metatarsophalangeal (joint(s) JOINTS
Sprain and strain of other and unspecified parts of foot INJURIES TO THE MUSCLES AND TENDONS AND
S93.6 7,200 2,160 5,040
including Tarsal (ligament), Tarsometatarsal (ligament) JOINTS
Injury of muscle and tendon of long flexor muscle of toe at INJURIES TO THE MUSCLES AND TENDONS AND
S96.0 7,200 2,160 5,040
ankle and foot level JOINTS
Injury of unspecified muscle and tendon at ankle and foot INJURIES TO THE MUSCLES AND TENDONS AND
S96.9 7,200 2,160 5,040
level JOINTS
T03.9 Multiple dislocations, sprains and strains, unspecified 7,200 2,160 5,040
JOINTS
Pulmonary oedema; Acute oedema of lung; Passive
J81 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
pulmonary congestion; Lung dropsy
Pulmonary eosinophilia, not elsewhere classified;
J82 Eosinophilic asthma; Loffler's pneumonia; Tropical INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
pulmonary eosinophilia NOS
Alveolar and parietoalveolar conditions; Alveolar
J84.0 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
proteinosis; Pulmonary alveolar microlithiasis
Other interstitial pulmonary diseases with fibrosis; Diffuse

J84.1 pulmonary fibrosis; Cryptogenic fibrosing alveolitis; INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
Hamman-Rich syndrome; Idiopathic pulmonary fibrosis
J84.8 Other specified interstitial pulmonary diseases INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
Interstitial pulmonary disease, unspecified; Interstitial
J84.9 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
pneumonia NOS
Acute vascular disorders of intestine; Acute fulminant

ischaemic colitis; Acute intestinal infarction; Acute small
intestine ischaemia; Mesentric artery embolism; Mesentric
K55.0 INTESTINAL DISORDERS 9,500 2,850 6,650
vein embolism; Mesentric artery infarction; Mesentric vein
infarction; Mesentric artery thrombosis; Mesenteric vein
thrombosis; Subacute ischaemic colitis
Chronic vascular disorders of intestine; Chronic ischaemic

colitis; Chronic ischaemic enteritis; Chronic ischaemic
enterocolitis; Ischaemic stricture of intestine; Mesentric
atherosclerosis; Mesentric vascular insufficiency
K55.2 Angiodysplasia of colon; Angiodysplasia of intestine NOS INTESTINAL DISORDERS 9,500 2,850 6,650
Vascular disorder of intestine, unspecified; Ischaemic colitis

NOS; Ischaemic enteritis NOS; Ischaemic enterocolitis NOS
Diverticular disease of small intestine with perforation and

K57.0 abscess; Diverticular disease of small intestine with INTESTINAL DISORDERS 9,500 2,850 6,650
peritonitis
Diverticular disease of small intestine without perforation

or abscess; Diverticular disease of small intestine NOS
Diverticular disease of large intestine with perforation and

K57.2 abscess; Diverticular disease/ Diverticulitis/ Diverticulosis/ INTESTINAL DISORDERS 9,500 2,850 6,650
Diverticulum of colon with peritonitis
Diverticular disease of large intestine without perforation

or abscess; Diverticular disease of colon NOS
Diverticular disease of both small and large intestine with

K57.4 perforation and abscess; Diverticular disease of both small INTESTINAL DISORDERS 9,500 2,850 6,650
and large intestine with peritonitis
Diverticular disease of both small and large intestine
K57.5 without perforation or abscess; Diverticular disease of both INTESTINAL DISORDERS 9,500 2,850 6,650
small and large intestine NOS
Diverticular disease of intestine, part unspecified, with
K57.8 perforation and abscess; Diverticular disease of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
NOS with peritonitis
Diverticular disease of intestine, part unspecified, without

perforation or abscess; Diverticular disease of intestine NOS
Megacolon, not elsewhere classified; Dilatation of colon;

Toxic megacolon
Other specified functional intestinal disorders; Atony of
colon
K59.9 Functional intestinal disorder, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650
K63.0 Abscess of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
Page 50 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
K63.1 Nontraumatic perforation of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.2 Fistula of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.3 Ulcer of intestine; Primary ulcer of small intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.4 Enteroptosis INTESTINAL DISORDERS 9,500 2,850 6,650
K63.5 Polyp of colon INTESTINAL DISORDERS 9,500 2,850 6,650
K63.8 Other specified diseases of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.9 Disease of intestine, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650
B05.4 Measles with intestinal complications INTESTINAL DISORDERS 9,500 2,850 6,650
Coeliac disease; Gluten-sensitive enteropathy; Idiopathic
K90.0 INTESTINAL MALABSORPTION 4,100 1,230 2,870
steatorrhoea; Nontropical sprue
K90.1 Tropical sprue; Sprue NOS; Tropical steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870
Blind loop syndrome, not elsewhere classified; Blind loop
K90.2 INTESTINAL MALABSORPTION 4,100 1,230 2,870
syndrome NOS
K90.3 Pancreatic steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870
Malabsorption due to intolerance, not elsewhere classified;
Malabsorption due to intolerance to carbohydrate;
K90.4 Malabsorption due to intolerance to fat; Malabsorption INTESTINAL MALABSORPTION 4,100 1,230 2,870
due to intolerance to protein; Malabsorption due to
intolerance to starch
K90.8 Other intestinal malabsorption INTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.9 Intestinal malabsorption, unspecified INTESTINAL MALABSORPTION 4,100 1,230 2,870
Paralytic ileus; Paralysis of bowel; Paralysis of colon;
K56.0 INTESTINAL OBSTRUCTION 10,100 3,030 7,070
Paralysis of intestine
Intussusception; Intussusception or invagination of bowel;
Intussusception or invagination of colon; Intussusception or
invagination of intestine; Intussusception or invagination of
rectum
Volvulus; Strangulation of colon or intestine; Torsion of
colon or intestine; Twist of colon or intestine
K56.3 Gallstone ileus; Obstruction of intestine by gallstone INTESTINAL OBSTRUCTION 10,100 3,030 7,070
Other impaction of intestine; Enterolith; Impaction of
colon; Impaction of faecal
Intestinal adhesions [bands] with obstruction; Peritoneal

adhesions [bands] with intestinal obstruction
Other and unspecified intestinal obstruction; Enterotenosis;

K56.6 Obstructive ileus NOS; Occlusion of colon or intestine; INTESTINAL OBSTRUCTION 10,100 3,030 7,070
Stenosis of colon or intestine; Stricture of colon or intestine
K56.7 Ileus, unspecified INTESTINAL OBSTRUCTION 10,100 3,030 7,070
Intracranial abscess and granuloma; Abscess (embolic)(of)

brain [any part]; Abscess (embolic)(of) cerebellar; Abscess
(embolic)(of) cerebral; Abscess (embolic)(of) otogenic; INTRACRANIAL AND INTRASPINAL ABSCESS AND
G06.0 27,900 8,370 19,530
IIntracranial abscess or granuloma, epidural; Intracranial GRANULOMA
abscess or granuloma, extradural; Intracranial abscess or
granuloma, subdural
Intraspinal abscess and granuloma; Abscess (embolic) of

spinal cord [any part]; Intraspinal abscess or granuloma INTRACRANIAL AND INTRASPINAL ABSCESS AND
G06.1 27,900 8,370 19,530
epidural; Intraspinal abscess or granuloma extradural; GRANULOMA
Intraspinal abscess or granuloma subdural
Encephalitis, myelitis and encephalomyelitis in Extradural INTRACRANIAL AND INTRASPINAL ABSCESS AND
G06.2 27,900 8,370 19,530
and subdural abscess, unspecified GRANULOMA
Injury of optic nerve and pathways; Injury of Optic chiasm;

S04.0 INTRACRANIAL INJURIES 8,800 2,640 6,160
Injury of 2nd cranial nerve; Injury of Visual cortex
S04.1 Injury of oculomotor nerve; injury of 3rd cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.4 Injury of abducent nerve; injury of 6th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.5 Injury of facial nerve; injury of 7th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
Injury of acoustic nerve; injury of Auditory nerve; injury of
8th cranial nerve
Injury of other cranial nerves; injury of Glossopharyngeal

S04.8 [9th] nerve; injury of Hypoglossal [12th] nerve; injury of; INTRACRANIAL INJURIES 8,800 2,640 6,160
injury of Olfactory [1st] nerve; injury of Vagus [10th] nerve
S04.9 Injury of unspecified cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
Injury of conjunctiva and corneal abrasion without mention
of foreign body
Concussion; Commotio cerebri (without open intracranial
wound)
Concussion; Commotio cerebri (with open intracranial
wound)
Traumatic cerebral oedema (without open intracranial
wound)
Page 51 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Diffuse brain injury; Cerebral contusion NOS; Cerebral
S06.20 laceration NOS; Traumatic compression of brain NOS (with INTRACRANIAL INJURIES 8,800 2,640 6,160
open intracranial wound)
Diffuse brain injury; Cerebral contusion NOS; Cerebral
S06.21 laceration NOS; Traumatic compression of brain NOS INTRACRANIAL INJURIES 8,800 2,640 6,160
(without open intracranial wound)
Focal brain injury; Focal cerebral; Focal cerebral contusion;

S06.30 Focal cerebral laceration; Focal traumatic intracerebral INTRACRANIAL INJURIES 8,800 2,640 6,160
haemorrhage (without open intracranial wound)
Focal brain injury; Focal cerebral; Focal cerebral contusion;

S06.31 Focal cerebral laceration; Focal traumatic intracerebral INTRACRANIAL INJURIES 8,800 2,640 6,160
haemorrhage (with open intracranial wound)
Epidural haemorrhage; Extradural haemorrhage, traumatic

Epidural haemorrhage; Extradural haemorrhage, traumatic
(with open intracranial wound)
Traumatic subdural haemorrhage (without open
intracranial wound)
Traumatic subdural haemorrhage (with open intracranial
wound)
Traumatic subarachnoid haemorrhage (without open
intracranial wound)
Traumatic subarachnoid haemorrhage (with open
intracranial wound)
Intracranial injury with prolonged coma (without open
intracranial wound)
Other intracranial injuries; traumatic haemorrhage
S06.80 cerebellar; traumatic haemorrhage intracranial NOS INTRACRANIAL INJURIES 8,800 2,640 6,160
Other intracranial injuries; traumatic haemorrhage
S06.81 cerebellar; traumatic haemorrhage intracranial NOS (with INTRACRANIAL INJURIES 8,800 2,640 6,160
Intracranial injury, unspecified; brain injury NOS (without
Intracranial injury, unspecified; brain injury NOS (with open
intracranial wound)
S09.0 Injury of blood vessels of head, not elsewhere classified INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.1 Injury of muscle and tendon of head INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.2 Traumatic rupture of ear drum INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.7 Multiple injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.8 Other specified injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160
Unspecified injury of head; Injury of face NOS; Injury of ear
NOS; Injury of nose NOS
Intraventricular (nontraumatic) haemorrhage, grade 1, of INTRAVENTRICULAR
P52.0 fetus and newborn; Subependymal haemorrhage (without HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920
intraventricular extension) THE NEWBORN
Intraventricular (nontraumatic) haemorrhage, grade 2, of INTRAVENTRICULAR
P52.1 fetus and newborn; Subependymal haemorrhage with HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920
intraventricular extension THE NEWBORN
INTRAVENTRICULAR
Unspecified intraventricular (nontraumatic) haemorrhage
P52.3 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920
of fetus and newborn
THE NEWBORN
INTRAVENTRICULAR
Intracerebral (nontraumatic) haemorrhage of fetus and
newborn
THE NEWBORN
INTRAVENTRICULAR
Subarachnoid (nontraumatic) haemorrhage of fetus and
newborn
THE NEWBORN
INTRAVENTRICULAR
Cerebellar (nontraumatic) and posterior fossa haemorrhage
of fetus and newborn
THE NEWBORN
INTRAVENTRICULAR
Other intracranial (nontraumatic) haemorrhages of fetus
and newborn
THE NEWBORN
INTRAVENTRICULAR
Intracranial (nontraumatic) haemorrhage of fetus and
newborn, unspecified
THE NEWBORN
Acute transmural myocardial infarction of anterior wall [or

duration of <4 weeks] KILLIPS stage unspecified; Acute
transmural infarction of anterior wall NOS [or duration of ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I21.0 18,900 5,670 13,230
<4 weeks] KILLIPS stage unspecified; Acute anteroapical; INFARCTION
anterolateral; anteroseptal transmural infarction [or
duration of <4 weeks] KILLIPS stage unspecified;
Page 52 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Acute transmural myocardial infarction of inferior wall [or
duration of <4 weeks] KILLIPS I; Acute transmural infarction
of diaphragmatic wall [or duration of <4 weeks] KILLIPS I; ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I21.1 18,900 5,670 13,230
Acute transmural infarction of inferior wall NOS; INFARCTION
inferolateral; inferoposterior [or duration of <4
weeks]KILLIPS I;
Acute transmural myocardial infarction of other sites [or
duration of <4 weeks] KILLIPS II; Acute apical-lateral
transmural infarction [or duration of <4 weeks] KILLIPS II;
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I21.2 Acute basal-lateral transmural infarction [or duration of <4 18,900 5,670 13,230
INFARCTION
weeks] KILLIPS II; high lateral; lateral wall NOS; posterior
(true); posterobasal; posterolateral; posteroseptal; septal
NOS
Acute transmural myocardial infarction of unspecified site; ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I21.3 18,900 5,670 13,230
Transmural myocardial infarction NOS INFARCTION
Acute subendocardial myocardial infarction; ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I21.4 18,900 5,670 13,230
Nontransmural myocardial infarction NOS INFARCTION
Acute myocardial infarction, unspecified [or duration of <4
I21.9 weeks] KILLIPS I; Acute myocardial infarction NOS [or 18,900 5,670 13,230
INFARCTION
duration of <4 weeks] KILLIPS I
Subsequent myocardial infarction of anterior wall; Acute
Subsequent infarction of anterior wall NOS; Acute
I22.0 subsequent infarction of anteroapical wall; Acute 18,900 5,670 13,230
INFARCTION
subsequent infarction of anterolateral wall; Acute
subsequent infarction of anteroseptal wall
Subsequent myocardial infarction of inferior wall; Acute
subsequent infarction of diaphragmatic wall; Acute
I22.1 subsequent infarction of inferior wall NOS; Acute 18,900 5,670 13,230
INFARCTION
subsequent infarction of inferolateral wall; Acute
subsequent infarction of inferoposterior wall
Subsequent myocardial infarction of other sites; Acute

myocardial infarction of apical-lateral wall; Acute
myocardial infarction of basal-lateral wall; Acute myocardial ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I22.8 18,900 5,670 13,230
infarction of high lateral wall; Acute myocardial infarction INFARCTION
of lateral wall NOS; posterior (true); posterobasal;
posterolateral; posteroseptal; septal NOS
I22.9 Subsequent myocardial infarction of unspecified site 18,900 5,670 13,230
INFARCTION
Haemopericardium as current complication following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.0 18,900 5,670 13,230
myocardial infarction INFARCTION
Atrial septal defect as current complication following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.1 18,900 5,670 13,230
myocardial infarction INFARCTION
Ventricular septal defect as current complication following ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.2 18,900 5,670 13,230
acute myocardial infarction INFARCTION
Rupture of cardiac wall without haemopericardium as ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.3 18,900 5,670 13,230
current complication following acute myocardial infarction INFARCTION
Rupture of chordae tendineae as current complication ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.4 18,900 5,670 13,230
following acute myocardial infarction INFARCTION
Rupture of papillary muscle as current complication ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.5 18,900 5,670 13,230
following acute myocardial infarction INFARCTION
Other current complications following acute myocardial ISCHEMIC HEART DISEASE WITH MYOCARDIAL
I23.8 18,900 5,670 13,230
infarction INFARCTION
I24.1 Dressler's syndrome; Postmyocardial infarction syndrome 18,900 5,670 13,230
INFARCTION
Unstable angina; Angina crescendo; Angina de novo effort;
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I20.0 Angina worsening effort; Intermediate coronary syndrome; 12,000 3,600 8,400
INFARCTION
Preinfarction syndrome
Angina pectoris with documented spasm; Angiospastic
I20.1 Angina ; Prinzmetal Angina ; spasm-induced Angina ; 12,000 3,600 8,400
INFARCTION
Variant Angina
Other forms of angina pectoris; Angina of effort; ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I20.8 12,000 3,600 8,400
Stenocardia INFARCTION
Angina pectoris, unspecified; Angina NOS; Cardiac Angina ; ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I20.9 12,000 3,600 8,400
Anginal syndrome; Ischaemic chest pain INFARCTION
Coronary thrombosis not resulting in myocardial infarction;

Coronary artery embolism not resulting in myocardial
infaction; Coronary vein embolism not resulting in
myocardial infarction; Coronary artery occlusion not ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I24.0 12,000 3,600 8,400
resulting in myocardial infarction; Coronary artery INFARCTION
thromboembolism not resulting in myocardial infarction;
Coronary vein thromboembolism not resulting in
myocardial infarction;
Other forms of acute ischaemic heart disease; Coronary ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I24.8 12,000 3,600 8,400
failure; Coronary insufficiency INFARCTION
Page 53 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
I25.5 Ischaemic cardiomyopathy 12,000 3,600 8,400
INFARCTION
I25.6 Silent myocardial ischaemia 12,000 3,600 8,400
INFARCTION
I25.8 Other forms of chronic ischaemic heart disease 12,000 3,600 8,400
INFARCTION
Chronic ischaemic heart disease, unspecified; Chronic ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
I25.9 12,000 3,600 8,400
Ischaemic heart disease NOS INFARCTION
P57.0 Kernicterus due to isoimmunization JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P57.8 Other specified kernicterus JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P57.9 Kernicterus, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.1 Neonatal jaundice due to bleeding JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.2 Neonatal jaundice due to infection JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.3 Neonatal jaundice due to polycythaemia JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
Neonatal jaundice due to drugs or toxins transmitted from
P58.4 JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
mother or given to newborn
Neonatal jaundice due to other specified excessive
haemolysis
P58.9 Neonatal jaundice due to excessive haemolysis, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
Neonatal jaundice associated with preterm delivery;

P59.0 Hyperbilirubinaemia of prematurity; Jaundice due to JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
delayed conjucation associated with preterm delivery
P59.1 Inspissated bile syndrome JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
Neonatal jaundice from other and unspecified
hepatocellular damage
P59.3 Neonatal jaundice from breast milk inhibitor JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.8 Neonatal jaundice from other specified causes JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
Neonatal jaundice, unspecified; Intense physiological
jaundice, NOS; Prolonged physiological jaundice, NOS
A30.0 Hansen's disease: Indeterminate leprosy; I leprosy LEPROSY 8,800 2,640 6,160
A30.1 Hansen's disease : Tuberculoid leprosy; TT leprosy LEPROSY 8,800 2,640 6,160
Hansen's disease: Borderline tuberculoid leprosy; BT
A30.2 LEPROSY 8,800 2,640 6,160
leprosy
Hansen's disease: Borderline lepromatous leprosy; BL
A30.4 LEPROSY 8,800 2,640 6,160
leprosy
A30.5 Hansen's disease: Lepromatous leprosy; LL leprosy LEPROSY 8,800 2,640 6,160
A30.8 Other forms of leprosy LEPROSY 8,800 2,640 6,160
Leprosy, unspecified
A30.9 LEPROSY 8,800 2,640 6,160
Hansen Disease
Leptospirosis icterohaemorrhagica; Leptospirosis due to
A27.0 LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
Leptospira interrogans serovar icterohaemorrhagiae
A27.8 Other forms of leptospirosis LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
A27.9 Leptospirosis, unspecified LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
K70.0 Alcoholic fatty liver LIVER DISEASES I 11,800 3,540 8,260
K70.1 Alcoholic hepatitis LIVER DISEASES I 11,800 3,540 8,260
K70.2 Alcoholic fibrosis and sclerosis of liver LIVER DISEASES I 11,800 3,540 8,260
Alcoholic cirrhosis of liver; Alcoholic cirrhosis NOS;
K70.3 LIVER DISEASES I 11,800 3,540 8,260
Laennec's cirrhosis
K70.9 Alcoholic liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
Toxic liver disease with cholestasis; Cholestatis with
hepatocyte injury; Pure cholestasis
Toxic liver disease with hepatic necrosis; Acute hepatic

failure due to drugs; Chronic hepatic failure due to drugs
K71.2 Toxic liver disease with acute hepatitis LIVER DISEASES I 11,800 3,540 8,260
K71.3 Toxic liver disease with chronic persistent hepatitis LIVER DISEASES I 11,800 3,540 8,260
Toxic liver disease with chronic active hepatitis; Toxic liver
disease with lupoid hepatitis
K71.6 Toxic liver disease with hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
Toxic liver disease with other disorders of liver; Toxic liver

disease with focal nodular hyperplasia; Toxic liver disease
K71.8 with hepatic granulomas; Toxic liver disease with peliosis LIVER DISEASES I 11,800 3,540 8,260
hepatis; Toxic liver disease with veno-occlusive disease of
liver
K71.9 Toxic liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
K73.0 Chronic persistent hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
Chronic active hepatitis, not elsewhere classified; Lupoid
hepatitis NEC
K73.8 Other chronic hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K73.9 Chronic hepatitis, unspecified LIVER DISEASES I 11,800 3,540 8,260
K74.1 Hepatic sclerosis LIVER DISEASES I 11,800 3,540 8,260
Oesophageal varices in other and unspecified cirrhosis of
K74.6+I98.2* LIVER DISEASES I 11,800 3,540 8,260
liver
Page 54 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Abscess of liver; Hepatic abscess NOS; Cholangitic hepatic

K75.0 abscess; Haematogenic hepatic abscess; Lymphogenic LIVER DISEASES I 11,800 3,540 8,260
hepatic abscess; Pylephlebitic hepatic abscess
K75.1 Phlebitis of portal vein; Pylephlebitis LIVER DISEASES I 11,800 3,540 8,260
K75.2 Nonspecific reactive hepatitis LIVER DISEASES I 11,800 3,540 8,260
K75.3 Granulomatous hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K75.4 Autoimmune hepatitis LIVER DISEASES I 11,800 3,540 8,260
Other specified inflammatory liver diseases
Non alcoholic Steatohepatitis (NASH)
K75.9 Inflammatory liver disease, unspecified; Hepatitis NOS LIVER DISEASES I 11,800 3,540 8,260
K76.0 Fatty (change of) liver, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
Other specified diseases of liver; Focal nodular hyperplasia
of liver; Hepatoptosis
K76.9 Liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
K71.4 Toxic liver disease with chronic lobular hepatitis LIVER DISEASES II 15,100 4,530 10,570
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver LIVER DISEASES II 15,100 4,530 10,570
K74.0 Hepatic fibrosis LIVER DISEASES II 15,100 4,530 10,570
K74.2 Hepatic fibrosis with hepatic sclerosis LIVER DISEASES II 15,100 4,530 10,570
Other and unspecified cirrhosis of liver; Cirrhosis of liver
NOS; Cryptogenic cirrhosis of liver; Macronodular cirrhosis
K74.6 of liver; Micronodular cirrhosis of liver; Mixed type cirrhosis LIVER DISEASES II 15,100 4,530 10,570
of liver; Portal cirrhosis of liver; Postnecrotic cirrhosis of
liver;
Chronic passive congestion of liver; Cardiac cirrhosis (so-
K76.1 LIVER DISEASES II 15,100 4,530 10,570
called) of liver; Cardiac sclerosis of liver
K76.2 Central haemorrhagic necrosis of liver LIVER DISEASES II 15,100 4,530 10,570
K76.3 Infarction of liver LIVER DISEASES II 15,100 4,530 10,570
K76.4 Peliosis hepatis; Hepatic angiomatosis LIVER DISEASES II 15,100 4,530 10,570
K76.6 Portal hypertension LIVER DISEASES II 15,100 4,530 10,570
K76.7 Hepatorenal syndrome LIVER DISEASES II 15,100 4,530 10,570
Nonspecific mesenteric lymphadenitis; Acute Mesenteric

I88.0 LYMPHADENITIS 6,800 2,040 4,760
lymphadenitis; Chronic Mesenteric lymphadenitis
Lymphangitis; Lymphangitis NOS; Chronic Lymphangitis;

I89.1 LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
Subacute Lymphangitis
Other specified noninfective disorders of lymphatic vessels
I89.8 and lymph nodes; Chylocele (nonfilarial); Lipomelanotic LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
reticulosis
Noninfective disorder of lymphatic vessels and lymph
I89.9 LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
nodes, unspecified; Disease of lymphatic vessels NOS
Malignant neoplasm of kidney, except renal pelvis & renal
C64 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
calyces
Malignant neoplasm of renal pelvis; Malignant neoplasm of

C65 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
Pelviureteric junction; Malignant neoplasm of Renal calyces
C66 Malignant neoplasm of ureter MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.0 Malignant neoplasm of Trigone of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.1 Malignant neoplasm of Dome of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.2 Malignant neoplasm of Lateral wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.3 Malignant neoplasm of Anterior wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
Malignant neoplasm of Bladder neck; Malignant neoplasm
C67.5 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
of Internal urethral orifice
C67.6 Malignant neoplasm of Ureteric orifice MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.7 Malignant neoplasm of Urachus MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.8 Malignant neoplasm of Overlapping lesion of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.9 Malignant neoplasm of Bladder, unspecified MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C68.0 Malignant neoplasm of Urethra MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
Malignant neoplasm of Urinary organ, unspecified;
Malignant neoplasm of Urinary system NOS
C79.0 Secondary malignant neoplasm of kidney and renal pelvis MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
Secondary malignant neoplasm of bladder and other and

unspecified urinary organs
Malignant neoplasm of Scapula and long bones of upper MALIGNANT NEOPLASMS OF BONE AND
C40.0 16,500 4,950 11,550
limb ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS OF BONE AND
C40.1 Malignant neoplasm of Short bones of upper limb 16,500 4,950 11,550
ARTICULAR CARTILAGE
C40.2 Malignant neoplasm of Long bones of lower limb 16,500 4,950 11,550
ARTICULAR CARTILAGE
C40.3 Malignant neoplasm of Short bones of lower limb 16,500 4,950 11,550
ARTICULAR CARTILAGE
Malignant neoplasm of Bone and articular cartilage of limb, MALIGNANT NEOPLASMS OF BONE AND
C40.9 16,500 4,950 11,550
unspecified ARTICULAR CARTILAGE
Malignant neoplasm of Bones of skull and face; Malignant
C41.0 neoplasm o f Superior maxilla; Malignant neoplasm of 16,500 4,950 11,550
ARTICULAR CARTILAGE
Orbital bone
Page 55 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Mandible; Malignant neoplasm of MALIGNANT NEOPLASMS OF BONE AND
C41.1 16,500 4,950 11,550
Lower jaw bone ARTICULAR CARTILAGE
C41.2 Malignant neoplasm of Vertebral column 16,500 4,950 11,550
ARTICULAR CARTILAGE
C41.3 Malignant neoplasm of Ribs, sternum and clavicle 16,500 4,950 11,550
ARTICULAR CARTILAGE
C41.4 Malignant neoplasm of Pelvic bones, sacrum and coccyx 16,500 4,950 11,550
ARTICULAR CARTILAGE
Malignant neoplasm of Overlapping lesion of bone and MALIGNANT NEOPLASMS OF BONE AND
C41.8 16,500 4,950 11,550
articular cartilage ARTICULAR CARTILAGE
Malignant neoplasm of Bone and articular cartilage, MALIGNANT NEOPLASMS OF BONE AND
C41.9 16,500 4,950 11,550
unspecified ARTICULAR CARTILAGE
C79.5 Secondary malignant neoplasm of bone and bone marrow 16,500 4,950 11,550
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C70.0 Malignant neoplasm of Cerebral meninges 16,900 5,070 11,830
SYSTEM
C70.1 Malignant neoplasm of Spinal meninges 16,900 5,070 11,830
SYSTEM
C70.9 Malignant neoplasm of Meninges, unspecified 16,900 5,070 11,830
SYSTEM
Malignant neoplasm of Cerebrum, except lobes and MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C71.0 16,900 5,070 11,830
ventricles; Malignant neoplasm of Supratentorial NOS SYSTEM
C71.1 Malignant neoplasm of Frontal lobe 16,900 5,070 11,830
SYSTEM
C71.2 Malignant neoplasm of Temporal lobe 16,900 5,070 11,830
SYSTEM
C71.3 Malignant neoplasm of Parietal lobe 16,900 5,070 11,830
SYSTEM
C71.4 Malignant neoplasm of Occipital lobe 16,900 5,070 11,830
SYSTEM
C71.5 Malignant neoplasm of Cerebral ventricle 16,900 5,070 11,830
SYSTEM
C71.6 Malignant neoplasm of Cerebellum 16,900 5,070 11,830
SYSTEM
Malignant neoplasm of Brain stem; Malignant neoplasm of MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C71.7 16,900 5,070 11,830
Fourth Ventricle; Malignant neoplasm of Infratentorial NOS SYSTEM

C71.8 Malignant neoplasm of Overlapping lesion of brain 16,900 5,070 11,830
SYSTEM
C71.9 Malignant neoplasm of Brain, unspecified 16,900 5,070 11,830
SYSTEM
C72.0 Malignant neoplasm of Spinal cord 16,900 5,070 11,830
SYSTEM
C72.1 Malignant neoplasm of Cauda equina 16,900 5,070 11,830
SYSTEM
Malignant neoplasm of Olfactory nerve; Malignant MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C72.2 16,900 5,070 11,830
neoplasm of Olfactory bulb SYSTEM
C72.3 Malignant neoplasm of Optic nerve 16,900 5,070 11,830
SYSTEM
C72.4 Malignant neoplasm of Acoustic nerve 16,900 5,070 11,830
SYSTEM
Malignant neoplasm of Other and unspecified cranial MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C72.5 16,900 5,070 11,830
nerves; Malignant neoplasm of Cranial nerve NOS SYSTEM
Malignant neoplasm of Overlapping lesion of brain and MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C72.8 16,900 5,070 11,830
other parts of central nervous system SYSTEM
Malignant neoplasm of Central nervous system, MALIGNANT NEOPLASMS OF CENTRAL NERVOUS

C72.9 16,900 5,070 11,830
unspecified; Malignant neoplasm of Nervous system NOS SYSTEM
Secondary malignant neoplasm of brain and cerebral MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C79.3 16,900 5,070 11,830
meninges SYSTEM
Secondary malignant neoplasm of other and unspecified MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
C79.4 16,900 5,070 11,830
parts of nervous system SYSTEM
C15.0 Malignant neoplasm of Cervical part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.2 Malignant neoplasm of Abdominal part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.3 Malignant neoplasm of Upper third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.4 Malignant neoplasm of Middle third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.5 Malignant neoplasm of Lower third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.8 Malignant neoplasm of Overlapping lesion of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.9 Malignant neoplasm of Oesophagus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Page 56 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
C16 Dermato(poly)myositis in Malignant neoplasm of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Cardia; Malignant neoplasm of

Cardiac orifice; Malignant neoplasm of Cardio-oesophageal
C16.0 junction; Malignant neoplasm of MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Gastro-oesophageal junction; Malignant neoplasm of
Oesophagus and stomach
C16.1 Malignant neoplasm of Fundus of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.2 Malignant neoplasm of Body of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Pyloric antrum; Malignant

C16.3 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
neoplasm of Gastric antrum
Malignant neoplasm of Pylorus; Malignant neoplasm of
Prepylorus; Malignant neoplasm of pyloric canal
Malignant neoplasm of Lesser curvature of stomach,
unspecified
Malignant neoplasm of Greater curvature of stomach,
unspecified
Malignant neoplasm of Stomach, unspecified; Gastric
cancer NOS
C17.0 Malignant neoplasm of Duodenum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.1 Malignant neoplasm of Jejunum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.2 Malignant neoplasm of Ileum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.9 Malignant neoplasm of Small intestine, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Caecum; Malignant neoplasm of

Ileocaecal valve
C18.1 Malignant neoplasm of Appendix MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.2 Malignant neoplasm of Ascending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.3 Malignant neoplasm of Hepatic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.4 Malignant neoplasm of Transverse colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.5 Malignant neoplasm of Splenic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.6 Malignant neoplasm of Descending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Sigmoid colon; Malignant neoplasm

of Sigmoid flexure
C18.8 Malignant neoplasm of Overlapping lesion of colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Colon, unspecified; Malignant

neoplasm of Large intestine NOS
Malignant neoplasm of rectosigmoid junction; Malignant
C19 neoplasm of Colon with rectum; Malignant neoplasm of MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Rectosigmoid colon
Malignant neoplasm of rectum; Malignant neoplasm of
C20 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Rectal ampulla
C21.0 Malignant neoplasm of Anus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Anal canal; Malignant neoplasm of

Anal sphincter
Malignant neoplasm of Overlapping lesion of rectum, anus
C21.8 and anal canal; Malignant neoplasm of Anorectal junction; MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Anorectum
Liver cell carcinoma; Hepatocellular carcinoma
Hepatoma
C22.1 Intrahepatic bile duct carcinoma; Cholangiocarcinoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.2 Hepatoblastoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.3 Angiosarcoma of liver; Kupffer cell sarcoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.4 Other sarcomas of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.7 Other specified carcinomas of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.9 Liver, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C23 Malignant neoplasm of gallbladder MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Page 57 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Extrahepatic bile duct; Malignant

neoplasm of Biliary duct or passage NOS; Malignant
neoplasm of Common bile duct; Malignant neoplasm of
Cystic duct; Malignant neoplasm of Hepatic duct
C24.1 Malignant neoplasm of Ampulla of Vater MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C24.8 Malignant neoplasm of Overlapping lesion of biliary tract MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C24.9 Malignant neoplasm of Biliary tract, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.0 Malignant neoplasm of Head of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.1 Malignant neoplasm of Body of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.2 Malignant neoplasm of Tail of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.3 Malignant neoplasm of Pancreatic duct MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Endocrine pancreas; Malignant

neoplasm of Islets of Langerhans
Malignant neoplasm of Other parts of pancreas; Malignant
neoplasm of Neck of pancreas
C25.8 Malignant neoplasm of Overlapping lesion of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.9 Malignant neoplasm of Pancreas, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Intestinal tract, part unspecified;

Malignant neoplasm of Intestine NOS
C26.1 Malignant neoplasm of Spleen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Malignant neoplasm of Overlapping lesion of digestive

system
Malignant neoplasm of Ill-defined sites within the digestive

C26.9 system; Malignant neoplasm of Alimentary canal or tract MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
NOS; Malignant neoplasm of Gastrointestinal tract NOS
Mesothelioma of peritoneum; Mesothelioma of Mesentery;

Mesothelioma of Mesocolon; Mesothelioma of Omentum;
Mesothelioma of Parietal
Peritoneum; Mesothelioma of Pelvic Peritoneum
Malignant neoplasm of Specified parts of peritoneum;

Malignant neoplasm of Mesentery; Malignant neoplasm of
C48.1 Mesocolon; Malignant neoplasm of Omentum; Malignant MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
neoplasm of Parietal Peritoneum; Malignant neoplasm of
Pelvic peritoneum
C48.2 Malignant neoplasm of Peritoneum, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C76.2 Malignant neoplasm of Abdomen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Secondary and unspecified malignant neoplasm of Intra-

abdominal lymph nodes
C78.4 Secondary malignant neoplasm of small intestine MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Secondary malignant neoplasm of large intestine and

rectum
Secondary malignant neoplasm of retroperitoneum and
peritoneum; Malignant ascites NOS
C78.7 Secondary malignant neoplasm of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Secondary malignant neoplasm of other and unspecified

digestive organs
Malignant neoplasm of Nasal cavity; Malignant neoplasm of
Cartilage of nose; Malignant neoplasm of nasal Concha;
C30.0 Malignant neoplasm of Internal nose; Malignant neoplasm MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210
of Septum of nose; Malignant neoplasm of Vestibule of
nose
Malignant neoplasm of Middle ear; Malignant neoplasm of
Eustachian tube; Malignant neoplasm of Inner ear;
C30.1 MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210
Malignant neoplasm of
Mastoid air cells
C69.1 Malignant neoplasm of Cornea MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.2 Malignant neoplasm of Retina MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.3 Malignant neoplasm of Choroid MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
Malignant neoplasm of Ciliary body; Malignant neoplasm
C69.4 MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
of Eyeball
Page 58 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Lacrimal gland and duct; Malignant
C69.5 neoplasm of Lacrimal sac; Malignant neoplasm of MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
Nasolacrimal duct
Malignant neoplasm of Orbit; Malignant neoplasm of
Connective tissue of orbit; Malignant neoplasm of
C69.6 Extraocular muscle; Malignant neoplasm of Peripheral MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
nerves of orbit; Malignant neoplasm of Retrobulbar tissue;
Malignant neoplasm of Retro-ocular tissue
C69.9 Malignant neoplasm of Eye, unspecified MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
Malignant neoplasm of Labium majus; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL
C51.0 11,400 3,420 7,980
of Bartholin's [greater vestibular] gland TRACT
MALIGNANT NEOPLASMS OF FEMALE GENITAL
C51.1 Malignant neoplasm of Labium minus 11,400 3,420 7,980
TRACT
C51.2 Malignant neoplasm of Clitoris 11,400 3,420 7,980
TRACT
Malignant neoplasm of Vulva, unspecified; Malignant
C51.9 neoplasm of External female genitalia NOS; Malignant 11,400 3,420 7,980
TRACT
neoplasm of Pudendum
C52 Malignant neoplasm of vagina 11,400 3,420 7,980
TRACT
C53.0 Malignant neoplasm of Endocervix 11,400 3,420 7,980
TRACT
C53.1 Malignant neoplasm of Exocervix 11,400 3,420 7,980
TRACT
C53.8 Malignant neoplasm of Overlapping lesion of cervix uteri 11,400 3,420 7,980
TRACT
C53.9 Malignant neoplasm of Cervix uteri, unspecified 11,400 3,420 7,980
TRACT
Malignant neoplasm of Isthmus uteri; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL
C54.0 11,400 3,420 7,980
of Lower uterine segment TRACT
C54.1 Malignant neoplasm of Endometrium 11,400 3,420 7,980
TRACT
C54.2 Malignant neoplasm of Myometrium 11,400 3,420 7,980
TRACT
C54.3 Malignant neoplasm of Fundus uteri 11,400 3,420 7,980
TRACT
C54.8 Malignant neoplasm of Overlapping lesion of corpus uteri 11,400 3,420 7,980
TRACT
C54.9 Corpus uteri, unspecified 11,400 3,420 7,980
TRACT
C55 Malignant neoplasm of uterus, part unspecified 11,400 3,420 7,980
TRACT
C56 Malignant neoplasm of ovary 11,400 3,420 7,980
TRACT
Malignant neoplasm of Fallopian tube; Malignant MALIGNANT NEOPLASMS OF FEMALE GENITAL

C57.0 11,400 3,420 7,980
neoplasm of Oviduct; Malignant neoplasm of Uterine tube TRACT
Malignant neoplasm of Parametrium; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL

C57.3 11,400 3,420 7,980
of Uterine ligament NOS TRACT
C57.4 Malignant neoplasm of Uterine adnexa, unspecified 11,400 3,420 7,980
TRACT
Malignant neoplasm of Other specified female genital MALIGNANT NEOPLASMS OF FEMALE GENITAL
C57.7 11,400 3,420 7,980
organs; Malignant neoplasm of Wolffian body or duct TRACT
Malignant neoplasm of Overlapping lesion of female genital
C57.8 organs; Malignant neoplasm of Tubo-ovarian; Malignant 11,400 3,420 7,980
TRACT
neoplasm of Utero-ovarian
Malignant neoplasm of Female genital organ, unspecified; MALIGNANT NEOPLASMS OF FEMALE GENITAL
C57.9 11,400 3,420 7,980
Malignant neoplasm of Female genitourinary tract NOS TRACT
Malignant neoplasm of placenta; Choriocarcinoma NOS; MALIGNANT NEOPLASMS OF FEMALE GENITAL

C58 11,400 3,420 7,980
Chorionepithelioma NOS TRACT
C79.6 Secondary malignant neoplasm of ovary 11,400 3,420 7,980
TRACT
Malignant neoplasm of External upper lip; Malignant
neoplasm of Upper lip NOS; Malignant neoplasm of Upper MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C00.0 11,500 3,450 8,050
lip; Malignant neoplasm of lipstick area; Malignant PHARYNX
neoplasm of Upper lip, vermilion border
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C00.9 Malignant neoplasm of Lip, unspecified 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of base of Dorsal surface of tongue ;
C01 Malignant neoplasm of Fixed part of tongue NOS; 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Posterior third of tongue
Malignant neoplasm of Dorsal surface of base of tongue;
C02.0 Malignant neoplasm of Anterior two-thirds of dorsal 11,500 3,450 8,050
PHARYNX
surface of tongue
Malignant neoplasm of Border of tongue; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C02.1 11,500 3,450 8,050
neoplasm of Tip of tongue PHARYNX
Page 59 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Ventral surface of tongue;
Malignant neoplasm of Anterior two-thirds of ventral MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C02.2 11,500 3,450 8,050
surface of tongue; Malignant neoplasm of Frenulum PHARYNX
linguae
Malignant neoplasm of Anterior two-thirds of tongue, part

C02.3 unspecified; Malignant neoplasm of Middle third of tongue 11,500 3,450 8,050
PHARYNX
NOS; Malignant neoplasm of Mobile part of tongue NOS

C02.4 Malignant neoplasm of Lingual tonsil 11,500 3,450 8,050
PHARYNX
C02.8 Malignant neoplasm of Overlapping lesion of tongue 11,500 3,450 8,050
PHARYNX
C02.9 Malignant neoplasm of Tongue, unspecified 11,500 3,450 8,050
PHARYNX
C03.0 Malignant neoplasm of Upper gum 11,500 3,450 8,050
PHARYNX
C03.1 Malignant neoplasm of Lower gum 11,500 3,450 8,050
PHARYNX
C03.9 Malignant neoplasm of Gum, unspecified 11,500 3,450 8,050
PHARYNX
C04.9 Malignant neoplasm of Floor of mouth, unspecified 11,500 3,450 8,050
PHARYNX
C05.0 Malignant neoplasm of Hard palate 11,500 3,450 8,050
PHARYNX
C05.1 Malignant neoplasm of Soft palate 11,500 3,450 8,050
PHARYNX
C05.9 Malignant neoplasm of Palate, unspecified 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Cheek mucosa; Malignant neoplasm
C06.0 of Buccal mucosa NOS; Malignant neoplasm of Internal 11,500 3,450 8,050
PHARYNX
cheek
Malignant neoplasm of Vestibule of mouth; Malignant

neoplasm of Upper buccal sulcus; Malignant neoplasm of MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C06.1 11,500 3,450 8,050
Lower buccal sulcus; Malignant neoplasm of Upper Labial PHARYNX
sulcus; Malignant neoplasm of Lower Labial sulcus

C06.2 Malignant neoplasm of Retromolar area 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Mouth, unspecified; Minor

C06.9 Malignant neoplasm of minor salivary gland, unspecified 11,500 3,450 8,050
PHARYNX
site; Malignant neoplasm of Oral cavity NOS

C07 Malignant neoplasm of parotid gland 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Submandibular gland; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C08.0 11,500 3,450 8,050
neoplasm of Submaxillary gland PHARYNX
C08.1 Malignant neoplasm of Sublingual gland 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Major salivary gland, unspecified; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C08.9 11,500 3,450 8,050
Malignant neoplasm of Major Salivary gland NOS PHARYNX

C09.0 Malignant neoplasm of Tonsillar fossa 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Tonsil, unspecified; Malignant
C09.9 neoplasm of Tonsil NOS; Malignant neoplasm of Faucial 11,500 3,450 8,050
PHARYNX
Tonsil; Malignant neoplasm of Palatine Tonsil
C10.0 Malignant neoplasm of Vallecula 11,500 3,450 8,050
PHARYNX
C10.3 Malignant neoplasm of Posterior wall of oropharynx 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Branchial cleft; Malignant neoplasm MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C10.4 11,500 3,450 8,050
of Branchial cyst PHARYNX
C10.9 Malignant neoplasm of Oropharynx, unspecified 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Superior wall of nasopharynx; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C11.0 11,500 3,450 8,050
Malignant neoplasm of Roof of nasopharynx PHARYNX
Malignant neoplasm of Posterior wall of nasopharynx;
C11.1 Malignant neoplasm of Adenoid; Malignant neoplasm of 11,500 3,450 8,050
PHARYNX
Pharyngeal tonsil
Malignant neoplasm of Lateral wall of nasopharynx;
Malignant neoplasm of Fossa of Rosenmüller; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C11.2 11,500 3,450 8,050
neoplasm of Opening of auditory tube; Malignant PHARYNX
neoplasm of Pharyngeal recess
Page 60 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Anterior wall of nasopharynx;

Malignant neoplasm of A nterior Nasopharyngeal surface
of soft palate; Malignant neoplasm of Posterior MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C11.3 11,500 3,450 8,050
Nasopharyngeal surface of soft palate; Malignant PHARYNX
neoplasm of Posterior margin of nasal choana; Malignant
of Posterior margin of nasal septum;

C11.9 Malignant neoplasm of Nasopharynx, unspecified 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Aryepiglottic fold, hypopharyngeal

aspect hypopharynx ; Malignant neoplasm of Aryepiglottic MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C13.1 11,500 3,450 8,050
fold, hypopharynx NOS; Malignant neoplasm of PHARYNX
Aryepiglottic fold, marginal zone, hypopharynx
Malignant neoplasm of Hypopharynx, unspecified; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,

C13.9 11,500 3,450 8,050
Malignant neoplasm of Hypopharyngeal wall NOS PHARYNX
C14.0 Malignant neoplasm of Pharynx, unspecified 11,500 3,450 8,050
PHARYNX
Malignant neoplasm of Overlapping lesion of lip, oral cavity MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C14.8 11,500 3,450 8,050
and pharynx PHARYNX
Malignant neoplasm of Head, face and neck; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
C76.0 11,500 3,450 8,050
neoplasm of Cheek NOS; Malignant neoplasm of Nose NOS PHARYNX
Secondary and unspecified malignant neoplasm of Lymph

C77.0 nodes of head, face and neck; Malignant neoplasm of 11,500 3,450 8,050
PHARYNX
Supraclavicular lymph nodes
Human immunodeficiency virus [HIV] disease resulting in MALIGNANT NEOPLASMS OF LYMPHOID,
B21.1 13,900 4,170 9,730
Burkitt's lymphoma HEMATOPOIETIC AND RELATED TISSUE
Human immunodeficiency virus [HIV] disease resulting in MALIGNANT NEOPLASMS OF LYMPHOID,
B21.2 13,900 4,170 9,730
other types of non-Hodgkin's lymphoma HEMATOPOIETIC AND RELATED TISSUE
Human immunodeficiency virus [HIV] disease resulting in
MALIGNANT NEOPLASMS OF LYMPHOID,
B21.3 other malignant neoplasms of lymphoid, haematopoietic 13,900 4,170 9,730
HEMATOPOIETIC AND RELATED TISSUE
and related tissue
Hodgkin's disease (Lymphocytic predominance); Hodgkin's

C81.0 disease (Lymphocytic-histiocytic predominance) 13,900 4,170 9,730
Nodular lymphocyte predominant Hodgkin lymphoma

C81.1 Hodgkin's disease( Nodular sclerosis) 13,900 4,170 9,730
C81.9 Hodgkin's disease, unspecified 13,900 4,170 9,730
Small cleaved cell, follicular non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C82.0 13,900 4,170 9,730
Follicular lymphoma grade I HEMATOPOIETIC AND RELATED TISSUE
Mixed small cleaved non-Hodgkin's lymphoma and large
C82.1 cell, follicular non-Hodgkin's lymphoma 13,900 4,170 9,730
Follicular lymphoma grade II
Large cell, follicular non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C82.2 13,900 4,170 9,730
Follicular lymphoma grade III, unspecified HEMATOPOIETIC AND RELATED TISSUE
C82.7 Other types of follicular non-Hodgkin's lymphoma 13,900 4,170 9,730
Follicular non-Hodgkin's lymphoma, unspecified; Nodular MALIGNANT NEOPLASMS OF LYMPHOID,
C82.9 13,900 4,170 9,730
non-Hodgkin's lymphoma NOS HEMATOPOIETIC AND RELATED TISSUE
Small cell diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C83.0 13,900 4,170 9,730
Small cell B-cell lymphoma HEMATOPOIETIC AND RELATED TISSUE
C83.2 Mixed small and large cell diffuse non-Hodgkin's lymphoma N/A N/A N/A
Large cell diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C83.3 13,900 4,170 9,730
Diffuse large B-cell lymphoma HEMATOPOIETIC AND RELATED TISSUE
C83.4 Immunoblastic diffuse non-Hodgkin's lymphoma N/A N/A N/A
C83.5 Lymphoblastic diffuse non-Hodgkin's lymphoma 13,900 4,170 9,730
Burkitt's tumour MALIGNANT NEOPLASMS OF LYMPHOID,
C83.7 13,900 4,170 9,730
Burkitt"s lymphoma HEMATOPOIETIC AND RELATED TISSUE
Other types of diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C83.8 13,900 4,170 9,730
Other non-follicular lymphoma HEMATOPOIETIC AND RELATED TISSUE
Diffuse non-Hodgkin's lymphoma, unspecified MALIGNANT NEOPLASMS OF LYMPHOID,
C83.9 13,900 4,170 9,730
Non-follicular lymphoma, unspecified HEMATOPOIETIC AND RELATED TISSUE
C84.0 Mycosis fungoides 13,900 4,170 9,730
C84.1 Sézary's disease 13,900 4,170 9,730
C84.3 Lymphoepithelioid lymphoma; Lennert's lymphoma N/A N/A N/A
C84.4 Peripheral T-cell lymphoma 13,900 4,170 9,730
Page 61 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
C84.5 Other and unspecified T-cell lymphomas 13,900 4,170 9,730
C85.0 Lymphosarcoma N/A N/A N/A
C85.1 B-cell lymphoma, unspecified 13,900 4,170 9,730
Other specified types of non-Hodgkin's lymphoma;
C85.7 Malignant reticuloendotheliosis; Malignant reticulosis; 13,900 4,170 9,730
Microglioma
Non-Hodgkin's lymphoma, unspecified type; Lymphoma MALIGNANT NEOPLASMS OF LYMPHOID,
C85.9 13,900 4,170 9,730
NOS HEMATOPOIETIC AND RELATED TISSUE
C90.0 Multiple myeloma; Kahler's disease; Myelomatosis 13,900 4,170 9,730
C90.1 Plasma cell leukaemia 13,900 4,170 9,730
Extramedullary Plasmacytoma; Malignant plasma cell MALIGNANT NEOPLASMS OF LYMPHOID,
C90.2 13,900 4,170 9,730
tumour NOS; Plasmacytoma NOS ; Solitary myeloma HEMATOPOIETIC AND RELATED TISSUE
C91.0 Acute lymphoblastic leukemia; Acute lymphocytic leukemia 13,900 4,170 9,730
C91.1 Chronic lymphocytic leukaemia of B-cell type 13,900 4,170 9,730
C91.2 Subacute lymphocytic leukaemia of B-cell type 13,900 4,170 9,730
C91.3 Prolymphocytic leukaemia 13,900 4,170 9,730
C91.4 Hairy-cell leukaemia; Leukaemic reticuloendotheliosis 13,900 4,170 9,730
C91.5 Adult T-cell leukaemia 13,900 4,170 9,730
C91.7 Other lymphoid leukaemia 13,900 4,170 9,730
C91.9 Lymphoid leukaemia, unspecified 13,900 4,170 9,730
Acute myeloid leukaemia MALIGNANT NEOPLASMS OF LYMPHOID,
C92.0 13,900 4,170 9,730
Acute myeloblastic leukaemia HEMATOPOIETIC AND RELATED TISSUE
C92.1 Chronic myeloid leukaemia 13,900 4,170 9,730
C92.2 Subacute myeloid leukaemia 13,900 4,170 9,730
C92.3 Myeloid sarcoma; Chloroma; Granulocytic sarcoma 13,900 4,170 9,730
C92.4 Acute promyelocytic leukaemia 13,900 4,170 9,730
C92.5 Acute myelomonocytic leukaemia 13,900 4,170 9,730
C92.7 Other myeloid leukaemia 13,900 4,170 9,730
C92.9 Myeloid leukaemia, unspecified 13,900 4,170 9,730
C93.0 Acute monocytic leukaemia 13,900 4,170 9,730
Chronic monocytic leukaemia MALIGNANT NEOPLASMS OF LYMPHOID,
C93.1 13,900 4,170 9,730
Chronic myelomonocytic leukaemia HEMATOPOIETIC AND RELATED TISSUE
C93.9 Monocytic leukaemia, unspecified 13,900 4,170 9,730
Acute erythraemia and erythroleukaemia; Acute
C94.0 erythraemic myelosis; Di Guglielmo's disease 13,900 4,170 9,730
Acute erythroid leukaemia
Acute megakaryoblastic leukaemia; Acute megakaryocytic MALIGNANT NEOPLASMS OF LYMPHOID,
C94.2 13,900 4,170 9,730
Leukaemia HEMATOPOIETIC AND RELATED TISSUE
C94.4 Acute panmyelosis 13,900 4,170 9,730
C94.5 Acute myelofibrosis 13,900 4,170 9,730
Acute leukaemia of unspecified cell type; Blast cell MALIGNANT NEOPLASMS OF LYMPHOID,
C95.0 13,900 4,170 9,730
leukaemia; Stem cell leukaemia HEMATOPOIETIC AND RELATED TISSUE
C95.1 Chronic leukaemia of unspecified cell type 13,900 4,170 9,730
C95.2 Subacute leukaemia of unspecified cell type N/A N/A N/A
C95.7 Other leukaemia of unspecified cell type 13,900 4,170 9,730
C95.9 Leukaemia, unspecified 13,900 4,170 9,730
Letterer-Siwe disease; Nonlipid reticuloendotheliosis; MALIGNANT NEOPLASMS OF LYMPHOID,
C96.0 13,900 4,170 9,730
Nonlipid reticulosis HEMATOPOIETIC AND RELATED TISSUE
Page 62 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
C96.1 Malignant histiocytosis; Histiocytic medullary reticulosis N/A N/A N/A
Malignant mast cell tumour; Malignant mastocytoma; MALIGNANT NEOPLASMS OF LYMPHOID,
C96.2 13,900 4,170 9,730
Malignant mastocytosis; Mast cell sarcoma HEMATOPOIETIC AND RELATED TISSUE
Other specified malignant neoplasms of lymphoid, MALIGNANT NEOPLASMS OF LYMPHOID,
C96.7 13,900 4,170 9,730
haematopoietic and related tissue HEMATOPOIETIC AND RELATED TISSUE
Malignant neoplasm of lymphoid, haematopoietic and MALIGNANT NEOPLASMS OF LYMPHOID,
C96.9 13,900 4,170 9,730
related tissue, unspecified HEMATOPOIETIC AND RELATED TISSUE
Malignant neoplasm of Penis, unspecified; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL
C60.9 13,400 4,020 9,380
neoplasm of Skin of penis NOS TRACT
MALIGNANT NEOPLASMS OF MALE GENITAL
C61 Malignant neoplasm of prostate 13,400 4,020 9,380
TRACT
Malignant neoplasm of Undescended testis; Ectopic testis MALIGNANT NEOPLASMS OF MALE GENITAL
C62.0 13,400 4,020 9,380
; Malignant neoplasm of Retained testis TRACT
Malignant neoplasm of Descended testis; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL
C62.1 13,400 4,020 9,380
neoplasm of Scrotal Testis TRACT
C62.9 Malignant neoplasm of Testis, unspecified 13,400 4,020 9,380
TRACT
C63.0 Malignant neoplasm of Epididymis 13,400 4,020 9,380
TRACT
C63.1 Malignant neoplasm of Spermatic cord 13,400 4,020 9,380
TRACT
Malignant neoplasm of Scrotum; Malignant neoplasm of MALIGNANT NEOPLASMS OF MALE GENITAL
C63.2 13,400 4,020 9,380
Skin of scrotum TRACT
Malignant neoplasm of Seminal vesicle; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL
C63.7 13,400 4,020 9,380
neoplasm of Tunica vaginalis TRACT
Malignant neoplasm of Male genital organ, unspecified; MALIGNANT NEOPLASMS OF MALE GENITAL
C63.9 13,400 4,020 9,380
Male genitourinary tract NOS TRACT
C45.2 Mesothelioma of pericardium MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C45.7 Mesothelioma of other sites MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C45.9 Mesothelioma, unspecified MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C48.0 Malignant neoplasm of Retroperitoneum MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
Malignant neoplasm of Pelvis; Malignant neoplasm of
Groin NOS; Malignant neoplasm of
C76.3 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
Sites overlapping systems within the pelvis, such as
rectovaginal (septum) & rectovesical (septum)
C76.4 Malignant neoplasm of Upper limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.5 Malignant neoplasm of Lower limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.7 Malignant neoplasm of Other ill-defined sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
Malignant neoplasm of Overlapping lesion of other and ill-
defined sites
Secondary and unspecified malignant neoplasm of Axillary

C77.3 and upper limb lymph nodes; Secondary and unspecified MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
malignant neoplasm of Pectoral lymph nodes
Secondary and unspecified malignant neoplasm of Lymph

node, unspecified
C79.7 Secondary malignant neoplasm of adrenal gland MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C79.8 Secondary malignant neoplasm of other specified sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
Malignant neoplasm without specification of site;
Unspecified site whether primary or secondary [Cancer,
Carcinoma, Carcinomatosis, Generalized cancer,
C80 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
Generalized malignancy, Malignancy, Multiple cancer];
Malignant cachexia; Malignant neoplasm of Primary site
unknown
Malignant neoplasm of Peripheral nerves of head, face and
C47.0 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
neck
Malignant neoplasm of Peripheral nerves of upper limb,
including shoulder
Malignant neoplasm of Peripheral nerves of lower limb,
including hip
C47.3 Malignant neoplasm of Peripheral nerves of thorax MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.4 Malignant neoplasm of Peripheral nerves of abdomen MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.5 Malignant neoplasm of Peripheral nerves of pelvis MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
Malignant neoplasm of Peripheral nerves of trunk,

unspecified
Malignant neoplasm of Peripheral nerves and autonomic
nervous system, unspecified
Malignant neoplasm of Glottis; Malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND

C32.0 14,600 4,380 10,220
Intrinsic larynx; Malignant neoplasm of true Vocal cord NOS INTRATHORACIC ORGANS
Page 63 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Supraglottis: Malignant neoplasm

of Aryepiglottic fold, laryngeal aspect; Malignant neoplasm
of Epiglottis (suprahyoid portion) NOS; Malignant neoplasm MALIGNANT NEOPLASMS OF RESPIRATORY AND
C32.1 14,600 4,380 10,220
of Extrinsic larynx; Malignant neoplasm of False vocal cord; INTRATHORACIC ORGANS
Malignant neoplasm of posterior laryngeal surface of
epiglottis; Malignant neoplasm of ventricular bands
MALIGNANT NEOPLASMS OF RESPIRATORY AND

C32.2 Malignant neoplasm of Subglottis 14,600 4,380 10,220
INTRATHORACIC ORGANS
C32.3 Malignant neoplasm of Laryngeal cartilage 14,600 4,380 10,220
C32.9 Malignant neoplasm of Larynx, unspecified 14,600 4,380 10,220
C33 Malignant neoplasm of trachea 14,600 4,380 10,220
Malignant neoplasm of Main bronchus; Malignant MALIGNANT NEOPLASMS OF RESPIRATORY AND

C34.0 14,600 4,380 10,220
neoplasm of Carina; Malignant neoplasm of Hilus of lung INTRATHORACIC ORGANS

C34.1 Malignant neoplasm of Upper lobe, bronchus or lung 14,600 4,380 10,220
C34.2 Malignant neoplasm of Middle lobe, bronchus or lung 14,600 4,380 10,220
C34.3 Malignant neoplasm of Lower lobe, bronchus or lung 14,600 4,380 10,220
Malignant neoplasm of Overlapping lesion of bronchus and MALIGNANT NEOPLASMS OF RESPIRATORY AND
C34.8 14,600 4,380 10,220
lung INTRATHORACIC ORGANS
C34.9 Malignant neoplasm of Bronchus or lung, unspecified 14,600 4,380 10,220
C37 Malignant neoplasm of thymus 14,600 4,380 10,220
Malignant neoplasm of Heart; Malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND
C38.0 14,600 4,380 10,220
Pericardium INTRATHORACIC ORGANS
C38.1 Malignant neoplasm of Anterior mediastinum 14,600 4,380 10,220
C38.3 Malignant neoplasm of Mediastinum, part unspecified 14,600 4,380 10,220
C38.4 Malignant neoplasm of Pleura 14,600 4,380 10,220
Malignant neoplasm of Overlapping lesion of heart, MALIGNANT NEOPLASMS OF RESPIRATORY AND
C38.8 14,600 4,380 10,220
mediastinum and pleura INTRATHORACIC ORGANS
Malignant neoplasm of Upper respiratory tract, part MALIGNANT NEOPLASMS OF RESPIRATORY AND
C39.0 14,600 4,380 10,220
unspecified INTRATHORACIC ORGANS
Malignant neoplasm of Overlapping lesion of respiratory MALIGNANT NEOPLASMS OF RESPIRATORY AND
C39.8 14,600 4,380 10,220
and intrathoracic organs INTRATHORACIC ORGANS
Malignant neoplasm of Ill-defined sites within the MALIGNANT NEOPLASMS OF RESPIRATORY AND
C39.9 14,600 4,380 10,220
respiratory system; Respiratory tract NOS INTRATHORACIC ORGANS
C45.0 Mesothelioma of pleura 10,600 3,180 7,420
Malignant neoplasm of Thorax; Malignant neoplasm of
C76.1 Axilla NOS; Malignant neoplasm of Intrathoracic NOS; 14,600 4,380 10,220
Malignant neoplasm of Thoracic NOS
Secondary and unspecified malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND
C77.1 14,600 4,380 10,220
Intrathoracic lymph nodes INTRATHORACIC ORGANS
C78.0 Secondary malignant neoplasm of lung 14,600 4,380 10,220
C78.1 Secondary malignant neoplasm of mediastinum 14,600 4,380 10,220
Secondary malignant neoplasm of pleura; Malignant pleural MALIGNANT NEOPLASMS OF RESPIRATORY AND
C78.2 14,600 4,380 10,220
effusion NOS INTRATHORACIC ORGANS
Secondary malignant neoplasm of other and unspecified MALIGNANT NEOPLASMS OF RESPIRATORY AND
C78.3 14,600 4,380 10,220
respiratory organs INTRATHORACIC ORGANS
Malignant neoplasm of Maxillary sinus; Malignant
C31.0 neoplasm of Antrum (Highmore); Malignant neoplasm of MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
Antrum (maxillary)
C31.1 Malignant neoplasm of Ethmoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.2 Malignant neoplasm of Frontal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.3 Malignant neoplasm of Sphenoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
Malignant neoplasm of Overlapping lesion of accessory
C31.8 MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
sinuses
C31.9 Malignant neoplasm of Accessory sinus, unspecified MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
Human Immunodeficiency Virus [HIV] Disease resulting in
B21.0 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
Kaposi's Sarcoma
C46.9 Kaposi's sarcoma, unspecified MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
Malignant neoplasm of Connective and soft tissue of head,

C49.0 face and neck; Malignant neoplasm of Connective tissue of MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
ear; Malignant neoplasm of Connective tissue of eyelid
Page 64 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Malignant neoplasm of Connective and soft tissue of upper
C49.1 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
limb, including shoulder
Malignant neoplasm of Connective and soft tissue of lower
limb, including hip
Malignant neoplasm of Connective and soft tissue of
thorax; Malignant neoplasm of Connective and soft tissue
C49.3 of Axilla; Malignant neoplasm of Connective and soft tissue MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
of Diaphragm; Malignant neoplasm of Connective and soft
tissue of Great vessels
abdomen; Malignant neoplasm of Connective and soft
tissue of Abdominal wall; Malignant neoplasm of
Connective and soft tissue of Hypochondrium
Malignant neoplasm of Connective and soft tissue of pelvis;
C49.5 Buttock; Malignant neoplasm of Connective and soft tissue MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
of Groin; Malignant neoplasm of Connective and soft
tissue of Perineum
Malignant neoplasm of Connective and soft tissue of trunk,
C49.6 unspecified; Malignant neoplasm of Connective and soft MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
tissue of Back NOS
Malignant neoplasm of Overlapping lesion of connective
and soft tissue
Malignant neoplasm of Connective and soft tissue,
unspecified
MALIGNANT NEOPLASMS OF THYROID AND
C73 Malignant neoplasm of thyroid gland 11,400 3,420 7,980
OTHER ENDOCRINE GLANDS
C74.0 Malignant neoplasm of Cortex of adrenal gland 11,400 3,420 7,980
C74.1 Malignant neoplasm of Medulla of adrenal gland 11,400 3,420 7,980
C74.9 Malignant neoplasm of Adrenal gland, unspecified 11,400 3,420 7,980
C75.0 Malignant neoplasm of Parathyroid gland 11,400 3,420 7,980
C75.1 Malignant neoplasm of Pituitary gland 11,400 3,420 7,980
C75.3 Malignant neoplasm of Pineal gland 11,400 3,420 7,980
C75.5 Malignant neoplasm of Aortic body and other paraganglia 11,400 3,420 7,980
C75.9 Malignant neoplasm of Endocrine gland, unspecified 11,400 3,420 7,980
E40 Kwashiorkor MALNUTRITION 11,700 3,510 8,190
E41 Nutritional marasmus; Severe malnutrition with marasmus MALNUTRITION 11,700 3,510 8,190
Marasmic kwashiorkor; Severe protein-energy malnutrition,

E42 intermediate form; Severe protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
with signs of both kwashiorkor and marasmus
E43 Unspecified severe protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190

E44.0 Moderate protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
E44.1 Mild protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
Retarded development following protein-energy
E45 malnutrition; Nutritional short stature; Nutritional MALNUTRITION 11,700 3,510 8,190
stunting; Physical retardation due to malnutrition
Unspecified protein-energy malnutrition; Malnutrition NOS;
E46 MALNUTRITION 11,700 3,510 8,190
Protein-energy imbalance NOS
Pre-existing essential hypertension complicating pregnancy
O10.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
child birth and the puerperium
Pre-existing hypertensive heart disease complicating
pregnancy, childbirth and the puerperium
Pre-existing hypertensive renal disease complicating
pregnancy childbirth and the puerperium
Pre-existing hypertensive heart and renal disease
complicating pregnancy, childbirth and the puerperium
Pre-existing secondary hypertension complicating
Unspecified pre-existing hypertension complicating
Pre-existing hypertensive disorder with superimposed
O11 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
proteinuria
O12.1 Gestational proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O12.2 Gestational oedema with proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Gestational [pregnancy-induced] hypertension wihtout
O13 significant proteinuria; Gestational hypertension NOS; Mild MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
pre-eclampsia
Page 65 of 127
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Case Rate
Fee Institution Fee
O14.0 Moderate pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O14.1 Severe pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O14.9 Pre-eclampsia, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.0 Eclampsia in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.1 Eclampsia in labour MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.9 Eclampsia, unspecified as to time period; Eclampsia NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O16 Unspecified maternal hypertension MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Threatened abortion; Haemorrhage specified as due to
threatened abortion
O20.8 Other haemorrhage in early pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O20.9 Haemorrhage in early pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Mild hyperemesis gravidarum; Hyperemesis gravidarum,
O21.0 mild or unspecified, starting before the end of the 22nd MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
week of gestation
Hyperemesis gravidarum with metabolic disturbance;

Hyperemesis gravidarum, starting before the end of the
22nd week of gestation, with metabolic disturbance such as
carbohydrate depletion, dehydration, elctrolyte imbalance
Late vomiting of pregnancy; Excessive vomiting starting

after 22 completed weeks of gestation
Other vomiting complicating pregnancy; Vomiting due to

disease classified elsewhere, complicating pregnancy
O21.9 Vomiting of pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Deep phlebothrombosis in pregnancy; Deep-vein
thrombosis, antepartum
Cerebral venous thrombosis in pregnancy; Cerebrovenous
sinus thrombosis in pregnancy
Venous complication in pregnancy, unspecified; Gestational
O22.9 phlebitis NOS; Gestational phlebopathy NOS; Gestational MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
thrombosis NOS
O23.0 Infections of kidney in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O23.3 Infections of other parts of urinary tract in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.0 Pre-existing diabetes mellitus, insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.1 Pre-existing diabetes mellitus, non-insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.2 Pre-existing malnutrition-related diabetes mellitus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.3 Pre-existing diabetes mellitus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Diabetes mellitus arising in pregnancy; Gestational diabetes
mellitus NOS
O24.9 Diabetes mellitus in pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.2 Pregnancy care of habitual aborter MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.3 Retained in trauterine contraceptive device in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.4 Herpes gestationis MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Maternal hypotension syndrome; Supine hypotensive
syndrome
O26.6 Liver disorders in pregnancy, childbirth and the puerperium MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Subluxation of symphysis (pubis) in pregnancy childbirth

and the puerperium
Other specified pregnancy-related conditions; Exhaustion

O26.8 and fatigue pregnancy-related; Peripheral neuritis MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
pregnancy-related; Renal disease pregnancy-related
O26.9 Pregnancy-relatedcondition, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Abnormal haematological finding on antenatal screening of
mother
Abnormal ultrasonic finding on antenatal screening of
mother
Abnormal chromosomal and genetic finding on antenatal
screening of mother
O28.8 Other abnormal findings on antenatal screening of mother MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Abnormal finding on antenatal screening of mother,

unspecified
O29.8 Other complications of anaesthesia during pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.0 Twin pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.1 Triplet pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.8 Other multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.9 Multiple gestation, unspecified; Multiple pregnancy NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O31.0 Papyraceous fetus; Fetus compressus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O31.1 Continuing pregnancy after abortion of one fetus or more MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 66 of 127
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Case Rate
Fee Institution Fee
Continuing pregnancy after intrauterine death of one fetus
or more
O31.8 Other complications specific to multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.0 Maternal care for unstable lie MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.1 Maternal care for breech presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for transverse and oblique lie; Oblique
presentation; Transverse presentation
O32.3 Maternal care for face, brow and chin presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for high head at term; Failure of head to
enter pelvic brim
Maternal care for multiple gestation with malpresentation
of one fetus or more
O32.6 Maternal care for compound presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.8 Maternal care for other malpresentation of fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.9 Maternal care for malpresentation of fetus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for disproportion due to deformity of

O33.0 maternal pelvic bones; Pelvic deformity causing MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
disproportion NOS
Maternal care for disproportion due to generally
O33.1 contracted pelvis; Contracted pelvis NOS causing MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
disproportion
Maternal care for disproportion due to inlet contraction of

pelvis; Inlet contraction (pelvis) causing disproportion
Maternal care for disproportion due to outlet contraction

of pelvis; Mid-cavity contraction pelvis causing
disproportion; Outlet contraction pelvis causing
disproportion
Maternal care for disproportion of mixed maternal and
fetal origin
Maternal care for disproportion due to unusually large
O33.5 fetus; Disproportion of fetal origin with normally formed MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
fetus; Fetal disproportion NOS
O33.6 Maternal care for disproportion due to hydrocephalic fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for disproportion due to other fetal

deformities; Conjoined twins; Fetal ascites causing
disproportion; Fetal hydrops causing disproportion; Fetal
meaningomyelocele causing disproportion; Fetal tumour
causing disproportion; Sacral teratoma causing
disproportion
Maternal care for disproportion, unspecified; Cephalopelvic

disproportion NOS; Fetopelvic disproportion NOS
Maternal care for congenital malformation of uterus;

O34.0 Maternal care for double uterus; Maternal care for Uterus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
bicornis
Maternal care for tumour of corpus uteri; Maternal for
polyp of corpus uteri; Maternal care for uterine fibroid
Maternal care due to uterine scar from previous surgery;
Maternal care for scar from previous
Maternal care for cervical incompetence; Maternal care for
cerclage with or without mention of cervical incompetence;
Maternal care for Shirodkar suture with or without mention
of cervical incompetence
Maternal care for other abnormalities of cervix; Maternal

care for polyp of cervix; Maternal care for previous surgery
to cervix; Maternal care for stricture or stenosis of cervix;
Maternal care for tumour of cervix
Maternal care for other abnormalities of gravid uterus;

Maternal care for incarceratiion of gravid uterus; Maternal
care for prolapse of gravid uterus; Maternal care for
retroversion of gravid uterus
Maternal care for abnormality of vagina; Maternal care for
previous surgery to vagina; Maternal care for septate
O34.6 vagina; Maternal care for acquired stenosis of vagina; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for congenital stenosis of vagina; Maternal
care for tumour of vagina
Maternal care for abnormality of vulva and perineum;

Maternal care for fibrosis of perineum; Maternal care for
previous surgery to perineum or vulva; Maternal care for
rigid perineum; Maternal care for tumour of vulva
Page 67 of 127
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Case Rate
Fee Institution Fee
Maternal care for other abnormalities of pelvic organs;
Maternal care for cystocele; Maternal care for previous
O34.8 pelvic floor repair; Maternal care for pendulous abdomen; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for rectocele; Maternal care for rigid pelvic
floor
O34.9 Maternal care for abnormality of pelvic organ, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for (suspected) central nervous system

O35.0 malformation in fetus; Maternal care for suspected fetal MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
anencephaly; Maternal care for suspected fetal spina bifida
O35.2 Maternal care for (suspected) hereditary disease in fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for (suspected) damage to fetus from viral

disease in mother; Maternal care for suspected damage to
fetus from maternal cytomegalovirus infection; Maternal
care for suspected damage to fetus from maternal rubella
Maternal care for (suspected) damage to fetus by drugs;

O35.5 Maternal care for suspected damage to fetus from drug MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
addiction
Maternal care for other (suspected) fetal abnormality and

damage; Maternal care for suspected damage to fetus from
maternal listeriosis; Maternal care for suspected damage to
fetus from maternal toxoplasmosis
Maternal care for (suspected) fetal abnormality and

damage, unspecified
Maternal care for rhesus isoimmunization; Anti-D [Rh]
antibodies; Rh incompatibility (with hydrops fetalis)
Maternal care for other isoimmunization; ABO
O36.1 isoimmunization; Isoimmunization NOS (with hydrops MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
fetalis)
Maternal care for hydrops fetalis; Hydrops fetalis NOS;
Hydrops fetalis not associated with isoimmunization
O36.3 Maternal care for signs of fetal hypoxia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.4 Maternal care for intrauterine death MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Maternal care for poor fetal growth; Maternal care for
known or suspected light-for-dates; Maternal care for
known or suspected placental insufficiency; Maternal care
for known or suspected small-for-dates
Maternal care for excessive fetal growth; Maternal care for
known or suspected large-for-dates
O36.8 Maternal care for other specified fetal problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.9 Maternal care for fetal problem, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O40 Polyhydramnios; Hydramnios MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Oligohydramnios; Oligohydramnios without mention of
rupture of membrane
Infection of amniotic sac and membranes; Amnionitis;
Chorioamnionitis; Membranitis; Placentitis
O41.8 Other specified disorders of amniotic fluid and membranes MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Disorder of amniotic fluid and membranes, unspecified;

Premature rupture of membranes
Premature rupture of membranes on set of labour within
24 hours
Premature rupture of membranes on set of labour after 24
hours
Premature rupture of membranes, labour delayed by
therapy
O42.9 Premature rupture of membranes, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Placental transfusion syndromes; Fetomaternal transfusion;

Maternofetal transfusion; Twin-to-twin transfusion
Malformation of placenta; Abnormal placenta NOS;

Circumvallate placenta
Other placental disorders; Placental dysfunction; Placental
infarction
O43.9 Placental disorder, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Placenta praevia specified as without haemorrhage; Low

implantation of placenta, NOS or with haemorrhage
Placenta praevia with haemorrhage; Low implantation of

placenta, NOS or with haemorrhage; Placenta praevia,
O44.1 marginal NOS or with haemorrhage; Placenta praevia, MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
partial NOS or with haemorrhage; Placenta praevia, total
NOS or with haemorrhage
Page 68 of 127
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Case Rate
Fee Institution Fee
Premature separation of placenta with coagulation defect;

Abruptio placentae with (excessive) haemorrhage
associated with afibrinogenaemia; Abruptio placentae with
(excessive) haemorrhage associated with disseminated
intravascular coagulation; Abruptio placentae with
(excessive) hemorrhage associated with
hyperfibrinogenaemia; Abruptio placentae with (excessive)
haemorrhage associated with hypofibrinogenaemia
O45.8 Other premature separation of placenta MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Premature separation of placenta, unspecified; Abruptio
placenta NOS
Antepartum haemorrhage with coagulation defect;

Antepartum haemorrhage (excessive) associated with
afibrinogenaemia; Antepartum haemorrhage (excessive)
O46.0 associated with disseminated intravascular coagulation; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Antepartum haemorrhage (excessive) associated with
hyperfibrinolysis; Antepartum haemorrahge (excessive)
associated with hypofibrinogenaemia
O46.8 Other antepartum haemorrhage MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O46.9 Antepartum haemorrhage, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.0 False labour before 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.1 False labour at or after 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.9 False labour, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O48 Prolonged pregnancy; Post-dates; Post-term MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Tuberculosis complicating pregnancy, childbirth and the
puerperium
Syphilis complicating pregnancy, childbirth and the
puerperium
Gonorrhoea complicating pregnancy, childbirth and the
puerperium
Other infections with apredominantly sexual mode of
O98.3 transmission complicating pregnancy, childbirth and the MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
puerperium
Viral hepatitis complicating pregnancy, childbirth and the
puerperium
Other viral diseases complicating pregnancy, childbirth and
the puerperium
Protozoal diseases complicating pregnancy, childbirth and
the puerperium
Other maternal infectious and parasitic diseases
Unspecified maternal infectious or parasitic disease
Anaemia complicating pregnancy, childbirth and the
puerperium
Other diseases of the blood and blood-forming organs and

O99.1 certain disorders involving the immune mechanism MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Endocrine, nutritional and metabolic diseases complicating

Mental disorders and diseases of the nervous system
Diseases of the circulatory system complicating pregnancy,
childbirth and the puerperium
Diseases of the respiratory system complicating pregnancy,
Diseases of the digestive system complicating pregnancy,
Diseases of the skin and subcutaneous tissue complicating
Other specified diseases and conditions complicating
O60.0 Preterm labor, not resulting to delivery MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.0 Supervision of normal first pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.8 Supervision of other normal pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.9 Supervision of normal pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.0 Supervision of pregnancy with history of infertility MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Supervision of pregnancy with history of abortive outcome;
Supervision of pregnancy with history of hydatidiform
Z35.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
mole; Supervision of pregnancy with history of vesicular
mole
Page 69 of 127
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Case Rate
Fee Institution Fee
Supervision of pregnancy with other poor reproductive or
obstetric history; Supervision of pregnancy with history of
Z35.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
neonatal death; Supervision of pregnancy with history of
stillbirth
Z35.4 Supervision of pregnancy with grand multiparity MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.5 Supervision of elderly primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.6 Supervision of very young primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.7 Supervision of high-risk pregnancy due to social problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.8 Supervision of other high-risk pregnancies MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.9 Supervision of high-risk pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
A87.8 Other viral meningitis MENINGITIS 25,700 7,710 17,990
A87.9 Viral meningitis, unspecified MENINGITIS 25,700 7,710 17,990
Haemophilus meningitis; Meningitis due to Haemophilus
G00.0 MENINGITIS 25,700 7,710 17,990
influenzae
G00.1 Pneumococcal meningitis MENINGITIS 25,700 7,710 17,990
G00.2 Streptococcal meningitis MENINGITIS 25,700 7,710 17,990
G00.3 Staphylococcal meningitis MENINGITIS 25,700 7,710 17,990
Other bacterial meningitis; Meningitis due to Escherichia
G00.8 coli; Meningitis due to Friedländer bacillus; Meningitis due MENINGITIS 25,700 7,710 17,990
to Klebsiella
Bacterial meningitis, unspecified; Meningitis purulent NOS;

G00.9 MENINGITIS 25,700 7,710 17,990
Meningitis pyogenic NOS; Meningitis suppurative NOS
G03.0 Nonpyogenic meningitis; Nonbacterial meningitis MENINGITIS 25,700 7,710 17,990

G03.1 Chronic meningitis MENINGITIS 25,700 7,710 17,990
G03.8 Meningitis due to other specified causes MENINGITIS 25,700 7,710 17,990
G03.9 Meningitis, unspecified; Arachnoiditis (spinal) NOS MENINGITIS 25,700 7,710 17,990
Measles complicated by meningitis; Meningitis in viral
B05.1+ G02.0* MENINGITIS 25,700 7,710 17,990
diseases classified elsewhere
A39.2 Acute meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860
A39.3 Chronic meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860
Meningococcaemia, unspecified; Meningococcal
A39.4 MENINGOCOCCAL INFECTION 19,800 5,940 13,860
bacteraemia NOS
Meningococcal infection, unspecified; Meningococcal
A39.9 MENINGOCOCCAL INFECTION 19,800 5,940 13,860
disease NOS
Primary amenorrhoea; Failure to start menstruation at
N91.0 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
puberty.
Secondary amenorrhoea; Absence of menstruation in a
woman who had previously menstruated.
N91.2 Amenorrhoea, unspecified; Absence of menstruation NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N91.5 Oligomenorrhoea, unspecified; Hypomenorrhoea NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
Excessive and frequent menstruation with regular cycle;

Heavy periods NOS; Menorrhagia NOS; Polymenorrhoea
Excessive and frequent menstruation with irregular cycle;

Irregular intermenstrual bleeding; Irregular, shortened
intervals between menstrual bleeding; Menometrorrhagia;
Metrorrhagia
Excessive menstruation at puberty; Excessive bleeding
N92.2 associated with onset of menstrual periods; Pubertal MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
menorrhagia; Puberty bleeding
N92.3 Ovulation bleeding; Regular intermenstrual bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
Excessive bleeding in the premenopausal period; Climateric

menorrhagia or metrorrhagia; Menopausal menorrhagia or
metrorrhagia; Preclimateric menorrhagia or metrorrhagia;
Premenopausal menorrhagia or metrorrhagia
N92.5 Other specified irregular menstruation MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
Irregular menstruation, unspecified; Irregular bleeding
NOS; Irregular periods NOS
N93.0 Postcoital and contact bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
Other specified abnormal uterine and vaginal bleeding;

Dysfunctional or functional uterine or vaginal bleeding NOS
Abnormal uterine and vaginal bleeding, unspecified

Uterine hemorrhage not due to menstraution
Other specified conditions associated with female genital
organs and menstrual cycle
Unspecified condition associated with female genital
organs and menstrual cycle
F01.1 Multi-infarct dementia; Predominantly cortical dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F01.8 Other vascular dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F01.9 Vascular dementia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 70 of 127
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Case Rate
Fee Institution Fee
Unspecified dementia; Presenile dementia NOS; Presenile

F03 psychosis NOS; Senile dementia NOS; Senile dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
depressed or paranoid type; Senile psychosis NOS
Organic amnesic syndrome, not induced by alcohol and

F04 other psychoactive substances; Korsakov's psychosis or MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
syndrome, nonalcoholic
F05.0 Delirium not superimposed on dementia, so described MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F05.8 Other delirium MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F05.9 Other delirium/Delirium, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Organic hallucinosis; Organic hallucinatory state
F06.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
(nonalcoholic)
Organic delusional [schizophrenia-like] disorder; Paranoid
F06.2 and paranoid-hallucinatory organic states; Schizophrenia- MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
like psychosis in epilepsy
F06.3 Organic mood [affective] disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.4 Organic anxiety disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.7 Mild cognitive disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Other specified mental disorders due to brain damage and
F06.8 dysfunction and to physical disease; Epileptic psychosis MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
NOS
Unspecified mental disorder due to brain damage and
F06.9 dysfunction and to physical disease; Organic brain MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
syndrome NOS; Organic mental disorder NOS
Organic personality disorder; Organic pseudopsychopathic
personality;
F07.0 Organic pseudoretarded personality; Frontal lobe MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Syndrome; Limbic epilepsy personality Syndrome ;
Lobotomy Syndrome; Postleucotomy Syndrome
F07.1 Postencephalitic syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Postconcussional syndrome; Postcontusional syndrome
F07.2 (encephalopathy); Post-traumatic brain syndrome, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
nonpsychotic
Unspecified organic personality and behavioural disorder
F07.9 due to brain disease, damage and dysfunction; Organic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
psychosyndrome
Unspecified organic or symptomatic mental disorder;
F09 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Organic Psychosis NOS; Symptomatic Psychosis NOS
Mental and behavioural disorders due to use of alcohol in
acute intoxication
Mental and behavioural disorders due to use of
alcohol:harmful use
Mental and behavioural disorders due to use of alcohol:
dependency syndrome
alcohol:withdrawal state
withdrawal state with delirium
psychotic disorder
amnesic syndrome
residual and late-onset psychotic disorder
other mental and behavioural disorders
unspecified mental and behavioural disorder
Mental and behavioural disorders due to use of opioids:
harmful use
dependence syndrome
psychotic disorder
cannabinoids: acute intoxication
cannabinoids: psychotic disorder
Mental and behavioural disorders due to use of sedatives
or hypnotics: harmful use
or hypnotics: dependence syndrome
or hypnotics: withdrawal state
Page 71 of 127
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Case Rate
Fee Institution Fee
or hypnotics: withdrawal state with delirium
or hypnotics: psychotic disorder

or hypnotics: residual and late-onset psychotic disorder
Mental and behavioural disorders due to use of cocaine:

acute intoxication
dependence syndrome
psychotic disorder
amnesic syndrome
Mental and behavioural disorders due to use of other
stimulants, including caffeine: acute intoxication
stimulants, including caffeine: harmful use
stimulants, including caffeine: dependence syndrome
stimulants, including caffeine: withdrawal state
stimulants, including caffeine: psychotic disorder
F15.8 stimulants, including caffeine: other mental and MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
behavioural disorders
F15.9 stimulants, including caffeine: unspecified mental and MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
behavioural disorder
hallucinogens: acute intoxication
hallucinogens: harmful use
hallucinogens: dependence syndrome
hallucinogens: psychotic disorder
Mental and behavioural disorders due to use of tobacco:
dependence syndrome
Mental and behavioural disorders due to use of tobacco:
withdrawal state
Mental and behavioural disorders due to use of volatile
solvents: acute intoxication
solvents: withdrawal state with delirium
solvents: amnesic syndrome
Mental and behavioural disorders due to multiple drug use
F19.1 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
NOS: harmful use
NOS: dependence syndrome
NOS: withdrawal state
NOS: psychotic disorder

NOS: residual and late-onset psychotic disorder

NOS: other mental and behavioural disorders

NOS: unspecified mental and behavioural disorder
F20.0 Paranoid schizophrenia; Paraphrenic schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Hebephrenic schizophrenia; Disorganized schizophrenia;
Hebephrenia
Page 72 of 127
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Case Rate
Fee Institution Fee
Catatonic schizophrenia; Catatonic stupor; Schizophrenic
F20.2 catalepsy; Schizophrenic catatonia; Schizophrenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
flexibilitas cerea
F20.3 Undifferentiated schizophrenia; Atypical schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Residual schizophrenia; Chronic undifferentiated
F20.5 schizophrenia; Restzustand (schizophrenic); Schizophrenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
residual state
F20.6 Simple schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Other schizophrenia; Cenesthopathic schizophrenia;
F20.8 Schizophreniform disorder NOS; Schizophreniform MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
psychosis NOS
F20.9 Schizophrenia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Schizotypal disorder; Latent schizophrenic reaction;
Schizophrenia borderline; Schizophrenia latent;
Schizophrenia prepsychotic; Schizophrenia prodromal;
Schizophrenia pseudoneurotic;
Schizophrenia pseudopsychopathic; Schizotypal personality
disorder
Delusional disorder; Paranoia; Paranoid psychosis; Paranoid

state; Paraphrenia (late); Sensitiver Beziehungswahn
Other persistent delusional disorders; Delusional

F22.8 dysmorphophobia; Involutional paranoid state; Paranoia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
querulans
Acute polymorphic psychotic disorder without symptoms

of schizophrenia; Bouffée délirante without symptoms of
schizophrenia or unspecified; Cycloid psychosis without
symptoms of schizophrenia or unspecified
Acute polymorphic psychotic disorder with symptoms of

schizophrenia; Bouffée délirante with symptoms of
schizophrenia; Cycloid psychosis with symptoms of
schizophrenia
Acute schizophrenia-like psychotic disorder;Acute
(undifferentiated) schizophrenia;Brief schizophreniform
disorder; Brief schizophreniform psychosis; Oneirophrenia;
Schizophrenic reaction
Other acute predominantly delusional psychotic disorders;

Paranoid reaction; Psychogenic paranoid psychosis
F23.8 Other acute and transient psychotic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Acute and transient psychotic disorder, unspecified; Brief
reactive psychosis NOS; Reactive psychosis
Induced delusional disorder; Folie à deux; Induced paranoid
disorder; Induced psychotic disorder
Schizoaffective disorder, manic type; Schizoaffective
F25.0 psychosis, manic type; Schizophreniform psychosis, manic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
type
Schizoaffective disorder, depressive type; Schizoaffective
F25.1 psychosis, depressive type; Schizophreniform psychosis, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
depressive type
Schizoaffective disorder, mixed type; Cyclic schizophrenia;

Mixed schizophrenic and affective psychosis
F25.8 Other schizoaffective disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Schizoaffective disorder, unspecified; Schizoaffective
psychosis NOS
Other nonorganic psychotic disorders; Chronic
hallucinatory psychosis
F29 Unspecified nonorganic psychosis; Psychosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.0 Hypomania MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.1 Mania without psychotic symptoms MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Mania with psychotic symptoms; Mania with mood-
F30.2 congruent psychotic symptoms; Mania with mood- MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
incongruent psychotic symptoms; Manic stupor
F30.9 Manic episode, unspecified; Mania NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.0 Bipolar affective disorder, current episode hypomanic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Bipolar affective disorder, current episode manic without
psychotic symptoms
Bipolar affective disorder, current episode manic with
psychotic symptoms
Bipolar affective disorder, current episode mild or
moderate depression
Bipolar affective disorder, current episode severe
depression with psychotic symptoms
F31.6 Bipolar affective disorder, current episode mixed MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.7 Bipolar affective disorder, currently in remission MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 73 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other bipolar affective disorders; Bipolar II disorder;
Recurrent manic episodes NOS
F31.9 Bipolar affective disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.0 Mild depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.1 Moderate depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Severe depressive episode without psychotic symptoms;

F32.2 [Agitated depression, Major depression, Vital depression] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
single episode without psychotic symptoms
Severe depressive episode with psychotic symptoms; Single

episodes of major depression with psychotic symptoms;
F32.3 Single episodes of psychogenic depressive psychosis; Single MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
episodes of psychotic depression; Single episodes of
reactive depressive psychosis
Other depressive episodes; Atypical depression; Single
episodes of "masked" depression NOS
Depressive episode, unspecified; Depression NOS;
Depressive disorder NOS
Recurrent depressive disorder, current episode severe

without psychotic symptoms; Endogenous depression
without psychotic symptoms; Major depression, recurrent
without psychotic symptoms; Manic-depressive psychosis,
depressed type without psychotic symptoms; Vital
depression, recurrent without psychotic symptoms
Recurrent depressive disorder, current episode severe with

psychotic symptoms including Endogenous depression with
psychotic symptoms; Manic-depressive psychosis,
depressed type with psychotic symptoms; Recurrent severe
F33.3 episodes of major depression with psychotic symptoms; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Recurrent severe episodes of psychogenic depressive
psychosis; Recurrent severe episodes of psychotic
depression; Recurrent severe episodes of reactive
depressive psychosis
F33.8 Other recurrent depressive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Recurrent depressive disorder, unspecified; Monopolar
depression NOS
Cyclothymia; Affective personality disorder; Cycloid
personality; Cyclothymic personality
Dysthymia; Depressive neurosis; Depressive personality
F34.1 disorder; Neurotic depression; Persistent anxiety MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
depression
F42.1 Predominantly compulsive acts [obsessional rituals] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.2 Mixed obsessional thoughts and acts MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.8 Other obsessive-compulsive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.9 Obsessive-compulsive disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Acute stress reaction including Acute crisis reaction; Acute
F43.0 reaction to stress; Combat fatigue; Crisis state; Psychic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
shock
F43.1 Post-traumatic stress disorder; Traumatic neurosis MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Adjustment disorders; Culture shock; Grief reaction;
Hospitalism in children
F43.8 Other reactions to severe stress MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F44.0 Dissociative amnesia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Dissociative motor disorders; Psychogenic aphonia;
Psychogenic dysphonia
Other dissociative [conversion] disorders; Ganser's
F44.8 syndrome; Multiple personality; Psychogenic confusion; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Psychogenic twilight state
F44.9 Dissociative [conversion] disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Somatization disorder; Briquet’s disorder; Multiple
psychosomatic disorder
Undifferentiated somatoform disorder; Undifferentiated
psychosomatic disorder
Hypochondriacal disorder; Body dysmorphic disorder;
F45.2 Dysmorphophobia (nondelusional); Hypochondriacal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
neurosis; Hypochondriasis; Nosophobia
Page 74 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Somatoform autonomic dysfunction; Cardiac neurosis; Da
Costa's syndrome; Gastric neurosis ; Neurocirculatory
asthenia
Psychogenic forms of aerophagy; Psychogenic forms of
cough, Psychogenic forms of diarrhea; Psychogenic forms
of dyspepsia; Psychogenic forms of dysuria; psychogenic
F45.3 forms of flatulence; Psychogenic forms of hiccough; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Psychogenic forms of hyperventilation; Psychogenic forms
of increased frequency of micturition; Psychogenic forms of
irritable bowel syndrome; Psychogenic forms of
pylorospasm
Psychogenic urine retention
Psychogenic polyuria
Persistent somatoform pain disorder; Psychalgia;
F45.4 Psychogenic backache; Psychogenic headache; Somatoform MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
pain disorder
Other somatoform disorders; Psychogenic dysmenorrhoea;
Psychogenic dysphagia, including "globus hystericus";
Psychogenic pruritus; Psychogenic torticollis; Teeth-
grinding
Somatoform disorder, unspecified; Psychosomatic disorder
NOS
Other specified neurotic disorders; Dhat syndrome;
Occupational neurosis, including writer's cramp;
Psychasthenia; Psychasthenic neurosis; Psychogenic
syncope
F48.9 Neurotic disorder, unspecified; Neurosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F50.2 Bulimia nervosa; Bulimia NOS; Hyperorexia nervosa MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Mild mental and behavioural disorders associated with the
F53.0 puerperium, not elsewhere classified; Depression postnatal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
NOS; Depression postpartum NOS
Severe mental and behavioural disorders associated with
F53.1 the puerperium, not elsewhere classified; Puerperal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
psychosis NOS
F53.9 Puerperal mental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Abuse of non-dependence-producing substances; Abuse of

F55 antacids; Abuse of herbal or folk remedies; Abuse of MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
steroids or hormones; Abuse of vitamins; Laxative habit
Unspecified behavioural syndromes associated with

F59 physiological disturbances and physical factors; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Psychogenic physiological dysfunction NOS
Mild mental retardation; feeble-mindedness; mild mental
F70.0 subnormality with the statement of no, or minimal, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
impairment of behaviour
Severe mental retardation; severe mental subnormality

without mention of impairment of behaviour
Other mental retardation with significant impairment of

behaviour requiring attention or treatment
Other mental retardation with other impairments of
behaviour
Other mental retardation without mention of impairment
of behaviour
Unspecified mental retardation; mental deficiency NOS;
F79.8 mental subnormality NOS with other impairments of MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
behaviour
F80.3 Acquired aphasia with epilepsy [Landau-Kleffner] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Specific developmental disorder of motor function; Clumsy
F82 child syndrome; Developmental coordination disorder; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Developmental dyspraxia
Childhood autism; Autistic disorder; Infantile autism;
Infantile psychosis; Kanner's syndrome
F84.2 Rett's syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Other childhood disintegrative disorder; Dementia
F84.3 infantilis; Disintegrative psychosis; Heller's syndrome; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Symbiotic psychosis
Asperger's syndrome; Autistic psychopathy; Schizoid
disorder of childhood
F84.9 Pervasive developmental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Unspecified disorder of psychological development;
Developmental disorder NOS
F90.8 Other hyperkinetic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F92.0 Depressive conduct disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Nonorganic encopresis; Functional encopresis;
F98.1 Incontinence of faeces of nonorganic origin; Psychogenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
encopresis
Page 75 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Mental disorder, not otherwise specified; Mental illness
NOS
Disorders of plasma-protein metabolism, not elsewhere

E88.0 METABOLIC DISORDERS 10,700 3,210 7,490
classified; a-1-Antitrypsin deficiency; Bisalbuminaemia
E88.1 Lipodystrophy, not elsewhere classified; Lipodystrophy NOS METABOLIC DISORDERS 10,700 3,210 7,490
Other specified metabolic disorders; Launois-Bensaude

E88.8 METABOLIC DISORDERS 10,700 3,210 7,490
adenolipomatosis; Trimethylaminuria
E88.9 Metabolic disorder, unspecified METABOLIC DISORDERS 10,700 3,210 7,490
P70.0 Syndrome of infant of mother with gestational diabetes METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Syndrome of infant of a diabetic mother; Maternal diabetes

P70.1 mellitus (pre-existing) affecting fetus or newborn with METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
hypoglycaemia
P70.2 Neonatal diabetes mellitus METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.3 Iatrogenic neonatal hypoglycaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Other neonatal hypoglycaemia; Transitory neonatal
P70.4 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
hypoglycaemia
Transitory disorder of carbohydrate metabolism of fetus
and newborn, unspecified
P71.0 Cow's milk hypocalcaemia in newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.1 Other neonatal hypocalcaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Neonatal tetany without calcium or magnesium deficiency;
Neonatal tetany NOS
P71.4 Transitory neonatal hypoparathyroidism METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Transitory neonatal disorder of calcium and magnesium
metabolism, unspecified
Neonatal goitre, not elsewhere classified; Transitory
congenital goitre with normal function
Transitory neonatal hyperthyroidism; neonatal
thyrotoxicosis
Other transitory neonatal disorders of thyroid function, not

elsewhere classified; Transitory neonatal hypothyroidism
P72.8 Other specified transitory neonatal endocrine disorders METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.9 Transitory neonatal endocrine disorder, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.0 Late metabolic acidosis of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.1 Dehydration of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.2 Disturbances of sodium balance of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.4 Other transitory electrolyte disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.8 Other transitory metabolic disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.9 Transitory metabolic disturbance of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P80.9 Hypothermia of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P81.0 Environmental hyperthermia of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Other specified disturbances of temperature regulation of
newborn
Disturbance of temperature regulation of newborn,
unspecified; Fever of newborn NOS
P83.1 Neonatal erythema toxicum METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
Breast engorgement of newborn; Noninfective mastitis of
newborn
Other specified conditions of integument specific to fetus
P83.8 and newborn; Bronze baby syndrome; Neonatal METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
scleroderma; Urticaria neonatorum
Blighted ovum and nonhydatidiform mole; Carneous mole;

O02.0 MISCARRIAGE 5,000 1,500 3,500
Fleshy mole; Intrauterine mole NOS; Pathological ovum
Missed abortion; Early fetal death with retention of dead

O02.1 MISCARRIAGE 5,000 1,500 3,500
fetus
O02.8 Other specified abnormal products of conception MISCARRIAGE 5,000 1,500 3,500
O02.9 Abnormal product of conception, unspecified MISCARRIAGE 5,000 1,500 3,500
O03.4 Spontaneous abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500
Spontaneous abortion, complete or unspecified, without

O03.9 MISCARRIAGE 5,000 1,500 3,500
complication
O05.4 Other abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500
Other abortion, complete or unspecified, without
O05.9 MISCARRIAGE 5,000 1,500 3,500
complication
Unspecified abortion or induced abortion NOS, incomplete,
O06.4 MISCARRIAGE 5,000 1,500 3,500
without complication
Unspecified abortion or induced abortion NOS, complete or
O06.9 MISCARRIAGE 5,000 1,500 3,500
unspecified, without complication
Page 76 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Failed medical abortion, complicated by genital tract and

pelvic infection with Endometritis; Oophoritis; Parametritis;
O07.0 MISCARRIAGE 5,000 1,500 3,500
Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-
oophoritis; Sepsis; Septic shock; Septicaemia
Failed medical abortion with other and unspecified

complications with Shock following abortion and ectopic
and molar pregnancy; Circulatory collapase; Postoperative
O07.3 MISCARRIAGE 5,000 1,500 3,500
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria; Acute Renal failure; Renal
shutdown; Renal tubular necrosis; Uraemia
Failed medical abortion without complication; Failed

O07.4 MISCARRIAGE 5,000 1,500 3,500
medical abortion NOS
Other and unspecified failed attempted abortion with other
and unspecified complications with with Shock following
abortion and ectopic and molar pregnancy; Circulatory
O07.8 collapase; Postoperative Shock; Renal failure following MISCARRIAGE 5,000 1,500 3,500
abortion and ectopic and molar pregnancy;
Afibrinogenaemia; Defibrination syndrome; Intravascular
coagulation
Other and unspecified failed attempted abortion without
O07.9 MISCARRIAGE 5,000 1,500 3,500
complication; Failed attempted abortion NOS
Spontaneous abortion, incomplete, complicated by Genital

tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
O03.0 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis
and/or Septic shock and/or Septicaemia
Spontaneous abortion, incomplete, complicated Delayed or

excessive haemorrhage with Delayed or excessive
O03.1 haemorrhage following abortion and ectopic and molar MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
pregnancy; Afibrinogenaemia; Defibrination syndrome;
Intravascular coagulation
Spontaneous abortion, incomplete, complicated by
Embolism with Embolism NOS or Air embolism or Amniotic
O03.2 fluid embolism or Blood-clot embolism or Pulmonary MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
embolism or Pyaemic embolism or Septic or
septicopyaemic embolism or Soap embolism
Spontaneous abortion, incomplete, with other and

unspecified complications with Shock following abortion
and ectopic and molar pregnancy; Circulatory collapase;
Postoperative Shock; Renal failure following abortion and
ectopic and molar pregnancy; Oliguria; Acute Renal failure;
Renal shutdown; Renal tubular necrosis; Uraemia
Spontaneous abortion, complete, complicated by Genital

tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis
and/or Septic shock and/or Septicaemia
Spontaneous abortion, complete or unspecified,

complicated Delayed or excessive haemorrhage with
O03.6 Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
ectopic and molar pregnancy; Afibrinogenaemia;
Spontaneous abortion, complete or unspecified, with other

complicated by Embolism with Embolism following
O03.7 abortion and ectopic and molar pregnancy; Embolism NOS; MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Air embolism; Amniotic fluid embolism; Blood-clot
embolism; Pulmonary embolism; Pyaemic embolism
Spontaneous abortion, complete or unspecified, with

other and unspecified complications with Shock following
O03.8 abortion and ectopic and molar pregnancy; Circulatory MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
collapase; Postoperative Shock; Renal failure following
abortion and ectopic and molar pregnancy
Other abortion, incomplete, complicated by Genital tract

and pelvic infection with Endometritis and/or Oophoritis
O05.0 and/or Parametritis and/or Pelvic peritonitis and/or MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Salpingitis and/or Salpingo-oophoritis and/or Sepsis and/or
Septic shock and/or Septicaemia
Page 77 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Other abortion, incomplete, complicated Delayed or
excessive haemorrhage with Delayed or excessive
O05.1 haemorrhage following abortion and ectopic and molar MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
pregnancy; Afibrinogenaemia; Defibrination syndrome;
Other abortion, complete, with other and unspecified
complications with Shock following abortion and ectopic
O05.8 and molar pregnancy; Circulatory collapase; Postoperative MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria Acute
complicated by Genital tract and pelvic infection with
Endometritis and/or Oophoritis and/or Parametritis and/or
Pelvic peritonitis and/or Salpingitis and/or Salpingo-
oophoritis and/or Sepsis and/or Septic shock and/or
Septicaemia
complicated Delayed or excessive haemorrhage with
Afibrinogenaemia or Defibrination syndrome or

complicated by Embolism or Embolism NOS with Air
O06.2 embolism or Amniotic fluid embolism or Blood-clot MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap embolism

with other and unspecified complications with Shock
following abortion and ectopic and molar pregnancy;
O06.3 Circulatory collapase; Postoperative Shock; Renal failure MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Oliguria; Acute Renal failure; Renal shutdown; Renal
tubular necrosis; Uraemia
Unspecified abortion or induced abortion NOS, complete,
or unspecified, complicated by Genital tract and pelvic
infection or Endometritis and/or Oophoritis and/or
Parametritis and/or Pelvic peritonitis and/or Salpingitis
and/or Salpingo-oophoritis and/or Sepsis and/or Septic
shock and/or Septicaemia
complicated by Delayed or excessive haemorrhage or
Afibrinogenaemia or Defibrination syndrome or

complicated by Embolism or Embolism NOS or Air
O06.7 embolism or Amniotic fluid embolism or Blood-clot MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap embolism

with other and unspecified complications with Shock
O06.8 Circulatory collapase; Postoperative Shock; Renal failure MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Oliguria; Acute Renal failure; Renal shutdown; Renal
tubular necrosis; Uraemia
Failed medical abortion complicated by delayed or
excessive haemorrhage; Afibrinogenaemia with Delayed or
O07.1 excessive haemorrhage following abortion and ectopic and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
molar pregnancy; Afibrinogenaemia; Defibrination
syndrome; Intravascular coagulation
Other and unspecified failed attempted abortion
complicated by genital tract and pelvic infection with
O07.5 Endometritis; Oophoritis; Parametritis; Pelvic peritonitis; MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Salpingitis; Salpingo-oophoritis; Sepsi; Septic shock;
Septicaemia
Other and unspecified failed attempted abortion
complicated by delayed or excessive haemorrhage with
O07.6 Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
ectopic and molar pregnancy; Afibrinogenaemia;
Shock following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative Shock
Other complications following abortion and ectopic and

molar pregnancy; Cardiac arrest; Urinary tract infection
M60.0 Infective myositis; Tropical pyomyositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 78 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M60.00 Infective myositis; Tropical pyomyositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.01 Infective myositis; Tropical pyomyositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.02 Infective myositis; Tropical pyomyositis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Infective myositis; Tropical pyomyositis Pelvic region and
M60.05 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
thigh
M60.06 Infective myositis; Tropical pyomyositis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.07 Infective myositis; Tropical pyomyositis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.08 Infective myositis; Tropical pyomyositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.09 Infective myositis; Tropical pyomyositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.1 Interstitial myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.11 Interstitial myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Foreign body granuloma of soft tissue, not elsewhere
classified
classified Shoulder region
classified Forearm
classified Ankle and foot
M60.8 Other myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.80 Other myositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.81 Other myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.88 Other myositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.89 Other myositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.9 Myositis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.90 Myositis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.91 Myositis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.92 Myositis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.95 Myositis, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.96 Myositis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.98 Myositis, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.99 Myositis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Calcification and ossification of muscles associated with
burns; Myositis ossificans associated with burns
M61.55 Other ossification of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.59 Other ossification of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.9 Calcification and ossification of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.0 Diastasis of muscle MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.05 Diastasis of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.08 Diastasis of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.1 Other rupture of muscle (nontraumatic) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.48 Contracture of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.49 Contracture of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Lower leg
Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Site unspecified
M62.60 Muscle strain Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.61 Muscle strain Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.62 Muscle strain Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.63 Muscle strain Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.65 Muscle strain Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.66 Muscle strain Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.67 Muscle strain Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.68 Muscle strain Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.69 Muscle strain Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.8 Muscle (sheath) hernia MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.80 Muscle (sheath) hernia Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.85 Muscle (sheath) hernia Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.86 Muscle (sheath) hernia Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.88 Muscle (sheath) hernia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.89 Muscle (sheath) hernia Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.9 Disorder of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.90 Disorder of muscle, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.91 Disorder of muscle, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.95 Disorder of muscle, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.96 Disorder of muscle, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.97 Disorder of muscle, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.98 Disorder of muscle, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.99 Disorder of muscle, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.0 Abscess of tendon sheath MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.1 Other infective tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.13 Other infective (teno)synovitis Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.2 Calcific tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.20 Calcific tendinitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 79 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M65.22 Calcific tendinitis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.25 Calcific tendinitis Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.29 Calcific tendinitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.3 Trigger finger;Nodular tendinous disease MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.4 Radial styloid tenosynovitis [de Quervain] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.8 Other synovitis and tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.80 Other synovitis and tenosynovitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.84 Other synovitis and tenosynovitis Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.86 Other synovitis and tenosynovitis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.87 Other synovitis and tenosynovitis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.89 Other synovitis and tenosynovitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.9 Synovitis and tenosynovitis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.90 Synovitis and tenosynovitis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.91 Synovitis and tenosynovitis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.92 Synovitis and tenosynovitis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.93 Synovitis and tenosynovitis, unspecified Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.94 Synovitis and tenosynovitis, unspecified Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Synovitis and tenosynovitis, unspecified Pelvic region and
thigh
M65.96 Synovitis and tenosynovitis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.97 Synovitis and tenosynovitis, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.99 Synovitis and tenosynovitis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M66.0 Rupture of popliteal cyst MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M66.4 Spontaneous rupture of other tendons MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Spontaneous rupture of unspecified tendon; Rupture at
musculotendinous junction, nontraumatic
M67.0 Short Achilles tendon (acquired) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.1 Other contracture of tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.2 Synovial hypertrophy, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.3 Transient synovitis; Toxic synovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.4 Ganglion; Ganglion of joint or tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.8 Other specified disorders of synovium and tendon MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.9 Disorder of synovium and tendon, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.0 Chronic crepitant synovitis of hand and wrist MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.1 Bursitis of hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.2 Olecranon bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.3 Other bursitis of elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.4 Prepatellar bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.5 Other bursitis of knee MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.6 Trochanteric bursitis; Trochanteric tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.7 Other bursitis of hip; Ischial bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Other soft tissue disorders related to use, overuse and
pressure
Unspecified soft tissue disorder related to use, overuse and
pressure
M71.1 Other infective bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.2 Synovial cyst of popliteal space [Baker] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.3 Other bursal cyst; Synovial cyst NOS MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.31 Other bursal cyst; Synovial cyst NOS Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.5 Other bursitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.51 Other bursitis, not elsewhere classified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.8 Other specified bursopathies MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.9 Bursopathy, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.91 Bursopathy, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.99 Bursopathy, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.0 Palmar fascial fibromatosis [Dupuytren] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.2 Plantar fascial fibromatosis; Plantar fasciitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.5 Fasciitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.88 Other fibroblastic disorders; Abscess of fascia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Fibroblastic disorder, unspecified; Fasciitis NOS;
Fibromatosis NOS
Fibromatosis NOS Other
Fibromatosis NOS Site unspecified
Adhesive capsulitis of shoulder; Frozen shoulder;
Periarthritis of shoulder
Rotator cuff syndrome; Rotator cuff or supraspinatus tear
M75.1 or rupture complete)(incomplete), not specified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
as traumatic; Supraspinatus syndrome
M75.2 Bicipital tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.3 Calcific tendinitis of shoulder; Calcified bursa of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.4 Impingement syndrome of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 80 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M75.5 Bursitis of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.8 Other shoulder lesions MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.9 Shoulder lesion, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76 Enthesopathies of lower limb, excluding foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.0 Gluteal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.1 Psoas tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.3 Iliotibial band syndrome MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.4 Tibial collateral bursitis [Pellegrini-Stieda] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.5 Patellar tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.6 Achilles tendinitis; Achilles bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.7 Peroneal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Other enthesopathies of lower limb, excluding foot;
Anterior tibial syndrome; Posterior tibial tendinitis
M76.9 Enthesopathy of lower limb, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.0 Medial epicondylitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.1 Lateral epicondylitis; Tennis elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.3 Calcaneal spur MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.5 Other enthesopathy of foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.8 Other enthesopathies, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Enthesopathy, unspecified; Bone spur NOS; Capsulitis NOS;
Periarthritis NOS; Tendinitis NOS
M79.80 Other specified soft tissue disorders Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.81 Other specified soft tissue disorders Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.82 Other specified soft tissue disorders Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.84 Other specified soft tissue disorders Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.85 Other specified soft tissue disorders Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.86 Other specified soft tissue disorders Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.87 Other specified soft tissue disorders Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.88 Other specified soft tissue disorders Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.89 Other specified soft tissue disorders Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.91 Soft tissue disorder, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.95 Soft tissue disorder, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.98 Soft tissue disorder, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.99 Soft tissue disorder, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.00 Rheumatism, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.01 Rheumatism, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.02 Rheumatism, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.05 Rheumatism, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.07 Rheumatism, unspecified Ankle and foot MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.08 Rheumatism, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.09 Rheumatism, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.10 Myalgia Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.11 Myalgia Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.12 Myalgia Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.15 Myalgia Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.16 Myalgia Lower leg MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.18 Myalgia Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.19 Myalgia Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.20 Neuralgia and neuritis, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.21 Neuralgia and neuritis, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.22 Neuralgia and neuritis, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.25 Neuralgia and neuritis, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.28 Neuralgia and neuritis, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.29 Neuralgia and neuritis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.39 Panniculitis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M96.8 Other postprocedural musculoskeletal disorders MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
P94.0 Transient neonatal myasthenia gravis MYASTHENIA GRAVIS NEWBORN 11,600 3,480 8,120
G70.0 Myasthenia gravis MYOPATHIES 7,900 2,370 5,530
G70.2 Congenital and developmental myasthenia MYOPATHIES 7,900 2,370 5,530
G70.8 Other specified myoneural disorders MYOPATHIES 7,900 2,370 5,530
G70.9 Myoneural disorder, unspecified MYOPATHIES 7,900 2,370 5,530
Muscular dystrophy; Muscular dystrophy autosomal

recessive, childhood type, resembling Duchenne or Becker;
Muscular dystrophy benign [Becker]; Muscular dystrophy
benign; capuloperoneal with early contractures [Emery-
G71.0 Dreifuss]; Muscular dystrophy distal; Muscular dystrophy MYOPATHIES 7,900 2,370 5,530
facioscapulohumeral; Muscular dystrophy limb-girdle;
Muscular dystrophy ocular; Muscular dystrophy
oculopharyngeal; Muscular dystrophy scapuloperoneal;
Muscular dystrophy severe [Duchenne]
Page 81 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Myotonic disorders; Dystrophia myotonica [Steinert];

Myotonia, chondrodystrophic; Myotonia, drug-induced;
Myotonia, symptomatic; Myotonia, congenita NOS;
G71.1 MYOPATHIES 7,900 2,370 5,530
Myotonia, congenita dominant [Thomsen]; Myotonia,
congenital recessive [Becker]; Neuromyotonia [Isaac];
Paramyotonia congenita; Pseudomyotonia
Congenital myopathies; Congenital muscular dystrophy

NOS; Congenital muscular dystrophy with specific
morphological abnormalities of the muscle fibre; Central
G71.2 MYOPATHIES 7,900 2,370 5,530
coreDisease ; Minicore Disease ; MulticoreDisease ; Fibre-
type disproportion; Myopathy myotubular (centronuclear);
Myopathy nemaline
Primary disorder of muscle, unspecified; Hereditary

G71.9 MYOPATHIES 7,900 2,370 5,530
myopathy NOS
G72.0 Drug-induced myopathy MYOPATHIES 7,900 2,370 5,530
G72.1 Alcoholic myopathy MYOPATHIES 7,900 2,370 5,530
G72.2 Myopathy due to other toxic agents MYOPATHIES 7,900 2,370 5,530
Periodic paralysis; Periodic paralysis (familial)
hyperkalaemic; Periodic paralysis (familial) hypokalaemic;
G72.3 MYOPATHIES 7,900 2,370 5,530
Periodic paralysis (familial) myotonic; Periodic paralysis
(familial) normokalaemic
G72.4 Inflammatory myopathy, not elsewhere classified MYOPATHIES 7,900 2,370 5,530
G72.8 Other specified myopathies MYOPATHIES 7,900 2,370 5,530
G72.9 Myopathy, unspecified MYOPATHIES 7,900 2,370 5,530
P91.0 Neonatal cerebral ischaemia NEONATAL CEREBRAL ISCHEMIA 25,800 7,740 18,060
Fetus and newborn affected by maternal hypertensive
P00.0 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
disorders
Fetus and newborn affected by maternal renal and urinary
tract diseases
Fetus and newborn affected by maternal infectious and
parasitic diseases
Fetus and newborn affected by other maternal circulatory
and respiratory diseases
Fetus and newborn affected by maternal nutritional
disorders; Maternal nutriotion NOS
P00.5 Fetus and newborn affected by maternal injury NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by surgical procedure on
mother
Fetus and newborn affected by other medical procedures
on mother, not elsewhere classified
Fetus and newborn affected by other maternal conditions;

Fetus or newborn affected by maternal genital tract and
other localized infections; Fetus or newborn affected by
maternal systemic lupus erythematosus
Fetus and newborn affected by unspecified maternal

condition
P01.0 Fetus and newborn affected by incompetent cervix NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by premature rupture of
membranes
P01.2 Fetus and newborn affected by oligohydramnios NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by polyhydramnios;
Hydramnios
Fetus and newborn affected by ectopic pregnancy;
Abdominal pregnancy
Fetus and newborn affected by multiple pregnancy; Triplet
pregnance; Twin pregnancy
P01.6 Fetus and newborn affected by maternal death NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by malpresentation before

labour; Breech presentation before labor; External version
before labour; Face presentation before labour; Transverse
lie before labour; Unstable lie before labour
Fetus and newborn affected by other maternal

complications of pregnancy; Spontaneous abortion, fetus
Fetus and newborn affected by maternal complication of

pregnancy, unspecified
P02.0 Fetus and newborn affected by placenta praevia NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by other forms of placental
separation and haemorrhage; Abruptio placentae;
Accidental haemorrhage; Antepartum haemorrhage;
Damage to placenta from amniocentesis, caesarian section
or surgical induction; Maternal blood loss; Premature
separation of placenta
Page 82 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Fetus and newborn affected by other and unspecified
morphological and functional abnormalities of placenta;
Placental dysfunction; Placental infarction; Placental
insufficiency
Fetus and newborn affected by placental transfusion
P02.3 syndromes; Placental and cord abnormalities resulting in NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
twin-to-twin or other transplacental transfusion
P02.4 Fetus and newborn affected by prolapsed cord NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by other compression of
P02.5 umbilical cord; Cord (tightly) around neck; Entanglement of NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
cord; Knot in cord
Fetus and newborn affected by other and unspecified
conditions of umbilical cord; Short cord; Vasa praevia
Fetus and newborn affected by chorioamnionitis;
Amnionitis; Membranitis; Placentitis
Fetus and newborn affected by other abnormalities of
membranes
Fetus and newborn affected by abnormality of membranes,
unspecified
Fetus and newborn affected by breech delivery and
extraction
Fetus and newborn affected by other malpresentation,
malposition and disproportion during labour and delivery;
Contracted pelvis; Persistent occipitoposterior; Transverse
lie
P03.2 Fetus and newborn affected by forceps delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by delivery by vacuum
extractor [ventouse]
P03.4 Fetus and newborn affected by caesarean delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.5 Fetus and newborn affected by precipitate delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by abnormal uterine
contractions; Fetus and newborn affected by abnormal
Hypertonic lahour; Fetus and newborn affected by
abnormal Uterine inertia
Fetus and newborn affected by other specified
complications of labour and delivery
Fetus and newborn affected by complication of labour and
delivery, unspecified
Fetus and newborn affected by maternal anaesthesia and
analgesia in pregnancy, labour and delivery
Fetus and newborn affected by other maternal medication;
Cancer chemotherapy; Cytotoxic drugs
P04.2 Fetus and newborn affected by maternal use of tobacco NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.3 Fetus and newborn affected by maternal use of alcohol NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Fetus and newborn affected by maternal use of nutritional
chemical substances
Fetus and newborn affected by other maternal noxious
influences
Neoplasm of uncertain or unknown behaviour of Lip, oral

cavity and pharynx; Neoplasm of uncertain or unknown
behaviour of Aryepiglottic fold NOS; Neoplasm of
uncertain or unknown behaviour of hypopharyngeal aspect
D37.0 of Aryepiglottic fold; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
behaviour of marginal zone of Aryepiglottic fold; Neoplasm
of uncertain or unknown behaviour of Major and minor
salivary glands; Neoplasm of uncertain or unknown
behaviour of Vermilion border of lip
D37.1 Neoplasm of uncertain or unknown behaviour of Stomach NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Neoplasm of uncertain or unknown behaviour of Small

D37.2 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
intestine
D37.3 Neoplasm of uncertain or unknown behaviour of Appendix NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.4 Neoplasm of uncertain or unknown behaviour of Colon NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Neoplasm of uncertain or unknown behaviour of Rectum;
D37.5 Neoplasm of uncertain or unknown behaviour of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Rectosigmoid junction
Neoplasm of uncertain or unknown behaviour of Liver,
D37.6 gallbladder and bile ducts; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
unknown behaviour of Ampulla of Vater
Page 83 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Neoplasm of uncertain or unknown behaviour of Other
digestive organs; Neoplasm of uncertain or unknown
behaviour of Anal canal; Neoplasm of uncertain or
unknown behaviour of Anal sphincter; Neoplasm of
D37.7 uncertain or unknown behaviour of Anus NOS; Neoplasm NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
of uncertain or unknown behaviour of Intestine NOS;
Neoplasm of uncertain or unknown behaviour of
Oesophagus; Neoplasm of uncertain or unknown behaviour
of Pancreas
Neoplasm of uncertain or unknown behaviour of Digestive
organ, unspecified
Neoplasm of uncertain or unknown behaviour of Larynx;

Neoplasm of uncertain or unknown behaviour of laryngeal
aspect of Aryepiglottic fold; Neoplasm of uncertain or
unknown behaviour of Suprahyoid portion of Epiglottis
Neoplasm of uncertain or unknown behaviour of Trachea,

bronchus and lung
D38.2 Neoplasm of uncertain or unknown behaviour of Pleura NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Mediastinum
D38.4 Neoplasm of uncertain or unknown behaviour of Thymus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

respiratory organs; Neoplasm of uncertain or unknown
behaviour of Accessory sinuses; Neoplasm of uncertain or
unknown behaviour of Cartilage of nose; Neoplasm of
uncertain or unknown behaviour of Middle ear; Neoplasm
of uncertain or unknown behaviour of Nasal cavities

Respiratory organ, unspecified
D39.0 Neoplasm of uncertain or unknown behaviour of Uterus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.1 Neoplasm of uncertain or unknown behaviour of Ovary NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Neoplasm of uncertain or unknown behaviour of Placenta;
D39.2 Chorioadenoma destruens; Invasive Hydatidiform mole; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Malignant Hydatidiform mole
D39.7 female genital organs; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
behaviour of Skin of female genital organs
Neoplasm of uncertain or unknown behaviour of Female
genital organ, unspecified
D40.0 Neoplasm of uncertain or unknown behaviour of Prostate NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.1 Neoplasm of uncertain or unknown behaviour of Testis NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.7 male genital organs; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
behaviour of Skin of male genital organs
Neoplasm of uncertain or unknown behaviour of Male
genital organ, unspecified
D41.0 Neoplasm of uncertain or unknown behaviour of Kidney NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Neoplasm of uncertain or unknown behaviour of Renal

pelvis
D41.2 Neoplasm of uncertain or unknown behaviour of Ureter NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.3 Neoplasm of uncertain or unknown behaviour of Urethra NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.4 Neoplasm of uncertain or unknown behaviour of Bladder NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Neoplasm of uncertain or unknown behaviour of Urinary

organ, unspecified
Neoplasm of uncertain or unknown behaviour of Cerebral
meninges
Neoplasm of uncertain or unknown behaviour of Spinal
meninges
Neoplasm of uncertain or unknown behaviour of Meninges,
unspecified
Page 84 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Neoplasm of uncertain or unknown behaviour of Brain,
supratentorial; Neoplasm of uncertain or unknown
behaviour of Cerebral ventricle; Neoplasm of uncertain or
unknown behaviour of Cerebrum; Neoplasm of uncertain
D43.0 or unknown behaviour of Frontal lobe; Neoplasm of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
uncertain or unknown behaviour of Occipital lobe;
Neoplasm of uncertain or unknown behaviour of Parietal
lobe; Neoplasm of uncertain or unknown behaviour of
Temporal lobe
infratentorial; Neoplasm of uncertain or unknown
D43.1 behaviour of Brain stem; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
unknown behaviour of Cerebellum; Neoplasm of
uncertain or unknown behaviour of Fourth ventricle
unspecified
Neoplasm of uncertain or unknown behaviour of Cranial
nerves
Neoplasm of uncertain or unknown behaviour of Spinal
cord
parts of central nervous system
Neoplasm of uncertain or unknown behaviour of Central

D43.9 nervous system, unspecified; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
unknown behaviour of Central Nervous system NOS
Neoplasm of uncertain or unknown behaviour of Thyroid

gland
Neoplasm of uncertain or unknown behaviour of Adrenal
gland
Parathyroid gland
Neoplasm of uncertain or unknown behaviour of Pituitary
gland
Craniopharyngeal duct
Neoplasm of uncertain or unknown behaviour of Pineal
gland
Neoplasm of uncertain or unknown behaviour of Carotid
body
Neoplasm of uncertain or unknown behaviour of Aortic
body and other paraganglia
D44.8 Pluriglandular involvement; Multiple endocrine NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
adenomatosis
Neoplasm of uncertain or unknown behaviour of Endocrine
gland, unspecified
D45 Polycythaemia vera NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D46 Myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D46.7 Other myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Myelodysplastic syndrome, unspecified; Myelodysplastic
D46.9 syndrome NOS; Myelodysplasia NOS; Preleukaemia NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
syndrome NOS
Histiocytic and mast cell tumours of uncertain and
D47.0 unknown behaviour; Mast cell tumour NOS; Mastocytoma NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
NOS
Chronic myeloproliferative disease; Myelofibrosis with
myeloid metaplasia; Myeloproliferative disease,
unspecified; Megakaryocytic Myelosclerosis with myeloid
metaplasia
D47.2 Monoclonal gammopathy NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Essential thrombocythaemia; Haemorrhagic
D47.3 thrombocythaemia; Idiopathic haemorrhagic NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
thrombocythaemia
Other specified neoplasms of uncertain or unknown

behaviour of lymphoid, haematopoietic and related tissue
Neoplasm of uncertain or unknown behaviour of lymphoid,

D47.9 haematopoietic and related tissue, unspecified; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Lymphoproliferative disease NOS
Neoplasm of uncertain or unknown behaviour of Bone and
articular cartilage

Connective and other soft tissue; Neoplasm of uncertain or
unknown behaviour of Connective tissue of ear; Neoplasm
of uncertain or unknown behaviour of eyelid
Page 85 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Neoplasm of uncertain or unknown behaviour of Peripheral
nerves and autonomic nervous system
Retroperitoneum
Peritoneum
Neoplasm of uncertain or unknown behaviour of Breast;

D48.6 Neoplasm of uncertain or unknown behaviour of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Connective tissue of breast; Cystosarcoma phyllodes

specified sites; Neoplasm of uncertain or unknown
D48.7 behaviour of Eye; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
behaviour of Heart; Neoplasm of uncertain or unknown
behaviour of Peripheral nerves of orbit
Neoplasm of uncertain or unknown behaviour, unspecified;
D48.9 "Growth" NOS ; Neoplasm NOS; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
New growth NOS; Tumour NOS
G54.0 Brachial plexus disorders; Thoracic outlet syndrome NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.1 Lumbosacral plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.2 Cervical root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.3 Thoracic root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.4 Lumbosacral root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
Neuralgic amyotrophy; Parsonage-Aldren-Turner
G54.5 NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
syndrome; Shoulder-girdle neuritis
G54.8 Other nerve root and plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.9 Nerve root and plexus disorder, unspecified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
Nerve root and plexus compressions in other diseases
G55.8* NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
classified elsewhere
NEWBORN COMPLICATED- LOW BIRTH
P05.0 Light for gestational age 16,900 5,070 11,830
WEIGHT/PRETERM
P05.1 Small for gestational age 16,900 5,070 11,830
WEIGHT/PRETERM
Fetal malnutrition without mention of light or small for NEWBORN COMPLICATED- LOW BIRTH
P05.2 16,900 5,070 11,830
gestational age WEIGHT/PRETERM
Slow fetal growth, unspecified; Fetal growth retardation NEWBORN COMPLICATED- LOW BIRTH
P05.9 16,900 5,070 11,830
NOS WEIGHT/PRETERM
P07.0 Extremely low birth weight; Birth weight 999 g or less. 16,900 5,070 11,830
WEIGHT/PRETERM
P07.1 Other low birth weight; Birth weight 1000-2499 g. 16,900 5,070 11,830
WEIGHT/PRETERM
Extreme immaturity; Less than 28 completed weeks (less NEWBORN COMPLICATED- LOW BIRTH
P07.2 16,900 5,070 11,830
than 196 completed days) of gestation. WEIGHT/PRETERM
Other preterm infants; 28 completed weeks or more but

P07.3 less than 37 completed weeks (196 completed days but less 16,900 5,070 11,830
WEIGHT/PRETERM
than 259 completed days) of gestation; Prematurity NOS
Exceptionally large baby; Usually implies a birth weight of

P08.0 NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900
4500 g or more.
Other heavy for gestational age infants; Other fetus or
P08.1 infant heavy- or large-for-dates regardless of period of NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900
gestation.
Post-term infant, not heavy for gestational age; Fetus or

infant with gestation period of 42 completed weeks or
P08.2 NEWBORN COMPLICATED-POSTTERM 7,500 2,250 5,250
more (294 days or
more), not heavy- or large-for-dates; Postmaturity NOS
P36.0 Sepsis of newborn due to streptococcus, group B NEWBORN SEPSIS 11,700 3,510 8,190
Sepsis of newborn due to other and unspecified
P36.1 NEWBORN SEPSIS 11,700 3,510 8,190
streptococci
P36.2 Sepsis of newborn due to Staphylococcus aureus NEWBORN SEPSIS 11,700 3,510 8,190
Sepsis of newborn due to other and unspecified
P36.3 NEWBORN SEPSIS 11,700 3,510 8,190
staphylococci
P36.4 Sepsis of newborn due to Escherichia coli NEWBORN SEPSIS 11,700 3,510 8,190
P36.5 Sepsis of newborn due to anaerobes NEWBORN SEPSIS 11,700 3,510 8,190
P36.8 Other bacterial sepsis of newborn NEWBORN SEPSIS 11,700 3,510 8,190
Bacterial sepsis of newborn, unspecified
P36.9 Sepsis neonatorum NEWBORN SEPSIS 11,700 3,510 8,190
Septicemia, newborn
Other noninflammatory disorders of ovary, fallopian tube
NONINFLAMMATORY DISORDERS OF THE FEMALE
N83.8 and broad ligament; Broad ligament laceration syndrome 8,500 2,550 5,950
GENITAL TRACT
[Allen-Masters]
Noninflammatory disorder of ovary, fallopian tube and NONINFLAMMATORY DISORDERS OF THE FEMALE
N83.9 8,500 2,550 5,950
broad ligament, unspecified GENITAL TRACT
Other specified noninflammatory disorders of uterus; NONINFLAMMATORY DISORDERS OF THE FEMALE
N85.8 8,500 2,550 5,950
Atrophy of uterus, acquired; Fibrosis of uterus NOS GENITAL TRACT
Page 86 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Noninflammatory disorder of uterus, unspecified; Disorder NONINFLAMMATORY DISORDERS OF THE FEMALE
N85.9 8,500 2,550 5,950
of uterus NOS GENITAL TRACT
E50.0 Vitamin A deficiency with conjunctival xerosis NUTRITIONAL DISORDER 9,200 2,760 6,440
Vitamin A deficiency with Bitot's spot and conjunctival
E50.1 NUTRITIONAL DISORDER 9,200 2,760 6,440
xerosis; Bitot's spot in the young child
Other manifestations of vitamin A deficiency; Follicular
E50.8 keratosis due to vitamin A deficiency; Xeroderma due to NUTRITIONAL DISORDER 9,200 2,760 6,440
vitamin A deficiency
E50.9 Vitamin A deficiency, unspecified; Hypovitaminosis A NOS NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.1 Dry Beriberi NUTRITIONAL DISORDER 9,200 2,760 6,440

E51.2 Wernicke's encephalopathy NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.8 Other manifestations of thiamine deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.9 Thiamine deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E53.1 Pyridoxine deficiency; Vitamin B6 deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
Deficiency of other specified B group vitamins; Biotin
Deficiency; Cyanocobalamin Deficiency; Folate Deficiency;
Folic acid Deficiency; Pantothenic acid Deficiency; Vitamin
B12 Deficiency
E53.9 Vitamin B deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E54 Ascorbic acid deficiency; Deficiency of vitamin C; Scurvy NUTRITIONAL DISORDER 9,200 2,760 6,440
Rickets, active; Infantile Osteomalacia; Juvenile

Osteomalacia
E55.9 Vitamin D deficiency, unspecified; Avitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.0 Deficiency of vitamin E NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.1 Deficiency of vitamin K NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.8 Deficiency of other vitamins NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.9 Vitamin deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E58 Dietary calcium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E60 Dietary zinc deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.1 Iron deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.2 Magnesium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.6 Vanadium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.9 Deficiency of nutrient element, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.1 Imbalance of constituents of food intake NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.8 Other specified nutritional deficiencies NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.9 Nutritional deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E64.9 Sequelae of unspecified nutritional deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.0 Hypervitaminosis A NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.1 Hypercarotenaemia NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.3 Hypervitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440
Extreme obesity with alveolar hypoventilation; Obesity

E66.2 OBESITY HYPOVENTILATION 13,600 4,080 9,520
hypoventilation syndrome (OHS); Pickwickian syndrome
N13.0 Hydronephrosis with ureteropelvic junction obstruction OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
Hydronephrosis with ureteral stricture, not elsewhere

N13.1 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
classified
Hydronephrosis with renal and ureteral calculous
obstruction
N13.3 Other and unspecified hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.4 Hydroureter OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.5 Kinking and stricture of ureter without hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
Pyonephrosis; Conditions in N13.0-N13.5 with infection;
Obstructive uropathy with infection
Vesicoureteral-reflux-associated uropathy; Vesicoureteral

reflux NOS; Vesicoureteral reflux with scarring
N13.8 Other obstructive and reflux uropathy OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
Obstructive and reflux uropathy, unspecified; Urinary tract
obstruction NOS
Orchitis, epididymitis and epididymo-orchitis with abscess;
N45.0 ORCHITIS 7,900 2,370 5,530
Abscess of epididymis or testis
Orchitis, epididymitis and epididymo-orchitis without
N45.9 ORCHITIS 7,900 2,370 5,530
abscess; Epididymitis NOS; Orchitis NOS
M86.0 Acute haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.1 Other acute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.15 Other acute osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.17 Other acute osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.19 Other acute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.2 Subacute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.29 Subacute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.4 Chronic osteomyelitis with draining sinus OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.5 Other chronic haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.50 Other chronic haematogenous osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
Page 87 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
M86.6 Other chronic osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.60 Other chronic osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.61 Other chronic osteomyelitis Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.62 Other chronic osteomyelitis Upper arm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.63 Other chronic osteomyelitis Forearm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.65 Other chronic osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.66 Other chronic osteomyelitis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.67 Other chronic osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.68 Other chronic osteomyelitis Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.69 Other chronic osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.8 Other osteomyelitis; Brodie's abscess OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.80 Other osteomyelitis; Brodie's abscess Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.81 Other osteomyelitis; Brodie's abscess Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.88 Other osteomyelitis; Brodie's abscess Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
Osteomyelitis, unspecified; Infection of bone NOS;
M86.9 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
Periostitis NOS

Periostitis without mention of osteomyelitis Multiple site

M86.91 Periostitis without mention of osteomyelitis Shoulder OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
region

Periostitis without mention of osteomyelitis Upper arm

Periostitis without mention of osteomyelitis Hand
M86.95 Periostitis without mention of osteomyelitis Pelvic region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
and thigh
Periostitis without mention of osteomyelitis Lower leg

Periostitis without mention of osteomyelitis Ankle and foot

Periostitis without mention of osteomyelitis Other
M86.99 Periostitis without mention of osteomyelitis Site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
unspecified
M87.05 Idiopathic aseptic necrosis of bone Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.2 Osteonecrosis due to previous trauma OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.8 Other osteonecrosis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.85 Other osteonecrosis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.86 Other osteonecrosis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.9 Osteonecrosis, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.90 Osteonecrosis, unspecified Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.91 Osteonecrosis, unspecified Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.95 Osteonecrosis, unspecified Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.99 Osteonecrosis, unspecified Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M88.0 Paget's disease of skull OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M88.9 Paget's disease of bone, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
A31.8 Other mycobacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Mycobacterial infection, unspecified ; Atypical
mycobacterium infection Not Otherwise Specified;
A31.9 OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Mycobacteriosis NOS; Listeriosis (listerial foodborne
infection)
A42.0 Pulmonary actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.1 Abdominal actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.2 Cervicofacial actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.7 Actinomycotic septicaemia OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.8 Other forms of actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.9 Actinomycosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A43.1 Cutaneous nocardiosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A43.9 Nocardiosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Cutaneous and mucocutaneous bartonellosis; Verruga
A44.1 OTHER BACTERIAL DISEASES 8,900 2,670 6,230
peruana
A44.9 Bartonellosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A48.8 Other specified bacterial diseases OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.0 Staphylococcal infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.2 Haemophilus influenzae infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.3 Mycoplasma infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Other specified cardia arrhythmias; Brugada syndrome; ont

A49.8 QT syndrome; Long QT syndrome; coronary sinus rhythm OTHER BACTERIAL DISEASES 8,900 2,670 6,230
disorder; ectopic shythm disorder; nodal rhythm disorder
Page 88 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
A49.9 Bacterial infection, unspecified; Bacteraemia NOS OTHER BACTERIAL DISEASES 8,900 2,670 6,230
B20.1 HIV disease resulting in other bacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's
M89.0 OTHER BONE DISORDERS 8,800 2,640 6,160
atrophy; Sympathetic reflex dystrophy
Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's

atrophy; Sympathetic reflex dystrophy Shoulder region
M89.2 Other disorders of bone development and growth OTHER BONE DISORDERS 8,800 2,640 6,160
Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; Pachydermoperiostosis
Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; Pachydermoperiostosis Other
M89.5 Osteolysis OTHER BONE DISORDERS 8,800 2,640 6,160
M89.54 Osteolysis Hand OTHER BONE DISORDERS 8,800 2,640 6,160
M89.6 Osteopathy after poliomyelitis OTHER BONE DISORDERS 8,800 2,640 6,160
Other specified disorders of bone; Infantile cortical

hyperostoses; Post-traumatic subperiosteal ossification

M89.85 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160
Pelvic region and thigh
Lower leg
Ankle and foot
Other
Site unspecified
M89.95 Disorder of bone, unspecified Pelvic region and thigh OTHER BONE DISORDERS 8,800 2,640 6,160
M89.98 Disorder of bone, unspecified Other OTHER BONE DISORDERS 8,800 2,640 6,160
M89.99 Disorder of bone, unspecified Site unspecified OTHER BONE DISORDERS 8,800 2,640 6,160
Juvenile osteochondrosis of head of femur [LEGG-CALVÉ-
PERTHES]
Other juvenile osteochondrosis after reduction of
congenital dislocation of hip
M94.0 Chondrocostal junction syndrome [Tietze] OTHER BONE DISORDERS 8,800 2,640 6,160
M94.8 Other specified disorders of cartilage OTHER BONE DISORDERS 8,800 2,640 6,160
M99.8 Other biomechanical lesions OTHER BONE DISORDERS 8,800 2,640 6,160
M99.9 Biomechanical lesion, unspecified OTHER BONE DISORDERS 8,800 2,640 6,160
I65.2 Occlusion and stenosis of carotid artery OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.0 Dissection of cerebral arteries, nonruptured OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
Cerebral aneurysm, nonruptured; Cerebral aneurysm NOS;
I67.1 OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
Cerebral arteriovenous fistula, acquired
I67.2 Cerebral atherosclerosis; Atheroma of cerebral arteries OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
Progressive vascular leukoencephalopathy; Binswanger's
I67.3 OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
disease
I67.5 Moyamoya disease OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
Nonpyogenic thrombosis of intracranial venous system;
I67.6 Nonpyogenic thrombosis of cerebral vein; Nonpyogenic OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
thrombosis of intracrannial venous sinus
I67.7 Cerebral arteritis, not elsewhere classified OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
Other specified cerebrovascular diseases; Acute
I67.8 cerebrovascular insufficiency NOS; Chronic Cerebral OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
ischaemia
Other lacunar syndrome in unspecified cerebrovascular
I67.9+G46.7* OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
disease
Other vascular syndrome in unspecified cerebrovascular
I67.9+G46.8* OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
disease
A56.4 Chlamydial infection of pharynx OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
Active stage of trachoma; Trachomatous Granular
A71.1 conjunctivitis; Trachomatous follicular conjunctivitis; OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
Trachomatous pannus
A71.9 Trachoma, unspecified OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
A74.9 Chlamydial infection, unspecified; Chlamydiosis NOS OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
Q85.1 Tuberous sclerosis; Bourneville's disease; Epiloia OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Congenital malformation syndromes predominantly
affecting facial appearance; Acrocephalopolysyndactyly;
Acrocephalosyndactyly [Apert]; Cryptophthalmos
Q87.0 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
syndrome; Cyclopia; Goldenhar Syndrome; Moebius
Syndrome; oro-facial-digital Syndrome; Robin Syndrome;
Whistling face
Page 89 of 127
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associated with short stature; Aarskog Syndrome;
Cockayne Syndrome; De Lange Syndrome ; Dubowitz
Q87.1 Syndrome; Noonan Syndrome; Prader-Willi Syndrome; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Robinow-Silverman-Smith Syndrome ;
Russell-Silver Syndrome; Seckel syndrome; Smith-Lemli-
Opitz syndrome
involving limbs; Holt-Oram Syndrome; Klippel-Trénaunay-
Weber Syndrome; nail patella Syndrome;
Rubinstein-Taybi Syndrome; sirenomelia Syndrome;
thrombocytopenia Syndrome with absent radius [TAR];
VATER
Congenital malformation syndromes involving early
Q87.3 overgrowth; Beckwith-Wiedemann Syndrome; Sotos; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Syndrome Weaver Syndrome
Q87.4 Marfan's syndrome OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Other specified congenital malformation syndromes, not
Q87.8 elsewhere classified; Alport Syndrome; Laurence-Moon(- OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Bardet)-Biedl Syndrome; Zellweger Syndrome
Congenital malformations of spleen; Asplenia (congenital);
Congenital splenomegaly
Q89.1 Congenital malformations of adrenal gland OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Congenital malformations of other endocrine glands;
Q89.2 Congenital malformation of parathyroid or thyroid gland; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Persistent thyroglossal duct; Thyroglossal cyst
Conjoined twins; Craniopagus; Dicephaly; Double monster;
Pygopagus; Thoracopagus
Multiple congenital malformations, not elsewhere
Q89.7 classified; Monster NOS; Multiple congenital anomalies OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
NOS; Multiple congenital deformities NOS
Q89.8 Other specified congenital malformations OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Congenital malformation, unspecified; Congenital anomaly
NOS; Congenital deformity NOS
Phlebitis and thrombophlebitis of superficial vessels of
I80.0 OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
lower extremities
I80.1 Phlebitis and thrombophlebitis of femoral vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
Phlebitis and thrombophlebitis of other deep vessels of
lower extremities; Deep vein thrombosis NOS
Phlebitis and thrombophlebitis of lower extremities,
I80.3 unspecified; Embolism or thrombosis of lower extermity OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
NOS
I80.8 Phlebitis and thrombophlebitis of other sites OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.9 Phlebitis and thrombophlebitis of unspecified site OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I81 Portal vein thrombosis; Portal (vein) obstruction OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.0 Budd-Chiari syndrome OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.1 Thrombophlebitis migrans OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.2 Embolism and thrombosis of vena cava OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.3 Embolism and thrombosis of renal vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.8 Embolism and thrombosis of other specified veins OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
Embolism and thrombosis of unspecified vein; Embolism of
vein NOS; Thrombosis (vein) NOS
Nondiabetic hypoglycaemic coma; Nondiabetic
hypoglycaemic coma; Drug-induced insulin coma in
E15 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
nondiabetic; Hyperinsulinism with hypoglycaemic coma;
Hypoglycaemic coma NOS
E16.0 Drug-induced hypoglycaemia without coma OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
Other hypoglycaemia; Functional nonhyperinsulinaemic

hypoglycaemia; Hyperinsulinism NOS; Functional
E16.1 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
Hyperinsulinism; Hyperplasia of pancreatic islet beta cells
NOS; Posthypoglycaemic coma encephalopathy
Increased secretion of glucagon; Hyperplasia of pancreatic

E16.3 endocrine cells with glucagon excess; Hyperplasia of OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
pancreatic endocrine cells with glucagon excess
Abnormal secretion of gastrin; Hypergastrinaemia; Zollinger-

E16.4 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
Ellison syndrome
Other specified disorders of pancreatic internal secretion;

Increased secretion from endocrine pancreas of growth
hormone-releasing hormone; Increased secretion from
E16.8 endocrine pancreas of pancreatic polypeptide; Increased OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
secretion from endocrine pancreas of somatostatin;
Increased secretion from endocrine pancreas of vasoactive-
intestinal polypeptide
Page 90 of 127
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Fee Institution Fee
Disorder of pancreatic internal secretion, unspecified; Islet-
E16.9 cell hyperplasia NOS; Pancreatic endocrine cell hyperplasia OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
NOS
OTHER DISORDERS OF THE FEMALE GENITAL
N82.0 Vesicovaginal fistula 7,800 2,340 5,460
TRACT
Follicular cyst of ovary; Cyst of graafian follicle; OTHER DISORDERS OF THE FEMALE GENITAL
N83.0 7,800 2,340 5,460
Haemorrhagic follicular cyst of ovary TRACT
N83.3 Acquired atrophy of ovary and fallopian tube 7,800 2,340 5,460
TRACT
N83.6 Haematosalpinx 7,800 2,340 5,460
TRACT
N83.7 Haematoma of broad ligament 7,800 2,340 5,460
TRACT
N85.7 Haematometra; Haematosalpinx with haematometra 7,800 2,340 5,460
TRACT
Haematocolpos; Haematocolpos with haematometra or OTHER DISORDERS OF THE FEMALE GENITAL
N89.7 7,800 2,340 5,460
haematosalpinx TRACT
Q51.2 Other doubling of uterus' Doubling of uterus NOS 7,800 2,340 5,460
TRACT
Q51.3 Bicornate uterus 7,800 2,340 5,460
TRACT
Other congenital malformations of uterus and cervix; OTHER DISORDERS OF THE FEMALE GENITAL
Q51.8 7,800 2,340 5,460
Hypoplasia of uterus and cervix TRACT
Q52.1 Doubling of vagina; Septate vagina 7,800 2,340 5,460
TRACT
Q52.2 Congenital rectovaginal fistula 7,800 2,340 5,460
TRACT
Q52.3 Imperforate hymen 7,800 2,340 5,460
TRACT
Other specified congenital malformations of female OTHER DISORDERS OF THE FEMALE GENITAL
Q52.8 7,800 2,340 5,460
genitalia TRACT
Redundant prepuce, phimosis and paraphimosis; Adherent
N47 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
prepuce; Tight foreskin
Other specified disorders of penis; Atrophyof corpus

N48.8 cavernosum and penis ; Hypertrophy of corpus cavernosum OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
and penis ; Thrombosis of corpus cavernosum and penis
N50.0 Atrophy of testis OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Vascular disorders of male genital organs; Haematocele of

N50.1 male genital organs NOS; Haemorrhage of male genital OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
organs;, Thrombosis of male genital organs
Other specified disorders of male genital organs; Atrophy of

scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Hypertrophy of
atrophy], tunica vaginalis and vas deferens; Oedema of
N50.8 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
atrophy], tunica vaginalis and vas deferens; Ulcer of
atrophy], tunica vaginalis and vas deferens; Chylocele,
tunica vaginalis (nonfilarial) NOS; Fistula, urethroscrotal;
Stricture of spermatic cord; Stricture of tunica vaginalis;
Stricture of vas deferens
Q55.0 Absence and aplasia of testis; Monorchism OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.1 Hypoplasia of testis and scrotum; Fusion of testes OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Other congenital malformations of testis and scrotum;

Q55.2 Congenital malformation of testis or scrotum NOS; OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Polyorchism; Retractile testis; Testis migrans
Other congenital malformations of vas deferens,
epididymis, seminal vesicles and prostate; Absence or
aplasia of prostate; Absence or aplasia of spermatic cord;
Q55.4 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Congenital malformation of vas deferens, epididymis,
seminal vesicles or prostate
NOS
Other congenital malformations of penis; Congenital
Q55.6 malformation of penis NOS; Curvature of penis (lateral); OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Hypoplasia of penis
Congenital malformation of male genital organ,

Q55.9 unspecified; Congenital anomalyNOS of male genital organ OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
; Congenital deformity NOS of male genital organ
Page 91 of 127
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Male pseudohermaphroditism, not elsewhere classified;
Q56.1 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Male pseudohermaphroditism NOS
Q56.3 Pseudohermaphroditism, unspecified OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Idiopathic peripheral autonomic neuropathy; Carotid sinus

G90.0 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
syncope
G90.1 Familial dysautonomia [Riley-Day] OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G90.2 Horner's syndrome; Bernard(-Horner) syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Multi-system degeneration; Neurogenic orthostatic
G90.3 OTHER DISORDERS OF THE NERVOUS SYSTEM N/A N/A N/A
hypotension [Shy-Drager]
G90.4 Autonomic dysreflexia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Disorder of autonomic nervous system, unspecified;
G90.9 acquired hydrocephalus OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Autonomic neuropathy
G93.0 Cerebral cysts; Arachnoid cyst; Porencephalic cyst, acquired OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.2 Benign intracranial hypertension OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Postviral fatigue syndrome; Benign myalgic
encephalomyelitis
G93.4 Encephalopathy, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.7 Reye's syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.8 Other specified disorders of brain OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.9 Disorder of brain, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Other specified disorders of brain in diseases classified
G94.8* OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
elswhere
G95.0 Syringomyelia and syringobulbia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Vascular myelopathies; Acute infarction of spinal cord
(embolic)(nonembolic); Arterial thrombosis of spinal cord;
G95.1 Haematomyelia; Nonpyogenic intraspinal phlebitis and OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
thrombophlebitis; Oedema of spinal cord; Subacute
necrotic myelopathy
G95.2 Cord compression, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Other specified diseases of spinal cord; Cord bladder NOS;

G95.8 elopathy drug-induced; Myelopathy radiation-induced OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Spinal sclerosis
G95.9 Disease of spinal cord, unspecified; Myelopathy NOS OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.0 Cerebrospinal fluid leak OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Disorders of meninges, not elsewhere classified; Cerebral

Meningeal adhesions; Spinal Meningeal adhesions
G96.8 Other specified disorders of central nervous system OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.9 Disorder of central nervous system, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
Other disorders of nervous system, not elsewhere
G98 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
classified; Nervous system disorder NOS
Convulsions of newborn
P90 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
Seizures, newborn
P91.1 Acquired periventricular cysts of newborn OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P91.2 Neonatal cerebral leukomalacia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.1 Congenital hypertonia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.2 Congenital hypotonia; Nonspecific floppy baby syndrome OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.9 Disorder of muscle tone of newborn, unspecified OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
Complications of intrauterine procedures, not elsewhere
P96.5 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
classified
Other specified conditions originating in the perinatal
period
Condition originating in the perinatal period, unspecified;
Congenital debility NOS
Acute thyroiditis; Abscess of thyroid; Pyogenic Thyroiditis;
E06.0 OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
Suppurative Thyroiditis
Subacute thyroiditis; de Quervain Thyroiditis; Giant-Cell
E06.1 Thyroiditis; Granulomatous Thyroiditis; Nonsuppurative OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
Thyroiditis
E06.2 Chronic thyroiditis with transient thyrotoxicosis OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
Autoimmune thyroiditis; Hashimoto's thyroiditis ; Transient
E06.3 hashitoxicosis; Lymphadenoid goitre; lymphocytic OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
thyroiditis; Struma lymphomatosa
Other chronic thyroiditis; Chronic Thyroiditis NOS; Chronic

Fibrous Thyroiditis; Ligneous Thyroiditis; Riedel Thyroiditis
E06.9 Thyroiditis, unspecified OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
Hypersecretion of calcitonin; C-cell hyperplasia of thyroid;
Hypersecretion of thyrocalcitonin
Dyshormogenetic goitre; Familial dyshormogenetic goitre;
Pendred's syndrome
Page 92 of 127
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Other specified disorders of thyroid; Abnormality of thyroid-
E07.8 binding globulin; Haemorrhage of thyroid; Infarction of OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
thyroid; Sick-euthyroid syndrome
Adrenogenital disorder, unspecified; Adrenogenital
E25.9 OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
syndrome NOS
E28.8 Other ovarian dysfunction; Ovarian hyperfunction NOS OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
Testicular hypofunction; Defective biosynthesis of testicular

E29.1 androgen NOS; 5-a-Reductase deficiency (with male OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
pseudohermaphroditism); Testicular hypogonadism NOS
E29.9 Testicular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.0 Autoimmune polyglandular failure OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.1 Polyglandular hyperfunction OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.9 Polyglandular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.0 Persistent hyperplasia of thymus; Hypertrophy of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.8 Other diseases of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.9 Disease of thymus, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E34.0 Carcinoid syndrome OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
Other specified endocrine disorders; Pineal gland
dysfunction; Progeria
Endocrine disorder, unspecified; Endocrine Disturbance
NOS; Hormone Disturbance NOS
Renal osteodystrophy; Azotaemic osteodystrophy;
N25.0 Phosphate-losing tubular disorders; Renal rickets; Renal OTHER NEPHROPATHY 9,500 2,850 6,650
short stature
Other disorders resulting from impaired renal tubular
function; Lightwood-Albright syndrome; Renal tubular
N25.8 OTHER NEPHROPATHY 9,500 2,850 6,650
acidosis NOS; Secondary hyperparathyroidism of renal
origin
Disorder resulting from impaired renal tubular function,
unspecified
Cyst of kidney, acquired; Multiple cyst of kidney, acquired;
Solitary cyst of kidney, acquired
Pleural plaque without asbestos; Pleural plaque NOS;
J92.9 OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
Pleural thickening
J94.0 Chylous effusion; Chyliform effusion OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.1 Fibrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.8 Other specified pleural conditions; Hydrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.9 Pleural condition, unspecified OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
Diseases of bronchus, not elsewhere classified;
Broncholithiasis; Calcification of bronchus; Stenosis of
J98.0 OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
bronchus; Ulcer of bronchus; Tracheobronchial collapse;
Tracheobronchial dyskinesia
Other disorders of lung; Calcification of lung; Acquired
cystic lung disease; Lung disease NOS; Pulmolithiasis
Diseases of mediastinum, not elsewhere classified; Fibrosis

J98.5 of mediastinum; Hernia of mediastinum; Retraction of OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
mediastinum; Mediastinitis of mediastinum
Disorders of diaphragm; Diaphragmatitis; Paralysis of

diaphragm; Relaxation of diaphragm
J98.8 Other specified respiratory disorders OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
Respiratory disorder, unspecified; Chronic respiratory
disease NOS
A66.9 Yaws, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
Intermediate lesions of pinta; Erythematous plaques of
A67.1 carate pinta; Hyperchromic lesions of carate pinta; OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
Hyperkeratosis of carate pinta; Pintids of carate pinta
A68.9 Relapsing fever, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
Necrotizing ulcerative stomatitis; Cancrum oris;

A69.0 OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
Fusospirochaetal gangrene; Noma; Stomatitis gangrenosa
Other Vincent's infections; Fusospirochaetal pharyngitis ;

Acute Necrotizing Ulcerative gingivitis; Acute Necrotizing
Ulcerative Gingivostomatitis; Spirochaetal stomatitis,
Trench mouth; Vincent's angina; Vincent’s gingivitis
Lyme disease; Erythema chronicum migrans due to Borrelia

burgdorferi
A69.9 Spirochaetal infection, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
Acute serous otitis media; Acute and subacute secretory
H65.0 OTITIS MEDIA 7,800 2,340 5,460
otitis media
Page 93 of 127
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Case Rate
Fee Institution Fee
Other acute nonsuppurative otitis media; Acute otitis

media; Subacute otitis media; Acute Mucoid allergic otitis
media; Subacute mucoid allergic otitis media; Acute
allergic Sanguinous otitis media; Subacute Sanguinous
allergic otitis media; Acute allergic serous otitis media;
H65.1 OTITIS MEDIA 7,800 2,340 5,460
Subacute allergic serous otitis media; Acute nonsuppurative
NOS otitis media; Subcute nonsuppurative NOS otitis
media; Acute sanguinous otitis media; Subacute
sanguinous otitis media; Acute seromucinous otitis media;
Subacute seromucinous otitis media
H65.2 Chronic serous otitis media; Chronic tubotympanal catarrh OTITIS MEDIA 7,800 2,340 5,460
Chronic mucoid otitis media; Glue ear; Otitis media, chronic

H65.3 mucinous; Otitis media, chronic secretory; Otitis media, OTITIS MEDIA 7,800 2,340 5,460
chronic transudative
Other chronic nonsuppurative otitis media; Otitis media,
chronic allergic; Otitis media, chronic exudative; Otitis
H65.4 media, chronic nonsuppurative NOS; Otitis media, chronic OTITIS MEDIA 7,800 2,340 5,460
seromucinous; Otitis media, chronic with effusion
(nonpurulent)
Nonsuppurative otitis media, unspecified; Allergic Otitis
media ; Catarrhal Otitis media; Exudative Otitis media ;
Mucoid Otitis media ; Secretory Otitis media ;
H65.9 OTITIS MEDIA 7,800 2,340 5,460
Seromucinous otitis media; Serous Otitis media;
Transudative Otitis media; Otitis media with (nonpurulent)
effusion
H66.0 Acute suppurative otitis media OTITIS MEDIA 7,800 2,340 5,460
Chronic tubotympanic suppurative otitis media; Benign
H66.1 chronic suppurative otitis media; Chronic tubotympanic OTITIS MEDIA 7,800 2,340 5,460
disease
Chronic atticoantral suppurative otitis media; Chronic
H66.2 OTITIS MEDIA 7,800 2,340 5,460
atticoantral disease
Other chronic suppurative otitis media; Chronic
H66.3 OTITIS MEDIA 7,800 2,340 5,460
suppurative otitis media NOS
Suppurative otitis media, unspecified; Purulent otitis media
H66.4 OTITIS MEDIA 7,800 2,340 5,460
NOS
Otitis media, unspecified; Otitis media NOS; Acute Otitis
H66.9 OTITIS MEDIA 7,800 2,340 5,460
media NOS; Chronic Otitis media NOS
B05.3+ H67.1* Otitis media in measles OTITIS MEDIA 7,800 2,340 5,460
N83.1 Corpus luteum cyst; Haemorrhagic corpus luteum cyst OVARIAN CYSTS 7,800 2,340 5,460
Other and unspecified ovarian cysts; Retention cyst of
N83.2 OVARIAN CYSTS 7,900 2,370 5,530
ovary; Simple cyst of ovary
N70.0 Acute salpingitis and oophoritis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N70.1 Chronic salpingitis and oophoritis; Hydrosalpinx PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N70.9 Salpingitis and oophoritis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.0 Acute inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.1 Chronic inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.9 Inflammatory disease of uterus, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
Inflammatory disease of cervix uteri; Cervicitis with or
without erosion or ectropion; Endocervicitis with or
N72 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
without erosion or ectropion; Exocervicitis with or without
erosion or ectropion
Acute parametritis and pelvic cellulitis; Acute abcess of
N73.0 broad ligament; Acute abscess of parametrium; Acute PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
pelvic cellulitis, female
N73.1 Chronic parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.2 Unspecified parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.3 Female acute pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.4 Female chronic pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.5 Female pelvic peritonitis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.6 Female pelvic peritoneal adhesions PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.8 Other specified female pelvic inflammatory diseases PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
Female pelvic inflammatory disease, unspecified; Female
N73.9 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
pelvic infection or inflammation NOS
Female pelvic inflammatory disorders in other diseases
N74.8* PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
Genital tract and pelvic infection following abortion and
ectopic and molar pregnancy; Endometritis; Oophoritis;
O08.0 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-
oophoritis; Sepsis; Septic shock; Septicaemia
N94.0 Mittelschmerz PELVIC PAIN 4,800 1,440 3,360
N94.1 Dyspareunia PELVIC PAIN 4,800 1,440 3,360
N94.2 Vaginismus PELVIC PAIN 4,800 1,440 3,360
N94.3 Premenstrual tension syndrome PELVIC PAIN 4,800 1,440 3,360
N94.4 Primary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360
N94.5 Secondary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360
Page 94 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
N94.6 Dysmenorrhoea, unspecified PELVIC PAIN 4,800 1,440 3,360
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus

K25.0 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
peptic ulcer / Stomach peptic ulcer with hemorrhage
Gastric ulcer, acute/ Acute erosion of stomach/ Pylorus

peptic ulcer / Stomach peptic ulcer with perforation

K25.2 peptic ulcer / Stomach peptic ulcer with both haemorrhage PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
and perforation
K25.4 peptic ulcer / Stomach peptic ulcer, chronic or unspecified PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
with haemorrhage
with perforation
with both haemorrhage and perforation
Duodenal ulcer, acute / Acute erosion of duodenum/
K26.0 Duodenal peptic ulcer/ Postpyloric peptic ulcer with PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
haemorrhage
K26.1 Duodenal peptic ulcer/ Postpyloric peptic ulcer with PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
perforation
Chronic Duodenal/ Postpyloric ulcer/ erosion, or
unspecified with haemorrhage
unspecified with perforation
unspecified with both haemorrhage and perforation
Acute Peptic ulcer/ Gastroduodenal ulcer NOS, site
unspecified, with haemorrhage
Acute Peptic ulcer / Gastroduodenal ulcer, site unspecified,
with perforation
Acute Peptic/ Gastroduodenal ulcer, site unspecified, with
both haemorrhage and perforation
Chronic or unspecified Peptic/ Gastroduodenal ulcer, site
unspecified, with haemorrhage
unspecified with perforation

unspecified, with both haemorrhage and perforation
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or

erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
erosion
erosion
erosion
Chronic or unspecified Gastrojejunal ulcer/ Anastomotic
peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/
erosion
Page 95 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
erosion
erosion
Acute haemorrhagic gastritis; Acute erosive gastritis with
haemorrhage
K25.3 peptic ulcer / Stomach peptic ulcer without haemorrhage PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
or perforation
Gastric/ Peptic/ Pyloric ulcer/ erosion, chronic without
K25.7 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
haemorrhage or perforation
Gastric/ Peptic/ Pyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforation
K26.3 Duodenal peptic ulcer/ Postpyloric peptic ulcer without PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
Chronic Duodenal/ Postpyloric ulcer/ erosion, without
Duodenal/ Postpyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforation
Acute Peptic/ Gastroduodenal ulcer, site unspecified,
K27.3 without haemorrhage or perforation; gastroduodenal ulcer PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
NOS; Peptic ulcer NOS
Chronic Peptic/ Gastroduodenal ulcer, site unspecified,
K27.7 without haemorrhage or perforation; gastroduodenal ulcer PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
NOS; Peptic ulcer NOS
Peptic/ Gastroduodenal ulcer, unspecified as acute or
K27.9 chronic, without haemorrhage or perforation; PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
gastroduodenal ulcer NOS; Peptic ulcer NOS
Chronic Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion
Unspecified as acute or chronic Gastrojejunal ulcer/
Anastomotic peptic ulcer or erosion/ Gastrocolic peptic
ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/
Gastrojejunal peptic ulcer or erosion/ Jejunal peptic ulcer
or erosion/ Marginal peptic ulcer or erosion; Stomal peptic
ulcer or erosion
K29.1 Other acute gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.2 Alcoholic gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.3 Chronic superficial gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.4 Chronic atrophic gastritis; Gastric atrophy PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
Chronic gastritis, unspecified; Chronic Antral gastritis;

Chronic Fundal gastritis
Other gastritis; Giant hypertrophic gastritis; Granulomatous
gastritis; Menetrier's disease
K29.7 Gastritis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.8 Duodenitis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.9 Gastroduodenitis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
P23.0 Congenital pneumonia due to viral agent PERINATAL INFECTIONS 12,700 3,810 8,890
P23.1 Congenital pneumonia due to Chlamydia PERINATAL INFECTIONS 12,700 3,810 8,890
P23.2 Congenital pneumonia due to staphylococcus PERINATAL INFECTIONS 12,700 3,810 8,890
P23.3 Congenital pneumonia due to streptococcus, group B PERINATAL INFECTIONS 12,700 3,810 8,890
P23.4 Congenital pneumonia due to Escherichia coli PERINATAL INFECTIONS 12,700 3,810 8,890
P23.5 Congenital pneumonia due to Pseudomonas PERINATAL INFECTIONS 12,700 3,810 8,890
Congenital pneumonia due to other bacterial agents;
P23.6 Haemophilus influenzae; Klebsiella pneumonia; PERINATAL INFECTIONS 12,700 3,810 8,890
Mycoplasma; Streptococcus, except group B
P23.9 Congenital pneumonia, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
Page 96 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
Congenital rubella syndrome; Congenital rubella
P35.0 PERINATAL INFECTIONS 12,700 3,810 8,890
pneumonitis
P35.1 Congenital cytomegalovirus infection PERINATAL INFECTIONS 12,700 3,810 8,890
P35.2 Congenital herpesviral [herpes simplex] infection PERINATAL INFECTIONS 12,700 3,810 8,890
P35.3 Congenital viral hepatitis PERINATAL INFECTIONS 12,700 3,810 8,890
Other congenital viral diseases; Congenital varicella
[chickenpox]
P35.9 Congenital viral disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
P37.0 Congenital tuberculosis PERINATAL INFECTIONS 12,700 3,810 8,890
Congenital toxoplasmosis; Hydrocephalus due to congenital
toxoplasmosis
P37.3 Congenital falciparum malaria PERINATAL INFECTIONS 12,700 3,810 8,890
P37.5 Neonatal candidiasis PERINATAL INFECTIONS 12,700 3,810 8,890
P37.8 Other specified congenital infectious and parasitic diseases PERINATAL INFECTIONS 12,700 3,810 8,890
P37.9 Congenital infectious and parasitic disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
P38 Omphalitis of newborn with or without mild haemorrhage PERINATAL INFECTIONS 12,700 3,810 8,890
P39.0 Neonatal infective mastitis PERINATAL INFECTIONS 12,700 3,810 8,890

Neonatal conjunctivitis and dacryocystitis; Neonatal
chlaydial conjunctivitis; Ophthalmia neonatorum NOS
P39.2 Intra-amniotic infection of fetus, not elsewhere classified PERINATAL INFECTIONS 12,700 3,810 8,890
P39.3 Neonatal urinary tract infection PERINATAL INFECTIONS 12,700 3,810 8,890
P39.4 Neonatal skin infection; Neonatal pyoderma PERINATAL INFECTIONS 12,700 3,810 8,890
P39.8 Other specified infections specific to the perinatal period PERINATAL INFECTIONS 12,700 3,810 8,890
P39.9 Infection specific to the perinatal period, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
Peritoneal adhesions; Adhesions of abdominal wall;

Adhesions of diaphragm; Adhesions of intestine; Adhesions
K66.0 PERITONEAL DISORDERS 10,800 3,240 7,560
of male pelvis; Mesenteric Adhesions; Adhesions of
omentum; Adhesions of stomach; Adhesive bands
K66.8 Other specified disorders of peritoneum PERITONEAL DISORDERS 10,800 3,240 7,560
K66.9 Disorder of peritoneum, unspecified PERITONEAL DISORDERS 10,800 3,240 7,560
Acute peritonitis; Abdominopelvic abscess; Mesenteric
abscess; Abscess of omentum; Abscess of peritoneum;
Retrocaecal abscess; Retroperitoneal abscess;
K65.0 Subdiaphragmatic abscess; Subhepatic abscess; Subphrenic PERITONITIS 14,700 4,410 10,290
abscess; Acute Generalized peritonitis; Acute male pelvic
peritonitis; Acute subphrenic peritonitis; Acute suppurative
peritonitis
Other peritonitis; Chronic proliferative peritonitis;
K65.8 Mesentric fat necrosis; Mesentric saponification; Peritonitis PERITONITIS 14,700 4,410 10,290
due to bile; Peritonitis due to urine
K65.9 Peritonitis, unspecified PERITONITIS 14,700 4,410 10,290
Other phakomatoses, not elsewhere classified; Peutz-
Q85.8 Jeghers Syndrome; Sturge-Weber(-Dimitri)Syndrome; von PHAKOMATOSES 10,800 3,240 7,560
Hippel-Lindau Syndrome
Q85.9 Phakomatosis, unspecified; Hamartosis NOS PHAKOMATOSES 10,800 3,240 7,560
Pleural effusion, not elsewhere classified; Pleurisy with
J90 PLEURAL EFFUSION 14,200 4,260 9,940
effusion
J91* Pleural effusion in conditions classified elsewhere PLEURAL EFFUSION 14,200 4,260 9,940
B20.6 HIV disease resulting in pneumocystis carinii pneumonia PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.03 Adenoviral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.13 Respiratory syncytial virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.23 Parainfluenza virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.33 Human metapneumovirus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.93 Viral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
Pneumonia [bronchopneumonia]due to Streptococcus
J13.3 PNEUMONIA HIGH RISK 32,000 9,600 22,400
pneumoniae, high risk
Pneumonia [bronchopneumonia] due to Haemophilus
influenzae, high risk
J15.03 Pneumonia due to Klebsiella pneumoniae, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.13 Pneumonia due to Pseudomonas, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.23 Pneumonia due to staphylococcus, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.33 Pneumonia due to streptococcus, group B, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.43 Pneumonia due to other streptococci, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.53 Pneumonia due to Escherichia coli, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
Pneumonia due to other aerobic Gram-negative bacteria;

Pneumonia due to Serratia marcescens, high risk
J15.73 Pneumonia due to Mycoplasma pneumoniae, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.93 Bacterial pneumonia [bronchopneumonia], high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J16.03 Chlamydial pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.03 Bronchopneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
Page 97 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
J18.13 Lobar pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.23 Hypostatic pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
Community-acquired pneumonia IV
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, high risk in the
Philippine Clinical Practice Guidelines on the Diagnosis,
Empiric Management, and Prevention of Community-
J18.93 acquired Pneumonia in Immunocompetent Adults, 2010 PNEUMONIA HIGH RISK 32,000 9,600 22,400
update)
Adult high risk Community Acquired Pneumonia (CAP),
organism is not specified
Pedia Community Acquired Pneumonia D (PCAP-D) high
risk, organism is not specified
Nosocomial pneumonia
J18.99, Y95 PNEUMONIA HIGH RISK 32,000 9,600 22,400
Health care associated pneumonia
A01.0+ J17.0* Pneumonia in typhoid fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A02.2+ J17.0* Pneumonia in salmonella infection PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A21.2+ J17.0* Pneumonia in tularemia PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A22.1+ J17.0* Pneumonia in anthrax PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Pulmonary mycobacterial infection; Infection due to
A31.0 Mycobacterium avium, Mycobacterium intracellulare PNEUMONIA MODERATE RISK 15,000 4,500 10,500
[Battey bacillus]; Mycobacterium kansasii
A37.0+ J17.0* Pneumonia in whooping cough due to Bordatella pertusis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Pneumonia in whooping cough due to Bordatella

A37.1+ J17.0* PNEUMONIA MODERATE RISK 15,000 4,500 10,500
parapertusis
Pneumonia in whooping cough due to Bordatella species
A37.8+ J17.0* PNEUMONIA MODERATE RISK 15,000 4,500 10,500
other than pertusis or parapertusis
A37.9+ J17.0* Pneumonia in whooping cough PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A42.0+ J17.0* Pneumonia in actinomycoses PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A48.1 Legionnaires' disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A43.0+ J17.0* Pneumonia in nocardiosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A54.8+ J17.0* Pneumonia in gonorrhea PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A69.8+ J17.8* Pneumonia in spirochaetal PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A70+ J17.8* Pneumonia in ornithosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A78+ J17.8* Pneumonia in Q fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B01.2+ J17.1* Pneumonia in varicella PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B05.2+ J17.1* Pneumonia in measles PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B06.8+ J17.1* Pneumonia in rubella PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B25.0+ J17.1* Pneumonia in cytomegalovirus disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B37.1+ J17.2* Pneumonia in candidiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.0+ J17.2* Pneumonia in acute pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.1+ J17.2* Pneumonia in chronic pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.2+ J17.2* Pneumonia in pulmonary coccidioidomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.0+ J17.2* Pneumonia in acute pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.1+ J17.2* Pneumonia in chronic pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.2+ J17.2* Pneumonia in pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.9+ J17.2* Pneumonia in histoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B44.0+ J17.2* Pneumonia in invasive pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B44.1+ J17.2* Pneumonia in other pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B58.3+ J17.3* Pneumonia in taxoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Pneumonia in schistosomiasis due to Schistosoma
B65.0+ J17.3* PNEUMONIA MODERATE RISK 15,000 4,500 10,500
hematobium
B65.1+ J17.3* Pneumonia in schistosomiasis due to Schistosoma mansoni PNEUMONIA MODERATE RISK 15,000 4,500 10,500

japonicum
intercalatum; mattheei; mekongi
B65.9+ J17.3* Pneumonia in schistosomiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B77.8+ J17.3* Pneumonia in ascariasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
I00+ J17.8* Pneumonia in rheumatic fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.02 Adenoviral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.12 Respiratory syncytial virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.22 Parainfluenza virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.32 Human metapneumovirus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.92 Viral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Pneumonia [bronchopneumonia] due to Streptococcus
J13.2 PNEUMONIA MODERATE RISK 15,000 4,500 10,500
pneumoniae, moderate risk
Pneumonia [bronchopneumonia]due to Haemophilus
influenzae, moderate risk
J15.02 Pneumonia due to Klebsiella pneumoniae, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.12 Pneumonia due to Pseudomonas, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.22 Pneumonia due to staphylococcus, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Page 98 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
J15.32 Pneumonia due to streptococcus, group B, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.42 Pneumonia due to other streptococci, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.52 Pneumonia due to Escherichia coli, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Pneumonia due to other aerobic Gram-negative bacteria;

Pneumonia due to Serratia marcescens, moderate risk
Pneumonia due to Mycoplasma pneumoniae, moderate

risk
J15.92 Bacterial pneumonia [bronchopneumonia], moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J16.02 Chlamydial pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.02 Bronchopneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.12 Lobar pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.22 Hypostatic pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Community-acquired pneumonia III
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, moderate risk
in the Philippine Clinical Practice Guidelines on the
Diagnosis, Empiric Management, and Prevention of
J18.92 Community- acquired Pneumonia in Immunocompetent PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Adults, 2010 update)
Adult moderate risk Community Acquired Pneumonia
(CAP), organism is not specified
Pedia Community Acquired Pneumonia C (PCAP-C)
moderate risk, organism is not specified
J93.0 Spontaneous tension pneumothorax PNEUMOTHORAX 15,300 4,590 10,710
Other spontaneous pneumothorax
J93.1 PNEUMOTHORAX 15,300 4,590 10,710
Spontaneous pneumothorax
J93.8 Other pneumothorax PNEUMOTHORAX 15,300 4,590 10,710
J93.9 Pneumothorax, unspecified PNEUMOTHORAX 15,300 4,590 10,710
Poisoning by Otheropioids; Poisoning by Codeine; POISONING CAUSED BY ANESTHETICS AND DRUGS
T40.2 6,700 2,010 4,690
Poisoning by Morphine AFFECTING THE NERVOUS SYSTEM
Poisoning by Other synthetic narcotics; Poisoning by POISONING CAUSED BY ANESTHETICS AND DRUGS
T40.4 6,700 2,010 4,690
Pethidine AFFECTING THE NERVOUS SYSTEM
POISONING CAUSED BY ANESTHETICS AND DRUGS
T40.6 Poisoning by Other and unspecified narcotics 6,700 2,010 4,690
AFFECTING THE NERVOUS SYSTEM
T40.7 Poisoning by Cannabis (derivatives) 6,700 2,010 4,690
Poisoning by Other and unspecified psychodysleptics
T40.9 [hallucinogens]; Poisoning by Mescaline; Poisoning by 6,700 2,010 4,690
Psilocin; Poisoning by Psilocybine
T41.0 Poisoning by Inhaled anaesthetics 6,700 2,010 4,690
T41.1 Poisoning by Intravenous anaesthetics; Thiobarbiturates 6,700 2,010 4,690
T41.3 Poisoning by Local anaesthetics 6,700 2,010 4,690
T41.5 Poisoning by Therapeutic gases; Carbon dioxide; Oxygen 6,700 2,010 4,690
T42.0 Poisoning by Hydantoin derivatives 6,700 2,010 4,690
T42.1 Poisoning by Iminostilbenes; Carbamazepine 6,700 2,010 4,690
T42.2 Poisoning by Succinimides and oxazolidinediones 6,700 2,010 4,690
T42.3 Poisoning by Barbiturates 6,700 2,010 4,690
T42.4 Poisoning by Benzodiazepines 6,700 2,010 4,690
Poisoning by Other antiepileptic and sedative-
T42.6 hypnoticdrugs; Poisoning by Methaqualone;Poisoning by 6,700 2,010 4,690
Valproic acid
Poisoning by Antiepileptic and sedative-hypnotic drugs,

T42.7 unspecified; Poisoning by Draught sleeping NOS; Poisoning 6,700 2,010 4,690
by Sleeping drug NOS;Poisoning by Sleeping tablet NOS
Poisoning by Antiparkinsonism drugs and other central POISONING CAUSED BY ANESTHETICS AND DRUGS
T42.8 6,700 2,010 4,690
muscle-tone depressants; Poisoning by Amantadine AFFECTING THE NERVOUS SYSTEM
T43.2 Poisoning by Other and unspecified antidepressants 6,700 2,010 4,690
T43.3 Poisoning by Phenothiazine antipsychotics and neuroleptics 6,700 2,010 4,690
Poisoning by Butyrophenone and thioxanthene POISONING CAUSED BY ANESTHETICS AND DRUGS
T43.4 6,700 2,010 4,690
neuroleptics AFFECTING THE NERVOUS SYSTEM
Poisoning by Other and unspecified antipsychotics and POISONING CAUSED BY ANESTHETICS AND DRUGS
T43.5 6,700 2,010 4,690
neuroleptics AFFECTING THE NERVOUS SYSTEM
Page 99 of 127
FIRST CASE RATE

Case Rate
Fee Institution Fee
T43.6 Poisoning by Psychostimulants with abuse potential 6,700 2,010 4,690
T43.9 Poisoning by Psychotropic drug, unspecified 6,700 2,010 4,690
T44.1 Poisoning by Other parasympathomimetics [cholinergics] 6,700 2,010 4,690
Poisoning by Ganglionic blocking drugs, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS
T44.2 6,700 2,010 4,690
classified AFFECTING THE NERVOUS SYSTEM
Poisoning by Other parasympatholytics [anticholinergics

T44.3 and antimuscarinics] and spasmolytics, not elsewhere 6,700 2,010 4,690
classified; Poisoning byPapaverine
Poisoning by Predominantly α-adrenoreceptor agonists, not POISONING CAUSED BY ANESTHETICS AND DRUGS
T44.4 6,700 2,010 4,690
elsewhere classified; Poisoning by Metaraminol AFFECTING THE NERVOUS SYSTEM
Poisoning by Predominantly ß-adrenoreceptor agonists, not POISONING CAUSED BY ANESTHETICS AND DRUGS
T44.5 6,700 2,010 4,690
elsewhere classified AFFECTING THE NERVOUS SYSTEM
Poisoning by α-Adrenoreceptor antagonists, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS
T44.6 6,700 2,010 4,690
Poisoning by ß-Adrenoreceptor antagonists, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS
T44.7 6,700 2,010 4,690
Poisoning by Other and unspecified drugs primarily
T44.9 affecting the autonomic nervous system; Drug stimulating 6,700 2,010 4,690
both α-and ß-adrenoreceptors
T45.0 Poisoning by Antiallergic and antiemetic drugs 6,700 2,010 4,690
Poisoning by Antineoplastic and immunosuppressive drugs;
T45.1 Poisoning by Antineoplastic antibiotics; Poisoning by 6,700 2,010 4,690
Cytarabine
T45.2 Poisoning by Vitamins, not elsewhere classified 6,700 2,010 4,690
T45.3 Poisoning by Enzymes, not elsewhere classified 6,700 2,010 4,690
T50.7 Poisoning by Analeptics and opioid receptor antagonists 6,700 2,010 4,690
Drugs, medicaments and biological substances causing
Y46.2 adverse effects in therapeutic 6,700 2,010 4,690
use: Hydantoin derivatives
use: Other and unspecified antiepileptics
use: Barbiturates, not elsewhere classified
use: Benzodiazepines
adverse effects in therapeutic
Y47.9 use: Sedative, hypnotic and antianxiety drug, 6,700 2,010 4,690
unspecified;sleeping draught NOS;sleeping drug
NOS;sleeping tablet NOS
use: Other antipsychotics and neuroleptics
use: Psychodysleptics [hallucinogens]
Y51.3 use: Other parasympatholytics [anticholinergics and 6,700 2,010 4,690
antimuscarinics] and spasmolytics, not elsewhere
classified;papaverine
adverse effects in therapeutic POISONING CAUSED BY ANESTHETICS AND DRUGS
Y51.7 6,700 2,010 4,690
use: Beta-adrenoreceptor antagonists, not elsewhere AFFECTING THE NERVOUS SYSTEM
classified
T36.0 Poisoning by Penicillins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.1 Poisoning by Cefalosporins and other ß-lactam antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.2 Poisoning by Chloramphenicol group POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.3 Poisoning by Macrolides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.4 Poisoning by Tetracyclines POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.5 Poisoning by Aminoglycosides; Streptomycin POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.6 Poisoning by Rifamycins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.8 Poisoning by Other systemic antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.9 Poisoning by Systemic antibiotic, unspecified POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Page 100 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
T37.0 Poisoning by Sulfonamides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.1 Poisoning by Antimycobacterial drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Poisoning by Antimalarials and drugs acting on other blood
T37.2 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
protozoa
T37.4 Poisoning by Anthelminthics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.5 Poisoning by Antiviral drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Poisoning by Other specified systemic anti-infectives and

antiparasitics; Poisoning by Hydroxyquinoline derivatives
Poisoning by Systemic anti-infective and antiparasitic,

unspecified
Y40.0 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
use: Systemic antibiotics: Penicillins
Y40.1 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
use: Systemic antibiotics: Cefalosporins and other beta-
lactam antibiotics
use: Systemic antibiotics: Chloramphenicol group
use: Systemic antibiotics: Tetracyclines
use: Systemic antibiotics: Rifamycins
use: Systemic antibiotics: Other systemic antibiotics

use: Systemic antibiotics: Systemic antibiotic, unspecified

Y41.0 adverse effects in therapeutic use: Other systemic anti- POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
infectives and antiparasitics; Sulfonamides
infectives and antiparasitics; Antimycobacterial drugs
infectives and antiparasitics; Antiviral drugs
adverse effects in therapeutic use: Other specified
systemic anti-infectives and antiparasitics;
hydroxyquinoline derivatives
Y41.9 adverse effects in therapeutic use: Systemic anti-infective POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
and antiparasitic, unspecified
adverse effects in therapeutic use: Topical agents primarily
affecting skin and mucous membrane and
ophthalmological, otorhinolaryngological and dental drugs:
Local antifungal, anti-infective and anti-inflammatory drugs,
not elsewhere classified
POISONING CAUSED BY ANTI-INFLAMMATORY
T39.0 Poisoning by Salicylates 7,400 2,220 5,180
AGENTS
T39.1 Poisoning by 4-Aminophenol derivatives 7,400 2,220 5,180
AGENTS
Poisoning by Other nonsteroidal anti-inflammatory drugs POISONING CAUSED BY ANTI-INFLAMMATORY
T39.3 7,400 2,220 5,180
[NSAID] AGENTS
Poisoning by Other nonopioid analgesics and antipyretics, POISONING CAUSED BY ANTI-INFLAMMATORY
T39.8 7,400 2,220 5,180
not elsewhere classified AGENTS
Poisoning by Nonopioid analgesic, antipyretic and POISONING CAUSED BY ANTI-INFLAMMATORY
T39.9 7,400 2,220 5,180
antirheumatic, unspecified AGENTS
Y45.8 Other analgesics and antipyretics 7,400 2,220 5,180
AGENTS
adverse effects in therapeutic POISONING CAUSED BY ANTI-INFLAMMATORY
Y45.9 7,400 2,220 5,180
use: Analgesic, antipyretic and anti-inflammatory drug, AGENTS
unspecified
Poisoning by Cardiac-stimulant glycosides and drugs of
T46.0 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
similar action
T46.1 Poisoning by Calcium-channel blockers POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
Page 101 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Poisoning by Other antidysrhythmic drugs, not elsewhere
classified
Poisoning by Coronary vasodilators, not elsewhere
classified; Poisoning by Dipyridamole
Poisoning by Other antihypertensive drugs, not elsewhere
T46.5 classified; Poisoning by Clonidine;Poisoning by POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
Guanethidine; Poisoning by Rauwolfia
Poisoning by Antihyperlipidaemic and antiarteriosclerotic
drugs
Poisoning by Peripheral vasodilators;Poisoning by Nicotimic
acid (derivatives)
Poisoning by Other and unspecified agents primarily
affecting the cardiovascular system
Y52.0 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
use: Cardiac-stimulant glycosides and drugs of similar
action

Y52.2 adverse effects in therapeutic POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
use: Other antidysrhythmic drugs, not elsewhere classified
POISONING CAUSED BY DRUGS AFFECTING THE

T48.3 Poisoning by Antitussives 6,200 1,860 4,340
PULMONARY SYSTEM
T48.4 Poisoning by Expectorants 6,200 1,860 4,340
PULMONARY SYSTEM
T48.5 Poisoning by Anti-common-cold drugs 6,200 1,860 4,340
PULMONARY SYSTEM
Poisoning by Antiasthmatics, not elsewhere classified; β-
T48.6 adrenoreceptor agonists used in asthma theraphy; 6,200 1,860 4,340
PULMONARY SYSTEM
Poisoning by Salbutamol
PULMONARY SYSTEM
use: Antitussives
PULMONARY SYSTEM
use: Expectorants
adverse effects in therapeutic POISONING CAUSED BY DRUGS AFFECTING THE
Y55.6 6,200 1,860 4,340
use: Antiasthmatics, not elsewhere classified: PULMONARY SYSTEM
aminophylline, salbutamol, theobromine;theophylline
T50.0 Poisoning by Mineralocorticoids and their antagonists 6,300 1,890 4,410
RENAL SYSTEM
T50.1 Poisoning by Loop [high-ceiling] diuretics 6,300 1,890 4,410
RENAL SYSTEM
Poisoning by Carbonic-anhydrase inhibitors,
T50.2 benzothiadiazides and other diuretics;Poisoning by 6,300 1,890 4,410
RENAL SYSTEM
Acetazolamide
T50.4 Poisoning by Drugs affecting uric acid metabolism 6,300 1,890 4,410
RENAL SYSTEM
Poisoning by Other and unspecified drugs, medicaments
and biological substances; Poisoning by Acidifying agents;
Poisoning by Alkalizing agents; Poisoning by POISONING CAUSED BY DRUGS AFFECTING THE
T50.9 6,300 1,890 4,410
Immunoglobulin; Poisoning by Immunologicals; Poisoning RENAL SYSTEM
by Lipotropic drugs; Poisoning by Parathyroid hormones
and derivatives
POISONING CAUSED BY GASTROINTESTINAL
T47.0 Poisoning by HistamineH2-receptor antagonists 8,300 2,490 5,810
DRUGS
Poisoning by Other antacids and anti-gastric-secretion POISONING CAUSED BY GASTROINTESTINAL
T47.1 8,300 2,490 5,810
drugs DRUGS
T47.2 Poisoning by Stimulant laxatives 8,300 2,490 5,810
DRUGS
T47.3 Poisoning by Saline and osmotic laxatives 8,300 2,490 5,810
DRUGS
Poisoning by Other laxatives; Poisoning by Intestinal atonia POISONING CAUSED BY GASTROINTESTINAL
T47.4 8,300 2,490 5,810
drugs DRUGS
T47.5 Poisoning by Digestants 8,300 2,490 5,810
DRUGS
T47.6 Poisoning by Antidiarrhoeal drugs 8,300 2,490 5,810
DRUGS
Poisoning by Other agents primarily affecting the POISONING CAUSED BY GASTROINTESTINAL
T47.8 8,300 2,490 5,810
gastrointestinal system DRUGS
Poisoning by Agent primarily affecting the gastrointestinal POISONING CAUSED BY GASTROINTESTINAL
T47.9 8,300 2,490 5,810
system, unspecified DRUGS
Poisoning by Skeletal muscle relaxants [neuromuscular POISONING CAUSED BY GASTROINTESTINAL
T48.1 8,300 2,490 5,810
blocking agents] DRUGS
Page 102 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
adverse effects in therapeutic POISONING CAUSED BY GASTROINTESTINAL
Y53.8 8,300 2,490 5,810
use: Other agents primarily affecting the gastrointestinal DRUGS
system
T45.4 Poisoning by Iron and its compounds POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.5 Poisoning by Anticoagulants POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.6 Poisoning by Fibrinolysis-affecting drugs POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
Poisoning by Anticoagulant antagonists, vitamin K and

T45.7 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
other coagulants
Poisoning by Other primarily systemic and haematological

agents; Poisoning by Liver preparations and other
T45.8 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
antianaemic agents; Poisoning by Natural blood and blood
products; Poisoning by Plasma substitute
T45.9 Primarily systemic and haematological agent, unspecified POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110

Y44.2 adverse effects in therapeutic POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
use: Anticoagulants
Y44.3 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
use: Anticoagulant antagonists, vitamin K and other
coagulants
T38.0 Poisoning by Glucocorticoids and synthetic analogues POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.1 Poisoning by Thyroid hormones and substitutes POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.2 Poisoning by Antithyroid drugs POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Poisoning by Insulin and oral hypoglycaemic [antidiabetic]
T38.3 POISONING CAUSED BY HORMONES 8,500 2,550 5,950
drugs
Poisoning by Oral contraceptives; Poisoning by Multiple-
and-single-ingredient preparations
Poisoning by Other estrogens and progestogens; Mixtures
and substitutes
Poisoning by Antigonadotrophins, antiestrogens,
T38.6 antiandrogens, not elsewhere classified; Poisoning by POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Tamoxifen
T38.7 Poisoning by Androgens and anabolic congeners POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.0 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950
use: Glucocorticoids and synthetic analogues
use: Antithyroid drugs

use: Insulin and oral hypoglycaemic [antidiabetic] drugs

Y42.4 POISONING CAUSED BY HORMONES 8,500 2,550 5,950
use: Oral contraceptives;multiple-and single-ingredient
preparations
Y42.5 POISONING CAUSED BY HORMONES 8,500 2,550 5,950
use: Other estrogens and progestogens;mixtures and
substitutes
use: Salicylates

use: Propionic acid derivatives;propanoic acid derivatives

use: Other nonsteroidal anti-inflammatory drugs [NSAID]

use: 4-Aminophenol derivatives
POISONING CAUSED BY ORGANIC SUBSTANCES
T51.0 Toxic effect of Ethanol;Toxic effect of Ethyl alcohol 6,400 1,920 4,480
AND HEAVY METALS
Toxic effect of 2-Propanol; Toxic effect of Isoprophyl POISONING CAUSED BY ORGANIC SUBSTANCES
T51.2 6,400 1,920 4,480
aclohol AND HEAVY METALS
Page 103 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Toxic effect of Fusel oil; Toxic effect of Amyl alcohol; Toxic
T51.3 effect of Butyl alcohol [1-butanol]; Toxic effect of Propyl 6,400 1,920 4,480
AND HEAVY METALS
alcohol [1-proponol]
T51.8 Toxic effect of Other alcohols 6,400 1,920 4,480
AND HEAVY METALS
T51.9 Toxic effect of Alcohol, unspecified 6,400 1,920 4,480
AND HEAVY METALS
Toxic effect of Petroleum products; Toxic effect of
Gasoline [petrol]; Toxic effect of Kerosine [paraffin oil];
T52.0 Toxic effect of Paraffin wax; Toxic effect of Petroleum 6,400 1,920 4,480
AND HEAVY METALS
ether; Toxic effect of Petroleum naphtha; Toxic effect of
Petroleum spirits
Toxic effect of Homologues of benzene; Toxic effect of
T52.2 Toluene [methylbenzene]; Toxic effect of Xylene 6,400 1,920 4,480
AND HEAVY METALS
[dimethylbenzene]
T52.4 Toxic effect of Ketones 6,400 1,920 4,480
AND HEAVY METALS
T52.8 Toxic effect of Other organic solvents 6,400 1,920 4,480
AND HEAVY METALS
T52.9 Toxic effect of Organic solvent, unspecified 6,400 1,920 4,480
AND HEAVY METALS
Toxic effect of Carbon tetrachloride;Toxic effect of POISONING CAUSED BY ORGANIC SUBSTANCES
T53.0 6,400 1,920 4,480
Tetrachloromethane AND HEAVY METALS
Toxic effect of Chloroform; Toxic effect of POISONING CAUSED BY ORGANIC SUBSTANCES
T53.1 6,400 1,920 4,480
Trichloromethane AND HEAVY METALS
Toxic effect of Dichloromethane;Toxic effect of Methylene POISONING CAUSED BY ORGANIC SUBSTANCES
T53.4 6,400 1,920 4,480
chloride AND HEAVY METALS
Toxic effect of Other halogen derivatives of aliphatic POISONING CAUSED BY ORGANIC SUBSTANCES
T53.6 6,400 1,920 4,480
hydrocarbons AND HEAVY METALS
Toxic effect of Halogen derivative of aliphatic and aromatic POISONING CAUSED BY ORGANIC SUBSTANCES
T53.9 6,400 1,920 4,480
hydrocarbons, unspecified AND HEAVY METALS
T54.1 Toxic effect of Other corrosive organic compounds 6,400 1,920 4,480
AND HEAVY METALS
Toxic effect of Corrosive acids and acid-like substances;
T54.2 Toxic effect of Acid hydrochlorie;Toxic effect of Acid 6,400 1,920 4,480
AND HEAVY METALS
sulfurie
Toxic effect of Corrosive alkalis and alkali-like substances;
T54.3 Toxic effect of Potassium hydroxide;Toxic effect of Sodium 6,400 1,920 4,480
AND HEAVY METALS
hydroxide
T54.9 Toxic effect of Corrosive substance, unspecified 6,400 1,920 4,480
AND HEAVY METALS
T55 Toxic effect of soaps and detergents 6,400 1,920 4,480
AND HEAVY METALS
T56.0 Toxic effect of Lead and its compounds 6,400 1,920 4,480
AND HEAVY METALS
T56.1 Toxic effect of Mercury and its compounds 6,400 1,920 4,480
AND HEAVY METALS
T56.5 Toxic effect of Zinc and its compounds 6,400 1,920 4,480
AND HEAVY METALS
T56.8 Toxic effect of Other metals 6,400 1,920 4,480
AND HEAVY METALS
T57.0 Toxic effect of Arsenic and its compounds 6,400 1,920 4,480
AND HEAVY METALS
T57.1 Toxic effect of Phosphorus and its compounds 6,400 1,920 4,480
AND HEAVY METALS
T57.3 Toxic effect of Hydrogen cyanide 6,400 1,920 4,480
AND HEAVY METALS
T57.8 Toxic effect of Other specified in organic substances 6,400 1,920 4,480
AND HEAVY METALS
T57.9 Toxic effect of Inorganic substance, unspecified 6,400 1,920 4,480
AND HEAVY METALS
T58 Toxic effect of carbon monoxide from all sources 6,400 1,920 4,480
AND HEAVY METALS
T59.0 Toxic effect of Nitrogen oxides 6,400 1,920 4,480
AND HEAVY METALS
T59.2 Toxic effect of Formal dehyde 6,400 1,920 4,480
AND HEAVY METALS
T59.3 Toxic effect of Lacrimogenic gas; Toxic effect of Tear gas 6,400 1,920 4,480
AND HEAVY METALS
T59.4 Toxic effect of Chlorine gas 6,400 1,920 4,480
AND HEAVY METALS
T59.7 Toxic effect of Carbon dioxide 6,400 1,920 4,480
AND HEAVY METALS
T59.8 Toxic effect of Other specified gases, fumes and vapours 6,400 1,920 4,480
AND HEAVY METALS
T59.9 Toxic effect of Gases, fumes and vapours, unspecified 6,400 1,920 4,480
AND HEAVY METALS
Page 104 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Toxic effect of Organophosphate and carbamate POISONING CAUSED BY ORGANIC SUBSTANCES
T60.0 6,400 1,920 4,480
insecticides AND HEAVY METALS
T60.1 Toxic effect of Halogenated insecticides 6,400 1,920 4,480
AND HEAVY METALS
T60.2 Other and unspecified insecticides 6,400 1,920 4,480
AND HEAVY METALS
T60.3 Toxic effect of Herbicides and fungicides 6,400 1,920 4,480
AND HEAVY METALS
T60.4 Toxic effect of Rodenticides; Toxic effect of Thallium 6,400 1,920 4,480
AND HEAVY METALS
T60.8 Toxic effect of Other pesticides 6,400 1,920 4,480
AND HEAVY METALS
T60.9 Toxic effect of Pesticide, unspecified 6,400 1,920 4,480
AND HEAVY METALS
T65.0 Toxic effect of Cyanides 6,400 1,920 4,480
AND HEAVY METALS
Toxic effect of Nitro derivatives and aminoderivatives of
benzene and its homologues; Toxic effect of Aniline POISONING CAUSED BY ORGANIC SUBSTANCES
T65.3 6,400 1,920 4,480
[benzenamine]; Toxic effect of Nitrobenzene; Toxic effect AND HEAVY METALS
of Trinitrotoluene
T65.4 Toxic effect of Carbondisulfide 6,400 1,920 4,480
AND HEAVY METALS
T65.6 Toxic effect of Paints and dyes, not elsewhere classified 6,400 1,920 4,480
AND HEAVY METALS
T65.8 Toxic effect of other specified substances 6,400 1,920 4,480
AND HEAVY METALS
T49.2 Poisoning by Local astringents and local detergents POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.3 Poisoning by Emollients, demulcents and protectants POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
Poisoning by Keratolytics, keratoplastics and other hair
T49.4 POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
treatment drugs and preparations
Poisoning by Ophthalmological drugs and preparations;

T49.5 POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
Poisoning by Eye, nose and throat anti-infectives
T49.7 Poisoning by Dental drugs, topically applied POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.8 Othertopical agents; Spermicides POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.9 Poisoning by Topical agent, unspecified POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
Y56.2 adverse effects in therapeutic POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
use: Local astringents and local detergents
Y56.3 adverse effects in therapeutic POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
use: Emollients, demulcents and protectants
T61.0 Toxic effect of Ciguatera fish poisoning POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of Scombroid fish poisoning;Toxic effect of
T61.1 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Histamine-like syndrome
Toxic effect of Other fish and shellfish poisoning
Fish poisoning
T61.8 Toxic effect of other seafoods POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of unspecified seafood
Seafood poisoning
T62.0 Toxic effect of Ingested mushrooms POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.1 Toxic effect of Ingested berries POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.2 Toxic effect of Other ingested (parts of) plant(s) POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of Other specified noxious substances eaten as
food
Toxic effect of Noxious substance eaten as food,
T62.9 unspecified POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Food poisoning
Toxic effect of Snake venom;Toxic effect of Sea-snake
venom
Toxic effect of Venom of other reptiles; Toxic effect of
Lizard venom
T63.2 Toxic effect of Venom of scorpion POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.3 Toxic effect of Venom of spider POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of Venom of other arthropods;Toxic effect of
Insect bite or sting, venomous
T63.5 Toxic effect of contact with fish POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of contact with other marine animals; Jellyfish;
Sea anemone; Shellfish; Starfish
Toxic effect of contact with other venomous animals;
Venom of amphibian
T63.9 Toxic effect of contact with unspecified venomous animal POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Toxic effect of aflation and other mycotoxin food

T64 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
contaminants
T65.2 Toxic effect of Tobacco and nicotine POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Page 105 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Y43.0 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810
use: Antiallergic and antiemetic drugs
use: Benzothiadiazine derivatives
use: Agents affecting uric acid metabolism
use: Oxytocic drugs;ergot alkaloids
use: Otorhinolaryngological drugs and preparations
use: BCG vaccine
use: Tetanus vaccine
use: Vaccine or biological substance, unspecified
Hereditary motor and sensory neuropathy; Disease Charcot-
Marie-Tooth; Disease Déjerine-Sottas; Hereditary motor
and sensory neuropathy, types I-IV; Hypertrophic
G60.0 POLYNEUROPATHIES 10,600 3,180 7,420
neuropathy of infancy; Peroneal muscular atrophy axonal
type; Peroneal muscular atrophy hypertrophic type; Roussy-
Levy syndrome
G60.1 Refsum's disease POLYNEUROPATHIES 10,600 3,180 7,420
G60.2 Neuropathy in association with hereditary ataxia POLYNEUROPATHIES 10,600 3,180 7,420
G60.3 Idiopathic progressive neuropathy POLYNEUROPATHIES 10,600 3,180 7,420
Other hereditary and idiopathic neuropathies; Morvan's
disease; Nelaton's syndrome; Sensory neuropathy
dominantly inherited; Sensory neuropathy recessively
inherited
G60.9 Hereditary and idiopathic neuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420
Guillain-Barré syndrome; Acute post- infective polyneuritis;
Acute infective polyneuritis
G61.8 Other inflammatory polyneuropathies POLYNEUROPATHIES 10,600 3,180 7,420
G61.9 Inflammatory polyneuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420
G62.0 Drug-induced polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420
G62.1 Alcoholic polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420
G62.2 Polyneuropathy due to other toxic agents POLYNEUROPATHIES 10,600 3,180 7,420
Other specified polyneuropathies; Radiation-induced
polyneuropathy
Polyneuropathy, unspecified; Neuropathy NOS
Peripheral neuropathy
Polyneuropathy in other diseases classified elsewhere;
G63.8* POLYNEUROPATHIES 10,600 3,180 7,420
Uraemic neuropathy
Other disorders of peripheral nervous system; Disorder of
G64 POLYNEUROPATHIES 10,600 3,180 7,420
peripheral nervous system NOS
Polyp of corpus uteri; Polyp of endometrium; Polyp of
N84.0 POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
uterus NOS
N84.1 Polyp of cervix uteri; Mucous polyp of cervix POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.2 Polyp of vagina POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.3 Polyp of vulva; Polyp of labia POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.8 Polyp of other parts of female genital tract POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.9 Polyp of female genital tract, unspecified POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
Embolism following abortion and ectopic and molar
pregnancy; Embolism NOS; Air embolism; Amniotic fluid
O08.2 embolism; Blood-clot embolism; Pulmonary embolism; POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Pyaemic embolism; Septic or septicopyaemic embolism;
Soap embolism
Metabolic disorders following abortion and ectopic and
O08.5 POST PARTUM COMPLICATIONS 9,300 2,790 6,510
molar pregnancy
Complication following abortion and ectopic and molar
pregnancy, unspecified
Other intrapartum haemorrhage; Excessive intrapartum
haemorrhage
O71.0 Rupture of uterus before on set of labour POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Rupture of uterus during labour; Rupture of uterus not
stated as occuring before onset of labour
O71.2 Post partum inversion of uterus POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.3 Obstetric laceration of cervix; Annular detachment of cervix POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Page 106 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Other obstetric injury to pelvic organs; Obstetric injury to
bladder; Obstetric injury to urethra
Obstetric haematoma of pelvis; Obstetric haematoma of
O71.7 perineum; Obstetric haematoma of vagina; Obstetric POST PARTUM COMPLICATIONS 9,300 2,790 6,510
haematoma of vulva
O71.8 Other specified obstetric trauma POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.9 Obstetric trauma, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Aspiration pneumonitis due to anaesthesia during labour
and delivery; Inhalation of stomach contents or secretions
O74.0 NOS due to anaesthesia during labour and delivery; POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Mendelson's syndrome due to anaesthesia during labour
and delivery
Cardiac complications of anaesthesia during labour and
delivery; Cardiac arrest due to anaesthesia during labour
and delivery; Cardiac failure due to anaesthesia during
labour and delivery
Other complications of anaesthesia during labour and
delivery
Shock during or following labour and delivery; Obstetic
shock
O75.8 Other specified complications of labour and delivery POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O75.9 Complication of labour and delivery, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Venous complication in the puerperium, unspecified;
O87.9 Puerperal phlebitis NOS; Puerperal phlebopathy NOS; POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Puerperal thrombosis NOS
Care and examination immediately after delivery; Care and
Z39.0 POSTPARTUM CARE FOR DELIVERIES IN TRANSIT 2,000 600 1,400
observation in uncomplicated cases
Postprocedural hypothyroidism; Postirradiation
E89.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
hypothyroidism; Postsurgical hypothyroidism
E89.2 Postprocedural hypoparathyroidism; Parathyroprival tetany POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Postprocedural hypopituitarism; Postirradiation

hypopituitarism
E89.4 Postprocedural ovarian failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.5 Postprocedural testicular hypofunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Postprocedural adrenocortical hypofunction;
Postprocedural adreno-medullary hypofunction
E89.8 Other postprocedural endocrine and metabolic disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
G97.1 Other reaction to spinal and lumbar puncture POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
G97.8 Other postprocedural disorders of nervous system POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Vitreous syndrome following cataract surgery

H59.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Keratopathy (bullous aphakic) following cataract surgery
Other postprocedural disorders of eye and adnexa;

H59.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Chorioretinal scars after surgery for detachment
H59.9 Postprocedural disorder of eye and adnexa, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
H95.8 Other postprocedural disorders of ear and mastoid process POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
I97.0 Postcardiotomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Postmastectomy lymphoedema syndrome; Elephantiasis
I97.2 due to mastectomy; Obliteration of lymphatic vessels due POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
to mastectomy
Tracheostomy malfunction; Haemorrhage from
tracheostomy stoma; Obstruction of tracheostomy airway;
J95.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Sepsis of tracheostomy stoma; Tracheo-oesophageal fistula
following tracheostomy
J95.1 Acute pulmonary insufficiency following thoracic surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Acute pulmonary insufficiency following nonthoracic

surgery
Mendelson syndrome; Chemical pneumonitis due to
aspiration during anaesthesia
J95.5 Postprocedural subglottic stenosis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.8 Other postprocedural respiratory disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.9 Postprocedural respiratory disorder, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.0 Vomiting following gastrointestinal surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Postgastric surgery syndromes; Dumping syndrome;
K91.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Postgastrectomy syndrome; Postvagotomy syndrome
Postsurgical malabsorption, not elsewhere classified;
Postsurgical blind loop syndrome
K91.3 Postoperative intestinal obstruction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.4 Colostomy and enterostomy malfunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.5 Postcholecystectomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Other postprocedural disorders of digestive system, not
elsewhere classified
Page 107 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
K91.9 Postprocedural disorder of digestive system, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.0 Postprocedural renal failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Postprocedural urethral stricture; Postcatheterization
N99.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
urethral stricture
N99.4 Postprocedural pelvic peritoneal adhesions POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Other postprocedural disorders of genitourinary system;
Residual ovary syndrome
Postprocedural disorder of genitourinary system,
unspecified
Haemorrhage and haematoma complicating a procedure,
T81.0 not elsewhere classified; Haemorrhage at any site resulting POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
from a procedure
Shock during or resulting from a procedure not elsewhere

classified; Collapse NOS during or following a procedure;
T81.1 Endotoxic shock during or following a procedure; POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Hypovolaemic during or following a procedure; Septic
shock during or following a procedure;
Accidental puncture and laceration during a procedure not

elsewhere classified; Accidental perforation of blood vessel
T81.2 by catheter, endoscope, instrument, probe during a POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
procedure; Accidental perforation of nerve by catheter,
endoscope, instrument, probe
Disruption of operation wound, not elsewhere classified;
T81.3 Dehiscene of operation wound; Rupture of operation POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
wound
Infection following a procedure, not elsewhere classified;

Intra-abdominal abscess postprocedural abcess; Intra-
T81.4 abdominal stitch postprocedural abscess; Intra-abdominal POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
subphrenic postprocedural abcess; Intra-abdominal wound
postprocedural abcess; Septicemia
Other complications of procedures, not elsewhere

classified; Complication of inhalation therapy; Emphysema
T81.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
(subcutaneous) resulting from a procedure; Persistent
postoperative fistula
Mechanical complication of heart valve prosthesis;
Mechanical breakdown due to heart valve prosthesis;
Displacement due to heart valve prosthesis; Failure due to
heart valve prosthesis; Leakage due to heart valve
prosthesis; Malposition due to heart valve prosthesis;
Mechanical obstruction due to heart valve prosthesis;
Perforation due to heart valve prosthesis; Protrusion due to
heart valve prosthesis;
Mechanical complication of cardiac electronic device;

T82.1 Conditions listed in T82.0 due to electrodes; Conditions POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
listed in T82.0 due to pulse generator (battery)
Mechanical complication of coronary artery bypass and

valve grafts
Mechanical complication of other vascular grafts; Condition
listed in T82.0 due to aortic (bifurcation) graft
(replacement); Condition listed in T82.0 due to arterial
(carotid) (femoral) graft (bypass)
T82.4 Mechanical complication of vascular dialysis catheter POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Mechanical complication of other cardiac and vascular

devices and implants; Conditions listed in T82.0 due to
T82.5 arteriovenous fistula surgically created; arterivenous POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Shunt surgically created; Artificial heart; Balloon
counterpulsation device; Infusion catheter; umbrella device
Infection and inflammatory reaction due to other cardiac

and vascular devices, implants and grafts
Other complications of cardiac and vascular prosthetic

devices, implants and grafts; Complication due to cardiac
and vascular prosthetic devices, implants and grafts;
Embolism due to cardiac and vascular prosthetic devices,
implants and grafts; Fibrosis due to cardiac and vascular
prosthetic devices, implants and grafts; Haemorrhage due
to cardiac and vascular prosthetic devices, implants and
grafts; Pain due to cardiac and vascular prosthetic devices,
implants and grafts; Stenosis due to cardiac and vascular
prosthetic devices, implants and grafts; Thrombosis due to
cardiac and vascular prosthetic devices, implants and
grafts;
Page 108 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Mechanical complication of other urinary devices and
implants; Concditions listed in T82.0 due to Urinary
electronic stimultor device; Urinary sphincter implant;
Urinary stent
T83.2 Mechanical complication of graft of urinary organ POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Mechanical complication of intrauterine contraceptive
device
Infection and inflammatory reaction due to prosthetic
device, implant and graft in urinary system
Other complications of genitourinary prosthetic devices,
implants and grafts
Unspecified complication of genitourinary prosthetic
device, implants and grafts
T84.0 Mechanical complication of internal joint prosthesis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Mechanical complication of internal fixation device of
bones of limb
Mechanical complication of internal fixation device of other
bones
Mechanical complication of other internal orthopaedic
devices, implants and grafts
Infection and inflammatory reaction due to internal joint
prosthesis
Infection and inflammatory reaction due to internal fixation
device [any site]
Infection and inflammatory reaction due to other internal

orthopaedic prosthetic devices, implants and grafts
Other complications of internal orthopaedic prosthetic

devices, implants and grafts
Unspecified complication of internal orthopaedic prosthetic
device, implant and graft
Mechanical complication of ventricular intracranial
(communicating) shunt
Mechanical complication of other ocular prosthetic devices,
implants and grafts Conditions listed in T82.0 due to
corneal graft; Conditions listed in T82.0 due to prosthetic
orbit of eye
Mechanical complication of gastrointestinal prosthetic
devices implants and grafts; Conditions listed in T82.0 due
to Bile-duct prosthesis; Conditions listed in T82.0
oesophageal anti-reflux device
Mechanical complication of other specified internal
prosthetic devices, Implants and grafts; Conditions listed in
T85.6 T82.0 due to epidural and subdural infusion catheter; POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Conditions listed in T82.0 due to intraperitonael dialysis
catheter; Conditions listed
Infection and inflammatory reaction due to other internal
prosthetic devices, implants and grafts
Other complications of internal prosthetic devices, implants
and grafts, not elsewhere classified
Unspecified complication of internal prosthetic device,
T85.9 implant and graft; Complication of internal prosthetic POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
device, implants and graft NOS
Hyperplasia of prostate; Adenofibromatous hypertrophy of

prostate; Adenoma (benign)of prostate ; Enlargement of
N40 prostate (benign); Fibroadenoma of prostate; Fibroma of PROSTATE DISORDERS 9,200 2,760 6,440
prostate; Hypertrophy of prostate (benign); Myoma of
prostate; Median bar (prostate); Prostatic obstruction NOS
N41.0 Acute prostatitis PROSTATE DISORDERS 9,200 2,760 6,440

N41.1 Chronic prostatitis PROSTATE DISORDERS 9,200 2,760 6,440
N41.2 Abscess of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N41.3 Prostatocystitis PROSTATE DISORDERS 9,200 2,760 6,440
N41.8 Other inflammatory diseases of prostate PROSTATE DISORDERS 9,200 2,760 6,440
Inflammatory disease of prostate, unspecified; Prostatitis
N41.9 PROSTATE DISORDERS 9,200 2,760 6,440
NOS
N42.0 Calculus of prostate; Prostatic stone PROSTATE DISORDERS 9,200 2,760 6,440
N42.1 Congestion and haemorrhage of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.2 Atrophy of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.8 Other specified disorders of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.9 Disorder of prostate, unspecified PROSTATE DISORDERS 9,200 2,760 6,440
O15.2 Eclampsia in the puerperium PUERPERAL COMPLICATIONS 6,800 2,040 4,760
Puerperal sepsis; Puerperal endometritis; Puerperal fever;
O85 Puerperal peritonitis; Puerperal septicaemia; Postpartum PUERPERAL COMPLICATIONS 10,600 3,180 7,420
sepsis
Page 109 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Infection of obstetric surgical wound; Infected caesarean
O86.0 section wound following delivery; Infected perineal repair PUERPERAL COMPLICATIONS 10,600 3,180 7,420
following delivery
Other infection of genital tract following delivery; Cervicitis

O86.1 PUERPERAL COMPLICATIONS 10,600 3,180 7,420
following delivery; Vaginitis following delivery
O86.2 Urinary tract infection following delivery PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Other genitourinary tract infections following delivery;
Puerperal genitourinary tract infection NOS
Pyrexia of unknown origin following delivery; Puerperal
infection NOS; Puerperal pyrexia NOS
O86.8 Other specified puerpera linfections PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O87.0 Superficial thrombophlebitis in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Deep phlebothrombosis in the puerperium; Deep-vein
O87.1 thrombosis, postpartum; Pelvic thrombophlebitis, PUERPERAL COMPLICATIONS 10,600 3,180 7,420
postpartum
O87.2 Haemorrhoids in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Other venous complications in the puerperium; Genital
varices in the puerperium
O88.1 Amniotic fluid embolism PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Obstetric blood-clot embolism; Obstetric pulmonary
embolism NOS; Puerperal pulmonary embolism NOS
Pulmonary complications of anaesthesia during the

puerperium; Aspiration pneumonitis due to anaesthesia
during the puerperium; Chemical pneumonitis due to
aspiration, due to anaesthesia during the puerperium;
Inhalation of stomach contents or secretions NOS due to
anaestheisa during the puerperium; Mendelson syndrome
due to anaesthesia during the puerperium; Pressure
collapse of lung due to anaesthesia during the puerperium
Cardiac complications of anaesthesia during the

puerperium; Cardiac arrest due to anaesthesia during the
puerperium; Cardiac failure due to anaesthesia during the
puerperium
Central nervous system complications of anaesthesia
O89.2 during the puerperium; Cerebral anoxia due to anaesthesia PUERPERAL COMPLICATIONS 10,600 3,180 7,420
during the puerperium
Spinal and epidural anaesthesia-induced headache during
the puerperium
O89.8 Other complications of anaesthesia during the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Complication of anaesthesia during the puerperium,

unspecified
O90.0 Disruption of caesarean section wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Disruption of perineal obstetric wound; Disruption of
O90.1 wound of episiotomy; Disruption of wound of perineal PUERPERAL COMPLICATIONS 10,600 3,180 7,420
laceration; Secondary perineal tear
O90.2 Haematoma of obstetric wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.3 Cardiomyopathy in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Postpartum acute renal failure; Hepatorenal syndrome
following labour and delivery
O90.5 Postpartum thyroiditis PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Other complications of the puerperium, not elsewhere
classified; Placental polyp
O90.9 Complication of the puerperium, unspecified PUERPERAL COMPLICATIONS 10,600 3,180 7,420
P20.0 Intrauterine hypoxia first noted before onset of labour PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P20.1 Intrauterine hypoxia first noted during labour and delivery PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P20.9 Intrauterine hypoxia, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Severe birth asphyxia; Pulse less than 100 per minute at

birth and falling or steady, respiration absent or gasping,
P21.0 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
colour poor, tone absent; Asphyxia with 1-minute apgar
score 0-3; White asphyxia
Mild and moderate birth asphyxia; Normal respiration not

established within one minute, but heart rate 100 or above,
some muscle tone present, some response to stimulation;
Asphyxia with 1-minute Apgar score 4-7; Blue asphyxia
Birth asphyxia, unspecified; Anoxia, NOS; Asphyxia, NOS;

Hypoxia, NOS
Respiratory distress syndrome of newborn; Hyaline
P22.0 membrane disease PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Respiratory distress syndrome, child
Page 110 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
P22.1 Transient tachypnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P22.8 Other respiratory distress of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P22.9 Respiratory distress of newborn, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.0 Neonatal aspiration of meconium PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Neonatal aspiration of amniotic fluid and mucus;Aspiration

of liquor (amnii)
P24.2 Neonatal aspiration of blood PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.3 Neonatal aspiration of milk and regurgitated food PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.8 Other neonatal aspiration syndromes PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Neonatal aspiration syndrome, unspecified; Neonatal

aspiration pneumonia NOS
P25.0 Interstitial emphysema originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Pneumothorax originating in the perinatal period

P25.1 Pneumothorax of fetus PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Pneumothorax of newborn
P25.2 Pneumomediastinum originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Other conditions related to interstitial emphysema

originating in the perinatal period
Tracheobronchial haemorrhage originating in the perinatal
period
Massive pulmonary haemorrhage originating in the
perinatal period
Other pulmonary haemorrhages originating in the perinatal
period
Unspecified pulmonary haemorrhage originating in the
perinatal period
P27.0 Wilson-Mikity syndrome; Pulmonary dysmaturity PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Bronchopulmonary dysplasia originating in the perinatal

period
Other chronic respiratory diseases originating in the
P27.8 perinatal period; Congenital pulmonary fibrosis; Ventilator PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
lung in newborn
Unspecified chronic respiratory disease originating in the
perinatal period
Primary atelectasis of newborn; Primary failure to expand

P28.0 terminal respiratory units; Pulmonary hypoplasia associated PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
with short gestation; Pulmonary immaturity NOS
Other and unspecified atelectasis of newborn; Atelectasis,

P28.1 NOS; Atelectasis, partial; Atelectasis, secondary; Resorption PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
atelectasis without respiratory distress syndrome
P28.2 Cyanotic attacks of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Primary sleep apnoea of newborn; leep apnoea of newborn

NOS
P28.4 Other apnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.5 Respiratory failure of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Other specified respiratory conditions of newborn;

congenital laryngeal stridor NOS; Snuffles in newborn
Persistent fetal circulation; Delayed closure of ductus

arteriosus; Persistent pulmonary hypertension of newborn
Cardiovascular disorder originating in the perinatal period,

unspecified
Pulmonary embolism with mention of acute cor pulmonale;
I26.0 PULMONARY EMBOLISM 24,300 7,290 17,010
Acute cor pulmonale NOS
Pulmonary embolism without mention of acute cor
I26.9 PULMONARY EMBOLISM 24,300 7,290 17,010
pulmonale; Pulmonary embolism NOS
Primary pulmonary hypertension; Primary idiopathic
I27.0 PULMONARY HEART DISEASE 14,100 4,230 9,870
pulmonary artery hypertension
I27.1 Kyphoscoliotic heart disease PULMONARY HEART DISEASE 14,100 4,230 9,870
Other secondary pulmonary hypertension; Pulmonary
artery hypertension
I27.8 Other specified pulmonary heart diseases PULMONARY HEART DISEASE 14,100 4,230 9,870
Page 111 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Pulmonary heart disease, unspecified; Chronic
cardiopulmonary disease; Chronic Cor pulmonale NOS
Nonobstructive reflux-associated chronic pyelonephritis;

N11.0 PYELONEPHRITIS 10,900 3,270 7,630
Chronic Pyelonephritis associated with vesicoureteral reflux
Chronic obstructive pyelonephritis; Chronic pyelonephritis

associated with anomaly of [pelviureteric junction,
pyeloureteric junction, ureter]; Chronic pyelonephritis
N11.1 associated with kinking of [pelviureteric junction, PYELONEPHRITIS 10,900 3,270 7,630
pyeloureteric junction, ureter]; Chronic pyelonephritis
associated with stircture of[pelviureteric junction,
pyeloureteric junction, ureter]
Other chronic tubulo-interstitial nephritis; Nonobstructive

N11.8 PYELONEPHRITIS 10,900 3,270 7,630
chronic pyelonephritis NOS
D60.0 Chronic acquired pure red cell aplasia RED CELL APLASIA 7,300 2,190 5,110
D60.8 Other acquired pure red cell aplasias RED CELL APLASIA 7,300 2,190 5,110
D60.9 Acquired pure red cell aplasia, unspecified RED CELL APLASIA 7,300 2,190 5,110
Ischaemia and infarction of kidney; Embolism of renal
N28.0 artery; Obstruction of renal artery; Occlusion of renal RENAL INFARCT 9,600 2,880 6,720
artery; Thrombosis of renal artery; Renal infarct
N15.1 Renal and perinephric abscess RENAL/BLADDER ABSCESS 13,900 4,170 9,730
N30.8 Other cystitis; Abscess of bladder RENAL/BLADDER ABSCESS 13,900 4,170 9,730
Urethral abscess; Abscess of Cowper's gland; Abscess of
N34.0 Littré's gland; Periurethral Abscess ; Abscess of urethral RENAL/BLADDER ABSCESS 13,900 4,170 9,730
gland
Coalworker's pneumoconiosis; Anthracosilicosis; RESPIRATORY CONDITIONS DUE TO EXTERNAL
J60 14,700 4,410 10,290
Anthracosis; Coalworker's lung AGENTS
Pneumoconiosis due to asbestos and other mineral fibres; RESPIRATORY CONDITIONS DUE TO EXTERNAL
J61 14,700 4,410 10,290
Asbestosis AGENTS
RESPIRATORY CONDITIONS DUE TO EXTERNAL
J62.0 Pneumoconiosis due to talc dust 14,700 4,410 10,290
AGENTS
Pneumoconiosis due to other dust containing silica; Silicosis RESPIRATORY CONDITIONS DUE TO EXTERNAL
J62.8 14,700 4,410 10,290
NOS AGENTS
J63.0 Aluminosis (of lung) 14,700 4,410 10,290
AGENTS
J63.3 Graphite fibrosis (of lung) 14,700 4,410 10,290
AGENTS
J63.4 Siderosis 14,700 4,410 10,290
AGENTS
J63.8 Pneumoconiosis due to other specified inorganic dusts 14,700 4,410 10,290
AGENTS
J64 Unspecified pneumoconiosis 14,700 4,410 10,290
AGENTS
J65 Pneumoconiosis associated with tuberculosis 14,700 4,410 10,290
AGENTS
J66.2 Cannabinosis 14,700 4,410 10,290
AGENTS
J66.8 Airway disease due to other specific organic dusts 14,700 4,410 10,290
AGENTS
Farmer's lung; Harvester's lung; Haymaker's lung; Mouldy RESPIRATORY CONDITIONS DUE TO EXTERNAL
J67.0 14,700 4,410 10,290
hay disease AGENTS
J67.1 Bagassosis; Bagasse disease; Bagasse pneumonitis 14,700 4,410 10,290
AGENTS
J67.5 Mushroom-worker's lung 14,700 4,410 10,290
AGENTS
Air-conditioner and humidifier lung; Allergic alveolitis due

J67.7 to fungi, thermophilic actinomycetees and other organisms 14,700 4,410 10,290
AGENTS
growing in ventilation (air-conditioning) systems
Hypersensitivity pneumonitis due to other organic dusts;

J67.8 Cheese-washer's lung; Coffee-worker's lung; Fishmeal- 14,700 4,410 10,290
AGENTS
worker's lung; Furrier's lung; Sequoiosis
Hypersensitivity pneumonitis due to unspecified organic
J67.9 dust; Extrinsic allergic alveolitis NOS; Hypersensitivity 14,700 4,410 10,290
AGENTS
pneumonitis NOS
Bronchitis and pneumonitis due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.0 14,700 4,410 10,290
and vapours; Acute chemical bronchitis AGENTS
Acute pulmonary oedema due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.1 14,700 4,410 10,290
and vapours; Acute Chemical pulmonary oedema AGENTS
Upper respiratory inflammation due to chemicals, gases, RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.2 14,700 4,410 10,290
fumes and vapours, not elsewhere classified AGENTS
Other acute and subacute respiratory conditions due to

J68.3 chemicals, gases, fumes and vapours; Reactive airways 14,700 4,410 10,290
AGENTS
dysfunction syndrome; Hyperactive airway disease
Page 112 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Chronic respiratory conditions due to chemicals, gases,
fumes and vapours; Diffuse emphysema due to inhalation
of chemicals, gases, fumes and vapours; Chronic
emphysema due to inhalation of chemicals, gases, fumes
and vapours; Chronic obliterative bronchiolitis due to RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.4 14,700 4,410 10,290
inhalation of chemicals, gases, fumes and vapours; AGENTS
Subacute obliterative bronchiolitis due to inhalation of
chemicals, gases, fumes and vapours; Chronic pulmonary
fibrosis due to inhalation of chemicals, gases, fumes and
vapours
Other respiratory conditions due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.8 14,700 4,410 10,290
and vapours AGENTS
Unspecified respiratory condition due to chemicals, gases, RESPIRATORY CONDITIONS DUE TO EXTERNAL
J68.9 14,700 4,410 10,290
fumes and vapours AGENTS
Pneumonitis due to food and vomit; Aspiration pneumonia
due to NOS; Aspiration pneumonia due to regurgitated
J69.0 food; Aspiration pneumonia due to gastric secretions; 14,700 4,410 10,290
AGENTS
Aspiration pneumonia due to milk; Aspiration pneumonia
due to vomit
J69.1 Pneumonitis due to oils and essences; Lipid pneumonia 14,700 4,410 10,290
AGENTS
Pneumonitis due to other solids and liquids; Pneumonitis RESPIRATORY CONDITIONS DUE TO EXTERNAL
J69.8 14,700 4,410 10,290
due to aspiration of blood AGENTS
Acute pulmonary manifestations due to radiation; RESPIRATORY CONDITIONS DUE TO EXTERNAL
J70.0 14,700 4,410 10,290
Radiation pneumonitis AGENTS
J70.2 Acute drug-induced interstitial lung disorders 14,700 4,410 10,290
AGENTS
J70.4 Drug-induced interstitial lung disorders, unspecified 14,700 4,410 10,290
AGENTS
Respiratory conditions due to other specified external RESPIRATORY CONDITIONS DUE TO EXTERNAL
J70.8 14,700 4,410 10,290
agents AGENTS
J70.9 Respiratory conditions due to unspecified external agent 14,700 4,410 10,290
AGENTS
J96.0 Acute respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400
J96.1 Chronic respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400
J96.9 Respiratory failure, unspecified RESPIRATORY FAILURE 32,000 9,600 22,400
H34.1 Central retinal artery occlusion RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
Other retinal artery occlusions; Hollenhorst's plaque;

H34.2 Retinal artery occlusion; Retinal artery branch occlusion ; RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
Retinal artery partial occlusion; Retinal microembolism
Other retinal vascular occlusions; Retinal central vein

H34.8 occlusion ; Retinal vein occlusion incipient; Retinal vein RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
occlusion partial; Retinal vein occlusion tributary
H34.9 Retinal vascular occlusion, unspecified RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
Rheumatic fever without mention of heart involvement;

I00 RHEUMATIC FEVER 10,100 3,030 7,070
Arthritis, rheumatic, acute or subacute involvement
I01.0 Acute rheumatic pericarditis; Acute rheumatic pericarditis RHEUMATIC FEVER 10,100 3,030 7,070
I01.1 Acute rheumatic endocarditis; Acute rheumatic valvulitis RHEUMATIC FEVER 10,100 3,030 7,070
I01.2 Acute rheumatic myocarditis; RHEUMATIC FEVER 10,100 3,030 7,070

Other acute rheumatic heart disease; Acute rheumatic
I01.8 RHEUMATIC FEVER 10,100 3,030 7,070
pancarditis
Acute rheumatic heart disease unspecified; Acute
rheumatic carditis; Active rheumatic heart disease; Acute
rheumatic heart disease
Rheumatic fever with heart involvement
Rheumatic chorea with heart involvement; Chorea NOS
with heart involvement
Rheumatic chorea without heart involvement; Rheumatic
chorea NOS
I05.0 Mitral stenosis; Rheumatic mitral valve obstruction RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Rheumatic mitral insufficiency; Rheumatic mitral
I05.1 RHEUMATIC HEART DISEASE 12,800 3,840 8,960
incompetence; Rheumatic mitral regurgitation
Mitral stenosis with insufficiency; Mitral stenosis with
incompetence or regurgitation
I05.8 Other mitral valve diseases; Mitral valve failure RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Mitral valve disease unspecified; Chronic mitral valve
disorder NOS
Rheumatic aortic stenosis; Rheumatic aortic valve
obstruction
Rheumatic aortic insufficiency; Rheumatic aortic
incompetence; Rheumatic aortic regurgitation
Page 113 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Rheumatic aortic stenosis with insufficiency; Rheumatic

aortic stenosis with incompetence or regurgitation
I06.8 Other rheumatic aortic valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Rheumatic aortic valve disease unspecified; Rheumatic
aortic valve disease NOS
I07.0 Tricuspid stenosis; Rheumatic tricuspid valve stenosis RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Tricuspid insufficiency; Rheumatic tricuspid valve
insufficiency
Tricuspid valve disease unspecified; Tricuspid valve disorder
NOS
Disorders of both mitral and aortic valves; Involvement of
I08.0 both mitral and aortic valves whether specified as RHEUMATIC HEART DISEASE 12,800 3,840 8,960
rheumatic or of unspecified origin
I08.1 Disorders of both mitral and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.2 Disorders of both aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.3 Combined disorders of mitral aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.8 Other multiple valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.9 Multiple valve disease, unspecified RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I09.0 Rheumatic myocarditis RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Rheumatic diseases of endocardium, valve unspecified;
I09.1 Chronic rheumatic endocarditis; Chronic rheumatic RHEUMATIC HEART DISEASE 12,800 3,840 8,960
valvulitis
Chronic rheumatic pericarditis; Rheumatic adherent

I09.2 pericardium; Chronic rheumatic mediastinopericarditis; RHEUMATIC HEART DISEASE 12,800 3,840 8,960
Chronic rheumatic myopericarditis
Other specified rheumatic heart diseases; Rheumatic

disease of pulmonary valve
Epidemic louse-borne typhus fever due to Rickettsia
A75.0 prowazekii; Classical typhus fever; RICKETTSIOSES 7,000 2,100 4,900
Epidemic louse-borne typhus
A75.9 Typhus fever, unspecified RICKETTSIOSES 7,000 2,100 4,900
Spotted fever due to Rickettsia rickettsii; Rocky Mountain
A77.0 RICKETTSIOSES 7,000 2,100 4,900
spotted fever; Sao Paulo fever
A79.0 Trench fever ; Quintan fever; Wolhynian fever RICKETTSIOSES 7,000 2,100 4,900
A79.9 Rickettsiosis, unspecified; Rickettsial infection NOS RICKETTSIOSES 7,000 2,100 4,900
U04.9 Severe Acute Respiratory Syndrome (SARS) SARS
A38 Scarlet fever; Scarlatina SCARLET FEVER 8,300 2,490 5,810
A40.0 Sepsis due to streptococcus, group A SEPSIS 32,000 9,600 22,400
A40.1 Sepsis due to streptococcus, group B SEPSIS 32,000 9,600 22,400
Sepsis due to Streptococcus pneumoniae; Pneumococcal
A40.3 SEPSIS 32,000 9,600 22,400
septicaemia
A40.8 Other streptococcal sepsis SEPSIS 32,000 9,600 22,400
A40.9 Streptococcal septicaemia, unspecified SEPSIS 32,000 9,600 22,400
A41.0 Sepsis due to Staphylococcus aureus SEPSIS 32,000 9,600 22,400
Sepsis due to other specified staphylococcus; Sepsis due
A41.1 SEPSIS 32,000 9,600 22,400
to coagulase-negative staphylococcus
A41.2 Sepsis due to unspecified staphylococcus SEPSIS 32,000 9,600 22,400
A41.3 Sepsis due to Haemophilus influenzae SEPSIS 32,000 9,600 22,400
A41.4 Sepsis due to anaerobes SEPSIS 32,000 9,600 22,400
Sepsis due to other Gram-negative organisms; Gram-
A41.5 SEPSIS 32,000 9,600 22,400
negative septicaemia NOS
A41.8 Other specified septicaemia SEPSIS 32,000 9,600 22,400
A41.9 Sepsis , unspecified; Septic shock SEPSIS 32,000 9,600 22,400
A48.3 Toxic shock syndrome SEPSIS 32,000 9,600 22,400
I69.0 Sequelae of subarachnoid haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.1 Sequelae of intracerebral haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.2 Sequelae of other nontraumatic intracranial haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.3 Sequelae of cerebral infarction SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
Sequelae of stroke, not specified as haemorrhage or
I69.4 SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
infarction
I69.8 Sequelae of other and unspecified cerebrovascular diseases SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
SEQUELAE OF INFECTIOUS AND PARASITIC

B90.0 Sequelae of central nervous system tuberculosis 10,700 3,210 7,490
DISEASES
B90.8 Sequelae of tuberculosis of other organs 10,700 3,210 7,490
DISEASES
Sequelae of respiratory and unspecified tuberculosis; SEQUELAE OF INFECTIOUS AND PARASITIC
B90.9 10,700 3,210 7,490
sequelae of tuberculosis NOS DISEASES
B94.1 Sequelae of viral encephalitis 10,700 3,210 7,490
DISEASES
B94.2 Sequelae of viral hepatitis 10,700 3,210 7,490
DISEASES
Page 114 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
B94.8 Sequelae of other specified infectious and parasitic diseases 10,700 3,210 7,490
DISEASES
B94.9 Sequelae of unspecified infectious or parasitic disease 10,700 3,210 7,490
DISEASES
Sequelae of inflammatory diseases of central nervous SEQUELAE OF INFLAMMATORY DISEASE OF THE
G09 8,000 2,400 5,600
system CENTRAL NERVOUS SYSTEM
E64.8 Sequelae of other nutritional deficiencies SEQUELAE OF NUTRITIONAL DEFICIENCIES 8,800 2,640 6,160
T90.0 Sequelae of superficial injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.1 Sequelae of open wound of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.2 Sequelae of fracture of skull and facial bones SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.5 Sequelae of intra cranial injury SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.8 Sequelae of other specified injuries of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.9 Sequelae of unspecified injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
Sequelae of superficial injury and open wound of neck and
T91.0 SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
trunk
T91.1 Sequelae of fracture of spine SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.2 Sequelae of other fracture of thorax and pelvis SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.3 Sequelae of injury of spinal cord SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.0 Sequelae of open wound of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.1 Sequelae of fracture of arm SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.8 Sequelae of other specified injuries of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.0 Sequelae of open wound of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.1 Sequelae of fracture of femur SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.2 Sequelae of other fractures of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.3 Sequelae of dislocation sprain and strain of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.8 Sequelae of other specified injuries of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T94.0 Sequelae of injuries involving multiple body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T94.1 Sequelae of injuries, not specified by body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.0 Sequelae of burn, corrosion and frostbite of head and neck SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.2 Sequelae of burn, corrosion and frostbite of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.3 Sequelae of burn, corrosion and frostbite of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.8 Sequelae of other specified burn corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.9 Sequelae of unspecified burn, corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T98.2 Sequelae of certain early complications of trauma SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
R57.0 Cardiogenic shock SHOCK 32,000 9,600 22,400
R57.1 Hypovolaemic shock SHOCK 32,000 9,600 22,400
R57.8 Other shock; Endotoxic shock SHOCK 32,000 9,600 22,400
R57.9 Shock, unspecified; Failure of peripheral circulation NOS SHOCK 32,000 9,600 22,400
Shock due to anaesthesia; Shock due to anaesthesia in

T88.2 SHOCK 32,000 9,600 22,400
which the correct sustance was properly administered
Situs inversus; Dextrocardia with situs inversus; Mirror-
image atrial arrangement with situs inversus; Situs inversus
Q89.3 or transverses abdominalis; Situs inversus or transversus SITUS INVERSUS 6,700 2,010 4,690
thoracis; Transposition of abdominal viscera; Transposition
of thoracic visce
Fracture o f vault of skull; Fracture of Frontal bone;
S02.0 SKULL FRACTURES 10,700 3,210 7,490
Fracture of Parietal bone
Closed fracture o f vault of skull; Fracture of Frontal bone;
Open fracture o f vault of skull; Fracture of Frontal bone;
Fracture of base of skull: Fracture of anterior fossa, middle

fossa, posterior fossa; Fracture of Occiput; Fracture of
orbital roof; Fracture of ethmoid sinus & frontal sinus;
Fracture of Sphenoid; Fracture of temporal bone
Closed fracture of base of skull; fracture of anterior fossa;

fracture of middle fossa; fracture of posterior fossa;
S02.10 fracture of occiput; fracture of orbital roof; fracture of SKULL FRACTURES 10,700 3,210 7,490
ethmoid sinus; fracture of frontal sinus; fracture of
sphenoid; fracture of temporal bone
Opem fracture of base of skull; fracture of anterior fossa;
fracture of middle fossa; fracture of posterior fossa;
S02.11 fracture of occiput; fracture of orbital roof; fracture of SKULL FRACTURES 10,700 3,210 7,490
ethmoid sinus; fracture of frontal sinus; fracture of
sphenoid; fracture of temporal bone
S02.20 closed fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490
S02.21 open fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490
S02.30 Closed fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490
S02.31 Open fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490
Closed Fracture of malar and maxillary bones; superior
maxilla; upper jaw (bone); zygoma
Open Fracture of malar and maxillary bones; superior
maxilla; upper jaw (bone); zygoma
Page 115 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
S02.50 Closed Fracture of tooth SKULL FRACTURES 10,700 3,210 7,490
S02.60 Closed Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490
S02.61 Open Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490
S02.70 Closed Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490
S02.71 Open Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490
closed Fractures of other skull and facial bones including

Alveolus, Orbit NOS, Palate
open Fractures of other skull and facial bones including
Alveolus, Orbit NOS, Palate
S02.90 Closed Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490
S02.91 Open Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490
Sleep apnoea; Central sleep apnoea; obstructive sleep

G47.3 SLEEP APNEA 10,800 3,240 7,560
apnoea,
M43.0 Spondylolysis SPONDYLOPATHIES 8,300 2,490 5,810
M43.1 Spondylolisthesis SPONDYLOPATHIES 8,300 2,490 5,810
M43.2 Other fusion of spine; Ankylosis of spinal joint SPONDYLOPATHIES 8,300 2,490 5,810
M43.5 Other recurrent vertebral subluxation SPONDYLOPATHIES 8,300 2,490 5,810
M43.6 Torticollis SPONDYLOPATHIES 8,300 2,490 5,810
M45 Ankylosing spondylitis; Rheumatoid arthritis of spine SPONDYLOPATHIES 8,300 2,490 5,810
Spinal enthesopathy; Disorder of ligamentous or muscular
M46.0 SPONDYLOPATHIES 8,300 2,490 5,810
attachments of spine
M46.1 Sacroiliitis, not elsewhere classified SPONDYLOPATHIES 8,300 2,490 5,810
M46.16 Sacroiliitis, not elsewhere classified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.19 Sacroiliitis, not elsewhere classified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.2 Osteomyelitis of vertebra SPONDYLOPATHIES 8,300 2,490 5,810
M46.28 Osteomyelitis of vertebra sacral and sacrococcygeal region SPONDYLOPATHIES 8,300 2,490 5,810
M46.29 Osteomyelitis of vertebra site unspecified SPONDYLOPATHIES 8,300 2,490 5,810

M46.3 Infection of intervertebral disc (pyogenic) SPONDYLOPATHIES 8,300 2,490 5,810
M46.36 Infection of intervertebral disc (pyogenic) lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.4 Discitis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810

M46.46 Discitis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.47 Discitis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M46.49 Discitis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.5 Other infective spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810
M46.8 Other specified inflammatory spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810
Other specified inflammatory spondylopathies lumbosacral
region
M46.9 Inflammatory spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.92 Inflammatory spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
Inflammatory spondylopathy, unspecified lumbosacral

region
Inflammatory spondylopathy, unspecified sacral and
M46.99 Inflammatory spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M47.1 Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810

M47.1+G99.2* Myelopathy in Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810
M47.2 Other spondylosis with radiculopathy SPONDYLOPATHIES 8,300 2,490 5,810
Other spondylosis with radiculopathy Multiple sites in
spine
M47.22 Other spondylosis with radiculopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M47.26 Other spondylosis with radiculopathy lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.27 Other spondylosis with radiculopathy lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M47.29 Other spondylosis with radiculopathy site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy

radiculopathy Multiple sites in spine

radiculopathy occipito-atlanto-axial region
Page 116 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
radiculopathy cervical region

radiculopathy cervicothoracic region

radiculopathy thoracic region

radiculopathy thoracolumbar region

radiculopathy lumbar region

radiculopathy lumbosacral region

radiculopathy sacral and sacrococcygeal region

radiculopathy site unspecified
M47.9 Spondylosis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M47.90 Spondylosis, unspecified Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810
M47.92 Spondylosis, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M47.94 Spondylosis, unspecified thoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M47.95 Spondylosis, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.96 Spondylosis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.97 Spondylosis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M47.99 Spondylosis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M48.0 Spinal stenosis; Caudal stenosis SPONDYLOPATHIES 8,300 2,490 5,810
M48.00 Spinal stenosis; Caudal stenosis Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810
M48.02 Spinal stenosis; Caudal stenosis cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.03 Spinal stenosis; Caudal stenosis cervicothoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M48.04 Spinal stenosis; Caudal stenosis thoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M48.05 Spinal stenosis; Caudal stenosis thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.06 Spinal stenosis; Caudal stenosis lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.07 Spinal stenosis; Caudal stenosis lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
Spinal stenosis; Caudal stenosis sacral and sacrococcygeal
region
M48.09 Spinal stenosis; Caudal stenosis site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH]
Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH] lumbar region
M48.2 Kissing spine SPONDYLOPATHIES 8,300 2,490 5,810
M48.3 Traumatic spondylopathy SPONDYLOPATHIES 8,300 2,490 5,810
M48.32 Traumatic spondylopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.4 Fatigue fracture of vertebra; Stress fracture of vertebra SPONDYLOPATHIES 8,300 2,490 5,810
Collapsed vertebra, not elsewhere classified; Collapsed
vertebra NOS; Wedging of vertebra NOS
Collapsed vertebra NOS; Wedging of vertebra NOS thoracic
region
Collapsed vertebra NOS; Wedging of vertebra NOS lumbar
region
Collapsed vertebra NOS; Wedging of vertebra NOS
lumbosacral region
Other specified spondylopathies; Ossification of posterior
longitudinal ligament
Ossification of posterior longitudinal ligament Multiple sites
in spine
Ossification of posterior longitudinal ligament
thoracolumbar region
Page 117 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Ossification of posterior longitudinal ligament lumbar
region
Ossification of posterior longitudinal ligament site
unspecified
M48.9 Spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M48.92 Spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.95 Spondylopathy, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.96 Spondylopathy, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
Spondylopathy, unspecified sacral and sacrococcygeal
region
M48.99 Spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M49.0* Tuberculosis of spine; Pott's curvature SPONDYLOPATHIES 8,300 2,490 5,810
M49.8* Spondylopathy in other diseases classified elsewhere SPONDYLOPATHIES 8,300 2,490 5,810
Staphylococcal scalded skin syndrome; Pemphigus
L00 STAPHYLOCCOCAL SCALDED SKIN SYNDROME 10,200 3,060 7,140
neonatorum; Ritter's disease
G41.0 Grand mal status epilepticus; Tonic-clonic status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.1 Petit mal status epilepticus; Epileptic absence status STATUS EPILEPTICUS 15,600 4,680 10,920
G41.2 Complex partial status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.8 Other status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.9 Status epilepticus, unspecified STATUS EPILEPTICUS 15,600 4,680 10,920
L51.1 Bullous erythema multiforme; Stevens-Johnson syndrome STEVEN JOHNSONS SYNDROME 12,300 3,690 8,610
Subarachnoid haemorrhage from carotid siphon and

I60.0 STROKE - HEMORRHAGIC 38,000 11,400 26,600
bifurcation
I60.1 Subarachnoid haemorrhage from middle cerebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
Subarachnoid haemorrhage from anterior communicating

artery
Subarachnoid haemorrhage from posterior communicating
artery
I60.4 Subarachnoid haemorrhage from basilar artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.5 Subarachnoid haemorrhage from vertebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
Subarachnoid haemorrhage from other intracranial
arteries; Multiple involvement of intracranial arteries
Subarachnoid haemorrhage from intracranial artery,
unspecified; Congenital ruptured berry aneurysm NOS;
I60.7 Subarachnoid haemorrhage from cerebral artery NOS; STROKE - HEMORRHAGIC 38,000 11,400 26,600
Subarachnoid haemorrhage from communicating artery
NOS
Other subarachnoid haemorrhage; Meningeal
I60.8 haemorrhage; Rupture of cerebral arteriovenous STROKE - HEMORRHAGIC 38,000 11,400 26,600
malformation
Subarachnoid haemorrhage, unspecified; Congenital
ruptured cerebral aneurysm NOS
Intracerebral haemorrhage in hemisphere, subcortical;
Deep intracerebral haemorrhage
Intracerebral haemorrhage in hemisphere, cortical;
I61.1 Cerebral lobe haemorrhage; Superficial intracerebral STROKE - HEMORRHAGIC 38,000 11,400 26,600
haemorrhage
I61.2 Intracerebral haemorrhage in hemisphere, unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.3 Intracerebral haemorrhage in brain stem STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.4 Intracerebral haemorrhage in cerebellum STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.5 Intracerebral haemorrhage, intraventricular STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.6 Intracerebral haemorrhage, multiple localized STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.8 Other intracerebral haemorrhage STROKE - HEMORRHAGIC 38,000 11,400 26,600
Intracerebral haemorrhage, unspecified
Cerebrovascular Accident hemorrhage
Acute Subdural haemorrhage; Nontraumatic Subdural
haemorrhage
Nontraumatic extradural haemorrhage; Nontraumatic
epidural haemorrhage
I62.9 Intracranial haemorrhage (nontraumatic), unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600
Cerebral infarction due to thrombosis of precerebral
I63.0 STROKE - INFARCTION 28,000 8,400 19,600
arteries
I63.1 Cerebral infarction due to embolism of precerebral arteries STROKE - INFARCTION 28,000 8,400 19,600
Cerebral infarction due to unspecified occlusion or stenosis

of precerebral arteries
Cerebral infarction due to thrombosis of cerebral arteries

Cerebrovascular disease (CVD), thrombotic infarct
I63.4 Cerebral infarction due to embolism of cerebral arteries STROKE - INFARCTION 28,000 8,400 19,600
Cerebral infarction due to unspecified occlusion or stenosis

of cerebral arteries
Page 118 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Cerebral infarction due to cerebral venous thrombosis,
nonpyogenic
I63.8 Other cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600
Cerebral infarction, unspecified
I63.9 Reversible Ischemic Neurologic Deficit (RIND) STROKE - INFARCTION 28,000 8,400 19,600
CVA with infarction
I63.9+G46.7* Other lacunar syndrome in unspecified cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600
Stroke, not specified as hemorrhage or infarction;

I64 Cerebrovascular Accident (CVA) STROKE - INFARCTION 28,000 8,400 19,600
Cardioembolic CVA
SYSTEMIC ATROPHIES INVOLVING CENTRAL
G10 Huntington's disease; Huntington's chorea 10,400 3,120 7,280
NERVOUS SYSTEM
G11.0 Congenital nonprogressive ataxia 10,400 3,120 7,280
NERVOUS SYSTEM
Early-onset cerebellar ataxia including Early-onset
cerebellar ataxia with essential tremor; Early-onset
G11.1 cerebellar ataxia with myoclonus [Hunt's ataxia]; Early- 10,400 3,120 7,280
NERVOUS SYSTEM
onset cerebellar ataxia with retained tendon reflexes;
Friedreich's ataxia (autosomal recessiv
Cerebellar ataxia with defective DNA repair; Ataxia SYSTEMIC ATROPHIES INVOLVING CENTRAL
G11.3 10,400 3,120 7,280
telangiectasia [Louis-Bar] NERVOUS SYSTEM
Hereditary ataxia, unspecified; Hereditary cerebellar ataxia

G11.9 NOS; Hereditary cerebellar degeneration; Hereditary 10,400 3,120 7,280
NERVOUS SYSTEM
cerebellar disease; Hereditary cerebellar syndrome

G12.0 Infantile spinal muscular atrophy, type I [Werdnig-Hoffman] 10,400 3,120 7,280
NERVOUS SYSTEM
Other inherited spinal muscular atrophy; Progressive bulbar
palsy of childhood [Fazio-Londe]; Spinal muscular atrophy
adult form;
G12.1 Spinal muscular atrophy childhood form, type II; Spinal 10,400 3,120 7,280
NERVOUS SYSTEM
muscular atrophy distal; Spinal muscular atrophy juvenile
form, type III [Kugelberg-FWelander]; Spinal muscular
atrophy scapuloperoneal form
Motor neuron disease; Familial motor neuron disease;
AmyotrophicLateral sclerosis; Primary Lateral sclerosis ; SYSTEMIC ATROPHIES INVOLVING CENTRAL
G12.2 10,400 3,120 7,280
Progressive bulbar palsy; Progressive spinal muscular NERVOUS SYSTEM
atrophy
G12.9 Spinal muscular atrophy, unspecified 10,400 3,120 7,280
NERVOUS SYSTEM
Parkinson's disease; Hemiparkinsonism; Paralysis agitans;
Parkinsonism or Parkinson's disease NOS; Idiopathic SYSTEMIC ATROPHIES INVOLVING CENTRAL
G20 10,400 3,120 7,280
Parkinsonism or Parkinson's disease; Primary Parkinsonism NERVOUS SYSTEM
or Parkinson's disease
L93.0 Discoid lupus erythematosus; Lupus erythematosus NOS SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
L93.1 Subacute cutaneous lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
Other local lupus erythematosus; Lupus erymatosus
L93.2 SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
profundus; Lupus panniculitis
M32.0 Drug-induced systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
M32.8 Other forms of systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
M32.9 Systemic lupus erythematosus, unspecified SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
A33 Tetanus neonatorum TETANUS 16,500 4,950 11,550
A34 Obstetrical tetanus TETANUS 16,500 4,950 11,550
A35 Other tetanus; Tetanus NOS TETANUS 16,500 4,950 11,550
R29.0 Tetany; Carpopedal spasm TETANUS 16,500 4,950 11,550
D56.0 Alpha thalassaemia THALASSEMIA 5,600 1,680 3,920
Beta thalassaemia; Cooley's anaemia; Severe beta
D56.1 thalassaemia; Sickle-cell bet thalassaemia; Thalassaemia THALASSEMIA 5,600 1,680 3,920
intermedia; Thalassaemia major;
D56.2 Delta-beta thalassaemia THALASSEMIA 5,600 1,680 3,920
D56.3 Thalassaemia trait THALASSEMIA 5,600 1,680 3,920
D56.4 Hereditary persistence of fetal haemoglobin [HPFH] THALASSEMIA 5,600 1,680 3,920
D56.8 Other thalassaemias THALASSEMIA 5,600 1,680 3,920
L51.2 Toxic epidermal necrolysis [Lyell] TOXIC EPIDERMAL NECROLYSIS 15,900 4,770 11,130
G45.0 Vertebro-basilar artery syndrome TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.1 Carotid artery syndrome (Hemispheric) TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.2 Multiple and bilateral precerebral artery syndromes TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.3 Amaurosis fugax TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.4 Transient global amnesia TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
Other transient cerebral ischaemic attacks and related
G45.8 TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
syndromes
Transient cerebral ischaemic attack, unspecified; Spasm of

G45.9 TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
cerebral artery; Transient cerebral ischaemia NOS
Page 119 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Subdural haemorrhage due to birth injury; Subdural
P10.0 TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
haematoma (localized) due to birth injury
P10.1 Cerebral haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.2 Intraventricular haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.3 Subarachnoid haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.4 Tentorial tear due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
Unspecified intracranial laceration and haemorrhage due to
P10.9 TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
birth injury
P11.1 Other specified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P11.2 Unspecified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P11.9 Birth injury to central nervous system, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.0 Cephalhaematoma due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.3 Bruising of scalp due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.8 Other birth injuries to scalp TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.9 Birth injury to scalp, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.2 Birth injury to femur TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.4 Fracture of clavicle due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.8 Birth injuries to other parts of skeleton TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.9 Birth injury to skeleton, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P14.0 Erb's paralysis due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P14.3 Other brachial plexus birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.4 Birth injury to face; Facial congestion due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.5 Birth injury to external genitalia TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.8 Other specified birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.9 Birth injury, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
Tuberculosis of intrathoracic lymph nodes, confirmed
bacteriologically & histologicaly; Tuberculosis of hilar
lymph nodes, confirmed bacteriologically & histologicaly;
A15.4 Tuberculosis of mediastinal lymph nodes, confirmed TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
bacteriologically & histologicaly; Tuberculosis of
tracheobronchial lymph nodes, confirmed bacteriologically
& histologicaly
Tuberculosis of larynx, trachea and bronchus, confirmed
bacteriologically
and histologically; Tuberculosis of bronchus confirmed
bacteriologically and histologically; Tuberculosis of glottis
A15.5 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
confirmed bacteriologically and histologically; Tuberculosis
of larynx confirmed bacteriologically and histologically;
Tuberculosis of trachea, confirmed bacteriologically and
histologically
Tuberculous pleurisy, confirmed bacteriologically and

histologically; Tuberculosis of pleura, confirmed
bacteriologically and histologically; Tuberculous empyema,
confirmed bacteriologically & histologically
Other respiratory tuberculosis, confirmed bacteriologically

and histologically; Mediastinal tuberculosis, confirmed
bacteriologically and histologically; Nasopharyngeal
A15.8 tuberculosis, confirmed bacteriologically and histologically; TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
Tuberculosis of nose confirmed bacteriologically and
histologically; Tuberculosis of sinus (any nasal) confirmed
bacteriologically and histologically
Tuberculosis of intrathoracic lymph nodes, without

mention of bacteriological or histological confirmation;
Tuberculosis of hillar lymph nodes NOS (without mention
of bacteriological or histological confirmation);
Tuberculosis of intrathoracic lymph nodes NOS (without
A16.3 mention of bacteriological or histological confirmation); TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
Tuberculosis of mediastinal lymp nodes NOS (without
mention of bacteriological or histological confirmation);
Tuberculosis of tracheobronchial lymph nodes NOS
(without mention of bacteriological or histological
confirmation)
Tuberculosis of larynx, trachea, glottis and bronchus,
without mention of bacteriological or histological
onfirmation; Tuberculosis of bronchus NOS (without
mention of bacteriological or histological onfirmation):
Tuberculosis of glottis NOS (without mention of
bacteriological or histological onfirmation); Tuberculosis of
larynx NOS (without mention of bacteriological or
histological onfirmation); Tuberculosis of trachea NOS
(without mention of bacteriological or histological
onfirmation)
Page 120 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Tuberculous pleurisy, without mention of bacteriological or
histological
confirmation; Tuberculosis of pleura, NOS (without
A16.5 mention of bacteriological or histological confirmation); TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
Tuberculous empyema NOS (without mention of
bacteriological or histological confirmation); Tuberculous
plurisy NOS (without mention of bacteriological or
Other respiratory tuberculosis, without mention of
bacteriological or histological confirmation; Mediastinal
tuberculosis, NOS without mention of bacteriological or
histological confirmation; Nasopharyngeal tuberculosis,
NOS without mention of bacteriological or histological
confirmation; Tuberculosis of nose; sinus (any nasal), NOS
confirmation
Tuberculous peripheral lymphadenopathy; Tuberculous
adenitis
Tuberculosis of intestines, peritoneum and mesenteric
glands; Tuberculosis of anus and rectum; Tuberculosis of
A18.3 intestine (large)(small); Tuberculosis of retroperitoneal TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
(lymph nodes); Tuberculous ascites; Tuberculous enteritis;
Tuberculous peritonitis
Tuberculosis of skin and subcutaneous tissue; Erythema

A18.4 tuberculous induratum, ; Lupus exedens; Lupus vulgaris; TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
Lupus exedens, NOS; Lupus vulgaris, NOS; Scrofuloderma
A19.0 Acute miliary tuberculosis of a single specified site TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.1 Acute miliary tuberculosis of multiple sites TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.2 Acute miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.8 Other miliary tuberculosis TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.9 Miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570
Tuberculosis of lung, confirmed by sputum microscopy with

or without culture; Tuberculous Bronchiectasis' confirmed
by sputum microscopy with or without culture;
Tuberculous fibrosis of lung, confirmed by sputum
A15.0 microscopy with or without culture; Tuberculous TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
pneumonia, confirmed by sputum microscopy with or
without culture; Tuberculous pneumothorax, confirmed by
sputum microscopy with or without culture
Tuberculosis of lung, confirmed by culture only;

A15.1 Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia; TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
pneumothorax, confirmed by culture only
Tuberculosis of lung, confirmed histologically; Tuberculous:

A15.2 Bronchiectasis; fibrosis of lung; pneumonia; pneumothorax, TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
confirmed histologically only
Tuberculosis of lung, confirmed by unspecified means;

Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia;
A15.3 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
pneumothorax, confirmed but unspecified whether
bacteriologically or histologically
Primary respiratory tuberculosis, confirmed

Childhood type (first infection) pulmonary tuberculosis
confirmed bacteriologically and histologically
Respiratory tuberculosis unspecified, confirmed
Tuberculosis of lung, bacteriologically and histologically
negative;
Tuberculous Bronchiectasis , bacteriologically and
histologically negative; Tuberculous fibrosis of lung,
bacteriologically and histologically negative; Tuberculous
pneumonia, bacteriologically and histologically negative;
Tuberculous pneumothorax, bacteriologically and
histologically negative
Tuberculosis of lung, bacteriological and histological

examination not done
Page 121 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Tuberculosis of lung, without mention of bacteriological or
histological confirmation; Tuberculous: bronchiectasis;
A16.2 fibrosis of lung; pneumonia; pneumothorax; NOS ( TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
confirmation)
Primary respiratory tuberculosis without mention of
bacteriological or histological confirmation; Primary
A16.7 respiratory tuberculosis NOS; Primary tuberculous TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
complex
Childhood type (first infection) pulmonary tuberculosis
Respiratory tuberculosis unspecified, without mention of
bacteriological or histological confirmation; Respiratory
tuberculosis NOS; Tuberculosis NOS
Koch's Infection; Koch's Disease
A01.0 Typhoid fever; infection due to Salmonella typhi TYPHOID FEVER 10,000 3,000 7,000
A01.1 Paratyphoid fever A TYPHOID FEVER 10,000 3,000 7,000
A01.2 Paratyphoid fever B TYPHOID FEVER 10,000 3,000 7,000
A01.3 Paratyphoid fever C TYPHOID FEVER 10,000 3,000 7,000
Paratyphoid fever, unspecified; Infection due to Salmonella
A01.4 TYPHOID FEVER 10,000 3,000 7,000
paratyphi NOS
A02.0 Salmonella enteritis; Salmonellosis TYPHOID FEVER 10,000 3,000 7,000
A02.1 Salmonella sepsis TYPHOID FEVER 10,000 3,000 7,000
Localized salmonella infections; Salmonella arthritis;

A02.2 salmonella meningitis; salmonella osteomyelitis; salmonella TYPHOID FEVER 10,000 3,000 7,000
pneumonia; salmonella renal tubulo-interstitial disease
A02.8 Other specified salmonella infections TYPHOID FEVER 10,000 3,000 7,000
A02.9 Salmonella infection, unspecified TYPHOID FEVER 10,000 3,000 7,000
Unspecified contracted kidney; Atrophy of kidney
N26 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
(terminal); Renal sclerosis NOS
N27.0 Small kidney, unilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N27.1 Small kidney, bilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N27.9 Small kidney, unspecified URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
Other specified disorders of kidney and ureter;
Hypertrophy of kidney; Megaloureter; Nephroptosis;
N28.8 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
Pyelitis cystica; Pyeloureteritis cystica; Ureteritis cystica;
Ureterocele
Disorder of kidney and ureter, unspecified; Nephropathy
N28.9 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
NOS; Renal disease NOS
Other disorders of kidney and ureter in other diseases
N29.8* URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N30.0 Acute cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.1 Chronic Interstitial cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.2 Other chronic cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.3 Trigonitis; Urethrotrigonitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.9 Cystitis, unspecified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N39.0 Urinary tract infection, site not specified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
M50.1 Cervical disc disorder with radiculopathy VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.2 Other cervical disc displacement VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.3 Other cervical disc degeneration VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.8 Other cervical vertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
Lumbar and other intervertebral disc disorders with

M51.1 VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
radiculopathy; Sciatica due to intervertebral disc disorder
Other specified intervertebral disc displacement

Lumbago due to displacement of intervertebral disc
M51.3 Other specified intervertebral disc degenerations VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.4 Schmorl's node VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.8 Other specified intervertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.0 Segmental and somatic dysfunction, rib cage VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.1 Subluxation complex (vertebral) VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.3 Osseous stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.5 Intervertebral disc stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
Connective tissue and disc stenosis of intervertebral
foramina
Ménière's disease; Labyrinthine hydrops; Ménière's
H81.0 VERTIGINOUS DISORDERS 5,700 1,710 3,990
syndrome or vertigo
H81.1 Benign paroxysmal vertigo VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.2 Vestibular neuronitis VERTIGINOUS DISORDERS 5,700 1,710 3,990
Other peripheral vertigo; Lermoyez' syndrome; Aural
Vertigo ; Otogenic Vertigo; Peripheral NOS Vertigo
H81.4 Vertigo of central origin; Central positional nystagmus VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.8 Other disorders of vestibular function VERTIGINOUS DISORDERS 5,700 1,710 3,990
Disorder of vestibular function, unspecified; Vertiginous
syndrome NOS
H83.1 Labyrinthine fistula VERTIGINOUS DISORDERS 5,700 1,710 3,990
Page 122 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Labyrinthine dysfunction; Hypersensitivity of labyrinth;

Hypofunction of labyrinth; Loss of function Of labyrinth
R42 Dizziness and giddiness; Light-headedness; Vertigo NOS VERTIGINOUS DISORDERS 5,700 1,710 3,990
A96.0 Junin haemorrhagic fever; Argentinian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A96.1 Machupo haemorrhagic fever; Bolivian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A98.8 Other specified viral haemorrhagic fevers VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A99 Unspecified viral haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
B15.0 Acute Hepatitis A with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
Acute hepatitis A without hepatic coma; Hepatitis A
B15.9 VIRAL HEPATITIS 11,800 3,540 8,260
(acute)(viral) NOS
Acute hepatitis B with delta-agent (coinfection) with
hepatic coma
Acute hepatitis B with delta-agent (coinfection) without
hepatic coma
B16.2 Acute hepatitis B without delta-agent with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
Acute hepatitis B without delta-agent and without hepatic

coma; Acute hepatitis B (viral) NOS
B17.0 Acute delta-(super) infection of hepatitis B carrier VIRAL HEPATITIS 11,800 3,540 8,260
B17.1 Acute hepatitis C VIRAL HEPATITIS 11,800 3,540 8,260
B17.2 Acute hepatitis E VIRAL HEPATITIS 11,800 3,540 8,260
Other specified acute viral hepatitis; Hepatitis non-A non-B
(acute)(viral) NEC
B18.0 Chronic viral hepatitis B with delta-agent VIRAL HEPATITIS 11,800 3,540 8,260
Chronic viral hepatitis B wtihout delta-agent: Hepatitis B
(viral) NOS
B18.2 Chronic viral hepatitis C VIRAL HEPATITIS 11,800 3,540 8,260
B18.8 Other chronic viral hepatitis VIRAL HEPATITIS 11,800 3,540 8,260
B18.9 Chronic viral hepatitis, unspecified VIRAL HEPATITIS 11,800 3,540 8,260
B19.0 Unspecified viral hepatitis hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
Unspecified viral hepatitis without hepatic coma; Viral
Hepatitis NOS
A80.1 Acute paralytic poliomyelitis, wild virus, imported VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A80.2 Acute paralytic poliomyelitis, wild virus, indigenous VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A80.9 Acute poliomyelitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
Creutzfeldt-Jakob disease; Subacute spongiform

A81.0 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
encephalopathy
Subacute sclerosing panencephalitis; Dawson's inclusion
A81.1 body encephalitis ; Van Bogaert's sclerosing VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
leukoencephalopathy
Progressive multifocal leukoencephalopathy; Multifocal
leukoencephalopathy NOS
Atypical virus infection of central nervous system,

unspecified; Prion disease of central nervous system NOS
A82.0 Sylvatic rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A82.1 Urban rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A82.9 Rabies, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.0 Japanese encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.2 Eastern equine encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
California encephalitis; California meningoencephalitis

La Crosse encephalitis
A83.8 Other mosquito-borne viral encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.9 Mosquito-borne viral encephalitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A85.2 Arthropod-borne viral encephalitis, unspecified; VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
Other specified viral encephalitis; Encephalitis lethargica;

Von Economo-Cruchet disease
Unspecified viral encephalitis; Viral encephalomyelitis NOS;
A86 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
Viral meningoencephalitis NOS
A88.8 Other specified viral infections of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
Page 123 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
A89 Unspecified viral infection of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A37.0 Whooping cough due to Bordetella pertussis WHOOPING COUGH 10,600 3,180 7,420
A37.1 Whooping cough due to Bordetella parapertussis WHOOPING COUGH 10,600 3,180 7,420
A37.8 Whooping cough due to other Bordetella species WHOOPING COUGH 10,600 3,180 7,420
A37.9 Whooping cough, unspecified WHOOPING COUGH 10,600 3,180 7,420
A20.0 Bubonic plague ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A20.9 Plague, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.0 Ulceroglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.1 Oculoglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.2 Pulmonary tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.3 Gastrointestinal tularaemia; Abdominal tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.9 Tularaemia, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
Cutaneous anthrax; Malignant carbuncle; Malignant
A22.0 ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
pustule
A22.2 Gastrointestinal anthrax ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.7 Anthrax sepsis ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.9 Anthrax, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A23.1 Brucellosis due to Brucella abortus ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A23.9 Brucellosis, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A24.0 Glanders; Infection due to Pseudomonas mallei; Malleus ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
Acute and fulminating melioidosis; Melioidosis pneumonia

; Melioidosis septicaemia
A25.9 Rat-bite fever, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A26.8 Other forms of erysipeloid ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A26.9 Erysipeloid, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.0 Pasteurellosis ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.1 Cat-scratch disease; Cat-scratch fever ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
Other specified zoonotic bacterial diseases, not elsewhere
classified
A28.9 Zoonotic bacterial disease, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
Insulin-dependent diabetes mellitus with renal
complications: diabetic nephropathy; Glomerular disorders
in diabetes mellitus; Brittle diabetes (mellitus); Juvenile- DIABETES MELLITUS WITH COMPLICATIONS
E10.2+ N08.3* 12,600 3,780 8,820
onset diabetes (mellitus); Ketosis-prone diabetes (mellitus); OTHER THAN COMA AND KETOSIS
Type I diabetes (mellitus)
Insulin-dependent diabetes mellitus nephropathy
Non-insulin-dependent diabetes mellitus with renal

complications: diabetic nephropathy; Glomerular disorders
in diabetes mellitus; Adult-onset diabetes
(mellitus)(nonobese)(obese); Maturity-onset diabetes
(mellitus)(nonobese)(obese); Nonketonic diabetes DIABETES MELLITUS WITH COMPLICATIONS
E11.2+ N08.3* 12,600 3,780 8,820
(mellitus)(nonobese)(obese); Stable diabetes OTHER THAN COMA AND KETOSIS
(mellitus)(nonobese)(obese); Type II diabetes
(mellitus)(nonobese)(obese); Non-insulin-dependent
diabetes of the young
Non - insulin-dependent diabetes mellitus nephropathy
Malnutrition-related diabetes mellitus with renal

E12.2+ N08.3* complications: diabetic nephropathy; Glomerular disorders 12,600 3,780 8,820
in diabetes mellitus;
Other specified diabetes mellitus with renal complications:
E13.2+ N08.3* diabetic nephropathy;Glomerular disorders in diabetes 12,600 3,780 8,820
mellitus
Unspecified diabetes mellitus with renal complications:
diabetic nephropathy; Glomerular disorders in diabetes DIABETES MELLITUS WITH COMPLICATIONS
E14.2+ N08.3* 12,600 3,780 8,820
mellitus OTHER THAN COMA AND KETOSIS
Measles with other complications; Measles keratitis and

B05.8 VIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390
keratoconjunctivitis
B05.9 Measles without complications; Measles NOS VIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390
B01.9 Varicella [chickenpox] without complication; Varicella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Rubella with other complications; Encephalitis Rubella;

B06.8 VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Meningitis Rubella; Meningoencephalitis Rubella
B06.9 Rubella without complication; Rubella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Unspecified viral infection characterized by skin and
B09 mucous membrane lesions; Viral enanthema NOS; Viral VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
exanthem
Enterovirus infection, unspecified; Coxsackievirus infection
NOS; Echovirus infection NOS
B34.2 Coronavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.3 Parvovirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.4 Papovavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.8 Other viral infections of unspecified site VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Viral infection, unspecified; Viraemia NOS
Systemic Viral Infection
Page 124 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
B50.9 Plasmodium falciparum malaria, unspecified MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
Plasmodium vivax malaria without complications;
B51.9 MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
Plasmodium vivax malaria NOS
Plasmodium malariae malaria without complications;
B52.9 MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
Plasmodium malariae malaria NOS
Schistosomiasis due to Schistosoma mansoni [intestinal
B65.1 PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
schistosomiasis]
Schistosomiasis due to Schistosoma japonicum; Asiatic
schistosomiasis
B65.3 Cercarial dermatitis; Swimmer's itch PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Infection due to Schistosoma intercalatum, Schistosoma

mattheei , Schistosoma mekongi
B65.9 Schistosomiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B77.9 Ascariasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B82.0 Intestinal helminthiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B82.9 Intestinal parasitism, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Non-insulin-dependent diabetes mellitus without

E11.9 complications (NIDDM) DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800
Type II diabetes mellitus
Insulin dependent diabetes mellitus without complications
E10.9 (IDDM) DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800
Type I diabetes mellitus
E16.2 Hypoglycemia, unspecified HYPOGLYCEMIA 4,000 1,200 2,800
E86.1 Moderate dehydration DEHYDRATION 4,000 1,200 2,800
E86.2 Severe dehydration DEHYDRATION 4,000 1,200 2,800
CHRONIC HEART DISEASES WITHOUT
I25.0 Atherosclerotic cardiovascular disease (ASCVD) 4,000 1,200 2,800
COMPLICATIONS
Atherosclerotic heart disease; Coronary artery atheroma;
Coronary artery atherosclerosis; Coronary artery disease;
Coronary artery sclerosis CHRONIC HEART DISEASES WITHOUT
I25.1 4,000 1,200 2,800
Arteriosclerotic heart disease (ASHD) COMPLICATIONS
Coronary artery disease (CAD)
Cardiac sclresosis
CHRONIC HEART DISEASES WITHOUT
I25.3 Aneurysm of heart; Mural aneurysm; Venticular aneurysm 4,000 1,200 2,800
COMPLICATIONS
Coronary artery aneurysm; Coronary arteriovenous fistula, CHRONIC HEART DISEASES WITHOUT
I25.4 4,000 1,200 2,800
acquired COMPLICATIONS
J03.0 Streptococcal tonsillitis UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J03.8 Acute tonsillitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Acute tonsillitis, unspecified; Acute tonsillitis NOS; Acute
Follicular tonsillitis; Acute Gangrenous tonsillitis; Acute
J03.9 UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Infective tonsillitis; Acute Ulcerative tonsillitis; Septic
tonsillitis
J06.0 Acute laryngopharyngitis UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Other acute upper respiratory infections of multiple sites

J06.8 UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Acute tonsillopharyngitis
Acute upper respiratory infection, unspecified; Acute upper

J06.9 respiratory disease; Upper respiratory infection NOS UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Upper Respiratory Tract Infection
J20.0 Acute bronchitis due to Mycoplasma pneumoniae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.1 Acute bronchitis due to Haemophilus influenzae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.2 Acute bronchitis due to streptococcus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.3 Acute bronchitis due to coxsackievirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.4 Acute bronchitis due to parainfluenza virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.5 Acute bronchitis due to respiratory syncytial virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.6 Acute bronchitis due to rhinovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.7 Acute bronchitis due to echovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.8 Acute bronchitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.9 Acute bronchitis, unspecified UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Unspecified acute lower respiratory infection; Acute
(lower) respiratory (tract) infection NOS
J22 LOWER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Acute Respiratory Infection
Severe Acute Respiratory Infection
Bronchitis, not specified as acute or chronic; Bronchitis
J40 NOS; Catarrhal Bronchitis; Bronchitis with tracheitis NOS; UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
Trancheobronchitis NOS
Pulpitis; Pulpal abscess; Pulpal polyp; Acute pulpitis;
K04.0 Hyperplastic chronic pulpitis; Ulcerative chronic pulpitis; DENTAL DISORDERS 4,000 1,200 2,800
Supparative pulpitis
K04.1 Necrosis of pulp; Pulpal gangrene DENTAL DISORDERS 4,000 1,200 2,800
Page 125 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
Pulp degeneration; Denticles; Pulpal calcifications; Pulpal
K04.2 DENTAL DISORDERS 4,000 1,200 2,800
stones
Abnormal hard tissue formation in pulp; Secondary or
irregular dentine
Acute apical periodontitis of pulpal origin; Acute apical
periodontitis NOS
Chronic apical periodontitis; Apical or periapical granuloma;
Apical periodontitis NOS
Periapical abscess with sinus; Dental abscess with sinus;
Dentoalveolar abscess with sinus
Periapical abscess without sinus; Dental abscess NOS;
Dentoalveolar abscess NOS; Periapical abscess NOS
Radicular cyst; Periodontal apical cyst; Periapical cyst;
Residual radicular cyst
Other and unspecified diseases of pulp and periapical
tissues
K30 Dyspepsia; Indigestion BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K31.0 Acute dilatation of stomach; Acute distension of stomach BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K31.9 Disease of stomach and duodenum, unspecified BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K59.0 Constipation BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
L02.0 Cutaneous abscess, furuncle and carbuncle of face SKIN INFECTIONS 4,000 1,200 2,800
L02.1 Cutaneous abscess, furuncle and carbuncle of neck SKIN INFECTIONS 4,000 1,200 2,800
Cutaneous abscess, furuncle and carbuncle of trunk;

Cutaneous abscess, furuncle and carbuncle of Abdominal
wall; Cutaneous abscess, furuncle and carbuncle of Back
[any part, except buttock]; Cutaneous abscess, furuncle and
L02.2 SKIN INFECTIONS 4,000 1,200 2,800
carbuncle of Chest wall; Cutaneous abscess, furuncle and
carbuncle of Groin; Cutaneous abscess, furuncle and
carbuncle of Perineum; Cutaneous abscess, furuncle and
carbuncle of Umbilicus
Cutaneous abscess, furuncle and carbuncle of buttock;

L02.3 Cutaneous abscess, furuncle and carbuncle of Gluteal SKIN INFECTIONS 4,000 1,200 2,800
region
Cutaneous abscess, furuncle and carbuncle of limb, Axilla,
Hip & Shoulder
Cutaneous abscess, furuncle and carbuncle of other sites:
Head [any part, except face]; Scalp
Cutaneous abscess, furuncle and carbuncle, unspecified;
Furunculosis NOS
L72.0 Epidermal cyst CUTANEOUS CYSTS 4,000 1,200 2,800
L72.1 Trichilemmal cyst; Pilar cyst; Sebaceous cyst CUTANEOUS CYSTS 4,000 1,200 2,800
L72.2 Steatocystoma multiplex CUTANEOUS CYSTS 4,000 1,200 2,800
L72.8 Other follicular cysts of skin and subcutaneous tissue CUTANEOUS CYSTS 4,000 1,200 2,800
L72.9 Follicular cyst of skin and subcutaneous tissue, unspecified CUTANEOUS CYSTS 4,000 1,200 2,800
Calculus of kidney; Nephrolithiasis NOS; Renal calculus or

N20.0 UROLITHIASIS 4,000 1,200 2,800
stone; Staghorn calculus; Stone in kidney
N20.1 Calculus of ureter; Ureteric stone UROLITHIASIS 4,000 1,200 2,800
N20.2 Calculus of kidney with calculus of ureter UROLITHIASIS 4,000 1,200 2,800
N20.9 Urinary calculus, unspecified; Calculous pyelonephritis UROLITHIASIS 4,000 1,200 2,800
N30.4 Irradiation cystitis IRRADIATION CYSTITIS 4,000 1,200 2,800
O23.1 Infections of bladder in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.2 Infections of urethra in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.4 Unspecified infection of urinary tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.5 Infections of the genital tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
Other and unspecified genitourinary tract infection in

O23.9 URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
pregnancy; Genitourinary tract infection in pregnancy NOS
S00.0 Superficial injury of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800

S00.1 Contusion of eyelid and periocular area; Black eye SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.2 Other superficial injuries of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.3 Superficial injury of nose SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.4 Superficial injury of ear SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.5 Superficial injury of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.7 Multiple superficial injuries of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.8 Superficial injury of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.9 Superficial injury of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.0 Open wound of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.1 Open wound of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.2 Open wound of nose SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.3 Open wound of ear SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.4 Open wound of cheek and temporomandibular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.5 Open wound of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.7 Multiple open wounds of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.8 Open wound of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800
Page 126 of 127

FIRST CASE RATE

Case Rate
Fee Institution Fee
S01.9 Open wound of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
Open wound of finger(s) without damage to nail; Open
S61.0 SUPERFICIAL INJURIES 4,000 1,200 2,800
wound of finger(s) NOS
S61.1 Open wound of finger(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.7 Multiple open wounds of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.8 Open wound of other parts of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.9 Open wound of wrist and hand part, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.0 Open wound of knee SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.7 Multiple open wounds of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.8 Open wound of other parts of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.9 Open wound of lower leg, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S91.0 Open wound of ankle SUPERFICIAL INJURIES 4,000 1,200 2,800
Open wound of toe(s) without damage to nail; open wound
of toe (s) NOS
S91.2 Open wound of toe(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800
Open wound of other parts of foot; open wound of foot
NOS
S91.7 Multiple open wounds of ankle and foot SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.0 Superficial injuries involving head with neck SUPERFICIAL INJURIES 4,000 1,200 2,800
Superficial injuries involving thorax with abdomen lower
T00.1 SUPERFICIAL INJURIES 4,000 1,200 2,800
back and pelvis
Superficial injuries involving multiple regions of upper
limb(s)
Superficial injuries involving multiple regions of lower
limb(s)
Superficial injuries involving multiple regions of upper
limb(s) with lower limb(s)
Superficial injuries involving other combinations of body
regions
Multiple superficial injuries, unspecified; Multiple abrasions

NOS; Multiple nonthermal blisters NOS; Multiple bruises
NOS; Multiple contusions NOS; Multiple haematomas NOS;
Multiple nonvenomous insect bite NOS
50,000 up to
J12.8, B97.2 Middle East Respiratory Syndrome (MERS-CoV) MIDDLE EAST RESPIRATORY SYNDROME
100,000
110,000 up to
A98.4 Ebola Virus Disease (EVD) EBOLA VIRUS DISEASE
222,000
Zika virus disease, unspecified; Zika; Zika virus fever; Zika
U06.9 ZIKA VIRUS DISEASE 8,100 2,430 5,670
virus infection
Page 127 of 127

AnnexA MedicalCaseRates

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List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE

J85.3 Abscess of mediastinum ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000

Viral intestinal infection, unspecified; Viral enteritis NOS;

FIRST CASE RATE

Gastroenteritis and colitis of unspecified origin; Neonatal

Noninfective gastroenteritis and colitis, unspecified;

Acute renal failure with tubular necrosis; Tubular necrosis

Acute renal failure with acute cortical necrosis; Cortical

Renal failure following abortion and ectopic and molar

Adult respiratory distress syndrome; Adult hyaline

Allergy, unspecified; Allergic reaction NOS; Hypersensitivity

Unspecified adverse effect of drug or medicament; Adverse

FIRST CASE RATE

Anaemia due to glucose-6-phosphate dehydrogenase

D57.8 Other sickle-cell disorders ANEMIA 10,000 3,000 7,000

Other haemoglobinopathies; Abnormal haemoglobin NOS;

Other specified hereditary haemolytic anaemias;

Other autoimmune haemolytic anaemias; Autoimmune

FIRST CASE RATE

Haemoglobinuria due to haemolysis from other external

D59.8 Other acquired haemolytic anaemias ANEMIA 10,000 3,000 7,000

Other sideroblastic anaemias; Sideroblastic anaemia NOS;

Other specified anaemias; Infantile pseudoleukaemia;

Other streptococcal arthritis and polyarthritis, Site

FIRST CASE RATE

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis

Idiopathic gout; Gouty bursitis; Primary gout;

Idiopathic gout; Gouty bursitis; Primary gout;

FIRST CASE RATE

Other specified arthritis; Allergic arthritis pelvic region and

Chikungunya virus disease; Chikungunya (haemorrhagic)

Venezuelan equine fever; Venezuelan equine encephalitis;

Other specified arthropod-borne viral fevers; Piry virus

Unspecified arthropod-borne viral fever; Unspecified

M15.4 Erosive (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900

M16.0 Primary coxarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900

FIRST CASE RATE

Other post-traumatic gonarthrosis; Post-traumatic

Other secondary gonarthrosis; Secondary gonarthrosis

FIRST CASE RATE

Dorsalgia, unspecified; Backache NOS sacral and

FIRST CASE RATE

Inflammatory disorders of breast; Acute abscess of non

Infection of nipple associated with childbirth; Gestational

Abscess of breast associated with childbirth; Mammary

L13.9 Bullous disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400

FIRST CASE RATE

FIRST CASE RATE

Frostbite with tissue necrosis of other and unspecified

T21.3 Burn of third degree of trunk BURN C 16,100 4,830 11,270

I49.2 Junctional premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540

Other specified cardiac arrhythmias; Brugada syndrome;

I42.0 Dilated cardiomyopathy; Congestive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380

Endomyocardial (eosinophilic) disease; Endomyocardial

I42.4 Endocardial fibroelastosis; Congenital cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380

I42.8 Other cardiomyopathies CARDIOMYOPATHY 13,400 4,020 9,380

Cellulitis of finger and toe; Infection of nail; Onychia;

FIRST CASE RATE

Primary biliary cirrhosis; Chronic nonsupparative

Acute cholecystitis; Abscess of gallbladder without calculus;

K81.1 Chronic cholecystitis CHOLECYSTITIS 11,300 3,390 7,910