PMJAY RatesNew

Cluster - 1 BURNS AND PLASTIC SURGERY
No of Specialt Procedure Govern

Packa Sub Pre-Operative Post Operative Package
Procedure Name Follow Remarks y Code Code ment
ge No Specialty Investigation Investigation Rates
up PMJAY PMJAY Reserve
20% burns or scalds/burns over face (with

1.1 Burns Clinical Photograph Clinical Photograph 3 23000 S11 S1112001 No
or without grafting)
1.2 Burns Up to 30% (with grafting) Clinical Photograph Clinical Photograph 3 34500 S11 S1112002 No
upto-40% with Scalds (Conservative/

without grafting)
1.4 Burns upto-40% Mixed Burns (with grafting) Clinical Photograph Clinical Photograph 3 40250 S11 S1100002 No
1.5 Burns upto-50% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 28750 S11 S1112004 No
upto-50% Mixed Burns (with surgery

grafting)
1.7 Burns upto-60% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 46000 S11 No
1.8 Burns Up to-60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 57500 S11 S1100003 No
1.9 Burns Above 60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 63250 S11 S1100004 No
Post Burn Contracture surgeries for

Functional Improvement(Package including
splints, pressure garments and
physiotherapy), Mild
physiotherapy), Moderate

physiotherapy), Severe
Reconstructive lower limb surgery

Plastic following infection, Trauma, Tumors /
1.13 Clinical photograph Clinical photograph 4 48300 S10 S1012001 No
Surgery Malignancy, Developmental including
diabetic foot – SEVERE
Plastic Abdominal wall reconstruction including
Surgery post cancer excision.
Reconstructive Micro surgery Replantation
Plastic
1.15 of hand, finger, thumb, arm, scalp etc (Per Clinical photograph Clinical photograph 4 57500 S10 S1012003 No
Surgery
finger 15000)
Plastic Reconstructive Micro surgery B) free tissue
Surgery transfer
Plastic
1.17 Flap surgeries b) myocutaneous flap Clinical photograph Clinical photograph 4 40250 S10 S1012005 No
Surgery
Plastic
1.18 Flap surgeries c) osteo myocutaneous flap Clinical photograph Clinical photograph 4 40250 S10 S1012006 No
Surgery
Plastic
1.19 operation for vascularmalformation Clinical photograph Clinical photograph 4 34500 S10 S1012007 No
Surgery
Governm
Plastic
1.20 Ear Reconstruction for Microtia (stage-I) Clinical photograph Clinical photograph 4 28750 ent S10 S1012008 Yes
Surgery
Reserve
Governm
Plastic
1.21 Ear Reconstruction for Microtia (stage-II) Clinical photograph Clinical photograph 4 34500 ent S10 S1012009 Yes
Surgery
Reserve
Governm
Plastic
1.22 Ear Reconstruction for Microtia (stage-III) Clinical photograph Clinical photograph 4 40250 ent S10 S1012010 Yes
Surgery
Reserve
Governm
PLASTIC Corrective Surgery for Congenital
1.23 Clinical photograph Clinical photograph 4 20000 ent S10 S1012011 Yes
REPAIR deformity of Upper Limb (Per Procedure)
Reserve
PLASTIC
1.24 Corrective Surgery for Craniosynostosis Clinical photograph Clinical photograph 4 50000 S10 S1012012 No
REPAIR
% Total Body Surface Area Burns (TBSA) Clinical photograph and

Burns/Pl
(thermal/ scald/ flame burns) - any % (not diagram with Rule of 9/
1.25 astic Clinical photograph 2 7000 S11 S1100001 No
requiring admission). Needs at least 5-6 L & B Chart for extent
Surgery
dressing of burns
Electrical contact burns: Low voltage-

without part of limb/limb loss; Includes %
Clinical photograph and
Burns/Pl TBSA skin grafted, flap cover, follow-up
diagram with Rule of 9/
1.29 astic dressings etc. as deemed necessary; Clinical photograph 2 30000 S11 S1100005 No
L & B Chart for extent
Surgery Surgical procedures are required for deep
of burns
burns that are not amenable to heal with
dressings alone.
Electrical contact burns: Low voltage- with

part of limb/limb loss; Includes % TBSA skin Clinical photograph and
Burns/Pl
grafted, flap cover, follow-up dressings etc. diagram with Rule of 9/
as deemed necessary; Surgical procedures L & B Chart for extent
Surgery
are required for deep burns that are not of burns
amenable to heal with dressings alone.
Electrical contact burns: High voltage-

without part of limb/limb loss; Includes %
of burns
dressings alone.
Electrical contact burns: High voltage- with

part of limb/limb loss; Includes % TBSA skin Clinical photograph and
Burns/Pl
grafted, flap cover, follow-up dressings etc. diagram with Rule of 9/
as deemed necessary; Surgical procedures L & B Chart for extent
Surgery
are required for deep burns that are not of burns
amenable to heal with dressings alone.
Chemical burns: Without significant facial

scarring and/or loss of function; Includes %
of burns
dressings alone.
Chemical burns: With significant facial

scarring and/or loss of function; Includes %
of burns
dressings alone.
Plastic
1.35 Hemangioma – Sclerotherapy (under GA) Doppler/ MRI Clinical Photo 2 35000 S10 S1000003 No
Surgery
Plastic
1.36 Hemangioma – Debulking/ Excision MRI Clinical Photo 2 35000 S10 S1000004 No
Surgery
Tissue Expander for disfigurement
Plastic following burns/ trauma/ congenital
1.37 Clinical Photo Clinical Photo 2 50000 S10 S1000005 No
Surgery deformity (including cost of expander /
implant)
Plastic
1.38 Scalp avulsion reconstruction Clinical Photo Clinical Photo 2 50000 S10 S1000006 No
Surgery
Plastic NPWT (Inpatient only)(Per day Packege
1.39 Clinical Photo Clinical Photo 2 2000 per day S10 S1000007 No
Surgery Amount)
Plastic
1.40 Pressure Sore – Surgery Clinical Photo Clinical Photo 2 30000 S10 S1000008 No
Surgery
Burns/Pl Unspecified Surgical Package (Amount

Concern
1.41 astic Capped @ 1,00,000rs per anum for Concern Investigation 1 100000 S11 U100 No
Investigation
Surgery family,Package amount is Negotiable)
Cluster - 2 CARDIOLOGY
Intervent
ion
2.1 CAG (Coronary Angiography) 2D ECHO - 0 4025 S12 S1212001 No
Cardiolo
gy
Intervent
ion
2.2 Peripheral/ Renal Angiography 2D ECHO - 0 4025 S12 S1212002 No
Cardiolo
gy
Intervent
ion
2.3 Coronary Ballon Angioplasty CAG - 5 24150 S12 S1212003 No
Cardiolo
gy
Intervent
ion
2.4 Cath with Oxymetry 2D ECHO - 0 5520 S12 S1212004 No
Cardiolo
gy
Intervent
ion
2.5 Cath without Oxymetry 2D ECHO - 0 4428 S12 S1212005 No
Cardiolo
gy
Intervent
ion
2.6 Check Angiography 2D ECHO - 0 3335 S12 S1212006 No
Cardiolo
gy
Intervent
ion Coronary Angiography + Peripheral/ Renal
2.7 2D ECHO - 0 4025 S12 S1212007 No
Cardiolo Angiography
gy
2.10 has
been
modified
Cardiolo Renal/ Carotid /Peripheral Ballon Plasty tthen 2.8
2.10 PAG - 5 23000 S12 S1212008 No
gy (Unilateral) & 2.9 can
be
included
in 2.10
Rare case
cover
stent may
Intervent
be
ion
2.11 Aortic Stenting PAG - 5 60000 permitted S12 S1212009 No
Cardiolo
after
gy
special
permissio
n
Intervent
ion
2.12 Ballon Atrial Septectomy – BAS 2D ECHO - 1 16100 S12 S1200001 No
Cardiolo
gy
Intervent Different
ion size and
2.13 IVC filter - - 1 50000 S12 S1212010 No
Cardiolo types of
gy filter
Intervent Bi-Ventricular
ion Pacing - CRT Report,
2.14 Bi Ventricular Pacing - CRT ECG, ECHO, CAG 1 290000 S12 S1212011 No
Cardiolo ECG, ECHO, X-Ray
gy Chest
After
AICD- Automatic special
Intervent
Implantable cardiac Permissio
2.15 ion AICD - Automatic Implantable Cardiac
ECG, ECHO, CAG Defibrillator (with 1 310000 n in very S12 S1212012 No
A Cardiolo Defibrillator (with device Single Chamber)
device) report, ECG, Rare
gy
ECHO,X-Ray Chest Case,as
life saving
After
AICD- Automatic special
Intervent
Implantable cardiac Permissio
2.15 ion AICD - Automatic Implantable Cardiac
ECG, ECHO, CAG Defibrillator (with 1 412000 n in very S12 S1212013 No
B Cardiolo Defibrillator (with device Double Chamber)
device) report, ECG, Rare
gy
ECHO, X-Ray Chest Case,as
life saving
After
Combo: AICD+Bi
Intervent specialPer
ventricular
ion Combo: AICD+Bi ventricular pacemaker mission in
2.16 ECG, ECHO pacemaker (with 1 597000 S12 S1212014 No
Cardiolo (with device) very Rare
device) report, ECG,
gy Case,as
ECHO, X-Ray Chest
life saving
Intervent
ion
2.17 PTCA - one stent (non-medicated) CAG X-Ray 5 62100 S12 S1212015 No
Cardiolo
gy
Intervent
ion
2.18 PTCA - 2 stent (non-medicated) CAG X-Ray 5 85100 S12 S1212016 No
Cardiolo
gy
Intervent
ion
2.19 Balloon Mitral Valvotomy – BMV 2D ECHO 2D ECHO 1 20000 S12 S1200003 No
Cardiolo
gy
Intervent
ion
2.20 Coarctation dilatation – BDC 2D ECHO 2D ECHO, x-RAY 1 16000 S12 S1200012 No
Cardiolo
gy
Intervent
ion
2.21 Balloon Pulmonary Valvotomy – BPV 2D ECHO 2D ECHO 1 16100 S12 S1200004 No
Cardiolo
gy
Intervent
ion
2.22 Balloon Aortic Valvotomy – BAV 2D ECHO 2D ECHO 1 16100 S12 S1200002 No
Cardiolo
gy
Intervent
ion
2.23 Peripheral Angioplasty withstent 2D ECHO , ANGIOGRAM DOPPLER 5 50000 S12 S1212017 No
Cardiolo
gy
Intervent
ion
2.24 Renal Angioplasty withstent ANGIOGRAM DOPPLER , X-RAY 5 55000 S12 S1200008 No
Cardiolo
gy
Intervent
ion Both side renal Angioplasty withstent (non-
2.25 ANGIOGRAM DOPPLER , X-RAY 5 80000 S12 S1212018 No
Cardiolo medicated)
gy
Intervent
ion
2.26 Vertebral Angioplasty with stent ANGIOGRAM DOPPLER 5 55000 S12 S1200005 No
Cardiolo
gy
Intervent
ion
2.27 Temporary Pacemaker implantation CAG , ECG ECHO , X-RAY 0 4600 S12 S1200021 No
Cardiolo
gy
Intervent
ion Permanent pacemaker implantation (only
2.28 CAG , ECG ECHO , X-RAY 1 63250 S12 S1212019 No
Cardiolo VVI) including Pacemaker value
gy
Intervent
ion
2.29 Pericardiocentesis 2D ECHO 2D ECHO 1 3450 S12 S1200020 No
Cardiolo
gy
Intervent
ion
2.30 PDA Device Closure 2D ECHO 2D ECHO 1 50000 S12 S1200016 No
Cardiolo
gy
Intervent
ion
2.31 ASD Device Closure 2D ECHO 2D ECHO , X-RAY 1 92000 S12 S1200014 No
Cardiolo
gy
Intervent
ion
2.32 VSD Device Closure 2D ECHO 2D ECHO , X-RAY 1 92000 S12 S1200015 No
Cardiolo
gy
Intervent
ion
2.33 PDA Coil (one) insertion 2D ECHO 2D ECHO , X-RAY 1 13800 S12 S1200018 No
Cardiolo
gy
Intervent
ion
2.34 PDA Multiple coil insertion 2D ECHO 2D ECHO , X-RAY 1 23000 S12 S1200017 No
Cardiolo
gy
Intervent
ion
2.35 IVUS angiogram IVUS report 0 4600 S12 S1212020 No
Cardiolo
gy
Intervent
ion
2.36 EP study ECG, 2D Echo Clinical Photograph 0 11308 S12 S1212021 No
Cardiolo
gy
Intervent
ion
2.37 RF Ablation ECG, 2D Echo Clinical Photograph 1 16100 S12 S1212022 No
Cardiolo
gy
Intervent
ion
2.38 3D Maping + Ablation ECG, 2D Echo Clinical Photograph 1 27313 S12 S1212023 No
Cardiolo
gy
Cardiolo Medical treatment of Acute MI with 2D ECHO, CPKMB, ECG, 2D ECHO, ECG, LAB
2.39 1 17250 S12 S1200013 No
gy Thrombolysis TROPONINE-T INVESTIGATION
Cardiolo
2.40 Thrombolysis for peripheral ischemia ECG, 2D Echo 0 1 11500 S12 S1200034 No
gy
Intervent
ion
2.41 Rotablation+ PTCA CAG X-Ray 5 34500 S12 S1200031 No
Cardiolo
gy
Intervent
ion
2.42 Rotablation+ PTCA+ Stent X-Ray 5 80500 S12 S1200032 No
Cardiolo
gy
Intervent
ion
2.43 Coiling (Coil clouser) 2D ECHO 2D ECHO,X-ray 5 20000 S12 S1212024 No
Cardiolo
gy
Intervent
ion
2.44 Post mi vsd closure 2D ECHO,ECG 2D ECHO,X-ray 5 92000 S12 S1212025 No
Cardiolo
gy
Indication
for DES
1)Diabete
s
2)Lesion
>18 mm
in length
3)vessel
Intervent <2.5 mm
ion in
2.45 PTCA - one stent (medicated) CAG X-ray 5 72000 S12 S1200024 No
Cardiolo diametre
gy 4)ISR (In
Stent
Restenosi
s)
5)Bifurcat
ion or
Osteal
Lesion
Indication
for DES
1)Diabete
s
2)Lesion
>18 mm
in length
3)vessel
Intervent <2.5 mm
ion in
2.46 PTCA - 2 stent (medicated) CAG X-ray 5 100000 S12 S1200025 No
Cardiolo diametre
gy 4)ISR (In
Stent
Restenosi
s)
5)Bifurcat
ion or
Osteal
Lesion
Intervent
ion PTCA - Additional Stent (Mediated)
2.60 28000
Cardiolo (Additional for more than 2 stent)
gy
Intervent
ion
2.47 IABP 2D Echo 2D Echo 0 15000 S12 S1212026 No
Cardiolo
gy
Cardiolo 2D ECHO,Angiogram
2.48 PDA stenting 2 40000 S12 S1200019 No
gy report & stills
Cardiolo
2.49 PTSMA CAG X-Ray 2 25000 S12 S1200027 No
gy
Cardiolo
2.50 Pulmonary artery stenting CAG X-Ray 2 40000 S12 S1200028 No
gy
Cardiolo
2.51 Pulmonary artery stenting (double) CAG X-Ray 2 65000 S12 S1200029 No
gy
Cardiolo Right ventricular outflow tract (RVOT)
2.52 CAG X-Ray 2 40000 S12 S1200030 No
gy stenting
Chest x-Ray/CT Chest x-Ray/CT
Cardiolo Bronchial artery Embolisation (for
2.53 Scan,Serum Scan,Hb,Serum 2 25000 S12 S1200035 No
gy Haemoptysis)
Creatinine,HB Creatinine
Cardiolo Percutaneous Transluminal Tricuspid
2.54 2D ECHO 2D ECHO 2 25000 S12 S1200036 No
gy Commissurotormy (PTTC)
CT,Serum
CT,Serum Creatinine,PT(Proth
Cardiolo Creatinine,PT(Prothrom rombin
2.55 Coiling - Pseudoaneurysms of Abdomen 2 55000 S12 S1200037 No
gy bin Time),International Time),International
normalized ratio (INR) normalized ratio
(INR)
CT,Serum
CT,Serum Creatinine,PT(Proth
Cardiolo Embolization - Arteriovenous Creatinine,PT(Prothrom rombin
2.56 2 40000 S12 S1200038 No
gy Malformation (AVM) in the Limbs bin Time),International Time),International
normalized ratio (INR) normalized ratio
(INR),HB
Catheter directed Thrombolysis for: Deep
Cardiolo
2.57 vein thrombosis (DVT), Mesenteric PT,S.Creatinine ,CT/MRI PT,S.Creatinine 2 50000 S12 S1200039 No
gy
Thrombosis & Peripheral vessels
X Ray,MRI of
shoulder,Carton of
Cardiolo Angiogram report & film the stent used
2.59 Carotid angioplasty with stent (medicated) 2 60000 S12 S1200007 No
gy showing the lesion approved by
FDA/DCGI
only,Doppler Report
Unspecified Surgical Package (Amount

Cardiolo Concern
2.58 Capped @ 1,00,000rs per anum per Concern Investigation 1 1,00,000 S12 U100 No
gy Investigation
family,Package amount is Negotiable)
Cluster - 3 CARDIO THORACIC & VASCULAR SURGERY

3.1 Cardiac CABG CAG Clinical Photograph 5 78200 S13 S1300001 No
3.2 Cardiac Re DO CABG CAG Clinical Photograph 5 83375 S13 S1312001 No
3.3 Cardiac CABG with IABP 2D ECHO , CAG Clinical Photograph 5 93200 S13 S1312002 No
3.4 Cardiac CABG with Aneurismal repair CAG Clinical Photograph 5 96025 S13 S1312003 No
3.5 Cardiac CABG with MV repair 2D ECHO , CAG Clinical Photograph 5 97750 S13 S1312004 No
3.6 Cardiac CABG with post MI VSD repair 2D ECHO , CAG Clinical Photograph 5 99475 S13 No
3.7 Cardiac Open Mitral Valvotomy 2D ECHO 2D ECHO 5 78200 S13 S1300008 No
3.8 Cardiac Open Aortic Valvotomy 2D ECHO 2D ECHO , X-RAY 5 78200 S13 S1312005 No
3.9 Cardiac Open Pulmonary Valvotomy 2D ECHO 2D ECHO 5 80500 S13 S1300010 No
3.10 Cardiac Mitral Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300011 No
3.11 Cardiac Tricuspid Valve Repair 2D ECHO 2D ECHO , X-RAY 5 92000 S13 S1300012 No
Mitral Valve Repair + Tricuspid Valve
3.12 Cardiac 2D ECHO 2D ECHO , X-RAY 5 119600 S13 S1312006 No
Repair
3.13 Cardiac Aortic Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300013 No
Bioprosth
etic Valve
in special
case like
,during
3.14 Cardiac Mitral Valve Replacement 2D ECHO 2D ECHO , X-RAY 5 120750 pregnenc S13 S1312007 No
y
,Expectin
g Woman
,Old Age
>70 yrs
Bioprosth
etic Valve
in special
case like
,during
3.15 Cardiac Aortic Valve Replacement 2D ECHO 3D ECHO , X-RAY 5 128800 pregnenc S13 S1312008 No
y
,Expectin
g Woman
,Old Age
>70 yrs
3.16 Cardiac Double Valve Replacement 2D ECHO 5D ECHO , X-RAY 5 152950 S13 S1312009 No
3.17 Cardiac Ross Procedure 2D ECHO 2D ECHO , X-RAY 5 120000 S13 S1300023 No
3.18 Cardiac ASD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300024 No
3.19 Cardiac VSD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300025 No
3.20 Cardiac AVSD/ AV Canal Defect 2D ECHO 2D ECHO , X-RAY 2 90850 S13 S1300026 No
3.21 Cardiac ICR for TOF 2D ECHO 2D ECHO , X-RAY 5 95000 S13 S1300027 No
2D ECHO, X-RAY,
3.22 Cardiac Pulmonary Valvotomy + RVOT Resection 2D ECHO 5 90850 S13 S1300028 No
clinical photograph
2D ECHO, X-RAY,
3.23 Cardiac AP Window 2D ECHO 2 57500 S13 S1300029 No
clinical photograph
2D ECHO, X-RAY,
3.24 Cardiac Surgery for HOCM 2D ECHO/TEE 2 90850 S13 S1300030 No
clinical photograph
2D ECHO, X-RAY,
3.25 Cardiac Ebsteins 2D ECHO 2 90850 S13 S1300031 No
clinical photograph
2D ECHO, X-RAY,
3.26 Cardiac Fontan 2D ECHO 2 90850 S13 S1300032 No
clinical photograph
2D ECHO , clinical
3.27 Cardiac TAPVC 2D ECHO 2 90850 S13 S1300033 No
photograph
2D ECHO , X-RAY,
3.28 Cardiac Pulmonary Atresia with or without VSD 2D ECHO 2 97750 S13 S1312010 No
clinical photograph
2D ECHO , X-RAY,
3.29 Cardiac TGA 2D ECHO/Angio 2 97750 S13 S1312011 No
clinical photograph
2D ECHO , X-RAY,
3.30 Cardiac Arterial Switch Operation 2D ECHO/Angio 2 86250 S13 S1300035 No
clinical photograph
3.31 Cardiac ALCAPA - - 2 86250 S13 No
2D ECHO , X-RAY,
3.32 Cardiac Sennings 2D ECHO/Angio 2 74750 S13 S1300037 No
clinical photograph
2D ECHO , X-RAY,
3.33 Cardiac Mustards 2D ECHO 2 86250 S13 S1300038 No
clinical photograph
2D ECHO , X-RAY,
3.34 Cardiac Pulmonary Conduit 2D ECHO 2 105000 S13 S1312013 No
clinical photograph
2D ECHO , X-RAY,
3.35 Cardiac Truncus Arteriosus Surgery 2D ECHO 2 97750 S13 S1300039 No
clinical photograph
Root Replacement (Aortic Aneurysm/ 2D ECHO , X-RAY,

3.36 Cardiac 2D ECHO 2 130000 S13 S1300040 No
Aortic Dissection) / Bental Procedure clinical photograph
2D ECHO , X-RAY,
3.37 Cardiac Aortic Arch Replacement 2D ECHO 2 38065 S13 S1300041 No
clinical photograph
2D ECHO , X-RAY,
3.38 Cardiac Aortic Aneurysm Repair using CPB 2D ECHO 2 125000 S13 S1300042 No
clinical photograph
2D ECHO , X-RAY,
3.39 Cardiac Aortic Aneurysm Repair without using CPB 2D ECHO 2 65000 S13 S1300043 No
clinical photograph
2D ECHO , X-RAY,
3.40 Cardiac Pulmonary Embolectomy / Endarterectomy ABG, 2D ECHO, X-Ray 2 92000 S13 S1312014 No
clinical photograph
Surgery for Cardiac Tumour/ LA Myxoma/ 2D ECHO , X-RAY,

3.41 Cardiac 2D ECHO 2 96600 S13 S1300045 No
RA Myxoma clinical photograph
3.42 Cardiac Closed Mitral Valvotomy 2D ECHO 2D ECHO , X-RAY 2 23000 S13 S1300009 No
3.43 Cardiac PDA Closure 2D ECHO 2D ECHO , X-RAY 5 23000 S13 S1300046 No
3.44 Cardiac Coarctation Repair 2D ECHO, CAG Doppler 2 28750 S13 S1300047 No
3.45 Cardiac Coarctation Repair with graft 2D ECHO, CAG Doppler 2 36800 S13 S1300048 No
3.46 Cardiac BT Shunt (inclusives of grafts) 2D ECHO 2D ECHO, x-RAY 2 42000 S13 S1300049 No
3.47 Cardiac Glenn Shunt 2D ECHO 2D ECHO, x-RAY 2 57500 S13 S1300050 No
3.48 Cardiac Central Shunt 2D ECHO 2D ECHO, x-RAY 2 42000 S13 S1300051 No
3.49 Cardiac Aortic arch Anamolies 2D ECHO 2D ECHO, x-RAY 2 57500 S13 S1312016 No
3.50 Cardiac Pericardiectomy 2D ECHO 2D ECHO , X-RAY 2 34500 S13 S1300052 No
3.51 Cardiac Thoracoscopic surgery CT Chest X-Ray 2 40250 S13 S1312017 No
3.52 Cardiac Surgery without CPB CT Chest X-Ray 2 57500 S13 S1312018 No
3.53 Cardiac Surgery with CPB CT Chest X-Ray 2 57500 S13 S1312019 No
Clinical Photograph
3.54 Thoracic Lobectomy CT-Chest , X-RAY 2 34500 S13 S1312020 No
, X-RAY
Clinical Photograph
3.55 Thoracic Pneumonectomy CT-Chest , X-RAY 2 46000 S13 S1312021 No
, X-RAY
Clinical Photograph
3.56 Thoracic Pleurectomy CT-Chest , X-RAY 2 46000 S13 S1312022 No
, X-RAY
X-RAY,Biopsy , CT/ PET Biopsy , Clinical

3.57 Thoracic Decortication 1 51750 S13 S1312023 No
scan Photograph , X-RAY
Clinical Photograph
3.58 Thoracic Mediastinotomy CT-Chest , X-RAY 2 28750 S13 S1312024 No
, X-RAY
Biopsy , Clinical
3.59 Thoracic Pulmonary AV Fistula surgery Biopsy , CT , X-RAY 2 23000 S13 S1300053 No
Photograph , X-RAY
Clinical Photograph
3.60 Thoracic Lung Cyst CT-Chest , X-RAY 2 34500 S13 S1300054 No
, X-RAY
Clinical Photograph
3.61 Thoracic SOL mediastinum CT-Chest , X-RAY 2 51750 S13 S1300055 No
, X-RAY
Surgical Correction of Bronchopleural Biopsy , Clinical

3.62 Thoracic Biopsy , CT , X-RAY 2 35000 S13 S1512026 No
Fistula. Photograph , X-RAY
3.63 Thoracic Diaphragmatic Eventeration Barium Study, CT SCAN USG 2 46000 S13 S1300057 No
BArium Study, X-RAY, BIOPSY, CLINICAL

3.64 Thoracic Diaphragmatic Hernia 2 40000 S13 S1312025 No
ENDOSCOPY/ USG PHOTOGRAPH
3.65 Thoracic Oesophageal Diverticula /Achalasia Cardia Barium Study, CT SCAN USG 2 23000 S13 S1300058 No
Clinical Photograph
3.66 Thoracic Diaphragmatic Injuries CT-Chest , X-RAY 2 23000 S13 S1300059 No
, X-RAY
Thoracotomy, Thoraco Abdominal Clinical Photograph

3.67 Thoracic CT-Chest , X-RAY 2 34500 S13 S1300060 No
Approach , X-RAY
post ix-
CT-Chest , ENDOSCOPY endoscop
3.68 Thoracic Foreign Body Removal with scope 2 11500 S13 S1300061 No
BRONCHOSCOPY PICTURE y or ct
chest
post ix-
Bronchial Repair Surgery for Injuries due to CT-Chest , ENDOSCOPY endoscop
3.69 Thoracic 2 28750 S13 S1300062 No
FB BRONCHOSCOPY PICTURE y or ct
chest
post ix-
Gastro StudyFollowed by Thoracotomy &
ENDOSCOPY endoscop
3.70 Thoracic Repairs for Oesophageal Injury for GASTROSCOPY 2 16100 S13 S1312026 No
PICTURE y or ct
Corrosive Injuries/FB
thorax
ENDOSCOPY, X-RAY, Biopsy , Clinical

3.71 Thoracic Oesophageal tumour removal 2 28750 S13 S1312027 No
BARIUM STUDY Photograph , USG
Biopsy , CT , Endoscopy Biopsy , Clinical
3.72 Thoracic Oesophagectomy 2 34500 S13 S1312028 No
, USG Photograph , USG
Clinical Photograph
3.73 Thoracic Lung Injury repair CT-Chest , X-RAY 2 23000 S13 S1300063 No
, X-RAY
Clinical Photograph
3.74 Thoracic Diaphragmatic injury repair CT-Chest , X-RAY 2 28750 S13 S1312029 No
, X-RAY
Clinical Photograph
3.75 Thoracic Thyomectomy CT-Chest , X-RAY 2 28750 S13 S1300064 No
, X-RAY
3.76 Cardiac CABG with Post MI Cardiac repair CAG, 2D Echo,ECG 2D Echo, X-ray 5 100000 S13 S1312030 No
3.77 Cardiac Tricuspid valve replacement 2D Echo 2D Echo, X-ray 5 115000 S13 S1312031 No
2D Echo, X-
3.78 Cardiac Root enlargement with/ without graft 2D Echo ray,Clinical 5 90000 S13 S1312032 No
Photograph
3.79 Cardiac ICR 2D Echo 2D Echo, X-ray 5 90000 S13 S1312033 No
2D ECHO, X-Ray,
3.80 Cardiac Double Switch Operation 2D ECHO 2 120000 S13 S1300036 No
Clinical Photograph
3.81 Cardiac Pulmonary Valve Replacement 2D ECHO Scar Photo,ECHO 2 120000 S13 S1300065 No
Intercostal Drainage and Management of
Post Op X-ray / CT
3.82 Cardiac ICD, Intercostal Block, Antibiotics & Post Op X-ray / CT Scan 2 10000 S13 S1300066 No
Scan,Scar Photo
Physiotherapy
Encysted Empyema/Pleural Effusion - Post Op X-ray / CT
3.83 Cardiac Post Op X-ray / CT Scan 2 10000 S13 S1300067 No
Tubercular Scan,Scar Photo
First rib Excision by transaxillary approach,
Post Op X-ray / CT
3.84 Cardiac Excision of cervical rib / fibrous band / Post Op X-ray / CT Scan 2 30000 S13 S1300068 No
Scan,Scar Photo
muscle by cervical approach
Post Op X-ray / CT
3.85 Cardiac Congenital Cystic Lesions Post Op X-ray / CT Scan 2 30000 S13 S1300069 No
Scan,Scar Photo
Post Op X-ray / CT
3.86 Cardiac Pulmonary Sequestration Resection Post Op X-ray / CT Scan 2 40000 S13 S1300070 No
Scan,Scar Photo
Post Op X-ray / CT
3.87 Cardiac Pulmonary artero venous malformation Post Op X-ray / CT Scan 2 40000 S13 S1300071 No
Scan,Scar Photo
THORACI CLINICAL CLINICAL Governm
8.84 C THORACOPLASTY PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 34500 ent S13 S612032 Yes
SURGERY CT SCAN THORAX RAY Reserve
Angiogram report,
4.1 Vascular Patch Graft Angioplasty Regional angiogram 5 18400 S13 S1312034 No
clinical Photograph
Femoropopliteal by pass procedure with
4.2 Vascular ANGIO Doppler 5 51750 S13 S1312035 No
graft (inclu. Graft)
4.3 Vascular Thromboembolectomy ANGIO Color Doppler 5 20700 S13 S1312036 No
Surgery for Arterial Aneursysm -Distal Angiogram/spiral CT

4.4 Vascular Color Doppler 5 65000 S13 S1312037 No
Abdominal Aorta Angiogram
Surgery for Arterial Aneursysm -Upper Angiogram/spiral CT
Abdominal Aorta Angiogram
Angiogram/spiral CT
4.6 Vascular Surgery for Arterial Aneursysm –Vertebral Color Doppler 5 23000 S13 S1312039 No
Angiogram
Dissecting Aneurysms with CPB (inclu.
4.9 Vascular CT-Angio , Cath DOPPLER 5 94300 S13 S1312040 No
Graft)
Dissecting Aneurysms without CPB (incl.
4.10 Vascular CT-Angio , Cath DOPPLER 5 86250 S13 S1312041 No
graft)
color
4.11 Vascular Vascular Procedure – Major Vessels Color Doppler 5 23000 S13 S1312042 No
Doppler/Angiogram
color
4.12 Vascular Vascular Procedure – Minor Vessels Color Doppler 5 20000 S13 S1312043 No
Doppler/Angiogram
Renal arterial
4.13 Vascular Surgery for Arterial Aneurysm Renal Artery Clinical Photograph 5 17250 S13 S1300076 No
Doppler,angiogram
4.14 Vascular Surgery for Arterial Aneurysm Carotid Carotid Doppler Clinical Photograph 5 17250 S13 S1312044 No
Surgery for Arterial Aneursysm Main

4.15 Vascular Peripheral Doppler Clinical Photograph 5 17250 S13 S1312045 No
Arteries of the Limb
Operations for Acquired Arteriovenous
4.16 Vascular regional Angiogram Clinical Photograph 5 11500 S13 S1312046 No
Fistual
4.17 Vascular Congenital Arterio Venous Fistula regional Angiogram Clinical Photograph 5 17250 S13 S1300077 No
Renal arterial
4.18 Vascular Operations for Stenosis of Renal Arteries Clinical Photograph 5 23000 S13 S1300078 No
Doppler,angiogram
Angiogram/spiral CT
4.19 Vascular Peripheral Embolectomy without graft Color Doppler 5 17250 S13 S1312047 No
Angiogram
Aorto Billiac / Bifemoral bypass with Angiogram/spiral CT
Synthetic Graft Angiogram
Axillo bifemoral bypass with Synthetic Angiogram/spiral CT
Graft Angiogram
Angiogram/spiral CT
4.22 Vascular Femoro Distal Bypass with Vein Graft Color Doppler 5 57500 S13 S1300080 No
Angiogram
Angiogram/spiral CT
4.23 Vascular Femoro Distal Bypass with Synthetic Graft Color Doppler 5 70000 S13 S1300081 No
Angiogram
Axillo Brachial Bypass using with Synthetic Angiogram/spiral CT
Graft Angiogram
Brachio - Radial Bypass with Synthetic Angiogram/spiral CT
Graft Angiogram
Excision of Carotid body Tumor with Angiogram/spiral CT
vascular repair Angiogram
Angiogram/spiral CT
4.27 Vascular Carotid artery bypass with Synthetic Graft Color Doppler 5 69000 S13 S1300085 No
Angiogram
Excision of Arterio Venous malformation – Spiral CT Angiogram
Large /MRI Angiogram
Excision of Arterio Venous malformation – Spiral CT Angiogram

Small /MRI Angiogram
Angiogram/colour Color
4.30 Vascular Arterial Embolectomy 5 17250 S13 S1312049 No
Doppler Doppler/SBP/PVR
Plain X-ray
4.31 Vascular D V T - IVC Filter color Doppler 5 28750 S13 S1300088 No
abdomen
Angiogram/Spiral CT
4.32 Vascular Vascular Tumors Color Doppler 5 46000 S13 S1312050 No
Angiogram
Angiogram/Spiral CT
4.33 Vascular Small Arterial Aneurysms – Repair Color Doppler 5 11500 S13 S1312051 No
Angiogram
Angiogram/Spiral CT
4.34 Vascular Medium size arterial aneurysms – Repair Color Doppler 5 17250 S13 S1312052 No
Angiogram
Medium size arterial aneurysms with Angiogram/Spiral CT
synthetic graft Angiogram
4.36 Vascular Carotid endarterectomy ANGIOGRAM X-RAY/DOPPLER 5 28750 S13 S1300089 No
Intrathoracic Aneurysm-Aneurysm not

4.37 Vascular CT Angio, CATH Doppler 2 74750 S13 S1300074 No
Requiring Bypass Techniques
Intrathoracic Aneurysm-Requiring Bypass
4.38 Vascular CT Angio, CATH Doppler 2 86250 S13 S1300075 No
Techniques
Angioplasty stills
Aortic Angioplasty with two stents / Iliac showing Balloon &
4.39 Vascular PAG 2 90000 S13 S1300090 No
angioplasty with stent Bilateral post flow,Scar
Photo
Duplex
4.40 Vascular Bilateral thrombo embolectomy ultrasound/Angiogram - Scar Photo 2 30000 S13 S1300091 No
pre or intra operative
Angiogram/ Computed
Tomography Duplex
Aorto-uni-iliac/uni-femoral bypass with
4.41 Vascular Angiography (3D- ultrasound,Scar 2 70000 S13 S1300092 No
synthetic graft
CTA)/Magnetic Photo
Resonance Angiography

Concern
4.42 Vascular Capped @ 1,00,000rs per anum per Concern Investigation 1 1,00,000 S13 U100 No
Investigation
Cluster - 5 GENITO URINARY SURGERY (RENAL)

Procedure name Follow Remarks y Code Code ment
ge no Specialty Investigation Investigation Rates
Clinical Photograph
5.1 Urology Open Pyelolithotomy IVP , KUB , USG , USG , X-RAY, urine 2 15000 S7 S700028 No
analysis
Clinical Photograph
5.2 Urology Open Nephrolithotomy IVP , KUB , USG , USG , X-RAY, urine 2 15000 S7 S700030 No
analysis
Clinical Photograph
5.3 Urology Open Cystolithotomy IVP , KUB , USG 2 10000 S7 No
, USG , X-RAY
Clinical Photograph
5.4 Urology VVF Repair IVP , KUB , USG , USG , voiding 3 23000 S7 S712001 No
cystogram
Clinical Photograph
5.5 Urology Pyeloplasty IVP , KUB , USG , IVP/DTPA renal 3 23000 S7 S700016 No
scan
Clinical Photograph
5.6 Urology Cystolithotripsy IVP , KUB , USG 2 10000 S7 No
, X-RAY
Clinical Photograph
IVP , KUB , USG, Spiral
5.7 Urology PCNL (Percutaneous Nephro Lithotomy) , X-RAY KUB, USG 2 23000 S7 S700025 No
CT KUB
KUB
ESWL (Extra carporial shock-wave
5.8 Urology IVP , KUB , USG X-RAY and USG KUB 2 8625 S7 S700026 No
lithotripsy)
IVP , KUB , USG, Spiral
5.9 Urology URSL X-RAY KUB 2 10000 S7 S712002 No
CT KUB
5.10 Urology Nephrostomy (PCN) IVP , USG Clinical Photograph 1 5750 S7 S712003 No
5.11 Urology DJ stent (One side) IVP , USG X-RAY KUB 1 5750 S7 S712004 No
RGU & MCU,

Urethroplasty for Stricture Diseases-single RGU & MCU,
5.12 Urology Uroflometry, 1 25000 S7 No
stage Uroflometry
Clinical Photograph
RGU & MCU,

Urethroplasty for Stricture Diseases-First RGU & MCU,
5.13 Urology Uroflometry, 2 18000 S7 S712005 No
Stage Uroflometry
Clinical Photograph
RGU & MCU,

Urethroplasty for Stricture Diseases- RGU & MCU,
5.14 Urology Uroflometry, 3 18000 S7 S712006 No
Second Stage Uroflometry
Clinical Photograph
USG,Clinical Clinical Photograph,

5.15 Urology Hypospadiasis(Adult) 3 20700 S7 S712007 No
Photograph Uroflowmetry
5.16 Urology TURBT Biopsy , CT , USG, ECHO Biopsy , USG KUB 3 28750 S7 S700062 No
Biopsy , USG
USG, Uroflometry,
5.17 Urology TURP bladder and 3 24150 S7 S700093 No
ECHO
prostate
Biopsy , CT KUB , USG, Biopsy , Clinical
5.18 Urology Simple Nephrectomy 3 20700 S7 S700006 No
Renal Scan Photograph , USG
USG, CT, ECHO, Renal Biopsy , Clinical
5.19 Urology Lap. Nephrectomy Simple 3 20700 S7 S700007 No
Scan Photograph , USG
CT, KUB , USG, Renal Biopsy , Clinical
5.20 Urology Lap. Nephrectomy Radical 6 25300 S7 S700009 No
Scan Photograph , USG
CBC, S. CREATININE,
Urology/
RETROGRADE INTRARENAL SURGERY WITH URINE R/M, URINE C/S, X RAY KUB, USG
5.22 Nephrol 5 30000 S7 S712008 No
LASER LITHOTRIPSY PT/ APTT, X RAY KUB, KUB
ogy
IVP, USG KUB
CBC, S. CREATININE,
Urology/ URINE R/M, URINE C/S,
USG KUB,
5.24 Nephrol HOLMIUM ENUCLEATION OF PROSTATE X RAY KUB, USG KUB, S. 5 30000 S7 S700094 No
UROFLOWMETRY
ogy PSA, UROFLOWMETRY,
S. ELECTROLYTES
Urology/ CBC, S. CREATININE,

5.30 Nephrol CHECK CYSTOSCOPY URINE R/M, USG KUB, - 5 5750 S7 S700067 No
ogy URINE CYTOLOGY
CBC, S. CREATININE,
Urology/
URINE R/M, URINE C/S,
5.31 Nephrol CYSTOSCOPY + URINE SAMPLING + B/L RGP - 5 9200 S7 S700057 No
PT/ APTT, X RAY KUB,
ogy
USG KUB

COLOSTOMY & SUPRAPUBIC URINARY
5.41 Nephrol URINE R/M, USG KUB, - 5 23000 S7 S712009 No
DIVERSION FOR PELVIC FRACTURE INJURY
ogy RGU + MCU
CBC, S. CREATININE,
Urology/
5.45 Nephrol SURGERY FOR URETHRORECTAL FISTULA MCU 5 28750 S7 S712010 No
USG KUB, RGU + MCU,
ogy
CT ABDOMEN
CBC, S. CREATININE,
Urology/
5.46 Nephrol OPEN SURGERY FOR COLOVESICAL FISTULA MCU 5 34500 S7 S712011 No
USG KUB, RGU + MCU,
ogy
CT ABDOMEN
CBC, S. CREATININE,
Urology/ URINE C/S, X RAY KUB, S. CREATININE, USG
OPEN NEPHROURETERECTOMY WITH
5.54 Nephrol USG KUB, CECT KUB, CHEST X RAY, 5 34500 S7 S700014 No
BLADDER CUFF EXCISION
ogy ABDOMEN, LFT, CHEST CT ABDOMEN
X RAY, URINE CYTOLOTY
CBC, S. CREATININE,
Urology/ URINE C/S, X RAY KUB, S. CREATININE, USG
LAPAROSCOPIC NEPHROURETERECTOMY
5.55 Nephrol USG KUB, CECT KUB, CHEST X RAY, 5 51750 S7 S700015 No
WITH BLADDER CUFF EXCISION
ogy ABDOMEN, LFT, CHEST CT ABDOMEN
X RAY, URINE CYTOLOTY
CBC, S. CREATININE,
USG KUB, DIURETIC
5.57 Nephrol OPEN URETEROCALICOSTOMY X RAY KUB, IVP, USG 5 34500 S7 S700020 No
RENAL SCAN
ogy KUB, DIURETIC RENAL
SCAN
CBC, S. CREATININE,
USG KUB, DIURETIC
5.58 Nephrol LAPAROSCOPIC URETEROCALICOSTOMY X RAY KUB, IVP, USG 5 40250 S7 S700021 No
RENAL SCAN
SCAN
CBC, S. CREATININE,
OPEN HEMINEPHRECTOMY FOR FUSION
5.59 Nephrol X RAY KUB, CT IVU, USG USG KUB 5 34500 S7 S712012 No
ANOMALY
SCAN
CBC, S. CREATININE,
LAPROSCOPIC HEMINEPHRECTOMY FOR
5.60 Nephrol X RAY KUB, CT IVU, USG USG KUB 5 40250 S7 S712013 No
FUSION ANOMALY
SCAN
CBC, S. CREATININE,
Urology/
OPEN ANATROPHIC NEPHROLITHOTOMY ( URINE R/M, URINE C/S, USG KUB, X RAY
5.61 Nephrol 5 34500 S7 S712014 No
For Staghorn Stone) X RAY KUB, CT IVU, USG KUB, S. CREATININE
ogy
KUB
CBC, S. CREATININE,
Urology/
OPEN URETERAL REIMPLANTATION FOR URINE R/M, URINE C/S, USG KUB, DIURETIC
5.66 Nephrol 5 34500 S7 S700044 No
URETEROVAGINAL FISTULA PT/ APTT, X RAY KUB, IVP, MCU
ogy
IVP, USG KUB, MCU
CBC, S. CREATININE,
Urology/ LAPAROSCOPIC URETERAL
URINE R/M, URINE C/S, USG KUB, DIURETIC
5.67 Nephrol REIMPLANTATION FOR URETEROVAGINAL 5 46000 S7 S700046 No
PT/ APTT, X RAY KUB, IVP, MCU
ogy FISTULA
IVP, USG KUB, MCU

5.68 Nephrol LAPAROSCOPIC VVF REPAIR URINE R/M, URINE C/S, MCU 5 43700 S7 S700085 No
ogy IVP, USG KUB, MCU

URETEROLYSIS FOR RETROPERITONEAL
5.71 Nephrol URINE R/M, URINE C/S, DIURETIC IVP 5 34500 S7 S712015 No
FIBROSIS
ogy CT IVU, USG KUB
CBC, S. CREATININE,
Urology/ URINE CYTOLOGY,
OPEN RADICAL CYSTECTOMY WITH USG KUB, CT IVU,
5.78 Nephrol URINE C/S,CT 5 80500 S7 S700075 No
NEOBLADDER POUCHOGRAM
ogy ABDOMEN, USG KUB,
CHEST X RAY
CBC, S. CREATININE,
URINE CYTOLOGY, CBC, S. CREATININE,
Urology/
OPEN RADICAL CYSTECTOMY WITH MAINZ URINE C/S,CT ABG, USG
5.80 Nephrol 5 57500 S7 S712016 No
2 POUCH ABDOMEN, USG KUB, ABDOMEN, CT IVU,
ogy
CHEST X RAY, COLONOSCOPY
COLONOSCOPY
CBC, S. CREATININE,
Urology/ MCU, URINE C/S,CT
5.82 Nephrol OPEN AUGMENTATION CYSTOPLASTY ABDOMEN, USG KUB, MCU 5 57500 S7 S700089 No
ogy CHEST X RAY, URINE
AFB, IVP
CBC, S. CREATININE,
Urology/
OPEN BLADDER DIVERTICULECTOMY WITH URINE R/M, URINE C/S, MCU, DMSA RENAL
5.84 Nephrol 5 34500 S7 S700091 No
URETERIC REIMPLANTATION USG KUB, MCU, DMSA SCAN
ogy
SCAN
USG SCROTUM,
Urology/
DOPPLER SCROTUM / AFP, LDH, B HCG, CT
5.91 Nephrol OPEN ORCHIECTOMY (SIMPLE / RADICAL) 5 17250 S7 S712017 No
AFP, LDH, B HCG, CT ABDOMEN
ogy
ABDOMEN
Urology/ CT IVU, MCU, URINE

OPEN ILEAL REPLACEMENT FOR URETERIC
5.11 Nephrol FOR AFB, USG DIURETIC IVP 5 57500 S7 S712018 No
STRICTURE
ogy ABDOMEN
Urology/
CT IVU, MCU, USG
5.11 Nephrol OPEN BOARI FLAP MCU 5 28750 S7 S700052 No
ABDOMEN
ogy

5.12 Nephrol OPEN URETEROLYSIS URINE R/M, URINE C/S, DIURETIC IVP 5 34500 S7 S712019 No
ogy CT IVU, USG KUB
Urology/
CT ABDOMEN,
5.13 Nephrol OPEN COLOVAGINAL FISTULA REPAIR BARIUM ENEMA 5 34500 S7 S712020 No
COLONOSCOPY
ogy

5.13 Nephrol URETHROVAGINAL FISTULA REPAIR URINE R/M, URINE C/S, MCU 5 34500 S7 S700087 No
ogy IVP, USG KUB, MCU
Urology/
RADIOCEPHALIC AV FISTULA FOR DOPPLER UPPER
5.14 Nephrol DOPPLER UPPER LIMB 5 6440 S7 S712022 No
HEMODIALYSIS LIMB
ogy
Urology/
BRACHIOCEPHALIC AV FISTULA FOR DOPPLER UPPER
HEMODIALYSIS LIMB
ogy
CBC, S.CRETAIN, BL
Urology/ MAINTENANCE HEMODIALYSIS (MHD) UREA, S. Na+ /S.K+,
5.14 Nephrol (WITH INJ. ERYTHROPOETINE WITH INJ. HIV(ELLISA), HCV - 0 2300 S7 S712024 No
ogy IRON) –PER DIALYSIS. (ELLISA), HBS Ag
(ELLISA)
Intervent
Permanent tunnelled catheter placement
ional Colour Doppler/
5.14 as substitute for AV fistula in long term Clinical Photograph 0 16000 S7 S712025 No
Radiolog Peripheral Angiogram
dialysis
y
Intervent
Governm
ional Endovascular intervention for salvaging Colour Doppler/
5.14 Clinical Photograph 0 40000 ent S7 S712026 Yes
Radiolog hemodialysis AV fistula Peripheral Angiogram
Reserve
y
Intervent
ional Colour Doppler/
5.15 SPC for atony bladder Clinical Photograph 3 20000 S7 S712027 No
Radiolog Peripheral Angiogram
y
clinical Clinical
5.15 Urology Adrenalectomy-unilateral, open 2 25000 S7 S700001 No
notes,CT/MRI/USG photograph,USG
clinical Clinical
5.15 Urology Adrenalectomy-unilateral, Laparoscopic 2 30000 S7 S700002 No
clinical Clinical
5.15 Urology Adrenalectomy-bilateral, open 2 32000 S7 S700003 No
clinical Clinical
5.15 Urology Adrenalectomy-biilateral, Laparoscopic 2 40000 S7 S700004 No
Paraganglioma excision with liver clinical Clinical

5.150 Urology 2 50000 S7 S700005 No
mobilization notes,CT/MRI/USG photograph,USG
5.15 Urology Nephrectomy-Radical (Renal tumor) Open USG ,CT / MRI HPEE 2 25000 S7 S700008 No
5.15 Urology Nephrectomy-Partial or Hemi, Open USG ,CT / MRI HPEE 2 30000 S7 S700010 No
Nephrectomy-Partial or Hemi,
5.15 Urology USG ,CT / MRI HPEE 2 35000 S7 S700011 No
Laparoscopic
5.15 Urology Nephro ureterectomy (Benign) Open Renal Scan(DTPA) HPEE 2 25000 S7 S700012 No
Nephro ureterectomy (Benign)

5.16 Urology Renal Scan(DTPA) HPEE 2 30000 S7 S700013 No
Laparoscopic
Endopyelotomy (retrograde with
5.16 Urology USG,X Ray,IVP/CT USG 2 25000 S7 S700018 No
laser/bugbee)
Endopyelotomy (antegrade with
laser/bugbee)
5.16 Urology Uretero-ureterostomy Open USG,X Ray,IVP/CT USG 2 25000 S7 S700022 No
5.16 Urology Uretero-ureterostomy Laparoscopic USG,X Ray,IVP/CT USG 2 35000 S7 S700023 No
5.160 Urology Pyelolithotomy-Laparoscopic USG,X Ray,IVP/CT USG 2 30000 S7 S700029 No

Perinephric Abscess drainage
5.16 Urology USG/CT USG 2 10000 S7 S700032 No
(percutaneous)
5.16 Urology Perinephric Abscess drainage (Open) USG/CT USG 2 20000 S7 S700033 No
Renal Cyst deroofing or marsupialization-

Open
Renal Cyst deroofing or marsupialization-
Laparoscopic
Clinical
5.17 Urology Ureterolithotomy-Open USG,X Ray,IVP/CT 2 20000 S7 S700037 No
photograph,USG
Clinical
5.17 Urology Ureterolithotomy-Laparoscopic USG,X Ray,IVP/CT 2 30000 S7 S700038 No
photograph,USG
Clinical
5.17 Urology Ureterotomy (Cutaneous) USG,X Ray,IVP/CT 2 20000 S7 S700042 No
photograph,USG
Clinical
5.17 Urology Endoureterotomy (laser/bugbee) USG,X Ray,IVP/CT 2 20000 S7 S700043 No
photograph,USG
USG KUB,CT Urography/
5.17 Urology Uretero-vaginal/uterine fistula repair open USG 2 27000 S7 S700048 No
MRI Urography
Uretero-vaginal/uterine fistula repair USG KUB,CT Urography/

5.170 Urology USG 2 37000 S7 S700049 No
Laparoscopic MRI Urography
Boari flap for ureteric stricture,
5.17 Urology USG,IVP/CT USG 2 40000 S7 S700053 No
Laparoscopic
Ureterocele incision including cystoscopy,
5.17 Urology ureteric catheterization, retrograde USG,IVP/CT USG 2 15000 S7 S700058 No
pyelogram
5.17 Urology Urachal Cyst excision -open USG,IVP/CT USG 2 15000 S7 S700059 No
5.17 Urology Cystolithotomy-open, including cystoscopy USG,IVP/CT USG 2 15000 S7 S700060 No
Urethral Stone endoscopic, including

5.18 Urology USG,IVP/CT USG 2 10000 S7 S700061 No
cystoscopy
TUR-fulgration (Transurethral fulgration of
5.18 Urology USG/CT USG/HPEE 2 18000 S7 S700063 No
the Bladder Tumor)
CBC, S. Cretanine, Urine-
5.18 Urology Bladder Neck incision-endoscopic R/M, USG KUB, Urine CLINICAL NOTES 2 15000 S7 S700068 No
Cytology
Extrophy Bladder repair including
5.18 Urology osteotomy if needed + epispadias repair + Clinical Photo Clinical Photo 2 50000 S7 S700069 No
ureteric reimplant
clinical notes,CT
5.18 Urology Partial Cystectomy-open Clinical Photo, HPEE 2 20000 S7 S700073 No
Scan/USG/MRI /MCU
clinical notes,CT
5.18 Urology Partial Cystectomy-Laparoscopic Clinical Photo, HPEE 2 30000 S7 S700074 No
Scan/USG/MRI /MCU
Radical cystectomy with continent clinical notes,CT

5.18 Urology Clinical Photo, HPEE 2 50000 S7 S700076 No
diversion-open Scan/USG/MRI /MCU
clinical notes,CT
5.18 Urology Radical Cystectomy with Ileal Conduit-open Clinical Photo, HPEE 2 50000 S7 S700077 No
Scan/USG/MRI /MCU
Radical Cystectomy with ureterostomy- clinical notes,CT

open Scan/USG/MRI /MCU
Radical Cystectomy with clinical notes,CT

ureterosigmoidostomy-open Scan/USG/MRI /MCU
clinical notes,CT
5.19 Urology Other Cystectomies Clinical Photo, HPEE 2 40000 S7 S700080 No
Scan/USG/MRI /MCU
Suprapubic Cystostomy - Open, as an clinical notes,CT
5.19 Urology Clinical Photo 2 10000 S7 S700081 No
independent procedure Scan/USG/MRI
clinical notes,CT
5.19 Urology Suprapubic Drainage - Closed/Trocar Clinical Photo 2 5000 S7 S700082 No
Scan/USG/MRI
VVF/Uterovaginal Repair - Transvaginal clinical notes,CT
approach Scan/USG/MRI /IVP
VVF/Uterovaginal Repair - clinical notes,CT

Abdominal,Open Scan/USG/MRI /IVP
Hysterectomy as part of VVF/uterovaginal clinical notes,CT

fistula repair (top-up) Scan/USG/MRI /IVP
Y V Plasty of Bladder Neck/Bladder Neck clinical notes,CT
Reconstruction Scan/USG/MRI
clinical notes,CT
5.2 Urology Augmentation cystoplasty-Laparoscopic Clinical Photo 2 40000 S7 S700090 No
Scan/USG/MRI
clinical notes,CT
5.2 Urology Open simple prostatetctomy for BPH Clinical Photo 2 25000 S7 S700092 No
Scan/USG/MRI
5.2 Urology TURP/Laser + Circumcision USG, Uroflowmetry HPEE, USG 2 30000 S7 S700095 No
5.200 Urology TURP/Laser + Cystolithotripsy USG, Uroflowmetry HPEE, USG 2 30000 S7 S700096 No
5.2 Urology TURP/Laser + Cystolithotomy-open USG, Uroflowmetry HPEE, USG 2 35000 S7 S700097 No
5.2 Urology TURP/Laser + Orchidectomy USG, Uroflowmetry HPEE, USG 2 30000 S7 S700098 No
5.2 Urology TURP/Laser + TURBT USG, Uroflowmetry HPEE, USG 2 30000 S7 S700099 No
5.2 Urology TURP/Laser + URS with stone removal USG, Uroflowmetry HPEE, USG 2 40000 S7 S700100 No
TURP/Laser + VIU (visual internal

5.21 Urology USG, Uroflowmetry HPEE, USG 2 40000 S7 S700101 No
Ureterotomy)
5.21 Urology TURP/Laser + Hydrocele surgery USG, Uroflowmetry HPEE, USG 2 40000 S7 S700102 No
5.21 Urology TURP/Laser + Hernioplasty USG, Uroflowmetry HPEE, USG 2 40000 S7 S700103 No
TURP/Laser + Urethral dilatation-non

endoscopic
TURP/Laser + Urethral dilatation-
endoscopic
5.210 Urology Radical prostatectomy - laparoscopic USG HPEE, USG 2 70000 S7 S700107 No
Transrectal Ultrasound guided prostate

5.211 Urology USG HPEE, USG 2 10000 S7 S700108 No
biopsy (minimum 12 core)
5.212 Urology Reduction of Paraphimosis Clinical Photo Clinical Photo 2 2000 S7 S700109 No
5.213 Urology Excision of Urethral Caruncle Clinical Notes Clinical Photo 2 6000 S7 S700110 No
5.214 Urology Meatoplasty Clinical Photo Clinical Photo 2 3500 S7 S700111 No
5.215 Urology Meatotomy Clinical Photo Clinical Photo 2 3500 S7 S700112 No
5.216 Urology Post Urethral Valve fulguration USG, MCU USG 2 10000 S7 S700113 No
clinical
5.217 Urology Urethroplasty-End to end notes,RGU/MCU/ RGU/MCU 2 20000 S7 S700114 No
Uroflowmetry
clinical
5.218 Urology Urethroplasty-Transpubic notes,RGU/MCU/ RGU/MCU 2 30000 S7 S700117 No
Uroflowmetry
5.219 Urology Perineal Urethrostomy without closure USG, Clinical Notes Clinical Photo 2 20000 S7 S700119 No
5.220 Urology Urethrorectal fistula repair Dye Study Clinical Notes 2 40000 S7 S700120 No
Urethral Dilatation-non endocopic as an
5.221 Urology Clinical Notes Clinical Notes 2 2000 S7 S700121 No
independent procedure
Urethral Dilatation-endocopic as an
5.222 Urology Clinical Notes Clinical Notes 2 5000 S7 S700122 No
independent procedure
Internal Ureterotomy including cystoscopy
5.223 Urology clinical notes,RGU/MCU Clinical Notes 2 10000 S7 S700123 No
as an independent procedure
5.224 Urology Orchiopexy-without laparoscopy, unilateral USG, Clinical Notes USG 2 15000 S7 S700126 No
5.225 Urology Orchiopexy-without laparoscopy, bilateral USG, Clinical Notes USG 2 15000 S7 S700127 No
5.226 Urology Orchiopexy-with laparoscopy, unilateral USG, Clinical Notes USG 2 30000 S7 S700128 No
5.227 Urology Orchiopexy-with laparoscopy, bilateral USG, Clinical Notes USG 2 30000 S7 S700129 No
5.228 Urology Stress incontinence surgery, open Clinical Notes Uroflowmetry 2 20000 S7 S700130 No
5.229 Urology Stress incontinence surgery, laparoscopic Clinical Notes Uroflowmetry 2 30000 S7 S700131 No
5.230 Urology Stress incontinence surgery with slings Clinical Notes Uroflowmetry 2 35000 S7 S700132 No
5.231 Urology Partial Penectomy Clinical Notes Clinical Notes 2 15000 S7 S700133 No
5.232 Urology Total Penectomy + Perineal Urethrostomy Clinical Notes Clinical Notes 2 20000 S7 S700134 No
5.233 Urology Ilio-Inguinal lymphadenectomy-unilateral USG/FNAC HPEE 2 15000 S7 S700135 No
5.234 Urology Ilio-Inguinal lymphadenectomy-bilateral USG/FNAC HPEE 2 25000 S7 S700136 No
Pelvic lymphadenectomy open, after prior CT/MRI/USG

5.235 Urology HPEE 2 25000 S7 S700137 No
cancer surgery pelvis,clinical notes
Pelvic lymphadenectomy laparoscopic, CT/MRI/USG

after prior cancer surgery pelvis,clinical notes
USG/CT Abdomen
5.237 Urology Orchiectomy-simple HPEE 2 10000 S7 S700140 No
pelvis
Retroperitoneal lymph node dissection- CT/MRI,USG Abdomen

Laparoscopic pelvis,clinical notes
5.239 Urology Infertility-Scrotal exploration unilateral Semen Analysis Clinical Notes/HPEE 2 10000 S7 S700144 No
5.240 Urology Infertility-Scrotal exploration bilateral Semen Analysis Clinical Notes/HPEE 2 12000 S7 S700145 No
Infertility-Vasoepididymostomy,
5.241 Urology USG Vasography 2 15000 S7 S700146 No
microsurgical, unilateral
Infertility-Vasoepididymostomy,
5.242 Urology USG Vasography 2 20000 S7 S700147 No
microsurgical, bilateral
5.243 Urology Varicocele-unilateral-non microsurgical Doppler Doppler 2 10000 S7 S700148 No
5.244 Urology Varicocele-unilateral-microsurgical Doppler Doppler 2 12000 S7 S700149 No
5.245 Urology Varicocele-bilateral-non microsurgical Doppler Doppler 2 15000 S7 S700150 No
5.246 Urology Varicocele-bilateral-microsurgical Doppler Doppler 2 20000 S7 S700151 No

Penile prosthesis insertion, Malleable
5.247 Urology Clinincal History implant sticker 2 30000 S7 S700152 No
(Indian implant)
5.248 Urology Priapism-aspiration/shunt Clinical Notes Clinical Notes 2 15000 S7 S700153 No
Neurogenic bladder-Package for

evaluation/investigation (catheter +
Clinical assessment and
5.249 Urology ultrasound + culture + RGU/ MCU) for 1 Clinical Notes 2 7500 S7 S700154 No
investigations
month (medicines - antibiotics). Follow up
visit once in 3 months
Chronic prostatitis-Package for
evaluation/investigation (ultrasound +
Clinical assessment and
5.250 Urology culture + prostate massage) for 1 month Clinical Notes 2 2500 S7 S700155 No
investigations
(medicines). Follow up visit once in 3
months
Emergency management of Ureteric stone -
Package for evaluation/investigation Clinical assessment and
5.251 Urology Clinical Notes 2 3500 S7 S700156 No
(ultrasound + culture) for 3 weeks investigations
(medicines).
Package
Emergency management of Hematuria
5.252 Urology Daily Urine- RM Clinical Notes 2 2000 rete per S7 S700157 No
(Package rete per day)
day
Package
Emergency management of Acute
5.253 Urology Clinincal Notes/USG Clinical Notes 2 2000 rete per S7 S700158 No
retention of Urine (Package rete per day)
day
Acute management of upper urinary tract Package
5.254 Urology trauma – conservative (Package rete per USG/CT, Clinical History Clinical Notes 2 2000 rete per S7 S700159 No
day) day
Urinary tract trauma – open surgery
5.255 Urology USG/CT, Clinical History Clinical Notes 2 20000 S7 S700160 No
(exploratory)
5.256 Urology Urinary tract trauma – Laparoscopy surgery USG/CT, Clinical History Clinical Notes 2 30000 S7 S700161 No
Pyeloplasty/pyeloureterostomy/pyelopyel
ostomy Open
Pyeloplasty/pyeloureterostomy/pyelopyel
ostomy Laparoscopic
CLINICAL CLINICAL
UROLOG
8.62 OPERATION FOR INJURY OF BLADDER PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 32200 S7 S612019 No
Y
USG ABD, CT SCAN ABD RAY
CLINICAL CLINICAL
UROLOG
8.63 URETHRAL INJURY PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 28750 S7 S612020 No
Y
CLINICAL CLINICAL
UROLOG
8.64 URETHRAL RECONSTRUCTION PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 34500 S7 S612021 No
Y

Concern
5.259 Urology Capped @ 1,00,000rs per anum per Concern Investigation 1 1,00,000 S7 U100 No
Investigation
Cluster - 6 NEUROSURGERY/NEUROLOGY/INTERVENTIONAL NEURORADIOLOGY

Craniotomy and Evacuation of Haematoma

6.1 Brain CT Clinical Photograph 3 57040 S8 S812001 No
–Subdural
– Extradural
Excision of Brain Tumor Supratentorial-
Parasagital
Excision of Brain Tumor Supratentorial-
Basal
6.5 Brain Excision of Brain Tumor - Brainstem CT Clinical Photograph 3 70000 S8 S812005 No
6.6 Brain Excision of Brain Tumor - C P Angle CT Clinical Photograph 3 50000 S8 S812006 No
Excision of Brain Tumor Supratentorial &

others
6.8 Brain Excision of Brain Tumors – Infratentorial MRI Clinical Photograph 3 110000 S8 S812007 No
Brain /
Spinal Intervention with coiling / embolisation
6.9 DSA DSA 3 85000 S8 S812008 No
(Endovas procedures
cular)
Ventriculoatrial /Ventriculoperitoneal/
Ventriculo-other Shunt
6.11 Brain Twist Drill Craniostomy CT Clinical Photograph 3 18630 S8 S800051 No
6.12 Brain Subdural Tapping CT Clinical Photograph 3 17020 S8 S812010 No
6.13 Brain Abscess Tapping Single CT Clinical Photograph 3 17250 S8 S800057 No
6.14 Brain Abscess Tapping multiple CT Clinical Photograph 3 23920 S8 S800058 No
6.15 Brain Meningo Encephalocele MRI Clinical Photograph 3 34270 S8 S812011 No
C.S.F. Rhinorrhoea (Transcranial /

Transnasal)
6.18 Brain Cranioplasty CT , Clinical Photograph Clinical Photograph 3 27830 S8 S812013 No
6.20 Brain Excision of Brain Abcess CT Clinical Photograph 3 28750 S8 S800059 No
Clinical Photograph
6.21 Brain Aneurysm Clipping MRI Angio / DSA 3 34500 S8 S800060 No
, X-RAY
Brain /
Spinal
6.22 Carotid angioplasty with stent ANGIOGRAM DOPPLER , X-RAY 3 60000 S8 S812014 No
(Endovas
cular)
Brain /
Spinal
6.23 Carotid angioplasty without stent ANGIOGRAM DOPPLER , X-RAY 3 40000 S8 S812015 No
(Endovas
cular)
6.24 Brain External Ventricular Drainage (EVD) CT Clinical Photograph 3 28750 S8 S812016 No
Biopsy , Clinical
6.25 Spinal Spinal Cord Tumours (extramedullary) MRI 3 34270 S8 S812017 No
Photograph
6.26 Spinal Excision of Cervical Inter-Vertebral Discs MRI Clinical Photograph 3 34270 S8 S812018 No
6.27 Spinal Anterior Cervical Spine Surgery with fusion MRI Clinical Photograph 3 34270 S8 S812019 No
6.28 Spinal Anterio Lateral Decompression MRI Clinical Photograph 3 17250 S8 S812020 No
6.29 Spinal Laminectomy-Cervical/dorsal/lumbar MRI Clinical Photograph 3 34270 S8 S812021 No
6.30 Spinal Discectomy-Dorsal MRI Clinical Photograph 3 28520 S8 S812022 No
6.31 Spinal Discectomy-Lumbar MRI Clinical Photograph 3 28520 S8 S812023 No
6.32 Spinal Discectomy + cost of implant MRI Clinical Photograph 3 34270 S8 S812024 No
Biopsy , Clinical
6.33 Spinal Spinal Intra Medullary Tumours MRI 3 68540 S8 S812025 No
Photograph , X-RAY
Clinical Photograph
6.34 Spinal Spina Bifida Surgery Major MRI 3 28750 S8 S812026 No
, X-RAY
Clinical Photograph
6.35 Spinal Spina Bifida Surgery Minor MRI 3 20700 S8 S812027 No
, X-RAY
Brain / Stereotaxic Procedures (Framed /
6.36 CT/MRI Clinical Photograph 3 50000 S8 S800065 No
Spinal Frameless)
Brain /
Spinal
6.37 Vertebral artery Stenting ANGIOGRAM DOPPLER 3 60000 S8 S812028 No
(Endovas
cular)
AAD Transoral surgery and CV Junction (With MRI , X-Ray Cerical
6.38 Clinical Photograph 3 125000 S8 S812029 No
Surgeries Posterior Fixation) Spine
AAD Biopsy , Clinical

6.39 Trans oral Surgery CT 3 39790 S8 S800071 No
Surgeries Photograph
Biopsy , Clinical
6.40 Brain Trans Sphenoidal Surgery CT, MRI 3 34040 S8 S812030 No
Photograph
6.41 Brain RF Lesions for Trigminal Neuralgia MRI Clinical Photograph 3 28750 S8 S800050 No
Neuro
6.44 Muscle Biopsy with report EMG, NCV Biopsy 3 17250 S8 S800074 No
muscular
6.45 Brain MVD MRI Clinical Photograph 3 45000 S8 S812031 No
Neuro
6.46 Nerve Biopsy with report EMG, NCV Biopsy 3 8625 S8 S812032 No
Surgery
Neuro
6.47 Nerve Decompression MRI Clinical Photograph 3 17250 S8 S800075 No
Surgery
Neuro
6.48 Peripheral Nerve Surgery Major EMG, NCV Clinical Photograph 3 34500 S8 S800076 No
Surgery
Neuro
6.49 Peripheral Nerve Surgery Minor EMG, NCV Clinical Photograph 3 17250 S8 S800077 No
Surgery
MRI SPINE +CT SPINE-
C.V.JUNC
6.50 POSTERIOR FIXATION ALONE FLEXION/ EXTENTION/ X RAY SPINE 5 65000 S8 S812033 No
TION
NEUTRAL
SURGERY FOR ORBITAL CECT+BIOPSY
6.51 BRAIN MRI CONTRAST/ CECT 5 90000 S8 S812034 No
TUMORS/PROPTOSIS REPORT
BRAIN+S INFRATENTORIAL TUMOR WITH SPINAL CECT+BIOPSY
6.52 MRI CONTRAST/ CECT 5 100000 S8 S812035 No
PINE EXTENSION REPORT
VASCULAR MALFORMATION
6.53 BRAIN SURGERY/Procedure CTA/MRA/DSA CTA+BIOPSY 5 120000 S8 S812036 No
(SUPRATENTORIAL/INFRATENTORIAL)
EPILEPSY SURGERY-GRID INSERTION + MRI BRAIN (1.5/3

6.54 BRAIN CT BRAIN 5 110000 S8 S812037 No
LOCALISATION +SURGERY/Procedure TESLA) +VEEG +CT SCAN
MRI BRAIN (1.5/3
6.55 BRAIN EPILEPSY SURGERY-LESIONECTOMY CT BRAIN 5 60000 S8 S812038 No
TESLA) +EEG
MRI BRAIN (1.5/3
6.56 BRAIN EPILEPSY SURGERY- ATL/AH FOR MTS CT BRAIN 5 70000 S8 S812039 No
TESLA) +EEG
CT BRAIN +BIOPSY
6.57 SKULL BONY TUMOR OF SKULL CECT 5 50000 S8 S812040 No
REPORT
6.58 BRAIN ENDOSPIC BRAIN SURGERIES (DIAGNOSTIC) MRI BRAIN/CT BRAIN CT BRAIN 5 30000 S8 S812041 No
ENDOSPIC BRAIN SURGERIES (THIRD

6.59 BRAIN MRI BRAIN/CT BRAIN CT BRAIN 5 45000 S8 S812042 No
VENTRICULOSTOMY)
ENDOSPIC BRAIN SURGERY
6.60 BRAIN MRI BRAIN/ CT BRAIN CT BRAIN 5 50000 S8 S812043 No
(AQUEDUCTOPLASTY) WITHOUT IMPLANT
ENDOSPIC BRAIN SURGERY

6.61 BRAIN MRI BRAIN/ CT BRAIN CT BRAIN 5 60000 S8 S812044 No
(AQUEDUCTOPLASTY) WITH IMPLANT
ENDOSPIC BRAIN SURGERIES (
6.62 BRAIN MRI BRAIN/CT BRAIN CT BRAIN +BIOPSY 5 60000 S8 S812045 No
TUMOUR/CYST EXISION)
PAIN MANAGEMENT SURGERY RELATED RELATED
6.63 NERVE 3 40000 S8 S812046 No
(SYMPETHECTOMY/RHIZOTOMY) INVESTIGATIONS INVESTIGATIONS
MRI CV JUNCTION + CT
C V JUNCTION DECOMPRESSION
C.V.JUNC CV JUNCTION-
6.64 (POSTERIOR) (ARNOLD-CHIARY X RAY SPINE 3 70000 S8 S812047 No
TION FLEXION/EXTENTION/N
MALFORMATION AND OTHERS)
EUTRAL
6.65 SKULL BONE FLAP REMOVAL CT BRAIN CT BRAIN 3 35000 S8 S812048 No
CORPECTOMY AND FIXATION

6.66 SPINE MRI SPINE X RAY SPINE 5 65000 S8 S812049 No
CERVICAL/DORSAL/LUMBER(SINGLE LEVEL)
CORPECTOMY AND FIXATION
6.67 SPINE CERVICAL/DORSAL/LUMBER (MULTIPLE MRI SPINE X RAY SPINE 5 80000 S8 S812050 No
LEVEL)
6.68 SPINE CERVICAL SPINE STABLISATION ANTERIOR MRI SPINE X RAY SPINE 5 60000 S8 S812051 No
6.69 CERVICAL SPINE STABLISATION-POSTERIOR S812052

SPINE MRI SPINE X RAY SPINE 5 50000 S8 No
A Level one A
B Level two B
6.70 CERVICALSPINE STABLISATION-GLOBAL S812053

A (Anterior & Posterior combine) A

B Level three B
C Level four C
6.71 SPINE DL SPINE STABLISATION-ANTERTIOR MRI SPINE X RAY SPINE 5 60000 S8 S812054 No
6.72 DL SPINE STABLISATION-POSTERIOR Level S812055

A one A
B two B
6.73 DL SPINE STABLISATION-GLOBAL (Anterior S812056
A & Posterior combine) A
B three B
C four C
6.74 SKULL CRANIOSYNOSTOSIS SURGERY MRI+3D CT BRAIN CT BRAIN 5 100000 S8 S800009 No
LAMINOPLASTY
6.75 SPINE MRI SPINE X RAY SPINE 3 50000 S8 S812057 No
CERVICAL/DORSAL/LUMBER
DIAGNOSTIC CEREBRAL/SPINAL
RELATED
6.76 BRAIN ANGIOGRAPHY (DSA-DIGITAL CT BRAIN/MRI SPINE 0 12000 S8 S812058 No
INVESTIGATIONS
SUBSTRACTION ANGIOGRAPHY)
6.77 SPINE ENDOSCOPIC SPINE SURGERY MRI SPINE X RAY SPINE 3 40000 S8 S812059 No
X RAY SPINE+CSF
6.78 SPINE THECO-PERITONEAL SHUNT MRI BRAIN/CT BRAIN 3 30000 S8 S812060 No
REPORT
MRI BRAIN/CT BRAIN
6.79 BRAIN CRANIO-FACIAL RESECTION CT BRAIN +FACE 5 90000 S8 S812061 No
+FACE
BRAIN
REVASCU
6.80 ST-MCA BYPASS/EC-ICA BYPASS CTA/MRA/DSA CTA 5 95000 S8 S812062 No
LARISATI
ON
VASCULA CAROTID LIGATION FOR CCF/GIANT
6.81 CTA/MRA/DSA CTA 5 30000 S8 S812063 No
R ANEURYSM
REEXPLORATION FOR DEBRIDEMENT/CSF
6.82 BRAIN CT BRAIN CT BRAIN 3 25000 S8 S812064 No
LEAK/HAEMATOMA
REANIM CONCERNED CONCERNED
6.83 FACIAL NERVE REANIMATION 5 40000 S8 S812065 No
ATION INVESTIGATIONS INVESTIGATIONS
X RAY SPINE
6.84 SPINE TRANSPEDICULAR BIOPSY MRI SPINE CONTRAST 1 25000 S8 S812066 No
+BIOPSY REPORT
X RAY SPINE
6.85 SPINE VERTEBROPLASTY/KYPHOPLASTY MRI SPINE 5 50000 S8 S812067 No
+BIOPSY REPORT
6.86 Brain NCCT BRAIN NCCT BRAIN 5 90000 S8 S812068 No
- Intracranial Spontaneous / Traumatic
Decompressive Craniectomy - For Infarct /

6.87 Brain NCCT BRAIN NCCT BRAIN 5 70000 S8 S812069 No
Lesion with mass effect on brain
SUPRATENTORIAL TUMOUR WITH MRI/CT BRAIN (WITH CECT+BIOPSY

6.88 BRAIN 5 100000 S8 S812070 No
INFRATENTORIAL TUMOR EXTENSION CONTRAST) REPORT
60000
(Payment
fraction ( (Payment
1st week- fraction (
40%,2nd 1st week-
week- 40%,2nd
week-
25%,3rd
MEDICAL 25%,3rd
CONSERVATIVE MANAGEMENT MRI brain with week-
6.89* NEUROL CT brain plain,others 3 week- S8 M112001 No
(ISCHEMIC STROKE) angiography 15%,4th
OGY 15%,4th
week- week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
120000
(Payment
fraction ( (Payment
55%,2nd 1st week-
week- 55%,2nd
week-
Repeat CT brain 15%,3rd
MEDICAL 15%,3rd
THROMBOLYSIS WITH ACTILYSE FOR after 24 hours,MRI week-
6.90* NEUROL CT brain plain,others 3 week- S8 M112002 No
ISCHEMIC STROKE brain with 10%,4th
OGY 10%,4th
angiography week- week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
40000
(Payment
fraction ( (Payment
40%,2nd 1st week-
week- 40%,2nd
week-
25%,3rd
MEDICAL INTRAPARENCHYMAL /SUBARACHNOID Repeat CT brain 25%,3rd
week-
6.91* NEUROL HEMMORRHAGE (CONSERVATIVE CT brain plain,others plain , CT 3 week- S8 M112003 No
15%,4th
OGY MANAGEMENT) angiography brain 15%,4th
week- week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
110000
(Payment
fraction ( (Payment
40%,2nd 1st week-
week- 40%,2nd
week-
25%,3rd
MEDICAL 25%,3rd
MENINGOENCEPHALITIS, OR/ AND EVD/VP CT brain plain,CSF MRI brain with week-
6.92* NEUROL 3 week- S8 M112004 No
shunt (CONSERVATIVE MANAGEMENT) ,others contrast 15%,4th
OGY 15%,4th
week- week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
110000
(Payment
fraction ( (Payment
40%,2nd 1st week-
Anyone of the week- 40%,2nd
week-
Clinical diagnosis by following:repetitive 25%,3rd
MEDICAL 25%,3rd
MYASTHENIA CRISIS MANAGEMENT BY neurophysician OR nerve week-
PLASMAPHERESIS previously diagnosed stimulation,ACH-R 15%,4th
OGY 15%,4th
case antibody,Anti- week- week-
MUSK antibody 10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
200000
(Payment
fraction ( (Payment
55%,2nd 1st week-
Anyone of the week- 55%,2nd
week-
MEDICAL 15%,3rd
MYASTHENIA CRISIS MANAGEMENT BY IV neurophysician OR nerve week-
IMMUNOGLOBINS previously diagnosed stimulation,ACH-R 10%,4th
OGY 10%,4th
case antibody,Anti- week- week-
MUSK antibody 10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
109627
(Payment
fraction ( (Payment
40%,2nd 1st week-
week- 40%,2nd
week-
25%,3rd
MEDICAL 25%,3rd
Gullian-barre syndrome management by Clinical diagnosis by CSF study, week-
plasmapheresis neurophysician NCV/EMG 15%,4th
OGY 15%,4th
week- week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
total package
package rate)
rate)
200000
(Payment
(Payment
fraction ( fraction (
1st week- 1st week-
55%,2nd 55%,2nd
week- week-
15%,3rd 15%,3rd
MEDICAL
Gullian-barre syndrome management by Clinical diagnosis by CSF study, week- week-
6.96* NEUROL 3 S8 M112008 No
Intravenous immunoglobulin neurophysician NCV/EMG 10%,4th 10%,4th
OGY week-
week-
10%,5th 10%,5th
week- week-10%)
10%) of of total
package
total
rate)
package
rate)
Neurolog
6.97 Anterior Encephalocele CT Brain/ MRI Brain CT Brain 2 50000 S8 S800001 No
y
Neurolog Carpal Tunnel Release including pre and

6.100 MRI, EMG/NCV - 2 10000 S8 S800004 No
y post Op. MRI
X-Ray Cervical
Neurolog X-Ray Cervical Spine/
6.1 Cervical Ribs – Bilateral Spine/ Chest X-Ray, 2 35000 S8 S800005 No
y Chest X-Ray, CT Scan
CT Scan
X-Ray Cervical
Neurolog X-Ray Cervical Spine/
6.1 Cervical Ribs – Unilateral Spine/ Chest X-Ray, 2 20000 S8 S800006 No
y Chest X-Ray, CT Scan
CT Scan
Neurolog
6.1 Duroplasty - Endogenous CT Brain CT Brain 2 12500 S8 S800010 No
y
Implant
cost will
Neurolog Duroplasty - Exogenous(Implant cost is not added
6.1 CT Brain Plain CT Brain 2 12500 S8 S800011 No
y iclluded in package rate) seperatly
in this
package
Neurolog Haematoma (Child subdural) inclusive of
6.11 CT Brain CT Brain 2 50000 S8 S800014 No
y General anaesthesia, pre and post Op. CT
Neurolog
6.11 Laminectomy with Fusion and fixation MRI Spine X-Ray Spine. 2 50000 S8 S800015 No
y
Neurolog
6.11 Laminectomy with Fusion MRI Spine X-Ray Spine. 2 40000 S8 S800016 No
y
Neurolog
6.11 Local Neurectomy CT/MRI Clinical Photograph 2 16000 S8 S800017 No
y
Neurolog X Ray/ Post OP
6.11 Meningocele – Anterior Brain , Spinal Cord MRI 2 36000 S8 S800019 No
y Operative Site
6.110 Meningocele – Lumbar Brain , Spinal Cord MRI 2 36000 S8 S800020 No
y Operative Site
6.11 Meningococcal – Occipital Clinical Photo/MRI/CT 2 50000 S8 S800021 No
y Operative Site
Neurolog
6.11 Spine - Canal Stenosis CT/MRI CT 2 40000 S8 S800027 No
y
Neurolog
6.11 Spine - Extradural Haematoma MRI Spine X-Ray Spine. 2 30000 S8 S800032 No
y
Neurolog Spine - Extradural Haematoma with
6.12 MRI Spine X-Ray Spine. 2 40000 S8 S800033 No
y fixation
Neurolog
6.12 Spine - Intradural Haematoma MRI X-Ray Spine. 2 40000 S8 S800036 No
y
Neurolog Spine - Intradural Haematoma with
6.12 MRI Spine X-Ray Spine. 2 50000 S8 S800037 No
y fixation
Neurolog
6.12 Spine - Intramedullar Tumour CT/MRI HPEE 2 50000 S8 S800038 No
y
Neurolog
6.12 Spine - Intramedullar Tumour - fixation MRI Spine Biopsy , X-Ray Spin 2 60000 S8 S800039 No
y
Neurolog
6.120 Brain Biopsy MRI Brain/ CT Brain Biopsy 2 15000 S8 S800045 No
y
Neurolog concecrned concecrned
6.12 Cranial Nerve Anastomosis 2 32000 S8 S800046 No
y Investigation Investigation
Neurolog
6.12 Depressed Fracture CT Brain CT Brain 2 40000 S8 S800047 No
y
Neurolog
6.12 Peripheral Neurectomy (Trigeminal) MRI Biopsy 2 16500 S8 S800049 No
y
X Ray + Clinical
Neurolog
6.12 Additonal clip for Aneurysm Clipping MRI ANGIO/DSA Photo of Operative 2 15000 S8 S800061 No
y
Site
X Ray + Clinical
Neurolog
6.13 Cervical Disc Multiple level without Fusion MRI Spine Photo of Operative 2 40000 S8 S800068 No
y
Site
Neurolog
6.13 Foramen Magnum Decompression CT/MRI X-Ray 2 45000 S8 S800072 No
y
X-Ray , Clinical
Neurolog Arterio venous malformation (AVM)
6.13 MRA/DSA Report Photo of Operative 2 50000 S8 S800079 No
y excision (whatever size and location)
Site
HistoPatho Repot +
Neurolog
6.13 Scalp Arterio venous malformation (AVM) CT/MRI ANGIO Clinical Photo of 2 25000 S8 S800080 No
y
Operative Site
Gamma Knife radiosurgery (GKRS)/ SRS for
Neurolog
6.13 tumours/ Arteriovenous malformation CT/MRI Clinical Photo 2 75000 S8 S800083 No
y
(AVM)
Intervent Coil embolization for aneurysms (includes

ional cost of first 3 coils + balloon and/ or stent
6.130 DSA/CT/MRI ANGIO CT/MR ANGIO 2 1,00,000 S9 S900001 No
Neurora if used) 1 to 20 coils may be required as
diology per need.
Intervent
ional Additional coil for coil embolization for
6.131 DSA/CT/MRI ANGIO CT/MR ANGIO 2 24000 S9 S900002 No
Neurora aneurysms
diology
Intervent
ional
6.13 Dural AVMs/AVFs (per sitting) with glue DSA/CT/MR ANGIO CT/MR ANGIO 2 70000 S9 S900003 No
Neurora
diology
Intervent
ional
6.13 Dural AVMs/AVFs (per sitting) with onyx DSA/CT/MR ANGIO CT/MR ANGIO 2 1,50,000 S9 S900004 No
Neurora
diology
Intervent Carotico-cavernous Fistula (CCF)
ional embolization with coils. [includes 5 coils,
6.13 DSA/CT/MR ANGIO CT/MR ANGIO 2 1,50,000 S9 S900005 No
Neurora guide catheter, micro-catheter, micro-
diology guidewire, general items]
Intervent Carotid-cavernous Fistula (CCF)

ional embolization with balloon (includes one
6.14 DSA/CT/MR ANGIO CT/MR ANGIO 2 75000 S9 S900006 No
Neurora balloon, guide catheter, micro-catheter,
diology micro-guidewire, general items)
Intervent
ional Cerebral & Spinal AVM embolization (per
Neurora sitting). Using Histoacryl
diology
Intervent
ional
6.14 Parent vessel occlusion - Basic CT/MR ANGIO CT/MR ANGIO 2 30000 S9 S900008 No
Neurora
diology
Intervent
ional
6.14 Additonal coil for Parent Vessel Occlusion DSA/CT/MR ANGIO CT/MR ANGIO 2 24000 S9 S900009 No
Neurora
diology
Intervent
ional Additonal balloon for Parent Vessel
Neurora Occlusion
diology
Intervent
ional
6.140 Balloon test occlusion CT/MR ANGIO CT/MR ANGIO 2 70000 S9 S900011 No
Neurora
diology
Intervent
ional Intracranial balloon angioplasty with
Neurora stenting
diology
Intervent
ional
6.14 Intracranial thrombolysis / clot retrieval DSA/CT/MR ANGIO CT/MR ANGIO 2 1,60,000 S9 S900013 No
Neurora
diology
Intervent
ional Pre-operative tumour embolization (per
Neurora session)
diology
CLINICAL CLINICAL
NEUROS
8.76 SKULL TRACTION PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 12880 S8 S612027 No
URGERY
CT SCAN BRAIN RAY
CLINICAL CLINICAL
NEUROS
8.77 BURR HOLE PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 28750 S8 S612028 No
URGERY
CT SCAN BRAIN RAY
CLINICAL CLINICAL
NEUROS
8.78 TEMPORAL BONE RESECTION PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 57500 S8 S612029 No
URGERY
CT SCAN BRAIN RAY
CLINICAL CLINICAL
NEUROS
8.79 SKULL BASE SURGERY PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 69000 S8 S612030 No
URGERY
CT SCAN BRAIN RAY
NEUROS DEFORMITY SURGERY FOR SPINE Clinical Photograph, Clinical Photograph,
8.88 3 150000 S8 S612036 No
URGERY (KYPHO/SCOLIOSIS) Xray Xray
Pre-op. Doppler Post-op. Doppler
NEUROS Plexus injury along with Vascular injury
8.89 study,Nerve Conduction study,Clinical photo 2 60000 S8 S600002 No
URGERY repair/ graft
study,CT showing scar
Clinical photograph
NEUROS Head injury requiring Facio-Maxillary Injury
8.91 X-RAY/CT showing scar,Post- 2 35000 S8 S600004 No
URGERY repairs & fixations (including implants)
op. X-ray

NEUROS Concern
URGERY Investigation
Cluster - 7 PAEDIATRIC SURGERY

Gastro X-ray with infant

Oesophageal atresia –1.pure atresia- first
7.1 Intestinal feeding tube or Dye Clinical Photograph 3 23000 S14 S1412001 No
stage(‘o’stomy & ‘G’stomy)
Tract study
Gastro
Oesophageal atresia –2.pure atresia- 2D-ECHO, Dye study,
7.2 Intestinal Clinical Photograph 3 70000 S14 S1412002 No
second stage(oesaphageal replacement) ultrasound
Tract
Gastro X-ray with infant
7.3 Intestinal 3.tracheo-oesphageal fistula(type c) feeding tube or Dye Clinical Photograph 3 40250 S14 S1412003 No
Tract study
Gastro
Dye study,
7.4 Intestinal 4. H- type fistula Clinical Photograph 1 40000 S14 S1412004 No
Bronchoscopy
Tract
Gastro
7.5 Intestinal Intestinal Atresias & Obstructions X-RAY /CT Clinical Photograph 3 46000 S14 S1412005 No
Tract
Gastro
7.6 Intestinal Biliary Atresia HIDA scan Clinical Photograph 3 46000 S14 S1412006 No
Tract
Gastro
7.7 Intestinal Choledochal Cyst MRCP or CT scan Clinical Photograph 3 46000 S14 S1412007 No
Tract
Gastro
BArium Study, X-RAY, BIOPSY, CLINICAL
7.8 Intestinal Diaphragmatic Hernia 1 40000 S14 No
ENDOSCOPY/ USG PHOTOGRAPH
Tract
Gastro
Anorectal Malformation1. Low ARM(male Invertogram or clinical
& female) photograph
Tract
Gastro
2.Intermediate & High variety a. Stage 1 Invertogram or clinical
colostomy photograph
Tract
Gastro 2-D ECHO,
b. Stage two PSARP/Abdominoperineal Pull
7.11 Intestinal ULTRASOUND, Dye Clinical Photograph 3 34500 S14 S1412010 No
through
Tract Study
Gastro
c. Stage three colostomy closure/
7.12 Intestinal Clinical photograph Clinical Photograph 3 35000 S14 S1412011 No
Ileostomy closure
Tract
ANORECTAL MALFORMATION.[Colostomy,
Gastro iliostomy/ pouchostomy (first stage of
Invertogram or clinical
7.13 Intestinal male/female ARM, cloaca, pouch colon or Clinical Photograph 1 30000 S14 S1412012 No
photograph,
Tract hirschsprung diease]
Gastro Second stage- 2-D ECHO,

7.14 Intestinal PSARVUP/Abdominoperineal Pull through ULTRASOUND Dye Clinical Photograph 1 60000 S14 S1412013 No
Tract Definitive surgery Study
Gastro 2-D ECHO,
7.15 Intestinal Third stage- Colostomy / ileostomy closure ULTRASOUND Dye Clinical Photograph 3 34500 S14 S1412014 No
Tract Study
Gastro Clinical
Dye Study/ Rectal
7.16 Intestinal Hirschsprung's Disease- Single Stage Photograph/Histop 3 60000 S14 S1412015 No
Biopsy
Tract athological Report
Gastro Clinical
Dye Study/ Rectal
7.18 Intestinal Second stage-Definitive surgery Photograph/Histop 3 57500 S14 S1412016 No
Biopsy
Tract athological Report
Thoracic
7.20 Empyema Thoracis X-Ray/CT Scan Clinical Photograph 3 40000 S14 S1412017 No
Surgeries
GENITOU
7.21 RINARY HYPOSPIDIAS- 1. SINGLE STAGE SURGERY Clinical Photograph Clinical Photograph 3 34500 S14 S1412018 No
Surgeries
GENITOU
HYPOSPIDIAS- 2.STAGED SURGERIES a) 1st
7.22 RINARY Clinical Photograph Clinical Photograph 3 34500 S14 S1412019 No
Stage procedure
Surgeries
GENITOU
7.23 RINARY a) 2nd Stage procedure Clinical Photograph Clinical Photograph 3 25300 S14 S1412020 No
Surgeries
Peadiatri EXSTROPHY BLADDER TOTAL

7.24 - 8 126500 S14 S1412021 No
c Surgery CORRECTION1) SINGLE STAGE
Peadiatri EXSTROPHY BLADDER 2) FIRST STAGE USG/ELECTROLYTES/MC

7.25 8 100625 S14 S1412022 No
c Surgery BLADDER CLOSURE U
Peadiatri EXSTROPHY BLADDER 3) SECOND STAGE

7.26 - 8 60000 S14 S1412023 No
c Surgery BLADDER NECK RECONSTRUCTION
Peadiatri EXSTROPHY BLADDER 4) PRIMARY OR

7.27 - 8 86250 S14 S1412024 No
c Surgery SECONDARY URETEROSIGMOIDOSTOMY
Peadiatri
7.28 EPISPADIAS REPAIR 1) CONTINENT USG/MCU 5 40000 S14 S1412025 No
c Surgery
Peadiatri EPISPADIAS REPAIR 2) INCONTINENT

7.29 USG/MCU 5 51750 S14 S1412026 No
c Surgery (EPISPADIAS REPAIR +BNR)
NEC-operative-
Gastroint 1 Exploratory laparotomy+ repair of X ray , USG same as Clinical photo, X ray
7.30 4 48000 S14 S1412027 No
estinal perforation above abd
Clinical photograph,
Single stage PSARP female (
Gastroint Xray lumbosacral spine,
7.31 Rectovestibular fistula/ anovestibular Clinical photgraph 4 50000 S14 S1412028 No
estinal USG KUB, 2d echo,
fistula/ vestibular anus etc)
MCU
Gastroint Duodenal atresia- Kimuras
7.32 X ray abdomen Clinicl photograph 2 48000 S14 S1412029 No
estinal duodenoduodenostomy
Gastroint Pyloric stenoses Ramstedts USG abdomen/dye

7.33 Clinical photograph 2 26000 S14 S1412030 No
estinal pyloromyotomy study
Gastroint Upper gi scopy/ Upper

7.34 GERD Fundoplication/Anti GERD Surgery Clinical photograph 2 35000 S14 S1400016 No
estinal GI dye study
MCU, USG KUB, urine

Posterior urethral valve- stabilization +
Genitour analysis, Bl urea, ser
7.35 cystoscopy+ puv fulguration & or USG KUB, 4 30000 S14 S1412031 No
inary creatinine & S
vesicostomy
electrolyte
Ct brain/ MRI Brain
Hydrocephalus in children- Clinical photograph,
7.36 Brain USG, Fundus 4 25000 S14 S1412032 No
Ventriculoperitoneal shunt CSF report
examination
Genitour Vesicoureteric reflux, megaureter- ureteric MCU, USG KUB, Renal
7.37 Clinical photo 4 40000 S14 S1412033 No
inary reimplantation unilateral/bilateral scan
Pediatrician advise for

splenectomy,
Abdome
7.38 Splenectomy for Thalessemia Vaccinations ( Clinical photo 2 35000 S14 S1412034 No
n
pneumococcal),USG
Abdomen
Paediatri
7.39 Ankyloglossia Major Clinical Photo Clinical Photo 2 15000 S14 S1400001 No
c surgery
Paediatri
7.40 Ankyloglossia Minor Clinical Photo Clinical Photo 2 5000 S14 S1400002 No
c surgery
Paediatri
7.41 Hernia & Hydrocele USG clinical notes 2 20000 S14 S1400003 No
c surgery
Paediatri CECT L-S Region, Clinical

7.42 Sacrococcygeal Teratoma Clinical Photo 2 20000 S14 S1400004 No
c surgery Photo, Sputum AFB
Paediatri Undescended Testis - Bilateral-Palp +

7.43 USG Clinical Photo 2 15000 S14 S1400005 No
c surgery Nonpalp
Paediatri
7.44 Undescended Testis - Bilateral Palpable USG Clinical Photo 2 15000 S14 S1400006 No
c surgery
Paediatri Undescended Testis - Bilateral Non-

c surgery Palpable
Paediatri Undescended Testis - Reexploration/

c surgery Second Stage
Paediatri
7.47 Undescended Testis - Unilateral-Palpable USG Clinical Photo 2 15000 S14 S1400009 No
c surgery
Clinical Photo, Distal
Paediatri Ano Rectal Malformation - Redo
7.48 Cologram/ USG Dye Clinical Photo 2 15000 S14 S1400014 No
c surgery Pullthrough
Study
Clinical Photo, Distal
Paediatri
7.49 Ano Rectal Malformation - Transposition Cologram/ USG Dye Clinical Photo 2 15000 S14 S1400015 No
c surgery
Study
Paediatri
7.50 Duplication Cyst Excision CECT Abdomen Clinical Photo 2 20000 S14 S1400017 No
c surgery
Clinical Photo,
Paediatri
7.51 Fecal Fistula Closure Operative Details of Clinical Photo 2 25000 S14 S1400018 No
c surgery
Previous Surgery
X-Ray with Infant
Paediatri
7.52 Gastrostomy + Esophagoscopy+ Threading Feeding Tube/ Dye Clinical Photo 2 20000 S14 S1400019 No
c surgery
Study
Paediatri
7.53 GI Tumor Excision CECT, Clinical Photo Clinical Photo 2 30000 S14 S1400020 No
c surgery
Paediatri Hirschsprung’s Disease - Retal Biopsy-

7.54 Barium Enema HPEE 2 10000 S14 S1400023 No
c surgery Punch
Paediatri Hirschsprung’s Disease - Retal Biopsy

7.55 Barium Enema HPEE 2 10000 S14 S1400024 No
c surgery –Open
Paediatri
7.56 Hirschsprung’s Disease - Sphinecterotomy Barium Enema HPEE 2 15000 S14 S1400025 No
c surgery
Paediatri Intussusception - Non –Operative

7.57 USG Abdomen USG 2 20000 S14 S1400026 No
c surgery Reduction in infants
Paediatri USG Abdomen, Clinical

7.58 Intussusception – Operative in infants Clinical Photo 2 25000 S14 S1400027 No
c surgery Photo
X-Ray Abdomen
Paediatri Standing, USG
7.59 Ladds Procedure Clinical Photo 2 30000 S14 S1400028 No
c surgery Abdomen/Barium
MEAL
Paediatri
7.60 Rectal Polypectomy - Sigmoiescopic (Ga) Sigmoidoscopic Picutre HPEE, Clinical Notes 2 8000 S14 S1400029 No
c surgery
Paediatri CECT Abdomen, Clinical

7.61 Retro-Peritoneal Lymphangioma Excision HPEE, Clinical Notes 2 25000 S14 S1400030 No
c surgery Picture
Paediatri X-Ray, Clinical

7.62 Congenital Lobar Emphysema CECT, X-Ray Chest 2 25000 S14 S1400032 No
c surgery Photo
Paediatri
7.63 Exomphalos/gastroschisis Clinical Photo Clinical Photo 2 25000 S14 S1400033 No
c surgery
Paediatri
7.64 Cleft Lip and Palate Surgery (per stage) Clinical Photo Clinical Photo 2 15000 S14 S1400034 No
c surgery

Paediatri Concern
c surgery Investigation
Cluster- 9 MEDICAL ONCOLOGY

Packa Sub- Pre-Operative Post Operative Package
ge No specialty Investigation Investigation Rates
Biopsy with
immunohistochemistry,
Mammography, 2D Clinical Photograph,
4 to 6
9.1* Breast Adriamycin/Cyclophosphamide (AC) Echo, Chest X-ray, Mammography, 0 4485 M5 M512001 No
months
Sonography, Bone scan, chest X-ray
Blood Investigations,
clinical Photograph
Biopsy with
4 to 6
9.2* Breast 5- Fluorouracil A-C (FAC) Echo, Chest X-ray, Mammography, 0 4600 M5 M512002 No
months
clinical Photograph
Biopsy with
4 to 6
9.3* Breast AC (AC then T) Echo, Chest X-ray, Mammography, 0 4600 M5 M512003 No
months
clinical Photograph
Biopsy with
9.4* Breast Paclitaxel Echo, Chest X-ray, Mammography, 0 11500 4 motnhs M5 M512004 No
clinical Photograph
Biopsy with
Cyclophosphamide/Methotrexate/5Fluoro 4 to 6
9.5* Breast Echo, Chest X-ray, Mammography, 0 3450 M5 M512005 No
uracil (CMF) months
clinical Photograph
Biopsy with
4 to 5
9.6# Breast Tamoxifen tabs Echo, Chest X-ray, Mammography, 0 109 M5 M512006 No
years
clinical Photograph
Biopsy with
2 to 5
9.7# Breast Aromatase Inhibitors Echo, Chest X-ray, Mammography, 0 1150 M5 M512007 No
years
clinical Photograph
Biopsy with
HER2 +ve
After 4 cycles of 9.3 package followed by Mammography, 2D Clinical Photograph,
Early 6 months
9.8* Taxanes with GCSF, Herceptin with or Echo, Chest X-ray, Mammography, 0 20000 M5 M512008 No
Breast to 1 year
without Carboplatin Sonography, Bone scan, chest X-ray
Cancer
clinical Photograph
Biopsy, USG,CT Clinical Photograph,

Cervical 6 to 8
9.9* Weekly Cisplatin scan/MRI, Chest X-ray, USG,CT scan/MRI, 0 4025 M5 M512009 No
Cancer weeks
clinical Photograph. Chest X-ray.

Vulval
9.10* Cisplatin/5-FU scan/MRI, Chest X-ray, USG,CT scan/MRI, 0 9200 M5 M512010 No
Cancer

Vaginal 6 to 8
9.11* Cisplatin/5-FU scan/MRI, Chest X-ray, USG,CT scan/MRI, 0 9200 M5 M512011 No
Cancer weeks
Biopsy with
Clinical Photograph,
Ovarian Sonography, CT 4 to 6
9.12* Carboplatin/Paclitaxel Chest X-ray, USG, CT 0 11500 M5 M512012 No
Cancer scan, CA 125, chest months
scan, CA 125, Cytology,
x-ray.
clinical Photograph
Biopsy with
Ovarian Sonography, CT 4 to 6
9.13* Liposomal Doxorubicin & Gemcitabine Chest X-ray, USG, CT 0 13800 M5 M512013 No
Cancer scan, CA 125, chest months
scan, CA 125, Cytology,
x-ray.
clinical Photograph
Biopsy with
CT scan, USG, Chest
Ovary immunohistochemistry,
x-ray, Tumor
Germ CT scan, USG, Chest x- 3 to 4
9.14* Bleomycin /Etoposide/ Cisplatin (BEP) markers, Clinical 0 11270 M5 M512014 No
cell ray, Tumor markers, months
Photograph, 2 D
Tumor Clinical Photograph, 2 D
echo.
echo.
Gestatio
Biopsy, CT scan, USC, CT scan, USC, Chest
nal
Chest x-ray, Tumor x-ray, Tumor 3 to 4
9.15* Trophobl Weekly Methotrexate 0 863 M5 M512015 No
markers, MRI Brain, markers, MRI, months
ast Ds.-
Clinical Photograph. clinical Photograph.
Lowrisk
Gestatio
Biopsy, CT scan, USG, CT scan, USC, Chest
nal
Chest x-ray, Tumor x-ray, Tumor 3 to 4
9.16* Trophobl Actinomycin 0 4370 M5 M512016 No
markers, MRI, Brain, markers, MRI, months
ast Ds.-
Lowrisk
Gestatio
Biopsy, CT scan, USG, CT scan, USC, Chest
nal
Etoposide-Methotrexate-Actinomycin / Chest x-ray, Tumor x-ray, Tumor 4 to 6
9.17* Trophobl 0 8280 M5 M512017 No
Cyclophosphamide -Vincristine (EMA-CO) markers, MRI Brain, markers, MRI, months
ast Ds.-
Highrisk
Biopsy with
CT scan, USG, Chest
x-ray, Tumor
Testicula CT scan, USG, Chest x- 3 to 4
9.18* Bleomycin-Etoposide-Cisplatin (BEP) markers, Clinical 0 11040 M5 M512018 No
r Cancer ray, Tumor markers, months
Photograph, 2 D
Clinical Photograph, 2 D
echo.
echo.
Biopsy with
immunohistochemistry, CT scan, USG, Chest
Testicula Taxanes, Ifosphamides, Vinblastine, CT scan, USG, Chest x- x-ray, Tumor 3 to 4
9.19* 0 16100 M5 M512019 No
r Cancer Gemcitabine, Docetaxol, Platin ray, Tumor markers, markers, MRI Brain, months
MRI Brain, Clinical Clinical Photograph.
Photograph.
Biopsy, CT scan/MRI, CT scan/MRI, USG, x-

Prostate USG, x-ray, Tumor ray, Tumor markers, 1.5 to 2
9.20# Hormonal therapy 0 4140 M5 M512020 No
Cancer markers, Bone scan, Bone scan, Clinical years
Clinical Photograph. Photograph.

Prostate USG, x-ray, Tumor ray, Tumor markers, 1.5 to 2
9.21* Docetaxol + steriods with G-CSF 0 18400 M5 M512021 No
Cancer markers, Bone scan, Bone scan, Clinical years
Clinical Photograph. Photograph.

Bladder 4 to 6
9.22* Weekly Cisplatin scan/MRI, Chest X-ray, USG,CT scan/MRI, 0 4140 M5 M512022 No
Cancer weeks

Bladder Methotrexate Vinblastine Adriamycin USG, x-ray, Urine ray, Urine 4 to 6
9.23* 0 7130 M5 M512023 No
Cancer Cyclophosphamide (MVAC) cystology, Clinical cystology, Clinical months
Photograph. Photograph.

Bladder USG, x-ray, Urine ray, Urine 4 to 6
9.24* Gemcitabine/Carboplatin 0 12880 M5 M512024 No
Cancer cystology, Clinical cystology, Clinical months
Photograph. Photograph.
Lung
cancer-
Biopsy with CT scan, USG, x-ray,
Non-
immunohistochemistry, Sonography, Bone
small cell 4 to 6
9.25* Platin/Etoposide CT scan, USG, x-ray, scan, MRI Brain PET- 0 9430 M5 M512025 No
lung months
Sonography, Bone scan, CT Scan, Clinical
cancer
MRI Brain PET-CT Scan. Photograph.
(NSCLC)
and SCLC
Lung
cancer- Biopsy with CT scan, USG, x-ray,
Non- immunohistochemistry, Sonography, Bone
Pemetrexed/ Platin Gemcitabine/ Platin 4 to 6
9.26* small cell CT scan, USG, x-ray, scan, MRI Brain PET- 0 14950 M5 M512026 No
Gefitinib months
lung Sonography, Bone scan, CT Scan, Clinical
cancer MRI Brain PET-CT Scan. Photograph.
(NSCLC)
Biopsy, CT scan,
Esophag Biopsy, CT scan, USG, x- USG, x-ray,
Weekly Cisplatin/ Carboplatin Cisplatin- 4 to 6
9.27* eal ray, Sonography, Sonography, 0 8625 M5 M512027 No
5FU Epirubicin/ Taxanes months
Cancer Endoscopy. Endoscopy, Clinical
Photograph.
Biopsy, CT scan,
Biopsy, CT scan, USG, x- USG, x-ray,
Gastric 5-FU -Leucovorin (McDonald Regimen), 4 to 6
9.28* ray, Sonography, Sonography, 0 17250 M5 M512028 No
Cancer Epirubicin/Taxanes/Platin months
Endoscopy. Endoscopy, Clinical
Photograph.
Biopsy, CT
Biopsy, CT scan/MRI, x- scan/MRI, x-ray,
Colorect 4 to 6
9.29* Monthly 5-FU ray, Tumor marker-S. Tumor marker-S. 0 5750 M5 M512029 No
al Cancer months
CEA CEA, Clinical
Photograph.
Biopsy, CT
Colorect 5-Fluorouracil-Oxaliplatin -Leucovorin 4 to 6
9.30* ray, Tumor marker-S. Tumor marker-S. 0 13800 M5 M512030 No
al Cancer (FOLFOX) (Stage III only) months
CEA CEA, Clinical
Photograph.
Biopsy, CT
Colorect 5-FU, Irinotican, Leucovorin, (FOLFIRI) 4 to 6
9.31* ray, Tumor marker-S. Tumor marker-S. 0 11500 M5 M512031 No
al Cancer Capecitabine, months
CEA CEA, Clinical
Photograph.
Osteosar
Biopsy, CT scan, MRI
coma X-Ray, Clinical 8 to 9
9.32* Cisplatin/Adriamycin + ifosmide (IAP) scan, x-ray, Bone scan, 0 13800 M5 M512032 No
Bone Photograph. months
2 D Echo.
Tumors
Biopsy-
Lympho Adriamycin/ Bleomycin/Vinblastine/ Blood investigations
Serum biochemistry,
ma- Dacarbazine (ABVD), & imaging-USG/CT 6 to 8
9.33* Bone marrow 0 6900 M5 M512033 No
Hodgkin Cyclophosphamide/Vincristine/Prednisolon scan/PET-CT scan, months
examination, CT scan, x-
disease e/Procarbazine (COPP). Clinical Photograph
ray, Sonography, PET-
CT Scan, 2 D Echo, PFT.
Biopsy-,
Cyclophosphamide/Adriamycin/Vincristine immunohistochemistry,
/Prednisolone (CHOP), Rituximab, Serum biochemistry,
Blood investigations
Chlorambucil CVP Bone marrow
Lympho & imaging-USG/CT 4 months
9.34* (Cyclophosphamide/Vincristine,/Prednisolo examination, CT scan, x- 0 13800 M5 M512034 No
ma-NHL scan/PET-CT scan, to 2 years
ne), Bendamustine Cladribone High dose ray, Sonography, PET-
Clinical Photograph
Methotrexate/VCR/Procarbazine- CT, CSF cytology, MRI
Cytarabine brain/spine, Viral
markers,2 D Echo.
Hematology, Serum
biochemistry, Serum Blood
Protein electrophoresis investigations, &
Multiple
Vincristine, and immunofixatation, Bone marrow 2 to 5
9.35* Myelom 0 5750 M5 M512035 No
Adriamycin,Dexamethasone(VAD) Bone marrow examination, X- years
a
examination, skeletal Rays, Clinical
survey & MRI Spine, 2 D Photograph
Echo.
Hematology, Serum
biochemistry, Serum
Blood
Protein electrophoresis
Multiple investigations, &
and immunofixatation, 2 to 5
9.36# Myelom Thalidomide+Dexamethasone(Oral) Bone marrow 0 4830 M5 M512036 No
Bone marrow years
a examination,
examination, skeletal
Clinical Photograph
survey & MRI Spine, 2 D
Echo.
Hematology, Serum
Multiple
and immunofixatation, Bone marrow 2 to 5
9.37# Myelom Melphalan -Prednisone (oral) 0 2530 M5 M512037 No
Bone marrow examination, X- years
a
Echo.
Hematology, Serum
Multiple Bortezamib, Lenalinomide,
and immunofixatation, Bone marrow 2 to 5
9.38# Myelom Bisphosphonates, Autologus stem cell 0 13800 M5 M512038 No
Bone marrow examination, X- years
a transplant
Echo.
Imaging USG/CT
Wilm's USG/CT, biopsy with 4 to 6
9.39* SIOP/NWTS regimen(Stages I - IV) scan, Clinical 0 9775 M5 M512039 No
Tumor Immunohistochemistry months
Photograph
Hepatobl USG/CT, Tumor

USG/CT, biopsy, Tumor 4 to 6
9.40* astoma Cisplatin – Adriamycin marker, Clinical 0 5175 M5 M512040 No
marker-AFP, 2D Echo. months
Operable Photograph.
Hematology, Serum
biochemistry, CT Scan
Childhoo whole body Or PET Bone marrow
6 months
d B Cell Variable Regimen - MCP 841/BFM - 90, Scan, Tissue biopsy with examination,
9.41* 0 16100 to 6.5 M5 M512041 No
Lympho BFM-NHL, LMB 96, Rasburrycase immunochemistry/IPT, Imaging- Studies,
years
mas Bone marrow Clinical Photograph
examination, CSF
Cytology.
CT, Biopsy-With
Neurobla Blood investigations
Immunohistochemistry,
stoma ( Variable Regimen Variable regimens, & imaging- USG/CT 3 to 6
9.42* Blood investigations, 0 16100 M5 M512042 No
Stages I- Autologous Stem Cell scan, MIBG scan, months
MIBG scan, Bone
III ) Clinical Photograph
marrow examination.
Biopsy, Blood
investigations, MRI Ophthalmologic
Carbo/Etoposide/Vincristine,
Retinobl Orbit & Brain, CSF examination, 4 months
9.43* Endoxan/vincristine/doxorubicin- 0 7130 M5 M512043 No
astoma study, Bone marrow Imaging-Studies, to 1 year
platin/Etoposide
examination, Bone Clinical Photograph
scan.
Hematology, Biopsy,
Serum biochemistry,
Bone marrow
examination, Chest X-
Variable Regimen- LCH-III, Vinblastine + Blood investigations
Histiocyt Ray, skeletal survey, 6 to 12
9.44* Prednisolone, 6MP, MTX, Cladribone, and imagine, 0 20700 M5 M512044 No
osis MRI Brain, Endocrine months
Allergenic stem cell transplant. Clinical Photograph
evaluation, HAL typing
& matching, serum
cyclosporine level.CSF
Cytology.
Blood investigations,
Physical
Biopsy &
Rhabdo examination,
Vincristine-Actinomycin-Cyclophosphamide Immunohistochemistry, 8 to 10
9.45* myosarc Imagine MRI/CT 0 5750 M5 M512045 No
(VAC) based chemo CT scan/MRI, Bone months
oma can, Clinical
marrow examination,
Photograph
Bone scan.
X-Ray/CT Scan/MRI,
Biopsy & Physical
Variable Regimen-
Ewings Immunohistochemistry, examination, X-
9.46* Endoxan/VCR/Doxorubicin- 0 16100 1 year M5 M512046 No
sarcoma Bone Scan, Bone Ray/CT scan/MRI,
Ifosphamides/Etoposide.
marrow examination, Clinical Photograph
2D Echo.
Hematology, Bone
marrow examination Physical
Acute with examination, Blood
Myeloid Immunophenotyping, investigations, Bone
9.47* Induction Phase 0 25300 1 month M5 M512047 No
Leukemi Conventional marrow
a Cytogenetics and FISH examination,
studies, MRI Brain, X- Clinical Photograph
Ray, 2D Echo.
Hematology, Bone
Acute with examination, Blood
Myeloid Immunophenotyping, investigations, Bone
9.48* Consolidation Phase 0 43700 4 months M5 M512048 No
Leukemi Conventional marrow
a Cytogenetics and FISH examination,
studies, MRI Brain, X- Clinical Photograph
Ray, 2D Echo.
Hematology, Bone
Acute
with examination, Blood
Lymphob
Induction phase 1st and 2nd months, MCP Immunophenotyping, investigations, Bone 1 to 2
9.49* lastic 0 71300 M5 M512049 No
841/BFM 90 protocol, Imatinib Cytogenetics and FISH marrow months
Leukemi
studies, CSF cytology, examination,
a
MRI Brain, USG/CT Clinical Photograph
scan.
Hematology, Bone
Acute
with examination, Blood
Lymphob 3rd, 4th, 5th month-MCP 841/BFM 90
Immunophenotyping, investigations, Bone 3 to 4
9.50* lastic protocol, Imatinib, Allergenic stem cell 0 36800 M5 M512050 No
Cytogenetics and FISH marrow months
Leukemi transplant
studies, CSF cytology, examination,
a
MRI Brain, USG/CT Clinical Photograph
scan, 2D Echo.
Physical
Acute
Hematology, Bone examination, Blood
Lymphob
Maintenance- MCP 841/BFM 90 protocol, marrow examination, investigations, Bone
9.51* lastic 0 4830 2 years M5 M512051 No
Imatinib FISH study, CSF marrow
Leukemi
cytology. examination,
a
Clinical Photograph
Blood
unlisted Biopsy. CT, USG, Blood investigations,
9.52* Palliative Chemotherapy 0 7130 M5 M512052 No
regimen investigations USG/CT scan,
Clinical Photograph
For
Terminall
9.53* y ill Palliative and Supportive Therapy Biopsy , CT , USG Clinical Photograph 0 4830 M5 M512053 No
cancer
patient
Colorect CT scan Abdomen,

USG/CT/biopsy,
al Cancer Pelvis, Tissue biopsy,
9.54* XELOX along with Adjuvant chemotherapy Biochemical 0 10120 6 months M5 M512054 No
Stage 2& Photograph, Tummor
investigations
3 marker-S. CEA.
1ST Line iv antibiotics And other supportive

Febrile therapy ( third generation
Neutrop cephalosporin,aminoglycoside, Blood C&S, Urine C&S, USG/CT/biopsy,
9.55* enia- Comnination of Beta Lactum with beta Chest X-Ray, Tissue Biochemical 0 17250 M5 M512055 No
Highrisk- lactamase inhibitor (Piperacillin- Biopsy, CT scan. investigations.
1 tazobactum), Vancomycin, Anti-Fun gals
(azoles), G-CSF etc.,)
Febrile USG/CT/biopsy,
2nd line iv antibiotics and other supportive
Neutrop Blood C&S, Urine C&S, Blood
therapy(Carbapenems, Fourth generation
9.56* enia- Chest X-Ray, Tissue investigations, 0 48300 M5 M512056 No
cephalosporins, Piperacillin, anti-fungal -
Highrisk- Biopsy, CT scan. Blood Culture-
azoles etc.,)
2 sensitivity, X-Ray.
Serum biochemistry,
Relapsed
Ifosphamides /Platin /Etoposide (ICE), Bone marrow Blood investigations
lympho 4-6
9.57* Cytarabine/ Platin/ Steroids (DHAP), examination, CT scan, X- & imaging- USG/CT 0 36800 M5 M512057 No
ma- NHL months
Autologous stem cell Transplant ray, Sonography, PET- scan/PET-CT scan
and HD
CT scan
Bone Marrow
examination with
Immunophe-notyping,
ATRA, Arsenic trioxide, Daunorubicin, Conventional Bone marrow exam 2 to 2.5
9.58* APML 0 64400 M5 M512058 No
Cytarabine 6 MP, methotrexate Cytogenetics and with RT-PCR study, years
FISH/RT-PCR studies,
MRI Brain, X-ray, 2 D
echo, ECG
Bone Marrow
examination with
Physical exam,
Immunophe-notyping,
Blood
Paediatri Conventional 2-2.5
9.59* BFM 93 investigations, bone 0 59800 M5 M512059 No
c AML Cytogenetics and FISH years
marrow exam (if
study, MRI Brain, CSF
clinically indicated)
cytology, X-ray, 2 D
echo, ECG
Hematology, Serum
Biochemistry, Bone Physical exam,
marrow examination Blood
9.60* CVP - Cyclophosphamide, Vincristine, M512060
CLL with Immunophe- investigations, 0 5463 M5 No
A Steroids [CLL *] A
notyping, Lymph node Imaging USG/CT
biopsy with IHC, scan
USG/CT scan, 2 D Echo
Hematology, Serum
9.60* M512060
CLL L +P -- Chlorambucil, Steroids [CLL *] with Immunophe- investigations, 0 5463 M5 No
B B
Hematology, Serum
9.60* Fludarabine, Cyclophosphamide, Rituximab M512060
CLL with Immunophe- investigations, 0 43700 M5 No
C (FCR) [CLL *] C
Hematology, Serum
9.60* M512060
CLL Rituximab [CLL *] with Immunophe- investigations, 0 38237 M5 No
D D
Hematology, Serum
9.60* M512060
CLL Bendamustine [CLL *] with Immunophe- investigations, 0 16387 2-3 years M5 No
E E
Hematology with serum

Physical exam,
biochemistry, Bone
CML Blood
Imatinib, Nilotinib, Dasatinib Allogeneic marrow examination,
9.61# Blastic investigations, Bone 0 4600 M5 M512061 No
stem cell Transplant cytogenetic study, Ph
crisis marrow study, RT-
by FISH or RT-PCR, USG
PCR for BCR-ABL
study
Hematology and serum

biochemistry, Bone
Marrow examination,
9.62A Aplastic Aplastic Anaemia - ATG + Cyclosporine +
viral markers, IPT for Blood investigations 0 320000 M5 M512062 No
^ Anaemia Steroid
PNH, HLA typing &
matching. S.
Cyclosporine level
Hematology and serum

biochemistry, Bone
Marrow examination,
9.62B Aplastic
Allogeneic stem cell Transplant viral markers, IPT for Blood investigations 0 780000 M5 M512063 No
^ Anaemia
PNH, HLA typing &
matching. S.
Cyclosporine level
Hematology, serum
Myelody
biochemistry, Bone
9.63A splastic Myelodysplastic syndrome - Lenalinomide
marrow examination Blood investigations 0 200000 M5 M512064 No
^ syndrom Decitabine
with cytogenetics, FISH
e
study,
Hematology, serum
Myelody
biochemistry, Bone
9.63B splastic
Allogeneic stem cell Transplant marrow examination Blood investigations 0 780000 M5 M512065 No
^ syndrom
with cytogenetics, FISH
e
study,
Thalasse
mia/Hae
moglobi Thalassemia/Haemoglobinopat hies Sickle Blood investigations Hb
9.64^ nopathie cell anaemia - Allogeneic Bone Marrow electrophoresis ,HLA Blood investigations 0 780000 M5 M512066 No
s Sickle Transplant study
cell
anaemia
Congenit
al Hematology, serum
conditio Congenital condition amenable to BMT - biochemistry, Hb
9.65^ Blood investigations 0 780000 M5 M512067 No
n Allogeneic stem cell Transplant electrophoresis , HLA
amenabl typing
e to BMT
Hematology, Serum
biochemistry, RI brain &
Medullo Cisplatin/cyclophosphamide/VCR/Procarba Physical exam, MRI 4-6
9.66* spine, Biopsy 0 6900 M5 M512068 No
blastoma zine, Lomustine study months
CSF cytology
Relapsed
Paediatri Relapsed Paediatric Solid Tumor - Blood investigations Blood investigations
9.67^ 0 780000 M5 M512069 No
c Solid Autologus stem cell transplant - and Imaging, and Imaging,
Tumours
9.68A Palliative Fixation of pathological fracture [Palliative Blood investigations Blood investigations M512070
0 31740 M5 No
^ package package ^] and Imaging, and Imaging, A
9.68B Palliative Oesophageal Stenting /prosthesis- double Blood investigations Blood investigations M512070
0 31750 M5 No
^ package [Palliative package ^] and Imaging, and Imaging, B
9.68C Palliative Oesophageal Stenting/prosthesis- Single Blood investigations Blood investigations M512070
0 26450 M5 No
^ package [Palliative package ^] and Imaging, and Imaging, C
Nerve blockage With Image / Nerve

9.68D Palliative Blood investigations Blood investigations M512070
blockage Without Image [Palliative 0 10580 M5 No
^ package and Imaging, and Imaging, D
package ^]
Pain killer / G-CSF/ Drainage – Biliary and
9.68E Palliative urinary / Stenting – Biliary/ Stenting – Blood investigations Blood investigations M512070
0 5290 M5 No
^ package urinary / Nutritional supplement and Imaging, and Imaging, E
[Palliative package ^]
Anal CXR , USG ABDOMEN, 3 to 4

9.69* MITOMYCIN, 5FU ULTRASOUND 0 4600 M5 M512071 No
Cancer CT Abdomen months
Head & Chest X ray, CT/MRI, 5 to 6
9.70* CISPLATIN WEEKLY CT Scan Xrays 0 4140 M5 M512072 No
Neck Biopsy weeks
Head & 2 to 3
9.71* TPF (DOCETAXEL ,CISPLATIN , 5-FU) X ray, CT, MRI Biopsy CT Scan X-rays 0 16330 M5 M512073 No
Neck months
Head & 2 to 3
9.72# CISPLATIN + MTX X ray, CT, MRI Biopsy CT Scan X-rays 0 4600 M5 M512074 No
Neck months
AFP , USG ABDOMEN, 4 to 8
9.73# HCC SORAFENIB ORAL USG ABDOMEN 0 8280 M5 M512075 No
CT Scan, Chest x ray months
USG, Biopsy, CT Scan, 4 to 8
9.74# RCC SUNITINIB USG ABDOMEN 0 27600 M5 M512076 No
Chest x ray months
MRI Brain, Biopsy with
Brain Tenozolamide, Procarbazine, CCNU,
9.75* Immunohistochemistry, MRI Brain, X-ay 0 17480 6months M5 M512077 No
Tumour Vincristine
X-ray
MRI, CT scan, Biopsy

Sarcoma-
with 4 to 6
9.76* soft Cisplatin/ Adriamycin/ Ifosphamides MRI, CT scan, X-ray 0 17250 M5 M512078 No
Immunohistochemistry, months
tissue
X-ray
Hepatobi CT scan, Biopsy, Tumor CT scan, Tumor
Gemcitabine/ Oxaliplatin/ Capecitabine/ 5 4 to 6
9.77* lliary markers, X-ray, markers, X-ray, 0 17480 M5 M512079 No
FU months
tumor Sonography Sonography
CT scan, Biopsy, Tumor CT scan, Tumor
Pancreat Gemcitabine/ Oxaliplatin/ Capecitabine/ 5 4 to 6
9.78* markers, X-ray, markers, X-ray, 0 17480 M5 M512080 No
ic cancer FU/Erlotinib months
Sonography Sonography
Endomet
CT scan/MRI study, X- CT scan, X-ray, 4 to 6
9.79* rial Weekly Platin Paclitaxel/ Carboplatin 0 4830 M5 M512081 No
ray, Biopsy, Sonography Sonography months
cancer
Biopsy report of proven

PET Study (All Cancer for all oncology
cancer of any past time
9.80 Oncology cluster diagnostic or staging in proven - 0 10000 - M5 M512082 No
necessary for pre
cancer patient)
authorisation
Cluster-10 RADIATION ONCOLOGY

Cobalt
60
external Clinical photograph, 6 to 7
10.1 Radical treatment Usg/x-ray/ct, biopsy 0 20000 M6 M612001 No
beam rt treatment charts weeks
radiother
apy
Cobalt
60
external Clinical photograph,
10.2 Palliative treatment Usg/x-ray/ct, biopsy 0 10000 3 weeks M6 M612002 No
beam rt treatment charts
radiother
apy
Cobalt
60
external Clinical photograph,
10.3 Adjuvent therapy Usg/x-ray/ct, biopsy 0 20000 4 weeks M6 M612003 No
beam rt treatment charts
radiother
apy
Linear
Radical treatment with photons (linear Clinical photograph, 6 to 7
10.4 accelerat Usg/x-ray/ct, biopsy 0 50000 M6 M612004 No
accelarator) rt treatment charts weeks
ors
Linear
Palliative treatment with photons (linear Clinical photograph,
10.5 accelerat Usg/x-ray/ct, biopsy 0 20000 3 weeks M6 M612005 No
accelarator) rt treatment charts
ors
Linear
Adjuvant treatment with Clinical photograph,
10.6 accelerat Usg/x-ray/ct, biopsy 0 40000 4 weeks M6 M612006 No
photons/electrons rt treatment charts
ors
Brachyth Weekly
erapy- Clinical photograph, applicatio
10.7 Ii. Hdr per application Usg/x-ray/ct, biopsy 0 11500 M6 M612007 No
intracavi rt treatment charts n for 2 to
tary-ii 5 weeks
Brachyth
erapy- Ii. Hdr - one application and multiple dose Clinical photograph,
10.8 Usg/x-ray/ct, biopsy 0 11500 5 days M6 M612008 No
interstiti fractions rt treatment charts
al-ii
LA with
multi
USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/ 6 to 7
10.9 leaf Radical treatment with IMRT 0 70000 M6 M612009 No
Biopsy MRI/ Biopsy weeks
collimato
r
LA with
multi
USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/ 6 to 7
10.10 leaf Radical treatment with IGRT 0 90000 M6 M612010 No
Biopsy MRI/ Biopsy weeks
collimato
r
LA with
some USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/
10.2 SRS (Stereotactic Radiosurgery) 0 110000 1 day M6 M612011 No
accessori Biopsy MRI/ Biopsy
es
LA with
some USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/
10.2 SRT (Stereotactic Radiotherapy) 0 110000 6 weeks M6 M612012 No
accessori Biopsy MRI/ Biopsy
es
Brain
10.2 Gamma Knife / Cyber Knife CT CT 0 115000 1 day M6 M612013 No
Tumour
Total
Body USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/ 6 to 7
10.2 Pre Bonemarrow/Stem Cell Transplant 0 66700 M6 M612014 No
Radiatio Biopsy MRI/ Biopsy weeks
n
Iodine Clinical photograph,
10.20 Radio Iodine Therapy Usg,/x-ray,/ct,/biopsy 0 15000 Per dose M6 M612015 No
Therapy rt treatment charts
Daily
EBRT
(5day x
(External Clinical photograph,
10.2 SBRT (Sterotactic Beam RT) Usg,/x-ray,/ct,/biopsy 0 110000 week) 6 M6 M612016 No
Beam rt treatment charts
to 7
RT)
weeks
Daily
(5day x
10.2 EBRT 3DCRT (3 Dimentional Conformal RT) Usg,/x-ray,/ct,/biopsy 0 70000 week) 6 M6 M612017 No
rt treatment charts
to 7
weeks
10.2 EBRT Electron Boost Usg,/x-ray,/ct,/biopsy 0 5000 2 weeks M6 M612018 No
rt treatment charts
Clinical photograph, 6 to 7
10.2 EBRT Electron treatment curative Usg,/x-ray,/ct,/biopsy 0 50000 M6 M612019 No
rt treatment charts weeks
Clinical photograph, 6 to 7
10.3 EBRT Rapidarc/VMAT Usg,/x-ray,/ct,/biopsy 0 100000 M6 M612020 No
rt treatment charts weeks
2
weeks(6.5
Brachyth Intraluminal Brachytherapy in addition to Clinical photograph,
10.3 Usg,/x-ray,/ct,/biopsy 0 11500 x2 M6 M612021 No
erapy EBRT rt treatment charts
up to 55
Gray)
2
Brachyth CT guided ICR (Intra Cavitory RT)in addition Clinical photograph, weeks(we
10.3 Usg,/x-ray,/ct,/biopsy 0 11500 M6 M612022 No
erapy to EBRT rt treatment charts ekly upto
66 Gray)
2 to 3
days(6ho
urly two
Brachyth CT guided Interstitial RT in addition to Clinical photograph,
10.3 Usg,/x-ray,/ct,/biopsy 0 16500 fraction M6 M612023 No
erapy EBRT rt treatment charts
per day
for two
days )
2 weeks
Brachyth Clinical photograph, (weekly
10.3 MRI guided ICR in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 16500 M6 M612024 No
erapy rt treatment charts upto 66
Gray)
2 to 3
days
(6hourly
Brachyth MRI guided Interstial RT in addition to Clinical photograph, two
10.30 Usg,/x-ray,/ct,/biopsy 0 16500 M6 M612025 No
erapy EBRT rt treatment charts fraction
per day
for two
days)
Radiatio
Respiratory Gating along with Linear Clinical Photo, RT
10.3 n CT, Biopsy 0 70000 M6 M600009 No
Accelerator planning Chart
Oncology
Radiatio
Tomotherapy(Radical/Adjuvant/Neoadjuva Clinical Photo, RT
10.3 n Blood test, CT, Biopsy 0 75000 M6 M600011 No
nt) Chart
Oncology
Cluster-11 SURGICAL ONCOLOGY

Microlaryngeal Surgery including

11.2 Throat Biopsy, CT Scan/ MRI Biopsy 1 11500 S15 S1512001 No
Phonosurgery
Excision/ Hypopharynx of Tumors in Clinical Photograph,
11.3 Throat Biopsy, CT Scan/ MRI 1 23000 S15 S1512002 No
Pharynx biopsy
11.4 Pancreas Distal Pancreatectomy CT , CA 19-9, PET Scan Clinical Photograph 1 55000 S15 S1512003 No
11.5 Pancreas Enucleation of Cyst CT, CA 19-9 Clinical Photograph 1 35000 S15 S1500030 No
CT , ERCP, CA 19-9, PET

11.6 Pancreas Whipples - any type Clinical Photograph 1 75000 S15 S1512004 No
Scan, EUS
Clinical Photograph
11.7 Spleen Splenectomy USG/CT 1 30000 S15 S1512005 No
, USG
Genito
Biopsy , CT , IVP , KUB Biopsy , Clinical
11.8 Urinary Radical Nephrectomy 1 34500 S15 S1512006 No
,USG Photograph , USG
System
Genito
Biopsy , CT , IVP , KUB Biopsy , Clinical
11.9 Urinary Radical Cystectomy 1 60000 S15 S1512007 No
,USG Photograph , USG
System
Genito
Biops,clinical notes,CT
11.10 Urinary Other cystectomies Clinical Photo, HPEE 1 40000 S15 S1512008 No
Scan/USG/MRI /MCU
System
Genito CT Scan (Abdomen,

Biopsy , Clinical
11.1 Urinary High Orchidectomy Pelvis), Biopsy, USG, CT 1 15000 S15 S1512009 No
Photograph , USG
System Scan Thorax
Genito
Biopsy , USG, Bone Biopsy , Clinical
11.1 Urinary Bilateral Orchidectomy 1 11500 S15 S1512010 No
Scan, Local X-ray Photograph , USG
System
Biopsy, CT Scan
Genito
(Abdomen, Biopsy , Clinical
11.1 Urinary Total Penectomy 1 25000 S15 S1512011 No
Pelvis),Clinical Photograph , USG
System
Photograph
Genito
Biopsy , Clinical Biopsy , Clinical
11.2 Urinary Inguinal Block Dissection-one side 1 8740 S15 S1512012 No
phtograph, CT Scan Photograph , USG
System
Genito
CT , KUB , USG, Bone Biopsy , Clinical
11.2 Urinary Radical Prostatectomy 1 60000 S15 S1512013 No
Scan, Biopsy Photograph , USG
System
Genito Biopsy, Clinical
Biopsy , Clinical
11.2 Urinary Partial Penectomy Photograph, USG 1 15000 S15 S1512014 No
Photograph , USG
System Abdomen Pelvis
Biopsy , Clinical
11.2 Gynaec Radical Hysterectomy Biopsy , CT , USG 1 34500 S15 S1512015 No
Photograph , USG
CA 125, CEA, Biopsy/ Biopsy , Clinical
11.2 Gynaec Surgery for Ca Ovary - early stage cytology, aFP, ßHCG, Photograph , USG, 1 23000 S15 S1512016 No
LDH, X-ray chest Tumor Marker
CA 125, CEA, Biopsy/ Biopsy , Clinical

11.20 Gynaec Surgery for Ca Ovary - advance stage cytology, aFP, ßHCG, Photograph , USG, 1 40000 S15 S1512017 No
LDH, X-ray chest Tumor Marker
Biopsy , Clinical
11.2 Gynaec Vulvectomy Biopsy, Photograph 1 17250 S15 S1512018 No
Photograph , USG
Biopsy, X-rays,
Mammogram, Biopsy , Clinical
11.2 Breast Mastectomy - any type 1 25000 S15 S1512019 No
Photograph, USG, CT, Photograph
Bone scan
Biopsy, X-rays,
Mammogram, Biopsy , Clinical
11.2 Breast Axillary Dissection 1 23000 S15 S1500022 No
Photograph, USG, CT, Photograph
Bone scan
Biopsy, X-rays,
Biopsy , Clinical
11.2 Breast Wide excision Mammogram, 1 11500 S15 S1512020 No
Photograph
Photograph, USG, CT
Ca.Rectu Abdomino Perineal Resection (APR) CT/ Barium Meal Follow Clinical Photograph,
11.3 1 50000 S15 S1512021 No
m +Sacrectomy through biopsy
Ca. Gall Biopsy , Clinical
11.3 Radical Cholecystectomy CT , USG, PET Scan 1 60000 S15 S1500031 No
Bladder Photograph , USG
CT/BMFT,
Wide excision + Reconstruction ( Pedicle Clinical Photograph,
11.3 Breast Colonoscopy,Biopsy, 1 25000 S15 S1512022 No
flap) biopsy
CEA, PET Scan
Biopsy, X-rays,
Lung Biopsy , Clinical
11.3 Pneumonectomy Mammogram, 1 50000 S15 S1512023 No
Cancer Photograph , USG
Photograph, USG, CT
Biopsy, X-rays,
Lung Biopsy , Clinical
11.3 Lobectomy Mammogram, 1 50000 S15 S1512024 No
Cancer Photograph
Photograph, USG, CT
Lung Biopsy , CT , X-RAY, PET Biopsy , Clinical

11.30 Decortication 1 40000 S15 S1512025 No
Cancer scan, CT brain Photograph , X-RAY
Lung Surgical Correction of Bronchopleural Biopsy , CT , X-RAY, PET Biopsy , Clinical

11.3 2 35000 S15 S1512026 No
Cancer Fistula. scan (SOS) Photograph , X-RAY
Head Biopsy , CT , X-RAY, PET Biopsy , Clinical

11.3 Resection of Nasopharyngeal Tumor 1 50000 S15 S1500004 No
&Neck scan, CT brain Photograph , X-RAY
Head Biopsy , Clinical

11.3 Craniofacial resection of any type Biopsy , CT , X-RAY 1 90000 S15 S1512027 No
&Neck Photograph , X-RAY
11.34 Head Biopsy , Clinical S1512028
Composite Resection ANY TYPE Biopsy, CT/MRI 1 41250 S15 No
A &Neck Photograph A
11.34 Head Biopsy , Clinical S1512028
PEDICLE FLAP Reconstruction Biopsy, CT/MRI 1 13750 S15 No
B &Neck Photograph B
11.4 Neck Dissection - any type CT/ MRI, Biopsy 1 32200 S15 S1512029 No
&Neck Photograph
Head Clinical Photograph/X- Clinical Photograph,

11.4 Hemiglossectomy 1 20700 S15 S1512030 No
&Neck Ray,USG/biopsy/CT biopsy
Biopsy , Clinical
11.4 Maxillectomy - any type Photograph , USG , X- 1 25000 S15 S1512031 No
&Neck Photograph
RAY, CT Scan
Biopsy , Clinical
11.4 Thyroidectomy - any type Photograph , USG , X- 1 25000 S15 S1512032 No
&Neck Photograph
RAY, MRI
Head x-ray of maxilla, biopsy and Clinical
11.4 Parotidectomy - any type 1 20000 S15 S1512033 No
&Neck CT/MRI, biopsy Photograph
Biopsy , Clinical
11.40 Laryngectomy - any type Photograph , USG , X- 1 40000 S15 S1512034 No
&Neck Photograph
RAY, CT Scan
Biopsy , Clinical
11.4 Laryngopharyngo Oesophagectomy Photograph , USG , X- 1 70000 S15 S1512035 No
&Neck Photograph
RAY, CT Scan
Biopsy , Clinical
11.4 Hemimandibulectomy Photograph , USG , X- 1 25000 S15 S1512036 No
&Neck Photograph
RAY, CT Scan
Biopsy , Clinical
11.4 Wide excision Any type Photograph , USG , X- 1 11500 S15 S1512037 No
&Neck Photograph
RAY, CT Scan
Ca. Biopsy , Clinical
Biopsy , Clinical
11.4 Salivary Submandibular Gland Excision Photograph , USG , X- 1 18400 S15 S1512038 No
Photograph
Gland RAY, OPG/CT scan
Biopsy , Clinical
11.5 Tracheal Resection Photograph , USG , X- 1 50000 S15 S1500001 No
Trachea Photograph
RAY
Biopsy , Clinical
Ca. Sternotomy + Superior Mediastinal Biopsy , Clinical
11.5 Photograph , USG , X- 1 45000 S15 S1500002 No
Trachea Dissection Photograph
RAY
Ca.
Biopsy, CT, Clinical Photograph,
11.5 Parathyr Parathyroidectomy 1 20700 S15 S1512039 No
Bronchoscopy biopsy
oid
Ca.
Gastro Clinical Photograph,
11.5 Small bowel resection Biopsy, CT 1 18400 S15 S1512040 No
Intestinal biopsy
Tract
Gastro Photograph , USG , X- Biopsy , Clinical
11.5 Closure of Ileostomy/ Colostomy 1 8050 S15 S1512041 No
Intestinal RAY, Serum Photograph
Tract Parathormone
Biopsy , Clinical
11.50 Spleen Radical Splenectomy CT , USG 1 30000 S15 S1512042 No
Photograph , USG
Gastro
Barium meal test, CT Biopsy, clinical
11.5 Intestinal Resection of Retroperitoneal Tumors 1 45000 S15 S1512043 No
abdomen, biopsy photograph
System
Gastro
USG, CT abdomen, BIOPSY, CLINICAL
11.5 Intestinal Abdominal wall tumor Resection 1 35000 S15 S1500032 No
biopsy PHOTOGRAPH
System
Gastro
USG, CT abdomen, BIOPSY, CLINICAL
11.5 Intestinal Resection with reconstruction 1 20700 S15 S1500033 No
biopsy PHOTOGRAPH
System
Gastro
11.6 Intestinal Oesophagectomy - any type 1 60000 S15 S1512044 No
,USG, PET SCAN Photograph , USG
System
Gastro
11.6 Intestinal Gastrectomy - any type 1 40000 S15 S1512045 No
,USG, PET SCAN Photograph , USG
System
Gastro
11.6 Intestinal Colectomy - any type 1 40000 S15 S1512046 No
, USG, CEA Photograph , USG
System
Gastro
11.6 Intestinal Anterior Resection 1 50000 S15 S1512047 No
System
Gastro
11.6 Intestinal Abdominoperinial Resection 1 40000 S15 S1512048 No
System
Gastro
11.60 Intestinal Triple Bypass 1 23000 S15 S1500035 No
, USG Photograph , USG
System
Gastro
Other GI Bypasses surgery any type Biopsy , CT , Endoscopy Biopsy , Clinical
11.6 Intestinal 1 25000 S15 S1512049 No
(including pancreas) , USG Photograph , USG
System
11.6 Gynaec Radical Trachelectomy CT/MRI, Biopsy 1 35000 S15 S1500043 No
biopsy
11.6 Gynaec Radical vaginectomy CT, Biopsy 1 26450 S15 S1500040 No
biopsy
11.6 Gynaec Radical vaginectomy + Reconstruction CT, Biopsy 1 45000 S15 S1500041 No
biopsy
Radical Hysterectomy +Bilateral Pelvic

Gynaec- Lymph Node Dissection (BPLND) + Bilateral Clinical Photograph,
11.7 Pap Smear / biopsy, CT 1 45000 S15 S1500037 No
Ca.Cervix Salpingo Ophorectomy (BSO) / Ovarian biopsy
transposition
Gynaec- Clinical Photograph,

11.7 Anterior Exenteration (Gynaec) Pap Smear / biopsy, CT 1 60000 S15 S1512050 No
Ca.Cervix biopsy

11.7 Posterior Exenteration (Gynaec) Pap Smear / biopsy, CT 1 50000 S15 S1512051 No
Ca.Cervix biopsy

11.7 Total Pelvic Exenteration Pap Smear / biopsy, CT 1 75000 S15 S1512052 No
Ca.Cervix biopsy
Chest wall resection for SOFT tissue bone Biopsy, CT Chest, Bone Clinical Photograph,
11.7 Chest 1 9660 S15 S1512053 No
tumors Scan biopsy
Biopsy, CT Chest, Bone Clinical Photograph,

11.70 Chest Chest wall resection + Reconstruction 1 30000 S15 S1500048 No
Scan biopsy
Bone /
soft Limb salvage surgery for Bone Tumors with CT-Local part, CT Clinical Photograph,
11.7 1 75000 S15 S1500045 No
tissue modular Prosthesis Chest,MRI, Bone Scan biopsy
tumors
Bone /
Clinical
soft
11.7 Forequarter amputation Biopsy, CT Chest Photlograph/ X-Ray, 1 30000 S15 S1512054 No
tissue
biopsy
tumors
Bone /
Clinical
soft Biopsy, CT/MRI Pelvis,
11.7 Hemipelvectomy Photlograph/ X-Ray, 1 55000 S15 S1500046 No
tissue CT Chest, PET scan
biopsy
tumors
Bone /
Clinical
soft
11.7 Bone resection CT/MRI, Biopsy Photograph/X-ray, 1 30000 S15 S1512055 No
tissue
biopsy
tumors
Renal
11.8 Cell Partial Nephrectomy CT/Isotope renogram 1 40000 S15 S1512056 No
biopsy
Cancer
Renal
Nephroureterectomy for Transitional Cell Clinical Photograph,
11.8 Cell CT, Biopsy 1 46000 S15 S1512057 No
Carcinoma of renal pelvis (one side) biopsy
Cancer
CT-Chest,
Testes Retro Peritoneal Lymph Node Clinical Photograph,
11.8 CT.Abd+Pelvis, Tumor 1 60000 S15 S1512058 No
cancer Dissection(RPLND) (for Residual Disease) biopsy
markers, biopsy
CT/MRI, Urinary Clinical Photograph,

11.8 Tumours Adrenalectomy 1 45000 S15 S1512059 No
hormones biopsy
Testes Clinical Photograph,

11.8 Urinary diversion biopsy, USG Scrotum 1 40000 S15 S1512060 No
cancer biopsy
Testes Retro Peritoneal Lymph Node Dissection Clinical Photograph,

11.80 CT, biopsy 1 23000 S15 S1512061 No
cancer RPLND as part of staging biopsy
Ca.
11.8 Urinary Anterior Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT 1 60000 S15 S1512062 No
biopsy
Bladder
Ca.
11.8 Urinary Total Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT 1 75000 S15 S1512063 No
biopsy
Bladder
Ca.
Bilateral pelvic lymph Node Clinical Photograph,
11.8 Urinary CT, biopsy 1 25000 S15 S1500042 No
Dissection(BPLND) biopsy
Bladder
Thoracic
and Clinical Photograph,
11.8 Mediastinal tumor resection CT 1 50000 S15 S1512064 No
Mediasti biopsy
num
CT, biopsy, Bone scan/
11.9 Lung Lung metastatectomy of any type X-Ray, Biospy 1 35000 S15 S1512065 No
PET scan
CT/ Bronchoscopy,
11.9 Lung Sleeve resection of Lung cancer. X-Ray, Biospy 1 90000 S15 S1500027 No
biopsy, PET scan
Esophag Oesophagectomy with Two field UGI Endoscopy, biopsy Clinical Photograph,
11.9 1 80000 S15 S1500028 No
us Lymphadenectomy / CT biopsy
Esophag Oesophagectomy with Three field UGI Endoscopy, biopsy Clinical Photograph,
11.9 1 80000 S15 S1500029 No
us Lymphadenectomy / CT biopsy
Palliative
11.9 Tracheostomy Clinical Photograph Clinical Photograph 1 5520 S15 S1500021 No
Surgeries
Palliative
11.90 Gastrostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512066 No
Surgeries
Palliative
11.9 Jejunostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512067 No
Surgeries
Palliative
11.9 Ileostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512068 No
Surgeries
Palliative
11.9 Colostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512069 No
Surgeries
Palliative
11.9 Suprapubic Cystostomy Clinical Photograph Clinical Photograph 1 10000 S15 S1512070 No
Surgeries
Palliative USG, CT SCAN, Clinical Clinical Photograph,

12 Gastro Jejunostomy 1 20000 S15 S1512071 No
Surgeries Photograph biopsy
CT SCAN, USG,
Palliative Clinical Photograph,
12 Ileotransverse BYPASSColostomy Endoscopy, Biopsy, 1 9890 S15 S1512072 No
Surgeries biopsy
Clinical Photograph
CT SCAN, USG,
Palliative Clinical Photograph,
12 Substernal bypass Endoscopy, Biopsy, 1 35000 S15 S1500003 No
Surgeries biopsy
Clinical Photograph
Reconstr
12 Myocutaneous / cutaneous flap Clinical Photograph Clinical Photograph 1 25000 S15 S1500005 No
uction
Reconstr Doppler study, Clinical

12 Micro vascular reconstruction Clinical Photograph 1 45000 S15 S1500009 No
uction Photograph
Soft
Tissue
11.10 Wide excision - for soft tissue and bone Clinical Photograph, Clinical Photograph,
and 1 12650 S15 S1512073 No
0 tumors biopsy biopsy
Bone
Tumors
Soft
Tissue
Wide excision + Reconstruction for soft Clinical Photograph, Clinical Photograph,
11.1 and 1 25000 S15 S1512074 No
tissue and bone tumors biopsy biopsy
Bone
Tumors
Soft
Tissue
Amputation for bone / soft tissue tumours Clinical Photograph, Clinical Photograph,
11.1 and 1 25000 S15 S1512075 No
(Major / Minor) biopsy Biopsy
Bone
Tumors
Genito
Biopsy, Clinical Biopsy, Clinical
11.1 Urinary Inguinal Block Dissection-both side 1 16100 S15 S1512076 No
Photograph, CT scan Photograph, USG
System
CT/ BMFT,
Ano- Low Anterior resection OR Sphincter Biopsy, Clinical
11.1 Colonoscopy, Biopsy, 1 40000 S15 S1512077 No
rectal preserving surgery of any type Photograph, USG
CEA
Barium meal test, CT

Gastro
abdomen, biopsy, Biopsy, Clinical
11.1 Intestinal Laproscopic resection of any type 1 50000 S15 S1512078 No
Endoscopy, Tumor Photograph, USG
Surgery
Marker
CT abdomen, biopsy,
Biopsy, Clinical
11.1 Liver Hepatic surgery of any type Endoscopy, Tumor 1 70000 S15 S1512079 No
Photograph, USG
Marker
Lung &
Thoracoscopic and Laproscopic surgery of CT abdomen, biopsy, Biopsy, Clinical
11.1 Oesopha 1 60000 S15 S1512080 No
any type Endoscopy Photograph, USG
gus
Genito
Laproscopic surgery for kidney & supra CT abdomen, biopsy, Biopsy, Clinical
11.1 Urinary 1 40000 S15 S1512081 No
renal any type Endoscopy Photograph, USG
System
Brain
11.1 Brain tumours surgery of any type CT/ MRI, Biopsy CT, Photograph 1 55000 S15 S1512082 No
Tumour
Gynaec
11.11 Body of Biopsy, CT scan, USG, CT, Biopsy,
TAH + BSO + BLND + O.S. 1 45000 S15 S1512083 No
0 the CA 125 Photograph
uterus
Bone &
MRI, Bone scan & PET CT, Biopsy,
11.1 soft Hind Quarter Amputation 1 40000 S15 S1512084 No
scan Photograph
tissue
Bone &
11.1 soft Hip & Knee Disarticulation MRI Photograph 1 45000 S15 S1512085 No
tissue
Gynaec
CIN Early
cancer of Radical Trachelectomy Cone Biopsy, Simple Biopsy, CT scan, USG,
11.1 Biopsy, USG 1 40000 S15 S1512086 No
any Hysterectomy CA 125
female
organ
All
System
Pre
11.1 malignan Laser Surgery Any type Usg,/x-ray,/ct,/biopsy clinical photograph 1 15000 S15 S1512087 No
t and
Malignan
t Lesion
Usg,/x-ray,/ct,/biopsy
Head &
11.1 Flap Cutting any type previous procedure clinical photograph 1 5000 S15 S1512088 No
Neck
report
Head &
11.1 Eyeball enucleation Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512089 No
Neck
For All
Long
11.1 term PICC (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 10000 S15 S1512090 No
Chemoth
erapy
For All
Long
11.1 term Port Insertion (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512091 No
Chemoth
erapy
Palliative
11.1 ICD Tube Insertion Usg,/x-ray,/ct,/biopsy clinical photograph 1 1500 S15 S1512092 No
Surgeries
11.12 Wide Excision any type (Surgery other

Pancreas Usg,/x-ray,/ct,/biopsy clinical photograph 3 50000 S15 S1512093 No
0 than Whipples)
Palliative
11.1 Drain Insertion any type Usg,/x-ray,/ct,/biopsy clinical photograph 1 1500 S15 S1512094 No
Surgeries
Any
Usg,/x-ray,/ct,/biopsy
Wound
11.1 Resuturing previous procedure clinical photograph 1 3000 S15 S1512095 No
Gap
report
Surgery
Invoice of
11.1 Larynx Voice prosthesis Biopsy, CECT prosthesis, scar 1 30000 S15 S1500018 No
photo
Skin Tumours Wide Excision + Biopsy, Blood Routine
11.1 Skin clinical photograph 1 25000 S15 S1500038 No
Reconstruction (CBC), CT Scan
Biopsy, Blood Routine

11.1 Skin Skin Tumours Amputation clinical photograph 1 25000 S15 S1500039 No
(CBC), CT Scan
HPE report,Clinical
Breast conserving surgery (lumpectomy +
11.1 Brest CECT,FNAC/ BIOPSY photograph showing 1 12000 S16 S1500023 No
axillary surgery)
scar
Oncosur Unspecified Surgical Package (Amount Concern

11.1 Concern Investigation 1 100000 S15 U100 No
gery Capped @ 1,00,000rs per anum per family) Investigation
Cluster-14 JOINT REPLACEMENT

Haematology, Serum
Hip
Total Hip Replacement (cemented) (With Biochemistry, Viral Clinical Photograph,
14.2 Replace 3 75000 S5 S500091 No
US FDA Approved Implants) markers, Clinical X-RAY
ment
Photograph, X-RAY
Haematology, Serum
Hip
Total Hip Replacement (cementless)(With Biochemistry, Viral Clinical Photograph,
14.2 Replace 3 90000 S5 S500092 No
US FDA Approved Implants) markers, Clinical X-RAY
ment
Photograph, X-RAY
Haematology, Serum
Hip
Total Hip Replacement (hybrid)(With US Biochemistry, Viral Clinical Photograph,
14.2 Replace 3 75000 S5 S500093 No
FDA Approved Implants) markers, Clinical X-RAY
ment
Photograph, X-RAY
Haematology, Serum
Biochemistry, Viral
Knee markers, Clinical
Total Knee Replacement (With US FDA Clinical Photograph,
14.2 Replace Photograph, X-RAY, 3 80000 S5 S500096 No
Approved Implants - Metal Back Implant) X-RAY
ment Bilateral Lower Limb
Standing ORG/CT
scanogram
Cluster-15 ORGAN TRANSPLANT PACKAGES

Blood group, FBS, PPBS,

ELISA
USG ABDOMEN, Urine
R/M and C/S
CBC, RFT, LFT, Uric acid,
PTH, Lipid profile, Iron
Kidney
Kidney transplantation Laparoscopic Donor profile, CMV IgG and IgM
15.1 transpla RFT 2 60000 S17 S1712001 No
nephrectomy BT, CT, PT, G6PD
ntation 2D Echocardiogram
Chest X Ray, ECG, DTPA
Renogram, PAP smear
(female)
CT Angiogram for kidney
vessel
Blood group, HbA1C,

FBS, PPBS, ELISA, HCV
RNA Qualitative, CMV
Open Kidney transplantation from living IgG and IgM
donor Part-1 Investigations USG Abdomen,
Blood group, HbA1C, FBS, PPBS, ELISA, Urine R/M and C/S
HCV RNA Qualitative, CMV IgG and IgM iPTH, Vit D, Uric Acid
USG Abdomen, BT,CT, PT, aPTT, G6PD
Urine R/M and C/S level
Kidney
15.2 iPTH, Vit D, Uric Acid Chest X Ray, ECG, 2D
transpla 0 15000 S17 S1712002 No
A BT,CT, PT, aPTT, G6PD level echocardiogram
ntation
Chest X Ray, ECG, 2D echocardiogram Lipid Profile,
Lipid Profile, Anticardiolipin Antibody, Anticardiolipin
Lupus Anticoagulant, C3, C4, ANA, dsDNA, Antibody, Lupus
pANCA, cANCA, USG Doppler Neck vessels Anticoagulant, C3, C4,
Usg Doppler Iliofemoral Vessels ANA, dsDNA, pANCA,
MCU, Uroflowmetry cANCA, USG Doppler
Neck vessels
Usg Doppler Iliofemoral
Vessels
MCU, Uroflowmetry
Open Kidney transplantation from living

Kidney donor Part-2 Investigations HLA Typing
15.2
transpla HLA Typing LCM, FCM 0 22500 S17 S1712003 No
B
ntation LCM, FCM Single Antigen
Single Antigen Qualitative Qualitative
Open Kidney transplantation from living
Kidney
15.2 donor Part-3 Investigation Single Antigen
transpla 0 22500 S17 S1712004 No
C Single Antigen Quantitative Quantitative
ntation
Kidney Open Kidney transplantation from living S. Creatinine, USG

15.2
transpla donor Part-4 Operative Part kidney graft, Doppler 4 240000 S17 S1712005 No
D
ntation study for graft
Blood group, HbA1C, FBS,

PPBS, ELISA, HCV RNA
Open Kidney transplantation from Qualitative, CMV IgG and
deceased donor Part-1 Investigations IgM
Blood group, HbA1C, FBS, PPBS, ELISA, USG Abdomen,
HCV RNA Qualitative, CMV IgG and IgM Urine R/M and C/S
USG Abdomen, iPTH, Vit D, Uric Acid
BT, CT, PT, aPTT, G6PD
Urine R/M and C/S
Kidney level
15.3 iPTH, Vit D, Uric Acid
transpla Chest X Ray, ECG, 2D 0 18000 S17 S1712006 No
A BT, CT, PT, aPTT, G6PD level
ntation echocardiogram
Lipid Profile, Anticardiolipin Antibody, Anticardiolipin Antibody,
Lupus Anticoagulant, C3, C4, ANA, dsDNA, Lupus Anticoagulant, C3,
pANCA, cANCA, USG Doppler Neck vessels C4, ANA, dsDNA, pANCA,
Usg Doppler Iliofemoral Vessels cANCA, USG Doppler Neck
MCU, Uroflowmetry vessels
Vessels
MCU, Uroflowmetry
Open Kidney transplantation from

Kidney deceased donor Part-2 Investigations
15.3 HLA Typing
transpla HLA Typing 0 27000 S17 S1712007 No
B LCM, FCM
ntation LCM, FCM Single Antigen Qualitative
Single Antigen Qualitative
Open Kidney transplantation from

Kidney Single Antigen
15.3 deceased donor Part=3 InvestigationSingle
transpla Quantitative 0 27000 S17 S1712008 No
C Antigen Quantitative
ntation
Kidney Open Kidney transplantation from S. Creatinine, USG

15.3
transpla deceased donor Part-4 Operative Part kidney graft, Doppler 4 288000 S17 S1712009 No
D
ntation study for graft
Blood group ,HbA1C, FBS,

Open dual Kidney transplantation from Qualitative, CMV IgG and
Blood group ,HbA1C, FBS, PPBS, ELISA, USG Abdomen,
BT,CT, PT,aPTT,. G6PD
Urine R/M and C/S
Kidney level
A BT,CT, PT,aPTT,. G6PD level
pANCA, cANCA,USG Doppler Neck vessels C4, ANA, dsDNA, pANCA,
Usg Doppler Iliofemoral Vessels cANCA,USG Doppler Neck
Vessels
MCU, Uroflowmetry
Open dual Kidney transplantation from

15.4 HLA Typing
B LCM, FCM
Kidney Open dual Kidney transplantation from

15.4
transpla deceased donor Part=3 Investigation Single Antigen 0 30000 S17 S1712012 No
C
ntation Single Antigen Quantitative Quantitative
Kidney S. Creatinine, USG

15.4 Open dual Kidney transplantation from
transpla kidney graft,Doppler 4 320000 S17 S1712013 No
D deceased donor Part - 4 Operative Part
ntation for both kidney grafts
Kidney
Wound exploration for kidney graft USG and Doppler study of Clinical photo, S.
15.5 transpla 1 40000 S17 S1712014 No
nephrectomy kidney allograft Creatinine
ntation

Robotic kidney transplantation from living Qualitative, CMV IgG and
donor Part-1 Investigations IgM
Urine R/M and C/S
Kidney level
pANCA, cANCA,USG Doppler Neck vessels C4, ANA, dsDNA, pANCA,
Usg Doppler Iliofemoral Vessels cANCA,USG Doppler Neck
Vessels
MCU, Uroflowmetry
Robotic kidney transplantation from living

Kidney donor Part-2 Investigations
15.6 HLA Typing
B LCM, FCM
Kidney Robotic kidney transplantation from living

15.6
transpla donor Part-3 Investigation Single Antigen 0 33000 S17 S1712017 No
C
Kidney
15.6 Robotic kidney transplantation from living S. Creatinine, USG
transpla 4 352000 S17 S1712018 No
D donor Part - 4 Operative Part kidney graft
ntation
Blood group ,HbA1C,

FBS, PPBS, ELISA, HCV
RNA Qualitative, CMV
Robotic kidney transplantation from IgG and IgM
deceased donor Part-1 Investigations USG Abdomen,
Blood group ,HbA1C, FBS, PPBS, ELISA, Urine R/M and C/S
HCV RNA Qualitative, CMV IgG and IgM iPTH, Vit D, Uric Acid
USG Abdomen, BT,CT, PT,aPTT,. G6PD
Urine R/M and C/S level
Kidney
15.7 iPTH, Vit D, Uric Acid Chest X Ray, ECG, 2D
transpla 0 23000 S17 S1712019 No
A BT,CT, PT,aPTT,. G6PD level echocardiogram
ntation
Lipid Profile, Anticardiolipin Antibody, Anticardiolipin
Lupus Anticoagulant, C3, C4, ANA, dsDNA, Antibody, Lupus
pANCA, cANCA,USG Doppler Neck vessels Anticoagulant, C3, C4,
Usg Doppler Iliofemoral Vessels ANA, dsDNA, pANCA,
MCU, Uroflowmetry cANCA,USG Doppler
Neck vessels
Vessels
MCU, Uroflowmetry
Robotic kidney transplantation from

Kidney deceased donor Part-2 Investigations HLA Typing
15.7
transpla HLA Typing LCM, FCM 0 34500 S17 S1712020 No
B
ntation LCM, FCM Single Antigen
Single Antigen Qualitative Qualitative
Robotic kidney transplantation from

Kidney
15.7 deceased donor Part-3 Investigation Single Antigen
transpla 0 34500 S17 S1712021 No
C Single Antigen Quantitative Quantitative
ntation
Kidney
15.7 Robotic kidney transplantation from S. Creatinine, USG
transpla 4 368000 S17 S1712022 No
D deceased donor Part - 4 Operative Part kidney graft
ntation

Robotic dual kidney transplantation from Qualitative, CMV IgG and
Urine R/M and C/S
Kidney level
pANCA, cANCA, USG Doppler Neck vessels C4, ANA, dsDNA, pANCA,
Usg Doppler Iliofemoral Vessels cANCA, USG Doppler Neck
Vessels
MCU, Uroflowmetry
Robotic dual kidney transplantation from

15.8 HLA Typing
B LCM, FCM
Kidney Robotic dual kidney transplantation from

15.8
transpla deceased donor Part-3 Investigation Single Antigen 0 36000 S17 S1712025 No
C
Kidney Clinical photograph,

15.8 Robotic dual kidney transplantation from
transpla S. Creatinine, USG 4 384000 S17 S1712026 No
D deceased donor Part-4 Operative Part
ntation kidney graft
49,000*
Single antigen per
Kidney Plasmapheresis for acute B cell rejection Single antigen qualitative
qualitative and sittings
15.9* transpla Albumin and Rituximab based protocol ( and quantitative, Flow 0 49000 S17 S1712027 No
quantitative, Flow with limit
ntation Rate is per sittings with limit of 4 sittings) Cytometry, Kidney biospy Cytometry of 4
sittings
37,500*
Plasmapheresis for highly sensitized Single antigen per
Kidney Single antigen qualitative
recipient Albumin and Rituximab based qualitative and sittings
15.10 transpla and quantitative, Flow 0 37500 S17 S1712028 No
protocol (rate is per sittings with limit of 4 quantitative, Flow with limit
ntation Cytometry
sittings) Cytometry of 4
sittings
Monthly investigations and

immunosuppression from discharge after
CBC, RFT, RBS, Urine,
Kidney kidney transplant Include Prednisolone CBC, RFT, RBS, Urine, 10,000*
Graft Doppler,
15.1 transpla ,Tacrolimus 4mg/day, Mycophenolate 360 Graft Doppler, Tacrolimus 0 10000 Rate per S17 S1712029 No
Tacrolimus
ntation or 500 mg (4 tables) /day, Valgancyclovir level month
level(monthly)
450 mg OD, Fluconazole 100mg OD,
Sepmax OD (Rate is per Month)

immunosuppression after kidney
Kidney transplant Include * Rate
15.1 transpla Prednisolone,Tacrolimus CBC, RFT, RBS, Urine CBC, RFT, RBS, Urine 0 5000 per S17 S1712030 No
ntation 4mg/day,Mycophenolate 360 or 500 mg (4 month
tables) /day, Sepmax OD (Package Rate
per month)
Treatment of Invasive fungal infection

after kidney transplant Include Liposomal Blood culture, CBC, RFT,
RBS, XR Chest, CT of organ * Rate
Kidney Amphotericin 300MG /day(5mg/kg for 60 Blood culture, CBC,
of invasion (plain) , Urine per day
15.1 transpla kg person) for 30 days and Surgical RFT, RBS, XR Chest, 0 12000 S17 S1712031 No
Routine and culture, with limit
ntation debridement Hospital stay for 10 days ,ICU CT Thorax
Endoscopy for fluid and of 30 days
stay for 10 d (Rate per day with limit of 30 reports, BAL charges
days)
Kidney graft biopsy, CBC,

RFT, RBS, XR Chest, CT of
CMV infection after kidney transplant CBC, RFT, RBS, XR
Kidney organ of invasion (Plain),
15.14 Include IV gancyclovir 500 mg / Hospital Chest, Tacrolimus
transpla Graft Doppler, Tacrolimus 0 18000 S17 S1712032 No
A stay for 14 day, tab.Valgancyclovir 450 mg level, CMV DNA
ntation level, CMV DNA quantity,
OD for 3-7 days quantity
BKV DNA quantity, Urine
routine and culture

B stay for 14 day, tab.Valgancyclovir 450 mg level, CMV DNA
OD for 8-12 days quantity
routine and culture

C stay for 14 day, tab.Valgancyclovir 450 mg level, CMV DNA
OD for 13 and above Days quantity
routine and culture
Single antigen quantity

Treatment for B cell rejection with Kidney graft biopsy , CBC Single antigen
Therapeutic Plasma exchange with RFT, RBS, XR Chest, CT quantity , CBC,
Thorax, RFT, RBS, XR Chest,
Kidney ALBUMIN +IVIG 5 gm (4 sessions), Inj
15.15 Graft Doppler, Tacrolimus Tacrolimus level,
transpla Rituximab 200 mg or Inj Boretezomib 2 mg 3 67500 S17 S1712035 No
A level CMV DNA quantity,
ntation (4 doses) CMV DNA quantity, BKV BKV DNA quantity
IV methyl prednisolone, Hospital stay for3- DNA quantity, Urine CS
7 days

B level CMV DNA quantity,
IV methyl prednisolone, Hospital stay for 8- DNA quantity, Urine CS
13 Days

C level CMV DNA quantity,
IV methyl prednisolone, Hospital stay for DNA quantity, Urine CS
13 Days abd above

Kidney graft biopsy, CBC
CBC,
RFT, RBS, XR Chest, CT
Treatment for T cell rejection with RFT, RBS, XR Chest,
Kidney Thorax, Graft Doppler,
15.16 thymoglobulin IV methyl prednisolone, IV Tacrolimus level,
transpla Tacrolimus level 3 39000 S17 S1712038 No
A thymoglobulin 75 mg, Hospital stay for 3-7 CMV DNA quantity,
ntation CMV DNA quantity, BKV
days BKV DNA quantity
DNA quantity, Urine CS

CBC,
B thymoglobulin 75 mg, Hospital stay for 8- CMV DNA quantity,
12 days BKV DNA quantity

CBC,
C thymoglobulin 75 mg, Hospital stay for 13 CMV DNA quantity,
and above Days BKV DNA quantity
Blood culture, CBC, RFT,

RBS
XR Chest, CT Thorax, Graft Blood culture
Chest Infection after transplant with 10day Doppler ,CBC,RFT,RBS
Kidney ICU care with Ventilator, isolation ward for Tacrolimus level, CMV XR Chest,
15.17
transpla 3-10 days DNA quantity, BKV DNA CT Thorax, 3 75000 S17 S1712041 No
A
ntation quantity Tacrolimus level,
Urine culture, Urine culture
Bronchoscopy charges
and reports

RBS
15.17
transpla 11-20 days DNA quantity, BKV DNA CT Thorax, 3 112500 S17 S1712042 No
B
and reports

RBS
15.17
transpla 21 and above days DNA quantity, BKV DNA CT Thorax, 3 150000 S17 S1712043 No
C
and reports
HEPATITIS C VIRUS TREAMENTInclude HCVRNA quantity,

Kidney HCVRNA quantity, CBC, * Rate
Sofosbuvir400+ledispasvir90mg OD for 3 CBC,
15.2 transpla RFT, LFT, Tacrolimus level 0 10500 per S17 S1712044 No
months and HCVRNA quantity ( 3 times) LFT, RFT
ntation month
(Rate per Month)
Yearly HEPATITIS B VIRUS TREATMENT

Kidney * Rate
Include ENTECAVIR 0.5 MG OD for 12 HBVDNA quantity, CBC, HBVDNA quantity,
15.2 transpla 0 2200 per S17 S1712045 No
months, HBVDNA quantity( 3 time) (Rate RFT, LFT, Tacrolimus level CBC, LFT, RFT
ntation month
per Month)
Kidney Monthly once a day tacrolimus * Rate

tacrolimus lvel, CBC, FRT, tacrolimus lvel, CBC,
15.20 transpla immunosuppression after kidney 0 6800 per S17 S1712046 No
LFR, RBS FRT, LFR, RBS
ntation transplant (Rate per Month) month
Kidney * Rate
Monthly sirolimus immunosuppression Sirolimus LEVEL, CBC, LFT, Sirolimus LEVEL, CBC,
after kidney transplant (Rate per Month) RFT, RBS LFT, RFT, RBS
ntation month
Kidney * Rate
Monthly everolimus Immunosuppression Everolimus LEVEL, CBC, Everolimus LEVEL,
after kidney transplant(Rate per Month) LFT, RFT, RBS CBC, LFT, RFT, RBS
ntation month
Blood group CBC, FBS,

PPBS, Glycosylated
Hemoglobin, Lipid
profile, G6PD
deficiency, Uric acid,
Living donor hepatectomy Part-1
Serum Ceruloplasmin,
Investigations
24 hours urinary
Blood group CBC, FBS, PPBS, Glycosylated
copper, S. Creatinine,
Hemoglobin, Lipid profile, G6PD deficiency,
Blood urea, LFT, aPTT,
Uric acid, Serum Ceruloplasmin, 24 hours
PT, INR, S. Calcium, S.
urinary copper, S. Creatinine, Blood urea,
Magnesium, S. Na, S. K,
Liver LFT, aPTT, PT, INR, S. Calcium, S.
15.23 S. Alpha feto protein, S.
transpla Magnesium, S. Na, S. K, S. Alpha feto 0 11250 S17 S1712049 No
A CEA, S. CA19-9, Stool
ntation protein, S. CEA, S. CA19-9, Stool for occult
for occult blood, Urine
blood, Urine R/M, HIV ELISA, HCV ELISA,
R/M, HIV ELISA, HCV
HBV DNA, Anti-HBc antibody, CMV IgG and
ELISA, HBV DNA, Anti-
IgM, EBV, TORCH Complex, Varicella zoster
HBc antibody, CMV IgG
IgG and IgM, X-ray chest, USG abdomen,
and IgM, EBV, TORCH
ECG, Pulmonary function test, 2D
Complex, Varicella
echocardiography, NCCT abdomen
zoster IgG and IgM, X-
ray chest, USG
abdomen, ECG,
Pulmonary function
test, 2D
echocardiography,
Living donor hepatectomy Part-2

Liver CT triphasic
15.23 Investigations
transpla angiography for celiac 0 7500 S17 S1712050 No
B CT triphasic angiography for celiac axis, CT
ntation axis, CT Volumetry, MR
Volumetry, MR cholengiography
cholengiography
Liver
15.23 Living donor hepatectomy Part-3 Operative LFT, RFT, Lipid profile,
transpla 3 131250 S17 S1712051 No
C Part ELISA, CT volumetry
ntation
Blood group, CBC, S.

Creatinine, Blood urea,
S. Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Liver transplantation from living donor Part- Glycosylated
1 Investigations hemoglobin, LFT, Urine
Blood group, CBC, S. Creatinine, Blood R/M, 24 hours urinary
urea, S. Na+, S. K+, S. Ca++, S. Mg++, FBS, proteins, 24 hours
PPBS, Glycosylated hemoglobin, LFT, Urine urinary copper, S.
R/M, 24 hours urinary proteins, 24 hours Ammonia, Lipid profile,
urinary copper, S. Ammonia, Lipid profile, G6PD, D-dimer, S.
Liver
15.24 G6PD, D-dimer, S. Fibrinogen, PT, INR, a- Fibrinogen, PT, INR, a-
transpla 0 8750 S17 S1712052 No
A PTT, S. Iron, S. Ferritin, S. Transferrin, TIBC, PTT, S. Iron, S. Ferritin,
ntation
S. Alfa feto protein, S. CEA, S. CA19-9, S. Transferrin, TIBC, S.
Arterial blood gas study, HIV ELISA, HBsAg Alfa feto protein, S.
ELISA, Anti HBs antibody titer, HCV ELISA, CEA, S. CA19-9, Arterial
HCV RNA by PCR Assay, HBV DNA by PCR blood gas study, HIV
Assay, HEV antibody, TORCH complex, EBV ELISA, HBsAg ELISA, Anti
antibody titers, Varicella Zoster antibody HBs antibody titer, HCV
titers, CMV IgG and IgM ELISA, HCV RNA by PCR
Assay, HBV DNA by PCR
Assay, HEV antibody,
TORCH complex, EBV
antibody titers,
Varicella Zoster
Protein C, Protein S,
Antithrombin C,
Homocysteine,
Homocysteine, ANA,
Liver transplantation from living donor Part- AMA, ASMA, LKM1, IgG
2 Investigations level, USG abdomen,
Protein C, Protein S, Antithrombin C, Colour Doppler study
Homocysteine, Homocysteine, ANA, AMA, for portal vein, X-ray
ASMA, LKM1, IgG level, USG abdomen, chest, ECG, Triphasic CT
Liver Colour Doppler study for portal vein, X-ray abdomen for celiac axis,
15.24
transpla chest, ECG, Triphasic CT abdomen for Pulmonary function 0 17500 S17 S1712053 No
B
ntation celiac axis, Pulmonary function tests, 2D tests, 2D
echocardiography, Dobutamine stress echocardiography,
echo., Coronary angiography, Arterial Dobutamine stress
blood gas analysis, Ascites fluid R/M, echo., Coronary
Ascites fluid culture, Pleural fluid R/M, TB angiography, Arterial
PCR assay, Vit D level, Vit. B12 level blood gas analysis,
Ascites fluid R/M,
Ascites fluid culture,
Pleural fluid R/M, TB
PCR assay, Vit D level,
Vit. B12 level
Liver
15.24 Liver transplantation from living donor Part LFT, S. Creatinine,
transpla 4 323750 S17 S1712054 No
C -3 Operative Part Clinical photograph
ntation

Creatinine, Blood urea,
S. Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Liver transplantation from deceased donor Glycosylated
Part 1 Investigations hemoglobin, LFT, Urine
Blood group, CBC, S. Creatinine, Blood R/M, 24 hours urinary
urea, S. Na+, S. K+, S. Ca++, S. Mg++, FBS, proteins, 24 hours
PPBS, Glycosylated hemoglobin, LFT, Urine urinary copper, S.
R/M, 24 hours urinary proteins, 24 hours Ammonia, Lipid profile,
urinary copper, S. Ammonia, Lipid profile, G6PD, D-dimer, S.
Liver
15.25 G6PD, D-dimer, S. Fibrinogen, PT, INR, a- Fibrinogen, PT, INR, a-
transpla 0 12500 S17 S1712055 No
A PTT, S. Iron, S. Ferritin, S. Transferrin, TIBC, PTT, S. Iron, S. Ferritin,
ntation
S. Alfa feto protein, S. CEA, S. CA19-9, S. Transferrin, TIBC, S.
Arterial blood gas study, HIV ELISA, HBsAg Alfa feto protein, S.
ELISA, Anti HBs antibody titer, HCV ELISA, CEA, S. CA19-9, Arterial
HCV RNA by PCR Assay, HBV DNA by PCR blood gas study, HIV
Assay, HEV antibody, TORCH complex, EBV ELISA, HBsAg ELISA, Anti
antibody titers, Varicella Zoster antibody HBs antibody titer, HCV
titers, CMV IgG and IgM ELISA, HCV RNA by PCR
Assay, HBV DNA by PCR
Assay, HEV antibody,
TORCH complex, EBV
antibody titers,
Varicella Zoster
Antithrombin C,
Homocysteine,
Homocysteine, ANA,
Liver transplantation from deceased donor AMA, ASMA, LKM1, IgG
Part 2 Investigations level, USG abdomen,
Protein C, Protein S, Antithrombin C, Colour Doppler study
Homocysteine, Homocysteine, ANA, AMA, for portal vein, X-ray
ASMA, LKM1, IgG level, USG abdomen, chest, ECG, Triphasic CT
Liver Colour Doppler study for portal vein, X-ray abdomen for celiac axis,
15.25
transpla chest, ECG, Triphasic CT abdomen for Pulmonary function 0 25000 S17 S1712056 No
B
ntation celiac axis, Pulmonary function tests, 2D tests, 2D
echocardiography, Dobutamine stress echocardiography,
echo., Coronary angiography, Arterial Dobutamine stress
blood gas analysis, Ascites fluid R/M, echo., Coronary
Ascites fluid culture, Pleural fluid R/M, TB angiography, Arterial
PCR assay, Vit D level, Vit. B12 level blood gas analysis,
Ascites fluid R/M,
Ascites fluid culture,
Pleural fluid R/M, TB
PCR assay, Vit D level,
Vit. B12 level
Liver
15.25 Liver transplantation from deceased donor
transpla LFT, S. Creatinine 4 462500 S17 S1712057 No
C Part - 3 Operative Part
ntation

Creatinine, Blood urea, S.
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Split liver transplantation from deceased
Glycosylated hemoglobin,
donor Part 1 Investigations
LFT, Urine R/M, 24 hours
Blood group, CBC, S. Creatinine, Blood urinary proteins, 24 hours
urea, S. Na+, S. K+, S. Ca++, S. Mg++, FBS, urinary copper, S.
PPBS, Glycosylated hemoglobin, LFT, Urine Ammonia, Lipid profile,
R/M, 24 hours urinary proteins, 24 hours G6PD, D-dimer, S.
urinary copper, S. Ammonia, Lipid profile, Fibrinogen, PT, INR, a-PTT,
Liver
15.26 G6PD, D-dimer, S. Fibrinogen, PT, INR, a- S. Iron, S. Ferritin, S.
transpla 0 12500 S17 S1712058 No
A PTT, S. Iron, S. Ferritin, S. Transferrin, TIBC, Transferrin, TIBC, S. Alfa
ntation feto protein, S. CEA, S.
S. Alfa feto protein, S. CEA, S. CA19-9,
Arterial blood gas study, HIV ELISA, HBsAg CA19-9, Arterial blood gas
ELISA, Anti HBs antibody titer, HCV ELISA, study, HIV ELISA, HBsAg
HCV RNA by PCR Assay, HBV DNA by PCR ELISA, Anti HBs antibody
titer, HCV ELISA, HCV RNA
Assay, HEV antibody, TORCH complex, EBV
by PCR Assay, HBV DNA
antibody titers, Varicella Zoster antibody
by PCR Assay, HEV
titers, CMV IgG and IgM
antibody, TORCH
complex, EBV antibody
titers, Varicella Zoster
antibody titers, CMV IgG
and IgM
Antithrombin C,
Homocysteine,
Split liver transplantation from deceased
Homocysteine, ANA,
donor Part 2 Investigations AMA, ASMA, LKM1, IgG
Protein C, Protein S, Antithrombin C, level, USG abdomen,
Homocysteine, Homocysteine, ANA, AMA, Colour Doppler study for
ASMA, LKM1, IgG level, USG abdomen, portal vein, X-ray chest,
Liver Colour Doppler study for portal vein, X-ray ECG, Triphasic CT
15.26
transpla chest, ECG, Triphasic CT abdomen for abdomen for celiac axis, 0 25000 S17 S1712059 No
B
ntation celiac axis, Pulmonary function tests, 2D Pulmonary function tests,
echocardiography, Dobutamine stress 2D echocardiography,
echo., Coronary angiography, Arterial Dobutamine stress echo.,
blood gas analysis, Ascites fluid R/M, Coronary angiography,
Arterial blood gas
Ascites fluid culture, Pleural fluid R/M, TB
analysis, Ascites fluid
PCR assay, Vit D level, Vit. B12 level
R/M, Ascites fluid culture,
Pleural fluid R/M, TB PCR
assay, Vit D level, Vit. B12
level
Liver
15.26 Split liver transplantation from deceased
transpla LFT, S. Creatinine 4 462500 S17 S1712060 No
C donor Part - 3 Operative Part
ntation
Blood group CBC, FBS,

PPBS, Glycosylated
Dual lobe liver transplantation: One lobe
Hemoglobin, Lipid profile,
from one living donor and other lobe from
G6PD deficiency, Uric
other living donor (Two donor
acid, Serum
hepatectomy and one liver recipient Ceruloplasmin, 24 hours
surgery) DONOR Ix Part-1 Investigations urinary copper, S.
Blood group CBC, FBS, PPBS, Glycosylated Creatinine, Blood urea,
Hemoglobin, Lipid profile, G6PD deficiency, LFT, aPTT, PT, INR, S.
Uric acid, Serum Ceruloplasmin, 24 hours Calcium, S. Magnesium, S.
Liver
15.27 urinary copper, S. Creatinine, Blood urea, Na, S. K, S. Alpha feto
transpla 0 30000 S17 S1712061 No
A LFT, aPTT, PT, INR, S. Calcium, S. protein, S. CEA, S. CA19-9,
ntation Stool for occult blood,
Magnesium, S. Na, S. K, S. Alpha feto
protein, S. CEA, S. CA19-9, Stool for occult Urine R/M, HIV ELISA,
blood, Urine R/M, HIV ELISA, HCV ELISA, HCV ELISA, HBV DNA, Anti-
HBV DNA, Anti-HBc antibody, CMV IgG and HBc antibody, CMV IgG
and IgM, EBV, TORCH
IgM, EBV, TORCH Complex, Varicella zoster
Complex, Varicella zoster
IgG and IgM, X-ray chest, USG abdomen,
IgG and IgM, X-ray chest,
ECG, Pulmonary function test, 2D
USG abdomen, ECG,
echocardiography, NCCT abdomen Pulmonary function test,
2D echocardiography,
NCCT abdomen

Liver other living donor (Two donor CT triphasic angiography
15.27 transpla hepatectomy and one liver recipient for celiac axis, CT 0 30000 S17 S1712062 No
B ntation surgery) DONOR Ix Part-2 Investigations Volumetry, MR
CT triphasic angiography for celiac axis, CT cholengiography
Volumetry, MR cholengiography

Dual lobe liver transplantation: One lobe Creatinine, Blood urea, S.
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
other living donor (Two donor
Glycosylated hemoglobin,
hepatectomy and one liver recipient
LFT, Urine R/M, 24 hours
surgery) Receipient Ix urinary proteins, 24 hours
Part-3 Investigations urinary copper, S.
Blood group, CBC, S. Creatinine, Blood Ammonia, Lipid profile,
urea, S. Na+, S. K+, S. Ca++, S. Mg++, FBS, G6PD, D-dimer, S.
PPBS, Glycosylated hemoglobin, LFT, Urine Fibrinogen, PT, INR, a-PTT,
Liver
15.27 R/M, 24 hours urinary proteins, 24 hours S. Iron, S. Ferritin, S.
transpla 0 30000 S17 S1712063 No
C urinary copper, S. Ammonia, Lipid profile, Transferrin, TIBC, S. Alfa
ntation feto protein, S. CEA, S.
G6PD, D-dimer, S. Fibrinogen, PT, INR, a-
PTT, S. Iron, S. Ferritin, S. Transferrin, TIBC, CA19-9, Arterial blood gas
S. Alfa feto protein, S. CEA, S. CA19-9, study, HIV ELISA, HBsAg
Arterial blood gas study, HIV ELISA, HBsAg ELISA, Anti HBs antibody
titer, HCV ELISA, HCV RNA
ELISA, Anti HBs antibody titer, HCV ELISA,
by PCR Assay, HBV DNA
HCV RNA by PCR Assay, HBV DNA by PCR
by PCR Assay, HEV
Assay, HEV antibody, TORCH complex, EBV
antibody, TORCH
antibody titers, Varicella Zoster antibody complex, EBV antibody
titers, CMV IgG and IgM titers, Varicella Zoster
antibody titers, CMV IgG
and IgM
Dual lobe liver transplantation: One lobe Antithrombin C,
from one living donor and other lobe from Homocysteine,
other living donor (Two donor Homocysteine, ANA,
hepatectomy and one liver recipient AMA, ASMA, LKM1, IgG
surgery) Receipient Ix Part-4 Investigations level, USG abdomen,
Protein C, Protein S, Antithrombin C, Colour Doppler study for
portal vein, X-ray chest,
Homocysteine, Homocysteine, ANA, AMA,
Liver ECG, Triphasic CT LFT, RFT, Lipid profile,
15.27 ASMA, LKM1, IgG level, USG abdomen,
transpla abdomen for celiac axis, ELISA, CT volumetry 0 30000 S17 S1712064 No
D Colour Doppler study for portal vein, X-ray
ntation Pulmonary function tests, of both donors
chest, ECG, Triphasic CT abdomen for 2D echocardiography,
celiac axis, Pulmonary function tests, 2D Dobutamine stress echo.,
echocardiography, Dobutamine stress Coronary angiography,
echo., Coronary angiography, Arterial Arterial blood gas
blood gas analysis, Ascites fluid R/M, analysis, Ascites fluid
Ascites fluid culture, Pleural fluid R/M, TB R/M, Ascites fluid culture,
PCR assay, Vit D level, Vit. B12 level Pleural fluid R/M, TB PCR
assay, Vit D level, Vit. B12
level

Liver
15.27 other living donor (Two donor
transpla 3 1080000 S17 S1712065 No
E hepatectomy and one liver recipient
ntation
surgery) Receipient Ix Part-5 Operativr Part
for both Donor and recippient
Liver
Emergency Exploratory laparotomy for
15.3 transpla ABG, USG abdomen USG abdomen 0 20000 S17 S1712066 No
liver donor
ntation
Liver
Emergency Exploratory laparotomy for
liver recipient
ntation
Liver
Post liver transplant Percutaneous
15.30 transpla LFT, CBC Photograph 1 8000 S17 S1712068 No
Endoscopy guided gastrostomy (PEG)
ntation
Liver
Post liver transplant incisional hernia Clinical photograph, for 7 days
15.3 transpla CT abdomen 3 40000 S17 S1712069 No
repair (Prosthetic mesh) LFT admission
ntation
Liver
LFT, CECT, HRCT thorax, LFT, CECT, Alfa
15.3 transpla Liver resection for HCC in Child-A cirrhosis 5 125000 S17 S1712070 No
Alfa fetoprotein fetoprotein
ntation
Liver
Radiofrequency ablation (RFA) for HCC for LFT, CECT, HRCT thorax, LFT, CECT, Alfa * Per
15.3 transpla 5 25000 S17 S1712071 No
Child-A, B and C cirrhosis(Rate per session) Alfa fetoprotein fetoprotein session
ntation
Liver LFT, S. Creatinine, PT, INR, X-ray abdomen,

Trans-jugular Intrahepatic Porto-Systemic
15.3 transpla CBC, S. Ammonia, Doppler Doppler portal vein, 2 150000 S17 S1712072 No
Shunt procedure (TIPS)
ntation portal vein, USG abdomen S. Creatinine
(Including
Procedur
Liver
CBC, PT, LFT, S. X-ray chest, biopsy e and
15.4 transpla Trans-jugular liver allograft biopsy 0 8000 S17 S1712073 No
Creatinine, report histopath
ntation
ology
charge)
(Including
Procedur
Liver
CBC, PT, LFT, S. X-ray chest, biopsy e and
15.4 transpla Percutaneous liver allograft biopsy 0 5000 S17 S1712074 No
Creatinine, report histopath
ntation
ology
charge)
Liver
Post liver transplant percutaneous LFT, MRCP, USG X-ray abdomen, USG
15.4 transpla 2 15000 S17 S1712075 No
transhepatic biliary drainage (PTBD) abdomen, CBC, PT abdomen, LFT
ntation
(2 weeks
Liver Post liver transplant roux en Y
LFT, MRCP, USG X-ray abdomen, USG of
15.4 transpla jejunojejunostomy and 4 50000 S17 S1712076 No
abdomen, CBC, PT abdomen, LFT hospitaliz
ntation choledochojejunostomy
ation)
Liver
LFT, MRCP, USG X-ray abdomen, USG
15.4 transpla Post liver transplant ERCP 2 10000 S17 S1712077 No
abdomen, CBC, PT abdomen, LFT
ntation
Liver
LFT, MRCP, USG X-ray abdomen, USG
15.40 transpla Post liver transplant ERCP with stenting 2 18000 S17 S1712078 No
abdomen, CBC, PT abdomen, LFT
ntation
immunosuppression from day of discharge
to 3 months after liver transplant Include
Liver CBC, RFT, Na, K, LFT, RBS,
15.41 Prednisolone, Tacrolimus 4mg/day, CBC, RFT, LFT, RBS,
transpla Tacrolimus level, USG 3 41580 S17 S1712079 No
A Mycophenolate upto 2 g /day, Tacrolimus level
ntation liver allograft
Valgancyclovir 450 mg ,Fluconazole
100mg/day, Septran 1 tablet once a day
For First Month

B Mycophenolate upto 2 g /day, Tacrolimus level
For Second Month

C Mycophenolate upto 2 g /day, Tacrolimus level
For Third Month

immunosuppression from 4-12 months
Liver
after liver transplant Include Prednisolone *Rate per
15.4 transpla CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 4200 S17 S1712082 No
,Tacrolimus 4mg/day, Mycophenolate month
ntation
upto 2 g / day , Fluconazole 100mg/day,
Septran 1 tablet once a day,

immunosuppression (with everolimus)from
Liver 4-12 months after liver transplant Include
*Rate per
15.4 transpla Prednisolone Tacrolimus 2 mg/day CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 7800 S17 S1712083 No
month
ntation +Everolimus 1 mg/day, Mycophenolate
upto 2 g /day Fluconazole 100mg/day,
Septran 1 tablet once a day
Maintainence immunosuppresants and

investigations after 12 months of liver
Liver
transplant(Calcineurin based ) Include *Rate per
15.4 transpla CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 3500 S17 S1712084 No
Prednisolone, Tacrolimus 2mg/day month
ntation
Mycophenolate upto 2 g /day(Rate per
month)
Maintainence immunosuppresants and

investigations and for 12 months after
Liver liver transplant (Calcineurin and mTOR
*Rate per
15.5 transpla based ) Include Prednisolone Tacrolimus 2 CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 8000 S17 S1712085 No
month
ntation mg/day Everolimus 1 mg/day,
Mycophenolate upto 2 g/day (Rate per
month)
Invasive fungal infection after liver

transplant Include Liposomal Amphotericin Fluid KOH preperation
Liver and culture, CBC, RFT, Blood culture, CBC,
5-10 mg/kg/day for 30 days and Surgical
15.5 transpla LFT, RBS, XR Chest, CT of RFT, LFT, RBS, XR 0 375000 S17 S1712086 No
debridement, ICU stay for 10 days Hospital
ntation organ of invasion, Chest, CT Thorax
stay for 21 days With Liposomal Endoscopy
Amphotericin 300 mg/day
CBC,RFT, LFT, RBS, X-ray

CMV infection after liver transplant Include Chest, CT Thorax, Graft CBC, RFT, LFT, RBS, XR
Liver
15.47 IV gancyclovir 500 mg / Hospital stay for 14 Doppler, Tacrolimus level, Chest, Tacrolimus
transpla 0 19800 S17 S1712087 No
A day, tab.Valgancyclovir 450 mg OD for 3-7 CMV DNA quality and level, CMV DNA
ntation quantity, Urine RM and quantity
days
Culture

Liver
transpla 0 39600 S17 S1712088 No
B day, tab.Valgancyclovir 450 mg OD for 8-12 CMV DNA quality and level, CMV DNA
days
Culture

Liver
transpla 0 66000 S17 S1712089 No
C day, tab.Valgancyclovir 450 mg OD for 13 CMV DNA quality and level, CMV DNA
and above Days
Culture
Liver graft biopsy, CBC,

CBC, RFT, RBS, XR
Liver LFT, RFT, RBS, XR Chest,
15.48 Treatment for T cell rejection IV methyl Chest, Tacrolimus
A prednisolone IV, Hospital stay for 3-7 days level, CMV DNA
ntation level, CMV DNA quality
quantity
and quantity

CBC, RFT, RBS, XR
Liver Treatment for T cell rejection IV methyl LFT, RFT, RBS, XR Chest,
15.48 Chest, Tacrolimus
transpla prednisolone IV, Hospital stay for 8-12 Graft Doppler, Tacrolimus 0 18000 S17 S1712091 No
B level, CMV DNA
ntation days level, CMV DNA quality
quantity
and quantity

CBC, RFT, RBS, XR
Liver Treatment for T cell rejection IV methyl LFT, RFT, RBS, XR Chest,
15.48 Chest, Tacrolimus
transpla prednisolone IV, Hospital stay for 13 and Graft Doppler, Tacrolimus 0 30000 S17 S1712092 No
C level, CMV DNA
ntation above days level, CMV DNA quality
quantity
and quantity
Treatment for T cell rejection with

Livergraft biopsy , CBC, CBC, RFT, RBS, XR
Liver thymoglobulin IV methyl prednisolone ,IV
15.49 RFT, LFT, RBS, XR Chest, Chest, Tacrolimus
transpla thymoglobulin 75 mg , Hospital stay for 15 0 80000 S17 S1712093 No
A Graft Doppler, Tacrolimus level, CMV DNA
ntation d,Valgancyclovir 450 mg/day Fluconazole level, CMV DNA quantity quantity
100 mg/day for First month

B Graft Doppler, Tacrolimus level, CMV DNA
100 mg/day for second month

C Graft Doppler, Tacrolimus level, CMV DNA
100 mg/day for 3rd month
Blood culture , CBC , RFT,

LFT, RBS, XR Chest, CT
Blood culture , CBC,
Liver Chest Infection after transplant with 10day Thorax, Graft Doppler,
15.50 RFT, LFT, RBS, XR
transpla ICU care Include ICU stay , ICU ventilator , Tacrolimus level, CMV 0 75000 S17 S1712096 No
A Chest, CT Thorax,
ntation ICU medicine , isolation ward for 1 to 3 day DNA quantity,
Tacrolimus level
bronchoscopy charges
and reports

LFT, RBS, XR Chest, CT
Blood culture , CBC,
Liver Chest Infection after transplant with 10day Thorax, Graft Doppler,
15.50 RFT, LFT, RBS, XR
transpla ICU care Include ICU stay , ICU ventilator , Tacrolimus level, CMV 0 112500 S17 S1712097 No
B Chest, CT Thorax,
ntation ICU medicine , isolation ward for 3 to 7 day DNA quantity,
Tacrolimus level
and reports

Chest Infection after transplant with 10day LFT, RBS, XR Chest, CT Blood culture , CBC,
Liver Thorax, Graft Doppler,
15.50 ICU care Include ICU stay , ICU ventilator , RFT, LFT, RBS, XR
transpla Tacrolimus level, CMV 0 150000 S17 S1712098 No
C ICU medicine , isolation ward for 10 day or Chest, CT Thorax,
ntation DNA quantity,
above Tacrolimus level
and reports
Post-liver transplant Hepatitis C

Liver LFT, RFT, CBC, RBS,
infectionIncludes sofosbuvir 400 mg/ day LFT, RFT, CBC, RBS, HCV *Rate per
15.5 Transpla HCV ELISA, HCV RNA 0 30000 S17 S1712099 No
+ daclatasavir 60 mg/day + ribavirin 1000 ELISA, HCV RNA quantity month
ntation quantity
mg/day (Rate Per Month)
Liver Post-liver transplant Hepatitis B infection LFT, RFT, CBC, RBS,
LFT, RFT, CBC, RBS, HBV *Rate per
15.5 Transpla Includes entecavir 0.5 mg /day (Rate Per HBV ELISA, HBV DNA 0 4000 S17 S1712100 No
ELISA, HBV DNA quantity month
ntation Month) quantity
Liver Post-liver transplant Hepatitis B infection LFT, RFT, CBC, RBS,

LFT, RFT, CBC, RBS, HBV *Rate per
15.5 Transpla (entecavir resistant)Includes tenofovir 300 HBV ELISA, HBV DNA 0 4700 S17 S1712101 No
ELISA, HBV DNA quantity month
ntation mg /day (Rate Per Month) quantity
Blood group, CBC, RFT,

LFT, Thyroid Function
Test, Calcium, S.
Pancreas transplant Part-1 Investigations Phosphorus, S. Vit D, S.
Blood group, CBC, RFT, LFT, Thyroid Uric Acid, Blood Sugar
Function Test, Calcium, S. Phosphorus, S. FaSTING, PPBS, HIV ELISA,
Vit D, S. Uric Acid, Blood Sugar FaSTING, HCV ELISA, HBSAgelisa,
PPBS, HIV ELISA, HCV ELISA, HBSAgelisa, HCV RNA quantitative,
CMV IgG and IgM, Urine
HCV RNA quantitative, CMV IgG and IgM,
Pancreas Routine and Micro, Urine
15.54 Urine Routine and Micro, Urine Culture,
transpla Culture, USG Abdomen, 0 10000 S17 S1712102 No
A USG Abdomen, Chest XR, ECG, Lipid Profile,
ntation Chest XR, ECG, Lipid
Anticardiolipid Ab, Lupus Anticoagulant, Profile, Anticardiolipid Ab,
C3, C4, P-ANCA, C-ANCA, ANA, DSDNA, PT Lupus Anticoagulant, C3,
INR, APTT, Pulmonary Function Test, ABG, C4, P-ANCA, C-ANCA,
Doppler of Neck Vessels, Doppler of ANA, DSDNA, PT INR,
Iliofemoral Vessels, Uroflometry, MCU, APTT, Pulmonary Function
Urodynamic study Test, ABG, Doppler of
Neck Vessels, Doppler of
Iliofemoral Vessels,
Uroflometry, MCU,
Urodynamic study
Pancreas transplant Part-2 Investigations

Pancreas
15.54 HLA Typing HLA Typing
transpla 0 40000 S17 S1712103 No
B LCM, FCM LCM, FCM
ntation Single Antigen Qualitative
Pancreas transplant Part-3 Investigation Single Antigen

Pancreas Single Antigen Quantitative, S. Amylase, S. Quantitative, S. Amylase,
15.54
transpla lipase, C-Peptide, GAD Antibody, Plain CT S. lipase, C-Peptide, GAD 0 30000 S17 S1712104 No
C
ntation of Abdomen Antibody, Plain CT of
Abdomen
Pancreas blood sugar, Doppler
15.54
transpla Pancreas transplant Part - 4 Operative Part study for pancreas 4 420000 S17 S1712105 No
D
ntation and kidney graft, C-
peptide
Pancreas
Exploratory laparotomy after pancreas
transplant for abdominal wash
ntation
Pancreas
Exploratory laparotomy after pancreas
transplant for pancreatectomy
ntation
Cluster - 16 OTORHINOLARYNGOLOGY (ENT)

clinical notes and
16.1 ENT Aural polypectomy 1 4000 S2 S200001 No
autoscopy examination
Governm
CT temporal
16.2 ENT Labyrinthectomy HPEE 2 20000 ent S2 S200002 Yes
bone,CECT/ MRI
Reserve
Clinical photo
16.3 ENT Mastoidectomy X RAY,CT/MRI 1 12500 S2 S200003 No
showing scar
PTA , X-Ray Clinical photo
16.4 ENT Mastoidectomy corticol modified/ radical 1 11500 S2 S200004 No
Mastoids,clinical notes showing scar
clinical notes and
autoscopy POST OP. SCOP
16.5 ENT Mastoidectomy with tympanoplasty 2 16000 S2 S200005 No
examination/CTSCAN/ Y PICTURE
MRI
16.6 ENT Myringoplasty PTA and IA PTA and IA 1 7500 S2 S200006 No
PTA and IA,Endoscopy

16.7 ENT Myringoplasty with Ossiculoplasty clinical notes 1 13500 S2 S200007 No
Picture,clinical notes
Operative notes
with steps of
16.8 ENT Myringotomy – Bilateral clinical notes 1 6000 S2 S200008 No
surgery,clinical
notes
Operative notes
with steps of
16.9 ENT Myringotomy – Unilateral clinical notes surgery,clinical 1 3500 S2 S200009 No
notes,Endoscopy
Picture
16.10 ENT Myringotomy with Grommet - One ear PTA and IA Otoscopic findings 1 6500 S2 S200010 No
16.1 ENT Myrinogotomy with Grommet - Both ear PTA and IA Otoscopic findings 1 8500 S2 S200011 No
16.1 ENT Ossiculoplasty PTA and IA Otoscopic findings 1 9500 S2 S200012 No
Governm
16.1 ENT Partial amputation – Pinna PTA and IA Post op audiogram 1 4000 ent S2 S200013 Yes
Reserve
Excision of Pinna for Growths
(Squamous/Basal) Injuries - Total CT/FNAC/HPE/CLINICAL HPE/POST OP.
16.1 ENT 1 8000 S2 S200014 No
Amputation & Excision of External Auditory PHOTO CLINICAL PHOTO
Meatus
Excision of Pinna for Growths clinical
16.2 ENT (Squamous/Basal) Injuries Total CT notes,Histopatholo 1 6500 S2 S200015 No
Amputation gical report
16.2 ENT Stapedectomy PTA and IA Post op audiogram 1 10000 S2 S200016 No
clinical
PTA and IA,clinical
16.2 ENT Tympanoplasty notes,Clinical photo 1 9000 S2 S200017 No
notes
showing scar
16.2 ENT Vidian neurectomy – Micro clinical notes clinical notes 1 9000 S2 S200018 No
Governm
POST.OP CLINICAL
16.2 ENT Ear lobe repair - single (daycare) CLINICAL PHOTO 1 1500 ent S2 S200019 Yes
PHOTO
Reserve
Excision of Pinna for Growth
POST.OP CLINICAL
16.20 ENT (Squamous/Basal/ Injuries) Skin and CLINICAL PHOTO 1 4000 S2 S200020 No
PHOTO
Cartilage
Excision of Pinna for Growth POST.OP CLINICAL

16.2 ENT CLINICAL PHOTO 1 2500 S2 S200021 No
(Squamous/Basal/ Injuries) Skin Only PHOTO
16.2 ENT Pharyngectomy and reconstruction CT/MRI clinical notes 1 15000 S2 S200022 No
Governm
POST OPCLINICIAL
16.2 ENT Skull base surgery CT/MRI 2 69000 ent S2 S200023 Yes
PHOTO
Reserve
Governm
Total Amputation & Excision of External POST.OP CLINICAL
16.2 ENT CLINICAL PHOTO 1 7500 ent S2 S200024 Yes
Auditory Meatus PHOTO
Reserve
POST.OP CLINICAL
16.3 ENT Tympanotomy CLINICAL PHOTO 1 4000 S2 S200025 No
PHOTO
16.3 ENT Removal of foreign body from ear clinical notes clinical notes 1 3000 S2 S200026 No
16.3 ENT Aural polypectomy +Tympanoplasty PTA and IA clinical notes 1 10000 S2 S200027 No
Ant. Ethmoidal artery ligation - open/ POST.OP CLINICAL

16.3 ENT CT/MRI 1 11000 S2 S200028 No
endoscopic PHOTO
clinical notes,CT/MRI,X-
16.3 ENT Antrostomy – Bilateral clinical notes,X Ray 1 8500 S2 S200029 No
Ray
16.30 ENT Antrostomy – Unilateral X RAY PNS CLINICAL NOTES 1 6000 S2 S200030 No
16.3 ENT Cryosurgery CLINICAL NOTES CLINICAL NOTES 1 3000 S2 S200031 No
Governm
16.3 ENT CSF Rhinorrhoea – Repair CT/MRI Clinical Photograph 1 14000 ent S2 S200032 Yes
Reserve
CLINICAL
16.3 ENT Septoplasty + FESS X RAY PNS/CT PNS 1 11500 S2 S200033 No
PHOTO/HPE
16.3 ENT Ethmoidectomy – External X RAY PNS/CT PNS HPEE 1 11500 S2 S200034 No
Fracture reduction nose with septal X RAY/CT/MRI/CLINIAL

16.4 ENT clinical notes,X Ray 1 8000 S2 S200035 No
correction NOTES
16.4 ENT Fracture - setting maxilla X RAY PNS/CT PNS clinical notes,X Ray 1 8000 S2 S200036 No
16.4 ENT Fracture - setting nasal bone X RAY PNS/CT PNS clinical notes,X Ray 1 5000 S2 S200037 No
16.4 ENT Functional Endoscopic Sinus (FESS) X RAY PNS/CT PNS clinical notes 1 11000 S2 S200038 No
16.4 ENT Intra Nasal Ethmoidectomy X RAY PNS/CT PNS clinical notes 1 5000 S2 S200039 No
16.40 ENT Rhinotomy – Lateral X RAY PNS/CT PNS clinical notes 1 7500 S2 S200040 No
16.41 ENT Nasal polypectomy – Bilateral X RAY PNS/CT PNS HPEE 1 9000 S2 S200041 No
16.42 ENT Nasal polypectomy – Unilateral X RAY PNS/CT PNS HPEE 1 6000 S2 S200042 No
16.43 ENT Turbinectomy Partial – Bilateral X RAY PNS/CT PNS clinical notes 1 3000 S2 S200043 No
16.44 ENT Turbinectomy Partial – Unilateral X RAY PNS/CT PNS clinical notes 1 2000 S2 S200044 No
16.45 ENT Radical fronto ethmo sphenodectomy clinical notes,CT/MRI HPEE 2 18000 S2 S200045 No
POST OP CLINICAL
16.46 ENT Rhinoplasty CLINICAL PHOTO 1 15000 S2 S200046 No
PHOTO
X RAY PNS/NASAL
16.47 ENT Septoplasty clinical notes 1 5000 S2 S200047 No
ENDOSCOPY
16.48 ENT Youngs operation NASAL ENDOSCOPY clinical notes 1 3000 S2 S200048 No
Governm
16.49 ENT Angiofibrom Excision CT PNS HPE 2 18000 ent S2 S200049 Yes
Reserve
X RAY PNS/SCOPY ENDOSCOPY
16.51 ENT Endoscopic DCR 1 7000 S2 S200051 No
EXAMINATION PICTURE
16.52 ENT Endoscopic Hypophysectomy CT/MRI HPEE 2 21000 S2 S200052 No
16.53 ENT Intranasal Diathermy X RAY PNS clinical notes 1 3000 S2 S200053 No
16.54 ENT Rhinosporidiosis CT PNS ,HPE HPEE 1 5000 S2 S200054 No
CLINICAL PHOTO/CT
16.55 ENT Septo-rhinoplasty clinical notes 1 12500 S2 S200055 No
PNS
16.56 ENT Adeno Tonsillectomy X RAY NASOPHARYNX HPEE 1 8000 S2 S200056 No
Governm
16.57 ENT Adenoidectomy X RAY NASOPHARYNX HPEE 1 5000 ent S2 S200057 Yes
Reserve
16.58 ENT Arytenoidectomy CT clinical notes 1 10000 S2 S200058 No
CT PNS/NASAL
16.59 ENT Choanal atresia clinical notes 1 12500 S2 S200059 No
ENDOSCOPY
16.60 ENT Tonsillectomy + Myrinogotomy PTA/IA HPEE 1 10000 S2 S200060 No
16.61 ENT Pharyngeal diverticulum's – Excision CT/BARIUM STUDY HPEE 1 10000 S2 S200061 No
Governm
16.62 ENT Laryngectomy with block dissection CT/MRI HPEE 2 25000 ent S2 S200062 Yes
Reserve
16.63 ENT Laryngofissure clinical notes clinical notes 1 5000 S2 S200063 No
Governm
16.64 ENT Laryngophayryngectomy clinical notes,CT/MRI HPEE 2 20000 ent S2 S200064 Yes
Reserve
Governm
16.65 ENT Maxilla – Excision clinical notes,CT/MRI HPEE 1 12500 ent S2 S200065 Yes
Reserve
16.66 ENT Oro Antral fistula CT/MRI CLINICAL NOTES 1 7500 S2 S200066 No
16.67 ENT Parapharyngeal – Exploration CT/MRI clinical notes 1 12500 S2 S200067 No
16.68 ENT Parapharyngeal Abscess – Drainage CT/MRI clinical notes 1 12500 S2 S200068 No
Governm
16.69 ENT Peritonsillor abscess under LA clinical notes Clinical NOTES 1 2500 ent S2 S200069 Yes
Reserve
16.70 ENT Pharyngoplasty CT/MRI clinical notes 1 10000 S2 S200070 No
CLINICAL NOTES, X
16.71 ENT Retro pharyngeal abscess – Drainage clinical notes 1 5000 S2 S200071 No
RAY/CT
Governm
16.72 ENT Tonsillectomy + Styloidectomy X RAY ,CLINICAL NOTES CLINICAL NOTES 1 10000 ent S2 S200072 Yes
Reserve
Governm
16.73 ENT Thyroglossal Fistula/ cyst – Excision USG/ X-RAY clinical notes 1 7000 ent S2 S200073 Yes
Reserve
Governm
16.74 ENT Tonsillectomy – (Uni/ Bilateral) CLINICAL NOTES HPEE 1 7500 ent S2 S200074 Yes
Reserve
Governm
16.75 ENT Total Parotidectomy USG,FNAC,CT/MRI HPEE 2 18000 ent S2 S200075 Yes
Reserve
16.76 ENT Superficial Parotidectomy USG,FNAC,CT/MRI HPEE 1 12000 S2 S200076 No
16.77 ENT Uvulophanyngo Plasty clinical notes clinical notes 1 14000 S2 S200077 No
HPEE,CLINICAL Governm
16.78 ENT Commondo Operation (glossectomy) CT /MRI ,BIOPSY PHOTO 2 17500 ent S2 S200078 Yes
SHOWING SCAR Reserve
Governm
16.79 ENT Excision of Branchial Cyst CT/USG CLINICAL NOTES 1 7000 ent S2 S200079 Yes
Reserve
16.80 ENT Excision of Branchial Sinus CT/USG CLINICAL NOTES 1 7000 S2 S200080 No
Governm
Excision of Cystic Hygroma Major/ CLINICAL
16.81 ENT HPEE 1 10000 ent S2 S200081 Yes
Extensive PHOTO/FNAC/CT
Reserve
Governm
CLINICAL
16.82 ENT Excision of Cystic Hygroma Minor HPEE 1 5000 ent S2 S200082 Yes
PHOTO/FNAC/CT
Reserve
CLINICAL NOTES /X RAY
16.83 ENT Excision of the Mandible Segmental CLINICAL PHOTO 1 7500 S2 S200083 No
OPG.
16.84 ENT Hemi-mandibulectomy with graft X RAY,BIOPSY/CT CLINICAL PHOTO 1 15000 S2 S200084 No
Governm
CLINICAL
16.85 ENT Hemiglossectomy CLINICAL PHOTO 2 20700 ent S2 S200085 Yes
NOTES/BIOPSY
Reserve
Governm
16.86 ENT Palatopharyngoplasty CLINICAL NOTES CLINICAL NOTES 1 10000 ent S2 S200086 Yes
Reserve
Governm
CLINICAL
16.87 ENT Partial Glossectomy CLINICAL PHOTO 1 5000 ent S2 S200087 Yes
NOTES/BIOPSY
Reserve
CLINICAL
16.88 ENT Ranula excision CLINICAL PHOTO 1 5000 S2 S200088 No
NOTE,CLINICAL PHOTO
16.89 ENT Removal of Submandibular Salivary gland USG/FNAC HPEE 1 5000 S2 S200089 No
Governm
CLINICAL
16.90 ENT Total Glossectomy CLINICAL PHOTO 1 15000 ent S2 S200090 Yes
NOTES/BIOPSY
Reserve
Governm
16.91 ENT Total Laryngectomy + Neck dissection BIOPSY,CT/MRI HPEE 2 25000 ent S2 S200091 Yes
Reserve
Governm
Laryngopharyngectomy with Gastric pull- CLINICAL
16.92 ENT HPEE 2 30000 ent S2 S200092 Yes
up/ jejunal graft NOTES/BIOPSY/ CT/MRI
Reserve
Governm
Excision of CA cheek/ oral cavity + radial
16.93 ENT BIOPSY,CT/MRI HPEE 2 30000 ent S2 S200093 Yes
forearm flap
Reserve
Governm
Excision of growth Jaw + free fibular flap
16.94 ENT BIOPSY,CT/MRI HPEE 2 30000 ent S2 S200094 Yes
reconstruction
Reserve
Concern
16.95 ENT Capped @ 1,00,000rs per anum per Concern Investigation 1 1,00,000 S2 U100 No
Investigation
Cluster - 17 OBSTETRICS AND GYNAECOLOGY

Governm
Obs & USG, PRE OP, MINOR
17.1 Hysterectomy ± Salpingo-oophorectomy HPEE 2 20000 ent S4 S400001 Yes
Gyac PROFILE , HPEE of D& C
Reserve
Governm
Obs & USG, Preop Minor
17.2 Abdominal Myomectomy HPEE 2 16000 ent S4 S400002 Yes
Gyac Profile
Reserve
Governm
Obs & USG, Clinical History
17.3 Surgeries for Prolapse - Sling Surgeries USG 2 16000 ent S4 S400003 Yes
Gyac Preop minor profile
Reserve
USG ( PVR) Clinical
Obs &
17.4 Surgeries for Stress Incontinence 'Burch' History, Preop Minor 2 35000 S4 S400004 No
Gyac
Profile
Obs & USG, Indication for 2nd

17.5 Hysterotomes - 2nd Trimester abortions USG 1 5000 S4 S400005 No
Gyac trimester termination
Obs & Clinical History Notes, Mesh Sticker
17.6 Incisional Hernia Repair 2 15000 S4 S400006 No
Gyac USG Stapler ( If Used)
USG, CT SCAN, Preop Governm
Obs &
17.7 Radical Hysterectomy (Wertheims) Major Profile HPEE HPEE 2 20000 ent S4 S400007 Yes
Gyac
Report Reserve
USG, CT Scan, Tumer

Laparotomy and proceed for Ovarian
Obs & Marker ( CA125), HPEE,
17.8 Cancers. Omentomy with Bilateral Salpingo- HPEE 2 20000 S4 S400008 No
Gyac Preop Major Profile, X-
oophorectomy
Ray Chest
USG/CT Scan, Clinical Governm

Obs & HPEE Report Minor
17.9 Non descent vaginal hysterectomy History Notes, HPEE 2 14,000 ent S4 S400009 Yes
Gyac Profile
Preop Reserve
USG, Clinical History Governm

Obs & Vaginal hysterectomy with anterior and
17.10 Notes, HPEE Report HPEE Report 2 16000 ent S4 S400010 Yes
Gyac posterior colpoperineorrhaphy
Preop Minor Profile Reserve
Clinical History Notes,

Obs & Vaginal surgical repair for vesico-vaginal
17.1 RFT, CT IVP ( KUB ), Clinical Examination 2 10000 S4 S400011 No
Gyac fistula
Preop Minor Profile
USG, Preop.minor
Obs &
17.1 Sacrocolpopexy Profile, Clinical History Clinical Examination 2 16000 S4 S400012 No
Gyac
Notes
Obs & CT, Barium Encma,
17.1 Repair for rectovaginal fitulas Clinical Examination 2 10000 S4 S400013 No
Gyac Preop Minor Profile
Obs & USG, Clinical Historm,

17.1 Vaginoplasty Clinical Examination 2 10000 S4 S400014 No
Obs &
17.2 LLETZ Colposcopy, Biopsy HPEE Report 2 15000 S4 S400015 No
Gyac
Obs & Clinical Hiatory, USG
17.2 Colpotomy HPEE Report 1 1200 S4 S400016 No
Gyac Preop, Minor Profile
Obs & USG, Clinical History,

17.2 Dilation and Evacuation (D&E) NO 1 5000 S4 S400017 No

17.2 Cervical biopsy and Polypectomy HPEE 1 3000 S4 S400018 No
Gyac Minor Profile
Governm
Obs & Bartholins Cyst Enucleation/ Incision Clinical History Notes
17.2 HPEE 1 3000 ent S4 S400019 Yes
Gyac drainage Preop Minor Profile
Reserve
Obs & HPEE, Clinical History
17.20 Vulvectomy simple HPEE 2 17250 S4 S400020 No
Gyac Preop Minor History
HPEE, CT, Clinical
Obs &
17.2 Radical Vulvectomy History Preop Major HPEE 2 17250 S4 S400021 No
Gyac
Profile
Obs & Clinical History Preop
17.2 Diagnostic laparoscopy CD, HPEE Report 2 11000 S4 S400022 No
Gyac Minor Profile
USG / Ct, Clinical Governm
Obs &
17.2 Laparoscopic hysterectomy (TLH) History, Minor Preofile, HPEE / CD 2 20000 ent S4 S400023 Yes
Gyac
HPEE Reserve
USG / Ct, Clinical
Obs &
17.2 Laparoscopic myomectomy History, Minor Preofile, HPEE / CD 2 15000 S4 S400024 No
Gyac
HPEE
USG / Ct, Clinical Governm
Obs &
17.3 Laparoscopic cystectomy History, Minor Preofile, HPEE / CD 2 15000 ent S4 S400025 Yes
Gyac
HPEE ( CA - 125 ) Reserve
USG / CT, Clinical
Obs &
17.3 Laparoscopic ovarotomy History, Minor Profile HPEE / CD 2 10000 S4 S400026 No
Gyac
CA - 125
Obs & USG / CT, Clinical
17.3 Laparoscopic adhesiolysis NO / CD 2 15000 S4 S400027 No
Gyac History, Minor Profile
Obs & Laparoscopic tubal surgeries - USG / Clinical History

17.3 HPEE / CD 2 11000 S4 S400028 No
Gyac salpingectomy, salpingotomy Preop Minor Profile

17.3 Drag hysteroscopy CD 1 6000 S4 S400029 No

17.30 Hysteroscopic myomectomies CD , HPEE 1 6000 S4 S400030 No

17.3 Hysteroscopic adhesiolysis CD 1 6000 S4 S400031 No

17.3 Hysteroscopic polypectomy CD , HPEE 1 3000 S4 S400032 No

17.3 Hysteroscopic IUCD removal CD 1 3000 S4 S400033 No
Operative notes
Obs &
17.3 Caesarian Delivery Clinical report with steps of 1 9000 S4 S400034 No
Gyac
surgery
Obs &
17.4 Caesarian hysterectomy USG HPEE 2 16000 S4 S400035 No
Gyac
Clinical History
ANC Profile, Clinical
Obs & Notes in Details
17.4 High risk delivery: Pre-mature delivery History Notes, USG 1 9000 S4 S400036 No
Gyac with Tratment
Preop, Major Profile
Given
Clinical History
Obs & High risk delivery: Expected Gestation at Notes in Details
17.4 History Notes, USG 1 9000 S4 S400037 No
Gyac delivery less than 35 weeks with Tratment
Given
Clinical History
ANC Profile, Clinical Governm
Obs & High risk delivery: Mothers with eclampsia Notes in Details
17.4 History Notes, USG 1 9000 ent S4 S400038 Yes
Gyac or imminent eclampsia with Tratment
Preop, Major Profile Reserve
Given
Clinical History
17.4 High risk delivery: Obstructed labour History Notes, USG 1 9000 S4 S400039 No
Gyac with Tratment
Given
Clinical History
High risk delivery: Major Fetal ANC Profile, Clinical
17.40 malformation requiring intervention History Notes, USG 1 9000 S4 S400040 No
Gyac with Tratment
immediately after birth Preop, Major Profile
Given
Clinical History
Obs & High risk delivery: Mothers with severe Notes in Details
17.41 History Notes, USG 1 9000 S4 S400041 No
Gyac anaemia (<7 g/dL) with Tratment
Given
High risk delivery: Other maternal and fetal
Clinical History
conditions as per guidelines-Such as Rh ANC Profile, Clinical
17.42 haemolytic disease, uncontrolled diabetes, History Notes, USG 1 9000 S4 S400042 No
Gyac with Tratment
severe growth retardation etc that qualify Preop, Major Profile
Given
for high risk delivery etc.
Obs & Clinical Notes, USG,

17.43 Manual removal of placenta HPEE 1 5000 S4 S400043 No
Obs & USG, Clinical History

17.44 Laparotomy for ruptured ectopic HPEE 2 10000 S4 S400044 No
Gyac Preop Minor
USG, Clinical History

Obs &
17.45 MTP > 12 weeks Preop Minor, Consort NO 1 6500 S4 S400045 No
Gyac
Form
USG, Clinical History

Obs &
17.46 MTP upto 12 weeks Preop Minor, Consort NO 1 5000 S4 S400046 No
Gyac
Form
USG, Clinical History,

Obs &
17.47 MTP upto 8 weeks Preop Minor Profile, NO 1 3500 S4 S400047 No
Gyac
Consort Form

Obs &
17.48 McDonald's stitch Preop Minor Profile, NO 1 4000 S4 S400048 No
Gyac
Consort Form

Obs &
17.49 Shirodkar's stitch Preop Minor Profile, NO 1 4000 S4 S400049 No
Gyac
Consort Form
HSG, USG, Clinical
Obs &
17.50 Tuboplasty History Preop Minor NO 2 10000 S4 S400050 No
Gyac
Profile
Obs & Laparotomy for broad ligament USG, Minor Profile
17.51 NO 2 16000 S4 S400051 No
Gyac haematoma Clinical History
Obs & Clinical History, TVT / TUT Tape
17.52 Trans-vaginal tape/ Trans-obturator tape 1 5000 S4 S400052 No
Gyac USGPreop Minor Sticker
Obs & Abdominal Perineal neo construction Cx + USG, HSG, Clinical
17.53 USG 2 20000 S4 S400053 No
Gyac Uteria + Vagina History, Preop Minor
USG / CT, Clinical
Obs & Ablation of Endometriotic Spot +
17.54 History, Preop Minor CD (if Laproscopy) 2 10000 S4 S400054 No
Gyac Adhenolysis
Profile
USG / CT, Clinical
Obs & Ablation of Endometriotic Spot
Gyac +Salpingostomy
Profile
USG / CT, Clinical

Obs & Adhenolysis + Hernia - Ventral -
Gyac Lipectomy/Incision
Profile
USG / CT, Clinical
Obs &
17.57 Adhenolysis+ Ovarian Cystectomy History, Preop Minor CD (if Laproscopy) 2 10000 S4 S400057 No
Gyac
Profile
USG / CT, Clinical
Obs &
17.58 Adhenolysis+ Salpingostomy History, Preop Minor CD (if Laproscopy) 2 10000 S4 S400058 No
Gyac
Profile
USG / CT, Clinical
Obs &
17.59 Broad Ligment Haemotoma drainage History, Preop Minor CD (if Laproscopy) 2 10000 S4 S400059 No
Gyac
Profile
Obs & Clinical History, Minor
17.60 Brust abdomen repair Clincial Notes 2 14000 S4 S400060 No
Gyac Profile
Obs & Pap Smcar, Colposcopy
17.61 Cone Biopsy Cervix HPEE 1 1000 S4 S400061 No
Gyac Minor Profile
Obs & Preop Minor, Clinical
17.62 Conventional Tubectomy HPEE 1 4000 S4 S400062 No
Gyac Notes
Governm
Obs & Clinical History Notes
17.63 Cyst -Vaginal Enucleation HPEE 1 3000 ent S4 S400063 Yes
Gyac Preop Minor / USG
Reserve
Governm
17.64 Cyst-Labial HPEE 1 3000 ent S4 S400064 Yes
Reserve
17.65 Cystocele - Anterior repair HPEE 2 12000 S4 S400065 No
Obs & Cystocele - Anterior Repair + Perineal Tear Clinical History Notes
17.66 HPEE 2 13000 S4 S400066 No
Gyac Repair Preop Minor / USG
Clinical History Notes

Obs & D&C (Dilatation &curretage) + Electro
17.67 Preop Minor / USG + HPEE 1 4000 S4 S400067 No
Gyac Cauterisation Cryo Surgery
Pap Smcar
Obs & Clinical History USG,
17.68 D&C (Dilatation&curretage) HPEE 1 3000 S4 S400068 No
Gyac Preop Minor
Obs & Diagnostic laparoscopy & hysteroscopy for Clinical History USG,
17.69 CD , HPEE 1 5000 S4 S400069 No
Gyac infertility Preop Minor
Obs & Pap Smcar, Clinical
17.70 Electro Cauterisation Cryo Surgery NO 1 4000 S4 S400070 No
Gyac History
USG / CT, Clinical
Obs & Exploration of abdominal haematoma
17.71 History Preop Minor NO 2 14000 S4 S400071 No
Gyac (after laparotomy + LSCS)
Profile
Obs & Preop Minor Profile
17.72 Fractional Curretage HPEE 1 4000 S4 S400072 No
Gyac USG, Clinical History
Preop Minor Profile,

Obs & Gaping Perineal wound secondary
17.73 Clinical History Notes, NO 1 2500 S4 S400073 No
Gyac suturing/ episiotomy
Clinical Site photo
Obs & USG / CT, Clinical
17.74 HaematoColpo/Excision - Vaginal Septum HPEE 1 5000 S4 S400074 No
Gyac History
Clinical History, USG
Obs &
17.75 Hymenectomy& Repair of Hymen Clinical Site Photo, HPEE 1 7000 S4 S400075 No
Gyac
Preop Minor Profile
Obs &
17.76 Amniocentesis AN Profile USG Triple 1 5000 S4 S400076 No
Gyac
Obs &
17.77 Chorionic villus sampling Electrophoresi 1 5000 S4 S400077 No
Gyac
Obs &
17.78 Cordocentesis 1 5000 S4 S400078 No
Gyac
Obs & Clinical Treatment
17.79 Intrauterine transfusions 2 10000 S4 S400079 No
Gyac Notes, USG Plates
CLINICAL Governm
GYNAEC RUPTURE UTERUS, CLOSER AND REPAIR CLINICAL
8.80 PHOTOGRAPH, X- 3 40250 ent S4 S612031 Yes
OLOGY WITH TUBAL LIGATION PHOTOGRAPH, X-RAY,
RAY Reserve

Obs & Concern
Gyac Investigation
Cluster - 18 OPTHALMOLOGY

History of Previous Governm

Opthelm
18.1 Buckel Removal Operation/ Discharge Clinical Photo 1 5000 ent S3 S300001 Yes
ology
Summary (RD) Reserve
Governm
Opthelm
18.2 Canaliculo Dacryocysto Rhinostomy Dacryocysto Graphy Clinical Photo 1 10000 ent S3 S300002 Yes
ology
Reserve
Governm
Opthelm
18.3 Capsulotomy (YAG) B-scan/clinical photo _ 1 1500 ent S3 S300003 Yes
ology
Reserve
Governm
Opthelm
18.4 Corneal Grafting clinical photo clinical photo 1 8500 ent S3 S300004 Yes
ology
Reserve
Governm
Opthelm
18.5 Prophylactic Cryoretinopexy- Closed retinal photo retinal photo 1 2500 ent S3 S300005 Yes
ology
Reserve
Governm
Opthelm
18.6 Cyclocryotherapy/Cyclophotocoagulation retinal photo retinal photo 1 3000 ent S3 S300006 Yes
ology
Reserve
Governm
Opthelm
18.7 Pterygium + ConjunctivalAutograft clinical photo Clinical Photo 1 9000 ent S3 S300007 Yes
ology
Reserve
Clinical Governm
Opthelm
18.8 Dacryocystectomy with implants Dacryocysto Graphy Photo,sticker of 1 10000 ent S3 S300008 Yes
ology
implant Reserve
Governm
Opthelm
18.9 Enucleation B-scan/clinical photo clinical photo 1 6000 ent S3 S300009 Yes
ology
Reserve
Clinical Governm
Opthelm
18.10 Enucleation with Implant B-scan/clinical photo Photo,sticker of 1 11000 ent S3 S300010 Yes
ology
implant Reserve
Governm
Opthelm
18.1 Exenteration MRI X RAY 1 15000 ent S3 S300011 Yes
ology
Reserve
Glaucoma Surgery (Trabeculectomy only)

with or without Mitomycin C, including
Visual field Governm
Opthelm postoperative medications for 12 weeks
18.1 report/tonometry/retin clinical photo 1 10000 ent S3 S300012 Yes
ology (and wherever surgical or laser procedures
al photo Reserve
required for bleb augmentation and
anterior chamber maintenance)
Governm
Opthelm Intraocular Foreign Body Removal from
18.1 B-scan/clinical photo clinical photo 1 4000 ent S3 S300013 Yes
ology Anterior Segment
Reserve
Governm
Opthelm Intraocular Foreign Body Removal from B-scan/clinical
18.1 B-scan/clinical photo 2 20000 ent S3 S300014 Yes
ology Posterior Segment photo
Reserve
Governm
Opthelm B-scan/clinical
18.2 Lensectomy /pediatric lens aspiration B-scan/clinical photo 1 9000 ent S3 S300015 Yes
ology photo
Reserve
Governm
Opthelm
18.2 Limbal Dermoid Removal clinical photo clinical photo 1 4000 ent S3 S300016 Yes
ology
Reserve
Governm
Opthelm
18.2 Surgical Membranectomy B-scan/clinical photo clinical photo 1 8000 ent S3 S300017 Yes
ology
Reserve
Governm
Opthelm
18.2 Perforating Corneo - Scleral Injury clinical photo clinical photo 1 10000 ent S3 S300018 Yes
ology
Reserve
Governm
Opthelm
18.2 Ptosis Surgery clinical photo clinical photo 1 10000 ent S3 S300019 Yes
ology
Reserve
Governm
Opthelm
18.20 IRIS Prolapse – Repair clinical photo clinical photo 1 4000 ent S3 S300020 Yes
ology
Reserve
Governm
Opthelm
18.2 Retinal Detachment Surgery retinal photo retinal photo 1 15000 ent S3 S300021 Yes
ology
Reserve
Governm
Opthelm Small Tumour of Lid – Excision + Lid
18.2 clinical photo clinical photo 1 10000 ent S3 S300022 Yes
ology Reconstruction
Reserve
Governm
Opthelm Socket Reconstruction with amniotic
18.2 clinical photo clinical photo 1 8000 ent S3 S300023 Yes
ology membrane
Reserve
Governm
Opthelm
18.2 Iridectomy – Laser clinical photo clinical photo 1 2000 ent S3 S300024 Yes
ology
Reserve
Governm
Opthelm
18.3 Iridectomy – Surgical clinical photo clinical photo 1 3000 ent S3 S300025 Yes
ology
Reserve
Governm
Opthelm
18.3 Iris cyst removal B-scan/clinical Notes clinical photo 1 2500 ent S3 S300026 Yes
ology
Reserve
retinal Governm
Opthelm
18.3 Vitrectomy retinal photo photo/CLINICAL 1 7500 ent S3 S300027 Yes
ology
PHOTO Reserve
retinal Governm
Opthelm Vitrectomy + Retinal Detachment surgery
18.3 retinal photo photo/CLINICAL 2 17500 ent S3 S300028 Yes
ology (pre-auth required)
PHOTO Reserve
Governm
Opthelm
18.3 Conjunctival tumour excision + AMG clinical photo clinical photo 1 5000 ent S3 S300033 Yes
ology
Reserve
Governm
Opthelm
18.3 Entropion correction clinical photo clinical photo 1 4000 ent S3 S300034 Yes
ology
Reserve
Governm
Opthelm
18.4 Ectropion correction clinical photo clinical photo 1 5000 ent S3 S300035 Yes
ology
Reserve
Governm
Opthelm
18.4 Evisceration clinical photo/B -scan clinical photo 1 3500 ent S3 S300036 Yes
ology
Reserve
Governm
Opthelm
18.4 Laser for retinopathy (per sitting) retinal photo retinal photo 1 1500 ent S3 S300037 Yes
ology
Reserve
Governm
Opthelm
18.4 Lid tear clinical photo clinical photo 1 5000 ent S3 S300038 Yes
ology
Reserve
Governm
Opthelm
18.4 Orbitotomy B-Scan/MRI clinical photo 1 10000 ent S3 S300039 Yes
ology
Reserve
Governm
Opthelm
18.40 Squint correction (per muscle) clinical photo clinical photo 1 4000 ent S3 S300040 Yes
ology
Reserve
Governm
Opthelm Anterior Chamber Reconstruction clinical photo,IOL
18.41 A-Scan,clinical photo 1 11500 ent S3 S300041 Yes
ology +Perforating corneo - Scleral Injury + IOL Sticker
Reserve
Governm
Opthelm
18.42 PRP - Retinal Laser including 3 sittings retinal photo retinal photo 1 5000 ent S3 S300042 Yes
ology
Reserve
Unspecified Surgical Package (Amount Governm
Opthelm Concern
18.43 Capped @ 1,00,000rs per anum per Concern Investigation 1 100000 ent S3 U100 Yes
ology Investigation
family,Package amount is Negotiable) Reserve
Cluster - 19 GENERAL SURGERY

Governm
General
19.1 Adventious Burse – Excision USG/MRI 1 10000 ent S1 S100001 Yes
Surgery
Reserve
General USG/Colonoscopy/CT/Bi
19.2 Anterior Resection for CA HPE 1 15000 S1 S100002 No
Surgery opsy
Governm
General
19.3 Appendicectomy Clinical notes + USG HPE 1 10000 ent S1 S100003 Yes
Surgery
Reserve
Governm
General
19.4 Appendicular Abscess – Drainage USG/CT HPE/USG 1 12000 ent S1 S100004 Yes
Surgery
Reserve
General Arteriovenous (AV) Malformation of Soft
19.5 USG/Color droppler HPE/USG 1 15000 S1 S100005 No
Surgery Tissue Tumour - Excision
Governm
General
19.6 Bakers Cyst – Excision Clinical report/USG HPE/USG 1 6000 ent S1 S100006 Yes
Surgery
Reserve
General
19.7 Bilateral Inguinal block dissection USG/CT/FNAC HPE 2 25000 S1 S100007 No
Surgery
General
19.8 Bleeding Ulcer - Gastrectomy & vagotomy USG/CT/HPE/OGD USG/HPE 2 25000 S1 S100008 No
Surgery
General
19.9 Bleeding Ulcer - Partial Gastrectomy USG/CT USG 2 25000 S1 S100009 No
Surgery
General
19.10 Block dissection Cervical Nodes CT scan/USG,FNAC HPE 1 10000 S1 S100010 No
Surgery
Governm
General
19.1 Branchial Fistula USG/CT HPE 1 14000 ent S1 S100011 Yes
Surgery
Reserve
General
19.1 Breast Lump - Left – Excision USG/CT/FNAC HPE 1 6500 S1 S100012 No
Surgery
General
19.1 Breast Lump - Right – Excision USG/CT/FNAC HPE 1 6500 S1 S100013 No
Surgery
General
19.1 Branchial Cyst USG/CT HPE 1 10000 S1 S100014 No
Surgery
General
19.2 Bursa – Excision USG/Clinical Note HPE 1 4000 S1 S100015 No
Surgery
Governm
General CT/MRI,USG,Tumor
19.2 Bypass - Inoperable Pancreas HPE/USG 1 15000 ent S1 S100016 Yes
Surgery Marker
Reserve
General
19.2 Cervial Lymphnodes – Excision USG/FNAC HPE/USG 1 2000 S1 S100017 No
Surgery
Governm
General USG/CT/Xray/Loopogra HPE/USG,Clinical
19.2 Colostomy 1 15000 ent S1 S100018 Yes
Surgery m Photograph
Reserve
Governm
General
19.2 Cyst over Scrotum – Excision clinical notes/USG 1 2000 ent S1 S100019 Yes
Surgery
Reserve
Governm
General
19.20 Cystic Mass – Excision clinical notes/USG 1 2000 ent S1 S100020 Yes
Surgery
Reserve
Governm
General
19.2 Dermoid Cyst - Large – Excision USG/FNAC 1 4000 ent S1 S100021 Yes
Surgery
Reserve
Governm
General
19.2 Dermoid Cyst - Small – Excision USG/FNAC 1 2000 ent S1 S100022 Yes
Surgery
Reserve
Governm
General
19.2 Drainage of Ischio Rectal Abscess clinical notes/USG 1 4000 ent S1 S100023 Yes
Surgery
Reserve
Governm
General
19.2 Incision and Drainage of large Abscess clinical notes 1 4000 ent S1 S100024 Yes
Surgery
Reserve
Governm
General
19.3 Drainage of Psoas Abscess USG/CT,clinical notes 1 7500 ent S1 S100025 Yes
Surgery
Reserve
Governm
General
19.3 Drainage of Subdiaphramatic Abscess USG/CT,clinical notes 1 10000 ent S1 S100026 Yes
Surgery
Reserve
Governm
General
19.3 Drainage Pericardial Effusion USG/CT,Echo 1 13750 ent S1 S100027 Yes
Surgery
Reserve
General
19.3 Duodenal Diverticulum USG/CT/UGI 2 20000 S1 S100028 No
Surgery
Governm
General
19.3 Duodenal Jejunostomy USG/CT 2 20000 ent S1 S100029 Yes
Surgery
Reserve
General
19.30 Duplication of Intestine Clinical report,CT HPE 2 18000 S1 S100030 No
Surgery
Governm
General
19.3 Hydrocele + Orchidectomy Clinical report,USG HPE 1 8000 ent S1 S100031 Yes
Surgery
Reserve
General
19.3 Epidedectomy Clinical report,USG 1 8000 S1 S100032 No
Surgery
General
19.3 Epididymal Swelling –Excision USG/FNAC 1 6000 S1 S100033 No
Surgery
Governm
General
19.3 Epidymal Cyst Clinical report,USG 1 4000 ent S1 S100034 Yes
Surgery
Reserve
Governm
General
19.4 Evacuation of Scrotal Hematoma Clinical report,USG 1 5000 ent S1 S100035 Yes
Surgery
Reserve
General
19.4 Excision Benign Tumor -Small intestine USG/CT HPE 1 15000 S1 S100036 No
Surgery
Clinical
General
19.4 Excision Bronchial Sinus report,Broncoscopy/HR HPE 1 8000 S1 S100037 No
Surgery
CT
Governm
General
19.4 Drainage of liver Abscess Clinical report,USG USG 1 8000 ent S1 S100038 Yes
Surgery
Reserve
General
19.4 Excision Filarial Scrotum Clinical report,USG,PS 1 5000 S1 S100039 No
Surgery
General Clinical
19.40 Excision Mammary Fistula HPE 1 5000 S1 S100040 No
Surgery report,mammogram
General
19.41 Excision Meckel's Diverticulum USG/CT HPE 1 15000 S1 S100041 No
Surgery
General
19.42 Excision Pilonidal Sinus clinical notes 1 8000 S1 S100042 No
Surgery
Governm
General
19.43 Excision Small Intestinal Fistula USG/CT HPE 1 15000 ent S1 S100043 Yes
Surgery
Reserve
General
19.44 Excision of Growth from Tongue only Biopsy,Clinical Note HPE 1 6000 S1 S100044 No
Surgery
General Excision of Growth from Tongue with neck
19.45 Biopsy,CT HPE 1 15000 S1 S100045 No
Surgery node dissection
General
19.46 Excision of Swelling in Right Cervical Region clinical notes 1 5000 S1 S100046 No
Surgery
Governm
General
19.47 Excision of Large Swelling in Hand clinical notes 1 3000 ent S1 S100047 Yes
Surgery
Reserve
Governm
General
19.48 Excision of Small Swelling in Hand clinical notes 1 1500 ent S1 S100048 Yes
Surgery
Reserve
General
19.49 Excision of Neurofibroma clinical notes HPE 1 3000 S1 S100049 No
Surgery
Governm
General
19.50 Exicision of Sinus and Curettage clinical notes 1 5000 ent S1 S100050 Yes
Surgery
Reserve
General
19.51 Fibroadenoma – Bilateral clinical notes HPE 1 8000 S1 S100051 No
Surgery
General
19.52 Fibrodenoma – Unilateral clinical notes HPE 1 7000 S1 S100052 No
Surgery
Governm
General
19.53 Fissurectomy clinical notes 1 8000 ent S1 S100053 Yes
Surgery
Reserve
Governm
General
19.54 Fissurectomy and Haemorrhoidectomy clinical notes 1 12000 ent S1 S100054 Yes
Surgery
Reserve
Governm
General
19.55 Eversion of Hydrocele Sac – Bilateral clinical notes 1 10000 ent S1 S100055 Yes
Surgery
Reserve
Governm
General
19.56 Eversion of Hydrocele Sac – Unilateral clinical notes 1 5000 ent S1 S100056 Yes
Surgery
Reserve
Photograph of Governm
General
19.57 Fissurectomy with Sphincterotomy clinical notes removed part of 1 15000 ent S1 S100057 Yes
Surgery
body Reserve
Governm
General Foreign Body Removal in Deep Region
19.58 Pre-op. X-ray 1 5000 ent S1 S100058 Yes
Surgery requiring GA
Reserve
Governm
General
19.59 Fundoplication Clinical report,OGD/CT USG 2 20000 ent S1 S100059 Yes
Surgery
Reserve
General
19.60 G J Vagotomy/ Vagotomy + Pyloroplasty Clinical report HPE 1 15000 S1 S100060 No
Surgery
General
19.61 Ganglion - large – Excision Clinical report 1 3000 S1 S100061 No
Surgery
General
19.62 Ganglion - Small – Excision clinical notes 1 2000 S1 S100062 No
Surgery
Governm
General
19.63 Gastrojejunostomy Clinical notes + USG Clinical Photograph 1 15000 ent S1 S100063 Yes
Surgery
Reserve
Governm
General
19.64 Gastrostomy Clinical notes + USG Clinical Photograph 1 15000 ent S1 S100064 Yes
Surgery
Reserve
General Graham's Operation for duodenal
19.65 X-ray abdomen/USG 1 15000 S1 S100065 No
Surgery perforation
General
19.66 Granuloma – Excision Clinical report 1 2000 S1 S100066 No
Surgery
Governm
General
19.67 Haemangioma – Excision (large) Doppler 1 10000 ent S1 S100067 Yes
Surgery
Reserve
Governm
General
19.68 Haemangioma – Excision (small) Doppler 1 5000 ent S1 S100068 Yes
Surgery
Reserve
Governm
General
19.69 Haemorrhage of Small Intestine clinical notes 1 15000 ent S1 S100069 Yes
Surgery
Reserve
Governm
General
19.70 Hepatic Resection (lobectomy) Clinical report,USG/CT HPE 2 20000 ent S1 S100070 Yes
Surgery
Reserve
Governm
General
19.71 Hernia – Epigastric Clinical report USG,Mesh Sticker 1 11000 ent S1 S100071 Yes
Surgery
Reserve
Governm
General
19.72 Hernia – Incisional Clinical report 1 15000 ent S1 S100072 Yes
Surgery
Reserve
Governm
General
19.73 Hernia - Repair & release of obstruction Clinical report,X-ray 1 15000 ent S1 S100073 Yes
Surgery
Reserve
Governm
General
19.74 Hernia – Umbilical Clinical report USG/CT 1 11000 ent S1 S100074 Yes
Surgery
Reserve
Governm
General
19.75 Hernia – Femoral Clinical report/USG Mesh Sticker 1 10000 ent S1 S100075 Yes
Surgery
Reserve
Governm
General
19.76 Hernioplasty – Inguinal Clinical report/USG Mesh Sticker 1 10000 ent S1 S100076 Yes
Surgery
Reserve
Governm
General
19.77 Herniorraphy Clinical report 1 9000 ent S1 S100077 Yes
Surgery
Reserve
Governm
General Clinical
19.78 Hiatus Hernia – abdominal 1 15000 ent S1 S100078 Yes
Surgery report,USG/OGD
Reserve
Governm
General
19.79 Hydatid Cyst of Liver Clinical report/USG HPE 1 12500 ent S1 S100079 Yes
Surgery
Reserve
General
19.80 Hydrocele - Excision – Unilateral clinical notes 1 5000 S1 S100080 No
Surgery
General
19.81 Hydrocele - Excision – Bilateral Clinical report 1 10000 S1 S100081 No
Surgery
General
19.83 Infected Bunion Foot – Excision clinical notes 1 4000 S1 S100083 No
Surgery
General
19.84 Inguinal Node (dissection) - Unilateral Clinical notes + USG HPE 1 10000 S1 S100084 No
Surgery
General
19.85 Intestinal perforation Clinical report,X-ray 1 12500 S1 S100085 No
Surgery
General
19.86 Intestinal Obstruction Clinical report,X-ray 1 12500 S1 S100086 No
Surgery
General
19.87 Intussusception Clinical report,X-ray 1 15000 S1 S100087 No
Surgery
Governm
General
19.88 Jejunostomy X-RAY/USG Clinical Photo 1 15000 ent S1 S100088 Yes
Surgery
Reserve
General Clinical report,X-
19.89 Gastric Perforation 1 15000 S1 S100089 No
Surgery ray/USG
General Intestinal Perforation (Resection Clinical report,X-
19.90 2 20000 S1 S100090 No
Surgery Anastomosis) ray/USG
General
19.91 Appendicular Perforation X-RAY/USG HPE 1 15000 S1 S100091 No
Surgery
General
19.92 Burst Abdomen Obstruction Clinical report 1 15000 S1 S100092 No
Surgery
General
19.93 Closure of Hollow Viscus Perforation Clinical notes + USG 1 15000 S1 S100093 No
Surgery
General Laryngectomy & Pharyngeal Diverticulum
19.94 Clinical report,CT HPE 1 15000 S1 S100094 No
Surgery (Throat)
Governm
General
19.95 Ileostomy clinical notes Clinical Photo 1 15000 ent S1 S100095 Yes
Surgery
Reserve
Governm
General
19.96 Lipoma excision clinical notes 1 2500 ent S1 S100096 Yes
Surgery
Reserve
Governm
General
19.97 Loop Colostomy Sigmoid clinical notes 1 12000 ent S1 S100097 Yes
Surgery
Reserve
General clinical
19.98 Mastectomy HPE 1 12000 S1 S100098 No
Surgery notes,Mammogram
General
19.99 Mesenteric Cyst – Excision USG/ CT HPE 2 16000 S1 S100099 No
Surgery
19.10 General
Mesenteric Caval Anastomosis USG/ CT 1 15000 S1 S100100 No
0 Surgery
General
19.1 Microlaryngoscopic Surgery Clinical Note 1 15000 S1 S100101 No
Surgery
Governm
General Oeshophagoscopy for foreign body Photo of removed
19.1 Clinical Note 1 7500 ent S1 S100102 Yes
Surgery removal foreign body
Reserve
General
19.1 Oesophagectomy CT HPE 2 34500 S1 S100103 No
Surgery
General
19.1 Portal Hypertension shunt surgery USG 2 18000 S1 S100104 No
Surgery
Governm
General
19.1 Pelvic Abscess - Open Drainage Clinical Note 1 10000 ent S1 S100105 Yes
Surgery
Reserve
Governm
General
19.1 PancreaticoDuodenectomy CT HPE 2 25000 ent S1 S100106 Yes
Surgery
Reserve
Governm
General Distal Pancreatectomy with
19.1 CT HPE 2 25000 ent S1 S100107 Yes
Surgery PancreaticoJejunostomy
Reserve
General
19.1 Papilloma Rectum – Excision clinical notes HPE 1 4000 S1 S100108 No
Surgery
General
19.1 Haemorroidectomy+ Fistulectomy clinical notes 1 10000 S1 S100109 No
Surgery
19.11 General
Growth in the Scalp – Excision clinical notes 1 4000 S1 S100110 No
0 Surgery
General
19.1 Porto Caval Anastomosis USG 1 15000 S1 S100111 No
Surgery
General
19.1 Pyeloroplasty USG 1 10000 S1 S100112 No
Surgery
General Mammogram,USG/X-
19.1 Radical Mastectomy HPE 1 10000 S1 S100113 No
Surgery ray
General
19.1 Radical Neck Dissection – Excision CT,Biopasy HPE 1 15000 S1 S100114 No
Surgery
General
19.1 Hernia – Spigelian USG 1 5000 S1 S100115 No
Surgery
General
19.1 Rectal Dilation clinical notes 1 2000 S1 S100116 No
Surgery
General
19.1 Prolapse of Rectal Mass – Excision clinical notes 1 10000 S1 S100117 No
Surgery
General
19.1 Rectopexy clinical notes 1 10000 S1 S100118 No
Surgery
General
19.1 Repair of Common Bile Duct USG 1 15000 S1 S100119 No
Surgery
General
19.1 Retroperitoneal Tumor – Excision USG/CT HPE 2 20000 S1 S100122 No
Surgery
General
19.1 Haemorroidectomy Clinical Notes 1 5000 S1 S100123 No
Surgery
General
19.1 Salivary Gland – Excision FNAC HPE 1 10000 S1 S100124 No
Surgery
General
19.1 Segmental Resection of Breast clinical notes 1 10000 S1 S100125 No
Surgery
General
19.1 Scrotal Swelling (Multiple) – Excision clinical notes,USG 1 5000 S1 S100126 No
Surgery
General
19.1 Sigmoid Diverticulum USG/ X-RAY 1 15000 S1 S100127 No
Surgery
General
19.1 Simple closure - Peptic perforation Clinical Note,X-ray 1 15000 S1 S100128 No
Surgery
General
19.1 Sinus – Excision clinical notes 1 5000 S1 S100129 No
Surgery
19.13 General
Soft Tissue Tumor (small) – Excision clinical notes HPE 1 5000 S1 S100130 No
0 Surgery
19.13 General
Soft Tissue Tumor (large) – Excision clinical notes,USG HPE 1 10000 S1 S100131 No
1 Surgery
Governm
19.13 General
Splenectomy clinical notes,USG HPE 2 30000 ent S1 S100132 Yes
2 Surgery
Reserve
19.13 General
Submandibular Lymph node – Excision clinical notes,FNAC 1 5000 S1 S100133 No
3 Surgery
19.13 General Submandibular Mass Excision +
clinical notes,CT/FNAC HPE 2 20000 S1 S100134 No
4 Surgery Reconstruction
19.13 General
Swelling in foot (small) – Excision clinical notes 1 1500 S1 S100135 No
5 Surgery
19.13 General
Swelling in foot (large) – Excision clinical notes 1 3500 S1 S100136 No
6 Surgery
Governm
19.13 General
Coloectomy – Total USG/Colonoscopy HPE 2 20000 ent S1 S100137 Yes
7 Surgery
Reserve
19.13 General
Pharyngectomy& Reconstruction – Total CT/MRI HPE 2 20000 S1 S100138 No
8 Surgery
19.13 General Tracheal Stenosis (End to end Anastamosis)
CT/MRI,Laryngoscopy 1 15000 S1 S100139 No
9 Surgery (Throat)
19.14 General
Tracheoplasty (Throat) CT/USG 1 15000 S1 S100140 No
0 Surgery
19.14 General
Umbilical Sinus – Excision clinical notes 1 5000 S1 S100141 No
1 Surgery
19.14 General
Varicose Veins - Excision and Ligation Clinical notes,Doppler 1 10000 S1 S100142 No
2 Surgery
19.14 General
Vasovasostomy Clinical Note/USG 1 12000 S1 S100143 No
3 Surgery
19.14 General
Volvlous of Large Bowel Clinical Note/X-ray 2 25000 S1 S100144 No
4 Surgery
Governm
19.14 General PRE OP CLINICAL
Cleft lip operation Clinical photograph 1 12000 ent S1 S100145 Yes
5 Surgery PICTURE
Reserve
Governm
Cleft palate repair (for each stage) Clinical photograph 1 12000 ent S1 S100146 Yes
6 Surgery PICTURE
Reserve
Governm
Cleft lip & palate operation (for each stage) Clinical photograph 1 15000 ent S1 S100147 Yes
7 Surgery PICTURE
Reserve
19.14 General Aneurysm not Requiring Bypass
CT Angio CT Angio,Doppler 2 36000 S1 S100148 No
8 Surgery Techniques t
19.14 General
Aneurysm Resection & Grafting CT Angio 2 36000 S1 S100149 No
9 Surgery
19.15 General
Arterial Embolectomy CT Angio/Color Doppler Doppler 2 17250 S1 S100150 No
0 Surgery
19.15 General
Carotid artery aneurysm repair Angiogram Color Doppler 2 17250 S1 S100151 No
1 Surgery
Governm
19.15 General
Carotid Body tumour - Excision Angiogram Color Doppler 2 20000 ent S1 S100152 Yes
2 Surgery
Reserve
Governm
19.15 General
Cholecystectomy & Exploration of CBD USG/CT HPE 2 22000 ent S1 S100153 Yes
3 Surgery
Reserve
Governm
19.15 General
Cholecystostomy USG/CT HPE 1 10000 ent S1 S100154 Yes
4 Surgery
Reserve
Governm
19.15 General
Congential Arteriovenus Fistula (large) CT Angio/ Doppler 2 20000 ent S1 S100155 Yes
5 Surgery
Reserve
Governm
19.15 General
Congential Arteriovenus Fistula (small) CT Angio/ Doppler 1 10000 ent S1 S100156 Yes
6 Surgery
Reserve
19.15 General X-RAY,Biopsy , CT/ PET Biopsy , Clinical
Decortication (Pleurectomy) 1 51750 S1 S100157 No
7 Surgery scan Photograph , X-RAY
19.15 General
Dissecting Aneurysms CT Angio/ Cath Doppler 2 36000 S1 S100158 No
8 Surgery
19.15 General
Distal Abdominal Aorta repair Angiogram Color Doppler 2 36000 S1 S100159 No
9 Surgery
19.16 General
Estlander Operation (lip) Clinical Note 1 7000 S1 S100160 No
0 Surgery
19.16 General
Excision and Skin Graft of Venous Ulcer Clinical Note 1 15000 S1 S100161 No
1 Surgery
19.16 General Excision of Parathyroid Biopsy,CT,Bronchoscop Biopsy,Clinical
2 20700 S1 S100162 No
2 Surgery Adenoma/Carcinoma y Photograph
Governm
19.16 General
Flap Reconstructive Surgery clinical notes 2 20000 ent S1 S100163 Yes
3 Surgery
Reserve
Governm
19.16 General Split thickness skin grafts – Small (< 4%
clinical notes Clinical Photograph 1 5000 ent S1 S100164 Yes
4 Surgery TBSA)
Reserve
Governm
19.16 General Split thickness skin grafts – Medium (4 - 8%
5 Surgery TBSA)
Reserve
Governm
19.16 General Split thickness skin grafts – Large (> 8%
6 Surgery TBSA)
Reserve
Governm
19.16 General
Free Grafts - Wolfe Grafts clinical notes Clinical Photograph 1 10000 ent S1 S100167 Yes
7 Surgery
Reserve
19.16 General
Hemi thyroidectomy USG/FNAC/TFT HPE 1 10000 S1 S100168 No
8 Surgery
19.16 General
Total thyroidectomy USG/FNAC/TFT HPE 2 20000 S1 S100169 No
9 Surgery
19.17 General
Laparoscopic Hernia Repair clinical notes Mesh Sticker 2 18000 S1 S100170 No
0 Surgery
Governm
19.17 General
Lap. Assisted left Hemi colectomy t USG HPE 2 25000 ent S1 S100171 Yes
1 Surgery
Reserve
Governm
19.17 General
Lap. Assisted Right Hemi colectomy t USG HPE 2 25000 ent S1 S100172 Yes
2 Surgery
Reserve
19.17 General
Lap. Assisted small bowel resection USG/CT HPE 1 15000 S1 S100173 No
3 Surgery
Governm
19.17 General
Lap. Assisted Total Colectomy USG/CT HPE 2 25000 ent S1 S100174 Yes
4 Surgery
Reserve
Governm
19.17 General
Lap. Cholecystectomy & CBD exploration USG HPE 2 20000 ent S1 S100175 Yes
5 Surgery
Reserve
19.17 General
Lap. For intestinal obstruction USG/CT,X-ray 1 15000 S1 S100176 No
6 Surgery
Governm
19.17 General
Lap. Hepatic resection USG/CT HPE 2 25000 ent S1 S100177 Yes
7 Surgery
Reserve
Governm
19.17 General
Lap. Hydatid of liver surgery USG/CT HPE 2 20000 ent S1 S100178 Yes
8 Surgery
Reserve
19.17 General
Laparoscopic Adhesinolysis Clinical notes + USG 1 15000 S1 S100179 No
9 Surgery
19.18 General
Laparoscopic Appendicectomy Clinical notes + USG HPE 2 18000 S1 S100180 No
0 Surgery
19.18 General
Laparoscopic Cholecystectomy USG HPE 1 15000 S1 S100181 No
1 Surgery
Governm
19.18 General
Laparoscopic cystogastrostomy USG 2 20000 ent S1 S100182 Yes
2 Surgery
Reserve
Governm
19.18 General
Laparoscopic Gastrostomy USG/CT,Clinical note 1 12000 ent S1 S100183 Yes
3 Surgery
Reserve
19.18 General
Laparoscopic Hiatus Hernia Repair OGD/USG 2 22000 S1 S100184 No
4 Surgery
19.18 General
Laparoscopic Pyloromyotomy OGD/USG 2 20000 S1 S100185 No
5 Surgery
19.18 General
Laparoscopic Rectopexy Clinical notes + USG 1 15000 S1 S100186 No
6 Surgery
19.18 General
Laparoscopic Spleenectomy Clinical notes + USG HPE 2 16500 S1 S100187 No
7 Surgery
19.18 General
Laparoscopic umbilical hernia repair Clinical notes + USG 1 15000 S1 S100188 No
8 Surgery
19.18 General
Laparoscopic ventral hernia repair Clinical notes + USG Mesh Sticker 2 20000 S1 S100189 No
9 Surgery
19.19 General Laparotomy-peritonitis lavage and
Clinical notes + USG 1 10000 S1 S100190 No
0 Surgery drainage
19.19 General
Ligation of Ankle Perforators Doppler 1 5000 S1 S100191 No
1 Surgery
19.19 General Lymphatics Excision of Subcutaneous
clinical notes,USG pelvis 1 10000 S1 S100192 No
2 Surgery Tissues In Lymphoedema
19.19 General
Repair of Main Arteries of the Limbs Clinical notes,Doppler 2 25000 S1 S100193 No
3 Surgery
19.19 General Biopsy,Clinical
Mediastinal Tumour CT 2 20000 S1 S100194 No
4 Surgery photo showing scar
19.19 General Oesophagectomy for Carcinoma
USG/CT,Biopsy HPE 2 25000 S1 S100195 No
5 Surgery Oesophagus
Governm
19.19 General
Operation for Bleeding Peptic Ulcer Clinical notes,OGD 1 15000 ent S1 S100196 Yes
6 Surgery
Reserve
19.19 General Operation for Carcinoma Lip –
Clinical notes HPE 1 10000 S1 S100197 No
7 Surgery Vermilionectomy
19.19 General Operation for Carcinoma Lip - Wedge

8 Surgery Excision and Vermilionectomy
19.19 General Operation for Carcinoma Lip - Wedge-
9 Surgery Excision
Governm
19.20 General Appendicectomy - Appendicular Abscess –
USG HPE 1 12000 ent S1 S100200 Yes
0 Surgery Drainage
Reserve
19.20 General
Caecostomy Clinical notes + USG 1 10000 S1 S100201 No
1 Surgery
Governm
19.20 General
Closure of Colostomy Clinical notes 1 5000 ent S1 S100202 Yes
2 Surgery
Reserve
19.20 General
Coccygeal Teratoma Excision USG/CT HPE 1 15000 S1 S100203 No
3 Surgery
19.20 General Congenital Atresia & Stenosis of Small
USG/CT 2 20000 S1 S100204 No
4 Surgery Intestine
Governm
19.20 General
CystoJejunostomy/or Cystogastrostomy clinical notes 2 20000 ent S1 S100205 Yes
5 Surgery
Reserve
Governm
19.20 General
Drainage of perivertebral abscess Clinical notes + USG 1 10000 ent S1 S100206 Yes
6 Surgery
Reserve
clinical
19.20 General
Hernia -hiatus-Transthoracic notes,OGD/CHEST X- 2 25000 S1 S100207 No
7 Surgery
ray
19.20 General
Intercostal drainage X-ray X-ray 1 2000 S1 S100208 No
8 Surgery
19.20 General Operation for carcinoma lip- cheek
clinical notes HPE 1 12000 S1 S100209 No
9 Surgery advancement
19.21 General
Thymectomy CT scan HPE 2 20000 S1 S100210 No
0 Surgery
19.21 General
Operation of Choledochal Cyst USG 1 15000 S1 S100211 No
1 Surgery
19.21 General Operations for Acquired Arteriovenous clinical
1 15000 S1 S100212 No
2 Surgery Fistula notes,Doppler/Angio
19.21 General Operations for Replacement of
clinical notes,OGD 2 25000 S1 S100213 No
3 Surgery Oesophagus by Colon
19.21 General
Hemodialysis per sitting RFT Serum Creatinine 1 2300 S1 S100214 No
4 Surgery
19.21 General
Parapharyngeal Tumour Excision USG,CT/FNAC HPE 2 20000 S1 S100215 No
5 Surgery
19.21 General Partial/Subtotal Gastrectomy for

OGD/CT HPE 2 22000 S1 S100216 No
6 Surgery Carcinoma
19.21 General
Patch Graft Angioplasty Angiography 2 18400 S1 S100217 No
7 Surgery
19.21 General
Pericardiostomy Clinical note,X-ray 2 30000 S1 S100218 No
8 Surgery
19.21 General Clinical photo
Pneumonectomy CT/Xray 2 46000 S1 S100219 No
9 Surgery showing scar,X-ray
Photograph of
19.22 General Removal of Foreign Body from Trachea or
clinical notes removed foreign 1 5000 S1 S100220 No
0 Surgery Oesophagus
body
19.22 General
Removal Tumours of Chest Wall USG/CT HPE 2 20000 S1 S100221 No
1 Surgery
19.22 General
Procedures Requiring Bypass Techniques Doopler/Angio 2 35000 S1 S100222 No
2 Surgery
19.22 General
Resection Enucleation of Adenoma (lung) HRCT HPE 1 10000 S1 S100223 No
3 Surgery
19.22 General
Rib Resection & Drainage X-ray/USG X-ray 1 10000 S1 S100224 No
4 Surgery
19.22 General
Skin Flaps - Rotation Flaps clinical notes 1 6200 S1 S100225 No
5 Surgery
19.22 General
Splenectomy - For Trauma CT Angio Report HPE 2 20000 S1 S100226 No
6 Surgery
19.22 General
Surgery for Arterial Aneurism Spleen Artery Doopler/Angio 2 20000 S1 S100227 No
7 Surgery
19.22 General
Surgery for Arterial Aneurism –Vertebral Doopler/MR Angio 2 25000 S1 S100228 No
8 Surgery
19.22 General
Sympathetectomy – Cervical clinical notes 1 5000 S1 S100229 No
9 Surgery
19.23 General
Temporal Bone resection clinical notes 1 57500 S1 S100230 No
0 Surgery
19.23 General
Thorachostomy X-ray,clinical notes 1 10000 S1 S100231 No
1 Surgery
19.23 General
Thoracocentesis X-ray 1 1500 S1 S100232 No
2 Surgery
19.23 General
Thoracoplasty X-ray 2 34500 S1 S100233 No
3 Surgery
Governm
19.23 General
Thoracoscopic Decortication CT X-ray 2 25000 ent S1 S100234 Yes
4 Surgery
Reserve
Governm
19.23 General
Thoracoscopic Hydatid Cyst excision CT X-ray 2 20000 ent S1 S100235 Yes
5 Surgery
Reserve
Governm
19.23 General
Thoracoscopic Lobectomy CT X-ray 2 25000 ent S1 S100236 Yes
6 Surgery
Reserve
Governm
19.23 General
Thoracoscopic Pneumonectomy CT X-ray 2 30000 ent S1 S100237 Yes
7 Surgery
Reserve
Governm
19.23 General
Thoracoscopic Segmental Resection CT X-ray 2 25000 ent S1 S100238 Yes
8 Surgery
Reserve
Governm
19.23 General
Thoracoscopic Sympathectomy CT X-ray 1 15000 ent S1 S100239 Yes
9 Surgery
Reserve
19.24 General
Thrombendarterectomy CT/Angio 1 15000 S1 S100240 No
0 Surgery
19.24 General
Thorax (penetrating wounds) clinical notes,CT/X-ray X-ray 1 12500 S1 S100241 No
1 Surgery
19.24 General
Total Thyroidectomy and Block Dissection USG HPE 2 20000 S1 S100242 No
2 Surgery
19.24 General
Trendelenburg Operation Doppler 1 10000 S1 S100243 No
3 Surgery
Governm
19.24 General
Debridement of Ulcer-Leprosy clinical notes 1 5000 ent S1 S100244 Yes
4 Surgery
Reserve
Governm
19.24 General
Tissue Reconstruction Flap Leprosy clinical notes 2 25000 ent S1 S100245 Yes
5 Surgery
Reserve
Governm
19.24 General
Tendon Transfer-Leprosy clinical notes 2 25000 ent S1 S100246 Yes
6 Surgery
Reserve
19.24 General
Adhenolysis + Appendicectomy USG HPE 2 20000 S1 S100247 No
7 Surgery
19.24 General Hernia - Repair & release of obstruction+
clinical notes 2 20000 S1 S100248 No
8 Surgery Hernioplasty
Governm
19.24 General
Aspiration of cold Abscess of Lymphnode clinical notes HPE/Cytology 1 3000 ent S1 S100249 Yes
9 Surgery
Reserve
19.25 General
Aspiration of Empyema X-ray Fluid-RM/CS 1 2000 S1 S100250 No
0 Surgery
19.25 General clinical note,Serum
AV Shunt for dialysis Doppler 1 6000 S1 S100251 No
1 Surgery Creatinine
19.25 General clinical notes,Serum

Peritoneal dialysis per sitting Serum Creatinine 1 2300 S1 S100252 No
2 Surgery Creatinine
19.25 General
Vasectomy clinical notes clinical notes 1 2500 S1 S100253 No
3 Surgery
CLINICAL CLINICAL
General
8.61 RESECTION & ANASTOMOSIS OF INTESTINE PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 34500 S1 S612018 No
Surgery
CLINICAL CLINICAL
General
8.66 INTESTINAL RESECTION PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 40250 S1 S612022 No
Surgery
CLINICAL CLINICAL
8.70 SURGERY ILIEOSIGMOIDOSTOMY PHOTOGRAPH, X-RAY, PHOTOGRAPH, X- 3 28750 S1 S612024 No

General Concern
Surgery Investigation
Cluster - 20 ORAL AND MAXILLO FACIAL SURGERY

Oral and
Maxillofa Fixation of fracture of jaw with closed
20.1 OPG/CT Scan Clinical Photo 1 5000 S16 S1600001 No
cial reduction (1 jaw) using wires - under LA
Surgery
Oral and
Fixation of fracture of jaw with open
Maxillofa
20.2 reduction (1 jaw) and fixing of plates/ wire OPG/CT Scan Clinical Photo 1 12000 S16 S1600002 No
cial
– under GA
Surgery
Oral and
Maxillofa
20.3 Sequestrectomy OPG/CT Scan Clinical Photo 1 1500 S16 S1600003 No
cial
Surgery
Oral and
Maxillofa
20.4 TM joint ankylosis of both jaws - under GA OPG/CT Scan Clinical Photo 1 15000 S16 S1600004 No
cial
Surgery
Oral and
Maxillofa Release of fibrous bands & grafting -in
20.5 Clinical Photo Clinical Photo 1 3000 S16 S1600005 No
cial (OSMF) treatment under GA
Surgery
Oral and
Maxillofa
20.6 Extraction of impacted tooth under LA X-Ray Clinical Photo 1 500 S16 S1600006 No
cial
Surgery
Oral and
Cyst & tumour of Maxilla/mandible by
Maxillofa
20.7 enucleation/excision/marsupialization OPG/CT Scan/X-Ray Clinical Photo 1 2500 S16 S1600007 No
cial
under LA
Surgery
Oral and
Maxillofa Mandible Tumour Resection and
20.8 OPG/CT Scan Clinical Photo 1 6000 S16 S1600008 No
cial reconstruction/Cancer surgery
Surgery
Oral and
Maxillofa
20.9 Cleft lip and palate surgery (each stage) Clinical Photo Clinical Photo 1 15000 S16 S1600009 No
cial
Surgery
Oral and
Maxillofa Concern
cial Investigation
Surgery
Cluster - 21 GENERAL MEDICINE

Governm
ent
Acute gastroenteritis with moderate
21.1 General Reserve
dehydration (admission type: Routine Clinical Notes clinical notes 0 1800 M1 M100001 Yes
A Medicine (Package
ward )
Amount
per day)
Governm
ent
21.1 General Acute gastroenteritis with moderate Reserve
Clinical Notes clinical notes 0 2700 M1 M100001 Yes
B Medicine dehydration (admission type: HDU ) (Package
Amount
per day)
Governm
ent
dehydration (admission type: ICU Clinical Notes clinical notes 0 3600 M1 M100001 Yes
C Medicine (Package
,without ventilator)
Amount
per day)
Governm
ent
dehydration (admission type: ICU (with Clinical Notes clinical notes 0 4500 M1 M100001 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
X-Ray abd.Standing
21.2 General Recurrent vomiting with dehydration Reserve
/USG Abd.Pelvis,clinical clinical notes 0 1800 M1 M100002 Yes
A Medicine (admission type: Routine ward ) (Package
notes
Amount
per day)
Governm
ent
X-Ray abd.Standing
21.2 General Recurrent vomiting with Reserve
/USG Abd.Pelvis,clinical clinical notes 0 2700 M1 M100002 Yes
B Medicine dehydration(admission type: HDU ) (Package
notes
Amount
per day)
Governm
ent
Recurrent vomiting with X-Ray abd.Standing
dehydration(admission type: ICU ,without /USG Abd.Pelvis,clinical clinical notes 0 3600 M1 M100002 Yes
C Medicine (Package
ventilator) notes
Amount
per day)
Governm
ent
Recurrent vomiting with X-Ray abd.Standing
dehydration(admission type: ICU (with /USG Abd.Pelvis,clinical clinical notes 0 4500 M1 M100002 Yes
D Medicine (Package
ventilator ) notes
Amount
per day)
Governm
ent
Dysentery (admission type: Routine ward ) Clinical Notes clinical notes 0 1800 M1 M100003 Yes
A Medicine (Package
Amount
per day)
Governm
ent
Dysentery(admission type: HDU ) Clinical Notes clinical notes 0 2700 M1 M100003 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.3 General Dysentery(admission type: ICU ,without Reserve
C Medicine ventilator) (Package
Amount
per day)
Governm
ent
21.3 General Dysentery(admission type: ICU (with Reserve
D Medicine ventilator ) (Package
Amount
per day)
Governm
ent
Renal colic (admission type: Routine ward ) X-Ray/USG clinical notes 0 1800 M1 M100004 Yes
A Medicine (Package
Amount
per day)
Governm
ent
Renal colic(admission type: HDU ) X-Ray/USG clinical notes 0 2700 M1 M100004 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.4 General Renal colic(admission type: ICU ,without Reserve
X-Ray/USG clinical notes 0 3600 M1 M100004 Yes
Amount
per day)
Governm
ent
21.4 General Renal colic(admission type: ICU (with Reserve
X-Ray/USG clinical notes 0 4500 M1 M100004 Yes
Amount
per day)
Governm
ent
21.5 General Acute bronchitis (admission type: Routine Reserve
Chest X-Ray clinical notes 0 1800 M1 M100005 Yes
A Medicine ward ) (Package
Amount
per day)
Governm
ent
Acute bronchitis(admission type: HDU ) Chest X-Ray clinical notes 0 2700 M1 M100005 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.5 General Acute bronchitis(admission type: ICU Reserve
C Medicine ,without ventilator) (Package
Amount
per day)
Governm
ent
21.5 General Acute bronchitis(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.6 General Pneumothroax (admission type: Routine Reserve
Amount
per day)
Governm
ent
Pneumothroax(admission type: HDU ) Chest X-Ray clinical notes 0 2700 M1 M100006 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.6 General Pneumothroax(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.6 General Pneumothroax(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.7 General Accelerated hypertension (admission type: Reserve
clinical notes,ECG clinical notes 0 1800 M1 M100007 Yes
A Medicine Routine ward ) (Package
Amount
per day)
Governm
ent
21.7 General Accelerated hypertension(admission type: Reserve
B Medicine HDU ) (Package
Amount
per day)
Governm
ent
C Medicine ICU ,without ventilator) (Package
Amount
per day)
Governm
ent
D Medicine ICU (with ventilator ) (Package
Amount
per day)
Governm
ent
21.8 General Congestive heart failure (admission type: Chest X-Ray, 2 D Echo, Reserve
clinical notes 0 1800 M1 M100008 Yes
A Medicine Routine ward ) ECG (Package
Amount
per day)
Governm
ent
21.8 General Congestive heart failure(admission type: Chest X-Ray, 2 D Echo, Reserve
B Medicine HDU ) ECG (Package
Amount
per day)
Governm
ent
C Medicine ICU ,without ventilator) ECG (Package
Amount
per day)
Governm
ent
D Medicine ICU (with ventilator ) ECG (Package
Amount
per day)
Governm
ent
21.9 General Severe anemia (admission type: Routine Reserve
HB clinical notes 0 1800 M1 M100009 Yes
Amount
per day)
Governm
ent
Severe anemia(admission type: HDU ) HB clinical notes 0 2700 M1 M100009 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.9 General Severe anemia(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.9 General Severe anemia(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.10 General Diabetic ketoacidosis (admission type: FBS, PP2BS,HBA1C, Reserve
A Medicine Routine ward ) Urine Ketons (Package
Amount
per day)
Governm
ent
21.10 General Diabetic ketoacidosis(admission type: HDU FBS, PP2BS,HBA1C, Reserve
B Medicine ) Urine Ketons (Package
Amount
per day)
Governm
ent
21.10 General Diabetic ketoacidosis(admission type: ICU FBS, PP2BS,HBA1C, Reserve
C Medicine ,without ventilator) Urine Ketons (Package
Amount
per day)
Governm
ent
21.10 General Diabetic ketoacidosis(admission type: ICU FBS, PP2BS,HBA1C, Reserve
D Medicine (with ventilator ) Urine Ketons (Package
Amount
per day)
Governm
ent
21.11 General Acute febrile illness (admission type: Reserve
Fever Profile clinical notes 0 1800 M1 M100011 Yes
Amount
per day)
Governm
ent
Acute febrile illness(admission type: HDU ) Fever Profile clinical notes 0 2700 M1 M100011 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.11 General Acute febrile illness(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.11 General Acute febrile illness(admission type: ICU Reserve
D Medicine (with ventilator ) (Package
Amount
per day)
Governm
ent
21.12 General Acute excaberation of COPD (admission Reserve
A Medicine type: Routine ward ) (Package
Amount
per day)
Governm
ent
21.12 General Acute excaberation of COPD(admission Reserve
B Medicine type: HDU ) (Package
Amount
per day)
Governm
ent
C Medicine type: ICU ,without ventilator) (Package
Amount
per day)
Governm
ent
D Medicine type: ICU (with ventilator ) (Package
Amount
per day)
Governm
ent
21.13 General USG KUB, Urine routine Reserve
UTI (admission type: Routine ward ) clinical notes 0 1800 M1 M100013 Yes
A Medicine Micro (Package
Amount
per day)
Governm
ent
UTI(admission type: HDU ) clinical notes 0 2700 M1 M100013 Yes
B Medicine Micro (Package
Amount
per day)
Governm
ent
21.13 General UTI(admission type: ICU ,without USG KUB, Urine routine Reserve
C Medicine ventilator) Micro (Package
Amount
per day)
Governm
ent
UTI(admission type: ICU (with ventilator ) clinical notes 0 4500 M1 M100013 Yes
D Medicine Micro (Package
Amount
per day)
Governm
ent
Malaria (admission type: Routine ward ) PSMP clinical notes 0 1800 M1 M100014 Yes
A Medicine (Package
Amount
per day)
Governm
ent
Malaria(admission type: HDU ) PSMP clinical notes 0 2700 M1 M100014 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.14 General Malaria(admission type: ICU ,without Reserve
PSMP clinical notes 0 3600 M1 M100014 Yes
Amount
per day)
Governm
ent
21.14 General Malaria(admission type: ICU (with Reserve
PSMP clinical notes 0 4500 M1 M100014 Yes
Amount
per day)
Governm
ent
21.15 General Dengue fever (admission type: Routine Reserve
NS, Antigen clinical notes 0 1800 M1 M100015 Yes
Amount
per day)
Governm
ent
Dengue fever(admission type: HDU ) NS, Antigen clinical notes 0 2700 M1 M100015 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.15 General Dengue fever(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.15 General Dengue fever(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.16 General Chikungunya fever (admission type: Reserve
Clinical History clinical notes 0 1800 M1 M100016 Yes
Amount
per day)
Governm
ent
Chikungunya fever(admission type: HDU ) Clinical History clinical notes 0 2700 M1 M100016 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.16 General Chikungunya fever(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.16 General Chikungunya fever(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.17 General Leptospirosis (admission type: Routine Reserve
Amount
per day)
Governm
ent
Leptospirosis(admission type: HDU ) Clinical History clinical notes 0 2700 M1 M100017 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.17 General Leptospirosis(admission type: ICU ,without Reserve
Amount
per day)
Governm
ent
21.17 General Leptospirosis(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.18 General Enteric fever (admission type: Routine Reserve
CBC, S. Widal clinical notes 0 1800 M1 M100018 Yes
Amount
per day)
Governm
ent
Enteric fever(admission type: HDU ) CBC, S. Widal clinical notes 0 2700 M1 M100018 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.18 General Enteric fever(admission type: ICU ,without Reserve
Amount
per day)
Governm
ent
21.18 General Enteric fever(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.19 General Pneumonia (admission type: Routine ward Reserve
CBC, X-Ray Chest clinical notes 0 1800 M1 M100019 Yes
A Medicine ) (Package
Amount
per day)
Governm
ent
Pneumonia(admission type: HDU ) CBC, X-Ray Chest clinical notes 0 2700 M1 M100019 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.19 General Pneumonia(admission type: ICU ,without Reserve
Amount
per day)
Governm
ent
21.19 General Pneumonia(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.20 General Acute excaberation of ILD (admission type: Reserve
Amount
per day)
Governm
ent
21.20 General Acute excaberation of ILD(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.21 General Liver abscess (admission type: Routine USG, Chest X-Ray, X-ray Reserve
A Medicine ward ) Abd (Package
Amount
per day)
Governm
ent
21.21 General USG, Chest X-Ray, X-ray Reserve
Liver abscess(admission type: HDU ) clinical notes 0 2700 M1 M100021 Yes
B Medicine Abd (Package
Amount
per day)
Governm
ent
21.21 General Liver abscess(admission type: ICU ,without USG, Chest X-Ray, X-ray Reserve
C Medicine ventilator) Abd (Package
Amount
per day)
Governm
ent
21.21 General Liver abscess(admission type: ICU (with USG, Chest X-Ray, X-ray Reserve
D Medicine ventilator ) Abd (Package
Amount
per day)
Governm
ent
21.22 General Acute viral hepatitis (admission type: USG ABD, Hepatits Reserve
A Medicine Routine ward ) Marker, HBSAG,NTHCV (Package
Amount
per day)
Governm
ent
21.22 General USG ABD, Hepatits Reserve
Acute viral hepatitis(admission type: HDU ) clinical notes 0 2700 M1 M100022 Yes
B Medicine Marker, HBSAG,NTHCV (Package
Amount
per day)
Governm
ent
21.22 General Acute viral hepatitis(admission type: ICU USG ABD, Hepatits Reserve
C Medicine ,without ventilator) Marker, HBSAG,NTHCV (Package
Amount
per day)
Governm
ent
21.22 General Acute viral hepatitis(admission type: ICU USG ABD, Hepatits Reserve
D Medicine (with ventilator ) Marker, HBSAG,NTHCV (Package
Amount
per day)
Governm
ent
Snake bite (admission type: Routine ward ) BT,CT,PT,APTT clinical notes 0 1800 M1 M100023 Yes
A Medicine (Package
Amount
per day)
Governm
ent
Snake bite(admission type: HDU ) BT,CT,PT,APTT clinical notes 0 2700 M1 M100023 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.23 General Snake bite(admission type: ICU ,without Reserve
BT,CT,PT,APTT clinical notes 0 3600 M1 M100023 Yes
Amount
per day)
Governm
ent
21.23 General Snake bite(admission type: ICU (with Reserve
BT,CT,PT,APTT clinical notes 0 4500 M1 M100023 Yes
Amount
per day)
Governm
ent
21.24 General Acute organophosphorus poisoning Reserve
Anti Choline esterase clinical notes 0 1800 M1 M100024 Yes
Amount
per day)
Governm
ent
21.24 General Acute organophosphorus Reserve
Anti Choline esterase clinical notes 0 2700 M1 M100024 Yes
B Medicine poisoning(admission type: HDU ) (Package
Amount
per day)
Governm
ent
Acute organophosphorus
poisoning(admission type: ICU ,without Anti Choline esterase clinical notes 0 3600 M1 M100024 Yes
C Medicine (Package
ventilator)
Amount
per day)
Governm
ent
Acute organophosphorus
poisoning(admission type: ICU (with Anti Choline esterase clinical notes 0 4500 M1 M100024 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
21.25 General Other poisoning (admission type: Routine Reserve
Amount
per day)
Governm
ent
Other poisoning(admission type: HDU ) Clinical Notes clinical notes 0 2700 M1 M100025 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.25 General Other poisoning(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.25 General Other poisoning(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.26 General Pyrexia of unknown origin (admission type: Reserve
Amount
per day)
Governm
ent
21.26 General Pyrexia of unknown origin(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.27 General Pericardial/ Pleural tuberculosis (admission Chest X-Ray, Reserve
A Medicine type: Routine ward ) PL.TAPPING,AFB (Package
Amount
per day)
Governm
ent
21.27 General Pericardial/ Pleural tuberculosis(admission Chest X-Ray, Reserve
B Medicine type: HDU ) PL.TAPPING,AFB (Package
Amount
per day)
Governm
ent
C Medicine type: ICU ,without ventilator) PL.TAPPING,AFB (Package
Amount
per day)
Governm
ent
D Medicine type: ICU (with ventilator ) PL.TAPPING,AFB (Package
Amount
per day)
Governm
ent
21.28 General Systematic lupus erythematosus Clinical History/Concern Reserve
A Medicine (admission type: Routine ward ) Investigation (Package
Amount
per day)
Governm
ent
21.28 General Systematic lupus erythematosus(admission Clinical History/Concern Reserve
B Medicine type: HDU ) Investigation (Package
Amount
per day)
Governm
ent
C Medicine type: ICU ,without ventilator) Investigation (Package
Amount
per day)
Governm
ent
D Medicine type: ICU (with ventilator ) Investigation (Package
Amount
per day)
Governm
ent
21.29 General Clinical History/Concern Reserve
Vasculitis (admission type: Routine ward ) clinical notes 0 1800 M1 M100029 Yes
A Medicine Investigation (Package
Amount
per day)
Governm
ent
21.29 General Clinical History/Concern Reserve
Vasculitis(admission type: HDU ) clinical notes 0 2700 M1 M100029 Yes
B Medicine Investigation (Package
Amount
per day)
Governm
ent
21.29 General Vasculitis(admission type: ICU ,without Clinical History/Concern Reserve
C Medicine ventilator) Investigation (Package
Amount
per day)
Governm
ent
21.29 General Vasculitis(admission type: ICU (with Clinical History/Concern Reserve
D Medicine ventilator ) Investigation (Package
Amount
per day)
Governm
ent
Seizures (admission type: Routine ward ) Clinical History clinical notes 0 1800 M1 M100030 Yes
A Medicine (Package
Amount
per day)
Governm
ent
Seizures(admission type: HDU ) Clinical History clinical notes 0 2700 M1 M100030 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.30 General Seizures(admission type: ICU ,without Reserve
Amount
per day)
Governm
ent
21.30 General Seizures(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.31 General Bacterial/ fungal endocarditis (admission Reserve
2 D Echo clinical notes 0 1800 M1 M100031 Yes
Amount
per day)
Governm
ent
21.31 General Bacterial/ fungal endocarditis(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Acute inflammatory demyelinating
polyneuropathy (admission type: Routine EMG,NCV,CSF,MRI clinical notes 0 1800 M1 M100032 Yes
A Medicine (Package
ward )
Amount
per day)
Governm
ent
21.32 General Acute inflammatory demyelinating Reserve
EMG,NCV,CSF,MRI clinical notes 0 2700 M1 M100032 Yes
B Medicine polyneuropathy(admission type: HDU ) (Package
Amount
per day)
Governm
ent
polyneuropathy(admission type: ICU EMG,NCV,CSF,MRI clinical notes 0 3600 M1 M100032 Yes
C Medicine (Package
Amount
per day)
Governm
ent
polyneuropathy(admission type: ICU (with EMG,NCV,CSF,MRI clinical notes 0 4500 M1 M100032 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
21.33 General Lung abscess/ Empyema (admission type: Reserve
Chest X-Ray, CT Thorax clinical notes 0 1800 M1 M100033 Yes
Amount
per day)
Governm
ent
21.33 General Lung abscess/ Empyema(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.34 General Acute and chronic meningitis (admission Reserve
CSF,MRI Brain clinical notes 0 1800 M1 M100034 Yes
Amount
per day)
Governm
ent
21.34 General Acute and chronic meningitis(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.35 General Viral encephalitis (admission type: Routine Reserve
CSF, MRI clinical notes 0 1800 M1 M100035 Yes
Amount
per day)
Governm
ent
Viral encephalitis(admission type: HDU ) CSF, MRI clinical notes 0 2700 M1 M100035 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.35 General Viral encephalitis(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.35 General Viral encephalitis(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.36 General Persistent/ Chronic diarrohea (admission Reserve
Concern Investigation clinical notes 0 1800 M1 M100036 Yes
Amount
per day)
Governm
ent
21.36 General Persistent/ Chronic diarrohea(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.37 General Acute and chronic pancreatitis (admission Reserve
USG ABD, CT clinical notes 0 1800 M1 M100037 Yes
Amount
per day)
Governm
ent
21.37 General Acute and chronic pancreatitis(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.38 General Visceral leishmaniasis (admission type: Reserve
IGM,Ab clinical notes 0 1800 M1 M100038 Yes
Amount
per day)
Governm
ent
21.38 General Visceral leishmaniasis(admission type: HDU Reserve
B Medicine ) (Package
Amount
per day)
Governm
ent
21.38 General Visceral leishmaniasis(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.38 General Visceral leishmaniasis(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.39 General HIV with complications (admission type: Reserve
HIV clinical notes 0 1800 M1 M100039 Yes
Amount
per day)
Governm
ent
21.39 General HIV with complications(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.40 General Neuromuscular disorders (admission type: Reserve
EMG,NCV,MRI clinical notes 0 1800 M1 M100040 Yes
Amount
per day)
Governm
ent
21.40 General Neuromuscular disorders(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.41 General Metabolic encephalopathy (admission Reserve
RFT,LFT,Uric acid, CBC clinical notes 0 1800 M1 M100041 Yes
Amount
per day)
Governm
ent
21.41 General Metabolic encephalopathy(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.42 General Sickle cell Anemia (admission type: Routine Sicklmg test, Electro Reserve
A Medicine ward ) phoresis (Package
Amount
per day)
Governm
ent
21.42 General Sicklmg test, Electro Reserve
Sickle cell Anemia(admission type: HDU ) clinical notes 0 2700 M1 M100042 Yes
B Medicine phoresis (Package
Amount
per day)
Governm
ent
21.42 General Sickle cell Anemia(admission type: ICU Sicklmg test, Electro Reserve
C Medicine ,without ventilator) phoresis (Package
Amount
per day)
Governm
ent
21.42 General Sickle cell Anemia(admission type: ICU Sicklmg test, Electro Reserve
D Medicine (with ventilator ) phoresis (Package
Amount
per day)
Governm
ent
21.43 General Poisonings with unstable vitals (admission Reserve
Gastic Levage clinical notes 0 1800 M1 M100043 Yes
Amount
per day)
Governm
ent
21.43 General Poisonings with unstable vitals(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.44 General Type 1/2 respiratory failure (admission Reserve
ABG Analysis clinical notes 0 1800 M1 M100044 Yes
Amount
per day)
Governm
ent
21.44 General Type 1/2 respiratory failure(admission Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.45 General Acute asthmatic attack (admission type: Reserve
Amount
per day)
Governm
ent
21.45 General Acute asthmatic attack(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.47 General Severe pneumonia (admission type: Reserve
Chesr X-Ray(PA) clinical notes 0 1800 M1 M100047 Yes
Amount
per day)
Governm
ent
Severe pneumonia(admission type: HDU ) Chesr X-Ray(PA) clinical notes 0 2700 M1 M100047 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.47 General Severe pneumonia(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.47 General Severe pneumonia(admission type: ICU Reserve
Amount
per day)
Governm
ent
Acute gastroenteritis with severe
dehydration (admission type: Routine ward Stool Culture clinical notes 0 1800 M1 M100048 Yes
A Medicine (Package
)
Amount
per day)
Governm
ent
21.48 General Acute gastroenteritis with severe Reserve
Stool Culture clinical notes 0 2700 M1 M100048 Yes
B Medicine dehydration(admission type: HDU ) (Package
Amount
per day)
Governm
ent
dehydration(admission type: ICU ,without Stool Culture clinical notes 0 3600 M1 M100048 Yes
C Medicine (Package
ventilator)
Amount
per day)
Governm
ent
dehydration(admission type: ICU (with Stool Culture clinical notes 0 4500 M1 M100048 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
21.49 General Hypertensive emergencies (admission Reserve
ECG, 2D Echo clinical notes 0 1800 M1 M100049 Yes
Amount
per day)
Governm
ent
21.49 General Hypertensive emergencies(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.50 General Dengue hemorrhagic fever/Dengue shock Reserve
Dengue NS1, IGM clinical notes 0 1800 M1 M100050 Yes
A Medicine syndrome (admission type: Routine ward ) (Package
Amount
per day)
Governm
ent
21.50 General Dengue hemorrhagic fever/Dengue shock Reserve
Dengue NS1, IGM clinical notes 0 2700 M1 M100050 Yes
B Medicine syndrome(admission type: HDU ) (Package
Amount
per day)
Governm
ent
Dengue hemorrhagic fever/Dengue shock
syndrome(admission type: ICU ,without Dengue NS1, IGM clinical notes 0 3600 M1 M100050 Yes
C Medicine (Package
ventilator)
Amount
per day)
Governm
ent
Dengue hemorrhagic fever/Dengue shock
syndrome(admission type: ICU (with Dengue NS1, IGM clinical notes 0 4500 M1 M100050 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
21.51 General Complicated malaria (admission type: Reserve
CBC, RFT,LFT clinical notes 0 1800 M1 M100051 Yes
Amount
per day)
Governm
ent
21.51 General Complicated malaria(admission type: HDU Reserve
B Medicine ) (Package
Amount
per day)
Governm
ent
21.51 General Complicated malaria(admission type: ICU Reserve
Amount
per day)
Governm
ent
Complicated malaria(admission type: ICU
,without ventilator)(admission type: ICU CBC, RFT,LFT clinical notes 0 4500 M1 M100051 Yes
D Medicine (Package
(with ventilator )
Amount
per day)
Governm
ent
21.52 General Heat stroke (admission type: Routine ward Reserve
CPK Total clinical notes 0 1800 M1 M100052 Yes
A Medicine ) (Package
Amount
per day)
Governm
ent
Heat stroke(admission type: HDU ) CPK Total clinical notes 0 2700 M1 M100052 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.52 General Heat stroke(admission type: ICU ,without Reserve
Amount
per day)
Governm
ent
21.52 General Heat stroke(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.53 General Hyperosmolar Non-Ketotic coma Reserve
ABGA,RBS clinical notes 0 1800 M1 M100053 Yes
Amount
per day)
Governm
ent
21.53 General Hyperosmolar Non-Ketotic Reserve
ABGA,RBS clinical notes 0 2700 M1 M100053 Yes
B Medicine coma(admission type: HDU ) (Package
Amount
per day)
Governm
ent
Hyperosmolar Non-Ketotic
coma(admission type: ICU ,without ABGA,RBS clinical notes 0 3600 M1 M100053 Yes
C Medicine (Package
ventilator)
Amount
per day)
Governm
ent
Hyperosmolar Non-Ketotic
coma(admission type: ICU (with ventilator ABGA,RBS clinical notes 0 4500 M1 M100053 Yes
D Medicine (Package
)
Amount
per day)
Governm
ent
21.54 General Severe sepsis/Septic shock (admission Reserve
Blood Culture clinical notes 0 1800 M1 M100055 Yes
Amount
per day)
Governm
ent
21.54 General Severe sepsis/Septic shock(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.55 General Upper GI bleeding (conservative) Reserve
Amount
per day)
Governm
ent
21.55 General Upper GI bleeding Reserve
B Medicine (conservative)(admission type: HDU ) (Package
Amount
per day)
Governm
ent
Upper GI bleeding
(conservative)(admission type: ICU Clinical History clinical notes 0 3600 M1 M100056 Yes
C Medicine (Package
Amount
per day)
Governm
ent
Upper GI bleeding
(conservative)(admission type: ICU (with Clinical History clinical notes 0 4500 M1 M100056 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
21.56 General Upper GI bleeding (endoscopic) (admission Reserve
Scopy clinical notes 0 1800 M1 M100057 Yes
Amount
per day)
Governm
ent
Upper GI bleeding (endoscopic) Scopy clinical notes 0 2700 M1 M100057 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.56 General Upper GI bleeding (endoscopic)(admission Reserve
Amount
per day)
Governm
ent
21.56 General Upper GI bleeding (endoscopic)(admission Reserve
Amount
per day)
Governm
ent
21.57 General Lower GI hemorrhage (admission type: Colonoscopy, USG Abd/ Reserve
A Medicine Routine ward ) CT (Package
Amount
per day)
Governm
ent
21.57 General Lower GI hemorrhage(admission type: HDU Colonoscopy, USG Abd/ Reserve
B Medicine ) CT (Package
Amount
per day)
Governm
ent
21.57 General Lower GI hemorrhage(admission type: ICU Colonoscopy, USG Abd/ Reserve
C Medicine ,without ventilator) CT (Package
Amount
per day)
Governm
ent
21.57 General Lower GI hemorrhage(admission type: ICU Colonoscopy, USG Abd/ Reserve
D Medicine (with ventilator ) CT (Package
Amount
per day)
Governm
ent
Immune mediated CNS disorders such as
autoimmune encephalitis (admission type: CSF,MRI clinical notes 0 1800 M1 M100059 Yes
A Medicine (Package
Routine ward )
Amount
per day)
Governm
ent
autoimmune encephalitis(admission type: CSF,MRI clinical notes 0 2700 M1 M100059 Yes
B Medicine (Package
HDU )
Amount
per day)
Governm
ent
C Medicine (Package
ICU ,without ventilator)
Amount
per day)
Governm
ent
D Medicine (Package
ICU (with ventilator )
Amount
per day)
Governm
ent
21.59 General Acute transverse myelitis (admission type: Reserve
MRI.CSF clinical notes 0 1800 M1 M100060 Yes
Amount
per day)
Governm
ent
21.59 General Acute transverse myelitis(admission type: Reserve
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
Amount
per day)
Governm
ent
21.60 General Hydrocephalus (admission type: Routine Reserve
CT clinical notes 0 1800 M1 M100062 Yes
Amount
per day)
Governm
ent
Hydrocephalus(admission type: HDU ) CT clinical notes 0 2700 M1 M100062 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.60 General Hydrocephalus(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.60 General Hydrocephalus(admission type: ICU (with Reserve
Amount
per day)
Governm
ent
21.61 General Cerebral sino-venous thrombosis Reserve
MR Veno clinical notes 0 1800 M1 M100063 Yes
Amount
per day)
Governm
ent
21.61 General Cerebral sino-venous Reserve
MR Veno clinical notes 0 2700 M1 M100063 Yes
B Medicine thrombosis(admission type: HDU ) (Package
Amount
per day)
Governm
ent
Cerebral sino-venous
thrombosis(admission type: ICU ,without MR Veno clinical notes 0 3600 M1 M100063 Yes
C Medicine (Package
ventilator)
Amount
per day)
Governm
ent
Cerebral sino-venous
thrombosis(admission type: ICU (with MR Veno clinical notes 0 4500 M1 M100063 Yes
D Medicine (Package
ventilator )
Amount
per day)
Governm
ent
AKI/ renal failure(dialysis payable
separately as an add on package for ) RFT, USG clinical notes 0 1800 M1 M100064 Yes
A Medicine (Package
(admission type: Routine ward )
Amount
per day)
Governm
ent
separately as an add on package for RFT, USG clinical notes 0 2700 M1 M100064 Yes
B Medicine (Package
)(admission type: HDU )
Amount
per day)
Governm
ent
C Medicine (Package
)(admission type: ICU ,without ventilator)
Amount
per day)
Governm
ent
D Medicine (Package
)(admission type: ICU (with ventilator )
Amount
per day)
Governm
ent
21.63 General Status epilepticus (admission type: Routine Reserve
MRI,CSF clinical notes 0 1800 M1 M100065 Yes
Amount
per day)
Governm
ent
Status epilepticus(admission type: HDU ) MRI,CSF clinical notes 0 2700 M1 M100065 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.63 General Status epilepticus(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.63 General Status epilepticus(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.64 General Status asthmaticus (admission type: Reserve
Amount
per day)
Governm
ent
Status asthmaticus(admission type: HDU ) Clinical History clinical notes 0 2700 M1 M100066 Yes
B Medicine (Package
Amount
per day)
Governm
ent
21.64 General Status asthmaticus(admission type: ICU Reserve
Amount
per day)
Governm
ent
21.64 General Status asthmaticus(admission type: ICU Reserve
Amount
per day)
Governm
Respiratory failure due to any cause ent
21.65 General (pneumonia, asthma, COPD, ARDS, foreign Reserve
A Medicine body, poisoning, head injury etc.) (Package
(admission type: Routine ward ) Amount
per day)
Governm
B Medicine body, poisoning, head injury (Package
etc.)(admission type: HDU ) Amount
per day)
Governm
Respiratory failure due to any cause
ent
(pneumonia, asthma, COPD, ARDS, foreign
body, poisoning, head injury Concern Investigation clinical notes 0 3600 M1 M100067 Yes
C Medicine (Package
etc.)(admission type: ICU ,without
Amount
ventilator)
per day)
Governm
D Medicine body, poisoning, head injury (Package
etc.)(admission type: ICU (with ventilator ) Amount
per day)
Blood and blood component transfusion

(admission for a diagnostic procedure Governm
leading to treatment requiring admission, ent
General e.g. bone marrow and bone biopsy, Reserve
21.66 Concern Investigation clinical notes 0 2000 M1 M100068 Yes
Medicine endoscopy, liver biopsy, bronchoscopy, (Package
CT/MRI under GA, broncho-alveolar lavage, Amount
lumbar puncture, muscle biopsy, pleural per day)
aspiration, ascitic tapping etc.)
Governm
General
21.67 Plasmapheresis - per session Concern Investigation clinical notes 0 2000 ent M1 M100069 Yes
Medicine
Reserve
Governm
General Haemodialysis/Peritoneal Dialysis - per
21.68 Concern Investigation clinical notes 0 2300 ent M1 M100070 Yes
Medicine session
Reserve
(Governm
ent
Reserve
High end radiological diagnostic (CT, MRI,
0capped
General Imaging including nuclear imaging) - can
21.69 clinical notes clinical notes 0 5000 @ Rs M1 M100071 Yes
Medicine only be clubbed with medical package. Rs
5000 per
5000 per annum limit to a family
annum
for a
family
(Governm
ent
Reserve
High end histopathology (Biopsies) and
)capped
General advanced serology investigations - can only
21.70 clinical notes clinical notes 0 5000 @ Rs M1 M100072 Yes
Medicine be clubbed with medical package. Rs 5000
5000 per
per annum limit to a family
annum
for a
family
60000
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
week- week-
25%,3rd
25%,3rd
week-
General CONSERVATIVE MANAGEMENT MRI brain with week-
21.71 CT brain plain,others 3 15%,4th M1 M112001 Yes
Medicine (ISCHEMIC STROKE) angiography 15%,4th
week-
week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
120000
(Payment (Payment
1st week- 1st week-
55%,2nd 55%,2nd
week- week-
15%,3rd
Repeat CT brain 15%,3rd
week-
General THROMBOLYSIS WITH ACTILYSE FOR after 24 hours,MRI week-
21.72 CT brain plain,others 3 10%,4th M1 M112002 Yes
Medicine ISCHEMIC STROKE brain with 10%,4th
week-
angiography week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
40000
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
week- week-
25%,3rd
25%,3rd
INTRAPARENCHYMAL /SUBARACHNOID Repeat CT brain week-
General week-
21.73 HEMMORRHAGE (CONSERVATIVE CT brain plain,others plain , CT 3 15%,4th M1 M112003 Yes
Medicine 15%,4th
MANAGEMENT) angiography brain week-
week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
110000
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
week- week-
25%,3rd
25%,3rd
week-
General MENINGOENCEPHALITIS, OR/ AND EVD/VP CT brain plain,CSF MRI brain with week-
21.74 3 15%,4th M1 M112004 Yes
Medicine shunt (CONSERVATIVE MANAGEMENT) ,others contrast 15%,4th
week-
week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
110000
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
Anyone of the week- week-
25%,3rd
week-
General MYASTHENIA CRISIS MANAGEMENT BY neurophysician OR nerve week-
21.75 3 15%,4th M1 M112005 Yes
Medicine PLASMAPHERESIS previously diagnosed stimulation,ACH-R 15%,4th
week-
case antibody,Anti- week- 10%,5th
MUSK antibody 10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
200000
(Payment (Payment
1st week- 1st week-
55%,2nd 55%,2nd
Anyone of the week- week-
15%,3rd
week-
General MYASTHENIA CRISIS MANAGEMENT BY IV neurophysician OR nerve week-
21.76 3 10%,4th M1 M112006 Yes
Medicine IMMUNOGLOBINS previously diagnosed stimulation,ACH-R 10%,4th
week-
case antibody,Anti- week- 10%,5th
MUSK antibody 10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
109627
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
week- week-
25%,3rd
25%,3rd
week-
General Gullian-barre syndrome management by Clinical diagnosis by CSF study, week-
21.77 3 15%,4th M1 M112007 Yes
Medicine plasmapheresis neurophysician NCV/EMG 15%,4th
week-
week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
200000
(Payment
(Payment
fraction (
fraction ( 1st week-
1st week- 55%,2nd
55%,2nd week-
week- 15%,3rd
15%,3rd week-
General Gullian-barre syndrome management by Clinical diagnosis by CSF study, week- 10%,4th
21.78 3 M1 M112008 Yes
Medicine Intravenous immunoglobulin neurophysician NCV/EMG 10%,4th week-
week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
rate)(Gove
total
rnment
package
Reserve)
rate)
Cluster - 22 MENTAL DISORDER PACKAGES

Governm
Clinical ent
Organic, including symptomatic, mental
Mental Clinical assessment and assessment& Reserve,P
22.1 disorders (Admision Type -routine 0 1500 M8 M800001 Yes
Disorder investigations Report/ Mental ackage
ward)(Package Rate Per Day)
Status Examination amount is
per Day
Governm
Clinical ent
Mental and Behavioural disorders due to
22.2 psychoactive substance use (Admision 0 1500 M8 M800002 Yes
Type - routine ward)(Package Rate Per Day)
per Day
Governm
Clinical ent
Schizophrenia, schizotypal and delusional
per Day
Clinical Governm
assessment& ent
Mental Mood (affective) disorders (Admision Type - Clinical assessment and Report/ Mental Reserve,P
22.4 0 1500 M8 M800004 Yes
Disorder routine ward)(Package Rate Per Day) investigations Status ackage
Examination/Relate amount is
d Investigations per Day
Clinical Governm
assessment& ent
Neurotic, stress-related and somatoform
Mental Clinical assessment and Report/ Mental Reserve,P
Disorder investigations Status ackage
Clinical Governm
assessment& ent
Behavioural syndromes associated with
22.6 physiological disturbances and physical 0 1500 M8 M800006 Yes
factors (Admision Type -routine ward)
Clinical Governm
assessment& ent
Mental Mental retardation (Admision Type - Clinical assessment and Report/ Mental Reserve,P
22.7 0 1500 M8 M800007 Yes
Disorder routine ward)(Package Rate Per Day) investigations Status ackage
Clinical Governm
assessment& ent
Organic, including symptomatic, mental
22.8 disorders (Admision Type -HDU)(Package 0 2500 M8 M800008 Yes
Rate Per Day)
Clinical Governm
assessment& ent
Mental and Behavioural disorders due to
22.9 psychoactive substance use (Admision 0 2500 M8 M800009 Yes
Type -HDU)(Package Rate Per Day)
Clinical Governm
assessment& ent
Schizophrenia, schizotypal and delusional
Rate Per Day)
Clinical Governm
assessment& ent
Mental Mood (affective) disorders (Admision Type - Clinical assessment and Report/ Mental Reserve,P
22.1 0 2500 M8 M800011 Yes
Disorder HDU)(Package Rate Per Day) investigations Status ackage
Clinical Governm
assessment& ent
Neurotic, stress-related and somatoform
Rate Per Day)
Clinical Governm
Behavioural syndromes associated with assessment& ent
Mental physiological disturbances and physical Clinical assessment and Report/ Mental Reserve,P
22.1 0 2500 M8 M800013 Yes
Disorder factors (Admision Type -HDU)(Package investigations Status ackage
Rate Per Day) Examination/Relate amount is
Clinical Governm
assessment& ent
Mental Mental Retardation (Admision Type - Clinical assessment and Report/ Mental Reserve,P
22.1 0 2500 M8 M800014 Yes
Disorder HDU)(Package Rate Per Day) investigations Status ackage
Pre- Electro Convulsive Therapy (ECT) and Pre-

Transcranial Magnetic Stimulation (TMS) Clinical
Package (Cognitive Tests, Complete
assessment&
Haemogram, Liver Function Test, Renal Governm
Mental Clinical assessment and Report/ Mental
22.2 Function Test, Serum Electrolytes, Electro 0 10000 ent M8 M800015 Yes
Disorder investigations Status
Cardiogram (ECG), CT/MRI Brain, Reserve
Electroencephalogram, Thyroid Function Test, Examination/Relate
VDRL, HIV Test, Vitamin B12 levels, Folate d Investigations
levels, Lipid Profile, Homocysteine levels)
Clinical
assessment&
Governm
Mental Clinical assessment and Report/ Mental
22.2 Electro Convulsive Therapy (ECT) - per session 0 3000 ent M8 M800016 Yes
Disorder investigations Status
Reserve
Examination/Relate
d Investigations
Clinical
assessment&
Governm
Mental Transcranial Magnetic Stimulation (TMS) - per Clinical assessment and Report/ Mental
22.2 0 1000 ent M8 M800017 Yes
Disorder session investigations Status
Reserve
Examination/Relate
d Investigations
Cluster - 23 EMERGENCY ROOM PACKAGES (Care Requiring Less Than 12 hrs Stay )
Emergen Governm
Emergency with stable cardiopulmonary X Ray,ECG with
23.1 cy Room X Ray,ECG with report 0 1000 ent M7 M700001 Yes
status report
Packages Reserve
Emergen Emergency consultation: acute colic, high Governm

23.2 cy Room fever, cut, stitches, soft tissue injury, FB Blood test clinical notes 0 1000 ent M7 M700002 Yes
Packages removal Reserve
Single bone fracture plaster, nebulization

Emergen for asthmatic attack, moderate Governm
23.3 cy Room dehydration, hypoglycaemia in a diabetic, Blood test clinical notes 0 1000 ent M7 M700003 Yes
Packages Dengue without complication, Syncope, Reserve
Food poisoning etc
Emergen Antirabies Governm

Animal bites (Payment after completion of
23.4 cy Room clinical notes register/Stock 0 1700 ent M7 M700004 Yes
5th dose)
Packages register Reserve
Cluster - 24 PEDIATRIC MEDICAL MANAGEMENT

(Governm
ent
clinical
24.1 Pediatric clinical notes,Concern Reserve)P
Diarrhoea (admission type: Routine ward) notes,Concern 0 1800 M2 M200001 Yes
A Medicine Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Diarrhoea (admission type: HDU) notes,Concern 0 2700 M2 M200001 Yes
B Medicine Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.1 Pediatric Diarrhoea (admission type: ICU without clinical notes,Concern Reserve)P
notes,Concern 0 3600 M2 M200001 Yes
C Medicine ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.1 Pediatric Diarrhoea (admission type: ICU (with clinical notes,Concern Reserve)P
D Medicine ventilator)) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.2 Pediatric Acute dysentery (admission type: Routine clinical notes,Concern Reserve)P
A Medicine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Acute dysentery(admission type: HDU) notes,Concern 0 2700 M2 M200002 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.2 Pediatric Acute dysentery (admission type: ICU clinical notes,Concern Reserve)P
C Medicine (without ventilator)) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.2 Pediatric Acute dysentery (admission type: ICU (with clinical notes,Concern Reserve)P
D Medicine ventilator)) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Pneumonia (admission type: Routine ward) notes,Concern 0 1800 M2 M200003 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Pneumonia (admission type: HDU) notes,Concern 0 2700 M2 M200003 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.3 Pediatric Pneumonia (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.3 Pediatric Pneumonia (admission type: ICU, with clinical notes,Concern Reserve)P
D Medicine ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.4 Pediatric Urinary tract infection (admission type: clinical notes,Concern Reserve)P
A Medicine Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
B Medicine HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
C Medicine ICU, without ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
D Medicine ICU, with ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.5 Pediatric Acute Exacerbation of asthma (admission clinical notes,Concern Reserve)P
A Medicine type: Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
B Medicine type:HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
C Medicine type: ICU, without ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
D Medicine type: ICU, with ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.6 Pediatric Acute glomerulonephritis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.7 Pediatric Acute urticaria/ Anaphylaxis acute asthma clinical notes,Concern Reserve)P
A Medicine (admission type: Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
B Medicine (admission type: HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
C Medicine (admission type: ICU, without ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
D Medicine (admission type: ICU, with ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.8 Pediatric Poisonings with normal vital signs clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.9 Pediatric Febrile seizures/other seizures (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
B Medicine type: HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.10 Pediatric Epileptic encephalopathy (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.11 Pediatric Optic neuritis (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Optic neuritis (admission type: HDU) notes,Concern 0 2700 M2 M200011 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.11 Pediatric Optic neuritis (admission type: ICU, clinical notes,Concern Reserve)P
C Medicine without ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.11 Pediatric Optic neuritis (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.12 Pediatric Aseptic meningitis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Aseptic meningitis (admission type: HDU) notes,Concern 0 2700 M2 M200012 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.12 Pediatric Aseptic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.12 Pediatric Aseptic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
D Medicine with ventilator) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Trauma (admission type: Routine ward) notes,Concern 0 1800 M2 M200013 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Trauma (admission type: HDU) notes,Concern 0 2700 M2 M200013 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.13 Pediatric Trauma (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.13 Pediatric Trauma (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.14 Pediatric Pyrexia of unexplained origin (admission clinical notes,Concern Reserve)P
A Medicine type:Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.15 Pediatric Chronic cough (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Chronic cough (admission type: HDU) notes,Concern 0 2700 M2 M200015 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.15 Pediatric Chronic cough (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.15 Pediatric Chronic cough (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Wheezing (admission type: Routine ward) notes,Concern 0 1800 M2 M200016 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Wheezing (admission type: HDU) notes,Concern 0 2700 M2 M200016 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.16 Pediatric Wheezing (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.16 Pediatric Wheezing (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.17 Pediatric Unexplained seizures (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.17 Pediatric Unexplained seizures (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.17 Pediatric Unexplained seizures (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.17 Pediatric Unexplained seizures (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
Global developmental delay/ Intellectual clinical
disability of unknown etiology (admission notes,Concern 0 1800 M2 M200018 Yes
type: Routine ward) Investigations
Amount
per day
(Governm
ent
type: HDU) Investigations
Amount
per day
(Governm
ent
C Medicine Investigations ackage
type: ICU, without ventilator Investigations
Amount
per day
(Governm
ent
D Medicine Investigations ackage
type: ICU, with ventilator) Investigations
Amount
per day
(Governm
ent
clinical
24.19 Pediatric Dysmorphic children (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.19 Pediatric Dysmorphic children (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.19 Pediatric Dysmorphic children (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.19 Pediatric Dysmorphic children (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Rickets (admission type: Routine ward) notes,Concern 0 1800 M2 M200020 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Rickets (admission type: HDU) notes,Concern 0 2700 M2 M200020 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.20 Pediatric Rickets (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.20 Pediatric Rickets (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.21 Pediatric Unexplained severe anemia (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.22 Pediatric Short stature (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Short stature (admission type: HDU) notes,Concern 0 2700 M2 M200022 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.22 Pediatric Short stature (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.22 Pediatric Short stature (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.23 Pediatric Musculoskeletal problems (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.24 Pediatric Developmental and behavioral disorders clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.25 Pediatric Diabetic ketoacidosis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.25 Pediatric Diabetic ketoacidosis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.25 Pediatric Diabetic ketoacidosis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.25 Pediatric Diabetic ketoacidosis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.26 Pediatric Nephrotic syndrome with peritonitis clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.27 Pediatric Pyogenic meningitis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Pyogenic meningitis (admission type: HDU) notes,Concern 0 2700 M2 M200027 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.27 Pediatric Pyogenic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.27 Pediatric Pyogenic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.28 Pediatric Persistent/ Chronic diarrhea (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.29 Pediatric Acute severe malnutrition (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Dengue (admission type: Routine ward) notes,Concern 0 1800 M2 M200030 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Dengue (admission type: HDU) notes,Concern 0 2700 M2 M200030 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.30 Pediatric Dengue (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.30 Pediatric Dengue (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.31 Pediatric Enteric fever (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Enteric fever (admission type: HDU) notes,Concern 0 2700 M2 M200031 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.31 Pediatric Enteric fever (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.31 Pediatric Enteric fever (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.32 Pediatric Chikungunya (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Chikungunya (admission type: HDU) notes,Concern 0 2700 M2 M200032 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.32 Pediatric Chikungunya (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.32 Pediatric Chikungunya (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.33 Pediatric Acute hepatitis (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Acute hepatitis (admission type: HDU) notes,Concern 0 2700 M2 M200033 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.33 Pediatric Acute hepatitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.33 Pediatric Acute hepatitis (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Kala azar (admission type: Routine ward) notes,Concern 0 1800 M2 M200034 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Kala azar (admission type: HDU) notes,Concern 0 2700 M2 M200034 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.34 Pediatric Kala azar (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.34 Pediatric Kala azar (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.35 Pediatric Tuberculosis (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Tuberculosis (admission type: HDU) notes,Concern 0 2700 M2 M200035 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.35 Pediatric Tuberculosis (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.35 Pediatric Tuberculosis (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.36 Pediatric HIV with complications (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.37 Pediatric Infantile cholestasis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Infantile cholestasis (admission type: HDU) notes,Concern 0 2700 M2 M200037 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.37 Pediatric Infantile cholestasis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.37 Pediatric Infantile cholestasis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.38 Pediatric Haemolytic uremic syndrome (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
ITP (admission type: Routine down) notes,Concern 0 1800 M2 M200039 Yes
Investigations
Amount
per day
(Governm
ent
clinical
ITP (admission type: HDU) notes,Concern 0 2700 M2 M200039 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.39 Pediatric ITP (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
ITP (admission type: ICU, with ventilator) notes,Concern 0 4500 M2 M200039 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.40 Pediatric Juvenile myasthenia (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Juvenile myasthenia (admission type: HDU) notes,Concern 0 2700 M2 M200040 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.40 Pediatric Juvenile myasthenia (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.40 Pediatric Juvenile myasthenia (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.41 Pediatric Kawasaki Disease (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Kawasaki Disease (admission type: HDU) notes,Concern 0 2700 M2 M200041 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.41 Pediatric Kawasaki Disease (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.41 Pediatric Kawasaki Disease (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.42 Pediatric Persistent pneumonia (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Empyema (admission type: Routine ward) notes,Concern 0 1800 M2 M200043 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Empyema (admission type: HDU) notes,Concern 0 2700 M2 M200043 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.43 Pediatric Empyema (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.43 Pediatric Empyema (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.44 Pediatric Immune haemolytic anemia (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.45 Pediatric Cyanotic spells (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Cyanotic spells (admission type: HDU) notes,Concern 0 2700 M2 M200045 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.45 Pediatric Cyanotic spells (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.45 Pediatric Cyanotic spells (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.46 Pediatric Rheumatic fever (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Rheumatic fever (admission type: HDU) notes,Concern 0 2700 M2 M200046 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.46 Pediatric Rheumatic fever (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.46 Pediatric Rheumatic fever (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.47 Pediatric Rheumatoid arthritis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.47 Pediatric Rheumatoid arthritis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.47 Pediatric Rheumatoid arthritis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.47 Pediatric Rheumatoid arthritis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.48 Pediatric Encephalitis (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Encephalitis (admission type: HDU) notes,Concern 0 2700 M2 M200048 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.48 Pediatric Encephalitis (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.48 Pediatric Encephalitis (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.49 Pediatric Chronic meningitis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Chronic meningitis (admission type: HDU) notes,Concern 0 2700 M2 M200049 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.49 Pediatric Chronic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.49 Pediatric Chronic meningitis (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
Intracranial ring enhancing lesion with ent
clinical
24.50 Pediatric complication (neurocysticercosis, clinical notes,Concern Reserve)P
A Medicine tuberculoma) (admission type: Routine Investigations ackage
Investigations
ward) Amount
per day
(Governm
ent
Intracranial ring enhancing lesion with clinical
complication (neurocysticercosis, notes,Concern 0 2700 M2 M200050 Yes
tuberculoma) (admission type: HDU) Investigations
Amount
per day
(Governm
clinical
C Medicine tuberculoma) (admission type: ICU, Investigations ackage
Investigations
without ventilator) Amount
per day
(Governm
clinical
D Medicine tuberculoma) (admission type: ICU, with Investigations ackage
Investigations
ventilator) Amount
per day
(Governm
ent
clinical
24.51 Pediatric Refractory seizures (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Refractory seizures (admission type: HDU) notes,Concern 0 2700 M2 M200051 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.51 Pediatric Refractory seizures (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.51 Pediatric Refractory seizures (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.52 Pediatric Floppy infant (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Floppy infant (admission type: HDU) notes,Concern 0 2700 M2 M200052 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.52 Pediatric Floppy infant (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.52 Pediatric Floppy infant (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.53 Pediatric Acute neuroregression (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.54 Pediatric Neuromuscular disorders (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.55 Pediatric Opsoclonus myoclonus syndrome clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.56 Pediatric Acute ataxia (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Acute ataxia (admission type: HDU) notes,Concern 0 2700 M2 M200056 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.56 Pediatric Acute ataxia (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.56 Pediatric Acute ataxia (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.57 Pediatric Steven Johnson syndrome (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.58 Pediatric Metabolic encephalopathy (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.59 Pediatric Ketogenic diet initiation in refractory clinical notes,Concern Reserve)P
A Medicine epilepsy (admission type: Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.59 Pediatric Ketogenic diet initiation in refractory clinical notes,Concern Reserve)P
B Medicine epilepsy (admission type: HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
Ketogenic diet initiation in refractory clinical
epilepsy (admission type: ICU, without notes,Concern 0 3600 M2 M200059 Yes
ventilator) Investigations
Amount
per day
(Governm
ent
Ketogenic diet initiation in refractory clinical
epilepsy (admission type: ICU, with notes,Concern 0 4500 M2 M200059 Yes
Amount
per day
(Governm
ent
clinical
24.60 Pediatric Inborn errors of metabolism (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.61 Pediatric Wilson’s disease (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Wilson’s disease (admission type: HDU) notes,Concern 0 2700 M2 M200061 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.61 Pediatric Wilson’s disease (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.61 Pediatric Wilson’s disease (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.62 Pediatric Celiac disease (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Celiac disease (admission type: HDU) notes,Concern 0 2700 M2 M200062 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.62 Pediatric Celiac disease (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.62 Pediatric Celiac disease (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.63 Pediatric Unexplained jaundice (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.63 Pediatric Unexplained jaundice (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.63 Pediatric Unexplained jaundice (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.63 Pediatric Unexplained jaundice (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.64 Pediatric Unexplained hepatosplenomegaly clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.65 Pediatric Severe pneumonia (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Severe pneumonia (admission type: HDU) notes,Concern 0 2700 M2 M200065 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.65 Pediatric Severe pneumonia (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.65 Pediatric Severe pneumonia (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.66 Pediatric Severe exacerbation of asthma (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.67 Pediatric Acute kidney injury (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Acute kidney injury (admission type: HDU) notes,Concern 0 2700 M2 M200067 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.67 Pediatric Acute kidney injury (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.67 Pediatric Acute kidney injury (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Poisonings (admission type: Routine ward) notes,Concern 0 1800 M2 M200068 Yes
Investigations
Amount
per day
(Governm
ent
clinical
Poisonings (admission type: HDU) notes,Concern 0 2700 M2 M200068 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.68 Pediatric Poisonings (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.68 Pediatric Poisonings (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.69 Pediatric Serious trauma with unstable vitals clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.70 Pediatric Upper GI hemorrhage (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.71 Pediatric Lower GI hemorrhage (admission type: clinical notes,Concern Reserve)P
A Medicine Routine ward ) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.72 Pediatric Acute abdomen (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Acute abdomen (admission type: HDU) notes,Concern 0 2700 M2 M200072 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.72 Pediatric Acute abdomen (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.72 Pediatric Acute abdomen (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.73 Pediatric Liver abscess (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Liver abscess (admission type: HDU) notes,Concern 0 2700 M2 M200073 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.73 Pediatric Liver abscess (admission type: ICU, without clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.73 Pediatric Liver abscess (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.74 Pediatric Complicated malaria (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.74 Pediatric Complicated malaria (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.74 Pediatric Complicated malaria (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.74 Pediatric Complicated malaria (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.75 Pediatric Severe dengue with shock (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.76 Pediatric Congestive cardiac failure (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.77 Pediatric Brain abscess (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Brain abscess (admission type: HDU) notes,Concern 0 2700 M2 M200077 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.77 Pediatric Brain abscess (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.77 Pediatric Brain abscess (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.78 Pediatric Acute encephalitic syndrome (admission clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.79 Pediatric Acute demyelinating myelopathy, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
Immune mediated CNS disorders such as clinical
autoimmune encephalitis (admission type: notes,Concern 0 1800 M2 M200080 Yes
Routine ward) Investigations
Amount
per day
(Governm
ent
HDU) Investigations
Amount
per day
(Governm
ent
ICU, without ventilator) Investigations
Amount
per day
(Governm
ent
ICU, with ventilator) Investigations
Amount
per day
(Governm
ent
clinical
24.81 Pediatric Acute transverse myelitis (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
109627
(Payment (Payment
1st week- 1st week-
40%,2nd 40%,2nd
week- week-
25%,3rd
Gullian-barre syndrome management by 25%,3rd
week-
24.82 Pediatric plasmapheresis (Payment fraction ( 1st week- Clinical diagnosis by week- M200082
CSF study, NCV/EMG 3 15%,4th M2 Yes
A Medicine 35 ,2nd week-25 ,3rd week-15 ,4th week-10 neurophysician 15%,4th A
week-
,5th week-10 ,F/u-5 ) of total package rate) week- 10%,5th
10%,5th week-10%)
week- of total
10%) of package
total rate)(Gove
package rnment
rate) Reserve)
200000 (Governm
(Payment ent
fraction ( Reserve)(P
1st week- ayment
55%,2nd fraction (
week- 1st week-
Gullian-barre syndrome management by 55%,2nd
15%,3rd
Intravenous immunoglobulin (Payment week-
24.82 Pediatric Clinical diagnosis by week- M200082
fraction ( 1st week-35 ,2nd week-25 ,3rd week- CSF study, NCV/EMG 3 15%,3rd M2 Yes
B Medicine neurophysician 10%,4th B
15 ,4th week-10 ,5th week-10 ,F/u-5 ) of total week-
package rate) week- 10%,4th
10%,5th week-
week- 10%,5th
10%) of week-10%)
total of total
package package
rate) rate)
(Governm
ent
clinical
24.83 Pediatric Hydrocephalus (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Hydrocephalus (admission type:HDU) notes,Concern 0 2700 M2 M200083 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.83 Pediatric Hydrocephalus (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.83 Pediatric Hydrocephalus (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.84 Pediatric Intracranial space occupying lesion clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.85 Pediatric Cerebral malaria (admission type: Routine clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Cerebral malaria (admission type: HDU) notes,Concern 0 2700 M2 M200085 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.85 Pediatric Cerebral malaria (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.85 Pediatric Cerebral malaria (admission type: ICU, with clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.86 Pediatric Acute ischemic stroke (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.87 Pediatric Cerebral sino-venous thrombosis clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
Respiratory failure due to any causes ent
clinical
24.88 Pediatric (pneumonia, asthma, foreign body, clinical notes,Concern Reserve)P
A Medicine poisoning, head injury etc.) (admission Investigations ackage
Investigations
type: Routine ward) Amount
per day
(Governm
clinical
B Medicine poisoning, head injury etc.) (admission Investigations ackage
Investigations
type: HDU) Amount
per day
(Governm
clinical
C Medicine poisoning, head injury etc.) (admission Investigations ackage
Investigations
type: ICU, without ventilator) Amount
per day
(Governm
clinical
D Medicine poisoning, head injury etc.) (admission Investigations ackage
Investigations
type: ICU, with ventilator) Amount
per day
(Governm
ent
clinical
24.90 Pediatric Acute encephalitis –infectious/immune- clinical notes,Concern Reserve)P
A Medicine mediated (admission type: Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.90 Pediatric Acute encephalitis –infectious/immune- clinical notes,Concern Reserve)P
B Medicine mediated (admission type: HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
Acute encephalitis –infectious/immune- clinical
mediated (admission type: ICU, without notes,Concern 0 3600 M2 M200090 Yes
Amount
per day
(Governm
ent
Acute encephalitis –infectious/immune- clinical
mediated (admission type: ICU, with notes,Concern 0 4500 M2 M200090 Yes
Amount
per day
(Governm
ent
clinical
24.91 Pediatric Convulsive & non convulsive status clinical notes,Concern Reserve)P
A Medicine epilepticus (admission type: Routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
24.91 Pediatric Convulsive & non convulsive status clinical notes,Concern Reserve)P
B Medicine epilepticus (admission type: HDU) Investigations ackage
Investigations
Amount
per day
(Governm
ent
Convulsive & non convulsive status clinical
epilepticus (admission type: ICU, without notes,Concern 0 3600 M2 M200091 Yes
Amount
per day
(Governm
ent
Convulsive & non convulsive status clinical
epilepticus (admission type: ICU, with notes,Concern 0 4500 M2 M200091 Yes
Amount
per day
(Governm
ent
clinical
24.92 Pediatric Cerebral herniation (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Cerebral herniation (admission type: HDU) notes,Concern 0 2700 M2 M200092 Yes
Investigations
Amount
per day
(Governm
ent
clinical
24.92 Pediatric Cerebral herniation (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.92 Pediatric Cerebral herniation (admission type: ICU, clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
24.93 Pediatric Intracranial hemorrhage (admission type: clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.94 Pediatric Hepatic encephalopathy (admission type: clinical notes,Concern Reserve)P
A Medicine Rourine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.95 Pediatric Complicated bacterial meningitis clinical notes,Concern Reserve)P
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.96 Pediatric Raised intracranial pressure (admission clinical notes,Concern Reserve)P
A Medicine type: routine ward) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
24.97 Pediatric Hypertensive encephalopathy (admission clinical notes,Concern Reserve)P
A Medicine type: Routind) Investigations ackage
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Investigations
Amount
per day
(Governm
ent
clinical
Pediatric clinical notes,Concern Reserve)P
25 CRRT (per session) notes,Concern 0 8000 M2 M200098 Yes
Medicine Investigations ackage
Investigations
Amount
per day
Blood and blood component transfusion

up to a limit of 2 days(admission for a
diagnostic procedure leading to treatment (Governm
requiring admission, e.g. bone marrow and ent
clinical
Pediatric bone biopsy, endoscopy, liver biopsy, clinical notes,Concern Reserve)P
25 notes,Concern 0 1500 M2 M200099 Yes
Medicine bronchoscopy, CT/MRI under GA, broncho- Investigations ackage
Investigations
alveolar lavage, lumbar puncture, muscle Amount
biopsy, FNAC, pleural aspiration, ascitic per day
tapping, neostigmine challenge test
etc.)Package rate per Day
(Governm
Blood and blood component transfusion ent
clinical
24.10 Pediatric for indications like clinical notes,Concern Reserve)P
0 Medicine Thalassemia/Hemoglobinopathies - upto a Investigations ackage
Investigations
limit of 2 days,Package rate per Day Amount
per day
(Governm
ent
Reserve)c
High end radiological diagnostic (CT, MRI, clinical apped @
Pediatric clinical notes,Concern
24.1 Imaging including nuclear imaging) - can notes,Concern 0 5000 Rs 5000 M2 M200101 Yes
Medicine Investigations
only be clubbed with medical package. Investigations per
annum
for a
family
(Governm
ent
Reserve)c
High end histopathology (Biopsies) and clinical apped @
Pediatric clinical notes,Concern
24.1 advanced serology investigations - can only notes,Concern 0 5000 Rs 5000 M2 M200102 Yes
Medicine Investigations
be clubbed with medical package. Investigations per
annum
for a
family
Cluster - 25 NEO-NATAL PACKAGES

Basic neonatal care package (Rs. 500 per

day, maximum 1500): Babies that can be
managed by side of mother in postnatal
ward without requiring admission in
(Governm
SNCU/NICU:
Blood sugar,Blood ent
• Any newborn needing feeding support
group,Complete blood Reserve)C
• Babies requiring closer monitoring or clinical
count,Coombs apped
25.1 Neonatal short-term care for conditions like: notes,Concern 0 500 M3 M300001 Yes
test,others as Amount is
o Birth asphyxia (need for positive pressure Investigaions
required,Concern 1500 for
ventilation; no HIE)
Investigaions this
o Moderate jaundice requiring
Package
phototherapy
o Large for dates (>97 percentile) Babies
o Small for gestational age (less than 3rd
centile) (Package rate is per day)
Special Neonatal Care Package (Rs. 3000

per day, maximum of 18000 - pre-auth
Blood sugar (Package
after 4 days): Babies that required
rate is per day)
admission to SNCU or NICU:
Complete Blood Picture
Babies admitted for short term care for
Blood group
conditions like: (Governm
Bilirubin
• Mild Respiratory Distress/tachypnea ent
Coombs Test
• Mild encephalopathy Reserve)C
Chest X ray clinical
• Severe jaundice requiring intensive apped
25.2 Neonatal CRP notes,Concern 0 3000 M3 M300002 Yes
phototherapy Amount is
Micro ESR Investigaions
• Haemorrhagic disease of newborn 18000 for
Blood Culture
• Unwell baby requiring monitoring this
Electrolytes
• Some dehydration Package
Renal function tests
• Hypoglycaemia
Coagulation profile
Mother's stay and food in the hospital for
Others as required
breastfeeding, family centred care and
(Kangaroo Mother Care) KMC is mandatory
and included in the package rate
Intensive Neonatal Care Package (Rs. 5000

per day, maximum of Rs. 50,000 – pre-auth
is needed after 5 days) (Package rate is per
day)
Babies with birthweight 1500-1799 g
or
Babies of any birthweight and at least one
of the following conditions:
• Need for mechanical ventilation for less
than 24 hours or non-invasive respiratory (Governm
support (CPAP, HFFNC) ent
• Sepsis / pneumonia without Reserve)C
clinical
complications apped
25.3 Neonatal Concern Investigaions notes,Concern 0 5000 M3 M300003 Yes
• Hyperbilirubinemia requiring exchange Amount is
Investigaions
transfusion 50000 for
• Seizures this
• Major congenital malformations (pre- Package
surgical stabilization, not requiring
ventilation)
• Cholestasis significant enough requiring
work up and in-hospital management
• Congestive heart failure or shock
Advanced Neonatal Care Package (Rs. 6000

per day, maximum of Rs. 75,000 – pre-auth
is needed after 7 days) (Package rate is per
day)
Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one
• Any condition requiring invasive
(Governm
ventilation longer than 24 hours
ent
• Hypoxic Ischemic encephalopathy
Reserve)C
requiring Therapeutic Hypothermia clinical
apped
25.4 Neonatal • Cardiac rhythm disorders needing Concern Investigaions notes,Concern 0 6000 M3 M300004 Yes
Amount is
intervention (the cost of cardiac surgery or Investigaions
75000 for
implant will be covered under cardiac
this
surgery packages)
Package
• Sepsis with complications such as
meningitis or bone and joint infection, DIC
or shock
• Renal failure requiring dialysis
• Inborn errors of metabolism
Critical Care Neonatal Package (Rs. 7000

per day, maximum of Rs. 1,20,000 – pre-
auth after 10 days) (Package rate is per
day)
Babies with birthweight of <1200 g
or
(Governm
Babies of any birthweight with at least one
ent
Reserve)C
• Severe Respiratory Failure requiring High clinical
apped
25.5 Neonatal Frequency Ventilation or inhaled Nitric Concern Investigaions notes,Concern 0 7000 M3 M300005 Yes
Amount is
Oxide (iNO) Investigaions
120000
• Multisystem failure requiring multiple
for this
organ support including mechanical
Package
ventilation and multiple inotropes
• Critical congenital heart disease
Chronic Care Package (Rs. 3000 per day, (Governm

maximum of Rs. 30,000): If the baby ent
requires stay beyond the upper limit of Reserve)C
clinical
usual stay in Package no 0004 or 0005 for clinical notes,Concern apped
25.6 Neonatal notes,Concern 0 3000 M3 M300006 Yes
conditions like severe BPD requiring Investigaions Amount is
Investigaions
respiratory support, severe NEC requiring 30000 for
prolonged TPN support (Package rate is per this
day) Package
clinical Governm
High Risk Newborn Post Discharge Care clinical notes,Concern
25.7 Neonatal notes,Concern 0 2400 ent M3 M300007 Yes
Package (Protocol Driven) Investigaions
Investigaions Reserve
Laser Therapy for Retinopathy of clinical Governm
clinical notes,Concern
25.8 Neonatal Prematurity (Irrespective of no. of eyes notes,Concern 0 1500 ent M3 M300008 Yes
Investigaions
affected) - per session Investigaions Reserve
clinical Governm
Advanced Surgery for Retinopathy of clinical notes,Concern
25.9 Neonatal notes,Concern 0 15000 ent M3 M300009 Yes
Prematurity Investigaions
Investigaions Reserve
Ventriculoperitoneal Shunt Surgery (VP) or clinical Governm

clinical notes,Concern
25.10 Neonatal Omaya Reservoir or External Drainage for notes,Concern 0 5000 ent M3 M300010 Yes
Investigaions
Hydrocephalus Investigaions Reserve
Cluster - 26 ORTHOPEDICS & POLYTRAUMA

AC joint reconstruction/ Stabilization/

Acromionplasty (Nonoperative
management is recommended for
Rockwood type I and II injuries, whereas
Orthopei X Ray of Affected Limb, X Ray of Affected
26.1 surgical reconstruction is recommended 2 25000 S5 S500001 No
dc MIR of Shoulder Limb
for type IV and VI separations. The
management for type III and V injuries is
more controversial and is determined on a
case-by-case basis)
Accessory bone – Excision (limbs) –

Orthopei X Ray of Affected
26.2 congenital, Accessory digits sometime can X Ray of Affected Limb 1 6000 S5 S500002 No
dc Limb
be removed
26.3 Amputation - Below Elbow 1 15000 S5 S500003 No
dc clinical picture Limb

26.4 Amputation - Above Elbow 1 15000 S5 S500004 No

26.5 Amputation – one or more fingers 1 6000 S5 S500005 No

26.6 Amputation – Wrist/Ankel 1 15000 S5 S500006 No

26.7 Amputation - one or more toes/ digits 1 6000 S5 S500007 No

26.8 Amputation – Below Knee 1 15000 S5 S500008 No

26.9 Amputation – Above Knee 2 18000 S5 S500009 No

26.10 Foot & Hand Amputation - partial 1 15000 S5 S500010 No
Clinical and Governm
Orthopei Clinical and radiological
26.1 Disarticulation (hind & for quarter) radiological 2 25000 ent S5 S500011 Yes
dc investigation
investigation Reserve
Clinical and
Orthopei Osteochondroma excision/ Excision of Clinical and radiological
26.1 radiological 1 10000 S5 S500014 No
dc Exostosis investigation
investigation
Clinical and
26.2 Excision Arthoplasty radiological 1 15000 S5 S500015 No
dc investigation
investigation
X-Ray/USG/ MRI of Clinical and
Orthopei
26.2 Arthorotomy of any joint affected joints and radiological 1 15000 S5 S500016 No
dc
clinical photo , CBC investigation
Clinical and
26.2 Arthrodesis Ankle Triple radiological 1 15000 S5 S500017 No
dc investigation
investigation
Orthopei X-Ray, MRI of affected Post-Operative X-
26.2 Excision Arthoplasty of Femur head 2 22500 S5 S500018 No
dc joints , CBC, ESR, CRP Ray
Clinical and
26.2 Bimalleolar Fracture Fixation radiological 1 15000 S5 S500019 No
dc investigation
investigation
Orthopei Bone Tumour Excision + reconstruction Clinical and radiological
26.20 radiological 2 50000 ent S5 S500020 Yes
dc using implant (malignant/ benign) investigation
Orthopei Bone Tumour (malignant/ benign) Clinical and radiological
26.2 radiological 2 20000 ent S5 S500021 Yes
dc curettage and bone grafting investigation
Bone Tumour Excision (malignant/ benign) Clinical and Governm
26.2 + Joint replacement (depending upon type radiological 2 1,50,000 ent S5 S500022 Yes
dc investigation
of joint and implant) investigation Reserve
Orthopei Clavicle fracture management - X- Ray of limb
26.2 X- Ray of affected sights 1 3000 S5 S500023 No
dc conservative (daycare) treated.
Orthopei X Ray of Affected Limb, X- Ray of limb
26.3 Close Reduction - Small Joints 1 4000 S5 S500026 No
dc clinical picture treated.
Orthopei Closed Interlock Nailing + Bone Grafting – X Ray of Affected Limb, X- Ray of limb
26.3 2 19000 S5 S500027 No
dc femur clinical picture treated.

26.3 Closed Interlocking Intermedullary 2 17500 S5 S500028 No
Orthopei Closed Reduction and Internal Fixation X Ray of Affected Limb, X- Ray of limb
26.30 1 6000 S5 S500030 No
dc with K wire clinical picture treated.
Orthopei Closed Reduction and Percutaneous Screw X Ray of Affected Limb, X- Ray of limb
26.3 1 15000 S5 S500031 No
dc Fixation (neck femur) clinical picture treated.
Debridement & Closure of Major injuries -

26.4 contused lacerated wounds (anti-biotic + 1 7000 S5 S500035 No
dressing) - minimum of 3 sessions

26.36 Debridement & Closure of Minor injuries 1 3000 S5 S500036 No

26.37 Closed reduction of dislocation (Knee/ Hip) 1 6000 S5 S500037 No
Orthopei Closed reduction of dislocation (Shoulder/ X Ray of Affected Limb, X- Ray of limb
26.38 1 5000 S5 S500038 No
dc Elbow) clinical picture treated.
Orthopei Duputryen’s Contracture release + clinical picture +
26.39 USG of Affected Hand 1 10000 S5 S500039 No
dc rehabilitation USG
Governm
Orthopei X-Ray, UGS, RMG &
26.40 Exploration and Ulnar nerve Repair Post of USG 1 10000 ent S5 S500040 Yes
dc NCV
Reserve
Orthopei X Ray of Affected Limb,
26.41 External fixation - Long bone Post of X -Ray 1 15000 S5 S500041 No
dc clinical picture

26.42 External fixation - Small bone Post of X -Ray 1 10000 S5 S500042 No
dc clinical picture

26.43 External fixation - Pelvis Post of X -Ray 1 15000 S5 S500043 No
dc clinical picture

26.44 Fasciotomy Post of X -Ray 1 7000 S5 S500044 No
dc clinical picture

26.46 Fracture - Acetabulum Post of X -Ray 2 30000 S5 S500046 No
dc clinical picture

26.47 Fracture - Fibula Internal Fixation Post of X -Ray 1 10000 S5 S500047 No
dc clinical picture
Fracture - Hip Internal Fixation
26.48 (Intertrochanteric Fracture with implant) + Post of X -Ray 2 17000 S5 S500048 No
dc clinical picture
rehabilitation

26.49 Fracture - Humerus Internal Fixation Post of X -Ray 2 17000 S5 S500049 No
dc clinical picture

26.50 Fracture - Olecranon of Ulna Post of X -Ray 1 10000 S5 S500050 No
dc clinical picture

26.51 Fracture - Radius Internal Fixation Post of X -Ray 1 10000 S5 S500051 No
dc clinical picture

26.52 Fracture - TIBIA Internal Fixation plating Post of X -Ray 2 17000 S5 S500052 No
dc clinical picture

26.53 Fracture - Ulna Internal Fixation Post of X -Ray 1 10000 S5 S500053 No
dc clinical picture

26.54 Head Radius – Excision Post of X -Ray 1 8000 S5 S500054 No
dc clinical picture

26.55 High Tibial Osteotomy Post of X -Ray 2 17000 S5 S500055 No
dc clinical picture

26.56 Closed reduction + Hip Spica Post of X -Ray 1 7000 S5 S500056 No
dc clinical picture

26.57 Internal Fixation Lateral Epicondyle Post of X -Ray 1 10000 S5 S500057 No
dc clinical picture
Clinical
Orthopei Multiple Tendon Repair( 5000/- Per Clinical + Electro
26.61 photographs 2 20000 S5 S500061 No
dc Tendon Repair up to Four Tendons) Diagnostic study
showing scar
Clinical
photographs Governm
Orthopei Clinical + Electro
26.62 Nerve Repair Surgery showing scar + 1 15000 ent S5 S500062 Yes
dc Diagnostic study
Electro Dignostic Reserve
study
Clinical
photographs
Orthopei Clinical + Electro
26.63 Nerve Transposition/Release/ Neurolysis showing scar + 1 8000 S5 S500063 No
dc Diagnostic study
Electro Dignostic
study
26.64 Open Reduction Internal Fixation (Small bone) Post of X -Ray 1 10000 S5 S500064 No
dc clinical picture

26.65 Open Reduction Internal Fixation (Large Bone) Post of X -Ray 2 20000 S5 S500065 No
dc clinical picture

26.66 Open Reduction of CDH Post of X -Ray 2 30000 S5 S500066 No
dc clinical picture

26.67 Open Reduction of Small Joint Post of X -Ray 1 15000 S5 S500067 No
dc clinical picture
Orthopei Open Reduction with bone grafting of X Ray of Affected Limb,

26.68 Post of X -Ray 2 20000 S5 S500068 No
dc nonunion clinical picture

26.69 Osteotomy -Small Bone Post of X -Ray 2 17000 S5 S500069 No
dc clinical picture

26.70 Osteotomy -Large Bone Post of X -Ray 2 30000 S5 S500070 No
dc clinical picture

26.71 Patellectomy Post of X -Ray 1 8000 S5 S500071 No
dc clinical picture
Orthopei X Ray of Affected Limb, Post of X -Ray,

26.72 Pelvic Osteotomy with fixation with plaster 2 30000 S5 S500072 No
dc clinical picture Clinical photo
Orthopei X Ray of Affected Limb, Radiology

26.74 Excision of Bursa 1 4000 S5 S500074 No
dc clinical picture Investigation
Clinical and
Orthopei Reconstruction of ACL/PCL with implant Clinical and radiological
dc and brace investigation
investigation
Clinical and
Orthopei Sequestrectomy of Long Bones + anti- Clinical and radiological
dc biotics + dressing investigation
investigation
Clinical and
26.77 Tendo Achilles Tenotomy radiological 1 5000 S5 S500077 No
dc clinical picture
investigation
Clinical and
26.78 Tendon Grafting radiological 1 15000 S5 S500078 No
dc investigation
investigation
Clinical and
26.79 Tendon Release/ Tenotomy radiological 1 5000 S5 S500079 No
dc investigation
investigation
Clinical and
26.80 Tenolysis radiological 1 5000 S5 S500080 No
dc investigation
investigation
Clinical and
26.81 Tension Band Wiring Patella radiological 1 15000 S5 S500081 No
dc investigation
investigation
Clinical and
Orthopei Application of P.O.P. casts for Upper & Clinical and radiological
dc Lower Limbs investigation
investigation
Clinical and
26.83 Application of P.O.P. Spikas& Jackets radiological 1 3500 S5 S500083 No
dc investigation
investigation
Clinical and
26.84 Application of Skeletal Tractions with pin radiological 1 3000 S5 S500084 No
dc investigation
investigation
Clinical and
26.85 Application of Skin Traction radiological 1 1000 S5 S500085 No
dc investigation
investigation
Clinical and
Orthopei Fracture intercondylarHumerus + Clinical and radiological
dc olecranon osteotomy investigation
investigation
Rate is
3,000/-
per casts,
Correction of club foot per casts (Rate is Clinical and
Orthopei Clinical and radiological Next visit
26.89 3,000/- per casts, Next visit after 3 weeks radiological 1 15000 S5 S500089 No
dc investigation after 3
Maximum for 5 Visit) investigation
weeks
Maximum
for 5 Visit
Clinical and
Orthopei Arthroscopic Meniscus Repair/ Clinical and radiological
dc Meniscectomy investigation
investigation
Clinical and
26.91 Bipolar Hemiarthroplasty (hip/shoulder) radiological 2 40000 S5 S500094 No
dc investigation
investigation
Clinical and
26.92 Unipolar Hemiarthroplasty radiological 2 30000 S5 S500095 No
dc investigation
investigation
Clinical and
26.93 Elbow replacement radiological 2 40000 S5 S500097 No
dc investigation
investigation
26.94 Arthrodesis of shoulder radiological 2 40000 ent S5 S500098 Yes
dc investigation
26.95 Arthrodesis of Knee (with implant) radiological 2 40000 ent S5 S500099 Yes
dc investigation
26.96 Arthrodesis of Wrist (with implant) radiological 2 30000 ent S5 S500100 Yes
dc investigation

26.97 Arthrodesis of Ankle (with implant) radiological 2 30000 ent S5 S500101 Yes
dc investigation
Governm
Orthopei Nerve Conduction
8.1 Nerve and tendon repair &/ Vascular repair Clinical Photograph 3 23000 ent S5 S612001 Yes
dc study, CT scan
Reserve
Governm
Orthopei Nerve & Tendon Repair &/ Vascular Repair Nerve Conduction
8.2 Clinical Photograph 3 14950 ent S5 S612002 Yes
dc (Grade-I& II) study, CT scan
Reserve
Orthopei Nerve & Tendon Repair &/ Vascular Repair Nerve Conduction
8.3 Clinical Photograph 3 26450 S5 No
dc (Grade-III) study, CT scan
Orthopei Flap cover Surgery for wound in compound CLINICAL CLINICAL
8.4 3 23000 S5 S612003 No
dc fracture PHOTOGRAPH, X-RAY PHOTOGRAPH
Orthopei Surgical Correction of Pelvic bone
8.8 X-RAY X-RAY 3 40000 S5 S612007 No
dc fractures.
CLINICAL
Orthopei MRI , CLINICAL
8.50 JOINT RECONSTRUCTION PHOTOGRAPH, X- 3 74750 S5 S612008 No
dc PHOTOGRAPH, X-RAY
RAY
CLINICAL
Orthopei CLINICAL
8.51 ELLIZAROV FIXATION PHOTOGRAPH, X- 3 75000 S5 S612009 No
dc PHOTOGRAPH, X-RAY
RAY
CLINICAL
Orthopei PREPATELLAR BURSA AND REPAIR OF MCL MRI, CLINICAL
8.57 PHOTOGRAPH, X- 3 57500 S5 S612015 No
dc OF KNEE PHOTOGRAPH, X-RAY
RAY
Wound management for compound
Orthopei Clinical Photograph, Clinical Photograph,
8.85 fracture 3 30000 S5 S612033 No
dc Xray Xray
(Any grade)
EXTERNAL FIXATOR WITH SOFT TISSUE
8.86 INJURY, SURGICAL MANAGEMENT, STG 3 50000 S5 S612034 No
dc Xray Xray
COVERING FOR SMALL BONES
EXTERNAL FIXATOR WITH SOFT TISSUE

8.87 INJURY, SURGICAL MANAGEMENT, STG 3 50000 S5 S612035 No
dc Xray Xray
COVERING FOR LARGE BONES
Post- op. X-
Orthopei Internal fixation with Flap cover Surgery for PRE OP CLINICAL ray,Clinical
8.90 2 40000 S5 S600003 No
dc wound in compound fracture PICTURE,X-RAY/CT Photograph
showing flap cover
Clinical photograph
Orthopei
8.92 Internal fixation of Pelviacetabular fracture X-RAY/CT showing scar,Post- 2 40000 S5 S600005 No
dc
op. X-ray
Visceral injury requiring surgical Clinical photograph

Orthopei
8.95 intervention along with fixation of fracture Pre-op. X-ray,CT,USG showing scar,Post- 2 30000 S5 S600008 No
dc
of single long bone. op. X-ray
Visceral injury requiring surgical Clinical photograph

Orthopei
8.96 intervention along with fixation of fracture Pre-op. X-ray,CT,USG showing scar,Post- 2 45000 S5 S600009 No
dc
of 2 or more long bones. op. X-ray
Clinical photograph
Orthopei Chest injury with one fracture of long bone Pre-op. X-ray of
8.97 showing scar,Post- 2 35000 S5 S600010 No
dc (with implants) fracture , Chest Xray
op. X-ray
Clinical photograph
Orthopei Chest injury with fracture of 2 or more long Pre-op. X-ray of
8.98 showing scar,Post- 2 45000 S5 S600011 No
dc bones fracture , Chest Xray
op. X-ray
Orthopei
6.68 CERVICAL SPINE STABLISATION ANTERIOR MRI SPINE X RAY SPINE 5 60000 S5 S812051 No
dc
6.69 Orthopei CERVICAL SPINE STABLISATION-POSTERIOR S812052
MRI SPINE X RAY SPINE 5 50000 S5 No
A dc Level one A
B dc Level two B
6.70 Orthopei CERVICALSPINE STABLISATION-GLOBAL S812053

A dc (Anterior & Posterior combine) A

B dc Level three B
C dc Level four C
Orthopei
6.71 DL SPINE STABLISATION-ANTERTIOR MRI SPINE X RAY SPINE 5 60000 S5 S812054 No
dc
6.72 Orthopei DL SPINE STABLISATION-POSTERIOR Level S812055
A dc one A
B dc two B
6.73 Orthopei DL SPINE STABLISATION-GLOBAL (Anterior S812056
A dc & Posterior combine) A
B dc three B
C dc four C
Orthopei CLINICAL PHOTOGRAPH, X- CLINICAL

8.60 SHOULDER JACKET 3 50000 S5 S612017 No
dc RAY PHOTOGRAPH, X-RAY

Orthopei Concern
27 Capped @ 1,00,000rs per anum per Concern Investigation 1 100000 S5 U100 No
dc Investigation
Cluster - 27 NEPHROLOGY

RADIOCEPHALIC AV FISTULA FOR DOPPLER UPPER

HEMODIALYSIS LIMB
ogy
BRACHIOCEPHALIC AV FISTULA FOR DOPPLER UPPER
HEMODIALYSIS LIMB
ogy
CBC, S.CRETAIN, BL
MAINTENANCE HEMODIALYSIS (MHD) UREA, S. Na+ /S.K+,
5.14 Nephrol (WITH INJ. ERYTHROPOETINE WITH INJ. HIV(ELLISA), HCV - 0 2300 S7 S712024 No
ogy IRON) –PER DIALYSIS. (ELLISA), HBS Ag
(ELLISA)
Permanent tunnelled catheter placement
Colour Doppler/
5.14 Nephrol as substitute for AV fistula in long term Clinical Photograph 0 16000 S7 S712025 No
Peripheral Angiogram
ogy dialysis
Governm
Endovascular intervention for salvaging Colour Doppler/
5.14 Nephrol Clinical Photograph 0 40000 ent S7 S712026 Yes
hemodialysis AV fistula Peripheral Angiogram
ogy Reserve

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Cluster - 1 BURNS AND PLASTIC SURGERY

No of Specialt Procedure Govern

20% burns or scalds/burns over face (with

upto-40% with Scalds (Conservative/

upto-50% Mixed Burns (with surgery

Post Burn Contracture surgeries for

Post Burn Contracture surgeries for

Reconstructive lower limb surgery

% Total Body Surface Area Burns (TBSA) Clinical photograph and

Electrical contact burns: Low voltage-

Electrical contact burns: Low voltage- with

Electrical contact burns: High voltage-

Electrical contact burns: High voltage- with

Chemical burns: Without significant facial

Chemical burns: With significant facial

Burns/Pl Unspecified Surgical Package (Amount

Unspecified Surgical Package (Amount

No of Specialt Procedure Govern

3.1 Cardiac CABG CAG Clinical Photograph 5 78200 S13 S1300001 No

3.2 Cardiac Re DO CABG CAG Clinical Photograph 5 83375 S13 S1312001 No

Root Replacement (Aortic Aneurysm/ 2D ECHO , X-RAY,

Surgery for Cardiac Tumour/ LA Myxoma/ 2D ECHO , X-RAY,

X-RAY,Biopsy , CT/ PET Biopsy , Clinical

Surgical Correction of Bronchopleural Biopsy , Clinical

BArium Study, X-RAY, BIOPSY, CLINICAL

Thoracotomy, Thoraco Abdominal Clinical Photograph

ENDOSCOPY, X-RAY, Biopsy , Clinical

Surgery for Arterial Aneursysm -Distal Angiogram/spiral CT

Surgery for Arterial Aneursysm Main

Excision of Arterio Venous malformation – Spiral CT Angiogram

Intrathoracic Aneurysm-Aneurysm not

Unspecified Surgical Package (Amount

No of Specialt Procedure Govern

RGU & MCU,

RGU & MCU,

RGU & MCU,

USG,Clinical Clinical Photograph,

Urology/ CBC, S. CREATININE,

Urology/ CBC, S. CREATININE,

Urology/ CBC, S. CREATININE,

Urology/ CBC, S. CREATININE,

Urology/ CT IVU, MCU, URINE

Urology/ CBC, S. CREATININE,

Urology/ CBC, S. CREATININE,

Paraganglioma excision with liver clinical Clinical

Nephro ureterectomy (Benign)

5.16 Urology Uretero-ureterostomy Laparoscopic USG,X Ray,IVP/CT USG 2 35000 S7 S700023 No

5.160 Urology Pyelolithotomy-Laparoscopic USG,X Ray,IVP/CT USG 2 30000 S7 S700029 No

Renal Cyst deroofing or marsupialization-

Uretero-vaginal/uterine fistula repair USG KUB,CT Urography/

5.17 Urology Cystolithotomy-open, including cystoscopy USG,IVP/CT USG 2 15000 S7 S700060 No

Urethral Stone endoscopic, including

Radical cystectomy with continent clinical notes,CT

Radical Cystectomy with ureterostomy- clinical notes,CT

Radical Cystectomy with clinical notes,CT

VVF/Uterovaginal Repair - clinical notes,CT

Hysterectomy as part of VVF/uterovaginal clinical notes,CT

TURP/Laser + VIU (visual internal

TURP/Laser + Urethral dilatation-non

Transrectal Ultrasound guided prostate

5.233 Urology Ilio-Inguinal lymphadenectomy-unilateral USG/FNAC HPEE 2 15000 S7 S700135 No

5.234 Urology Ilio-Inguinal lymphadenectomy-bilateral USG/FNAC HPEE 2 25000 S7 S700136 No

Pelvic lymphadenectomy open, after prior CT/MRI/USG