Benefit Packages (Government)

BENEFIT PACKAGES OF AYUSHMAN BHARAT - AROGYA KARNATAKA FOR GOVERNMENT HOSPITALS
Speciality
Sl. no. PRocedure code Procedure name Rates Pre-op Investigation Post-op Investigation
code
SIMPLE SECONDARY CARE (RESTRICTED TO PUBLIC HEALTH INSTITUTION)
BURNS
2A.S11.00001 : % Total Body Surface Area Burns

Clinical Photograph, Diagram with Rule
1 S11 2A.S11.00001 (TBSA) (thermal/ scald/ flame burns) - any % (not 3500 Clinical Photograph
of 9 for extent of burns
requiring admission). Needs at least 5-6 dressing
CARDIOTHORACIC SURGERY
2A.S1.00040A : Excision Mammary Fistula - cross
S1 2A.S1.00040A 5500 USG, Fistulogram Scar Photo, HPE Report
speciality
DENTAL AND ORAL AND MAXILLOFACIAL SURGERY
2A.S16.00001 : Fixation of fracture of jaw with closed

2 S16 2A.S16.00001 2500 X Ray film with report X Ray film with report
reduction (1 jaw) using wires - under LA
2A.S16.00006 : Extraction of impacted tooth under

3 S16 2A.S16.00006 250 X Ray film with report X Ray film with report
LA
2A.S16.00007 : Cyst & tumour of Maxilla/mandible X Ray film with report,Clinical X Ray film with report, Clinical
4 S16 2A.S16.00007 1250
by enucleation/excision/marsupialization under LA Photograph, Photograph
ENT
5 S2 2A.S2.00001 2A.S2.00001 : Aural polypectomy 2000 Clinical photo Scar photo, HPE
X-ray mastoid , Pure Tone Audiometry
6 S2 2A.S2.00003 2A.S2.00003 : Mastoidectomy 6250 X-Ray Mastoids, Scar photo
Report
Pure Tone Audiometry Report and Pure Tone Audiometry Report and
7 S2 2A.S2.00007 2A.S2.00007 : Myringoplasty with Ossiculoplasty 1750
Impedance Audiometry Report Impedance Audiometry Report
Pure Tone Audiometry Report and

8 S2 2A.S2.00008 2A.S2.00008 : Myringotomy – Bilateral 3000 Pure Tone Audiometry Report
Impedance Audiometry Report

9 S2 2A.S2.00009 2A.S2.00009 : Myringotomy – Unilateral 1750 Pure Tone Audiometry Report

10 S2 2A.S2.00010 2A.S2.00010 : Myringotomy with Grommet - One ear 3250 Pure Tone Audiometry Report
2A.S2.00011 : Myrinogotomy with Grommet - Both Pure Tone Audiometry Report and Pure Tone Audiometry Report and
11 S2 2A.S2.00011 4250
ear Impedance Audiometry Report Impedance Audiometry Report
12 S2 2A.S2.00013 2A.S2.00013 : Partial amputation – Pinna 2000 Clinical Photograph Clinical Photograph
13 S2 2A.S2.00017 2A.S2.00017 : Tympanoplasty 4500 CT Mastoid, Pure Tone Audiometry Pure Tone Audiometry Report
14 S2 2A.S2.00019 2A.S2.00019 : Ear lobe repair - single (daycare) 750 Clinical Photo, Clinical notes Scar Photograph
2A.S2.00035 : Fracture reduction nose with septal
15 S2 2A.S2.00035 4000 X-ray of the nasal bone Post-op X-ray with report
correction
Speciality
code
CT PNS , Direct Nasal Endoscopic Photo
16 S2 2A.S2.00038 2A.S2.00038 : Functional Endoscopic Sinus (FESS) 5500 Endoscopy Photo
graph, Clinical notes
17 S2 2A.S2.00039 2A.S2.00039 : Intra Nasal Ethmoidectomy 2500 Clinical notes, CT PNS X-Ray
18 S2 2A.S2.00043 2A.S2.00043 : Turbinectomy Partial – Bilateral 1500 CT, Clinical Notes clinical notes
19 S2 2A.S2.00044 2A.S2.00044 : Turbinectomy Partial – Unilateral 1000 CT, Clinical Notes clinical notes
20 S2 2A.S2.00046 2A.S2.00046 : Rhinoplasty 7500 X- Ray, CT, Clinical Notes X Ray
21 S2 2A.S2.00047 2A.S2.00047 : Septoplasty 2500 X- Ray, CT, Clinical Notes Clinical Photograph
22 S2 2A.S2.00048 2A.S2.00048 : Youngs operation 1500 clinical notes clinical notes
23 S2 2A.S2.00049 2A.S2.00049 : Angiofibroma Excision 9000 Endoscopy Picture, CT, Clinical Notes Clinical photo showing scar
24 S2 2A.S2.00052 2A.S2.00052 : Endoscopic Hypophysectomy 10500 Clinical notes, CT/MRI clinical notes
25 S2 2A.S2.00053 2A.S2.00053 : Intranasal Diathermy 1500 clinical notes clinical notes
26 S2 2A.S2.00054 2A.S2.00054 : Rhinosporidiosis 3500 X Ray Nasopharynx film with report HPR
27 S2 2A.S2.00056 2A.S2.00056 : Adeno Tonsillectomy 4000 Clinical Photograph clinical Photograph
28 S2 2A.S2.00057 2A.S2.00057 : Adenoidectomy 2500 X-Ray Nasopharynx Clinical Photograph
29 S2 2A.S2.00071 2A.S2.00071 : Retro pharyngeal abscess – Drainage 2500 CT/MRI, Clinical photograph X-Ray
30 S2 2A.S2.00074 2A.S2.00074 : Tonsillectomy – (Uni/ Bilateral) 3750 Clinical Notes Procedure notes
Clinical notes, Biopsy, Clinical Histopathological report, Operative
31 S2 2A.S2.00076 2A.S2.00076 : Superficial Parotidectomy 6000
Photograph, CT scan, CT/MRI notes with steps of surgery
Clinical photo showing scar, FNAC/
32 S2 2A.S2.00079 2A.S2.00079 : Excision of Branchial Cyst 3500 Clinical notes & photo BIOPSY, Operative notes with steps
of surgery
Clinical photo showing scar, FNAC/
33 S2 2A.S2.00080 2A.S2.00080 : Excision of Branchial Sinus 3500 Clinical notes & photo BIOPSY, Operative notes with steps
of surgery
34 S2 2A.S2.00086 2A.S2.00086 : Palatopharyngoplasty 5000 Clinical photo HPE Report, OT Notes
2A.S2.00089 : Removal of Submandibular Salivary Clinical Photograph , FNAC, Routine
35 S2 2A.S2.00089 2500 HPR , Clinical Photograph
gland Blood Inv
GENERAL MEDICINE
2A.M1.00001 : Acute gastroenteritis with moderate Relevant Hematological investigations,
36 M1 2A.M1.00001 900 Treatment notes
dehydration - routine ward Clinical notes
2A.M1.00001A : Acute gastroenteritis with moderate Relevant Hematological investigations,
M1 2A.M1.00001A 1350 Treatment notes
dehydration - HDU Clinical notes
2A.M1.00001B : Acute gastroenteritis with moderate Relevant Hematological investigations,
M1 2A.M1.00001B 1800 Treatment notes
dehydration - ICU without ventilator Clinical notes
2A.M1.00001C : Acute gastroenteritis with moderate Relevant Hematological investigations,
M1 2A.M1.00001C 2250 Treatment notes
dehydration - iCU with ventilator Clinical notes
Relevant Hematological investigations,
37 M1 2A.M1.00003 2A.M1.00003 : Dysentery - routine ward 900 Treatment notes
Clinical notes
M1 2A.M1.00003A 2A.M1.00003A : Dysentery - HDU 1350 Treatment notes
Clinical notes
M1 2A.M1.00003B 2A.M1.00003B : Dysentery - ICU without ventilator 1800 Treatment notes
Clinical notes
Speciality
code
M1 2A.M1.00003C 2A.M1.00003C : Dysentery - ICU with ventilator 2250 Treatment notes
Clinical notes
38 M1 2A.M1.00004 2A.M1.00004 : Renal colic - routine ward 900 clinical notes clinical notes
M1 2A.M1.00004A 2A.M1.00004A : Renal colic - HDU 1350 clinical notes clinical notes
M1 2A.M1.00004B 2A.M1.00004B : Renal colic - ICU without ventilator 1800 clinical notes clinical notes
M1 2A.M1.00004C 2A.M1.00004C : Renal colic - ICU with ventilator 2250 clinical notes clinical notes
39 M1 2A.M1.00005 2A.M1.00005 : Acute bronchitis - routine ward 900 clinical notes clinical notes
M1 2A.M1.00005A 2A.M1.00005A : Acute bronchitis - HDU 1350 clinical notes clinical notes
2A.M1.00005B : Acute bronchitis - ICU without
M1 2A.M1.00005B 1800 clinical notes clinical notes
ventilator
2A.M1.00005C : Acute bronchitis - iCU with
M1 2A.M1.00005C 2250 clinical notes clinical notes
ventilator
40 M1 2A.M1.00009 2A.M1.00009 : Severe anemia - routine ward 900 clinical notes, HB% clinical notes, HB%
M1 2A.M1.00009A 2A.M1.00009A : Severe anemia - HDU 1350 clinical notes, HB% clinical notes, HB%
2A.M1.00009B : Severe anemia - ICU without
M1 2A.M1.00009B 1800 clinical notes, HB% clinical notes, HB%
ventilator
M1 2A.M1.00009C 2A.M1.00009C : Severe anemia - ICU with ventilator 2250 clinical notes, HB% clinical notes, HB%
41 M1 2A.M1.00011 2A.M1.00011 : Acute febrile illness - routine ward 900 clinical notes clinical notes
M1 2A.M1.00011A 2A.M1.00011A : Acute febrile illness - HDU 1350 clinical notes clinical notes
2A.M1.00011B : Acute febrile illness - ICU without
ventilator
2A.M1.00011C : Acute febrile illness - ICU with
ventilator
42 M1 2A.M1.00013 2A.M1.00013 : UTI - routine ward 900 clinical notes, Urine - C/S clinical notes
M1 2A.M1.00013A 2A.M1.00013A : UTI - HDU 1350 clinical notes, Urine - C/S clinical notes
M1 2A.M1.00013B 2A.M1.00013B : UTI - ICU without ventilator 1800 clinical notes, Urine - C/S clinical notes
M1 2A.M1.00013C 2A.M1.00013C : UTI - ICU with ventilator 2250 clinical notes, Urine - C/S clinical notes
clinical notes, Peripheral blood
43 M1 2A.M1.00014 2A.M1.00014 : Malaria - routine ward 900 clinical notes
examination report
M1 2A.M1.00014A 2A.M1.00014A : Malaria - HDU 1350 clinical notes
examination report
M1 2A.M1.00014B 2A.M1.00014B : Malaria - ICU without ventilator 1800 clinical notes
examination report
M1 2A.M1.00014C 2A.M1.00014C : Malaria - ICU with ventilator 2250 clinical notes
examination report
44 M1 2A.M1.00015 2A.M1.00015 : Dengue fever - routine ward 900 clinical notes, Blood examination report clinical notes, Blood examination
M1 2A.M1.00015A 2A.M1.00015A : Dengue fever - HDU 1350 clinical notes, Blood examination report clinical notes, Blood examination
2A.M1.00015B : Dengue fever - ICU without clinical notes, Blood examination
M1 2A.M1.00015B 1800 clinical notes, Blood examination report
ventilator report
Speciality
code
clinical notes, Blood examination
M1 2A.M1.00015C 2A.M1.00015C : Dengue fever - ICU with ventilator 2250 clinical notes, Blood examination report
report
45 M1 2A.M1.00017 2A.M1.00017 : Leptospirosis - routine ward 900 clinical notes, Blood examination report clinical notes
M1 2A.M1.00017A 2A.M1.00017A : Leptospirosis - HDU 1350 clinical notes, Blood examination report clinical notes
2A.M1.00017B : Leptospirosis - ICU without
M1 2A.M1.00017B 1800 clinical notes, Blood examination report clinical notes
ventilator
M1 2A.M1.00017C 2A.M1.00017C : Leptospirosis - ICU with ventilator 2250 clinical notes, Blood examination report clinical notes
46 M1 2A.M1.00018 2A.M1.00018 : Enteric fever - routine ward 900 clinical notes, Blood examination report clinical notes
M1 2A.M1.00018A 2A.M1.00018A : Enteric fever - HDU 1350 clinical notes, Blood examination report clinical notes
2A.M1.00018B : Enteric fever - ICU without
ventilator
M1 2A.M1.00018C 2A.M1.00018C : Enteric fever - ICU with ventilator 2250 clinical notes, Blood examination report clinical notes
47 M1 2A.M1.00019 2A.M1.00019 : Pneumonia - routine ward 900 clinical notes, X-ray clinical notes
M1 2A.M1.00019A 2A.M1.00019A : Pneumonia - HDU 1350 clinical notes, X-ray clinical notes
M1 2A.M1.00019B 2A.M1.00019B : Pneumonia - ICU without ventilator 1800 clinical notes, X-ray clinical notes
M1 2A.M1.00019C 2A.M1.00019C : Pneumonia - ICU with ventilator 2250 clinical notes, X-ray clinical notes
48 M1 2A.M1.00021 2A.M1.00021 : Liver abscess - routine ward 900 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen
M1 2A.M1.00021A 2A.M1.00021A : Liver abscess - HDU 1350 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen
2A.M1.00021B : Liver abscess - ICU without
M1 2A.M1.00021B 1800 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen
ventilator
M1 2A.M1.00021C 2A.M1.00021C : Liver abscess - ICU with ventilator 2250 clinical notes, USG /X-ray abdomen clinical notes, USG /X-ray abdomen
49 M1 2A.M1.00022 2A.M1.00022 : Acute viral hepatitis - routine ward 900 clinical notes, LFT clinical notes, LFT
M1 2A.M1.00022A 2A.M1.00022A : Acute viral hepatitis - HDU 1350 clinical notes, LFT clinical notes, LFT
2A.M1.00022B : Acute viral hepatitis - ICU without
M1 2A.M1.00022B 1800 clinical notes, LFT clinical notes, LFT
ventilator
2A.M1.00022C : Acute viral hepatitis - ICU with
M1 2A.M1.00022C 2250 clinical notes, LFT clinical notes, LFT
ventilator
2A.M1.00026 : Pyrexia of unknown origin - routine clinical notes, Blood examination
50 M1 2A.M1.00026 900 clinical notes, Blood examination report
ward report
M1 2A.M1.00026A 2A.M1.00026A : Pyrexia of unknown origin - HDU 1350 clinical notes, Blood examination report
report
2A.M1.00026B : Pyrexia of unknown origin - ICU clinical notes, Blood examination
without ventilator report
2A.M1.00026C : Pyrexia of unknown origin - ICU clinical notes, Blood examination
M1 2A.M1.00026C 2250 clinical notes, Blood examination report
with ventilator report
2A.M1.00027 : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
51 M1 2A.M1.00027 900 clinical notes, X-ray chest
routine ward chest
Speciality
code
2A.M1.00027A : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
M1 2A.M1.00027A 1350 clinical notes, X-ray chest
HDU chest
2A.M1.00027B : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
M1 2A.M1.00027B 1800 clinical notes, X-ray chest
ICU without ventilator chest
2A.M1.00027C : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
M1 2A.M1.00027C 2250 clinical notes, X-ray chest
ICU with ventilator chest
2A.M1.00028 : Systematic lupus erythematosus -
52 M1 2A.M1.00028 900 clinical notes clinical notes
routine ward
2A.M1.00028A : Systematic lupus erythematosus -
M1 2A.M1.00028A 1350 clinical notes clinical notes
HDU
2A.M1.00028B : Systematic lupus erythematosus -
ICU without ventilator
2A.M1.00028C : Systematic lupus erythematosus -
ICU with ventilator
53 M1 2A.M1.00029 2A.M1.00029 : Vasculitis - routine ward 900 clinical notes clinical notes
M1 2A.M1.00029A 2A.M1.00029A : Vasculitis - HDU 1350 clinical notes clinical notes
M1 2A.M1.00029B 2A.M1.00029B : Vasculitis - ICU without ventilator 1800 clinical notes clinical notes
M1 2A.M1.00029C 2A.M1.00029C : Vasculitis - ICU with ventilator 2250 clinical notes clinical notes
2A.M1.00031 : Bacterial/ fungal endocarditis -
54 M1 2A.M1.00031 900 clinical notes, X-ray /USG -chest clinical notes
routine ward
2A.M1.00031A : Bacterial/ fungal endocarditis -
M1 2A.M1.00031A 1350 clinical notes, X-ray /USG -chest clinical notes
HDU
2A.M1.00031B : Bacterial/ fungal endocarditis - ICU
M1 2A.M1.00031B 1800 clinical notes, X-ray /USG -chest clinical notes
without ventilator
2A.M1.00031C : Bacterial/ fungal endocarditis - ICU
M1 2A.M1.00031C 2250 clinical notes, X-ray /USG -chest clinical notes
with ventilator
2A.M1.00036 : Persistent/ Chronic diarrohea -
55 M1 2A.M1.00036 900 Clinical notes Clinical notes
routine ward
M1 2A.M1.00036A 2A.M1.00036A : Persistent/ Chronic diarrohea - HDU 1350 Clinical notes Clinical notes
2A.M1.00036B : Persistent/ Chronic diarrohea - ICU

M1 2A.M1.00036B 1800 Clinical notes Clinical notes
without ventilator
2A.M1.00036C : Persistent/ Chronic diarrohea - ICU
M1 2A.M1.00036C 2250 Clinical notes Clinical notes
with ventilator
2A.M1.00037 : Acute and chronic pancreatitis - clinical notes, Blood examination
routine ward report
2A.M1.00037A : Acute and chronic pancreatitis - clinical notes, Blood examination
M1 2A.M1.00037A 1350 clinical notes, Blood examination report
HDU report
2A.M1.00037B : Acute and chronic pancreatitis - ICU clinical notes, Blood examination
without ventilator report
2A.M1.00037C : Acute and chronic pancreatitis - ICU clinical notes, Blood examination
with ventilator report
Speciality
code
2A.M1.00040 : Neuromuscular disorders - routine
ward
M1 2A.M1.00040A 2A.M1.00040A : Neuromuscular disorders - HDU 1350 clinical notes clinical notes
2A.M1.00040B : Neuromuscular disorders - ICU

without ventilator
2A.M1.00040C : Neuromuscular disorders - ICU with
ventilator
2A.M1.00068 : Blood and blood component

transfusion (admission for a diagnostic procedure
leading to treatment requiring admission, e.g. bone
58 M1 2A.M1.00068 marrow and bone biopsy, endoscopy, liver biopsy, 1000 Blood group matching Clinical notes
bronchoscopy, CT/MRI under GA, broncho-alveolar
lavage, lumbar puncture, muscle biopsy, pleural
aspiration, ascitic tapping etc.)
2A.M1.00071 : High end radiological diagnostic (CT,

MRI, Imaging including nuclear imaging) - can only
59 M1 2A.M1.00071 2500 Clincal notes Clincal notes
be clubbed with medical package. Rs 5000 per
annum limit to a family
2A.M1.00072 : High end histopathology (Biopsies)

and advanced serology investigations - can only be
clubbed with medical package. Rs 5000 per annum
limit to a family
2A.S1.00214A : Hemodialysis per sitting - cross

S1 2A.S1.00214A 1000 ECHO, RFT, CBC RFT, CBC
speciality
2A.S1.00252A : Peritoneal dialysis per sitting - cross
S1 2A.S1.00252A 1000 Clinical notes, Serum Creatinine OT notes
speciality
GENERAL SURGERY
61 S1 2A.S1.00001 2A.S1.00001 : Adventious Burse – Excision 5000 Clinical photo Scar photo
62 S1 2A.S1.00003 2A.S1.00003 : Appendicectomy 5000 Clinical notes, USG report OT note, scar photo, HPE Report
63 S1 2A.S1.00004 2A.S1.00004 : Appendicular Abscess – Drainage 6000 Clinical note, USG report OT note, scar photo
64 S1 2A.S1.00006 2A.S1.00006 : Bakers Cyst – Excision 3000 Clinical photo Scar photo
65 S1 2A.S1.00012 2A.S1.00012 : Breast Lump - Left – Excision 2500 USG/CT, Clinical notes OT note, HPE
66 S1 2A.S1.00013 2A.S1.00013 : Breast Lump - Right – Excision 3250 USG/CT, Clinical notes OT note, HPE
67 S1 2A.S1.00015 2A.S1.00015 : Bursa – Excision 2000 Clinical notes Scar photo
68 S1 2A.S1.00017 2A.S1.00017 : Cervial Lymphnodes – Excision 1000 USG/Biopsy/ FNAC USG, HPE Report
69 S1 2A.S1.00018 2A.S1.00018 : Colostomy 10000 Biopsy of the primary + CT Scan with Clinical Photograph of operated site
70 S1 2A.S1.00019 2A.S1.00019 : Cyst over Scrotum – Excision 1000 Clinical Photograph, USG OT notes, Scar photo
71 S1 2A.S1.00020 2A.S1.00020 : Cystic Mass – Excision 2000 X-ray/ CT, Clinical Photo Scar Photo
72 S1 2A.S1.00021 2A.S1.00021 : Dermoid Cyst - Large – Excision 2000 Clinical photo Scar photo
Speciality
code
73 S1 2A.S1.00022 2A.S1.00022 : Dermoid Cyst - Small – Excision 1000 Clinical photo Scar photo
74 S1 2A.S1.00023 2A.S1.00023 : Drainage of Ischio Rectal Abscess 2000 clinical notes OT notes
75 S1 2A.S1.00024 2A.S1.00024 : Incision and Drainage of large Abscess 2000 Clinical notes, Clinical Photo OT notes, Clinical photo
76 S1 2A.S1.00025 2A.S1.00025 : Drainage of Psoas Abscess 3750 CT/USG , clinical notes, X-Ray of spine Clinical photo, OT notes
Clinical Photograph showing scar ( if
77 S1 2A.S1.00031 2A.S1.00031 : Hydrocele + Orchidectomy 4000 USG scrotum, Tumour markers
patient consents)+ HPE report
78 S1 2A.S1.00032 2A.S1.00032 : Epidedectomy 4000 Clinical notes + USG Clinical photo, OT notes
79 S1 2A.S1.00033 2A.S1.00033 : Epididymal Swelling –Excision 3000 Clinical notes + USG Clinical photo, OT notes
80 S1 2A.S1.00034 2A.S1.00034 : Epidymal Cyst 2000 Clinical notes + USG Clinical photo, OT notes
81 S1 2A.S1.00035 2A.S1.00035 : Evacuation of Scrotal Hematoma 2500 Clinical notes + USG Clinical photo, OT notes
82 S1 2A.S1.00038 2A.S1.00038 : Drainage of liver Abscess 4000 CT/USG - abdomen Clinical photo, OT notes
83 S1 2A.S1.00039 2A.S1.00039 : Excision Filarial Scrotum 2500 Clinical notes + USG Clinical photo, OT notes
84 S1 2A.S1.00040 2A.S1.00040 : Excision Mammary Fistula 2750 USG, Fistulogram Scar Photo, HPE Report
85 S1 2A.S1.00042 2A.S1.00042 : Excision Pilonidal Sinus 4000 Clinical photo OT notes, HPE
86 S1 2A.S1.00047 2A.S1.00047 : Excision of Large Swelling in Hand 1500 Clinical photo OT notes, HPE
87 S1 2A.S1.00048 2A.S1.00048 : Excision of Small Swelling in Hand 750 Clinical photo OT notes, HPE
88 S1 2A.S1.00049 2A.S1.00049 : Excision of Neurofibroma 1500 Clinical photo OT notes, HPE

89 S1 2A.S1.00050 2A.S1.00050 : Exicision of Sinus and Curettage 2500 Clinical photo, Sinogram OT notes, HPE
90 S1 2A.S1.00052 2A.S1.00052 : Fibrodenoma – Unilateral 3500 Clinical notes + USG HPE
91 S1 2A.S1.00053 2A.S1.00053 : Fissurectomy 4000 Clinical notes OT notes
2A.S1.00054 : Fissurectomy and
92 S1 2A.S1.00054 6000 Clinical notes OT notes
Haemorrhoidectomy
93 S1 2A.S1.00055 2A.S1.00055 : Eversion of Hydrocele Sac – Bilateral 5000 Clinical Photograph, USG Clinical Notes
94 S1 2A.S1.00056 2A.S1.00056 : Eversion of Hydrocele Sac – Unilateral 2500 Clinical Photograph, USG Clinical Notes
2A.S1.00060 : G J Vagotomy/ Vagotomy +

95 S1 2A.S1.00060 7500 Biopsy , CT-Scan , Endoscopy , USG HPR, Clinical Photograph
Pyloroplasty
96 S1 2A.S1.00061 2A.S1.00061 : Ganglion - large – Excision 1500 clinical photograph clinical photograph & Scar photo
97 S1 2A.S1.00062 2A.S1.00062 : Ganglion - Small – Excision 1000 clinical photograph clinical photograph & Scar photo
98 S1 2A.S1.00066 2A.S1.00066 : Granuloma – Excision 1000 clinical photograph Scar photo

99 S1 2A.S1.00067 2A.S1.00067 : Haemangioma – Excision (large) 5000 clinical photograph Doppler
100 S1 2A.S1.00069 2A.S1.00069 : Haemorrhage of Small Intestine 7500 Endoscopy/ CT Abdomen Clinical Photograph, HPE report
Clinical Notes, Scar photo and OT
101 S1 2A.S1.00071 2A.S1.00071 : Hernia – Epigastric 5500 USG, Clinical Notes
notes
102 S1 2A.S1.00072 2A.S1.00072 : Hernia – Incisional 7500 USG, Clinical Photograph
notes
Speciality
code
103 S1 2A.S1.00074 2A.S1.00074 : Hernia – Umbilical 5500 USG, Clinical Photograph
notes
104 S1 2A.S1.00075 2A.S1.00075 : Hernia – Femoral 5000 USG, Clinical Notes
notes
105 S1 2A.S1.00076 2A.S1.00076 : Hernioplasty – Inguinal 5000 USG, Clinical Photograph
notes
106 S1 2A.S1.00077 2A.S1.00077 : Herniorraphy 4500 USG, Clinical Photograph Clinical Notes, Scar photo and OT
107 S1 2A.S1.00080 2A.S1.00080 : Hydrocele - Excision – Unilateral 2500 Clinical Photograph Clinical Notes
108 S1 2A.S1.00081 2A.S1.00081 : Hydrocele - Excision – Bilateral 5000 Clinical Photograph Clinical Notes
109 S1 2A.S1.00083 2A.S1.00083 : Infected Bunion Foot – Excision 2000 Clinical Photograph Scar photograph
110 S1 2A.S1.00096 2A.S1.00096 : Lipoma excision 1250 Clinical Photo HPR, Scar photo
111 S1 2A.S1.00108 2A.S1.00108 : Papilloma Rectum – Excision 2000 CT Scan, Colonoscopy OT Notes / Post-op CT
112 S1 2A.S1.00110 2A.S1.00110 : Growth in the Scalp – Excision 2000 Biopsy, Clinical photo Scar photo
113 S1 2A.S1.00116 2A.S1.00116 : Rectal Dilatation 1000 Clinical notes Procedure Notes
114 S1 2A.S1.00118 2A.S1.00118 : Rectopexy 5000 Clinical Findings Procedure Notes
Clinical notes, Practoscopy findings,
115 S1 2A.S1.00123 2A.S1.00123 : Haemorroidectomy 2500 OT Notes
Colonoscopy in elderly
116 S1 2A.S1.00126 2A.S1.00126 : Scrotal Swelling (Multiple) – Excision 2500 Clinical Photograph, USG OT notes, Scar photo
Endoscopy , USG , X-Ray Abdomen-

117 S1 2A.S1.00128 2A.S1.00128 : Simple closure - Peptic perforation 7500 Scar photo, HPE
Erect Posture
118 S1 2A.S1.00129 2A.S1.00129 : Sinus – Excision 2500 Sinogram Scar photo
119 S1 2A.S1.00130 2A.S1.00130 : Soft Tissue Tumor (small) – Excision 2500 Clinical notes, clinical photo Scar photo, HPE
120 S1 2A.S1.00132 2A.S1.00132 : Splenectomy 12500 CT/ MRI Scar photo
121 S1 2A.S1.00133 2A.S1.00133 : Submandibular Lymph node – Excision 2500 Clinical Photograph, HPE Scar Photo, HPE Report
122 S1 2A.S1.00135 2A.S1.00135 : Swelling in foot (small) – Excision 750 Clinical Photograph, X-ray Scar photo, HPE
123 S1 2A.S1.00136 2A.S1.00136 : Swelling in foot (large) – Excision 1750 Clinical Photograph, X-ray Scar photo, HPE
124 S1 2A.S1.00141 2A.S1.00141 : Umbilical Sinus – Excision 2500 Sinogram Scar photo
125 S1 2A.S1.00142 2A.S1.00142 : Varicose Veins - Excision and Ligation 5000 Venous Doppler Scar photo
126 S1 2A.S1.00154 2A.S1.00154 : Cholecystostomy 5000 Contrast X-ray, CT Clinical Photograph, HPE report
2A.S1.00161 : Excision and Skin Graft of Venous
127 S1 2A.S1.00161 7500 Clinical notes Scar photo
Ulcer
128 S1 2A.S1.00169 2A.S1.00169 : Total thyroidectomy 10000 Clinical Photograph , USG , X-RAY Scar photo, HPE
129 S1 2A.S1.00191 2A.S1.00191 : Ligation of Ankle Perforators 5250 Doppler OT Notes
130 S1 2A.S1.00208 2A.S1.00208 : Intercostal drainage 4000 X-ray X-ray
131 S1 2A.S1.00214 2A.S1.00214 : Hemodialysis per sitting 1000 ECHO, RFT, CBC RFT, CBC
132 S1 2A.S1.00244 2A.S1.00244 : Debridement of Ulcer-Leprosy 2500 Clinical photo, x-ray Scar photo, X-Ray
2A.S1.00248 : Hernia - Repair & release of Clinical Notes, Scar photo and OT
133 S1 2A.S1.00248 10000 USG
obstruction+ Hernioplasty notes
Speciality
code
2A.S1.00249 : Aspiration of cold Abscess of
134 S1 2A.S1.00249 1500 Clinical photo, x-ray chest Scar photo, HPE
Lymphnode
135 S1 2A.S1.00250 2A.S1.00250 : Aspiration of Empyema 1000 Chest X-ray C&S Report, X-Ray
136 S1 2A.S1.00252 2A.S1.00252 : Peritoneal dialysis per sitting 1000 Clinical notes, Serum Creatinine OT notes
137 S1 2A.S1.00253 2A.S1.00253 : Vasectomy 1250 Clinical notes OT notes
MENTAL DISORDER PACKAGES
2A.M8.00001 : Organic, including symptomatic,
138 M8 2A.M8.00001 750 Clinical notes, CT brain Clinical notes, CT brain
mental disorders (routine ward)
2A.M8.00002 : Mental and Behavioural disorders

due to psychoactive substance use (routine ward)
2A.M8.00003 : Schizophrenia, schizotypal and

delusional disorders (routine ward)
2A.M8.00004 : Mood (affective) disorders (routine
ward)
2A.M8.00009 : Mental and Behavioural disorders

due to psychoactive substance use (HDU)
2A.M8.00010 : Schizophrenia, schizotypal and

delusional disorders (HDU)
2A.M8.00012 : Neurotic, stress-related and
somatoform disorders (HDU)
2A.M8.00013 : Behavioural syndromes associated
145 M8 2A.M8.00013 with physiological disturbances and physical factors 1250 Clinical notes Clinical notes
(HDU)
146 M8 2A.M8.00014 2A.M8.00014 : Mental Retardation (HDU) 1250 Clinical notes Clinical notes
NEONATAL AND PAEDIATRICS
147 M2 2A.M2.00001 2A.M2.00001 : Diarrhoea - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00001A 2A.M2.00001A : Diarrhoea - HDU 1350 Clinical note with Lab reports Treatment note
M2 2A.M2.00001B 2A.M2.00001B : Diarrhoea - ICU without ventilator 1800 Clinical note with Lab reports Treatment note
M2 2A.M2.00001C 2A.M2.00001C : Diarrhoea - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
148 M2 2A.M2.00002 2A.M2.00002 : Acute dysentery - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00002A 2A.M2.00002A : Acute dysentery - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00002B : Acute dysentery - ICU without
M2 2A.M2.00002B 1800 Clinical note with Lab reports Treatment note
ventilator
2A.M2.00002C : Acute dysentery - ICU with
M2 2A.M2.00002C 2250 Clinical note with Lab reports Treatment note
ventilator
149 M2 2A.M2.00003 2A.M2.00003 : Pneumonia - routine ward 900 Clinical Notes with relevant Treatment Notes
M2 2A.M2.00003A 2A.M2.00003A : Pneumonia - HDU 1350 Clinical Notes with relevant Treatment Notes
Clinical Notes with relevant
M2 2A.M2.00003B 2A.M2.00003B : Pneumonia - ICU without ventilator 1800 Treatment Notes
investigations
M2 2A.M2.00003C 2A.M2.00003C : Pneumonia - ICU with ventilator 2250 Treatment Notes
investigations
Speciality
code
150 M2 2A.M2.00004 2A.M2.00004 : Urinary tract infection - routine ward 900 Treatment Notes
investigations
M2 2A.M2.00004A 2A.M2.00004A : Urinary tract infection - HDU 1350 Clinical Notes with relevant Treatment Notes
2A.M2.00004B : Urinary tract infection - ICU without Clinical Notes with relevant
M2 2A.M2.00004B 1800 Treatment Notes
ventilator investigations
2A.M2.00004C : Urinary tract infection - ICU with Clinical Notes with relevant
M2 2A.M2.00004C 2250 Treatment Notes
2A.M2.00006 : Acute glomerulonephritis - routine
151 M2 2A.M2.00006 900 Clinical note with Lab reports Treatment note
ward
M2 2A.M2.00006A 2A.M2.00006A : Acute glomerulonephritis - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00006B : Acute glomerulonephritis - ICU

without ventilator
2A.M2.00006C : Acute glomerulonephritis - ICU with
ventilator
152 M2 2A.M2.00013 2A.M2.00013 : Trauma - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00013A 2A.M2.00013A : Trauma - HDU 1350 Clinical note with Lab reports Treatment note
M2 2A.M2.00013B 2A.M2.00013B : Trauma - ICU without ventilator 1800 Clinical note with Lab reports Treatment note
M2 2A.M2.00013C 2A.M2.00013C : Trauma - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
2A.M2.00014 : Pyrexia of unexplained origin -
routine ward
2A.M2.00014A : Pyrexia of unexplained origin -
M2 2A.M2.00014A 1350 Clinical note with Lab reports Treatment note
HDU
2A.M2.00014B : Pyrexia of unexplained origin -
2A.M2.00014C : Pyrexia of unexplained origin -
ICU with ventilator
154 M2 2A.M2.00019 2A.M2.00019 : Dysmorphic children - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00019A 2A.M2.00019A : Dysmorphic children - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00019B : Dysmorphic children - ICU without
ventilator
2A.M2.00019C : Dysmorphic children - ICU with
ventilator
155 M2 2A.M2.00020 2A.M2.00020 : Rickets - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00020A 2A.M2.00020A : Rickets - HDU 1350 Clinical note with Lab reports Treatment note
M2 2A.M2.00020B 2A.M2.00020B : Rickets - ICU without ventilator 1800 Clinical note with Lab reports Treatment note
M2 2A.M2.00020C 2A.M2.00020C : Rickets - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
2A.M2.00021 : Unexplained severe anemia - routine
ward
M2 2A.M2.00021A 2A.M2.00021A : Unexplained severe anemia - HDU 1350 Clinical note with Lab reports Treatment note
Speciality
code
2A.M2.00021B : Unexplained severe anemia - ICU
without ventilator
2A.M2.00021C : Unexplained severe anemia - ICU
with ventilator
157 M2 2A.M2.00022 2A.M2.00022 : Short stature - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00022A 2A.M2.00022A : Short stature - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00022B : Short stature - ICU without
ventilator
M2 2A.M2.00022C 2A.M2.00022C : Short stature - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
2A.M2.00023 : Musculoskeletal problems - routine

ward
M2 2A.M2.00023A 2A.M2.00023A : Musculoskeletal problems - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00023B : Musculoskeletal problems - ICU

without ventilator
2A.M2.00023C : Musculoskeletal problems - ICU
with ventilator
2A.M2.00024 : Developmental and behavioral
disorders - routine ward
2A.M2.00024A : Developmental and behavioral
disorders - HDU
2A.M2.00024B : Developmental and behavioral
disorders - ICU without ventilator
2A.M2.00024C : Developmental and behavioral
disorders - ICU with ventilator
2A.M2.00028 : Persistent/ Chronic diarrhea - routine
ward
M2 2A.M2.00028A 2A.M2.00028A : Persistent/ Chronic diarrhea - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00028B : Persistent/ Chronic diarrhea - ICU

without ventilator
2A.M2.00028C : Persistent/ Chronic diarrhea - ICU
with ventilator
2A.M2.00029 : Acute severe malnutrition - routine
ward
M2 2A.M2.00029A 2A.M2.00029A : Acute severe malnutrition - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00029B : Acute severe malnutrition - ICU

without ventilator
2A.M2.00029C : Acute severe malnutrition - ICU with
ventilator
162 M2 2A.M2.00031 2A.M2.00031 : Enteric fever - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00031A 2A.M2.00031A : Enteric fever - HDU 1350 Clinical note with Lab reports Treatment note
Speciality
code
2A.M2.00031B : Enteric fever - ICU without
ventilator
M2 2A.M2.00031C 2A.M2.00031C : Enteric fever - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
163 M2 2A.M2.00032 2A.M2.00032 : Chikungunya - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00032A 2A.M2.00032A : Chikungunya - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00032B : Chikungunya - ICU without
ventilator
M2 2A.M2.00032C 2A.M2.00032C : Chikungunya - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
164 M2 2A.M2.00033 2A.M2.00033 : Acute hepatitis - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00033A 2A.M2.00033A : Acute hepatitis - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00033B : Acute hepatitis - ICU without
ventilator
M2 2A.M2.00033C 2A.M2.00033C : Acute hepatitis - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
165 M2 2A.M2.00034 2A.M2.00034 : Kala azar - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00034A 2A.M2.00034A : Kala azar - HDU 1350 Clinical note with Lab reports Treatment note
M2 2A.M2.00034B 2A.M2.00034B : Kala azar - ICU without ventilator 1800 Clinical note with Lab reports Treatment note
M2 2A.M2.00034C 2A.M2.00034C : Kala azar - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
2A.M2.00038 : Haemolytic uremic syndrome -

routine ward
M2 2A.M2.00038A 2A.M2.00038A : Haemolytic uremic syndrome - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00038B : Haemolytic uremic syndrome - ICU

without ventilator
2A.M2.00038C : Haemolytic uremic syndrome - ICU
with ventilator
167 M2 2A.M2.00039 2A.M2.00039 : ITP - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00039A 2A.M2.00039A : ITP - HDU 1350 Clinical note with Lab reports Treatment note
M2 2A.M2.00039B 2A.M2.00039B : ITP - ICU without ventilator 1800 Clinical note with Lab reports Treatment note
M2 2A.M2.00039C 2A.M2.00039C : ITP - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
168 M2 2A.M2.00040 2A.M2.00040 : Juvenile myasthenia - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00040A 2A.M2.00040A : Juvenile myasthenia - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00040B : Juvenile myasthenia - ICU without
ventilator
2A.M2.00040C : Juvenile myasthenia - ICU with
ventilator
169 M2 2A.M2.00041 2A.M2.00041 : Kawasaki Disease - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00041A 2A.M2.00041A : Kawasaki Disease - HDU 1350 Clinical note with Lab reports Treatment note
Speciality
code
2A.M2.00041B : Kawasaki Disease - ICU without
ventilator
2A.M2.00041C : Kawasaki Disease - ICU with
ventilator
2A.M2.00044 : Immune haemolytic anemia - routine Clinical Notes with relevant
170 M2 2A.M2.00044 900 Treatment Notes
ward investigations
M2 2A.M2.00044A 2A.M2.00044A : Immune haemolytic anemia - HDU 1350 Treatment Notes
investigations
2A.M2.00044B : Immune haemolytic anemia - ICU Clinical Notes with relevant
without ventilator investigations
2A.M2.00044C : Immune haemolytic anemia - ICU Clinical Notes with relevant
with ventilator investigations
171 M2 2A.M2.00045 2A.M2.00045 : Cyanotic spells - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00045A 2A.M2.00045A : Cyanotic spells - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00045B : Cyanotic spells - ICU without
ventilator
M2 2A.M2.00045C 2A.M2.00045C : Cyanotic spells - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
172 M2 2A.M2.00046 2A.M2.00046 : Rheumatic fever - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00046A 2A.M2.00046A : Rheumatic fever - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00046B : Rheumatic fever - ICU without
ventilator
2A.M2.00046C : Rheumatic fever - ICU with
ventilator
173 M2 2A.M2.00047 2A.M2.00047 : Rheumatoid arthritis - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00047A 2A.M2.00047A : Rheumatoid arthritis - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00047B : Rheumatoid arthritis - ICU without
ventilator
2A.M2.00047C : Rheumatoid arthritis - ICU with
ventilator
2A.M2.00054 : Neuromuscular disorders - routine
ward
M2 2A.M2.00054A 2A.M2.00054A : Neuromuscular disorders - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00054B : Neuromuscular disorders - ICU

without ventilator
2A.M2.00054C : Neuromuscular disorders - ICU with
ventilator
175 M2 2A.M2.00063 2A.M2.00063 : Unexplained jaundice - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00063A 2A.M2.00063A : Unexplained jaundice - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00063B : Unexplained jaundice - ICU without
ventilator
Speciality
code
2A.M2.00063C : Unexplained jaundice - ICU with
ventilator
176 M2 2A.M2.00073 2A.M2.00073 : Liver abscess - routine ward 900 Clinical note with Lab reports Treatment note
M2 2A.M2.00073A 2A.M2.00073A : Liver abscess - HDU 1350 Clinical note with Lab reports Treatment note
2A.M2.00073B : Liver abscess - ICU without
ventilator
M2 2A.M2.00073C 2A.M2.00073C : Liver abscess - ICU with ventilator 2250 Clinical note with Lab reports Treatment note
2A.M2.00100 : Blood and blood component

transfusion for indications like
Thalassemia/Hemoglobinopathies - upto a limit of 2
days
2A.M2.00101 : High end radiological diagnostic (CT,

178 M2 2A.M2.00101 MRI, Imaging including nuclear imaging) - can only 2500 Clinical note CT/MRI report and film
be clubbed with medical package.
2A.M2.00102 : High end histopathology (Biopsies)

179 M2 2A.M2.00102 and advanced serology investigations - can only be 2500 Clinical note HPE and Lab report
clubbed with medical package.
180 S14 2A.S14.00003 2A.S14.00003 : Hernia & Hydrocele 10000 X-ray abdomen or Ultrasound abdomen Scan Photography
2A.S14.00005 : Undescended Testis - Bilateral-Palp +

181 S14 2A.S14.00005 7500 Clinical examination Clinical examination
Nonpalp
2A.S14.00006 : Undescended Testis - Bilateral
182 S14 2A.S14.00006 7500 USG and Clinical notes OT note
Palpable
2A.S14.00007 : Undescended Testis - Bilateral Non-
183 S14 2A.S14.00007 10000 USG and Clinical notes OT note
Palpable
2A.S14.00029 : Rectal Polypectomy - Sigmoiescopic
184 S14 2A.S14.00029 4000 USG,CT report OT note and HPE report
(Ga)
2A.M1.00001D : Acute gastroenteritis with moderate Relevant Hematological investigations,

M1 2A.M1.00001D 900 Treatment notes
dehydration - routine ward - cross speciality Clinical notes
2A.M1.00001E : Acute gastroenteritis with moderate Relevant Hematological investigations,

M1 2A.M1.00001E 1350 Treatment notes
dehydration - HDU - cross speciality Clinical notes
2A.M1.00001F : Acute gastroenteritis with moderate Relevant Hematological investigations,

M1 2A.M1.00001F 2250 Treatment notes
dehydration - iCU with ventilator - cross speciality Clinical notes
2A.M1.00001G : Acute gastroenteritis with moderate

M1 2A.M1.00001G dehydration - ICU without ventilator - cross 1800 Treatment notes
Clinical notes
speciality
2A.M1.00003D : Dysentery - routine ward - cross Relevant Hematological investigations,
speciality Clinical notes
Speciality
code
M1 2A.M1.00003E 2A.M1.00003E : Dysentery - HDU - cross speciality 1350 Treatment notes
Clinical notes
2A.M1.00003F : Dysentery - ICU with ventilator - Relevant Hematological investigations,
cross speciality Clinical notes
2A.M1.00003G : Dysentery - ICU without ventilator - Relevant Hematological investigations,
M1 2A.M1.00003G 1800 Treatment notes
cross speciality Clinical notes
2A.M1.00005D : Acute bronchitis - routine ward -
M1 2A.M1.00005D 900 clinical notes clinical notes
cross speciality
2A.M1.00005E : Acute bronchitis - HDU - cross
M1 2A.M1.00005E 1350 clinical notes clinical notes
speciality
2A.M1.00005F : Acute bronchitis - iCU with
M1 2A.M1.00005F 2250 clinical notes clinical notes
ventilator - cross speciality
2A.M1.00005G : Acute bronchitis - ICU without
M1 2A.M1.00005G 1800 clinical notes clinical notes
2A.M1.00009D : Severe anemia - routine ward -
M1 2A.M1.00009D 900 clinical notes, HB% clinical notes, HB%
cross speciality
2A.M1.00009E : Severe anemia - HDU - cross
M1 2A.M1.00009E 1350 clinical notes, HB% clinical notes, HB%
speciality
2A.M1.00009F : Severe anemia - ICU with ventilator
M1 2A.M1.00009F 2250 clinical notes, HB% clinical notes, HB%
- cross speciality
2A.M1.00009G : Severe anemia - ICU without
M1 2A.M1.00009G 1800 clinical notes, HB% clinical notes, HB%
2A.M1.00011D : Acute febrile illness - routine ward -
cross speciality
2A.M1.00011E : Acute febrile illness - HDU - cross
speciality
2A.M1.00011F : Acute febrile illness - ICU with
2A.M1.00011G : Acute febrile illness - ICU without
2A.M1.00014 : Malaria - routine ward - cross clinical notes, Peripheral blood
M1 2A.M1.00014 900 clinical notes
speciality examination report
M1 2A.M1.00014A 2A.M1.00014A : Malaria - HDU - cross speciality 1350 clinical notes
examination report
2A.M1.00014B : Malaria - ICU without ventilator - clinical notes, Peripheral blood
M1 2A.M1.00014B 1800 clinical notes
cross speciality examination report
2A.M1.00014C : Malaria - ICU with ventilator - cross clinical notes, Peripheral blood
M1 2A.M1.00014C 2250 clinical notes
speciality examination report
2A.M1.00015C : Dengue fever - ICU with ventilator - clinical notes, Blood examination
cross speciality report
2A.M1.00015E : Dengue fever - HDU - cross clinical notes, Blood examination
M1 2A.M1.00015E 1350 clinical notes, Blood examination report
speciality report
2A.M1.00015F : Dengue fever - ICU without clinical notes, Blood examination
M1 2A.M1.00015F 1800 clinical notes, Blood examination report
ventilator - cross speciality report
Speciality
code
2A.M1.00015G : Dengue fever - routine ward - cross clinical notes, Blood examination
M1 2A.M1.00015G 900 clinical notes, Blood examination report
speciality report
2A.M1.00017D : Leptospirosis - routine ward - cross
M1 2A.M1.00017D 900 clinical notes, Blood examination report clinical notes
speciality
2A.M1.00017E : Leptospirosis - HDU - cross
M1 2A.M1.00017E 1350 clinical notes, Blood examination report clinical notes
speciality
2A.M1.00017F : Leptospirosis - ICU without
M1 2A.M1.00017F 1800 clinical notes, Blood examination report clinical notes
2A.M1.00017G : Leptospirosis - ICU with ventilator -
M1 2A.M1.00017G 2250 clinical notes, Blood examination report clinical notes
cross speciality
2A.M1.00022D : Acute viral hepatitis - routine ward -
M1 2A.M1.00022D 900 clinical notes, LFT clinical notes, LFT
cross speciality
2A.M1.00022E : Acute viral hepatitis - HDU - cross
M1 2A.M1.00022E 1350 clinical notes, LFT clinical notes, LFT
speciality
2A.M1.00022F : Acute viral hepatitis - ICU with
M1 2A.M1.00022F 2250 clinical notes, LFT clinical notes, LFT
2A.M1.00022G : Acute viral hepatitis - ICU without
M1 2A.M1.00022G 1800 clinical notes, LFT clinical notes, LFT
2A.M1.00029D : Vasculitis - routine ward - HDU -
cross speciality
M1 2A.M1.00029E 2A.M1.00029E : Vasculitis - HDU - cross speciality 1350 clinical notes clinical notes
2A.M1.00029F : Vasculitis - ICU with ventilator -

HDU - cross speciality
2A.M1.00029G : Vasculitis - ICU without ventilator -
2A.M1.00031D : Bacterial/ fungal endocarditis -
M1 2A.M1.00031D 900 clinical notes, X-ray /USG -chest clinical notes
routine ward - cross speciality
2A.M1.00031E : Bacterial/ fungal endocarditis -
M1 2A.M1.00031E 1350 clinical notes, X-ray /USG -chest clinical notes
2A.M1.00031F : Bacterial/ fungal endocarditis - ICU
M1 2A.M1.00031F 2250 clinical notes, X-ray /USG -chest clinical notes
with ventilator - cross speciality
2A.M1.00031G : Bacterial/ fungal endocarditis - ICU
M1 2A.M1.00031G 1800 clinical notes, X-ray /USG -chest clinical notes
without ventilator - cross speciality
2A.M1.00037D : Acute and chronic pancreatitis - clinical notes, Blood examination
M1 2A.M1.00037D 900 clinical notes, Blood examination report
routine ward - cross speciality report
2A.M1.00037E : Acute and chronic pancreatitis - ICU clinical notes, Blood examination
without ventilator - cross speciality report
2A.M1.00037F : Acute and chronic pancreatitis - ICU clinical notes, Blood examination
with ventilator - cross speciality report
2A.M1.00037G : Acute and chronic pancreatitis - clinical notes, Blood examination
HDU - cross speciality report
Speciality
code
2A.M1.00068A : Blood and blood component

transfusion (admission for a diagnostic procedure
leading to treatment requiring admission, e.g. bone
M1 2A.M1.00068A marrow and bone biopsy, endoscopy, liver biopsy, 1000 Blood group matching Clinical notes
bronchoscopy, CT/MRI under GA, broncho-alveolar
lavage, lumbar puncture, muscle biopsy, pleural
aspiration, ascitic tapping etc.) - cross speciality
2A.M1.00004BG : Renal colic - ICU without ventilator

M1 2A.M1.00004BG 1800 clinical notes clinical notes
- cross speciality
2A.M1.00004D : Renal colic - routine ward - cross
speciality
M1 2A.M1.00004E 2A.M1.00004E : Renal colic - HDU - cross speciality 1350 clinical notes clinical notes
2A.M1.00004F : Renal colic - ICU with ventilator -

cross speciality
M1 2A.M1.00013D 2A.M1.00013D : UTI - routine ward - cross speciality 900 clinical notes, Urine - C/S clinical notes
M1 2A.M1.00013E 2A.M1.00013E : UTI - HDU - cross speciality 1350 clinical notes, Urine - C/S clinical notes
2A.M1.00013F : UTI - ICU with ventilator - cross
M1 2A.M1.00013F 2250 clinical notes, Urine - C/S clinical notes
speciality
2A.M1.00013G : UTI - ICU without ventilator - cross
M1 2A.M1.00013G 1800 clinical notes, Urine - C/S clinical notes
speciality
2A.M1.00027D : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
M1 2A.M1.00027D 900 clinical notes, X-ray chest
routine ward - cross speciality chest
2A.M1.00027E : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray
M1 2A.M1.00027E 1350 clinical notes, X-ray chest
HDU - cross speciality chest
2A.M1.00027F : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray

M1 2A.M1.00027F 1800 clinical notes, X-ray chest
ICU without ventilator - cross speciality chest
2A.M1.00027G : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray

M1 2A.M1.00027G 2250 clinical notes, X-ray chest
ICU with ventilator - cross speciality chest
2A.M1.00026D : Pyrexia of unknown origin - clinical notes, Blood examination

M1 2A.M1.00026D 900 clinical notes, Blood examination report
routine ward - cross speciality report
2A.M1.00026E : Pyrexia of unknown origin - HDU - clinical notes, Blood examination
cross speciality report
2A.M1.00026F : Pyrexia of unknown origin - ICU with clinical notes, Blood examination
ventilator - cross speciality report
2A.M1.00026G : Pyrexia of unknown origin - ICU clinical notes, Blood examination
without ventilator - cross speciality report
Speciality
code
2A.M1.00028D : Systematic lupus erythematosus -

routine ward - cross speciality
2A.M1.00028E : Systematic lupus erythematosus -

2A.M1.00028F : Systematic lupus erythematosus -

ICU with ventilator - cross speciality
2A.M1.00028G : Systematic lupus erythematosus -

ICU without ventilator - cross speciality
NEUROSURGERY
2A.S8.00004 : Carpal Tunnel Release including pre
185 S8 2A.S8.00004 5000 MRI clinical photograph
and post Op. MRI
OBSTETRICS AND GYNAECOLOGY
2A.S4.00001 : Hysterectomy ± Salpingo- Clinical Photograph showing scar +
186 S4 2A.S4.00001 10000 CT report and Film, Biopsy
oophorectomy HPE report
187 S4 2A.S4.00002 2A.S4.00002 : Abdominal Myomectomy 8000 Ultrasonography/ Tubal patency test HPE, OT notes
APTT(activated partial thromboplastin

2A.S4.00004 : Surgeries for Stress Incontinence time) , Heamatocrit , PT (Prothrombin Clinical Photograph of Retroplacental
188 S4 2A.S4.00004 17500
'Burch' time), Platelet Count , S.Fibrinogen Level clots , USG
, USG
2A.S4.00005 : Hysterotomes - 2nd Trimester
189 S4 2A.S4.00005 2500 USG and clinical notes Clinical note
abortions
190 S4 2A.S4.00006 2A.S4.00006 : Incisional Hernia Repair 7500 USG and clinical notes Clinical Photograph and OT note
Clinical Photograph showing scar +
191 S4 2A.S4.00007 2A.S4.00007 : Radical Hysterectomy (Wertheims) 10000 CT report and Film, Biopsy
HPE report
Clinical notes and relevant lab
192 S4 2A.S4.00009 2A.S4.00009 : Non descent vaginal hysterectomy 7000 HPR,OT notes
investigations
193 S4 2A.S4.00017 2A.S4.00017 : Dilation and Evacuation (D&E) 2500 USG and clinical notes OT note and HPE
194 S4 2A.S4.00018 2A.S4.00018 : Cervical biopsy and Polypectomy 1500 USG and clinical notes OT note and HPE
2A.S4.00019 : Bartholins Cyst Enucleation/ Incision

195 S4 2A.S4.00019 1500 Clinical notes OT note
drainage
196 S4 2A.S4.00032 2A.S4.00032 : Hysteroscopic polypectomy 1500 USG and clinical notes OT note and HPE
197 S4 2A.S4.00033 2A.S4.00033 : Hysteroscopic IUCD removal 1500 X-ray,USG and Clinical note OT note
198 S4 2A.S4.00034 2A.S4.00034 : Caesarian Delivery 4500 USG and clinical notes OT Note
199 S4 2A.S4.00035 2A.S4.00035 : Caesarian hysterectomy 8000 USG and clinical notes OT note and HPE
200 S4 2A.S4.00045 2A.S4.00045 : MTP > 12 weeks 1500 USG and clinical notes Procedure Note
201 S4 2A.S4.00046 2A.S4.00046 : MTP upto 12 weeks 2500 USG and clinical notes Procedure Note
202 S4 2A.S4.00047 2A.S4.00047 : MTP upto 8 weeks 1750 USG and clinical notes Procedure Note
Speciality
code
2A.S4.00051 : Laparotomy for broad ligament
203 S4 2A.S4.00051 8000 USG and clinical notes OT Note
haematoma
2A.S4.00054 : Ablation of Endometriotic Spot +
Adhenolysis
205 S4 2A.S4.00061 2A.S4.00061 : Cone Biopsy Cervix 500 USG and clinical notes OT note and HPE
206 S4 2A.S4.00062 2A.S4.00062 : Conventional Tubectomy 2000 Clinical note OT note
207 S4 2A.S4.00063 2A.S4.00063 : Cyst -Vaginal Enucleation 1500 Clinical note OT note and HPE
208 S4 2A.S4.00064 2A.S4.00064 : Cyst-Labial 1500 Clinical note OT note
2A.S4.00067 : D&C (Dilatation &curretage) + Electro
Cauterisation Cryo Surgery
210 S4 2A.S4.00068 2A.S4.00068 : D&C (Dilatation&curretage) 1500 USG and clinical notes OT Note
211 S4 2A.S4.00072 2A.S4.00072 : Fractional Curretage 2000 USG and clinical notes OT Note and HPE
2A.S4.00073 : Gaping Perineal wound secondary
212 S4 2A.S4.00073 1250 Clinical note OT note
suturing/ episiotomy
213 S4 2A.S4.00075 2A.S4.00075 : Hymenectomy& Repair of Hymen 3500 USG and clinical notes OT Note
OT Note and Aminiotic fluid analysis

214 S4 2A.S4.00076 2A.S4.00076 : Amniocentesis 2500 USG and clinical notes
report
ONCOLOGY
2A.S15.00007A : Cyst & tumour of Maxilla/mandible
X Ray film with report,Clinical X Ray film with report, Clinical
S15 2A.S15.00007A by enucleation/excision/marsupialization under LA - 1250
Photograph, Photograph
cross speciality
OPTHALMOLOGY
215 S3 2A.S3.00001 2A.S3.00001 : Buckle Removal 2500 clinical notes Procedure notes
216 S3 2A.S3.00007 2A.S3.00007 : Pterygium + ConjunctivalAutograft 4500 Clinical Photograph Clinical Photograph
217 S3 2A.S3.00008 2A.S3.00008 : Dacryocystectomy with implants 5000 Sac Synrige Report Procedure notes
Hematological and radiological
218 S3 2A.S3.00016 2A.S3.00016 : Limbal Dermoid Removal 2000 clinical notes
investigations
2A.S3.00029 : Cataract with foldable hydrophobic

219 S3 2A.S3.00029 3750 A Scan Report patient photograph
acrylic IOL by Phaco emulsification tech
2A.S3.00030 : Cataract with non-foldable IOL using

220 S3 2A.S3.00030 2500 A Scan Report Clinical Photograph
SICS technique
221 S3 2A.S3.00033 2A.S3.00033 : Conjunctival tumour excision + AMG 2500 Clinical Photograph Clinical notes
222 S3 2A.S3.00034 2A.S3.00034 : Entropion correction 2000 Clinical Photograph patient photograph
223 S3 2A.S3.00035 2A.S3.00035 : Ectropion correction 2500 Clinical Photograph patient photograph
224 S3 2A.S3.00036 2A.S3.00036 : Evisceration 1750 Clinical Photograph Clinical Photograph
225 S3 2A.S3.00038 2A.S3.00038 : Lid tear 2500 Clinical Photograph Clinical Photograph
Speciality
code
ORTHOPAEDICS
2A.S5.00001 : AC joint reconstruction/ Stabilization/
Acromionplasty (Nonoperative management is
recommended for Rockwood type I and II injuries,
226 S5 2A.S5.00001 whereas surgical reconstruction is recommended for 12500 X-ray X-Ray, Scar photo
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)
2A.S5.00002 : Accessory bone – Excision (limbs) –

227 S5 2A.S5.00002 congenital, Accessory digits sometime can be 3000 X-ray, Clinical photo Scar photo, X-Ray
removed
X-ray, clinical photo of the part, HPE for
228 S5 2A.S5.00003 2A.S5.00003 : Amputation - Below Elbow 7500 Scar photo, X-Ray, HPE for tumours
tumours
229 S5 2A.S5.00004 2A.S5.00004 : Amputation - Above Elbow 9000 X-ray X-ray
230 S5 2A.S5.00005 2A.S5.00005 : Amputation – one or more fingers 3000 X-ray Scar photo, X-Ray
231 S5 2A.S5.00006 2A.S5.00006 : Amputation – Wrist 7500 X-ray Scar photo, X-Ray
232 S5 2A.S5.00007 2A.S5.00007 : Amputation - one or more toes/ digits 3000 X-ray Scar photo, X-Ray
X-ray, clinical photo of the part, HPE for

233 S5 2A.S5.00008 2A.S5.00008 : Amputation – Below Knee 7500 Scar photo, X-Ray, HPE for tumours
tumours
234 S5 2A.S5.00009 2A.S5.00009 : Amputation – Above Knee 10000 X-ray X-ray
2A.S5.00010 : Foot & Hand Amputation (whole/ X-ray, clinical photo of the part, HPE for
235 S5 2A.S5.00010 7500 Scar photo, X-Ray, HPE for tumours
partial) tumours
2A.S5.00014 : Osteochondroma excision/ Excision of
236 S5 2A.S5.00014 5000 X-ray Scar photo, X-Ray
Exostosis
237 S5 2A.S5.00015 2A.S5.00015 : Excision Arthoplasty 7500 X-ray, CT/MRI Scar photo, X-Ray
238 S5 2A.S5.00016 2A.S5.00016 : Arthorotomy of any joint 7500 X-ray, Rountine Blood Inv. Biopsy X-Ray, Scar photo
239 S5 2A.S5.00017 2A.S5.00017 : Arthrodesis Ankle Triple 7500 X-RAY, Fluid Analysis/Biospy X-Ray, Scar photo
240 S5 2A.S5.00018 2A.S5.00018 : Excision Arthoplasty of Femur head 11250 X-ray, CT/MRI Scar photo, X-Ray
2A.S5.00023 : Clavicle fracture management -

241 S5 2A.S5.00023 1500 X-ray X-Ray
conservative (daycare)
242 S5 2A.S5.00024 2A.S5.00024 : Close Fixation - Hand Bones 2000 X-ray X-Ray showing implant
243 S5 2A.S5.00025 2A.S5.00025 : Close Fixation - Foot Bones 2000 X-ray X-Ray showing implant
244 S5 2A.S5.00026 2A.S5.00026 : Close Reduction - Small Joints 2000 X-ray x-ray
2A.S5.00029 : Closed Interlocking Tibia + Orif of Post-operative X-ray, Clinical
245 S5 2A.S5.00029 15000 X-RAY/CT scan(If Required)
Fracture Fixation Photograph showing scar
2A.S5.00032 : Closed Reduction and Percutaneous
246 S5 2A.S5.00032 7500 X Ray Scar photo, x-ray showing implant
Pinning
2A.S5.00034 : Closed Reduction of the Hip
247 S5 2A.S5.00034 3500 X-ray Post-op X-ray, Scar photo
(including hip Spika)
Speciality
code
2A.S5.00036 : Debridement & Closure of Minor
248 S5 2A.S5.00036 1500 Clinical Notes + X-Rays Clinical Notes + X-Rays
injuries
2A.S5.00037 : Closed reduction of dislocation (Knee/
249 S5 2A.S5.00037 3000 X-ray X-ray, scar photo
Hip)
2A.S5.00038 : Closed reduction of dislocation Patient Photo with Arthroscopic
250 S5 2A.S5.00038 2500 X-ray
(Shoulder/ Elbow) incision
2A.S5.00039 : Duputryen’s Contracture release +
251 S5 2A.S5.00039 5000 clinical notes & photograph clinical notes & photograph
rehabilitation
Xray Films(if relevant)+ Clinical
252 S5 2A.S5.00040 2A.S5.00040 : Exploration and Ulnar nerve Repair 5000 Clinical photo showing Scar
Picture(Mandatory) + detail notes
Post-operative X-ray, Clinical
253 S5 2A.S5.00042 2A.S5.00042 : External fixation - Small bone 5000 X-RAY/CT scan(If Required)
Photograph showing scar
254 S5 2A.S5.00047 2A.S5.00047 : Fracture - Fibula Internal Fixation 5000 X-ray Scar photo, X-ray
255 S5 2A.S5.00050 2A.S5.00050 : Fracture - Olecranon of Ulna 5000 X-ray Scar photo, X-ray
256 S5 2A.S5.00051 2A.S5.00051 : Fracture - Radius Internal Fixation 5000 X-ray Scar photo, X-ray
2A.S5.00052 : Fracture - TIBIA Internal Fixation

257 S5 2A.S5.00052 8500 X-ray Scar photo, X-ray
plating
258 S5 2A.S5.00053 2A.S5.00053 : Fracture - Ulna Internal Fixation 5000 X-ray Scar photo, X-ray
259 S5 2A.S5.00054 2A.S5.00054 : Head Radius – Excision 4000 X-ray Scar photo, X-ray
260 S5 2A.S5.00055 2A.S5.00055 : High Tibial Osteotomy 8500 Clinical photo, X-ray Scar photo, X-ray
261 S5 2A.S5.00056 2A.S5.00056 : Closed reduction + Hip Spica 3500 X-ray Clinical photo with spica, X-ray
262 S5 2A.S5.00057 2A.S5.00057 : Internal Fixation Lateral Epicondyle 5000 X-ray Scar photo, X-ray
2A.S5.00058 : Internal Fixation of other Small Bones

263 S5 2A.S5.00058 5000 X-ray X-ray
(metatarsals)
2A.S5.00063 : Nerve Transposition/Release/
264 S5 2A.S5.00063 4000 Clinical Photograph Scar photo
Neurolysis
265 S5 2A.S5.00067 2A.S5.00067 : Open Reduction of Small Joint 7500 X-ray Scar photo, X-ray
266 S5 2A.S5.00069 2A.S5.00069 : Osteotomy -Small Bone 8500 X-ray Scar photo, X-ray
267 S5 2A.S5.00070 2A.S5.00070 : Osteotomy -Long Bone 15000 X-ray Scar photo, X-ray
268 S5 2A.S5.00071 2A.S5.00071 : Patellectomy 4000 X-ray Scar photo, X-ray
269 S5 2A.S5.00073 2A.S5.00073 : Percutaneous - Fixation of Fracture 3500 X-ray X-ray
270 S5 2A.S5.00074 2A.S5.00074 : Excision of Bursa 1500 Clinical photo Scar photo
Speciality
code
2A.S5.00076 : Sequestrectomy of Long Bones + anti-
271 S5 2A.S5.00076 12500 X-ray, Clinical photo X-ray
biotics + dressing
272 S5 2A.S5.00077 2A.S5.00077 : Tendo Achilles Tenotomy 2500 Clinical photo Clinical photo
273 S5 2A.S5.00079 2A.S5.00079 : Tendon Release/ Tenotomy 2500 Clinical photo Clinical photo
274 S5 2A.S5.00080 2A.S5.00080 : Tenolysis 2500 Clinical photo Clinical photo
275 S5 2A.S5.00081 2A.S5.00081 : Tension Band Wiring Patella 7500 X-ray Scar photo, X-ray
2A.S5.00082 : Application of P.O.P. casts for Upper &
276 S5 2A.S5.00082 1500 X-ray Clinical photo, X-ray
Lower Limbs
277 S5 2A.S5.00083 2A.S5.00083 : Application of P.O.P. Spikas& Jackets 1750 X-ray Clinical photo, X-ray
2A.S5.00084 : Application of Skeletal Tractions with

278 S5 2A.S5.00084 1500 X-ray Clinical photo, X-ray
pin
279 S5 2A.S5.00085 2A.S5.00085 : Application of Skin Traction 500 Clinical notes Clinical photo
2A.S5.00086 : Head radius - Excision + Fracture -
280 S5 2A.S5.00086 10000 X-ray Scar photo, X-ray
Ulna Internal Fixation
281 S5 2A.S5.00089 2A.S5.00089 : Correction of club foot per cast 7500 Clinical photo Clinical photo with POP
282 S5 2A.S5.00098 2A.S5.00098 : Arthrodesis of shoulder 20000 X-ray Scar photo, X-ray
2A.S8.00004A : Carpal Tunnel Release including pre

S8 2A.S8.00004A 5000 MRI clinical photograph
and post Op. MRI - cross speciality
2A.S1.00244A : Debridement of Ulcer-Leprosy -

S1 2A.S1.00244A 2500 Clinical photo, x-ray Scar photo, X-Ray
cross speciality
UROLOGY
2A.S7.00032 : Perinephric Abscess drainage
283 S7 2A.S7.00032 5000 USG Scar photo
(percutaneous)
284 S7 2A.S7.00067 2A.S7.00067 : Diagnostic Cystoscopy 2500 Clinical Notes Investigation Report
285 S7 2A.S7.00109 2A.S7.00109 : Reduction of Paraphimosis 750 Clinical Photograph Clinical Photograph
286 S7 2A.S7.00111 2A.S7.00111 : Meatoplasty 1750 Clinical photograph Operative photograph
287 S7 2A.S7.00112 2A.S7.00112 : Meatotomy 1750 Clinical photograph Operative photograph
2A.S7.00121 : Urethral Dilatation-non endocopic as
288 S7 2A.S7.00121 1000 CT Scan Clinical Photograph
an independent procedure

289 S7 2A.S7.00140 2A.S7.00140 : Orchiectomy-simple 5000 USG scrotum, Tumour markers
2A.S7.00148 : Varicocele-unilateral-non
290 S7 2A.S7.00148 5000 USG, Clinical photograph Clinical Photograph
microsurgical
291 S7 2A.S7.00149 2A.S7.00149 : Varicocele-unilateral-microsurgical 6000 USG, Clinical photograph Clinical Photograph
292 S7 2A.S7.00150 2A.S7.00150 : Varicocele-bilateral-non microsurgical 7500 USG, Clinical photograph Clinical Photograph
Operative notes with steps of

293 S7 2A.S7.00153 2A.S7.00153 : Priapism-aspiration/shunt 7500 CT/MRI/USG, clinical notes,
surgery, clinical notes
2A.S7.00159 : Acute management of upper urinary
294 S7 2A.S7.00159 1000 USG Doctors Note
tract trauma – conservative
Speciality
code
COMPLEX SECONDARY CARE
BURNS
2B.S11.17058 : Post Burn Contracture surgeries for
Functional Improvement involving only skin
295 S11 2B.S11.17058 22500 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
(Package including splints,pressure garment and
physiotherapy- Moderate
2b.S13.00077 : Operations for Congenital
296 S13 2b.S13.00077 15000 CT Chest report Post Op X-ray,scar photo
Arteriovenous Fistula
2B.S1.00005C : Arteriovenous (AV) Malformation of

S1 2B.S1.00005C 15000 Clinical Photograph Scar photo
Soft Tissue Tumour - Excision - cross speciality
Clinical notes (should have pre-op exam

S1 2B.S1.00143A 2B.S1.00143A : Vasovasostomy - cross speciality 11000 Clinical photo
of vasectomy site)
2B.S1.00192A : Lymphatics Excision of Subcutaneous

S1 2B.S1.00192A 8000 Clinical Photograph Clinical Photograph
Tissues In Lymphoedema - cross speciality
2b.S13.00077A : Operations for Congenital

S13 2B.S13.00077A 15000 CT Chest report Post Op X-ray,scar photo
Arteriovenous Fistula - cross speciality
2B.S1.00005B : Arteriovenous (AV) Malformation of

S1 2B.S1.00005B 15000 Clinical Photograph Scar photo
S1 2B.S1.00011A 2B.S1.00011A : Branchial Fistula -cross speciality 14000 CT scan, Clinical Photograph clinical
2B.S1.00027A : Drainage Pericardial Effusion - cross

S1 2B.S1.00027A 11000 X -Ray, ECHO X -Ray film with report
speciality
2B.S1.00037A : Excision Bronchial Sinus - cross
S1 2B.S1.00037A 8000 USG/CT Clinical photo, OT notes
speciality
S1 2B.S1.00143B 2B.S1.00143B : Vasovasostomy - cross speciality 11000 Clinical photo
of vasectomy site)
2B.S1.00184A : Laparoscopic Hiatus Hernia Repair -
S1 2B.S1.00184A 20000 UGI ENDOSCOPY Scar photo/ Intra op photo
cross speciality
2B.S1.00206A : Drainage of perivertebral abscess -
S1 2B.S1.00206A 7000 USG/ CT Scan Clinical Photograph
cross speciality
S1 2B.S1.00210A 2B.S1.00210A : Thymectomy - cross speciality 23000 USG Clinical Photograph
2B.S1.00224B : Rib Resection & Drainage - cross
S1 2B.S1.00224B 7500 Chest X-ray, Clinical Photograph Clinical Photograph
speciality
S1 2B.S1.00232A 2B.S1.00232A : Thoracocentesis - cross speciality 1500 X-ray, CT X-ray

2B.S16.00002 : Fixation of fracture of jaw with open
297 S16 2B.S16.00002 reduction (1 jaw) and fixing of plates/ wire – under 9000 X Ray film with report X Ray film with report
GA
298 S16 2B.S16.00003 2B.S16.00003 : Sequestrectomy 1125 X Ray film with report X Ray film with report
Speciality
code
2B.S16.00004 : TM joint ankylosis of both jaws -
299 S16 2B.S16.00004 11250 X Ray film with report X Ray film with report
under GA
2B.S16.00005 : Release of fibrous bands & grafting -
300 S16 2B.S16.00005 2250 Clinical notes 0
in (OSMF) treatment under GA
2B.S16.00008 : Mandible Tumour Resection and X Ray film with report, Clinical
301 S16 2B.S16.00008 4500 X Ray film with report
reconstruction/Cancer surgery Photograph
X Ray film with report, Clinical
302 S16 2B.S16.17174 2B.S16.17174 : Drainage of parotid abscess 5250 X Ray film with report
Photograph
2B.S2.00029A : Antrostomy – Bilateral - cross
S2 2B.S2.00029A 4875 CT PNS Clinical Photograph
speciality
2B.S2.00030A : Antrostomy – Unilateral - cross
S2 2B.S2.00030A 3375 CT PNS Clinical Photograph
speciality
S2 2B.S2.00066A 2B.S2.00066A : Oro Antral fistula - cross speciality 5625 Fistulogram/Clinical photograph Clinical Photograph
2B.S2.00078A : Commondo Operation (glossectomy)

S2 2B.S2.00078A 10500 CT Skull, HPE Clinical Photograph
- cross speciality
2B.S2.00083A : Excision of the Mandible Segmental - X Ray film with report, Routine Blood
S2 2B.S2.00083A 5625 X Ray film with report
cross speciality Inv
2B.S2.00084A : Hemi-mandibulectomy with graft - X Ray film with report, Routine Blood
cross speciality Inv
2B.S1.00044A : Excision of Growth from Tongue only
S1 2B.S1.00044A 4500 Clinical Photograph Scar Photo, HPE Report
- cross speciality
2B.S1.00124A : Salivary Gland – Excision - cross
S1 2B.S1.00124A 7500 Clinical Photograph , FNAC, CT HPR , Scar Photograph
speciality
S1 2B.S1.00145B 2B.S1.00145B : Cleft lip operation - cross speciality 9000 Clinical Photograph Clinical Photograph
2B.S1.00147B : Cleft lip & palate operation (for each

S1 2B.S1.00147B 11250 Clincal note and photograph OT note and clinical photograph
stage) - cross speciality
ENT
303 S2 2B.S2.00002 2B.S2.00002 : Labyrinthectomy 15000 Endoscopy Photo Endoscopy Photo
2B.S2.00004 : Mastoidectomy corticol modified/ CT Temporal Bone , Pure Tone
304 S2 2B.S2.00004 6525 X-Ray Mastoids, Scar photo
radical Audiometry Report
Pure Tone Audiometry Report, Clinical X-Ray Mastoids, Scar photo, Pure
305 S2 2B.S2.00005 2B.S2.00005 : Mastoidectomy with tympanoplasty 5625
notes Tone Audiometry Report
Pure Tone Audiometry Report, Clinical
306 S2 2B.S2.00006 2B.S2.00006 : Myringoplasty 3750 Pure Tone Audiometry Report
notes
Pure Tone Audiometry Report and Pure Tone Audiometry Report and
307 S2 2B.S2.00012 2B.S2.00012 : Ossiculoplasty 5625
Impedance Audiometry Report Impedance Audiometry Report
2B.S2.00014 : Excision of Pinna for Growths

308 S2 2B.S2.00014 (Squamous/Basal) Injuries - Total Amputation & 6000 Clinical Photograph HPR/Clinical photograph
Excision of External Auditory Meatus
Pure Tone Audiometry Report and Clinical Photograph With Piston ,
309 S2 2B.S2.00016 2B.S2.00016 : Stapedectomy 6000
Impedance Audiometry Report Pure Tone Audiometry Report
Speciality
code
2B.S2.00021 : Excision of Pinna for Growth
310 S2 2B.S2.00021 1875 Clinical Photograph/ FNAC HPR/Clinical photograph
(Squamous/Basal/ Injuries) Skin Only
311 S2 2B.S2.00025 2B.S2.00025 : Tympanotomy 3000 Otoscopy, Clinical Notes Scar photo
312 S2 2B.S2.00027 2B.S2.00027 : Aural polypectomy +Tympanoplasty 7500 CT, Clinical Notes, Audiometry Procedure Notes, Scar Photo
2B.S2.00028 : Ant. Ethmoidal artery ligation - open/

313 S2 2B.S2.00028 8250 CT PNS Clinical Photograph
endoscopic
314 S2 2B.S2.00029 2B.S2.00029 : Antrostomy – Bilateral 4875 CT PNS Clinical Photograph
315 S2 2B.S2.00030 2B.S2.00030 : Antrostomy – Unilateral 3375 CT PNS Clinical Photograph
316 S2 2B.S2.00031 2B.S2.00031 : Cryosurgery 2250 DNE Photo DNE Photo
317 S2 2B.S2.00033 2B.S2.00033 : Septoplasty + FESS 8625 CT/ MRI X-Ray
318 S2 2B.S2.00034 2B.S2.00034 : Ethmoidectomy – External 6900 CT/ MRI X-Ray
X Ray film with report with report with
319 S2 2B.S2.00036 2B.S2.00036 : Fracture - setting maxilla 6000 X Ray
reportPNS
320 S2 2B.S2.00041 2B.S2.00041 : Nasal polypectomy – Bilateral 6750 Clinical notes, CT PNS X-Ray
321 S2 2B.S2.00042 2B.S2.00042 : Nasal polypectomy – Unilateral 4500 Clinical notes, CT PNS X-Ray
322 S2 2B.S2.00051 2B.S2.00051 : Endoscopic DCR 5250 Lacrimal Syringing Report Clinical Photograph
323 S2 2B.S2.00055 2B.S2.00055 : Septo-rhinoplasty 4950 X Ray PNS , CT PNS Clinical Photograph
Clinical Photograph, Endo Picture, X-
324 S2 2B.S2.00058 2B.S2.00058 : Arytenoidectomy 7500 CT-Scan / MRI Scan/Endo photo
Ray
325 S2 2B.S2.00060 2B.S2.00060 : Tonsillectomy + Myrinogotomy 7500 Clinical Notes Procedure Notes
326 S2 2B.S2.00061 2B.S2.00061 : Pharyngeal diverticulum's – Excision 7500 USG Neck USG

327 S2 2B.S2.00062 2B.S2.00062 : Laryngectomy with block dissection 9000 CT Neck,USG
Photograph,HPE
328 S2 2B.S2.00063 2B.S2.00063 : Laryngofissure 2625 USG Neck USG
329 S2 2B.S2.00066 2B.S2.00066 : Oro Antral fistula 5625 Fistulogram/Clinical photograph Clinical Photograph, Procedure notes
330 S2 2B.S2.00068 2B.S2.00068 : Parapharyngeal Abscess – Drainage 5625 CT/MRI/ Clinical photograph Procedure notes
331 S2 2B.S2.00072 2B.S2.00072 : Tonsillectomy + Styloidectomy 9375 X-Ray Skull Lateral View X-Ray Skull Lateral View
332 S2 2B.S2.00073 2B.S2.00073 : Thyroglossal Fistula/ cyst – Excision 5250 Ultrasound Neck, Fistulogram HPR, X-Ray
333 S2 2B.S2.00077 2B.S2.00077 : Uvulophanyngo Plasty 10500 Polysomnography Clinical Photograph
334 S2 2B.S2.00078 2B.S2.00078 : Commondo Operation (glossectomy) 10500 CT Skull, HPE Clinical Photograph
Clinical photo showing scar, BIOPSY,

335 S2 2B.S2.00082 2B.S2.00082 : Excision of Cystic Hygroma Minor 3750 Clinical notes & photo, USG/CT Operative notes with steps of surgery
& Clinical notes
336 S2 2B.S2.00083 2B.S2.00083 : Excision of the Mandible Segmental 5625 X Ray film Scar Photo, X Ray film
337 S2 2B.S2.00084 2B.S2.00084 : Hemi-mandibulectomy with graft 11250 X Ray film Scar Photo, X Ray film
Speciality
code
S1 2B.S1.00011B 2B.S1.00011B : Branchial Fistula -cross speciality 10500 CT scan, Clinical Photograph clinical
2B.S1.00037A : Excision Bronchial Sinus - cross

S1 2B.S1.00037A 6000 USG/CT Clinical photo, OT notes
speciality
2B.S1.00094A : Laryngectomy & Pharyngeal
S1 2B.S1.00094A 7500 CT Neck,USG Clinical Photograph,HPE
Diverticulum (Throat) - cross speciality
2B.S1.00101A : Microlaryngoscopic Surgery - cross HPE, Clinical Notes, Intra-Op
S1 2B.S1.00101A 9375 DL scopy findings
speciality Photograph
2B.S1.00102B : Oeshophagoscopy for foreign body
S1 2B.S1.00102B 4500 Endoscopy/ X-Ray Clinical notes, endo picture
removal - cross speciality
2B.S1.00220B : Removal of Foreign Body from
S1 2B.S1.00220B 1875 Clinical photo, endoscopy Procedure notes
Trachea or Oesophagus - cross speciality
2B.S16.17174B : Drainage of parotid abscess - cross X Ray film with report, Clinical
S16 2B.S16.17174B 5250 X Ray film with report
GENERAL MEDICINE
2B.M1.00008 : Congestive heart failure - routine Clinical Notes with relevant
338 M1 2B.M1.00008 1350 Treatment Notes
ward investigations
M1 2B.M1.00008A 2B.M1.00008A : Congestive heart failure - HDU 2025 Treatment Notes
investigations
2B.M1.00008B : Congestive heart failure - ICU Clinical Notes with relevant
M1 2B.M1.00008B 2700 Treatment Notes
2B.M1.00008C : Congestive heart failure - ICU with Clinical Notes with relevant
M1 2B.M1.00008C 3375 Treatment Notes
339 M1 2B.M1.00010 2B.M1.00010 : Diabetic ketoacidosis - routine ward 1350 Treatment Notes
investigations
M1 2B.M1.00010A 2B.M1.00010A : Diabetic ketoacidosis - HDU 2025 Treatment Notes
investigations
2B.M1.00010B : Diabetic ketoacidosis - ICU without Clinical Notes with relevant
2B.M1.00010C : Diabetic ketoacidosis - ICU with Clinical Notes with relevant
2B.M1.00033 : Lung abscess/ Empyema - routine
340 M1 2B.M1.00033 1350 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
ward
M1 2B.M1.00033A 2B.M1.00033A : Lung abscess/ Empyema - HDU 2025 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
2B.M1.00033B : Lung abscess/ Empyema - ICU

M1 2B.M1.00033B 2700 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
without ventilator
2B.M1.00033C : Lung abscess/ Empyema - ICU with
M1 2B.M1.00033C 3375 clinical notes, X-ray /USG -chest clinical notes, X-ray /USG -chest
ventilator
2B.M1.00048 : Acute gastroenteritis with severe
341 M1 2B.M1.00048 1350 Clinical notes Clinical notes
dehydration - routine ward
2B.M1.00048A : Acute gastroenteritis with severe
M1 2B.M1.00048A 2025 Clinical notes Clinical notes
dehydration - HDU
Speciality
code
2B.M1.00048B : Acute gastroenteritis with severe
M1 2B.M1.00048B 2700 Clinical notes Clinical notes
dehydration - ICU without ventilator
2B.M1.00048C : Acute gastroenteritis with severe
M1 2B.M1.00048C 3375 Clinical notes Clinical notes
dehydration - ICU with ventilator
2B.M1.00057 : Upper GI bleeding (endoscopic) - Clinical Notes with relevant
routine ward investigations
2B.M1.00057A : Upper GI bleeding (endoscopic) - Clinical Notes with relevant
M1 2B.M1.00057A 2025 Treatment Notes
HDU investigations
2B.M1.00057B : Upper GI bleeding (endoscopic) - Clinical Notes with relevant
ICU without ventilator investigations
2B.M1.00057C : Upper GI bleeding (endoscopic) - Clinical Notes with relevant
ICU with ventilator investigations
2B.M1.00061 : Guillian Barre Syndrome - routine Clinical Notes with relevant
ward investigations
M1 2B.M1.00061A 2B.M1.00061A : Guillian Barre Syndrome - HDU 2025 Treatment Notes
investigations
2B.M1.00061B : Guillian Barre Syndrome - ICU Clinical Notes with relevant
2B.M1.00061C : Guillian Barre Syndrome - ICU with Clinical Notes with relevant
GENERAL SURGERY
2B.S1.00005 : Arteriovenous (AV) Malformation of
344 S1 2B.S1.00005 11250 Clinical Photograph Scar photo
Soft Tissue Tumour - Excision
345 S1 2B.S1.00009 2B.S1.00009 : Bleeding Ulcer - Partial Gastrectomy 18750 Endoscopy Scar photo, HPR
346 S1 2B.S1.00010 2B.S1.00010 : Block dissection Cervical Nodes 7500 Clinical photo, CT report Scar Photo, HPE Report
347 S1 2B.S1.00011 2B.S1.00011 : Branchial Fistula 10500 CT scan, Clinical Photograph clinical
348 S1 2B.S1.00026 2B.S1.00026 : Drainage of Subdiaphramatic Abscess 6000 USG/Clinical Notes Scar photo
349 S1 2B.S1.00027 2B.S1.00027 : Drainage Pericardial Effusion 8250 X -Ray, ECHO X -Ray film with report
350 S1 2B.S1.00028 2B.S1.00028 : Duodenal Diverticulum 11250 USG/CT Scan Scar Photo
351 S1 2B.S1.00029 2B.S1.00029 : Duodenal Jejunostomy 11250 USG Clinical Photo
352 S1 2B.S1.00030 2B.S1.00030 : Duplication of Intestine 12750 CT/ USG Scar Photo
353 S1 2B.S1.00036 2B.S1.00036 : Excision Benign Tumor -Small intestine 11250 CT/ USG HPE Report
354 S1 2B.S1.00037 2B.S1.00037 : Excision Bronchial Sinus 6000 USG/CT Clinical photo, OT notes
355 S1 2B.S1.00041 2B.S1.00041 : Excision Meckel's Diverticulum 11250 USG/ CT Scar Photo, HPE Report
356 S1 2B.S1.00043 2B.S1.00043 : Excision Small Intestinal Fistula 9000 USG/ CT Scar Photo
357 S1 2B.S1.00044 2B.S1.00044 : Excision of Growth from Tongue only 4500 Clinical Photograph Scar Photo, HPE Report
2B.S1.00046 : Excision of Swelling in Right Cervical

358 S1 2B.S1.00046 3000 FNAC/ Biopsy HPR
Region
359 S1 2B.S1.00051 2B.S1.00051 : Fibroadenoma – Bilateral 6000 Biopsy/ FNAC, USG, HPR
Speciality
code
360 S1 2B.S1.00057 2B.S1.00057 : Fissurectomy with Sphincterotomy 11250 Clinical notes Clinical Notes & OT Notes
2B.S1.00058 : Foreign Body Removal in Deep Region

361 S1 2B.S1.00058 3750 X-Ray / Scopy report X-Ray / Scopy report
requiring GA
362 S1 2B.S1.00063 2B.S1.00063 : Gastrojejunostomy 11250 USG, Endoscopy Scar Photo
2B.S1.00065 : Graham's Operation for duodenal
363 S1 2B.S1.00065 11250 X-ray abdomen/CT, USG USG, Scar Photo
perforation
2B.S1.00073 : Hernia - Repair & release of Clinical Notes, Scar photo and OT
364 S1 2B.S1.00073 11250 USG, Clinical Photograph
obstruction notes
Clinical Photograph/ Scar photo, HPE
365 S1 2B.S1.00079 2B.S1.00079 : Hydatid Cyst of Liver 7500 CT/MRI
Report
366 S1 2B.S1.00082 2B.S1.00082 : IlieoSigmoidostomy 9750 CT Scan/ MRI Scar photo
367 S1 2B.S1.00086 2B.S1.00086 : Intestinal Obstruction 9375 X-Ray abdomen /CT /USG USG, Scar Photo
368 S1 2B.S1.00088 2B.S1.00088 : Jejunostomy 7500 USG Clinical Photo
369 S1 2B.S1.00089 2B.S1.00089 : Gastric Perforation 11250 X Ray abdomen/ CT Clinical/ Scar photo
2B.S1.00090 : Intestinal Perforation (Resection
370 S1 2B.S1.00090 15000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo
Anastomosis)
371 S1 2B.S1.00091 2B.S1.00091 : Appendicular Perforation 9000 USG, Clinical Notes HPR , Clinical photograph
2B.S1.00094 : Laryngectomy & Pharyngeal
372 S1 2B.S1.00094 7500 CT Neck,USG Clinical Photograph,HPE
Diverticulum (Throat)
Biopsy of the primary + CT Scan with
373 S1 2B.S1.00095 2B.S1.00095 : Ileostomy 15000 Clinical Photograph
film
374 S1 2B.S1.00097 2B.S1.00097 : Loop Colostomy Sigmoid 9000 CT/MRI , Endoscopy , USG Clinical photograph
375 S1 2B.S1.00098 2B.S1.00098 : Mastectomy 9000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report
376 S1 2B.S1.00099 2B.S1.00099 : Mesenteric Cyst – Excision 6750 USG/ CT Scan/ MRI Scar Photo, HPE Report
377 S1 2B.S1.00100 2B.S1.00100 : Mesenteric Caval Anastomosis 7500 CT abdomen/USG OT Notes, Intra-Op Photograph
HPE, Clinical Notes, Intra-Op
378 S1 2B.S1.00101 2B.S1.00101 : Microlaryngoscopic Surgery 9375 DL scopy findings
Photograph
2B.S1.00102 : Oeshophagoscopy for foreign body
379 S1 2B.S1.00102 4500 Endoscopy/ X-Ray Clinical notes, endo picture
removal
380 S1 2B.S1.00105 2B.S1.00105 : Pelvic Abscess - Open Drainage 6000 USG Scar Photograph
2B.S1.00107 : Distal Pancreatectomy with
381 S1 2B.S1.00107 12750 CT/ MRI Scar photo
PancreaticoJejunostomy
Clinical notes, Practoscopy/
382 S1 2B.S1.00109 2B.S1.00109 : Haemorroidectomy+ Fistulectomy 7500 OT Notes
Colonoscopy findings, Fistulogram
383 S1 2B.S1.00111 2B.S1.00111 : Porto Caval Anastomosis 11250 CT/ MRI OT Notes / Post-op CT
CT/MRI Abdomen, Endoscopic
384 S1 2B.S1.00119 2B.S1.00119 : Repair of Common Bile Duct 9375 Retrograde Cholangio Pancreatography OT Notes
(ERCP)
385 S1 2B.S1.00124 2B.S1.00124 : Salivary Gland – Excision 7500 Clinical Photograph , FNAC, CT HPR , Scar Photograph
386 S1 2B.S1.00127 2B.S1.00127 : Sigmoid Diverticulum 11250 CT/ MRI Scar photo
387 S1 2B.S1.00137 2B.S1.00137 : Colectomy – Total 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
388 S1 2B.S1.00143 2B.S1.00143 : Vasovasostomy 8250 Clinical photo
of vasectomy site)
Speciality
code
389 S1 2B.S1.00145 2B.S1.00145 : Cleft lip operation 9000 Clinical Photograph Scar Photograph
2B.S1.00147 : Cleft lip & palate operation (for each Clincal note and photograph, CT Scan if
390 S1 2B.S1.00147 11250 OT note and clinical photograph
stage) indicated
2B.S1.00153 : Cholecystectomy & Exploration of
391 S1 2B.S1.00153 10125 CT , LFT HPR, Clinical photograph
CBD
2B.S1.00164 : Split thickness skin grafts – Small (<
392 S1 2B.S1.00164 3750 Clinical photograph Post-op photo
4% TBSA)
2B.S1.00166 : Split thickness skin grafts – Large (>
393 S1 2B.S1.00166 11250 Clinical photograph Post-op photo
8% TBSA)
394 S1 2B.S1.00168 2B.S1.00168 : Hemi thyroidectomy 7500 FNAC , T F T , USG HPR , Clinical Photograph
395 S1 2B.S1.00170 2B.S1.00170 : Laparoscopic Hernia Repair 13500 USG
notes
2B.S1.00175 : Lap. Cholecystectomy & CBD
396 S1 2B.S1.00175 15000 CT , LFT HPR, Clinical photograph
exploration
397 S1 2B.S1.00176 2B.S1.00176 : Lap. For intestinal obstruction 11250 X-Ray abdomen /CT /USG USG, Scar Photo
398 S1 2B.S1.00177 2B.S1.00177 : Lap. Hepatic resection 18750 MRI/ CT Abdomen Scar Photo, HPE Report
399 S1 2B.S1.00178 2B.S1.00178 : Lap. Hydatid of liver surgery 13500 MRI/ CT Abdomen Scar Photo, HPE Report
400 S1 2B.S1.00180 2B.S1.00180 : Laparoscopic Appendicectomy 7500 MRI/ CT Scar Photo
401 S1 2B.S1.00181 2B.S1.00181 : Laparoscopic Cholecystectomy 9000 CT , LFT HPR, Clinical photograph
402 S1 2B.S1.00182 2B.S1.00182 : Laparoscopic cystogastrostomy 11250 USG/ CT Scan Clinical photograph
403 S1 2B.S1.00183 2B.S1.00183 : Laparoscopic Gastrostomy 7875 USG/ CT Scan Clinical photograph
404 S1 2B.S1.00184 2B.S1.00184 : Laparoscopic Hiatus Hernia Repair 15000 UGI ENDOSCOPY Scar photo/ Intra op photo
405 S1 2B.S1.00185 2B.S1.00185 : Laparoscopic Pyloromyotomy 9375 USG, Clinical notes Clinical Photograph
406 S1 2B.S1.00186 2B.S1.00186 : Laparoscopic Rectopexy 11250 Clinical Findings Clinical Findings
407 S1 2B.S1.00187 2B.S1.00187 : Laparoscopic Spleenectomy 9000 CT/ MRI Scar photo
408 S1 2B.S1.00188 2B.S1.00188 : Laparoscopic umbilical hernia repair 9000 USG, Clinical Photograph
notes
409 S1 2B.S1.00189 2B.S1.00189 : Laparoscopic ventral hernia repair 15000 USG, Clinical Photograph
notes
2B.S1.00190 : Laparotomy-peritonitis lavage and
410 S1 2B.S1.00190 5250 USG/X Ray Scar photo
drainage
2B.S1.00192 : Lymphatics Excision of Subcutaneous
411 S1 2B.S1.00192 6000 Clinical Photograph Clinical Photograph
Tissues In Lymphoedema
412 S1 2B.S1.00196 2B.S1.00196 : Operation for Bleeding Peptic Ulcer 11250 Endoscopy report. Scar photo, HPE
413 S1 2B.S1.00203 2B.S1.00203 : Coccygeal Teratoma Excision 11250 Clinical Photograph Clincial Notes, Scar photo
414 S1 2B.S1.00206 2B.S1.00206 : Drainage of perivertebral abscess 5250 USG/ CT Scan Clinical Photograph
415 S1 2B.S1.00210 2B.S1.00210 : Thymectomy 17250 USG Clinical Photograph

416 S1 2B.S1.00211 2B.S1.00211 : Operation of Choledochal Cyst 11250 CT/ USG HPE, Scar photo, USG
2B.S1.00220 : Removal of Foreign Body from
417 S1 2B.S1.00220 1875 Clinical photo, endoscopy Procedure notes
Trachea or Oesophagus
Speciality
code
2B.S1.00223 : Resection Enucleation of Adenoma
(lung)
419 S1 2B.S1.00224 2B.S1.00224 : Rib Resection & Drainage 5625 Chest X-ray, Clinical Photograph Clinical Photograph
420 S1 2B.S1.00226 2B.S1.00226 : Splenectomy - For Trauma 15000 CT/ MRI Scar photo
421 S1 2B.S1.00232 2B.S1.00232 : Thoracocentesis 1125 X-ray, CT X-ray
422 S1 2B.S1.00243 2B.S1.00243 : Trendelenburg Operation 7500 Clinical notes Clinical Photograph
423 S1 2B.S1.00245 2B.S1.00245 : Tissue Reconstruction Flap Leprosy 16500 Clinical Photograph Scar photo
424 S1 2B.S1.00246 2B.S1.00246 : Tendon Transfer-Leprosy 16500 Clinical Photograph, Clinical Notes Clinical Photograph
2B.S1.17001 : Endoscopic Retrograde Cholangio

425 S1 2B.S1.17001 Pancreatography (Endoscopic Retrograde Cholangio 3000 Liver function test (LFT), USG Liver function test (LFT), USG
Pancreatography (ERCP) with Interventions
426 S1 2B.S1.17002 2B.S1.17002 : Laproscopic Adrenalectomy 22500 CT Clinical Photograph

427 S1 2B.S1.17003 2B.S1.17003 : Gastro jejuno Colic Fistula 9375 USG Scar Photo
2B.S1.17004 : Endoscopic Retrograde Cholangio

428 S1 2B.S1.17004 Pancreatography (ERCP) (Endoscopic Retrograde 1688 LFT, USG USG
Cholangio – Pancreatography)
2B.S1.17009 : Upper GI Therapeutic(including

429 S1 2B.S1.17009 1500 Endoscopy report. Procedure stills
Varicose Intervention)
2B.S16.17174A : Drainage of parotid abscess - cross X Ray film with report, Clinical
S2 2B.S2.00031A 2B.S2.00031A : Cryosurgery - cross speciality 2250 DNE Photo DNE Photo
MENTAL DISORDER PACKAGES
2B.M8.00005 : Neurotic, stress-related and
somatoform disorders (routine ward)
2B.M8.00006 : Behavioural syndromes associated
431 M8 2B.M8.00006 with physiological disturbances and physical factors 1125 Clinical notes Clinical notes
(routine ward)
432 M8 2B.M8.00007 2B.M8.00007 : Mental retardation (routine ward) 1125 Clinical notes Clinical notes
2B.M8.00008 : Organic, including symptomatic,

mental disorders (HDU)
434 M8 2B.M8.00011 2B.M8.00011 : Mood (affective) disorders (HDU) 1875 Clinical notes Clinical notes
Speciality
code
2B.M8.00015 : Pre- Electro Convulsive Therapy (ECT) Complete Haemogram, Liver

Complete Haemogram, Liver Function
and Pre- Transcranial Magnetic Stimulation (TMS) Function Test, Renal Function Test,
Test, Renal Function Test, Serum
Package (Cognitive Tests, Complete Haemogram, Serum Electrolytes, Electro
Electrolytes, Electro Cardiogram (ECG),
Liver Function Test, Renal Function Test, Serum Cardiogram (ECG), CT/MRI Brain,
435 M8 2B.M8.00015 7500 CT/MRI Brain, Electroencephalogram,
Electrolytes, Electro Cardiogram (ECG), CT/MRI Electroencephalogram, Thyroid
Thyroid Function Test, VDRL, HIV Test,
Brain, Electroencephalogram, Thyroid Function Test, Function Test, VDRL, HIV Test,
Vitamin B12 levels, Folate levels, Lipid
VDRL, HIV Test, Vitamin B12 levels, Folate levels, Vitamin B12 levels, Folate levels,
Profile, Homocysteine levels)
Lipid Profile, Homocysteine levels) Lipid Profile, Homocysteine levels)
2B.M8.00016 : Electro Convulsive Therapy (ECT) - per
session
2B.M8.00017 : Transcranial Magnetic Stimulation
(TMS) - per session
NEONATAL AND PAEDIATRICS SURGERIES
2B.M2.00008 : Poisonings with normal vital signs -
438 M2 2B.M2.00008 1350 Clinical note with Lab reports Treatment note
routine ward
2B.M2.00008A : Poisonings with normal vital signs -
M2 2B.M2.00008A 2025 Clinical note with Lab reports Treatment note
HDU
2B.M2.00008B : Poisonings with normal vital signs -
M2 2B.M2.00008B 2700 Clinical note with Lab reports Treatment note
2B.M2.00008C : Poisonings with normal vital signs -
M2 2B.M2.00008C 3375 Clinical note with Lab reports Treatment note
ICU with ventilator
439 M2 2B.M2.00025 2B.M2.00025 : Diabetic ketoacidosis - routine ward 1350 Treatment Notes
investigations
M2 2B.M2.00025A 2B.M2.00025A : Diabetic ketoacidosis - HDU 2025 Treatment Notes
investigations
2B.M2.00025B : Diabetic ketoacidosis - ICU without Clinical Notes with relevant
2B.M2.00025C : Diabetic ketoacidosis - ICU with Clinical Notes with relevant
2B.M2.00026 : Nephrotic syndrome with peritonitis - Complete blood count (CBC), Renal Complete blood count (CBC), Renal
440 M2 2B.M2.00026 1350
routine ward function test (RFT) function test (RFT)
2B.M2.00026A : Nephrotic syndrome with peritonitis Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026A 2025
- HDU function test (RFT) function test (RFT)
2B.M2.00026B : Nephrotic syndrome with peritonitis Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026B 2700
- ICU without ventilator function test (RFT) function test (RFT)
2B.M2.00026C : Nephrotic syndrome with peritonitis Complete blood count (CBC), Renal Complete blood count (CBC), Renal
M2 2B.M2.00026C 3375
- ICU with ventilator function test (RFT) function test (RFT)
441 M2 2B.M2.00037 2B.M2.00037 : Infantile cholestasis - routine ward 1350 Treatment Notes
investigations
M2 2B.M2.00037A 2B.M2.00037A : Infantile cholestasis - HDU 2025 Treatment Notes
investigations
2B.M2.00037B : Infantile cholestasis - ICU without Clinical Notes with relevant
Speciality
code
2B.M2.00037C : Infantile cholestasis - ICU with Clinical Notes with relevant
442 M2 2B.M2.00043 2B.M2.00043 : Empyema - routine ward 1350 Clinical note with Lab reports Treatment note
M2 2B.M2.00043A 2B.M2.00043A : Empyema - HDU 2025 Clinical note with Lab reports Treatment note
M2 2B.M2.00043B 2B.M2.00043B : Empyema - ICU without ventilator 2700 Clinical note with Lab reports Treatment note
M2 2B.M2.00043C 2B.M2.00043C : Empyema - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
2B.M2.00050 : Intracranial ring enhancing lesion
443 M2 2B.M2.00050 with complication (neurocysticercosis, tuberculoma) - 1350 Treatment Notes
investigations
routine ward
2B.M2.00050A : Intracranial ring enhancing lesion
M2 2B.M2.00050A with complication (neurocysticercosis, tuberculoma) - 2025 Treatment Notes
investigations
HDU
2B.M2.00050B : Intracranial ring enhancing lesion
M2 2B.M2.00050B with complication (neurocysticercosis, tuberculoma) - 2700 Treatment Notes
investigations
2B.M2.00050C : Intracranial ring enhancing lesion
M2 2B.M2.00050C with complication (neurocysticercosis, tuberculoma) - 3375 Treatment Notes
investigations
ICU with ventilator
2B.M2.00076 : Congestive cardiac failure - routine Clinical Notes with relevant
ward investigations
M2 2B.M2.00076A 2B.M2.00076A : Congestive cardiac failure - HDU 2025 Treatment Notes
investigations
2B.M2.00076B : Congestive cardiac failure - ICU Clinical Notes with relevant
2B.M2.00076C : Congestive cardiac failure - ICU with Clinical Notes with relevant
2B.M2.00099 : Blood and blood component

transfusion up to a limit of 2 days(admission for a
diagnostic procedure leading to treatment requiring
admission, e.g. bone marrow and bone biopsy,
445 M2 2B.M2.00099 1125 Clinical note with Lab reports Treatment note and HPE report
endoscopy, liver biopsy, bronchoscopy, CT/MRI
under GA, broncho-alveolar lavage, lumbar
puncture, muscle biopsy, FNAC, pleural aspiration,
ascitic tapping, neostigmine challenge test etc.)
2B.M3.00009 : Advanced Surgery for Retinopathy of

446 M3 2B.M3.00009 11250 Fundoscopy Report Fundoscopy Report
Prematurity
2B.S14.00009 : Undescended Testis - Unilateral-
447 S14 2B.S14.00009 11250 USG,Clinical photo Nil
Palpable
2B.S14.00019 : Gastrostomy + Esophagoscopy+
448 S14 2B.S14.00019 15000 USG Clinical Photograph
Threading
Speciality
code
2B.M1.00048D : Acute gastroenteritis with severe

M1 2B.M1.00048D 1350 Clinical notes Clinical notes
dehydration - routine ward - Cross speciality
2B.M1.00048E : Acute gastroenteritis with severe

M1 2B.M1.00048E 2025 Clinical notes Clinical notes
dehydration - HDU - Cross speciality
2B.M1.00048F : Acute gastroenteritis with severe

M1 2B.M1.00048F 3375 Clinical notes Clinical notes
dehydration - ICU with ventilator - Cross speciality
2B.M1.00048G : Acute gastroenteritis with severe

M1 2B.M1.00048G dehydration - ICU without ventilator - Cross 2700 Clinical notes Clinical notes
speciality
2B.S1.00030A : Duplication of Intestine - cross
S1 2B.S1.00030A 12750 CT/ USG Scar Photo
speciality
2B.S1.00176A : Lap. For intestinal obstruction - cross
S1 2B.S1.00176A 11250 X-Ray abdomen /CT /USG USG, Scar Photo
speciality
2B.S1.00185A : Laparoscopic Pyloromyotomy - cross
S1 2B.S1.00185A 9375 USG, Clinical notes Clinical Photograph
speciality
2B.S1.00188A : Laparoscopic umbilical hernia repair -
S1 2B.S1.00188A 9000 USG Clinical Photograph
cross speciality
2B.S1.00189A : Laparoscopic ventral hernia repair - Clinical photograph , USG, Routine
S1 2B.S1.00189A 15000 Clinical photograph
cross speciality Blood Inv
NEUROSURGERY
Clinical Photographs showing scar +
449 S8 2B.S8.00015 2B.S8.00015 : Laminectomy with Fusion and fixation 37500 CT/MRI report
X-ray-Lumbar Spine
2B.S8.00018 : Lumbar Disc including pre and post
450 S8 2B.S8.00018 22500 Clinical findings, MRI Report Clinical photograph showing scar
Op. MRI
451 S8 2B.S8.00023 2B.S8.00023 : Micro discectomy – Lumbar 30000 Clinical findings, MRI Report Clinical photograph showing scar
2B.S8.00029 : Spine - Decompression & Fusion with
452 S8 2B.S8.00029 37500 Clinical findings, MRI Report Post Op X-Ray Report and film
fixation
453 S8 2B.S8.00074 2B.S8.00074 : Muscle Biopsy with report 5250 Reports of relevant investigation HPE Report
2B.S1.00005A : Arteriovenous (AV) Malformation of

S1 2B.S1.00005A 11250 Clinical Photograph Scar photo

2B.S4.00003 : Surgeries for Prolapse - Sling
454 S4 2B.S4.00003 12000 Clinical Notes, USG OT Notes
Surgeries
2B.S4.00010 : Vaginal hysterectomy with anterior Relevant Hematological investigations,
455 S4 2B.S4.00010 12000 OT Notes and HPE
and posterior colpoperineorrhaphy Clinical notes
Clinical Notes, USG/KUB/Urology
456 S4 2B.S4.00013 2B.S4.00013 : Repair for rectovaginal fitulas 7500 OT notes
opinion
457 S4 2B.S4.00020 2B.S4.00020 : Vulvectomy simple 11250 Clinical Notes, USG/CT/MRI OT Notes, HPE
458 S4 2B.S4.00022 2B.S4.00022 : Diagnostic laparoscopy 8250 USG Clinical Photograph
Ultrasonography, X Ray, ECG, LFT,RFT,
459 S4 2B.S4.00023 2B.S4.00023 : Laparoscopic hysterectomy (TLH) 15000 HPR,OT notes
FBS,PPBS, T3,T4,THS
Speciality
code
460 S4 2B.S4.00024 2B.S4.00024 : Laparoscopic myomectomy 9000 Ultrasonography/ Tubal patency test HPE, OT notes
461 S4 2B.S4.00025 2B.S4.00025 : Laparoscopic cystectomy 11250 USG, Routine investigations and CA 125 HPE
462 S4 2B.S4.00027 2B.S4.00027 : Laparoscopic adhesiolysis 4500 CT , X-Ray Abdomen HPR , Clinical photograph
Serum Beta HCG, USG, CBC, Routine
463 S4 2B.S4.00044 2B.S4.00044 : Laparotomy for ruptured ectopic 7500 OT notes
investigation
464 S4 2B.S4.00048 2B.S4.00048 : McDonald's stitch 3000 USG and clinical notes OT Note
465 S4 2B.S4.00049 2B.S4.00049 : Shirodkar's stitch 3000 Clinical Notes OT Notes
466 S4 2B.S4.00050 2B.S4.00050 : Tuboplasty 7125 OT Notes
FBS,PPBS, T3,T4,THS
2B.S4.00056 : Adhenolysis + Hernia - Ventral -
467 S4 2B.S4.00056 12000 USG and clinical notes OT Note
Lipectomy/Incision
468 S4 2B.S4.00057 2B.S4.00057 : Adhenolysis+ Ovarian Cystectomy 7500 USG and clinical notes OT note and HPE
469 S4 2B.S4.00058 2B.S4.00058 : Adhenolysis+ Salpingostomy 7500 USG and clinical notes OT note and HPE
470 S4 2B.S4.00060 2B.S4.00060 : Brust abdomen repair 10500 USG and clinical notes OT note and HPE
471 S4 2B.S4.00065 2B.S4.00065 : Cystocele - Anterior repair 9000 USG and clinical notes OT Note
2B.S4.00069 : Diagnostic laparoscopy &
472 S4 2B.S4.00069 3750 USG and clinical notes OT Note
hysteroscopy for infertility
2B.S4.00071 : Exploration of abdominal haematoma
473 S4 2B.S4.00071 10500 USG and clinical notes OT Note and HPE
(after laparotomy + LSCS)
USG, Lab investigation and clinical
474 S4 2B.S4.00077 2B.S4.00077 : Chorionic villus sampling 3750 OT Note and sampling report
notes
475 S4 2B.S4.17015 2B.S4.17015 : Lap. Salphingo-oophorectomy 7500 USG, CA 125 HPE
2B.S4.17016 : Lap. Assisted Vaginal Hysterectomy
476 S4 2B.S4.17016 8625 FBS,PPBS, T3,T4,THS/ Endometrial HPR,OT notes
(LAVH)
Biopsy/Cervical biopsy
ONCOLOGY
2B.S15.00019 : Total Thyroidectomy with central Clinical Photograph showing scar +
477 S15 2B.S15.00019 15000 FNAC/CT/MRI report and Film
compartment LN dissection HPE report
2B.S2.00078B : Commondo Operation (glossectomy)
S2 2B.S2.00078B 10500 CT , Biopsy Clinical Photograph
- cross speciality
2B.S2.00083B : Excision of the Mandible Segmental -
S2 2B.S2.00083B 5625 X -Ray, CT , Biopsy X -Ray , Clinical photograph
cross speciality
2B.S2.00084B : Hemi-mandibulectomy with graft -
S2 2B.S2.00084B 11250 CT , Biopsy Clinical photograph
cross speciality
2B.S1.00010A : Block dissection Cervical Nodes -
S1 2B.S1.00010A 7500 Clinical photo, CT report Scar photo
cross speciality
2B.S1.00036B : Excision Benign Tumor -Small
S1 2B.S1.00036B 11250 CT/ USG HPE Report
intestine - cross speciality
2B.S1.00046A : Excision of Swelling in Right Cervical
S1 2B.S1.00046A 3000 FNAC/ Biopsy HPR
Region - cross speciality
Speciality
code
2B.S1.00051A : Fibroadenoma – Bilateral - cross
S1 2B.S1.00051A 6000 FNAC, USG, Routine Blood Inv HPR
speciality
S1 2B.S1.00088A 2B.S1.00088A : Jejunostomy - cross speciality 7500 USG Clinical Photo
2B.S1.00094B : Laryngectomy & Pharyngeal
S1 2B.S1.00094B 7500 CT Neck,USG Clinical Photograph,HPE
Diverticulum (Throat) - cross speciality
S1 2B.S1.00095A 2B.S1.00095A : Ileostomy - cross speciality 15000 Clinical Photograph
film
2B.S1.00097A : Loop Colostomy Sigmoid - cross
S1 2B.S1.00097A 9000 CT/MRI , Endoscopy , USG Clinical photograph
speciality
S1 2B.S1.00098A 2B.S1.00098A : Mastectomy - cross speciality 9000 Biopsy, Mammography/ USG, FNAC Clinical Photograph, HPE Report
2B.S1.00107A : Distal Pancreatectomy with
S1 2B.S1.00107A 12750 CT/ MRI Scar photo
PancreaticoJejunostomy - cross speciality
S1 2B.S1.00137A 2B.S1.00137A : Colectomy – Total - cross speciality 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
2B.S1.00168A : Hemi thyroidectomy - cross

S1 2B.S1.00168A 7500 FNAC , T F T , USG HPR , Clinical Photograph
speciality
2B.S1.00177A : Lap. Hepatic resection - cross
S1 2B.S1.00177A 18750 MRI/ CT Abdomen Scar Photo, HPE Report
speciality
2B.S1.00203A : Coccygeal Teratoma Excision - cross
S1 2B.S1.00203A 11250 Clinical Photograph Clincial Nortes, photo
speciality
2B.S1.00223A : Resection Enucleation of Adenoma
S1 2B.S1.00223A 7500 Clinical Photograph Clinical Photograph
(lung) - cross speciality
2B.S15.00008A : Mandible Tumour Resection and X Ray film with report, Clinical
reconstruction/Cancer surgery - cross speciality Photograph
OPTHALMOLOGY
478 S3 2B.S3.00004 2B.S3.00004 : Corneal Grafting 6375 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
479 S3 2B.S3.00005 2B.S3.00005 : Prophylactic Cryoretinopexy- Closed 1875 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
480 S3 2B.S3.00010 2B.S3.00010 : Enucleation with Implant 6000 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
2B.S3.00012 : Glaucoma Surgery (Trabeculectomy

only) with or without Mitomycin C, including
postoperative medications for 12 weeks (and
481 S3 2B.S3.00012 825 Intraocular Pressure reading Clinical Photograph
wherever surgical or laser procedures required for
bleb augmentation and anterior chamber
maintenance)
2B.S3.00013 : Intraocular Foreign Body Removal

482 S3 2B.S3.00013 3000 B Scan Report Clinical Photograph
from Anterior Segment
Slit lamp Examination report
483 S3 2B.S3.00015 2B.S3.00015 : Lensectomy /pediatric lens aspiration 6750 Fundus Photograph
&Fundoscopy
484 S3 2B.S3.00017 2B.S3.00017 : Surgical Membranectomy 6000 Indirect Opthalmoscopy report Fundus Photograph
Speciality
code
485 S3 2B.S3.00018 2B.S3.00018 : Perforating Corneo - Scleral Injury 4950 Clinical Photograph Scar photo
486 S3 2B.S3.00019 2B.S3.00019 : Ptosis Surgery 825 Clinical Photograph Clinical Photograph
487 S3 2B.S3.00020 2B.S3.00020 : IRIS Prolapse – Repair 3000 Slit lamp examination report Clinical Photograph
488 S3 2B.S3.00021 2B.S3.00021 : Retinal Detachment Surgery 11250 B Scan , Fundus Photograph Fundus Photograph
2B.S3.00022 : Small Tumour of Lid – Excision + Lid
Reconstruction
2B.S3.00023 : Socket Reconstruction with amniotic
membrane
491 S3 2B.S3.00025 2B.S3.00025 : Iridectomy – Surgical 2250 Clinical Note / slit lamp report Clinical Note / Slit lamp report
492 S3 2B.S3.00027 2B.S3.00027 : Vitrectomy 5625 B.Scan , Fundus Photograph Fundus Photograph
2B.S3.00031 : Cataract with foldable hydrophobic

493 S3 2B.S3.00031 7875 A Scan Report Clinical Photograph
acrylic IOL by Phaco emulsification tech + Glaucoma
2B.S3.00032 : Cataract with non-foldable IOL using

494 S3 2B.S3.00032 4875 A Scan Report Clinical Photograph
SICS technique + Glaucoma
495 S3 2B.S3.00037 2B.S3.00037 : Laser for retinopathy (per sitting) 1125 Fundoscopy Report Fundoscopy Report
496 S3 2B.S3.00039 2B.S3.00039 : Orbitotomy 4950 Clinical Photograph Clinical Photograph
497 S3 2B.S3.00040 2B.S3.00040 : Squint correction (per muscle) 3000 Clinical Photograph Clinical Photograph
2B.S3.00041 : Anterior Chamber Reconstruction

498 S3 2B.S3.00041 8625 Clinical Note / Slit lamp report Clinical Note / Slit lamp report
+Perforating corneo - Scleral Injury + IOL
499 S3 2B.S3.00042 2B.S3.00042 : PRP - Retinal Laser including 3 sittings 3750 Fundoscopy Report Fundoscopy Report
2B.S3.17010 : Photocoagulation for Retinopathy for

500 S3 2B.S3.17010 1500 Fundoscopy Report Fundoscopy Report
3 sittings-Complete package
501 S3 2B.S3.17011 2B.S3.17011 : Therapeutic Penetrating Keratoplasty 2475 Clinical Photo Clinical Photograph
502 S3 2B.S3.17012 2B.S3.17012 : Lamellar Keratoplasty 2475 Clinical Photo Clinical Photograph
503 S3 2B.S3.17013 2B.S3.17013 : Scleral Patch Graft 6000 Clinical Photograph Clinical Photograph
2B.S3.17014 : Glaucoma Filtering Surgery For
504 S3 2B.S3.17014 6375 Intraocular Pressure reading Clinical Photograph
Paediatric Glaucoma
ORTHOPAEDICS
505 S5 2B.S5.00019 2B.S5.00019 : Bimalleolar Fracture Fixation 11250 X-ray Scar photo, X-Ray
2B.S5.00021 : Bone Tumour (malignant/ benign)
506 S5 2B.S5.00021 15000 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
curettage and bone grafting
2B.S5.00027 : Closed Interlock Nailing + Bone
507 S5 2B.S5.00027 14250 X-ray, Rountine Blood Inv. Scar photo, x-ray
Grafting – femur
508 S5 2B.S5.00028 2B.S5.00028 : Closed Interlocking Intermedullary 13125 X-ray, Rountine Blood Inv. Scar photo, x-ray
2B.S5.00030 : Closed Reduction and Internal Fixation

509 S5 2B.S5.00030 4500 X-ray x-ray
with K wire
2B.S5.00031 : Closed Reduction and Percutaneous
510 S5 2B.S5.00031 11250 X-ray X-Ray showing implant
Screw Fixation (neck femur)
Speciality
code
2B.S5.00033 : Closed Reduction and Percutaneous
511 S5 2B.S5.00033 15000 X Ray Scar photo, x-ray showing implant
Nailing
512 S5 2B.S5.00041 2B.S5.00041 : External fixation - Long bone 11250 X-RAY/CT scan(If Required)
513 S5 2B.S5.00043 2B.S5.00043 : External fixation - Pelvis 11250 X Ray film with report X Ray film with report
514 S5 2B.S5.00045 2B.S5.00045 : Fixator with Joint Arthrolysis 15000 X-RAY Scar photo, X-RAY
2B.S5.00048 : Fracture - Hip Internal Fixation
515 S5 2B.S5.00048 (Intertrochanteric Fracture with implant) + 12750 X-ray Scar photo, X-ray
rehabilitation
516 S5 2B.S5.00049 2B.S5.00049 : Fracture - Humerus Internal Fixation 12750 X-ray Scar photo, X-ray
517 S5 2B.S5.00059 2B.S5.00059 : Limb Lengthening 11250 Clinical Photograph Scar Photo, Clinical Photograph
2B.S5.00065 : Open Reduction Internal Fixation
518 S5 2B.S5.00065 15000 X-ray X-ray, scar photo, Invoice of implants
(Large Bone)
519 S5 2B.S5.00066 2B.S5.00066 : Open Reduction of CDH 22500 X-ray Scar photo, X-ray
2B.S5.00068 : Open Reduction with bone grafting of
520 S5 2B.S5.00068 15000 X-ray Scar photo, X-ray
nonunion
2B.S5.00075 : Reconstruction of ACL/PCL with
521 S5 2B.S5.00075 22500 MRI MRI
implant and brace
2B.S5.00087 : External fixation - both bones of
522 S5 2B.S5.00087 18750 X-ray Clinical photo, X-ray
forearms
2B.S5.00088 : Fracture intercondylarHumerus +
olecranon osteotomy
2B.S5.00090 : Arthroscopic Meniscus Repair/
524 S5 2B.S5.00090 15000 MRI Report Scar photo, X-ray
Meniscectomy
2B.S5.00094 : Bipolar Hemiarthroplasty (hip &
shoulder)
526 S5 2B.S5.00095 2B.S5.00095 : Unipolar Hemiarthroplasty 22500 X-ray Scar photo, X-ray
527 S5 2B.S5.00097 2B.S5.00097 : Elbow replacement 30000 X-ray Scar photo, X-ray
528 S5 2B.S5.00099 2B.S5.00099 : Arthrodesis of Knee (with implant) 30000 X-ray Clinical photo, X-ray
529 S5 2B.S5.00100 2B.S5.00100 : Arthrodesis of Wrist (with implant) 22500 X-ray Clinical photo, X-ray
530 S5 2B.S5.00101 2B.S5.00101 : Arthrodesis of Ankle (with implant) 22500 X-ray Clinical photo, X-ray
2B.S5.17019 : Maysers muscle pedicle graft for Non-

531 S5 2B.S5.17019 15000 X Ray film with report X Ray film with report
union fracture neck femur (orthroplasty)
2B.S5.17020 : Facio-Maxillary Injury repairs & Clinical Photograph showing scar +

532 S5 2B.S5.17020 3750 X-RAY/CT scan
fixations post op. XRAY
2B.S5.17021 : Anterolateral Clearance For X Ray film with report, Clinical
533 S5 2B.S5.17021 13500 MRI
Tuberculosis Photograph
2B.S5.17022 : Posterior cruciate ligament (PCL)
534 S5 2B.S5.17022 13275 MRI MRI
Reconstruction
Speciality
code
535 S5 2B.S5.17023 2B.S5.17023 : Blunt injury abdomen 7500 USG USG
2B.S8.00015A : Laminectomy with Fusion and Clinical Photographs showing scar +
S8 2B.S8.00015A 37500 CT/MRI report
fixation - cross speciality X-ray-Lumbar Spine
2B.S8.00023A : Micro discectomy – Lumbar - cross
S8 2B.S8.00023A 30000 Clinical findings, MRI Report Clinical photograph showing scar
speciality
2B.S8.00029A : Spine - Decompression & Fusion
S8 2B.S8.00029A 37500 Clinical findings, MRI Report Post Op X-Ray Report and film
with fixation - cross speciality
2B.S8.00074A : Muscle Biopsy with report - cross
S8 2B.S8.00074A 5250 Reports of relevant investigation HPE Report
speciality
2B.S1.00164B : Split thickness skin grafts – Small (<
S1 2B.S1.00164B 3750 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
4% TBSA) - - cross speciality
2B.S1.00224A : Rib Resection & Drainage - cross
S1 2B.S1.00224A 5625 Chest X-ray, Clinical Photograph Clinical Photograph
speciality
2B.S1.00246B : Tendon Transfer-Leprosy - - cross
S1 2B.S1.00246B 16500 Clinical Photograph, Clinical Notes Clinical Photograph
speciality
S5 2B.S5.00003A 2B.S5.00003A : Sequestrectomy - cross speciality 1125 X Ray film with report X Ray film with report
PLASTIC AND RECONSTRUCTIVE SURGERY
S1 2B.S1.00145A 2B.S1.00145A : Cleft lip operation - cross speciality 9000 Clinical Photograph Clinical Photograph
2B.S1.00147A : Cleft lip & palate operation (for each

S1 2B.S1.00147A 11250 Clincal note and photograph OT note and clinical photograph
2B.S1.00164A : Split thickness skin grafts – Small (<
S1 2B.S1.00164A 3750 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
2B.S1.00166A : Split thickness skin grafts – Large (>
S1 2B.S1.00166A 11250 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
2B.S1.00245A : Tissue Reconstruction Flap Leprosy -
S1 2B.S1.00245A 16500 Clinical Photograph Scar photo
cross speciality
2B.S1.00246A : Tendon Transfer-Leprosy - - cross
S1 2B.S1.00246A 16500 Clinical Photograph, Clinical Notes Clinical Photograph
speciality
POLYTRAUMA
2B.S6.00005 : Internal fixation of Pelviacetabular
536 S6 2B.S6.00005 30000 X Ray film with report X Ray film with report, Scar Photo
fracture
SURGICAL GASTROENTEROLOGY
2B.S1.00009A : Bleeding Ulcer - Partial Gastrectomy -
S1 2B.S1.00009A 18750 Endoscopy Scar photo, HPR
cross speciality
2B.S1.00026A : Drainage of Subdiaphramatic
S1 2B.S1.00026A 6000 USG/Clinical Notes Scar photo
Abscess - cross speciality
2B.S1.00028A : Duodenal Diverticulum - cross
S1 2B.S1.00028A 11250 USG/CT Scan Scar Photo
speciality
2B.S1.00029A : Duodenal Jejunostomy - cross
S1 2B.S1.00029A 11250 USG Clinical Photo
speciality
2B.S1.00030B : Duplication of Intestine - cross
S1 2B.S1.00030B 12750 CT/ USG Scar Photo
speciality
Speciality
code
2B.S1.00036A : Excision Benign Tumor -Small
S1 2B.S1.00036A 11250 CT/ USG HPE Report
intestine - cross speciality
2B.S1.00041A : Excision Meckel's Diverticulum -
S1 2B.S1.00041A 11250 USG/ CT Scar Photo, HPE Report
cross speciality
2B.S1.00043A : Excision Small Intestinal Fistula -
S1 2B.S1.00043A 9000 USG/ CT Scar Photo
cross speciality
S1 2B.S1.00063A 2B.S1.00063A : Gastrojejunostomy - cross speciality 11250 USG, Endoscopy Scar Photo
2B.S1.00065A : Graham's Operation for duodenal

S1 2B.S1.00065A 11250 X-ray abdomen/CT, USG USG, Scar Photo
perforation - cross speciality
2B.S1.00079A : Hydatid Cyst of Liver - cross Clinical Photograph/ Scar photo, HPE
S1 2B.S1.00079A 7500 CT/MRI
speciality Report
S1 2B.S1.00082A 2B.S1.00082A : IlieoSigmoidostomy - cross speciality 9750 CT Scan/ MRI Scar photo
S1 2B.S1.00088B 2B.S1.00088B : Jejunostomy - cross speciality 7500 USG Clinical Photo

2B.S1.00090A : Intestinal Perforation (Resection
S1 2B.S1.00090A 15000 Erect abdomen X Ray/CT Abdomen OT Notes, Scar photo
Anastomosis) - cross speciality
S1 2B.S1.00095B 2B.S1.00095B : Ileostomy - cross speciality 15000 Clinical Photograph
film
2B.S1.00097B : Loop Colostomy Sigmoid - cross
S1 2B.S1.00097B 9000 CT/MRI , Endoscopy , USG Clinical photograph
speciality
S1 2B.S1.00099A 2B.S1.00099A : Mesenteric Cyst – Excision 6750 USG/ CT Scan/ MRI Scar Photo, HPE Report
2B.S1.00100A : Mesenteric Caval Anastomosis -
S1 2B.S1.00100A 7500 CT abdomen/USG OT Notes, Intra-Op Photograph
cross speciality
2B.S1.00102A : Oeshophagoscopy for foreign body
S1 2B.S1.00102A 4500 Endoscopy/ X-Ray Clinical notes, endo picture
removal - cross speciality
2B.S1.00107B : Distal Pancreatectomy with
S1 2B.S1.00107B 12750 CT/ MRI Scar photo
PancreaticoJejunostomy - cross speciality
2B.S1.00111A : Porto Caval Anastomosis - Cross
S1 2B.S1.00111A 11250 CT/ MRI OT Notes / Post-op CT
speciality
CT/MRI Abdomen, Endoscopic
S1 2B.S1.00119A 2B.S1.00119A : Repair of Common Bile Duct 9375 Retrograde Cholangio Pancreatography OT Notes
(ERCP)
S1 2B.S1.00137B 2B.S1.00137B : Colectomy – Total - cross speciality 12750 Colonoscopy , CT/ MRI, Biopsy HPR , Clinical photograph
2B.S1.00175A : Lap. Cholecystectomy & CBD

S1 2B.S1.00175A 15000 CT , LFT HPR, Clinical photograph
exploration - cross speciality
2B.S1.00176B : Lap. For intestinal obstruction - cross
S1 2B.S1.00176B 11250 X-Ray abdomen /CT /USG USG, Scar Photo
speciality
2B.S1.00185B : Laparoscopic Pyloromyotomy - cross
S1 2B.S1.00185B 9375 USG, Clinical notes Clinical Photograph
speciality
S1 2B.S1.00186A 2B.S1.00186A : Laparoscopic Rectopexy 11250 Clinical Findings Clinical Findings
2B.S1.00220A : Removal of Foreign Body from
S1 2B.S1.00220A 1875 Clinical photo, endoscopy Procedure notes
Trachea or Oesophagus - cross speciality
Speciality
code
2B.S1.17001A : Endoscopic Retrograde Cholangio
Pancreatography (Endoscopic Retrograde Cholangio
S1 2B.S1.17001A 3000 Liver function test (LFT), USG Liver function test (LFT), USG
Pancreatography (ERCP) with Interventions - cross
speciality
2B.S1.17002A : Laproscopic Adrenalectomy - cross
S1 2B.S1.17002A 22500 CT Clinical Photograph
speciality
2B.S1.17003A : Gastro jejuno Colic Fistula - cross
S1 2B.S1.17003A 9375 USG Scar Photo
speciality
2B.S1.17004A : Endoscopic Retrograde Cholangio

S1 2B.S1.17004A Pancreatography (ERCP) (Endoscopic Retrograde 1688 LFT, USG USG
Cholangio – Pancreatography) - cross speciality
2B.S1.17009A : Upper GI Therapeutic(including

S1 2B.S1.17009A 1500 Endoscopy report. Procedure stills
Varicose Intervention) - cross speciality
2B.S1.00058A : Foreign Body Removal in Deep

S1 2B.S1.00058A 3750 X-Ray / Scopy report X-Ray / Scopy report
Region requiring GA - cross speciality
UROLOGY
537 S7 2B.S7.00029 2B.S7.00029 : Pyelolithotomy-Laparoscopic 11250 USG Clinical Photograph
538 S7 2B.S7.00033 2B.S7.00033 : Perinephric Abscess drainage (Open) 5625 USG Scar photo
539 S7 2B.S7.00059 2B.S7.00059 : Urachal Cyst excision -open 11250 USG/CT KUB HPR
540 S7 2B.S7.00110 2B.S7.00110 : Excision of Urethral Caruncle 3750 Clinical Notes Clinical Photograph
2B.S7.00127 : Orchiopexy-without laparoscopy,
541 S7 2B.S7.00127 11250 USG Clinical Notes
bilateral
2B.S7.00135 : Ilio-Inguinal lymphadenectomy-
542 S7 2B.S7.00135 11250 USG Scar photo
unilateral
2B.S7.00136 : Ilio-Inguinal lymphadenectomy-
543 S7 2B.S7.00136 18750 USG Scar photo
bilateral
544 S7 2B.S7.17039 2B.S7.17039 : Operation for Double Ureter 11813 IVP/CT KUB with Contrast Scar Photo
545 S7 2B.S7.17040 2B.S7.17040 : Pyelolithotomy 10125 IVP/CT KUB with Contrast Scar Photo
2B.S1.17002B : Laproscopic Adrenalectomy - cross
S1 2B.S1.17002B 22500 CT Clinical Photograph
speciality
Speciality
code
TERTIARY CARE
BURNS
3A.S11.00006 : Electrical contact burns: Low voltage-
with part of limb/limb loss; Includes % TBSA skin
grafted, flap cover, follow-up dressings etc. as
546 S11 3A.S11.00006 30000 Clinical Photograph Clinical Photograph
deemed necessary; Surgical procedures are required
for deep burns that are not amenable to heal with
dressings alone.
3A.S11.00011 : Post Burn Contracture surgeries for
Functional Improvement (Package including splints,
pressure garments, silicone-gel sheet and
physiotherapy): Excluding Neck contracture;
Contracture release with - Split thickness Skin Graft
(STSG) / Full Thickness Skin Graft (FTSG)/ Flap cover
is done for each joint with post-operative regular
dressings for STSG / FTSG / Flap cover.
3A.S11.00012 : Post Burn Contracture surgeries for

Functional Improvement (Package including splints,
pressure garments, silicone-gel sheet and
physiotherapy): Neck contracture; Contracture
release with - Split thickness Skin Graft (STSG) /
Full Thickness Skin Graft (FTSG)/ Flap cover is done
for each joint with post-operative regular dressings
for STSG / FTSG / Flap cover.
CARDIOLOGY
549 S12 3A.S12.00001 3A.S12.00001 : Balloon Atrial Septostomy 25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO
550 S12 3A.S12.00002 3A.S12.00002 : Balloon Aortic Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO
551 S12 3A.S12.00003 3A.S12.00003 : Balloon Mitral Valvotomy 30000 2D ECHO report 2D ECHO report + stills of ECHO
552 S12 3A.S12.00004 3A.S12.00004 : Balloon Pulmonary Valvotomy 25000 2D ECHO report 2D ECHO report + stills of ECHO
3A.S12.00005 : Vertebral Angioplasty with single
553 S12 3A.S12.00005 55000 2D ECHO , ANGIOGRAM report & stills Post procedure Angio stills
stent (medicated)
3A.S12.00006 : Vertebral Angioplasty with double
554 S12 3A.S12.00006 70000 2D ECHO , Angiogram Report & Stills Angiogram-DSA/MRA/CTA
stent(medicated)
3A.S12.00007 : Carotid angioplasty with stent Angiogram report & Film showing the Post procedure Angio stills + XRAY
555 S12 3A.S12.00007 130000
(medicated) lesion + Doppler
1.Angioplasty stills showing stents &
3A.S12.00008 : Renal Angioplasty with single stent ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
556 S12 3A.S12.00008 65000
(medicated) blocks & Reports stents used approved by
FDA/CE/DCGI only
Speciality
code
3A.S12.00009 : Renal Angioplasty with double stent
(medicated)
ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
558 S12 3A.S12.00010 3A.S12.00010 : Peripheral Angioplasty with balloon 40000
blocks & Reports stents used approved by
FDA/CE/DCGI only
3A.S12.00011 : Peripheral Angioplasty with stent 2D ECHO , ANGIOGRAM report & stills ,
559 S12 3A.S12.00011 50000 Post procedure Angio stills, ABI
(medicated) ABI
560 S12 3A.S12.00012 3A.S12.00012 : Coarctation dilatation 25000 2D ECHO report 2D ECHO report + stills of ECHO
2D ECHO stills showing the device +

561 S12 3A.S12.00014 3A.S12.00014 : ASD Device Closure 88000 2D ECHO report
Report
562 S12 3A.S12.00015 3A.S12.00015 : VSD Device Closure 88000 2D ECHO report
Report
563 S12 3A.S12.00016 3A.S12.00016 : PDA Device Closure 80000 2D ECHO report
Report
2D ECHO stills showing the coil +
564 S12 3A.S12.00017 3A.S12.00017 : PDA multiple Coil insertion 30000 2D ECHO report
Report
2D ECHO stills showing the coil +
565 S12 3A.S12.00018 3A.S12.00018 : PDA Coil (one) insertion 25000 2D ECHO report
Report
566 S12 3A.S12.00019 3A.S12.00019 : PDA stenting 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
3A.S12.00022 : Permanent pacemaker implantation

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

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

3A.S12.00024 : PTCA - single stent (medicated, ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
569 S12 3A.S12.00024 60000
inclusive of diagnostic angiogram) blocks & Reports stents used approved by
FDA/CE/DCGI only
3A.S12.00025 : PTCA - double stent (medicated, ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
570 S12 3A.S12.00025 85000
inclusive of diagnostic angiogram) blocks & Reports stents used approved by
FDA/CE/DCGI only
3A.S12.00026 : PTCA - additonal stent (linked to ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent &
571 S12 3A.S12.00026 28849
package no:0025) blocks & Reports post Stent flow
572 S12 3A.S12.00028 3A.S12.00028 : Pulmonary artery stenting 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
573 S12 3A.S12.00029 3A.S12.00029 : Pulmonary artery stenting (double) 65000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
Speciality
code
3A.S12.00030 : Right ventricular outflow tract (RVOT)
574 S12 3A.S12.00030 50000 2D ECHO, Angiogram Report & Stills Post procedure Angio stills
stenting
CAG stills with balloon and stills with
575 S12 3A.S12.00031 3A.S12.00031 : Rotablation+ Balloon Angioplasty 45000 CAG Report with stills showing blocks
post flow
3A.S12.00032 : Rotablation+ Balloon Angioplasty + CAG stills with balloon and stills with
576 S12 3A.S12.00032 100000 CAG Report with stills showing blocks
1 stent (medicated) post flow
3A.S12.00033 : Rotablation+ Balloon Angioplasty + CAG stills with balloon and stills with
2 stent (medicated) post flow
Peripheral Angiogram /Doppler Report
578 S12 3A.S12.00034 3A.S12.00034 : Thrombolysis for peripheral ischemia 30000 Post procedure Angio stills
with Stills
3A.S12.00035 : Bronchial artery Embolisation (for Chest x-Ray/CT Scan, Hb, Serum Chest x-Ray/CT Scan, Hb, Serum
579 S12 3A.S12.00035 25000
Haemoptysis) Creatinine Creatinine
3A.S12.00036 : Percutaneous Transluminal Tricuspid
580 S12 3A.S12.00036 25000 2D ECHO report with stills 2D ECHO report + stills of the ECHO
Commissurotormy (PTTC)
CT/MRI or Angiogram, Prothrombin

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

582 S12 3A.S12.00038 40000 USG, CT PT, INR, Hb, Serum Creatinine
Malformation (AVM) in the Limbs Creatinine
3A.S12.00039 : Catheter directed Thrombolysis for: CT/MRI, Prothrombin Time (PT),

CT/MRI, PT,INR, Hb, Serum
583 S12 3A.S12.00039 Deep vein thrombosis (DVT), Mesenteric Thrombosis 50000 International normalized ratio (INR) Hb,
Creatinine
& Peripheral vessels Serum Creatinine
3A.S12.17059 : PTCA - one stent (non-medicated, ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent &
584 S12 3A.S12.17059 48000
elective) * blocks & Reports post Stent flow
3A.S12.17060 : Renal Angioplasty with stent (non-
medicated) *
586 S12 3A.S12.17061 3A.S12.17061 : Pulse Generator replacement 50000 X Ray showing the pacemaker in situ
587 S12 3A.S12.17062 3A.S12.17062 : Septostomy 20000 2D ECHO report 2D ECHO report + stills of the ECHO
3A.S12.17063 : Intravascular ultrasound

588 S12 3A.S12.17063 20000 Angiogram Report IVUS/FFR report
(IVUS)/Fractional Flow Reserve (FFR)
589 S12 3A.S12.17064 3A.S12.17064 : Electrophysiological Study (EP study) 10000 ECG with report + 2D ECHO report EP study report+ ECG
3A.S12.17065 : Radiofrequency Ablation (RF

590 S12 3A.S12.17065 25000 ECG with report + 2D ECHO report RF ablation report +ECG
Ablation)
591 S12 3A.S12.17066 3A.S12.17066 : 3D Mapping + Ablation 50000 ECG with report + 2D ECHO report 3D mapping report+ECG with report
3A.S12.17067 : Rotablation+ PTCA (non-medicated CAG stills with stents and stills with
Stent )* post flow
Speciality
code
3A.S12.17068 : Rotablation+ PTCA (One Drug ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
593 S12 3A.S12.17068 80000
Eluting Stent)* blocks & Reports stents used approved by
FDA/CE/DCGI only
594 S12 3A.S12.17069 3A.S12.17069 : Venous stenting* 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
595 S12 3A.S12.17070 3A.S12.17070 : Coarctoplasty with stenting* 75000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
3A.S12.17071 : Paravalvular leak/ Ruptured sinus of 2D ECHO stills showing the device +
596 S12 3A.S12.17071 88000 2D ECHO Report
Valsalva aneurysm (RSOV) Report
USG, clotting Time (CT), Prothrombin

USG, CT,PT,INR, Hb, Serum
597 S12 3A.S12.17072 3A.S12.17072 : Inferior Vena Cava (or IVC) Stenting 60000 Time (PT), International normalized ratio
Creatinine
(INR), Hb, Serum Creatinine
3A.S12.17087 : Peripheral Angioplasty with stent 2D ECHO , ANGIOGRAM report & stills ,
598 S12 3A.S12.17087 60000 Post procedure Angio stills, ABI
(non-medicated) * ABI
Angiogram report & Film showing the Post procedure Angio stills + XRAY
599 S12 3A.S12.17088 3A.S12.17088 : Carotid angioplasty with stent* 150000
lesion + Doppler
3A.S13.00001 : Coronary artery bypass grafting
600 S13 3A.S13.00001 95000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
(CABG)
601 S13 3A.S13.00002 125000 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
(CABG) with Intra-aortic balloon pump (IABP)
Post op X Ray , 2D ECHO with stills,
602 S13 3A.S13.00003 (CABG) + one mechanical Valve Replacement + Intra- 145000 2D ECHO with stills , CAG Report
scar photo
aortic balloon pump (IABP)
3A.S13.00004 : Coronary artery bypass grafting ECHO with stills,Post op X Ray ,scar
603 S13 3A.S13.00004 95000 2D ECHO with stills , CAG Report
(CABG) with LV Aneurysmal repair photo
3A.S13.00005 : Coronary artery bypass grafting ECHO with stills,Post op X Ray ,scar
(CABG) with Mitral Valve repair without ring photo
3A.S13.00006 : Coronary artery bypass grafting Post op X Ray , 2D ECHO with stills,
(CABG) with Mitral Valve repair with ring scar photo
ECHO with stills,Post op X Ray ,scar
606 S13 3A.S13.00007 (CABG) with post MI Ventricular Septal Defect 120000 2D ECHO with stills , CAG Report
photo
(Ventricular Septal Defect) repair
2D ECHO Report + stills of
607 S13 3A.S13.00008 3A.S13.00008 : Open Mitral Valvotomy 80000 2D ECHO Report with stills
ECHO,scar photo
2D ECHO Report + stills of ECHO +

608 S13 3A.S13.00009 3A.S13.00009 : Closed Mitral Valvotomy 30000 2D ECHO Report with stills
Post Op X-ray,scar photo

609 S13 3A.S13.00010 3A.S13.00010 : Open Pulmonary Valvotomy 80000 2D ECHO Report with stills
ECHO,scar photo
Speciality
code

610 S13 3A.S13.00011 3A.S13.00011 : Mitral Valve Repair 80000 2D ECHO Report with stills

611 S13 3A.S13.00012 3A.S13.00012 : Tricuspid Valve Repair 80000 2D ECHO Report with stills

612 S13 3A.S13.00013 3A.S13.00013 : Aortic Valve Repair 80000 2D ECHO Report with stills

613 S13 3A.S13.00014 3A.S13.00014 : Ring for any Valve Repair 20000 2D ECHO Report with stills
3A.S13.00015 : Mitral Valve Replacement 2D ECHO Report + stills of ECHO +

614 S13 3A.S13.00015 130000 2D ECHO Report with stills
(mechanical valve) Post Op X-ray,scar photo
3A.S13.00016 : Mitral Valve Replacement (biological 2D ECHO Report + stills of ECHO +

valve) Post Op X-ray,scar photo
3A.S13.00017 : Aortic Valve Replacement 2D ECHO Report + stills of ECHO +

3A.S13.00018 : Aortic Valve Replacement (biological 2D ECHO Report + stills of ECHO +

valve) Post Op X-ray,scar photo
3A.S13.00019 : Tricuspid Valve Replacement 2D ECHO Report + stills of ECHO +

3A.S13.00020 : Tricuspid Valve Replacement 2D ECHO Report + stills of ECHO +

(biological valve) Post Op X-ray,scar photo
3A.S13.00021 : Double Valve Replacement 2D ECHO Report + stills of ECHO +

3A.S13.00022 : Double Valve Replacement 2D ECHO Report + stills of ECHO +

(biological valve) Post Op X-ray,scar photo

622 S13 3A.S13.00023 3A.S13.00023 : Ross Procedure 110000 2D ECHO Report with stills

623 S13 3A.S13.00024 3A.S13.00024 : Atrial Septal Defect (ASD) 90000 2D ECHO Report with stills
Speciality
code

624 S13 3A.S13.00025 3A.S13.00025 : Ventricular Septal Defect (VSD) 90000 2D ECHO Report with stills
3A.S13.00026 : Atrioventricular septal defect/ 2D ECHO Report + stills of ECHO +

Atrioventricular (AV) Canal Defect Post Op X-ray,scar photo
3A.S13.00027 : Intracardiac repair (ICR) for Tetralogy 2D ECHO Report + stills of ECHO +
of Fallot (TOF) Post Op X-ray,scar photo
3A.S13.00028 : Pulmonary Valvotomy + Right 2D ECHO Report + stills of ECHO +

Ventricular Outflow Tract (RVOT) Resection Post Op X-ray,scar photo
3A.S13.00029 : Aortopulmonary Window (AP 2D ECHO Report + stills of ECHO +

Window) Post Op X-ray,scar photo
3A.S13.00030 : Surgery for Hypertrophic Obstructive 2D ECHO/TEE Report + Chest Xray AP 2D ECHO Report + stills of ECHO +
629 S13 3A.S13.00030 90000
Cardiomyopathy (HOCM) view /Cardiac MRI Post Op X-ray,scar photo

630 S13 3A.S13.00031 3A.S13.00031 : Ebsteins 90000 ECG, 2D ECHO Report

631 S13 3A.S13.00032 3A.S13.00032 : Fontan 100000 2D ECHO Report with stills
3A.S13.00033 : Total Anomalous Pulmonary Venous 2D ECHO Report + stills of ECHO +

Connection (TAPVC) Post Op X-ray,scar photo

633 S13 3A.S13.00034 3A.S13.00034 : Any RV to PA conduit (Valved) 120000 2D ECHO Report with stills

634 S13 3A.S13.00035 3A.S13.00035 : Arterial Switch Operation 120000 2D ECHO Report with stills

635 S13 3A.S13.00036 3A.S13.00036 : Double Switch Operation 120000 2D ECHO Report with stills

636 S13 3A.S13.00037 3A.S13.00037 : Sennings 120000 2D ECHO Report with stills

637 S13 3A.S13.00038 3A.S13.00038 : Mustards 120000 2D ECHO Report with stills
Speciality
code

638 S13 3A.S13.00039 3A.S13.00039 : Truncus Arteriosus Surgery 120000 2D ECHO Report with stills
3A.S13.00040 : Root Replacement (Aortic Aneurysm/ 2D ECHO Report + stills of ECHO +

Aortic Dissection) / Bental Procedure Post Op X-ray,scar photo

640 S13 3A.S13.00041 3A.S13.00041 : Aortic Arch Replacement 150000 2D ECHO Report with stills
3A.S13.00042 : Aortic Aneurysm Repair using

641 S13 3A.S13.00042 90000 CT Angio Report Scar photo + Intra op photo
Cardiopulmonary bypass (CPB)
3A.S13.00043 : Aortic Aneurysm Repair without
using Cardiopulmonary bypass (CPB)
2D ECHO with stills + ABG report + CT 2D ECHO Report + stills of ECHO +
643 S13 3A.S13.00044 3A.S13.00044 : Pulmonary Embolectomy 150000
Chest report Post Op X-ray,scar photo
3A.S13.00046 : Patent Ductus Arteriosus (PDA) 2D ECHO Report + stills of ECHO +

Closure Post Op X-ray, scar photo
645 S13 3A.S13.00047 3A.S13.00047 : Coarctation Repair 30000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
3A.S13.00048 : Coarctation Repair with interpostion

646 S13 3A.S13.00048 70000 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
graft
3A.S13.00049 : Blalock–Thomas–Taussig (BT) Shunt 2D ECHO Report + stills of ECHO +
(inclusives of grafts) Post Op X-ray,scar photo
3A.S13.00050 : Glenn Shunt (without 2D ECHO Report + stills of ECHO +

cardiopulmonary bypass) Post Op X-ray,scar photo

649 S13 3A.S13.00051 3A.S13.00051 : Central Shunt 60000 2D ECHO Report with stills

650 S13 3A.S13.00052 3A.S13.00052 : Pericardiectomy 50000 2D ECHO Report with stills
651 S13 3A.S13.00053 3A.S13.00053 : Pulmonary AV Fistula surgery 45000 CT Chest report Post Op X-ray,scar photo
652 S13 3A.S13.00054 3A.S13.00054 : Lung Cyst 60000 CT Chest report Post Op X-ray,scar photo
3A.S13.00055 : Space-Occupying Lesion (SOL)
653 S13 3A.S13.00055 60000 CT Chest report Post Op X-ray,scar photo
mediastinum
3A.S13.00056 : Surgical Correction of 2D ECHO Report + stills of ECHO +

654 S13 3A.S13.00056 70000 CT Chest report
Bronchopleural Fistula Post Op X-ray,scar photo

655 S13 3A.S13.00057 3A.S13.00057 : Diaphragmatic Eventeration 50000 CT Chest report
Speciality
code
3A.S13.00058 : Oesophageal Diverticula /Achalasia 2D ECHO Report + stills of ECHO +

656 S13 3A.S13.00058 50000 Barium Study + CT Chest report
Cardia Post Op X-ray,scar photo

657 S13 3A.S13.00059 3A.S13.00059 : Diaphragmatic Injuries/Repair 35000 CT Chest report
3A.S13.00060 : Thoracotomy, Thoraco Abdominal

658 S13 3A.S13.00060 40000 CT Chest report Post Op X-ray,scar photo
Approach
3A.S13.00062 : Bronchial Repair Surgery for Injuries
659 S13 3A.S13.00062 40000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE
due to FB
660 S13 3A.S13.00064 3A.S13.00064 : Thyomectomy 35000 CT Chest report X-RAY, scar photo

661 S13 3A.S13.00065 3A.S13.00065 : Pulmonary Valve Replacement 120000 2D ECHO Report
post Op X-ray,scar photo
3A.S13.00067 : Encysted Empyema/Pleural Effusion -

662 S13 3A.S13.00067 20000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
Tubercular
3A.S13.00068 : First rib Excision by transaxillary
663 S13 3A.S13.00068 approach, Excision of cervical rib / fibrous band / 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
muscle by cervical approach
664 S13 3A.S13.00069 3A.S13.00069 : Congenital Cystic Lesions 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
665 S13 3A.S13.00070 3A.S13.00070 : Pulmonary Sequestration Resection 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
3A.S13.00071 : Pulmonary artero venous

666 S13 3A.S13.00071 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
malformation
3A.S13.00074 : Intrathoracic Aneurysm-Aneurysm
667 S13 3A.S13.00074 65000 CT Angio Report Scar photo + Post op intra op photo
not Requiring Bypass Techniques
S13 3A.S13.00089A 3A.S13.00089A : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
3A.S13.17089 : Coronary artery bypass grafting ECHO,Post op X Ray ,scar photo +
668 S13 3A.S13.17089 100000 2D ECHO , CAG Report
(CABG) with additional arterial graft* scar photo of graft area
3A.S13.17090 : Valve Replacement with Intra-aortic 2D ECHO Report + stills of ECHO +

balloon pump (IABP) * Post Op X-ray,scar photo
3A.S13.17091 : Pulmonary Atresia with or without 2D ECHO Report + stills of ECHO +

Ventricular Septal Defect * Post Op X-ray,scar photo
671 S13 3A.S13.17092 3A.S13.17092 : Pleurectomy 50000 CT Chest report Post Op X-ray,scar photo
672 S13 3A.S13.17093 3A.S13.17093 : Mediastinotomy 40000 CT Chest report Post Op X-ray,scar photo
3A.S13.17094 : Gastro Study Followed by
673 S13 3A.S13.17094 Thoracotomy & Repairs of Oesophageal Injury for 50000 Gastroscopy Report ENDOSCOPY PICTURE, scar photo
Corrosive Injuries/FB
3A.S13.17095 : Thorocotomy and resection of pluera Pre Op X-ray / CT Scan, Bronchoscopy
674 S13 3A.S13.17095 50000 Post Op X-ray / CT Scan ,scar photo
with Lung Report
Speciality
code
675 S13 3A.S13.17096 3A.S13.17096 : Congenital Hypoplasia of the lung 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
3A.S13.17097 : Thoracotomy & Excision and fixation

676 S13 3A.S13.17097 65000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
of the Spine
3A.S13.17099 : Coronary artery bypass grafting Post op X Ray , 2D ECHO with stills,
(CABG) + Valve Replacement * scar photo
678 S13 3A.S13.17100 3A.S13.17100 : Open Aortic Valvotomy * 80000 2D ECHO Report with stills
ECHO,scar photo
3A.S13.17101 : Aortic Aneurysm Repair without
679 S13 3A.S13.17101 using Cardiopulmonary bypass (CPB) with/without 70000 CT Angio Report Scar photo + Intra op photo
graft*
680 S13 3A.S13.17102 3A.S13.17102 : Lobectomy 70000 CT Chest report Post Op X-ray,scar photo
3A.S6.17024B : Visceral injuries severe - cross
S6 3A.S6.17024B 60000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
speciality
3A.S6.17025B : Chest injuries with ICD bilateral - Post-Operative chest X-ray with ICD
S6 3A.S6.17025B 11000 X-ray /ultra sound
cross speciality in situ
3A.S6.17026B : Chest injuries with ICD + ICU - cross Post-Operative chest X-ray with ICD
speciality in situ
3A.S6.17027B : Chest injuries with ICD + ICU + Post-Operative chest X-ray with ICD
Ventilator - cross speciality in situ
3A.S8.00025B : Shunt (peritoneal, ventriculo-atrial/

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

S1 3A.S1.00078A 40000 USG, UGI ENDOSCOPY Scar photo + Intra op photo
speciality
3A.S1.00138B : Pharyngectomy& Reconstruction –
S1 3A.S1.00138B 12000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
Total - cross specaility
3A.S1.00139A : Tracheal Stenosis (End to end
S1 3A.S1.00139A 15000 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat) - cross speciality
3A.S1.00140A : Tracheoplasty (Throat) - cross
S1 3A.S1.00140A 40000 CT / Bronchoscopy report CT / Bronchoscopy report
speciality
3A.S1.00149B : Aneurysm Resection & Grafting -
S1 3A.S1.00149B 70000 CT Angio Report Scar photo + Intra op photo
cross speciality
3A.S1.00150A : Arterial Embolectomy - cross
S1 3A.S1.00150A 10000 Arterial doppler Scar photo
speciality
3A.S1.00151A : Carotid artery aneurysm repair - 2D ECHO Report + stills of ECHO +

S1 3A.S1.00151A 20000 2D ECHO Report with stills
cross speciality Post Op X-ray,scar photo
3A.S1.00152A : Carotid Body tumour - Excision - Stills showing the procedure

S1 3A.S1.00152A 35000 Angiogram/spiral CT Angiogram reports
cross speciality +Duplex scan, scar photo
3A.S1.00157A : Decortication (Pleurectomy) - cross
S1 3A.S1.00157A 50000 CT Chest report Post Op X-ray,scar photo
speciality
Speciality
code
3A.S1.00158A : Dissecting Aneurysms - cross 2D ECHO Report + stills of ECHO +

S1 3A.S1.00158A 36000 2D ECHO Report with stills, Doppler
speciality Post Op X-ray,scar photo
3A.S1.00159A : Distal Abdominal Aorta repair - cross

S1 3A.S1.00159A 36000 Angiogram/CTA/MRA Scar photo
speciality
S1 3A.S1.00194A 3A.S1.00194A : Mediastinal Tumour - cross speciality 50000 Biopsy/FNAC ,CT
HPE report + XRAY Chest
3A.S1.00195A : Oesophagectomy for Carcinoma
S1 3A.S1.00195A 50000 Biopsy , CT , Endoscopy reports HPE report, scar photo
Oesophagus - cross speciality
3A.S1.00207A : Hernia -hiatus-Transthoracic - cross
S1 3A.S1.00207A 25000 UGI ENDOSCOPY Scar photo/ Intra op photo
speciality
S1 3A.S1.00218A 3A.S1.00218A : Pericardiostomy - cross speciality 10000 2D ECHO
S1 3A.S1.00219A 3A.S1.00219A : Pneumonectomy - cross speciality 60000 CT Chest report Post Op X-ray,scar photo
3A.S1.00221A : Removal Tumours of Chest Wall - Clinical Photograph showing scar +

S1 3A.S1.00221A 40000 CT Chest, biopsy
cross speciality HPE report
3A.S1.00222A : Procedures Requiring Bypass
S1 3A.S1.00222A 35000 Angiogram Scar photo
Techniques - cross speciality
S1 3A.S1.00231A 3A.S1.00231A : Thorachostomy - cross speciality 10000 Chest X Ray Chest X Ray
S1 3A.S1.00233A 3A.S1.00233A : Thoracoplasty - cross speciality 20000 X-ray, CT X-ray

3A.S1.00234A : Thoracoscopic Decortication - cross
S1 3A.S1.00234A 25000 Clinical Photograph Scar photo
speciality
3A.S1.00235B : Thoracoscopic Hydatid Cyst excision -
S1 3A.S1.00235B 20000 Chest X-ray / CT Scar photo, HPE
cross speciality
3A.S1.00236A : Thoracoscopic Lobectomy - cross
S1 3A.S1.00236A 25000 CT/MRI Scar photo, HPE
speciality
3A.S1.00237A : Thoracoscopic Pneumonectomy -
cross speciality
3A.S1.00238A : Thoracoscopic Segmental Resection -
cross speciality
3A.S1.00239A : Thoracoscopic Sympathectomy -
S1 3A.S1.00239A 35000 CT Chest report Post Op X-ray, photo of scar, port
cross speciality
insertion
3A.S1.00241A : Thorax (penetrating wounds) -
S1 3A.S1.00241A 12500 X-ray, Clinical photo Post-op clinical photo & X-Ray
CROSS SPECIALITY
Speciality
code
CARDIOVASCULAR SURGERY
3A.S13.00072 : Thromboembolectomy (pre-auth not
681 S13 3A.S13.00072 30000 Duplex/Angio Report & stills Scar photo + Intra op photo
required, usually done as emergency)
3A.S13.00073 : Surgery for Arterial Aneursysm -
682 S13 3A.S13.00073 90000 Duplex/Angio Report & stills Scar photo + Intra op photo
Upper/Distal Abdominal Aorta
3A.S13.00075 : Intrathoracic Aneurysm-Requiring
Bypass Techniques
3A.S13.00076 : Surgery for Arterial Aneurysm Renal Renal arterial Doppler, Angiogram with
684 S13 3A.S13.00076 50000 Scar photo + Intra op photo
Artery stills
3A.S13.00078 : Operations for Stenosis of Renal Renal arterial Doppler,angiogram &
685 S13 3A.S13.00078 20000 Doppler Report + scar photo
Arteries Stills
3A.S13.00079 : Aorto Bi-lliac / Bi femoral /Axillo bi Stills showing the procedure with
686 S13 3A.S13.00079 90000 Angiogram/spiral CT Angiogram reports
femoral bypass with Synthetic Graft graft + scar photo
3A.S13.00080 : Femoro Distal / Femoral - Femoral / Stills showing the procedure with
Femoral infra popliteal Bypass with Vein Graft graft +Duplex scan, scar photo
3A.S13.00081 : Femoro Distal / Femoral - Femoral / Clinical Photographs Duplex, ABI,

688 S13 3A.S13.00081 70000 Angiogram Report
Femoral infra popliteal Bypass with Synthetic Graft scar photo
3A.S13.00082 : Axillo Brachial Bypass using with Stills showing the procedure with
Synthetic Graft graft +Duplex scan, scar photo
3A.S13.00083 : Brachio - Radial Bypass with Stills showing the procedure with
Synthetic Graft graft +Duplex scan, scar photo
3A.S13.00084 : Excision of body Tumor with vascular Stills showing the procedure with
691 S13 3A.S13.00084 40000 Angiogram report
repair graft + scar photo,
3A.S13.00085 : Carotid artery bypass with Synthetic Stills showing the procedure with
Graft graft +Duplex scan, scar photo
3A.S13.00086 : Excision of Arterio Venous Stills showing the procedure with

malformation - Large graft + scar photo
3A.S13.00087 : Excision of Arterio Venous Stills showing the procedure with
malformation - Small graft + scar photo
3A.S13.00088 : Deep Vein Thrombosis (DVT) - Plain X-ray abdomen showing the
695 S13 3A.S13.00088 65000 Color doppler
Inferior Vena Cava (IVC) filter filter
696 S13 3A.S13.00089 3A.S13.00089 : Carotid endarterectomy 45000 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
3A.S13.00090 : Aortic Angioplasty with two stents / ECG, 2D ECHO, CAG stills showing Angioplasty stills showing Balloon &
697 S13 3A.S13.00090 90000
Iliac angioplasty with stent Bilateral blocks & Reports post flow,scar photo
698 S13 3A.S13.00091 3A.S13.00091 : Bilateral thrombo embolectomy 40000 Duplex/Angio Report & stills Scar photo + Intra op photo
3A.S13.00092 : Aorto-uni-iliac/uni-femoral bypass Stills showing the procedure with

with synthetic graft graft +Duplex scan, scar photo
Speciality
code
700 S13 3A.S13.17103 3A.S13.17103 : Pericardiostomy without balloon 10000 2D ECHO report 2D ECHO report + stills of the ECHO
3A.S13.17104 : Carotid/other endarterectomy with Stills showing the procedure with

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

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

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

S1 3A.S1.00068A 5000 clinical photograph Doppler
cross speciality
3A.S1.00148A : Aneurysm not Requiring Bypass
S1 3A.S1.00148A 36000 CT Angio Report Scar photo + Post op intra op photo
Techniques - cross speciality
3A.S1.00149A : Aneurysm Resection & Grafting -
S1 3A.S1.00149A 70000 CT Angio Report Scar photo + Intra op photo
cross speciality
3A.S1.00150B : Arterial Embolectomy - cross
S1 3A.S1.00150B 10000 Arterial doppler Scar photo
speciality
3A.S1.00151B : Carotid artery aneurysm repair - 2D ECHO Report + stills of ECHO +

S1 3A.S1.00151B 20000 2D ECHO Report with stills
cross speciality Post Op X-ray,scar photo
3A.S1.00155A : Congential Arteriovenus Fistula

S1 3A.S1.00155A 20000 Arterial doppler, clinical photo Scar photo
(large) - cross speciality
3A.S1.00156B : Congential Arteriovenus Fistula
S1 3A.S1.00156B 10000 Arterial doppler, clinical photo Scar photo
(small) - cross speciality
3A.S1.00158B : Dissecting Aneurysms - cross 2D ECHO Report + stills of ECHO +

S1 3A.S1.00158B 36000 2D ECHO Report with stills, Doppler
speciality Post Op X-ray,scar photo
3A.S1.00159B : Distal Abdominal Aorta repair - cross

S1 3A.S1.00159B 36000 Angiogram/CTA/MRA Scar photo
speciality
3A.S1.00212A : Operations for Acquired
S1 3A.S1.00212A 15000 Arterial doppler / MRA Scar photo
Arteriovenous Fistula - cross speciality
Speciality
code
3A.S1.00217A : Patch Graft Angioplasty - cross
S1 3A.S1.00217A 20000 Arterial Doppler Post Op Arterial Doppler, Scar photo
speciality
3A.S1.00227A : Surgery for Arterial Aneurysm
S1 3A.S1.00227A 20000 CT Angio / MRA Scar photo
Spleenic Artery - cross speciality
3A.S1.00228A : Surgery for Arterial Aneurism
S1 3A.S1.00228A 25000 CT Angio / MRA Scar photo
–Vertebral - cross speciality
3A.S1.00240A : Thrombendarterectomy - cross
S1 3A.S1.00240A 15000 Arterial doppler, CT Angio/MRA Scar photo
speciality
3A.S10.00002A : Revascularization of limb/digit - - CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,, Doppler study, Clinical photo and OT
S10 3A.S10.00002A 25000
cross speciality CXR, ECG,(X-ray of limb/digit) note
3A.S12.00029A : Pulmonary artery stenting (double)

S12 3A.S12.00029A 65000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
- cross speciality
S12 3A.S12.17069A 3A.S12.17069A : Venous stenting* - cross speciality 50000 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
Pre-operative Doppler study, CT

3A.S1.00193A : Repair of Main Arteries of the Limbs - Post-operative Doppler study,
S1 3A.S1.00193A 7500 angio(Optional)+ Films+ detailed
cross speciality Clinical photo showing scar
Clinical notes
3A.S16.00009 : Cleft lip and palate surgery (each
stage)
CT/MRI report and Film if required/ Clinical Photograph showing scar +
S2 3A.S2.00085A 3A.S2.00085A : Hemiglossectomy - - cross speciality 18750
Biopsy HPE report
3A.S2.00087A : Partial Glossectomy - cross CT/MRI report and Film if required/ Clinical Photograph showing scar +
S2 3A.S2.00087A 18750
speciality Biopsy HPE report
CT/MRI report and Film if required/ Clinical Photograph showing scar +
S2 3A.S2.00088A 3A.S2.00088A : Ranula excision - cross speciality 18750
Biopsy HPE report
S2 3A.S2.00090A 3A.S2.00090A : Total Glossectomy - cross speciality 11250 CT Clinical photograph
3A.S6.00004A : Head injury requiring Facio-Maxillary

S6 3A.S6.00004A Injury repairs & fixations (including implants) - 26250 X-RAY/CT scan(If Required)
cross speciality
3A.S8 .00050A : R.F. Lesion for Trigeminal Neuralgia
S8 3A.S8 .00050A 11250 MRI Report CD of Procedure
- cross speciality
3A.S8.00049A : Peripheral Neurectomy (Trigeminal) -
S8 3A.S8.00049A 12375 MRI Report CD of Procedure
cross speciality
3A.S1.00197B : Operation for Carcinoma Lip –
S1 3A.S1.00197B 7500 Clinical photograph, HPE Scar photo, HPE
Vermilionectomy - cross speciality
3A.S1.00198A : Operation for Carcinoma Lip -
S1 3A.S1.00198A Wedge Excision and Vermilionectomy - cross 9000 Clinical photograph, HPE Scar photo, HPE
speciality
3A.S1.00199A : Operation for Carcinoma Lip -
S1 3A.S1.00199A 7500 Clinical photograph, HPE Scar photo, HPE
Wedge-Excision - cross speciality
Speciality
code
3A.S1.00209A : Operation for carcinoma lip- cheek
advancement - cross speciality
3A.S14.00034A : Cleft Lip and Palate Surgery (per
S14 3A.S14.00034A 11250 Clinical Photograph Clinical Photograph
3A.S15.00007A : Palatectomy- Soft palate - cross
S15 3A.S15.00007A 22500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
speciality
3A.S15.00008A : Palatectomy- Hard palate - cross
S15 3A.S15.00008A 15000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
speciality
3A.S15.00014A : Total Maxillectomy - - cross Clinical Photograph showing scar +
S15 3A.S15.00014A 13500 CT report and Film, Biopsy
speciality HPE report
ENT
3A.S2.00015 : Excision of Pinna for Growths
709 S2 3A.S2.00015 4875 Clinical Photograph HPR/Clinical photograph
(Squamous/Basal) Injuries Total Amputation
710 S2 3A.S2.00018 3A.S2.00018 : Vidian neurectomy – Micro 6750 Clinical notes OT notes
3A.S2.00020 : Excision of Pinna for Growth
711 S2 3A.S2.00020 3000 Clinical Photograph/ FNAC HPR/Clinical photograph
(Squamous/Basal/ Injuries) Skin and Cartilage
712 S2 3A.S2.00022 3A.S2.00022 : Pharyngectomy and reconstruction 11250 CT Neck HPE, Scar Photo
713 S2 3A.S2.00023 3A.S2.00023 : Skull base surgery 27750 CT-Scan / MRI Scan Clinical Photograph
3A.S2.00024 : Total Amputation & Excision of
714 S2 3A.S2.00024 5625 Clinical photograph Scar photo HPE
External Auditory Meatus
715 S2 3A.S2.00032 3A.S2.00032 : CSF Rhinorrhoea – Repair 32250 CT report Clinical Photograph with Scar
716 S2 3A.S2.00040 3A.S2.00040 : Rhinotomy – Lateral 5625 clinical notes, CT/MRI clinical notes
CT report and film, Clinical
717 S2 3A.S2.00050 3A.S2.00050 : Cranio-facial resection 52500 CT/MRI Report, Clinical Notes Photograph showing scar + HPE
report
718 S2 3A.S2.00059 3A.S2.00059 : Choanal atresia 9375 Clinical photo Clinical photo showing scar
719 S2 3A.S2.00064 3A.S2.00064 : Laryngophayryngectomy 15000 Clinical notes, CT/MRI clinical notes
720 S2 3A.S2.00065 3A.S2.00065 : Maxilla – Excision 9375 Clinical notes, CT/MRI Procedure notes
721 S2 3A.S2.00067 3A.S2.00067 : Parapharyngeal – Exploration 9375 CT/MRI Procedure notes
722 S2 3A.S2.00070 3A.S2.00070 : Pharyngoplasty 7500 CT/MRI Clinical notes
723 S2 3A.S2.00075 3A.S2.00075 : Total Parotidectomy 30000 FNAC,CT
HPE report
Clinical photo showing scar, BIOPSY,
3A.S2.00081 : Excision of Cystic Hygroma Major/
724 S2 3A.S2.00081 7500 Clinical notes & photo, USG/CT Operative notes with steps of surgery
Extensive
& Clinical notes
725 S2 3A.S2.00085 3A.S2.00085 : Hemiglossectomy 18750 CT/MRI, Biopsy
HPE report
726 S2 3A.S2.00087 3A.S2.00087 : Partial Glossectomy 18750 CT/MRI, Biopsy
HPE report
727 S2 3A.S2.00088 3A.S2.00088 : Ranula excision 18750 CT/MRI, Biopsy
HPE report
728 S2 3A.S2.00090 3A.S2.00090 : Total Glossectomy 11250 CT, Biopsy HPE Report
Speciality
code
Biopsy , Clinical Photograph, HPE
729 S2 3A.S2.00091 3A.S2.00091 : Total Laryngectomy + Neck dissection 18750 CT, Biopsy
Report
3A.S2.00092 : Laryngopharyngectomy with Gastric Clinical Photograph showing scar +
730 S2 3A.S2.00092 22500 CT , Biopsy
pull-up/ jejunal graft HPE report
3A.S2.00093 : Excision of CA cheek/ oral cavity + Clinical photograph showing scar +
731 S2 3A.S2.00093 22500 CT , Biopsy
radial forearm flap HPE report
3A.S2.00094 : Excision of growth Jaw + free fibular Clinical Photograph showing scar +
732 S2 3A.S2.00094 18750 CT , Biopsy
flap reconstruction HPE report
3A.S1.00045A : Excision of Growth from Tongue with

S1 3A.S1.00045A 11250 CT/MRI, Clinical Photo OT notes, HPE
neck node dissection - cross speciality
3A.S1.00114B : Radical Neck Dissection – Excision - Clinical photo, Clinical notes & Biopsy/
S1 3A.S1.00114B 11250 Scar photo & HPE
cross speciality Cytology
3A.S1.00134B : Submandibular Mass Excision + CT/MRI/USG report and Film if required/ Clinical Photograph showing scar +
S1 3A.S1.00134B 18750
Reconstruction - Cross speciality Biopsy HPE report
3A.S1.00138A : Pharyngectomy& Reconstruction –
S1 3A.S1.00138A 9000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
Total - cross specaility
3A.S1.00139B : Tracheal Stenosis (End to end
S1 3A.S1.00139B 11250 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat) - cross speciality
3A.S1.00140B : Tracheoplasty (Throat) - cross
S1 3A.S1.00140B 30000 CT / Bronchoscopy report CT / Bronchoscopy report
speciality
3A.S1.00146A : Cleft palate repair (for each stage) -
S1 3A.S1.00146A 9000 Clinical photo Scar photo
cross speciality
3A.S1.00152B : Carotid Body tumour - Excision - Stills showing the procedure
S1 3A.S1.00152B 26250 Angiogram/spiral CT Angiogram reports
cross speciality +Duplex scan, scar photo
3A.S1.00162B : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
S1 3A.S1.00162B 22500
Adenoma/Carcinoma - cross speciality reports/USG HPE report
3A.S1.00215A : Parapharyngeal Tumour Excision -
S1 3A.S1.00215A 8250 USG, CT Neck USG,HPE,Scar Photo
cross speciality
3A.S10.00001A : Ear Pinna Reconstruction with

costal cartilage/ Prosthesis (including the cost of
prosthesis/implants). *If requiring multiple stages, OT note with clinical photograph of
S10 3A.S10.00001A 2250 X-ray and clinical note
each stage will cost Rs. 30,000 provided the stages
operating surgeon demonstrates the photographic
results of previous stages. - cross speciality
GENERAL MEDICINE
3A.M1.00002 : Recurrent vomiting with dehydration - Relevant Hematological investigations,
733 M1 3A.M1.00002 1350 Treatment notes
routine ward Clinical notes
3A.M1.00002A : Recurrent vomiting with Relevant Hematological investigations,
M1 3A.M1.00002A 2025 Treatment notes
dehydration - HDU Clinical notes
3A.M1.00002B : Recurrent vomiting with Relevant Hematological investigations,
M1 3A.M1.00002B 2700 Treatment notes
dehydration - ICU without ventilator Clinical notes
Speciality
code
3A.M1.00002C : Recurrent vomiting with Relevant Hematological investigations,
M1 3A.M1.00002C 3375 Treatment notes
dehydration - ICU with ventilator Clinical notes
734 M1 3A.M1.00016 3A.M1.00016 : Chikungunya fever - routine ward 1350 clinical notes, Blood examination report clinical notes
M1 3A.M1.00016A 3A.M1.00016A : Chikungunya fever - HDU 2025 clinical notes, Blood examination report clinical notes
3A.M1.00016B : Chikungunya fever - ICU without

ventilator
3A.M1.00016C : Chikungunya fever - ICU with
M1 3A.M1.00016C 3375 clinical notes, Blood examination report clinical notes
ventilator
3A.M1.00032 : Acute inflammatory demyelinating
polyneuropathy - routine ward
3A.M1.00032A : Acute inflammatory demyelinating
M1 3A.M1.00032A 2025 clinical notes clinical notes
polyneuropathy - HDU
3A.M1.00032B : Acute inflammatory demyelinating

polyneuropathy - ICU without ventilator
3A.M1.00032C : Acute inflammatory demyelinating

polyneuropathy - iCU with ventilator
3A.M1.00034 : Acute and chronic meningitis - Clinical Notes with relevant

M1 3A.M1.00034A 3A.M1.00034A : Acute and chronic meningitis - HDU 2025 Treatment Notes
investigations
3A.M1.00034B : Acute and chronic meningitis - ICU Clinical Notes with relevant
3A.M1.00034C : Acute and chronic meningitis - ICU Clinical Notes with relevant
737 M1 3A.M1.00038 3A.M1.00038 : Visceral leishmaniasis - routine ward 1350 clinical notes, Blood examination report
report
M1 3A.M1.00038A 3A.M1.00038A : Visceral leishmaniasis - HDU 2025 clinical notes, Blood examination report
report
3A.M1.00038B : Visceral leishmaniasis - ICU without clinical notes, Blood examination
ventilator report
3A.M1.00038C : Visceral leishmaniasis - ICU with clinical notes, Blood examination
ventilator report
3A.M1.00039 : HIV with complications - routine
738 M1 3A.M1.00039 1350 clinical notes, Blood examination report clinical notes
ward
M1 3A.M1.00039A 3A.M1.00039A : HIV with complications - HDU 2025 clinical notes, Blood examination report clinical notes
3A.M1.00039B : HIV with complications - ICU

without ventilator
3A.M1.00039C : HIV with complications - ICU with
M1 3A.M1.00039C 3375 clinical notes, Blood examination report clinical notes
ventilator
Speciality
code
3A.M1.00041 : Metabolic encephalopathy - routine
739 M1 3A.M1.00041 1350 clinical notes, CT clinical notes, CT
ward
M1 3A.M1.00041A 3A.M1.00041A : Metabolic encephalopathy - HDU 2025 clinical notes, CT clinical notes, CT
3A.M1.00041B : Metabolic encephalopathy - ICU

M1 3A.M1.00041B 2700 clinical notes, CT clinical notes, CT
without ventilator
3A.M1.00041C : Metabolic encephalopathy - ICU
M1 3A.M1.00041C 3375 clinical notes, CT clinical notes, CT
with ventilator
740 M1 3A.M1.00042 3A.M1.00042 : Sickle cell Anemia - routine ward 1350 Clinical notes confirming digonosis clinical notes in relevant reports
M1 3A.M1.00042A 3A.M1.00042A : Sickle cell Anemia - HDU 2025 Clinical notes confirming digonosis clinical notes in relevant reports
3A.M1.00042B : Sickle cell Anemia - ICU without
M1 3A.M1.00042B 2700 Clinical notes confirming digonosis clinical notes in relevant reports
ventilator
3A.M1.00042C : Sickle cell Anemia - ICU with
M1 3A.M1.00042C 3375 Clinical notes confirming digonosis clinical notes in relevant reports
ventilator
3A.M1.00043 : Poisonings with unstable vitals -
routine ward
3A.M1.00043A : Poisonings with unstable vitals -
M1 3A.M1.00043A 2025 Clinical notes Clinical notes
HDU
3A.M1.00043B : Poisonings with unstable vitals - ICU
without ventilator
3A.M1.00043C : Poisonings with unstable vitals - ICU
with ventilator
742 M1 3A.M1.00047 3A.M1.00047 : Severe pneumonia - routine ward 1350 Treatment Notes
investigations, X-ray/USG of chest
M1 3A.M1.00047A 3A.M1.00047A : Severe pneumonia- HDU 2025 Treatment Notes
investigations, X-ray/USG of chest
3A.M1.00047B : Severe pneumonia - ICU without Clinical Notes with relevant
ventilator investigations, X-ray/USG of chest
3A.M1.00047C : Severe pneumonia - ICU with Clinical Notes with relevant
ventilator investigations, X-ray/USG of chest
743 M1 3A.M1.00058 3A.M1.00058 : Lower GI hemorrhage - routine ward 1350 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
M1 3A.M1.00058A 3A.M1.00058A : Lower GI hemorrhage - HDU 2025 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
3A.M1.00058B : Lower GI hemorrhage - ICU without
M1 3A.M1.00058B 2700 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
ventilator
3A.M1.00058C : Lower GI hemorrhage - ICU with
M1 3A.M1.00058C 3375 clinical notes, USG/CT/MRI clinical notes, USG/CT/MRI
ventilator
744 M1 3A.M1.00062 3A.M1.00062 : Hydrocephalus - routine ward 1350 CT Report CT Report, Scar Photo, X Ray
M1 3A.M1.00062A 3A.M1.00062A : Hydrocephalus - HDU 2025 CT Report CT Report, Scar Photo, X Ray
3A.M1.00062B : Hydrocephalus - ICU without
M1 3A.M1.00062B 2700 CT Report CT Report, Scar Photo, X Ray
ventilator
M1 3A.M1.00062C 3A.M1.00062C : Hydrocephalus - ICU with ventilator 3375 CT Report CT Report, Scar Photo, X Ray
Speciality
code
3A.M1.00063 : Cerebral sino-venous thrombosis -
745 M1 3A.M1.00063 1350 Clinical notes, CT - brain Clinical notes, CT - brain
routine ward
3A.M1.00063A : Cerebral sino-venous thrombosis -
M1 3A.M1.00063A 2025 Clinical notes, CT - brain Clinical notes, CT - brain
HDU
3A.M1.00063B : Cerebral sino-venous thrombosis -
M1 3A.M1.00063B 2700 Clinical notes, CT - brain Clinical notes, CT - brain
3A.M1.00063C : Cerebral sino-venous thrombosis -
M1 3A.M1.00063C 3375 Clinical notes, CT - brain Clinical notes, CT - brain
ICU with ventilator
746 M1 3A.M1.00069 3A.M1.00069 : Plasmapheresis - per session 1500 Blood examination Blood examination
3A.M1.00070 : Haemodialysis/Peritoneal Dialysis Clinical Notes with relevant
(only for ARF) - per session investigations
3A.M2.00015D : Chronic cough - cross speciality -
M2 3A.M2.00015D 1350 Clinical note with Lab reports Treatment note
routine ward
3A.M2.00015E : Chronic cough - cross speciality -
M2 3A.M2.00015E 2025 Clinical note with Lab reports Treatment note
HDU
3A.M2.00015F : Chronic cough - cross speciality -
M2 3A.M2.00015F 3375 Clinical note with Lab reports Treatment note
ICU with ventilator
3A.M2.00015G : Chronic cough - cross speciality -
M2 3A.M2.00015G 2700 Clinical note with Lab reports Treatment note
GENERAL SURGERY
748 S1 3A.S1.00002 3A.S1.00002 : Anterior Resection for Ca 52500 Endoscopy, biopsy, CT report with film
HPE report
749 S1 3A.S1.00007 3A.S1.00007 : Bilateral Inguinal block dissection 30000 Biopsy Reports
HPE report
3A.S1.00008 : Bleeding Ulcer - Gastrectomy &
750 S1 3A.S1.00008 18750 USG/CT, Clinical notes OT note
vagotomy
751 S1 3A.S1.00014 3A.S1.00014 : Branchial Cyst 7500 USG/CT Scar Photo, HPE Report
752 S1 3A.S1.00016 3A.S1.00016 : Bypass - Inoperable Pancreas 11250 USG/CT USG, Scar photo, HPE Report
3A.S1.00045 : Excision of Growth from Tongue with
753 S1 3A.S1.00045 11250 CT/MRI, Clinical Photo OT notes, HPE
neck node dissection
754 S1 3A.S1.00059 3A.S1.00059 : Fundoplication 26250 Contrast X ray/endoscopy findings Clinical Photograph showing scar
755 S1 3A.S1.00064 3A.S1.00064 : Gastrostomy 11250 USG/ CT Scan Clinical photograph
756 S1 3A.S1.00068 3A.S1.00068 : Haemangioma – Excision (small) 3750 clinical photograph Doppler
757 S1 3A.S1.00070 3A.S1.00070 : Hepatic Resection (lobectomy) 15000 MRI/ CT Abdomen Scar Photo, HPE Report
758 S1 3A.S1.00078 3A.S1.00078 : Hiatus Hernia – abdominal 30000 UGI ENDOSCOPY Scar photo/ Intra op photo
759 S1 3A.S1.00084 3A.S1.00084 : Inguinal Node (dissection) - Unilateral 15000 Biopsy Reports/ Clinical Photograph
HPE report
760 S1 3A.S1.00087 3A.S1.00087 : Intussusception 11250 USG/CT , Clinical notes Scar photo
HPR , Scar photo & Clinical
761 S1 3A.S1.00092 3A.S1.00092 : Burst Abdomen Obstruction 11250 Clinical Photograph, Clinical notes
Photograph,
762 S1 3A.S1.00103 3A.S1.00103 : Oesophagectomy 45000 Biopsy , CT , Endoscopy reports HPE report, scar photo
763 S1 3A.S1.00104 3A.S1.00104 : Portal Hypertension shunt surgery 37500 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar
Speciality
code
CT-Scan , ERCP , ER Clinical Photograph ,
764 S1 3A.S1.00106 3A.S1.00106 : PancreaticoDuodenectomy 18750 HPR , Scar Photograph
Endoscopy
765 S1 3A.S1.00112 3A.S1.00112 : Pyeloroplasty 7500 USG, Clinical Notes Scar photo, HPE
766 S1 3A.S1.00113 3A.S1.00113 : Radical Mastectomy 7500 Mammography, HPE, CT Scan Scar photo & HPE
Clinical photo, Clinical notes & Biopsy/
767 S1 3A.S1.00114 3A.S1.00114 : Radical Neck Dissection – Excision 11250 Scar photo & HPE
Cytology
768 S1 3A.S1.00115 3A.S1.00115 : Hernia – Spigelian 3750 USG
notes
769 S1 3A.S1.00117 3A.S1.00117 : Prolapse of Rectal Mass – Excision 7500 Clinical Findings Procedure Notes
3A.S1.00120 : Resection Anastomosis (Large

770 S1 3A.S1.00120 11250 USG / CT Scan Scar photo, HPE
Intestine)
3A.S1.00121 : Resection Anastomosis (Small
771 S1 3A.S1.00121 11250 USG / CT Scan Scar photo, HPE
Intestine)
772 S1 3A.S1.00122 3A.S1.00122 : Retroperitoneal Tumor – Excision 37500 CT abdomen with film, FNAC
HPE report
773 S1 3A.S1.00125 3A.S1.00125 : Segmental Resection of Breast 7500 Mamography, FNAC, CT if indicated Scar photo, HPE
Biopsy of the primary tumour + CT/MRI
774 S1 3A.S1.00131 3A.S1.00131 : Soft Tissue Tumor (large) – Excision 26250 Scar photo, HPE
with film
3A.S1.00134 : Submandibular Mass Excision + CT/MRI/USG report and Film if required/ Clinical Photograph showing scar +
775 S1 3A.S1.00134 18750
Reconstruction Biopsy HPE report
3A.S1.00138 : Pharyngectomy& Reconstruction –
776 S1 3A.S1.00138 9000 CT Neck, Biopsy HPE, CT Neck, Scar Photo
Total
3A.S1.00139 : Tracheal Stenosis (End to end
777 S1 3A.S1.00139 11250 Bronchoscopy , CT Scar photo, Biopsy
Anastamosis) (Throat)
778 S1 3A.S1.00140 3A.S1.00140 : Tracheoplasty (Throat) 30000 CT / Bronchoscopy report CT / Bronchoscopy report
779 S1 3A.S1.00146 3A.S1.00146 : Cleft palate repair (for each stage) 9000 Clinical photo Scar photo
3A.S1.00148 : Aneurysm not Requiring Bypass

780 S1 3A.S1.00148 27000 CT Angio Report Scar photo + Post op intra op photo
Techniques
781 S1 3A.S1.00149 3A.S1.00149 : Aneurysm Resection & Grafting 52500 CT Angio Report Scar photo + Intra op photo
782 S1 3A.S1.00150 3A.S1.00150 : Arterial Embolectomy 7500 Arterial doppler Scar photo
783 S1 3A.S1.00151 3A.S1.00151 : Carotid artery aneurysm repair 15000 Arterial doppler / CT Angio Scar photo
Stills showing the procedure
784 S1 3A.S1.00152 3A.S1.00152 : Carotid Body tumour - Excision 26250 Angiogram/Spiral CT Angiogram reports
+Duplex scan, scar photo
785 S1 3A.S1.00155 3A.S1.00155 : Congential Arteriovenus Fistula (large) 15000 Arterial doppler, clinical photo Scar photo
786 S1 3A.S1.00156 3A.S1.00156 : Congential Arteriovenus Fistula (small) 7500 Arterial doppler, clinical photo Scar photo
787 S1 3A.S1.00157 3A.S1.00157 : Decortication (Pleurectomy) 37500 CT Chest Post Op X-ray,scar photo

788 S1 3A.S1.00158 3A.S1.00158 : Dissecting Aneurysms 27000 2D ECHO Report with stills, Doppler
789 S1 3A.S1.00159 3A.S1.00159 : Distal Abdominal Aorta repair 27000 Angiogram/CTA/MRA Scar photo
Speciality
code
790 S1 3A.S1.00160 3A.S1.00160 : Estlander Operation (lip) 5250 Clinical notes and photograph Scar photo
3A.S1.00162 : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
791 S1 3A.S1.00162 22500
Adenoma/Carcinoma reports/USG HPE report
792 S1 3A.S1.00163 3A.S1.00163 : Flap Reconstructive Surgery 22500 X-ray Films + detail notes Clinical photo showing Scar
3A.S1.00165 : Split thickness skin grafts – Medium (4
793 S1 3A.S1.00165 7500 Clinical photograph Scar photo
- 8% TBSA)
794 S1 3A.S1.00167 3A.S1.00167 : Free Grafts - Wolfe Grafts 7500 Clinical photograph Scar photo
795 S1 3A.S1.00171 3A.S1.00171 : Lap. Assisted left Hemi colectomy t 18750 CT , colonoscopy , USG USG, Scar Photo, HPE
796 S1 3A.S1.00172 3A.S1.00172 : Lap. Assisted Right Hemi colectomy t 18750 CT , colonoscopy , USG USG, Scar Photo, HPE

797 S1 3A.S1.00173 3A.S1.00173 : Lap. Assisted small bowel resection 30000 CT, Biopsy
HPE report
Colonocopy with film, biopsy, CT report Clinical Photograph showing scar +
798 S1 3A.S1.00174 3A.S1.00174 : Lap. Assisted Total Colectomy 30000
with film HPE report
799 S1 3A.S1.00179 3A.S1.00179 : Laparoscopic Adhesinolysis 11250 MRI/ CT Abdomen Scar Photo, HPE Report
Pre-operative Doppler study, CT
Post-operative Doppler study,
800 S1 3A.S1.00193 3A.S1.00193 : Repair of Main Arteries of the Limbs 7500 angio(Optional)+ Films+ detailed
Clinical photo showing scar
Clinical notes
801 S1 3A.S1.00194 3A.S1.00194 : Mediastinal Tumour 37500 Biopsy/FNAC ,CT
3A.S1.00195 : Oesophagectomy for Carcinoma
802 S1 3A.S1.00195 37500 Biopsy , CT , Endoscopy reports HPE report, scar photo
Oesophagus
3A.S1.00197 : Operation for Carcinoma Lip –
803 S1 3A.S1.00197 7500 Clinical photograph, HPE Scar photo, HPE
Vermilionectomy
3A.S1.00198 : Operation for Carcinoma Lip - Wedge
Excision and Vermilionectomy
3A.S1.00199 : Operation for Carcinoma Lip - Wedge-
Excision
3A.S1.00200 : Appendicectomy - Appendicular
806 S1 3A.S1.00200 9000 Clinical notes, USG/ CT Scar photo, HPE
Abscess – Drainage
807 S1 3A.S1.00201 3A.S1.00201 : Caecostomy 7500 Clinical notes, USG/ CT Scar photo, HPE
808 S1 3A.S1.00202 3A.S1.00202 : Closure of Colostomy 22500 Colonoscopy, Biopsy Clinical Photograph showing scar
3A.S1.00205 : CystoJejunostomy/or
809 S1 3A.S1.00205 15000 USG/ CT Scan Clinical photograph
Cystogastrostomy
810 S1 3A.S1.00207 3A.S1.00207 : Hernia -hiatus-Transthoracic 18750 UGI ENDOSCOPY Scar photo/ Intra op photo
3A.S1.00209 : Operation for carcinoma lip- cheek
advancement
3A.S1.00212 : Operations for Acquired
812 S1 3A.S1.00212 11250 Arterial doppler / MRA Scar photo
Arteriovenous Fistula
3A.S1.00213 : Operations for Replacement of
813 S1 3A.S1.00213 18750 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon
814 S1 3A.S1.00215 3A.S1.00215 : Parapharyngeal Tumour Excision 8250 USG, CT Neck USG,HPE,Scar Photo
Speciality
code
3A.S1.00216 : Partial/Subtotal Gastrectomy for Clinical Photograph showing scar +
815 S1 3A.S1.00216 37500 Endoscopy, biopsy, CT
Carcinoma HPE report
816 S1 3A.S1.00217 3A.S1.00217 : Patch Graft Angioplasty 15000 Arterial Doppler Post Op Arterial Doppler, Scar photo

817 S1 3A.S1.00218 3A.S1.00218 : Pericardiostomy 7500 2D ECHO
818 S1 3A.S1.00219 3A.S1.00219 : Pneumonectomy 45000 CT Chest Post Op X-ray,scar photo
819 S1 3A.S1.00221 3A.S1.00221 : Removal Tumours of Chest Wall 30000 CT Chest, biopsy
HPE report
3A.S1.00222 : Procedures Requiring Bypass
820 S1 3A.S1.00222 26250 Angiogram Scar photo
Techniques
821 S1 3A.S1.00225 3A.S1.00225 : Skin Flaps - Rotation Flaps 4650 Clinical photo Scar photo
3A.S1.00227 : Surgery for Arterial Aneurysm Spleenic
822 S1 3A.S1.00227 15000 CT Angio / MRA Scar photo
Artery
3A.S1.00228 : Surgery for Arterial Aneurism
823 S1 3A.S1.00228 18750 CT Angio / MRA Scar photo
–Vertebral
824 S1 3A.S1.00229 3A.S1.00229 : Sympathetectomy – Cervical 3750 Clinical notes & Photo, Arterial doppler Scar photo

825 S1 3A.S1.00230 3A.S1.00230 : Temporal Bone resection 45000 CT/MRI, Biopsy
HPE report
826 S1 3A.S1.00231 3A.S1.00231 : Thorachostomy 7500 Chest X Ray Chest X Ray
827 S1 3A.S1.00233 3A.S1.00233 : Thoracoplasty 15000 X-ray, CT X-ray
828 S1 3A.S1.00234 3A.S1.00234 : Thoracoscopic Decortication 18750 Clinical Photograph Scar photo
829 S1 3A.S1.00235 3A.S1.00235 : Thoracoscopic Hydatid Cyst excision 15000 Chest X-ray / CT Scar photo, HPE
830 S1 3A.S1.00236 3A.S1.00236 : Thoracoscopic Lobectomy 18750 CT/MRI Scar photo, HPE
831 S1 3A.S1.00237 3A.S1.00237 : Thoracoscopic Pneumonectomy 22500 CT/MRI Scar photo, HPE
832 S1 3A.S1.00238 3A.S1.00238 : Thoracoscopic Segmental Resection 18750 CT/MRI Scar photo, HPE

833 S1 3A.S1.00239 3A.S1.00239 : Thoracoscopic Sympathectomy 26250 CT Chest Post Op X-ray, photo of scar, port
insertion
834 S1 3A.S1.00240 3A.S1.00240 : Thrombendarterectomy 11250 Arterial doppler, CT Angio/MRA Scar photo
835 S1 3A.S1.00241 3A.S1.00241 : Thorax (penetrating wounds) 9375 X-ray, Clinical photo Post-op clinical photo & X-Ray
3A.S1.00242 : Total Thyroidectomy and Block
836 S1 3A.S1.00242 15000 Clinical Photograph , USG Scar photo, HPE
Dissection
837 S1 3A.S1.00247 3A.S1.00247 : Adhenolysis + Appendicectomy 15000 MRI/ CT Abdomen Scar Photo, HPE Report
3A.S1.17005 : Prostate surgery (Code 3A.561) -
838 S1 3A.S1.17005 18750 CT report and Film, Biopsy Clinical Photograph, HPE report
additional cost
3A.S1.17006 : Nephrectomy – partial (Code 3A.451)- CT report with film, Isotope renogram Clinical Photograph showing scar+
839 S1 3A.S1.17006 18750
additional cost if required HPE report +USG Report
3A.S1.17007 : Low AR and APR (Code 3A.417, Endoscopy with film, biopsy, CT report Clinical Photograph showing scar +
840 S1 3A.S1.17007 18750
3A.418) - additional cost with film HPE report
Speciality
code
3A.S1.17008 : Radical hysterectomy for Ca cervix and Clinical Photograph showing scar +
Ca endometrium ( Code 3A.484)- additional cost HPE report
3A.S10.00003A : Hemangioma – Sclerotherapy CBC,RBS,RFT,S Electrolytes, HIV,

S10 3A.S10.00003A 26250 MRI/MRA
(under GA) - cross speciality HbsAg,CXR, ECG MRI/MRA
3A.S10.00004A : Hemangioma – Debulking/ Excision
S10 3A.S10.00004A 26250 CT report OT note,Scar photo
- cross speciality
3A.S10.00008A : Pressure Sore – Surgery - cross CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,
S10 3A.S10.00008A 22500 Clinical photo and OT note
speciality CXR, ECG, Pus for C/S
3A.S10.00009A : Diabetic Foot – Surgery - cross CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,

S10 3A.S10.00009A 22500 MRI/MRA
speciality CXR, ECG, Pus for C/S, MRI/MRA
S14 3A.S14.00016A 3A.S14.00016A : Anti GERD Surgery - Cross speciaity 7500 USG and Clinical notes OT Note
3A.S2.00075A : Total Parotidectomy - - cross Clinical Photograph showing scar +

S2 3A.S2.00075A 30000 FNAC,CT
Clinical photo showing scar, /
3A.S2.00081A : Excision of Cystic Hygroma Major/
S2 3A.S2.00081A 7500 Clinical notes & photo, USG/CT BIOPSY, Operative notes with steps
Extensive - cross speciality
of surgery & Clinical notes
3A.S6.17024A : Visceral injuries severe - cross
S6 3A.S6.17024A 45000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
speciality
3A.S6.17025A : Chest injuries with ICD bilateral - Post-Operative chest X-ray with ICD
S6 3A.S6.17025A 8250 X-ray /ultra sound
cross speciality in situ
3A.S6.17026A : Chest injuries with ICD + ICU - cross Post-Operative chest X-ray with ICD
speciality in situ
3A.S6.17027A : Chest injuries with ICD + ICU + Post-Operative chest X-ray with ICD
Ventilator - cross speciality in situ
3A.S8.00075A : Nerve Decompression - cross
S8 3A.S8.00075A 15000 Nerve Conductions study Clinical Photographs showing scar
speciality
Nerve Conduction Velocity (Nerve
3A.S8.00076A : Peripheral Nerve Surgery Major -
S8 3A.S8.00076A 33750 conduction velocity (NCV)) and Clinical Photographs showing scar
cross speciality
Electromyography (EMG) reports
3A.S8.00077B : Peripheral Nerve Surgery Minor -
S8 3A.S8.00077B 11250 conduction velocity (NCV) / Clinical Photographs showing scar
cross speciality
3A.M4.00035A# : Bone tumors/soft tissue sarcomas CT scan/MRI ,USG abdomen pelvis, X-ray, CT Scan, Clinical photograph
M4 3A.M4.00035A 176250
: surgery (inlcuding prosthesis) - cross speciality Clinical photograph Hemogram report
INTERVENTIONAL NEURORADIOLOGY
3A.S9.00001 : Coil embolization for aneurysms

842 S9 3A.S9.00001 (includes cost of first 3 coils + balloon and/ or stent 75000 ANGIOGRAM , MRI Angio Clinical Photograph
if used) 1 to 20 coils may be required as per need.
Speciality
code
3A.S9.00002 : Additional coil for coil embolization
843 S9 3A.S9.00002 18000 ANGIOGRAM , MRI Angio Clinical Photograph
for aneurysms
3A.S9.00003 : Dural AVMs/AVFs (per sitting) with Hematological and radiological Hematological and radiological
844 S9 3A.S9.00003 52500
glue investigations, CT/MRI investigations, CT/MRI
3A.S9.00004 : Dural AVMs/AVFs (per sitting) with Hematological and radiological Hematological and radiological
845 S9 3A.S9.00004 112500
onyx investigations, CT/MRI investigations, CT/MRI
3A.S9.00005 : Carotico-cavernous Fistula (CCF)
embolization with coils. [includes 5 coils, guide Hematological and radiological Hematological and radiological
846 S9 3A.S9.00005 112500
catheter, micro-catheter, micro-guidewire, general investigations, CT/MRI investigations, CT/MRI
items]
3A.S9.00006 : Carotid-cavernous Fistula (CCF)
embolization with balloon (includes one balloon, Hematological and radiological Hematological and radiological
847 S9 3A.S9.00006 56250
guide catheter, micro-catheter, micro-guidewire, investigations, CT/MRI investigations, CT/MRI
general items)
3A.S9.00007 : Cerebral & Spinal AVM embolization
848 S9 3A.S9.00007 75000 ANGIOGRAM , MRI Angio Clinical Photograph
(per sitting). Using Histoacryl
Hematological and radiological Hematological and radiological
849 S9 3A.S9.00008 3A.S9.00008 : Parent vessel occlusion - Basic 22500
investigations, CT/MRI investigations, CT/MRI

3A.S9.00009 : Additonal coil for Parent Vessel
Occlusion

3A.S9.00010 : Additonal balloon for Parent Vessel
Occlusion

852 S9 3A.S9.00011 3A.S9.00011 : Balloon test occlusion 52500 Time (PT), International normalized ratio CT, PT,INR, Hb, Serum Creatinine
USG, clotting Time (CT), Prothrombin

3A.S9.00012 : Intracranial balloon angioplasty with USG, CT,PT,INR, Hb, Serum
853 S9 3A.S9.00012 120000 Time (PT), International normalized ratio
stenting Creatinine
(INR), Hb, Serum Creatinine
CT/MRI, Prothrombin Time (PT),

3A.S9.00013 : Intracranial thrombolysis / clot CT/MRI, PT,INR, Hb, Serum
854 S9 3A.S9.00013 120000 International normalized ratio (INR) Hb,
retrieval Creatinine
Serum Creatinine
3A.S9.00014 : Pre-operative tumour embolization Chest x-Ray/CT Scan, Hb, Serum Chest x-Ray/CT Scan, Hb, Serum
855 S9 3A.S9.00014 30000
(per session) Creatinine Creatinine
856 S9 3A.S9.00015 3A.S9.00015 : Vertebroplasty 30000
3A.M2.00007 : Acute urticaria/ Anaphylaxis acute
asthma - routine ward
Speciality
code
3A.M2.00007A : Acute urticaria/ Anaphylaxis acute
asthma - HDU
3A.M2.00007B : Acute urticaria/ Anaphylaxis acute
asthma - ICU without ventilator
3A.M2.00007C : Acute urticaria/ Anaphylaxis acute
asthma - ICU with ventilator
858 M2 3A.M2.00011 3A.M2.00011 : Optic neuritis - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00011A 3A.M2.00011A : Optic neuritis - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00011B : Optic neuritis - ICU without
ventilator
M2 3A.M2.00011C 3A.M2.00011C : Optic neuritis - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
859 M2 3A.M2.00015 3A.M2.00015 : Chronic cough - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00015A 3A.M2.00015A : Chronic cough - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00015B : Chronic cough - ICU without
ventilator
M2 3A.M2.00015C 3A.M2.00015C : Chronic cough - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
860 M2 3A.M2.00016 3A.M2.00016 : Wheezing - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00016A 3A.M2.00016A : Wheezing - HDU 2025 Clinical note with Lab reports Treatment note
M2 3A.M2.00016B 3A.M2.00016B : Wheezing - ICU without ventilator 2700 Clinical note with Lab reports Treatment note
M2 3A.M2.00016C 3A.M2.00016C : Wheezing - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
3A.M2.00018 : Global developmental delay/

861 M2 3A.M2.00018 Intellectual disability of unknown etiology - routine 1350 Clinical note with Lab reports Treatment note
ward
3A.M2.00018A : Global developmental delay/

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

M2 3A.M2.00018B Intellectual disability of unknown etiology - ICU 2700 Clinical note with Lab reports Treatment note
without ventilator
3A.M2.00018C : Global developmental delay/
M2 3A.M2.00018C Intellectual disability of unknown etiology - ICU 3375 Clinical note with Lab reports Treatment note
with ventilator
3A.M2.00036 : HIV with complications - routine
ward
M2 3A.M2.00036A 3A.M2.00036A : HIV with complications - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00036B : HIV with complications - ICU

without ventilator
3A.M2.00036C : HIV with complications - ICU with
ventilator
Speciality
code
863 M2 3A.M2.00042 3A.M2.00042 : Persistent pneumonia - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00042A 3A.M2.00042A : Persistent pneumonia - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00042B : Persistent pneumonia - ICU without
ventilator
3A.M2.00042C : Persistent pneumonia - ICU with
ventilator
864 M2 3A.M2.00049 3A.M2.00049 : Chronic meningitis - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00049A 3A.M2.00049A : Chronic meningitis - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00049B : Chronic meningitis - ICU without
ventilator
3A.M2.00049C : Chronic meningitis - ICU with
ventilator
3A.M2.00058 : Metabolic encephalopathy - routine
ward
M2 3A.M2.00058A 3A.M2.00058A : Metabolic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00058B : Metabolic encephalopathy - ICU

without ventilator
3A.M2.00058C : Metabolic encephalopathy - ICU
with ventilator
866 M2 3A.M2.00061 3A.M2.00061 : Wilson’s disease - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00061A 3A.M2.00061A : Wilson’s disease - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00061B : Wilson’s disease - ICU without
ventilator
3A.M2.00061C : Wilson’s disease - ICU with
ventilator
867 M2 3A.M2.00062 3A.M2.00062 : Celiac disease - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00062A 3A.M2.00062A : Celiac disease - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00062B : Celiac disease - ICU without
ventilator
M2 3A.M2.00062C 3A.M2.00062C : Celiac disease - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
3A.M2.00064 : Unexplained hepatosplenomegaly -

routine ward
3A.M2.00064A : Unexplained hepatosplenomegaly -
HDU
3A.M2.00064B : Unexplained hepatosplenomegaly -
3A.M2.00064C : Unexplained hepatosplenomegaly -
ICU with ventilator
869 M2 3A.M2.00065 3A.M2.00065 : Severe pneumonia - routine ward 1350 Clinical note with Lab reports Treatment note
Speciality
code
M2 3A.M2.00065A 3A.M2.00065A : Severe pneumonia - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00065B : Severe pneumonia - ICU without
ventilator
3A.M2.00065C : Severe pneumonia - ICU with
ventilator
3A.M2.00066 : Severe exacerbation of asthma -
routine ward
3A.M2.00066A : Severe exacerbation of asthma -
HDU
3A.M2.00066B : Severe exacerbation of asthma - ICU
without ventilator
3A.M2.00066C : Severe exacerbation of asthma - ICU
with ventilator
871 M2 3A.M2.00070 3A.M2.00070 : Upper GI hemorrhage - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00070A 3A.M2.00070A : Upper GI hemorrhage - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00070B : Upper GI hemorrhage - ICU
without ventilator
3A.M2.00070C : Upper GI hemorrhage - ICU with
ventilator
872 M2 3A.M2.00071 3A.M2.00071 : Lower GI hemorrhage - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00071A 3A.M2.00071A : Lower GI hemorrhage - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00071B : Lower GI hemorrhage - ICU without
ventilator
3A.M2.00071C : Lower GI hemorrhage - ICU with
ventilator
873 M2 3A.M2.00072 3A.M2.00072 : Acute abdomen - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00072A 3A.M2.00072A : Acute abdomen - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00072B : Acute abdomen - ICU without
ventilator
3A.M2.00072C : Acute abdomen - ICU with
ventilator
874 M2 3A.M2.00077 3A.M2.00077 : Brain abscess - routine ward 1350 Clinical note with Lab reports Treatment note
M2 3A.M2.00077A 3A.M2.00077A : Brain abscess - HDU 2025 Clinical note with Lab reports Treatment note
3A.M2.00077B : Brain abscess - ICU without
ventilator
M2 3A.M2.00077C 3A.M2.00077C : Brain abscess - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
875 M2 3A.M2.00083 3A.M2.00083 : Hydrocephalus - routine ward 1350 Clinical examination Clinical examination
M2 3A.M2.00083A 3A.M2.00083A : Hydrocephalus - HDU 2025 Clinical examination Clinical examination
3A.M2.00083B : Hydrocephalus - ICU without
M2 3A.M2.00083B 2700 Clinical examination Clinical examination
ventilator
Speciality
code
M2 3A.M2.00083C 3A.M2.00083C : Hydrocephalus - ICU with ventilator 3375 Clinical examination Clinical examination
3A.M2.00084 : Intracranial space occupying lesion -

routine ward
3A.M2.00084A : Intracranial space occupying lesion -
HDU
3A.M2.00084B : Intracranial space occupying lesion -
3A.M2.00084C : Intracranial space occupying lesion -
ICU with ventilator
3A.M2.00087 : Cerebral sino-venous thrombosis -
routine ward
3A.M2.00087A : Cerebral sino-venous thrombosis -
HDU
3A.M2.00087B : Cerebral sino-venous thrombosis -
3A.M2.00087C : Cerebral sino-venous thrombosis -
ICU with ventilator
3A.M3.00002 : Special Neonatal Care Package (Rs.
3000 per day, maximum of 18000 - pre-auth after 4
days): Babies that required admission to SNCU or
NICU:
Babies admitted for short term care for conditions
like:
• Mild Respiratory Distress/tachypnea
• Mild encephalopathy
878 M3 3A.M3.00002 • Severe jaundice requiring intensive phototherapy 2250 Clinical note and lab reports Treament note
• Haemorrhagic disease of newborn
• Unwell baby requiring monitoring
• Some dehydration
• Hypoglycaemia
Mother's stay and food in the hospital for
breastfeeding, family centred care and (Kangaroo
Mother Care) KMC is mandatory and included in the
package rate
Speciality
code
3A.M3.00003 : Intensive Neonatal Care Package (Rs.
5000 per day, maximum of Rs. 50,000 – pre-auth is
needed after 5 days)
Babies with birthweight 1500-1799 g
or
Babies of any birthweight and at least one of the
following conditions:
• Need for mechanical ventilation for less than 24
hours or non-invasive respiratory support (CPAP,
HFFNC)
• Sepsis / pneumonia without complications
879 M3 3A.M3.00003 3750 Clinical note and lab reports Treament note
• Hyperbilirubinemia requiring exchange transfusion
• Seizures
• Major congenital malformations (pre-surgical
stabilization, not requiring ventilation)
• Cholestasis significant enough requiring work up
and in-hospital management
• Congestive heart failure or shock
package rate
Speciality
code
3A.M3.00004 : Advanced Neonatal Care Package (Rs.
6000 per day, maximum of Rs. 75,000 – pre-auth is
needed after 7 days):
Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one of the
• Any condition requiring invasive ventilation longer
than 24 hours
• Hypoxic Ischemic encephalopathy requiring
Therapeutic Hypothermia
• Cardiac rhythm disorders needing intervention (the
cost of cardiac surgery or implant will be covered
under cardiac surgery packages)
• Sepsis with complications such as meningitis or
bone and joint infection, DIC or shock
• Renal failure requiring dialysis
• Inborn errors of metabolism
package rate
3A.M3.00005 : Critical Care Neonatal Package (Rs.

7000 per day, maximum of Rs. 1,20,000 – pre-auth
after 10 days):
Babies with birthweight of <1200 g
or
Babies of any birthweight with at least one of the
• Severe Respiratory Failure requiring High
881 M3 3A.M3.00005 Frequency Ventilation or inhaled Nitric Oxide (iNO) 5250 Clinical note and lab reports Treament note
• Multisystem failure requiring multiple organ
support including mechanical ventilation and
multiple inotropes
• Critical congenital heart disease
package rate
Speciality
code
3A.M3.00006 : Chronic Care Package (Rs. 3000 per

day, maximum of Rs. 30,000): If the baby requires
stay beyond the upper limit of usual stay in Package
no 0004 or 0005 for conditions like severe BPD
requiring respiratory support, severe NEC requiring
prolonged TPN support
3A.M3.00007 : High Risk Newborn Post Discharge

Care Package (Protocol Driven)
3A.M3.00008 : Laser Therapy for Retinopathy of
884 M3 3A.M3.00008 Prematurity (Irrespective of no. of eyes affected) - 1125 Clinical note and lab reports Treament note
per session
3A.M4.00009 : Hodgkin Lymphoma (Favorable
USG abdomen pelvis,Chest x-ray,
885 M4 3A.M4.00009 group) (chemotherapy including diagnostics): 52500 Lymphnode Biopsy, HPE, CT/MRI scan
CT/MRI scan
induction
3A.M4.00012 : Hodgkin Lymphoma (unfavorable USG abdomen pelvis,Chest x-ray,

886 M4 3A.M4.00012 82500 Lymphnode Biopsy, HPE, CT/MRI scan
group): chemotherapy including diagnostics CT/MRI scan
Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy

887 M4 3A.M4.00019 3A.M4.00019 : Retinoblastoma (Intraocular): surgery 75000
Flow cytometry drug batch number with bar code
Clinical Photographs showing the

888 M4 3A.M4.00026 3A.M4.00026 : Brain tumors: surgery 41250 MRI Report
scar + HPE report
Clinical Photograph, chemotherapy

889 M4 3A.M4.00030 3A.M4.00030 : Wilms tumors: surgery 3750 CT report with film, biopsy/FNAC
drug batch number with bar code
890 S14 3A.S14.00001 3A.S14.00001 : Ankyloglossia Major 11250 Clinical Photography Post-op photo
891 S14 3A.S14.00002 3A.S14.00002 : Ankyloglossia Minor 3750 Clinical Photography Post op photo
892 S14 3A.S14.00004 3A.S14.00004 : Sacrococcygeal Teratoma 15000 Clinical examination Clinical examination
3A.S14.00008 : Undescended Testis - Reexploration/
893 S14 3A.S14.00008 18750 USG/OT notes of previous surgery Scar photo
Second Stage
3A.S14.00010 : Ano Rectal Malformation - Abd- Colostogram pic for males, Photo of
894 S14 3A.S14.00010 45000 Clinical Photograph showing scar
Perineal PSARP perineum region for females
895 S14 3A.S14.00011 3A.S14.00011 : Ano Rectal Malformation – Anoplasty 15000 Clinical Note OT note
896 S14 3A.S14.00012 3A.S14.00012 : Ano Rectal Malformation – Cutback 22500 Photo of the perineum region Scar photo
897 S14 3A.S14.00013 3A.S14.00013 : Ano Rectal Malformation - PSARP 15000 Clinical Note OT note
3A.S14.00014 : Ano Rectal Malformation - Redo

898 S14 3A.S14.00014 11250 CT, USG report and Films OT note
Pullthrough
3A.S14.00015 : Ano Rectal Malformation -
899 S14 3A.S14.00015 11250 CT, USG report and Films OT note
Transposition
900 S14 3A.S14.00016 3A.S14.00016 : Anti GERD Surgery 7500 USG and Clinical notes OT Note
Speciality
code
901 S14 3A.S14.00017 3A.S14.00017 : Duplication Cyst Excision 15000 USG and Clinical notes OT Note
902 S14 3A.S14.00018 3A.S14.00018 : Fecal Fistula Closure 18750 USG and Clinical notes OT Note
903 S14 3A.S14.00020 3A.S14.00020 : GI Tumor Excision 22500 CT, USG report and Films OT note
Clinical photo showing scar +
904 S14 3A.S14.00021 3A.S14.00021 : Hirschsprung’s Disease - Myectomy 30000 Rectal biopsy/ X-Ray/Contast Enema
Biopsy Report.
3A.S14.00022 : Hirschsprung’s Disease - Pull Clinical photo showing scar +
905 S14 3A.S14.00022 15000 Rectal biopsy/ X-Ray/Contast Enema
Through Biopsy Report.
3A.S14.00023 : Hirschsprung’s Disease - Retal Biopsy-
906 S14 3A.S14.00023 7500 Contrast Enema / Biopsy Clinical Photograph showing scar
Punch
3A.S14.00024 : Hirschsprung’s Disease - Retal Biopsy Clinical photo showing scar +
907 S14 3A.S14.00024 7500 Rectal biopsy/ X-Ray/Contast Enema
–Open Biopsy Report.
3A.S14.00025 : Hirschsprung’s Disease -
908 S14 3A.S14.00025 45000 Contrast Enema / Biopsy Clinical Photograph showing scar
Sphinecterotomy
3A.S14.00026 : Intussusception - Non –Operative
909 S14 3A.S14.00026 13500 USG/Xray Post op USG, Post op X Ray
Reduction in infants
910 S14 3A.S14.00028 3A.S14.00028 : Ladds Procedure 22500 X-ray abdomen or Ultrasound abdomen Scan Photography
3A.S14.00030 : Retro-Peritoneal Lymphangioma

911 S14 3A.S14.00030 18750 CT, USG report and Films OT note and HPE report
Excision
Clinical Photograph showing
912 S14 3A.S14.00031 3A.S14.00031 : Congenital Diaphragmatic Hernia 82500 X-Ray
scar+Post op X ray
913 S14 3A.S14.00032 3A.S14.00032 : Congenital Lobar Emphysema 18750 Treatment Notes
investigations
914 S14 3A.S14.00033 3A.S14.00033 : Exomphalos/gastroschisis 18750 CT, USG report and Films OT note
3A.S14.00034 : Cleft Lip and Palate Surgery (per
915 S14 3A.S14.00034 11250 Clinical Photograph Clincal Photograph
stage)
916 S14 3A.S14.17111 3A.S14.17111 : Splenectomy - Child 33750 CT/ MRI CT/ MRI
917 S14 3A.S14.17112 3A.S14.17112 : Biliary Atresia 48750 CT Abdomen Clinical Photograph showing scar
918 S14 3A.S14.17113 3A.S14.17113 : Oesophageal Atresia 82500 X-Ray Clinical Photograph showing scar
3A.S14.17114 : Unilateral Inguinal Hernia- Age less
919 S14 3A.S14.17114 11250 Clinical photograph, USG HPR, Clinical photograph
than 1 year
920 S14 3A.S14.17115 3A.S14.17115 : Urinary Diversion - Temporary 18750 MCU, USG Clinical Photograph showing scar
921 S14 3A.S14.17116 3A.S14.17116 : Urinary Diversion - Undiversion 26250 MCU, USG Clinical Photograph showing scar
Clinical Photograph showing chemo
922 S14 3A.S14.17117 3A.S14.17117 : Insertion of Chemo port 15000 Lab reports confirming cancer
Port
3A.S14.17118 : Congenital Hydronephrosis
923 S14 3A.S14.17118 37500 USG, Renal Isotope Scan Clinical Photograph showing scar
Open/Lap*
924 S14 3A.S14.17119 3A.S14.17119 : Anorectal Malformations Stage 3 33750 Clinical Photograph Clinical Photograph showing scar
925 S14 3A.S14.17120 3A.S14.17120 : Pyloromyotomy 26250 USG/Contrast X ray Clinical Photograph showing scar
926 S14 3A.S14.17121 3A.S14.17121 : Bladder Augumentation 60000 MCU/USG Clinical photo
3A.S14.17122 : Hypospadias Definitive Repair - Clinical photo showing the meatal
927 S14 3A.S14.17122 45000 Nil
proximal penile opening
Speciality
code
Clinical photo showing the meatal
928 S14 3A.S14.17123 3A.S14.17123 : Hypospadias Re-Do 30000 Nil
opening
929 S14 3A.S14.17124 3A.S14.17124 : Fistula Closure Hypospadiacs 15000 Clinical Photograph Nil
930 S14 3A.S14.17125 3A.S14.17125 : Faciomaxillary surgery 26250 X-RAY/CT scan
post op. XRAY
931 S14 3A.S14.17132 3A.S14.17132 : Surgery for chronic pancreatitis 52500 CT/MRI Clinical Photograph showing scar
932 S14 3A.S14.17133 3A.S14.17133 : Omphalocele-Minor 30000 Clinical Photograph Clinical Photograph showing scar
3A.S14.17134 : Bilateral Inguinal Hernia for age < 1
933 S14 3A.S14.17134 16875 Clinical Photograph Clinical Photograph showing scar
year
934 S14 3A.S14.17135 3A.S14.17135 : Meconium Aspiration syndrome 38175 Clinical notes confirming digonosis clinical notes in relevant reports
Post Op CT Report and film, Clinical

935 S14 3A.S14.17136 3A.S14.17136 : Meningo Encephalocele * 30000 MRI Report
Photograph showing Scar
3A.S14.17138 : Unsescended Non palpable testis

936 S14 3A.S14.17138 15000 USG abdomen Scar photo
stage 1
937 S14 3A.S14.17139 3A.S14.17139 : Stent Removal 3750 X Ray Post op X Ray
938 S14 3A.S14.17141 3A.S14.17141 : Septicemia not requiring ventilation 36900 Clinical notes confirming digonosis clinical notes in relevant reports
3A.S14.17142 : Hypospadias Definitive Repair - mid Clinical photo showing the meatal
939 S14 3A.S14.17142 37500 Nil
penile opening
3A.S14.17143 : Hypospadias Definitive Repair - distal Clinical photo showing the meatal
940 S14 3A.S14.17143 30000 Nil
penile opening
941 S14 3A.S14.17144 3A.S14.17144 : VLBW not requiring ventilation 89925 Clinical notes confirming digonosis clinical notes in relevant reports
942 S14 3A.S14.17145 3A.S14.17145 : Respiratory distress syndrome 56663 Clinical notes confirming digonosis clinical notes in relevant reports
Clinical photo showing the meatal
943 S14 3A.S14.17146 3A.S14.17146 : Hypospadias First Stage 22500 Nil
opening
944 S14 3A.S14.17147 3A.S14.17147 : Asphyxia with convulsions 55050 Clinical notes confirming digonosis clinical notes in relevant reports
Post Op CT Report and film, scar
945 S14 3A.S14.17148 3A.S14.17148 : Meningomyelocele * 30000 CT report
photo
3A.S14.17149 : Laparotomy and excision of cyst (For
946 S14 3A.S14.17149 22500 USG/CT Scar Photo, HPE Report
Paediatric benign abdominal cyst)
3A.S7.00045A : Ureteric reimplantation-bilateral-
S7 3A.S7.00045A 52500 MCU, USG Clinical Photograph showing scar
open - cross speciality
3A.S7.00046A : Ureteric reimplantation-unilateral-
S7 3A.S7.00046A 33750 MCU, USG Clinical Photograph showing scar
Laparoscopic - cross speciality
3A.S7.00069A : Extrophy Bladder repair including
S7 3A.S7.00069A osteotomy if needed + epispadias repair + ureteric 52500 MCU Clinical Photograph
reimplant - cross speciality
3A.S8.00025A : Shunt (peritoneal, ventriculo-atrial/

S8 3A.S8.00025A 15000 CT report Clinical Photographs
3A.S8.17048A : Fetal Surgery for

S8 3A.S8.17048A 56250 Ultrasound abdomen Ultrasound + scar photograph
Myelomeningocoele - cross speciality
Speciality
code
3A.S1.00078B : Hiatus Hernia – abdominal - cross
S1 3A.S1.00078B 30000 USG, UGI ENDOSCOPY Scar photo + Intra op photo
speciality
S1 3A.S1.00087A 3A.S1.00087A : Intussusception - cross speciality 11250 USG/CT , Clinical notes Scar photo
S1 3A.S1.00112B 3A.S1.00112B : Pyeloroplasty - cross speciality 7500 USG, Clinical Notes Scar photo, HPE
3A.S1.00157B : Decortication (Pleurectomy) - cross
S1 3A.S1.00157B 37500 CT Chest report Post Op X-ray,scar photo
speciality
S1 3A.S1.00219B 3A.S1.00219B : Pneumonectomy - cross speciality 45000 CT Chest report Post Op X-ray,scar photo

3A.S1.00239B : Thoracoscopic Sympathectomy -
S1 3A.S1.00239B 26250 CT Chest report Post Op X-ray, photo of scar, port
cross speciality
insertion
3A.M1.00002D : Recurrent vomiting with Relevant Hematological investigations,
dehydration - routine ward - cross speciality Clinical notes
3A.M1.00002E : Recurrent vomiting with Relevant Hematological investigations,
M1 3A.M1.00002E 2025 Treatment notes
dehydration - HDU - cross speciality Clinical notes
3A.M1.00002F : Recurrent vomiting with Relevant Hematological investigations,

dehydration - ICU with ventilator - cross speciality Clinical notes
3A.M1.00002G : Recurrent vomiting with

M1 3A.M1.00002G dehydration - ICU without ventilator - cross 3375 Treatment notes
Clinical notes
speciality
Speciality
code
NEUROSURGERY

947 S8 3A.S8.00001 3A.S8.00001 : Anterior Encephalocele 37500 MRI Report
3A.S8.00003 : Burr hole with chronic Sub Dural

948 S8 3A.S8.00003 15000 CT Report CT Report, Scar Photo
Haematoma (including pre and post Op. CT)
949 S8 3A.S8.00005 3A.S8.00005 : Cervical Ribs – Bilateral 26250 MRI
Photograph
950 S8 3A.S8.00006 3A.S8.00006 : Cervical Ribs – Unilateral 15000 MRI
Photograph

951 S8 3A.S8.00007 3A.S8.00007 : CranioPlasty - Endogenous graft 22500 CT report
Photograph showing the scar
3A.S8.00008 : CranioPlasty - Exogenous graft Post Op CT Report and film, Clinical

952 S8 3A.S8.00008 30000 CT report
(inclusive of cost of implant) Photograph showing the scar
953 S8 3A.S8.00009 3A.S8.00009 : Craniostenosis 37500 CT/MRI Report Post-op CT report and film
954 S8 3A.S8.00010 3A.S8.00010 : Duroplasty - Endogenous 9375 CT/MRI CT/MRI, scar Photo
955 S8 3A.S8.00011 3A.S8.00011 : Duroplasty - Exogenous 9375 CT/MRI CT/MRI, scar Photo
956 S8 3A.S8.00013 3A.S8.00013 : Haematoma - Brain (hypertensive) 37500 CT Report CT Report, Scar Photo, X Ray
3A.S8.00014 : Haematoma (Child subdural) inclusive

957 S8 3A.S8.00014 37500 CT Report CT Report, Scar Photo, X Ray
of General anaesthesia, pre and post Op. CT
958 S8 3A.S8.00016 3A.S8.00016 : Laminectomy with Fusion 30000 Clinical findings, MRI Report photo showing scar
959 S8 3A.S8.00017 3A.S8.00017 : Local Neurectomy 12000 Clinical notes Scar photo
960 S8 3A.S8.00019 3A.S8.00019 : Meningocele – Anterior 27000 CT report
photo
961 S8 3A.S8.00020 3A.S8.00020 : Meningocele – Lumbar 27000 CT report
photo
962 S8 3A.S8.00021 3A.S8.00021 : Meningococcal – Occipital 37500 CT /MRI report CT report, Scar photo
Post Op X-ray, Clinical Photograph
963 S8 3A.S8.00022 3A.S8.00022 : Micro discectomy – Cervical 30000 Clinical findings, MRI Report
showing scar
964 S8 3A.S8.00024 3A.S8.00024 : Brachial Plexus – Repair 20250 MRI X-RAY and clinical photograph
3A.S8.00025 : Shunt (peritoneal, ventriculo-atrial/
965 S8 3A.S8.00025 15000 CT report Clinical Photographs
peritoneal, theco peritoneal)
966 S8 3A.S8.00026 3A.S8.00026 : Skull Traction 6000 CT report Clinical photograph
967 S8 3A.S8.00027 3A.S8.00027 : Spine - Canal Stenosis 30000 MRI report & film, Clinical findings Post Op X-Ray Report and film
968 S8 3A.S8.00028 3A.S8.00028 : Spine - Decompression & Fusion 30000 Clinical findings, MRI Report Post Op X-Ray Report and film
Biopsy report + HPE Report + scar
969 S8 3A.S8.00030 3A.S8.00030 : Spine - Extradural Tumour 22500 MRI Report
photo
3A.S8.00031 : Spine - Extradural Tumour with Biopsy report + HPE Report + scar
970 S8 3A.S8.00031 33750 MRI Report
fixation photo
971 S8 3A.S8.00032 3A.S8.00032 : Spine - Extradural Haematoma 22500 MRI Report scar photo
Speciality
code
3A.S8.00033 : Spine - Extradural Haematoma with
fixation
Biopsy report + HPE Report + scar
973 S8 3A.S8.00034 3A.S8.00034 : Spine - Intradural Tumour 30000 MRI Report
photo
3A.S8.00035 : Spine - Intradural Tumour with
974 S8 3A.S8.00035 37500 CT Report CT Report, Scar Photo, X Ray & HPE
fixation
975 S8 3A.S8.00036 3A.S8.00036 : Spine - Intradural Haematoma 30000 MRI Report scar photo
3A.S8.00037 : Spine - Intradural Haematoma with
976 S8 3A.S8.00037 37500 MRI Report scar photo
fixation
Post Op X-ray Report and film +
977 S8 3A.S8.00038 3A.S8.00038 : Spine - Intramedullar Tumour 30000 MRI Report
HPE report
3A.S8.00039 : Spine - Intramedullar Tumour - Biopsy report + HPE Report + scar
978 S8 3A.S8.00039 45000 MRI Report
fixation photo
3A.S8.00040 : Trans Sphenoidal including pre and
979 S8 3A.S8.00040 30000 CT/MRI Report HPE report
post Op. MRI
980 S8 3A.S8.00041 3A.S8.00041 : Tumours – Supratentorial 37500 CT report /MRI Clinical features Photographs showing the scar +
HPE report
981 S8 3A.S8.00042 3A.S8.00042 : Tumours Meninges – Gocussa 37500 CT Histopathological report, CT
982 S8 3A.S8.00043 3A.S8.00043 : Tumours Meninges – Posterior 37500 CT report /MRI Clinical features Photographs showing the scar +
HPE report

983 S8 3A.S8.00044 3A.S8.00044 : Ventricular Puncture 11250 CT report
984 S8 3A.S8.00045 3A.S8.00045 : Brain Biopsy 11250 CT report HPE, scar photo
985 S8 3A.S8.00046 3A.S8.00046 : Cranial Nerve Anastomosis 24000 CT Post Op CT Report and film,
Clinical Photographs showing scar,
986 S8 3A.S8.00047 3A.S8.00047 : Depressed Fracture 22500 CT report
Post CT report and film
987 S8 3A.S8.00048 3A.S8.00048 : Nerve Biopsy excluding Hensens 7500 conduction velocity (NCV)) and Clinical Photograph + HPE report
988 S8 3A.S8.00049 3A.S8.00049 : Peripheral Neurectomy (Trigeminal) 12375 MRI Report CD of Procedure
989 S8 3A.S8.00050 3A.S8.00050 : R.F. Lesion for Trigeminal Neuralgia 11250 MRI Report CD of Procedure

3A.S8.00052 : Excision of Brain TumorSupratentorial-
990 S8 3A.S8.00052 60000 CT report /MRI Clinical features Photographs showing the scar +
Parasagital
HPE report
991 S8 3A.S8.00053 60000 CT report Photographs showing the scar +
Basal
HPE report
Speciality
code
Brainstem
HPE report
C P Angle
HPE report
3A.S8.00056 : Excision of Brain
TumorSupratentorial& others
HPE report
Post Op CT Report,film and scar
995 S8 3A.S8.00057 3A.S8.00057 : Abscess Tapping single 11250 CT report
photo
3A.S8.00060 : Aneurysm Clipping including Post Op CT Report and film, scar
996 S8 3A.S8.00060 82500 MRI/CT Angio / DSA report
angiogram photo
Post Op X-Ray Report and film, +
997 S8 3A.S8.00063 3A.S8.00063 : Spinal Fusion Procedure with implant 45000 Clinical findings, MRI Report Showing scar + XRAY showing the
implants
998 S8 3A.S8.00064 3A.S8.00064 : Spina Bifida Surgery 30000 MRI Report Clinical Photographs showing scar
Neuro Psychologist report, Neurologist Clinical Photographs showing scar ,

999 S8 3A.S8.00065 3A.S8.00065 : Stereotactic Lesioning 45000
report, MRI CT Brain report and film
3A.S8.00066 : Posterior Cervical Discetomy without
1000 S8 3A.S8.00066 22500 MRI report Clinical Photographs showing scar
implant
3A.S8.00067 : Posterior Cervical Fusion with implant Clinical Photographs showing scar +
1001 S8 3A.S8.00067 45000 MRI report
(Lateral mass fixation) X-ray - Cervical spine
3A.S8.00068 : Cervical Disc Multiple level without Clinical Photographs showing scar +
1002 S8 3A.S8.00068 26250 CT/MRI report
Fusion X-ray-Cervical Spine
Clinical Photographs showing scar +
3A.S8.00069 : Thoracic/Lumbar Corpectomy with
1003 S8 3A.S8.00069 52500 MRI Report X-ray Report and film showing the
fusion inclusive of implant
implants
3A.S8.00070 : Transoral surgery (Anterior) and CV
1004 S8 3A.S8.00070 60000 MRI Report + XRAY Post Op X-ray report and film
Junction (Posterior Sterlization)
Post Op X-ray Report and film, HPE
1005 S8 3A.S8.00071 3A.S8.00071 : Trans oral Surgery 30000 CT report
report
1006 S8 3A.S8.00072 3A.S8.00072 : Foramen Magnum Decompression 33750 CT/MRI report Clinical Photographs showing scar
1007 S8 3A.S8.00073 3A.S8.00073 : Endoscopic CSF Rhinorrhea Repair 22500 CT/MRI report Clinical Photographs showing scar
1008 S8 3A.S8.00075 3A.S8.00075 : Nerve Decompression 15000 Nerve Conductions study Clinical Photographs showing scar

1009 S8 3A.S8.00076 3A.S8.00076 : Peripheral Nerve Surgery Major 33750 conduction velocity (NCV)) and Clinical Photographs showing scar
Speciality
code
1010 S8 3A.S8.00077 3A.S8.00077 : Peripheral Nerve Surgery Minor 11250 conduction velocity (NCV) / Clinical Photographs showing scar
EEG, Neuro Psychologist report, CT + Clinical Photographs showing
1011 S8 3A.S8.00078 3A.S8.00078 : Epilepsy Surgery 37500
Neurologist report, CT/MRI scar
3A.S8.00079 : Arterio venous malformation (AVM)
1012 S8 3A.S8.00079 75000 MRI Angio/DSA report CT report and film,scar photo
excision (whatever size and location)
3A.S8.00080 : Scalp Arterio venous malformation Clinical Photograph showing scar +
1013 S8 3A.S8.00080 18750 CT/MRI Report
(AVM) HPE report
3A.S8.00081 : Superficial Temporal Artery (STA):
1014 S8 3A.S8.00081 middle cerebral artery (MCA) or (other EC - IC) 75000 MRI Angio/DSA report CT Report and film,scar photo
Bypass procedure
CT, Clinical Photograph showing
1015 S8 3A.S8.00082 3A.S8.00082 : Excision of Orbital Tumour 37500 CT/MRI Report scar + HPE report, Post-op CT report
and film
3A.S8.00083 : Gamma Knife radiosurgery (GKRS)/
1016 S8 3A.S8.00083 SRS for tumours/ Arteriovenous malformation 56250 CT/MRI Report Clinical Photographs
(AVM)
1017 S8 3A.S8.17048 3A.S8.17048 : Fetal Surgery for Myelomeningocoele 56250 Ultrasound abdomen Ultrasound + scar photograph

3A.S8.17049 : Excision of Brain Tumor Infratentorial-
C P Angle *
HPE report
3A.S8.17050 : Excision of Brain Tumor Supratentorial
& others *
HPE report
Post Op CT Report and film + HPE
1020 S8 3A.S8.17051 3A.S8.17051 : Stereotaxic Procedures 18750 CT/ MRI report
report
Clinical Photograph showing scar, DT
1021 S8 3A.S8.17052 3A.S8.17052 : Endoscopic venticulostomy 22500 CT report
Brain film and report
3A.S8.17053 : Anterior Cervical Discectomy Multiple Photo showing the scar + XRAY
1022 S8 3A.S8.17053 45000 Clinical findings, MRI Report
level with Implants* showing the implants
1023 S8 3A.S8.17054 3A.S8.17054 : Laminectomy-Cervical * 22500 Clinical findings, MRI Report photo showing scar
Clinical Photographs showing scar,
1024 S8 3A.S8.17055 3A.S8.17055 : Decompressive craniotomy 30000 CT report
Post CT report and film
1025 S8 3A.S8.17057 3A.S8.17057 : MVD (Micro Vascular Decompression) 37500 MRI Report Clinical Photographs

1026 S8 3A.S8.00061 3A.S8.00061 : Additonal clip for Aneurysm Clipping 11250 MRI/CT Angio / DSA report
photo
S9 3A.S9.00015A 3A.S9.00015A : Vertebroplasty - cross speciality 30000
3A.M2.00077D : Brain abscess - cross speciality -
routine ward
Speciality
code
3A.M2.00077E : Brain abscess - cross speciality -
HDU
3A.M2.00077F : Brain abscess - cross speciality -
ICU with ventilator
3A.M2.00077G : Brain abscess - cross speciality - -
3A.M2.00083D : Hydrocephalus - cross speciality -
M2 3A.M2.00083D 1350 CT Report CT Report, Scar Photo, X Ray
routine ward
3A.M2.00083E : Hydrocephalus - cross speciality -
M2 3A.M2.00083E 2025 CT Report CT Report, Scar Photo, X Ray
HDU
3A.M2.00083F : Hydrocephalus - cross speciality -
M2 3A.M2.00083F 3375 CT Report CT Report, Scar Photo, X Ray
ICU with ventilator
3A.M2.00083G : Hydrocephalus - cross speciality -
M2 3A.M2.00083G 2700 CT Report CT Report, Scar Photo, X Ray
3A.M2.00084D : Intracranial space occupying lesion -
cross speciality - routine ward
3A.M2.00084E : Intracranial space occupying lesion -
cross speciality - HDU
3A.M2.00084F : Intracranial space occupying lesion -
cross speciality - ICU with ventilator
3A.M2.00084G : Intracranial space occupying lesion -

cross speciality - ICU without ventilator
3A.M2.00087D : Cerebral sino-venous thrombosis -

M2 3A.M2.00087D 1350 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - routine ward
3A.M2.00087E : Cerebral sino-venous thrombosis -
M2 3A.M2.00087E 2025 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - HDU
3A.M2.00087F : Cerebral sino-venous thrombosis -

M2 3A.M2.00087F 3375 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - ICU with ventilator
3A.M2.00087G : Cerebral sino-venous thrombosis -

M2 3A.M2.00087G 2700 Clinical notes, CT - brain Clinical notes, CT - brain
cross speciality - ICU without ventilator
3A.M4.00026A : Brain tumors: surgery - cross Clinical Photographs showing the

M4 3A.M4.00026A 41250 MRI Report
speciality scar + HPE report
3A.S1.00230B : Temporal Bone resection - cross Clinical Photograph showing scar +
S1 3A.S1.00230B 45000 CT/MRI, Biopsy
3A.S10.00006A : Scalp avulsion reconstruction - CBC,RBS,RFT,S Electrolytes, HIV,HbsAg,
S10 3A.S10.00006A 37500 Clinical photo and OT note
cross speciality CXR, ECG
3A.S14.17136A : Meningo Encephalocele * - cross Post Op CT Report and film, Clinical

S14 3A.S14.17136A 30000 MRI Report
speciality Photograph showing Scar
3A.S14.17148A : Meningomyelocele * - cross Post Op CT Report and film, scar

S14 3A.S14.17148A 30000 CT report
speciality photo
Speciality
code
S2 3A.S2.00023A 3A.S2.00023A : Skull base surgery - cross speciality 27750 CT-Scan / MRI Scan Clinical Photograph
3A.S6.00001B : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001B 37500 Clinical photo showing Scar
repair/reconstruction/ Transfer - cross speciality Picture(Mandatory) + detail notes
3A.S6.00002A : Plexus injury along with Vascular MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002A 45000 Clinical photo showing Scar
injury repair/ graft - cross speciality Picture(Mandatory) + detail notes
3A.S6.00004B : Head injury requiring Facio-Maxillary

S6 3A.S6.00004B Injury repairs & fixations (including implants) - 26250 X-RAY/CT scan(If Required)
cross speciality
3A.S4.00008 : Laparotomy and proceed for Ovarian
1027 S4 3A.S4.00008 Cancers. Omentomy with Bilateral Salpingo- 15000 CT report and Film, Biopsy
HPE report
oophorectomy
3A.S4.00011 : Vaginal surgical repair for vesico- Clinical Notes, USG/KUB/Urology
1028 S4 3A.S4.00011 7500 OT notes
vaginal fistula opinion
1029 S4 3A.S4.00012 3A.S4.00012 : Sacrocolpopexy 12000 Clinical note,USG OT Note
1030 S4 3A.S4.00014 3A.S4.00014 : Vaginoplasty 7500 Clinical note OT Note
1031 S4 3A.S4.00015 3A.S4.00015 : LLETZ 11250 USG and clinical notes OT note and HPE
1032 S4 3A.S4.00016 3A.S4.00016 : Colpotomy 900 USG and clinical notes OT note
1033 S4 3A.S4.00021 3A.S4.00021 : Radical Vulvectomy 11250 USG and clinical notes OT note and HPE
1034 S4 3A.S4.00026 3A.S4.00026 : Laparoscopic ovarotomy 7500 USG and clinical notes OT note and HPE
3A.S4.00028 : Laparoscopic tubal surgeries -
1035 S4 3A.S4.00028 8250 USG and clinical notes OT note and HPE
salpingectomy, salpingotomy
1036 S4 3A.S4.00029 3A.S4.00029 : Drag hysteroscopy 4500 USG and clinical notes OT note
1037 S4 3A.S4.00030 3A.S4.00030 : Hysteroscopic myomectomies 4500 USG and clinical notes OT note and HPE
1038 S4 3A.S4.00031 3A.S4.00031 : Hysteroscopic adhesiolysis 4500 USG and clinical notes OT note and HPE
3A.S4.00053 : Abdominal Perineal neo construction
1039 S4 3A.S4.00053 15000 USG/CT, Lab report and clinical notes OT note
Cx + Uteria + Vagina
3A.S4.00055 : Ablation of Endometriotic Spot
+Salpingostomy
3A.S4.00066 : Cystocele - Anterior Repair + Perineal
Tear Repair
1042 S4 3A.S4.00070 3A.S4.00070 : Electro Cauterisation Cryo Surgery 3000 Clinical note OT Note, Clinical photograph
3A.S4.00074 : HaematoColpo/Excision - Vaginal

1043 S4 3A.S4.00074 3750 USG and clinical notes OT Note and HPE
Septum
1044 S4 3A.S4.00078 3A.S4.00078 : Cordocentesis 3750 USG and clinical notes OT Note
1045 S4 3A.S4.00079 3A.S4.00079 : Intrauterine transfusions 7500 USG and clinical notes Procedure Note
3A.S1.17008B : Radical hysterectomy for Ca cervix
S1 3A.S1.17008B and Ca endometrium ( Code 3A.484)- additional 15000 CT report and Film, Biopsy
HPE report
cost - cross speciality
Speciality
code
ONCOLOGY
3A.M4.00004 : Acute lymphoblastic leukemia: Haematology, Bone Marrow Aspitation/ Photo with RT Machine , RT
1046 M4 3A.M4.00004 3750
radiation Flow cytometry treatment chart
3A.M4.00010 : Hodgkin Lymphoma (Favorable Photo with RT Machine , RT
1047 M4 3A.M4.00010 7500 Hematology + Biopsy/FNAC report
group): radiation treatment chart
3A.M4.00013 : Hodgkin Lymphoma (unfavorable Photo with RT Machine , RT
group): radiation treatment chart
3A.M4.00018 : Retinoblastoma (Intraocular): Photo with RT Machine , RT
1049 M4 3A.M4.00018 7500 Biopsy , CT report with film
radiation treatment chart
3A.M4.00022 : Retinoblastoma (extraocular): Photo with RT Machine , RT
Photo with RT Machine , RT
1051 M4 3A.M4.00025 3A.M4.00025 : Brain tumors: radiation 22500 CT report /MRI Clinical features
treatment chart
1052 M4 3A.M4.00029 3A.M4.00029 : Wilms tumors: radiation 3750 CT report with film, biopsy/FNAC
treatment chart
3A.M4.00034 : Bone tumors/soft tissue sarcomas : Photo with RT Machine , RT
1053 M4 3A.M4.00034 18750 Biopsy , CT-Scan with film
X-ray, CT Scan,Tumor Board form,
3A.M4.00035#: Bone tumors/soft tissue sarcomas : CT scan/MRI ,Tumor board form, USG
1054 M4 3A.M4.00035 176250 Clinical photograph Hemogram
surgery (inlcuding prosthesis) abdomen pelvis, Clinical photograph
report
3A.M6.00001 : Cobalt 60 External Beam Photo with RT Machine , RT

1055 M6 3A.M6.00001 15000 Biopsy/FNAC ,CT report and Film
Radiotherapy (Radical/Adjuvant / Neoadjuvant) treatment chart RT planning Data

1056 M6 3A.M6.00002 7500 CT report and Film, Biopsy
Radiotherapy (Palliative) treatment chart RT planning Data
3A.M6.00003 : Linear Accelerator External Beam Photo with RT Machine , RT

Radiotherapy (Palliative) treatment chart
3A.M6.00004 : Linear Accelerator, External Beam
Photo with RT machine, RT treatment
1058 M6 3A.M6.00004 Radiotherapy 3D CRT/2D Planning 37500 CT report and film, biopsy
chart
(Radical/Adjuvant/ Neoadjuvant)
3A.M6.00005 : Linear Accelerator, External Beam

1059 M6 3A.M6.00005 Radiotherapy IMRT (Intensity Modulated 56250 CT report and Film, Biopsy
treatment chart
Radiotherapy) (Radical/Adjuvant/Neoadjuvant)
3A.M6.00006 : Linear Accelerator External Beam

Photo with RT Machine , RT treatment Photo with RT Machine , RT
1060 M6 3A.M6.00006 Radiotherapy IGRT (Image Guided radiotherapy) 90000
chart, CBCT machine log treatment chart, CBCT machine log
(Radical/Adjuvant/Neoadjuvent)

1061 M6 3A.M6.00007 3A.M6.00007 : SRT(Stereota1036ic radiotherapy) 56250 Biopsy/FNAC ,CT report and Film
treatment chart RT planning Data
Speciality
code

1062 M6 3A.M6.00008 3A.M6.00008 : SRS (Streotactic radiosurgery) 52500 Biopsy/FNAC ,CT report and Film
3A.M6.00009 : Respiratory Gating along with Linear Photo with RT Machine , RT

1063 M6 3A.M6.00009 52500 ECHO, Chest X Ray, RFT, CBC, ABG
Accelerator planning treatment chart RT planning Data
3A.M6.00010 : Electron beam with Linear accelerator Photo with RT Machine , RT

(Radical) treatment chart
3A.M6.00011 : Photo with RT machine, RT treatment
1065 M6 3A.M6.00011 37500 CT report and film, biopsy
Tomotherapy(Radical/Adjuvant/Neoadjuvant) chart
3A.M6.00012 : Brachytherapy High Dose Radiation Photo with RT Machine , RT

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

1067 M6 3A.M6.00013 22500 CT/MRI report and Film, Biopsy
(Interstitial) - for one application, multiple dose treatment chart RT planning Data

(Intraluminal) - per fraction, maximum 4 sessions treatment chart, RT planning data

Radiotherapy, Definitive, Neoadjuvant, Adjuvant treatment chart RT planning Data
3A.M6.17242 : Brachytherapy/ Interstitial LDR , Photo with RT Machine , RT

1070 M6 3A.M6.17242 11250 CT / MRI report with film, Biopsy
adjuvant treatment chart RT planning Data
3A.M6.17243 : Linear accelerator teletherapy, Photo with RT machine, RT treatment

1071 M6 3A.M6.17243 41250 CT report and film, biopsy
Definitive+Tab Temozolamide chart, RT planning data
3A.M6.17244 : Linear accelerator teletherapy,

1072 M6 3A.M6.17244 3DCRT, Definitive along with +concurrent Tab 60000 CT report and Film, Biopsy
Temozolamide along with RT
3A.M6.17245 : Linear accelerator (Photons) Photo with RT Machine , RT
teletherapy, Adjuvant treatment chart

Radiotherapy, Definitive treatment chart RT planning Data
3A.M6.17247 : Radioiodine Treatment < 100 Radioiodine original treatment chart

1075 M6 3A.M6.17247 15000 Biopsy/FNAC
Millicuries and Thyroid scan, Biopsy/HPE
3A.M6.17248 : Radioiodine Treatment > 100 Radioiodine original treatment chart

1076 M6 3A.M6.17248 22500 Biopsy/FNAC
Millicuries and Thyroid scan , Biopsy/HPE
Speciality
code
3A.M6.17249 : Accelerated partial breast irradiation Biopsy/FNAC , Mammography/USG, Photo with RT Machine , RT
1077 M6 3A.M6.17249 37500
(APBI) any type/ LINAC/3DCRT/IMRT chest Xray treatment chart
3A.M6.17250 : Linear accelerator,Involved-Site

1078 M6 3A.M6.17250 Radiotherapy (ISRT)/Involved field radiation therapy 18750 Hematology + Biopsy/FNAC report
treatment chart
(IFRT)/3DCRT/IMRT
3A.M6.17251 : Linear accelerator, less than 20 Photo with RT Machine , RT
fractions/3DCRT/IMRT treatment chart
3A.M6.17252 : Linear accelerator teletherapy, Photo with RT Machine , RT
3DCRT,IMRT,VMAT Adjuvant/Definitive treatment chart
3A.M6.17253 : Brachytherapy/ Interstitial HDR one Photo with RT Machine , RT

application, multiple doses Definitive/Boost treatment chart RT planning Data

1082 M6 3A.M6.17254 3A.M6.17254 : Cobalt 60 teletherapy, Palliative 7500 CT report and Film, Biopsy
3A.M6.17255 : Linear accelerator teletherapy, Photo with RT Machine , RT

Palliative treatment chart
1084 S15 3A.S15.00001 3A.S15.00001 : Tracheal resection 13500 CT report and Film, Biopsy
HPE report
3A.S15.00002 : Sternotomy with superior Clinical Photograph showing the
mediastinal dissection scar + HPE report
Clinical Photograph showing the
1086 S15 3A.S15.00003 3A.S15.00003 : Substernal bypass 26250 Biopsy of the primary
procedure/scar
1087 S15 3A.S15.00004 3A.S15.00004 : Resection of nasopharyngeal tumour 37500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
1088 S15 3A.S15.00005 3A.S15.00005 : Myocutaneous flap 18750 Biopsy of the primary Clinical Photograph showing scar
X-ray Films + detail notes+ pre-op

1089 S15 3A.S15.00006 3A.S15.00006 : Fasciocutaneous flap 11250 Clinical photo showing Scar
clinical photo
1090 S15 3A.S15.00007 3A.S15.00007 : Palatectomy- Soft palate 22500 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
1091 S15 3A.S15.00008 3A.S15.00008 : Palatectomy- Hard palate 15000 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
1092 S15 3A.S15.00009 3A.S15.00009 : Microvascular reconstruction 33750 Biopsy of the primary Clinical Photograph showing scar

1093 S15 3A.S15.00010 3A.S15.00010 : Composite resection 37500 CT report and Film, Biopsy
HPE report
3A.S15.00011 : Composite resection with Clinical Photograph showing scar +
reconstruction(excluding microvascular) HPE report
1095 S15 3A.S15.00012 3A.S15.00012 : Neck dissection-selective 9000 Biopsy , USG/CT of neck with film
HPE report
1096 S15 3A.S15.00013 3A.S15.00013 : Neck dissection-comprehensive 18750 Biopsy , USG/CT of neck with film
HPE report
1097 S15 3A.S15.00014 3A.S15.00014 : Total Maxillectomy 13500 CT report and Film, Biopsy
HPE report
Speciality
code
1098 S15 3A.S15.00015 3A.S15.00015 : Radical Maxillectomy 30000 CT report and Film, Biopsy
HPE report
1099 S15 3A.S15.00016 3A.S15.00016 : Radical parotidectomy 18750 FNAC,CT
HPE report
3A.S15.00017 : Partial laryngectomy ( voice Clinical Photograph showing scar +
preserving) HPE report
1101 S15 3A.S15.00018 3A.S15.00018 : Voice prosthesis 30000 CT report, Biopsy, +Photograph with AM Invoice of prosthesis, scar photo
3A.S15.00020 : Total Thyroidectomy with central

1102 S15 3A.S15.00020 compartment LN dissection with Lateral LN 18750 FNAC/CT/MRI report and Film
HPE report
dissection
Biopsy/FNAC , Mammography/USG, Clinical Photograph showing scar +
1103 S15 3A.S15.00022 3A.S15.00022 : Axillary dissection 11250
chest Xray HPE report
3A.S15.00023 : Breast conserving surgery Biopsy/FNAC , Mammography/USG, Clinical Photograph showing scar +
1104 S15 3A.S15.00023 18750
(lumpectomy + axillary surgery) chest Xray HPE report
1105 S15 3A.S15.00024 3A.S15.00024 : Lung metastectomy- solitary 22500 Biopsy/FNAC ,CT report and Film
3A.S15.00025 : Lung metastectomy- multiple (< Clinical Photograph showing scar +
1106 S15 3A.S15.00025 37500 Biopsy/FNAC ,CT report and Film
four) HPE report + XRAY Chest
3A.S15.00026 : Lung metastectomy- multiple (> Clinical Photograph showing scar +
1107 S15 3A.S15.00026 45000 Biopsy/FNAC ,CT report and Film
four) HPE report + XRAY Chest
1108 S15 3A.S15.00027 3A.S15.00027 : Sleeve resection of lung cancer 67500 Biopsy/FNAC ,CT report and Film
3A.S15.00028 : Oesophagectomy with two field
1109 S15 3A.S15.00028 56250 Biopsy , CT , Endoscopy reports HPE report, scar photo
lymphadenectomy
3A.S15.00029 : Oesophagectomy with three field
1110 S15 3A.S15.00029 67500 Biopsy , CT , Endoscopy reports Biopsy , CT , Endoscopy reports
lymphadenectomy
1111 S15 3A.S15.00030 3A.S15.00030 : Enucleation of pancreatic neoplasm 18750 CT / MRI with film/IHC report
HPE report
Clinical Photograph showing the scar
1112 S15 3A.S15.00031 3A.S15.00031 : Radical Cholecystectomy 45000 CT /MRI report and Film, biopsy
+ HPE report +USG Report
1113 S15 3A.S15.00032 3A.S15.00032 : Abdominal wall tumour resection 26250 CT abdomen report and Film
HPE report
3A.S15.00033 : Abdominal wall tumour resection Clinical Photograph showing scar +
1114 S15 3A.S15.00033 33750 CT abdomen report and Film
with reconstruction HPE report
3A.S15.00034 : Oesophageal stenting including stent
1115 S15 3A.S15.00034 30000 CT abdomen report and Film Stent invoice
cost
1116 S15 3A.S15.00035 3A.S15.00035 : Triple bypass GI tract 30000 Biopsy , CT , Endoscopy
HPE report
3A.S15.00036 : Segmentectomy- hepatobiliary Clinical Photograph showing scar,
1117 S15 3A.S15.00036 37500 CT /MRI report and Film
system USG and HPE Report
Speciality
code
3A.S15.00037 : Radical Hysterectomy + Bilateral

1118 S15 3A.S15.00037 pelvic lymph node dissection + bilateral salpingo 37500 CT report and Film, Biopsy
HPE report
ophorectomy (BSO)/ ovarian transposition
3A.S15.00038 : Skin Tumours Wide Excision + Biopsy of the primary tumour + CT/MRI Clinical Photograph showing scar +
1119 S15 3A.S15.00038 37500
Reconstruction with film HPE report
Biopsy of the primary tumour + CT/MRI Clinical Photograph showing scar +
1120 S15 3A.S15.00039 3A.S15.00039 : Skin Tumours Amputation 18750
1121 S15 3A.S15.00040 3A.S15.00040 : Radical Vaginectomy 30000 CT report and Film, Biopsy HPE report
3A.S15.00041 : Radical Vaginectomy +
1122 S15 3A.S15.00041 33750 CT report and Film, Biopsy HPE report
Reconstruction
3A.S15.00042 : Bilateral Pelvic Lymph Node Clinical Photograph showing scar +
Dissection (BPLND) HPE report
1124 S15 3A.S15.00043 3A.S15.00043 : Radical Trachelectomy 30000 CT report and Film, Biopsy
HPE report
3A.S15.00044 : Vulvectomy with bilateral groin
1125 S15 3A.S15.00044 33750 Clinical Notes, USG/CT/MRI OT Notes, HPE
dissection
3A.S15.00045 : Limb salvage surgery for bone tumor CT-Local part/MRI, CT Chest with film, Clinical Photograph XRAY Showing
1126 S15 3A.S15.00045 56250
with prosthesis ,Bone Scan report + Biopsy Report prosthesis + HPE report
Clinical Photograph showing scar /

1127 S15 3A.S15.00046 3A.S15.00046 : Hemipelvectomy 48750 CT/MRI Pelvis with film
HPE report + XRAY
Clinical Photograph showing scar /
1128 S15 3A.S15.00047 3A.S15.00047 : Sacral resection 45000 CT/MRI Pelvis with film
HPE report + XRAY
3A.S15.00048 : Chest wall resection with Clinical Photograph showing scar +
1129 S15 3A.S15.00048 30000 CT Chest with film, biopsy
reconstruction for soft tissue / bone tumors HPE report
CT-Local part/MRI with film + Biopsy Clinical Photograph showing scar+
1130 S15 3A.S15.17150 3A.S15.17150 : Forequarter amputation 22500
Report HPE report
CT-Local part including chest /MRI Clinical Photograph showing scar +
1131 S15 3A.S15.17151 3A.S15.17151 : Shoulder Girdle Resection 30000
report with film + Biopsy Report HPE report
Biopsy/FNAC , Mammography/USG, HPE report, scar photo ( if patient
1132 S15 3A.S15.17152 3A.S15.17152 : Mastectomy +Axillary Dissection 18750
chest Xray consents)
1133 S15 3A.S15.17153 3A.S15.17153 : Gastro Jejunostomy 22500 Clinical photograph showing scar
film
1134 S15 3A.S15.17154 3A.S15.17154 : Ileotransverse Colostomy 22500 Clinical photograph with scar
film
1135 S15 3A.S15.17155 3A.S15.17155 : Distal Pancreatectomy 45000 CT / MRI with film/IHC report
HPE report
1136 S15 3A.S15.17156 3A.S15.17156 : Enucleation of Cyst 37500 CT report and Film
HPE report
3A.S15.17157 : Whipples surgery ( inclusive of Clinical Photograph showing scar +
1137 S15 3A.S15.17157 60000 CT / MRI/IHC
staplers) HPE report
Clinical Photograph showing scar,
1138 S15 3A.S15.17158 3A.S15.17158 : Hepatectomy (right or left) 63750 CT /MRI report and Film
USG and HPE Report
Speciality
code
Clinical Photograph showing scar+
1139 S15 3A.S15.17159 3A.S15.17159 : Anterior Exenteration 52500 Cystoscopy, biopsy, CT report and Film
HPE report
Clinical Photograph showing scar+
1140 S15 3A.S15.17160 3A.S15.17160 : Total Exenteration 56250 Cystoscopy, biopsy, CT report and Film
HPE report
Clinical Photograph showing scar,
1141 S15 3A.S15.17161 3A.S15.17161 : Urinary diversion 30000 Biopsy, USG Scrotum report and Film
post op USG
3A.S15.17162 : Surgery for Ca Ovary - advance stage Clinical Photograph showing scar +
1142 S15 3A.S15.17162 45000 USG/CT Reports with film,CA 125
with Mesenteric/Peritoneal/Omental Metastatsis HPE report + USG report
3A.S15.17163 : Microlaryngeal Surgery including

1143 S15 3A.S15.17163 8250 Clinical Photograph Clinical Photograph, HPE report
Phonosurgery
3A.S15.17164 : Laryngectomy - any type, with neck Clinical Photograph showing scar +
node dissection HPE report
1145 S15 3A.S15.17165 3A.S15.17165 : Laryngopharyngo Oesophagectomy 52500 Biopsy , CT , Endoscopy reports HPE report, scar photo
1146 S15 3A.S15.17166 3A.S15.17166 : GI Stenting including stent cost 30000 CT abdomen report and Film Stent invoice
3A.S15.17167 : Composite Resection + Micro Clinical Photograph showing scar +
vascular reconstruction HPE report
Photos with laser machine, CD of
1148 S15 3A.S15.17168 3A.S15.17168 : Laser Surgery of Larynx 22500 Clinical Photograph procedure/intra op stills + HPE
report
3A.S15.17169 : VATS/Laparoscopy ( for deep seated
1149 S15 3A.S15.17169 7500 CT report with film Scar Photo
biopsy)
Endoscopy with film, biopsy, CT report Clinical Photograph showing scar +
1150 S15 3A.S15.17170 3A.S15.17170 : Abdominoperinial Resection 37500
1151 S15 3A.S15.17171 3A.S15.17171 : Surgery for Ca Ovary - early stage 30000 USG/CT Reports with film,CA 125
HPE report + USG report
3A.S15.17172 : Mastectomy +Axillary Biopsy/FNAC , Mammography/USG, HPE report, scar photo ( if patient
1152 S15 3A.S15.17172 30000
Dissection+Defect Closure with Flap chest Xray consents)
CT/MRI report and Film if required, Clinical Photograph showing scar +
1153 S15 3A.S15.17173 3A.S15.17173 : Wide excision of lesion 18750
Biopsy, clinical picture HPE report
3A.M4.00001 : Acute lymphoblastic leukemia Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1154 M4 3A.M4.00001 37500
(chemotherapy including diagnostics): induction Flow cytometry drug batch number with bar code
1155 M4 3A.M4.00002 37500
(chemotherapy including diagnostics): consolidation Flow cytometry drug batch number with bar code
1156 M4 3A.M4.00003 3750
(chemotherapy including diagnostics): maintainence Flow cytometry drug batch number with bar code
3A.M4.00005 : Acute lymphoblastic leukemia: Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1157 M4 3A.M4.00005 15000
Supportive care/ rehabilitation Flow cytometry drug batch number with bar code
Speciality
code
3A.M4.00006 : Acute myeloid leukemia Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1158 M4 3A.M4.00006 56250
(chemotherapy including diagnostics): induction Flow cytometry drug batch number with bar code
3A.M4.00007 : Acute myeloid leukemia Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1159 M4 3A.M4.00007 56250
(chemotherapy including diagnostics): consolidation Flow cytometry drug batch number with bar code

3A.M4.00008 : Acute myeloid leukemia: Supportive drug batch number with bar code,
1160 M4 3A.M4.00008 22500 Haematology + Cytoflowmetry report
care/ rehabilitation treatment drug details in discharge
summary
3A.M4.00011 : Hodgkin Lymphoma (Favorable Clinical Photograph, chemotherapy

1161 M4 3A.M4.00011 11250 Biopsy, CT
group): Supportive care/ rehabilitation drug batch number with bar code

3A.M4.00014 : Hodgkin Lymphoma (unfavorable drug batch number with bar code,
1162 M4 3A.M4.00014 18750 Biopsy, CT
group): Supportive care/ rehabilitation treatment drug details in discharge
summary
Heamogram,Biochemestry,chest x-
3A.M4.00015 : Non-Hodgkin Lymphoma: Lymphnode Biopsy,HPE, BMA with
1163 M4 3A.M4.00015 112500 ray, chemotherapy drug batch
chemotherapy including diagnostics biopsy, CT scan
number with bar code

3A.M4.00016 : Non-Hodgkin Lymphoma: Supportive drug batch number with bar code,
1164 M4 3A.M4.00016 37500 Biopsy, CT
care/ rehabilitation treatment drug details in discharge
summary
3A.M4.00017 : Retinoblastoma (Intraocular): Clinical Photograph, chemotherapy

chemotherapy including diagnostics drug batch number with bar code

3A.M4.00020 : Retinoblastoma (Intraocular): drug batch number with bar code,
supportive care/ rehabilitation treatment drug details in discharge
summary
3A.M4.00021 : Retinoblastoma (extraocular): Chest x-ray,USG abdomen

1167 M4 3A.M4.00021 82500 MRI of orbit and brain
chemotherapy including diagnostics pelvis,BMA
3A.M4.00023 : Retinoblastoma (extraocular): Clinical Photograph, chemotherapy

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

1169 M4 3A.M4.00024 30000 CT report /MRI Clinical features
including diagnostics drug batch number with bar code
Speciality
code
3A.M4.00027 : Brain tumors: supportive care/ Clinical Photograph, chemotherapy

1170 M4 3A.M4.00027 18750 CT report /MRI Clinical features
rehabilitation drug batch number with bar code
3A.M4.00028 : Wilms tumors: chemotherapy Clinical Photograph, chemotherapy

1171 M4 3A.M4.00028 15000 CT report with film, biopsy/FNAC
including diagnostics drug batch number with bar code
3A.M4.00031 : Histiocytosis: chemotherapy Skin Biopsy / Lymphnode Biopsy,USG

1172 M4 3A.M4.00031 37500 Heamogram,Biochemestry
including diagnostics abdomen pelvis
3A.M4.00032 : Histiocytosis: supportive care/ Clinical Photograph, chemotherapy

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

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

supportive care/ rehabilitation drug batch number with bar code
3A.M4.00037 : Chronic Myeloid Leukemia : Haematology, Bone Marrow Aspitation/ Photo with RT Machine , RT
1176 M4 3A.M4.00037 4500
chemotherapy including diagnostics Flow cytometry treatment chart
Heamogram,Biochemestry, ,
3A.M4.00038 : Chronic Myeloid Leukemia : BMA report and Molecular analysis
1177 M4 3A.M4.00038 75000 treatment drug details in discharge
supportive care/ rehabilitation report
summary
3A.M5.00001 : Lymphoma, Non-Hodgkin’sR-CHOP Clinical Photograph, chemotherapy

1178 M5 3A.M5.00001 4500 Biopsy, CT report with film
Regimen (per cycle) x 6 drug batch number with bar code
3A.M5.00002 : Multiple MyelomaBortezomib+ Bone Marrow Aspiration Report, Serum Clinical Photograph, chemotherapy
1179 M5 3A.M5.00002 3750
lenalidomide+ dexamethasone, per cycle x6 Protein electrophoresis, CRAB criteria drug batch number with bar code
3A.M5.00003 : Multiple MyelomaBortezomib+ Bone Marrow Aspiration Report, Serum Clinical Photograph, chemotherapy
1180 M5 3A.M5.00003 3750
cyclophosphamide+ dexamethasone, per cycle x 6 Protein electrophoresis, CRAB criteria drug batch number with bar code
3A.M5.00004 : Multiple MyelomaMPT - melphalan, Bone Marrow Aspiration Report, Serum Clinical Photograph, chemotherapy
1181 M5 3A.M5.00004 3750
thalidomide and prednisolone, per cycle x 9 Protein electrophoresis, CRAB criteria drug batch number with bar code
3A.M5.00005 : Multiple MyelomaBortezomib + Bone Marrow Aspiration Report, Serum Clinical Photograph, chemotherapy
1182 M5 3A.M5.00005 3750
dexamethasone, per cycle x 9 Protein electrophoresis, CRAB criteria drug batch number with bar code
3A.M5.00006 : Multiple
Bone Marrow Aspiration Report, Serum Clinical Photograph, chemotherapy
1183 M5 3A.M5.00006 MyelomaThalidomide+Dexamethasone(Oral)/ 3750
Protein electrophoresis, CRAB criteria drug batch number with bar code
month - max 12 months
3A.M5.00007 : Colon Rectum5-Fluorouracil-
Chemotherapy drug batch number
1184 M5 3A.M5.00007 Oxaliplatin - Leucovorin (FOLFOX) - Max. 6 cycles 6000 CT report and Film, Biopsy
with bar code
(Per cycle)
Speciality
code
3A.M5.00008 : Bone Tumors/Osteosarcoma/

1185 M5 3A.M5.00008 Hepatoblastoma -OperableCisplatin/carboplatin - 2250 Biopsy , CT-Scan with film
Adriamycin- max 6 cycles (Per cycle)
3A.M5.00009 : Lymphoma, Hodgkin'S Adriamycin

1186 M5 3A.M5.00009 Bleomycin VinblastinDacarbazine (ABVD) - max 8 7500 Biopsy, CT
cycles (Per cycle) (Day 1 & Day 15)
3A.M5.00010 : Cervix Cisplatin/Carboplatin (AUC2) Clinical Photograph, chemotherapy

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

1188 M5 3A.M5.00011 7500 CT report with film, biopsy/FNAC
Regimen – Neuroblastoma - max 1 year (Per cycle) drug batch number with bar code
3A.M5.00012 : Wilm'sTumor SIOP/National Wilms

1189 M5 3A.M5.00012 Tumour Study Group (NWTS) regimen(Stages I - V)- 5250 CT report with film, biopsy/FNAC
max 6 months (Per month) - Wilm's tumour

1190 M5 3A.M5.00013 3A.M5.00013 : Colon - rectum Monthly 5-FU 3000 CT report and Film, Biopsy
with bar code
Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
1191 M5 3A.M5.00014 3A.M5.00014 : BreastPaclitaxel weekly x 12 weeks 3375
chest Xray with bar code
3A.M5.00015 : Breast
1192 M5 3A.M5.00015 Cyclophosphamide/Methotrexate/5 Fluorouracil 1125
(CMF) (Per cycle)
3A.M5.00016 : BreastTamoxifen tabs - maximum 12 Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
1193 M5 3A.M5.00016 75
cycles (Per month) chest Xray with bar code
3A.M5.00017 : Breast
1194 M5 3A.M5.00017 Adriamycin/Cyclophosphamide (AC) – per cycle 2250
(Maximum 4 cycles)
3A.M5.00018 : Breast5- Fluorouracil A-C (FAC) – per Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
1195 M5 3A.M5.00018 3750
cycle (Maximum 6 cycles) chest Xray with bar code
1196 M5 3A.M5.00019 3A.M5.00019 : BreastAC (AC Then Taxol) 3750
3A.M5.00020 : Small Cell Lung Cancer
1197 M5 3A.M5.00020 Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles 5250 Biopsy/FNAC ,CT report and Film
with bar code
only)
3A.M5.00021 : Oncology oesophagusCisplatin + 5
Endoscopy with film, biopsy, CT report Chemotherapy drug batch number
1198 M5 3A.M5.00021 FU(Neoadjuvant Chemotherapy)/Adjuvant (ADJ)- 2250
with film with bar code
per cycle (Max. of 6 cycles only)
Speciality
code
3A.M5.00022 : Stomach Docetaxel +Oxaliplatin+5FU

20,000 per cycle for 4 cycles Endoscopy with film, biopsy, CT report Chemotherapy drug batch number
1199 M5 3A.M5.00022 3000
CapOX- 10,000 per cycle for 8 cycles with film with bar code
3A.M5.00023 : Breast Aromatase Inhibitors

1200 M5 3A.M5.00023 (Anastazole/Letrozole/Exemestane) - 675
maximum 12 cycles (Per month)
3A.M5.00024 : Urinary Bladder Weekly
1201 M5 3A.M5.00024 Cisplatin/Carboplatin- max 6 cycles with RT (Per 1500 CT report and Film, Biopsy
week)
3A.M5.00025 : Urinary Bladder Methotraxate Clinical Photograph, chemotherapy

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

Carbo/Etoposide/Vincristine-max 6 cycles (Per cycle) drug batch number with bar code
Clinical Photograph, Discharge

3A.M5.00027 : Febrile NeutropeniaIV antibiotics and
1204 M5 3A.M5.00027 22500 Haemogram for each episode summary (with details of drugs
other supportive therapy (Per episode)
given)
3A.M5.00028 : Vaginal/ Vulval Cancer Cisplastin/5- CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy
1205 M5 3A.M5.00028 2250
FU markers drug batch number with bar code
3A.M5.00029 : OvaryTaxol + Carboplatin-max 6 CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy
1206 M5 3A.M5.00029 11250
cycles (Per cycle) markers drug batch number with bar code
3A.M5.00030 : Multiple MyelomaMelphalan -

1207 M5 3A.M5.00030 Prednisone (oral) – per month (max 12 months) - 1125
Protein electrophoresis, CRAB criteria drug batch number with bar code
Ovarian CA, Bone CA
3A.M5.00031 : Rectal Cancer Stage 2 And
1208 M5 3A.M5.00031 3Gemcitabine +capecitabine-15,000 per cycle for 6 3000 CT report and Film, Biopsy
with bar code
cycles
3A.M5.00032 : Multiple MyelomaZoledronic acid - CT/PET /Bone scan/ Xray, Biopsy if Chemotherapy drug batch number
1209 M5 3A.M5.00032 1500
Max 12 cycles (Per month) required with bar code
3A.M5.00033 : Gestational Trophoblast Ds. High
RiskEtoposide-Methotrexate-Actinomycin / Clinical Photograph, chemotherapy
1210 M5 3A.M5.00033 7500 B HCG report,CT report and Film
Cyclophosphamide -Vincristine (EMA-CO)-max 6 drug batch number with bar code
cycles (Per cycle)
3A.M5.00034 : Gestational Trophoblast Ds. Low Risk Clinical Photograph, chemotherapy

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

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

Etoposide-Cisplatin (BEP) - max cycles 4 (Per cycle) drug batch number with bar code
3A.M5.00037 : Prostate Hormonal Therapy - Per CT report and Film, Biopsy,PSA with Clinical Photograph, chemotherapy
1214 M5 3A.M5.00037 2250
month evidence of bone metastasis drug batch number with bar code
3A.M5.00038 : Testis Bleomycin-Etoposide-Cisplatin

1215 M5 3A.M5.00038 (BEP) regimen for germ cell tumour - max cycles 4 7500 CT report and Film, Biopsy
(Per cycle)
3A.M5.00039 : Acute Myeloid LeukemiaInduction
Phase, up to (Daunomycin and cytosine arabinoside Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1216 M5 3A.M5.00039 75000
(3:7)) Flow cytometry drug batch number with bar code
3A.M5.00040 : Acute Myeloid

LeukemiaConsolidation Phase, up to (High dose Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1217 M5 3A.M5.00040 56250
cytosine arabinoside – per cycle, max. of 3 to 4 Flow cytometry drug batch number with bar code
cycles)
3A.M5.00041 : Histocytosis Variable Regimen- Clinical Photograph, chemotherapy

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

Actinomycin-Cyclophosphamide (VACTC) based Clinical Photograph, chemotherapy
chemo - max 1 year (Per month) - drug batch number with bar code
Rhabdomyosarcoma
3A.M5.00043 : Ewing’s SarcomaVariable Regimen Clinical Photograph, chemotherapy

1220 M5 3A.M5.00043 4500 X-Ray,CT Scan with film, Biopsy
Inv - Hematology, Biopsy – Payable drug batch number with bar code
3A.M5.00044 : Unlisted Regimen Palliative CT- Max Chemotherapy drug batch number
1221 M5 3A.M5.00044 3750 CT/MRI , HPE report
6 cycles (Per cycle) with bar code
3A.M5.00045 : Terminally Ill Palliative And Chemotherapy drug batch number
1222 M5 3A.M5.00045 2250 CT/MRI , HPE report
Supportive Therapy - Per month with bar code
3A.M5.00046 : Acute Lymphatic Leukemia Haematology, Bone Marrow Aspitation/ Photo with RT Machine , RT
1223 M5 3A.M5.00046 3750
Maintenance Phase - Per month (x 24) Flow cytometry treatment chart
Haematology, Bone Marrow Aspitation/ Photo with RT Machine , RT
1224 M5 3A.M5.00047 3A.M5.00047 : Acute Lymphatic Leukemia Induction 37500
Flow cytometry treatment chart
3A.M5.00048 : Acute Lymphatic Leukemia Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1225 M5 3A.M5.00048 37500
Consolidation Phase Flow cytometry drug batch number with bar code
3A.M5.00049 : Head and NeckTab Geftinib/Erlotinib- Chemotherapy drug batch number

Max 1 Year (Per month) with bar code
3A.M5.00050 : Renal cell carcinoma Sunitinib/ CT report with film, Isotope renogram Chemotherapy drug batch number
1227 M5 3A.M5.00050 1875
Pazopanib (per day) if required with bar code
3A.M5.00051 : Chronic myeloid leukemiaImatinib Haematology, Bone Marrow Aspitation/ Photo with RT Machine , RT
1228 M5 3A.M5.00051 4500
(per month) x 5 years Flow cytometry treatment chart
Speciality
code
3A.M5.00052 : Gall Bladder Cancer Gemcitabine + Clinical Photograph, chemotherapy

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

1230 M5 3A.M5.17176 Gemcitabine D1 & D8 + Cisplatin / Carboplatin - 9000 Biopsy/FNAC ,CT report and Film
with bar code
Max. 6 cycles only (Per cycle)
3A.M5.17177 : Pemetrexed +Carboplatin/Cisplatin

1231 M5 3A.M5.17177 (Stage IIIB, IV Adenocarcinoma)- Max. 6 cycles only 11250 Biopsy/FNAC ,CT report and Film,
with bar code
(Per cycle)
3A.M5.17178 : Cisplatin/Adriamycin+ifosmide (IAP)-

1232 M5 3A.M5.17178 max 6 cycles (Per cycle) -Adj/Neo adjuvant/Palliative 11250 Biopsy , CT-Scan with film
(Osteosarcoma)
3A.M5.17179 : High Dose Methotrexate (MTX)- max Clinical Photograph, chemotherapy

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

Adj/Neo adjuvant/Palliative drug batch number with bar code
3A.M5.17181 : Consolidation 1 to 4 phases(per Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1235 M5 3A.M5.17181 24750
phase)- AML Flow cytometry drug batch number with bar code
3A.M5.17182 : Adult ALL -Hyper CVAD/BFM - 4 Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1236 M5 3A.M5.17182 27000
cycles ( Each cycle= A + B) Flow cytometry drug batch number with bar code
3A.M5.17183 : D'angelo's for CNS primary and Clinical Photograph, chemotherapy

1237 M5 3A.M5.17183 15000 Haematology + Cytoflowmetry report
secondary lymphomas -(Max. 6 months) (Per month) drug batch number with bar code
3A.M5.17184 : Salvage CT - GDP (Gemcitabine -

1238 M5 3A.M5.17184 Cisplatin- Dexamethasone)- Maximum 6 cycles (Per 9000 Hematology + Biopsy/FNAC report
cycle)
3A.M5.17185 : Salvage CT - ICE (Ifosfamide-
1239 M5 3A.M5.17185 Carboplatin-Etoposide)- Maximum 6 cycles (Per 11250 Hematology + Biopsy/FNAC report
cycle)
3A.M5.17186 : Salvage CT -DHAP (cytosine
1240 M5 3A.M5.17186 arabinoside-cisplatin-dexamethasone) - Maximum 6 18750 Hematology + Biopsy/FNAC report
cycles (Per cycle)
3A.M5.17187 : Second generation Tab TKI - max 12 Hematology + FNAC report Clinical Photograph, chemotherapy
1241 M5 3A.M5.17187 4500
cycles per year (Per month) - (Failure of Imatinib) /Cytogenetics/ BCR-ABL drug batch number with bar code
3A.M5.17188 : Bendamustine- max 6 cycles (Per Clinical Photograph, chemotherapy

cycle) - CLL drug batch number with bar code
Speciality
code
3A.M5.17189 : Bendamustine + Ritumaxib- 6-8
1243 M5 3A.M5.17189 cycles (Per cycle) - CLL (Available only at select 15000 Hematology + Biopsy/FNAC report
centres)

1244 M5 3A.M5.17190 3A.M5.17190 : R-CHOP -max 6 cycles (Per cycle) 15000 Biopsy, CT report with film
3A.M5.17191 : Variable Regimen-Non

1245 M5 3A.M5.17191 Lymphoblastic NHL, (Per cycle) max. 8 15000 Hematology + Biopsy/FNAC report
cycles.(Amount as per drug cost)
3A.M5.17192 : Plasma cell Leukemia / Multiple
1246 M5 3A.M5.17192 Myeloma - Thaladomide, Dexamethasone, 15000
Protein electrophoresis drug batch number with bar code
Bortezomib - max 6 cycles
3A.M5.17193 : Carbo/Etoposide/Vincristine-max 6 Clinical Photograph, chemotherapy

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

1248 M5 3A.M5.17194 6000 Biopsy,IHC , CT report with film
(Per month)(Amount as per drug cost) drug batch number with bar code
3A.M5.17195 : FEC (Epirubicin based)(Maximum 6 Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
1249 M5 3A.M5.17195 6000
cycles) (Per cycle) chest Xray with bar code
3A.M5.17196 : 1. TC Docetaxel +
Cyclophosphamide. 2. TAC Docetaxel + Doxorubicin
1250 M5 3A.M5.17196 + Cyclophosphamide. 3. Gemcitabine D1 & D8 +/- 9000
Cisplatin/ Carboplatin - maximum 6 cycles (Per
cycle)
3A.M5.17197 : Capetabine (Day 1-14) - 6 cycles
1251 M5 3A.M5.17197 (Palliative/Adjuvant); As Concurrent as RT sensitizor 3000 CT/USG report and Film, Xray, Biopsy
with bar code
with all RT
3A.M5.17198 : Variable Regimen maximum 6 cycles Chemotherapy drug batch number
(Per cycle) (Amount as per drug cost) with bar code
3A.M5.17199 : Cisplatin/Carboplatin- 5FU (Per cycle) Endoscopy with film, biopsy, CT report Chemotherapy drug batch number
1253 M5 3A.M5.17199 4500
-Oesophageal CA with film with bar code
Endoscopy with film, biopsy, CT report Chemotherapy drug batch number
1254 M5 3A.M5.17200 3A.M5.17200 : Epirubicin+Cisplatin+5FU (Per cycle) 6000
with film with bar code
3A.M5.17201 : EOX (Epirubicin + Oxaloplatin + Endoscopy with film, biopsy, CT report Chemotherapy drug batch number
1255 M5 3A.M5.17201 9000
Capcetabine) - Max 6 cycles with film with bar code
3A.M5.17202 : Monthly 5-Fluorouracil(FU) (Per cycle) Chemotherapy drug batch number
-Colorectal cancer with bar code
3A.M5.17203 : Imatinib -Max for 6 months (Per Chemotherapy drug batch number
month) with bar code
3A.M5.17204 : Gemcitabine+Cisplatin(Day 1,Day 8 )- Chemotherapy drug batch number
max 6 cycles (Per cycle) with bar code
3A.M5.17205 : Tab Sorafenib- max 12 months (Per Chemotherapy drug batch number
Speciality
code
3A.M5.17206 : Oxiplatin+Capecitabine- max. of 6
1260 M5 3A.M5.17206 cycles for palliative only or 8 cycles for adjuvant (Per 6000 CT/MRI with film, Biopsy
with bar code
cycle)
3A.M5.17207 : Weekly Cisplatin/Carboplatin- max 6 Chemotherapy drug batch number
cycles with RT (Per week) with bar code
3A.M5.17208 :
Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vinblast CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy
1262 M5 3A.M5.17208 15000
ine,Ifosphimide,Cisplatin(VeIP)- max cycles 4 (Per markers drug batch number with bar code
cycle)
3A.M5.17209 : Cisplatin/Carboplatin (AUC2)- Max. of Clinical Photograph, chemotherapy

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

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

10 cycles drug batch number with bar code
3A.M5.17212 : Etoposide-Methotrexate-Actinomycin
1266 M5 3A.M5.17212 / Cyclophosphamide -Vincristine (EMA-CO)-max 6 6000 B HCG report,CT report and Film
cycles (Per cycle)
3A.M5.17213 : Variable Regimen (Amount as per Clinical Photograph, chemotherapy

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

1268 M5 3A.M5.17214 Liposomal Doxorubicin/ Albumin bound Paclitaxel ( 9000 CT report and Film, Biopsy
Adjuvant), max 6 cycles
3A.M5.17215 : Palliative CT- Max 6 cycles (Per cycle) Chemotherapy drug batch number
1269 M5 3A.M5.17215 6000 CT/USG report and Film, Xray, Biopsy
For Primary and secondary tumours with bar code
3A.M5.17216 : Zoledronic acid - Max 12 cycles (Per CT/PET /Bone scan/ Xray, Biopsy if Chemotherapy drug batch number
1270 M5 3A.M5.17216 2250
month) required with bar code
3A.M5.17217 : Tab Temozolemide for 6 months Pharmacy Bill/Invoice with batch no.
(5days every month x 6 months) of the drug strip
3A.M5.17218 : Growth Factor / Pegrafil (Per cycle) Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number
1272 M5 3A.M5.17218 1500
(Maximum 4 cycles) chest Xray with bar code
3A.M5.17219 : Cisplatin/Carboplatin (AUC2) along Chemotherapy drug batch number
with RT- max 6 cycles (Per cycle) with bar code
3A.M5.17220 : Cisplatin + 5FU + Taxol/Docitaxel ( Clinical Photograph showing scar +
only hypopharynx) HPE report
3A.M5.17221 : Palliative CT (Paclitaxel + Cisplatin or Chemotherapy drug batch number

1275 M5 3A.M5.17221 6000 CT / USG report and Film, X ray, Biopsy
5 FU + Cisplatin) - Max 6 cycles (Per cycle) with bar code
Speciality
code
3A.M5.17222 : Palliative CT 1. Docetaxel +

1276 M5 3A.M5.17222 Cisplatin / Carboplatin. 2. Gemcitabine D1& D8 + 7500 CT report and Film, Biopsy
with bar code
Cisplatin / Carboplatin - max 6 cycles (Per cycle)
3A.M5.17223 : Tab Sorefinib- max 12 months (Per Chemotherapy drug batch number
3A.M5.17225 : SIOP/NATIONAL WILMS TUMOUR

1278 M5 3A.M5.17225 STUDY GROUP(NWTS) regimen(Stages I - V)- max 6 6000 CT report with film, biopsy/FNAC
months (Per month) - Wilm's tumour
3A.M5.17226 : Bleomycin-Etoposide-Cisplatin (BEP)

1279 M5 3A.M5.17226 (Per cycle) - Germ cell tumours, extra gonadal 7500 CT report and Film, Biopsy
tumour
3A.M5.17227 : Vincristine-Actinomycin-
1280 M5 3A.M5.17227 Cyclophosphamide(Vact C) based chemo - max 1 6750 Biopsy , CT report with film
year (Per cycle)- Rhabdomyosarcoma
3A.M5.17228 : Cisplatin + 5 FU(Neoadjuvant
1281 M5 3A.M5.17228 Chemotherapy)/Palliative - Max. of 4 cycles only (Per 4500 CT report and Film, Biopsy
with bar code
cycle)
3A.M5.17229 : Bleomycin-Etoposide-Cisplatin (BEP)-
CT report and Film, Biopsy/Tumour Clinical Photograph, chemotherapy
1282 M5 3A.M5.17229 max cycles 4 (Per cycle) Germ cell tumours, extra 7500
markers drug batch number with bar code
gonadal tumour
3A.M5.17230 : Tab Sorafenib-max 12 months (Per Clinical Photograph,chemotherapy

month) drug batch number with bar code
3A.M5.17231 : Tab Geftinib/Erlotinib-Max 1 Year Chemotherapy drug batch number

(Per month) with bar code
3A.M5.17232 : Variable Regimen -Ewings Sarcoma-
1285 M5 3A.M5.17232 max 17 cycles in 1 year (Per cycle)(Amount as per 7500 X-Ray,CT Scan with film, Biopsy
drug cost)
3A.M5.17233 : Induction/1st Phase-AML ( 2nd Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1286 M5 3A.M5.17233 37500
Induction - permitted in adults only) Flow cytometry drug batch number with bar code
3A.M5.17234 : Doxorubicin - Bleomycin - Vinblastine

1287 M5 3A.M5.17234 Dacarbazine (DBVD)-max 6-8 cycles (Per cycle) 9000 Biopsy, CT
(Day1 & Day15) - Hodgkins Lymphoma
3A.M5.17235 : Aromatase Inhibitors (

1288 M5 3A.M5.17235 Anastazole/Letrozole/ Exemestane)- maximum 12 675
cycles (Per month)
3A.M5.17236 : Maintenance ( Paed and adults) - ALL Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
1289 M5 3A.M5.17236 2250
(Per month) Flow cytometry drug batch number with bar code
Speciality
code
3A.M5.17237 : Imatinib Min 400 mg/day-max 12 Hematology + FNAC report Clinical Photograph, chemotherapy
1290 M5 3A.M5.17237 3750
cycles per year (Per month) - AML, CML /Cytogenetics/ BCR-ABL drug batch number with bar code
3A.M5.17238 : Paclitaxel/docetaxel(Maximum Biopsy/FNAC , Mammography/USG, Chemotherapy drug batch number

1291 M5 3A.M5.17238 6750
4cycles) (Adjuvant) (Per cycle) chest Xray with bar code
3A.M5.17239 : Carboplatin/cisplatin +
Paclitaxel/Docetaxel (Neoadjuvant Chemotherapy)- Clinical Photograph showing scar +
1292 M5 3A.M5.17239 9000 Biopsy Reports
Max. of 4 cycles only (Per cycle) -For stage III and HPE report
IVA
1293 M5 3A.M5.17240 3A.M5.17240 : Palliative CT- Max 6 cycles (Per cycle) 6000
S2 3A.S2.00085B 3A.S2.00085B : Hemiglossectomy - - cross speciality 18750 CT , Biopsy Clinical photograph
S2 3A.S2.00087B 3A.S2.00087B : Partial Glossectomy - cross speciality 18750 CT , Biopsy Clinical photograph
S2 3A.S2.00090B 3A.S2.00090B : Total Glossectomy - cross speciality 11250 CT , Biopsy Clinical photograph
3A.S1.00002A : Anterior Resection for Ca - cross Clinical Photograph showing scar +

S1 3A.S1.00002A 52500 Endoscopy, biopsy, CT report with film
3A.S1.00007A : Bilateral Inguinal block dissection - Clinical Photograph showing scar +
S1 3A.S1.00007A 30000 Biopsy Reports
3A.S1.00016A : Bypass - Inoperable Pancreas - cross
S1 3A.S1.00016A 11250 USG/CT USG, Scar photo, HPE Report
speciality
3A.S1.00045B : Excision of Growth from Tongue with

S1 3A.S1.00045B 11250 CT/MRI, Clinical Photo OT notes, HPE
neck node dissection - cross speciality
3A.S1.00084A : Inguinal Node (dissection) - Clinical Photograph showing scar +

S1 3A.S1.00084A 15000 Biopsy Reports/ Clinical Photograph
Unilateral - cross speciality HPE report
S1 3A.S1.00103A 3A.S1.00103A : Oesophagectomy - cross speciality 45000 Biopsy , CT , Endoscopy reports HPE report, scar photo
S1 3A.S1.00113A 3A.S1.00113A : Radical Mastectomy - cross speciality 7500 Mammography, HPE, CT Scan Scar photo & HPE
3A.S1.00114A : Radical Neck Dissection – Excision - Clinical photo, Clinical notes & Biopsy/
S1 3A.S1.00114A 11250 Scar photo & HPE
cross speciality Cytology
3A.S1.00120A : Resection Anastomosis (Large
S1 3A.S1.00120A 11250 USG / CT Scan Scar photo, HPE
Intestine) - cross speciality
3A.S1.00121A : Resection Anastomosis (Small
S1 3A.S1.00121A 11250 USG / CT Scan Scar photo, HPE
Intestine) - cross speciality
3A.S1.00122A : Retroperitoneal Tumor – Excision - Clinical Photograph showing scar +
S1 3A.S1.00122A 37500 CT abdomen with film, FNAC
3A.S1.00125A : Segmental Resection of Breast -
S1 3A.S1.00125A 7500 Mamography, FNAC, CT if indicated Scar photo, HPE
cross speciality
3A.S1.00131A : Soft Tissue Tumor (large) – Excision - Biopsy of the primary tumour + CT/MRI
S1 3A.S1.00131A 26250 Scar photo, HPE
cross speciality with film
Speciality
code
3A.S1.00134A : Submandibular Mass Excision + CT/MRI/USG report and Film if required/ Clinical Photograph showing scar +
S1 3A.S1.00134A 18750
Reconstruction - Cross speciality Biopsy HPE report
3A.S1.00162A : Excision of Parathyroid CT Scan Functional scan/PTH Clinical Photograph showing scar +
S1 3A.S1.00162A 22500
Adenoma/Carcinoma - cross speciality reports/USG HPE report
3A.S1.00163A : Flap Reconstructive Surgery - cross
S1 3A.S1.00163A 22500 X-ray Films + detail notes Clinical photo showing Scar
speciality
3A.S1.00171A : Lap. Assisted left Hemi colectomy t -
S1 3A.S1.00171A 18750 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00172A : Lap. Assisted Right Hemi colectomy t
S1 3A.S1.00172A 18750 CT , colonoscopy , USG USG, Scar Photo, HPE
- cross speciality
3A.S1.00173A : Lap. Assisted small bowel resection - Clinical Photograph showing scar +
S1 3A.S1.00173A 30000 CT, Biopsy
3A.S1.00174B : Lap. Assisted Total Colectomy - cross Colonocopy with film, biopsy, CT report Clinical Photograph showing scar +
S1 3A.S1.00174B 30000
speciality with film HPE report
3A.S1.00195B : Oesophagectomy for Carcinoma
S1 3A.S1.00195B 37500 Biopsy , CT , Endoscopy reports HPE report, scar photo
Oesophagus - cross speciality
3A.S1.00197A : Operation for Carcinoma Lip –
Vermilionectomy - cross speciality
3A.S1.00198B : Operation for Carcinoma Lip -
S1 3A.S1.00198B Wedge Excision and Vermilionectomy - cross 9000 Clinical photograph, HPE Scar photo, HPE
speciality
3A.S1.00199B : Operation for Carcinoma Lip -
Wedge-Excision - cross speciality
3A.S1.00202A : Closure of Colostomy - cross
S1 3A.S1.00202A 22500 Colonoscopy, Biopsy Clinical Photograph showing scar
speciality
3A.S1.00205A : CystoJejunostomy/or
S1 3A.S1.00205A 15000 USG/ CT Scan Clinical photograph
Cystogastrostomy - cross speciality
3A.S1.00209B : Operation for carcinoma lip- cheek
advancement - cross speciality
3A.S1.00213A : Operations for Replacement of
S1 3A.S1.00213A 18750 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon - cross speciality
3A.S1.00215B : Parapharyngeal Tumour Excision -
S1 3A.S1.00215B 8250 USG, CT Neck USG,HPE,Scar Photo
cross speciality
3A.S1.00216B : Partial/Subtotal Gastrectomy for Clinical Photograph showing scar +
S1 3A.S1.00216B 37500 Endoscopy, biopsy, CT
Carcinoma - cross speciality HPE report
3A.S1.00230A : Temporal Bone resection - cross Clinical Photograph showing scar +
S1 3A.S1.00230A 45000 CT/MRI, Biopsy
3A.S1.00242A : Total Thyroidectomy and Block
S1 3A.S1.00242A 15000 Clinical Photograph , USG Scar photo, HPE
Dissection - cross speciality
3A.S1.17006A : Nephrectomy – partial (Code CT report with film, Isotope renogram Clinical Photograph showing scar+
S1 3A.S1.17006A 18750
3A.451)- additional cost - cross speciality if required HPE report +USG Report
3A.S1.17007A : Low AR and APR (Code 3A.417, Endoscopy with film, biopsy, CT report Clinical Photograph showing scar +
S1 3A.S1.17007A 18750
3A.418) - additional cost - cross speciality with film HPE report
Speciality
code
3A.S1.17008A : Radical hysterectomy for Ca cervix
S1 3A.S1.17008A and Ca endometrium ( Code 3A.484)- additional 15000 CT report and Film, Biopsy
HPE report
cost - cross speciality
3A.S7.00141A : Bilateral Orchidectomy for hormone Biopsy Reports /PSA with evidence of Clinical Photograph showing scar ( if
S7 3A.S7.00141A 11250
ablation bone metastasis patient consents)+ HPE report
3A.M4.00026B : Brain tumors: surgery - cross Clinical Photographs showing the

M4 3A.M4.00026B 41250 MRI Report
speciality scar + HPE report
3A.M4.00030A : Wilms tumors: surgery - cross
M4 3A.M4.00030A 3750 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report
speciality
OPTHALMOLOGY
1294 S3 3A.S3.00002 3A.S3.00002 : Canaliculo Dacryocysto Rhinostomy 7500 Clinical notes Procedure notes, sac syringe
1295 S3 3A.S3.00003 3A.S3.00003 : Capsulotomy (YAG) 1125 Clinical notes Clinical Photograph, Procedure notes
3A.S3.00006 :
1296 S3 3A.S3.00006 2250 Clinical notes,Clinical Photograph Clinical Photograph, Procedure notes
Cyclocryotherapy/Cyclophotocoagulation
1297 S3 3A.S3.00009 3A.S3.00009 : Enucleation 4500 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
1298 S3 3A.S3.00011 3A.S3.00011 : Exenteration 11250 CT Skull- Orbit , Clinical Photograph Clinical Photograph, Procedure notes
3A.S3.00014 : Intraocular Foreign Body Removal

1299 S3 3A.S3.00014 15000 B Scan Report Clinical Photograph
from Posterior Segment
1300 S3 3A.S3.00024 3A.S3.00024 : Iridectomy – Laser 1500 Clinical Note / slit lamp report Clinical Note / Slit lamp report
1301 S3 3A.S3.00026 3A.S3.00026 : Iris cyst removal 1875 Clinical Note / slit lamp report Clinical Note / Slit lamp report
3A.S3.00028 : Vitrectomy + Retinal Detachment
1302 S3 3A.S3.00028 13125 B.Scan , Fundus Photograph Fundus Photograph
surgery (pre-auth required)
CT, Clinical Photograph showing
3A.S8.00082A : Excision of Orbital Tumour - cross
S8 3A.S8.00082A 37500 CT/MRI Report scar + HPE report, Post-op CT report
speciality
and film
3A.M2.00011D : Optic neuritis - routine ward - cross
speciality
3A.M2.00011E : Optic neuritis - HDU - cross
speciality
3A.M2.00011F : Optic neuritis - ICU without
3A.M2.00011G : Optic neuritis - ICU with ventilator -
cross speciality
3A.M4.00019A : Retinoblastoma (Intraocular): Haematology, Bone Marrow Aspitation/ Clinical Photograph, chemotherapy
M4 3A.M4.00019A 75000
surgery - cross speciality Flow cytometry drug batch number with bar code
ORTHOPAEDICS
X-ray, clinical photo, CT, HPE for
1303 S5 3A.S5.00011 3A.S5.00011 : Disarticulation (hind & for quarter) 18750 Scar photo, X-Ray, HPE for tumours
tumours
Speciality
code
1304 S5 3A.S5.00012 3A.S5.00012 : Anterior Spine Fixation 26250 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo
1305 S5 3A.S5.00013 3A.S5.00013 : Posterior Spine Fixation 15000 X-ray, CT/MRI X-ray / CT/MRI Scan, scar photo
3A.S5.00020 : Bone Tumour Excision +

1306 S5 3A.S5.00020 37500 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
reconstruction using implant (malignant/ benign)
3A.S5.00022 : Bone Tumour Excision (malignant/

1307 S5 3A.S5.00022 benign) + Joint replacement (depending upon type 112500 X-ray, CT, Bone scan, HPE Scar photo, X-Ray, HPE
of joint and implant)
1308 S5 3A.S5.00046 3A.S5.00046 : Fracture - Acetabulum 19950 X-RAY/CT scan
post op. XRAY
Post op X-ray, Pt photo with
1309 S5 3A.S5.00060 3A.S5.00060 : Llizarov Fixation 19950 X-ray
applicator
X-ray Films/ Clinical Picture + detail
1310 S5 3A.S5.00061 3A.S5.00061 : Multiple Tendon Repair 7500 Clinical photo showing Scar
notes
1311 S5 3A.S5.00062 3A.S5.00062 : Nerve Repair Surgery 11250 Clinical Photograph Clinical Photograph
3A.S5.00072 : Pelvic Osteotomy with fixation with
1312 S5 3A.S5.00072 22500 X-ray photo with plaster, X-ray
plaster
Xray Films(if relevant)+ Clinical
1313 S5 3A.S5.00078 3A.S5.00078 : Tendon Grafting 15000 Clinical photo showing Scar
Picture(Mandatory) + detail notes
1314 S5 3A.S5.00091 3A.S5.00091 : Total Hip Replacement (cemented) 45075 X-ray Post-op X-ray, Scar photo
1315 S5 3A.S5.00092 3A.S5.00092 : Total Hip Replacement (cementless) 51825 X-ray Post-op X-ray, Scar photo
1316 S5 3A.S5.00093 3A.S5.00093 : Total Hip Replacement (hybrid) 75000 X-ray Post-op X-ray, Scar photo
1317 S5 3A.S5.00096 3A.S5.00096 : Total Knee Replacement 48750 X-ray Post-op X-ray, Scar photo
3A.S6.00001C : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001C 37500 Clinical photo showing Scar
3A.S6.00002B : Plexus injury along with Vascular MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002B 45000 Clinical photo showing Scar
3A.S6.00003B : Internal fixation with Flap cover

S6 3A.S6.00003B Surgery for wound in compound fracture - cross 30000 X-RAY/CT scan(If Required)
speciality
3A.S8.00016A : Laminectomy with Fusion - cross
S8 3A.S8.00016A 30000 Clinical findings, MRI Report photo showing scar
speciality
3A.S8.00028A : Spine - Decompression & Fusion -
S8 3A.S8.00028A 30000 Clinical findings, MRI Report Post Op X-Ray Report and film
cross speciality
3A.S8.00075B : Nerve Decompression - cross
S8 3A.S8.00075B 15000 Nerve Conductions study Clinical Photographs showing scar
speciality
3A.S8.00076B : Peripheral Nerve Surgery Major -
S8 3A.S8.00076B 33750 conduction velocity (NCV)) and Clinical Photographs showing scar
cross speciality
Speciality
code
3A.S8.00077A : Peripheral Nerve Surgery Minor -
S8 3A.S8.00077A 11250 conduction velocity (NCV) / Clinical Photographs showing scar
cross speciality
3A.M4.00035B# : Bone tumors/soft tissue sarcomas : CT scan/MRI ,USG abdomen pelvis, X-ray, CT Scan, Clinical photograph
M4 3A.M4.00035B 176250
surgery (inlcuding prosthesis) - cross speciality Clinical photograph Hemogram report

3A.S10.00001 : Ear Pinna Reconstruction with costal
cartilage/ Prosthesis (including the cost of
prosthesis/implants). *If requiring multiple stages, OT note with clinical photograph of
1318 S10 3A.S10.00001 22500 X-ray and clinical note
each stage will cost Rs. 30,000 provided the stages
operating surgeon demonstrates the photographic
results of previous stages.
CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,, Doppler study, Clinical photo and OT

1319 S10 3A.S10.00002 3A.S10.00002 : Revascularization of limb/digit 18750
CXR, ECG,(X-ray of limb/digit) note
3A.S10.00003 : Hemangioma – Sclerotherapy (under CBC,RBS,RFT,S Electrolytes, HIV,

1320 S10 3A.S10.00003 26250 MRI/MRA
GA) HbsAg,CXR, ECG MRI/MRA
CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,
1321 S10 3A.S10.00004 3A.S10.00004 : Hemangioma – Debulking/ Excision 26250 MRI/MRA
CXR, ECG, MRI/MRA
3A.S10.00005 : Tissue Expander for disfigurement

CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,
1322 S10 3A.S10.00005 following burns/ trauma/ congenital deformity 37500 Clinical photo and OT note
CXR, ECG.
(including cost of expander / implant)
CBC,RBS,RFT,S Electrolytes, HIV,HbsAg,

1323 S10 3A.S10.00006 3A.S10.00006 : Scalp avulsion reconstruction 37500 Clinical photo and OT note
CXR, ECG
CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,,
1324 S10 3A.S10.00007 3A.S10.00007 : NPWT (Inpatient only) 1500 Clinical photo and OT note
CXR, ECG.
CBC,RBS,RFT,S Electrolytes, HIV, HbsAg,
1325 S10 3A.S10.00008 3A.S10.00008 : Pressure Sore – Surgery 22500 Clinical photo and OT note
CXR, ECG, Pus for C/S
Clinical Photograph, CBC,RBS,RFT,S
1326 S10 3A.S10.00009 3A.S10.00009 : Diabetic Foot – Surgery 22500 Electrolytes, HIV, HbsAg,, CXR, ECG, Pus Post - op Photograph, MRI/MRA
for C/S, MRI/MRA
3A.S6.00001A : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00001A 37500 Clinical photo showing Scar
3A.S6.00003A : Internal fixation with Flap cover

S6 3A.S6.00003A Surgery for wound in compound fracture - cross 30000 X-RAY/CT scan(If Required)
speciality
3A.S1.00163B : Flap Reconstructive Surgery - cross
S1 3A.S1.00163B 22500 X-ray Films + detail notes Clinical photo showing Scar
speciality
3A.S1.00165A : Split thickness skin grafts – Medium
S1 3A.S1.00165A 7500 Clinical photograph Scar photo
(4 - 8% TBSA) - cross speciality
Speciality
code
3A.S1.00167A : Free Grafts - Wolfe Grafts - cross
S1 3A.S1.00167A 7500 Clinical photograph Scar photo
speciality
3A.S1.00225A : Skin Flaps - Rotation Flaps - cross
S1 3A.S1.00225A 4650 Clinical photo Scar photo
speciality
3A.S6.00002C : Plexus injury along with Vascular MRI + Xray Films(if relevant)+ Clinical
S6 3A.S6.00002C 45000 Clinical photo showing Scar
POLYTRAUMA
3A.S6.00001 : Nerve Plexus injuries, Tendon injury MRI + Xray Films(if relevant)+ Clinical
1327 S6 3A.S6.00001 37500 Clinical photo showing Scar
repair/reconstruction/ Transfer Picture(Mandatory) + detail notes
3A.S6.00002 : Plexus injury along with Vascular MRI + Xray Films(if relevant)+ Clinical
1328 S6 3A.S6.00002 45000 Clinical photo showing Scar
injury repair/ graft Picture(Mandatory) + detail notes
3A.S6.00003 : Internal fixation with Flap cover Post-operative X-ray, Clinical

Surgery for wound in compound fracture Photograph showing scar
3A.S6.00004 : Head injury requiring Facio-Maxillary Post-operative X-ray, Clinical

Injury repairs & fixations (including implants) Photograph showing scar
1331 S6 3A.S6.17024 3A.S6.17024 : Visceral injuries severe 45000 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
Post-Operative chest X-ray with ICD

1332 S6 3A.S6.17025 3A.S6.17025 : Chest injuries with ICD bilateral 8250 X-ray /ultra sound
in situ
Post-Operative chest X-ray with ICD
1333 S6 3A.S6.17026 3A.S6.17026 : Chest injuries with ICD + ICU 15000 X-ray /ultra sound
in situ
3A.S6.17027 : Chest injuries with ICD + ICU + Post-Operative chest X-ray with ICD
1334 S6 3A.S6.17027 19950 X-ray /ultra sound
Ventilator in situ
1335 U1 3A.U1.00001 3A.U1.00001 : Unspecified Surgical Package 0
3A.S1.00016B : Bypass - Inoperable Pancreas - cross
S1 3A.S1.00016B 11250 USG/CT USG, Scar photo, HPE Report
speciality
S1 3A.S1.00059A 3A.S1.00059A : Fundoplication - cross speciality 26250 Contrast X ray/endoscopy findings Clinical Photograph showing scar
S1 3A.S1.00064A 3A.S1.00064A : Gastrostomy - cross speciality 11250 USG/ CT Scan Clinical photograph
3A.S1.00070A : Hepatic Resection (lobectomy) -
S1 3A.S1.00070A 15000 MRI/ CT Abdomen Scar Photo, HPE Report
cross speciality
S1 3A.S1.00087B 3A.S1.00087B : Intussusception - cross speciality 11250 USG/CT , Clinical notes Scar photo
3A.S1.00104A : Portal Hypertension shunt surgery -

S1 3A.S1.00104A 37500 Endoscopy/ USG/ CT/ MRI Clinical Photograph showing scar
Cross speciality
3A.S1.00106A : PancreaticoDuodenectomy - cross CT-Scan , ERCP , ER Clinical Photograph ,
S1 3A.S1.00106A 18750 HPR , Scar Photograph
speciality Endoscopy
S1 3A.S1.00112A 3A.S1.00112A : Pyeloroplasty - cross speciality 7500 USG, Clinical Notes Scar photo, HPE
Speciality
code
3A.S1.00171B : Lap. Assisted left Hemi colectomy t -
S1 3A.S1.00171B 18750 CT , colonoscopy , USG USG, Scar Photo, HPE
cross speciality
3A.S1.00172B : Lap. Assisted Right Hemi colectomy t
S1 3A.S1.00172B 18750 CT , colonoscopy , USG USG, Scar Photo, HPE
- cross speciality
3A.S1.00174A : Lap. Assisted Total Colectomy - cross Colonocopy with film, biopsy, CT report Clinical Photograph showing scar +
S1 3A.S1.00174A 30000
speciality with film HPE report
S1 3A.S1.00201A 3A.S1.00201A : Caecostomy - cross speciality 7500 Clinical notes, USG/ CT Scar photo, HPE
3A.S1.00213B : Operations for Replacement of
S1 3A.S1.00213B 18750 Endoscopy, USG/CT Scar photo, HPE
Oesophagus by Colon - cross speciality
3A.S1.00216A : Partial/Subtotal Gastrectomy for Clinical Photograph showing scar +
S1 3A.S1.00216A 37500 Endoscopy, biopsy, CT
Carcinoma - cross speciality HPE report
3A.S1.00235A : Thoracoscopic Hydatid Cyst excision -
S1 3A.S1.00235A 15000 Chest X-ray / CT Scar photo, HPE
cross speciality
3A.S1.00247A : Adhenolysis + Appendicectomy -
S1 3A.S1.00247A 15000 MRI/ CT Abdomen Scar Photo, HPE Report
cross speciality
UROLOGY
CT/MRI report with film, Urinary Clinical Photograph showing scar+
1336 S7 3A.S7.00001 3A.S7.00001 : Adrenalectomy-unilateral, open 18750
hormones HPE report
3A.S7.00002 : Adrenalectomy-unilateral,
1337 S7 3A.S7.00002 22500 USG Clinical Photograph
Laparoscopic
1338 S7 3A.S7.00003 3A.S7.00003 : Adrenalectomy-bilateral, open 24000 USG Clinical Photograph
3A.S7.00004 : Adrenalectomy-biilateral, CT/MRI report with film, Urinary Clinical Photograph showing scar+
1339 S7 3A.S7.00004 33750
Laparoscopic hormones HPE report
3A.S7.00005 : Paraganglioma excision with liver Operative notes with steps of
1340 S7 3A.S7.00005 37500 CT/MRI, clinical notes
mobilization surgery, Scar photo, HPE report
1341 S7 3A.S7.00006 3A.S7.00006 : Nephrectomy (Benign) Open 26250 USG, CT KUB /Isotope Renogram Scar & Specimen Photo +HPE report
1342 S7 3A.S7.00007 3A.S7.00007 : Nephrectomy (Benign) Laparoscopic 33750 USG & CT KUB /Isotope Renogram Scar Photo + HPE Report
3A.S7.00008 : Nephrectomy-Radical (Renal tumor) Ultrasound abd /CT Scan abd with film, Clinical Photograph showing scar +
1343 S7 3A.S7.00008 33750
Open Isotope Renogram if required HPE report
3A.S7.00009 : Nephrectomy-Radical (Renal tumor) USG & CT KUB with Contrast / Isotope
1344 S7 3A.S7.00009 22500 Scar Photo + HPE Report
Laparoscopic Renogram
1345 S7 3A.S7.00010 3A.S7.00010 : Nephrectomy-Partial or Hemi, Open 22500 USG & CT KUB with Contrast Scar Photo + HPE Report
3A.S7.00011 : Nephrectomy-Partial or Hemi, USG & CT KUB with Contrast / Isotope

1346 S7 3A.S7.00011 45000 Scar Photo + HPE Report
Laparoscopic Renogram
1347 S7 3A.S7.00012 3A.S7.00012 : Nephro ureterectomy (Benign) Open 18750 IVP , USG USG
3A.S7.00013 : Nephro ureterectomy (Benign)

1348 S7 3A.S7.00013 22500 IVP , USG USG
Laparoscopic
3A.S7.00014 : Nephro ureterectomy with cuff of
1349 S7 3A.S7.00014 22500 IVP , USG USG
bladder Open
Speciality
code
3A.S7.00015 : Nephro ureterectomy with cuff of CT report with film, Isotope renogram Clinical Photograph showing scar+
1350 S7 3A.S7.00015 33750
bladder Laparoscopic if required HPE report
3A.S7.00016 :
1351 S7 3A.S7.00016 Pyeloplasty/pyeloureterostomy/pyelopyelostomy 18750 USG & IVP/CT with Contrast Scar Photo
Open
3A.S7.00017 :
1352 S7 3A.S7.00017 Pyeloplasty/pyeloureterostomy/pyelopyelostomy 30000 USG & IVP/CT with Contrast Scar Photo
Laparoscopic
3A.S7.00018 : Endopyelotomy (retrograde with
1353 S7 3A.S7.00018 18750 USG/IVP USG/IVP
laser/bugbee)
3A.S7.00019 : Endopyelotomy (antegrade with
1354 S7 3A.S7.00019 21000 USG/IVP USG/IVP
laser/bugbee)
1355 S7 3A.S7.00020 3A.S7.00020 : Ureterocalycostomy Open 22500 CT KUB with Contrast Scar Photo +X-Ray Kub
1356 S7 3A.S7.00021 3A.S7.00021 : Ureterocalycostomy Laparoscopic 26250 CT KUB with Contrast Scar Photo +X-Ray Kub
1357 S7 3A.S7.00022 3A.S7.00022 : Uretero-ureterostomy Open 18750 USG/IVP USG/IVP
1358 S7 3A.S7.00023 3A.S7.00023 : Uretero-ureterostomy Laparoscopic 26250 USG/IVP USG/IVP
3A.S7.00024 : PCNL (Percutaneous

1359 S7 3A.S7.00024 28500 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
Nephrolithotomy) - Bilateral
3A.S7.00025 : PCNL (Percutaneous
1360 S7 3A.S7.00025 18750 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
Nephrolithotomy) - Unilateral
3A.S7.00026 : Extracoporeal shock-wave Lithotripsy

1361 S7 3A.S7.00026 6375 CT KUB with Contrast X-ray KUB/USG
(SWL) stone, with or without stent (one side)
3A.S7.00027 : Extracoporeal shock-wave Lithotripsy

1362 S7 3A.S7.00027 13500 CT KUB with Contrast X-ray KUB
(SWL) stone, with or without stent (both sides)
1363 S7 3A.S7.00028 3A.S7.00028 : Pyelolithotomy-Open 27000 CT KUB with Contrast Scar Photo,X-Ray/USG KUB
1364 S7 3A.S7.00030 3A.S7.00030 : Nephrolithotomy-Open 27000 USG/X-ray KUB Scar Photo,X-Ray/USG KUB
1365 S7 3A.S7.00031 3A.S7.00031 : Anatrophic nephrolithotomy 33750 USG, CT KUB with Contrast Scar Photo +X-Ray Kub
3A.S7.00034 : Renal Cyst deroofing or
1366 S7 3A.S7.00034 15000 IVP , USG USG
marsupialization-Open
3A.S7.00035 : Renal Cyst deroofing or
1367 S7 3A.S7.00035 22500 IVP , USG USG
marsupialization-Laparoscopic
3A.S7.00036 : Nephrostomy-percutaneous
1368 S7 3A.S7.00036 7500 USG Scar Photo With Nephrostomy Tube
ultrasound guided
1369 S7 3A.S7.00037 3A.S7.00037 : Ureterolithotomy-Open 22500 CT KUB with Contrast Scar Photo +X-Ray Kub
1370 S7 3A.S7.00038 3A.S7.00038 : Ureterolithotomy-Laparoscopic 26250 CT KUB with Contrast Scar Photo +X-Ray Kub
3A.S7.00039 : Ureteroscopy+stone removal with
1371 S7 3A.S7.00039 15000 CT KUB X-ray KUB
lithotripsy, lower ureter, unilateral
lithotripsy, upper ureter, unilateral
Speciality
code
lithotripsy, bilateral
1374 S7 3A.S7.00042 3A.S7.00042 : Ureterotomy (Cutaneous) 15000 USG KUB/CT Scan/MRI Scan surgery, X-ray KUB/USG KUB/CT,
Urography
1375 S7 3A.S7.00043 3A.S7.00043 : Endoureterotomy (laser/bugbee) 15000 USG KUB/CT Scan/MRI Scan surgery, X-ray KUB/USG KUB/CT,
Urography
3A.S7.00044 : Ureteric reimplantation-unilateral-
1376 S7 3A.S7.00044 28500 CT KUB/IVP/MCU Scar photo
open
1377 S7 3A.S7.00045 3A.S7.00045 : Ureteric reimplantation-bilateral-open 52500 MCU, USG Clinical Photograph showing scar
3A.S7.00046 : Ureteric reimplantation-unilateral-

1378 S7 3A.S7.00046 33750 MCU, USG Clinical Photograph showing scar
Laparoscopic
3A.S7.00047 : Ureteric reimplantation-bilateral-
1379 S7 3A.S7.00047 26250 MCU, USG Clinical Photograph showing scar
Laparoscopic
3A.S7.00048 : Uretero-vaginal/uterine fistula repair
1380 S7 3A.S7.00048 20250 USG USG
open
3A.S7.00049 : Uretero-vaginal/uterine fistula repair
1381 S7 3A.S7.00049 27750 USG USG
Laparoscopic
3A.S7.00050 : Ureterolysis-open, for retroperitoneal

1382 S7 3A.S7.00050 15000 MCU/IVP/CT Urography, clinical notes OT notes, Scar photo
fibrosis (with or without omental wrapping)
3A.S7.00051 : Ureterolysis-Laparoscopic, for

X-ray KUB/USG KUB/CT, Urography,
1383 S7 3A.S7.00051 retroperitoneal fibrosis (with or without omental 22500 OT notes, Scar photo
Clinical notes
wrapping)
1384 S7 3A.S7.00052 3A.S7.00052 : Boari flap for ureteric stricture, open 31500 CT KUB/IVP Clinical Picture, Scar Photo
3A.S7.00053 : Boari flap for ureteric stricture,

1385 S7 3A.S7.00053 30000 CT KUB/IVP Clinical Picture, Scar Photo
Laparoscopic
1386 S7 3A.S7.00054 3A.S7.00054 : Ileal replacement for ureteric stricture 30000 IVP , USG , X-RAY Clinical Photograph
3A.S7.00055 : DJ stent unilateral including

1387 S7 3A.S7.00055 cystoscopy, ureteric catheterization, retrograde 5625 USG /X-ray KUB X-ray KUB
pyelogram
3A.S7.00056 : DJ stent bilateral including cystoscopy,

1388 S7 3A.S7.00056 7500 X-ray KUB & USG X-ray KUB & USG
ureteric catheterization, retrograde pyelogram
3A.S7.00057 : Ureteric sampling including

1389 S7 3A.S7.00057 cystoscopy, ureteric catheterization, retrograde 7500 USG USG
pyelogram
3A.S7.00058 : Ureterocele incision including
1390 S7 3A.S7.00058 cystoscopy, ureteric catheterization, retrograde 11250 RGU , X-RAY Clinical Photograph
pyelogram
Speciality
code
3A.S7.00060 : Cystolithotomy-open, including
1391 S7 3A.S7.00060 13500 USG/X ray KUB Scar Photo,X-Ray/USG KUB
cystoscopy
3A.S7.00061 : Cystolithotripsy/Urethral Stone
1392 S7 3A.S7.00061 12750 X-ray KUB/USG X-ray KUB
endoscopic, including cystoscopy
3A.S7.00062 : TURBT (Transurethral Resection of the Cystoscopy Finding/ HPE Report, P.O
1393 S7 3A.S7.00062 22500 USG/CT KUB with Contrast
Bladder Tumor) USG
3A.S7.00063 : TUR-fulgration (Transurethral
1394 S7 3A.S7.00063 13500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
fulgration of the Bladder Tumor)
3A.S7.00064 : Intravesical BCG/Mitomycin 6
1395 S7 3A.S7.00064 induction cycles (weekly for 6 weeks-total cost of 6 9000 USG, HPE Case sheets
cycles)
3A.S7.00065 : Intravesical BCG/Mitomycin

1396 S7 3A.S7.00065 18000 USG, HPE Case sheets
maintenance for 12 doses (total cost of 12 doses)
3A.S7.00066 : Post TURBT - Check Cystoscopy (Per

1397 S7 3A.S7.00066 3750 USG & urine cytology Cystoscopy Finding, X-Ray KUB
sitting) with or without cold-cup biopsy
1398 S7 3A.S7.00068 3A.S7.00068 : Bladder Neck incision-endoscopic 16875 USG & Uroflowmetry Uroflowmetry,ENDO Picture
3A.S7.00069 : Extrophy Bladder repair including

1399 S7 3A.S7.00069 osteotomy if needed + epispadias repair + ureteric 52500 MCU Clinical Photograph
reimplant
3A.S7.00070 : Bladder injury repair (as an
1400 S7 3A.S7.00070 independent procedure with or without urethral 15000 CT KUB Endo Picture/Operative Picture
injury)
3A.S7.00072 : Bladder injury repair with colostomy
1401 S7 3A.S7.00072 (as an independent procedure with or without 18750 Clinical photograph Scar photo
urethral injury)
1402 S7 3A.S7.00073 3A.S7.00073 : Partial Cystectomy-open 30000 CT KUB with Contrast Procedure Picture
1403 S7 3A.S7.00074 3A.S7.00074 : Partial Cystectomy-Laparoscopic 22500 CT KUB with Contrast Procedure Picture
3A.S7.00075 : Radical cystectomy with neobladder-
1404 S7 3A.S7.00075 37500 CT KUB with Contrast Scar photo
open
3A.S7.00076 : Radical cystectomy with continent
diversion-open
3A.S7.00077 : Radical Cystectomy with Ileal Conduit- Clinical Photograph showing scar +
open HPE report
3A.S7.00078 : Radical Cystectomy with ureterostomy-
open
3A.S7.00079 : Radical Cystectomy with
ureterosigmoidostomy-open
1409 S7 3A.S7.00080 3A.S7.00080 : Other Cystectomies 30000 CT report and Film, Biopsy
HPE report
3A.S7.00081 : Suprapubic Cystostomy - Open, as an Clinical Photograph showing
1410 S7 3A.S7.00081 7500 Biopsy of the primary tumor
independent procedure procedure/scar
Speciality
code
3A.S7.00083 : VVF/Uterovaginal Repair -
1411 S7 3A.S7.00083 18750 CT KUB USG, Treating doctor note
Transvaginal approach
3A.S7.00084 : VVF/Uterovaginal Repair -
1412 S7 3A.S7.00084 18750 CT KUB USG, Treating doctor note
Abdominal,Open
3A.S7.00085 : VVF/Uterovaginal Repair - Abdominal,
1413 S7 3A.S7.00085 30000 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram
Laparoscopic
3A.S7.00086 : Hysterectomy as part of
1414 S7 3A.S7.00086 3750 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram
VVF/uterovaginal fistula repair (top-up)
1415 S7 3A.S7.00087 3A.S7.00087 : Urethrovaginal fistula repair 30000 USG/X ray KUB NIL
3A.S7.00088 : Y V Plasty of Bladder Neck/Bladder
1416 S7 3A.S7.00088 15000 USG/MCU Clinical Photograph
Neck Reconstruction
1417 S7 3A.S7.00089 3A.S7.00089 : Augmentation cystoplasty-open 22500 USG Scar photo
3A.S7.00090 : Augmentation cystoplasty-
1418 S7 3A.S7.00090 30000 USG Scar photo
Laparoscopic
3A.S7.00091 : Open bladder diverticulectomy
1419 S7 3A.S7.00091 22500 CT KUB Endo Picture/Operative Picture
with/without ureteric re-implantation
1420 S7 3A.S7.00092 3A.S7.00092 : Open simple prostatetctomy for BPH 26250 USG, Uroflowmetry Scar Photo + HPE Report
3A.S7.00093 : TURP-Transurethral Resection of the

Prostate, BPH, Monopolar/Bipolar/Laser
1422 S7 3A.S7.00094 3A.S7.00094 : Holmium Laser Prostatectomy 30000 USG, Uroflowmetry Scar Photo + HPE Report
1423 S7 3A.S7.00095 3A.S7.00095 : TURP/Laser + Circumcision 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1424 S7 3A.S7.00096 3A.S7.00096 : TURP/Laser + Cystolithotripsy 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1425 S7 3A.S7.00097 3A.S7.00097 : TURP/Laser + Cystolithotomy-open 26250 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1426 S7 3A.S7.00098 3A.S7.00098 : TURP/Laser + Orchidectomy 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1427 S7 3A.S7.00099 3A.S7.00099 : TURP/Laser + TURBT 22500 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1428 S7 3A.S7.00100 3A.S7.00100 : TURP/Laser + URS with stone removal 30000 CT KUB X-ray KUB
3A.S7.00101 : TURP/Laser + VIU (visual internal

Ureterotomy)
1430 S7 3A.S7.00102 3A.S7.00102 : TURP/Laser + Hydrocele surgery 30000 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
1431 S7 3A.S7.00103 3A.S7.00103 : TURP/Laser + Hernioplasty 30000 USG/CT KUB,Uroflowmetry P.O USG
3A.S7.00104 : TURP/Laser + Urethral dilatation-non
1432 S7 3A.S7.00104 30000 USG/CT KUB,Uroflowmetry P.O USG
endoscopic
3A.S7.00105 : TURP/Laser + Urethral dilatation-
1433 S7 3A.S7.00105 30000 USG/CT KUB,Uroflowmetry P.O USG
endoscopic
1434 S7 3A.S7.00106 3A.S7.00106 : Radical prostatectomy - open 37500 CT report and Film, Biopsy Clinical Photograph, HPE report
1435 S7 3A.S7.00107 3A.S7.00107 : Radical prostatectomy - laparoscopic 56250 CT report and Film, Biopsy Clinical Photograph, HPE report
3A.S7.00108 : Transrectal Ultrasound guided

1436 S7 3A.S7.00108 4500 PSA,Transrectal USG HPE Report
prostate biopsy (minimum 12 core)
Clinical Photograph/Endoscopic
1437 S7 3A.S7.00113 3A.S7.00113 : Post Urethral Valve fulguration 22500 MCU, USG
picture
Speciality
code
1438 S7 3A.S7.00114 3A.S7.00114 : Urethroplasty-End to end 33750 RGU Clinical notes
3A.S7.00115 : Urethroplasty-Substitution-single
1439 S7 3A.S7.00115 22500 RGU & MCU Scar photo,
stage
1440 S7 3A.S7.00116 3A.S7.00116 : Urethroplasty-Substitution-two stage 18750 RGU & MCU Scar photo,
1441 S7 3A.S7.00117 3A.S7.00117 : Urethroplasty-Transpubic 22500 RGU Scar photo,

3A.S7.00118 : Urethroplasty-two stage without
1442 S7 3A.S7.00118 22500 RGU Scar photo,
substitution
1443 S7 3A.S7.00119 3A.S7.00119 : Perineal Urethrostomy without closure 18750 RGU& MCU Scar photo,
1444 S7 3A.S7.00120 3A.S7.00120 : Urethrorectal fistula repair 30000 RGU& MCU Scar photo,
3A.S7.00122 : Urethral Dilatation-endocopic as an
1445 S7 3A.S7.00122 3750 CT Scan Clinical Photograph
independent procedure
3A.S7.00123 : Internal Ureterotomy including
1446 S7 3A.S7.00123 7500 USG Clinical Photograph
cystoscopy as an independent procedure
1447 S7 3A.S7.00124 3A.S7.00124 : Hypospadias repair-single stage 18750 Clinical Photograph Scar photo,
1448 S7 3A.S7.00125 3A.S7.00125 : Hypospadias repair-two or more stage 18750 Clinical Photograph Scar photo,
3A.S7.00126 : Orchiopexy-without laparoscopy,

1449 S7 3A.S7.00126 11250 USG Clinical Notes
unilateral
3A.S7.00128 : Orchiopexy-with laparoscopy,
1450 S7 3A.S7.00128 22500 USG Clinical Notes
unilateral
1451 S7 3A.S7.00129 3A.S7.00129 : Orchiopexy-with laparoscopy, bilateral 22500 USG Clinical Notes
1452 S7 3A.S7.00130 3A.S7.00130 : Stress incontinence surgery, open 15000 Clinical Notes Endo Picture / Operative Picture
3A.S7.00131 : Stress incontinence surgery,

1453 S7 3A.S7.00131 22500 Clinical Notes Endo Picture / Operative Picture
laparoscopic
1454 S7 3A.S7.00132 3A.S7.00132 : Stress incontinence surgery with slings 33750 Clinical Notes Endo Picture / Operative Picture

1455 S7 3A.S7.00133 3A.S7.00133 : Partial Penectomy 11250 Biopsy Reports
3A.S7.00134 : Total Penectomy + Perineal Clinical Photograph showing scar ( if

1456 S7 3A.S7.00134 18750 Biopsy Reports
Urethrostomy patient consents)+ HPE report
3A.S7.00137 : Pelvic lymphadenectomy open, after

1457 S7 3A.S7.00137 18750 USG-KUB, HPE report Scar photo, HPE
prior cancer surgery
3A.S7.00138 : Pelvic lymphadenectomy laparoscopic,
1458 S7 3A.S7.00138 22500 USG-KUB, HPE report Scar photo, HPE
after prior cancer surgery

1459 S7 3A.S7.00139 3A.S7.00139 : Orchiectomy-High inguinal 11250 USG scrotum, Tumour markers
Speciality
code
3A.S7.00141 : Bilateral Orchidectomy for hormone Biopsy Reports /PSA with evidence of Clinical Photograph showing scar ( if
1460 S7 3A.S7.00141 11250
ablation bone metastasis patient consents)+ HPE report
3A.S7.00142 : Retroperitoneal lymph node

1461 S7 3A.S7.00142 18750 CT Scar photo
dissection-open
3A.S7.00143 : Retroperitoneal lymph node Clinical photograph showing scar,
1462 S7 3A.S7.00143 60000 CT report and film, biopsy
dissection-Laparoscopic HPE report
1463 S7 3A.S7.00144 3A.S7.00144 : Infertility-Scrotal exploration unilateral 7500 USG/CT- Clinical Photograph Clinical Photograph
1464 S7 3A.S7.00145 3A.S7.00145 : Infertility-Scrotal exploration bilateral 9000 USG/CT- Clinical Photograph Clinical Photograph
3A.S7.00146 : Infertility-Vasoepididymostomy,
1465 S7 3A.S7.00146 11250 USG/CT- Clinical Photograph Clinical Photograph
microsurgical, unilateral
3A.S7.00147 : Infertility-Vasoepididymostomy,
1466 S7 3A.S7.00147 15000 USG/CT- Clinical Photograph Clinical Photograph
microsurgical, bilateral
1467 S7 3A.S7.00151 3A.S7.00151 : Varicocele-bilateral-microsurgical 15000 USG, Clinical photograph Clinical Photograph
3A.S7.00152 : Penile prosthesis insertion, Malleable Operative notes with steps of

1468 S7 3A.S7.00152 22500 CT/MRI/USG, clinical notes,
(Indian implant) surgery, clinical notes
3A.S7.00154 : Neurogenic bladder-Package for

evaluation/investigation (catheter + ultrasound + X-Ray, catheter + ultrasound +
1469 S7 3A.S7.00154 5625 USG/CT
culture + RGU/ MCU) for 1 month (medicines - culture + RGU/ MCU
antibiotics). Follow up visit once in 3 months
3A.S7.00155 : Chronic prostatitis-Package for

evaluation/investigation (ultrasound + culture + ultrasound + culture + prostate
1470 S7 3A.S7.00155 1875 USG
prostate massage) for 1 month (medicines). Follow massage - Reports
up visit once in 3 months
3A.S7.00156 : Emergency management of Ureteric

1471 S7 3A.S7.00156 stone - Package for evaluation/investigation 2625 USG Ultrasound + culture Report
(ultrasound + culture) for 3 weeks (medicines).
1472 S7 3A.S7.00157 3A.S7.00157 : Emergency management of Hematuria 1500 USG Doctors Note
3A.S7.00161 : Urinary tract trauma – Laparoscopy

1473 S7 3A.S7.00161 22500 clinical notes, CT/MRI/USG - pelvis Operative notes with steps of surgery
surgery
USG & CT KUB with Contrast / Isotope
1474 S7 3A.S7.17041 3A.S7.17041 : Lap. Nephrectomy Radical 37500 Scar Photo + HPE Report
Renogram
3A.S7.17042 : Retrograde Intra Renal surgery (RIRS C ARM Picture with Patient Details, X-
1475 S7 3A.S7.17042 37500 CT KUB with Contrast
with laser) – for renal and PUJ calculi* ray KUB/USG
1476 S7 3A.S7.17043 3A.S7.17043 : URSL* (Inclusive of stent) 16875 CT KUB X-ray KUB
X-ray KUB, Purchase Voucher for
1477 S7 3A.S7.17044 3A.S7.17044 : URSL-LASER* 18750 CT KUB
Laser machine
1478 S7 3A.S7.17045 3A.S7.17045 : Hypospadiasis(Adult)* 26250 Clinical Photograph Scar photo,
Speciality
code
1479 S7 3A.S7.17046 3A.S7.17046 : Visual Internal Urethrotomy 9000 USG & RGU Uroflowmetry/ENDO PICTURE
3A.M4.00030B : Wilms tumors: surgery - cross
M4 3A.M4.00030B 3750 CT scan,USG abdomen pelvis, Chest x-ray,USG,HPE report
speciality
3A.S1.00122B : Retroperitoneal Tumor – Excision - Clinical Photograph showing scar +
S1 3A.S1.00122B 37500 CT abdomen with film, FNAC
3A.S1.17005A : Prostate surgery (Code 3A.561) -
S1 3A.S1.17005A 18750 CT report and Film, Biopsy Clinical Photograph, HPE report
additional cost - Cross speciality
3A.S1.17006B : Nephrectomy – partial (Code CT report with film, Isotope renogram Clinical Photograph showing scar+
S1 3A.S1.17006B 18750
3A.451)- additional cost - cross speciality if required HPE report +USG Report
Speciality
code
EMERGENCY CARE
BURNS
(TBSA) (thermal/ scald/ flame burns): Upto 40 %;
Includes % TBSA skin grafted, flap cover, follow-up Clinical Photograph, Diagram with Rule
1480 S11 4A.S11.00002 18750 Clinical Photograph
dressings etc. as deemed necessary; Surgical of 9 for extent of burns
procedures are required for deep burns that are not
amenable to heal with dressings alone.

(TBSA) (thermal/ scald/ flame burns): 40 % - 60 %;

(TBSA) (thermal/ scald/ flame burns): > 60 %;
4A.S11.00005 : Electrical contact burns: Low voltage-

without part of limb/limb loss; Includes % TBSA skin
dressings alone.
4A.S11.00007 : Electrical contact burns: High voltage-

without part of limb/limb loss; Includes % TBSA skin
dressings alone.
4A.S11.00008 : Electrical contact burns: High voltage-
with part of limb/limb loss; Includes % TBSA skin
dressings alone.
Speciality
code
4A.S11.00009 : Chemical burns: Without significant

facial scarring and/or loss of function; Includes %
TBSA skin grafted, flap cover, follow-up dressings
etc. as deemed necessary; Surgical procedures are
required for deep burns that are not amenable to
heal with dressings alone.
4A.S11.00010 : Chemical burns: With significant

facial scarring and/or loss of function; Includes %
TBSA skin grafted, flap cover, follow-up dressings
etc. as deemed necessary; Surgical procedures are
required for deep burns that are not amenable to
heal with dressings alone.
CARDIOLOGY
4A.S12.00013 : Medical treatment of Acute MI with 2D ECHO, CPKMB,CAG, ECG with report, 2D ECHO, ECG, LAB INVESTIGATION
1488 S12 4A.S12.00013 15000
Thrombolysis /Stuck Valve Thrombolysis TROPONINE-T reports (Trop T report)
1489 S12 4A.S12.00020 4A.S12.00020 : Pericardiocentesis 10000 2D ECHO report 2D ECHO report
1490 S12 4A.S12.00021 4A.S12.00021 : Temporary Pacemaker implantation 10000 ECG + Report by cardiologist X Ray showing the pacemaker in situ
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing Balloon &
1491 S12 4A.S12.00027 4A.S12.00027 : PTSMA 30000
blocks & Reports post flow
4A.S12.17073 : PTCA - one stent (non-medicated,
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stents &
1492 S12 4A.S12.17073 emergency, inclusive of angiogram) at the same 48000
blocks & Reports post Stent flow
admission.*
4A.S12.17074 : PTCA - one Drug Eluting stent (
ECG, 2D ECHO, CAG stills showing post Stent flow,2. Cartons of the
blocks & Reports stents used approved by
admission. *
FDA/CE/DCGI only
4A.S12.17075 : PTCA - two bare metal stents ( non-
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stent &
1494 S12 4A.S12.17075 medicated, emergency, inclusive of angiogram) at 55000
the same admission. *
4A.S12.17076 : PTCA - two Drug Eluting stents (
ECG, 2D ECHO, CAG stills showing Angioplasty stills showing stents &
admission. *
1496 S12 4A.S12.17077 4A.S12.17077 : Arrythmias 7000 CAG CAG
1497 S12 4A.S12.17078 4A.S12.17078 : Stuck valve with Thrombolysis 20000 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC
4A.S12.17079 : Medical management of unstable
1498 S12 4A.S12.17079 7500 ECG,ECHO,Cardiac Enzymes, RFT, CBC ECG, RFT, CBC
angina/non STS
1499 S12 4A.S12.17080 4A.S12.17080 : Cardiac failure 7500 ECG,ECHO,Chest X-ray, RFT, CBC ECHO, CHEST X RAY, RFT, CBC
4A.S12.17081 : Emergency dialysis for cardiac
1500 S12 4A.S12.17081 15000 ECHO, RFT, CBC RFT, CBC
conditions
1501 S12 4A.S12.17082 4A.S12.17082 : ICU with ventilator with dialysis 15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY RFT,RFT, CBC, ABG
Speciality
code
4A.S12.17083 : Acute respiratory distress - ventilator
1502 S12 4A.S12.17083 15000 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY, RFT, CBC, ABG
support
1503 S12 4A.S12.17084 4A.S12.17084 : Pulmonary edema 10000 ECG, ECHO,Chest X Ray, RFT, CBC, ABG ECHO, CHEST X RAY, RFT, CBC, ABG
4A.S12.17085 : Laryngoscopy / Bronchoscopy with

1504 S12 4A.S12.17085 5000 CT / Bronchoscopy report CT / Bronchoscopy report
dilatation of trachea with gum elastic bogie
1505 S12 4A.S12.17086 4A.S12.17086 : Pericardiostomy with balloon 20000 2D ECHO report 2D ECHO report + stills of the ECHO
4A.S13.00045 : Surgery for Cardiac Tumour/ Left 2D ECHO Report + stills of ECHO +
1506 S13 4A.S13.00045 95000 2D ECHO with stills + CT Chest report
Atrial (LA) Myxoma/ Right Atrial (RA) Myxoma Post Op X-ray,scar photo
1507 S13 4A.S13.00061 4A.S13.00061 : Foreign Body Removal with scope 20000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE
1508 S13 4A.S13.00063 4A.S13.00063 : Lung Injury repair 50000 CT Chest report X-RAY, scar photo
4A.S13.00066 : Intercostal Drainage and
1509 S13 4A.S13.00066 Management of ICD, Intercostal Block, Antibiotics & 15000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
Physiotherapy
4A.S13.17098 : Management of Mediastinitis /
1510 S13 4A.S13.17098 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
mediastinal bleeding
4A.S13.17098A : Management of Mediastinitis /
S13 4A.S13.17098A 40000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
mediastinal bleeding
4A.S6.00010B : Chest injury with one fracture of long
S6 4A.S6.00010B 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants) - cross speciality
4A.S6.00011B : Chest injury with fracture of 2 or
S6 4A.S6.00011B 35000 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
more long bones - cross speciality
4A.S6.17029B : Inter costal drainage (icd) one side -
S6 4A.S6.17029B 8000 X-ray X-ray
cross speciality
4A.S6.17030B : Inter costal drainage
S6 4A.S6.17030B 11000 X-ray X-ray
(icd)bilateral (flail chest) - cross speciality
S6 4A.S6.17031B (icd)bilateral (flail chest) with icu stay - cross 12000 X-ray X-ray
speciality
S6 4A.S6.17032B (icd)bilateral (flail chest) with icu stay with ventilator - 14000 X-ray X-ray
cross speciality
4A.S1.00251A : AV Shunt for dialysis - cross Clinical photos showing the AV
S1 4A.S1.00251A 7500 Duplex
speciality fistula
4A.S1.00251B : AV Shunt for dialysis - cross Clinical photos showing the AV
S1 4A.S1.00251B 7500 Duplex
speciality fistula
EMERGENCY ROOM
4A.M7.00001 : Emergency with stable
1511 M7 4A.M7.00001 750 Clincal notes, Chest X-ray/CT Clincal notes, Chest X-ray/CT
cardiopulmonary status
Speciality
code
4A.M7.00002 : Emergency consultation: acute colic,

high fever, cut, stitches, soft tissue injury, FB removal
4A.M7.00003 : Single bone fracture plaster,

nebulization for asthmatic attack, moderate X Ray film with report, clinical note, X Ray film with report, clinical note,
1513 M7 4A.M7.00003 750
dehydration, hypoglycaemia in a diabetic, Dengue Blood examination Blood examination
without complication, Syncope, Food poisoning etc
4A.M7.00004 : Animal bites (Payment after

1514 M7 4A.M7.00004 1275 Clinical examination Clinical examination
completion of 5th dose)
ENT
1515 S2 4A.S2.00026 4A.S2.00026 : Removal of foreign body from ear 488 Clinical Photograph, Otoscopic findings Procedure Notes
X Ray film with report with report with

1516 S2 4A.S2.00037 4A.S2.00037 : Fracture - setting nasal bone 3750 X Ray
reportPNS
1517 S2 4A.S2.00045 4A.S2.00045 : Radical fronto ethmo sphenodectomy 11625 X-Ray PNS,CT scan of sinuses CT scan of sinuses
1518 S2 4A.S2.00069 4A.S2.00069 : Peritonsillor abscess under LA 1125 Clinical Photograph Clinical Photograph
4A.S13.00061A : Foreign Body Removal with scope -
S13 4A.S13.00061A 15000 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE
cross speciality
GENERAL EMERGENCY
1519 M7 4A.M7.17256 4A.M7.17256 : Drowning 3000 Clinical Notes Clinical Notes
4A.M7.17257 : Injuries caused while operating
1520 M7 4A.M7.17257 3000 Clinical Notes Clinical Notes
agricultural equipments
GENERAL MEDICINE
1521 M1 4A.M1.00006 4A.M1.00006 : Pneumothroax - routine ward 1350 Treatment Notes
investigations
M1 4A.M1.00006A 4A.M1.00006A : Pneumothroax - HDU 2025 Treatment Notes
investigations
4A.M1.00006B : Pneumothroax - ICU without Clinical Notes with relevant
M1 4A.M1.00006C 4A.M1.00006C : Pneumothroax - ICU with ventilator 3375 Treatment Notes
investigations
4A.M1.00007 : Accelerated hypertension - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00007A 4A.M1.00007A : Accelerated hypertension - HDU 2025 Treatment Notes
investigations
4A.M1.00007B : Accelerated hypertension - ICU Clinical Notes with relevant
4A.M1.00007C : Accelerated hypertension - ICU with Clinical Notes with relevant
4A.M1.00012 : Acutre excaberation of COPD - Clinical Notes with relevant
Speciality
code
M1 4A.M1.00012A 4A.M1.00012A : Acutre excaberation of COPD - HDU 2025 Treatment Notes
investigations
4A.M1.00012B : Acutre excaberation of COPD - ICU Clinical Notes with relevant
4A.M1.00012C : Acutre excaberation of COPD - ICU Clinical Notes with relevant
4A.M1.00020 : Acute excaberation of ILD - routine
1524 M1 4A.M1.00020 1350 clinical notes, USG abdomen clinical notes
ward
M1 4A.M1.00020A 4A.M1.00020A : Acute excaberation of ILD - HDU 2025 clinical notes, USG abdomen clinical notes
4A.M1.00020B : Acute excaberation of ILD - ICU

M1 4A.M1.00020B 2700 clinical notes, USG abdomen clinical notes
without ventilator
4A.M1.00020C : Acute excaberation of ILD - ICU with
M1 4A.M1.00020C 3375 clinical notes, USG abdomen clinical notes
ventilator
1525 M1 4A.M1.00023 4A.M1.00023 : Snake bite - routine ward 1350 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023A 4A.M1.00023A : Snake bite - HDU 2025 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023B 4A.M1.00023B : Snake bite - ICU without ventilator 2700 Clinical notes, photo of bite mark Treatment Notes
M1 4A.M1.00023C 4A.M1.00023C : Snake bite - ICU with ventilator 3375 Clinical notes, photo of bite mark Treatment Notes
4A.M1.00024 : Acute organophosphorus poisoning - Clinical Notes with relevant

4A.M1.00024A : Acute organophosphorus poisoning Clinical Notes with relevant
M1 4A.M1.00024A 2025 Treatment Notes
- HDU investigations
4A.M1.00024B : Acute organophosphorus poisoning Clinical Notes with relevant
- ICU without ventilator investigations
4A.M1.00024C : Acute organophosphorus poisoning Clinical Notes with relevant
- ICU with ventilator investigations
1527 M1 4A.M1.00025 4A.M1.00025 : Other poisoning - routine ward 1350 Treatment Notes
investigations
M1 4A.M1.00025A 4A.M1.00025A : Other poisoning - HDU 2025 Treatment Notes
investigations
4A.M1.00025B : Other poisoning - ICU without Clinical Notes with relevant
4A.M1.00025C : Other poisoning - ICU with Clinical Notes with relevant
1528 M1 4A.M1.00030 4A.M1.00030 : Seizures - routine ward 1350 EEG EEG
M1 4A.M1.00030A 4A.M1.00030A : Seizures - HDU 2025 EEG EEG
M1 4A.M1.00030B 4A.M1.00030B : Seizures - ICU without ventilator 2700 EEG EEG
M1 4A.M1.00030C 4A.M1.00030C : Seizures - ICU with ventilator 3375 EEG EEG

1529 M1 4A.M1.00035 4A.M1.00035 : Viral encephalitis - routine ward 1350 Clinical notes, CT Clinical notes, CT
M1 4A.M1.00035A 4A.M1.00035A : Viral encephalitis - HDU 2025 Clinical notes, CT Clinical notes, CT
Speciality
code
4A.M1.00035B : Viral encephalitis - ICU without
M1 4A.M1.00035B 2700 Clinical notes, CT Clinical notes, CT
ventilator
4A.M1.00035C : Viral encephalitis - ICU with
M1 4A.M1.00035C 3375 Clinical notes, CT Clinical notes, CT
ventilator
4A.M1.00044 : Type 1/2 respiratory failure - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00044A 4A.M1.00044A : Type 1/2 respiratory failure - HDU 2025 Treatment Notes
investigations
4A.M1.00044B : Type 1/2 respiratory failure - ICU Clinical Notes with relevant
4A.M1.00044C : Type 1/2 respiratory failure - ICU Clinical Notes with relevant
1531 M1 4A.M1.00045 4A.M1.00045 : Acute asthmatic attack - routine ward 1350 Treatment Notes
investigations
M1 4A.M1.00045A 4A.M1.00045A : Acute asthmatic attack - HDU 2025 Treatment Notes
investigations
4A.M1.00045B : Acute asthmatic attack - ICU Clinical Notes with relevant
4A.M1.00045C : Acute asthmatic attack - ICU with Clinical Notes with relevant
1532 M1 4A.M1.00046 4A.M1.00046 : Acutre excaberation of COPD 0 Treatment Notes
investigations
4A.M1.00049 : Hypertensive emergencies - routine
ward
M1 4A.M1.00049A 4A.M1.00049A : Hypertensive emergencies - HDU 2025 Clinical notes Clinical notes
4A.M1.00049B : Hypertensive emergencies - ICU

without ventilator
4A.M1.00049C : Hypertensive emergencies - ICU
with ventilator
4A.M1.00050 : Dengue hemorrhagic fever/Dengue clinical notes, Blood examination
shock syndrome - routine ward report
4A.M1.00050A : Dengue hemorrhagic fever/Dengue clinical notes, Blood examination
M1 4A.M1.00050A 2025 clinical notes, Blood examination report
shock syndrome - HDU report
4A.M1.00050B : Dengue hemorrhagic fever/Dengue clinical notes, Blood examination

shock syndrome - ICU without ventilator report
4A.M1.00050C : Dengue hemorrhagic fever/Dengue clinical notes, Blood examination

shock syndrome - ICU with ventilator report

1535 M1 4A.M1.00051 4A.M1.00051 : Complicated malaria - routine ward 1350 Treatment Notes
investigations
M1 4A.M1.00051A 4A.M1.00051A : Complicated malaria - HDU 2025 Treatment Notes
investigations
Speciality
code
4A.M1.00051B : Complicated malaria - ICU without Clinical Notes with relevant
4A.M1.00051C : Complicated malaria - ICU with Clinical Notes with relevant
1536 M1 4A.M1.00052 4A.M1.00052 : Heat stroke - routine ward 1350 Treatment Notes
investigations
M1 4A.M1.00052A 4A.M1.00052A : Heat stroke - HDU 2025 Treatment Notes
investigations
M1 4A.M1.00052B 4A.M1.00052B : Heat stroke - ICU without ventilator 2700 Treatment Notes
investigations
M1 4A.M1.00052C 4A.M1.00052C : Heat stroke - ICU with ventilator 3375 Treatment Notes
investigations
4A.M1.00053 : Hyperosmolar Non-Ketotic coma - Clinical Notes with relevant
4A.M1.00053A : Hyperosmolar Non-Ketotic coma - Clinical Notes with relevant
HDU investigations
4A.M1.00053B : Hyperosmolar Non-Ketotic coma - Clinical Notes with relevant
4A.M1.00053C : Hyperosmolar Non-Ketotic coma - Clinical Notes with relevant
4A.M1.00054 : Cerebrovascular accident - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00054A 4A.M1.00054A : Cerebrovascular accident - HDU 2025 Treatment Notes
investigations
4A.M1.00054B : Cerebrovascular accident - ICU Clinical Notes with relevant
4A.M1.00054C : Cerebrovascular accident - ICU with Clinical Notes with relevant
4A.M1.00055 : Severe sepsis/Septic shock - routine Clinical Notes with relevant
ward investigations
M1 4A.M1.00055A 4A.M1.00055A : Severe sepsis/Septic shock - HDU 2025 Treatment Notes
investigations
4A.M1.00055B : Severe sepsis/Septic shock - ICU Clinical Notes with relevant
4A.M1.00055C : Severe sepsis/Septic shock - ICU Clinical Notes with relevant
4A.M1.00056 : Upper GI bleeding (conservative) - Clinical Notes with relevant
4A.M1.00056A : Upper GI bleeding (conservative) - Clinical Notes with relevant
HDU investigations
4A.M1.00056B : Upper GI bleeding (conservative) - Clinical Notes with relevant
4A.M1.00056C : Upper GI bleeding (conservative) - Clinical Notes with relevant
Speciality
code
4A.M1.00059 : Immune mediated CNS disorders

such as autoimmune encephalitis - routine ward
4A.M1.00059A : Immune mediated CNS disorders

M1 4A.M1.00059A 2025 Clinical notes Clinical notes
such as autoimmune encephalitis - HDU
4A.M1.00059B : Immune mediated CNS disorders

M1 4A.M1.00059B such as autoimmune encephalitis - ICU without 2700 Clinical notes Clinical notes
ventilator
4A.M1.00059C : Immune mediated CNS disorders
M1 4A.M1.00059C such as autoimmune encephalitis - ICU with 3375 Clinical notes Clinical notes
ventilator
4A.M1.00060 : Acute transverse myelitis - routine
ward
M1 4A.M1.00060A 4A.M1.00060A : Acute transverse myelitis - HDU 2025 Clinical notes Clinical notes
4A.M1.00060B : Acute transverse myelitis - ICU

without ventilator
4A.M1.00060C : Acute transverse myelitis - ICU with
ventilator
4A.M1.00064 : AKI/ renal failure(dialysis payable
1543 M1 4A.M1.00064 separately as an add on package for ) - routine 1350 Treatment Notes
investigations
ward
4A.M1.00064A : AKI/ renal failure(dialysis payable Clinical Notes with relevant

separately as an add on package for ) - HDU investigations
4A.M1.00064B : AKI/ renal failure(dialysis payable

M1 4A.M1.00064B separately as an add on package for ) - - ICU 2700 Treatment Notes
investigations
without ventilator
4A.M1.00064C : AKI/ renal failure(dialysis payable
M1 4A.M1.00064C separately as an add on package for ) - - ICU with 3375 Treatment Notes
investigations
ventilator
1544 M1 4A.M1.00065 4A.M1.00065 : Status epilepticus - routine ward 1350 Clinical Notes Clinical Notes
M1 4A.M1.00065A 4A.M1.00065A : Status epilepticus - HDU 2025 Clinical Notes Clinical Notes
4A.M1.00065B : Status epilepticus - ICU without
M1 4A.M1.00065B 2700 Clinical Notes Clinical Notes
ventilator
4A.M1.00065C : Status epilepticus - ICU with
M1 4A.M1.00065C 3375 Clinical Notes Clinical Notes
ventilator
1545 M1 4A.M1.00066 4A.M1.00066 : Status asthmaticus - routine ward 1350 Clinical Notes Clinical Notes
M1 4A.M1.00066A 4A.M1.00066A : Status asthmaticus - HDU 2025 Clinical Notes Clinical Notes
4A.M1.00066B : Status asthmaticus - ICU without
M1 4A.M1.00066B 2700 Clinical Notes Clinical Notes
ventilator
Speciality
code
4A.M1.00066C : Status asthmaticus - ICU with
M1 4A.M1.00066C 3375 Clinical Notes Clinical Notes
ventilator
4A.M1.00067 : Respiratory failure due to any cause

1546 M1 4A.M1.00067 (pneumonia, asthma, COPD, ARDS, foreign body, 1350 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - routine ward
4A.M1.00067A : Respiratory failure due to any cause

M1 4A.M1.00067A (pneumonia, asthma, COPD, ARDS, foreign body, 2025 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - HDU
4A.M1.00067B : Respiratory failure due to any cause

M1 4A.M1.00067B (pneumonia, asthma, COPD, ARDS, foreign body, 2700 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - ICU without ventilator
4A.M1.00067C : Respiratory failure due to any cause

M1 4A.M1.00067C (pneumonia, asthma, COPD, ARDS, foreign body, 3375 Clincal notes, X-ray/CT chest Clincal notes, X-ray/CT chest
poisoning, head injury etc.) - ICU with ventilator
GENERAL SURGERY
1547 S1 4A.S1.00085 4A.S1.00085 : Intestinal perforation 6750 X-Ray of abdomen/CT (Upright position) Scar photo
1548 S1 4A.S1.00093 4A.S1.00093 : Closure of Hollow Viscus Perforation 9375 X Ray abdomen ,USG Scar photo
1549 S1 4A.S1.00144 4A.S1.00144 : Volvlous of Large Bowel 18750 CT Scan Scar photo
4A.S1.00204 : Congenital Atresia & Stenosis of Small
1550 S1 4A.S1.00204 82500 USG/ CT OT Notes, Scar Photo
Intestine
Clinical photos showing the AV
1551 S1 4A.S1.00251 4A.S1.00251 : AV Shunt for dialysis 5625 Duplex
fistula
4A.S6.00008A : Visceral injury requiring surgical
S6 4A.S6.00008A intervention along with fixation of fracture of single 22500 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
long bone. - cross speciality
4A.S6.17029A : Inter costal drainage (icd) one side -
S6 4A.S6.17029A 6000 X-ray X-ray
cross speciality
4A.S6.17030A : Inter costal drainage
S6 4A.S6.17030A 8250 X-ray X-ray
(icd)bilateral (flail chest) - cross speciality
S6 4A.S6.17031A (icd)bilateral (flail chest) with icu stay - cross 9000 X-ray X-ray
speciality
S6 4A.S6.17032A (icd)bilateral (flail chest) with icu stay with ventilator - 10500 X-ray X-ray
cross speciality
4A.S6.17033A : Blunt injury abdomen with icu stay -
S6 4A.S6.17033A 9000 USG USG
cross speciality
Speciality
code
4A.S6.17034A : Supra pubic cystostomy in fracture
S6 4A.S6.17034A 6000 X-ray X-ray
pelvis - cross speciality
4A.S6.00009A : Visceral injury requiring surgical

S6 4A.S6.00009A intervention along with fixation of fracture of 2 or 33750 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
more long bones. - cross speciality

4A.M2.00005 : Acute Exacerbation of asthma - Clinical Notes with relevant
4A.M2.00005A : Acute Exacerbation of asthma - Clinical Notes with relevant
HDU investigations
4A.M2.00005B : Acute Exacerbation of asthma - ICU Clinical Notes with relevant
4A.M2.00005C : Acute Exacerbation of asthma - ICU Clinical Notes with relevant
4A.M2.00009 : Febrile seizures/other seizures -
routine ward
4A.M2.00009A : Febrile seizures/other seizures -
HDU
4A.M2.00009B : Febrile seizures/other seizures - ICU
without ventilator
4A.M2.00009C : Febrile seizures/other seizures - ICU
with ventilator
4A.M2.00010 : Epileptic encephalopathy - routine
ward
M2 4A.M2.00010A 4A.M2.00010A : Epileptic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00010B : Epileptic encephalopathy - ICU

without ventilator
4A.M2.00010C : Epileptic encephalopathy - ICU with
ventilator
1555 M2 4A.M2.00012 4A.M2.00012 : Aseptic meningitis - routine ward 1350 Treatment Notes
investigations
M2 4A.M2.00012A 4A.M2.00012A : Aseptic meningitis - HDU 2025 Treatment Notes
investigations
4A.M2.00012B : Aseptic meningitis - ICU without Clinical Notes with relevant
4A.M2.00012C : Aseptic meningitis - ICU with Clinical Notes with relevant
1556 M2 4A.M2.00017 4A.M2.00017 : Unexplained seizures - routine ward 1350 Clinical note with Lab reports Treatment note
M2 4A.M2.00017A 4A.M2.00017A : Unexplained seizures - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00017B : Unexplained seizures - ICU without
ventilator
Speciality
code
4A.M2.00017C : Unexplained seizures - ICU with
ventilator
1557 M2 4A.M2.00027 4A.M2.00027 : Pyogenic meningitis - routine ward 1350 Treatment Notes
investigations
M2 4A.M2.00027A 4A.M2.00027A : Pyogenic meningitis - HDU 2025 Treatment Notes
investigations
4A.M2.00027B : Pyogenic meningitis - ICU without Clinical Notes with relevant
4A.M2.00027C : Pyogenic meningitis - ICU with Clinical Notes with relevant
1558 M2 4A.M2.00030 4A.M2.00030 : Dengue - routine ward 1350 CBC
M2 4A.M2.00030A 4A.M2.00030A : Dengue - HDU 2025 CBC
M2 4A.M2.00030B 4A.M2.00030B : Dengue - ICU without ventilator 2700 CBC
M2 4A.M2.00030C 4A.M2.00030C : Dengue - ICU with ventilator 3375 CBC

1559 M2 4A.M2.00035 4A.M2.00035 : Tuberculosis - routine ward 1350 CBC, CT CBC,CT
M2 4A.M2.00035A 4A.M2.00035A : Tuberculosis - HDU 2025 CBC, CT CBC,CT
M2 4A.M2.00035B 4A.M2.00035B : Tuberculosis - ICU without ventilator 2700 CBC, CT CBC,CT
M2 4A.M2.00035C 4A.M2.00035C : Tuberculosis - ICU with ventilator 3375 CBC, CT CBC,CT
1560 M2 4A.M2.00048 4A.M2.00048 : Encephalitis - routine ward 1350 CT CT

M2 4A.M2.00048A 4A.M2.00048A : Encephalitis - HDU 2025 CT CT
M2 4A.M2.00048B 4A.M2.00048B : Encephalitis - ICU without ventilator 2700 CT CT
M2 4A.M2.00048C 4A.M2.00048C : Encephalitis - ICU with ventilator 3375 CT CT
1561 M2 4A.M2.00051 4A.M2.00051 : Refractory seizures - routine ward 1350 Clinical note with Lab reports Treatment note
M2 4A.M2.00051A 4A.M2.00051A : Refractory seizures - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00051B : Refractory seizures - ICU without
ventilator
4A.M2.00051C : Refractory seizures - ICU with
ventilator
1562 M2 4A.M2.00052 4A.M2.00052 : Floppy infant - routine ward 1350 Clinical note with Lab reports Treatment note
M2 4A.M2.00052A 4A.M2.00052A : Floppy infant - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00052B : Floppy infant - ICU without
ventilator
M2 4A.M2.00052C 4A.M2.00052C : Floppy infant - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
4A.M2.00053 : Acute neuroregression - routine

ward
M2 4A.M2.00053A 4A.M2.00053A : Acute neuroregression - HDU 2025 Clinical note with Lab reports Treatment note
Speciality
code
4A.M2.00053B : Acute neuroregression - ICU without
ventilator
4A.M2.00053C : Acute neuroregression - ICU with
ventilator
4A.M2.00055 : Opsoclonus myoclonus syndrome -
routine ward
4A.M2.00055A : Opsoclonus myoclonus syndrome -
HDU
4A.M2.00055B : Opsoclonus myoclonus syndrome -
4A.M2.00055C : Opsoclonus myoclonus syndrome -
ICU with ventilator
1565 M2 4A.M2.00056 4A.M2.00056 : Acute ataxia - routine ward 1350 Clinical examination Clinical examination
M2 4A.M2.00056A 4A.M2.00056A : Acute ataxia - HDU 2025 Clinical examination Clinical examination
4A.M2.00056B : Acute ataxia - ICU without
ventilator
M2 4A.M2.00056C 4A.M2.00056C : Acute ataxia - ICU with ventilator 3375 Clinical examination Clinical examination
4A.M2.00057 : Steven Johnson syndrome - routine

ward
M2 4A.M2.00057A 4A.M2.00057A : Steven Johnson syndrome - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00057B : Steven Johnson syndrome - ICU

without ventilator
4A.M2.00057C : Steven Johnson syndrome - ICU
with ventilator
4A.M2.00059 : Ketogenic diet initiation in refractory
epilepsy - routine ward
4A.M2.00059A : Ketogenic diet initiation in
refractory epilepsy - HDU
4A.M2.00059B : Ketogenic diet initiation in
refractory epilepsy - ICU without ventilator
4A.M2.00059C : Ketogenic diet initiation in
refractory epilepsy - ICU with ventilator
4A.M2.00060 : Inborn errors of metabolism - routine
ward
M2 4A.M2.00060A 4A.M2.00060A : Inborn errors of metabolism - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00060B : Inborn errors of metabolism - ICU

without ventilator
4A.M2.00060C : Inborn errors of metabolism - ICU
with ventilator
Speciality
code
CBC,RFT,USG
CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
1569 M2 4A.M2.00067 4A.M2.00067 : Acute kidney injury - routine ward 1350 Abd,HIV,HBsAg,HCV,Urine R/E,
R/E, LFT,Lipid Profile
LFT,Lipid Profile
CBC,RFT,USG
M2 4A.M2.00067A 4A.M2.00067A : Acute kidney injury - HDU 2025 Abd,HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile
CBC,RFT,USG
4A.M2.00067B : Acute kidney injury - ICU without CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
M2 4A.M2.00067B 2700 Abd,HIV,HBsAg,HCV,Urine R/E,
ventilator R/E, LFT,Lipid Profile
LFT,Lipid Profile
CBC,RFT,USG
4A.M2.00067C : Acute kidney injury - ICU with CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
M2 4A.M2.00067C 3375 Abd,HIV,HBsAg,HCV,Urine R/E,
ventilator R/E, LFT,Lipid Profile
LFT,Lipid Profile
1570 M2 4A.M2.00068 4A.M2.00068 : Poisonings - routine ward 1350 Clinical note with Lab reports Treatment note
M2 4A.M2.00068A 4A.M2.00068A : Poisonings - HDU 2025 Clinical note with Lab reports Treatment note
M2 4A.M2.00068B 4A.M2.00068B : Poisonings - ICU without ventilator 2700 Clinical note with Lab reports Treatment note
M2 4A.M2.00068C 4A.M2.00068C : Poisonings - ICU with ventilator 3375 Clinical note with Lab reports Treatment note
4A.M2.00069 : Serious trauma with unstable vitals -

1571 M2 4A.M2.00069 1350 X-ray
routine ward
4A.M2.00069A : Serious trauma with unstable vitals -
M2 4A.M2.00069A 2025 X-ray
HDU
4A.M2.00069B : Serious trauma with unstable vitals -
M2 4A.M2.00069B 2700 X-ray
4A.M2.00069C : Serious trauma with unstable vitals -
M2 4A.M2.00069C 3375 X-ray
ICU with ventilator
1572 M2 4A.M2.00074 4A.M2.00074 : Complicated malaria - routine ward 1350 Treatment Notes
investigations
M2 4A.M2.00074A 4A.M2.00074A : Complicated malaria - HDU 2025 Treatment Notes
investigations
4A.M2.00074B : Complicated malaria - ICU without Clinical Notes with relevant
4A.M2.00074C : Complicated malaria - ICU with Clinical Notes with relevant
4A.M2.00075 : Severe dengue with shock - routine
ward
M2 4A.M2.00075A 4A.M2.00075A : Severe dengue with shock - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00075B : Severe dengue with shock - ICU

without ventilator
4A.M2.00075C : Severe dengue with shock - ICU
with ventilator
4A.M2.00078 : Acute encephalitic syndrome -
routine ward
Speciality
code
M2 4A.M2.00078A 4A.M2.00078A : Acute encephalitic syndrome - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00078B : Acute encephalitic syndrome - ICU

without ventilator
4A.M2.00078C : Acute encephalitic syndrome - ICU
with ventilator
4A.M2.00079 : Acute demyelinating myelopathy -
routine ward
4A.M2.00079A : Acute demyelinating myelopathy, -
HDU
4A.M2.00079B : Acute demyelinating myelopathy, -
4A.M2.00079C : Acute demyelinating myelopathy, -
ICU with ventilator
4A.M2.00080 : Immune mediated CNS disorders

such as autoimmune encephalitis - routine ward
4A.M2.00080A : Immune mediated CNS disorders

such as autoimmune encephalitis - HDU
4A.M2.00080B : Immune mediated CNS disorders

M2 4A.M2.00080B such as autoimmune encephalitis - ICU without 2700 Clinical note with Lab reports Treatment note
ventilator
4A.M2.00080C : Immune mediated CNS disorders
M2 4A.M2.00080C such as autoimmune encephalitis - ICU with 3375 Clinical note with Lab reports Treatment note
ventilator
4A.M2.00081 : Acute transverse myelitis - routine
ward
M2 4A.M2.00081A 4A.M2.00081A : Acute transverse myelitis - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00081B : Acute transverse myelitis - ICU

without ventilator
4A.M2.00081C : Acute transverse myelitis - ICU with
ventilator
4A.M2.00082 : Guillain Barre Syndrome - routine
1578 M2 4A.M2.00082 1350 Clinical examination Clinical examination
ward
M2 4A.M2.00082A 4A.M2.00082A : Guillain Barre Syndrome - HDU 2025 Clinical examination Clinical examination
4A.M2.00082B : Guillain Barre Syndrome - ICU

without ventilator
4A.M2.00082C : Guillain Barre Syndrome - ICU with
M2 4A.M2.00082C 3375 Clinical examination Clinical examination
ventilator
1579 M2 4A.M2.00085 4A.M2.00085 : Cerebral malaria - routine ward 1350 CBC, CT CBC, CT
M2 4A.M2.00085A 4A.M2.00085A : Cerebral malaria - HDU 2025 CBC, CT CBC, CT
Speciality
code
4A.M2.00085B : Cerebral malaria - ICU without
M2 4A.M2.00085B 2700 CBC, CT CBC, CT
ventilator
4A.M2.00085C : Cerebral malaria - ICU with
M2 4A.M2.00085C 3375 CBC, CT CBC, CT
ventilator
1580 M2 4A.M2.00086 4A.M2.00086 : Acute ischemic stroke - routine ward 1350 Treatment Notes
investigations
M2 4A.M2.00086A 4A.M2.00086A : Acute ischemic stroke - HDU 2025 Treatment Notes
investigations
4A.M2.00086B : Acute ischemic stroke - ICU without Clinical Notes with relevant
4A.M2.00086C : Acute ischemic stroke - ICU with Clinical Notes with relevant
4A.M2.00088 : Respiratory failure due to any causes
1581 M2 4A.M2.00088 (pneumonia, asthma, foreign body, poisoning, head 1350 Treatment Notes
investigations
injury etc.) - routine ward
4A.M2.00088A : Respiratory failure due to any
M2 4A.M2.00088A causes (pneumonia, asthma, foreign body, 2025 Treatment Notes
investigations
poisoning, head injury etc.) - HDU
4A.M2.00088B : Respiratory failure due to any

M2 4A.M2.00088B causes (pneumonia, asthma, foreign body, 2700 Treatment Notes
investigations
poisoning, head injury etc.) - ICU without ventilator
4A.M2.00088C : Respiratory failure due to any

M2 4A.M2.00088C causes (pneumonia, asthma, foreign body, 3375 Treatment Notes
investigations
poisoning, head injury etc.) - ICU with ventilator
1582 M2 4A.M2.00089 4A.M2.00089 : Acute transverse myelitis 0 Clinical note with Lab reports Treatment note
4A.M2.00090 : Acute encephalitis
–infectious/immune-mediated - routine ward
4A.M2.00090A : Acute encephalitis
–infectious/immune-mediated - HDU
4A.M2.00090B : Acute encephalitis
M2 4A.M2.00090B –infectious/immune-mediated - ICU without 2700 Clinical note with Lab reports Treatment note
ventilator
4A.M2.00090C : Acute encephalitis

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

epilepticus - routine ward
4A.M2.00091A : Convulsive & non convulsive status
epilepticus - HDU
4A.M2.00091B : Convulsive & non convulsive status
epilepticus - ICU without ventilator
Speciality
code
4A.M2.00091C : Convulsive & non convulsive status
epilepticus - ICU with ventilator
1585 M2 4A.M2.00092 4A.M2.00092 : Cerebral herniation - routine ward 1350 Clinical note with Lab reports Treatment note
M2 4A.M2.00092A 4A.M2.00092A : Cerebral herniation - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00092B : Cerebral herniation - ICU without
ventilator
4A.M2.00092C : Cerebral herniation - ICU with
ventilator
4A.M2.00093 : Intracranial hemorrhage - routine Clinical Notes with relevant
ward investigations
M2 4A.M2.00093A 4A.M2.00093A : Intracranial hemorrhage - HDU 2025 Treatment Notes
investigations
4A.M2.00093B : Intracranial hemorrhage - ICU Clinical Notes with relevant
4A.M2.00093C : Intracranial hemorrhage - ICU with Clinical Notes with relevant
4A.M2.00094 : Hepatic encephalopathy - routine
ward
M2 4A.M2.00094A 4A.M2.00094A : Hepatic encephalopathy - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00094B : Hepatic encephalopathy - ICU

without ventilator
4A.M2.00094C : Hepatic encephalopathy - ICU with
ventilator
4A.M2.00095 : Complicated bacterial meningitis -
routine ward
4A.M2.00095A : Complicated bacterial meningitis -
HDU
4A.M2.00095B : Complicated bacterial meningitis -
4A.M2.00095C : Complicated bacterial meningitis -
ICU with ventilator
4A.M2.00096 : Raised intracranial pressure - routine
ward
M2 4A.M2.00096A 4A.M2.00096A : Raised intracranial pressure - HDU 2025 Clinical note with Lab reports Treatment note
4A.M2.00096B : Raised intracranial pressure - ICU

without ventilator
4A.M2.00096C : Raised intracranial pressure - ICU
with ventilator
4A.M2.00097 : Hypertensive encephalopathy -
routine ward
Speciality
code
4A.M2.00097A : Hypertensive encephalopathy -
HDU
4A.M2.00097B : Hypertensive encephalopathy - ICU
without ventilator
4A.M2.00097C : Hypertensive encephalopathy - ICU
with ventilator
1591 M2 4A.M2.00098 4A.M2.00098 : CRRT (per session) 6000 Clinical note with Lab reports Treatment note
4A.M2.17175 : Medical Management of Acute Renal

1592 M2 4A.M2.17175 1125 CBC, RFT CBC, RFT
Failure With Dialysis in Paediatric patients
4A.M3.00001 : Basic neonatal care package (Rs. 500

per day, maximum 1500): Babies that can be
managed by side of mother in postnatal ward
without requiring admission in SNCU/NICU:
• Any newborn needing feeding support
• Babies requiring closer monitoring or short-term
care for conditions like:
o Birth asphyxia (need for positive pressure
ventilation; no HIE)
o Moderate jaundice requiring phototherapy
o Large for dates (>97 percentile) Babies
o Small for gestational age (less than 3rd centile)
4A.M3.00010 : Ventriculoperitoneal Shunt Surgery

1594 M3 4A.M3.00010 (VP) or Omaya Reservoir or External Drainage for 20250 CT Report CT Report, Scar Photo, X Ray
Hydrocephalus
4A.S14.00027 : Intussusception – Operative in
1595 S14 4A.S14.00027 22500 USG OT notes
infants
4A.S14.17126 : Airway Reconstruction for benign
1596 S14 4A.S14.17126 37500 Endoscopic Picture OT notes
conditions
1597 S14 4A.S14.17127 4A.S14.17127 : Anorectal Malformations Stage 1 26250 USG OT notes
4A.S14.17128 : Paediatric intestinal obstruction

1598 S14 4A.S14.17128 48750 USG OT notes
>1month
1599 S14 4A.S14.17129 4A.S14.17129 : Laparotomy for peritonitis 37500 USG OT notes, Scar Picture
1600 S14 4A.S14.17130 4A.S14.17130 : Omphalocele-Major/Gastroschisis 52500 USG OT notes
1601 S14 4A.S14.17131 4A.S14.17131 : Exstropy Bladder Stage 1 60000 USG OT notes
4A.S14.17137 : Bronchoscospy for foreign body
1602 S14 4A.S14.17137 18750 X Ray OT Notes/ X Ray
removal
1603 S14 4A.S14.17140 4A.S14.17140 : Bowel resection and anastomosis 41250 USG OT notes
Speciality
code
4A.S1.00204A : Congenital Atresia & Stenosis of
S1 4A.S1.00204A 82500 USG/ CT OT Notes, Scar Photo
Small Intestine - cross speciality
NEUROSURGERY
1604 S8 4A.S8.00002 4A.S8.00002 : Burr hole 13500 CT Report CT Report, Scar Photo
4A.S8.00012 : Haematoma - Brain (head injuries) OT Notes, CT Report, Clinical
1605 S8 4A.S8.00012 45000 CT Report , X Ray
(including pre and post Op. CT) Photograph
1606 S8 4A.S8.00051 4A.S8.00051 : Twist Drill Craniostomy 11250 CT report Film and scar photo
Post Op CT Report,film and scar
1607 S8 4A.S8.00058 4A.S8.00058 : Abscess Tapping multiple 15000 CT report
photo

1608 S8 4A.S8.00059 4A.S8.00059 : Excision of Brain Abscess 37500 CT report
Photograph showing the scar
4A.S8.00062 : External Ventricular Drainage (EVD) Post Op CT Report and film, Clinical
1609 S8 4A.S8.00062 11250 CT report
including antibiotics Photograph showing Scar
4A.S8.17056 : Craniotomy and Evacuation of

Haematoma -Extradural *
4A.S6.00006A : Craniotomy and evacuation of
Haematoma – subdural/Extra dural along with OT Notes, CT Report, Clinical
S6 4A.S6.00006A 45000 CT Report , X Ray
fixation of fracture of single long bone - cross Photograph
speciality
4A.S6.00007A : Craniotomy and evacuation of
Haematoma – subdural/Extra dural along with OT Notes, CT Report, Clinical
S6 4A.S6.00007A 56250 CT Report , X Ray
fixation of fracture of 2 or more long bone. - cross Photograph
speciality
4A.S6.00012A : Emergency tendons repair ±
S6 4A.S6.00012A Peripheral Nerve repair/ reconstructive surgery - 22500 X-ray Films/ Clinical Picture Clinical photo showing Scar
cross speciality
4A.S6.17036A : Head injury with icu (conservative)) -
S6 4A.S6.17036A 5250 CT Clinical photo with treatment notes
cross speciality
4A.S6.17037A : Head injury with icu stay (with
S6 4A.S6.17037A 11250 CT Clinical photo with treatment notes
ventilator)
4A.S6.17038A : Head injury with minimal surgical Clinical/scar photo with treatment
S6 4A.S6.17038A 18750 CT
intervention - cross speciality notes
1611 S4 4A.S4.00036 4A.S4.00036 : High risk delivery: Pre-mature delivery 6750 USG and clinical notes Delivery note/OT note
4A.S4.00037 : High risk delivery: Expected Gestation

1612 S4 4A.S4.00037 6750 USG and clinical notes Delivery note/OT note
at delivery less than 35 weeks
4A.S4.00038 : High risk delivery: Mothers with
1613 S4 4A.S4.00038 6750 USG and clinical notes Delivery note/OT note
eclampsia or imminent eclampsia
1614 S4 4A.S4.00039 4A.S4.00039 : High risk delivery: Obstructed labour 6750 USG and clinical notes Delivery note/OT note
Speciality
code
4A.S4.00040 : High risk delivery: Major Fetal
1615 S4 4A.S4.00040 malformation requiring intervention immediately 6750 USG and clinical notes Delivery note/OT note
after birth
4A.S4.00041 : High risk delivery: Mothers with severe
1616 S4 4A.S4.00041 6750 USG, Lab report and clinical notes Delivery note/OT note
anaemia (<7 g/dL)
4A.S4.00042 : High risk delivery: Other maternal and

fetal conditions as per guidelines-Such as Rh
1617 S4 4A.S4.00042 haemolytic disease, uncontrolled diabetes, severe 6750 USG, Lab report and clinical notes Delivery note/OT note
growth retardation etc that qualify for high risk
delivery etc.
1618 S4 4A.S4.00043 4A.S4.00043 : Manual removal of placenta 3188 Clinical Notes/USG Clinical Notes
APTT(activated partial thromboplastin
4A.S4.00052 : Trans-vaginal tape/ Trans-obturator time) , Heamatocrit , PT (Prothrombin Clinical Photograph of Retroplacental
1619 S4 4A.S4.00052 11250
tape time), Platelet Count , S.Fibrinogen Level clots , USG
, USG
1620 S4 4A.S4.00059 4A.S4.00059 : Broad Ligment Haemotoma drainage 5738 Clinical Notes, Ultrasonography OT Notes
Arterial Blood Gas (ABG),APTT(activated

4A.S4.17017 : Abruptio-Placenta With Coagulation
partial thromboplastin
1621 S4 4A.S4.17017 Defects( Disseminated Intravascular Coagulation 18750 Biochemical investigations
time),CHE,LFT,RFT,Haematocrit, platelet
(DiC))
count, S fibrogen
4A.S4.17018 : Perforation of Uterus after D/E

1622 S4 4A.S4.17018 9563 Clinical Notes, Ultrassonography OT Notes
laprotomy and closure
ONCOLOGY
1623 S15 4A.S15.00021 4A.S15.00021 : Tracheostomy 3750 Clinical photo Clinical photo
Clinical Photograph, Discharge
4A.M5.17224 : IV antibiotics and other supportive
1624 M5 4A.M5.17224 7500 Haemogram for each episode summary (with details of drugs
therapy For Febrile Neutropenia (Per episode)
given)
ORTHOPAEDICS
4A.S5.00035 : Debridement & Closure of Major

1625 S5 4A.S5.00035 injuries - contused lacerated wounds (anti-biotic + 5250 Clinical Notes + X-Rays Clinical Notes + X-Rays
dressing) - minimum of 3 sessions
complete blood count,clinical

1626 S5 4A.S5.00044 4A.S5.00044 : Fasciotomy 11250 Scar photo
photograph
4A.S5.00064 : Open Reduction Internal Fixation (2
1627 S5 4A.S5.00064 9000 X-ray X-ray
Small Bones)
4A.S6.00008C : Visceral injury requiring surgical
S6 4A.S6.00008C intervention along with fixation of fracture of single 22500 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
4A.S6.00010A : Chest injury with one fracture of long
S6 4A.S6.00010A 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants) - cross speciality
Speciality
code
4A.S6.00011A : Chest injury with fracture of 2 or
S6 4A.S6.00011A 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
more long bones - cross speciality
4A.S6.00012C : Emergency tendons repair ±
S6 4A.S6.00012C Peripheral Nerve repair/ reconstructive surgery - 22500 X-ray Films/ Clinical Picture Clinical photo showing Scar
cross speciality
4A.S6.17028B : Deglove injury of extremities - cross complete blood count,clinical
S6 4A.S6.17028B 9000 Scar photo
speciality photograph, X ray of affected part
4A.S6.00009C : Visceral injury requiring surgical

S6 4A.S6.00009C intervention along with fixation of fracture of 2 or 33750 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo

4A.S6.00012B : Emergency tendons repair ±
S6 4A.S6.00012B Peripheral Nerve repair/ reconstructive surgery - 22500 X-ray Films/ Clinical Picture Clinical photo showing Scar
cross speciality
4A.S6.17028A : Deglove injury of extremities - cross complete blood count,clinical
S6 4A.S6.17028A 9000 Scar photo
speciality photograph, X ray of affected part
POLYTRAUMA
4A.S6.00006 : Craniotomy and evacuation of
OT Notes, CT Report, Clinical
1628 S6 4A.S6.00006 Haematoma – subdural/Extra dural along with 45000 CT Report , X Ray
Photograph
fixation of fracture of single long bone
4A.S6.00007 : Craniotomy and evacuation of
OT Notes, CT Report, Clinical
1629 S6 4A.S6.00007 Haematoma – subdural/Extra dural along with 56250 CT Report , X Ray
Photograph
fixation of fracture of 2 or more long bone.
4A.S6.00008 : Visceral injury requiring surgical
1630 S6 4A.S6.00008 intervention along with fixation of fracture of single 22500 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
long bone.
4A.S6.00009 : Visceral injury requiring surgical
1631 S6 4A.S6.00009 intervention along with fixation of fracture of 2 or 33750 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
more long bones.
4A.S6.00010 : Chest injury with one fracture of long
1632 S6 4A.S6.00010 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
bone (with implants)
4A.S6.00011 : Chest injury with fracture of 2 or more
1633 S6 4A.S6.00011 26250 X-ray of fracture, Chest x-ray / CT Clinical Photograph , X-RAY
long bones
4A.S6.00012 : Emergency tendons repair ±
1634 S6 4A.S6.00012 22500 X-ray Films/ Clinical Picture Clinical photo showing Scar
Peripheral Nerve repair/ reconstructive surgery
complete blood count,clinical
1635 S6 4A.S6.17028 4A.S6.17028 : Deglove injury of extremities 9000 Scar photo
photograph, X ray of affected part
1636 S6 4A.S6.17029 4A.S6.17029 : Inter costal drainage (icd) one side 6000 X-ray X-ray
4A.S6.17030 : Inter costal drainage (icd)bilateral (flail

1637 S6 4A.S6.17030 8250 X-ray X-ray
chest)
1638 S6 4A.S6.17031 9000 X-ray X-ray
chest) with icu stay
Speciality
code

1639 S6 4A.S6.17032 10500 X-ray X-ray
chest) with icu stay with ventilator
1640 S6 4A.S6.17033 4A.S6.17033 : Blunt injury abdomen with icu stay 9000 USG USG
4A.S6.17034 : Supra pubic cystostomy in fracture

1641 S6 4A.S6.17034 6000 X-ray X-ray
pelvis
1642 S6 4A.S6.17035 4A.S6.17035 : Spine injuries - with ct/mri 5250 CT/MRI CT/MRI
1643 S6 4A.S6.17036 4A.S6.17036 : Head injury with icu (conservative)) 5250 CT Clinical photo with treatment notes
4A.S6.17037 : Head injury with icu stay (with

1644 S6 4A.S6.17037 11250 CT Clinical photo with treatment notes
ventilator)
4A.S6.17038 : Head injury with minimal surgical Clinical/scar photo with treatment
1645 S6 4A.S6.17038 18750 CT
intervention notes
4A.S1.00085A : Intestinal perforation - cross
S1 4A.S1.00085A 6750 X-Ray of abdomen/CT (Upright position) Scar photo
speciality
4A.S1.00093A : Closure of Hollow Viscus Perforation -
S1 4A.S1.00093A 9375 X Ray abdomen ,USG Scar photo
cross speciality
4A.S1.00144A : Volvlous of Large Bowel - cross
S1 4A.S1.00144A 18750 CT Scan Scar photo
speciality
4A.S6.00008B : Visceral injury requiring surgical
S6 4A.S6.00008B intervention along with fixation of fracture of single 22500 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
4A.S6.17033B : Blunt injury abdomen with icu stay -
S6 4A.S6.17033B 9000 USG USG
cross speciality
4A.S6.00009B : Visceral injury requiring surgical

S6 4A.S6.00009B intervention along with fixation of fracture of 2 or 33750 X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
UROLOGY
4A.S7.00071 : Bladder injury repair (only to be used
Endoscopy with film, biopsy, CT report Clinical Photograph showing scar +
1646 S7 4A.S7.00071 if done as a part of ongoing laparotomy/other 15000
surgery)
1647 S7 4A.S7.00082 4A.S7.00082 : Suprapubic Drainage - Closed/Trocar 1500 RGU,MCU RGU,MCU
4A.S7.00158 : Emergency management of Acute

1648 S7 4A.S7.00158 1500 USG Doctors Note + X-ray
retention of Urine
CBC,RFT,USG
4A.S7.00160 : Urinary tract trauma – open surgery CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
1649 S7 4A.S7.00160 7500 Abd,HIV,HBsAg,HCV,Urine R/E,
(exploratory) R/E, LFT,Lipid Profile
LFT,Lipid Profile
Speciality
code
4A.S7.17047 : Acutekidney injury with hemodialysis, CBC,RFT,USG

1650 S7 4A.S7.17047 inclusive of pre-op inv,post -op inv,procedure 18750 Abd,HIV,HBsAg,HCV,Urine R/E,
cost,ICU/wards stay,and medication for 15 days LFT,Lipid Profile
4A.S1.00251C : AV Shunt for dialysis - cross Clinical photos showing the AV

S1 4A.S1.00251C 5625 Duplex
speciality fistula
4A.S6.17034B : Supra pubic cystostomy in fracture
S6 4A.S6.17034B 6000 X-ray X-ray
pelvis - cross speciality
Note:
• Empanelled hospitals should upload basic investigations conducted in each patient - routine investigations like haemotology, bio-chemical, histopathological, micro biological, radiological
films and reports and USG reports for arriving at the diagnosis and clinical notes, provisional diagnosis, planned treatment procedure, and the code selected from the procedure list mandatorily
for preauthorization
• Procedures mentioned as cross speciality can be done by specialities under which they have been included in addition to the main speciality.
• Codes mentioned as * are sub procedures which are a part of the main procedure. Case specific procedure to be selected accordingly and cannot be clubbed with the main procedure.
• Scar photos or certain clinical photographs which involves patient private parts need not be furnished at the time of preauth/claims.
3A.M4.00035#, 3A.M4.00035A#, 3A.M4.00035B# - Bone tumors/soft tissue sarcomas : surgery (inlcuding prosthesis) - Comprehensive package includes surgery, invoice, irradiation and mega
prothesis/custom made prothesis. The code is designed for limb salvage in sarcoma cases which are detected early and have a good prognosis. The design is for neo-adjuvant chemotherapy to
reduce the activity, local irradiation followed by surgical excision of the tumour. The CAD of the prosthesis requires sometime and normally being taken on the second stage of surgery. The
approvals are to be given in staged manner with the first approval for neo-adjuvant chemotherapy with appropriate drugs and the cost as per the chemo packages of AB-ArK, second for the
local irradiation as per the cost per cycle of irradiation factored in the packages, third for the surgical excision of the tumour as per the surgical package and fourth for the implantation of mega
prosthesis or custom designed prosthesis as per the cost within the limit of package and finally the follow of treatment of chemo, radio and follow up treatment. The treatment packages are
provided under code - 3A.M4.00033, 3A.M4.00034, 3A.S15.00045 & 3A.M4.00036. The whole package should not exceed the rates prescribed under 3A.M4.00035, 3A.M4.00035A,
3A.M4.00035B
3A.M6.00006 : Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) (Radical/Adjuvant/Neoadjuvent) - Hospitals needs to produce AERB Certificate of Linear
Acceleration, Cone Beam CT fitted in machine or tracking device with variable. Package includes planning and execution. Additional CBCT report log print to be submitted during claim
submission.
Oncology codes where in supportive care/rehabilitation is mentioned: Comprehensive package which includes treatment for Neutropenia, septicaemia and nutritional support along with
antibiotics, oral supplements with counselling. In case of relapse CT is recommended.

Benefit Packages (Government)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Benefit Packages (Government)

Uploaded by

Copyright:

Available Formats

BENEFIT PACKAGES OF AYUSHMAN BHARAT - AROGYA KARNATAKA FOR GOVERNMENT HOSPITALS

2A.S11.00001 : % Total Body Surface Area Burns

2A.S16.00001 : Fixation of fracture of jaw with closed

2A.S16.00006 : Extraction of impacted tooth under

Pure Tone Audiometry Report and

Pure Tone Audiometry Report and

Pure Tone Audiometry Report and

2A.M1.00036B : Persistent/ Chronic diarrohea - ICU

2A.M1.00040B : Neuromuscular disorders - ICU

2A.M1.00068 : Blood and blood component

2A.M1.00071 : High end radiological diagnostic (CT,

2A.M1.00072 : High end histopathology (Biopsies)

2A.S1.00214A : Hemodialysis per sitting - cross

88 S1 2A.S1.00049 2A.S1.00049 : Excision of Neurofibroma 1500 Clinical photo OT notes, HPE

2A.S1.00060 : G J Vagotomy/ Vagotomy +

98 S1 2A.S1.00066 2A.S1.00066 : Granuloma – Excision 1000 clinical photograph Scar photo

Endoscopy , USG , X-Ray Abdomen-

120 S1 2A.S1.00132 2A.S1.00132 : Splenectomy 12500 CT/ MRI Scar photo

2A.M8.00002 : Mental and Behavioural disorders

2A.M8.00003 : Schizophrenia, schizotypal and

2A.M8.00009 : Mental and Behavioural disorders

2A.M8.00010 : Schizophrenia, schizotypal and

2A.M2.00006B : Acute glomerulonephritis - ICU

2A.M2.00023 : Musculoskeletal problems - routine

2A.M2.00023B : Musculoskeletal problems - ICU

2A.M2.00028B : Persistent/ Chronic diarrhea - ICU

2A.M2.00029B : Acute severe malnutrition - ICU

2A.M2.00038 : Haemolytic uremic syndrome -

2A.M2.00038B : Haemolytic uremic syndrome - ICU

2A.M2.00054B : Neuromuscular disorders - ICU

2A.M2.00100 : Blood and blood component

2A.M2.00101 : High end radiological diagnostic (CT,

2A.M2.00102 : High end histopathology (Biopsies)

2A.S14.00005 : Undescended Testis - Bilateral-Palp +

2A.M1.00001D : Acute gastroenteritis with moderate Relevant Hematological investigations,

2A.M1.00001E : Acute gastroenteritis with moderate Relevant Hematological investigations,

2A.M1.00001F : Acute gastroenteritis with moderate Relevant Hematological investigations,

2A.M1.00001G : Acute gastroenteritis with moderate

2A.M1.00029F : Vasculitis - ICU with ventilator -

2A.M1.00068A : Blood and blood component

2A.M1.00004BG : Renal colic - ICU without ventilator

2A.M1.00004F : Renal colic - ICU with ventilator -

2A.M1.00027F : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray

2A.M1.00027G : Pericardial/ Pleural tuberculosis - clinical notes, Smear examination, X-ray

2A.M1.00026D : Pyrexia of unknown origin - clinical notes, Blood examination

2A.M1.00028D : Systematic lupus erythematosus -

2A.M1.00028E : Systematic lupus erythematosus -

2A.M1.00028F : Systematic lupus erythematosus -

2A.M1.00028G : Systematic lupus erythematosus -

APTT(activated partial thromboplastin

2A.S4.00019 : Bartholins Cyst Enucleation/ Incision

OT Note and Aminiotic fluid analysis

2A.S3.00029 : Cataract with foldable hydrophobic

2A.S3.00030 : Cataract with non-foldable IOL using

2A.S5.00002 : Accessory bone – Excision (limbs) –

X-ray, clinical photo of the part, HPE for

2A.S5.00023 : Clavicle fracture management -

2A.S5.00052 : Fracture - TIBIA Internal Fixation

2A.S5.00058 : Internal Fixation of other Small Bones

269 S5 2A.S5.00073 2A.S5.00073 : Percutaneous - Fixation of Fracture 3500 X-ray X-ray

2A.S5.00084 : Application of Skeletal Tractions with

2A.S8.00004A : Carpal Tunnel Release including pre