All Procedures

Cluster - 1 BURNS AND PLASTIC SURGERY
Specialt
Package Sub Pre-Operative Post Operative No of Package Procedure Code Government
Procedure Name Remarks y Code
No Specialty Investigation Investigation Follow up Rates PMJAY Reserve
PMJAY
20% burns or scalds/burns over face (with or without
1.1 Burns Clinical Photograph Clinical Photograph 3 23000 S11 S1112001 No
grafting)
1.2 Burns Up to 30% (with grafting) Clinical Photograph Clinical Photograph 3 34500 S11 S1112002 No
upto-40% with Scalds (Conservative/ without
1.3 Burns Clinical Photograph Clinical Photograph 3 28750 S11 S1112003 No
grafting)
1.4 Burns upto-40% Mixed Burns (with grafting) Clinical Photograph Clinical Photograph 3 40250 S11 S1100002 No
1.5 Burns upto-50% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 28750 S11 S1112004 No
1.6 Burns upto-50% Mixed Burns (with surgery grafting) Clinical Photograph Clinical Photograph 3 46000 S11 S1112005 No
1.7 Burns upto-60% with Scalds (Conservative) Clinical Photograph Clinical Photograph 3 46000 S11 S1112009 No
1.8 Burns Up to-60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 57500 S11 S1100003 No
1.9 Burns Above 60% Mixed Burns (with Surgeries) Clinical Photograph Clinical Photograph 3 63250 S11 S1100004 No
Post Burn Contracture surgeries for Functional
1.10 Burns Improvement(Package including splints, pressure Clinical Photograph Clinical Photograph 3 28175 S11 S1112006 No
garments and physiotherapy), Mild
garments and physiotherapy), Moderate
garments and physiotherapy), Severe
Reconstructive lower limb surgery following
Plastic
1.13 infection, Trauma, Tumors / Malignancy, Clinical photograph Clinical photograph 4 48300 S10 S1012001 No
Surgery
Developmental including diabetic foot – SEVERE
Plastic Abdominal wall reconstruction including post cancer
1.14 Clinical photograph Clinical photograph 4 40250 S10 S1012002 No
Surgery excision.
Plastic Reconstructive Micro surgery Replantation of hand,
1.15 Clinical photograph Clinical photograph 4 57500 S10 S1012003 No
Surgery finger, thumb, arm, scalp etc (Per finger 15000)
Plastic
1.16 Reconstructive Micro surgery B) free tissue transfer Clinical photograph Clinical photograph 4 57500 S10 S1012004 No
Surgery
Plastic
1.17 Flap surgeries b) myocutaneous flap Clinical photograph Clinical photograph 4 40250 S10 S1012005 No
Surgery
Plastic
1.18 Flap surgeries c) osteo myocutaneous flap Clinical photograph Clinical photograph 4 40250 S10 S1012006 No
Surgery
Plastic
1.19 operation for vascularmalformation Clinical photograph Clinical photograph 4 34500 S10 S1012007 No
Surgery
Plastic Government
1.20 Ear Reconstruction for Microtia (stage-I) Clinical photograph Clinical photograph 4 28750 S10 S1012008 Yes
Surgery Reserve
Plastic Government
1.21 Ear Reconstruction for Microtia (stage-II) Clinical photograph Clinical photograph 4 34500 S10 S1012009 Yes
Surgery Reserve
Plastic Government
1.22 Ear Reconstruction for Microtia (stage-III) Clinical photograph Clinical photograph 4 40250 S10 S1012010 Yes
Surgery Reserve
PLASTIC Corrective Surgery for Congenital deformity of Upper Government
1.23 Clinical photograph Clinical photograph 4 20000 S10 S1012011 Yes
REPAIR Limb (Per Procedure) Reserve
PLASTIC
1.24 Corrective Surgery for Craniosynostosis Clinical photograph Clinical photograph 4 50000 S10 S1012012 No
REPAIR
Clinical photograph and
% Total Body Surface Area Burns (TBSA) (thermal/
Burns/Plasti diagram with Rule of 9/ L
1.25 scald/ flame burns) - any % (not requiring Clinical photograph 2 7000 S11 S1100001 No
c Surgery & B Chart for extent of
admission). Needs at least 5-6 dressing
burns
Electrical contact burns: Low voltage- without part of
limb/limb loss; Includes % TBSA skin grafted, flap
1.29 cover, follow-up dressings etc. as deemed necessary; Clinical photograph 2 30000 S11 S1100005 No
Surgical procedures are required for deep burns that
burns
are not amenable to heal with dressings alone.
Electrical contact burns: Low voltage- with part of

burns
Electrical contact burns: High voltage- without part

of limb/limb loss; Includes % TBSA skin grafted, flap
burns
Electrical contact burns: High voltage- with part of

burns
Chemical burns: Without significant facial scarring
and/or loss of function; Includes % TBSA skin Clinical photograph and
Burns/Plasti grafted, flap cover, follow-up dressings etc. as diagram with Rule of 9/ L
1.33 Clinical photograph 2 40000 S11 S1100009 No
c Surgery deemed necessary; Surgical procedures are required & B Chart for extent of
for deep burns that are not amenable to heal with burns
dressings alone.
Chemical burns: With significant facial scarring
and/or loss of function; Includes % TBSA skin Clinical photograph and
Burns/Plasti grafted, flap cover, follow-up dressings etc. as diagram with Rule of 9/ L
1.34 Clinical photograph 2 60000 S11 S1100010 No
c Surgery deemed necessary; Surgical procedures are required & B Chart for extent of
for deep burns that are not amenable to heal with burns
dressings alone.
Plastic
1.35 Hemangioma – Sclerotherapy (under GA) Doppler/ MRI Clinical Photo 2 35000 S10 S1000003 No
Surgery
Plastic
1.36 Hemangioma – Debulking/ Excision MRI Clinical Photo 2 35000 S10 S1000004 No
Surgery
Tissue Expander for disfigurement following burns/
Plastic
1.37 trauma/ congenital deformity (including cost of Clinical Photo Clinical Photo 2 50000 S10 S1000005 No
Surgery
expander / implant)
Plastic
1.38 Scalp avulsion reconstruction Clinical Photo Clinical Photo 2 50000 S10 S1000006 No
Surgery
Plastic
1.39 NPWT (Inpatient only)(Per day Packege Amount) Clinical Photo Clinical Photo 2 2000 per day S10 S1000007 No
Surgery
Plastic
1.40 Pressure Sore – Surgery Clinical Photo Clinical Photo 2 30000 S10 S1000008 No
Surgery
Unspecified Surgical Package (Amount Capped @
Burns/Plasti
1.41 1,00,000rs per anum for family,Package amount is Concern Investigation Concern Investigation 1 100000 S11 U100 No
c Surgery
Negotiable)
Cluster - 2 CARDIOLOGY
Specialt
PMJAY
Intervention
2.1 CAG (Coronary Angiography) 2D ECHO - 0 4025 S12 S1212001 No
Cardiology
Intervention
2.2 Peripheral/ Renal Angiography 2D ECHO - 0 4025 S12 S1212002 No
Cardiology
Intervention
2.3 Coronary Ballon Angioplasty CAG - 5 24150 S12 S1212003 No
Cardiology
Intervention
2.4 Cath with Oxymetry 2D ECHO - 0 5520 S12 S1212004 No
Cardiology
Intervention
2.5 Cath without Oxymetry 2D ECHO - 0 4428 S12 S1212005 No
Cardiology
Intervention
2.6 Check Angiography 2D ECHO - 0 3335 S12 S1212006 No
Cardiology
Intervention Coronary Angiography + Peripheral/ Renal

2.7 2D ECHO - 0 4025 S12 S1212007 No
Cardiology Angiography
2.10 has been

modified tthen
2.10 Cardiology Renal/ Carotid /Peripheral Ballon Plasty (Unilateral) PAG - 5 23000 2.8 & 2.9 can S12 S1212008 No
be included in
2.10
Rare case cover
stent may be
Intervention
2.11 Aortic Stenting PAG - 5 60000 permitted after S12 S1212009 No
Cardiology
special
permission
Intervention
2.12 Ballon Atrial Septectomy – BAS 2D ECHO - 1 16100 S12 S1200001 No
Cardiology
Different size
Intervention
2.13 IVC filter - - 1 50000 and types of S12 S1212010 No
Cardiology
filter
Bi-Ventricular Pacing -
Intervention
2.14 Bi Ventricular Pacing - CRT ECG, ECHO, CAG CRT Report, ECG, ECHO, X- 1 290000 S12 S1212011 No
Cardiology
Ray Chest
AICD- Automatic After special
Implantable cardiac Permission in
Intervention AICD - Automatic Implantable Cardiac Defibrillator
2.15 A ECG, ECHO, CAG Defibrillator (with device) 1 310000 very Rare S12 S1212012 No
Cardiology (with device Single Chamber)
report, ECG, ECHO,X-Ray Case,as life
Chest saving
AICD- Automatic After special
Implantable cardiac Permission in
Intervention AICD - Automatic Implantable Cardiac Defibrillator
2.15 B ECG, ECHO, CAG Defibrillator (with device) 1 412000 very Rare S12 S1212013 No
Cardiology (with device Double Chamber)
report, ECG, ECHO, X-Ray Case,as life
Chest saving
After
Combo: AICD+Bi
specialPermissi
Intervention ventricular pacemaker
2.16 Combo: AICD+Bi ventricular pacemaker (with device) ECG, ECHO 1 597000 on in very Rare S12 S1212014 No
Cardiology (with device) report, ECG,
Case,as life
ECHO, X-Ray Chest
saving
Intervention
2.17 PTCA - one stent (non-medicated) CAG X-Ray 5 62100 S12 S1212015 No
Cardiology
Intervention
2.18 PTCA - 2 stent (non-medicated) CAG X-Ray 5 85100 S12 S1212016 No
Cardiology
Intervention
2.19 Balloon Mitral Valvotomy – BMV 2D ECHO 2D ECHO 1 20000 S12 S1200003 No
Cardiology
Intervention
2.20 Coarctation dilatation – BDC 2D ECHO 2D ECHO, x-RAY 1 16000 S12 S1200012 No
Cardiology
Intervention
2.21 Balloon Pulmonary Valvotomy – BPV 2D ECHO 2D ECHO 1 16100 S12 S1200004 No
Cardiology
Intervention
2.22 Balloon Aortic Valvotomy – BAV 2D ECHO 2D ECHO 1 16100 S12 S1200002 No
Cardiology
Intervention
2.23 Peripheral Angioplasty withstent 2D ECHO , ANGIOGRAM DOPPLER 5 50000 S12 S1212017 No
Cardiology
Intervention
2.24 Renal Angioplasty withstent ANGIOGRAM DOPPLER , X-RAY 5 55000 S12 S1200008 No
Cardiology
Intervention
2.25 Both side renal Angioplasty withstent ANGIOGRAM DOPPLER , X-RAY 5 80000 S12 S1212018 No
Cardiology
Intervention
2.26 Vertebral Angioplasty with stent ANGIOGRAM DOPPLER 5 55000 S12 S1200005 No
Cardiology
Intervention
2.27 Temporary Pacemaker implantation CAG , ECG ECHO , X-RAY 0 4600 S12 S1200021 No
Cardiology
Intervention Permanent pacemaker implantation (only VVI)

2.28 CAG , ECG ECHO , X-RAY 1 63250 S12 S1212019 No
Cardiology including Pacemaker value
Intervention
2.29 Pericardiocentesis 2D ECHO 2D ECHO 1 3450 S12 S1200020 No
Cardiology
Intervention
2.30 PDA Device Closure 2D ECHO 2D ECHO 1 50000 S12 S1200016 No
Cardiology
Intervention
2.31 ASD Device Closure 2D ECHO 2D ECHO , X-RAY 1 92000 S12 S1200014 No
Cardiology
Intervention
2.32 VSD Device Closure 2D ECHO 2D ECHO , X-RAY 1 92000 S12 S1200015 No
Cardiology
Intervention
2.33 PDA Coil (one) insertion 2D ECHO 2D ECHO , X-RAY 1 13800 S12 S1200018 No
Cardiology
Intervention
2.34 PDA Multiple coil insertion 2D ECHO 2D ECHO , X-RAY 1 23000 S12 S1200017 No
Cardiology
Intervention
2.35 IVUS angiogram IVUS report 0 4600 S12 S1212020 No
Cardiology
Intervention
2.36 EP study ECG, 2D Echo Clinical Photograph 0 11308 S12 S1212021 No
Cardiology
Intervention
2.37 RF Ablation ECG, 2D Echo Clinical Photograph 1 16100 S12 S1212022 No
Cardiology
Intervention
2.38 3D Maping + Ablation ECG, 2D Echo Clinical Photograph 1 27313 S12 S1212023 No
Cardiology
2D ECHO, CPKMB, ECG, 2D ECHO, ECG, LAB
2.39 Cardiology Medical treatment of Acute MI with Thrombolysis 1 17250 S12 S1200013 No
TROPONINE-T INVESTIGATION
2.40 Cardiology Thrombolysis for peripheral ischemia ECG, 2D Echo 0 1 11500 S12 S1200034 No
Intervention
2.41 Rotablation+ PTCA CAG X-Ray 5 34500 S12 S1200031 No
Cardiology
Intervention
2.42 Rotablation+ PTCA+ Stent X-Ray 5 80500 S12 S1200032 No
Cardiology
Intervention
2.43 Coiling (Coil clouser) 2D ECHO 2D ECHO,X-ray 5 20000 S12 S1212024 No
Cardiology
Intervention
2.44 Post mi vsd closure 2D ECHO,ECG 2D ECHO,X-ray 5 92000 S12 S1212025 No
Cardiology
Indication for
DES
1)Diabetes
2)Lesion >18
mm in length
3)vessel <2.5
Intervention mm in
2.45 PTCA - one stent (medicated) CAG X-ray 5 72000 S12 S1200024 No
Cardiology diametre
4)ISR (In Stent
Restenosis)
5)Bifurcation
or Osteal
Lesion
Indication for
DES
1)Diabetes
2)Lesion >18
mm in length
3)vessel <2.5
Intervention mm in
2.46 PTCA - 2 stent (medicated) CAG X-ray 5 100000 S12 S1200025 No
Cardiology diametre
4)ISR (In Stent
Restenosis)
5)Bifurcation
or Osteal
Lesion
Intervention PTCA - Additional Stent (Mediated)

2.60 28000 S1200026
Cardiology (Additional for more than 2 stent)
Intervention
2.47 IABP 2D Echo 2D Echo 0 15000 S12 S1212026 No
Cardiology
2D ECHO,Angiogram
2.48 Cardiology PDA stenting 2 40000 S12 S1200019 No
report & stills
2.49 Cardiology PTSMA CAG X-Ray 2 25000 S12 S1200027 No
2.50 Cardiology Pulmonary artery stenting CAG X-Ray 2 40000 S12 S1200028 No
2.51 Cardiology Pulmonary artery stenting (double) CAG X-Ray 2 65000 S12 S1200029 No
2.52 Cardiology Right ventricular outflow tract (RVOT) stenting CAG X-Ray 2 40000 S12 S1200030 No
Chest x-Ray/CT
Chest x-Ray/CT
2.53 Cardiology Bronchial artery Embolisation (for Haemoptysis) Scan,Serum 2 25000 S12 S1200035 No
Scan,Hb,Serum Creatinine
Creatinine,HB
Percutaneous Transluminal Tricuspid
2.54 Cardiology 2D ECHO 2D ECHO 2 25000 S12 S1200036 No
Commissurotormy (PTTC)
CT,Serum CT,Serum
Creatinine,PT(Prothromb Creatinine,PT(Prothrombi
2.55 Cardiology Coiling - Pseudoaneurysms of Abdomen 2 55000 S12 S1200037 No
in Time),International n Time),International
normalized ratio (INR) normalized ratio (INR)
CT,Serum CT,Serum
Embolization - Arteriovenous Malformation (AVM) in Creatinine,PT(Prothromb Creatinine,PT(Prothrombi
2.56 Cardiology 2 40000 S12 S1200038 No
the Limbs in Time),International n Time),International
normalized ratio (INR) normalized ratio (INR),HB
Catheter directed Thrombolysis for: Deep vein
2.57 Cardiology thrombosis (DVT), Mesenteric Thrombosis & PT,S.Creatinine ,CT/MRI PT,S.Creatinine 2 50000 S12 S1200039 No
Peripheral vessels
X Ray,MRI of
Angiogram report & film shoulder,Carton of the stent
2.59 Cardiology Carotid angioplasty with stent (medicated) 2 60000 S12 S1200007 No
showing the lesion used approved by FDA/DCGI
only,Doppler Report

2.58 Cardiology 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S12 U100 No
Negotiable)
Cluster - 3 CARDIO THORACIC & VASCULAR SURGERY
Specialt
PMJAY
3.1 Cardiac CABG CAG Clinical Photograph 5 78200 S13 S1300001 No
3.2 Cardiac Re DO CABG CAG Clinical Photograph 5 83375 S13 S1312001 No
3.3 Cardiac CABG with IABP 2D ECHO , CAG Clinical Photograph 5 93200 S13 S1312002 No
3.4 Cardiac CABG with Aneurismal repair CAG Clinical Photograph 5 96025 S13 S1312003 No
3.5 Cardiac CABG with MV repair 2D ECHO , CAG Clinical Photograph 5 97750 S13 S1312004 No
3.6 Cardiac CABG with post MI VSD repair 2D ECHO , CAG Clinical Photograph 5 99475 S13 S1300007 No
3.7 Cardiac Open Mitral Valvotomy 2D ECHO 2D ECHO 5 78200 S13 S1300008 No
3.8 Cardiac Open Aortic Valvotomy 2D ECHO 2D ECHO , X-RAY 5 78200 S13 S1312005 No
3.9 Cardiac Open Pulmonary Valvotomy 2D ECHO 2D ECHO 5 80500 S13 S1300010 No
3.10 Cardiac Mitral Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300011 No
3.11 Cardiac Tricuspid Valve Repair 2D ECHO 2D ECHO , X-RAY 5 92000 S13 S1300012 No
3.12 Cardiac Mitral Valve Repair + Tricuspid Valve Repair 2D ECHO 2D ECHO , X-RAY 5 119600 S13 S1312006 No
3.13 Cardiac Aortic Valve Repair 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300013 No
Bioprosthetic
Valve in special
case like
,during
3.14 Cardiac Mitral Valve Replacement 2D ECHO 2D ECHO , X-RAY 5 120750 S13 S1312007 No
pregnency
,Expecting
Woman ,Old
Age >70 yrs
Bioprosthetic
Valve in special
case like
,during
3.15 Cardiac Aortic Valve Replacement 2D ECHO 3D ECHO , X-RAY 5 128800 S13 S1312008 No
pregnency
,Expecting
Woman ,Old
Age >70 yrs
3.16 Cardiac Double Valve Replacement 2D ECHO 5D ECHO , X-RAY 5 152950 S13 S1312009 No
3.17 Cardiac Ross Procedure 2D ECHO 2D ECHO , X-RAY 5 120000 S13 S1300023 No
3.18 Cardiac ASD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300024 No
3.19 Cardiac VSD 2D ECHO 2D ECHO , X-RAY 5 86250 S13 S1300025 No
3.20 Cardiac AVSD/ AV Canal Defect 2D ECHO 2D ECHO , X-RAY 2 90850 S13 S1300026 No
3.21 Cardiac ICR for TOF 2D ECHO 2D ECHO , X-RAY 5 95000 S13 S1300027 No
2D ECHO, X-RAY, clinical
3.22 Cardiac Pulmonary Valvotomy + RVOT Resection 2D ECHO 5 90850 S13 S1300028 No
photograph
3.23 Cardiac AP Window 2D ECHO 2 57500 S13 S1300029 No
photograph
3.24 Cardiac Surgery for HOCM 2D ECHO/TEE 2 90850 S13 S1300030 No
photograph
3.25 Cardiac Ebsteins 2D ECHO 2 90850 S13 S1300031 No
photograph
3.26 Cardiac Fontan 2D ECHO 2 90850 S13 S1300032 No
photograph
2D ECHO , clinical
3.27 Cardiac TAPVC 2D ECHO 2 90850 S13 S1300033 No
photograph
2D ECHO , X-RAY, clinical
3.28 Cardiac Pulmonary Atresia with or without VSD 2D ECHO 2 97750 S13 S1312010 No
photograph
3.29 Cardiac TGA 2D ECHO/Angio 2 97750 S13 S1312011 No
photograph
3.30 Cardiac Arterial Switch Operation 2D ECHO/Angio 2 86250 S13 S1300035 No
photograph
3.31 Cardiac ALCAPA - - 2 86250 S13 S1312055 No
3.32 Cardiac Sennings 2D ECHO/Angio 2 74750 S13 S1300037 No
photograph
3.33 Cardiac Mustards 2D ECHO 2 86250 S13 S1300038 No
photograph
3.34 Cardiac Pulmonary Conduit 2D ECHO 2 105000 S13 S1312013 No
photograph
3.35 Cardiac Truncus Arteriosus Surgery 2D ECHO 2 97750 S13 S1300039 No
photograph
Root Replacement (Aortic Aneurysm/ Aortic 2D ECHO , X-RAY, clinical
3.36 Cardiac 2D ECHO 2 130000 S13 S1300040 No
Dissection) / Bental Procedure photograph
3.37 Cardiac Aortic Arch Replacement 2D ECHO 2 38065 S13 S1300041 No
photograph
3.38 Cardiac Aortic Aneurysm Repair using CPB 2D ECHO 2 125000 S13 S1300042 No
photograph
3.39 Cardiac Aortic Aneurysm Repair without using CPB 2D ECHO 2 65000 S13 S1300043 No
photograph
3.40 Cardiac Pulmonary Embolectomy / Endarterectomy ABG, 2D ECHO, X-Ray 2 92000 S13 S1312014 No
photograph
Surgery for Cardiac Tumour/ LA Myxoma/ RA 2D ECHO , X-RAY, clinical
3.41 Cardiac 2D ECHO 2 96600 S13 S1300045 No
Myxoma photograph
3.42 Cardiac Closed Mitral Valvotomy 2D ECHO 2D ECHO , X-RAY 2 23000 S13 S1300009 No
3.43 Cardiac PDA Closure 2D ECHO 2D ECHO , X-RAY 5 23000 S13 S1300046 No
3.44 Cardiac Coarctation Repair 2D ECHO, CAG Doppler 2 28750 S13 S1300047 No
3.45 Cardiac Coarctation Repair with graft 2D ECHO, CAG Doppler 2 36800 S13 S1300048 No
3.46 Cardiac BT Shunt (inclusives of grafts) 2D ECHO 2D ECHO, x-RAY 2 42000 S13 S1300049 No
3.47 Cardiac Glenn Shunt 2D ECHO 2D ECHO, x-RAY 2 57500 S13 S1300050 No
3.48 Cardiac Central Shunt 2D ECHO 2D ECHO, x-RAY 2 42000 S13 S1300051 No
3.49 Cardiac Aortic arch Anamolies 2D ECHO 2D ECHO, x-RAY 2 57500 S13 S1312016 No
3.50 Cardiac Pericardiectomy 2D ECHO 2D ECHO , X-RAY 2 34500 S13 S1300052 No
3.51 Cardiac Thoracoscopic surgery CT Chest X-Ray 2 40250 S13 S1312017 No
3.52 Cardiac Surgery without CPB CT Chest X-Ray 2 57500 S13 S1312018 No
3.53 Cardiac Surgery with CPB CT Chest X-Ray 2 57500 S13 S1312019 No
Clinical Photograph , X-
3.54 Thoracic Lobectomy CT-Chest , X-RAY 2 34500 S13 S1312020 No
RAY
3.55 Thoracic Pneumonectomy CT-Chest , X-RAY 2 46000 S13 S1312021 No
RAY
3.56 Thoracic Pleurectomy CT-Chest , X-RAY 2 46000 S13 S1312022 No
RAY
X-RAY,Biopsy , CT/ PET Biopsy , Clinical
3.57 Thoracic Decortication 1 51750 S13 S1312023 No
scan Photograph , X-RAY
3.58 Thoracic Mediastinotomy CT-Chest , X-RAY 2 28750 S13 S1312024 No
RAY
Biopsy , Clinical
3.59 Thoracic Pulmonary AV Fistula surgery Biopsy , CT , X-RAY 2 23000 S13 S1300053 No
Photograph , X-RAY
3.60 Thoracic Lung Cyst CT-Chest , X-RAY 2 34500 S13 S1300054 No
RAY
3.61 Thoracic SOL mediastinum CT-Chest , X-RAY 2 51750 S13 S1300055 No
RAY
Biopsy , Clinical
3.62 Thoracic Surgical Correction of Bronchopleural Fistula. Biopsy , CT , X-RAY 2 35000 S13 S1512026 No
Photograph , X-RAY
3.63 Thoracic Diaphragmatic Eventeration Barium Study, CT SCAN USG 2 46000 S13 S1300057 No
BArium Study, X-RAY, BIOPSY, CLINICAL
3.64 Thoracic Diaphragmatic Hernia 2 40000 S13 S1312025 No
ENDOSCOPY/ USG PHOTOGRAPH
3.65 Thoracic Oesophageal Diverticula /Achalasia Cardia Barium Study, CT SCAN USG 2 23000 S13 S1300058 No
3.66 Thoracic Diaphragmatic Injuries CT-Chest , X-RAY 2 23000 S13 S1300059 No
RAY
3.67 Thoracic Thoracotomy, Thoraco Abdominal Approach CT-Chest , X-RAY 2 34500 S13 S1300060 No
RAY
post ix-
CT-Chest ,
3.68 Thoracic Foreign Body Removal with scope ENDOSCOPY PICTURE 2 11500 endoscopy or S13 S1300061 No
BRONCHOSCOPY
ct chest
post ix-
CT-Chest ,
3.69 Thoracic Bronchial Repair Surgery for Injuries due to FB ENDOSCOPY PICTURE 2 28750 endoscopy or S13 S1300062 No
BRONCHOSCOPY
ct chest
post ix-
Gastro StudyFollowed by Thoracotomy & Repairs for
3.70 Thoracic GASTROSCOPY ENDOSCOPY PICTURE 2 16100 endoscopy or S13 S1312026 No
Oesophageal Injury for Corrosive Injuries/FB
ct thorax
ENDOSCOPY, X-RAY, Biopsy , Clinical
3.71 Thoracic Oesophageal tumour removal 2 28750 S13 S1312027 No
BARIUM STUDY Photograph , USG
Biopsy , CT , Endoscopy , Biopsy , Clinical
3.72 Thoracic Oesophagectomy 2 34500 S13 S1312028 No
USG Photograph , USG
3.73 Thoracic Lung Injury repair CT-Chest , X-RAY 2 23000 S13 S1300063 No
RAY
3.74 Thoracic Diaphragmatic injury repair CT-Chest , X-RAY 2 28750 S13 S1312029 No
RAY
3.75 Thoracic Thyomectomy CT-Chest , X-RAY 2 28750 S13 S1300064 No
RAY
3.76 Cardiac CABG with Post MI Cardiac repair CAG, 2D Echo,ECG 2D Echo, X-ray 5 100000 S13 S1312030 No
3.77 Cardiac Tricuspid valve replacement 2D Echo 2D Echo, X-ray 5 115000 S13 S1312031 No
2D Echo, X-ray,Clinical
3.78 Cardiac Root enlargement with/ without graft 2D Echo 5 90000 S13 S1312032 No
Photograph
3.79 Cardiac ICR 2D Echo 2D Echo, X-ray 5 90000 S13 S1312033 No
2D ECHO, X-Ray, Clinical
3.80 Cardiac Double Switch Operation 2D ECHO 2 120000 S13 S1300036 No
Photograph
3.81 Cardiac Pulmonary Valve Replacement 2D ECHO Scar Photo,ECHO 2 120000 S13 S1300065 No
Intercostal Drainage and Management of ICD, Post Op X-ray / CT
3.82 Cardiac Post Op X-ray / CT Scan 2 10000 S13 S1300066 No
Intercostal Block, Antibiotics & Physiotherapy Scan,Scar Photo
Post Op X-ray / CT
3.83 Cardiac Encysted Empyema/Pleural Effusion - Tubercular Post Op X-ray / CT Scan 2 10000 S13 S1300067 No
Scan,Scar Photo
First rib Excision by transaxillary approach, Excision
Post Op X-ray / CT
3.84 Cardiac of cervical rib / fibrous band / muscle by cervical Post Op X-ray / CT Scan 2 30000 S13 S1300068 No
Scan,Scar Photo
approach
Post Op X-ray / CT
3.85 Cardiac Congenital Cystic Lesions Post Op X-ray / CT Scan 2 30000 S13 S1300069 No
Scan,Scar Photo
Post Op X-ray / CT
3.86 Cardiac Pulmonary Sequestration Resection Post Op X-ray / CT Scan 2 40000 S13 S1300070 No
Scan,Scar Photo
Post Op X-ray / CT
3.87 Cardiac Pulmonary artero venous malformation Post Op X-ray / CT Scan 2 40000 S13 S1300071 No
Scan,Scar Photo
THORACIC CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH, Government
8.84 THORACOPLASTY 3 34500 S13 S612032 Yes
SURGERY X-RAY, CT SCAN THORAX X-RAY Reserve
Angiogram report, clinical
4.1 Vascular Patch Graft Angioplasty Regional angiogram 5 18400 S13 S1312034 No
Photograph
Femoropopliteal by pass procedure with graft (inclu.
4.2 Vascular ANGIO Doppler 5 51750 S13 S1312035 No
Graft)
4.3 Vascular Thromboembolectomy ANGIO Color Doppler 5 20700 S13 S1312036 No
Surgery for Arterial Aneursysm -Distal Abdominal Angiogram/spiral CT
4.4 Vascular Color Doppler 5 65000 S13 S1312037 No
Aorta Angiogram
Surgery for Arterial Aneursysm -Upper Abdominal Angiogram/spiral CT
4.5 Vascular Color Doppler 5 57500 S13 S1312038 No
Aorta Angiogram
Angiogram/spiral CT
4.6 Vascular Surgery for Arterial Aneursysm –Vertebral Color Doppler 5 23000 S13 S1312039 No
Angiogram
4.9 Vascular Dissecting Aneurysms with CPB (inclu. Graft) CT-Angio , Cath DOPPLER 5 94300 S13 S1312040 No
4.10 Vascular Dissecting Aneurysms without CPB (incl. graft) CT-Angio , Cath DOPPLER 5 86250 S13 S1312041 No
color
4.11 Vascular Vascular Procedure – Major Vessels Color Doppler 5 23000 S13 S1312042 No
Doppler/Angiogram
color
4.12 Vascular Vascular Procedure – Minor Vessels Color Doppler 5 20000 S13 S1312043 No
Doppler/Angiogram
Renal arterial
4.13 Vascular Surgery for Arterial Aneurysm Renal Artery Clinical Photograph 5 17250 S13 S1300076 No
Doppler,angiogram
4.14 Vascular Surgery for Arterial Aneurysm Carotid Carotid Doppler Clinical Photograph 5 17250 S13 S1312044 No
Surgery for Arterial Aneursysm Main Arteries of the
4.15 Vascular Peripheral Doppler Clinical Photograph 5 17250 S13 S1312045 No
Limb
4.16 Vascular Operations for Acquired Arteriovenous Fistual regional Angiogram Clinical Photograph 5 11500 S13 S1312046 No
4.17 Vascular Congenital Arterio Venous Fistula regional Angiogram Clinical Photograph 5 17250 S13 S1300077 No
Renal arterial
4.18 Vascular Operations for Stenosis of Renal Arteries Clinical Photograph 5 23000 S13 S1300078 No
Doppler,angiogram
Angiogram/spiral CT
4.19 Vascular Peripheral Embolectomy without graft Color Doppler 5 17250 S13 S1312047 No
Angiogram
Angiogram/spiral CT
4.20 Vascular Aorto Billiac / Bifemoral bypass with Synthetic Graft Color Doppler 5 86250 S13 S1300079 No
Angiogram
Angiogram/spiral CT
4.21 Vascular Axillo bifemoral bypass with Synthetic Graft Color Doppler 5 86250 S13 S1312048 No
Angiogram
Angiogram/spiral CT
4.22 Vascular Femoro Distal Bypass with Vein Graft Color Doppler 5 57500 S13 S1300080 No
Angiogram
Angiogram/spiral CT
4.23 Vascular Femoro Distal Bypass with Synthetic Graft Color Doppler 5 70000 S13 S1300081 No
Angiogram
Angiogram/spiral CT
4.24 Vascular Axillo Brachial Bypass using with Synthetic Graft Color Doppler 5 69000 S13 S1300082 No
Angiogram
Angiogram/spiral CT
4.25 Vascular Brachio - Radial Bypass with Synthetic Graft Color Doppler 5 57500 S13 S1300083 No
Angiogram
Angiogram/spiral CT
4.26 Vascular Excision of Carotid body Tumor with vascular repair Color Doppler 5 34500 S13 S1300084 No
Angiogram
Angiogram/spiral CT
4.27 Vascular Carotid artery bypass with Synthetic Graft Color Doppler 5 69000 S13 S1300085 No
Angiogram
Spiral CT Angiogram
4.28 Vascular Excision of Arterio Venous malformation – Large Color Doppler 5 57500 S13 S1300086 No
/MRI Angiogram
Spiral CT Angiogram
4.29 Vascular Excision of Arterio Venous malformation – Small Color Doppler 5 30000 S13 S1300087 No
/MRI Angiogram
Angiogram/colour
4.30 Vascular Arterial Embolectomy Color Doppler/SBP/PVR 5 17250 S13 S1312049 No
Doppler
4.31 Vascular D V T - IVC Filter color Doppler Plain X-ray abdomen 5 28750 S13 S1300088 No
Angiogram/Spiral CT
4.32 Vascular Vascular Tumors Color Doppler 5 46000 S13 S1312050 No
Angiogram
Angiogram/Spiral CT
4.33 Vascular Small Arterial Aneurysms – Repair Color Doppler 5 11500 S13 S1312051 No
Angiogram
Angiogram/Spiral CT
4.34 Vascular Medium size arterial aneurysms – Repair Color Doppler 5 17250 S13 S1312052 No
Angiogram
Angiogram/Spiral CT
4.35 Vascular Medium size arterial aneurysms with synthetic graft Color Doppler 5 34500 S13 S1312053 No
Angiogram
4.36 Vascular Carotid endarterectomy ANGIOGRAM X-RAY/DOPPLER 5 28750 S13 S1300089 No
Intrathoracic Aneurysm-Aneurysm not Requiring
4.37 Vascular CT Angio, CATH Doppler 2 74750 S13 S1300074 No
Bypass Techniques
Intrathoracic Aneurysm-Requiring Bypass
4.38 Vascular CT Angio, CATH Doppler 2 86250 S13 S1300075 No
Techniques
Angioplasty stills showing
Aortic Angioplasty with two stents / Iliac angioplasty
4.39 Vascular PAG Balloon & post flow,Scar 2 90000 S13 S1300090 No
with stent Bilateral
Photo
Duplex
4.40 Vascular Bilateral thrombo embolectomy ultrasound/Angiogram - Scar Photo 2 30000 S13 S1300091 No
pre or intra operative
Angiogram/ Computed
Tomography
Aorto-uni-iliac/uni-femoral bypass with synthetic Duplex ultrasound,Scar
4.41 Vascular Angiography (3D- 2 70000 S13 S1300092 No
graft Photo
CTA)/Magnetic
Resonance Angiography
4.42 Vascular 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S13 U100 No
Negotiable)
Cluster - 5 GENITO URINARY SURGERY (RENAL)
Specialt
Procedure name Remarks y Code
no Specialty Investigation Investigation Follow up Rates PMJAY Reserve
PMJAY
Clinical Photograph , USG

5.1 Urology Open Pyelolithotomy IVP , KUB , USG 2 15000 S7 S700028 No
, X-RAY, urine analysis

5.2 Urology Open Nephrolithotomy IVP , KUB , USG 2 15000 S7 S700030 No
, X-RAY, urine analysis
5.3 Urology Open Cystolithotomy IVP , KUB , USG 2 10000 S7 S712028 No
, X-RAY
5.4 Urology VVF Repair IVP , KUB , USG 3 23000 S7 S712001 No
, voiding cystogram
5.6 Urology Cystolithotripsy IVP , KUB , USG 2 10000 S7 S700061 No
RAY
IVP , KUB , USG, Spiral CT Clinical Photograph , X-
5.7 Urology PCNL (Percutaneous Nephro Lithotomy) 2 23000 S7 S700025 No
KUB RAY KUB, USG KUB
5.8 Urology ESWL (Extra carporial shock-wave lithotripsy) IVP , KUB , USG X-RAY and USG KUB 2 8625 S7 S700026 No
IVP , KUB , USG, Spiral CT
5.9 Urology URSL X-RAY KUB 2 10000 S7 S712002 No
KUB
5.10 Urology Nephrostomy (PCN) IVP , USG Clinical Photograph 1 5750 S7 S712003 No
5.11 Urology DJ stent (One side) IVP , USG X-RAY KUB 1 5750 S7 S712004 No
RGU & MCU,
RGU & MCU,
5.12 Urology Urethroplasty for Stricture Diseases-single stage Uroflometry, Clinical 1 25000 S7 S712029 No
Uroflometry
Photograph
RGU & MCU,
RGU & MCU,
5.13 Urology Urethroplasty for Stricture Diseases-First Stage Uroflometry, Clinical 2 18000 S7 S712005 No
Uroflometry
Photograph
RGU & MCU,
RGU & MCU,
5.14 Urology Urethroplasty for Stricture Diseases-Second Stage Uroflometry, Clinical 3 18000 S7 S712006 No
Uroflometry
Photograph
Clinical Photograph,
5.15 Urology Hypospadiasis(Adult) USG,Clinical Photograph 3 20700 S7 S712007 No
Uroflowmetry
5.16 Urology TURBT Biopsy , CT , USG, ECHO Biopsy , USG KUB 3 28750 S7 S700062 No
Biopsy , USG bladder and
5.17 Urology TURP USG, Uroflometry, ECHO 3 24150 S7 S700093 No
prostate
Biopsy , CT KUB , USG, Biopsy , Clinical
5.18 Urology Simple Nephrectomy 3 20700 S7 S700006 No
Renal Scan Photograph , USG
USG, CT, ECHO, Renal Biopsy , Clinical
5.19 Urology Lap. Nephrectomy Simple 3 20700 S7 S700007 No
Scan Photograph , USG
CT, KUB , USG, Renal Biopsy , Clinical
5.20 Urology Lap. Nephrectomy Radical 6 25300 S7 S700009 No
Scan Photograph , USG
CBC, S. CREATININE,
Urology/ RETROGRADE INTRARENAL SURGERY WITH LASER URINE R/M, URINE C/S,
5.22 X RAY KUB, USG KUB 5 30000 S7 S712008 No
Nephrology LITHOTRIPSY PT/ APTT, X RAY KUB,
IVP, USG KUB
CBC, S. CREATININE,
URINE R/M, URINE C/S, X
Urology/ USG KUB,
5.24 HOLMIUM ENUCLEATION OF PROSTATE RAY KUB, USG KUB, S. 5 30000 S7 S700094 No
Nephrology UROFLOWMETRY
PSA, UROFLOWMETRY,
S. ELECTROLYTES
CBC, S. CREATININE,
Urology/
5.30 CHECK CYSTOSCOPY URINE R/M, USG KUB, - 5 5750 S7 S700067 No
Nephrology
URINE CYTOLOGY
CBC, S. CREATININE,
Urology/ URINE R/M, URINE C/S,
5.31 CYSTOSCOPY + URINE SAMPLING + B/L RGP - 5 9200 S7 S700057 No
Nephrology PT/ APTT, X RAY KUB,
USG KUB
CBC, S. CREATININE,
Urology/ COLOSTOMY & SUPRAPUBIC URINARY DIVERSION
5.41 URINE R/M, USG KUB, - 5 23000 S7 S712009 No
Nephrology FOR PELVIC FRACTURE INJURY
RGU + MCU
CBC, S. CREATININE,
5.45 SURGERY FOR URETHRORECTAL FISTULA MCU 5 28750 S7 S712010 No
Nephrology USG KUB, RGU + MCU,
CT ABDOMEN
CBC, S. CREATININE,
5.46 OPEN SURGERY FOR COLOVESICAL FISTULA MCU 5 34500 S7 S712011 No
Nephrology USG KUB, RGU + MCU,
CT ABDOMEN
CBC, S. CREATININE,
URINE C/S, X RAY KUB, S. CREATININE, USG KUB,
Urology/ OPEN NEPHROURETERECTOMY WITH BLADDER CUFF
5.54 USG KUB, CECT CHEST X RAY, CT 5 34500 S7 S700014 No
Nephrology EXCISION
ABDOMEN, LFT, CHEST X ABDOMEN
RAY, URINE CYTOLOTY
CBC, S. CREATININE,
URINE C/S, X RAY KUB, S. CREATININE, USG KUB,
Urology/ LAPAROSCOPIC NEPHROURETERECTOMY WITH
5.55 USG KUB, CECT CHEST X RAY, CT 5 51750 S7 S700015 No
Nephrology BLADDER CUFF EXCISION
ABDOMEN, LFT, CHEST X ABDOMEN
RAY, URINE CYTOLOTY
CBC, S. CREATININE,
Urology/ URINE R/M, URINE C/S, X USG KUB, DIURETIC
5.57 OPEN URETEROCALICOSTOMY 5 34500 S7 S700020 No
Nephrology RAY KUB, IVP, USG KUB, RENAL SCAN
DIURETIC RENAL SCAN
CBC, S. CREATININE,
Urology/ URINE R/M, URINE C/S, X USG KUB, DIURETIC
5.58 LAPAROSCOPIC URETEROCALICOSTOMY 5 40250 S7 S700021 No
Nephrology RAY KUB, IVP, USG KUB, RENAL SCAN
DIURETIC RENAL SCAN
CBC, S. CREATININE,
Urology/
5.59 OPEN HEMINEPHRECTOMY FOR FUSION ANOMALY RAY KUB, CT IVU, USG USG KUB 5 34500 S7 S712012 No
Nephrology
KUB, DIURETIC RENAL
SCAN
CBC, S. CREATININE,
Urology/ LAPROSCOPIC HEMINEPHRECTOMY FOR FUSION
5.60 RAY KUB, CT IVU, USG USG KUB 5 40250 S7 S712013 No
Nephrology ANOMALY
KUB, DIURETIC RENAL
SCAN
CBC, S. CREATININE,
Urology/ OPEN ANATROPHIC NEPHROLITHOTOMY ( For URINE R/M, URINE C/S, X USG KUB, X RAY KUB, S.
5.61 5 34500 S7 S712014 No
Nephrology Staghorn Stone) RAY KUB, CT IVU, USG CREATININE
KUB
CBC, S. CREATININE,
Urology/ OPEN URETERAL REIMPLANTATION FOR URINE R/M, URINE C/S, USG KUB, DIURETIC IVP,
5.66 5 34500 S7 S700044 No
Nephrology URETEROVAGINAL FISTULA PT/ APTT, X RAY KUB, MCU
IVP, USG KUB, MCU
CBC, S. CREATININE,
Urology/ LAPAROSCOPIC URETERAL REIMPLANTATION FOR URINE R/M, URINE C/S, USG KUB, DIURETIC IVP,
5.67 5 46000 S7 S700046 No
Nephrology URETEROVAGINAL FISTULA PT/ APTT, X RAY KUB, MCU
IVP, USG KUB, MCU
CBC, S. CREATININE,
Urology/
5.68 LAPAROSCOPIC VVF REPAIR URINE R/M, URINE C/S, MCU 5 43700 S7 S700085 No
Nephrology
IVP, USG KUB, MCU
CBC, S. CREATININE,
Urology/
5.71 URETEROLYSIS FOR RETROPERITONEAL FIBROSIS URINE R/M, URINE C/S, DIURETIC IVP 5 34500 S7 S712015 No
Nephrology
CT IVU, USG KUB
CBC, S. CREATININE,
Urology/ URINE CYTOLOGY, URINE USG KUB, CT IVU,
5.78 OPEN RADICAL CYSTECTOMY WITH NEOBLADDER 5 80500 S7 S700075 No
Nephrology C/S,CT ABDOMEN, USG POUCHOGRAM
KUB, CHEST X RAY
CBC, S. CREATININE,
URINE CYTOLOGY, URINE CBC, S. CREATININE, ABG,
Urology/
5.80 OPEN RADICAL CYSTECTOMY WITH MAINZ 2 POUCH C/S,CT ABDOMEN, USG USG ABDOMEN, CT IVU, 5 57500 S7 S712016 No
Nephrology
KUB, CHEST X RAY, COLONOSCOPY
COLONOSCOPY
CBC, S. CREATININE,
MCU, URINE C/S,CT
Urology/
5.82 OPEN AUGMENTATION CYSTOPLASTY ABDOMEN, USG KUB, MCU 5 57500 S7 S700089 No
Nephrology
CHEST X RAY, URINE AFB,
IVP
CBC, S. CREATININE,
Urology/ OPEN BLADDER DIVERTICULECTOMY WITH URETERIC URINE R/M, URINE C/S,
5.84 MCU, DMSA RENAL SCAN 5 34500 S7 S700091 No
Nephrology REIMPLANTATION USG KUB, MCU, DMSA
SCAN
USG SCROTUM,
Urology/ DOPPLER SCROTUM / AFP, LDH, B HCG, CT
5.91 OPEN ORCHIECTOMY (SIMPLE / RADICAL) 5 17250 S7 S712017 No
Nephrology AFP, LDH, B HCG, CT ABDOMEN
ABDOMEN
Urology/ OPEN ILEAL REPLACEMENT FOR URETERIC CT IVU, MCU, URINE FOR
5.108 DIURETIC IVP 5 57500 S7 S712018 No
Nephrology STRICTURE AFB, USG ABDOMEN
Urology/ CT IVU, MCU, USG
5.111 OPEN BOARI FLAP MCU 5 28750 S7 S700052 No
Nephrology ABDOMEN
CBC, S. CREATININE,
Urology/
5.124 OPEN URETEROLYSIS URINE R/M, URINE C/S, DIURETIC IVP 5 34500 S7 S712019 No
Nephrology
CT IVU, USG KUB
Urology/ CT ABDOMEN,
5.126 OPEN COLOVAGINAL FISTULA REPAIR BARIUM ENEMA 5 34500 S7 S712020 No
Nephrology COLONOSCOPY
CBC, S. CREATININE,
Urology/
5.127 URETHROVAGINAL FISTULA REPAIR URINE R/M, URINE C/S, MCU 5 34500 S7 S700087 No
Nephrology
IVP, USG KUB, MCU
Urology/
5.135 RADIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 6440 S7 S712022 No
Nephrology
Urology/
5.136 BRACHIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 8280 S7 S712023 No
Nephrology
CBC, S.CRETAIN, BL
Urology/ MAINTENANCE HEMODIALYSIS (MHD) (WITH INJ. UREA, S. Na+ /S.K+,
5.142 - 0 2300 S7 S712024 No
Nephrology ERYTHROPOETINE WITH INJ. IRON) –PER DIALYSIS. HIV(ELLISA), HCV
(ELLISA), HBS Ag (ELLISA)
Intervention Permanent tunnelled catheter placement as Colour Doppler/

5.143 Clinical Photograph 0 16000 S7 S712025 No
al Radiology substitute for AV fistula in long term dialysis Peripheral Angiogram
Intervention Endovascular intervention for salvaging hemodialysis Colour Doppler/ Government

5.144 Clinical Photograph 0 40000 S7 S712026 Yes
al Radiology AV fistula Peripheral Angiogram Reserve
Intervention Colour Doppler/

5.145 SPC for atony bladder Clinical Photograph 3 20000 S7 S712027 No
al Radiology Peripheral Angiogram
clinical
5.146 Urology Adrenalectomy-unilateral, open Clinical photograph,USG 2 25000 S7 S700001 No
notes,CT/MRI/USG
clinical
5.147 Urology Adrenalectomy-unilateral, Laparoscopic Clinical photograph,USG 2 30000 S7 S700002 No
notes,CT/MRI/USG
clinical
5.148 Urology Adrenalectomy-bilateral, open Clinical photograph,USG 2 32000 S7 S700003 No
notes,CT/MRI/USG
clinical
5.149 Urology Adrenalectomy-biilateral, Laparoscopic Clinical photograph,USG 2 40000 S7 S700004 No
notes,CT/MRI/USG
clinical
5.150 Urology Paraganglioma excision with liver mobilization Clinical photograph,USG 2 50000 S7 S700005 No
notes,CT/MRI/USG
5.151 Urology Nephrectomy-Radical (Renal tumor) Open USG ,CT / MRI HPEE 2 25000 S7 S700008 No
5.152 Urology Nephrectomy-Partial or Hemi, Open USG ,CT / MRI HPEE 2 30000 S7 S700010 No
5.153 Urology Nephrectomy-Partial or Hemi, Laparoscopic USG ,CT / MRI HPEE 2 35000 S7 S700011 No
5.154 Urology Nephro ureterectomy (Benign) Open Renal Scan(DTPA) HPEE 2 25000 S7 S700012 No
5.155 Urology Nephro ureterectomy (Benign) Laparoscopic Renal Scan(DTPA) HPEE 2 30000 S7 S700013 No
5.156 Urology Endopyelotomy (retrograde with laser/bugbee) USG,X Ray,IVP/CT USG 2 25000 S7 S700018 No
5.157 Urology Endopyelotomy (antegrade with laser/bugbee) USG,X Ray,IVP/CT USG 2 28000 S7 S700019 No
5.158 Urology Uretero-ureterostomy Open USG,X Ray,IVP/CT USG 2 25000 S7 S700022 No
5.159 Urology Uretero-ureterostomy Laparoscopic USG,X Ray,IVP/CT USG 2 35000 S7 S700023 No
5.160 Urology Pyelolithotomy-Laparoscopic USG,X Ray,IVP/CT USG 2 30000 S7 S700029 No
5.161 Urology Perinephric Abscess drainage (percutaneous) USG/CT USG 2 10000 S7 S700032 No
5.162 Urology Perinephric Abscess drainage (Open) USG/CT USG 2 20000 S7 S700033 No
5.163 Urology Renal Cyst deroofing or marsupialization-Open USG/CT USG 2 20000 S7 S700034 No
Renal Cyst deroofing or marsupialization-
5.164 Urology USG/CT USG 2 30000 S7 S700035 No
Laparoscopic
5.165 Urology Ureterolithotomy-Open USG,X Ray,IVP/CT Clinical photograph,USG 2 20000 S7 S700037 No
5.166 Urology Ureterolithotomy-Laparoscopic USG,X Ray,IVP/CT Clinical photograph,USG 2 30000 S7 S700038 No
5.167 Urology Ureterotomy (Cutaneous) USG,X Ray,IVP/CT Clinical photograph,USG 2 20000 S7 S700042 No
5.168 Urology Endoureterotomy (laser/bugbee) USG,X Ray,IVP/CT Clinical photograph,USG 2 20000 S7 S700043 No
USG KUB,CT Urography/

5.169 Urology Uretero-vaginal/uterine fistula repair open USG 2 27000 S7 S700048 No
MRI Urography
USG KUB,CT Urography/

5.170 Urology Uretero-vaginal/uterine fistula repair Laparoscopic USG 2 37000 S7 S700049 No
MRI Urography
5.171 Urology Boari flap for ureteric stricture, Laparoscopic USG,IVP/CT USG 2 40000 S7 S700053 No
Ureterocele incision including cystoscopy, ureteric
5.172 Urology USG,IVP/CT USG 2 15000 S7 S700058 No
catheterization, retrograde pyelogram
5.173 Urology Urachal Cyst excision -open USG,IVP/CT USG 2 15000 S7 S700059 No
5.174 Urology Cystolithotomy-open, including cystoscopy USG,IVP/CT USG 2 15000 S7 S700060 No
5.175 Urology Urethral Stone endoscopic, including cystoscopy USG,IVP/CT USG 2 10000 S7 S700061 No
TUR-fulgration (Transurethral fulgration of the
5.176 Urology USG/CT USG/HPEE 2 18000 S7 S700063 No
Bladder Tumor)
CBC, S. Cretanine, Urine-
5.177 Urology Bladder Neck incision-endoscopic R/M, USG KUB, Urine CLINICAL NOTES 2 15000 S7 S700068 No
Cytology
Extrophy Bladder repair including osteotomy if
5.178 Urology Clinical Photo Clinical Photo 2 50000 S7 S700069 No
needed + epispadias repair + ureteric reimplant
clinical notes,CT
5.181 Urology Partial Cystectomy-open Clinical Photo, HPEE 2 20000 S7 S700073 No
Scan/USG/MRI /MCU
clinical notes,CT
5.182 Urology Partial Cystectomy-Laparoscopic Clinical Photo, HPEE 2 30000 S7 S700074 No
Scan/USG/MRI /MCU
clinical notes,CT
5.183 Urology Radical cystectomy with continent diversion-open Clinical Photo, HPEE 2 50000 S7 S700076 No
Scan/USG/MRI /MCU
clinical notes,CT
5.184 Urology Radical Cystectomy with Ileal Conduit-open Clinical Photo, HPEE 2 50000 S7 S700077 No
Scan/USG/MRI /MCU
clinical notes,CT
5.185 Urology Radical Cystectomy with ureterostomy-open Clinical Photo, HPEE 2 35000 S7 S700078 No
Scan/USG/MRI /MCU
Radical Cystectomy with ureterosigmoidostomy- clinical notes,CT
5.186 Urology Clinical Photo, HPEE 2 35000 S7 S700079 No
open Scan/USG/MRI /MCU
clinical notes,CT
5.187 Urology Other Cystectomies Clinical Photo, HPEE 2 40000 S7 S700080 No
Scan/USG/MRI /MCU
Suprapubic Cystostomy - Open, as an independent clinical notes,CT
5.188 Urology Clinical Photo 2 10000 S7 S700081 No
procedure Scan/USG/MRI
clinical notes,CT
5.189 Urology Suprapubic Drainage - Closed/Trocar Clinical Photo 2 5000 S7 S700082 No
Scan/USG/MRI
clinical notes,CT
5.190 Urology VVF/Uterovaginal Repair - Transvaginal approach Clinical Photo 2 25000 S7 S700083 No
Scan/USG/MRI /IVP
clinical notes,CT
5.191 Urology VVF/Uterovaginal Repair - Abdominal,Open Clinical Photo 2 25000 S7 S700084 No
Scan/USG/MRI /IVP
Hysterectomy as part of VVF/uterovaginal fistula clinical notes,CT
repair (top-up) Scan/USG/MRI /IVP
Y V Plasty of Bladder Neck/Bladder Neck clinical notes,CT
Reconstruction Scan/USG/MRI
clinical notes,CT
5.196 Urology Augmentation cystoplasty-Laparoscopic Clinical Photo 2 40000 S7 S700090 No
Scan/USG/MRI
clinical notes,CT
5.197 Urology Open simple prostatetctomy for BPH Clinical Photo 2 25000 S7 S700092 No
Scan/USG/MRI
5.199 Urology TURP/Laser + Circumcision USG, Uroflowmetry HPEE, USG 2 30000 S7 S700095 No
5.200 Urology TURP/Laser + Cystolithotripsy USG, Uroflowmetry HPEE, USG 2 30000 S7 S700096 No
5.201 Urology TURP/Laser + Cystolithotomy-open USG, Uroflowmetry HPEE, USG 2 35000 S7 S700097 No
5.202 Urology TURP/Laser + Orchidectomy USG, Uroflowmetry HPEE, USG 2 30000 S7 S700098 No
5.203 Urology TURP/Laser + TURBT USG, Uroflowmetry HPEE, USG 2 30000 S7 S700099 No
5.204 Urology TURP/Laser + URS with stone removal USG, Uroflowmetry HPEE, USG 2 40000 S7 S700100 No
5.205 Urology TURP/Laser + VIU (visual internal Ureterotomy) USG, Uroflowmetry HPEE, USG 2 40000 S7 S700101 No
5.206 Urology TURP/Laser + Hydrocele surgery USG, Uroflowmetry HPEE, USG 2 40000 S7 S700102 No
5.207 Urology TURP/Laser + Hernioplasty USG, Uroflowmetry HPEE, USG 2 40000 S7 S700103 No
5.208 Urology TURP/Laser + Urethral dilatation-non endoscopic USG, Uroflowmetry HPEE, USG 2 40000 S7 S700104 No
5.209 Urology TURP/Laser + Urethral dilatation-endoscopic USG, Uroflowmetry HPEE, USG 2 40000 S7 S700105 No
5.210 Urology Radical prostatectomy - laparoscopic USG HPEE, USG 2 70000 S7 S700107 No
Transrectal Ultrasound guided prostate biopsy
5.211 Urology USG HPEE, USG 2 10000 S7 S700108 No
(minimum 12 core)
5.212 Urology Reduction of Paraphimosis Clinical Photo Clinical Photo 2 2000 S7 S700109 No
5.213 Urology Excision of Urethral Caruncle Clinical Notes Clinical Photo 2 6000 S7 S700110 No
5.214 Urology Meatoplasty Clinical Photo Clinical Photo 2 3500 S7 S700111 No
5.215 Urology Meatotomy Clinical Photo Clinical Photo 2 3500 S7 S700112 No
5.216 Urology Post Urethral Valve fulguration USG, MCU USG 2 10000 S7 S700113 No
clinical notes,RGU/MCU/
5.217 Urology Urethroplasty-End to end RGU/MCU 2 20000 S7 S700114 No
Uroflowmetry
clinical notes,RGU/MCU/
5.218 Urology Urethroplasty-Transpubic RGU/MCU 2 30000 S7 S700117 No
Uroflowmetry
5.219 Urology Perineal Urethrostomy without closure USG, Clinical Notes Clinical Photo 2 20000 S7 S700119 No
5.220 Urology Urethrorectal fistula repair Dye Study Clinical Notes 2 40000 S7 S700120 No
Urethral Dilatation-non endocopic as an
5.221 Urology Clinical Notes Clinical Notes 2 2000 S7 S700121 No
independent procedure
Urethral Dilatation-endocopic as an independent
5.222 Urology Clinical Notes Clinical Notes 2 5000 S7 S700122 No
procedure
Internal Urethrotomy including cystoscopy as an
5.223 Urology clinical notes,RGU/MCU Clinical Notes 2 10000 S7 S700123 No
independent procedure
5.224 Urology Orchiopexy-without laparoscopy, unilateral USG, Clinical Notes USG 2 15000 S7 S700126 No
5.225 Urology Orchiopexy-without laparoscopy, bilateral USG, Clinical Notes USG 2 15000 S7 S700127 No
5.226 Urology Orchiopexy-with laparoscopy, unilateral USG, Clinical Notes USG 2 30000 S7 S700128 No
5.227 Urology Orchiopexy-with laparoscopy, bilateral USG, Clinical Notes USG 2 30000 S7 S700129 No
5.228 Urology Stress incontinence surgery, open Clinical Notes Uroflowmetry 2 20000 S7 S700130 No
5.229 Urology Stress incontinence surgery, laparoscopic Clinical Notes Uroflowmetry 2 30000 S7 S700131 No
5.230 Urology Stress incontinence surgery with slings Clinical Notes Uroflowmetry 2 35000 S7 S700132 No
5.231 Urology Partial Penectomy Clinical Notes Clinical Notes 2 15000 S7 S700133 No
5.232 Urology Total Penectomy + Perineal Urethrostomy Clinical Notes Clinical Notes 2 20000 S7 S700134 No
5.233 Urology Ilio-Inguinal lymphadenectomy-unilateral USG/FNAC HPEE 2 15000 S7 S700135 No
5.234 Urology Ilio-Inguinal lymphadenectomy-bilateral USG/FNAC HPEE 2 25000 S7 S700136 No
Pelvic lymphadenectomy open, after prior cancer CT/MRI/USG
5.235 Urology HPEE 2 25000 S7 S700137 No
surgery pelvis,clinical notes
Pelvic lymphadenectomy laparoscopic, after prior CT/MRI/USG
5.236 Urology HPEE 2 30000 S7 S700138 No
cancer surgery pelvis,clinical notes
5.237 Urology Orchiectomy-simple USG/CT Abdomen pelvis HPEE 2 10000 S7 S700140 No
CT/MRI,USG Abdomen
5.238 Urology Retroperitoneal lymph node dissection-Laparoscopic HPEE 2 35000 S7 S700143 No
pelvis,clinical notes
5.239 Urology Infertility-Scrotal exploration unilateral Semen Analysis Clinical Notes/HPEE 2 10000 S7 S700144 No
5.240 Urology Infertility-Scrotal exploration bilateral Semen Analysis Clinical Notes/HPEE 2 12000 S7 S700145 No
Infertility-Vasoepididymostomy, microsurgical,
5.241 Urology USG Vasography 2 15000 S7 S700146 No
unilateral
Infertility-Vasoepididymostomy, microsurgical,
5.242 Urology USG Vasography 2 20000 S7 S700147 No
bilateral
5.243 Urology Varicocele-unilateral-non microsurgical Doppler Doppler 2 10000 S7 S700148 No
5.244 Urology Varicocele-unilateral-microsurgical Doppler Doppler 2 12000 S7 S700149 No
5.245 Urology Varicocele-bilateral-non microsurgical Doppler Doppler 2 15000 S7 S700150 No
5.246 Urology Varicocele-bilateral-microsurgical Doppler Doppler 2 20000 S7 S700151 No
Penile prosthesis insertion, Malleable (Indian
5.247 Urology Clinincal History implant sticker 2 30000 S7 S700152 No
implant)
5.248 Urology Priapism-aspiration/shunt Clinical Notes Clinical Notes 2 15000 S7 S700153 No
Neurogenic bladder-Package for
evaluation/investigation (catheter + ultrasound + Clinical assessment and
5.249 Urology Clinical Notes 2 7500 S7 S700154 No
culture + RGU/ MCU) for 1 month (medicines - investigations
antibiotics). Follow up visit once in 3 months
Chronic prostatitis-Package for
evaluation/investigation (ultrasound + culture + Clinical assessment and
5.250 Urology Clinical Notes 2 2500 S7 S700155 No
prostate massage) for 1 month (medicines). Follow investigations
up visit once in 3 months
Emergency management of Ureteric stone - Package
Clinical assessment and
5.251 Urology for evaluation/investigation (ultrasound + culture) Clinical Notes 2 3500 S7 S700156 No
investigations
for 3 weeks (medicines).
Emergency management of Hematuria (Package rete Package rete
5.252 Urology Daily Urine- RM Clinical Notes 2 2000 S7 S700157 No
per day) per day
Emergency management of Acute retention of Urine Package rete
5.253 Urology Clinincal Notes/USG Clinical Notes 2 2000 S7 S700158 No
(Package rete per day) per day
Acute management of upper urinary tract trauma – Package rete
5.254 Urology USG/CT, Clinical History Clinical Notes 2 2000 S7 S700159 No
conservative (Package rete per day) per day
5.255 Urology Urinary tract trauma – open surgery (exploratory) USG/CT, Clinical History Clinical Notes 2 20000 S7 S700160 No
5.256 Urology Urinary tract trauma – Laparoscopy surgery USG/CT, Clinical History Clinical Notes 2 30000 S7 S700161 No
Pyeloplasty/pyeloureterostomy/pyelopyelostomy
5.257 Urology USG,X Ray,IVP/CT USG 2 25000 S7 S700016 No
Open
Pyeloplasty/pyeloureterostomy/pyelopyelostomy
5.258 Urology USG,X Ray,IVP/CT USG 2 30000 S7 S700017 No
Laparoscopic
CLINICAL PHOTOGRAPH,
8.62 UROLOGY OPERATION FOR INJURY OF BLADDER X-RAY, USG ABD, CT 3 32200 S7 S612019 No
X-RAY
SCAN ABD
8.63 UROLOGY URETHRAL INJURY X-RAY, USG ABD, CT 3 28750 S7 S612020 No
X-RAY
SCAN ABD
8.64 UROLOGY URETHRAL RECONSTRUCTION X-RAY, USG ABD, CT 3 34500 S7 S612021 No
X-RAY
SCAN ABD
5.259 Urology 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S7 U100 No
Negotiable)
Cluster - 6 NEUROSURGERY/NEUROLOGY/INTERVENTIONAL NEURORADIOLOGY
Specialt
PMJAY
Craniotomy and Evacuation of Haematoma
6.1 Brain CT Clinical Photograph 3 57040 S8 S812001 No
–Subdural
Craniotomy and Evacuation of Haematoma –
Extradural
6.3 Brain Excision of Brain Tumor Supratentorial- Parasagital CT Clinical Photograph 3 51750 S8 S812003 No
6.4 Brain Excision of Brain Tumor Supratentorial-Basal CT Clinical Photograph 3 51750 S8 S812004 No
6.5 Brain Excision of Brain Tumor - Brainstem CT Clinical Photograph 3 70000 S8 S812005 No
6.6 Brain Excision of Brain Tumor - C P Angle CT Clinical Photograph 3 50000 S8 S812006 No
6.7 Brain Excision of Brain Tumor Supratentorial & others CT Clinical Photograph 3 34500 S8 S800056 No
6.8 Brain Excision of Brain Tumors – Infratentorial MRI Clinical Photograph 3 110000 S8 S812007 No
Brain /
Spinal
6.9 Intervention with coiling / embolisation procedures DSA DSA 3 85000 S8 S812008 No
(Endovascul
ar)
Ventriculoatrial /Ventriculoperitoneal/ Ventriculo-
other Shunt
6.11 Brain Twist Drill Craniostomy CT Clinical Photograph 3 18630 S8 S800051 No
6.12 Brain Subdural Tapping CT Clinical Photograph 3 17020 S8 S812010 No
6.13 Brain Abscess Tapping Single CT Clinical Photograph 3 17250 S8 S800057 No
6.14 Brain Abscess Tapping multiple CT Clinical Photograph 3 23920 S8 S800058 No
6.15 Brain Meningo Encephalocele MRI Clinical Photograph 3 34270 S8 S812011 No
6.17 Brain C.S.F. Rhinorrhoea (Transcranial / Transnasal) CT Clinical Photograph 3 75000 S8 S812012 No
6.18 Brain Cranioplasty CT , Clinical Photograph Clinical Photograph 3 27830 S8 S812013 No
6.20 Brain Excision of Brain Abcess CT Clinical Photograph 3 28750 S8 S800059 No
6.21 Brain Aneurysm Clipping MRI Angio / DSA 3 34500 S8 S800060 No
RAY
Brain /
Spinal
6.22 Carotid angioplasty with stent ANGIOGRAM DOPPLER , X-RAY 3 60000 S8 S812014 No
(Endovascul
ar)
Brain /
Spinal
6.23 Carotid angioplasty without stent ANGIOGRAM DOPPLER , X-RAY 3 40000 S8 S812015 No
(Endovascul
ar)
6.24 Brain External Ventricular Drainage (EVD) CT Clinical Photograph 3 28750 S8 S812016 No
Biopsy , Clinical
6.25 Spinal Spinal Cord Tumours (extramedullary) MRI 3 34270 S8 S812017 No
Photograph
6.26 Spinal Excision of Cervical Inter-Vertebral Discs MRI Clinical Photograph 3 34270 S8 S812018 No
6.27 Spinal Anterior Cervical Spine Surgery with fusion MRI Clinical Photograph 3 34270 S8 S812019 No
6.28 Spinal Anterio Lateral Decompression MRI Clinical Photograph 3 17250 S8 S812020 No
6.29 Spinal Laminectomy-Cervical/dorsal/lumbar MRI Clinical Photograph 3 34270 S8 S812021 No
6.30 Spinal Discectomy-Dorsal MRI Clinical Photograph 3 28520 S8 S812022 No
6.31 Spinal Discectomy-Lumbar MRI Clinical Photograph 3 28520 S8 S812023 No
6.32 Spinal Discectomy + cost of implant MRI Clinical Photograph 3 34270 S8 S812024 No
Biopsy , Clinical
6.33 Spinal Spinal Intra Medullary Tumours MRI 3 68540 S8 S812025 No
Photograph , X-RAY
6.34 Spinal Spina Bifida Surgery Major MRI 3 28750 S8 S812026 No
RAY
6.35 Spinal Spina Bifida Surgery Minor MRI 3 20700 S8 S812027 No
RAY
Brain /
6.36 Stereotaxic Procedures (Framed / Frameless) CT/MRI Clinical Photograph 3 50000 S8 S800065 No
Spinal
Brain /
Spinal
6.37 Vertebral artery Stenting ANGIOGRAM DOPPLER 3 60000 S8 S812028 No
(Endovascul
ar)
AAD Transoral surgery and CV Junction (With Posterior
6.38 MRI , X-Ray Cerical Spine Clinical Photograph 3 125000 S8 S812029 No
Surgeries Fixation)
AAD Biopsy , Clinical
6.39 Trans oral Surgery CT 3 39790 S8 S800071 No
Surgeries Photograph
Biopsy , Clinical
6.40 Brain Trans Sphenoidal Surgery CT, MRI 3 34040 S8 S812030 No
Photograph
6.41 Brain RF Lesions for Trigminal Neuralgia MRI Clinical Photograph 3 28750 S8 S800050 No
Neuro
6.44 Muscle Biopsy with report EMG, NCV Biopsy 3 17250 S8 S800074 No
muscular
6.45 Brain MVD MRI Clinical Photograph 3 45000 S8 S812031 No
Neuro
6.46 Nerve Biopsy with report EMG, NCV Biopsy 3 8625 S8 S812032 No
Surgery
Neuro
6.47 Nerve Decompression MRI Clinical Photograph 3 17250 S8 S800075 No
Surgery
Neuro
6.48 Peripheral Nerve Surgery Major EMG, NCV Clinical Photograph 3 34500 S8 S800076 No
Surgery
Neuro
6.49 Peripheral Nerve Surgery Minor EMG, NCV Clinical Photograph 3 17250 S8 S800077 No
Surgery
MRI SPINE +CT SPINE-
C.V.JUNCTIO
6.50 POSTERIOR FIXATION ALONE FLEXION/ EXTENTION/ X RAY SPINE 5 65000 S8 S812033 No
N
NEUTRAL
6.51 BRAIN SURGERY FOR ORBITAL TUMORS/PROPTOSIS MRI CONTRAST/ CECT CECT+BIOPSY REPORT 5 90000 S8 S812034 No
BRAIN+SPIN
6.52 INFRATENTORIAL TUMOR WITH SPINAL EXTENSION MRI CONTRAST/ CECT CECT+BIOPSY REPORT 5 100000 S8 S812035 No
E
VASCULAR MALFORMATION SURGERY/Procedure
6.53 BRAIN CTA/MRA/DSA CTA+BIOPSY 5 120000 S8 S812036 No
(SUPRATENTORIAL/INFRATENTORIAL)
EPILEPSY SURGERY-GRID INSERTION + LOCALISATION MRI BRAIN (1.5/3 TESLA)

6.54 BRAIN CT BRAIN 5 110000 S8 S812037 No
+SURGERY/Procedure +VEEG +CT SCAN
MRI BRAIN (1.5/3 TESLA)
6.55 BRAIN EPILEPSY SURGERY-LESIONECTOMY CT BRAIN 5 60000 S8 S812038 No
+EEG
MRI BRAIN (1.5/3 TESLA)
6.56 BRAIN EPILEPSY SURGERY- ATL/AH FOR MTS CT BRAIN 5 70000 S8 S812039 No
+EEG
CT BRAIN +BIOPSY
6.57 SKULL BONY TUMOR OF SKULL CECT 5 50000 S8 S812040 No
REPORT
6.58 BRAIN ENDOSPIC BRAIN SURGERIES (DIAGNOSTIC) MRI BRAIN/CT BRAIN CT BRAIN 5 30000 S8 S812041 No
ENDOSPIC BRAIN SURGERIES (THIRD
6.59 BRAIN MRI BRAIN/CT BRAIN CT BRAIN 5 45000 S8 S812042 No
VENTRICULOSTOMY)
ENDOSPIC BRAIN SURGERY (AQUEDUCTOPLASTY)
6.60 BRAIN MRI BRAIN/ CT BRAIN CT BRAIN 5 50000 S8 S812043 No
WITHOUT IMPLANT
ENDOSPIC BRAIN SURGERY (AQUEDUCTOPLASTY)
6.61 BRAIN MRI BRAIN/ CT BRAIN CT BRAIN 5 60000 S8 S812044 No
WITH IMPLANT
ENDOSPIC BRAIN SURGERIES ( TUMOUR/CYST
6.62 BRAIN MRI BRAIN/CT BRAIN CT BRAIN +BIOPSY 5 60000 S8 S812045 No
EXISION)
PAIN MANAGEMENT SURGERY RELATED RELATED
6.63 NERVE 3 40000 S8 S812046 No
(SYMPETHECTOMY/RHIZOTOMY) INVESTIGATIONS INVESTIGATIONS
MRI CV JUNCTION + CT
C.V.JUNCTIO C V JUNCTION DECOMPRESSION (POSTERIOR) CV JUNCTION-
6.64 X RAY SPINE 3 70000 S8 S812047 No
N (ARNOLD-CHIARY MALFORMATION AND OTHERS) FLEXION/EXTENTION/NE
UTRAL
6.65 SKULL BONE FLAP REMOVAL CT BRAIN CT BRAIN 3 35000 S8 S812048 No
CORPECTOMY AND FIXATION
6.66 SPINE MRI SPINE X RAY SPINE 5 65000 S8 S812049 No
CERVICAL/DORSAL/LUMBER(SINGLE LEVEL)
CORPECTOMY AND FIXATION
6.67 SPINE MRI SPINE X RAY SPINE 5 80000 S8 S812050 No
CERVICAL/DORSAL/LUMBER (MULTIPLE LEVEL)
6.68 SPINE CERVICAL SPINE STABLISATION ANTERIOR MRI SPINE X RAY SPINE 5 60000 S8 S812051 No
CERVICAL SPINE STABLISATION-POSTERIOR Level
6.69 A SPINE MRI SPINE X RAY SPINE 5 50000 S8 S812052 No
one
6.69 B SPINE MRI SPINE X RAY SPINE 5 60000 S8 S812071 No
two
CERVICALSPINE STABLISATION-GLOBAL (Anterior &
Posterior combine)
6.70 B SPINE MRI SPINE X RAY SPINE 5 70000 S8 S812072 No
three
6.70 C SPINE MRI SPINE X RAY SPINE 5 80000 S8 S812075 No
four
6.71 SPINE DL SPINE STABLISATION-ANTERTIOR MRI SPINE X RAY SPINE 5 60000 S8 S812054 No
6.72 A SPINE DL SPINE STABLISATION-POSTERIOR Level one MRI SPINE X RAY SPINE 5 50000 S8 S812055 No
6.72 B SPINE DL SPINE STABLISATION-POSTERIOR Level two MRI SPINE X RAY SPINE 5 60000 S8 S812073 No
DL SPINE STABLISATION-GLOBAL (Anterior &
Posterior combine)
6.73 B SPINE DL SPINE STABLISATION-POSTERIOR Level three MRI SPINE X RAY SPINE 5 70000 S8 S812074 No
6.73 C SPINE DL SPINE STABLISATION-POSTERIOR Level four MRI SPINE X RAY SPINE 5 80000 S8 S812076 No
6.74 SKULL CRANIOSYNOSTOSIS SURGERY MRI+3D CT BRAIN CT BRAIN 5 100000 S8 S800009 No
6.75 SPINE LAMINOPLASTY CERVICAL/DORSAL/LUMBER MRI SPINE X RAY SPINE 3 50000 S8 S812057 No
DIAGNOSTIC CEREBRAL/SPINAL ANGIOGRAPHY (DSA- RELATED
6.76 BRAIN CT BRAIN/MRI SPINE 0 12000 S8 S812058 No
DIGITAL SUBSTRACTION ANGIOGRAPHY) INVESTIGATIONS
6.77 SPINE ENDOSCOPIC SPINE SURGERY MRI SPINE X RAY SPINE 3 40000 S8 S812059 No
6.78 SPINE THECO-PERITONEAL SHUNT MRI BRAIN/CT BRAIN X RAY SPINE+CSF REPORT 3 30000 S8 S812060 No
MRI BRAIN/CT BRAIN
6.79 BRAIN CRANIO-FACIAL RESECTION CT BRAIN +FACE 5 90000 S8 S812061 No
+FACE
BRAIN
6.80 REVASCULA ST-MCA BYPASS/EC-ICA BYPASS CTA/MRA/DSA CTA 5 95000 S8 S812062 No
RISATION
6.81 VASCULAR CAROTID LIGATION FOR CCF/GIANT ANEURYSM CTA/MRA/DSA CTA 5 30000 S8 S812063 No
REEXPLORATION FOR DEBRIDEMENT/CSF
6.82 BRAIN CT BRAIN CT BRAIN 3 25000 S8 S812064 No
LEAK/HAEMATOMA
REANIMATI CONCERNED CONCERNED
6.83 FACIAL NERVE REANIMATION 5 40000 S8 S812065 No
ON INVESTIGATIONS INVESTIGATIONS
X RAY SPINE +BIOPSY
6.84 SPINE TRANSPEDICULAR BIOPSY MRI SPINE CONTRAST 1 25000 S8 S812066 No
REPORT
X RAY SPINE +BIOPSY
6.85 SPINE VERTEBROPLASTY/KYPHOPLASTY MRI SPINE 5 50000 S8 S812067 No
REPORT
Craniotomy and Evacuation of Haematoma -
6.86 Brain NCCT BRAIN NCCT BRAIN 5 90000 S8 S812068 No
Intracranial Spontaneous / Traumatic
Decompressive Craniectomy - For Infarct / Lesion
6.87 Brain NCCT BRAIN NCCT BRAIN 5 70000 S8 S812069 No
with mass effect on brain
SUPRATENTORIAL TUMOUR WITH INFRATENTORIAL MRI/CT BRAIN (WITH
6.88 BRAIN CECT+BIOPSY REPORT 5 100000 S8 S812070 No
TUMOR EXTENSION CONTRAST)
60000
(Payment
fraction (
1st week-
40%,2nd (Payment
fraction ( 1st
week-
week-40%,2nd
25%,3rd
MEDICAL MRI brain with week-25%,3rd
6.89* CONSERVATIVE MANAGEMENT (ISCHEMIC STROKE) CT brain plain,others 3 week- S8 S812086 No
NEUROLOGY angiography week-15%,4th
15%,4th week-10%,5th
week- week-10%) of
10%,5th total package
week-10%) rate)
of total
package
rate)
120000
(Payment
fraction (
1st week-
55%,2nd (Payment
fraction ( 1st
week-
week-55%,2nd
Repeat CT brain after 24 15%,3rd
MEDICAL THROMBOLYSIS WITH ACTILYSE FOR ISCHEMIC week-15%,3rd
6.90* CT brain plain,others hours,MRI brain with 3 week- S8 S812087 No
NEUROLOGY STROKE week-10%,4th
angiography 10%,4th week-10%,5th
week- week-10%) of
week-10%) rate)
of total
package
rate)
40000
(Payment
fraction (
1st week-
40%,2nd (Payment
week- fraction ( 1st
week-40%,2nd
25%,3rd
MEDICAL INTRAPARENCHYMAL /SUBARACHNOID Repeat CT brain plain , CT week-25%,3rd
6.91* CT brain plain,others 3 week- S8 S812088 No
NEUROLOGY HEMMORRHAGE (CONSERVATIVE MANAGEMENT) angiography brain week-15%,4th
week- week-10%) of
week-10%) rate)
of total
package
rate)
110000
(Payment
fraction (
1st week-
40%,2nd (Payment
fraction ( 1st
week-
week-40%,2nd
25%,3rd
MEDICAL MENINGOENCEPHALITIS, OR/ AND EVD/VP shunt CT brain plain,CSF week-25%,3rd
6.92* MRI brain with contrast 3 week- S8 S812089 No
NEUROLOGY (CONSERVATIVE MANAGEMENT) ,others week-15%,4th
week- week-10%) of
week-10%) rate)
of total
package
rate)
110000
(Payment
fraction (
1st week-
40%,2nd (Payment
Anyone of the week- fraction ( 1st
Clinical diagnosis by week-40%,2nd
following:repetitive nerve 25%,3rd
MEDICAL MYASTHENIA CRISIS MANAGEMENT BY neurophysician OR week-25%,3rd
6.93* stimulation,ACH-R 3 week- S8 S812080 No
NEUROLOGY PLASMAPHERESIS previously diagnosed week-15%,4th
antibody,Anti-MUSK 15%,4th week-10%,5th
case
antibody week- week-10%) of
week-10%) rate)
of total
package
rate)
200000
(Payment
fraction (
1st week-
55%,2nd (Payment
Anyone of the fraction ( 1st
week-
Clinical diagnosis by week-55%,2nd
following:repetitive nerve 15%,3rd
MEDICAL MYASTHENIA CRISIS MANAGEMENT BY IV neurophysician OR week-15%,3rd
6.94* stimulation,ACH-R 3 week- S8 S812081 No
NEUROLOGY IMMUNOGLOBINS previously diagnosed week-10%,4th
case
antibody week- week-10%) of
week-10%) rate)
of total
package
rate)
109627
(Payment
fraction (
1st week-
40%,2nd (Payment
fraction ( 1st
week-
week-40%,2nd
25%,3rd
MEDICAL Gullian-barre syndrome management by Clinical diagnosis by week-25%,3rd
6.95* CSF study, NCV/EMG 3 week- S8 S812082 No
NEUROLOGY plasmapheresis neurophysician week-15%,4th
week- week-10%) of
week-10%) rate)
of total
package
rate)
200000
(Payment
fraction (
1st week- (Payment
55%,2nd fraction ( 1st
week- week-55%,2nd
15%,3rd week-15%,3rd
MEDICAL Gullian-barre syndrome management by Clinical diagnosis by
6.96* CSF study, NCV/EMG 3 week- week-10%,4th S8 S812083 No
NEUROLOGY Intravenous immunoglobulin neurophysician
week- week-10%) of
week-10%) rate)
of total
package
rate)
6.97 Neurology Anterior Encephalocele CT Brain/ MRI Brain CT Brain 2 50000 S8 S800001 No
Carpal Tunnel Release including pre and post Op.
6.100 Neurology MRI, EMG/NCV - 2 10000 S8 S800004 No
MRI
X-Ray Cervical Spine/ X-Ray Cervical Spine/
6.101 Neurology Cervical Ribs – Bilateral 2 35000 S8 S800005 No
Chest X-Ray, CT Scan Chest X-Ray, CT Scan
X-Ray Cervical Spine/ X-Ray Cervical Spine/
6.102 Neurology Cervical Ribs – Unilateral 2 20000 S8 S800006 No
Chest X-Ray, CT Scan Chest X-Ray, CT Scan
6.103 Neurology Duroplasty - Endogenous CT Brain CT Brain 2 12500 S8 S800010 No
Implant cost
Duroplasty - Exogenous(Implant cost is not iclluded will added
6.104 Neurology CT Brain Plain CT Brain 2 12500 S8 S800011 No
in package rate) seperatly in
this package
Haematoma (Child subdural) inclusive of General
6.105 Neurology CT Brain CT Brain 2 50000 S8 S800014 No
anaesthesia, pre and post Op. CT
6.106 Neurology Laminectomy with Fusion and fixation MRI Spine X-Ray Spine. 2 50000 S8 S800015 No
6.107 Neurology Laminectomy with Fusion MRI Spine X-Ray Spine. 2 40000 S8 S800016 No
6.108 Neurology Local Neurectomy CT/MRI Clinical Photograph 2 16000 S8 S800017 No
X Ray/ Post OP Operative
6.109 Neurology Meningocele – Anterior Brain , Spinal Cord MRI 2 36000 S8 S800019 No
Site
6.110 Neurology Meningocele – Lumbar Brain , Spinal Cord MRI 2 36000 S8 S800020 No
Site
6.111 Neurology Meningococcal – Occipital Clinical Photo/MRI/CT 2 50000 S8 S800021 No
Site
6.113 Neurology Spine - Canal Stenosis CT/MRI CT 2 40000 S8 S800027 No
6.114 Neurology Spine - Extradural Haematoma MRI Spine X-Ray Spine. 2 30000 S8 S800032 No
6.115 Neurology Spine - Extradural Haematoma with fixation MRI Spine X-Ray Spine. 2 40000 S8 S800033 No
6.116 Neurology Spine - Intradural Haematoma MRI X-Ray Spine. 2 40000 S8 S800036 No
6.117 Neurology Spine - Intradural Haematoma with fixation MRI Spine X-Ray Spine. 2 50000 S8 S800037 No
6.118 Neurology Spine - Intramedullar Tumour CT/MRI HPEE 2 50000 S8 S800038 No
6.119 Neurology Spine - Intramedullar Tumour - fixation MRI Spine Biopsy , X-Ray Spin 2 60000 S8 S800039 No
6.120 Neurology Brain Biopsy MRI Brain/ CT Brain Biopsy 2 15000 S8 S800045 No
6.121 Neurology Cranial Nerve Anastomosis concecrned Investigation concecrned Investigation 2 32000 S8 S800046 No
6.122 Neurology Depressed Fracture CT Brain CT Brain 2 40000 S8 S800047 No
6.123 Neurology Peripheral Neurectomy (Trigeminal) MRI Biopsy 2 16500 S8 S800049 No
X Ray + Clinical Photo of
6.124 Neurology Additonal clip for Aneurysm Clipping MRI ANGIO/DSA 2 15000 S8 S800061 No
Operative Site
X Ray + Clinical Photo of
6.125 Neurology Cervical Disc Multiple level without Fusion MRI Spine 2 40000 S8 S800068 No
Operative Site
6.126 Neurology Foramen Magnum Decompression CT/MRI X-Ray 2 45000 S8 S800072 No
Arterio venous malformation (AVM) excision X-Ray , Clinical Photo of
6.127 Neurology MRA/DSA Report 2 50000 S8 S800079 No
(whatever size and location) Operative Site
HistoPatho Repot +
6.128 Neurology Scalp Arterio venous malformation (AVM) CT/MRI ANGIO Clinical Photo of 2 25000 S8 S800080 No
Operative Site
Gamma Knife radiosurgery (GKRS)/ SRS for tumours/
6.129 Neurology CT/MRI Clinical Photo 2 75000 S8 S800083 No
Arteriovenous malformation (AVM)
Intervention
Coil embolization for aneurysms (includes cost of
al
6.130 first 3 coils + balloon and/ or stent if used) 1 to 20 DSA/CT/MRI ANGIO CT/MR ANGIO 2 1,00,000 S9 S900001 No
Neuroradiol
coils may be required as per need.
ogy
Intervention
al
6.131 Additional coil for coil embolization for aneurysms DSA/CT/MRI ANGIO CT/MR ANGIO 2 24000 S9 S900002 No
Neuroradiol
ogy
Intervention
al
6.132 Dural AVMs/AVFs (per sitting) with glue DSA/CT/MR ANGIO CT/MR ANGIO 2 70000 S9 S900003 No
Neuroradiol
ogy
Intervention
al
6.133 Dural AVMs/AVFs (per sitting) with onyx DSA/CT/MR ANGIO CT/MR ANGIO 2 1,50,000 S9 S900004 No
Neuroradiol
ogy
Intervention
Carotico-cavernous Fistula (CCF) embolization with
al
6.134 coils. [includes 5 coils, guide catheter, micro- DSA/CT/MR ANGIO CT/MR ANGIO 2 1,50,000 S9 S900005 No
Neuroradiol
catheter, micro-guidewire, general items]
ogy
Intervention
Carotid-cavernous Fistula (CCF) embolization with
al
6.135 balloon (includes one balloon, guide catheter, micro- DSA/CT/MR ANGIO CT/MR ANGIO 2 75000 S9 S900006 No
Neuroradiol
catheter, micro-guidewire, general items)
ogy
Intervention
al Cerebral & Spinal AVM embolization (per sitting).
6.136 DSA/CT/MR ANGIO CT/MR ANGIO 2 1,00,000 S9 S900007 No
Neuroradiol Using Histoacryl
ogy
Intervention
al
6.137 Parent vessel occlusion - Basic CT/MR ANGIO CT/MR ANGIO 2 30000 S9 S900008 No
Neuroradiol
ogy
Intervention
al
6.138 Additonal coil for Parent Vessel Occlusion DSA/CT/MR ANGIO CT/MR ANGIO 2 24000 S9 S900009 No
Neuroradiol
ogy
Intervention
al
6.139 Additonal balloon for Parent Vessel Occlusion DSA/CT/MR ANGIO CT/MR ANGIO 2 11000 S9 S900010 No
Neuroradiol
ogy
Intervention
al
6.140 Balloon test occlusion CT/MR ANGIO CT/MR ANGIO 2 70000 S9 S900011 No
Neuroradiol
ogy
Intervention
al
6.141 Intracranial balloon angioplasty with stenting DSA/CT/MR ANGIO CT/MR ANGIO 2 1,60,000 S9 S900012 No
Neuroradiol
ogy
Intervention
al
6.142 Intracranial thrombolysis / clot retrieval DSA/CT/MR ANGIO CT/MR ANGIO 2 1,60,000 S9 S900013 No
Neuroradiol
ogy
Intervention
al
6.143 Pre-operative tumour embolization (per session) DSA/CT/MR ANGIO CT/MR ANGIO 2 40000 S9 S900014 No
Neuroradiol
ogy
NEUROSUR CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH,
8.76 SKULL TRACTION 3 12880 S8 S612027 No
GERY X-RAY, CT SCAN BRAIN X-RAY

8.77 BURR HOLE 3 28750 S8 S612028 No
8.78 TEMPORAL BONE RESECTION 3 57500 S8 S612029 No

8.79 SKULL BASE SURGERY 3 69000 S8 S612030 No
NEUROSUR
8.88 DEFORMITY SURGERY FOR SPINE (KYPHO/SCOLIOSIS) Clinical Photograph, Xray Clinical Photograph, Xray 3 150000 S8 S612036 No
GERY
Pre-op. Doppler Post-op. Doppler
NEUROSUR
8.89 Plexus injury along with Vascular injury repair/ graft study,Nerve Conduction study,Clinical photo 2 60000 S8 S600002 No
GERY
study,CT showing scar
Clinical photograph
NEUROSUR Head injury requiring Facio-Maxillary Injury repairs &
8.91 X-RAY/CT showing scar,Post- op. X- 2 35000 S8 S600004 No
GERY fixations (including implants)
ray
NEUROSUR
6.144 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S8 U100 No
GERY
Negotiable)
Cluster - 7 PAEDIATRIC SURGERY
Specialt
PMJAY
Gastro
Oesophageal atresia –1.pure atresia- first X-ray with infant feeding
7.1 Intestinal Clinical Photograph 3 23000 S14 S1412001 No
stage(‘o’stomy & ‘G’stomy) tube or Dye study
Tract
Gastro
Oesophageal atresia –2.pure atresia- second 2D-ECHO, Dye study,
stage(oesaphageal replacement) ultrasound
Tract
Gastro
X-ray with infant feeding
7.3 Intestinal 3.tracheo-oesphageal fistula(type c) Clinical Photograph 3 40250 S14 S1412003 No
tube or Dye study
Tract
Gastro
7.4 Intestinal 4. H- type fistula Dye study, Bronchoscopy Clinical Photograph 1 40000 S14 S1412004 No
Tract
Gastro
7.5 Intestinal Intestinal Atresias & Obstructions X-RAY /CT Clinical Photograph 3 46000 S14 S1412005 No
Tract
Gastro
7.6 Intestinal Biliary Atresia HIDA scan Clinical Photograph 3 46000 S14 S1412006 No
Tract
Gastro
7.7 Intestinal Choledochal Cyst MRCP or CT scan Clinical Photograph 3 46000 S14 S1412007 No
Tract
Gastro
BArium Study, X-RAY, BIOPSY, CLINICAL
7.8 Intestinal Diaphragmatic Hernia 1 40000 S14 S1400031 No
ENDOSCOPY/ USG PHOTOGRAPH
Tract
Gastro
Invertogram or clinical
7.9 Intestinal Anorectal Malformation1. Low ARM(male & female) Clinical Photograph 3 18400 S14 S1412008 No
photograph
Tract
Gastro
Invertogram or clinical
7.10 Intestinal 2.Intermediate & High variety a. Stage 1 colostomy Clinical Photograph 3 30000 S14 S1412009 No
photograph
Tract
Gastro
2-D ECHO,
7.11 Intestinal b. Stage two PSARP/Abdominoperineal Pull through Clinical Photograph 3 34500 S14 S1412010 No
ULTRASOUND, Dye Study
Tract
Gastro
7.12 Intestinal c. Stage three colostomy closure/ Ileostomy closure Clinical photograph Clinical Photograph 3 35000 S14 S1412011 No
Tract
ANORECTAL MALFORMATION.[Colostomy, iliostomy/
Gastro
pouchostomy (first stage of male/female ARM, Invertogram or clinical
cloaca, pouch colon or hirschsprung diease] photograph,
Tract
Gastro
Second stage- PSARVUP/Abdominoperineal Pull 2-D ECHO, ULTRASOUND
through Definitive surgery Dye Study
Tract
Gastro
2-D ECHO, ULTRASOUND
7.15 Intestinal Third stage- Colostomy / ileostomy closure Clinical Photograph 3 34500 S14 S1412014 No
Dye Study
Tract
Gastro Clinical
7.16 Intestinal Hirschsprung's Disease- Single Stage Dye Study/ Rectal Biopsy Photograph/Histopatholo 3 60000 S14 S1412015 No
Tract gical Report
Gastro Clinical
7.18 Intestinal Second stage-Definitive surgery Dye Study/ Rectal Biopsy Photograph/Histopatholo 3 57500 S14 S1412016 No
Tract gical Report
Thoracic
7.20 Empyema Thoracis X-Ray/CT Scan Clinical Photograph 3 40000 S14 S1412017 No
Surgeries
GENITOURI
7.21 NARY HYPOSPIDIAS- 1. SINGLE STAGE SURGERY Clinical Photograph Clinical Photograph 3 34500 S14 S1412018 No
Surgeries
GENITOURI
HYPOSPIDIAS- 2.STAGED SURGERIES a) 1st Stage
7.22 NARY Clinical Photograph Clinical Photograph 3 34500 S14 S1412019 No
procedure
Surgeries
GENITOURI
7.23 NARY a) 2nd Stage procedure Clinical Photograph Clinical Photograph 3 25300 S14 S1412020 No
Surgeries
Peadiatric EXSTROPHY BLADDER TOTAL CORRECTION1) SINGLE
7.24 - 8 126500 S14 S1412021 No
Surgery STAGE
Peadiatric EXSTROPHY BLADDER 2) FIRST STAGE BLADDER USG/ELECTROLYTES/MC
7.25 8 100625 S14 S1412022 No
Surgery CLOSURE U
Peadiatric EXSTROPHY BLADDER 3) SECOND STAGE BLADDER
7.26 - 8 60000 S14 S1412023 No
Surgery NECK RECONSTRUCTION
Peadiatric EXSTROPHY BLADDER 4) PRIMARY OR SECONDARY
7.27 - 8 86250 S14 S1412024 No
Surgery URETEROSIGMOIDOSTOMY
Peadiatric
7.28 EPISPADIAS REPAIR 1) CONTINENT USG/MCU 5 40000 S14 S1412025 No
Surgery
Peadiatric EPISPADIAS REPAIR 2) INCONTINENT (EPISPADIAS
7.29 USG/MCU 5 51750 S14 S1412026 No
Surgery REPAIR +BNR)
NEC-operative-
Gastrointest X ray , USG same as
7.30 1 Exploratory laparotomy+ repair of perforation Clinical photo, X ray abd 4 48000 S14 S1412027 No
inal above
Clinical photograph, Xray

Gastrointest Single stage PSARP female ( Rectovestibular fistula/
7.31 lumbosacral spine, USG Clinical photgraph 4 50000 S14 S1412028 No
inal anovestibular fistula/ vestibular anus etc)
KUB, 2d echo, MCU
Gastrointest
7.32 Duodenal atresia- Kimuras duodenoduodenostomy X ray abdomen Clinicl photograph 2 48000 S14 S1412029 No
inal
Gastrointest
7.33 Pyloric stenoses Ramstedts pyloromyotomy USG abdomen/dye study Clinical photograph 2 26000 S14 S1412030 No
inal
Gastrointest Upper gi scopy/ Upper GI
7.34 GERD Fundoplication/Anti GERD Surgery Clinical photograph 2 35000 S14 S1400016 No
inal dye study
MCU, USG KUB, urine
Genitourina Posterior urethral valve- stabilization + cystoscopy+
7.35 analysis, Bl urea, ser USG KUB, 4 30000 S14 S1412031 No
ry puv fulguration & or vesicostomy
creatinine & S electrolyte
Hydrocephalus in children- Ventriculoperitoneal Ct brain/ MRI Brain USG, Clinical photograph, CSF
7.36 Brain 4 25000 S14 S1412032 No
shunt Fundus examination report
Genitourina Vesicoureteric reflux, megaureter- ureteric MCU, USG KUB, Renal
7.37 Clinical photo 4 40000 S14 S1412033 No
ry reimplantation unilateral/bilateral scan
Pediatrician advise for
splenectomy,
7.38 Abdomen Splenectomy for Thalessemia Vaccinations ( Clinical photo 2 35000 S14 S1412034 No
pneumococcal),USG
Abdomen
Paediatric
7.39 Ankyloglossia Major Clinical Photo Clinical Photo 2 15000 S14 S1400001 No
surgery
Paediatric
7.40 Ankyloglossia Minor Clinical Photo Clinical Photo 2 5000 S14 S1400002 No
surgery
Paediatric
7.41 Hernia & Hydrocele USG clinical notes 2 20000 S14 S1400003 No
surgery
Paediatric CECT L-S Region, Clinical
7.42 Sacrococcygeal Teratoma Clinical Photo 2 20000 S14 S1400004 No
surgery Photo, Sputum AFB
Paediatric
7.43 Undescended Testis - Bilateral-Palp + Nonpalp USG Clinical Photo 2 15000 S14 S1400005 No
surgery
Paediatric
7.44 Undescended Testis - Bilateral Palpable USG Clinical Photo 2 15000 S14 S1400006 No
surgery
Paediatric
7.45 Undescended Testis - Bilateral Non-Palpable USG Clinical Photo 2 20000 S14 S1400007 No
surgery
Paediatric
7.46 Undescended Testis - Reexploration/ Second Stage USG Clinical Photo 2 20000 S14 S1400008 No
surgery
Paediatric
7.47 Undescended Testis - Unilateral-Palpable USG Clinical Photo 2 15000 S14 S1400009 No
surgery
Clinical Photo, Distal
Paediatric
7.48 Ano Rectal Malformation - Redo Pullthrough Cologram/ USG Dye Clinical Photo 2 15000 S14 S1400014 No
surgery
Study
Clinical Photo, Distal
Paediatric
7.49 Ano Rectal Malformation - Transposition Cologram/ USG Dye Clinical Photo 2 15000 S14 S1400015 No
surgery
Study
Paediatric
7.50 Duplication Cyst Excision CECT Abdomen Clinical Photo 2 20000 S14 S1400017 No
surgery
Clinical Photo, Operative
Paediatric
7.51 Fecal Fistula Closure Details of Previous Clinical Photo 2 25000 S14 S1400018 No
surgery
Surgery
X-Ray with Infant
Paediatric
7.52 Gastrostomy + Esophagoscopy+ Threading Feeding Tube/ Dye Clinical Photo 2 20000 S14 S1400019 No
surgery
Study
Paediatric
7.53 GI Tumor Excision CECT, Clinical Photo Clinical Photo 2 30000 S14 S1400020 No
surgery
Paediatric
7.54 Hirschsprung’s Disease - Retal Biopsy-Punch Barium Enema HPEE 2 10000 S14 S1400023 No
surgery
Paediatric
7.55 Hirschsprung’s Disease - Retal Biopsy –Open Barium Enema HPEE 2 10000 S14 S1400024 No
surgery
Paediatric
7.56 Hirschsprung’s Disease - Sphinecterotomy Barium Enema HPEE 2 15000 S14 S1400025 No
surgery
Paediatric Intussusception - Non –Operative Reduction in
7.57 USG Abdomen USG 2 20000 S14 S1400026 No
surgery infants
Paediatric USG Abdomen, Clinical
7.58 Intussusception – Operative in infants Clinical Photo 2 25000 S14 S1400027 No
surgery Photo
X-Ray Abdomen
Paediatric
7.59 Ladds Procedure Standing, USG Clinical Photo 2 30000 S14 S1400028 No
surgery
Abdomen/Barium MEAL
Paediatric
7.60 Rectal Polypectomy - Sigmoiescopic (Ga) Sigmoidoscopic Picutre HPEE, Clinical Notes 2 8000 S14 S1400029 No
surgery
Paediatric CECT Abdomen, Clinical
7.61 Retro-Peritoneal Lymphangioma Excision HPEE, Clinical Notes 2 25000 S14 S1400030 No
surgery Picture
Paediatric
7.62 Congenital Lobar Emphysema CECT, X-Ray Chest X-Ray, Clinical Photo 2 25000 S14 S1400032 No
surgery
Paediatric
7.63 Exomphalos/gastroschisis Clinical Photo Clinical Photo 2 25000 S14 S1400033 No
surgery
Paediatric
7.64 Cleft Lip and Palate Surgery (per stage) Clinical Photo Clinical Photo 2 15000 S14 S1400034 No
surgery
Paediatric
surgery
Negotiable)
Cluster- 9 MEDICAL ONCOLOGY
Specialt
Package Sub- Pre-Operative Post Operative No of Package Procedure Code Government
No specialty Investigation Investigation Follow up Rates PMJAY Reserve
PMJAY
Biopsy with
immunohistochemistry,
Mammography, 2D Echo, Clinical Photograph,
9.1* Breast Adriamycin/Cyclophosphamide (AC) Chest X-ray, Sonography, Mammography, chest X- 0 4485 4 to 6 months M5 M512001 No
Bone scan, Blood ray
Investigations, clinical
Photograph
Biopsy with
9.2* Breast 5- Fluorouracil A-C (FAC) Chest X-ray, Sonography, Mammography, chest X- 0 4600 4 to 6 months M5 M512002 No
Photograph
Biopsy with
9.3* Breast AC (AC then T) Chest X-ray, Sonography, Mammography, chest X- 0 4600 4 to 6 months M5 M512003 No
Photograph
Biopsy with
9.4* Breast Paclitaxel Chest X-ray, Sonography, Mammography, chest X- 0 11500 4 motnhs M5 M512004 No
Photograph
Biopsy with
Cyclophosphamide/Methotrexate/5Fluorouracil
9.5* Breast Chest X-ray, Sonography, Mammography, chest X- 0 3450 4 to 6 months M5 M512005 No
(CMF)
Photograph
Biopsy with
9.6# Breast Tamoxifen tabs Chest X-ray, Sonography, Mammography, chest X- 0 109 4 to 5 years M5 M512006 No
Photograph
Biopsy with
9.7# Breast Aromatase Inhibitors Chest X-ray, Sonography, Mammography, chest X- 0 1150 2 to 5 years M5 M512007 No
Photograph
Biopsy with
HER2 +ve Mammography, 2D Echo, Clinical Photograph,
After 4 cycles of 9.3 package followed by Taxanes 6 months to 1
9.8* Early Breast Chest X-ray, Sonography, Mammography, chest X- 0 20000 M5 M512008 No
with GCSF, Herceptin with or without Carboplatin year
Cancer Bone scan, Blood ray
Photograph
Biopsy, USG,CT Clinical Photograph,
Cervical
9.9* Weekly Cisplatin scan/MRI, Chest X-ray, USG,CT scan/MRI, Chest X- 0 4025 6 to 8 weeks M5 M512009 No
Cancer
clinical Photograph. ray.
Vulval
9.10* Cisplatin/5-FU scan/MRI, Chest X-ray, USG,CT scan/MRI, Chest X- 0 9200 M5 M512010 No
Cancer
Vaginal
9.11* Cisplatin/5-FU scan/MRI, Chest X-ray, USG,CT scan/MRI, Chest X- 0 9200 6 to 8 weeks M5 M512011 No
Cancer
Biopsy with
immunohistochemistry, Clinical Photograph,
Ovarian
9.12* Carboplatin/Paclitaxel Chest X-ray, USG, CT Sonography, CT scan, CA 0 11500 4 to 6 months M5 M512012 No
Cancer
scan, CA 125, Cytology, 125, chest x-ray.
clinical Photograph
Biopsy with
immunohistochemistry, Clinical Photograph,
Ovarian
9.13* Liposomal Doxorubicin & Gemcitabine Chest X-ray, USG, CT Sonography, CT scan, CA 0 13800 4 to 6 months M5 M512013 No
Cancer
scan, CA 125, Cytology, 125, chest x-ray.
clinical Photograph
Biopsy with
CT scan, USG, Chest x-ray,
Ovary Germ CT scan, USG, Chest x-
9.14* Bleomycin /Etoposide/ Cisplatin (BEP) Tumor markers, Clinical 0 11270 3 to 4 months M5 M512014 No
cell Tumor ray, Tumor markers,
Photograph, 2 D echo.
Clinical Photograph, 2 D
echo.
Biopsy, CT scan, USC,
Gestational CT scan, USC, Chest x-ray,
Chest x-ray, Tumor
9.15* Trophoblast Weekly Methotrexate Tumor markers, MRI, 0 863 3 to 4 months M5 M512015 No
markers, MRI Brain,
Ds.-Lowrisk clinical Photograph.
Clinical Photograph.
Biopsy, CT scan, USG,
Chest x-ray, Tumor
9.16* Trophoblast Actinomycin Tumor markers, MRI, 0 4370 3 to 4 months M5 M512016 No
markers, MRI, Brain,
Ds.-Lowrisk clinical Photograph.
Biopsy, CT scan, USG,
Etoposide-Methotrexate-Actinomycin / Chest x-ray, Tumor
9.17* Trophoblast Tumor markers, MRI, 0 8280 4 to 6 months M5 M512017 No
Cyclophosphamide -Vincristine (EMA-CO) markers, MRI Brain,
Ds.-Highrisk clinical Photograph.
Biopsy with
CT scan, USG, Chest x-ray,
Testicular CT scan, USG, Chest x-
9.18* Bleomycin-Etoposide-Cisplatin (BEP) Tumor markers, Clinical 0 11040 3 to 4 months M5 M512018 No
Cancer ray, Tumor markers,
Photograph, 2 D echo.
Clinical Photograph, 2 D
echo.
Biopsy with
immunohistochemistry, CT scan, USG, Chest x-ray,
Testicular Taxanes, Ifosphamides, Vinblastine, Gemcitabine, CT scan, USG, Chest x- Tumor markers, MRI
9.19* 0 16100 3 to 4 months M5 M512019 No
Cancer Docetaxol, Platin ray, Tumor markers, MRI Brain, Clinical
Brain, Clinical Photograph.
Photograph.
Biopsy, CT scan/MRI,
CT scan/MRI, USG, x-ray,
Prostate USG, x-ray, Tumor
9.20# Hormonal therapy Tumor markers, Bone 0 4140 1.5 to 2 years M5 M512020 No
Cancer markers, Bone scan,
scan, Clinical Photograph.
Prostate USG, x-ray, Tumor
9.21* Docetaxol + steriods with G-CSF Tumor markers, Bone 0 18400 1.5 to 2 years M5 M512021 No
Cancer markers, Bone scan,
scan, Clinical Photograph.
Bladder
9.22* Weekly Cisplatin scan/MRI, Chest X-ray, USG,CT scan/MRI, Chest X- 0 4140 4 to 6 weeks M5 M512022 No
Cancer
Bladder Methotrexate Vinblastine Adriamycin USG, x-ray, Urine
9.23* Urine cystology, Clinical 0 7130 4 to 6 months M5 M512023 No
Cancer Cyclophosphamide (MVAC) cystology, Clinical
Photograph.
Photograph.
Bladder USG, x-ray, Urine
9.24* Gemcitabine/Carboplatin Urine cystology, Clinical 0 12880 4 to 6 months M5 M512024 No
Cancer cystology, Clinical
Photograph.
Photograph.
Lung cancer-
Biopsy with
Non-small CT scan, USG, x-ray,
cell lung Sonography, Bone scan,
9.25* Platin/Etoposide CT scan, USG, x-ray, 0 9430 4 to 6 months M5 M512025 No
cancer MRI Brain PET-CT Scan,
Sonography, Bone scan,
(NSCLC) and Clinical Photograph.
MRI Brain PET-CT Scan.
SCLC
Lung cancer- Biopsy with
CT scan, USG, x-ray,
Non-small immunohistochemistry,
Sonography, Bone scan,
9.26* cell lung Pemetrexed/ Platin Gemcitabine/ Platin Gefitinib CT scan, USG, x-ray, 0 14950 4 to 6 months M5 M512026 No
MRI Brain PET-CT Scan,
cancer Sonography, Bone scan,
(NSCLC) MRI Brain PET-CT Scan.
Biopsy, CT scan, USG, x-
Esophageal Weekly Cisplatin/ Carboplatin Cisplatin-5FU ray, Sonography,
9.27* ray, Sonography, 0 8625 4 to 6 months M5 M512027 No
Cancer Epirubicin/ Taxanes Endoscopy, Clinical
Endoscopy.
Photograph.
Gastric 5-FU -Leucovorin (McDonald Regimen), ray, Sonography,
9.28* ray, Sonography, 0 17250 4 to 6 months M5 M512028 No
Cancer Epirubicin/Taxanes/Platin Endoscopy, Clinical
Endoscopy.
Photograph.
Biopsy, CT scan/MRI, x- Biopsy, CT scan/MRI, x-
Colorectal
9.29* Monthly 5-FU ray, Tumor marker-S. ray, Tumor marker-S. 0 5750 4 to 6 months M5 M512029 No
Cancer
CEA CEA, Clinical Photograph.

Colorectal 5-Fluorouracil-Oxaliplatin -Leucovorin (FOLFOX)
9.30* ray, Tumor marker-S. ray, Tumor marker-S. 0 13800 4 to 6 months M5 M512030 No
Cancer (Stage III only)

Colorectal
9.31* 5-FU, Irinotican, Leucovorin, (FOLFIRI) Capecitabine, ray, Tumor marker-S. ray, Tumor marker-S. 0 11500 4 to 6 months M5 M512031 No
Cancer
Osteosarco Biopsy, CT scan, MRI
X-Ray, Clinical
9.32* ma Bone Cisplatin/Adriamycin + ifosmide (IAP) scan, x-ray, Bone scan, 2 0 13800 8 to 9 months M5 M512032 No
Photograph.
Tumors D Echo.
Biopsy-
Adriamycin/ Bleomycin/Vinblastine/ Dacarbazine Blood investigations &
Lymphoma- Serum biochemistry,
(ABVD), imaging-USG/CT scan/PET-
9.33* Hodgkin Bone marrow 0 6900 6 to 8 months M5 M512033 No
Cyclophosphamide/Vincristine/Prednisolone/Procar CT scan, Clinical
disease examination, CT scan, x-
bazine (COPP). Photograph
ray, Sonography, PET-CT
Scan, 2 D Echo, PFT.
Biopsy-,
Cyclophosphamide/Adriamycin/Vincristine/Prednisol Serum biochemistry,
Blood investigations &
one (CHOP), Rituximab, Chlorambucil CVP Bone marrow
Lymphoma- imaging-USG/CT scan/PET- 4 months to 2
9.34* (Cyclophosphamide/Vincristine,/Prednisolone), examination, CT scan, x- 0 13800 M5 M512034 No
NHL CT scan, Clinical years
Bendamustine Cladribone High dose ray, Sonography, PET-CT,
Photograph
Methotrexate/VCR/Procarbazine- Cytarabine CSF cytology, MRI
brain/spine, Viral
markers,2 D Echo.
Hematology, Serum
biochemistry, Serum
Protein electrophoresis Blood investigations, &
Multiple and immunofixatation, Bone marrow
9.35* Vincristine, Adriamycin,Dexamethasone(VAD) 0 5750 2 to 5 years M5 M512035 No
Myeloma Bone marrow examination, X-Rays,
examination, skeletal Clinical Photograph
survey & MRI Spine, 2 D
Echo.
Hematology, Serum
biochemistry, Serum
9.36# Thalidomide+Dexamethasone(Oral) 0 4830 2 to 5 years M5 M512036 No
Myeloma Bone marrow examination, Clinical
examination, skeletal Photograph
Echo.
Hematology, Serum
biochemistry, Serum
9.37# Melphalan -Prednisone (oral) 0 2530 2 to 5 years M5 M512037 No
Myeloma Bone marrow examination, X-Rays,
Echo.
Hematology, Serum
biochemistry, Serum
Multiple Bortezamib, Lenalinomide, Bisphosphonates, and immunofixatation, Bone marrow
9.38# 0 13800 2 to 5 years M5 M512038 No
Myeloma Autologus stem cell transplant Bone marrow examination, X-Rays,
Echo.
Wilm's USG/CT, biopsy with Imaging USG/CT scan,
9.39* SIOP/NWTS regimen(Stages I - IV) 0 9775 4 to 6 months M5 M512039 No
Tumor Immunohistochemistry Clinical Photograph
Hepatoblast
USG/CT, biopsy, Tumor USG/CT, Tumor marker,
9.40* oma Cisplatin – Adriamycin 0 5175 4 to 6 months M5 M512040 No
marker-AFP, 2D Echo. Clinical Photograph.
Operable
Hematology, Serum
biochemistry, CT Scan
whole body Or PET Scan, Bone marrow
Childhood B
Variable Regimen - MCP 841/BFM - 90, BFM-NHL, Tissue biopsy with examination, Imaging- 6 months to
9.41* Cell 0 16100 M5 M512041 No
LMB 96, Rasburrycase immunochemistry/IPT, Studies, Clinical 6.5 years
Lymphomas
Bone marrow Photograph
examination, CSF
Cytology.
CT, Biopsy-With
Blood investigations &
Neuroblasto Immunohistochemistry,
Variable Regimen Variable regimens, Autologous imaging- USG/CT scan,
9.42* ma ( Stages I- Blood investigations, 0 16100 3 to 6 months M5 M512042 No
Stem Cell MIBG scan, Clinical
III ) MIBG scan, Bone marrow
Photograph
examination.
Biopsy, Blood
Ophthalmologic
investigations, MRI Orbit
Retinoblasto Carbo/Etoposide/Vincristine, examination, Imaging- 4 months to 1
9.43* & Brain, CSF study, Bone 0 7130 M5 M512043 No
ma Endoxan/vincristine/doxorubicin-platin/Etoposide Studies, Clinical year
marrow examination,
Photograph
Bone scan.
Hematology, Biopsy,
Serum biochemistry,
Bone marrow
examination, Chest X-
Variable Regimen- LCH-III, Vinblastine + Blood investigations and
Ray, skeletal survey, MRI
9.44* Histiocytosis Prednisolone, 6MP, MTX, Cladribone, Allergenic imagine, Clinical 0 20700 6 to 12 months M5 M512044 No
Brain, Endocrine
stem cell transplant. Photograph
evaluation, HAL typing &
matching, serum
cyclosporine level.CSF
Cytology.
Blood investigations,
Biopsy &
Physical examination,
Rhabdomyo Vincristine-Actinomycin-Cyclophosphamide (VAC) Immunohistochemistry,
9.45* Imagine MRI/CT can, 0 5750 8 to 10 months M5 M512045 No
sarcoma based chemo CT scan/MRI, Bone
Clinical Photograph
marrow examination,
Bone scan.
X-Ray/CT Scan/MRI,
Biopsy & Physical examination, X-
Ewings Variable Regimen- Endoxan/VCR/Doxorubicin-
9.46* Immunohistochemistry, Ray/CT scan/MRI, Clinical 0 16100 1 year M5 M512046 No
sarcoma Ifosphamides/Etoposide.
Bone Scan, Bone marrow Photograph
examination, 2D Echo.
Hematology, Bone
marrow examination
with
Acute Blood investigations,
Immunophenotyping,
9.47* Myeloid Induction Phase Bone marrow 0 25300 1 month M5 M512047 No
Conventional
Leukemia examination, Clinical
Cytogenetics and FISH
Photograph
studies, MRI Brain, X-
Ray, 2D Echo.
Hematology, Bone
marrow examination
with
Immunophenotyping,
9.48* Myeloid Consolidation Phase Bone marrow 0 43700 4 months M5 M512048 No
Conventional
Leukemia examination, Clinical
Cytogenetics and FISH
Photograph
studies, MRI Brain, X-
Ray, 2D Echo.
Hematology, Bone
marrow examination Physical examination,
Acute with Blood investigations,
Induction phase 1st and 2nd months, MCP 841/BFM
9.49* Lymphoblas Immunophenotyping, Bone marrow 0 71300 1 to 2 months M5 M512049 No
90 protocol, Imatinib
tic Leukemia Cytogenetics and FISH examination, Clinical
studies, CSF cytology, Photograph
MRI Brain, USG/CT scan.
Hematology, Bone
marrow examination
with
3rd, 4th, 5th month-MCP 841/BFM 90 protocol, Immunophenotyping,
9.50* Lymphoblas Bone marrow 0 36800 3 to 4 months M5 M512050 No
Imatinib, Allergenic stem cell transplant Cytogenetics and FISH
tic Leukemia examination, Clinical
studies, CSF cytology,
Photograph
MRI Brain, USG/CT scan,
2D Echo.
Acute Hematology, Bone Blood investigations,
9.51* Lymphoblas Maintenance- MCP 841/BFM 90 protocol, Imatinib marrow examination, Bone marrow 0 4830 2 years M5 M512051 No
tic Leukemia FISH study, CSF cytology. examination, Clinical
Photograph
Blood investigations,
unlisted Biopsy. CT, USG, Blood
9.52* Palliative Chemotherapy USG/CT scan, Clinical 0 7130 M5 M512052 No
regimen investigations
Photograph
For
Terminally
9.53* Palliative and Supportive Therapy Biopsy , CT , USG Clinical Photograph 0 4830 M5 M512053 No
ill cancer
patient
CT scan Abdomen, Pelvis,
Colorectal USG/CT/biopsy,
Tissue biopsy,
9.54* Cancer XELOX along with Adjuvant chemotherapy Biochemical 0 10120 6 months M5 M512054 No
Photograph, Tummor
Stage 2& 3 investigations
marker-S. CEA.
1ST Line iv antibiotics And other supportive therapy (
Febrile third generation cephalosporin,aminoglycoside, Blood C&S, Urine C&S, USG/CT/biopsy,
9.55* Neutropenia- Comnination of Beta Lactum with beta lactamase Chest X-Ray, Tissue Biochemical 0 17250 M5 M512055 No
Highrisk-1 inhibitor (Piperacillin-tazobactum), Vancomycin, Anti- Biopsy, CT scan. investigations.
Fun gals (azoles), G-CSF etc.,)
Febrile 2nd line iv antibiotics and other supportive Blood C&S, Urine C&S, USG/CT/biopsy, Blood
9.56* Neutropenia- therapy(Carbapenems, Fourth generation Chest X-Ray, Tissue investigations, Blood 0 48300 M5 M512056 No
Highrisk-2 cephalosporins, Piperacillin, anti-fungal -azoles etc.,) Biopsy, CT scan. Culture-sensitivity, X-Ray.
Serum biochemistry,
Relapsed Ifosphamides /Platin /Etoposide (ICE), Cytarabine/ Bone marrow Blood investigations &
9.57* lymphoma- Platin/ Steroids (DHAP), Autologous stem cell examination, CT scan, X- imaging- USG/CT 0 36800 4-6 months M5 M512057 No
NHL and HD Transplant ray, Sonography, PET-CT scan/PET-CT scan
scan
Bone Marrow
examination with
Immunophe-notyping,
ATRA, Arsenic trioxide, Daunorubicin, Cytarabine 6 Conventional Bone marrow exam with
9.58* APML 0 64400 2 to 2.5 years M5 M512058 No
MP, methotrexate Cytogenetics and RT-PCR study,
FISH/RT-PCR studies,
MRI Brain, X-ray, 2 D
echo, ECG
Bone Marrow
examination with
Immunophe-notyping, Physical exam, Blood
Paediatric Conventional investigations, bone
9.59* BFM 93 0 59800 2-2.5 years M5 M512059 No
AML Cytogenetics and FISH marrow exam (if clinically
study, MRI Brain, CSF indicated)
cytology, X-ray, 2 D echo,
ECG
Hematology, Serum
Biochemistry, Bone
marrow examination Physical exam, Blood
9.60*A CLL CVP - Cyclophosphamide, Vincristine, Steroids [CLL *] with Immunophe- investigations, Imaging 0 5463 M5 M512060 No
notyping, Lymph node USG/CT scan
biopsy with IHC, USG/CT
scan, 2 D Echo
Hematology, Serum
Biochemistry, Bone
9.60*B CLL L +P -- Chlorambucil, Steroids [CLL *] with Immunophe- investigations, Imaging 0 5463 M5 M512093 No
scan, 2 D Echo
Hematology, Serum
Biochemistry, Bone
Fludarabine, Cyclophosphamide, Rituximab (FCR)
9.60*C CLL with Immunophe- investigations, Imaging 0 43700 M5 M512094 No
[CLL *]
scan, 2 D Echo
Hematology, Serum
Biochemistry, Bone
9.60*D CLL Rituximab [CLL *] with Immunophe- investigations, Imaging 0 38237 M5 M512095 No
scan, 2 D Echo
Hematology, Serum
Biochemistry, Bone
9.60*E CLL Bendamustine [CLL *] with Immunophe- investigations, Imaging 0 16387 2-3 years M5 M512096 No
scan, 2 D Echo
Hematology with serum
biochemistry, Bone Physical exam, Blood
CML Blastic Imatinib, Nilotinib, Dasatinib Allogeneic stem cell marrow examination, investigations, Bone
9.61# 0 4600 M5 M512061 No
crisis Transplant cytogenetic study, Ph by marrow study, RT- PCR
FISH or RT-PCR, USG for BCR-ABL
study
Hematology and serum

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

biochemistry, Bone
Marrow examination,
Aplastic
9.62B^ Allogeneic stem cell Transplant viral markers, IPT for Blood investigations 0 780000 M5 M512063 No
Anaemia
PNH, HLA typing &
matching. S.
Cyclosporine level
Hematology, serum
Myelodyspla biochemistry, Bone
Myelodysplastic syndrome - Lenalinomide
9.63A^ stic marrow examination Blood investigations 0 200000 M5 M512064 No
Decitabine
syndrome with cytogenetics, FISH
study,
Hematology, serum
Myelodyspla biochemistry, Bone
9.63B^ stic Allogeneic stem cell Transplant marrow examination Blood investigations 0 780000 M5 M512065 No
syndrome with cytogenetics, FISH
study,
Thalassemia
/Haemoglob Blood investigations Hb
Thalassemia/Haemoglobinopat hies Sickle cell
9.64^ inopathies electrophoresis ,HLA Blood investigations 0 780000 M5 M512066 No
anaemia - Allogeneic Bone Marrow Transplant
Sickle cell study
anaemia
Congenital Hematology, serum
condition Congenital condition amenable to BMT - Allogeneic biochemistry, Hb
9.65^ Blood investigations 0 780000 M5 M512067 No
amenable to stem cell Transplant electrophoresis , HLA
BMT typing
Hematology, Serum
biochemistry, RI brain &
Medulloblas Cisplatin/cyclophosphamide/VCR/Procarbazine,
9.66* spine, Biopsy Physical exam, MRI study 0 6900 4-6 months M5 M512068 No
toma Lomustine
CSF cytology
Relapsed
Paediatric Relapsed Paediatric Solid Tumor - Autologus stem Blood investigations and Blood investigations and
9.67^ 0 780000 M5 M512069 No
Solid cell transplant - Imaging, Imaging,
Tumours
Palliative Fixation of pathological fracture [Palliative package Blood investigations and Blood investigations and
9.68A^ 0 31740 M5 M512070 No
package ^] Imaging, Imaging,
Palliative Oesophageal Stenting /prosthesis- double [Palliative Blood investigations and Blood investigations and
9.68B^ 0 31750 M5 M512097 No
package package ^] Imaging, Imaging,
Palliative Oesophageal Stenting/prosthesis- Single [Palliative Blood investigations and Blood investigations and
9.68C^ 0 26450 M5 M512098 No
package package ^] Imaging, Imaging,
Palliative Nerve blockage With Image / Nerve blockage Blood investigations and Blood investigations and
9.68D^ 0 10580 M5 M512099 No
package Without Image [Palliative package ^] Imaging, Imaging,
Pain killer / G-CSF/ Drainage – Biliary and urinary /
Palliative Blood investigations and Blood investigations and
9.68E^ Stenting – Biliary/ Stenting – urinary / Nutritional 0 5290 M5 M512100 No
package Imaging, Imaging,
supplement [Palliative package ^]
CXR , USG ABDOMEN, CT
9.69* Anal Cancer MITOMYCIN, 5FU ULTRASOUND 0 4600 3 to 4 months M5 M512071 No
Abdomen
Head & Chest X ray, CT/MRI,
9.70* CISPLATIN WEEKLY CT Scan Xrays 0 4140 5 to 6 weeks M5 M512072 No
Neck Biopsy
Head &
9.71* TPF (DOCETAXEL ,CISPLATIN , 5-FU) X ray, CT, MRI Biopsy CT Scan X-rays 0 16330 2 to 3 months M5 M512073 No
Neck
Head &
9.72# CISPLATIN + MTX X ray, CT, MRI Biopsy CT Scan X-rays 0 4600 2 to 3 months M5 M512074 No
Neck
AFP , USG ABDOMEN, CT
9.73# HCC SORAFENIB ORAL USG ABDOMEN 0 8280 4 to 8 months M5 M512075 No
Scan, Chest x ray
USG, Biopsy, CT Scan,
9.74# RCC SUNITINIB USG ABDOMEN 0 27600 4 to 8 months M5 M512076 No
Chest x ray
MRI Brain, Biopsy with
Brain
9.75* Tenozolamide, Procarbazine, CCNU, Vincristine Immunohistochemistry, MRI Brain, X-ay 0 17480 6months M5 M512077 No
Tumour
X-ray
MRI, CT scan, Biopsy
Sarcoma- with
9.76* Cisplatin/ Adriamycin/ Ifosphamides MRI, CT scan, X-ray 0 17250 4 to 6 months M5 M512078 No
soft tissue Immunohistochemistry,
X-ray
CT scan, Biopsy, Tumor
Hepatobillia CT scan, Tumor markers,
9.77* Gemcitabine/ Oxaliplatin/ Capecitabine/ 5 FU markers, X-ray, 0 17480 4 to 6 months M5 M512079 No
ry tumor X-ray, Sonography
Sonography
CT scan, Biopsy, Tumor
Pancreatic Gemcitabine/ Oxaliplatin/ Capecitabine/ 5 CT scan, Tumor markers,
9.78* markers, X-ray, 0 17480 4 to 6 months M5 M512080 No
cancer FU/Erlotinib X-ray, Sonography
Sonography
Endometrial CT scan/MRI study, X- CT scan, X-ray,
9.79* Weekly Platin Paclitaxel/ Carboplatin 0 4830 4 to 6 months M5 M512081 No
cancer ray, Biopsy, Sonography Sonography
Biopsy report of proven
PET Study (All Cancer for all oncology cluster cancer of any past time
9.80 Oncology - 0 10000 - M5 M512082 No
diagnostic or staging in proven cancer patient) necessary for pre
authorisation
Cluster-10 RADIATION ONCOLOGY
Specialt
PMJAY
Cobalt 60
external
Clinical photograph, rt
10.1 beam Radical treatment Usg/x-ray/ct, biopsy 0 20000 6 to 7 weeks M6 M612001 No
treatment charts
radiotherap
y
Cobalt 60
external
10.2 beam Palliative treatment Usg/x-ray/ct, biopsy 0 10000 3 weeks M6 M612002 No
treatment charts
radiotherap
y
Cobalt 60
external
10.3 beam Adjuvent therapy Usg/x-ray/ct, biopsy 0 20000 4 weeks M6 M612003 No
treatment charts
radiotherap
y
Linear Clinical photograph, rt
10.4 Radical treatment with photons (linear accelarator) Usg/x-ray/ct, biopsy 0 50000 6 to 7 weeks M6 M612004 No
accelerators treatment charts
Linear Palliative treatment with photons (linear Clinical photograph, rt
10.5 Usg/x-ray/ct, biopsy 0 20000 3 weeks M6 M612005 No
accelerators accelarator) treatment charts
Linear Clinical photograph, rt

10.6 Adjuvant treatment with photons/electrons Usg/x-ray/ct, biopsy 0 40000 4 weeks M6 M612006 No
accelerators treatment charts
Brachythera
Weekly
py- Clinical photograph, rt
10.7 Ii. Hdr per application Usg/x-ray/ct, biopsy 0 11500 application for M6 M612007 No
intracavitary- treatment charts
2 to 5 weeks
ii
Brachythera
10.8 py- Ii. Hdr - one application and multiple dose fractions Usg/x-ray/ct, biopsy 0 11500 5 days M6 M612008 No
treatment charts
interstitial-ii
LA with
USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/ MRI/
10.9 multi leaf Radical treatment with IMRT 0 70000 6 to 7 weeks M6 M612009 No
Biopsy Biopsy
collimator
LA with
10.10 multi leaf Radical treatment with IGRT 0 90000 6 to 7 weeks M6 M612010 No
Biopsy Biopsy
collimator
LA with
10.15 some SRS (Stereotactic Radiosurgery) 0 110000 1 day M6 M612011 No
Biopsy Biopsy
accessories
LA with
10.16 some SRT (Stereotactic Radiotherapy) 0 110000 6 weeks M6 M612012 No
Biopsy Biopsy
accessories
Brain
10.17 Gamma Knife / Cyber Knife CT CT 0 115000 1 day M6 M612013 No
Tumour
Total Body USG/ X-ray/ CT/ MRI/ USG/ X-ray/ CT/ MRI/
10.19 Pre Bonemarrow/Stem Cell Transplant 0 66700 6 to 7 weeks M6 M612014 No
Radiation Biopsy Biopsy
Iodine Clinical photograph, rt
10.20 Radio Iodine Therapy Usg,/x-ray,/ct,/biopsy 0 15000 Per dose M6 M612015 No
Therapy treatment charts
EBRT Daily (5day x
10.21 (External SBRT (Sterotactic Beam RT) Usg,/x-ray,/ct,/biopsy 0 110000 week) 6 to 7 M6 M612016 No
treatment charts
Beam RT) weeks
Daily (5day x
10.22 EBRT 3DCRT (3 Dimentional Conformal RT) Usg,/x-ray,/ct,/biopsy 0 70000 week) 6 to 7 M6 M612017 No
treatment charts
weeks
10.23 EBRT Electron Boost Usg,/x-ray,/ct,/biopsy 0 5000 2 weeks M6 M612018 No
treatment charts
10.24 EBRT Electron treatment curative Usg,/x-ray,/ct,/biopsy 0 50000 6 to 7 weeks M6 M612019 No
treatment charts
10.25 EBRT Rapidarc/VMAT Usg,/x-ray,/ct,/biopsy 0 100000 6 to 7 weeks M6 M612020 No
treatment charts
Brachythera Clinical photograph, rt 2 weeks(6.5 x 2
10.26 Intraluminal Brachytherapy in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 11500 M6 M612021 No
py treatment charts up to 55 Gray)
2
Brachythera Clinical photograph, rt
10.27 CT guided ICR (Intra Cavitory RT)in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 11500 weeks(weekly M6 M612022 No
py treatment charts
upto 66 Gray)
2 to 3
days(6hourly
10.28 CT guided Interstitial RT in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 16500 two fraction M6 M612023 No
py treatment charts
per day for two
days )
2 weeks
10.29 MRI guided ICR in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 16500 (weekly upto M6 M612024 No
py treatment charts
66 Gray)
2 to 3 days
(6hourly two
10.30 MRI guided Interstial RT in addition to EBRT Usg,/x-ray,/ct,/biopsy 0 16500 fraction per M6 M612025 No
py treatment charts
day for two
days)
Radiation Respiratory Gating along with Linear Accelerator
10.31 CT, Biopsy Clinical Photo, RT Chart 0 70000 M6 M600009 No
Oncology planning
Radiation
10.32 Tomotherapy(Radical/Adjuvant/Neoadjuvant) Blood test, CT, Biopsy Clinical Photo, RT Chart 0 75000 M6 M600011 No
Oncology
Cluster-11 SURGICAL ONCOLOGY
Specialt
PMJAY
11.2 Throat Microlaryngeal Surgery including Phonosurgery Biopsy, CT Scan/ MRI Biopsy 1 11500 S15 S1512001 No
11.3 Throat Excision/ Hypopharynx of Tumors in Pharynx Biopsy, CT Scan/ MRI 1 23000 S15 S1512002 No
biopsy
11.4 Pancreas Distal Pancreatectomy CT , CA 19-9, PET Scan Clinical Photograph 1 55000 S15 S1512003 No
11.5 Pancreas Enucleation of Cyst CT, CA 19-9 Clinical Photograph 1 35000 S15 S1500030 No
CT , ERCP, CA 19-9, PET
11.6 Pancreas Whipples - any type Clinical Photograph 1 75000 S15 S1512004 No
Scan, EUS
11.7 Spleen Splenectomy USG/CT Clinical Photograph , USG 1 30000 S15 S1512005 No
Genito
Biopsy , CT , IVP , KUB Biopsy , Clinical
11.8 Urinary Radical Nephrectomy 1 34500 S15 S1512006 No
,USG Photograph , USG
System
Genito
Biopsy , CT , IVP , KUB Biopsy , Clinical
11.9 Urinary Radical Cystectomy 1 60000 S15 S1512007 No
,USG Photograph , USG
System
Genito
Biops,clinical notes,CT
11.10 Urinary Other cystectomies Clinical Photo, HPEE 1 40000 S15 S1512008 No
Scan/USG/MRI /MCU
System
Genito CT Scan (Abdomen,
Biopsy , Clinical
11.11 Urinary High Orchidectomy Pelvis), Biopsy, USG, CT 1 15000 S15 S1512009 No
Photograph , USG
System Scan Thorax
Genito
Biopsy , USG, Bone Scan, Biopsy , Clinical
11.12 Urinary Bilateral Orchidectomy 1 11500 S15 S1512010 No
Local X-ray Photograph , USG
System
Biopsy, CT Scan
Genito
(Abdomen, Biopsy , Clinical
11.14 Urinary Total Penectomy 1 25000 S15 S1512011 No
Pelvis),Clinical Photograph , USG
System
Photograph
Genito
Biopsy , Clinical Biopsy , Clinical
11.15 Urinary Inguinal Block Dissection-one side 1 8740 S15 S1512012 No
phtograph, CT Scan Photograph , USG
System
Genito
CT , KUB , USG, Bone Biopsy , Clinical
11.16 Urinary Radical Prostatectomy 1 60000 S15 S1512013 No
Scan, Biopsy Photograph , USG
System
Genito Biopsy, Clinical
Biopsy , Clinical
11.17 Urinary Partial Penectomy Photograph, USG 1 15000 S15 S1512014 No
Photograph , USG
System Abdomen Pelvis
Biopsy , Clinical
11.18 Gynaec Radical Hysterectomy Biopsy , CT , USG 1 34500 S15 S1512015 No
Photograph , USG
CA 125, CEA, Biopsy/ Biopsy , Clinical
11.19 Gynaec Surgery for Ca Ovary - early stage cytology, aFP, ßHCG, Photograph , USG, Tumor 1 23000 S15 S1512016 No
LDH, X-ray chest Marker
CA 125, CEA, Biopsy/ Biopsy , Clinical
11.20 Gynaec Surgery for Ca Ovary - advance stage cytology, aFP, ßHCG, Photograph , USG, Tumor 1 40000 S15 S1512017 No
LDH, X-ray chest Marker
Biopsy , Clinical
11.21 Gynaec Vulvectomy Biopsy, Photograph 1 17250 S15 S1512018 No
Photograph , USG
Biopsy, X-rays,
Mammogram, Biopsy , Clinical
11.22 Breast Mastectomy - any type 1 25000 S15 S1512019 No
Photograph, USG, CT, Photograph
Bone scan
Biopsy, X-rays,
Mammogram, Biopsy , Clinical
11.23 Breast Axillary Dissection 1 23000 S15 S1500022 No
Photograph, USG, CT, Photograph
Bone scan
Biopsy, X-rays,
Biopsy , Clinical
11.24 Breast Wide excision Mammogram, 1 11500 S15 S1512020 No
Photograph
Photograph, USG, CT
CT/ Barium Meal Follow Clinical Photograph,
11.25 Ca.Rectum Abdomino Perineal Resection (APR) +Sacrectomy 1 50000 S15 S1512021 No
through biopsy
Ca. Gall Biopsy , Clinical
11.26 Radical Cholecystectomy CT , USG, PET Scan 1 60000 S15 S1500031 No
Bladder Photograph , USG
CT/BMFT,
11.27 Breast Wide excision + Reconstruction ( Pedicle flap) Colonoscopy,Biopsy, 1 25000 S15 S1512022 No
biopsy
CEA, PET Scan
Biopsy, X-rays,
Biopsy , Clinical
11.28 Lung Cancer Pneumonectomy Mammogram, 1 50000 S15 S1512023 No
Photograph , USG
Photograph, USG, CT
Biopsy, X-rays,
Biopsy , Clinical
11.29 Lung Cancer Lobectomy Mammogram, 1 50000 S15 S1512024 No
Photograph
Photograph, USG, CT
Biopsy , CT , X-RAY, PET Biopsy , Clinical
11.30 Lung Cancer Decortication 1 40000 S15 S1512025 No
scan, CT brain Photograph , X-RAY
11.31 Lung Cancer Surgical Correction of Bronchopleural Fistula. 2 35000 S15 S1512026 No
scan (SOS) Photograph , X-RAY
11.32 Head &Neck Resection of Nasopharyngeal Tumor 1 50000 S15 S1500004 No
scan, CT brain Photograph , X-RAY
Biopsy , Clinical
11.33 Head &Neck Craniofacial resection of any type Biopsy , CT , X-RAY 1 90000 S15 S1512027 No
Photograph , X-RAY
Biopsy , Clinical
11.34 A Head &Neck Composite Resection ANY TYPE Biopsy, CT/MRI 1 41250 S15 S1512028 No
Photograph
Biopsy , Clinical
11.34 B Head &Neck PEDICLE FLAP Reconstruction Biopsy, CT/MRI 1 13750 S15 S1512096 No
Photograph
Biopsy , Clinical
11.35 Head &Neck Neck Dissection - any type CT/ MRI, Biopsy 1 32200 S15 S1512029 No
Photograph
Clinical Photograph/X- Clinical Photograph,
11.36 Head &Neck Hemiglossectomy 1 20700 S15 S1512030 No
Ray,USG/biopsy/CT biopsy
Biopsy , Clinical
Biopsy , Clinical
11.37 Head &Neck Maxillectomy - any type Photograph , USG , X- 1 25000 S15 S1512031 No
Photograph
RAY, CT Scan
Biopsy , Clinical
Biopsy , Clinical
11.38 Head &Neck Thyroidectomy - any type Photograph , USG , X- 1 25000 S15 S1512032 No
Photograph
RAY, MRI
x-ray of maxilla, CT/MRI, biopsy and Clinical
11.39 Head &Neck Parotidectomy - any type 1 20000 S15 S1512033 No
biopsy Photograph
Biopsy , Clinical
Biopsy , Clinical
11.40 Head &Neck Laryngectomy - any type Photograph , USG , X- 1 40000 S15 S1512034 No
Photograph
RAY, CT Scan
Biopsy , Clinical
Biopsy , Clinical
11.41 Head &Neck Laryngopharyngo Oesophagectomy Photograph , USG , X- 1 70000 S15 S1512035 No
Photograph
RAY, CT Scan
Biopsy , Clinical
Biopsy , Clinical
11.42 Head &Neck Hemimandibulectomy Photograph , USG , X- 1 25000 S15 S1512036 No
Photograph
RAY, CT Scan
Biopsy , Clinical
Biopsy , Clinical
11.43 Head &Neck Wide excision Any type Photograph , USG , X- 1 11500 S15 S1512037 No
Photograph
RAY, CT Scan
Biopsy , Clinical
Ca. Salivary Biopsy , Clinical
11.44 Submandibular Gland Excision Photograph , USG , X- 1 18400 S15 S1512038 No
Gland Photograph
RAY, OPG/CT scan
Biopsy , Clinical
Biopsy , Clinical
11.45 Ca. Trachea Tracheal Resection Photograph , USG , X- 1 50000 S15 S1500001 No
Photograph
RAY
Biopsy , Clinical
Biopsy , Clinical
11.46 Ca. Trachea Sternotomy + Superior Mediastinal Dissection Photograph , USG , X- 1 45000 S15 S1500002 No
Photograph
RAY
Ca. Biopsy, CT, Clinical Photograph,
11.47 Parathyroidectomy 1 20700 S15 S1512039 No
Parathyroid Bronchoscopy biopsy
Ca. Gastro
11.48 Intestinal Small bowel resection Biopsy, CT 1 18400 S15 S1512040 No
biopsy
Tract
Biopsy , Clinical
Ca. Gastro
Photograph , USG , X- Biopsy , Clinical
11.49 Intestinal Closure of Ileostomy/ Colostomy 1 8050 S15 S1512041 No
RAY, Serum Photograph
Tract
Parathormone
Biopsy , Clinical
11.50 Spleen Radical Splenectomy CT , USG 1 30000 S15 S1512042 No
Photograph , USG
Gastro
Barium meal test, CT Biopsy, clinical
11.51 Intestinal Resection of Retroperitoneal Tumors 1 45000 S15 S1512043 No
abdomen, biopsy photograph
System
Gastro
USG, CT abdomen, BIOPSY, CLINICAL
11.52 Intestinal Abdominal wall tumor Resection 1 35000 S15 S1500032 No
biopsy PHOTOGRAPH
System
Gastro
USG, CT abdomen, BIOPSY, CLINICAL
11.53 Intestinal Resection with reconstruction 1 20700 S15 S1500033 No
biopsy PHOTOGRAPH
System
Gastro
Biopsy , CT , Endoscopy Biopsy , Clinical
11.55 Intestinal Oesophagectomy - any type 1 60000 S15 S1512044 No
,USG, PET SCAN Photograph , USG
System
Gastro
Biopsy , CT , Endoscopy Biopsy , Clinical
11.56 Intestinal Gastrectomy - any type 1 40000 S15 S1512045 No
,USG, PET SCAN Photograph , USG
System
Gastro
11.57 Intestinal Colectomy - any type 1 40000 S15 S1512046 No
USG, CEA Photograph , USG
System
Gastro
11.58 Intestinal Anterior Resection 1 50000 S15 S1512047 No
System
Gastro
11.59 Intestinal Abdominoperinial Resection 1 40000 S15 S1512048 No
System
Gastro
11.60 Intestinal Triple Bypass 1 23000 S15 S1500035 No
USG Photograph , USG
System
Gastro
Other GI Bypasses surgery any type (including Biopsy , CT , Endoscopy , Biopsy , Clinical
11.61 Intestinal 1 25000 S15 S1512049 No
pancreas) USG Photograph , USG
System
11.62 Gynaec Radical Trachelectomy CT/MRI, Biopsy 1 35000 S15 S1500043 No
biopsy
11.63 Gynaec Radical vaginectomy CT, Biopsy 1 26450 S15 S1500040 No
biopsy
11.64 Gynaec Radical vaginectomy + Reconstruction CT, Biopsy 1 45000 S15 S1500041 No
biopsy
Radical Hysterectomy +Bilateral Pelvic Lymph Node
Gynaec- Clinical Photograph,
11.65 Dissection (BPLND) + Bilateral Salpingo Ophorectomy Pap Smear / biopsy, CT 1 45000 S15 S1500037 No
Ca.Cervix biopsy
(BSO) / Ovarian transposition
11.66 Anterior Exenteration (Gynaec) Pap Smear / biopsy, CT 1 60000 S15 S1512050 No
Ca.Cervix biopsy
11.67 Posterior Exenteration (Gynaec) Pap Smear / biopsy, CT 1 50000 S15 S1512051 No
Ca.Cervix biopsy
11.68 Total Pelvic Exenteration Pap Smear / biopsy, CT 1 75000 S15 S1512052 No
Ca.Cervix biopsy
Biopsy, CT Chest, Bone Clinical Photograph,
11.69 Chest Chest wall resection for SOFT tissue bone tumors 1 9660 S15 S1512053 No
Scan biopsy
Biopsy, CT Chest, Bone Clinical Photograph,
11.70 Chest Chest wall resection + Reconstruction 1 30000 S15 S1500048 No
Scan biopsy
Bone / soft
Limb salvage surgery for Bone Tumors with modular CT-Local part, CT Clinical Photograph,
11.71 tissue 1 75000 S15 S1500045 No
Prosthesis Chest,MRI, Bone Scan biopsy
tumors
Bone / soft
Clinical Photlograph/ X-
11.72 tissue Forequarter amputation Biopsy, CT Chest 1 30000 S15 S1512054 No
Ray, biopsy
tumors
Bone / soft
Biopsy, CT/MRI Pelvis, CT Clinical Photlograph/ X-
11.73 tissue Hemipelvectomy 1 55000 S15 S1500046 No
Chest, PET scan Ray, biopsy
tumors
Bone / soft
Clinical Photograph/X-ray,
11.74 tissue Bone resection CT/MRI, Biopsy 1 30000 S15 S1512055 No
biopsy
tumors
Renal Cell Clinical Photograph,
11.75 Partial Nephrectomy CT/Isotope renogram 1 40000 S15 S1512056 No
Cancer biopsy
Renal Cell Nephroureterectomy for Transitional Cell Carcinoma Clinical Photograph,
11.76 CT, Biopsy 1 46000 S15 S1512057 No
Cancer of renal pelvis (one side) biopsy
Testes Retro Peritoneal Lymph Node Dissection(RPLND) (for CT-Chest, CT.Abd+Pelvis, Clinical Photograph,
11.77 1 60000 S15 S1512058 No
cancer Residual Disease) Tumor markers, biopsy biopsy
CT/MRI, Urinary Clinical Photograph,
11.78 Tumours Adrenalectomy 1 45000 S15 S1512059 No
hormones biopsy
Testes Clinical Photograph,
11.79 Urinary diversion biopsy, USG Scrotum 1 40000 S15 S1512060 No
cancer biopsy
Testes Retro Peritoneal Lymph Node Dissection RPLND as Clinical Photograph,
11.80 CT, biopsy 1 23000 S15 S1512061 No
cancer part of staging biopsy
Ca. Urinary Clinical Photograph,
11.81 Anterior Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT 1 60000 S15 S1512062 No
Bladder biopsy
11.82 Total Exenteration (Urinary Bladder) Cystoscopy, biopsy/CT 1 75000 S15 S1512063 No
Bladder biopsy
11.83 Bilateral pelvic lymph Node Dissection(BPLND) CT, biopsy 1 25000 S15 S1500042 No
Bladder biopsy
Thoracic
and Clinical Photograph,
11.84 Mediastinal tumor resection CT 1 50000 S15 S1512064 No
Mediastinu biopsy
m
CT, biopsy, Bone scan/
11.85 Lung Lung metastatectomy of any type X-Ray, Biospy 1 35000 S15 S1512065 No
PET scan
CT/ Bronchoscopy,
11.86 Lung Sleeve resection of Lung cancer. X-Ray, Biospy 1 90000 S15 S1500027 No
biopsy, PET scan
UGI Endoscopy, biopsy / Clinical Photograph,
11.87 Esophagus Oesophagectomy with Two field Lymphadenectomy 1 80000 S15 S1500028 No
CT biopsy
Oesophagectomy with Three field UGI Endoscopy, biopsy / Clinical Photograph,
11.88 Esophagus 1 80000 S15 S1500029 No
Lymphadenectomy CT biopsy
Palliative
11.89 Tracheostomy Clinical Photograph Clinical Photograph 1 5520 S15 S1500021 No
Surgeries
Palliative
11.90 Gastrostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512066 No
Surgeries
Palliative
11.91 Jejunostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512067 No
Surgeries
Palliative
11.92 Ileostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512068 No
Surgeries
Palliative
11.93 Colostomy Clinical Photograph Clinical Photograph 1 15000 S15 S1512069 No
Surgeries
Palliative
11.94 Suprapubic Cystostomy Clinical Photograph Clinical Photograph 1 10000 S15 S1512070 No
Surgeries
Palliative USG, CT SCAN, Clinical Clinical Photograph,
11.95 Gastro Jejunostomy 1 20000 S15 S1512071 No
Surgeries Photograph biopsy
CT SCAN, USG,
Palliative Clinical Photograph,
11.96 Ileotransverse BYPASSColostomy Endoscopy, Biopsy, 1 9890 S15 S1512072 No
Surgeries biopsy
Clinical Photograph
CT SCAN, USG,
Palliative Clinical Photograph,
11.97 Substernal bypass Endoscopy, Biopsy, 1 35000 S15 S1500003 No
Surgeries biopsy
Clinical Photograph
Reconstructi
11.98 Myocutaneous / cutaneous flap Clinical Photograph Clinical Photograph 1 25000 S15 S1500005 No
on
Reconstructi Doppler study, Clinical
11.99 Micro vascular reconstruction Clinical Photograph 1 45000 S15 S1500009 No
on Photograph
Soft Tissue
Clinical Photograph, Clinical Photograph,
11.100 and Bone Wide excision - for soft tissue and bone tumors 1 12650 S15 S1512073 No
biopsy biopsy
Tumors
Soft Tissue
Wide excision + Reconstruction for soft tissue and Clinical Photograph, Clinical Photograph,
11.101 and Bone 1 25000 S15 S1512074 No
bone tumors biopsy biopsy
Tumors
Soft Tissue
Amputation for bone / soft tissue tumours (Major / Clinical Photograph, Clinical Photograph,
11.102 and Bone 1 25000 S15 S1512075 No
Minor) biopsy Biopsy
Tumors
Genito
Biopsy, Clinical Biopsy, Clinical
11.103 Urinary Inguinal Block Dissection-both side 1 16100 S15 S1512076 No
Photograph, CT scan Photograph, USG
System
Low Anterior resection OR Sphincter preserving CT/ BMFT, Colonoscopy, Biopsy, Clinical
11.104 Ano-rectal 1 40000 S15 S1512077 No
surgery of any type Biopsy, CEA Photograph, USG
Barium meal test, CT
Gastro
abdomen, biopsy, Biopsy, Clinical
11.105 Intestinal Laproscopic resection of any type 1 50000 S15 S1512078 No
Endoscopy, Tumor Photograph, USG
Surgery
Marker
CT abdomen, biopsy,
Biopsy, Clinical
11.106 Liver Hepatic surgery of any type Endoscopy, Tumor 1 70000 S15 S1512079 No
Photograph, USG
Marker
Lung & CT abdomen, biopsy, Biopsy, Clinical
11.107 Thoracoscopic and Laproscopic surgery of any type 1 60000 S15 S1512080 No
Oesophagus Endoscopy Photograph, USG
Genito
Laproscopic surgery for kidney & supra renal any CT abdomen, biopsy, Biopsy, Clinical
11.108 Urinary 1 40000 S15 S1512081 No
type Endoscopy Photograph, USG
System
Brain
11.109 Brain tumours surgery of any type CT/ MRI, Biopsy CT, Photograph 1 55000 S15 S1512082 No
Tumour
Gynaec
Biopsy, CT scan, USG, CA
11.110 Body of the TAH + BSO + BLND + O.S. CT, Biopsy, Photograph 1 45000 S15 S1512083 No
125
uterus
Bone & soft MRI, Bone scan & PET
11.111 Hind Quarter Amputation CT, Biopsy, Photograph 1 40000 S15 S1512084 No
tissue scan
Bone & soft
11.112 Hip & Knee Disarticulation MRI Photograph 1 45000 S15 S1512085 No
tissue
Gynaec CIN
Early cancer
Radical Trachelectomy Cone Biopsy, Simple Biopsy, CT scan, USG, CA
11.113 of any Biopsy, USG 1 40000 S15 S1512086 No
Hysterectomy 125
female
organ
All System
Pre
malignant
11.114 Laser Surgery Any type Usg,/x-ray,/ct,/biopsy clinical photograph 1 15000 S15 S1512087 No
and
Malignant
Lesion
Usg,/x-ray,/ct,/biopsy
Head &
11.115 Flap Cutting any type previous procedure clinical photograph 1 5000 S15 S1512088 No
Neck
report
Head &
11.116 Eyeball enucleation Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512089 No
Neck
For All Long
term
11.117 PICC (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 10000 S15 S1512090 No
Chemothera
py
For All Long
term
11.118 Port Insertion (For cluster 9 user also) Usg,/x-ray,/ct,/biopsy clinical photograph 3 15000 S15 S1512091 No
Chemothera
py
Palliative
11.119 ICD Tube Insertion Usg,/x-ray,/ct,/biopsy clinical photograph 1 1500 S15 S1512092 No
Surgeries
Wide Excision any type (Surgery other than
11.120 Pancreas Usg,/x-ray,/ct,/biopsy clinical photograph 3 50000 S15 S1512093 No
Whipples)
Palliative
11.121 Drain Insertion any type Usg,/x-ray,/ct,/biopsy clinical photograph 1 1500 S15 S1512094 No
Surgeries
Usg,/x-ray,/ct,/biopsy
Any Wound
11.122 Resuturing previous procedure clinical photograph 1 3000 S15 S1512095 No
Gap Surgery
report
Invoice of prosthesis, scar
11.123 Larynx Voice prosthesis Biopsy, CECT 1 30000 S15 S1500018 No
photo
Biopsy, Blood Routine
11.124 Skin Skin Tumours Wide Excision + Reconstruction clinical photograph 1 25000 S15 S1500038 No
(CBC), CT Scan
Biopsy, Blood Routine
11.125 Skin Skin Tumours Amputation clinical photograph 1 25000 S15 S1500039 No
(CBC), CT Scan
HPE report,Clinical
11.127 Brest Breast conserving surgery (lumpectomy + axillary surgery) CECT,FNAC/ BIOPSY 1 12000 S16 S1500023 No
photograph showing scar
11.126 Oncosurgery Concern Investigation Concern Investigation 1 100000 S15 U100 No
1,00,000rs per anum per family)
Cluster-14 JOINT REPLACEMENT
Specialt
PMJAY
Haematology, Serum
Hip
Total Hip Replacement (cemented) (With US FDA Biochemistry, Viral Clinical Photograph,
14.15 Replacemen 3 75000 S5 S500091 No
Approved Implants) markers, Clinical X-RAY
t
Photograph, X-RAY
Haematology, Serum
Hip
Total Hip Replacement (cementless)(With US FDA Biochemistry, Viral Clinical Photograph,
14.16 Replacemen 3 90000 S5 S500092 No
t
Photograph, X-RAY
Haematology, Serum
Hip
Total Hip Replacement (hybrid)(With US FDA Biochemistry, Viral Clinical Photograph,
14.17 Replacemen 3 75000 S5 S500093 No
t
Photograph, X-RAY
Haematology, Serum
Biochemistry, Viral
Knee markers, Clinical
Total Knee Replacement (With US FDA Approved Clinical Photograph, X-
14.18 Replacemen Photograph, X-RAY, 3 80000 S5 S500096 No
Implants - Metal Back Implant) RAY
t Bilateral Lower Limb
Standing ORG/CT
scanogram
Cluster-15 ORGAN TRANSPLANT PACKAGES
Specialt
PMJAY
Blood group, FBS, PPBS,

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

FBS, PPBS, ELISA, HCV
RNA Qualitative, CMV
Open Kidney transplantation from living donor Part-
IgG and IgM
1 Investigations
USG Abdomen,
Blood group, HbA1C, FBS, PPBS, ELISA, HCV RNA
Urine R/M and C/S
Qualitative, CMV IgG and IgM
iPTH, Vit D, Uric Acid
USG Abdomen,
BT,CT, PT, aPTT, G6PD
Urine R/M and C/S
Kidney level
15.2 A transplantat Chest X Ray, ECG, 2D 0 15000 S17 S1712002 No
BT,CT, PT, aPTT, G6PD level
ion echocardiogram
Chest X Ray, ECG, 2D echocardiogram
Lipid Profile,
Lipid Profile, Anticardiolipin Antibody, Lupus
Anticardiolipin Antibody,
Anticoagulant, C3, C4, ANA, dsDNA, pANCA, cANCA,
Lupus Anticoagulant, C3,
USG Doppler Neck vessels
C4, ANA, dsDNA, pANCA,
Usg Doppler Iliofemoral Vessels
cANCA, USG Doppler
MCU, Uroflowmetry
Neck vessels
Usg Doppler Iliofemoral
Vessels
MCU, Uroflowmetry
Kidney 2 Investigations HLA Typing
15.2 B transplantat HLA Typing LCM, FCM 0 22500 S17 S1712003 No
ion LCM, FCM Single Antigen
Single Antigen Qualitative Qualitative
Kidney
3 Investigation Single Antigen
15.2 C transplantat 0 22500 S17 S1712004 No
Single Antigen Quantitative Quantitative
ion
Kidney Open Kidney transplantation from living donor Part- S. Creatinine, USG kidney
15.2 D transplantat 4 Operative Part graft, Doppler study for 4 240000 S17 S1712005 No
ion graft
Blood group, HbA1C, FBS,

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

Kidney Part-2 Investigations
HLA Typing
15.3 B transplantat HLA Typing 0 27000 S17 S1712007 No
LCM, FCM
ion LCM, FCM Single Antigen Qualitative
Single Antigen Qualitative
Kidney Open Kidney transplantation from deceased donor
Single Antigen Quantitative
15.3 C transplantat Part=3 InvestigationSingle Antigen Quantitative 0 27000 S17 S1712008 No
ion
Kidney Open Kidney transplantation from deceased donor S. Creatinine, USG kidney
15.3 D transplantat Part-4 Operative Part graft, Doppler study for 4 288000 S17 S1712009 No
ion graft
Blood group ,HbA1C, FBS,
Open dual Kidney transplantation from deceased PPBS, ELISA, HCV RNA
donor Part-1 Investigations Qualitative, CMV IgG and
Blood group ,HbA1C, FBS, PPBS, ELISA, HCV RNA IgM
Qualitative, CMV IgG and IgM USG Abdomen,
USG Abdomen, Urine R/M and C/S
Urine R/M and C/S
Kidney BT,CT, PT,aPTT,. G6PD level
BT,CT, PT,aPTT,. G6PD level
ion echocardiogram
Chest X Ray, ECG, 2D echocardiogram Lipid Profile, Anticardiolipin
Lipid Profile, Anticardiolipin Antibody, Lupus Antibody, Lupus
Anticoagulant, C3, C4, ANA, dsDNA, pANCA, Anticoagulant, C3, C4, ANA,
cANCA,USG Doppler Neck vessels dsDNA, pANCA, cANCA,USG
Usg Doppler Iliofemoral Vessels Doppler Neck vessels
MCU, Uroflowmetry Usg Doppler Iliofemoral
Vessels
MCU, Uroflowmetry
Open dual Kidney transplantation from deceased

Kidney donor Part-2 Investigations
HLA Typing
LCM, FCM
Kidney Open dual Kidney transplantation from deceased
15.4 C transplantat donor Part=3 Investigation 0 30000 S17 S1712012 No
ion Single Antigen Quantitative
Kidney S. Creatinine, USG kidney
Open dual Kidney transplantation from deceased
15.4 D transplantat graft,Doppler for both 4 320000 S17 S1712013 No
donor Part - 4 Operative Part
ion kidney grafts
Kidney
USG and Doppler study of
15.5 transplantat Wound exploration for kidney graft nephrectomy Clinical photo, S. Creatinine 1 40000 S17 S1712014 No
kidney allograft
ion
Robotic kidney transplantation from living donor
Part-1 Investigations IgM
Kidney
ion echocardiogram
Anticoagulant, C3, C4, ANA, dsDNA, pANCA, Antibody, Lupus
cANCA,USG Doppler Neck vessels Anticoagulant, C3, C4, ANA,
dsDNA, pANCA, cANCA,USG
Doppler Neck vessels
MCU, Uroflowmetry
Vessels
MCU, Uroflowmetry
Robotic kidney transplantation from living donor

Kidney Part-2 Investigations
HLA Typing
LCM, FCM
Kidney Robotic kidney transplantation from living donor
15.6 C transplantat Part-3 Investigation 0 33000 S17 S1712017 No
Kidney
Robotic kidney transplantation from living donor S. Creatinine, USG kidney
15.6 D transplantat 4 352000 S17 S1712018 No
Part - 4 Operative Part graft
ion
Blood group ,HbA1C,
FBS, PPBS, ELISA, HCV
RNA Qualitative, CMV
Robotic kidney transplantation from deceased donor
IgG and IgM
Part-1 Investigations
USG Abdomen,
Blood group ,HbA1C, FBS, PPBS, ELISA, HCV RNA
Urine R/M and C/S
Qualitative, CMV IgG and IgM
USG Abdomen,
BT,CT, PT,aPTT,. G6PD
Urine R/M and C/S
Kidney level
BT,CT, PT,aPTT,. G6PD level
ion echocardiogram
Lipid Profile,
Lipid Profile, Anticardiolipin Antibody, Lupus
Anticardiolipin Antibody,
Anticoagulant, C3, C4, ANA, dsDNA, pANCA,
Lupus Anticoagulant, C3,
cANCA,USG Doppler Neck vessels
C4, ANA, dsDNA, pANCA,
cANCA,USG Doppler
MCU, Uroflowmetry
Neck vessels
Vessels
MCU, Uroflowmetry
Kidney Part-2 Investigations HLA Typing
15.7 B transplantat HLA Typing LCM, FCM 0 34500 S17 S1712020 No
ion LCM, FCM Single Antigen
Single Antigen Qualitative Qualitative
Kidney
Part-3 Investigation Single Antigen
Single Antigen Quantitative Quantitative
ion
Kidney
Robotic kidney transplantation from deceased donor S. Creatinine, USG kidney
Part - 4 Operative Part graft
ion
Robotic dual kidney transplantation from deceased
donor Part-1 Investigations IgM
Kidney
ion echocardiogram
Anticoagulant, C3, C4, ANA, dsDNA, pANCA, cANCA, Antibody, Lupus
USG Doppler Neck vessels Anticoagulant, C3, C4, ANA,
dsDNA, pANCA, cANCA,
MCU, Uroflowmetry
Vessels
MCU, Uroflowmetry
Robotic dual kidney transplantation from deceased

Kidney donor Part-2 Investigations
HLA Typing
LCM, FCM
Kidney Robotic dual kidney transplantation from deceased
15.8 C transplantat donor Part-3 Investigation 0 36000 S17 S1712025 No
Kidney
Robotic dual kidney transplantation from deceased Clinical photograph, S.
donor Part-4 Operative Part Creatinine, USG kidney graft
ion
49,000* per
Kidney Plasmapheresis for acute B cell rejection Albumin Single antigen qualitative Single antigen qualitative
sittings with
15.9* transplantat and Rituximab based protocol ( Rate is per sittings and quantitative, Flow and quantitative, Flow 0 49000 S17 S1712027 No
limit of 4
ion with limit of 4 sittings) Cytometry, Kidney biospy Cytometry
sittings
37,500* per
Kidney Plasmapheresis for highly sensitized recipient Single antigen qualitative Single antigen qualitative
sittings with
15.10 transplantat Albumin and Rituximab based protocol (rate is per and quantitative, Flow and quantitative, Flow 0 37500 S17 S1712028 No
limit of 4
ion sittings with limit of 4 sittings) Cytometry Cytometry
sittings
Monthly investigations and immunosuppression
from discharge after kidney transplant Include
Kidney CBC, RFT, RBS, Urine, Graft
Prednisolone ,Tacrolimus 4mg/day, Mycophenolate CBC, RFT, RBS, Urine, Graft 10,000* Rate
15.11 transplantat Doppler, Tacrolimus 0 10000 S17 S1712029 No
360 or 500 mg (4 tables) /day, Valgancyclovir 450 Doppler, Tacrolimus level per month
ion level(monthly)
mg OD, Fluconazole 100mg OD, Sepmax OD (Rate is
per Month)
Kidney after kidney transplant Include
* Rate per
15.12 transplantat Prednisolone,Tacrolimus 4mg/day,Mycophenolate CBC, RFT, RBS, Urine CBC, RFT, RBS, Urine 0 5000 S17 S1712030 No
month
ion 360 or 500 mg (4 tables) /day, Sepmax OD (Package
Rate per month)
Treatment of Invasive fungal infection after kidney Blood culture, CBC, RFT,
RBS, XR Chest, CT of organ
Kidney transplant Include Liposomal Amphotericin 300MG * Rate per day
of invasion (plain) , Urine Blood culture, CBC, RFT,
15.13 transplantat /day(5mg/kg for 60 kg person) for 30 days and 0 12000 with limit of 30 S17 S1712031 No
Routine and culture, RBS, XR Chest, CT Thorax
ion Surgical debridement Hospital stay for 10 days ,ICU Endoscopy for fluid and days
stay for 10 d (Rate per day with limit of 30 days) reports, BAL charges
Kidney graft biopsy, CBC,

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

15.14 B transplantat gancyclovir 500 mg / Hospital stay for 14 day, Graft Doppler, Tacrolimus Tacrolimus level, CMV DNA 0 36000 S17 S1712033 No
ion tab.Valgancyclovir 450 mg OD for 8-12 days level, CMV DNA quantity, quantity
routine and culture

15.14 C transplantat gancyclovir 500 mg / Hospital stay for 14 day, Graft Doppler, Tacrolimus Tacrolimus level, CMV DNA 0 60000 S17 S1712034 No
ion tab.Valgancyclovir 450 mg OD for 13 and above Days level, CMV DNA quantity, quantity
routine and culture
Single antigen quantity

Kidney graft biopsy , CBC Single antigen quantity ,
Treatment for B cell rejection with Therapeutic RFT, RBS, XR Chest, CT CBC,
Thorax, RFT, RBS, XR Chest,
Kidney Plasma exchange with ALBUMIN +IVIG 5 gm (4
Graft Doppler, Tacrolimus Tacrolimus level,
15.15 A transplantat sessions), Inj Rituximab 200 mg or Inj Boretezomib 2 3 67500 S17 S1712035 No
level CMV DNA quantity,
ion mg (4 doses) CMV DNA quantity, BKV BKV DNA quantity
IV methyl prednisolone, Hospital stay for3-7 days DNA quantity, Urine CS
Thorax, RFT, RBS, XR Chest,
Kidney Plasma exchange with ALBUMIN +IVIG 5 gm (4
Graft Doppler, Tacrolimus Tacrolimus level,
15.15 B transplantat sessions), Inj Rituximab 200 mg or Inj Boretezomib 2 3 135000 S17 S1712036 No
level CMV DNA quantity,
ion mg (4 doses) CMV DNA quantity, BKV BKV DNA quantity
IV methyl prednisolone, Hospital stay for 8-13 Days DNA quantity, Urine CS

Plasma exchange with ALBUMIN +IVIG 5 gm (4 Thorax, RFT, RBS, XR Chest,
Kidney
sessions), Inj Rituximab 200 mg or Inj Boretezomib 2 Graft Doppler, Tacrolimus Tacrolimus level,
mg (4 doses) level CMV DNA quantity,
ion CMV DNA quantity, BKV BKV DNA quantity
IV methyl prednisolone, Hospital stay for 13 Days
abd above DNA quantity, Urine CS

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

CBC,
RFT, RBS, XR Chest,
Tacrolimus level,
15.16 B transplantat methyl prednisolone, IV thymoglobulin 75 mg, Tacrolimus level 3 78000 S17 S1712039 No
ion Hospital stay for 8-12 days CMV DNA quantity, BKV
DNA quantity
CBC,
RFT, RBS, XR Chest,
Tacrolimus level,
15.16 C transplantat methyl prednisolone, IV thymoglobulin 75 mg, Tacrolimus level 3 130000 S17 S1712040 No
ion Hospital stay for 13 and above Days CMV DNA quantity, BKV
DNA quantity
Blood culture, CBC, RFT,

RBS
XR Chest, CT Thorax, Graft Blood culture ,CBC,RFT,RBS
Chest Infection after transplant with 10day ICU care Doppler XR Chest,
Kidney
with Ventilator, isolation ward for 3-10 days Tacrolimus level, CMV DNA CT Thorax,
quantity, BKV DNA quantity Tacrolimus level,
ion Urine culture, Urine culture
Bronchoscopy charges and
reports

RBS
Kidney
with Ventilator, isolation ward for 11-20 days Tacrolimus level, CMV DNA CT Thorax,
15.17 B transplantat 3 112500 S17 S1712042 No
reports

RBS
Kidney
with Ventilator, isolation ward for 21 and above days Tacrolimus level, CMV DNA CT Thorax,
reports
Kidney HEPATITIS C VIRUS TREAMENTInclude HCVRNA quantity, CBC, HCVRNA quantity, CBC,
* Rate per
15.18 transplantat Sofosbuvir400+ledispasvir90mg OD for 3 months RFT, LFT, Tacrolimus level LFT, RFT 0 10500 S17 S1712044 No
month
ion and HCVRNA quantity ( 3 times) (Rate per Month)
Kidney Yearly HEPATITIS B VIRUS TREATMENT Include
HBVDNA quantity, CBC, HBVDNA quantity, CBC, LFT, * Rate per
15.19 transplantat ENTECAVIR 0.5 MG OD for 12 months, HBVDNA 0 2200 S17 S1712045 No
RFT, LFT, Tacrolimus level RFT month
ion quantity( 3 time) (Rate per Month)
Kidney
Monthly once a day tacrolimus immunosuppression tacrolimus lvel, CBC, FRT, tacrolimus lvel, CBC, FRT, * Rate per
15.20 transplantat 0 6800 S17 S1712046 No
after kidney transplant (Rate per Month) LFR, RBS LFR, RBS month
ion
Kidney
Monthly sirolimus immunosuppression after kidney Sirolimus LEVEL, CBC, LFT, Sirolimus LEVEL, CBC, LFT, * Rate per
transplant (Rate per Month) RFT, RBS RFT, RBS month
ion
Kidney
Monthly everolimus Immunosuppression after Everolimus LEVEL, CBC, Everolimus LEVEL, CBC, LFT, * Rate per
kidney transplant(Rate per Month) LFT, RFT, RBS RFT, RBS month
ion
Blood group CBC, FBS,

PPBS, Glycosylated
Hemoglobin, Lipid
profile, G6PD deficiency,
Uric acid, Serum
Living donor hepatectomy Part-1 Investigations Ceruloplasmin, 24 hours
Blood group CBC, FBS, PPBS, Glycosylated urinary copper, S.
Hemoglobin, Lipid profile, G6PD deficiency, Uric acid, Creatinine, Blood urea,
Serum Ceruloplasmin, 24 hours urinary copper, S. LFT, aPTT, PT, INR, S.
Creatinine, Blood urea, LFT, aPTT, PT, INR, S. Calcium, S. Magnesium,
Liver
Calcium, S. Magnesium, S. Na, S. K, S. Alpha feto S. Na, S. K, S. Alpha feto
protein, S. CEA, S. CA19-9, Stool for occult blood, protein, S. CEA, S. CA19-
ion
Urine R/M, HIV ELISA, HCV ELISA, HBV DNA, Anti-HBc 9, Stool for occult blood,
antibody, CMV IgG and IgM, EBV, TORCH Complex, Urine R/M, HIV ELISA,
Varicella zoster IgG and IgM, X-ray chest, USG HCV ELISA, HBV DNA,
abdomen, ECG, Pulmonary function test, 2D Anti-HBc antibody, CMV
echocardiography, NCCT abdomen IgG and IgM, EBV, TORCH
Complex, Varicella zoster
IgG and IgM, X-ray chest,
USG abdomen, ECG,
Pulmonary function test,
2D echocardiography,
NCCT abdomen
Liver Living donor hepatectomy Part-2 Investigations CT triphasic angiography

15.23 B transplantat CT triphasic angiography for celiac axis, CT for celiac axis, CT 0 7500 S17 S1712050 No
ion Volumetry, MR cholengiography Volumetry, MR
cholengiography
Liver
LFT, RFT, Lipid profile, ELISA,
15.23 C transplantat Living donor hepatectomy Part-3 Operative Part 3 131250 S17 S1712051 No
CT volumetry
ion
Blood group, CBC, S.
Creatinine, Blood urea, S.
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Glycosylated
Liver transplantation from living donor Part-1 hemoglobin, LFT, Urine
Investigations R/M, 24 hours urinary
Blood group, CBC, S. Creatinine, Blood urea, S. Na+, proteins, 24 hours
S. K+, S. Ca++, S. Mg++, FBS, PPBS, Glycosylated urinary copper, S.
hemoglobin, LFT, Urine R/M, 24 hours urinary Ammonia, Lipid profile,
proteins, 24 hours urinary copper, S. Ammonia, Lipid G6PD, D-dimer, S.
Liver
profile, G6PD, D-dimer, S. Fibrinogen, PT, INR, a-PTT, Fibrinogen, PT, INR, a-
S. Iron, S. Ferritin, S. Transferrin, TIBC, S. Alfa feto PTT, S. Iron, S. Ferritin, S.
ion
protein, S. CEA, S. CA19-9, Arterial blood gas study, Transferrin, TIBC, S. Alfa
HIV ELISA, HBsAg ELISA, Anti HBs antibody titer, HCV feto protein, S. CEA, S.
ELISA, HCV RNA by PCR Assay, HBV DNA by PCR CA19-9, Arterial blood
Assay, HEV antibody, TORCH complex, EBV antibody gas study, HIV ELISA,
titers, Varicella Zoster antibody titers, CMV IgG and HBsAg ELISA, Anti HBs
IgM antibody titer, HCV
ELISA, HCV RNA by PCR
Assay, HBV DNA by PCR
Assay, HEV antibody,
TORCH complex, EBV
antibody titers, Varicella
Zoster antibody titers,
Protein C, Protein S,
Antithrombin C,
Homocysteine,
Homocysteine, ANA,
AMA, ASMA, LKM1, IgG
Liver transplantation from living donor Part-2
level, USG abdomen,
Investigations
Colour Doppler study for
Protein C, Protein S, Antithrombin C, Homocysteine,
portal vein, X-ray chest,
Homocysteine, ANA, AMA, ASMA, LKM1, IgG level,
ECG, Triphasic CT
Liver USG abdomen, Colour Doppler study for portal vein,
abdomen for celiac axis,
15.24 B transplantat X-ray chest, ECG, Triphasic CT abdomen for celiac 0 17500 S17 S1712053 No
Pulmonary function
ion axis, Pulmonary function tests, 2D echocardiography,
tests, 2D
Dobutamine stress echo., Coronary angiography,
echocardiography,
Arterial blood gas analysis, Ascites fluid R/M, Ascites
Dobutamine stress
fluid culture, Pleural fluid R/M, TB PCR assay, Vit D
echo., Coronary
level, Vit. B12 level
angiography, Arterial
blood gas analysis,
Ascites fluid R/M, Ascites
fluid culture, Pleural fluid
R/M, TB PCR assay, Vit D
Liver
Liver transplantation from living donor Part -3 LFT, S. Creatinine, Clinical
Operative Part photograph
ion
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Glycosylated
Liver transplantation from deceased donor Part 1 hemoglobin, LFT, Urine
Investigations R/M, 24 hours urinary
Blood group, CBC, S. Creatinine, Blood urea, S. Na+, proteins, 24 hours
proteins, 24 hours urinary copper, S. Ammonia, Lipid G6PD, D-dimer, S.
Liver
profile, G6PD, D-dimer, S. Fibrinogen, PT, INR, a-PTT, Fibrinogen, PT, INR, a-
S. Iron, S. Ferritin, S. Transferrin, TIBC, S. Alfa feto PTT, S. Iron, S. Ferritin, S.
ion
protein, S. CEA, S. CA19-9, Arterial blood gas study, Transferrin, TIBC, S. Alfa
HIV ELISA, HBsAg ELISA, Anti HBs antibody titer, HCV feto protein, S. CEA, S.
ELISA, HCV RNA by PCR Assay, HBV DNA by PCR CA19-9, Arterial blood
Assay, HEV antibody, TORCH complex, EBV antibody gas study, HIV ELISA,
titers, Varicella Zoster antibody titers, CMV IgG and HBsAg ELISA, Anti HBs
IgM antibody titer, HCV
ELISA, HCV RNA by PCR
Assay, HBV DNA by PCR
Assay, HEV antibody,
TORCH complex, EBV
Zoster antibody titers,
Antithrombin C,
Homocysteine,
Homocysteine, ANA,
AMA, ASMA, LKM1, IgG
Liver transplantation from deceased donor Part 2
level, USG abdomen,
Investigations
Colour Doppler study for
Protein C, Protein S, Antithrombin C, Homocysteine,
portal vein, X-ray chest,
Homocysteine, ANA, AMA, ASMA, LKM1, IgG level,
ECG, Triphasic CT
abdomen for celiac axis,
Pulmonary function
ion axis, Pulmonary function tests, 2D echocardiography,
tests, 2D
Dobutamine stress echo., Coronary angiography,
echocardiography,
Arterial blood gas analysis, Ascites fluid R/M, Ascites
Dobutamine stress
fluid culture, Pleural fluid R/M, TB PCR assay, Vit D
echo., Coronary
angiography, Arterial
blood gas analysis,
Liver
Liver transplantation from deceased donor Part - 3
15.25 C transplantat LFT, S. Creatinine 4 462500 S17 S1712057 No
Operative Part
ion
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
Split liver transplantation from deceased donor Part Glycosylated hemoglobin,
1 Investigations LFT, Urine R/M, 24 hours
Blood group, CBC, S. Creatinine, Blood urea, S. Na+, urinary proteins, 24 hours
G6PD, D-dimer, S.
proteins, 24 hours urinary copper, S. Ammonia, Lipid
Liver Fibrinogen, PT, INR, a-PTT,
profile, G6PD, D-dimer, S. Fibrinogen, PT, INR, a-PTT,
15.26 A transplantat S. Iron, S. Ferritin, S. 0 12500 S17 S1712058 No
S. Iron, S. Ferritin, S. Transferrin, TIBC, S. Alfa feto
ion Transferrin, TIBC, S. Alfa
protein, S. CEA, S. CA19-9, Arterial blood gas study, feto protein, S. CEA, S.
HIV ELISA, HBsAg ELISA, Anti HBs antibody titer, HCV CA19-9, Arterial blood gas
ELISA, HCV RNA by PCR Assay, HBV DNA by PCR study, HIV ELISA, HBsAg
Assay, HEV antibody, TORCH complex, EBV antibody ELISA, Anti HBs antibody
titers, Varicella Zoster antibody titers, CMV IgG and titer, HCV ELISA, HCV RNA
IgM by PCR Assay, HBV DNA by
PCR Assay, HEV antibody,
TORCH complex, EBV
Zoster antibody titers, CMV
IgG and IgM
Antithrombin C,
Homocysteine,
Split liver transplantation from deceased donor Part Homocysteine, ANA, AMA,
2 Investigations ASMA, LKM1, IgG level,
Protein C, Protein S, Antithrombin C, Homocysteine, USG abdomen, Colour
Homocysteine, ANA, AMA, ASMA, LKM1, IgG level, Doppler study for portal
vein, X-ray chest, ECG,
Triphasic CT abdomen for
celiac axis, Pulmonary
ion axis, Pulmonary function tests, 2D echocardiography, function tests, 2D
Dobutamine stress echo., Coronary angiography, echocardiography,
Arterial blood gas analysis, Ascites fluid R/M, Ascites Dobutamine stress echo.,
fluid culture, Pleural fluid R/M, TB PCR assay, Vit D Coronary angiography,
level, Vit. B12 level Arterial blood gas analysis,
Liver
Split liver transplantation from deceased donor Part -
15.26 C transplantat LFT, S. Creatinine 4 462500 S17 S1712060 No
3 Operative Part
ion
Blood group CBC, FBS,

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

living donor and other lobe from other living donor
Liver CT triphasic angiography
(Two donor hepatectomy and one liver recipient
15.27 B transplantat for celiac axis, CT 0 30000 S17 S1712062 No
surgery) DONOR Ix Part-2 Investigations
ion Volumetry, MR
CT triphasic angiography for celiac axis, CT cholengiography
Volumetry, MR cholengiography
Na+, S. K+, S. Ca++, S.
Mg++, FBS, PPBS,
living donor and other lobe from other living donor
Glycosylated hemoglobin,
(Two donor hepatectomy and one liver recipient
LFT, Urine R/M, 24 hours
surgery) Receipient Ix urinary proteins, 24 hours
Part-3 Investigations urinary copper, S.
Blood group, CBC, S. Creatinine, Blood urea, S. Na+, Ammonia, Lipid profile,
S. K+, S. Ca++, S. Mg++, FBS, PPBS, Glycosylated G6PD, D-dimer, S.
Liver hemoglobin, LFT, Urine R/M, 24 hours urinary Fibrinogen, PT, INR, a-PTT,
15.27 C transplantat proteins, 24 hours urinary copper, S. Ammonia, Lipid S. Iron, S. Ferritin, S. 0 30000 S17 S1712063 No
ion profile, G6PD, D-dimer, S. Fibrinogen, PT, INR, a-PTT, Transferrin, TIBC, S. Alfa
S. Iron, S. Ferritin, S. Transferrin, TIBC, S. Alfa feto feto protein, S. CEA, S.
protein, S. CEA, S. CA19-9, Arterial blood gas study, CA19-9, Arterial blood gas
HIV ELISA, HBsAg ELISA, Anti HBs antibody titer, HCV study, HIV ELISA, HBsAg
ELISA, Anti HBs antibody
ELISA, HCV RNA by PCR Assay, HBV DNA by PCR
titer, HCV ELISA, HCV RNA
Assay, HEV antibody, TORCH complex, EBV antibody
by PCR Assay, HBV DNA by
titers, Varicella Zoster antibody titers, CMV IgG and
PCR Assay, HEV antibody,
IgM TORCH complex, EBV
Zoster antibody titers, CMV
IgG and IgM
Antithrombin C,
Dual lobe liver transplantation: One lobe from one Homocysteine,
living donor and other lobe from other living donor Homocysteine, ANA, AMA,
(Two donor hepatectomy and one liver recipient ASMA, LKM1, IgG level,
surgery) Receipient Ix Part-4 Investigations USG abdomen, Colour
Protein C, Protein S, Antithrombin C, Homocysteine, Doppler study for portal
vein, X-ray chest, ECG,
Liver Homocysteine, ANA, AMA, ASMA, LKM1, IgG level, LFT, RFT, Lipid profile, ELISA,
Triphasic CT abdomen for
15.27 D transplantat USG abdomen, Colour Doppler study for portal vein, CT volumetry of both 0 30000 S17 S1712064 No
celiac axis, Pulmonary
ion X-ray chest, ECG, Triphasic CT abdomen for celiac donors
function tests, 2D
axis, Pulmonary function tests, 2D echocardiography, echocardiography,
Dobutamine stress echo., Coronary angiography, Dobutamine stress echo.,
Arterial blood gas analysis, Ascites fluid R/M, Ascites Coronary angiography,
fluid culture, Pleural fluid R/M, TB PCR assay, Vit D Arterial blood gas analysis,
level, Vit. B12 level Ascites fluid R/M, Ascites
Liver living donor and other lobe from other living donor
15.27 E transplantat (Two donor hepatectomy and one liver recipient 3 1080000 S17 S1712065 No
ion surgery) Receipient Ix Part-5 Operativr Part for both
Donor and recippient
Liver
15.28 transplantat Emergency Exploratory laparotomy for liver donor ABG, USG abdomen USG abdomen 0 20000 S17 S1712066 No
ion
Liver
15.29 transplantat Emergency Exploratory laparotomy for liver recipient ABG, USG abdomen USG abdomen 0 50000 S17 S1712067 No
ion
Liver
Post liver transplant Percutaneous Endoscopy guided
15.30 transplantat LFT, CBC Photograph 1 8000 S17 S1712068 No
gastrostomy (PEG)
ion
Liver
Post liver transplant incisional hernia repair for 7 days
15.31 transplantat CT abdomen Clinical photograph, LFT 3 40000 S17 S1712069 No
(Prosthetic mesh) admission
ion
Liver
LFT, CECT, HRCT thorax,
15.32 transplantat Liver resection for HCC in Child-A cirrhosis LFT, CECT, Alfa fetoprotein 5 125000 S17 S1712070 No
Alfa fetoprotein
ion
Liver
Radiofrequency ablation (RFA) for HCC for Child-A, B LFT, CECT, HRCT thorax,
15.33 transplantat LFT, CECT, Alfa fetoprotein 5 25000 * Per session S17 S1712071 No
and C cirrhosis(Rate per session) Alfa fetoprotein
ion
Liver LFT, S. Creatinine, PT, INR,
Trans-jugular Intrahepatic Porto-Systemic Shunt X-ray abdomen, Doppler
15.34 transplantat CBC, S. Ammonia, Doppler 2 150000 S17 S1712072 No
procedure (TIPS) portal vein, S. Creatinine
ion portal vein, USG abdomen
(Including
Liver
Procedure and
15.35 transplantat Trans-jugular liver allograft biopsy CBC, PT, LFT, S. Creatinine, X-ray chest, biopsy report 0 8000 S17 S1712073 No
histopathology
ion
charge)
(Including
Liver
Procedure and
15.36 transplantat Percutaneous liver allograft biopsy CBC, PT, LFT, S. Creatinine, X-ray chest, biopsy report 0 5000 S17 S1712074 No
histopathology
ion
charge)
Liver
Post liver transplant percutaneous transhepatic LFT, MRCP, USG abdomen, X-ray abdomen, USG
biliary drainage (PTBD) CBC, PT abdomen, LFT
ion
Liver
Post liver transplant roux en Y jejunojejunostomy LFT, MRCP, USG abdomen, X-ray abdomen, USG (2 weeks of
and choledochojejunostomy CBC, PT abdomen, LFT hospitalization)
ion
Liver
LFT, MRCP, USG abdomen, X-ray abdomen, USG
15.39 transplantat Post liver transplant ERCP 2 10000 S17 S1712077 No
CBC, PT abdomen, LFT
ion
Liver
LFT, MRCP, USG abdomen, X-ray abdomen, USG
15.40 transplantat Post liver transplant ERCP with stenting 2 18000 S17 S1712078 No
CBC, PT abdomen, LFT
ion
from day of discharge to 3 months after liver
Liver CBC, RFT, Na, K, LFT, RBS,
transplant Include Prednisolone, Tacrolimus CBC, RFT, LFT, RBS,
15.41 A transplantat Tacrolimus level, USG liver 3 41580 S17 S1712079 No
4mg/day, Mycophenolate upto 2 g /day, Tacrolimus level
ion allograft
Valgancyclovir 450 mg ,Fluconazole 100mg/day,
Septran 1 tablet once a day For First Month
15.41 B transplantat Tacrolimus level, USG liver 3 13860 S17 S1712080 No
ion allograft
Septran 1 tablet once a day For Second Month
15.41 C transplantat Tacrolimus level, USG liver 3 13860 S17 S1712081 No
ion allograft
Septran 1 tablet once a day For Third Month
Liver from 4-12 months after liver transplant Include
*Rate per
15.42 transplantat Prednisolone ,Tacrolimus 4mg/day, Mycophenolate CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 4200 S17 S1712082 No
month
ion upto 2 g / day , Fluconazole 100mg/day, Septran 1
tablet once a day,

(with everolimus)from 4-12 months after liver
Liver
transplant Include Prednisolone Tacrolimus 2 *Rate per
15.43 transplantat CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 7800 S17 S1712083 No
mg/day +Everolimus 1 mg/day, Mycophenolate upto month
ion
2 g /day Fluconazole 100mg/day, Septran 1 tablet
once a day
Maintainence immunosuppresants and
Liver investigations after 12 months of liver
*Rate per
15.44 transplantat transplant(Calcineurin based ) Include Prednisolone, CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 3500 S17 S1712084 No
month
ion Tacrolimus 2mg/day Mycophenolate upto 2 g
/day(Rate per month)
Maintainence immunosuppresants and
investigations and for 12 months after liver
Liver
transplant (Calcineurin and mTOR based ) Include *Rate per
15.45 transplantat CBC, RFT, RBS, LFT CBC, RFT, RBS, LFT 0 8000 S17 S1712085 No
Prednisolone Tacrolimus 2 mg/day Everolimus 1 month
ion
mg/day, Mycophenolate upto 2 g/day (Rate per
month)
Invasive fungal infection after liver transplant
Fluid KOH preperation and
Liver Include Liposomal Amphotericin 5-10 mg/kg/day for
culture, CBC, RFT, LFT, RBS, Blood culture, CBC, RFT, LFT,
15.46 transplantat 30 days and Surgical debridement, ICU stay for 10 0 375000 S17 S1712086 No
XR Chest, CT of organ of RBS, XR Chest, CT Thorax
ion days Hospital stay for 21 days With Liposomal invasion, Endoscopy
Amphotericin 300 mg/day
CBC,RFT, LFT, RBS, X-ray
Chest, CT Thorax, Graft
Liver CMV infection after liver transplant Include IV CBC, RFT, LFT, RBS, XR
Doppler, Tacrolimus level,
15.47 A transplantat gancyclovir 500 mg / Hospital stay for 14 day, Chest, Tacrolimus level, 0 19800 S17 S1712087 No
CMV DNA quality and
ion tab.Valgancyclovir 450 mg OD for 3-7 days CMV DNA quantity
quantity, Urine RM and
Culture
15.47 B transplantat gancyclovir 500 mg / Hospital stay for 14 day, Chest, Tacrolimus level, 0 39600 S17 S1712088 No
CMV DNA quality and
ion tab.Valgancyclovir 450 mg OD for 8-12 days CMV DNA quantity
quantity, Urine RM and
Culture
15.47 C transplantat gancyclovir 500 mg / Hospital stay for 14 day, Chest, Tacrolimus level, 0 66000 S17 S1712089 No
CMV DNA quality and
ion tab.Valgancyclovir 450 mg OD for 13 and above Days quantity, Urine RM and CMV DNA quantity
Culture
Liver graft biopsy, CBC, LFT,
Liver RFT, RBS, XR Chest, Graft CBC, RFT, RBS, XR Chest,
Treatment for T cell rejection IV methyl prednisolone
15.48 A transplantat Doppler, Tacrolimus level, Tacrolimus level, CMV DNA 0 9000 S17 S1712090 No
IV, Hospital stay for 3-7 days
ion CMV DNA quality and quantity
quantity

15.48 B transplantat Doppler, Tacrolimus level, Tacrolimus level, CMV DNA 0 18000 S17 S1712091 No
IV, Hospital stay for 8-12 days
quantity

15.48 C transplantat Doppler, Tacrolimus level, Tacrolimus level, CMV DNA 0 30000 S17 S1712092 No
IV, Hospital stay for 13 and above days
quantity
Treatment for T cell rejection with thymoglobulin IV Livergraft biopsy , CBC,

Liver CBC, RFT, RBS, XR Chest,
methyl prednisolone ,IV thymoglobulin 75 mg , RFT, LFT, RBS, XR Chest,
15.49 A transplantat Tacrolimus level, CMV DNA 0 80000 S17 S1712093 No
Hospital stay for 15 d,Valgancyclovir 450 mg/day Graft Doppler, Tacrolimus
ion quantity
Fluconazole 100 mg/day for First month level, CMV DNA quantity
15.49 B transplantat Tacrolimus level, CMV DNA 0 60000 S17 S1712094 No
ion quantity
Fluconazole 100 mg/day for second month level, CMV DNA quantity

15.49 C transplantat Tacrolimus level, CMV DNA 0 60000 S17 S1712095 No
ion quantity
Fluconazole 100 mg/day for 3rd month level, CMV DNA quantity
Blood culture , CBC , RFT,

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

15.50 B transplantat Include ICU stay , ICU ventilator , ICU medicine , LFT, RBS, XR Chest, CT 0 112500 S17 S1712097 No
ion isolation ward for 3 to 7 day Thorax, Tacrolimus level
charges and reports

15.50 C transplantat Include ICU stay , ICU ventilator , ICU medicine , LFT, RBS, XR Chest, CT 0 150000 S17 S1712098 No
ion isolation ward for 10 day or above Thorax, Tacrolimus level
charges and reports
Liver Post-liver transplant Hepatitis C infectionIncludes

LFT, RFT, CBC, RBS, HCV LFT, RFT, CBC, RBS, HCV *Rate per
15.51 Transplantat sofosbuvir 400 mg/ day + daclatasavir 60 mg/day + 0 30000 S17 S1712099 No
ELISA, HCV RNA quantity ELISA, HCV RNA quantity month
ion ribavirin 1000 mg/day (Rate Per Month)
Liver
Post-liver transplant Hepatitis B infection Includes LFT, RFT, CBC, RBS, HBV LFT, RFT, CBC, RBS, HBV *Rate per
15.52 Transplantat 0 4000 S17 S1712100 No
entecavir 0.5 mg /day (Rate Per Month) ELISA, HBV DNA quantity ELISA, HBV DNA quantity month
ion
Liver Post-liver transplant Hepatitis B infection (entecavir
LFT, RFT, CBC, RBS, HBV LFT, RFT, CBC, RBS, HBV *Rate per
15.53 Transplantat resistant)Includes tenofovir 300 mg /day (Rate Per 0 4700 S17 S1712101 No
ELISA, HBV DNA quantity ELISA, HBV DNA quantity month
ion Month)
Blood group, CBC, RFT, LFT,
Thyroid Function Test,
Calcium, S. Phosphorus, S.
Vit D, S. Uric Acid, Blood
Pancreas transplant Part-1 Investigations Sugar FaSTING, PPBS, HIV
Blood group, CBC, RFT, LFT, Thyroid Function Test, ELISA, HCV ELISA,
Calcium, S. Phosphorus, S. Vit D, S. Uric Acid, Blood HBSAgelisa, HCV RNA
Sugar FaSTING, PPBS, HIV ELISA, HCV ELISA, quantitative, CMV IgG and
HBSAgelisa, HCV RNA quantitative, CMV IgG and IgM, Urine Routine and
Pancreas
IgM, Urine Routine and Micro, Urine Culture, USG Micro, Urine Culture, USG
Abdomen, Chest XR, ECG, Lipid Profile, Abdomen, Chest XR, ECG,
ion
Anticardiolipid Ab, Lupus Anticoagulant, C3, C4, P- Lipid Profile, Anticardiolipid
ANCA, C-ANCA, ANA, DSDNA, PT INR, APTT, Ab, Lupus Anticoagulant,
Pulmonary Function Test, ABG, Doppler of Neck C3, C4, P-ANCA, C-ANCA,
Vessels, Doppler of Iliofemoral Vessels, Uroflometry, ANA, DSDNA, PT INR, APTT,
Pulmonary Function Test,
MCU, Urodynamic study
ABG, Doppler of Neck
Vessels, Doppler of
Iliofemoral Vessels,
Uroflometry, MCU,
Urodynamic study
Pancreas transplant Part-2 Investigations

Pancreas
HLA Typing HLA Typing
15.54 B transplantat 0 40000 S17 S1712103 No
LCM, FCM LCM, FCM
ion Single Antigen Qualitative
Single Antigen
Pancreas transplant Part-3 Investigation
Pancreas Quantitative, S. Amylase,
Single Antigen Quantitative, S. Amylase, S. lipase, C-
15.54 C transplantat S. lipase, C-Peptide, GAD 0 30000 S17 S1712104 No
Peptide, GAD Antibody, Plain CT of Abdomen
ion Antibody, Plain CT of
Abdomen
Clinical photograph, blood

Pancreas
sugar, Doppler study for
15.54 D transplantat Pancreas transplant Part - 4 Operative Part 4 420000 S17 S1712105 No
pancreas and kidney graft, C-
ion peptide
Pancreas
Exploratory laparotomy after pancreas transplant for
15.55 transplantat ABG, USG abdomen USG abdomen 2 20000 S17 S1712106 No
abdominal wash
ion
Pancreas
Exploratory laparotomy after pancreas transplant for
15.56 transplantat ABG, USG abdomen USG abdomen 4 50000 S17 S1712107 No
pancreatectomy
ion
Cluster - 16 OTORHINOLARYNGOLOGY (ENT)
Specialt
PMJAY
clinical notes and

16.1 ENT Aural polypectomy 1 4000 S2 S200001 No
autoscopy examination
CT temporal bone,CECT/ Government
16.2 ENT Labyrinthectomy HPEE 2 20000 S2 S200002 Yes
MRI Reserve
Clinical photo showing
16.3 ENT Mastoidectomy X RAY,CT/MRI 1 12500 S2 S200003 No
scar
PTA , X-Ray Clinical photo showing
16.4 ENT Mastoidectomy corticol modified/ radical 1 11500 S2 S200004 No
Mastoids,clinical notes scar
clinical notes and
autoscopy POST OP. SCOP
16.5 ENT Mastoidectomy with tympanoplasty 2 16000 S2 S200005 No
examination/CTSCAN/M Y PICTURE
RI
16.6 ENT Myringoplasty PTA and IA PTA and IA 1 7500 S2 S200006 No
PTA and IA,Endoscopy
16.7 ENT Myringoplasty with Ossiculoplasty clinical notes 1 13500 S2 S200007 No
Picture,clinical notes
Operative notes with
16.8 ENT Myringotomy – Bilateral clinical notes steps of surgery,clinical 1 6000 S2 S200008 No
notes
16.9 ENT Myringotomy – Unilateral clinical notes steps of surgery,clinical 1 3500 S2 S200009 No
notes,Endoscopy Picture
16.10 ENT Myringotomy with Grommet - One ear PTA and IA Otoscopic findings 1 6500 S2 S200010 No
16.11 ENT Myrinogotomy with Grommet - Both ear PTA and IA Otoscopic findings 1 8500 S2 S200011 No
16.12 ENT Ossiculoplasty PTA and IA Otoscopic findings 1 9500 S2 S200012 No
Government
16.13 ENT Partial amputation – Pinna PTA and IA Post op audiogram 1 4000 S2 S200013 Yes
Reserve
Excision of Pinna for Growths (Squamous/Basal)
CT/FNAC/HPE/CLINICAL HPE/POST OP.
16.14 ENT Injuries - Total Amputation & Excision of External 1 8000 S2 S200014 No
PHOTO CLINICAL PHOTO
Auditory Meatus
clinical
Excision of Pinna for Growths (Squamous/Basal)
16.15 ENT CT notes,Histopathological 1 6500 S2 S200015 No
Injuries Total Amputation
report
16.16 ENT Stapedectomy PTA and IA Post op audiogram 1 10000 S2 S200016 No
clinical notes,Clinical
16.17 ENT Tympanoplasty PTA and IA,clinical notes 1 9000 S2 S200017 No
photo showing scar
16.18 ENT Vidian neurectomy – Micro clinical notes clinical notes 1 9000 S2 S200018 No
Government
16.19 ENT Ear lobe repair - single (daycare) CLINICAL PHOTO POST.OP CLINICAL PHOTO 1 1500 S2 S200019 Yes
Reserve
Excision of Pinna for Growth (Squamous/Basal/
16.20 ENT CLINICAL PHOTO POST.OP CLINICAL PHOTO 1 4000 S2 S200020 No
Injuries) Skin and Cartilage
Excision of Pinna for Growth (Squamous/Basal/
16.21 ENT CLINICAL PHOTO POST.OP CLINICAL PHOTO 1 2500 S2 S200021 No
Injuries) Skin Only
16.22 ENT Pharyngectomy and reconstruction CT/MRI clinical notes 1 15000 S2 S200022 No
Government
16.23 ENT Skull base surgery CT/MRI POST OPCLINICIAL PHOTO 2 69000 S2 S200023 Yes
Reserve
Total Amputation & Excision of External Auditory Government
16.24 ENT CLINICAL PHOTO POST.OP CLINICAL PHOTO 1 7500 S2 S200024 Yes
Meatus Reserve
16.25 ENT Tympanotomy CLINICAL PHOTO POST.OP CLINICAL PHOTO 1 4000 S2 S200025 No
16.26 ENT Removal of foreign body from ear clinical notes clinical notes 1 3000 S2 S200026 No
16.27 ENT Aural polypectomy +Tympanoplasty PTA and IA clinical notes 1 10000 S2 S200027 No
16.28 ENT Ant. Ethmoidal artery ligation - open/ endoscopic CT/MRI POST.OP CLINICAL PHOTO 1 11000 S2 S200028 No
clinical notes,CT/MRI,X-
16.29 ENT Antrostomy – Bilateral clinical notes,X Ray 1 8500 S2 S200029 No
Ray
16.30 ENT Antrostomy – Unilateral X RAY PNS CLINICAL NOTES 1 6000 S2 S200030 No
16.31 ENT Cryosurgery CLINICAL NOTES CLINICAL NOTES 1 3000 S2 S200031 No
Government
16.32 ENT CSF Rhinorrhoea – Repair CT/MRI Clinical Photograph 1 14000 S2 S200032 Yes
Reserve
16.33 ENT Septoplasty + FESS X RAY PNS/CT PNS CLINICAL PHOTO/HPE 1 11500 S2 S200033 No
16.34 ENT Ethmoidectomy – External X RAY PNS/CT PNS HPEE 1 11500 S2 S200034 No
X RAY/CT/MRI/CLINIAL
16.35 ENT Fracture reduction nose with septal correction clinical notes,X Ray 1 8000 S2 S200035 No
NOTES
16.36 ENT Fracture - setting maxilla X RAY PNS/CT PNS clinical notes,X Ray 1 8000 S2 S200036 No
16.37 ENT Fracture - setting nasal bone X RAY PNS/CT PNS clinical notes,X Ray 1 5000 S2 S200037 No
16.38 ENT Functional Endoscopic Sinus (FESS) X RAY PNS/CT PNS clinical notes 1 11000 S2 S200038 No
16.39 ENT Intra Nasal Ethmoidectomy X RAY PNS/CT PNS clinical notes 1 5000 S2 S200039 No
16.40 ENT Rhinotomy – Lateral X RAY PNS/CT PNS clinical notes 1 7500 S2 S200040 No
16.41 ENT Nasal polypectomy – Bilateral X RAY PNS/CT PNS HPEE 1 9000 S2 S200041 No
16.42 ENT Nasal polypectomy – Unilateral X RAY PNS/CT PNS HPEE 1 6000 S2 S200042 No
16.43 ENT Turbinectomy Partial – Bilateral X RAY PNS/CT PNS clinical notes 1 3000 S2 S200043 No
16.44 ENT Turbinectomy Partial – Unilateral X RAY PNS/CT PNS clinical notes 1 2000 S2 S200044 No
16.45 ENT Radical fronto ethmo sphenodectomy clinical notes,CT/MRI HPEE 2 18000 S2 S200045 No
16.46 ENT Rhinoplasty CLINICAL PHOTO POST OP CLINICAL PHOTO 1 15000 S2 S200046 No
X RAY PNS/NASAL
16.47 ENT Septoplasty clinical notes 1 5000 S2 S200047 No
ENDOSCOPY
16.48 ENT Youngs operation NASAL ENDOSCOPY clinical notes 1 3000 S2 S200048 No
Government
16.49 ENT Angiofibrom Excision CT PNS HPE 2 18000 S2 S200049 Yes
Reserve
X RAY PNS/SCOPY
16.51 ENT Endoscopic DCR ENDOSCOPY PICTURE 1 7000 S2 S200051 No
EXAMINATION
16.52 ENT Endoscopic Hypophysectomy CT/MRI HPEE 2 21000 S2 S200052 No
16.53 ENT Intranasal Diathermy X RAY PNS clinical notes 1 3000 S2 S200053 No
16.54 ENT Rhinosporidiosis CT PNS ,HPE HPEE 1 5000 S2 S200054 No
16.55 ENT Septo-rhinoplasty CLINICAL PHOTO/CT PNS clinical notes 1 12500 S2 S200055 No
16.56 ENT Adeno Tonsillectomy X RAY NASOPHARYNX HPEE 1 8000 S2 S200056 No
Government
16.57 ENT Adenoidectomy X RAY NASOPHARYNX HPEE 1 5000 S2 S200057 Yes
Reserve
16.58 ENT Arytenoidectomy CT clinical notes 1 10000 S2 S200058 No
CT PNS/NASAL
16.59 ENT Choanal atresia clinical notes 1 12500 S2 S200059 No
ENDOSCOPY
16.60 ENT Tonsillectomy + Myrinogotomy PTA/IA HPEE 1 10000 S2 S200060 No
16.61 ENT Pharyngeal diverticulum's – Excision CT/BARIUM STUDY HPEE 1 10000 S2 S200061 No
Government
16.62 ENT Laryngectomy with block dissection CT/MRI HPEE 2 25000 S2 S200062 Yes
Reserve
16.63 ENT Laryngofissure clinical notes clinical notes 1 5000 S2 S200063 No
Government
16.64 ENT Laryngophayryngectomy clinical notes,CT/MRI HPEE 2 20000 S2 S200064 Yes
Reserve
Government
16.65 ENT Maxilla – Excision clinical notes,CT/MRI HPEE 1 12500 S2 S200065 Yes
Reserve
16.66 ENT Oro Antral fistula CT/MRI CLINICAL NOTES 1 7500 S2 S200066 No
16.67 ENT Parapharyngeal – Exploration CT/MRI clinical notes 1 12500 S2 S200067 No
16.68 ENT Parapharyngeal Abscess – Drainage CT/MRI clinical notes 1 12500 S2 S200068 No
Government
16.69 ENT Peritonsillor abscess under LA clinical notes Clinical NOTES 1 2500 S2 S200069 Yes
Reserve
16.70 ENT Pharyngoplasty CT/MRI clinical notes 1 10000 S2 S200070 No
CLINICAL NOTES, X
16.71 ENT Retro pharyngeal abscess – Drainage clinical notes 1 5000 S2 S200071 No
RAY/CT
Government
16.72 ENT Tonsillectomy + Styloidectomy X RAY ,CLINICAL NOTES CLINICAL NOTES 1 10000 S2 S200072 Yes
Reserve
Government
16.73 ENT Thyroglossal Fistula/ cyst – Excision USG/ X-RAY clinical notes 1 7000 S2 S200073 Yes
Reserve
Government
16.74 ENT Tonsillectomy – (Uni/ Bilateral) CLINICAL NOTES HPEE 1 7500 S2 S200074 Yes
Reserve
Government
16.75 ENT Total Parotidectomy USG,FNAC,CT/MRI HPEE 2 18000 S2 S200075 Yes
Reserve
16.76 ENT Superficial Parotidectomy USG,FNAC,CT/MRI HPEE 1 12000 S2 S200076 No
16.77 ENT Uvulophanyngo Plasty clinical notes clinical notes 1 14000 S2 S200077 No
HPEE,CLINICAL PHOTO Government
16.78 ENT Commondo Operation (glossectomy) CT /MRI ,BIOPSY 2 17500 S2 S200078 Yes
SHOWING SCAR Reserve
Government
16.79 ENT Excision of Branchial Cyst CT/USG CLINICAL NOTES 1 7000 S2 S200079 Yes
Reserve
16.80 ENT Excision of Branchial Sinus CT/USG CLINICAL NOTES 1 7000 S2 S200080 No
CLINICAL Government
16.81 ENT Excision of Cystic Hygroma Major/ Extensive HPEE 1 10000 S2 S200081 Yes
PHOTO/FNAC/CT Reserve
CLINICAL Government
16.82 ENT Excision of Cystic Hygroma Minor HPEE 1 5000 S2 S200082 Yes
PHOTO/FNAC/CT Reserve
CLINICAL NOTES /X RAY
16.83 ENT Excision of the Mandible Segmental CLINICAL PHOTO 1 7500 S2 S200083 No
OPG.
16.84 ENT Hemi-mandibulectomy with graft X RAY,BIOPSY/CT CLINICAL PHOTO 1 15000 S2 S200084 No
Government
16.85 ENT Hemiglossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 2 20700 S2 S200085 Yes
Reserve
Government
16.86 ENT Palatopharyngoplasty CLINICAL NOTES CLINICAL NOTES 1 10000 S2 S200086 Yes
Reserve
Government
16.87 ENT Partial Glossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 1 5000 S2 S200087 Yes
Reserve
CLINICAL NOTE,CLINICAL
16.88 ENT Ranula excision CLINICAL PHOTO 1 5000 S2 S200088 No
PHOTO
16.89 ENT Removal of Submandibular Salivary gland USG/FNAC HPEE 1 5000 S2 S200089 No
Government
16.90 ENT Total Glossectomy CLINICAL NOTES/BIOPSY CLINICAL PHOTO 1 15000 S2 S200090 Yes
Reserve
Government
16.91 ENT Total Laryngectomy + Neck dissection BIOPSY,CT/MRI HPEE 2 25000 S2 S200091 Yes
Reserve
Laryngopharyngectomy with Gastric pull-up/ jejunal CLINICAL NOTES/BIOPSY/ Government
16.92 ENT HPEE 2 30000 S2 S200092 Yes
graft CT/MRI Reserve
Government
16.93 ENT Excision of CA cheek/ oral cavity + radial forearm flap BIOPSY,CT/MRI HPEE 2 30000 S2 S200093 Yes
Reserve
Excision of growth Jaw + free fibular flap Government
16.94 ENT BIOPSY,CT/MRI HPEE 2 30000 S2 S200094 Yes
reconstruction Reserve
16.95 ENT 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S2 U100 No
Negotiable)
Cluster - 17 OBSTETRICS AND GYNAECOLOGY
Specialt
PMJAY
USG, PRE OP, MINOR Government

17.1 Obs & Gyac Hysterectomy ± Salpingo-oophorectomy HPEE 2 20000 S4 S400001 Yes
PROFILE , HPEE of D& C Reserve
Government
17.2 Obs & Gyac Abdominal Myomectomy USG, Preop Minor Profile HPEE 2 16000 S4 S400002 Yes
Reserve
USG, Clinical History Government
17.3 Obs & Gyac Surgeries for Prolapse - Sling Surgeries USG 2 16000 S4 S400003 Yes
Preop minor profile Reserve
USG ( PVR) Clinical
17.4 Obs & Gyac Surgeries for Stress Incontinence 'Burch' History, Preop Minor 2 35000 S4 S400004 No
Profile
USG, Indication for 2nd
17.5 Obs & Gyac Hysterotomes - 2nd Trimester abortions USG 1 5000 S4 S400005 No
trimester termination
Clinical History Notes, Mesh Sticker Stapler ( If
17.6 Obs & Gyac Incisional Hernia Repair 2 15000 S4 S400006 No
USG Used)
USG, CT SCAN, Preop
Government
17.7 Obs & Gyac Radical Hysterectomy (Wertheims) Major Profile HPEE HPEE 2 20000 S4 S400007 Yes
Reserve
Report
USG, CT Scan, Tumer
Laparotomy and proceed for Ovarian Cancers. Marker ( CA125), HPEE,
17.8 Obs & Gyac HPEE 2 20000 S4 S400008 No
Omentomy with Bilateral Salpingo-oophorectomy Preop Major Profile, X-
Ray Chest
USG/CT Scan, Clinical
HPEE Report Minor Government
17.9 Obs & Gyac Non descent vaginal hysterectomy History Notes, HPEE 2 14,000 S4 S400009 Yes
Profile Reserve
Preop
USG, Clinical History
Vaginal hysterectomy with anterior and posterior Government
17.10 Obs & Gyac Notes, HPEE Report HPEE Report 2 16000 S4 S400010 Yes
colpoperineorrhaphy Reserve
Preop Minor Profile
Clinical History Notes,
17.11 Obs & Gyac Vaginal surgical repair for vesico-vaginal fistula RFT, CT IVP ( KUB ), Clinical Examination 2 10000 S4 S400011 No
Preop Minor Profile
USG, Preop.minor
17.12 Obs & Gyac Sacrocolpopexy Profile, Clinical History Clinical Examination 2 16000 S4 S400012 No
Notes
CT, Barium Encma, Preop
17.13 Obs & Gyac Repair for rectovaginal fitulas Clinical Examination 2 10000 S4 S400013 No
Minor Profile
USG, Clinical Historm,
17.14 Obs & Gyac Vaginoplasty Clinical Examination 2 10000 S4 S400014 No
Preop Minor Profile
17.15 Obs & Gyac LLETZ Colposcopy, Biopsy HPEE Report 2 15000 S4 S400015 No
Clinical Hiatory, USG
17.16 Obs & Gyac Colpotomy HPEE Report 1 1200 S4 S400016 No
Preop, Minor Profile
USG, Clinical History,
17.17 Obs & Gyac Dilation and Evacuation (D&E) NO 1 5000 S4 S400017 No
Preop Minor Profile
17.18 Obs & Gyac Cervical biopsy and Polypectomy HPEE 1 3000 S4 S400018 No
Minor Profile
Clinical History Notes Government
17.19 Obs & Gyac Bartholins Cyst Enucleation/ Incision drainage HPEE 1 3000 S4 S400019 Yes
Preop Minor Profile Reserve
HPEE, Clinical History
17.20 Obs & Gyac Vulvectomy simple HPEE 2 17250 S4 S400020 No
Preop Minor History
HPEE, CT, Clinical History
17.21 Obs & Gyac Radical Vulvectomy HPEE 2 17250 S4 S400021 No
Preop Major Profile
Clinical History Preop
17.22 Obs & Gyac Diagnostic laparoscopy CD, HPEE Report 2 11000 S4 S400022 No
Minor Profile
USG / Ct, Clinical History, Government
17.23 Obs & Gyac Laparoscopic hysterectomy (TLH) HPEE / CD 2 20000 S4 S400023 Yes
Minor Preofile, HPEE Reserve
USG / Ct, Clinical History,

17.24 Obs & Gyac Laparoscopic myomectomy HPEE / CD 2 15000 S4 S400024 No
Minor Preofile, HPEE
USG / Ct, Clinical History,

Government
17.25 Obs & Gyac Laparoscopic cystectomy Minor Preofile, HPEE ( HPEE / CD 2 15000 S4 S400025 Yes
Reserve
CA - 125 )
USG / CT, Clinical History,

17.26 Obs & Gyac Laparoscopic ovarotomy HPEE / CD 2 10000 S4 S400026 No
Minor Profile CA - 125
17.27 Obs & Gyac Laparoscopic adhesiolysis NO / CD 2 15000 S4 S400027 No
Minor Profile
Laparoscopic tubal surgeries - salpingectomy, USG / Clinical History
17.28 Obs & Gyac HPEE / CD 2 11000 S4 S400028 No
salpingotomy Preop Minor Profile
17.29 Obs & Gyac Drag hysteroscopy CD 1 6000 S4 S400029 No
Preop Minor Profile
17.30 Obs & Gyac Hysteroscopic myomectomies CD , HPEE 1 6000 S4 S400030 No
Preop Minor Profile
17.31 Obs & Gyac Hysteroscopic adhesiolysis CD 1 6000 S4 S400031 No
Preop Minor Profile
17.32 Obs & Gyac Hysteroscopic polypectomy CD , HPEE 1 3000 S4 S400032 No
Preop Minor Profile
17.33 Obs & Gyac Hysteroscopic IUCD removal CD 1 3000 S4 S400033 No
Preop Minor Profile
17.34 Obs & Gyac Caesarian Delivery Clinical report 1 9000 S4 S400034 No
steps of surgery
17.35 Obs & Gyac Caesarian hysterectomy USG HPEE 2 16000 S4 S400035 No
ANC Profile, Clinical Clinical History Notes in
17.36 Obs & Gyac High risk delivery: Pre-mature delivery History Notes, USG Details with Tratment 1 9000 S4 S400036 No
Preop, Major Profile Given
High risk delivery: Expected Gestation at delivery less
17.37 Obs & Gyac History Notes, USG Details with Tratment 1 9000 S4 S400037 No
than 35 weeks
High risk delivery: Mothers with eclampsia or Government
17.38 Obs & Gyac History Notes, USG Details with Tratment 1 9000 S4 S400038 Yes
imminent eclampsia Reserve
17.39 Obs & Gyac High risk delivery: Obstructed labour History Notes, USG Details with Tratment 1 9000 S4 S400039 No
High risk delivery: Major Fetal malformation
requiring intervention immediately after birth
High risk delivery: Mothers with severe anaemia (<7
g/dL)
High risk delivery: Other maternal and fetal
conditions as per guidelines-Such as Rh haemolytic
disease, uncontrolled diabetes, severe growth
retardation etc that qualify for high risk delivery etc.
Clinical Notes, USG,
17.43 Obs & Gyac Manual removal of placenta HPEE 1 5000 S4 S400043 No
Preop Minor Profile
17.44 Obs & Gyac Laparotomy for ruptured ectopic HPEE 2 10000 S4 S400044 No
Preop Minor
17.45 Obs & Gyac MTP > 12 weeks Preop Minor, Consort NO 1 6500 S4 S400045 No
Form
17.46 Obs & Gyac MTP upto 12 weeks Preop Minor, Consort NO 1 5000 S4 S400046 No
Form
17.47 Obs & Gyac MTP upto 8 weeks Preop Minor Profile, NO 1 3500 S4 S400047 No
Consort Form
17.48 Obs & Gyac McDonald's stitch Preop Minor Profile, NO 1 4000 S4 S400048 No
Consort Form
17.49 Obs & Gyac Shirodkar's stitch Preop Minor Profile, NO 1 4000 S4 S400049 No
Consort Form
HSG, USG, Clinical
17.50 Obs & Gyac Tuboplasty History Preop Minor NO 2 10000 S4 S400050 No
Profile
USG, Minor Profile
17.51 Obs & Gyac Laparotomy for broad ligament haematoma NO 2 16000 S4 S400051 No
Clinical History
Clinical History,
17.52 Obs & Gyac Trans-vaginal tape/ Trans-obturator tape TVT / TUT Tape Sticker 1 5000 S4 S400052 No
USGPreop Minor
Abdominal Perineal neo construction Cx + Uteria + USG, HSG, Clinical
17.53 Obs & Gyac USG 2 20000 S4 S400053 No
Vagina History, Preop Minor
17.54 Obs & Gyac Ablation of Endometriotic Spot + Adhenolysis CD (if Laproscopy) 2 10000 S4 S400054 No
Preop Minor Profile

17.55 Obs & Gyac Ablation of Endometriotic Spot +Salpingostomy CD (if Laproscopy) 2 10000 S4 S400055 No
Preop Minor Profile

17.56 Obs & Gyac Adhenolysis + Hernia - Ventral - Lipectomy/Incision CD (if Laproscopy) 2 16000 S4 S400056 No
Preop Minor Profile

17.57 Obs & Gyac Adhenolysis+ Ovarian Cystectomy CD (if Laproscopy) 2 10000 S4 S400057 No
Preop Minor Profile

17.58 Obs & Gyac Adhenolysis+ Salpingostomy CD (if Laproscopy) 2 10000 S4 S400058 No
Preop Minor Profile

17.59 Obs & Gyac Broad Ligment Haemotoma drainage CD (if Laproscopy) 2 10000 S4 S400059 No
Preop Minor Profile
Clinical History, Minor
17.60 Obs & Gyac Brust abdomen repair Clincial Notes 2 14000 S4 S400060 No
Profile
Pap Smcar, Colposcopy
17.61 Obs & Gyac Cone Biopsy Cervix HPEE 1 1000 S4 S400061 No
Minor Profile
Preop Minor, Clinical
17.62 Obs & Gyac Conventional Tubectomy HPEE 1 4000 S4 S400062 No
Notes
17.63 Obs & Gyac Cyst -Vaginal Enucleation HPEE 1 3000 S4 S400063 Yes
Preop Minor / USG Reserve
17.64 Obs & Gyac Cyst-Labial HPEE 1 3000 S4 S400064 Yes
Preop Minor / USG Reserve
Clinical History Notes
17.65 Obs & Gyac Cystocele - Anterior repair HPEE 2 12000 S4 S400065 No
Preop Minor / USG
17.66 Obs & Gyac Cystocele - Anterior Repair + Perineal Tear Repair HPEE 2 13000 S4 S400066 No
Preop Minor / USG
D&C (Dilatation &curretage) + Electro Cauterisation
17.67 Obs & Gyac Preop Minor / USG + Pap HPEE 1 4000 S4 S400067 No
Cryo Surgery
Smcar
Clinical History USG,
17.68 Obs & Gyac D&C (Dilatation&curretage) HPEE 1 3000 S4 S400068 No
Preop Minor
Clinical History USG,
17.69 Obs & Gyac Diagnostic laparoscopy & hysteroscopy for infertility CD , HPEE 1 5000 S4 S400069 No
Preop Minor
Pap Smcar, Clinical
17.70 Obs & Gyac Electro Cauterisation Cryo Surgery NO 1 4000 S4 S400070 No
History
Exploration of abdominal haematoma (after USG / CT, Clinical History
17.71 Obs & Gyac NO 2 14000 S4 S400071 No
laparotomy + LSCS) Preop Minor Profile
Preop Minor Profile USG,
17.72 Obs & Gyac Fractional Curretage HPEE 1 4000 S4 S400072 No
Clinical History
Preop Minor Profile,
Gaping Perineal wound secondary suturing/
17.73 Obs & Gyac Clinical History Notes, NO 1 2500 S4 S400073 No
episiotomy
Clinical Site photo
17.74 Obs & Gyac HaematoColpo/Excision - Vaginal Septum USG / CT, Clinical History HPEE 1 5000 S4 S400074 No
Clinical History, USG
17.75 Obs & Gyac Hymenectomy& Repair of Hymen Clinical Site Photo, Preop HPEE 1 7000 S4 S400075 No
Minor Profile
17.76 Obs & Gyac Amniocentesis AN Profile USG Triple 1 5000 S4 S400076 No
17.77 Obs & Gyac Chorionic villus sampling Electrophoresi 1 5000 S4 S400077 No
17.78 Obs & Gyac Cordocentesis 1 5000 S4 S400078 No

Clinical Treatment Notes,
17.79 Obs & Gyac Intrauterine transfusions 2 10000 S4 S400079 No
USG Plates
GYNAECOLO RUPTURE UTERUS, CLOSER AND REPAIR WITH TUBAL CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH, Government
8.80 3 40250 S4 S612031 Yes
GY LIGATION X-RAY, X-RAY Reserve
17.80 Obs & Gyac 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S4 U100 No
Negotiable)
Cluster - 18 OPTHALMOLOGY
Specialt
PMJAY
History of Previous
Opthelmolo Government
18.1 Buckel Removal Operation/ Discharge Clinical Photo 1 5000 S3 S300001 Yes
gy Reserve
Summary (RD)
18.2 Canaliculo Dacryocysto Rhinostomy Dacryocysto Graphy Clinical Photo 1 10000 S3 S300002 Yes
gy Reserve
18.3 Capsulotomy (YAG) B-scan/clinical photo _ 1 1500 S3 S300003 Yes
gy Reserve
18.4 Corneal Grafting clinical photo clinical photo 1 8500 S3 S300004 Yes
gy Reserve
18.5 Prophylactic Cryoretinopexy- Closed retinal photo retinal photo 1 2500 S3 S300005 Yes
gy Reserve
18.6 Cyclocryotherapy/Cyclophotocoagulation retinal photo retinal photo 1 3000 S3 S300006 Yes
gy Reserve
18.7 Pterygium + ConjunctivalAutograft clinical photo Clinical Photo 1 9000 S3 S300007 Yes
gy Reserve
Opthelmolo Clinical Photo,sticker of Government
18.8 Dacryocystectomy with implants Dacryocysto Graphy 1 10000 S3 S300008 Yes
gy implant Reserve
18.9 Enucleation B-scan/clinical photo clinical photo 1 6000 S3 S300009 Yes
gy Reserve
Opthelmolo Clinical Photo,sticker of Government
18.10 Enucleation with Implant B-scan/clinical photo 1 11000 S3 S300010 Yes
gy implant Reserve
18.11 Exenteration MRI X RAY 1 15000 S3 S300011 Yes
gy Reserve
Glaucoma Surgery (Trabeculectomy only) with or
without Mitomycin C, including postoperative Visual field
18.12 medications for 12 weeks (and wherever surgical or report/tonometry/retina clinical photo 1 10000 S3 S300012 Yes
gy Reserve
laser procedures required for bleb augmentation l photo
and anterior chamber maintenance)
Opthelmolo Intraocular Foreign Body Removal from Anterior Government
18.13 B-scan/clinical photo clinical photo 1 4000 S3 S300013 Yes
gy Segment Reserve
Opthelmolo Intraocular Foreign Body Removal from Posterior Government
18.14 B-scan/clinical photo B-scan/clinical photo 2 20000 S3 S300014 Yes
gy Segment Reserve
18.15 Lensectomy /pediatric lens aspiration B-scan/clinical photo B-scan/clinical photo 1 9000 S3 S300015 Yes
gy Reserve
18.16 Limbal Dermoid Removal clinical photo clinical photo 1 4000 S3 S300016 Yes
gy Reserve
18.17 Surgical Membranectomy B-scan/clinical photo clinical photo 1 8000 S3 S300017 Yes
gy Reserve
18.18 Perforating Corneo - Scleral Injury clinical photo clinical photo 1 10000 S3 S300018 Yes
gy Reserve
18.19 Ptosis Surgery clinical photo clinical photo 1 10000 S3 S300019 Yes
gy Reserve
18.20 IRIS Prolapse – Repair clinical photo clinical photo 1 4000 S3 S300020 Yes
gy Reserve
18.21 Retinal Detachment Surgery retinal photo retinal photo 1 15000 S3 S300021 Yes
gy Reserve
18.22 Small Tumour of Lid – Excision + Lid Reconstruction clinical photo clinical photo 1 10000 S3 S300022 Yes
gy Reserve
18.23 Socket Reconstruction with amniotic membrane clinical photo clinical photo 1 8000 S3 S300023 Yes
gy Reserve
18.24 Iridectomy – Laser clinical photo clinical photo 1 2000 S3 S300024 Yes
gy Reserve
18.25 Iridectomy – Surgical clinical photo clinical photo 1 3000 S3 S300025 Yes
gy Reserve
18.26 Iris cyst removal B-scan/clinical Notes clinical photo 1 2500 S3 S300026 Yes
gy Reserve
Opthelmolo retinal photo/CLINICAL Government
18.27 Vitrectomy retinal photo 1 7500 S3 S300027 Yes
gy PHOTO Reserve
Opthelmolo Vitrectomy + Retinal Detachment surgery (pre-auth retinal photo/CLINICAL Government
18.28 retinal photo 2 17500 S3 S300028 Yes
gy required) PHOTO Reserve
18.33 Conjunctival tumour excision + AMG clinical photo clinical photo 1 5000 S3 S300033 Yes
gy Reserve
18.34 Entropion correction clinical photo clinical photo 1 4000 S3 S300034 Yes
gy Reserve
18.35 Ectropion correction clinical photo clinical photo 1 5000 S3 S300035 Yes
gy Reserve
18.36 Evisceration clinical photo/B -scan clinical photo 1 3500 S3 S300036 Yes
gy Reserve
18.37 Laser for retinopathy (per sitting) retinal photo retinal photo 1 1500 S3 S300037 Yes
gy Reserve
18.38 Lid tear clinical photo clinical photo 1 5000 S3 S300038 Yes
gy Reserve
18.39 Orbitotomy B-Scan/MRI clinical photo 1 10000 S3 S300039 Yes
gy Reserve
18.40 Squint correction (per muscle) clinical photo clinical photo 1 4000 S3 S300040 Yes
gy Reserve
Opthelmolo Anterior Chamber Reconstruction +Perforating Government
18.41 A-Scan,clinical photo clinical photo,IOL Sticker 1 11500 S3 S300041 Yes
gy corneo - Scleral Injury + IOL Reserve
18.42 PRP - Retinal Laser including 3 sittings retinal photo retinal photo 1 5000 S3 S300042 Yes
gy Reserve
18.43 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 100000 S3 U100 Yes
gy Reserve
Negotiable)
Cluster - 19 GENERAL SURGERY
Specialt
PMJAY
General Government
19.1 Adventious Burse – Excision USG/MRI 1 10000 S1 S100001 Yes
Surgery Reserve
General USG/Colonoscopy/CT/Bi
19.2 Anterior Resection for CA HPE 1 15000 S1 S100002 No
Surgery opsy
General Government
19.3 Appendicectomy Clinical notes + USG HPE 1 10000 S1 S100003 Yes
Surgery Reserve
General Government
19.4 Appendicular Abscess – Drainage USG/CT HPE/USG 1 12000 S1 S100004 Yes
Surgery Reserve
General Arteriovenous (AV) Malformation of Soft Tissue
19.5 USG/Color droppler HPE/USG 1 15000 S1 S100005 No
Surgery Tumour - Excision
General Government
19.6 Bakers Cyst – Excision Clinical report/USG HPE/USG 1 6000 S1 S100006 Yes
Surgery Reserve
General
19.7 Bilateral Inguinal block dissection USG/CT/FNAC HPE 2 25000 S1 S100007 No
Surgery
General
19.8 Bleeding Ulcer - Gastrectomy & vagotomy USG/CT/HPE/OGD USG/HPE 2 25000 S1 S100008 No
Surgery
General
19.9 Bleeding Ulcer - Partial Gastrectomy USG/CT USG 2 25000 S1 S100009 No
Surgery
General
19.10 Block dissection Cervical Nodes CT scan/USG,FNAC HPE 1 10000 S1 S100010 No
Surgery
General Government
19.11 Branchial Fistula USG/CT HPE 1 14000 S1 S100011 Yes
Surgery Reserve
General
19.12 Breast Lump - Left – Excision USG/CT/FNAC HPE 1 6500 S1 S100012 No
Surgery
General
19.13 Breast Lump - Right – Excision USG/CT/FNAC HPE 1 6500 S1 S100013 No
Surgery
General
19.14 Branchial Cyst USG/CT HPE 1 10000 S1 S100014 No
Surgery
General
19.15 Bursa – Excision USG/Clinical Note HPE 1 4000 S1 S100015 No
Surgery
General CT/MRI,USG,Tumor Government
19.16 Bypass - Inoperable Pancreas HPE/USG 1 15000 S1 S100016 Yes
Surgery Marker Reserve
General
19.17 Cervial Lymphnodes – Excision USG/FNAC HPE/USG 1 2000 S1 S100017 No
Surgery
General HPE/USG,Clinical Government
19.18 Colostomy USG/CT/Xray/Loopogram 1 15000 S1 S100018 Yes
Surgery Photograph Reserve
General Government
19.19 Cyst over Scrotum – Excision clinical notes/USG 1 2000 S1 S100019 Yes
Surgery Reserve
General Government
19.20 Cystic Mass – Excision clinical notes/USG 1 2000 S1 S100020 Yes
Surgery Reserve
General Government
19.21 Dermoid Cyst - Large – Excision USG/FNAC 1 4000 S1 S100021 Yes
Surgery Reserve
General Government
19.22 Dermoid Cyst - Small – Excision USG/FNAC 1 2000 S1 S100022 Yes
Surgery Reserve
General Government
19.23 Drainage of Ischio Rectal Abscess clinical notes/USG 1 4000 S1 S100023 Yes
Surgery Reserve
General Government
19.24 Incision and Drainage of large Abscess clinical notes 1 4000 S1 S100024 Yes
Surgery Reserve
General Government
19.25 Drainage of Psoas Abscess USG/CT,clinical notes 1 7500 S1 S100025 Yes
Surgery Reserve
General Government
19.26 Drainage of Subdiaphramatic Abscess USG/CT,clinical notes 1 10000 S1 S100026 Yes
Surgery Reserve
General Government
19.27 Drainage Pericardial Effusion USG/CT,Echo 1 13750 S1 S100027 Yes
Surgery Reserve
General
19.28 Duodenal Diverticulum USG/CT/UGI 2 20000 S1 S100028 No
Surgery
General Government
19.29 Duodenal Jejunostomy USG/CT 2 20000 S1 S100029 Yes
Surgery Reserve
General
19.30 Duplication of Intestine Clinical report,CT HPE 2 18000 S1 S100030 No
Surgery
General Government
19.31 Hydrocele + Orchidectomy Clinical report,USG HPE 1 8000 S1 S100031 Yes
Surgery Reserve
General
19.32 Epidedectomy Clinical report,USG 1 8000 S1 S100032 No
Surgery
General
19.33 Epididymal Swelling –Excision USG/FNAC 1 6000 S1 S100033 No
Surgery
General Government
19.34 Epidymal Cyst Clinical report,USG 1 4000 S1 S100034 Yes
Surgery Reserve
General Government
19.35 Evacuation of Scrotal Hematoma Clinical report,USG 1 5000 S1 S100035 Yes
Surgery Reserve
General
19.36 Excision Benign Tumor -Small intestine USG/CT HPE 1 15000 S1 S100036 No
Surgery
Clinical
General
19.37 Excision Bronchial Sinus report,Broncoscopy/HRC HPE 1 8000 S1 S100037 No
Surgery
T
General Government
19.38 Drainage of liver Abscess Clinical report,USG USG 1 8000 S1 S100038 Yes
Surgery Reserve
General
19.39 Excision Filarial Scrotum Clinical report,USG,PS 1 5000 S1 S100039 No
Surgery
General Clinical
19.40 Excision Mammary Fistula HPE 1 5000 S1 S100040 No
Surgery report,mammogram
General
19.41 Excision Meckel's Diverticulum USG/CT HPE 1 15000 S1 S100041 No
Surgery
General
19.42 Excision Pilonidal Sinus clinical notes 1 8000 S1 S100042 No
Surgery
General Government
19.43 Excision Small Intestinal Fistula USG/CT HPE 1 15000 S1 S100043 Yes
Surgery Reserve
General
19.44 Excision of Growth from Tongue only Biopsy,Clinical Note HPE 1 6000 S1 S100044 No
Surgery
General Excision of Growth from Tongue with neck node
19.45 Biopsy,CT HPE 1 15000 S1 S100045 No
Surgery dissection
General
19.46 Excision of Swelling in Right Cervical Region clinical notes 1 5000 S1 S100046 No
Surgery
General Government
19.47 Excision of Large Swelling in Hand clinical notes 1 3000 S1 S100047 Yes
Surgery Reserve
General Government
19.48 Excision of Small Swelling in Hand clinical notes 1 1500 S1 S100048 Yes
Surgery Reserve
General
19.49 Excision of Neurofibroma clinical notes HPE 1 3000 S1 S100049 No
Surgery
General Government
19.50 Exicision of Sinus and Curettage clinical notes 1 5000 S1 S100050 Yes
Surgery Reserve
General
19.51 Fibroadenoma – Bilateral clinical notes HPE 1 8000 S1 S100051 No
Surgery
General
19.52 Fibrodenoma – Unilateral clinical notes HPE 1 7000 S1 S100052 No
Surgery
General Government
19.53 Fissurectomy clinical notes 1 8000 S1 S100053 Yes
Surgery Reserve
General Government
19.54 Fissurectomy and Haemorrhoidectomy clinical notes 1 12000 S1 S100054 Yes
Surgery Reserve
General Government
19.55 Eversion of Hydrocele Sac – Bilateral clinical notes 1 10000 S1 S100055 Yes
Surgery Reserve
General Government
19.56 Eversion of Hydrocele Sac – Unilateral clinical notes 1 5000 S1 S100056 Yes
Surgery Reserve
General Photograph of removed Government
19.57 Fissurectomy with Sphincterotomy clinical notes 1 15000 S1 S100057 Yes
Surgery part of body Reserve
General Government
19.58 Foreign Body Removal in Deep Region requiring GA Pre-op. X-ray 1 5000 S1 S100058 Yes
Surgery Reserve
General Government
19.59 Fundoplication Clinical report,OGD/CT USG 2 20000 S1 S100059 Yes
Surgery Reserve
General
19.60 G J Vagotomy/ Vagotomy + Pyloroplasty Clinical report HPE 1 15000 S1 S100060 No
Surgery
General
19.61 Ganglion - large – Excision Clinical report 1 3000 S1 S100061 No
Surgery
General
19.62 Ganglion - Small – Excision clinical notes 1 2000 S1 S100062 No
Surgery
General Government
19.63 Gastrojejunostomy Clinical notes + USG Clinical Photograph 1 15000 S1 S100063 Yes
Surgery Reserve
General Government
19.64 Gastrostomy Clinical notes + USG Clinical Photograph 1 15000 S1 S100064 Yes
Surgery Reserve
General
19.65 Graham's Operation for duodenal perforation X-ray abdomen/USG 1 15000 S1 S100065 No
Surgery
General
19.66 Granuloma – Excision Clinical report 1 2000 S1 S100066 No
Surgery
General Government
19.67 Haemangioma – Excision (large) Doppler 1 10000 S1 S100067 Yes
Surgery Reserve
General Government
19.68 Haemangioma – Excision (small) Doppler 1 5000 S1 S100068 Yes
Surgery Reserve
General Government
19.69 Haemorrhage of Small Intestine clinical notes 1 15000 S1 S100069 Yes
Surgery Reserve
General Government
19.70 Hepatic Resection (lobectomy) Clinical report,USG/CT HPE 2 20000 S1 S100070 Yes
Surgery Reserve
General Government
19.71 Hernia – Epigastric Clinical report USG,Mesh Sticker 1 11000 S1 S100071 Yes
Surgery Reserve
General Government
19.72 Hernia – Incisional Clinical report 1 15000 S1 S100072 Yes
Surgery Reserve
General Government
19.73 Hernia - Repair & release of obstruction Clinical report,X-ray 1 15000 S1 S100073 Yes
Surgery Reserve
General Government
19.74 Hernia – Umbilical Clinical report USG/CT 1 11000 S1 S100074 Yes
Surgery Reserve
General Government
19.75 Hernia – Femoral Clinical report/USG Mesh Sticker 1 10000 S1 S100075 Yes
Surgery Reserve
General Government
19.76 Hernioplasty – Inguinal Clinical report/USG Mesh Sticker 1 10000 S1 S100076 Yes
Surgery Reserve
General Government
19.77 Herniorraphy Clinical report 1 9000 S1 S100077 Yes
Surgery Reserve
General Government
19.78 Hiatus Hernia – abdominal Clinical report,USG/OGD 1 15000 S1 S100078 Yes
Surgery Reserve
General Government
19.79 Hydatid Cyst of Liver Clinical report/USG HPE 1 12500 S1 S100079 Yes
Surgery Reserve
General
19.80 Hydrocele - Excision – Unilateral clinical notes 1 5000 S1 S100080 No
Surgery
General
19.81 Hydrocele - Excision – Bilateral Clinical report 1 10000 S1 S100081 No
Surgery
General
19.83 Infected Bunion Foot – Excision clinical notes 1 4000 S1 S100083 No
Surgery
General
19.84 Inguinal Node (dissection) - Unilateral Clinical notes + USG HPE 1 10000 S1 S100084 No
Surgery
General
19.85 Intestinal perforation Clinical report,X-ray 1 12500 S1 S100085 No
Surgery
General
19.86 Intestinal Obstruction Clinical report,X-ray 1 12500 S1 S100086 No
Surgery
General
19.87 Intussusception Clinical report,X-ray 1 15000 S1 S100087 No
Surgery
General Government
19.88 Jejunostomy X-RAY/USG Clinical Photo 1 15000 S1 S100088 Yes
Surgery Reserve
General Clinical report,X-
19.89 Gastric Perforation 1 15000 S1 S100089 No
Surgery ray/USG
General Clinical report,X-
19.90 Intestinal Perforation (Resection Anastomosis) 2 20000 S1 S100090 No
Surgery ray/USG
General
19.91 Appendicular Perforation X-RAY/USG HPE 1 15000 S1 S100091 No
Surgery
General
19.92 Burst Abdomen Obstruction Clinical report 1 15000 S1 S100092 No
Surgery
General
19.93 Closure of Hollow Viscus Perforation Clinical notes + USG 1 15000 S1 S100093 No
Surgery
General
19.94 Laryngectomy & Pharyngeal Diverticulum (Throat) Clinical report,CT HPE 1 15000 S1 S100094 No
Surgery
General Government
19.95 Ileostomy clinical notes Clinical Photo 1 15000 S1 S100095 Yes
Surgery Reserve
General Government
19.96 Lipoma excision clinical notes 1 2500 S1 S100096 Yes
Surgery Reserve
General Government
19.97 Loop Colostomy Sigmoid clinical notes 1 12000 S1 S100097 Yes
Surgery Reserve
General clinical
19.98 Mastectomy HPE 1 12000 S1 S100098 No
Surgery notes,Mammogram
General
19.99 Mesenteric Cyst – Excision USG/ CT HPE 2 16000 S1 S100099 No
Surgery
General
19.100 Mesenteric Caval Anastomosis USG/ CT 1 15000 S1 S100100 No
Surgery
General
19.101 Microlaryngoscopic Surgery Clinical Note 1 15000 S1 S100101 No
Surgery
General Photo of removed foreign Government
19.102 Oeshophagoscopy for foreign body removal Clinical Note 1 7500 S1 S100102 Yes
Surgery body Reserve
General
19.103 Oesophagectomy CT HPE 2 34500 S1 S100103 No
Surgery
General
19.104 Portal Hypertension shunt surgery USG 2 18000 S1 S100104 No
Surgery
General Government
19.105 Pelvic Abscess - Open Drainage Clinical Note 1 10000 S1 S100105 Yes
Surgery Reserve
General Government
19.106 PancreaticoDuodenectomy CT HPE 2 25000 S1 S100106 Yes
Surgery Reserve
General Government
19.107 Distal Pancreatectomy with PancreaticoJejunostomy CT HPE 2 25000 S1 S100107 Yes
Surgery Reserve
General
19.108 Papilloma Rectum – Excision clinical notes HPE 1 4000 S1 S100108 No
Surgery
General
19.109 Haemorroidectomy+ Fistulectomy clinical notes 1 10000 S1 S100109 No
Surgery
General
19.110 Growth in the Scalp – Excision clinical notes 1 4000 S1 S100110 No
Surgery
General
19.111 Porto Caval Anastomosis USG 1 15000 S1 S100111 No
Surgery
General
19.112 Pyeloroplasty USG 1 10000 S1 S100112 No
Surgery
General
19.113 Radical Mastectomy Mammogram,USG/X-ray HPE 1 10000 S1 S100113 No
Surgery
General
19.114 Radical Neck Dissection – Excision CT,Biopasy HPE 1 15000 S1 S100114 No
Surgery
General
19.115 Hernia – Spigelian USG 1 5000 S1 S100115 No
Surgery
General
19.116 Rectal Dilation clinical notes 1 2000 S1 S100116 No
Surgery
General
19.117 Prolapse of Rectal Mass – Excision clinical notes 1 10000 S1 S100117 No
Surgery
General
19.118 Rectopexy clinical notes 1 10000 S1 S100118 No
Surgery
General
19.119 Repair of Common Bile Duct USG 1 15000 S1 S100119 No
Surgery
General
19.122 Retroperitoneal Tumor – Excision USG/CT HPE 2 20000 S1 S100122 No
Surgery
General
19.123 Haemorroidectomy Clinical Notes 1 5000 S1 S100123 No
Surgery
General
19.124 Salivary Gland – Excision FNAC HPE 1 10000 S1 S100124 No
Surgery
General
19.125 Segmental Resection of Breast clinical notes 1 10000 S1 S100125 No
Surgery
General
19.126 Scrotal Swelling (Multiple) – Excision clinical notes,USG 1 5000 S1 S100126 No
Surgery
General
19.127 Sigmoid Diverticulum USG/ X-RAY 1 15000 S1 S100127 No
Surgery
General
19.128 Simple closure - Peptic perforation Clinical Note,X-ray 1 15000 S1 S100128 No
Surgery
General
19.129 Sinus – Excision clinical notes 1 5000 S1 S100129 No
Surgery
General
19.130 Soft Tissue Tumor (small) – Excision clinical notes HPE 1 5000 S1 S100130 No
Surgery
General
19.131 Soft Tissue Tumor (large) – Excision clinical notes,USG HPE 1 10000 S1 S100131 No
Surgery
General Government
19.132 Splenectomy clinical notes,USG HPE 2 30000 S1 S100132 Yes
Surgery Reserve
General
19.133 Submandibular Lymph node – Excision clinical notes,FNAC 1 5000 S1 S100133 No
Surgery
General
19.134 Submandibular Mass Excision + Reconstruction clinical notes,CT/FNAC HPE 2 20000 S1 S100134 No
Surgery
General
19.135 Swelling in foot (small) – Excision clinical notes 1 1500 S1 S100135 No
Surgery
General
19.136 Swelling in foot (large) – Excision clinical notes 1 3500 S1 S100136 No
Surgery
General Government
19.137 Coloectomy – Total USG/Colonoscopy HPE 2 20000 S1 S100137 Yes
Surgery Reserve
General
19.138 Pharyngectomy& Reconstruction – Total CT/MRI HPE 2 20000 S1 S100138 No
Surgery
General
19.139 Tracheal Stenosis (End to end Anastamosis) (Throat) CT/MRI,Laryngoscopy 1 15000 S1 S100139 No
Surgery
General
19.140 Tracheoplasty (Throat) CT/USG 1 15000 S1 S100140 No
Surgery
General
19.141 Umbilical Sinus – Excision clinical notes 1 5000 S1 S100141 No
Surgery
General
19.142 Varicose Veins - Excision and Ligation Clinical notes,Doppler 1 10000 S1 S100142 No
Surgery
General
19.143 Vasovasostomy Clinical Note/USG 1 12000 S1 S100143 No
Surgery
General
19.144 Volvlous of Large Bowel Clinical Note/X-ray 2 25000 S1 S100144 No
Surgery
General PRE OP CLINICAL Government
19.145 Cleft lip operation Clinical photograph 1 12000 S1 S100145 Yes
Surgery PICTURE Reserve
19.146 Cleft palate repair (for each stage) Clinical photograph 1 12000 S1 S100146 Yes
19.147 Cleft lip & palate operation (for each stage) Clinical photograph 1 15000 S1 S100147 Yes
General
19.148 Aneurysm not Requiring Bypass Techniques t CT Angio CT Angio,Doppler 2 36000 S1 S100148 No
Surgery
General
19.149 Aneurysm Resection & Grafting CT Angio 2 36000 S1 S100149 No
Surgery
General
19.150 Arterial Embolectomy CT Angio/Color Doppler Doppler 2 17250 S1 S100150 No
Surgery
General
19.151 Carotid artery aneurysm repair Angiogram Color Doppler 2 17250 S1 S100151 No
Surgery
General Government
19.152 Carotid Body tumour - Excision Angiogram Color Doppler 2 20000 S1 S100152 Yes
Surgery Reserve
General Government
19.153 Cholecystectomy & Exploration of CBD USG/CT HPE 2 22000 S1 S100153 Yes
Surgery Reserve
General Government
19.154 Cholecystostomy USG/CT HPE 1 10000 S1 S100154 Yes
Surgery Reserve
General Government
19.155 Congential Arteriovenus Fistula (large) CT Angio/ Doppler 2 20000 S1 S100155 Yes
Surgery Reserve
General Government
19.156 Congential Arteriovenus Fistula (small) CT Angio/ Doppler 1 10000 S1 S100156 Yes
Surgery Reserve
General X-RAY,Biopsy , CT/ PET Biopsy , Clinical
19.157 Decortication (Pleurectomy) 1 51750 S1 S100157 No
Surgery scan Photograph , X-RAY
General
19.158 Dissecting Aneurysms CT Angio/ Cath Doppler 2 36000 S1 S100158 No
Surgery
General
19.159 Distal Abdominal Aorta repair Angiogram Color Doppler 2 36000 S1 S100159 No
Surgery
General
19.160 Estlander Operation (lip) Clinical Note 1 7000 S1 S100160 No
Surgery
General
19.161 Excision and Skin Graft of Venous Ulcer Clinical Note 1 15000 S1 S100161 No
Surgery
General Biopsy,Clinical
19.162 Excision of Parathyroid Adenoma/Carcinoma Biopsy,CT,Bronchoscopy 2 20700 S1 S100162 No
Surgery Photograph
General Government
19.163 Flap Reconstructive Surgery clinical notes 2 20000 S1 S100163 Yes
Surgery Reserve
General Government
19.164 Split thickness skin grafts – Small (< 4% TBSA) clinical notes Clinical Photograph 1 5000 S1 S100164 Yes
Surgery Reserve
General Government
19.165 Split thickness skin grafts – Medium (4 - 8% TBSA) clinical notes Clinical Photograph 1 10000 S1 S100165 Yes
Surgery Reserve
General Government
19.166 Split thickness skin grafts – Large (> 8% TBSA) clinical notes Clinical Photograph 1 15000 S1 S100166 Yes
Surgery Reserve
General Government
19.167 Free Grafts - Wolfe Grafts clinical notes Clinical Photograph 1 10000 S1 S100167 Yes
Surgery Reserve
General
19.168 Hemi thyroidectomy USG/FNAC/TFT HPE 1 10000 S1 S100168 No
Surgery
General
19.169 Total thyroidectomy USG/FNAC/TFT HPE 2 20000 S1 S100169 No
Surgery
General
19.170 Laparoscopic Hernia Repair clinical notes Mesh Sticker 2 18000 S1 S100170 No
Surgery
General Government
19.171 Lap. Assisted left Hemi colectomy t USG HPE 2 25000 S1 S100171 Yes
Surgery Reserve
General Government
19.172 Lap. Assisted Right Hemi colectomy t USG HPE 2 25000 S1 S100172 Yes
Surgery Reserve
General
19.173 Lap. Assisted small bowel resection USG/CT HPE 1 15000 S1 S100173 No
Surgery
General Government
19.174 Lap. Assisted Total Colectomy USG/CT HPE 2 25000 S1 S100174 Yes
Surgery Reserve
General Government
19.175 Lap. Cholecystectomy & CBD exploration USG HPE 2 20000 S1 S100175 Yes
Surgery Reserve
General
19.176 Lap. For intestinal obstruction USG/CT,X-ray 1 15000 S1 S100176 No
Surgery
General Government
19.177 Lap. Hepatic resection USG/CT HPE 2 25000 S1 S100177 Yes
Surgery Reserve
General Government
19.178 Lap. Hydatid of liver surgery USG/CT HPE 2 20000 S1 S100178 Yes
Surgery Reserve
General
19.179 Laparoscopic Adhesinolysis Clinical notes + USG 1 15000 S1 S100179 No
Surgery
General
19.180 Laparoscopic Appendicectomy Clinical notes + USG HPE 2 18000 S1 S100180 No
Surgery
General
19.181 Laparoscopic Cholecystectomy USG HPE 1 15000 S1 S100181 No
Surgery
General Government
19.182 Laparoscopic cystogastrostomy USG 2 20000 S1 S100182 Yes
Surgery Reserve
General Government
19.183 Laparoscopic Gastrostomy USG/CT,Clinical note 1 12000 S1 S100183 Yes
Surgery Reserve
General
19.184 Laparoscopic Hiatus Hernia Repair OGD/USG 2 22000 S1 S100184 No
Surgery
General
19.185 Laparoscopic Pyloromyotomy OGD/USG 2 20000 S1 S100185 No
Surgery
General
19.186 Laparoscopic Rectopexy Clinical notes + USG 1 15000 S1 S100186 No
Surgery
General
19.187 Laparoscopic Spleenectomy Clinical notes + USG HPE 2 16500 S1 S100187 No
Surgery
General
19.188 Laparoscopic umbilical hernia repair Clinical notes + USG 1 15000 S1 S100188 No
Surgery
General
19.189 Laparoscopic ventral hernia repair Clinical notes + USG Mesh Sticker 2 20000 S1 S100189 No
Surgery
General
19.190 Laparotomy-peritonitis lavage and drainage Clinical notes + USG 1 10000 S1 S100190 No
Surgery
General
19.191 Ligation of Ankle Perforators Doppler 1 5000 S1 S100191 No
Surgery
General Lymphatics Excision of Subcutaneous Tissues In
19.192 clinical notes,USG pelvis 1 10000 S1 S100192 No
Surgery Lymphoedema
General
19.193 Repair of Main Arteries of the Limbs Clinical notes,Doppler 2 25000 S1 S100193 No
Surgery
General Biopsy,Clinical photo
19.194 Mediastinal Tumour CT 2 20000 S1 S100194 No
Surgery showing scar
General
19.195 Oesophagectomy for Carcinoma Oesophagus USG/CT,Biopsy HPE 2 25000 S1 S100195 No
Surgery
General Government
19.196 Operation for Bleeding Peptic Ulcer Clinical notes,OGD 1 15000 S1 S100196 Yes
Surgery Reserve
General
19.197 Operation for Carcinoma Lip – Vermilionectomy Clinical notes HPE 1 10000 S1 S100197 No
Surgery
General Operation for Carcinoma Lip - Wedge Excision and
19.198 Clinical notes HPE 1 12000 S1 S100198 No
Surgery Vermilionectomy
General
19.199 Operation for Carcinoma Lip - Wedge-Excision Clinical notes HPE 1 10000 S1 S100199 No
Surgery
General Government
19.200 Appendicectomy - Appendicular Abscess – Drainage USG HPE 1 12000 S1 S100200 Yes
Surgery Reserve
General
19.201 Caecostomy Clinical notes + USG 1 10000 S1 S100201 No
Surgery
General Government
19.202 Closure of Colostomy Clinical notes 1 5000 S1 S100202 Yes
Surgery Reserve
General
19.203 Coccygeal Teratoma Excision USG/CT HPE 1 15000 S1 S100203 No
Surgery
General
19.204 Congenital Atresia & Stenosis of Small Intestine USG/CT 2 20000 S1 S100204 No
Surgery
General Government
19.205 CystoJejunostomy/or Cystogastrostomy clinical notes 2 20000 S1 S100205 Yes
Surgery Reserve
General Government
19.206 Drainage of perivertebral abscess Clinical notes + USG 1 10000 S1 S100206 Yes
Surgery Reserve
General clinical
19.207 Hernia -hiatus-Transthoracic 2 25000 S1 S100207 No
Surgery notes,OGD/CHEST X- ray
General
19.208 Intercostal drainage X-ray X-ray 1 2000 S1 S100208 No
Surgery
General
19.209 Operation for carcinoma lip- cheek advancement clinical notes HPE 1 12000 S1 S100209 No
Surgery
General
19.210 Thymectomy CT scan HPE 2 20000 S1 S100210 No
Surgery
General
19.211 Operation of Choledochal Cyst USG 1 15000 S1 S100211 No
Surgery
General clinical
19.212 Operations for Acquired Arteriovenous Fistula 1 15000 S1 S100212 No
Surgery notes,Doppler/Angio
General
19.213 Operations for Replacement of Oesophagus by Colon clinical notes,OGD 2 25000 S1 S100213 No
Surgery
General
19.214 Hemodialysis per sitting RFT Serum Creatinine 1 2300 S1 S100214 No
Surgery
General
19.215 Parapharyngeal Tumour Excision USG,CT/FNAC HPE 2 20000 S1 S100215 No
Surgery
General
19.216 Partial/Subtotal Gastrectomy for Carcinoma OGD/CT HPE 2 22000 S1 S100216 No
Surgery
General
19.217 Patch Graft Angioplasty Angiography 2 18400 S1 S100217 No
Surgery
General
19.218 Pericardiostomy Clinical note,X-ray 2 30000 S1 S100218 No
Surgery
General Clinical photo showing
19.219 Pneumonectomy CT/Xray 2 46000 S1 S100219 No
Surgery scar,X-ray
General Removal of Foreign Body from Trachea or Photograph of removed
19.220 clinical notes 1 5000 S1 S100220 No
Surgery Oesophagus foreign body
General
19.221 Removal Tumours of Chest Wall USG/CT HPE 2 20000 S1 S100221 No
Surgery
General
19.222 Procedures Requiring Bypass Techniques Doopler/Angio 2 35000 S1 S100222 No
Surgery
General
19.223 Resection Enucleation of Adenoma (lung) HRCT HPE 1 10000 S1 S100223 No
Surgery
General
19.224 Rib Resection & Drainage X-ray/USG X-ray 1 10000 S1 S100224 No
Surgery
General
19.225 Skin Flaps - Rotation Flaps clinical notes 1 6200 S1 S100225 No
Surgery
General
19.226 Splenectomy - For Trauma CT Angio Report HPE 2 20000 S1 S100226 No
Surgery
General
19.227 Surgery for Arterial Aneurism Spleen Artery Doopler/Angio 2 20000 S1 S100227 No
Surgery
General
19.228 Surgery for Arterial Aneurism –Vertebral Doopler/MR Angio 2 25000 S1 S100228 No
Surgery
General
19.229 Sympathetectomy – Cervical clinical notes 1 5000 S1 S100229 No
Surgery
General
19.230 Temporal Bone resection clinical notes 1 57500 S1 S100230 No
Surgery
General
19.231 Thorachostomy X-ray,clinical notes 1 10000 S1 S100231 No
Surgery
General
19.232 Thoracocentesis X-ray 1 1500 S1 S100232 No
Surgery
General
19.233 Thoracoplasty X-ray 2 34500 S1 S100233 No
Surgery
General Government
19.234 Thoracoscopic Decortication CT X-ray 2 25000 S1 S100234 Yes
Surgery Reserve
General Government
19.235 Thoracoscopic Hydatid Cyst excision CT X-ray 2 20000 S1 S100235 Yes
Surgery Reserve
General Government
19.236 Thoracoscopic Lobectomy CT X-ray 2 25000 S1 S100236 Yes
Surgery Reserve
General Government
19.237 Thoracoscopic Pneumonectomy CT X-ray 2 30000 S1 S100237 Yes
Surgery Reserve
General Government
19.238 Thoracoscopic Segmental Resection CT X-ray 2 25000 S1 S100238 Yes
Surgery Reserve
General Government
19.239 Thoracoscopic Sympathectomy CT X-ray 1 15000 S1 S100239 Yes
Surgery Reserve
General
19.240 Thrombendarterectomy CT/Angio 1 15000 S1 S100240 No
Surgery
General
19.241 Thorax (penetrating wounds) clinical notes,CT/X-ray X-ray 1 12500 S1 S100241 No
Surgery
General
19.242 Total Thyroidectomy and Block Dissection USG HPE 2 20000 S1 S100242 No
Surgery
General
19.243 Trendelenburg Operation Doppler 1 10000 S1 S100243 No
Surgery
General Government
19.244 Debridement of Ulcer-Leprosy clinical notes 1 5000 S1 S100244 Yes
Surgery Reserve
General Government
19.245 Tissue Reconstruction Flap Leprosy clinical notes 2 25000 S1 S100245 Yes
Surgery Reserve
General Government
19.246 Tendon Transfer-Leprosy clinical notes 2 25000 S1 S100246 Yes
Surgery Reserve
General
19.247 Adhenolysis + Appendicectomy USG HPE 2 20000 S1 S100247 No
Surgery
General Hernia - Repair & release of obstruction+
19.248 clinical notes 2 20000 S1 S100248 No
Surgery Hernioplasty
General Government
19.249 Aspiration of cold Abscess of Lymphnode clinical notes HPE/Cytology 1 3000 S1 S100249 Yes
Surgery Reserve
General
19.250 Aspiration of Empyema X-ray Fluid-RM/CS 1 2000 S1 S100250 No
Surgery
General clinical note,Serum
19.251 AV Shunt for dialysis Doppler 1 6000 S1 S100251 No
Surgery Creatinine
General clinical notes,Serum
19.252 Peritoneal dialysis per sitting Serum Creatinine 1 2300 S1 S100252 No
Surgery Creatinine
General
19.253 Vasectomy clinical notes clinical notes 1 2500 S1 S100253 No
Surgery
General CLINICAL PHOTOGRAPH,
8.61 RESECTION & ANASTOMOSIS OF INTESTINE X-RAY, USG ABD, CT 3 34500 S1 S612018 No
Surgery X-RAY
SCAN ABD
General CLINICAL PHOTOGRAPH,
8.66 INTESTINAL RESECTION X-RAY, USG ABD, CT 3 40250 S1 S612022 No
Surgery X-RAY
SCAN ABD
8.70 SURGERY ILIEOSIGMOIDOSTOMY X-RAY, USG ABD, CT 3 28750 S1 S612024 No
X-RAY
SCAN ABD
General
Surgery
Negotiable)
Cluster - 20 ORAL AND MAXILLO FACIAL SURGERY
Specialt
PMJAY
Oral and
Fixation of fracture of jaw with closed reduction (1
20.1 Maxillofacial OPG/CT Scan Clinical Photo 1 5000 S16 S1600001 No
jaw) using wires - under LA
Surgery
Oral and
Fixation of fracture of jaw with open reduction (1
jaw) and fixing of plates/ wire – under GA
Surgery
Oral and
20.3 Maxillofacial Sequestrectomy OPG/CT Scan Clinical Photo 1 1500 S16 S1600003 No
Surgery
Oral and
20.4 Maxillofacial TM joint ankylosis of both jaws - under GA OPG/CT Scan Clinical Photo 1 15000 S16 S1600004 No
Surgery
Oral and
Release of fibrous bands & grafting -in (OSMF)
20.5 Maxillofacial Clinical Photo Clinical Photo 1 3000 S16 S1600005 No
treatment under GA
Surgery
Oral and
20.6 Maxillofacial Extraction of impacted tooth under LA X-Ray Clinical Photo 1 500 S16 S1600006 No
Surgery
Oral and
Cyst & tumour of Maxilla/mandible by
20.7 Maxillofacial OPG/CT Scan/X-Ray Clinical Photo 1 2500 S16 S1600007 No
enucleation/excision/marsupialization under LA
Surgery
Oral and
Mandible Tumour Resection and
reconstruction/Cancer surgery
Surgery
Oral and
20.9 Maxillofacial Cleft lip and palate surgery (each stage) Clinical Photo Clinical Photo 1 15000 S16 S1600009 No
Surgery
Oral and Unspecified Surgical Package (Amount Capped @
20.10 Maxillofacial 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 1,00,000 S16 U100 No
Surgery Negotiable)
Cluster - 21 GENERAL MEDICINE
Specialt
PMJAY
Government
Reserve
General Acute gastroenteritis with moderate dehydration
21.1 A Clinical Notes clinical notes 0 1800 (Package M1 M100001 Yes
Medicine (admission type: Routine ward )
Amount per
day)
Government
Reserve
21.1 B Clinical Notes clinical notes 0 2700 (Package M1 M100001 Yes
Medicine (admission type: HDU )
Amount per
day)
Government
Reserve
21.1 C Clinical Notes clinical notes 0 3600 (Package M1 M100001 Yes
Medicine (admission type: ICU ,without ventilator)
Amount per
day)
Government
Reserve
21.1 D Clinical Notes clinical notes 0 4500 (Package M1 M100001 Yes
Medicine (admission type: ICU (with ventilator )
Amount per
day)
Government
Reserve
General Recurrent vomiting with dehydration (admission X-Ray abd.Standing /USG
21.2 A clinical notes 0 1800 (Package M1 M100002 Yes
Medicine type: Routine ward ) Abd.Pelvis,clinical notes
Amount per
day)
Government
Reserve
General Recurrent vomiting with dehydration(admission X-Ray abd.Standing /USG
21.2 B clinical notes 0 2700 (Package M1 M100002 Yes
Medicine type: HDU ) Abd.Pelvis,clinical notes
Amount per
day)
Government
Reserve
21.2 C clinical notes 0 3600 (Package M1 M100002 Yes
Medicine type: ICU ,without ventilator) Abd.Pelvis,clinical notes
Amount per
day)
Government
Reserve
21.2 D clinical notes 0 4500 (Package M1 M100002 Yes
Medicine type: ICU (with ventilator ) Abd.Pelvis,clinical notes
Amount per
day)
Government
Reserve
General
21.3 A Dysentery (admission type: Routine ward ) Clinical Notes clinical notes 0 1800 (Package M1 M100003 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.3 B Dysentery(admission type: HDU ) Clinical Notes clinical notes 0 2700 (Package M1 M100003 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.3 C Dysentery(admission type: ICU ,without ventilator) Clinical Notes clinical notes 0 3600 (Package M1 M100003 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.3 D Dysentery(admission type: ICU (with ventilator ) Clinical Notes clinical notes 0 4500 (Package M1 M100003 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.4 A Renal colic (admission type: Routine ward ) X-Ray/USG clinical notes 0 1800 (Package M1 M100004 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.4 B Renal colic(admission type: HDU ) X-Ray/USG clinical notes 0 2700 (Package M1 M100004 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.4 C Renal colic(admission type: ICU ,without ventilator) X-Ray/USG clinical notes 0 3600 (Package M1 M100004 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.4 D Renal colic(admission type: ICU (with ventilator ) X-Ray/USG clinical notes 0 4500 (Package M1 M100004 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.5 A Acute bronchitis (admission type: Routine ward ) Chest X-Ray clinical notes 0 1800 (Package M1 M100005 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.5 B Acute bronchitis(admission type: HDU ) Chest X-Ray clinical notes 0 2700 (Package M1 M100005 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute bronchitis(admission type: ICU ,without
21.5 C Chest X-Ray clinical notes 0 3600 (Package M1 M100005 Yes
Medicine ventilator)
Amount per
day)
Government
Reserve
General Acute bronchitis(admission type: ICU (with
21.5 D Chest X-Ray clinical notes 0 4500 (Package M1 M100005 Yes
Medicine ventilator )
Amount per
day)
Government
Reserve
General
21.6 A Pneumothroax (admission type: Routine ward ) Chest X-Ray clinical notes 0 1800 (Package M1 M100006 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.6 B Pneumothroax(admission type: HDU ) Chest X-Ray clinical notes 0 2700 (Package M1 M100006 Yes
Medicine
Amount per
day)
Government
Reserve
General Pneumothroax(admission type: ICU ,without
Amount per
day)
Government
Reserve
General Pneumothroax(admission type: ICU (with ventilator
Medicine )
Amount per
day)
Government
Reserve
General Accelerated hypertension (admission type: Routine
21.7 A clinical notes,ECG clinical notes 0 1800 (Package M1 M100007 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.7 B Accelerated hypertension(admission type: HDU ) clinical notes,ECG clinical notes 0 2700 (Package M1 M100007 Yes
Medicine
Amount per
day)
Government
Reserve
General Accelerated hypertension(admission type: ICU
21.7 C clinical notes,ECG clinical notes 0 3600 (Package M1 M100007 Yes
Medicine ,without ventilator)
Amount per
day)
Government
Reserve
General Accelerated hypertension(admission type: ICU (with
21.7 D clinical notes,ECG clinical notes 0 4500 (Package M1 M100007 Yes
Amount per
day)
Government
Reserve
General Congestive heart failure (admission type: Routine Chest X-Ray, 2 D Echo,
Medicine ward ) ECG
Amount per
day)
Government
Reserve
General Chest X-Ray, 2 D Echo,
21.8 B Congestive heart failure(admission type: HDU ) clinical notes 0 2700 (Package M1 M100008 Yes
Medicine ECG
Amount per
day)
Government
Reserve
General Congestive heart failure(admission type: ICU Chest X-Ray, 2 D Echo,
Medicine ,without ventilator) ECG
Amount per
day)
Government
Reserve
General Congestive heart failure(admission type: ICU (with Chest X-Ray, 2 D Echo,
Medicine ventilator ) ECG
Amount per
day)
Government
Reserve
General
21.9 A Severe anemia (admission type: Routine ward ) HB clinical notes 0 1800 (Package M1 M100009 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.9 B Severe anemia(admission type: HDU ) HB clinical notes 0 2700 (Package M1 M100009 Yes
Medicine
Amount per
day)
Government
Reserve
General Severe anemia(admission type: ICU ,without
21.9 C HB clinical notes 0 3600 (Package M1 M100009 Yes
Amount per
day)
Government
Reserve
General
21.9 D Severe anemia(admission type: ICU (with ventilator ) HB clinical notes 0 4500 (Package M1 M100009 Yes
Medicine
Amount per
day)
Government
Reserve
General Diabetic ketoacidosis (admission type: Routine ward FBS, PP2BS,HBA1C, Urine
Medicine ) Ketons
Amount per
day)
Government
Reserve
General FBS, PP2BS,HBA1C, Urine
21.10 B Diabetic ketoacidosis(admission type: HDU ) clinical notes 0 2700 (Package M1 M100010 Yes
Medicine Ketons
Amount per
day)
Government
Reserve
General Diabetic ketoacidosis(admission type: ICU ,without FBS, PP2BS,HBA1C, Urine
Medicine ventilator) Ketons
Amount per
day)
Government
Reserve
General Diabetic ketoacidosis(admission type: ICU (with FBS, PP2BS,HBA1C, Urine
Medicine ventilator ) Ketons
Amount per
day)
Government
Reserve
General
21.11 A Acute febrile illness (admission type: Routine ward ) Fever Profile clinical notes 0 1800 (Package M1 M100011 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.11 B Acute febrile illness(admission type: HDU ) Fever Profile clinical notes 0 2700 (Package M1 M100011 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute febrile illness(admission type: ICU ,without
21.11 C Fever Profile clinical notes 0 3600 (Package M1 M100011 Yes
Amount per
day)
Government
Reserve
General Acute febrile illness(admission type: ICU (with
21.11 D Fever Profile clinical notes 0 4500 (Package M1 M100011 Yes
Amount per
day)
Government
Reserve
General Acute excaberation of COPD (admission type:
21.12 A Chest X-Ray clinical notes 0 1800 (Package M1 M100012 Yes
Medicine Routine ward )
Amount per
day)
Government
Reserve
General
21.12 B Acute excaberation of COPD(admission type: HDU ) Chest X-Ray clinical notes 0 2700 (Package M1 M100012 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute excaberation of COPD(admission type: ICU
Amount per
day)
Government
Reserve
General Acute excaberation of COPD(admission type: ICU
Medicine (with ventilator )
Amount per
day)
Government
Reserve
General USG KUB, Urine routine
21.13 A UTI (admission type: Routine ward ) clinical notes 0 1800 (Package M1 M100013 Yes
Medicine Micro
Amount per
day)
Government
Reserve
21.13 B UTI(admission type: HDU ) clinical notes 0 2700 (Package M1 M100013 Yes
Medicine Micro
Amount per
day)
Government
Reserve
21.13 C UTI(admission type: ICU ,without ventilator) clinical notes 0 3600 (Package M1 M100013 Yes
Medicine Micro
Amount per
day)
Government
Reserve
21.13 D UTI(admission type: ICU (with ventilator ) clinical notes 0 4500 (Package M1 M100013 Yes
Medicine Micro
Amount per
day)
Government
Reserve
General
21.14 A Malaria (admission type: Routine ward ) PSMP clinical notes 0 1800 (Package M1 M100014 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.14 B Malaria(admission type: HDU ) PSMP clinical notes 0 2700 (Package M1 M100014 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.14 C Malaria(admission type: ICU ,without ventilator) PSMP clinical notes 0 3600 (Package M1 M100014 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.14 D Malaria(admission type: ICU (with ventilator ) PSMP clinical notes 0 4500 (Package M1 M100014 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.15 A Dengue fever (admission type: Routine ward ) NS, Antigen clinical notes 0 1800 (Package M1 M100015 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.15 B Dengue fever(admission type: HDU ) NS, Antigen clinical notes 0 2700 (Package M1 M100015 Yes
Medicine
Amount per
day)
Government
Reserve
General Dengue fever(admission type: ICU ,without
21.15 C NS, Antigen clinical notes 0 3600 (Package M1 M100015 Yes
Amount per
day)
Government
Reserve
General
21.15 D Dengue fever(admission type: ICU (with ventilator ) NS, Antigen clinical notes 0 4500 (Package M1 M100015 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.16 A Chikungunya fever (admission type: Routine ward ) Clinical History clinical notes 0 1800 (Package M1 M100016 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.16 B Chikungunya fever(admission type: HDU ) Clinical History clinical notes 0 2700 (Package M1 M100016 Yes
Medicine
Amount per
day)
Government
Reserve
General Chikungunya fever(admission type: ICU ,without
21.16 C Clinical History clinical notes 0 3600 (Package M1 M100016 Yes
Amount per
day)
Government
Reserve
General Chikungunya fever(admission type: ICU (with
21.16 D Clinical History clinical notes 0 4500 (Package M1 M100016 Yes
Amount per
day)
Government
Reserve
General
21.17 A Leptospirosis (admission type: Routine ward ) Clinical History clinical notes 0 1800 (Package M1 M100017 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.17 B Leptospirosis(admission type: HDU ) Clinical History clinical notes 0 2700 (Package M1 M100017 Yes
Medicine
Amount per
day)
Government
Reserve
General Leptospirosis(admission type: ICU ,without
Amount per
day)
Government
Reserve
General
21.17 D Leptospirosis(admission type: ICU (with ventilator ) Clinical History clinical notes 0 4500 (Package M1 M100017 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.18 A Enteric fever (admission type: Routine ward ) CBC, S. Widal clinical notes 0 1800 (Package M1 M100018 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.18 B Enteric fever(admission type: HDU ) CBC, S. Widal clinical notes 0 2700 (Package M1 M100018 Yes
Medicine
Amount per
day)
Government
Reserve
General Enteric fever(admission type: ICU ,without
21.18 C CBC, S. Widal clinical notes 0 3600 (Package M1 M100018 Yes
Amount per
day)
Government
Reserve
General
21.18 D Enteric fever(admission type: ICU (with ventilator ) CBC, S. Widal clinical notes 0 4500 (Package M1 M100018 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.19 A Pneumonia (admission type: Routine ward ) CBC, X-Ray Chest clinical notes 0 1800 (Package M1 M100019 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.19 B Pneumonia(admission type: HDU ) CBC, X-Ray Chest clinical notes 0 2700 (Package M1 M100019 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.19 C Pneumonia(admission type: ICU ,without ventilator) CBC, X-Ray Chest clinical notes 0 3600 (Package M1 M100019 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.19 D Pneumonia(admission type: ICU (with ventilator ) CBC, X-Ray Chest clinical notes 0 4500 (Package M1 M100019 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute excaberation of ILD (admission type: Routine
21.20 A Chest X-Ray clinical notes 0 1800 (Package M1 M100020 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.20 B Acute excaberation of ILD(admission type: HDU ) Chest X-Ray clinical notes 0 2700 (Package M1 M100020 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute excaberation of ILD(admission type: ICU
Amount per
day)
Government
Reserve
General Acute excaberation of ILD(admission type: ICU (with
Amount per
day)
Government
Reserve
General USG, Chest X-Ray, X-ray
21.21 A Liver abscess (admission type: Routine ward ) clinical notes 0 1800 (Package M1 M100021 Yes
Medicine Abd
Amount per
day)
Government
Reserve
21.21 B Liver abscess(admission type: HDU ) clinical notes 0 2700 (Package M1 M100021 Yes
Medicine Abd
Amount per
day)
Government
Reserve
General Liver abscess(admission type: ICU ,without USG, Chest X-Ray, X-ray
Medicine ventilator) Abd
Amount per
day)
Government
Reserve
21.21 D Liver abscess(admission type: ICU (with ventilator ) clinical notes 0 4500 (Package M1 M100021 Yes
Medicine Abd
Amount per
day)
Government
Reserve
General USG ABD, Hepatits
21.22 A Acute viral hepatitis (admission type: Routine ward ) clinical notes 0 1800 (Package M1 M100022 Yes
Medicine Marker, HBSAG,NTHCV
Amount per
day)
Government
Reserve
General USG ABD, Hepatits
21.22 B Acute viral hepatitis(admission type: HDU ) clinical notes 0 2700 (Package M1 M100022 Yes
Medicine Marker, HBSAG,NTHCV
Amount per
day)
Government
Reserve
General Acute viral hepatitis(admission type: ICU ,without USG ABD, Hepatits
Medicine ventilator) Marker, HBSAG,NTHCV
Amount per
day)
Government
Reserve
General Acute viral hepatitis(admission type: ICU (with USG ABD, Hepatits
Medicine ventilator ) Marker, HBSAG,NTHCV
Amount per
day)
Government
Reserve
General
21.23 A Snake bite (admission type: Routine ward ) BT,CT,PT,APTT clinical notes 0 1800 (Package M1 M100023 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.23 B Snake bite(admission type: HDU ) BT,CT,PT,APTT clinical notes 0 2700 (Package M1 M100023 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.23 C Snake bite(admission type: ICU ,without ventilator) BT,CT,PT,APTT clinical notes 0 3600 (Package M1 M100023 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.23 D Snake bite(admission type: ICU (with ventilator ) BT,CT,PT,APTT clinical notes 0 4500 (Package M1 M100023 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute organophosphorus poisoning (admission type:
21.24 A Anti Choline esterase clinical notes 0 1800 (Package M1 M100024 Yes
Amount per
day)
Government
Reserve
General Acute organophosphorus poisoning(admission type:
21.24 B Anti Choline esterase clinical notes 0 2700 (Package M1 M100024 Yes
Medicine HDU )
Amount per
day)
Government
Reserve
21.24 C Anti Choline esterase clinical notes 0 3600 (Package M1 M100024 Yes
Medicine ICU ,without ventilator)
Amount per
day)
Government
Reserve
21.24 D Anti Choline esterase clinical notes 0 4500 (Package M1 M100024 Yes
Medicine ICU (with ventilator )
Amount per
day)
Government
Reserve
General
21.25 A Other poisoning (admission type: Routine ward ) Clinical Notes clinical notes 0 1800 (Package M1 M100025 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.25 B Other poisoning(admission type: HDU ) Clinical Notes clinical notes 0 2700 (Package M1 M100025 Yes
Medicine
Amount per
day)
Government
Reserve
General Other poisoning(admission type: ICU ,without
21.25 C Clinical Notes clinical notes 0 3600 (Package M1 M100025 Yes
Amount per
day)
Government
Reserve
General Other poisoning(admission type: ICU (with
21.25 D Clinical Notes clinical notes 0 4500 (Package M1 M100025 Yes
Amount per
day)
Government
Reserve
General Pyrexia of unknown origin (admission type: Routine
21.26 A Fever Profile clinical notes 0 1800 (Package M1 M100026 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.26 B Pyrexia of unknown origin(admission type: HDU ) Fever Profile clinical notes 0 2700 (Package M1 M100026 Yes
Medicine
Amount per
day)
Government
Reserve
General Pyrexia of unknown origin(admission type: ICU
21.26 C Fever Profile clinical notes 0 3600 (Package M1 M100026 Yes
Amount per
day)
Government
Reserve
General Pyrexia of unknown origin(admission type: ICU (with
21.26 D Fever Profile clinical notes 0 4500 (Package M1 M100026 Yes
Amount per
day)
Government
Reserve
General Pericardial/ Pleural tuberculosis (admission type: Chest X-Ray,
Medicine Routine ward ) PL.TAPPING,AFB
Amount per
day)
Government
Reserve
General Pericardial/ Pleural tuberculosis(admission type: Chest X-Ray,
Medicine HDU ) PL.TAPPING,AFB
Amount per
day)
Government
Reserve
General Pericardial/ Pleural tuberculosis(admission type: ICU Chest X-Ray,
Medicine ,without ventilator) PL.TAPPING,AFB
Amount per
day)
Government
Reserve
General Pericardial/ Pleural tuberculosis(admission type: ICU Chest X-Ray,
Medicine (with ventilator ) PL.TAPPING,AFB
Amount per
day)
Government
Reserve
General Systematic lupus erythematosus (admission type: Clinical History/Concern
Medicine Routine ward ) Investigation
Amount per
day)
Government
Reserve
General Systematic lupus erythematosus(admission type: Clinical History/Concern
Medicine HDU ) Investigation
Amount per
day)
Government
Reserve
Medicine ICU ,without ventilator) Investigation
Amount per
day)
Government
Reserve
Medicine ICU (with ventilator ) Investigation
Amount per
day)
Government
Reserve
General Clinical History/Concern
21.29 A Vasculitis (admission type: Routine ward ) clinical notes 0 1800 (Package M1 M100029 Yes
Medicine Investigation
Amount per
day)
Government
Reserve
21.29 B Vasculitis(admission type: HDU ) clinical notes 0 2700 (Package M1 M100029 Yes
Amount per
day)
Government
Reserve
21.29 C Vasculitis(admission type: ICU ,without ventilator) clinical notes 0 3600 (Package M1 M100029 Yes
Amount per
day)
Government
Reserve
21.29 D Vasculitis(admission type: ICU (with ventilator ) clinical notes 0 4500 (Package M1 M100029 Yes
Amount per
day)
Government
Reserve
General
21.30 A Seizures (admission type: Routine ward ) Clinical History clinical notes 0 1800 (Package M1 M100030 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.30 B Seizures(admission type: HDU ) Clinical History clinical notes 0 2700 (Package M1 M100030 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.30 C Seizures(admission type: ICU ,without ventilator) Clinical History clinical notes 0 3600 (Package M1 M100030 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.30 D Seizures(admission type: ICU (with ventilator ) Clinical History clinical notes 0 4500 (Package M1 M100030 Yes
Medicine
Amount per
day)
Government
Reserve
General Bacterial/ fungal endocarditis (admission type:
21.31 A 2 D Echo clinical notes 0 1800 (Package M1 M100031 Yes
Amount per
day)
Government
Reserve
General
21.31 B Bacterial/ fungal endocarditis(admission type: HDU ) 2 D Echo clinical notes 0 2700 (Package M1 M100031 Yes
Medicine
Amount per
day)
Government
Reserve
General Bacterial/ fungal endocarditis(admission type: ICU
21.31 C 2 D Echo clinical notes 0 3600 (Package M1 M100031 Yes
Amount per
day)
Government
Reserve
General Bacterial/ fungal endocarditis(admission type: ICU
21.31 D 2 D Echo clinical notes 0 4500 (Package M1 M100031 Yes
Amount per
day)
Government
Reserve
General Acute inflammatory demyelinating polyneuropathy
21.32 A EMG,NCV,CSF,MRI clinical notes 0 1800 (Package M1 M100032 Yes
Amount per
day)
Government
Reserve
General Acute inflammatory demyelinating
21.32 B EMG,NCV,CSF,MRI clinical notes 0 2700 (Package M1 M100032 Yes
Medicine polyneuropathy(admission type: HDU )
Amount per
day)
Government
Acute inflammatory demyelinating Reserve
General
21.32 C polyneuropathy(admission type: ICU ,without EMG,NCV,CSF,MRI clinical notes 0 3600 (Package M1 M100032 Yes
Medicine
ventilator) Amount per
day)
Government
Acute inflammatory demyelinating Reserve
General
21.32 D polyneuropathy(admission type: ICU (with ventilator EMG,NCV,CSF,MRI clinical notes 0 4500 (Package M1 M100032 Yes
Medicine
) Amount per
day)
Government
Reserve
General Lung abscess/ Empyema (admission type: Routine
21.33 A Chest X-Ray, CT Thorax clinical notes 0 1800 (Package M1 M100033 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.33 B Lung abscess/ Empyema(admission type: HDU ) Chest X-Ray, CT Thorax clinical notes 0 2700 (Package M1 M100033 Yes
Medicine
Amount per
day)
Government
Reserve
General Lung abscess/ Empyema(admission type: ICU
21.33 C Chest X-Ray, CT Thorax clinical notes 0 3600 (Package M1 M100033 Yes
Amount per
day)
Government
Reserve
General Lung abscess/ Empyema(admission type: ICU (with
21.33 D Chest X-Ray, CT Thorax clinical notes 0 4500 (Package M1 M100033 Yes
Amount per
day)
Government
Reserve
General Acute and chronic meningitis (admission type:
21.34 A CSF,MRI Brain clinical notes 0 1800 (Package M1 M100034 Yes
Amount per
day)
Government
Reserve
General
21.34 B Acute and chronic meningitis(admission type: HDU ) CSF,MRI Brain clinical notes 0 2700 (Package M1 M100034 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute and chronic meningitis(admission type: ICU
21.34 C CSF,MRI Brain clinical notes 0 3600 (Package M1 M100034 Yes
Amount per
day)
Government
Reserve
General Acute and chronic meningitis(admission type: ICU
21.34 D CSF,MRI Brain clinical notes 0 4500 (Package M1 M100034 Yes
Amount per
day)
Government
Reserve
General
21.35 A Viral encephalitis (admission type: Routine ward ) CSF, MRI clinical notes 0 1800 (Package M1 M100035 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.35 B Viral encephalitis(admission type: HDU ) CSF, MRI clinical notes 0 2700 (Package M1 M100035 Yes
Medicine
Amount per
day)
Government
Reserve
General Viral encephalitis(admission type: ICU ,without
21.35 C CSF, MRI clinical notes 0 3600 (Package M1 M100035 Yes
Amount per
day)
Government
Reserve
General Viral encephalitis(admission type: ICU (with
21.35 D CSF, MRI clinical notes 0 4500 (Package M1 M100035 Yes
Amount per
day)
Government
Reserve
General Persistent/ Chronic diarrohea (admission type:
21.36 A Concern Investigation clinical notes 0 1800 (Package M1 M100036 Yes
Amount per
day)
Government
Reserve
General
21.36 B Persistent/ Chronic diarrohea(admission type: HDU ) Concern Investigation clinical notes 0 2700 (Package M1 M100036 Yes
Medicine
Amount per
day)
Government
Reserve
General Persistent/ Chronic diarrohea(admission type: ICU
21.36 C Concern Investigation clinical notes 0 3600 (Package M1 M100036 Yes
Amount per
day)
Government
Reserve
General Persistent/ Chronic diarrohea(admission type: ICU
21.36 D Concern Investigation clinical notes 0 4500 (Package M1 M100036 Yes
Amount per
day)
Government
Reserve
General Acute and chronic pancreatitis (admission type:
21.37 A USG ABD, CT clinical notes 0 1800 (Package M1 M100037 Yes
Amount per
day)
Government
Reserve
General Acute and chronic pancreatitis(admission type: HDU
21.37 B USG ABD, CT clinical notes 0 2700 (Package M1 M100037 Yes
Medicine )
Amount per
day)
Government
Reserve
General Acute and chronic pancreatitis(admission type: ICU
21.37 C USG ABD, CT clinical notes 0 3600 (Package M1 M100037 Yes
Amount per
day)
Government
Reserve
General Acute and chronic pancreatitis(admission type: ICU
21.37 D USG ABD, CT clinical notes 0 4500 (Package M1 M100037 Yes
Amount per
day)
Government
Reserve
General Visceral leishmaniasis (admission type: Routine ward
21.38 A IGM,Ab clinical notes 0 1800 (Package M1 M100038 Yes
Medicine )
Amount per
day)
Government
Reserve
General
21.38 B Visceral leishmaniasis(admission type: HDU ) IGM,Ab clinical notes 0 2700 (Package M1 M100038 Yes
Medicine
Amount per
day)
Government
Reserve
General Visceral leishmaniasis(admission type: ICU ,without
21.38 C IGM,Ab clinical notes 0 3600 (Package M1 M100038 Yes
Amount per
day)
Government
Reserve
General Visceral leishmaniasis(admission type: ICU (with
21.38 D IGM,Ab clinical notes 0 4500 (Package M1 M100038 Yes
Amount per
day)
Government
Reserve
General HIV with complications (admission type: Routine
21.39 A HIV clinical notes 0 1800 (Package M1 M100039 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.39 B HIV with complications(admission type: HDU ) HIV clinical notes 0 2700 (Package M1 M100039 Yes
Medicine
Amount per
day)
Government
Reserve
General HIV with complications(admission type: ICU ,without
21.39 C HIV clinical notes 0 3600 (Package M1 M100039 Yes
Amount per
day)
Government
Reserve
General HIV with complications(admission type: ICU (with
21.39 D HIV clinical notes 0 4500 (Package M1 M100039 Yes
Amount per
day)
Government
Reserve
General Neuromuscular disorders (admission type: Routine
21.40 A EMG,NCV,MRI clinical notes 0 1800 (Package M1 M100040 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.40 B Neuromuscular disorders(admission type: HDU ) EMG,NCV,MRI clinical notes 0 2700 (Package M1 M100040 Yes
Medicine
Amount per
day)
Government
Reserve
General Neuromuscular disorders(admission type: ICU
21.40 C EMG,NCV,MRI clinical notes 0 3600 (Package M1 M100040 Yes
Amount per
day)
Government
Reserve
General Neuromuscular disorders(admission type: ICU (with
21.40 D EMG,NCV,MRI clinical notes 0 4500 (Package M1 M100040 Yes
Amount per
day)
Government
Reserve
General Metabolic encephalopathy (admission type: Routine
21.41 A RFT,LFT,Uric acid, CBC clinical notes 0 1800 (Package M1 M100041 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.41 B Metabolic encephalopathy(admission type: HDU ) RFT,LFT,Uric acid, CBC clinical notes 0 2700 (Package M1 M100041 Yes
Medicine
Amount per
day)
Government
Reserve
General Metabolic encephalopathy(admission type: ICU
21.41 C RFT,LFT,Uric acid, CBC clinical notes 0 3600 (Package M1 M100041 Yes
Amount per
day)
Government
Reserve
General Metabolic encephalopathy(admission type: ICU
21.41 D RFT,LFT,Uric acid, CBC clinical notes 0 4500 (Package M1 M100041 Yes
Amount per
day)
Government
Reserve
General Sicklmg test, Electro
21.42 A Sickle cell Anemia (admission type: Routine ward ) clinical notes 0 1800 (Package M1 M100042 Yes
Medicine phoresis
Amount per
day)
Government
Reserve
General Sicklmg test, Electro
21.42 B Sickle cell Anemia(admission type: HDU ) clinical notes 0 2700 (Package M1 M100042 Yes
Medicine phoresis
Amount per
day)
Government
Reserve
General Sickle cell Anemia(admission type: ICU ,without Sicklmg test, Electro
Medicine ventilator) phoresis
Amount per
day)
Government
Reserve
General Sickle cell Anemia(admission type: ICU (with Sicklmg test, Electro
Medicine ventilator ) phoresis
Amount per
day)
Government
Reserve
General Poisonings with unstable vitals (admission type:
21.43 A Gastic Levage clinical notes 0 1800 (Package M1 M100043 Yes
Amount per
day)
Government
Reserve
General Poisonings with unstable vitals(admission type: HDU
21.43 B Gastic Levage clinical notes 0 2700 (Package M1 M100043 Yes
Medicine )
Amount per
day)
Government
Reserve
General Poisonings with unstable vitals(admission type: ICU
21.43 C Gastic Levage clinical notes 0 3600 (Package M1 M100043 Yes
Amount per
day)
Government
Reserve
General Poisonings with unstable vitals(admission type: ICU
21.43 D Gastic Levage clinical notes 0 4500 (Package M1 M100043 Yes
Amount per
day)
Government
Reserve
General Type 1/2 respiratory failure (admission type: Routine
21.44 A ABG Analysis clinical notes 0 1800 (Package M1 M100044 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.44 B Type 1/2 respiratory failure(admission type: HDU ) ABG Analysis clinical notes 0 2700 (Package M1 M100044 Yes
Medicine
Amount per
day)
Government
Reserve
General Type 1/2 respiratory failure(admission type: ICU
21.44 C ABG Analysis clinical notes 0 3600 (Package M1 M100044 Yes
Amount per
day)
Government
Reserve
General Type 1/2 respiratory failure(admission type: ICU
21.44 D ABG Analysis clinical notes 0 4500 (Package M1 M100044 Yes
Amount per
day)
Government
Reserve
General Acute asthmatic attack (admission type: Routine
21.45 A Clinical History clinical notes 0 1800 (Package M1 M100045 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.45 B Acute asthmatic attack(admission type: HDU ) Clinical History clinical notes 0 2700 (Package M1 M100045 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute asthmatic attack(admission type: ICU ,without
Amount per
day)
Government
Reserve
General Acute asthmatic attack(admission type: ICU (with
Amount per
day)
Government
Reserve
General
21.47 A Severe pneumonia (admission type: Routine ward ) Chesr X-Ray(PA) clinical notes 0 1800 (Package M1 M100047 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.47 B Severe pneumonia(admission type: HDU ) Chesr X-Ray(PA) clinical notes 0 2700 (Package M1 M100047 Yes
Medicine
Amount per
day)
Government
Reserve
General Severe pneumonia(admission type: ICU ,without
21.47 C Chesr X-Ray(PA) clinical notes 0 3600 (Package M1 M100047 Yes
Amount per
day)
Government
Reserve
General Severe pneumonia(admission type: ICU (with
21.47 D Chesr X-Ray(PA) clinical notes 0 4500 (Package M1 M100047 Yes
Amount per
day)
Government
Reserve
General Acute gastroenteritis with severe dehydration
21.48 A Stool Culture clinical notes 0 1800 (Package M1 M100048 Yes
Amount per
day)
Government
Reserve
General Acute gastroenteritis with severe
21.48 B Stool Culture clinical notes 0 2700 (Package M1 M100048 Yes
Medicine dehydration(admission type: HDU )
Amount per
day)
Government
Acute gastroenteritis with severe Reserve
General
21.48 C dehydration(admission type: ICU ,without Stool Culture clinical notes 0 3600 (Package M1 M100048 Yes
Medicine
day)
Government
Reserve
General Acute gastroenteritis with severe
21.48 D Stool Culture clinical notes 0 4500 (Package M1 M100048 Yes
Medicine dehydration(admission type: ICU (with ventilator )
Amount per
day)
Government
Reserve
General Hypertensive emergencies (admission type: Routine
21.49 A ECG, 2D Echo clinical notes 0 1800 (Package M1 M100049 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.49 B Hypertensive emergencies(admission type: HDU ) ECG, 2D Echo clinical notes 0 2700 (Package M1 M100049 Yes
Medicine
Amount per
day)
Government
Reserve
General Hypertensive emergencies(admission type: ICU
21.49 C ECG, 2D Echo clinical notes 0 3600 (Package M1 M100049 Yes
Amount per
day)
Government
Reserve
General Hypertensive emergencies(admission type: ICU
21.49 D ECG, 2D Echo clinical notes 0 4500 (Package M1 M100049 Yes
Amount per
day)
Government
Reserve
General Dengue hemorrhagic fever/Dengue shock syndrome
21.50 A Dengue NS1, IGM clinical notes 0 1800 (Package M1 M100050 Yes
Amount per
day)
Government
Reserve
General Dengue hemorrhagic fever/Dengue shock
21.50 B Dengue NS1, IGM clinical notes 0 2700 (Package M1 M100050 Yes
Medicine syndrome(admission type: HDU )
Amount per
day)
Government
Reserve
21.50 C Dengue NS1, IGM clinical notes 0 3600 (Package M1 M100050 Yes
Medicine syndrome(admission type: ICU ,without ventilator)
Amount per
day)
Government
Reserve
21.50 D Dengue NS1, IGM clinical notes 0 4500 (Package M1 M100050 Yes
Medicine syndrome(admission type: ICU (with ventilator )
Amount per
day)
Government
Reserve
General
21.51 A Complicated malaria (admission type: Routine ward ) CBC, RFT,LFT clinical notes 0 1800 (Package M1 M100051 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.51 B Complicated malaria(admission type: HDU ) CBC, RFT,LFT clinical notes 0 2700 (Package M1 M100051 Yes
Medicine
Amount per
day)
Government
Reserve
General Complicated malaria(admission type: ICU ,without
21.51 C CBC, RFT,LFT clinical notes 0 3600 (Package M1 M100051 Yes
Amount per
day)
Government
Reserve
General Complicated malaria(admission type: ICU ,without
21.51 D CBC, RFT,LFT clinical notes 0 4500 (Package M1 M100051 Yes
Medicine ventilator)(admission type: ICU (with ventilator )
Amount per
day)
Government
Reserve
General
21.52 A Heat stroke (admission type: Routine ward ) CPK Total clinical notes 0 1800 (Package M1 M100052 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.52 B Heat stroke(admission type: HDU ) CPK Total clinical notes 0 2700 (Package M1 M100052 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.52 C Heat stroke(admission type: ICU ,without ventilator) CPK Total clinical notes 0 3600 (Package M1 M100052 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.52 D Heat stroke(admission type: ICU (with ventilator ) CPK Total clinical notes 0 4500 (Package M1 M100052 Yes
Medicine
Amount per
day)
Government
Reserve
General Hyperosmolar Non-Ketotic coma (admission type:
21.53 A ABGA,RBS clinical notes 0 1800 (Package M1 M100053 Yes
Amount per
day)
Government
Reserve
General Hyperosmolar Non-Ketotic coma(admission type:
21.53 B ABGA,RBS clinical notes 0 2700 (Package M1 M100053 Yes
Medicine HDU )
Amount per
day)
Government
Reserve
21.53 C ABGA,RBS clinical notes 0 3600 (Package M1 M100053 Yes
Amount per
day)
Government
Reserve
21.53 D ABGA,RBS clinical notes 0 4500 (Package M1 M100053 Yes
Amount per
day)
Government
Reserve
General Severe sepsis/Septic shock (admission type: Routine
21.54 A Blood Culture clinical notes 0 1800 (Package M1 M100055 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.54 B Severe sepsis/Septic shock(admission type: HDU ) Blood Culture clinical notes 0 2700 (Package M1 M100055 Yes
Medicine
Amount per
day)
Government
Reserve
General Severe sepsis/Septic shock(admission type: ICU
21.54 C Blood Culture clinical notes 0 3600 (Package M1 M100055 Yes
Amount per
day)
Government
Reserve
General Severe sepsis/Septic shock(admission type: ICU
21.54 D Blood Culture clinical notes 0 4500 (Package M1 M100055 Yes
Amount per
day)
Government
Reserve
General Upper GI bleeding (conservative) (admission type:
21.55 A Clinical History clinical notes 0 1800 (Package M1 M100056 Yes
Amount per
day)
Government
Reserve
General Upper GI bleeding (conservative)(admission type:
21.55 B Clinical History clinical notes 0 2700 (Package M1 M100056 Yes
Medicine HDU )
Amount per
day)
Government
Reserve
Amount per
day)
Government
Reserve
Amount per
day)
Government
Reserve
General Upper GI bleeding (endoscopic) (admission type:
21.56 A Scopy clinical notes 0 1800 (Package M1 M100057 Yes
Amount per
day)
Government
Reserve
General
21.56 B Upper GI bleeding (endoscopic) Scopy clinical notes 0 2700 (Package M1 M100057 Yes
Medicine
Amount per
day)
Government
Reserve
General Upper GI bleeding (endoscopic)(admission type: ICU
21.56 C Scopy clinical notes 0 3600 (Package M1 M100057 Yes
Amount per
day)
Government
Reserve
General Upper GI bleeding (endoscopic)(admission type: ICU
21.56 D Scopy clinical notes 0 4500 (Package M1 M100057 Yes
Amount per
day)
Government
Reserve
General Lower GI hemorrhage (admission type: Routine ward Colonoscopy, USG Abd/
Medicine ) CT
Amount per
day)
Government
Reserve
General Colonoscopy, USG Abd/
21.57 B Lower GI hemorrhage(admission type: HDU ) clinical notes 0 2700 (Package M1 M100058 Yes
Medicine CT
Amount per
day)
Government
Reserve
General Lower GI hemorrhage(admission type: ICU ,without Colonoscopy, USG Abd/
Medicine ventilator) CT
Amount per
day)
Government
Reserve
General Lower GI hemorrhage(admission type: ICU (with Colonoscopy, USG Abd/
Medicine ventilator ) CT
Amount per
day)
Government
Immune mediated CNS disorders such as Reserve
General
21.58 A autoimmune encephalitis (admission type: Routine CSF,MRI clinical notes 0 1800 (Package M1 M100059 Yes
Medicine
ward ) Amount per
day)
Government
Reserve
General Immune mediated CNS disorders such as
21.58 B CSF,MRI clinical notes 0 2700 (Package M1 M100059 Yes
Medicine autoimmune encephalitis(admission type: HDU )
Amount per
day)
Government
General
21.58 C autoimmune encephalitis(admission type: ICU CSF,MRI clinical notes 0 3600 (Package M1 M100059 Yes
Medicine
,without ventilator) Amount per
day)
Government
General
21.58 D autoimmune encephalitis(admission type: ICU (with CSF,MRI clinical notes 0 4500 (Package M1 M100059 Yes
Medicine
ventilator ) Amount per
day)
Government
Reserve
General Acute transverse myelitis (admission type: Routine
21.59 A MRI.CSF clinical notes 0 1800 (Package M1 M100060 Yes
Medicine ward )
Amount per
day)
Government
Reserve
General
21.59 B Acute transverse myelitis(admission type: HDU ) MRI.CSF clinical notes 0 2700 (Package M1 M100060 Yes
Medicine
Amount per
day)
Government
Reserve
General Acute transverse myelitis(admission type: ICU
21.59 C MRI.CSF clinical notes 0 3600 (Package M1 M100060 Yes
Amount per
day)
Government
Reserve
General Acute transverse myelitis(admission type: ICU (with
21.59 D MRI.CSF clinical notes 0 4500 (Package M1 M100060 Yes
Amount per
day)
Government
Reserve
General
21.60 A Hydrocephalus (admission type: Routine ward ) CT clinical notes 0 1800 (Package M1 M100062 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.60 B Hydrocephalus(admission type: HDU ) CT clinical notes 0 2700 (Package M1 M100062 Yes
Medicine
Amount per
day)
Government
Reserve
General Hydrocephalus(admission type: ICU ,without
21.60 C CT clinical notes 0 3600 (Package M1 M100062 Yes
Amount per
day)
Government
Reserve
General Hydrocephalus(admission type: ICU (with ventilator
21.60 D CT clinical notes 0 4500 (Package M1 M100062 Yes
Medicine )
Amount per
day)
Government
Reserve
General Cerebral sino-venous thrombosis (admission type:
21.61 A MR Veno clinical notes 0 1800 (Package M1 M100063 Yes
Amount per
day)
Government
Reserve
General Cerebral sino-venous thrombosis(admission type:
21.61 B MR Veno clinical notes 0 2700 (Package M1 M100063 Yes
Medicine HDU )
Amount per
day)
Government
Reserve
21.61 C MR Veno clinical notes 0 3600 (Package M1 M100063 Yes
Amount per
day)
Government
Reserve
21.61 D MR Veno clinical notes 0 4500 (Package M1 M100063 Yes
Amount per
day)
Government
Reserve
General AKI/ renal failure(dialysis payable separately as an
21.62 A RFT, USG clinical notes 0 1800 (Package M1 M100064 Yes
Medicine add on package for ) (admission type: Routine ward )
Amount per
day)
Government
Reserve
General AKI/ renal failure(dialysis payable separately as an
21.62 B RFT, USG clinical notes 0 2700 (Package M1 M100064 Yes
Medicine add on package for )(admission type: HDU )
Amount per
day)
Government
AKI/ renal failure(dialysis payable separately as an Reserve
General
21.62 C add on package for )(admission type: ICU ,without RFT, USG clinical notes 0 3600 (Package M1 M100064 Yes
Medicine
day)
Government
AKI/ renal failure(dialysis payable separately as an Reserve
General
21.62 D add on package for )(admission type: ICU (with RFT, USG clinical notes 0 4500 (Package M1 M100064 Yes
Medicine
ventilator ) Amount per
day)
Government
Reserve
General
21.63 A Status epilepticus (admission type: Routine ward ) MRI,CSF clinical notes 0 1800 (Package M1 M100065 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.63 B Status epilepticus(admission type: HDU ) MRI,CSF clinical notes 0 2700 (Package M1 M100065 Yes
Medicine
Amount per
day)
Government
Reserve
General Status epilepticus(admission type: ICU ,without
21.63 C MRI,CSF clinical notes 0 3600 (Package M1 M100065 Yes
Amount per
day)
Government
Reserve
General Status epilepticus(admission type: ICU (with
21.63 D MRI,CSF clinical notes 0 4500 (Package M1 M100065 Yes
Amount per
day)
Government
Reserve
General
21.64 A Status asthmaticus (admission type: Routine ward ) Clinical History clinical notes 0 1800 (Package M1 M100066 Yes
Medicine
Amount per
day)
Government
Reserve
General
21.64 B Status asthmaticus(admission type: HDU ) Clinical History clinical notes 0 2700 (Package M1 M100066 Yes
Medicine
Amount per
day)
Government
Reserve
General Status asthmaticus(admission type: ICU ,without
Amount per
day)
Government
Reserve
General Status asthmaticus(admission type: ICU (with
Amount per
day)
Government
Respiratory failure due to any cause (pneumonia, Reserve
General
21.65 A asthma, COPD, ARDS, foreign body, poisoning, head Concern Investigation clinical notes 0 1800 (Package M1 M100067 Yes
Medicine
injury etc.) (admission type: Routine ward ) Amount per
day)
Government
General
21.65 B asthma, COPD, ARDS, foreign body, poisoning, head Concern Investigation clinical notes 0 2700 (Package M1 M100067 Yes
Medicine
injury etc.)(admission type: HDU ) Amount per
day)
Government
General
21.65 C asthma, COPD, ARDS, foreign body, poisoning, head Concern Investigation clinical notes 0 3600 (Package M1 M100067 Yes
Medicine
injury etc.)(admission type: ICU ,without ventilator) Amount per
day)
Government
General
21.65 D asthma, COPD, ARDS, foreign body, poisoning, head Concern Investigation clinical notes 0 4500 (Package M1 M100067 Yes
Medicine
injury etc.)(admission type: ICU (with ventilator ) Amount per
day)
Blood and blood component transfusion (admission
for a diagnostic procedure leading to treatment Government
requiring admission, e.g. bone marrow and bone Reserve
General
21.66 biopsy, endoscopy, liver biopsy, bronchoscopy, Concern Investigation clinical notes 0 2000 (Package M1 M100068 Yes
Medicine
CT/MRI under GA, broncho-alveolar lavage, lumbar Amount per
puncture, muscle biopsy, pleural aspiration, ascitic day)
tapping etc.)
General Government
21.67 Plasmapheresis - per session Concern Investigation clinical notes 0 2000 M1 M100069 Yes
Medicine Reserve
General Government
21.68 Haemodialysis/Peritoneal Dialysis - per session Concern Investigation clinical notes 0 2300 M1 M100070 Yes
Medicine Reserve
(Government
High end radiological diagnostic (CT, MRI, Imaging Reserve
General including nuclear imaging) - can only be clubbed with 0capped @ Rs
21.69 clinical notes clinical notes 0 5000 M1 M100071 Yes
Medicine medical package. Rs 5000 per annum limit to a 5000 per
family annum for a
family
(Government
High end histopathology (Biopsies) and advanced Reserve
General serology investigations - can only be clubbed with )capped @ Rs
21.70 clinical notes clinical notes 0 5000 M1 M100072 Yes
Medicine medical package. Rs 5000 per annum limit to a 5000 per
family annum for a
family
60000
(Payment
fraction (
1st week- (Payment
week- week-40%,2nd
General MRI brain with
21.71 CONSERVATIVE MANAGEMENT (ISCHEMIC STROKE) CT brain plain,others 3 week- week-15%,4th M1 M112001 Yes
Medicine angiography
week- week-10%) of
week-10%) rate)(Governme
nt Reserve)
of total
package
rate)
120000
(Payment
fraction (
1st week- (Payment
week- week-55%,2nd
Repeat CT brain after 24 15%,3rd week-15%,3rd
General THROMBOLYSIS WITH ACTILYSE FOR ISCHEMIC
21.72 CT brain plain,others hours,MRI brain with 3 week- week-10%,4th M1 M112002 Yes
Medicine STROKE
angiography 10%,4th week-10%,5th
week- week-10%) of
nt Reserve)
of total
package
rate)
40000
(Payment
fraction (
1st week- (Payment
week- week-40%,2nd
General INTRAPARENCHYMAL /SUBARACHNOID Repeat CT brain plain , CT
21.73 CT brain plain,others 3 week- week-15%,4th M1 M112003 Yes
Medicine HEMMORRHAGE (CONSERVATIVE MANAGEMENT) angiography brain
week- week-10%) of
nt Reserve)
of total
package
rate)
110000
(Payment
fraction (
1st week- (Payment
week- week-40%,2nd
General MENINGOENCEPHALITIS, OR/ AND EVD/VP shunt CT brain plain,CSF
21.74 MRI brain with contrast 3 week- week-15%,4th M1 M112004 Yes
Medicine (CONSERVATIVE MANAGEMENT) ,others
week- week-10%) of
nt Reserve)
of total
package
rate)
110000
(Payment
fraction (
1st week- (Payment
Anyone of the week- week-40%,2nd
Clinical diagnosis by
following:repetitive nerve 25%,3rd week-25%,3rd
General MYASTHENIA CRISIS MANAGEMENT BY neurophysician OR
21.75 stimulation,ACH-R 3 week- week-15%,4th M1 M112005 Yes
Medicine PLASMAPHERESIS previously diagnosed
case week-10%) of
antibody week-
nt Reserve)
of total
package
rate)
200000
(Payment
fraction (
1st week- (Payment
Anyone of the week- week-55%,2nd
Clinical diagnosis by
following:repetitive nerve 15%,3rd week-15%,3rd
General MYASTHENIA CRISIS MANAGEMENT BY IV neurophysician OR
21.76 stimulation,ACH-R 3 week- week-10%,4th M1 M112006 Yes
Medicine IMMUNOGLOBINS previously diagnosed
case week-10%) of
antibody week-
nt Reserve)
of total
package
rate)
109627
(Payment
fraction (
1st week- (Payment
week- week-40%,2nd
General Gullian-barre syndrome management by Clinical diagnosis by
21.77 CSF study, NCV/EMG 3 week- week-15%,4th M1 M112007 Yes
Medicine plasmapheresis neurophysician
week- week-10%) of
nt Reserve)
of total
package
rate)
200000
(Payment
fraction (
1st week- (Payment
week-55%,2nd
week-
week-15%,3rd
15%,3rd
General Gullian-barre syndrome management by Clinical diagnosis by week-10%,4th
21.78 CSF study, NCV/EMG 3 week- M1 M112008 Yes
Medicine Intravenous immunoglobulin neurophysician week-10%,5th
10%,4th week-10%) of
week- total package
10%,5th rate)(Governme
week-10%) nt Reserve)
of total
package
rate)
Cluster - 22 MENTAL DISORDER PACKAGES
Specialt
PMJAY
Government
Organic, including symptomatic, mental disorders Clinical assessment&
Mental Clinical assessment and Reserve,Packag
22.1 (Admision Type -routine ward)(Package Rate Per Report/ Mental Status 0 1500 M8 M800001 Yes
Disorder investigations e amount is
Day) Examination
per Day
Government
Mental and Behavioural disorders due to Clinical assessment&
22.2 psychoactive substance use (Admision Type - routine Report/ Mental Status 0 1500 M8 M800002 Yes
ward)(Package Rate Per Day) Examination
per Day
Government
Schizophrenia, schizotypal and delusional disorders Clinical assessment&
22.3 (Admision Type -routine ward)(Package Rate Per Report/ Mental Status 0 1500 M8 M800003 Yes
Day) Examination
per Day
Clinical assessment& Government
Mental Mood (affective) disorders (Admision Type -routine Clinical assessment and Report/ Mental Status Reserve,Packag
22.4 0 1500 M8 M800004 Yes
Disorder ward)(Package Rate Per Day) investigations Examination/Related e amount is
Investigations per Day
Neurotic, stress-related and somatoform disorders
Mental Clinical assessment and Report/ Mental Status Reserve,Packag
22.5 (Admision Type -routine ward)(Package Rate Per 0 1500 M8 M800005 Yes
Disorder investigations Examination/Related e amount is
Day)
Behavioural syndromes associated with physiological
22.6 disturbances and physical factors (Admision Type - 0 1500 M8 M800006 Yes
routine ward)
Mental Mental retardation (Admision Type -routine Clinical assessment and Report/ Mental Status Reserve,Packag
22.7 0 1500 M8 M800007 Yes
Disorder ward)(Package Rate Per Day) investigations Examination/Related e amount is
Mental Organic, including symptomatic, mental disorders Clinical assessment and Report/ Mental Status Reserve,Packag
22.8 0 2500 M8 M800008 Yes
Disorder (Admision Type -HDU)(Package Rate Per Day) investigations Examination/Related e amount is
Mental and Behavioural disorders due to
22.9 psychoactive substance use (Admision Type - 0 2500 M8 M800009 Yes
HDU)(Package Rate Per Day)
Mental Schizophrenia, schizotypal and delusional disorders Clinical assessment and Report/ Mental Status Reserve,Packag
22.10 0 2500 M8 M800010 Yes
Mental Mood (affective) disorders (Admision Type - Clinical assessment and Report/ Mental Status Reserve,Packag
22.11 0 2500 M8 M800011 Yes
Disorder HDU)(Package Rate Per Day) investigations Examination/Related e amount is
Mental Neurotic, stress-related and somatoform disorders Clinical assessment and Report/ Mental Status Reserve,Packag
22.12 0 2500 M8 M800012 Yes
Behavioural syndromes associated with physiological
22.13 disturbances and physical factors (Admision Type - 0 2500 M8 M800013 Yes
HDU)(Package Rate Per Day)
Mental Mental Retardation (Admision Type -HDU)(Package Clinical assessment and Report/ Mental Status Reserve,Packag
22.14 0 2500 M8 M800014 Yes
Disorder Rate Per Day) investigations Examination/Related e amount is
Pre- Electro Convulsive Therapy (ECT) and Pre-
Transcranial Magnetic Stimulation (TMS) Package
Clinical assessment&
(Cognitive Tests, Complete Haemogram, Liver Function
Mental Clinical assessment and Report/ Mental Status Government
22.15 Test, Renal Function Test, Serum Electrolytes, Electro 0 10000 M8 M800015 Yes
Disorder investigations Examination/Related Reserve
Cardiogram (ECG), CT/MRI Brain, Electroencephalogram,
Thyroid Function Test, VDRL, HIV Test, Vitamin B12 levels, Investigations
Folate levels, Lipid Profile, Homocysteine levels)
22.16 Electro Convulsive Therapy (ECT) - per session 0 3000 M8 M800016 Yes
Investigations
22.17 Transcranial Magnetic Stimulation (TMS) - per session 0 1000 M8 M800017 Yes
Investigations
Cluster - 23 EMERGENCY ROOM PACKAGES (Care Requiring Less Than 12 hrs Stay )
Specialt
PMJAY
Emergency
Government
23.1 Room Emergency with stable cardiopulmonary status X Ray,ECG with report X Ray,ECG with report 0 1000 M7 M700001 Yes
Reserve
Packages
Emergency
Emergency consultation: acute colic, high fever, cut, Government
23.2 Room Blood test clinical notes 0 1000 M7 M700002 Yes
stitches, soft tissue injury, FB removal Reserve
Packages
Single bone fracture plaster, nebulization for
Emergency
asthmatic attack, moderate dehydration, Government
23.3 Room Blood test clinical notes 0 1000 M7 M700003 Yes
hypoglycaemia in a diabetic, Dengue without Reserve
Packages
complication, Syncope, Food poisoning etc
Emergency
Antirabies register/Stock Government
23.4 Room Animal bites (Payment after completion of 5th dose) clinical notes 0 1700 M7 M700004 Yes
register Reserve
Packages
Cluster - 24 PEDIATRIC MEDICAL MANAGEMENT
Specialt
PMJAY
(Government
Pediatric clinical notes,Concern clinical notes,Concern Reserve)Packag
24.1 A Diarrhoea (admission type: Routine ward) 0 1800 M2 M200001 Yes
Medicine Investigations Investigations e Amount per
day
(Government
24.1 B Diarrhoea (admission type: HDU) 0 2700 M2 M200001 Yes
day
(Government
24.1 C Diarrhoea (admission type: ICU without ventilator) 0 3600 M2 M200001 Yes
day
(Government
24.1 D Diarrhoea (admission type: ICU (with ventilator)) 0 4500 M2 M200001 Yes
day
(Government
24.2 A Acute dysentery (admission type: Routine ward) 0 1800 M2 M200002 Yes
day
(Government
24.2 B Acute dysentery(admission type: HDU) 0 2700 M2 M200002 Yes
day
(Government
Pediatric Acute dysentery (admission type: ICU (without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.2 C 0 3600 M2 M200002 Yes
Medicine ventilator)) Investigations Investigations e Amount per
day
(Government
Pediatric Acute dysentery (admission type: ICU (with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.2 D 0 4500 M2 M200002 Yes
Medicine ventilator)) Investigations Investigations e Amount per
day
(Government
24.3 A Pneumonia (admission type: Routine ward) 0 1800 M2 M200003 Yes
day
(Government
24.3 B Pneumonia (admission type: HDU) 0 2700 M2 M200003 Yes
day
(Government
24.3 C Pneumonia (admission type: ICU, without ventilator) 0 3600 M2 M200003 Yes
day
(Government
24.3 D Pneumonia (admission type: ICU, with ventilator) 0 4500 M2 M200003 Yes
day
(Government
Pediatric Urinary tract infection (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.4 A 0 1800 M2 M200004 Yes
Medicine ward) Investigations Investigations e Amount per
day
(Government
24.4 B Urinary tract infection (admission type: HDU) 0 2700 M2 M200004 Yes
day
(Government
Pediatric Urinary tract infection (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.4 C 0 3600 M2 M200004 Yes
Medicine ventilator) Investigations Investigations e Amount per
day
(Government
Pediatric Urinary tract infection (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.4 D 0 4500 M2 M200004 Yes
day
(Government
Pediatric Acute Exacerbation of asthma (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.5 A 0 1800 M2 M200005 Yes
Medicine Routine ward) Investigations Investigations e Amount per
day
(Government
24.5 B Acute Exacerbation of asthma (admission type:HDU) 0 2700 M2 M200005 Yes
day
(Government
Pediatric Acute Exacerbation of asthma (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.5 C 0 3600 M2 M200005 Yes
Medicine without ventilator) Investigations Investigations e Amount per
day
(Government
Pediatric Acute Exacerbation of asthma (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.5 D 0 4500 M2 M200005 Yes
Medicine with ventilator) Investigations Investigations e Amount per
day
(Government
Pediatric Acute glomerulonephritis (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.6 A 0 1800 M2 M200006 Yes
day
(Government
24.6 B Acute glomerulonephritis (admission type: HDU) 0 2700 M2 M200006 Yes
day
(Government
Pediatric Acute glomerulonephritis (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.6 C 0 3600 M2 M200006 Yes
day
(Government
Pediatric Acute glomerulonephritis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.6 D 0 4500 M2 M200006 Yes
day
(Government
Pediatric Acute urticaria/ Anaphylaxis acute asthma clinical notes,Concern clinical notes,Concern Reserve)Packag
24.7 A 0 1800 M2 M200007 Yes
Medicine (admission type: Routine ward) Investigations Investigations e Amount per
day
(Government
24.7 B 0 2700 M2 M200007 Yes
Medicine (admission type: HDU) Investigations Investigations e Amount per
day
(Government
24.7 C 0 3600 M2 M200007 Yes
Medicine (admission type: ICU, without ventilator) Investigations Investigations e Amount per
day
(Government
24.7 D 0 4500 M2 M200007 Yes
Medicine (admission type: ICU, with ventilator) Investigations Investigations e Amount per
day
(Government
Pediatric Poisonings with normal vital signs (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.8 A 0 1800 M2 M200008 Yes
day
(Government
24.8 B 0 2700 M2 M200008 Yes
Medicine HDU) Investigations Investigations e Amount per
day
(Government
24.8 C 0 3600 M2 M200008 Yes
Medicine ICU, without ventilator) Investigations Investigations e Amount per
day
(Government
24.8 D 0 4500 M2 M200008 Yes
Medicine ICU, with ventilator) Investigations Investigations e Amount per
day
(Government
Pediatric Febrile seizures/other seizures (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.9 A 0 1800 M2 M200009 Yes
day
(Government
Pediatric Febrile seizures/other seizures (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.9 B 0 2700 M2 M200009 Yes
day
(Government
Pediatric Febrile seizures/other seizures (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.9 C 0 3600 M2 M200009 Yes
day
(Government
Pediatric Febrile seizures/other seizures (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.9 D 0 4500 M2 M200009 Yes
day
(Government
Pediatric Epileptic encephalopathy (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.10 A 0 1800 M2 M200010 Yes
day
(Government
24.10 B Epileptic encephalopathy (admission type: HDU) 0 2700 M2 M200010 Yes
day
(Government
Pediatric Epileptic encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.10 C 0 3600 M2 M200010 Yes
day
(Government
Pediatric Epileptic encephalopathy (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.10 D 0 4500 M2 M200010 Yes
day
(Government
24.11 A Optic neuritis (admission type: Routine ward) 0 1800 M2 M200011 Yes
day
(Government
24.11 B Optic neuritis (admission type: HDU) 0 2700 M2 M200011 Yes
day
(Government
Pediatric Optic neuritis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.11 C 0 3600 M2 M200011 Yes
day
(Government
24.11 D Optic neuritis (admission type: ICU, with ventilator) 0 4500 M2 M200011 Yes
day
(Government
24.12 A Aseptic meningitis (admission type: Routine ward) 0 1800 M2 M200012 Yes
day
(Government
24.12 B Aseptic meningitis (admission type: HDU) 0 2700 M2 M200012 Yes
day
(Government
Pediatric Aseptic meningitis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.12 C 0 3600 M2 M200012 Yes
day
(Government
Pediatric Aseptic meningitis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.12 D 0 4500 M2 M200012 Yes
day
(Government
24.13 A Trauma (admission type: Routine ward) 0 1800 M2 M200013 Yes
day
(Government
24.13 B Trauma (admission type: HDU) 0 2700 M2 M200013 Yes
day
(Government
24.13 C Trauma (admission type: ICU, without ventilator) 0 3600 M2 M200013 Yes
day
(Government
24.13 D Trauma (admission type: ICU, with ventilator) 0 4500 M2 M200013 Yes
day
(Government
Pediatric Pyrexia of unexplained origin (admission clinical notes,Concern clinical notes,Concern Reserve)Packag
24.14 A 0 1800 M2 M200014 Yes
Medicine type:Routine ward) Investigations Investigations e Amount per
day
(Government
24.14 B Pyrexia of unexplained origin (admission type: HDU) 0 2700 M2 M200014 Yes
day
(Government
Pediatric Pyrexia of unexplained origin (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.14 C 0 3600 M2 M200014 Yes
day
(Government
Pediatric Pyrexia of unexplained origin (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.14 D 0 4500 M2 M200014 Yes
day
(Government
24.15 A Chronic cough (admission type: Routine ward) 0 1800 M2 M200015 Yes
day
(Government
24.15 B Chronic cough (admission type: HDU) 0 2700 M2 M200015 Yes
day
(Government
Pediatric Chronic cough (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.15 C 0 3600 M2 M200015 Yes
day
(Government
24.15 D Chronic cough (admission type: ICU, with ventilator) 0 4500 M2 M200015 Yes
day
(Government
24.16 A Wheezing (admission type: Routine ward) 0 1800 M2 M200016 Yes
day
(Government
24.16 B Wheezing (admission type: HDU) 0 2700 M2 M200016 Yes
day
(Government
24.16 C Wheezing (admission type: ICU, without ventilator) 0 3600 M2 M200016 Yes
day
(Government
24.16 D Wheezing (admission type: ICU, with ventilator) 0 4500 M2 M200016 Yes
day
(Government
24.17 A Unexplained seizures (admission type: Routine ward) 0 1800 M2 M200017 Yes
day
(Government
24.17 B Unexplained seizures (admission type: HDU) 0 2700 M2 M200017 Yes
day
(Government
Pediatric Unexplained seizures (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.17 C 0 3600 M2 M200017 Yes
day
(Government
Pediatric Unexplained seizures (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.17 D 0 4500 M2 M200017 Yes
day
(Government
Pediatric Global developmental delay/ Intellectual disability of clinical notes,Concern clinical notes,Concern Reserve)Packag
24.18 A 0 1800 M2 M200018 Yes
Medicine unknown etiology (admission type: Routine ward) Investigations Investigations e Amount per
day
(Government
Pediatric Global developmental delay/ Intellectual disability of clinical notes,Concern clinical notes,Concern Reserve)Packag
24.18 B 0 2700 M2 M200018 Yes
Medicine unknown etiology (admission type: HDU) Investigations Investigations e Amount per
day
(Government
Global developmental delay/ Intellectual disability of
24.18 C unknown etiology (admission type: ICU, without 0 3600 M2 M200018 Yes
ventilator
day
(Government
Global developmental delay/ Intellectual disability of
24.18 D unknown etiology (admission type: ICU, with 0 4500 M2 M200018 Yes
ventilator)
day
(Government
24.19 A Dysmorphic children (admission type: Routine ward) 0 1800 M2 M200019 Yes
day
(Government
24.19 B Dysmorphic children (admission type: HDU) 0 2700 M2 M200019 Yes
day
(Government
Pediatric Dysmorphic children (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.19 C 0 3600 M2 M200019 Yes
day
(Government
Pediatric Dysmorphic children (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.19 D 0 4500 M2 M200019 Yes
day
(Government
24.20 A Rickets (admission type: Routine ward) 0 1800 M2 M200020 Yes
day
(Government
24.20 B Rickets (admission type: HDU) 0 2700 M2 M200020 Yes
day
(Government
24.20 C Rickets (admission type: ICU, without ventilator) 0 3600 M2 M200020 Yes
day
(Government
24.20 D Rickets (admission type: ICU, with ventilator) 0 4500 M2 M200020 Yes
day
(Government
Pediatric Unexplained severe anemia (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.21 A 0 1800 M2 M200021 Yes
day
(Government
24.21 B Unexplained severe anemia (admission type: HDU) 0 2700 M2 M200021 Yes
day
(Government
Pediatric Unexplained severe anemia (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.21 C 0 3600 M2 M200021 Yes
day
(Government
Pediatric Unexplained severe anemia (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.21 D 0 4500 M2 M200021 Yes
day
(Government
24.22 A Short stature (admission type: Routine ward) 0 1800 M2 M200022 Yes
day
(Government
24.22 B Short stature (admission type: HDU) 0 2700 M2 M200022 Yes
day
(Government
Pediatric Short stature (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.22 C 0 3600 M2 M200022 Yes
day
(Government
24.22 D Short stature (admission type: ICU, with ventilator) 0 4500 M2 M200022 Yes
day
(Government
Pediatric Musculoskeletal problems (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.23 A 0 1800 M2 M200023 Yes
day
(Government
24.23 B Musculoskeletal problems (admission type: HDU) 0 2700 M2 M200023 Yes
day
(Government
Pediatric Musculoskeletal problems (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.23 C 0 3600 M2 M200023 Yes
day
(Government
Pediatric Musculoskeletal problems (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.23 D 0 4500 M2 M200023 Yes
day
(Government
Pediatric Developmental and behavioral disorders (admission clinical notes,Concern clinical notes,Concern Reserve)Packag
24.24 A 0 1800 M2 M200024 Yes
Medicine type: Routine ward) Investigations Investigations e Amount per
day
(Government
24.24 B 0 2700 M2 M200024 Yes
Medicine type: HDU) Investigations Investigations e Amount per
day
(Government
24.24 C 0 3600 M2 M200024 Yes
Medicine type: ICU, without ventilator) Investigations Investigations e Amount per
day
(Government
24.24 D 0 4500 M2 M200024 Yes
Medicine type: ICU, with ventilator) Investigations Investigations e Amount per
day
(Government
24.25 A Diabetic ketoacidosis (admission type: Routine ward) 0 1800 M2 M200025 Yes
day
(Government
24.25 B Diabetic ketoacidosis (admission type: HDU) 0 2700 M2 M200025 Yes
day
(Government
Pediatric Diabetic ketoacidosis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.25 C 0 3600 M2 M200025 Yes
day
(Government
Pediatric Diabetic ketoacidosis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.25 D 0 4500 M2 M200025 Yes
day
(Government
Pediatric Nephrotic syndrome with peritonitis (admission clinical notes,Concern clinical notes,Concern Reserve)Packag
24.26 A 0 1800 M2 M200026 Yes
Medicine type: Routine ward) Investigations Investigations e Amount per
day
(Government
24.26 B 0 2700 M2 M200026 Yes
Medicine type: HDU) Investigations Investigations e Amount per
day
(Government
24.26 C 0 3600 M2 M200026 Yes
Medicine type: ICU, without ventilator) Investigations Investigations e Amount per
day
(Government
24.26 D 0 4500 M2 M200026 Yes
Medicine type: ICU, with ventilator) Investigations Investigations e Amount per
day
(Government
24.27 A Pyogenic meningitis (admission type: Routine ward) 0 1800 M2 M200027 Yes
day
(Government
24.27 B Pyogenic meningitis (admission type: HDU) 0 2700 M2 M200027 Yes
day
(Government
Pediatric Pyogenic meningitis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.27 C 0 3600 M2 M200027 Yes
day
(Government
Pediatric Pyogenic meningitis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.27 D 0 4500 M2 M200027 Yes
day
(Government
Pediatric Persistent/ Chronic diarrhea (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.28 A 0 1800 M2 M200028 Yes
day
(Government
24.28 B Persistent/ Chronic diarrhea (admission type: HDU) 0 2700 M2 M200028 Yes
day
(Government
Pediatric Persistent/ Chronic diarrhea (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.28 C 0 3600 M2 M200028 Yes
day
(Government
Pediatric Persistent/ Chronic diarrhea (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.28 D 0 4500 M2 M200028 Yes
day
(Government
Pediatric Acute severe malnutrition (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.29 A 0 1800 M2 M200029 Yes
day
(Government
24.29 B Acute severe malnutrition (admission type: HDU) 0 27000 M2 M200029 Yes
day
(Government
Pediatric Acute severe malnutrition (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.29 C 0 3600 M2 M200029 Yes
day
(Government
Pediatric Acute severe malnutrition (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.29 D 0 4500 M2 M200029 Yes
day
(Government
24.30 A Dengue (admission type: Routine ward) 0 1800 M2 M200030 Yes
day
(Government
24.30 B Dengue (admission type: HDU) 0 2700 M2 M200030 Yes
day
(Government
24.30 C Dengue (admission type: ICU, without ventilator) 0 3600 M2 M200030 Yes
day
(Government
24.30 D Dengue (admission type: ICU, with ventilator) 0 4500 M2 M200030 Yes
day
(Government
24.31 A Enteric fever (admission type: Routine ward) 0 1800 M2 M200031 Yes
day
(Government
24.31 B Enteric fever (admission type: HDU) 0 2700 M2 M200031 Yes
day
(Government
Pediatric Enteric fever (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.31 C 0 3600 M2 M200031 Yes
day
(Government
24.31 D Enteric fever (admission type: ICU, with ventilator) 0 4500 M2 M200031 Yes
day
(Government
24.32 A Chikungunya (admission type: Routine ward) 0 1800 M2 M200032 Yes
day
(Government
24.32 B Chikungunya (admission type: HDU) 0 2700 M2 M200032 Yes
day
(Government
Pediatric Chikungunya (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.32 C 0 3600 M2 M200032 Yes
day
(Government
24.32 D Chikungunya (admission type: ICU, with ventilator) 0 4500 M2 M200032 Yes
day
(Government
24.33 A Acute hepatitis (admission type: Routine ward) 0 1800 M2 M200033 Yes
day
(Government
24.33 B Acute hepatitis (admission type: HDU) 0 2700 M2 M200033 Yes
day
(Government
Pediatric Acute hepatitis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.33 C 0 3600 M2 M200033 Yes
day
(Government
24.33 D Acute hepatitis (admission type: ICU, with ventilator) 0 4500 M2 M200033 Yes
day
(Government
24.34 A Kala azar (admission type: Routine ward) 0 1800 M2 M200034 Yes
day
(Government
24.34 B Kala azar (admission type: HDU) 0 2700 M2 M200034 Yes
day
(Government
24.34 C Kala azar (admission type: ICU, without ventilator) 0 3600 M2 M200034 Yes
day
(Government
24.34 D Kala azar (admission type: ICU, with ventilator) 0 4500 M2 M200034 Yes
day
(Government
24.35 A Tuberculosis (admission type: Routine ward) 0 1800 M2 M200035 Yes
day
(Government
24.35 B Tuberculosis (admission type: HDU) 0 2700 M2 M200035 Yes
day
(Government
Pediatric Tuberculosis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.35 C 0 3600 M2 M200035 Yes
day
(Government
24.35 D Tuberculosis (admission type: ICU, with ventilator) 0 4500 M2 M200035 Yes
day
(Government
Pediatric HIV with complications (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.36 A 0 1800 M2 M200036 Yes
day
(Government
24.36 B HIV with complications (admission type: HDU) 0 2700 M2 M200036 Yes
day
(Government
Pediatric HIV with complications (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.36 C 0 3600 M2 M200036 Yes
day
(Government
Pediatric HIV with complications (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.36 D 0 4500 M2 M200036 Yes
day
(Government
24.37 A Infantile cholestasis (admission type: Routine ward) 0 1800 M2 M200037 Yes
day
(Government
24.37 B Infantile cholestasis (admission type: HDU) 0 2700 M2 M200037 Yes
day
(Government
Pediatric Infantile cholestasis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.37 C 0 3600 M2 M200037 Yes
day
(Government
Pediatric Infantile cholestasis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.37 D 0 4500 M2 M200037 Yes
day
(Government
Pediatric Haemolytic uremic syndrome (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.38 A 0 1800 M2 M200038 Yes
day
(Government
24.38 B Haemolytic uremic syndrome (admission type: HDU) 0 2700 M2 M200038 Yes
day
(Government
Pediatric Haemolytic uremic syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.38 C 0 3600 M2 M200038 Yes
day
(Government
Pediatric Haemolytic uremic syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.38 D 0 4500 M2 M200038 Yes
day
(Government
24.39 A ITP (admission type: Routine down) 0 1800 M2 M200039 Yes
day
(Government
24.39 B ITP (admission type: HDU) 0 2700 M2 M200039 Yes
day
(Government
24.39 C ITP (admission type: ICU, without ventilator) 0 3600 M2 M200039 Yes
day
(Government
24.39 D ITP (admission type: ICU, with ventilator) 0 4500 M2 M200039 Yes
day
(Government
24.40 A Juvenile myasthenia (admission type: Routine ward) 0 1800 M2 M200040 Yes
day
(Government
24.40 B Juvenile myasthenia (admission type: HDU) 0 2700 M2 M200040 Yes
day
(Government
Pediatric Juvenile myasthenia (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.40 C 0 3600 M2 M200040 Yes
day
(Government
Pediatric Juvenile myasthenia (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.40 D 0 4500 M2 M200040 Yes
day
(Government
24.41 A Kawasaki Disease (admission type: Routine ward) 0 1800 M2 M200041 Yes
day
(Government
24.41 B Kawasaki Disease (admission type: HDU) 0 2700 M2 M200041 Yes
day
(Government
Pediatric Kawasaki Disease (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.41 C 0 3600 M2 M200041 Yes
day
(Government
Pediatric Kawasaki Disease (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.41 D 0 4500 M2 M200041 Yes
day
(Government
Pediatric Persistent pneumonia (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.42 A 0 1800 M2 M200042 Yes
day
(Government
24.42 B Persistent pneumonia (admission type: HDU) 0 2700 M2 M200042 Yes
day
(Government
Pediatric Persistent pneumonia (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.42 C 0 3600 M2 M200042 Yes
day
(Government
Pediatric Persistent pneumonia (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.42 D 0 4500 M2 M200042 Yes
day
(Government
24.43 A Empyema (admission type: Routine ward) 0 1800 M2 M200043 Yes
day
(Government
24.43 B Empyema (admission type: HDU) 0 2700 M2 M200043 Yes
day
(Government
24.43 C Empyema (admission type: ICU, without ventilator) 0 3600 M2 M200043 Yes
day
(Government
24.43 D Empyema (admission type: ICU, with ventilator) 0 4500 M2 M200043 Yes
day
(Government
Pediatric Immune haemolytic anemia (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.44 A 0 1800 M2 M200044 Yes
day
(Government
24.44 B Immune haemolytic anemia (admission type: HDU) 0 2700 M2 M200044 Yes
day
(Government
Pediatric Immune haemolytic anemia (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.44 C 0 3600 M2 M200044 Yes
day
(Government
Pediatric Immune haemolytic anemia (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.44 D 0 4500 M2 M200044 Yes
day
(Government
24.45 A Cyanotic spells (admission type: Routine ward) 0 1800 M2 M200045 Yes
day
(Government
24.45 B Cyanotic spells (admission type: HDU) 0 2700 M2 M200045 Yes
day
(Government
Pediatric Cyanotic spells (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.45 C 0 3600 M2 M200045 Yes
day
(Government
24.45 D Cyanotic spells (admission type: ICU, with ventilator) 0 4500 M2 M200045 Yes
day
(Government
24.46 A Rheumatic fever (admission type: Routine ward) 0 1800 M2 M200046 Yes
day
(Government
24.46 B Rheumatic fever (admission type: HDU) 0 2700 M2 M200046 Yes
day
(Government
Pediatric Rheumatic fever (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.46 C 0 3600 M2 M200046 Yes
day
(Government
Pediatric Rheumatic fever (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.46 D 0 4500 M2 M200046 Yes
day
(Government
24.47 A Rheumatoid arthritis (admission type: Routine ward) 0 1800 M2 M200047 Yes
day
(Government
24.47 B Rheumatoid arthritis (admission type: HDU) 0 2700 M2 M200047 Yes
day
(Government
Pediatric Rheumatoid arthritis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.47 C 0 3600 M2 M200047 Yes
day
(Government
Pediatric Rheumatoid arthritis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.47 D 0 4500 M2 M200047 Yes
day
(Government
24.48 A Encephalitis (admission type: Routine ward) 0 1800 M2 M200048 Yes
day
(Government
24.48 B Encephalitis (admission type: HDU) 0 2700 M2 M200048 Yes
day
(Government
Pediatric Encephalitis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.48 C 0 3600 M2 M200048 Yes
day
(Government
24.48 D Encephalitis (admission type: ICU, with ventilator) 0 4500 M2 M200048 Yes
day
(Government
24.49 A Chronic meningitis (admission type: Routine ward) 0 1800 M2 M200049 Yes
day
(Government
24.49 B Chronic meningitis (admission type: HDU) 0 2700 M2 M200049 Yes
day
(Government
Pediatric Chronic meningitis (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.49 C 0 3600 M2 M200049 Yes
day
(Government
Pediatric Chronic meningitis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.49 D 0 4500 M2 M200049 Yes
day
(Government
Intracranial ring enhancing lesion with complication
24.50 A (neurocysticercosis, tuberculoma) (admission type: 0 1800 M2 M200050 Yes
Routine ward)
day
(Government
24.50 B (neurocysticercosis, tuberculoma) (admission type: 0 2700 M2 M200050 Yes
HDU)
day
(Government
24.50 C (neurocysticercosis, tuberculoma) (admission type: 0 3600 M2 M200050 Yes
ICU, without ventilator)
day
(Government
24.50 D (neurocysticercosis, tuberculoma) (admission type: 0 4500 M2 M200050 Yes
ICU, with ventilator)
day
(Government
24.51 A Refractory seizures (admission type: Routine ward) 0 1800 M2 M200051 Yes
day
(Government
24.51 B Refractory seizures (admission type: HDU) 0 2700 M2 M200051 Yes
day
(Government
Pediatric Refractory seizures (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.51 C 0 3600 M2 M200051 Yes
day
(Government
Pediatric Refractory seizures (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.51 D 0 4500 M2 M200051 Yes
day
(Government
24.52 A Floppy infant (admission type: Routine ward) 0 1800 M2 M200052 Yes
day
(Government
24.52 B Floppy infant (admission type: HDU) 0 2700 M2 M200052 Yes
day
(Government
Pediatric Floppy infant (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.52 C 0 3600 M2 M200052 Yes
day
(Government
24.52 D Floppy infant (admission type: ICU, with ventilator) 0 4500 M2 M200052 Yes
day
(Government
Pediatric Acute neuroregression (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.53 A 0 1800 M2 M200053 Yes
day
(Government
24.53 B Acute neuroregression (admission type: HDU) 0 2700 M2 M200053 Yes
day
(Government
Pediatric Acute neuroregression (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.53 C 0 3600 M2 M200053 Yes
day
(Government
Pediatric Acute neuroregression (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.53 D 0 4500 M2 M200053 Yes
day
(Government
Pediatric Neuromuscular disorders (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.54 A 0 1800 M2 M200054 Yes
day
(Government
24.54 B Neuromuscular disorders (admission type: HDU) 0 2700 M2 M200054 Yes
day
(Government
Pediatric Neuromuscular disorders (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.54 C 0 3600 M2 M200054 Yes
day
(Government
Pediatric Neuromuscular disorders (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.54 D 0 4500 M2 M200054 Yes
day
(Government
Pediatric Opsoclonus myoclonus syndrome (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.55 A 0 1800 M2 M200055 Yes
day
(Government
24.55 B 0 2700 M2 M200055 Yes
day
(Government
24.55 C 0 3600 M2 M200055 Yes
day
(Government
24.55 D 0 4500 M2 M200055 Yes
day
(Government
24.56 A Acute ataxia (admission type: Routine ward) 0 1800 M2 M200056 Yes
day
(Government
24.56 B Acute ataxia (admission type: HDU) 0 2700 M2 M200056 Yes
day
(Government
Pediatric Acute ataxia (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.56 C 0 3600 M2 M200056 Yes
day
(Government
24.56 D Acute ataxia (admission type: ICU, with ventilator) 0 4500 M2 M200056 Yes
day
(Government
Pediatric Steven Johnson syndrome (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.57 A 0 1800 M2 M200057 Yes
day
(Government
24.57 B Steven Johnson syndrome (admission type: HDU) 0 2700 M2 M200057 Yes
day
(Government
Pediatric Steven Johnson syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.57 C 0 3600 M2 M200057 Yes
day
(Government
Pediatric Steven Johnson syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.57 D 0 4500 M2 M200057 Yes
day
(Government
Pediatric Metabolic encephalopathy (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.58 A 0 1800 M2 M200058 Yes
day
(Government
24.58 B Metabolic encephalopathy (admission type: HDU) 0 2700 M2 M200058 Yes
day
(Government
Pediatric Metabolic encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.58 C 0 3600 M2 M200058 Yes
day
(Government
Pediatric Metabolic encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.58 D 0 4500 M2 M200058 Yes
day
(Government
Pediatric Ketogenic diet initiation in refractory epilepsy clinical notes,Concern clinical notes,Concern Reserve)Packag
24.59 A 0 1800 M2 M200059 Yes
day
(Government
24.59 B 0 2700 M2 M200059 Yes
day
(Government
24.59 C 0 3600 M2 M200059 Yes
day
(Government
24.59 D 0 4500 M2 M200059 Yes
day
(Government
Pediatric Inborn errors of metabolism (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.60 A 0 1800 M2 M200060 Yes
day
(Government
24.60 B Inborn errors of metabolism (admission type: HDU) 0 2700 M2 M200060 Yes
day
(Government
Pediatric Inborn errors of metabolism (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.60 C 0 3600 M2 M200060 Yes
day
(Government
Pediatric Inborn errors of metabolism (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.60 D 0 4500 M2 M200060 Yes
day
(Government
24.61 A Wilson’s disease (admission type: Routine ward) 0 1800 M2 M200061 Yes
day
(Government
24.61 B Wilson’s disease (admission type: HDU) 0 2700 M2 M200061 Yes
day
(Government
Pediatric Wilson’s disease (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.61 C 0 3600 M2 M200061 Yes
day
(Government
Pediatric Wilson’s disease (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.61 D 0 4500 M2 M200061 Yes
day
(Government
24.62 A Celiac disease (admission type: Routine ward) 0 1800 M2 M200062 Yes
day
(Government
24.62 B Celiac disease (admission type: HDU) 0 2700 M2 M200062 Yes
day
(Government
Pediatric Celiac disease (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.62 C 0 3600 M2 M200062 Yes
day
(Government
24.62 D Celiac disease (admission type: ICU, with ventilator) 0 4500 M2 M200062 Yes
day
(Government
Pediatric Unexplained jaundice (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.63 A 0 1800 M2 M200063 Yes
day
(Government
24.63 B Unexplained jaundice (admission type: HDU) 0 2700 M2 M200063 Yes
day
(Government
Pediatric Unexplained jaundice (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.63 C 0 3600 M2 M200063 Yes
day
(Government
Pediatric Unexplained jaundice (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.63 D 0 4500 M2 M200063 Yes
day
(Government
Pediatric Unexplained hepatosplenomegaly (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.64 A 0 1800 M2 M200064 Yes
day
(Government
24.64 B 0 2700 M2 M200064 Yes
day
(Government
24.64 C 0 3600 M2 M200064 Yes
day
(Government
24.64 D 0 4500 M2 M200064 Yes
day
(Government
24.65 A Severe pneumonia (admission type: Routine ward) 0 1800 M2 M200065 Yes
day
(Government
24.65 B Severe pneumonia (admission type: HDU) 0 2700 M2 M200065 Yes
day
(Government
Pediatric Severe pneumonia (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.65 C 0 3600 M2 M200065 Yes
day
(Government
Pediatric Severe pneumonia (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.65 D 0 4500 M2 M200065 Yes
day
(Government
Pediatric Severe exacerbation of asthma (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.66 A 0 1800 M2 M200066 Yes
day
(Government
Pediatric Severe exacerbation of asthma (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.66 B 0 2700 M2 M200066 Yes
day
(Government
Pediatric Severe exacerbation of asthma (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.66 C 0 3600 M2 M200066 Yes
day
(Government
Pediatric Severe exacerbation of asthma (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.66 D 0 4500 M2 M200066 Yes
day
(Government
24.67 A Acute kidney injury (admission type: Routine ward) 0 1800 M2 M200067 Yes
day
(Government
24.67 B Acute kidney injury (admission type: HDU) 0 2700 M2 M200067 Yes
day
(Government
Pediatric Acute kidney injury (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.67 C 0 3600 M2 M200067 Yes
day
(Government
Pediatric Acute kidney injury (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.67 D 0 4500 M2 M200067 Yes
day
(Government
24.68 A Poisonings (admission type: Routine ward) 0 1800 M2 M200068 Yes
day
(Government
24.68 B Poisonings (admission type: HDU) 0 2700 M2 M200068 Yes
day
(Government
24.68 C Poisonings (admission type: ICU, without ventilator) 0 3600 M2 M200068 Yes
day
(Government
24.68 D Poisonings (admission type: ICU, with ventilator) 0 4500 M2 M200068 Yes
day
(Government
Pediatric Serious trauma with unstable vitals (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.69 A 0 1800 M2 M200069 Yes
day
(Government
24.69 B 0 2700 M2 M200069 Yes
day
(Government
24.69 C 0 3600 M2 M200069 Yes
day
(Government
24.69 D 0 4500 M2 M200069 Yes
day
(Government
Pediatric Upper GI hemorrhage (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.70 A 0 1800 M2 M200070 Yes
day
(Government
24.70 B Upper GI hemorrhage (admission type: HDU) 0 2700 M2 M200070 Yes
day
(Government
Pediatric Upper GI hemorrhage (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.70 C 0 3600 M2 M200070 Yes
day
(Government
Pediatric Upper GI hemorrhage (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.70 D 0 4500 M2 M200070 Yes
day
(Government
Pediatric Lower GI hemorrhage (admission type: Routine ward clinical notes,Concern clinical notes,Concern Reserve)Packag
24.71 A 0 1800 M2 M200071 Yes
Medicine ) Investigations Investigations e Amount per
day
(Government
24.71 B Lower GI hemorrhage (admission type: HDU) 0 2700 M2 M200071 Yes
day
(Government
Pediatric Lower GI hemorrhage (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.71 C 0 3600 M2 M200071 Yes
day
(Government
Pediatric Lower GI hemorrhage (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.71 D 0 4500 M2 M200071 Yes
day
(Government
24.72 A Acute abdomen (admission type: Routine ward) 0 1800 M2 M200072 Yes
day
(Government
24.72 B Acute abdomen (admission type: HDU) 0 2700 M2 M200072 Yes
day
(Government
Pediatric Acute abdomen (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.72 C 0 3600 M2 M200072 Yes
day
(Government
Pediatric Acute abdomen (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.72 D 0 4500 M2 M200072 Yes
day
(Government
24.73 A Liver abscess (admission type: Routine ward) 0 1800 M2 M200073 Yes
day
(Government
24.73 B Liver abscess (admission type: HDU) 0 2700 M2 M200073 Yes
day
(Government
Pediatric Liver abscess (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.73 C 0 3600 M2 M200073 Yes
day
(Government
24.73 D Liver abscess (admission type: ICU, with ventilator) 0 4500 M2 M200073 Yes
day
(Government
24.74 A Complicated malaria (admission type: Routine ward) 0 1800 M2 M200074 Yes
day
(Government
24.74 B Complicated malaria (admission type: HDU) 0 2700 M2 M200074 Yes
day
(Government
Pediatric Complicated malaria (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.74 C 0 3600 M2 M200074 Yes
day
(Government
Pediatric Complicated malaria (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.74 D 0 4500 M2 M200074 Yes
day
(Government
Pediatric Severe dengue with shock (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.75 A 0 1800 M2 M200075 Yes
day
(Government
24.75 B Severe dengue with shock (admission type: HDU) 0 2700 M2 M200075 Yes
day
(Government
Pediatric Severe dengue with shock (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.75 C 0 3600 M2 M200075 Yes
day
(Government
Pediatric Severe dengue with shock (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.75 D 0 4500 M2 M200075 Yes
day
(Government
Pediatric Congestive cardiac failure (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.76 A 0 1800 M2 M200076 Yes
day
(Government
24.76 B Congestive cardiac failure (admission type: HDU) 0 2700 M2 M200076 Yes
day
(Government
Pediatric Congestive cardiac failure (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.76 C 0 3600 M2 M200076 Yes
day
(Government
Pediatric Congestive cardiac failure (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.76 D 0 4500 M2 M200076 Yes
day
(Government
24.77 A Brain abscess (admission type: Routine ward) 0 1800 M2 M200077 Yes
day
(Government
24.77 B Brain abscess (admission type: HDU) 0 2700 M2 M200077 Yes
day
(Government
Pediatric Brain abscess (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.77 C 0 3600 M2 M200077 Yes
day
(Government
24.77 D Brain abscess (admission type: ICU, with ventilator) 0 4500 M2 M200077 Yes
day
(Government
Pediatric Acute encephalitic syndrome (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.78 A 0 1800 M2 M200078 Yes
day
(Government
24.78 B Acute encephalitic syndrome (admission type: HDU) 0 2700 M2 M200078 Yes
day
(Government
Pediatric Acute encephalitic syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.78 C 0 3600 M2 M200078 Yes
day
(Government
Pediatric Acute encephalitic syndrome (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.78 D 0 4500 M2 M200078 Yes
day
(Government
Pediatric Acute demyelinating myelopathy, (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.79 A 0 1800 M2 M200079 Yes
day
(Government
24.79 B 0 2700 M2 M200079 Yes
day
(Government
24.79 C 0 3600 M2 M200079 Yes
day
(Government
24.79 D 0 4500 M2 M200079 Yes
day
(Government
Immune mediated CNS disorders such as
24.80 A autoimmune encephalitis (admission type: Routine 0 1800 M2 M200080 Yes
ward)
day
(Government
Pediatric Immune mediated CNS disorders such as clinical notes,Concern clinical notes,Concern Reserve)Packag
24.80 B 0 2700 M2 M200080 Yes
Medicine autoimmune encephalitis (admission type: HDU) Investigations Investigations e Amount per
day
(Government
24.80 C autoimmune encephalitis (admission type: ICU, 0 3600 M2 M200080 Yes
without ventilator)
day
(Government
24.80 D autoimmune encephalitis (admission type: ICU, with 0 4500 M2 M200080 Yes
ventilator)
day
(Government
Pediatric Acute transverse myelitis (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.81 A 0 1800 M2 M200081 Yes
day
(Government
24.81 B Acute transverse myelitis (admission type: HDU) 0 2700 M2 M200081 Yes
day
(Government
Pediatric Acute transverse myelitis (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.81 C 0 3600 M2 M200081 Yes
day
(Government
Pediatric Acute transverse myelitis (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.81 D 0 4500 M2 M200081 Yes
day
109627
(Payment
fraction (
1st week- (Payment
week- week-40%,2nd
Gullian-barre syndrome management by plasmapheresis
Pediatric (Payment fraction ( 1st week-35 ,2nd week-25 ,3rd week- Clinical diagnosis by
24.82 A CSF study, NCV/EMG 3 week- week-15%,4th M2 M212001 Yes
Medicine 15 ,4th week-10 ,5th week-10 ,F/u-5 ) of total package neurophysician
rate)
week- week-10%) of
nt Reserve)
of total
package
rate)
200000
(Payment
fraction (
1st week- (Government
55%,2nd Reserve)(Payme
nt fraction ( 1st
week-
Gullian-barre syndrome management by Intravenous week-55%,2nd
15%,3rd
Pediatric immunoglobulin (Payment fraction ( 1st week-35 ,2nd Clinical diagnosis by week-15%,3rd
24.82 B CSF study, NCV/EMG 3 week- M2 M212002 Yes
Medicine week-25 ,3rd week-15 ,4th week-10 ,5th week-10 ,F/u-5 ) neurophysician week-10%,4th
of total package rate)
week- week-10%) of
week-10%) rate)
of total
package
rate)
(Government
24.83 A Hydrocephalus (admission type: Routine ward) 0 1800 M2 M200083 Yes
day
(Government
24.83 B Hydrocephalus (admission type:HDU) 0 2700 M2 M200083 Yes
day
(Government
Pediatric Hydrocephalus (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.83 C 0 3600 M2 M200083 Yes
day
(Government
24.83 D Hydrocephalus (admission type: ICU, with ventilator) 0 4500 M2 M200083 Yes
day
(Government
Pediatric Intracranial space occupying lesion (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.84 A 0 1800 M2 M200084 Yes
day
(Government
24.84 B 0 2700 M2 M200084 Yes
day
(Government
24.84 C 0 3600 M2 M200084 Yes
day
(Government
24.84 D 0 4500 M2 M200084 Yes
day
(Government
24.85 A Cerebral malaria (admission type: Routine ward) 0 1800 M2 M200085 Yes
day
(Government
24.85 B Cerebral malaria (admission type: HDU) 0 2700 M2 M200085 Yes
day
(Government
Pediatric Cerebral malaria (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.85 C 0 3600 M2 M200085 Yes
day
(Government
Pediatric Cerebral malaria (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.85 D 0 4500 M2 M200085 Yes
day
(Government
Pediatric Acute ischemic stroke (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.86 A 0 1800 M2 M200086 Yes
day
(Government
24.86 B Acute ischemic stroke (admission type: HDU) 0 2700 M2 M200086 Yes
day
(Government
Pediatric Acute ischemic stroke (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.86 C 0 3600 M2 M200086 Yes
day
(Government
Pediatric Acute ischemic stroke (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.86 D 0 4500 M2 M200086 Yes
day
(Government
Pediatric Cerebral sino-venous thrombosis (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.87 A 0 1800 M2 M200087 Yes
day
(Government
24.87 B 0 2700 M2 M200087 Yes
day
(Government
24.87 C 0 3600 M2 M200087 Yes
day
(Government
24.87 D 0 4500 M2 M200087 Yes
day
(Government
Respiratory failure due to any causes (pneumonia,
24.88 A asthma, foreign body, poisoning, head injury etc.) 0 1800 M2 M200088 Yes
(admission type: Routine ward)
day
(Government
24.88 B asthma, foreign body, poisoning, head injury etc.) 0 2700 M2 M200088 Yes
(admission type: HDU)
day
(Government
24.88 C asthma, foreign body, poisoning, head injury etc.) 0 3600 M2 M200088 Yes
(admission type: ICU, without ventilator)
day
(Government
24.88 D asthma, foreign body, poisoning, head injury etc.) 0 4500 M2 M200088 Yes
(admission type: ICU, with ventilator)
day
(Government
Pediatric Acute encephalitis –infectious/immune-mediated clinical notes,Concern clinical notes,Concern Reserve)Packag
24.90 A 0 1800 M2 M200090 Yes
day
(Government
24.90 B 0 2700 M2 M200090 Yes
day
(Government
24.90 C 0 3600 M2 M200090 Yes
day
(Government
24.90 D 0 4500 M2 M200090 Yes
day
(Government
Pediatric Convulsive & non convulsive status epilepticus clinical notes,Concern clinical notes,Concern Reserve)Packag
24.91 A 0 1800 M2 M200091 Yes
day
(Government
24.91 B 0 2700 M2 M200091 Yes
day
(Government
24.91 C 0 3600 M2 M200091 Yes
day
(Government
24.91 D 0 4500 M2 M200091 Yes
day
(Government
24.92 A Cerebral herniation (admission type: Routine ward) 0 1800 M2 M200092 Yes
day
(Government
24.92 B Cerebral herniation (admission type: HDU) 0 2700 M2 M200092 Yes
day
(Government
Pediatric Cerebral herniation (admission type: ICU, without clinical notes,Concern clinical notes,Concern Reserve)Packag
24.92 C 0 3600 M2 M200092 Yes
day
(Government
Pediatric Cerebral herniation (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.92 D 0 4500 M2 M200092 Yes
day
(Government
Pediatric Intracranial hemorrhage (admission type: Routine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.93 A 0 1800 M2 M200093 Yes
day
(Government
24.93 B Intracranial hemorrhage (admission type: HDU) 0 2700 M2 M200093 Yes
day
(Government
Pediatric Intracranial hemorrhage (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.93 C 0 3600 M2 M200093 Yes
day
(Government
Pediatric Intracranial hemorrhage (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.93 D 0 4500 M2 M200093 Yes
day
(Government
Pediatric Hepatic encephalopathy (admission type: Rourine clinical notes,Concern clinical notes,Concern Reserve)Packag
24.94 A 0 1800 M2 M200094 Yes
day
(Government
24.94 B Hepatic encephalopathy (admission type: HDU) 0 2700 M2 M200094 Yes
day
(Government
Pediatric Hepatic encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.94 C 0 3600 M2 M200094 Yes
day
(Government
Pediatric Hepatic encephalopathy (admission type: ICU, with clinical notes,Concern clinical notes,Concern Reserve)Packag
24.94 D 0 4500 M2 M200094 Yes
day
(Government
Pediatric Complicated bacterial meningitis (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.95 A 0 1800 M2 M200095 Yes
day
(Government
24.95 B 0 2700 M2 M200095 Yes
day
(Government
24.95 C 0 3600 M2 M200095 Yes
day
(Government
24.95 D 0 4500 M2 M200095 Yes
day
(Government
Pediatric Raised intracranial pressure (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.96 A 0 1800 M2 M200096 Yes
Medicine routine ward) Investigations Investigations e Amount per
day
(Government
24.96 B Raised intracranial pressure (admission type: HDU) 0 2700 M2 M200096 Yes
day
(Government
Pediatric Raised intracranial pressure (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.96 C 0 3600 M2 M200096 Yes
day
(Government
Pediatric Raised intracranial pressure (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.96 D 0 4500 M2 M200096 Yes
day
(Government
Pediatric Hypertensive encephalopathy (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.97 A 0 1800 M2 M200097 Yes
Medicine Routind) Investigations Investigations e Amount per
day
(Government
Pediatric Hypertensive encephalopathy (admission type: clinical notes,Concern clinical notes,Concern Reserve)Packag
24.97 B 0 2700 M2 M200097 Yes
day
(Government
Pediatric Hypertensive encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.97 C 0 3600 M2 M200097 Yes
day
(Government
Pediatric Hypertensive encephalopathy (admission type: ICU, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.97 D 0 4500 M2 M200097 Yes
day
(Government
24.98 CRRT (per session) 0 8000 M2 M200098 Yes
day
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 (Government
Pediatric marrow and bone biopsy, endoscopy, liver biopsy, clinical notes,Concern clinical notes,Concern Reserve)Packag
24.99 0 1500 M2 M200099 Yes
Medicine bronchoscopy, CT/MRI under GA, broncho-alveolar Investigations Investigations e Amount per
lavage, lumbar puncture, muscle biopsy, FNAC, day
pleural aspiration, ascitic tapping, neostigmine
challenge test etc.)Package rate per Day
(Government
Blood and blood component transfusion for
24.100 indications like Thalassemia/Hemoglobinopathies - 0 1500 M2 M200100 Yes
upto a limit of 2 days,Package rate per Day
day
(Government
High end radiological diagnostic (CT, MRI, Imaging Reserve)cappe
Pediatric clinical notes,Concern clinical notes,Concern
24.101 including nuclear imaging) - can only be clubbed with 0 5000 d @ Rs 5000 M2 M200101 Yes
Medicine Investigations Investigations
medical package. per annum for
a family
(Government
High end histopathology (Biopsies) and advanced Reserve)cappe
Pediatric clinical notes,Concern clinical notes,Concern
24.102 serology investigations - can only be clubbed with 0 5000 d @ Rs 5000 M2 M200102 Yes
Medicine Investigations Investigations
medical package. per annum for
a family
Cluster - 25 NEO-NATAL PACKAGES
Specialt
PMJAY
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:
Blood sugar,Blood
• Any newborn needing feeding support (Government
group,Complete blood
• Babies requiring closer monitoring or short-term Reserve)Cappe
count,Coombs clinical notes,Concern
25.1 Neonatal care for conditions like: 0 500 d Amount is M3 M300001 Yes
test,others as Investigaions
o Birth asphyxia (need for positive pressure 1500 for this
required,Concern
ventilation; no HIE) Package
Investigaions
o Moderate jaundice requiring phototherapy
o Large for dates (>97 percentile) Babies
o Small for gestational age (less than 3rd centile)
(Package rate is per day)
Special Neonatal Care Package (Rs. 3000 per day,
Blood sugar (Package
maximum of 18000 - pre-auth after 4 days): Babies
rate is per day)
that required admission to SNCU or NICU:
Complete Blood Picture
Babies admitted for short term care for conditions
Blood group
like:
Bilirubin
• Mild Respiratory Distress/tachypnea
Coombs Test (Government
• Mild encephalopathy
Chest X ray Reserve)Cappe
• Severe jaundice requiring intensive phototherapy clinical notes,Concern
25.2 Neonatal CRP 0 3000 d Amount is M3 M300002 Yes
• Haemorrhagic disease of newborn Investigaions
Micro ESR 18000 for this
• Unwell baby requiring monitoring
Blood Culture Package
• Some dehydration
Electrolytes
• Hypoglycaemia
Renal function tests
Mother's stay and food in the hospital for
Coagulation profile
breastfeeding, family centred care and (Kangaroo
Others as required
Mother Care) KMC is mandatory and included in the
package rate
Intensive Neonatal Care Package (Rs. 5000 per day,

maximum of Rs. 50,000 – pre-auth is needed after 5
days) (Package rate is per day)
Babies with birthweight 1500-1799 g
or
Babies of any birthweight and at least one of the
following conditions:
• Need for mechanical ventilation for less than 24
hours or non-invasive respiratory support (CPAP,
(Government
HFFNC)
Reserve)Cappe
• Sepsis / pneumonia without complications clinical notes,Concern
25.3 Neonatal Concern Investigaions 0 5000 d Amount is M3 M300003 Yes
• Hyperbilirubinemia requiring exchange transfusion Investigaions
50000 for this
• Seizures
Package
• 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
Advanced Neonatal Care Package (Rs. 6000 per day,
maximum of Rs. 75,000 – pre-auth is needed after 7
days) (Package rate is per day)
Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one of the
following conditions:
• Any condition requiring invasive ventilation longer
than 24 hours
(Government
• Hypoxic Ischemic encephalopathy requiring
Reserve)Cappe
Therapeutic Hypothermia clinical notes,Concern
25.4 Neonatal Concern Investigaions 0 6000 d Amount is M3 M300004 Yes
• Cardiac rhythm disorders needing intervention Investigaions
75000 for this
(the cost of cardiac surgery or implant will be
Package
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
Critical Care Neonatal Package (Rs. 7000 per day,
maximum of Rs. 1,20,000 – pre-auth after 10 days)
(Package rate is per day)
Babies with birthweight of <1200 g
or
Babies of any birthweight with at least one of the
following conditions: (Government
• Severe Respiratory Failure requiring High Reserve)Cappe
clinical notes,Concern
25.5 Neonatal Frequency Ventilation or inhaled Nitric Oxide (iNO) Concern Investigaions 0 7000 d Amount is M3 M300005 Yes
Investigaions
• Multisystem failure requiring multiple organ 120000 for this
support including mechanical ventilation and Package
multiple inotropes
• Critical congenital heart disease
package rate
Chronic Care Package (Rs. 3000 per day, maximum of

(Government
Rs. 30,000): If the baby requires stay beyond the
Reserve)Cappe
upper limit of usual stay in Package no 0004 or 0005 clinical notes,Concern clinical notes,Concern
25.6 Neonatal 0 3000 d Amount is M3 M300006 Yes
for conditions like severe BPD requiring respiratory Investigaions Investigaions
30000 for this
support, severe NEC requiring prolonged TPN
Package
support (Package rate is per day)
High Risk Newborn Post Discharge Care Package clinical notes,Concern clinical notes,Concern Government
25.7 Neonatal 0 2400 M3 M300007 Yes
(Protocol Driven) Investigaions Investigaions Reserve
Laser Therapy for Retinopathy of Prematurity clinical notes,Concern clinical notes,Concern Government
25.8 Neonatal 0 1500 M3 M300008 Yes
(Irrespective of no. of eyes affected) - per session Investigaions Investigaions Reserve
clinical notes,Concern clinical notes,Concern Government
25.9 Neonatal Advanced Surgery for Retinopathy of Prematurity 0 15000 M3 M300009 Yes
Investigaions Investigaions Reserve
Ventriculoperitoneal Shunt Surgery (VP) or Omaya clinical notes,Concern clinical notes,Concern Government
25.10 Neonatal 0 5000 M3 M300010 Yes
Reservoir or External Drainage for Hydrocephalus Investigaions Investigaions Reserve
Cluster - 26 ORTHOPEDICS & POLYTRAUMA
Specialt
PMJAY
AC joint reconstruction/ Stabilization/

Acromionplasty (Nonoperative management is
recommended for Rockwood type I and II injuries,
X Ray of Affected Limb,
26.1 Orthopeidc whereas surgical reconstruction is recommended for X Ray of Affected Limb 2 25000 S5 S500001 No
MIR of Shoulder
type IV and VI separations. The management for
type III and V injuries is more controversial and is
determined on a case-by-case basis)
Accessory bone – Excision (limbs) – congenital,
26.2 Orthopeidc X Ray of Affected Limb X Ray of Affected Limb 1 6000 S5 S500002 No
Accessory digits sometime can be removed
26.3 Orthopeidc Amputation - Below Elbow X Ray of Affected Limb 1 15000 S5 S500003 No
clinical picture
26.4 Orthopeidc Amputation - Above Elbow X Ray of Affected Limb 1 15000 S5 S500004 No
clinical picture
26.5 Orthopeidc Amputation – one or more fingers X Ray of Affected Limb 1 6000 S5 S500005 No
clinical picture
26.6 Orthopeidc Amputation – Wrist/Ankel X Ray of Affected Limb 1 15000 S5 S500006 No
clinical picture
26.7 Orthopeidc Amputation - one or more toes/ digits X Ray of Affected Limb 1 6000 S5 S500007 No
clinical picture
26.8 Orthopeidc Amputation – Below Knee X Ray of Affected Limb 1 15000 S5 S500008 No
clinical picture
26.9 Orthopeidc Amputation – Above Knee X Ray of Affected Limb 2 18000 S5 S500009 No
clinical picture
26.10 Orthopeidc Foot & Hand Amputation - partial X Ray of Affected Limb 1 15000 S5 S500010 No
clinical picture
Clinical and radiological Clinical and radiological Government
26.11 Orthopeidc Disarticulation (hind & for quarter) 2 25000 S5 S500011 Yes
investigation investigation Reserve
Clinical and radiological Clinical and radiological

26.14 Orthopeidc Osteochondroma excision/ Excision of Exostosis 1 10000 S5 S500014 No
investigation investigation
26.15 Orthopeidc Excision Arthoplasty 1 15000 S5 S500015 No
X-Ray/USG/ MRI of
Clinical and radiological
26.16 Orthopeidc Arthorotomy of any joint affected joints and 1 15000 S5 S500016 No
investigation
clinical photo , CBC
26.17 Orthopeidc Arthrodesis Ankle Triple 1 15000 S5 S500017 No
X-Ray, MRI of affected
26.18 Orthopeidc Excision Arthoplasty of Femur head Post-Operative X-Ray 2 22500 S5 S500018 No
joints , CBC, ESR, CRP
26.19 Orthopeidc Bimalleolar Fracture Fixation 1 15000 S5 S500019 No
Bone Tumour Excision + reconstruction using Clinical and radiological Clinical and radiological Government
26.20 Orthopeidc 2 50000 S5 S500020 Yes
implant (malignant/ benign) investigation investigation Reserve
Bone Tumour (malignant/ benign) curettage and Clinical and radiological Clinical and radiological Government
26.21 Orthopeidc 2 20000 S5 S500021 Yes
bone grafting investigation investigation Reserve
Bone Tumour Excision (malignant/ benign) + Joint
26.22 Orthopeidc replacement (depending upon type of joint and 2 1,50,000 S5 S500022 Yes
implant)
Clavicle fracture management - conservative
26.23 Orthopeidc X- Ray of affected sights X- Ray of limb treated. 1 3000 S5 S500023 No
(daycare)
26.26 Orthopeidc Close Reduction - Small Joints X- Ray of limb treated. 1 4000 S5 S500026 No
clinical picture
26.27 Orthopeidc Closed Interlock Nailing + Bone Grafting – femur X- Ray of limb treated. 2 19000 S5 S500027 No
clinical picture
26.28 Orthopeidc Closed Interlocking Intermedullary X- Ray of limb treated. 2 17500 S5 S500028 No
clinical picture
26.30 Orthopeidc Closed Reduction and Internal Fixation with K wire X- Ray of limb treated. 1 6000 S5 S500030 No
clinical picture
Closed Reduction and Percutaneous Screw Fixation X Ray of Affected Limb,
26.31 Orthopeidc X- Ray of limb treated. 1 15000 S5 S500031 No
(neck femur) clinical picture
Debridement & Closure of Major injuries - contused
26.35 Orthopeidc lacerated wounds (anti-biotic + dressing) - minimum X- Ray of limb treated. 1 7000 S5 S500035 No
clinical picture
of 3 sessions
26.36 Orthopeidc Debridement & Closure of Minor injuries X- Ray of limb treated. 1 3000 S5 S500036 No
clinical picture
26.37 Orthopeidc Closed reduction of dislocation (Knee/ Hip) X- Ray of limb treated. 1 6000 S5 S500037 No
clinical picture
26.38 Orthopeidc Closed reduction of dislocation (Shoulder/ Elbow) X- Ray of limb treated. 1 5000 S5 S500038 No
clinical picture
26.39 Orthopeidc Duputryen’s Contracture release + rehabilitation USG of Affected Hand clinical picture + USG 1 10000 S5 S500039 No
Government
26.40 Orthopeidc Exploration and Ulnar nerve Repair X-Ray, UGS, RMG & NCV Post of USG 1 10000 S5 S500040 Yes
Reserve
26.41 Orthopeidc External fixation - Long bone Post of X -Ray 1 15000 S5 S500041 No
clinical picture
26.42 Orthopeidc External fixation - Small bone Post of X -Ray 1 10000 S5 S500042 No
clinical picture
26.43 Orthopeidc External fixation - Pelvis Post of X -Ray 1 15000 S5 S500043 No
clinical picture
26.44 Orthopeidc Fasciotomy Post of X -Ray 1 7000 S5 S500044 No
clinical picture
26.46 Orthopeidc Fracture - Acetabulum Post of X -Ray 2 30000 S5 S500046 No
clinical picture
26.47 Orthopeidc Fracture - Fibula Internal Fixation Post of X -Ray 1 10000 S5 S500047 No
clinical picture
Fracture - Hip Internal Fixation (Intertrochanteric X Ray of Affected Limb,
26.48 Orthopeidc Post of X -Ray 2 17000 S5 S500048 No
Fracture with implant) + rehabilitation clinical picture
26.49 Orthopeidc Fracture - Humerus Internal Fixation Post of X -Ray 2 17000 S5 S500049 No
clinical picture
26.50 Orthopeidc Fracture - Olecranon of Ulna Post of X -Ray 1 10000 S5 S500050 No
clinical picture
26.51 Orthopeidc Fracture - Radius Internal Fixation Post of X -Ray 1 10000 S5 S500051 No
clinical picture
26.52 Orthopeidc Fracture - TIBIA Internal Fixation plating Post of X -Ray 2 17000 S5 S500052 No
clinical picture
26.53 Orthopeidc Fracture - Ulna Internal Fixation Post of X -Ray 1 10000 S5 S500053 No
clinical picture
26.54 Orthopeidc Head Radius – Excision Post of X -Ray 1 8000 S5 S500054 No
clinical picture
26.55 Orthopeidc High Tibial Osteotomy Post of X -Ray 2 17000 S5 S500055 No
clinical picture
26.56 Orthopeidc Closed reduction + Hip Spica Post of X -Ray 1 7000 S5 S500056 No
clinical picture
26.57 Orthopeidc Internal Fixation Lateral Epicondyle Post of X -Ray 1 10000 S5 S500057 No
clinical picture
Multiple Tendon Repair( 5000/- Per Tendon Repair Clinical + Electro Clinical photographs
26.61 Orthopeidc 2 20000 S5 S500061 No
up to Four Tendons) Diagnostic study showing scar
Clinical photographs
Clinical + Electro Government
26.62 Orthopeidc Nerve Repair Surgery showing scar + Electro 1 15000 S5 S500062 Yes
Diagnostic study Reserve
Dignostic study
Clinical photographs
Clinical + Electro
26.63 Orthopeidc Nerve Transposition/Release/ Neurolysis showing scar + Electro 1 8000 S5 S500063 No
Diagnostic study
Dignostic study
26.64 Orthopeidc Open Reduction Internal Fixation (Small bone) Post of X -Ray 1 10000 S5 S500064 No
clinical picture
26.65 Orthopeidc Open Reduction Internal Fixation (Large Bone) Post of X -Ray 2 20000 S5 S500065 No
clinical picture
26.66 Orthopeidc Open Reduction of CDH Post of X -Ray 2 30000 S5 S500066 No
clinical picture
26.67 Orthopeidc Open Reduction of Small Joint Post of X -Ray 1 15000 S5 S500067 No
clinical picture
26.68 Orthopeidc Open Reduction with bone grafting of nonunion Post of X -Ray 2 20000 S5 S500068 No
clinical picture
26.69 Orthopeidc Osteotomy -Small Bone Post of X -Ray 2 17000 S5 S500069 No
clinical picture
26.70 Orthopeidc Osteotomy -Large Bone Post of X -Ray 2 30000 S5 S500070 No
clinical picture
26.71 Orthopeidc Patellectomy Post of X -Ray 1 8000 S5 S500071 No
clinical picture
X Ray of Affected Limb, Post of X -Ray, Clinical
26.72 Orthopeidc Pelvic Osteotomy with fixation with plaster 2 30000 S5 S500072 No
clinical picture photo
26.74 Orthopeidc Excision of Bursa Radiology Investigation 1 4000 S5 S500074 No
clinical picture
26.75 Orthopeidc Reconstruction of ACL/PCL with implant and brace 2 30000 S5 S500075 No
Sequestrectomy of Long Bones + anti-biotics + Clinical and radiological Clinical and radiological
26.76 Orthopeidc 2 25000 S5 S500076 No
dressing investigation investigation
X Ray of Affected Limb, Clinical and radiological

26.77 Orthopeidc Tendo Achilles Tenotomy 1 5000 S5 S500077 No
clinical picture investigation

26.78 Orthopeidc Tendon Grafting 1 15000 S5 S500078 No

26.79 Orthopeidc Tendon Release/ Tenotomy 1 5000 S5 S500079 No

26.80 Orthopeidc Tenolysis 1 5000 S5 S500080 No

26.81 Orthopeidc Tension Band Wiring Patella 1 15000 S5 S500081 No

26.82 Orthopeidc Application of P.O.P. casts for Upper & Lower Limbs 1 3000 S5 S500082 No

26.83 Orthopeidc Application of P.O.P. Spikas& Jackets 1 3500 S5 S500083 No

26.84 Orthopeidc Application of Skeletal Tractions with pin 1 3000 S5 S500084 No

26.85 Orthopeidc Application of Skin Traction 1 1000 S5 S500085 No
Fracture intercondylarHumerus + olecranon Clinical and radiological Clinical and radiological
26.88 Orthopeidc 2 20000 S5 S500088 No
osteotomy investigation investigation
Rate is 3,000/-
per casts, Next
Correction of club foot per casts (Rate is 3,000/- per Clinical and radiological Clinical and radiological visit after 3
26.89 Orthopeidc 1 15000 S5 S500089 No
casts, Next visit after 3 weeks Maximum for 5 Visit) investigation investigation weeks
Maximum for 5
Visit

26.90 Orthopeidc Arthroscopic Meniscus Repair/ Meniscectomy 2 20000 S5 S500090 No

26.91 Orthopeidc Bipolar Hemiarthroplasty (hip/shoulder) 2 40000 S5 S500094 No

26.92 Orthopeidc Unipolar Hemiarthroplasty 2 30000 S5 S500095 No

26.93 Orthopeidc Elbow replacement 2 40000 S5 S500097 No

26.94 Orthopeidc Arthrodesis of shoulder 2 40000 S5 S500098 Yes

26.95 Orthopeidc Arthrodesis of Knee (with implant) 2 40000 S5 S500099 Yes

26.96 Orthopeidc Arthrodesis of Wrist (with implant) 2 30000 S5 S500100 Yes

26.97 Orthopeidc Arthrodesis of Ankle (with implant) 2 30000 S5 S500101 Yes
Nerve Conduction study, Government
8.1 Orthopeidc Nerve and tendon repair &/ Vascular repair Clinical Photograph 3 23000 S5 S612001 Yes
CT scan Reserve
Nerve & Tendon Repair &/ Vascular Repair (Grade-I& Nerve Conduction study, Government
8.2 Orthopeidc Clinical Photograph 3 14950 S5 S612002 Yes
II) CT scan Reserve
Nerve & Tendon Repair &/ Vascular Repair (Grade- Nerve Conduction study,
8.3 Orthopeidc Clinical Photograph 3 26450 S5 S512013 No
III) CT scan
8.4 Orthopeidc Flap cover Surgery for wound in compound fracture CLINICAL PHOTOGRAPH 3 23000 S5 S612003 No
X-RAY
8.8 Orthopeidc Surgical Correction of Pelvic bone fractures. X-RAY X-RAY 3 40000 S5 S612007 No
MRI , CLINICAL CLINICAL PHOTOGRAPH,
8.50 Orthopeidc JOINT RECONSTRUCTION 3 74750 S5 S612008 No
PHOTOGRAPH, X-RAY X-RAY
CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH,
8.51 Orthopeidc ELLIZAROV FIXATION 3 75000 S5 S612009 No
X-RAY X-RAY
MRI, CLINICAL CLINICAL PHOTOGRAPH,
8.57 Orthopeidc PREPATELLAR BURSA AND REPAIR OF MCL OF KNEE 3 57500 S5 S612015 No
PHOTOGRAPH, X-RAY X-RAY
Wound management for compound fracture
8.85 Orthopeidc Clinical Photograph, Xray Clinical Photograph, Xray 3 30000 S5 S612033 No
(Any grade)
EXTERNAL FIXATOR WITH SOFT TISSUE INJURY,
8.86 Orthopeidc SURGICAL MANAGEMENT, STG COVERING FOR Clinical Photograph, Xray Clinical Photograph, Xray 3 50000 S5 S612034 No
SMALL BONES
EXTERNAL FIXATOR WITH SOFT TISSUE INJURY,
8.87 Orthopeidc SURGICAL MANAGEMENT, STG COVERING FOR Clinical Photograph, Xray Clinical Photograph, Xray 3 50000 S5 S612035 No
LARGE BONES
Post- op. X-ray,Clinical
Internal fixation with Flap cover Surgery for wound PRE OP CLINICAL
8.90 Orthopeidc Photograph showing flap 2 40000 S5 S600003 No
in compound fracture PICTURE,X-RAY/CT
cover
Clinical photograph
8.92 Orthopeidc Internal fixation of Pelviacetabular fracture X-RAY/CT showing scar,Post- op. X- 2 40000 S5 S600005 No
ray
Clinical photograph
Visceral injury requiring surgical intervention along
8.95 Orthopeidc Pre-op. X-ray,CT,USG showing scar,Post- op. X- 2 30000 S5 S600008 No
with fixation of fracture of single long bone.
ray
Clinical photograph
Visceral injury requiring surgical intervention along
8.96 Orthopeidc Pre-op. X-ray,CT,USG showing scar,Post- op. X- 2 45000 S5 S600009 No
with fixation of fracture of 2 or more long bones.
ray
Clinical photograph
Chest injury with one fracture of long bone (with Pre-op. X-ray of fracture
8.97 Orthopeidc showing scar,Post- op. X- 2 35000 S5 S600010 No
implants) , Chest Xray
ray
Clinical photograph
Pre-op. X-ray of fracture
8.98 Orthopeidc Chest injury with fracture of 2 or more long bones showing scar,Post- op. X- 2 45000 S5 S600011 No
, Chest Xray
ray
6.68 Orthopeidc CERVICAL SPINE STABLISATION ANTERIOR MRI SPINE X RAY SPINE 5 60000 S5 S512016 No
6.69 A Orthopeidc MRI SPINE X RAY SPINE 5 50000 S5 S812052 No
one
6.69 B Orthopeidc MRI SPINE X RAY SPINE 5 60000 S5 S812071 No
two
CERVICALSPINE STABLISATION-GLOBAL (Anterior &
Posterior combine)
6.70 B Orthopeidc MRI SPINE X RAY SPINE 5 70000 S5 S812072 No
three
6.70 C Orthopeidc MRI SPINE X RAY SPINE 5 80000 S5 S812075 No
four
6.71 Orthopeidc DL SPINE STABLISATION-ANTERTIOR MRI SPINE X RAY SPINE 5 60000 S5 S512004 No
6.72 A Orthopeidc DL SPINE STABLISATION-POSTERIOR Level one MRI SPINE X RAY SPINE 5 50000 S5 S812055 No
6.72 B Orthopeidc DL SPINE STABLISATION-POSTERIOR Level two MRI SPINE X RAY SPINE 5 60000 S5 S812073 No
DL SPINE STABLISATION-GLOBAL (Anterior &
Posterior combine)
6.73 B Orthopeidc DL SPINE STABLISATION-POSTERIOR Level three MRI SPINE X RAY SPINE 5 70000 S5 S812074 No
6.73 C Orthopeidc DL SPINE STABLISATION-POSTERIOR Level four MRI SPINE X RAY SPINE 5 80000 S5 S812076 No
CLINICAL PHOTOGRAPH, X- CLINICAL PHOTOGRAPH, X-
8.60 Orthopeidc SHOULDER JACKET 3 50000 S5 S612017 No
RAY RAY
26.98 Orthopeidc 1,00,000rs per anum per family,Package amount is Concern Investigation Concern Investigation 1 100000 S5 U100 No
Negotiable)
Cluster - 27 NEPHROLOGY
Specialt
PMJAY
5.135 Nephrology RADIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 6440 S7 S712022 No
5.136 Nephrology BRACHIOCEPHALIC AV FISTULA FOR HEMODIALYSIS DOPPLER UPPER LIMB DOPPLER UPPER LIMB 5 8280 S7 S712023 No
CBC, S.CRETAIN, BL
MAINTENANCE HEMODIALYSIS (MHD) (WITH INJ. UREA, S. Na+ /S.K+,
5.142 Nephrology - 0 2300 S7 S712024 No
ERYTHROPOETINE WITH INJ. IRON) –PER DIALYSIS. HIV(ELLISA), HCV
(ELLISA), HBS Ag (ELLISA)
Permanent tunnelled catheter placement as Colour Doppler/
5.143 Nephrology Clinical Photograph 0 16000 S7 S712025 No
substitute for AV fistula in long term dialysis Peripheral Angiogram
Endovascular intervention for salvaging hemodialysis Colour Doppler/ Government
5.144 Nephrology Clinical Photograph 0 40000 S7 S712026 Yes
AV fistula Peripheral Angiogram Reserve

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Cluster - 1 BURNS AND PLASTIC SURGERY

Electrical contact burns: Low voltage- with part of

Electrical contact burns: High voltage- without part

Electrical contact burns: High voltage- with part of

Intervention Coronary Angiography + Peripheral/ Renal

2.10 has been

Intervention Permanent pacemaker implantation (only VVI)

Intervention PTCA - Additional Stent (Mediated)

Unspecified Surgical Package (Amount Capped @

Clinical Photograph , USG

Clinical Photograph , USG

Intervention Permanent tunnelled catheter placement as Colour Doppler/

Intervention Endovascular intervention for salvaging hemodialysis Colour Doppler/ Government

Intervention Colour Doppler/

5.166 Urology Ureterolithotomy-Laparoscopic USG,X Ray,IVP/CT Clinical photograph,USG 2 30000 S7 S700038 No

USG KUB,CT Urography/

USG KUB,CT Urography/

EPILEPSY SURGERY-GRID INSERTION + LOCALISATION MRI BRAIN (1.5/3 TESLA)

NEUROSUR CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH,

NEUROSUR CLINICAL PHOTOGRAPH, CLINICAL PHOTOGRAPH,

Clinical photograph, Xray

Biopsy, CT scan/MRI, x- Biopsy, CT scan/MRI, x-

Biopsy, CT scan/MRI, x- Biopsy, CT scan/MRI, x-

Hematology and serum

Hematology and serum

Linear Clinical photograph, rt

Blood group, FBS, PPBS,

Blood group, HbA1C,

Blood group, HbA1C, FBS,

Open Kidney transplantation from deceased donor

Open dual Kidney transplantation from deceased

Robotic kidney transplantation from living donor

Robotic dual kidney transplantation from deceased

Kidney graft biopsy, CBC,

Kidney graft biopsy, CBC,

Kidney graft biopsy, CBC,

Single antigen quantity

Single antigen quantity

Single antigen quantity

Single antigen quantity

Blood culture, CBC, RFT,

Blood culture, CBC, RFT,

Blood culture, CBC, RFT,

Blood group CBC, FBS,

Liver Living donor hepatectomy Part-2 Investigations CT triphasic angiography

Blood group CBC, FBS,

Dual lobe liver transplantation: One lobe from one

Monthly investigations and immunosuppression

Liver graft biopsy, CBC, LFT,

Liver graft biopsy, CBC, LFT,

Treatment for T cell rejection with thymoglobulin IV Livergraft biopsy , CBC,

Treatment for T cell rejection with thymoglobulin IV Livergraft biopsy , CBC,

Blood culture , CBC , RFT,

Blood culture , CBC , RFT,

Blood culture , CBC , RFT,

Liver Post-liver transplant Hepatitis C infectionIncludes

Pancreas transplant Part-2 Investigations

Clinical photograph, blood

clinical notes and

USG, PRE OP, MINOR Government

USG / Ct, Clinical History,

USG / Ct, Clinical History,

USG / CT, Clinical History,