Surgery List

Speciality Name	Speciality Code	Sub Speciality Name	Sub Speciality Code	Surgery Name	Surgery Code	Package Amount	Mandatory Document at the Time of Preauth	Mandatory Document at the Time of Claim	Clinical Protocol Guidelines
Burns	S13	Burns	S13N1	Up To - 30% ( Conservative) -5 days 15 to 30% in Adults 5 to 30% in below 12 years patients	S13N1.1	35000	Clinical photo of affected part, diagramatic distribution of burns mandatory(Rule of 9) Note that lessthan 30 % burns are covered by the scheme	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	30 - 40% Mixed Burns( With Surgeries)	S13N1.2	70000	Clinical photo of affected part, diagramatic distribution of burns mandatory(Rule of 9) Note that lessthan 30 % burns are covered by the scheme	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	30 to 45% (Conservative) 7 days	S13N1.3	60000	Clinical photo of affected part ,diagramatic distribution of burns mandatory(Rule of 9)	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	10-30% Mixed Burns( With Surgeries)	S13N1.4	70000	Clinical photo of affected part,diagramatic distribution of burns mandatory(Rule of 9)	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	45 to 60% ( Conservative) 7 days	S13N1.5	80000	Clinical photo of affected part,diagramatic distribution of burns mandatory(Rule of 9)	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	40- 60% Mixed Burns( With Surgeries)	S13N1.6	100000	Clinical photo of affected part,diagramatic distribution of burns mandatory(Rule of 9)	Clinical Photo Of Affected Part
Burns	S13	Burns	S13N1	Above 60% Mixed Burns( With Surgeries) 10 days	S13N1.7	120000	Clinical photo of affected part,diagramatic distribution of burns mandatory(Rule of 9)	Clinical Photo Of Affected Part
Burns	S13	Burns Post Burn Contracture Surgeries For Functional Improvement (Package And Physiotherapy)	S13N2	Mild Contracture Surgeries For Functional Improvement (including splints, pressure garments And Physiotherapy)	S13N2.1	20000	Clinical photo of affected part	Clinical Photo Of Affected Part
Burns	S13	Burns Post Burn Contracture Surgeries For Functional Improvement (Package And Physiotherapy)	S13N2	Moderate Contracture Surgeries For Functional Improvement (including splints, pressure garments And Physiotherapy)	S13N2.2	30000	Clinical photo of affected part	Clinical Photo Of Affected Part
Burns	S13	Burns Post Burn Contracture Surgeries For Functional Improvement (Package And Physiotherapy)	S13N2	Severe Contracture Surgeries For Functional Improvement (including splints, pressure garments And Physiotherapy)	S13N2.3	40000	Clinical photo of affected part	Clinical Photo Of Affected Part
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F3	Abdominal Vascular Injuries - Aorta, Iliac Arteries, IVC, Iliac Veins with graft - Payable maximum upto	S7F3.1	140000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Abdominal Vascular Injuries - Aorta, Iliac Arteries, IVC, Iliac Veins without graft- Payable maximum upto	S7F24.9	100000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	CVTS Valve Repairs	S7F17	Annulus Aortic Ectasia With Valved Conduits	S7F17.5	150000	Angio / 2Decho/ CT	2D Echo/Scar Photo
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Aortic debranching surgery with prosthetic graft	S7PM1.17	125000	CT Angio	Scar photo and doppler	-
Cardiac And Cardiothoracic Surgery	S7P	Valve Replacement	S7PM1	Aortic Valve Replacement (With Biprosthetic Valve)	S7PM1.3	160000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7F	Valve Replacement	S7F9	Aortic Valve Replacement (With Mechanical valve)	S7F9.1	145000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Aorto Billac - Bifemoral Bypass With Synthetic Graft	S7F9.10	150000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes, Barcode Sticker
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Aorto-Aorto Bypass With Graft	S7F13.1	125000	Angio /CT angio/ MR angio	Doppler, Operation Notes/ Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Arterial Embolectomy	S7F9.19	50000	?ANGIOGRAM/ COLOR DOPPLER	Colour Doppler & Proceedure Notes Sufficient (For Peripheral Arterial Embolectomy) & Ct Angio For Other Arteries
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Axillo Bifemoral Bypass With Synthetic Graft	S7F9.11	125000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	Color Doppler, Operation Notes, Barcode Sticker
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Axillo Brachial Bypass Using With Synthetic Graft	S7F9.14	100000	Angiogram / Spiral CT	?Color Doppler / Scar Photo, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Brachioradial Bypass With Synthetic Graft	S7F9.15	100000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes, Barcode Sticker
Cardiac And Cardiothoracic Surgery	S7F	CAD	S7F6	CABG Off Pump With IABP	S7F6.6	165000	Coronary Angiography report & Video, 2D Echo	X-Ray Chest, Operation Notes ,Post Surgery Photo,2D Echo Required .Iabp Sticker For Claims Required .
Cardiac And Cardiothoracic Surgery	S7F	CAD	S7F6	CABG Off Pump Without IABP	S7F6.2	125000	Coronary Angiography report & Video, 2D Echo	X-Ray Chest, Operation Notes Post Surgery Photo (Female Patients May Be Made An Exception For Scar Photo)
Cardiac And Cardiothoracic Surgery	S7F	CAD	S7F6	CABG On Pump With IABP	S7F6.5	190000	Coronary Angiography report & Video, 2D Echo	X-Ray Chest, Operation Notes Post Surgery Photo,2D Echo Required . Iabp Sticker For Claims Required	-
Cardiac And Cardiothoracic Surgery	S7F	CAD	S7F6	CABG On Pump Without IABP	S7F6.1	150000	Coronary Angiography report & Video, 2D Echo	X-Ray Chest, Operation Notes Post Surgery Photo,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)	-
Cardiac And Cardiothoracic Surgery	S7F	CAD	S7F6	CABG With Aneurysmal Repair	S7F6.3	110000	Angiography	?Post Surgery Photograph / Doppler, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Carotid Artery Bypass With Synthetic Graft	S7F9.17	100000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes, Barcode Sticker
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Carotid Body Tumour Excision	S7F13.26	45000	Angiogram / Spiral CT	?Color Doppler / Scar Photo, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Carotid Embolectomy	S7F13.11	50000	CT- Angio	Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Carotid to brachial bypass with prosthetic graft	S7PM1.16	90000	Color doppler	Scar photo, Graft sticker	-
Cardiac And Cardiothoracic Surgery	S7F	Coarctation Of Aorta Repair	S7F11	Coarctation Of Aorta Repair With Graft	S7F11.1	100000	2D Echo & CT Angio (AORTOGRAM)	Post Procedure Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Coarctation Of Aorta Repair	S7F11	Coarctation Of Aorta Repair Without Graft	S7F11.2	70000	2D Echo & CT Angio (AORTOGRAM)	Post Procedure Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	CVTS Chest	S7F20	Diaphragmatic Eventeration	S7F20.1	100000	Barium studies / CT scan	Clinical Photo / Xray
Cardiac And Cardiothoracic Surgery	S7F	CVTS Chest	S7F20	Diaphragmatic Hernia	S7F20.2	100000	?X-ray ,USG	Post Procedure Clinical Photo, Xray, Operation Notes ,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)
Cardiac And Cardiothoracic Surgery	S7P	Valve Replacement	S7PM1	Double Valve Replacement (With Biprosthatic Valve)	S7PM1.4	200000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7F	Valve Replacement	S7F9	Double Valve Replacement (With mechnical Valve)	S7F9.3	180000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Double valve replacement with tricuspid valve repair - with ring	S7PM1.11	150000	Clinical Photo, 2D Echo	Clinical Photo. 2D Echo, Operation notes	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Double valve replacement with tricuspid valve repair - without ring	S7PM1.12	140000	Clinical Photo, 2D Echo	Clinical Photo. 2D Echo, Operation notes	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Emergency IABP insertion	S7PM1.15	50000	Clinical notes	IABP sticker	-
Cardiac And Cardiothoracic Surgery	S7P	Cardiac And Cardiothoracic Surgery	S7PM1	Encysted Empyema/Pleural Effusion - Tubercular	S7PM1.10	10000	?CT Scan Chest With Contrast,Pulmonary Function Test(Major),Aspirate For Culture,PUS Culture & Sensitivity,Chest X-Ray PA View(1 Film)	Chest X-Ray PA View(1 Film)
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Excision Of AV Malformation Large - with graft	S7F9.22	100000	?MRI ANGIOGRAM/SPIRAL CT /ANGIOGRAM	?Color Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Excision Of AV Malformation without graft	S7F9.18	50000	?MRI ANGIOGRAM/SPIRAL CT /ANGIOGRAM	?Color Doppler, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Failed device closure for ASD and/or VSD. Emergency retrieval of device with defect closure under cardiopulmonary bypass	S7F13.18	125000	2 D Echo	Scar photo/Post-op 2 D Echo/Post-op X ray
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Femoro Popliteal Bypass With Graft	S7F13.3	75000	CT- Angio/ MRI Angio	Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Femorodistal Bypass With Synthetic Graft	S7F9.13	100000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes, Barcode Sticker	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Femorodistal Bypass With Vein Graft	S7F9.12	60000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Femoro-Femoral Bypass With Graft	S7F13.7	90000	CT- Angio/ MRI Angio	Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Fontan Procedure	S7PM1.18	170000	ECHO,ECG, Chest X Ray, Partial thromboplastin time(PTT) Hyperornithilemia, Hyperammoniemia, Homocitrullinuria (HHH),LFT,RFT, CT Angio, Cardiac Cath	Echo showing graft in situ, Procedure video, Scar photo, X Ray chest PA View	-
Cardiac And Cardiothoracic Surgery	S7P	Cardiac And Cardiothoracic Surgery	S7PM1	Glenn Shunt (without cardiopulmonary bypass)	S7PM1.2	35000	2D ECHO	ECHO,Post op X Ray, scar photo
Cardiac And Cardiothoracic Surgery	S7F	Limb Ischaemia	S7F8	ICU Management of Acute Limb Ischaemia 4 days	S7F8.1	25000	Color Doppler, Clinical Photo	Color Doppler, Clinical Photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Ileofemoral Bypass With Graft	S7F13.5	80000	CT- Angio/ MRI Angio	Doppler, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Intracardiac repair - TOF with RVPA Conduit	S7PM1.1	200000	Clinical Photo, 2D Echo	Clinical Photo. 2D Echo, Operation notes	-
Cardiac And Cardiothoracic Surgery	S7F	Congenital heart disease	S7F19	Intracardiac Repair Of ASD	S7F19.1	120000	2D Echo	2D Echo, Operation Notes ,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Intracardiac Repair Of VSD	S7F13.15	125000	2D Echo	2D Echo, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7F	Aortic dissection / aneurysm	S7F11	Intrathoracic Aneurysm-Aneurysm Not Requiring Bypass (With Graft)	S7F11.4	125000	?CT-ANGIO	Post Procedure Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	CVTS Lungs	S7F18	Lobectomy	S7F18.2	75000	?CT-CHEST /X- RAY	Xray, Histopathology Report, Operation Notes ,Clinical Photo,Ct/Mri (Submitted At Time Of Preauth)
Cardiac And Cardiothoracic Surgery	S7F	CVTS Lungs	S7F18	Lung Cyst	S7F18.4	75000	?CT-CHEST /X- RAY	Xray, Histopathology Report, Operation Notes,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F3	Major Vascular Injury -In Lower Limbs-Repair with graft - Payable maximum upto	S7F3.2	100000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Major Vascular Injury -In Lower Limbs-Repair without graft- Payable maximum upto	S7F24.3	90000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Medium Size Arterial Aneurysms - Repair	S7F9.8	90000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Medium Size Arterial Aneurysms With Synthetic Graft	S7F9.9	90000	?CT angio/ MRI-angio/ Color Doppler/ ANGIOGRAM	?Color Doppler, Operation Notes, Barcode Sticker
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Minimal Invasive Aortic/Mitral valve replacement with bioprosthetic ?valve	S7F7.5	250000	2 D Echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Minimal Invasive Aortic/Mitral valve replacement with mechanical valve	S7F7.4	200000	2 D Echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Minimal invasive atrial/ventricular septal defect closure	S7F7.3	100000	2 D echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Minimal invasive valve repair with ring	S7F7.7	180000	2 D Echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7F	Valve Replacement	S7F9	Mitral Valve Replacement (With biprosthatic Valve)	S7F9.26	160000	2D Echo	Post Procedure Clinical Photo, 2D Echo/ Xray Chest, Operation Notes Sticker Mandatory For Claim (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7F	Valve Replacement	S7F9	Mitral Valve Replacement (With mechanical Valve)	S7F6.4	145000	2D Echo	Post Procedure Clinical Photo, 2D Echo/ Xray Chest, Operation Notes Sticker Mandatory For Claim (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Mitral valve replacement with tricuspid valve repair with ring	S7PM1.13	150000	Clinical Photo, 2D Echo	Clinical Photo. 2D Echo, Operation notes	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Mitral valve replacement with tricuspid valve repair without ring	S7PM1.14	140000	Clinical Photo, 2D Echo	Clinical Photo. 2D Echo, Operation notes	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Neck Vascular Injury - Carotid Vessels without graft - Payable maximum upto	S7F24.8	100000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F3	Neck Vascular Injury - Carotid Vessels with graft - Payable maximum upto	S7F3.3	125000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	On pump multivessel minimal?invasive coronary artery bypass grafting	S7F7.2	220000	coronary angiography, 2 D echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	Open aortic Valvotomy/ Supra / Subvalvular Aortic stenosis	S7PM1.19	100000	ECHO,ECG,Chest X Ray, HHH, PTT, LFT,RFT, CT Angio/ Cardiac Cath	Echo showing stent in situ, Procedure video, Scar photo, X Ray chest PA View	-
Cardiac And Cardiothoracic Surgery	S7F	Cvts Valve Repairs	S7F17	Open Mitral Valvotomy	S7F17.4	110000	2D Echo	2D Echo, Operation Notes,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS Valve Repairs	S7F17	Open Pulmonary Valvotomy	S7F17.2	90000	2D Echo	2D Echo, Operation Notes , Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Partial Anomalous?pulmonary venous connection/return	S7F7.6	100000	2 D echo	x-ray chest, operative photo, operative notes, scar photo	-
Cardiac And Cardiothoracic Surgery	S7P	Pericardium	S7PM1	Pericardiectomy with CPB	S7PM1.8	125000	2D Echo / CT	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	Pericardium	S7F10	Pericardiectomy without CPB	S7F10.1	75000	2D Echo / CT	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular	S7F9	Peripheral Embolectomy Without Graft	S7F13.28	30000	?ANGIOGRAM/ COLOR DOPPLER	?Color Doppler, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Pulmonary arterio venous malformation	S7F13.21	135000	HRCT Thorax or CT Pulmonary Angiogram	HRCT Thorax or CT Pulmonary Angiogram	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Pulmonary Valve Replacement - with mechanical valve	S7F13.22	150000	2D ECHO	ECHO,Post op X Ray ,scar photo
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F7	Pulmonary Valve Replacement - with biprosthatic valve	S7F7.1	160000	2D ECHO	ECHO,Post op X Ray ,scar photo	-
Cardiac And Cardiothoracic Surgery	S7F	Ross Procedure Intracardiac Repair Of Complex Congenital Heart Diseases	S7F16	Ross procedure - Intracardiac repair of complex congenital heart diseases With Special Conduits	S7F16.2	155000	2D Echo	2D Echo/Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Ross Procedure Intracardiac Repair Of Complex Congenital Heart Diseases	S7F16	Ross procedure - Intracardiac repair of complex congenital heart diseases Without Special Conduits	S7F16.1	120000	2D Echo	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Ruptured Sinus Of Valsalva Correction	S7F13.13	150000	CAG / 2D Echo	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS Lungs	S7F18	SOL Mediastinum	S7F18.5	110000	?CT-CHEST /X- RAY	Xray, Histopathology Report, Operation Notes,Clinical Photo Showing Suture/Incision/Scar((Female Patients May Be Made An Exception)
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Surgery for Arterial Aneurysm Renal Artery with graft / patch	S7F13.23	125000	?ANGIOGRAM,Spiral CT Angiogram	?Color Doppler
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Surgery for HOCM (Hypertrophic obstructive cardiomyopathy)	S7F13.20	125000	2 D Echo	Scar photo/Post-op 2 D Echo/Post-op X ray
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Surgery For Intracardiac Tumours	S7F13.12	150000	?2D ECHO	?2D Echo/ Histopath , Post Surgery Photograph, Operation Notes Scar Photo Is Mandatory(Female Patients May Be Made An Exception)	-
Cardiac And Cardiothoracic Surgery	S7F	Cardiac Injuries	S7F12	Surgery With CPB	S7F12.2	150000	2D Echo / Xray chest/ CT	2D Echo/Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Surgery With Vein Graft	S7F24.6	20000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Surgery Without Graft For Arterial Injuries, Venous Injuries	S7F24.1	10000	Angiogram /Doppler/ CT angio	Clinical Photo With Scar
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Surgery-PDA	S7F13.16	45000	2D Echo	2D Echo, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Systemic Pulmonary Shunts	S7F5	Systemic Pulmonary Shunts With Graft with CPB	S7F5.1	125000	?2D ECHO	2D Echo, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Systemic Pulmonary Shunts	S7F14	Systemic Pulmonary Shunts With Graft without CPB	S7F14.1	80000	?2D ECHO	2D Echo, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7F	Systemic Pulmonary Shunts	S7F14	Systemic Pulmonary Shunts Without Graft without CPB	S7F14.2	50000	2D Echo	2D Echo, Operation Notes
Cardiac And Cardiothoracic Surgery	S7F	Systemic Pulmonary Shunts	S7F5	Systemic Pulmonary Shunts Without Graft with CPB	S7F5.2	100000	2D Echo	2D Echo, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	TAPVC Correction	S7F13.14	150000	2D Echo/ CT	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7P	CVTS	S7PM1	TGA (Transposition of greater arteries) Arterial switch / Senning procedure / Mustard Procedure	S7PM1.20	155000	ECHO/CT Angio/CT Scan chest without contrast, Chest X Ray, ABG, PT, PTTK, USG Abdomen, HHH, CBC,CRP,RFT,LFT, Serum calcium	2D ECHO, Chest X RAY, LFT,RFT,ABG	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Thoracic Vascular Injuries - Payable maximum upto	S7F24.10	150000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7P	Cardiac And Cardiothoracic Surgery	S7PM1	Thoracocentesis	S7PM1.6	1500	Clinical Notes, X-ray	Clinical Notes, Clinical Photograph
Cardiac And Cardiothoracic Surgery	S7F	CVTS Chest	S7F4	Thoracoplasty	S7F4.1	50000	CT Chest	Clinical Photo / Xray	-
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Thoracotomy, Thoraco Abdominal Approach	S7F13.25	40000	CT Scan	Clinical Photo With Scar
Cardiac And Cardiothoracic Surgery	S7P	Cardiac And Cardiothoracic Surgery	S7PM1	Thrombendarterectomy	S7PM1.7	15000	Colour Doppler/CT-Angio	Colour Doppler
Cardiac And Cardiothoracic Surgery	S7P	Cardiac And Cardiothoracic Surgery	S7PM1	Thromboembolectomy usually done as emergency by ETI)	S7PM1.5	20000	Duplex ultrasound/Angio report	Scar photo + Post op CT angio
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Thyomectomy	S7F13.24	50000	CT-CHEST,X- RAY	CLINICAL PHOTOGRAPH/X-RAY
Cardiac And Cardiothoracic Surgery	S7F	Congenital heart disease	S7F19	Total correction of tetralogy of fallots (TOF)	S7F19.6	150000	2D Echo	2D Echo, Operation Notes	-
Cardiac And Cardiothoracic Surgery	S7F	Surgical Correction Of Bronchopleural Fistula	S7F19	Transpleural BPF Closure/Myoplasty/Thoracoplasty	S7F19.5	60000	CT Chest	Clinical Photo / Xray
Cardiac And Cardiothoracic Surgery	S7P	Valve Replacement	S7PM1	Tricuspid Valve Replacement with biprosthatic valve	S7PM1.9	150000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)	-
Cardiac And Cardiothoracic Surgery	S7F	Valve Replacement	S7F9	Tricuspid Valve Replacement with mechanical valve	S7F9.2	150000	?2D ECHO	2D Echo/ Xray, Post Surgery Photo, Bar Code Sticker, Operation Notes (Female Patients May Be Made An Exception For Scar Photo)
Cardiac And Cardiothoracic Surgery	S7F	CVTS	S7F13	Truncus Arteriosus surgery	S7F13.19	150000	2 D Echo	Scar photo/Post-op 2 D Echo/Post-op X ray
Cardiac And Cardiothoracic Surgery	S7F	CVTS Valve Repairs	S7F17	Valve Repair With Prosthetic Ring	S7F17.6	140000	2D Echo	2D Echo/Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	CVTS Valve Repairs	S7F17	Valve Repair Without Prosthetic Ring / Supramitral membrane	S7F17.1	100000	2D Echo	2D Echo/Scar Photo	-
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Vascular Injuries Repair With Prosthetic Graft	S7F24.7	75000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery	S7F	Vascular Injuries	S7F24	Vascular Injury In Upper Limbs ? Axillary,Branchial,Radial And Ulnar - Repair With Vein Graft - Payable maximum upto	S7F24.2	75000	Angiogram /Doppler/ CT angio	Doppler / Scar Photo
Cardiac And Cardiothoracic Surgery/Surgical Oncology	S7F	CVTS Lungs	S7F18	Pneumonectomy	S7F18.1	120000	?CT-CHEST /X- RAY	Xray, Histopathology Report, Operation Notes ,Clinical Photo,Ct/Mri (Submitted At Time Of Preauth)
Cardiology	M7T	Cardiology	M7T1	Acute MI Requiring IABP Pump - 7 Days	M7T1.4	60000	TROPONIN/CPKMB , ECG, 2D Echo, Clinical notes	Lab Investigations, Clinical Notes Iabp Sticker Mandatory At The Time Of Claim.
Cardiology	M7T	Cardiology	M7T1	Acute MI With Cardiogenic Shock - 7 Days	M7T1.3	30000	ECG with date & name, Cardiac Enzymes, Clinical Notes, 2D Echo	Lab Investigations, Clinical Notes
Cardiology	M7P	Cardiology	M7PM1	Alcohol septal ablation for hypertrophic Obstructive Cardiomyopathy	M7PM1.1	100000	2D Echo	Procedures notes, 2D Echo, Evidence of Injection given	-
Cardiology	M7T	Cardiology	M7T1	ASD Device Closure	M7T1.14	95000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	S7F	Cardiology Balloon Procedures	S7F2	Balloon Atrial Septostomy	S7F2.2	30000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	M7F	Coarctation Of Aorta Repair / Aortoplasty	M7F2	Baloon dilatation of Coarctation of Aorta Without Stent	M7F2.1	30000	2D ECHO & CT Aortogram or aortogram	Fluroscopy Video/Images Req, Sticker Mandatory For Claim.Claims Approval Subject To Stent/ Balloon Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Cardiology	M7F	Coarctation Of Aorta Repair / Aortoplasty	M7F4	Coarctation Of Aorta Repair With Stent	M7F4.1	100000	2D ECHO & CT Aortogram or aortogram	Fluroscopy Video/Images Req, Sticker Mandatory For Claim.Claims Approval Subject To Stent/ Balloon Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Cardiology	M7T	Cardiology	M7T1	Coil Closure Multiple Coils (MAPCA - Major Aortopulmonary Collaterals)	M7T1.15	40000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	M7T	Cardiology	M7T1	Coil Closure Single Coil (PDA etc)	M7T1.16	30000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	M7T	Cardiology	M7T1	Complex Arrhythmias - 2 Days	M7T1.8	60000	ECG with date & name of patient (preferably printed)	Clinical Notes, Ecg Cartoguided Ablation If Done, Then Procedure Notes Are Mandatory For Claims
Cardiology	M7T	Cardiology	M7T1	Coronary - Cameral Fistula closure / Pulmonary AV fistula Closure /PDA Device Closure	M7T1.17	75000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	M7F	Angioplasty	M7F1	Coronary Balloon Angioplasty	M7F1.1	60000	Coronary Angiography report & Video	Angioplasty Video, Stent Stickers Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Cardiology	M7T	Cardiology	M7T2	Device closure of RSOV (Rupture of Sinus of Valsalva Aneurysm)	M7T2.1	100000	ECG, ECHO,TEE	Fluoroscopy, Vedio and Post procedure ECHO.	-
Cardiology	M7T	Cardiology	M7T1	PDA Stenting	M7T1.18	80000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology	M7F	Cardiology Balloon Procedures	M7F5	Percutaneous Balloon Dilatation procedures in Cardiology	M7F5.1	50000	Procedure with Haemodynamics, ECG, X Ray Chest, 2D Echo	Post procedures 2 D ECHO and Video	-
Cardiology	M7T	Cardiology	M7T1	Percutaneous Transluminal Tricuspid Commissurotomy (PTTC)	M7T1.13	25000	2D ECHO	2D ECHO, fluroscopy video/sketch	-
Cardiology	M7T	Cardiology	M7T1	Pericardial Effusion / Tamponade - 4 days	M7T1.10	25000	2D ECHO	?2D Echo,Lab Investigations Of Pericardial Fluid
Cardiology	M7F	Angioplasty	M7F1	Peripheral Angioplasty	M7F1.6	60000	Angiography	Angioplasty Video, Stent Stickers, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Cardiology	M7T	Cardiology	M7T2	Post MI Ventricular septal Rupture - Device closure	M7T2.2	100000	ECG, ECHO,TEE, Cardiac Enzymes.	Fluoroscopy, Vedio and Post procedure ECHO.	-
Cardiology	M7F	Angioplasty	M7F1	PTCA Additional Stent	M7F1.2	20000	Coronary Angiography report & Video	Angioplasty Video, Stent Stickers Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Cardiology	M7P	Cardiac And Cardiothoracic Surgery	M7PM1	PTSMA (Percutaneous Transluminal Septal Myocardial Ablation)	M7PM1.2	40000	ECG, 2D ECHO, CAG stills showing blocks & reports	Post op. Angiogram report, showing stent & post Stent flow + carton of the stents used approved by FDA/DCGI only	-
Cardiology	M7T	Cardiology	M7T1	Pulmonary artery stenting	M7T1.1	40000	2D ECHO , Angiogram report & stills/ Video	Post procedure Angio stills / Video	-
Cardiology	M7T	Cardiology	M7T1	Pulmonary artery stenting (double)	M7T1.2	65000	Doppler, CT Pul angio/ angio,	Ecg , Clinical Note,Ct Pulm (Submitted During Preauth) post procedure angio video	-
Cardiology	M7T	Cardiology	M7T1	Pulmonary Embolism - 5 Days	M7T1.7	30000	Doppler, CT Pul angio/ angio,	Ecg , Clinical Note,Ct Pulm (Submitted During Preauth)
Cardiology	M7T	Cardiology	M7T1	Refractory Cardiac Failure - 5 Days	M7T1.5	25000	ECG, 2D Echo,Evidence of treatment resulting in refractory cardiac failure,Patient has to be certified by cardiologist/Physician for the same .	Post Treatment Evidence Of Clinical Improvement & 2D Echo, Lab Investigations
Cardiology	M7F	Angioplasty	M7F1	Renal Angioplasty	M7F1.4	60000	Angiography	Angioplasty Video, Stent Stickers Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Cardiology	M7T	Cardiology	M7T1	Right ventricular outflow tract (RVOT) stenting	M7T1.12	40000	2D ECHO , Angiogram report & stills	Post procedure Angio stills	-
Cardiology	M7T	Cardiology	M7T1	Simple Arrhythmias - 2 Days	M7T1.9	50000	ECG with date & name of patient (preferably printed)	Clinical Notes, Ecg Focus Ablation If Done, Then Procedure Notes Are Mandatory For Claims
Cardiology	M7F	Cardiology Pacemaker Implantation	M7F3	Single chamber Permanent Pacemaker Implantation - 5 Days	M7F3.1	75000	ECG with date & name of patient (preferably printed)	Ecg, X-Ray Chest/ Fluoroscopic Image ,Post Procedure Clinical Photo.
Cardiology	M7F	Cardiology Pacemaker Implantation	M7F3	Temporary Pacemaker Implantation - 2 Days	M7F3.2	10000	ECG with date & name of patient (preferably printed)	Post Procedure Clinical Photo, Ecg
Cardiology	M7F	Angioplasty	M7F1	Vertebral Angioplasty	M7F1.5	75000	Angiography	Angioplasty Video, Stent Stickers, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Cardiology	S7F	Cardiology	S7F1	VSD Device Closure	S7F1.4	95000	?2D ECHO	Fluroscopy Video/Images, Ot Notes. Stickers As And Where Applicable	-
Cardiology/Interventional Radiology	S7F	Vascular	S7F9	D V T - IVC Filter	S7F9.5	100000	?COLOR DOPPLER	Post Procedure Angio
Critical Care	M3Q	Critical Care	M3Q1	Acute Bronchitis And Pneumonia With Respiratory Failure, Ventilator 8 Days Stay - Rs 6000 per day. Rs 50000 if completed LOS	M3Q1.3	50000	Chest X-Ray/ HRCT Chest, Machine generated ABG, Clinical photo with ventilatory support	Abg, Lab Investigations, Post Treatment Evidence Of Clinical Improvement
Critical care	M3Q	Critical care	M3Q2	Acute liver failure with Coagulopathy - 5 days	M3Q2.3	40000	PTINR, LFT	PTINR, Evidence of FFP administration	-
Critical Care	M3Q	Critical Care	M3Q1	Acute Severe Asthma With Acute Respiratory Failure 10 Days ICU Stay. Rs 45000 if complete stay of 10 days.	M3Q1.1	45000	Machine generated ABG, Clinical Photo with ventilator support, Chest X-Ray	Abg, Lab Investigations, X-Ray, Post Treatment Evidence Of Clinical Improvement
Critical Care	M3Q	Critical Care	M3Q1	ARDS Plus DIC (Blood & Blood Products) With Ventilatory Care - 14 Days	M3Q1.6	100000	Chest X-Ray, Machine generated ABG, Clinical photo with ventilator support, CBC, DIC profile	Abg, Lab Investigations, Post Treatment Evidence Of Clinical Improvement
Critical Care	M3Q	Critical Care	M3Q1	ARDS With Multi Organ Failure With Ventilatory Care 14 Days Stay	M3Q1.5	100000	Chest X-Ray/ HRCT Chest, Machine generated ABG, Clinical photo, RFT, LFT, CBC, Sr Electrolites For ARDS packages Ventilator with NIV Mask / invasive ventilator should be discretion of treating physician	Abg, Lab Investigations(Cbc, Lft, Rft), Post Treatment Evidence Of Clinical Improvement. Justification From Treating Dr For Standalone Niv Treatment(If Given) In Ards
Critical Care	M3Q	Critical Care	M3Q1	ARDS With Ventilatory Care 10 Days Stay. Rs 65000 if LOS complete.	M3Q1.4	65000	Chest X-Ray/ HRCT Chest, Machine generated ABG, Clinical photo with Ventilatory support, For ARDS packages Ventilator with NIV Mask / invasive ventilator should be discretion of treating physician, CPAP, BiPAP is not accepted	Abg, Lab Investigations, Post Treatment Evidence Of Clinical Improvement
Critical Care	M3Q	Critical Care	M3Q1	COPD Respiratory Failure (Infective Exacerbation) 11 Days Stay with ventilator support. Rs 70000 will be approved if LOS 11 days	M3Q1.2	70000	Chest X-Ray/ HRCT Chest/ Spirometry, Clinical photo, , Machine generated ABG	Abg, Lab Investigations, X-Ray, Post Treatment Evidence Of Clinical Improvement
Critical Care	M3Q	Critical Care	M3Q1	OP or other Poisoning without Ventilatory Assistance Clinical Photo 7 days ICU Stay	M3Q1.9	28000	RFT, Machine generated ABG, Sr cholinesterase, X-ray Chest P/A view	Lab Investigations, Post Treatment Evidence Of Clinical Improvement	-
Critical Care	M3Q	Critical Care	M3Q1	OP Poisoning / Other Poisoning Requiring Ventilatory Assistance Clinical Photo - 5 days Stay	M3Q1.7	30000	Clinical photo on ventilator, RFT, Machine generated ABG, Sr cholinesterase	Abg, Lab Investigations, Post Treatment Evidence Of Clinical Improvement
Critical Care	M3Q	Critical Care	M3Q1	Septic Shock(ICU Management) With Ventilatory Assistance - 7 Days	M3Q1.8	50000	Machine generated ABG, RFT, USG, Urine R/M, Clinical photograph, Xray chest, CBC.Justification from treating Physician for necessity of ventilatory support if SpO2 is >80%, esp. of no evidence of alkalosis/acidosis	Abg, Lab Investigations, Post Treatment Evidence Of Clinical Improvement, Report Of Blood Culture/ Urine Culture . If Blood Culture Report Is Negative Then Other Markers Of Sepsis Like Urine Culture/ Sputum Culture/Csf Analysis/ C3 Marker To Be Given To Confirm The Dignosis Of Septic Shock.
Critical care	M3Q	Critical care	M3Q2	Snake bite with Coagulopathy with Dialysis 7 days	M3Q2.2	40000	RFT, INR, BTCT	Post Treatment Evidence Of Clinical And Lab Investigations	-
Critical care	M3Q	Critical care	M3Q2	Snake bite with Coagulopathy without Dialysis 7 days	M3Q2.1	30000	INR, Platelet count, BTCT	Post Treatment Evidence Of Clinical And Lab Investigations	-
Critical Care	M13	Critical Care	M13U1	Cavernous / Saggital Sinus Thrombosis 10 Days Stay	M13U1.4	40000	MRI, Venogram	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations
Dermatology	M11	Dermatology	M11T5	Hidradenitis suppurativa 5 days stay	M11T5.6	15000	CBC, Skin swab, clinical notes	Clinical Notes, Cbc, Lft, Rft, Skin Biopsy	-
Dermatology	M11	Dermatology	M11T5	Leprosy and recurrent lepra reactions 10 days stay	M11T5.7	10000	CBC, LFT, RFT, clinical notes	Clinical Notes, Cbc, Lft, Rft, Skin Biopsy	-
Dermatology	M11	Dermatology	M11T5	Pemphigus / Pemphigoid Tzanck Clinical Protocol 15 Days Stay	M11T5.3	25000	Tzanck Smear, Serum DSG 1& 3	Clinical Notes, Skin Biopsy
Dermatology	M11	Dermatology	M11T5	Psoriatic erythroderma/ Arthropathy 3 days stay	M11T5.4	20000	CBC, X-ray of joints, clinical notes	Clinical Notes, Skin Biopsy	-
Dermatology	M11	Dermatology	M11T5	Stevens- Johnson Syndrome 5 Days ICU Stay	M11T5.2	20000	Urine R/M, CBC, LFT, RFT, Skin Swab	Clinical Notes, Cbc, Lft, Rft, Skin Biopsy
Dermatology	M11	Dermatology	M11T5	Toxic Epidermal Necrolysis 7 Days ICU Stay. Rs 30000 if LOS 7 days complete	M11T5.1	30000	Urine R/M, CBC, LFT, RFT, Skin Swab	Clinical Notes, Cbc, Lft, Rft, Skin Biopsy
Dermatology	M11	Dermatology	M11T5	Urticaria and Atopic dermatitis 5days stay	M11T5.5	12000	CBC, sr. IgE, clinical notes	Clinical Notes, Cbc, Lft, Rft, Skin Biopsy	-
Endocrinology	M13	Endocrinology	M13U3	Adrenal Insufficiency - (medicines should be given for 6 months duration)(3 day indoor stay)	M13U3.1	15000	Basal Cortisol, Basal ACTH, Serum Sodium, Serum Potassium	Clinical Improvement	-
Endocrinology	M13	Other Endocrinal Disorders	M13U2	Endogenous Cushings Syndrome (minimum three day stay)(Injections/tablets to be given of 6 months duration)	M13U2.2	75000	Cortisol assay after dexamethasone, ACTH assay, DHEAS, MRI pituitary CT Abd, Dexa of Hip spine	?Post Procedure Evidance Of Clinical, Lab Investigations
Endocrinology	M13	Endocrinology	M13U3	Endogenous Hyperthyroidism with or without Graves opthalmopathy (3 day indoor stay)medicines to given for 6 months	M13U3.2	30000	T3, T4, TSH, TC-99 thyroid scan	Clinical Improvement	-
Endocrinology	M13	Endocrinology	M13U3	Gonadotropin releasing hormone excess state, 3 day indoor stay(medicines to be given for 6 months duration)	M13U3.3	72000	LH, FSH, X ray upper limb	Clinical Improvement	-
Endocrinology	M13	Other endocrinal disorders	M13U2	Hypopitutarism (Injections/tablets to be given of 6 months duration) (three day indoor stay)	M13U1.6	150000	T3 T4 TSH, basal cortisol post-ACTH cortisol, GH stimulation test, FSH, LH, Testosterone or Estradiol GH stimulation test 1 yr. needed MRI pic visual field water deprivation test 1 yr. needed	?Post Procedure Evidance Of Clinical, Lab Investigations, Injection Vial With Patient Name On It And Bills Of The Injection Are Mandatory For Claims
Endocrinology	M13	Endocrinology	M13U4	Osteoporosis medicines (denosumab/ PTH) to be given for 6 months duration)(2 day indoor stay)	M13U4.3	30000	DEXA Scan, calcium biochemistry	Photograph of patient given stock of six months injection/tablets	-
Endocrinology	M13	Other Endocrinal Disorders	M13U2	Pituitary - Acromegaly (Injections/tablets to be given of 6 months) (three day indoor stay) - Cost of 6 months Medicines	M13U2.1	120000	Post glucose GH assay, prolactin, t3 t4 TSH, Basal cortisol cost FSH / LH, testosterone / estriol, water deprivation test (if needed)	?Post Procedure Evidance Of Clinical, Lab Investigations
Endocrinology	M13	Endocrinology	M13U3	Prolactin Excess (Prolactinoma) medicines to be given for 6 months duration) (3 day indoor stay)	M13U3.4	38000	LH, FSH, T3, T4, TSH, Testerterone (males), Basal Cortisol, IGF1, MRI pituatory	Clinical Improvement	-
Endocrinology	M13	Endocrinology	M13U3	PTH deficiency/ PTH resistance/ Vit D resistance states/Renal rickets (medicines to be given for 6 months duration)(3 day indoor stay)	M13U3.5	30000	PTH, Calcium, Phosphorus, Albumin, Creatinine, Alkaline phosphatase	Clinical Improvement	-
Endocrinology	M13	Endocrinology	M13U4	Somatostatin expressing neuroendocrine lesions (hyperinsulinemic hypoglycemia, tumor induced osteomalacia, thymic, pancreatic, GI-NET)(medicines to be given for 6 months duration)(3 day indoor stay)	M13U4.2	120000	Somatostatin receptor based nuclear scan (at time of initial diagnosis), CT scan chest or adbdomen (baseline) and hormonal test ( optional)	Photograph of patient given stock of six months injection/tablets	-
Endocrinology	M13	Endocrinology	M13U4	Thyrotoxic crisis - Routine Ward - 1500 ICU (without Ventilator) - 4000 ICU (with Ventilator) - 6000 - 5 Days	M13U4.1	30000	CBC, T3T4TSH	Post Procedure Evidence Of Clinical Improvement	-
Endocrinology	M13	Other Endocrinal Disorders	M13U2	Turner syndrome/ Prader willi syndrome , three Days indoor Stay (Injections/tablets to be given of 6 months duration)	M13U2.3	150000	FSH, LH, testosterone, USG pelvis, karyotyping, T4 TSH, Xray bone age, MRI brain DEXA, 2D echo	?Post Procedure Evidance Of Clinical, Lab Investigations
ENT	S2B	Throat	S2B2	Adenoidectomy	S2B2.6	20000	?X-RAY NASOPHARYNX	?Post Procedure Clinical Photograph, Nasal endoscopy
ENT	S2B	Nose	S2B3	Angiofibroma Nose	S2B3.6	40000	CT PNS, DNE	Clinical Photo (Nasal endoscopy)
ENT	S2P	ENT	S2PM1	Antrostomy - Bilateral	S2PM1.14	15000	X-Ray Paranasal Sinus	Clinical notes	-
ENT	S2P	ENT	S2PM1	Antrostomy - Unilateral	S2PM1.15	10000	X-Ray Paranasal Sinus	Clinical notes	-
ENT	S2P	ENT	S2PM1	Arytenoidectomy	S2PM1.28	17000	Clinical Notes,IDL Photograph	IDL Photograph, Clinical Notes	-
ENT	S2B	Hearing Aid	S2B7	Behind The Ear Analogue Hearing Aid	S2B7.1	2500	machine generated Audiometry	Clinical Photo(10% Of The Cases Will Be Reinvestigated In Government Hospitals For Audiometry After Discharge) PTA with hearing aid
ENT	S2B	Head And Neck	S2B5	Brachial Cyst / Sinus Excision	S2B5.2	20000	?CLINICAL PHOTOGRAPH	?histopath, Post Procedure Clinical Photograph	-
ENT	S2B	Bronchial Injuries	S2B6	Bronchial Injuries Due To Foreign Body Repair Surgery	S2B5.3	40000	Broncoscopy / CT scan	Post Procedure Endoscopic Picture
ENT	S2B	ENT Surgery	S2B4	Bronchoscopic Foreign Body Removal	S2B4.1	20000	?RELEVANT X-RAY	?Post Procedure Clinical (Bronchoscopic) Photograph, Post Op Xray
ENT	S2P	ENT	S2PM1	Choanal atresia	S2PM1.29	25000	Nasal Endoscopy, CTScan/ X-Ray PNS	Post Procedure Nasal Endoscopy, CTScan/ X-Ray PNS	-
ENT	S2B	ENT Surgery	S2B8	Cochlear Implant surgery for Children below 2 Years	S2B8.3	500000	Hearing aid Trial, IA with Stapedial reflex, Brain stem Auditory Evoked respose (BERA), MRI brain with contrast/ CT Scan brain Plain and Cntrast - Preauth will be approved by Committee approved by CEO.	PTA, IA with Stapedial reflex, Implant registration form, Warranty, Invoice, Telemetry reports, Scar Photo	-
ENT	S2B	Head And Neck	S2B5	Cystic Hygroma Excision	S2B5.4	25000	?CLINICAL PHOTOGRAPH	?histopath, Post Procedure Clinical Photograph	-
ENT	S2B	ENT Surgery	S2B4	Drainage of Peritonsillor abscess	S2B4.6	10000	Clinical findings by surgeon	Clinical Notes of 5 days after surgery.	-
ENT	S2B	Nose	S2B3	Endoscopic DCR	S2B3.7	25000	Clinical photo	Clinical Photo
ENT	S2B	Nose	S2B3	Endoscopic Sinus Surgery	S2B3.1	25000	?CT PNS,DNE PHOTO GRAPH	?Endoscopic Photograph/ Sketch
ENT	S2P	ENT	S2PM1	Ethmoidectomy ? External	S2PM1.45	15000	CT ethmoidal sinus	Clinical Photograph and Notes	-
ENT	S2B	Nose	S2B3	Excision Of Benign Tumour Nose	S2B3.5	25000	?CT PNS, DNE	?Post Procedure Clinical (endoscopic) Photograph
ENT	S2P	ENT	S2PM1	Excision of CA cheek/ oral cavity + radial forearm flap	S2PM1.39	35000	Clinical Photograph, Clinical Notes, CT Scan Maxilla and Mandible.	Scar Photo, Clinical Notes	-
ENT	S2B	Head And Neck	S2B5	Excision Of Thyroglossal Cyst Fistula	S2B5.7	20000	?CLINICAL PHOTOGRAPH, USG Neck	?histopath, Post Procedure Clinical Photograph	-
ENT	S2B	Throat	S2B2	Excision Of Tumours In Pharynx	S2B2.4	20000	CT Scan	?histopath,Post Procedure Clinical Photograph
ENT	S2B	ENT Surgery	S2B8	FESS	S2B8.5	20000	Xray /CT	Post Procedure Clinical Photograph	-
ENT	S2P	ENT	S2PM1	Fracture - setting nasal bone	S2PM1.18	10000	X-Ray	Post procedure X-Ray	-
ENT	S2B	ENT Surgery	S2B4	Fracture setting nasal bone with surgical intervention	S2B4.3	15000	X-Ray Skull Lateral view	Post Operative Patient Photograph after 6 weeks	-
ENT	M13	Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies	M13U1	Fungal Sinusitis Pns 10 Days Stay	M13U1.2	40000	CT PNS, Direct microscopy report to confirm Fungal hyphae is mandatory during preauth	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations
ENT	S2B	Head And Neck	S2B5	Hemi/Subtotal/ Total thyroidectomy for Benign Thyroid lesion	S2B5.9	40000	FNAC , T F T , USG Neck , Thyroid Scan(optional)	??histopath, Post Procedure Clinical Photograph	-
ENT	S2B	Head And Neck	S2B5	Hemimandibulectomy	S2B5.8	25000	CT Scan, Clinical phtot	Clinical Photo,?X- Ray, histopath	-
ENT	S2P	ENT	S2PM1	Intra Nasal Ethmoidectomy	S2PM1.41	10000	CT ethmoidal sinus	Clinical Photograph and Notes	-
ENT	S2P	ENT	S2PM1	Intranasal Diathermy	S2PM1.25	5000	Clinical Notes	Clinical Notes	-
ENT	S2B	Ear	S2B1	Labyrinthectomy	S2B1.1	20000	CT Scan Ear microscopic finding and clinical findings	Clinical Photo
ENT	S2B	Throat	S2B2	Laryngo Fissure	S2B2.3	20000	CT scan, Clinical findings	Clinical Photo
ENT	S2P	ENT	S2PM1	Laryngopharyngectomy with Gastric pull-up/ jejunal graft	S2PM1.38	40000	CT Scan of Neck, Thorax and abdomen	Scar Photo, Clinical Notes	-
ENT	S2P	ENT	S2PM1	Laryngophayryngectomy	S2PM1.31	20000	CT Scan of Neck	Scar Photo, Clinical Notes	-
ENT	S2B	Throat	S2B2	Microlaryngeal Surgery	S2B2.1	20000	IDL Findings	Clinical Photo, IDL Findings
ENT	S2B	Nose	S2B3	Modified radical Mastoidectomy / Radical mastoidectomy	S2B3.2	25000	PTA findings & X-ray Mastoid	Post Procedure Clinical Photograph
ENT	S2B	ENT Surgery	S2B4	Myringoplasty	S2B4.4	20000	Ear Microscopy and Pure Tone Audiogram, Ear findings by ENT surgeon	Post Procedure Ear Microscopy and Pure Tone Audiogram performed after 2 months of surgery	-
ENT	S2B	ENT Surgery	S2B8	Myringoplasty with Ossiculoplasty	S2B8.2	17000	PTA, X Ray both mastoids, OTO Endoscopic photos	PTA	-
ENT	S2P	ENT	S2PM1	Myringotomy with Grommet - One ear	S2PM1.7	15000	Ear Microscopy and Pure Tone Audiogram	Post Procedure Ear Microscopy and Pure Tone Audiogram	-
ENT	S2B	ENT Surgery	S2B4	Myringotomy without grommet insertion	S2B4.2	10000	Ear findings by ENT surgeon	Post Procedure Ear Microscopy	-
ENT	S2P	ENT	S2PM1	Nasal polypectomy ? Unilateral single or multiple	S2PM1.43	10000	X-Ray PNS	Clinical Notes, HPR	-
ENT	S2P	ENT	S2PM1	Oro Antral fistula	S2PM1.32	10000	CT Scan/X-Ray PNS, Nasal Endoscopy	Post Procedure CT Scan/X-Ray PNS, Nasal Endoscopy	-
ENT	S2P	ENT	S2PM1	Ossiculoplasty	S2PM1.9	15000	Ear Microscopy and Pure Tone Audiogram	Post Procedure Ear Microscopy and Pure Tone Audiogram	-
ENT	S2P	ENT	S2PM1	Parapharyngeal / Retropharyngeal Abscess ? Drainage	S2PM1.34	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
ENT	S2B	Head And Neck	S2B5	Parathyroidectomy	S2B5.11	30000	?USG	?histopath, Post Procedure Clinical Photograph	-
ENT	S2B	Head And Neck	S2B5	Parotid Duct Repair	S2B5.12	25000	Silography	Post Procedure Evidence Of Silography	-
ENT	S2B	Head And Neck	S2B5	Partial Glossectomy	S2B5.13	20000	?BIOPSY, CLINICAL PHOTOGRAPH	??histopath, Post Procedure Clinical Photograph	-
ENT	S2P	ENT	S2PM1	Pharyngeal diverticulum's ? Excision	S2PM1.30	15000	Clinical Photograph,Clinical Notes	Scar Photo, Clinical Notes	-
ENT	S2B	Throat	S2B2	Phono Surgery For Vocal Cord Paralysis	S2B2.2	25000	IDL examination finding	Clinical Photo, IDL examination finding
ENT	S2P	ENT	S2PM1	Radical fronto ethmo sphenodectomy	S2PM1.22	25000	CT Scan PNS	Clinical Notes, Photograph	-
ENT	S2P	ENT	S2PM1	Ranula excision	S2PM1.37	5000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
ENT	S2B	Head And Neck	S2B5	Removal Of Submandibular Salivary Gland	S2B5.14	12000	?CLINICAL PHOTOGRAPH, FNAC, USG	?histopath, Post Procedure Clinical Photograph	-
ENT	M13	ENT Surgery	M13U1	Rhinocerebral Mucormycosis 10 Days Stay	M13U1.5	40000	CT-Scan, (Brain PNS Chest) when necessary, Direct microscopy report for Fungal hyphae is mandatory during preauth.	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations
ENT	S2P	ENT	S2PM1	Rhinotomy ? Lateral	S2PM1.19	15000	CT Scan PNS	Clinical Notes, Photograph	-
ENT	S2B	ENT Surgery	S2B8	Sailo endoscopy for removal of Salivary gland stone	S2B8.4	30000	USG / X Ray Mandible, Sialogram	Post op Sialogram	-
ENT	S2B	Head And Neck	S2B5	Segmental Mandible Excision	S2B5.15	25000	?X- RAY Mandible	Clinical Photo,?X- Ray Mandible	-
ENT	S2P	ENT	S2PM1	Septoplasty	S2PM1.16	20000	Xray /CT	Post Procedure Clinical Photograph	-
ENT	S2B	ENT Surgery	S2B4	Septo-rhinoplasty	S2B4.5	20000	X-ray- skull AP & lateral clinical findings by surgeon	Clinical Notes, Photograph,Post procedure, X-ray- skull AP & lateral	-
ENT	S2P	ENT	S2PM1	Skull base surgery	S2PM1.12	37000	Clinical notes, CT Scan of Skull base	Post procedure evidance of Surgery, Scar Photo	-
ENT	S2B	Ear	S2B1	Stapedectomy + Veingraft	S2B1.5	18000	CT Temporal Bone, PTA, Impedance audiometry	Clinical Photo With Piston
ENT	S2B	Throat	S2B8	Tonsillectomy	S2B8.1	15000	Evidence of chronic Tonsillitis	Clinical Photo	-
ENT	S2P	ENT	S2PM1	Turbinectomy Partial - Bilateral	S2PM1.20	12000	X-Ray PNS	Clinical Notes	-
ENT	S2P	ENT	S2PM1	Turbinectomy Partial - unilateral	S2PM1.21	10000	X-Ray PNS	Clinical Notes	-
ENT	S2B	Ear	S2B1	Tympanoplasty	S2B1.4	30000	Audiometry, ear findings	Intra Op Photo PTA after 2 months
ENT	S2P	ENT	S2PM1	Tympanotomy	S2PM1.13	10000	Ear Microscopy and Pure Tone Audiogram	Ear Microscopy and Pure Tone Audiogram	-
ENT	S2B	Throat	S2B2	Uvulo-Palato Pharyngoplasty	S2B2.7	25000	Polysomnography, CT/MRI	Clinical Photo
ENT	S2P	ENT	S2PM1	Youngs operation	S2PM1.23	10000	X-Ray PNS Clinical Notes	Clinical Notes	-
ENT	S8G	Congenital Malformations	S8G2	Velo-Pharyngial Incompetence	S8G2.11	15000	Endoscopy, Contrast Study	Post Procedure Photo	-
General Medicine	M16P	General Medicine	M16PM1	Acute inflammatory demyelinating polyneuropathy	M16PM1.1	2000	Nerve Conduction Study(NCS)	Clinical Notes	-
General Medicine	M16P	General Medicine	M16PM1	Acute transverse myelitis	M16PM1.5	4000	MRI Spine, CSF analysis, CBC	Clinical Notes	-
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Cerebral Malaria management with or without Ventilatory support and treatment - 10 Days	M16Q1.5	60000	Test for detection of Malarial Parasite/ Rapid test, CBC, CT brain	Post Treatment Evidence Of Clinical Improvement & Lab Investigations, E/O ARDS
General Medicine	M16P	General Medicine	M16PM1	Cerebral sino-venous thrombosis (any Isolated/Multiple sinovenus thrombosis without involvment of cavernous sinus) Renamed as independent procedure	M16PM1.6	40000	MRI, Venogram	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations	-
General Medicine	M13	Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies	M13U1	Cholecystitis - Abd 10 Days Stay	M13U1.3	25000	USG /CT Abd, LFT	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations
General Medicine	M16P	General Medicine	M16PM1	Hyperosmolar Non-Ketotic coma	M16PM1.4	2000	Blood Sugar, Electrolyte Studies, ABG	Clinical Notes	-
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Metabolic Coma with or without Ventilatory Support per day - 7 days stay - 6000 per day	M16Q1.9	42000	Machine generated ABG, ECG, Blood Urea, Blood sugar, Sr. Creat, Sr. Electrolites, LFT, clinical photo with ventilatory support, CT brain/ MRI brain	Post Treatment Evidence Of Clinical Improvement, Vit B12 Level / Lab Investigations
General Medicine	M16P	General Medicine	M16PM1	Metabolic encephalopathy/encephalitis due to any cause	M16PM1.2	2000	EEG, Lab Investigations	Clinical Notes	-
General Medicine	M16	General Medicine	M16Q1	Rituximab Treatment for Neurological, Rheumatological, Nephrological Haematological and dermatological problems 15 days	M16Q1.2	60000	Concerned specialist opinion along with 1. CSF and Clinical findings for Neurology problems 2. RFT, Renal Biopsy,24 Hour urine protein/ C3C4/ANCA for Nephrolgy problems. 3. ANA/ANA Blot for Rheumatological problems. 4. CBC,PS,Reticulocyte count for Haematological problems. 5. Skin biopsy / Antibodies	Proof of administration of Injections	-
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Scorpion Sting Requiring Ventilator Support per day - 6000 per day - 5 Days	M16Q1.8	30000	Serial ABG, ECG	Post Treatment Evidence Of Clinical Improvement & Rft Investigations
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Sickle cell Crisis presenting with Fever, Joint pains, Tachycardia) per day including PCV administration. General ward 1500 ICU - 4000 ICU with NIV - 5000 ICU with invasive ventilator 6000 - 5 days stay	M16Q1.10	30000	Electrophorosis and other confirmatory test	Clinical Improvement and Lab Investigations	-
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Snake Bite Requiring Ventilator Support - 10 Days stay	M16Q1.7	60000	Serial ABG, ECG, PT/PTTK/ DIC profile RFT	Post Treatment Evidence Of Clinical Improvement & Cpk, Lab Investigations, Serum Cholinesterase, BT CT, RFT
General Medicine	M16	Critical Care Gen Medicine	M16Q1	TB Meningitis or Tuberculoma 10 days - ICU Stay	M16Q1.6	40000	CT Scan-Brain, CSF Analysis, Chest X-Ray	Post Treatment Evidence Of Clinical Improvement & Lab Investigations, Csf
General Medicine	M16	Critical Care Gen Medicine	M16Q1	Thrombocytopenia With Bleeding Diathesis 7 days	M16Q1.1	30000	CBC (platelet count), PT INR, BT, CT, Bone marrow aspiration	?Post Procedure Evidance Of Clinical Imrovement
General Medicine / Cardiology	M7T	Cardiology	M7T1	Thrombolytic Therapy for Acute MI - 5 Days	M7T1.11	30000	Serial ECG with date & name, Cardiac Enzymes	Lab Investigations, Clinical Notes
General Medicine / Cardiology	M16	Cardiology	M16Q1	NSTEMI / Evolved MI - 5 Days stay	M16Q1.3	15000	Serial ECG with date & time name, CPKMB	2D Echo	-
General Medicine / Cardiology	M16	Cardiology	M16Q1	Acute LVF (Known IHD / Valvular Heart Disease. - 5 Days	M16Q1.4	20000	ECG, X Ray chest / HRCT, BNP	2D Echo	-
General Medicine /Endocrinology	M16	Diabetes	M16Q1	Diabetic Ketoacidosis - per day ICU Stay - 10 Days	M16Q1.11	30000	ABG optional, Blood sugar, Urine Ketone	Post Treatment Evidence For Clinical Improvement With Biochemical Parameters, Blood Sugar	-
General Surgery	S1A	General Surgery	S1A15	Anal fissures with or without Sphincterotomy with anal dilatation	S1A15.6	10000	Clinical Notes, sckech	Clinical Notes	-
General Surgery	S1A	Abdomen	S1A5	AppendIcular Perforation	S1A5.2	20000	X-ray Abdomen,?USG, CBC	?Biopsy, Post Procedure Clinical Photograph, Pus C/S	-
General Surgery	S1P	General Surgery	S1PM1	I and D cold Abscess minimum 2 follow up dressing	S1PM1.47	5000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1P	General Surgery	S1PM1	Bakers Cyst ? Excision	S1PM1.5	6000	Clinical Notes	Clinical Notes	-
General Surgery	S1A	General Surgery	S1A15	Benign Retroperitoneal Tumor ? Excision	S1A15.13	20000	CT,FNAC	BIOPSY,CLINICAL PHOTOGRAPH	-
General Surgery	S1P	General Surgery	S1PM1	Benign Soft Tissue Tumor ? Excision	S1PM1.73	10000	CT,FNAC	BIOPSY,CLINICAL PHOTOGRAPH	-
General Surgery	S1A	General Surgery	S1A15	Benign Submandibular Lymph node ? Excision	S1A15.15	5000	?BIOPSY, clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
General Surgery	S1A	General Surgery	S1A15	Benign Submandibular Mass Excision + Reconstruction	S1A15.16	20000	?BIOPSY,X-Ray Chest	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Branchial Fistula	S1PM1.6	13000	Clinical Notes, Clinical Photograph	Clinical Notes, Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Cervial Lymphnodes / Cervical swelling	S1PM1.51	2000	Clinical Photograph, Clinical Notes	HPR, Scar Photo	-
General Surgery	S1A	Head And Neck	S1A1	Cervical Rib Excision	S1A1.2	15000	Color Doppler , X-RAY, CT chest	Post Procedure Evidence Of X-Ray	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Colostomy Closure for Malignant and Non malignant conditions	S1A14.8	20000	?CLINICAL PHOTOGRAPH, Barium Study	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Colostomy for Malignant and Non Malignant conditions	S1A14.7	20000	?USG/ CT, ENDOSCOPY/ Sketch	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Cyst over Scrotum ? Excision	S1PM1.61	2000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1P	General Surgery	S1PM1	Cystic mass ? Excision	S1PM1.52	2000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1A	Gall Bladder	S1A11	Cystogastrostomy / Cystojejunostomy	S1A11.6	40000	?CT/USG, LFT	?Post Procedure Clinical Photograph,Usg Intra Op Photographic E/O Surgery Mandatory For Claim	-
General Surgery	S1P	General Surgery	S1PM1	Debridement of Ulcer-Leprosy And 3 follow up dressing	S1PM1.45	5000	Clinical Photograph	Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Dermoid Cyst ? Excision	S1PM1.1	3000	Clinical Notes, Clinical Photograph	Clinical Notes, Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Drainage of Intra abdominal abscess Fr ex - Psoas Abscess, Pelvic abscess, Appendicular abscess etc with minimum 2 followup dressings	S1A15.20	20000	USG Abdomen	Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Drainage of Ischio Rectal Abscess with minimum 2 followup dressings	S1A15.19	15000	Clinical Notes, Clinical Photograph	Clinical Notes, Clinical Photograph	-
General Surgery	S1A	General Surgery	S1A15	Drainage of liver Abscess	S1A15.1	6000	USG abdomen	Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Drainage of perivertebral abscess	S1A15.11	10000	Clinical Photograph, clinical Notes	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Epidymal Cyst	S1PM1.62	3000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1A	Abdomen Hernia	S1A4	Epigastric Hernia With Mesh	S1A4.2	30000	?CLINICAL PHOTOGRAPH, USG Abdomen	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Hernia	S1A4	Epigastric Hernia Without Mesh	S1A4.1	15000	?CLINICAL PHOTOGRAPH, USG Abdomen	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Evacuation of Scrotal Hematoma	S1PM1.14	5000	Clinical Notes, Clinical Photograph	Clinical Notes, Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Eversion of Hydrocele Sac- unilateral	S1A15.3	5000	Clinical Notes, Clinical Photograph	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision and Skin Graft of Venous or non healing Ulcer Unilateral, multiple	S1PM1.29	12000	Clinical Photograph, clinical notes	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision and Skin Graft of Venous or non healing Ulcer Unilateral,single	S1PM1.28	10000	Clinical Photograph, clinical notes	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision Benign Tumor -Small intestine	S1PM1.15	15000	USG	HPE, Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision Mammary Fistula	S1PM1.18	5000	Clinical Notes, Clinical Photograph	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision Meckel's Diverticulum Isolated	S1PM1.57	10000	USG Abdomen	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Excision of Neurofibroma	S1PM1.23	3000	Clinical Notes, Clinical Photograph	Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Excision of salivary glands	S1A15.22	25000	CLINICAL PHOTOGRAPH,FNAC	BIOPSY,CLINICAL PHOTOGRAPH	-
General Surgery	S1A	General Surgery	S1A15	Excision Pilonidal Sinus	S1A15.2	8000	Clinical Notes	Post operative evidence of surgery	-
General Surgery	S1P	General Surgery	S1PM1	Exicision of Sinus and Curettage	S1PM1.24	5000	Clinical Notes, Clinical Photograph	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Fibroadenoma - unilateral	S1PM1.12	5000	?BIOPSY, Clinical Notes	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Free Grafts - Wolfe Grafts	S1PM1.48	10000	Clinical Photograph	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Ganglion - Excision	S1PM1.53	2000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1P	General Surgery	S1PM1	Gastric Perforation Isolated	S1PM1.60	20000	X-ray Abdomen	Scar Photo	-
General Surgery	S1A	Abdomen Stomach, Duodenum, Jejunum	S1A7	Gastrostomy	S1A7.9	20000	?BIOPSY,USG, ENDOSCOPY/ Sketch	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Stomach, Duodenum, Jejunum	S1A7	Gastrostomy Closure	S1A7.10	20000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Granuloma - Excision	S1PM1.54	2000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1A	General Surgery	S1A15	Haemorroidectomy	S1A15.9	5000	Clinical Notes, sckech	Clinical Notes	-
General Surgery	S1A	General Surgery	S1A15	Haemorroidectomy+ Fistulectomy with or without sphinctor repair	S1A15.4	10000	Clinical Photo, Clinical Notes,sckech	Scar Photo	-
General Surgery	S1A	Abdomen Hernia	S1A4	Hiatus Hernia Repair Abdominal	S1A4.4	35000	?USG ABDOMEN, UGI ENDOSCOPY/ Sketch	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Hydrocele + Orchidectomy / Epidydectomy	S1PM1.7	8000	Clinical Photograph	Clinical Notes, Scar Photo	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Ileostomy	S1A8.7	20000	?CT abd / USG	?Post Procedure Clinical Photograph, Hp Report	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Ileostomy Closure	S1A8.8	20000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Incision and Drainage of large Abscess with minimum 2 followup dressings	S1PM1.3	4000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
General Surgery	S1A	General Surgery	S1A15	Inguinal Hernia Repair	S1A15.7	8000	Clinical Photograph, Clinical Notes	Scar Photo, Laproscopic Video	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Intussusception	S1A8.1	30000	? X-RAY ABD, USG / CT abd	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Abdomen	S1A5	Lap. Appendectomy	S1A5.1	25000	?USG/ X-ray Abdomen	?Biopsy, Video, Clinical Photo	-
General Surgery	S1A	Gall Bladder	S1A11	Lap.Cholecystectomy	S1A11.2	30000	?CT/USG, LFT	?Post Procedure Clinical Photograph,Video,Usg Post Op Hp For Claim	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Left Hemi Colectomy	S1A14.4	30000	Barium / CT , Endoscopy , Biopsy, USG	Post Procedure Evidence Of Clinical Photograph/Biopsy	-
General Surgery	S1A	General Surgery	S1A15	Ligation of Ankle Perforators	S1A15.12	10000	Clinical Photograph, Doppler venous	Scar Photo	-
General Surgery	S1P	General Surgery	S1PM1	Lipoma in lower limb	S1PM1.55	2000	Clinical Photograph, Clinical Notes	Scar Photo, Clinical Notes	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Mal-Rotation & Volvulus Of The Midgut	S1A14.1	35000	?CT, X-RAY ABD	?X- Ray/Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen	S1A12	Mesentric cyst excision	S1A12.1	22000	USG	HPE, Scar photo, Operation notes	-
General Surgery	S1A	Gall Bladder	S1A11	Open Cholecystectomy	S1A11.1	20000	?CT/USG, LFT	?Post Procedure Clinical Photograph,Usg Post Op Hp For Claim	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Operation For Acute Intestinal Obstruction	S1A8.2	30000	?X-RAY ABD, USG / CT abd	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Abdomen Stomach, Duodenum, Jejunum	S1A7	Operation For Bleeding Peptic Ulcer	S1A7.6	40000	?ENDOSCOPY/ Sketch	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Operation For Duodinal / Jejunal / Ileal Perforation	S1A8.3	30000	?X-RAY ABD, USG / CT abd	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Operation For Haemorrhage Of The Small Intestine	S1A8.4	40000	?CT WITH CONTRAST	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Operation For Volvulus Of Large Bowel	S1A14.2	35000	?CT-CONTRAST, X-RAY ABDOMEN	?X- Ray/Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Operation Of The Duplication Of The Intestines	S1A14.3	40000	CT-Contrast/ USG	Post Procedure Evidence Of Clinical Photograph	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Operations For Recurrent Intestinal Obstruction (Noble Plication Other)	S1A8.5	35000	?CT-CONTRAST / USG, Xray	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Abdomen Stomach, Duodenum, Jejunum	S1A7	Partial/Subtotal Gastrectomy For Ulcer	S1A7.7	40000	?ENDOSCOPY/ Biopsy / Barium meal	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Rectum And Anus	S1A9	Pull Through Abdominal Resection	S1A9.1	30000	?CLINICAL PHOTOGRAPH, CT Abdomen + Pelvis	?Post Procedure Clinical Photograph, Rectal Biopsy	-
General Surgery	S1A	Abdomen Stomach, Duodenum, Jejunum	S1A7	Pyloromyotomy	S1A7.8	20000	?ENDOSCOPY / Sketch	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Hernia	S1A4	Rare Hernias (Spigalion,Obuturator,Sciatic)	S1A4.5	20000	?CLINICAL PHOTOGRAPH, USG	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Rectopexy	S1PM1.37	10000	Clinical Photo	Scar Photo	-
General Surgery	S1A	Gall Bladder	S1A11	Repair Of CBD	S1A11.7	25000	?CT/USG, LFT	?T-Tube Cholangiogram, Usg Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Small Intestine	S1A8	Resection & Anastomosis Of Small Intestine	S1A8.6	35000	?CT/ USG, X-RAY ABD	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1P	General Surgery	S1PM1	Resection Anastomosis (Large Intestine)	S1PM1.38	25000	?CT/ USG, X-RAY ABD	?Post Procedure Clinical Photograph, Biopsy	-
General Surgery	S1A	Head And Neck Thyroid Non Malignant	S1A2	Resection Enucleation	S1A2.4	20000	FNAC , T F T , USG/ Thyroid Scan(optional), Biopsy	?Biopsy,Post Procedure Clinical Photograph	-
General Surgery	S1A	General Surgery	S1A15	Rib Resection & Drainage for empyema in adults	S1A15.18	10000	?X- RAY, CBC, Fluid Analysis	?X- Ray Chest	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Right Hemi Colectomy	S1A14.5	30000	Barium / CT , Endoscopy , Biopsy, USG	Post Procedure Evidence Of Clinical Photograph/Biopsy	-
General Surgery	S1A	General Surgery	S1A15	Scrotal Swelling (Multiple) ? Excision	S1A15.10	5000	Clinical Photo	Scar Photo	-
General Surgery	S1A	Breast	S1A3	Simple Mastectomy(NM)	S1A3.1	20000	?MAMMOGRAPHY, FNAC	?Biopsy, Post Procedure Clinical Photograph	-
General Surgery	S1A	Spleen	S1A13	Splenectomy For Hypersplenism	S1A13.1	35000	?CT, USG, PERIPHERAL SMEAR	?Post Procedure Clinical Photograph,Usg, Biopsy	-
General Surgery	S1A	Spleen	S1A13	Splenorenal Anastomosis	S1A13.2	60000	MRI , UGI Endoscopy , USG	Post Procedure Evidence Of Usg, Endoscopy	-
General Surgery	S1A	Genitourinary	S1A16	Suprapubic Cystostomy	S1A16.1	10000	Clinical indications	Operative Notes, Post Procedure Clinical Photograph	-
General Surgery	S1A	General Surgery	S1A6	Surgery of high fistula in ano	S1A6.2	20000	CLINICAL PHOTOGRAPH,FNAC	CLINICAL PHOTOGRAPH with face of patient	-
General Surgery	S1A	General Surgery	S1A6	Surgery of low fistula in ano	S1A6.1	10000	CLINICAL PHOTOGRAPH,FNAC	CLINICAL PHOTOGRAPH with face of patient	-
General Surgery	S1A	General Surgery	S1A15	Surgery on Rectal prolapse	S1A15.8	20000	Clinical Photo	Scar Photo	-
General Surgery	S1A	Abdomen Large Intestine	S1A14	Total Colectomy	S1A14.6	40000	?BARIUM, USG/ CT, ENDOSCOPY/ Sketch	?Post Procedure Clinical Photograph,Biopsy	-
General Surgery	S1A	Abdomen Hernia	S1A4	Umbilical Hernia With Mesh	S1A4.7	25000	?CLINICAL PHOTOGRAPH, USG	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Hernia	S1A4	Umbilical Hernia Without Mesh	S1A4.6	15000	?CLINICAL PHOTOGRAPH, USG	?Post Procedure Clinical Photograph	-
General Surgery	S1P	General Surgery	S1PM1	Umbilical Sinus ? Excision	S1PM1.43	5000	Clinical Notes, Clinical Photograph	Scar Photo	-
General Surgery	S1A	General Surgery	S1A15	Varicose Veins - Radiofrequency Ablation / Excision and Ligation	S1A15.21	10000	Clinical Photograph, Doppler venous	Scar Photo	-
General Surgery	S1A	Abdomen Hernia	S1A4	Ventral And Scar Hernia With Mesh	S1A4.9	30000	?CLINICAL PHOTOGRAPH, USG	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Abdomen Hernia	S1A4	Ventral and Scar Hernia Without Mesh	S1A4.8	20000	?CLINICAL PHOTOGRAPH, USG	?Post Procedure Clinical Photograph	-
General Surgery	S1A	Spleen	S1A13	Warren Shunt	S1A13.3	60000	MRI , UGI Endoscopy , USG	Post Procedure Evidence Of Usg,Endoscopy	-
General Surgery	S1A	abdomen	S1A13	Burst abdomen (Complete Dehiscence) closure	S1A13.4	30000			-
General Surgery	S1	General Surgery	S1PM1	Drainage of intraperitoneal Abscess	S1PM1.39	10000			-
General Surgery / Cardiovascular surgery	S1A	Head And Neck	S1A1	Carotid Body-Tumours Excision	S1A1.8	30000	Clinical Photograph , USG Neck/ Color doppler, MRI	Post Procedure Evidence Of Clinical Photograph, Biopsy	-
Gynaecology And Obstetrics Surgery	S4C	Gynaecology And Obstetrics Surgery	S4C4	Abdominal Hysterectomy	S4C4.1	10000	USG, HPR of D and C if indicated	USG, SCAR PHOTO	-
Gynaecology And Obstetrics Surgery	S4C	Obstetrics	S4C1	Abruptio Placenta With Coagulation Defect - DIC	S4C1.4	20000	?USG / (APTT, S.FIBRINOGEN LEVEL, PT, PLATELET COUNT, HAEMATOCRIT) Coagulation profile, LFT, RFT	?Clinical Photograph Of Retroplacental Clots, Usg
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Bartholins Cyst Incision drainage / Enucleation	S4PM1.13	3000	Clinical Notes	Post op Evidence of Surgery	-
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Cervical Polypectomy	S4PM1.11	3000	Clinical Notes	Post op Evidence of Surgery	-
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Cyst-Labial / Bartholin cyst enucleation	S4PM1.9	3000	Clinical Notes, Clinical Photograph	Post op evidence of Surgery	-
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Cystocele,Rectocele & Perineorraphy	S4C2.4	15000	?USG	?Usg, Sketch
Gynaecology And Obstetrics Surgery	S4C	Obstetrics	S4C1	Eclampsia With Complication Requiring Ventilatory Support	S4C1.3	20000	?ABG, (S.FIBRINOGEN LEVEL, PT, PLATELET COUNT, HAEMATOCRIT, APTT) / Sr. Uric acid , Sr. Creat, Urine albumin , LFT/RFT	?Biochemical Investigations, Post Procedure Clinical Photograph
Gynaecology And Obstetrics Surgery	S4C	Gynaecology And Obstetrics Surgery	S4C3	Hysteroscopic adhesiolysis	S4C3.4	6000	USG	USG	-
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Hysteroscopic myomectomies	S4PM1.5	6000	USG	USG	-
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Hysteroscopic polypectomy	S4PM1.6	3000	Clinical/ Histopathological report	Post.op ultrasound (pelvis)	-
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Adhesolysis (G)	S4C2.16	25000	?USG	Usg , Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Cystectomy	S4C2.10	20000	?USG	Hpe & Video Is Mandatory
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Myomectomy	S4C2.13	25000	?USG	Hpe, Usg,Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Ovarian Drilling	S4C2.12	15000	?USG	Usg , Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Recanalisation	S4C2.14	20000	evidence of blockage, HSG	Usg , Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Laparoscopic Sling Operations	S4C2.15	25000	?USG	Usg , Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	LAVH	S4C2.1	30000	?USG	?Hpe
Gynaecology And Obstetrics Surgery	S4C	Gynaecology And Obstetrics Surgery	S4C3	LLETZ (Large Loop Excision of the transformation zone )	S4C3.2	10000	Clinical/ Histopathological report	Post.op ultrasound (pelvis)	-
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Mc Indo-S Repair For Vaginal Atresia	S4C2.6	30000	?USG	?Usg, Sketch
Gynaecology And Obstetrics Surgery	S4C	Obstetrics	S4C1	Obstetric Hysterectomy /Internal iliac ligation With or without Bladder Repair	S4C1.1	30000	?USG	?Usg, Photograph
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Perineal/ Vesico-vaginal/ Recto-vaginal tear repair	S4C2.22	14500	Clinical Notes	Clinical Improvement	-
Gynaecology And Obstetrics Surgery	S4P	Gynaecology And Obstetrics Surgery	S4PM1	Repair for rectovaginal fistulas / Vsicovaginal fistula	S4PM1.1	20000	Clinical Notes	Intra Operative Photoghraph	-
Gynaecology And Obstetrics Surgery	S4C	Obstetrics	S4C1	Rupture Uterus	S4C1.2	25000	?USG	?Usg, Clinical Photograph/ Hpe
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Slings With Mesh Repair For Prolapse	S4C2.7	40000	?USG	?Usg, Sketch
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Surgical management of ruptured ectopic pregnancy	S4C2.11	20000	?USG	Hpe, Usg,Video Is Mandatory.
Gynaecology And Obstetrics Surgery	S4C	Gynaecology And Obstetrics Surgery	S4C3	Tuboplasty (G)	S4C3.3	10000	USG and HSG	USG	-
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Vaginal Hysterectomy	S4C2.17	15000	USG	Hpe
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Vaginal Hysterectomy With Pelvic Floor Repair	S4C2.2	15000	?USG	?Hpe
Gynaecology And Obstetrics Surgery	S4C	Gynaecology	S4C2	Vault Prolapse Abdominal / Vaginal Repair With or without Mesh	S4C2.9	25000	?USG	?Usg, Intra Op Photo Showing Mesh
Haematology	M18	Haematology	M18Q1	Anaemia treated with Haematinics, Blood Transfusion etc for per day - Rs 2000 per day - Length of stay 2 Days	M18Q1.1	4000	?BONE MARROW EAMINATION SOS, HAEMOGRAM / HB ELECTROPHORESIS	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations (Cbc)	-
Haematology	M18	Haematology	M18Q1	Aplastic Anaemia with ATG+Cyclosporin+Eltrombopeg / Danazol+Cyclosporin+Eltrombopeg - 7 Days	M18Q1.6	400000	CBC+Bone marrow biopsy	Treatment protocol sheet and Clinical notes	-
Haematology	M18	Haematology	M18Q1	Autoimmune hemolytic Anaemia with Rituximab Rs 20000 per week- 4 weeks	M18Q1.13	80000			-
Haematology	M18	Haematology	M18Q1	Haemophilia A treatment with , Recombinant or Plasma derived Factor VIII Day Care procedure	M18Q1.2	25000	?VON WILL BRANDS / FACTOR VIII/ IX ASSAY Coagulation Parameters	?Post Procedure Evidance Of Clinical Imrovement , Case Sheet With Records Of Factor Given	-
Haematology	M18	Haematology	M18Q1	Haemophilia A with VWF deficiency - Treatment with factor VIII with VWF - Day care procedure	M18Q1.8	25000	Coagulation Parameters, VON WILL BRANDS / FACTOR VIII ASSAY	Post Procedure Evidence Of Clinical Improvement, Case Sheet With Records Of Factor Given	-
Haematology	M18	Haematology	M18Q1	Haemophilia with Inhibitors treatment by Factor VII or FEIBA or Emicizumab (Hemlibra) for Haemophilia A with inhibitor - Day Care procedure	M18Q1.5	60000	FACTOR VIII/ IX ASSAY Coagulation Parameters and Inhibitor report	Post Procedure Evidence of Clinical Imrovement. Case Sheet With Records of Factors, injections Given	-
Haematology	M18	Haematology	M18Q1	Hemophilia B with Plasma derived / Recombinant Factor IXDay care	M18Q1.9	40000	Coagulation Parameters, Factor IX ASSAY and Inhibitor Assay	Post Procedure Evidence Of Clinical Improvement, Case Sheet With Records Of Factor Given	-
Haematology	M18	Haematology	M18Q1	Immune Thrombocytopenia per month	M18Q1.7	12000	CBC, Peripheral smear	Treatment protocol sheet and Clinical notes	-
Haematology	M18	Haematology	M18Q1	Immune Thrombocytopenia per month with immunosupressants	M18Q1.10	20000	CBC, Peripheral smear,Treatment protocol sheet and Clinical notes	Post Treatment Clinical Notes & Geotagged photo	-
Haematology	M18	Haematology	M18Q1	Immune Thrombocytopenia per month with Injectable TPO agonist	M18Q1.12	20000	CBC, Peripheral smear,Treatment protocol sheet and Clinical notes	Post Treatment Clinical Notes & Geotagged photo	-
Haematology	M18	Haematology	M18Q1	Immune Thrombocytopenia per month with Oral TPO agonist	M18Q1.11	12000	CBC, Peripheral smear,Treatment protocol sheet and Clinical notes	Post Treatment Clinical Notes & Geotagged photo	-
Haematology	M18	Haematology	M18Q1	Oral Chelation Therapy for Thalassemia or Thalassemia and Sickle cell combination - Day care blood transfusion (PCV or Whole blood) Leucodepleted or NAT tested or Leucodepletion filter.	M18Q1.4	10000	Haemogram, Hb Electrophoresis, Serum Ferritin	Post Treatment Evidence Of Clinical Improvement & Lft, Lab Investigations	-
Haematology	M18	Haematology	M18Q1	Thalassemia trasfusion dependant or Thalassemia and Sickle cell combination requiring parental Chelation therapy - Day care blood transfusion (PCV or Whole blood) Leucodepleted or NAT tested or Leucodepletion filter.	M18Q1.3	20000	HB ELECTROPHORESIS/ HPLC, SERUM FERRITIN(6 monthly)req	Case Sheet With Records Of Chelation Therapy	-
Haematooncology / Medical Oncology	M1K	Febrile Neutropenia Fn High Risk 2	M1K27	1st Line Iv Antibiotics And Other Supportive Therapy ( Third Generation Cephalosporin, Aminoglycoside Etc.,)- 5 days stay	M1K27.1	9000	Clinical notes, CBC, Blood C/s / Urine C/S, CXR/ CT scan,	Usg/Ct/Biopsy/Biochemical Investigations	-
Haematooncology / Medical Oncology	M1K	Febrile Neutropenia Fn High Risk 2	M1K27	2nd Line Iv Antibiotics And Other Supportive Therapy(Carbapenems, Fourth Generation Cephalosporins, Piperacillin, Anti-Fungal . Azoles Etc.,)	M1K27.2	30000	Clinical notes, CBC, Blood C/s / Urine C/S, Biopsy, CXR	Usg/Ct/Biopsy/Biochemical Investigations	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	AEVD Lymphoma and others Adriamycin 25mg/m2 Vinblastine 6mg/m2 Dacarbazine 375 mg/m2 Day 1,15 Etoposide 65mg/m2 Day 1-3, 15-17 Every 28 days for 6 cycles	M19U.1	12800	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Arsenic trioxide ATRA - Daunomycin or Idarubcin Cytarabine - multiagent - vary in each protocol - AML M3/APML/Promyelocytic	M19U.16	93600	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Arsenic trioxide ATRA Daunomycin or Idarubcin Cytarabine - multiagent - vary on protocol - AML M3/APML/Promyelocytic	M19U.17	125800	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	ATO 0.15 mg / kg day 1- 45 or 60 ATRA 45 mg / M2 - day 1-45 or 60 - AML M3/APML/Promyelocytic	M19U.19	105300	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	ATO 0.15 mg / kg day 1- Day 5, day 8-12, day 15- 19, day 22-26 every 56 days for 4 cycles ATRA 45 mg / M2 day 1- Day 14 and Day 29-43 every 56 days for 4 cycles - AML M3/APML/Promyelocytic	M19U.18	68750	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M18	Multiple Myeloma	M18R3	Bortezomib+Lenoladomide+Dexamethasone/Cyclophosphamide+Bortezomib+Dexamethasone	M18R3.44	20000			-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Bosutinib (Per Month)	M19U.34	6000	Planned Chemotherapy regimen and /Biopsy/Histopatholigy report/ / FISH/Cytogenetics/Mlecular for BCR/ABL	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Burkitt Lumphoma and others - Codox - M - IVAC / Acute Lymphoblastic Leukemia - GMALL or BFM or Hyper CVAD	M19U.5	44900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Multiple Myeloma	M19U	Carfinzomib +Pomalidomide+Dexamethasone / Carfinzomib +Thalidomide+Dexamethasone/Carfinzomib +Lenalidomide+Dexamethasone	M19U.31	50000			-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	CLL and other lymphomas- Acalbrutinib - per month	M19U.35	20000	CBC, Peripheral smear, Flow cytometry	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Haematooncology / Medical Oncology	M18	Acute Lymphatic Leukemia	M18R1	Consolidation Chemotherapy / Intensive Chemotherapy upto 4 Cycles - Payable maximum upto for each cycle	M18R1.2	20000			-
Haematooncology / Medical Oncology	M1K	Acute Myeloid Leukemia	M1K20	Consolidation Phase up to 4 Cycles - Payable maximum upto for each cycle	M1K20.2	60000	BM Asp Biopsy	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M1K	NHL	M1K9	Cyclophosphamide Adriamycin Vincristin Prednisolone (CHOP)+Rituximab/Bendamustine+Rituximab/R-CVP/ Chlorambicil+Rituximab/Fludarabine+Rituximab/R-GDP/Ibrutinib/Ibrutinib+rituximab/Acalabrutinib	M1K9.1	30000	Biospy, CT scan/PET Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Cytrabine 100- 200mg/m2/day days 1-7 and Daunorubicin 50mg/m2 days 1, 3 and 5 - AML Induction	M19U.25	136400	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Cytrabine 200mg/m2/day days 1- 10 and Daunorubicin 50 mg/m2 days 1, 3 and 5 Etposide 100mg/m2 days 1-5 - AML	M19U.24	136900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Cytrabine 3 gram/m2 twice a day Days 1, 3 and 5 - AML Consolidation phase	M19U.23	74900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Dasatinib + chemo (to be used only with ALL therapy) To be used with Philadelphia Chromosome/PH Positive ALL	M19U.21	6250	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics Fish t (9:22) /PCR BCR:ABL Copies	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Dasatinib per month	M19U.32	5000	Planned Chemotherapy regimen and /Biopsy/Histopatholigy report/ / FISH/Cytogenetics/Mlecular for BCR/ABL	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	De-Angelis/MTR (methotrexate, dexamethasone, procarbazine, vincristine, intrathecal MTX, CYTARABINE) - NHL /Primary CNS Lymphoma	M19U.30	46800	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	DHAP - NHL and others Dexamethasone 40mg D1-4 Cisplatin 100mg/m2 or Carboplatin AUC-5D1 Cytarabine 2 gm/m2 BD D2 Repeat every 21 days	M19U.15	16300	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Follicular Lymphoma - Fludarabine + Cyclophosphamide Fludarabine 25mg/m2 D1-3 Cyclophosphamide 250 mg/m2 D1-3 every 28 days for 6 cycles	M19U.8	23600	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Follicular Lymphoma/CLL/NHL and others - Rituximab + Fludarabine + Cyclophosphamide Rituximab 375mg/m2 on day 1 Fludarabine 25mg/m2 D1 - 3 Cyclophosphamide 250 mg/m2 D1 - 3 Every 28 days for 6 cycles	M19U.9	53000	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Follicular Lymphoma/Non Hodgkin's Lumphoma/CLL/SLL and others - Lenalidomide + Rituximab Rituximab 375mg/m2 Day 1 Lenlidomide 25 mg D1- 28, for 8 cycles	M19U.6	28200	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	GELOX NHL and others Gemcitabine 1000mg/m2 D1 and D8 Oxaliplatin 130mg/m2 D1 L- asparginase 6000 U/m2 D1-7 Repeat every 21 days	M19U.11	25100	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	ICE - NHL and others Ifosfamide 1.5 mg/m2 D1-3 Carboplatin AUC5 D2 Etoposide 100mg/m2 D1-3 Every 3 weeks	M19U.12	13700	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	ICICLE BFM KLALL MCP:841 - ALL	M19U.20	113100	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Imatinib + chemo ((to be used only with ALL therapy) - To be used with Philadelphia Chromosome/PH Positive ALL	M19U.22	6250	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / CytogeneticsCytogenetics Fish t (9:22) /PCR BCR:ABL Copies	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M18	Haemato Oncology	M18R3	Imatinib(Per month)	M18R3.34	4000			-
Haematooncology / Medical Oncology	M1K	Acute Lymphatic Leukemia	M1K21	Induction 1st And 2 nd Months - Payable maximum upto	M1K21.1	50000	CBC, BM Asp Biopsy, cytochemistry/ Surface markers	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M1K	Acute Myeloid Leukemia	M1K20	Induction Phase - Payable maximum upto	M1K20.1	60000	CBC, BM Asp Biopsy, cytochemistry/ Surface markers	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Inj Crinzalizumab for Sickle cell anemia - per month	M19U.36	20000	CBC,HPLC, Clinical notes mentioning refractory to Cap Hydroxyurea	Post Treatment Clinical Notes ,Geotagged photo	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Langerhans Cell Histiocytosis (Histiocytosis Protocol - Induction)	M19U.3	32900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Langerhans Cell Histiocytosis (Histiocytosis Protocol - Maintenance)	M19U.4	37600	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	LMB 89 - 96 - Induction - COPADAM ( first month) - ALL/NHL and others	M19U.27	55200	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	LMB 89 - 96 - Maintenance - ALL/NHL and others	M19U.28	85600	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	LMB 89 - 96 - Consolidation (second month) - ALL/NHL and others	M19U.26	55400	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Low grade lymphomas /NHL (Low grades) and others - Rituximab Rituximab 375mg/m2 per week for 6 week	M19U.7	20000	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M1K	Acute Lymphatic Leukemia	M1K21	Maintenance Phase - Per month	M1K21.3	3000	CBC	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	MCP - 842 - ALL and others	M19U.29	128400	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M1K	Multiple Myeloma	M1K10	Melphalan+Thalidomide+Prednisone Oral	M1K10.3	5000	Bone marrow, S. Immune electrophoresis, Bence Jones Protiens (urine) Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	MINE - NHL and others Ifosfamide 4 gm/m2 over 3days (D1-3) Mitoxantrone 8mg/m2 Etoposide 65mg/m2 D1- 3 Every 3 weeks	M19U.13	13700	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Multiple Myeloma / Plasma Cytoma Pomalidomide + Dexamethasone Pomalidomide 4 mg daily Day 1-21 Dexamethasone 40mg Day 1, 8, 15, 22 Every 28 days	M19U.2	8900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Nilotinib(Per month)	M19U.33	8000	Planned Chemotherapy regimen and /Biopsy/Histopatholigy report/ / FISH/Cytogenetics/Mlecular for BCR/ABL	Post Treatment Clinical Notes & Chemo Sheets	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	NK/T Cell Lymphoma/NHL and others - SMILE Methotrexate 2gm/m2 D1 Ifosfamide 1500mg/m2 D2-4 Etoposide 100mg/m2 D2-4 L-asparginase 6000U/m2 D8,10,12,14,16,18,20 Dexamethasone 40mg D1-4 every 28 days	M19U.10	25600	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Non Hodgkin's Lymphoma and others -CHOEP Cyclophosphamide 750mg/m2 D1 Vincristine 1.4mg/m2 D1 Adriamycin 50 mg/m2 D1 Etoposide 100mg/m2 D1-3 Prednisolone 100 mg D1-5 Every 21days. Total 6 cycles	M19U.38	6900	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	Primary Myelofibrosis and Other MPN - Ruxolitinib - per month	M19U.37	40000	CBC,PS, Bone marrow aspiration and biopsy, Molecular studies	Clinical notes, Geotagged photo	-
Haematooncology / Medical Oncology	M19	Haematooncology	M19U	PTCL - GDP, NHL and others Gemcitabine 1000mg/m2 D1 and D8 Dexamethasone 40mg D1-4 Cisplatin 75mg/m2 D1 or Cacrboplatin AUC-5 Every 3 weeks	M19U.14	19200	HPE/Bone marrow aspiration / Biopsy/ Immunophenotyping/ flow Cytometry / Cytogenetics	Clinical photographs, Chemo charts	-
Haematooncology / Medical Oncology	M1K	Multiple Myeloma	M1K10	Thalidomide+Dexamethasone(Oral) /Lenalidomide	M1K10.2	3000	Bone marrow, S. Immune electrophoresis, Bence Jones Protiens (urine) Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Haematooncology / Medical Oncology	M1K	Childhood B-Cell Lymphomas	M1K14	Variable Regimen	M1K14.1	20000	Tumour Biospy/Bone marrow aspi / USG/CT/PET-CT & Planned CHEMOTHERAPY REGIMEN (any change in regimen should be informed promptly)	Clinical Photograph, Chemo Charts	-
Haematooncology / Medical Oncology	M1K	Histocytosis	M1K17	Variable Regimen	M1K17.1	10000	Biopsy, CT/Skeletal study Planned CHEMOTHERAPY REGIMEN (any change in regimen should be informed promptly)	Clinical Photograph, Chemo Charts	-
Haematooncology / Medical Oncology	M1K	Multiple Myeloma/ Bone Metastasis	M1K10	Zoledronic Acid/Pamindronic acid Along With any chemotherapy regime	M1K10.4	3000	Bone marrow, S. Immune electrophoresis, Bence Jones Protiens (urine) Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Infectious diseases	M5R	Infectious Diseases	M5R1	Tetanus Severe 21 days	M5R1.1	42000	Clinical Photo of posture, ABG	Clinical Photograph Post Treatment E/O Clinical Improvement,Swab For C/S Mandatory For Claims Settlement
Infectious diseases	M5R	Infectious Diseases	M5R1	Diphtheria Complicated 10 days	M5R1.2	25000	ECG, Clinical photograph, Throat swab for C/S	Lab Investigations
Infectious diseases	M5R	Infectious Diseases	M5R1	Cryptococcal Meningitis 21 days	M5R1.3	42000	Investigation foe cryptococcal antigen/ CSF India ink preparation	Lab Investigations
Interventional Radiology	M15	Interventional Radiology	M15W1	Acute Stroke Thrombolysis With rTPA	M15W1.3	100000	CT/ CT-perfusion/ MRI	Ct, Post Procedure Dsa ?
Interventional Radiology	M15	Interventional Radiology	M15W1	Arterial Chemoinfusion in malignant tumours	M15W1.41	100000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Balloon Retrograde Transvenous Obliteration Of Bleeding Gastric Varices ( BRTO)	M15W1.22	100000	clinical history, endoscopic images of gastric varices, CT	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Biliary Drainage Procedures - External Drainage And Stent Placement - Single Metallic Stent	M15W1.15	100000	CT/MRI/ USG/ERCP req at the time of preauth	?Post Procedure Clinical Photograph, Radiographic Image/Cd ,Stent Sticker At Time Of Claims Mandatory
Interventional Radiology	M15	Interventional Radiology	M15W1	Bronchial Artery Embolization In Hemoptysis Using PVA And Micro Catheter	M15W1.11	60000	Xray/CT chest	?Post Procedure Clinical Photograph, Intra Op Video(Mandatory)
Interventional Radiology	M15	Interventional Radiology	M15W1	Carotid Stenting Single Stent With Protection Device	M15W1.30	150000	?MRI/CT- Angiogram, Pre- Doppler (carotid)	?Post Porocedure Dsa Stent Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Interventional Radiology	M15	Interventional Radiology	M15W1	Catheter directed thrombolysis in acute Mesenteric arterial or venous Ischemia	M15W1.37	100000	Angiogram / CT angio	Post Procedure Clinical Photograph, Radiographic Image/Cd rTPA Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Central Venous Balloon plasty For Central Venous Occlusion ( Brachiocephalic or Subclavian Vein or Sup Vena Cava or Common Iliac Vein ) Single Metallic Stent	M15W1.36	70000	COLOR DOPPLER IS MANDATORY AT TIME OF PREAUTH. DSA/CT venography/MRI	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker At Time Of Claims Mandatory	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Central Venous Stenting For Central Venous Occlusion ( Brachiocephalic or Subclavian Vein or Sup Vena Cava or Common Iliac Vein ) Single Metallic Stent	M15W1.20	125000	COLOR DOPPLER IS MANDATORY AT TIME OF PREAUTH. DSA/CT venography/MRI	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker At Time Of Claims Mandatory
Interventional Radiology	M15	Interventional Radiology	M15W1	Chemo Embolization For Liver Tumors or metastases Using Drug And PVA Or DC Beads	M15W1.24	100000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Chemoport or Implantable lines	M15W1.44	28000	CT or USG images	Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Cortical Venous Sinus Thrombolysis	M15W1.5	100000	CT/ MRI	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Deep Venous Thrombolysis For DVT With IVC Filter	M15W1.6	125000	Color Doppler/ Clinical Photograph	?Post Procedure Clinical Photograph, Doppler/ Venographic Dsa Image
Interventional Radiology	M15	Interventional Radiology	M15W1	Embolization Of AV Malformation Of Brain Per Sitting With Onyx	M15W1.29	150000	CT/MRI MANDATORY AT TIME OF PREAUTH, DSA	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Embolization of AV Malformation Of Peripheral Extremity or Craniofascial or Visceral Per Sitting	M15W1.34	90000	CT scan/ MRI, DSA	?Post Procedure Angiographic Image
Interventional Radiology	M15	Interventional Radiology	M15W1	Embolization Of Caratico-Cavernous Fistula	M15W1.33	150000	CT/MRI MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Embolization Of Postoperative or Post Traumatic Bleeding	M15W1.13	100000	clinical photo	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Embolization Of Pulmonary AV Malformation Post Procedure Evidence Of Clinical Photograph And Radiographic Image	M15W1.27	100000	CT MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Endovascular Intervention For Salvaging Hemodialysis AV Fistula	M15W1.21	120000	COLOR DOPPLER IS MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Endovenous thermal ablation for one limb in Vericose veins	M15W1.47	45000	Color Doppler or Venogram	Fluoroscopic DSA images	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Gastrointestinal Visceral Arterial Embolization In Upper or Lower Gastrointestinal Bleeding With Microcatheter	M15W1.10	100000	USG, CT, Endoscopy	?Post Procedure Clinical Photograph, Intra Op Video (Mandatory)
Interventional Radiology	M15	Interventional Radiology	M15W1	Hepatic Vein Stenting In Budd - Chiari Syndrome Single Stent	M15W1.2	125000	CT/MRI Liver	Angiography,Stent Sticker Req At The Time Of Claims
Interventional Radiology	M15	Interventional Radiology	M15W1	HIFU (High intensity focus ultrasound) or Cryoablation or IRE (Irreversible Eletroporration) for tumor	M15W1.43	150000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Iliac Artery Stenting with stent	M15W1.38	125000	Angiogram / Doppler	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Inferior Vena Cava Filter Placement	M15W1.14	100000	COLOR DOPPLER/ Venogram IS MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Inferior Vena Cava Stenting Single Stent	M15W1.1	125000	USG/ CT scan/ DSA IVC Gram	?Post Procedure Angiographic Image
Interventional Radiology	M15	Interventional Radiology	M15W1	Intra-Arterial Thrombolysis For Acute Ischemic Limbs	M15W1.18	100000	COLOR DOPPLER/PERIPHERAL ANGIOGRAM IS MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Intracranial Arterial And Venous Stenting	M15W1.31	150000	?MRI/CT- Angiogram, DSA	?Post Procedure Dsa
Interventional Radiology	M15	Interventional Radiology	M15W1	Intracranial clot retrieval	M15W1.35	150000	CT/ CT-perfusion/ MRI	Ct, Post Procedure Dsa ?	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Mesenteric Artery Angioplasty & Stenting In Chronic Mesenteric Ischemia - Single Stent	M15W1.9	110000	Angiogram / CT angio	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Interventional Radiology	M15	Interventional Radiology	M15W1	Microwave ablation for tumor	M15W1.42	120000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Nephrostomy Tube And Nephroureteral Stent Placement	M15W1.16	60000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Percutaneous Vertebro Plasty/Cementoplasty (For Each Level) Post Procedure Evidence Of Clinical Photograph And Radiographic Image	M15W1.25	50000	CT/MRI IS MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Peripheral Stent Graft For aorta or Peripheral Aneurysms And AV Fistulae	M15W1.32	150000	CT or Doppler	?Post Procedure Angiography Picture
Interventional Radiology	M15	Interventional Radiology	M15W1	Permanent Tunnelled Catheter Placement As Substitute For AV Fistula In Long Term Dialysis / CAPD	M15W1.19	40000	COLOR DOPPLER MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	PICC line insertion for Chemotherapy or longterm antibiotic infusion	M15W1.45	12000	CT or USG images	Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Preoperative Portal Vein Embolization For Liver Tumors	M15W1.23	100000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Preoperative Prophylactic Tumor Embolization	M15W1.28	100000	CT/MRI/ USG req at the time of preauth	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Prostate artery embolisation in BPH or Haematuria	M15W1.40	100000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Radiofrequency Tumor Ablation Therapy	M15W1.12	120000	USG/CT/ MRI	?Post Procedure CT/MRI Scan, intra operative images showing RF probe
Interventional Radiology	M15	Interventional Radiology	M15W1	Renal Artery Embolization With Multiple Coils And Microcatheter	M15W1.4	100000	?CT-Angiogram/ DSA Angiogram	?Post Procedure Angiograpgic Image
Interventional Radiology	M15	Interventional Radiology	M15W1	Retrieval of foreign body for example IVC Filter or device or IV line	M15W1.48	30000	Radiographic images	Post Procedure Clinical Photograph, Radiographic Image/Cd	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Subclavian Artery Stenting with stent	M15W1.7	125000	Angiogram / Doppler	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.
Interventional Radiology	M15	Interventional Radiology	M15W1	Superficial Femoral Artery Stenting With Stent.	M15W1.39	125000	Angiogram / Doppler	?Post Procedure Clinical Photograph, Radiographic Image/Cd Stent Sticker, Claims Approval Subject To Stent Visiblity And Restoration Of Arterial Lumen In Angioplasty Video.	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Tibial Angioplasty In Critical Limb Ischemia	M15W1.8	60000	Angiogram / Doppler	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	Trans Jugular Intrahepatic Portosystemic Shunt (TIPSS)	M15W1.26	150000	MRI/COLOR DOPPLER MANDATORY AT TIME OF PREAUTH	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Interventional Radiology	M15	Interventional Radiology	M15W1	USG or Fluoroscopy or CT guided percutaneous Neoronolysis for reducing pain in Cancer or Non malignant conditions	M15W1.46	10000	Radiographic or HPE diagnosis	CT or USG images	-
Interventional Radiology	M15	Interventional Radiology	M15W1	Uterine Artery Embolization In Severe Menorrhagia Secondary To PPH or Uterine Fibroids or AVM	M15W1.17	80000	USG/CT IS MANDATORY AT TIME OF PREAUTH.	?Post Procedure Clinical Photograph, Radiographic Image/Cd
Maxillo facial Surgery / Plastic Surgery	S16	Plastic Surgery	S161	Benign tumour of Mandible And Maxilla - Excision with reconstruction	S161.1	50000	CT/MRI/Xray/HPE clinical photograph	Clinical Phoptograph/ Xray, Biopsy Report	-
Maxillo facial Surgery / Plastic Surgery	S12	Plastic Surgery	S12M1	Benign tumour of Mandible And Maxilla - Excision	S12M1.11	40000	CT/MRI/Xray/HPE clinical photograph	Clinical Phoptograph/ Xray, Biopsy Report	-
Maxillofacial Surgery / Poly Trauma	S16	Orthopedic And Facial Trauma Wound Management For Compound Fractures	S162	Facial Bone Fractures (Closed or Compound) - Multiple (Faciomaxillary Injuries)	S162.1	40000	?CLINICAL PHOTOGRAPH, X- RAY	?Post Procedure Clinical Photograph, X- Ray Ot Notes	-
Maxillofacial Surgery / Poly Trauma	S14	Orthopedic And Facial Trauma Wound Management For Compound Fractures	S14O11	Facial Bone Fractures (Closed or Compound) - Single (Faciomaxillary Injuries)	S14O11.5	20000	?CLINICAL PHOTOGRAPH, X- RAY	?Post Procedure Clinical Photograph, X- Ray Ot Notes	-
Medical Gastroenterology	M14	Gastroenterology	M14V1	Achalasia Cardia - 7 Days Stay for POEM ( Peroral Endoscopic Myotomy)	M14V1.3	60000	UGI endoscopy , Barium swallow, manometry	Post Treatment Evidence Of Endoscopic Photograph/ Barium Swallow
Medical Gastroenterology	M14	Gastroenterology	M14V2	Achalasia Cardia Balloon Dilatation - Day Care	M14V2.9	30000	Manometry Report Barium Swallow Report	Post Procedure Video, Gastroscopy Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V1	Acute Pancreatitis (Mild) - 1 Week Stay With Post Treatment Evidence Of - Payable maximum upto	M14V1.9	30000	CT Abdomen/ EUS, Sr AMYLASE, Sr Lipase, LFT, electolytes , RANSON Scoring/ BISAP Scoring, RFT, RBS, Etiology of pancreatitis	Post Treatment Evidence Of Usg. Lab Investigation ( Sr. Amylase/Sr. Lipase ) Wbc Count,Sr. Amylase, Lipase Which Are Repeated At An Interval Of 48 Hours Of Admission,Lft : Esp. Ast,Blood Sugar Level,Rft: Urea & Creatinine Level,Sr Calcium Level,Usg Abdomen /Ct Scan Abdomen,Ranson/Bisap Score At Time Of Admission ,Diet Chart
Medical Gastroenterology	M14	Gastroenterology	M14V1	Acute Pancreatitis (Severe) -2 Weeks Stay - Payable maximum upto	M14V1.10	50000	CT Abdomen/ EUS, Sr AMYLASE, Sr Lipase, LFT, electolytes , RANSON Scoring/ BISAP Scoring, RFT, RBS, Etiology of pancreatitis	Post Treatment Evidence Of Usg. Lab Investigation ( Sr. Amylase/Sr. Lipase ) Wbc Count,Sr. Amylase, Lipase Which Are Repeated At An Interval Of 48 Hours Of Admission,Lft : Esp. Ast,Blood Sugar Level,Rft: Urea & Creatinine Level,Sr Calcium Level,Usg Abdomen /Ct Scan Abdomen, Ranson/Bisap Score At Time Of Admission ,Diet Chart
Medical Gastroenterology	M14	Gastroenterology	M14V1	Management of acute pancreatitis with Acute Pancreatitis With Pseudocyst / Walled off Necrosis 3 Weeks Stay - Payable maximum upto	M14V1.11	150000	?S. AMYLASE, Sr Lipase, EUS/ CT- ABDOMEN, USG, CBC	?Lab Investigations(S. Amylase/ Sr Lipase), Usg
Medical Gastroenterology	M14	Gastroenterology	M14V2	Albumin Therapy for Liver Cirrhosis, Nephrotic or Nephritic Syndrome, Sepsis etc per day - 6000 per day - Length of stay 5 days	M14V2.1	30000	Serum albumin, USG abdomen/24 Hours urine protein/CBC	Evidence of Albumin administration	-
Medical Gastroenterology	M14	Gastroenterology	M14V1	Endoscopic stenting for Benign Biliary Stricture - 3 Days	M14V1.16	50000	MRCP/ ERCP, Per cutaneous Transhepatic Billiary/ Endoscopic Drainage, USG, EUS & LFT	?Endoscopic Image/ Video Radiological
Medical Gastroenterology	M14	Gastroenterology	M14V1	Chronic Pancreatitis With Severe Pain - 7 Days Stay - Payable maximum upto	M14V1.12	20000	CT Scan abdomen/ USG/ EUS / ERCP/ MRCP RBS, Etiology of pancreatitis,LFT,RFT	Post Treatment Lab Investigation Wbc Count,Sr. Amylase, Lipase Which Are Repeated At An Interval Of 48 Hours Of Admission,Lft : Esp. Ast,Blood Sugar Level,Rft: Urea & Creatinine Level,Sr Calcium Level,Usg Abdomen /Ct Scan Abdomen,Apache Score At Time Of Admission & 48 Hrs Post Admission,Diet Chart
Medical Gastroenterology	M14	Gastroenterology	M14V1	Cirrhosis With Hepatic Encephalopathy -11 Days Stay	M14V1.14	30000	USG / ascitic fluid analysis, LFT, Sr Ammonia(optional), PT- INR, UGI Endoscopy(optional) Clinician notes of diagnosis & clinical finiding	Post Procedure Clinical Photograph And Lab Invistigations, (Lft)
Medical Gastroenterology	M14	Gastroenterology	M14V1	Cirrhosis With Hepato Renal Syndrome - 14 days Stay	M14V1.15	40000	Reports of Serum Chemistry USG/CT ABDOMEN IS MANDATORY AT TIME OF PREAUTH	Post Treatment Evidence Of Lab Investigation
Medical Gastroenterology	M14	Gastroenterology	M14V1	Corrosive Oesophageal Injury 7 Days Stay	M14V1.20	20000	clinical history of acid ingestion, (Alkali/corrosive)	Post Treatment Evidence Of Barium Swallow / Ugi Scopy Optional, Mlc
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic bilary drainage in recurrent / refractory benign biliary obstruction - 3 days	M14V2.20	60000	Radiological and Fluoroscopic image	Stent sticker,Endoscopic image	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of Benign Oesphagial Strictures 3 days	M14V2.2	45000	CT Scan, Endoscopy with biopsy at time of preauth	X Ray and Endoscopic picture of stent inserted	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of GI Fistule / Perforation / Leak 10 stays stay	M14V2.3	90000	Endoscopic and Radiological evidence (CT Scan of Fistula / Perfortaion / Leak	Endoscopic picture of closure of fisula / Perforations / Leak	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of Malignant biliary obstruction	M14V2.6	50000	CT / MRCP with biopsy or cytology evidence of malignancy	Endoscopic photo of stent placement	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of Malignant enteral or luminal obstruction	M14V2.7	60000	CT / Endoscopy with biopsy or cytology evidence of malignancy	Endoscopic photo of stent placement	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of Non variceal GI bleeding - 5 Days	M14V2.5	30000	Endoscopic evidence of Non variceal bleeding	Endoscopic photo application of Haemostatic measures	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic Management of Refractory Variceal bleed - 5 days	M14V2.16	50000	Endoscopic images	Stent sticker, Video	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic management of refractoty Non variceal GI bleeding with OTSC Placement- 5 Days	M14V2.19	60000	Endoscopic evidence of Non variceal bleeding	Endoscopic photo application of clip with Sticker	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic resection of Early GI Luminal Malignant/ Premalignant lesions - 5 days	M14V2.17	80000	Endoscopic images	HPR, Video	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Endoscopic Ultrasound guided coiling of Gastric Varices - 3 days	M14V2.18	70000	Endoscopic images	Coil sticker, Video	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	ERCP For CBD /PD Stones - Day Care	M14V2.10	40000	MRCP Report for CBD and USG abdomen for PD stones and Serum Amylase , RFT , LFT Report	Post Procedure Video. Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	ESWL For CBD /PD Stones - Day Care	M14V2.11	40000	MRCP Report,LFT, RFT and Serum Amylase for PD stones and Random Blood Sugar for PD stones.	Post Procedure Video,Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Gastric / Colonic Polypectomy- Day Care	M14V2.12	30000	Gastroscopy / Colonoscopy Report	Procedure Video,Hp Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V1	Gastric Varices / Ectopic varices 3 Days Stay	M14V1.8	15000	?UGI ENDOSCOPY	?Endoscopic Photograph
Medical Gastroenterology	M14	Gastroenterology	M14V1	GAVE (Gastric Antral Vascular Ectasia) - 2 Days Stay	M14V1.7	20000	UGI Endoscopy	Post Treatment Evidence Of Endoscopic Photograph
Medical Gastroenterology	M14	Gastroenterology	M14V2	Glue Insertion For Fundal Varices- Day Care	M14V2.13	20000	Gastroscopy Report	Post Procedure Video,Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Immunomodulatory refractory IBD (Inflammatory Bowel Disease) requiring Biologic Drug Therapy (14 days stay)	M14V2.15	80000	Diagnosis of IBD (Ulcerative Colitis or Crohn's disease) and Physician's notes suggestive of patient having immunomodulatory refractory IBD.	Empty vials of Injection or packets of drugs	-
Medical Gastroenterology	M14	Gastroenterology	M14V1	Obscure GI Bleed - 1 Week Stay	M14V1.13	50000	?CAPSULE ENDOSCOPY/ CT enterography/ Barium Meal Follow Through, ENTEROSCOPY BIOPSY (optional)	?Endoscopic Photograph/ Lab Investigations
Medical Gastroenterology	M14	Gastroenterology	M14V1	Oesophageal Varices, Sclerotherapy- One Day Stay	M14V1.5	5000	?UGI ENDOSCOPY	?Endoscopic Photograph
Medical Gastroenterology	M14	Gastroenterology	M14V1	Oesophageal Varices, Variceal Banding One Day Stay	M14V1.4	15000	UGI endoscopy	Post Treatment Evidence Of Endoscopic Photograph
Medical Gastroenterology	M14	Gastroenterology	M14V2	Percutaneous endoscopic Gastrostomy - Day Care	M14V2.4	10000	Physician's notes stating that atient requires assisted enteral nutrition for more than 4 weeks	Endoscopic photo of PEG tube placement	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Rectal Banding- Day Care	M14V2.14	15000	Colonoscopy Report	Post Procedure Video,Report	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Steroid refarctory acute severe ulcerative colitis 3 weeks stay	M14V2.8	80000	Endoscopic and biopsy proven ulcerative colitis with physician's note suggestive of steroid refractory disease	Clinical resolution of symptoms or progression to surgery	-
Medical Gastroenterology	M14	Gastroenterology	M14V2	Stricturising Crohn's Disease - 7 days	M14V2.21	80000	Clinical and Radiological findings	Empty Vials with batch no	-
Medical Gastroenterology / Surgical Gastroenterology	M14	Gastroenterology	M14V2	Fistulising Crohn's disease - 5 Days	M14V2.22	80000	Endoscopic and bipsy suggestive Crohn's disease with CT or MRI showing fisula	Empty vials of Injections given	-
Medical Oncology/ Haemato Oncology	M1K	Breast	M1K1	5- Flurouracil A-C (FAC)	M1K1.2	5000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Colon Rectum	M1K6	5- Flurouracil-Oxaliplastin Leucovorin (Folfox) - 2 weeks cycle	M1K6.2	10000	Endoscopy/CT Scan, Biopsy Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	5FU + Leucovorin + Irinotecan 5 FU 1200mg/m2 D1 D2 Leucovorin 400mg/m2 D1 Irinotecan 180mg/m2 85 mg/m2 D1 every 14 days	M1K12.1	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1	Medical Oncology	M1A4	5-FU 2 weekly/Capacitabine 3 weekly	M1A4.38	5500			-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	Abiraterone 30 days	M1K33.3	12000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Gestational Trophoblast Ds. Low Risk	M1K31	Actinomycin (Unlisted)	M1K31.2	3000	Biopsy , USG/CT, B HCG Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Lymphoma, Hodgkin'S	M1K8	Adriamycin Bleomycin Vinblastin Dacarbazine (ABVD) 2 weekly	M1K8.1	6000	Biospy, CT scan/PET Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Breast	M1K1	Adriamycin/Cyclophosphamide (Ac) protocol 2 weekly or 3 weekly	M1K1.1	6000	Biopsy/Histopathology report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K34	Bevacizumab 2weekly or 3weekly protocol	M1K34.2	20000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Ovary Germ Cell Tumour	M1K30	Bleomycin-Etoposide-Cisplastin (BEP) / VIP Protocol - 3 weekly	M1K30.1	8000	Biopsy, USG/CT, S.A FP/ B HCG Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Cabozantinib 60 mg od x 1 month every 4 weeks	M1K12.7	17000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Capecitabine + Gemcitabine Gemcitabine 1000mg/m2 D1 D8 D15 Capecitabine 830mg/m2 twice daily D1-D21 every 28 days	M1K12.3	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Capecitabine + Mitomycin C Capecitabine 825mg/m2 PO twice daily till completion of RT Mitomycin 10mg/2 D1	M1K7.7	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1	Medical Oncology	M1A4	CAPOX	M1A4.30	7000			-
Medical Oncology/ Haemato Oncology	M1K	Ovary	M1K29	Carboplastin/ Paclitaxel 3weekly	M1K29.1	10500	Biopsy, USG/CT, Ca 125 Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Unlisted Regimen	M1K22	Chemotherapy -Unlisted Regimen - Payable maximum upto per cycle	M1K22.1	5000	Biopsy/Histopatholigy report, USG/CT Scan	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K24	Cisplastin- 5FU	M1K24.1	5000	Biopsy/Histopathology report	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Small Cell Lung Cancer	M1K3	Cisplastin and Etoposide or Carboplatin and etoposide	M1K3.1	7000	X-Ray/CT Scan,Biopsy/FNAC Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Cisplatin + Adriamycin + Cyclophosphamide Cisplatin 50 mg/m2 D1 Doxorubicin 50 mg/m2 D1 Cyclophosphamide 500 mg/m2 D1 every 21 days	M1K12.5	9000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K13	Cisplatin + Cyclophosphamide + Vincristine Cyclophosphamide 1000mg/m2 (2 days every cycles) Vincristine 1.5mg/m2 (days 1 and 8) Cisplatin 100mg/m2 (1 day per cycle) Cycles given every 3 weekly	M1K13.3	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K5	Cisplatin + Irinotecan Cisplatin 60mg/m2 D1 Irinotecan 60 mg/m2 D1 D8 D15 every 28 days	M1K5.3	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Cisplatin Cisplatin 100mg/m2 every 21 days	M1K12.6	6000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1	Medical Oncology	M1A4	Cisplatin plus Adriamycin/Cisplatin plus Ifosfamide/Ifosmide plus Adriamycin	M1A4.40	20000			-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K16	Cyclophosphamide + Doxorubicin + Etoposide + Vincristine + Dactinomycin Vincristine 1.5 mg/m2 Dactinomycin 45 microgram/kg Adriamyicn 60mg/m2 Cyclophosphamide Etoposide Weekly chemotherapy - varying hybrid regimen	M1K16.5	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Dacarbazine + Cisplatin Dacarbazine 250mg/m2 D1-D5 Cisplatin 75 mg/m2 Every 21 days	M1K7.6	9300	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K26	DCF protocol (Docetaxel + Cisplatin/Carboplatin + 5 Flurouracil) 2 or 3 weekly cycle	M1K26.1	10000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets, Geotagged photo.	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K16	Denosumab Denosumab 120 mg s/c D1, 8, 15 then every 28 days	M1K16.4	22500	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K4	Docetaxel + Cyclophosphamide Docetaxel 75mg/m2 D1 Cyclophosphamide 600 mg/m2 D1 every 21 days	M1K4.4	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Gestational Trophoblast Ds. High Risk	M1K32	Etoposide - Methotrexate - Actinomycin / Cyclophosphamide vincristine (EMA-CO)	M1K32.1	6000	Biopsy , USG/CT, B HCG Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Etoposide + Methotrexate + Dactinomycin + Cisplatin Etoposide 100mg/m2 IV D1 D2 D8 Dactinomycin 0.5 mg IV push D1 D2 Methotrexate 300 mg /m2 D1 Leucovorin 15 mg PO every 12 hrs for 4 doses Cisplatin 75mg/m2 D8 every 2 weeks	M1K7.3	8000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	FLOT protocol (Docetaxel + Oxaliplatin + 5 Flurouracil) 2 weekly cycle	M1K33.6	10000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K26	FOLFIRINOX protocol (5 Flurouracil + Leucovorin + Irinotecan + Oxaliplatin) 2weekly cycle	M1K26.2	8000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K5	Fulvestrant Fulvestrant 500 mg D1 D15 D28 then every 28 days	M1K5.1	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K49	Gemcitabine + cisplatin 21 days or Gemcitabin + Carboplatin 21 days	M1K49.2	10	Biopsy, CT	Chemotherapy drug batch number with bar code	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K34	Gemcitabine + Docetaxel (3 weekly protocol)	M1K34.1	9000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Gemcitabine + Nanopaclitaxel Gemcitabine 1000mg/m2 D1 D8 Albumin bound Paclitaxel 125mg/m2 D1 D8 every 21 days	M1K12.2	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Gemcitabine + Paclitaxel Gemcitabine 1000mg/m2 D1 D8 D15 Paclitaxel 100 mg/m2 D1 D8 D15 every 28 days	M1K7.1	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Breast	M1K1	Hormonal Treatment - Per month (Letrozole/Tamoxifen)	M1K1.7	3000	Biopsy/Histopathology report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	Ibrutinib 30 days	M1K33.4	17000	Biopsy/Histopatholigy report/Flowcytometry, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K5	Lapatinib plus Capecitabine	M1K5.2	19600	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K26	Lenvatinib 30 days	M1K26.3	17000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	LHRH Agonist Leuprolide 22.5 ug every 3 months	M1K12.8	19200	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K5	Lipodox + Carboplatin Lipopdox 30 mg/m2 D1 Carboplatin AUC 5-6 D1 every 28 days	M1K5.4	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K5	Lipodox Lipodox 40 mg/m2 IV every 28 days	M1K5.5	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Urinary Bladder	M1K2	Methotraxate Vinblastin Adriamycin Cyclophosphamide (MVAC)	M1K2.2	6000	USG, Biopsy/Histopathology report Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Evidence Of Clinical Improvements & Lab Investigations	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Methotrexate + Doxorubicin + Cisplatin for Relapsed Osteogenic Sarcoma Cisplatin 120mg/sq.m Doxorubicin 75mg/m2 Methotrexate 8-12 gram/m2 Each cycle for 5 weeks	M1K7.5	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Mitoxantrone + Prednisolone Mitoxantrone 12mg/m2 every 3 weeks Prednsiolone 10 mg daily	M1K12.9	5500	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Oxaliplatin + Gemcitabine Gemcitabine 1000 mg/m2 D1 Oxaliplatin 100 mg/m2 D1 every 14 days	M1K12.4	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K13	PACKER	M1K13.2	8300	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Paclitaxel + Ifosfamide + Cisplatin Paclitaxel 240 mg/m2 D1 Ifosfamide 1500mg/m2 D2-D5 Mesna 300 mg/m2 0h 4h 8h D2-D5 Cisplatin 25mg/m2 D2- D5 every 21 days	M1K7.2	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K26	Paclitaxel + Trastuzumab weekly protocol	M1K26.4	11000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Breast	M1K1	Paclitaxel/Docitaxel two or Three weekly	M1K1.4	9500	Biopsy/Histopathology report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K4	Palbociclib 21 days out of 28 day cycle	M1K4.1	8000	Biopsy, Clinical Photograph	Discharge Photograph	-
Medical Oncology/ Haemato Oncology	M1K	Supportive Care	M1K23	Palliative And Supportive Therapy - Per month (Analgesics, Antibiotices, Nutrional supplements, vitamins etc)	M1K23.1	6000	Biopsy, USG/CT/ Blood test	Post Treatment Clinical Notes & Chemo Sheets	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K4	Pazopanib 30 days cycle	M1K4.2	12000	Biopsy, Clinical Photograph	Discharge Photograph	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K13	Pediatric - Germ Cell Tumor / JEB	M1K13.4	10000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K49	Radioiodine ablation therapy for cancer thyroid	M1K49.1	50000	Iodine scan, Biopsy , USG/CT Neck/thyroid	Chemo Chart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K4	Regorafenib 21 days out of 28 day cycle	M1K4.3	20000	Biopsy, Clinical Photograph	Discharge Photograph	-
Medical Oncology/ Haemato Oncology	M1K	Wilm's Tumour	M1K11	SIOP/NWTS Regimen (Stages I III) - Per month	M1K11.1	7000	Biopsy / USG/CT Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	Sorafenib 30 days	M1K33.2	8000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1	Medical Oncology	M1A4	Temozolamide 28 days cycle	M1A4.37	6000			-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	Temozolomide Plus Capcitabine 28 Cycles or Temozolomide plus Cisplatin 21 cycle)	M1K33.5	9000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K16	Topotecan Topotecan 1.5 mg/m2 D1-D5 every 21 days	M1K16.1	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K33	Trastuzumab 3 weekly protocol	M1K33.1	20000	Biopsy/Histopatholigy report, Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Post Treatment Clinical Notes & Chemo Sheets,Geotagged photo	-
Medical Oncology/ Haemato Oncology	M1K	Neuroblastoma Stage I ? III	M1K15	Variable Regimen Inv - X-Ray/CT Scan - Payable maximum upto/Per month	M1K15.1	9000	Biospy, CT scan/PET, Plan of CHEMOTHERAPY REGIMEN(any change in regimen should be informed promptly)	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1	Medical Oncology	M1A4	VIE (Vincristin, Ifosphamide,Etoposide) Inv - Hematology, Biopsy - Payable maximum upto	M1A4.27	10000			-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K13	Vinblastin Vinblastine 6 mg/m2 every week	M1K13.1	4400	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Rhabdomyosarcoma	M1K18	Vincristin-Actinomycin- Cyclophosphamide (VAC) Based Chemo - Per Cycle	M1K18.1	9000	Biospy, CT/USG/PET-CT Planned CHEMOTHERAPY REGIMEN AT TIME OF PREAUTH	Clinical Photograph, Chemo Charts	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K12	Vincristine + Carboplatin Vincristine 1.5mg/m2 (day 1, 8 and 15 for first 4 cycles and then only day 1 from cycle 5 to 17) Carboplatin 550mg/m2 every 3 weeks (all cycles)	M1K12.10	7700	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K7	Vincristine + Topotecan + Cyclophosphamide + Irinotecan + Temozolamide Vincristine 1.5mg/m2( day 1) Topotecan 1.5mg/m2 (day 1-5) Cyclophosphamide 250mg/m2 (days 1-5) Given every 3 weeks Irinotecan 10-50 mg/sqM days 1-5 and days 8-12 Temozolamide 100m	M1K7.4	20000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K16	Vinorelbine + Carboplatin Vinorelbine 25mg/m2 D1 D8 CarboplatinAUC 5-6 D1 every 21 days	M1K16.2	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Medical Oncology	M1K16	Vinorelbine + Cisplatin Vinorelbine 25mg/m2 D1 D8 Cisplatin 75mg/m2 D1 every 21 days	M1K16.3	15000	HPE and Chemoprotocol	Clinical photo, Chemochart	-
Medical Oncology/ Haemato Oncology	M1K	Urinary Bladder	M1K2	Weekly Cisplastin	M1K2.1	3000	USG, Biopsy/Histopathology report	Post Treatment Clinical Notes & Chemo Sheets	-
Mental Health Packages	M17	Mental Disorders Packages	M17A1	Electro Convulsive Therapy (ECT) per setting	M17A1.4	5000	Clinical assessment, Basic investigations for anaesthesia - CBC, RBS, ECG, chest X-ray, urine culture & microscopy	Clinical assessment	-
Mental Health Packages	M17	Mental Disorders Packages	M17A1	F20-F29 Schizophrenia, schizotypal and delusional disorders - Rs. 2000 per day - Length of stay 10 days	M17A1.1	20000	Clinical assessment/Risk assessment and investigations	Clinical assessment & Report	-
Mental Health Packages	M17	Mental Disorders Packages	M17A1	F30-F39 Mood (affective) disorders - Rs. 2000 per day - Length of stay 10 days	M17A1.2	20000	Clinical assessment/Risk assessment and investigations	Clinical assessment & Report	-
Mental Health Packages	M17	Mental Disorders Packages	M17A1	Pre- Electro Convulsive Therapy - Rs 3000 per sitting (ECT) Transcranial Magnetic Stimulation (TMS)Package. Three sittings. Rs 10000 if three sittings	M17A1.3	10000	Clinical assessment	Clinical assessment	-
Mental Health Packages	M17	Mental Disorders Packages	M17A2	Psychotherapy / Counseling session (Per session)	M17A2.2	0	Psychological testing reports	Clinical assessment and reports	-
Mental Health Packages	M17	Mental Disorders Packages	M17A2	Substance use disorder - 30 days stay - Rs 1000 per day	M17A2.1	30000	Clinical assessment	Report	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	<32 Weeks Preterm Hyaline Membrane Disease Clinical/Culture Positive Sepsis Patent Ductus Arteriosus - Medical Management Mechanical Ventilation per day - Rs 6000 - 15 Days	M6S1.3	90000	2D ECHO, Blood culture /CRP, CBC, ABG, Xray chest, Sr Bilirubin APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg), CRP	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S13	<32 Weeks Preterm Hyaline Membrane Disease Clinical/Culture Positive Sepsis Patent Ductus Arteriosus - Medical Management without Mechanical Ventilation / Bubble CPAP per day - Rs 6000 - 7 Days	M6S13.1	42000	2D ECHO, Blood culture /CRP, CBC, ABG, Xray chest, APGAR Score to be mandate at time of admission	Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg), CRPE/o Surfactant given	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	<32 Weeks Preterm Severe Hyaline Membrane Disease Clinical/ Culture Positive Sepsis Mechanical Ventilation per day - Rs 6000 - 3 Weeks	M6S1.17	126000	ABG, X- RAY CHEST, SERUM BILIRUBIN, CBC, CRP/BLOOD CULTURE APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg), SERUM BILIRUBIN	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	32 To 36 Weeks Preterm Baby Hyaline Membrane Disease Clinical / Culture Positive Sepsis Bubble CPAP per day - Rs 5000 - 2 Weeks	M6S1.11	70000	2D ECHO , Blood culture / CRP, CBC ABG, Sr Bilirubin, Xray chest APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg), 2D Echo	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	32 To 36 Weeks Preterm Hyaline Membrane Disease Clinical/ Culture Positive Sepsis Mechanical Ventilation - Rs 6000 per day - 2 Weeks	M6S1.16	84000	?ABG, X- RAY CHEST, SERUM BILIRUBIN, CBC, CRP/BLOOD CULTURE, Clinical photo wih ventilatory care	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg)	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S13	32 To 36 Weeks Preterm Hyaline Membrane Disease Clinical/ Culture Positive Sepsis without Mechanical Ventilation or CPAP per day - Rs 4000 - 10 Days	M6S13.2	40000	ABG, X- RAY CHEST, SERUM BILIRUBIN, CBC, CRP/BLOOD CULTURE, Clinical photo wih ventilatory care	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg) E/o Surfactant given	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	32-36 Weeks Preterm Hyaline Membrane Disease Clinical Sepsis Patent Ductus Arteriosus - Medical Management Mechanical Ventilation per day - Rs 6000- 14 Days	M6S1.2	84000	ABG, X- RAY CHEST, SERUM BILIRUBIN, CRP, CBC, APGAR Score (mandatory)	?Post Procedure Evidance Of Clinical Imrovement , Xray Chest, / ABG	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	33 To 34 Weeks Preterm Mild Hyaline Membrane Disease Culture Positive Sepsis ? Nonventilated Hyperbilirubinemia - Rs 4000 per day 14 days	M6S1.14	56000	?CBC, CRP/ BLOOD CULTURE, X- RAY CHEST, SERUM BILIRUBIN APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Sr Bilirubin), CRP	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	33 To 34 Weeks Preterm Severe Hyaline Membrane Disease Clinical/Culture Positive Sepsis Patent Ductus Arteriosus- Medical Management Mechanical Ventilation Hyperbilirubinemia 15 days	M6S1.18	90000	2D ECHO , blood culture/ CRP,CBC, ABG, X-Ray chest, Serum bilirubin APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Xray Chest /Abg), 2D Echo	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	35 To 36 Weeks Preterm Hyaline Membrane Disease Culture Positive Sepsis Nonventilated Hyperbilirubinemia 10 days	M6S1.13	35000	?BLOOD CULTURE/ CRP/ CBC, X- RAY CHEST, SERUM BILIRUBIN APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Cbc, Sr Bilirubin)	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics CVTS	M6S11	Acquired Heart Disease With Congestive Cardiac Failure- 7 Days Stay	M6S11.3	15000	X-Ray, 2D Echo, ECG	Post Treatment Evidence Of X-Ray Chest, 2D Echo, Ecg	-
Neonatal and Pediatric Medical Management	M6S	Gen Pediatrics Respiratory	M6S10	Acute Broncho/ Lobarpneumonia With Empyema/ Pleural Effusion per day - Rs 4000 per day - 10 Days	M6S10.1	40000	?X- RAY, CBC, Fluid Analysis	?X- Ray Chest, CBC, CRP	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics CVTS	M6S11	Acute Broncho/ Lobarpneumonia With Pyo Pneumothorax 14 Days	M6S11.1	20000	?BLOOD CULTURE/ CBC/CRP, X- RAY, PUS CULTURE/ Gram stain	?X- Ray Chest, CBC, CRP	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care GIT	M6S5	Acute Gastro Intestinal Bleed Inv - ABG/Upper GI Endoscopy, USG Abdomen PICU Stay With Post Treatment Evidence For Clinical Improvement With Lab Investigations per day - Rs 4000 per day - 7 Days	M6S5.1	30000	Upper GI Endoscopy	Post Treatment Evidence For Clinical Improvement With Lab Investigations,	-
Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Acute glomerulonephritis - 2000 per day - 5 days	M6PM1.4	2000	USG/CT and KFT, Urine Analysis	Clinical Notes	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care GIT	M6S5	Acute Hepatitis With Hepatic Encephalopathy ? Rs 4000 per day - 14 Days	M6S5.3	56000	?LFT, S. AMMONIA, HEPATIC VIRAL STUDIES (HEPATITIS B, HEPATITIS C), (HEPATITIS A optional),ABG, BLOOD SUGAR LEVELS, USG req	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations ( Lft, Sr. Ammonia)	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care GIT	M6S5	Acute Pancreatitis - Rs 4000 per day PICU Stay - 12 Days. Rs 50000 for complete LOS of 12 days	M6S5.2	50000	SERUM AMYLASE, LIPASE, USG/CT SCAN ABDOMEN	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations( Sr. Amylase, Sr Lipase)	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	Acute Severe Asthma with CPAP or high flow canula per day - Rs 4000 - 10 Days	M6S2.5	40000	Clinical photo with ventilatory support SERIAL ABG, X-RAY CHEST	?X-Ray, Abg	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	ARDS Plus DIC (Blood & Blood Products) per day with invasive ventilator or BIPAP - Rs 6000 - 14 days stay	M6S2.9	85000	?ABG optional, X- RAY CHEST, COAGULATION PROFILE	Xray Chest, Lab Investigations( Coagulation Profile Optional) Blood Culture At Claim	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	ARDS With Multi- Organ Failure per day with invasive ventilator or BIPAP - Rs 6000 per day -15 Days	M6S2.8	90000	?ABG, X- RAY CHEST, RFT ,LFT, CLINICAL PHOTOGRAPH	Abg, Lab Investigations (Lft, Rft), Xray Chest Blood Culture At Claim	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Cardiovascular	M6S3	Cardiogenic Shock or severe myocarditis per day PICU stay - Rs 5000 - 10 Days	M6S3.4	50000	? X-RAY CHEST, ECHO /CVP Monitoring	?Post Procedure Evidance Of Clinical Imrovement Photo And X-Ray	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Infections	M6S14	Cerebral Malaria (Falciparum) 7 Days Stay	M6S14.5	10000	Test for P. Falciparum PARASITE , CSF ANALYSIS, Blood sugar	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	pediatrics endocrine	M6S17	Congenital adrenal hyperplasia with failure to thrive - 10 Days	M6S17.3	15000	cbc,ABG,serum eletrolytes,usg abdomen,17 hydroxy progestrone,sr.cortisole level,sr.testostrone,karyotyping.	post procedure evidance of hydrocortisone tretment and fludrocortisone.	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics CVTS	M6S11	Congenital Heart Disease With Congestive Cardiac Failure - 7 Days	M6S11.2	15000	?2D ECHO, X- RAY chest, ECG, CBC req at time of preauth	Post Procedure Evidence Of Post Procedure Evidance Of Clinical Imrovement ?2D Echo, X- Ray Chest	-
Neonatal and Pediatric Medical Management	M6S	Pediatric Cardiovascular	M6S3	Congenital Heart Disease With Infection (Non Ventilated) ICU Stay 7 days	M6S3.2	30000	?CBC / CRP , 2 D ECHO, X-RAY CHEST	?Post Procedure Evidance Of Clinical Imrovement And X-Ray	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Cardiovascular	M6S3	Congenital Heart Disease With Infection And Cardiogenic Shock (Ventilated) per day - Rs 6000 - 10 Days	M6S3.3	60000	?X- RAY CHEST, SERIAL ABG, 2DECHO, clinical photo with ventilatory support	?Post Procedure Evidance Of Clinical Imrovement Photo And Abg, X-Ray	-
Neonatal and Pediatric Medical Management	M6S	Neonatal endocrine	M6S17	congenital hypothyroidism for new born - 10 Days	M6S17.1	20000	free T3,freeT4,THS,usg neck,MRI Brain	clinical notes with levothyroxin given	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Endocrine	M6S7	Diabetic Ketoacidosis - per day PICU Stay - 7 Days	M6S7.1	30000	ABG optional, Blood sugar, Urine Ketone	Post Treatment Evidence For Clinical Improvement With Biochemical Parameters, Blood Sugar	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Neurology	M6S15	Encephalitis / Encephalopathy - per Day Stay - Rs 1500 - 14 Days	M6S15.3	21000	?CSF Analysis, CT-brain/ MRI	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S4	Febrile Seizures (Atypical- Mechanical Ventilated) per day - Rs 6000 - 7 Days	M6S4.4	42000	?CSF ANALYSIS, SERIAL ABG,	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations, Eeg/ Ct Scan	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6PM	Idiopathic Thrombocytopenic Purpura per day - Rs 4000 per day ICU stay - 7 Days. (IVIG and other Injections). Cost up to Rs 80000	M6PM1.1	80000	CBC with P.S/ Bone Marrow	CBC with P.S	-
Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Immune haemolytic anemia per day	M6PM1.7	2000	CBC, Reticulocytes Count, PS, Coomb's Test	CBC, PS, Clinical Notes	-
Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Infantile cholestasis - per day	M6PM1.5	2000	LFT, USG Abdomen, Urine BS - BP	LFT	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Cardiovascular	M6S3	Infective Endocarditis per day - Rs 4000 - 15 Days	M6S3.5	60000	CBC, CRP/?BLOOD CULTURES X- RAY CHEST, ECHO	?Post Procedure Evidance Of Clinical Imrovement Photo And Blood Culture	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S16	Intra Cranial Bleed with ventilator per day - Rs 4000 - 14 Days	M6S16.1	56000	?CT- SCAN/ MRI	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S4	Intra Cranial Bleed without ventilator per day - Rs 4000 - 10 Days	M6S4.5	40000	?CT- SCAN/ MRI	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations	-
Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Juvenile myasthenia gravis - per day	M6PM1.2	2000	?CT-Abdomen,Thyroid profile,Neostgmine test,RNS,CT-Chest	?Clinical and lab investigation	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S4	Meningo- Encephalitis (Ventilated) per day - Rs 6000 - 15 Days	M6S4.2	90000	?SERIAL ABG, CT- SCAN, CSF ANALYSIS, Clinical photo with ventilatory support	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations ( Csf Analysis)	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S4	Meningo-Encephalitis (Non Ventilated) - Rs 4000 - 14 Days	M6S4.1	56000	?CSF ANALYSIS, CT- SCAN	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations ( Csf Analysis)	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Necrotising Enterocolitis, Clinical Sepsis Non Ventilated per day - Rs 4000 - 14 Days	M6S1.9	56000	CBC, CRP/Blood culture, Xray Abdomen ultrasound optional stool exam and usg mandatory for pre auth	Post Treatment Evidence Of Clinical Improvement , Xray Abdomen, Cbc, Crp	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Infections	M6S14	Neuro Tuberculosis- 10 Days Stay - DOTS Rx Free without ventilator - Rs 1500 per day	M6S14.2	15000	?CT- SCAN BRAIN, CSF ANALYSIS, X- RAY CHEST	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Infections	M6S14	Neuro Tuberculosis With Ventilation- per day Stay - DOTS Rx Free - Rs 6000 - 10 Days	M6S14.3	60000	?CT- SCAN BRAIN, CSF ANALYSIS, X- RAY CHEST, ABG	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Toxicology	M6S9	Poison Ingestion/ Aspiration Requiring Ventilatory Assistance per day PICU Stay - Rs 6000 - 10 Days	M6S9.3	60000	Serial ABG, CVP monitoring(optional)	Post Treatment Evidence For Clinical Improvement With Biochemical Parameters, Mlc	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Pre term - Necrotising Enterocolitis, Clinical Sepsis Ventilated - Rs 6000 - 14 Days	M6S1.19	84000	CBC, Sr Bilirubin/ Reticulocyte Count/USG abdomen/ Blood Culture & Sensitivity	CBC, Sr Bilirubin/ Blood Culture & Sensitivity	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Infections	M6S14	Pyogenic Meningitis per Day ICU Stay - 10 Days Rs 4000 per day	M6S14.1	40000	X- RAY CHEST, CSF ANALYSIS	Post Procedure Evidance Of Clinical Imrovement And Csf Analysis	-
Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Refractory seizures - Rs 2000 per day	M6PM1.10	2000	?CSF ANALYSIS, SERIAL ABG,	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations, Eeg/ Ct Scan	-
Neonatal and Pediatric Medical Management	M6S	Pediatrics	M6S16	Rickettsial fever 7 days stay	M6S16.2	20000	Weil felix test positive	Clinical improvement , regression of fever and rash	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Infection	M6S8	Septic Shock- per Day PICU ventilated - Rs 6000 - 10 Days	M6S8.1	40000	CBC,CRP , X- RAY CHEST, ABG, BLOOD SUGAR LEVELS MANDATORY	Post Procedure Evidance Of Clinical Imrovement With Lab Investigations(Cbc, Crp),Blood Culture .	-
Neonatal and Pediatric Medical Management	M6S	Pediatric Respiratory	M6S2	Severe Aspiration Pneumonia (Non Ventilated) ICU Stay per day - Rs 4000 - 7 Days	M6S2.6	28000	? X-RAY CHEST	?Post Procedure Evidance Of Clinical Imrovement And Xray, Lab Investigations	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	Severe Aspiration Pneumonia (Ventilated) per day - Rs 6000 - 10 Days	M6S2.7	60000	Clinical photo with ventilatory support SERIAL ABG, X-RAY CHEST	?Post Procedure Evidance Of Clinical Imrovement And Xray Chest, Abg	-
Neonatal and Pediatric Medical Management	M6S	Pediatric Respiratory	M6S2	Severe Bronchiolitis (Non Ventilated) per day High Flow Nasal Canula - Rs 4000 - 7 Days	M6S2.2	28000	?X- RAY CHES, ABG, CLINICAL PHOTOGRAPH	? X-Ray, Abg	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	Severe Bronchiolitis (Ventilated) per day - Rs 6000 - 10 Days	M6S2.1	60000	?X- RAY CHEST, CLINICAL PHOTOGRAPH	? X-Ray	-
Neonatal and Pediatric Medical Management	M6S	Pediatric Respiratory	M6S2	Severe Bronchopneumonia (Non Ventilated) per day - Rs 4000 - 7 Days	M6S2.3	28000	X-Ray Chest re at the time of preauth	?X-Ray	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Respiratory	M6S2	Severe Bronchopneumonia (Ventilated) per day - Rs 6000 - Length of stay 10 days	M6S2.4	60000	Clinical photo with ventilatory support SERIAL ABG, X-RAY CHEST	?X-Ray, Abg	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Cardiovascular	M6S3	Severe Myocarditis - 10 Days	M6S3.1	40000	?ECG, 2 D Echo, Xray chest	?Post Procedure Evidance Of Clinical Imrovement And X-Ray	-
Neonatal and Pediatric Medical Management	M6S	pediatrics endocrine	M6S17	short stature with growth hormone deficiency - 14 Days	M6S17.2	40000	MRI/CT brain,X-ray Skull,growth hormone levels,IGF-1,IGF1 binding protine level-3.clinical photo,karyotyping.	post procedure evidance of inj growth hormone given with sticker,thyroid level,bone age x-ray,HBA1C,	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care Toxicology	M6S9	Snake Bite Requiring Ventilatory Assistance With 10 Days PICU Stay	M6S9.1	50000	Serial ABG, coagulation profile(optional)	Picu Stay With Post Treatment Evidence For Clinical Improvement With Biochemical Parameters, Abg	-
Neonatal and Pediatric Medical Management	M6S	Pediatric ICU Care CNS	M6S4	Status Epilepticus per day PICU stay - Rs 4000 - 7 Days. Rs 30000 if complete 7 days stay	M6S4.3	30000	Clinical Notes,? EEG optional	?Post Procedure Evidance Of Clinical Imrovement With Lab Investigations, Eeg/ Ct Scan	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Renal	M6S12	Steroid Resistant Nephrotic Syndrome Complicated - per day - Rs 2500 - 14 Days	M6S12.1	35000	?URINE EXAM, RENAL BIOPSY SOS RFT'S MANDATORY AT THE TIME OF PREAUTH.	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations( Urine Albumin, Hpe If Biopsy Done)	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Neurology	M6S15	Stroke Syndrome-per day - Rs 2000 - 10 Days	M6S15.2	20000	CT	Post Treatment Evidence Of Clinical And Lab Investigation	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Infections	M6S14	Suspected Dengue Shock Syndrome With Thrombocytopenia - 7 Days	M6S14.4	20000	?CBC (PLATELET COUNT) / Dengue SEROLOGY	Evidence Of Platelet Transfusion If Given, Cbc	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S13	Term baby hyperbilirubinemia non septic more than 15 mg% per day - Rs 1500 - 5 Days	M6S13.3	7500	Serum Bilirubin, CBC,	Serum bilirubin	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S13	Term baby Meconium Aspiration Syndrome bubble CPAP/ Mechanical Ventilation - Rs 6000 - 10 Days	M6S13.4	60000	CBC, APGAR, CXR Photo with CPAP /ventilator	Clinical improvement , CBC, blood culture	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Term Baby Severe Hyperbilirubinemia Clinical or Culture positive Sepsis per day - Rs 4000 - 7 Days	M6S1.7	28000	? CBC / CRP, SERUM BILIRUBIN APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations,( Cbc Sr Bilirubin) Blood Culture Report Is Mandatory At Time Of Claims	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Term Baby With Persistent Pulmonary Hypertension Ventilation- HFO Clinical Sepsis - Rs 6000 per day - 14 Days	M6S1.4	84000	Xray chest, ABG, Sr. Bilirubin, 2decho APGAR Score to be mandate at time of admission	Post Treatment Evidence Of Clinical Improvement And Lab Investigations, Xray Chest, Abg, Sr. Bilirubin	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Term Baby With Severe Perinatal Asphyxia - Non Ventilated Clinical Sepsis Hyperbilirubinemia 7 days - Rs 4000 per day	M6S1.5	28000	CBC, CRP/ BLOOD CULTURE, Sr Bilirubin APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations, Neurosonogram/Ct- Scan/ Mri	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Term Baby With Severe Perinatal Asphyxia - Ventilated Clinical Sepsis per day - Rs 6000 - 10 Days	M6S1.6	60000	?CBC, CRP/ BLOOD CULTURE, , ABG ,X- RAY CHEST, Sr Bilirubin APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations, Neurosonogram/Ct- Scan/ Mri	-
Neonatal and Pediatric Medical Management	M6S	Neonatal	M6S1	Term Baby, Fulminant Culture Positive Sepsis, Septic Shock, Ventilated, Rs 6000 per day - 14 Days	M6S1.10	84000	?BLOOD CULTURE / CBC, CRP, RFT, SERUM BILIRUBIN, ABG APGAR Score to be mandate at time of admission	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations (Blood Culture/Crp/Cbc/Rft) Usg Abdomen Is Required In Claims Which Was There Previously	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics Renal	M6S12	Urinary Tract Infection With Complications Like Pyelonephritis And Renal Failure - 10 Days Stay	M6S12.2	15000	Urine R/M / URINE FOR CULTURE AND SENSITIVITY/ USG, BUN, Sr. Creat	?Post Procedure Evidance Of Clinical Imrovement And Urine Culture/ Uriner/M / Usg	-
Neonatal and Pediatric Medical Management	M6S	General Pediatrics CVTS	M6S11	Viral Myocarditis 7 Days Stay	M6S11.4	15000	?2D ECHO, X- RAY, ECG	?2D Echo, X- Ray Chest, Ecg	-
Neonatal and Pediatric Medical Management	M5	Neonatal	M5E7	Term Baby With clinical/ Culture Positive Sepsis- Non Ventilated per day - Rs 4000 - 7 Days	M5E7.1	28000			-
Neonatal and Pediatric Medical Management	M5	Neonatal	M5E7	Term Baby With Seizures per day - Rs 2500 - 21 Days	M5E7.19	52500			-
Neonatal and Pediatric Medical Management / Nephrology	M6S	Pediatric ICU Care Renal	M6S6	Acute Renal Failure With Dialysis Haemodialysis or Peritoneal Dialysis - Rs 4000 per Day PICU Stay - 14 Days	M6S6.1	56000	RFT, ?SERUM ELECTROLYTES, XRAY CHEST, USG MANDATORY	Post Procedure Evidance Of Clinical Imrovement And Lab Investigations (Rft)	-
Neonatal and Pediatric Medical Management / Nephrology	M6S	General Pediatrics Renal	M6S12	Acute Renal Failure without dialysis Rs 1500 per day - Length of stay 10 days	M6S12.3	15000	RFT, ELECTROLYTES req at time of preauth	?Post Procedure Evidance Of Clinical Imrovement And Lab Investigations (Rft)	-
Nephrology	M8S	Nephrology	M8S1	A V Fistula At Elbow or Wrist - Day Care	M8S1.1	20000	?COLOR DOPPLER	?Clinical Photo/Color Doppler
Nephrology	M8T	Nephrology	M8T2	Acute Renal Failure-(ARF) -10 Days Stay in ICU or General ward	M8T2.2	40000	RFT, S. Protein, USG Abdomen, Sr. Electrolytes	Post Treatment Evidence Of Clinical Improvements & Lab Investigations
Nephrology	M8S	Nephrology	M8S1	CAPD (Contineous Ambulatory Peritoneal Dialysis) One preauth of 30 days	M8S1.4	35000	Recommendation by treating Nephrologist with justification, CBC,RFT	Clinical photograph,CBC,RFT	-
Nephrology	M8T	Nephrology	M8T2	Chronic Renal Failure (CRF) - 10 Days Stay for Initial treatment and Dialysis and supportive therapy	M8T2.5	20000	RFT, S. Protein, Sr. Electrolites, USG Abdomen	Post Treatment Evidence Of Clinical Improvements & Lab Investigations
Nephrology	M8T	Nephrology	M8T2	Maintenance Haemodialysis For CRF- Dialysis and supportive therapy (12 dialysis per 28 days or as per advice of Nephrologist)- Package includes per dialysis cost including return fare, which includes administartion of ESA and iron. One Preauth of 42	M8T2.6	23400	RFT , S. Protein, USG Abdomen, ( At the time of first preauthorisation)	Post Treatment Evidence Of Clinical Improvements & Sr. Creatinine Photo Of Each Dialysis Sessions Mandatory For Claim
Nephrology	M8T	Nephrology	M8T2	Nephrotic Syndrome - 4 Days Stay (Except Diabetic Nephropathy)	M8T2.3	20000	RFT, S. Protein, USG Abdomen, Sr. Electrolytes	Post Treatment Evidence Of Clinical Improvements & Lab Investigations, Renal Biopsy
Nephrology	M8S	Nephrology	M8S1	Plasmapheresis - 7 Days	M8S1.3	40000	CBC,RFT,Urine Routine exam, Total proteins and Clinical notes	Clinical improvement, RFT,CBC	-
Nephrology	M8T	Nephrology	M8T2	Post-Transplant Immunosuppression Treatment After Transplantation for first 6 months of a year.To be continued as per advice of Nephrologist for further period	M8T2.1	50000	?RFT,USG	?Bills Copy	-
Nephrology	M8T	Nephrology	M8T2	Post-Transplant Immunosuppression Treatment After Transplantation for second 6 months of a year.To be continued as per advice of Nephrologist for further period	M8T2.7	50000	?RFT,USG	?Bills Copy	-
Nephrology	M13	Nephrology	M13U1	Pyelonephritis 10 Days Stay	M13U2.4	20000	?Urine R/M, USG	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations, Urine C/S
Nephrology	M8T	Nephrology	M8T2	Rapidly Progressive Renal Failure (RPRF)10 Days	M8T2.4	35000	RFT, S. Protein, USG Abdomen, Sr. Electrolytes, (ANA/DsDNA/ANCA/C3 /C4 optional)	Post Treatment Evidence Of Clinical Improvements & Lab Investigations, Renal Biopsy
Nephrology	M8S	Nephrology	M8S1	Resistant Nephritic Syndrome - 5 days stay	M8S1.2	20000	RFT,Urine Microscopy,24 Hours urine proteins,	RFT Urine Microscopy	-
Nephrology / Medical Gastroenterology	M8S	Nephrology	M8S1	CRRT (Contineous Renal Replacement Therapy) 3days stay for ALF and others	M8S1.5	100000	CBC,RFT,USG,Diagnosis and Prescription from treating Nephrologist	CBC,RFT, Clinical Photograph	-
Neurology	M9T	Neurology	M9T3	ADEM or NMO Spectrum disorders or Transverse Myelitis or relapse in Multiple Sclerosis 10 Days Stay	M9T3.12	20000	?MRI BRAIN/ SPINAL CORD (3 SITES) PLAIN/ CONTRAST, CSF ANALYSIS	?Clinical Improvement, Lab Investigations
Neurology	M9T	Neurology	M9T3	CIDP -10 Days Stay	M9T3.1	8000	?CSF ANALYSIS,SERUM PROTEIN ELECTROPHORESIS, NERVE BIOPSY(optional), NCS, EMG	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations
Neurology	M9T	Epilepsy	M9T4	Convulsive Disorders/Status EpileptICUs (Fits) - 7 Days Stay	M9T4.1	10000	?BLOOD SUGAR, ELECTROLYTES	?Post Procedure Evidance Of Clinical Imrovement ,Lab Investigations Eeg / Ct-Brain,	-
Neurology	M9T	Neurology	M9T3	Haemorrhagic Stroke/Strokes Management with all necessary investigations 15 days stay without surgery	M9T3.2	30000	CT-Brain/ MRI/MRV/MRA, ECG - not mandatory	Post Treatment Evidence Of Clinical Improvement & Lab Investigations
Neurology	M9T	Neurology	M9T2	Ischemic Strokes presenting in Window period - Management with all necessary investigations and Thrombolysis (With Tenecteplase or Alteplase) 7 days stay	M9T2.1	80000	CT Bain Plain showing no bleed / MRI with clinical diagnosis	CT Bain Plain	-
Neurology	M9T	Neurology	M9T3	Ischemic Strokes-Management with all necessary investigations without Thrombolysis 7 days stay	M9T3.3	20000	CT-Brain/ Carotid vertebral doppler	Post Treatment Evidence Of Clinical Improvements & Lab Investigations,
Neurology	M9T	Neurology	M9T3	Management of Guillian-Barre Syndrome 15 Days Stay	M9T3.13	60000	CSF Analysis, sr.pottassium	Post Treatment Evidence Of Clinical Improvements & Lab Investigations, Nerve Conduction Study, Emg	-
Neurology	M9T	Neurology	M9T3	Management of optic Neuritis - 5 Days Stay	M9T3.10	20000	MRI Brain and optic nerves, VEPs, CSF analysis	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations
Neurology	M9T	Neurology	M9T3	Myopathies - Acquired NCS, 15 Days Stay	M9T3.4	15000	EMG, Serum alkaline phosphatase, Endocrine evaluation, Muscle biopsy	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations
Neurology	M9T	Neurology	M9T3	Neuroinfections - Fungal Meningitis- 10 Days - ICU stay	M9T3.5	40000	CT Brain/MRI Brain, CSF analysis, cell count, ADA	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations/ Blood Culture
Neurology	M9T	Neurology	M9T3	Neuroinfections - Pyogenic Meningitis - 7 Days - ICU	M9T3.6	25000	?ADA, MRI BRAIN/CT BRAIN, CSF ANALYSIS, CELL COUNT	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations
Neurology	M9T	Neurology	M9T3	Neuroinfections - Viral Meningoencephalitis (Including Herpes Encephalitis) - 7 Days - ICU	M9T3.7	25000	CT/MRI Brain, CSF analysis, CSF Antibodies for HSV	Post Treatment Evidence Of Clinical Improvements & Lab Investigations
Neurology	M9T	Neurology	M9T3	Neuromuscular (Myasthenia Gravis or LEMS) -10 Days Stay	M9T3.8	15000	RNS/ CT chest/ Neostigmine test/ thyroid profile	?Post Treatment Evidance Of Clinical Imrovement ,Lab Investigations
Neurology	M9T	Neurology	M9T1	Plasma Exchange for GBS/Myesthenic Crisis/NMOSD/MS Relapse/Refractory Optic Neuritis/HUSTTP/RPRF/ Tranverse Myelitis/ Autoimmune Encephelitis / ALF /ACLF 14 days	M9T1.1	80000	Concerned specialist opinion along with Neurological Indications - NCS / CSF/ Imaging evidence with clinical diagnosis Nephrological indications - CBC,PS,Serum Creatinine.	Post Treatment Evidence Of Clinical Improvements & Lab Investigations, Nerve Conduction Study, Emg	-
Neurology / Nephrology	M9T	Neurology	M9T3	Immunoglobulin Therapy -5 Days Stay as per indications of Concerned specialist	M9T3.11	200000	Investigation Indicative of Disease, CSF Analysis, sr.pottassium	Post Treatment Evidence Of Clinical Improvements & Lab Investigations
Neurology / Paediatrics	M9T	Neurology	M9T5	ACTH Therapy for Epileptic Encephalopathy	M9T5.1	40000	EEG, MRI, Expert Opinion	Proof of administration of ACTH	-
Neurosurgery	S10	Spinal Surgeries	S10I5	Anterior Cervical Spine Surgery With Fusion - Cost per level per fusion	S10I5.8	45000	?MRI/ CT, X-RAY CERVICAL SPINE	Post Procedure Clinical Photograph /Xray/ Ct/Mri Bar Code Sticker If Allograft
Neurosurgery	S10	Spine	S10I8	Anterior Discectomy & Bone Grafting	S10I8.1	60000	?MRI/ CT	X Ray/Ct/Mri
Neurosurgery	S10	Brain surgeries	S10I7	Brain abscess aspiration under GA	S10I7.1	30000	CT/MRI	Post op scar CT/MRI	-
Neurosurgery	S10	Brain Tumours	S10I2	Brain Stem Tumour	S10I2.3	70000	CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Brain Tumours	S10I2	C P Angle Tumour	S10I2.4	70000	?CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10P	Neurosurgery	S10PM1	Carpal Tunnel Release including pre and post Op. MRI	S10PM1.13	10000	CT/MRI	CT/MRI	-
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	cerebellar tumours	S10I3.2	45000	?CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Spine	S10I8	Corpectomy For Spinal Fixation per level	S10I8.3	70000	?MRI/ CT	X Ray/Ct/Mri
Neurosurgery	S10	Management Of Aneurysms	S10I12	Cost Of Each Coil Coil Embolization	S10I12.2	30000	CT/MRI/ DSA	?Post Procedure Clinical Photograph/Ct/Mri/Angio
Neurosurgery	S10	Brain Tumours	S10I7	Cranioplasty using artificial implant	S10I7.4	75000	?CT/MRI	?Post Procedure Clinical Photograph/Ct/Xray	-
Neurosurgery	S10	Brain	S10I1	Craniotomy And Evacuation Of Hematoma Extradural	S10I1.2	50000	CT/MRI	?Post Procedure Clinical Photograph/Ct/Mri Post Op Suture Line Photo Mandatory For Claim
Neurosurgery	S10	Brain	S10I1	Craniotomy And Evacuation Of Hematoma Subdural	S10I1.1	60000	CT/MRI	?Post Procedure Clinical Photograph/Ct/Mri Post Op Suture Line Photo Mandatory For Claim
Neurosurgery	S10	Other Surgical Procedures	S10I6	CV Junction Fusion	S10I6.4	80000	?MRI/ CT, X-RAY CERVICAL SPINE	?Post Procedure Clinical Photograph /X-Ray/Ct/Mri
Neurosurgery	S10	Spinal Surgeries	S10I4	Decompression or fixation for CV Junction anomalies	S10I4.4	80000	?X Rsy/ CT/MRI	CT/MRI/X-ray	-
Neurosurgery	S10	Brain	S10I1	De-Compressive Craniotomy(Non Traumatic)	S10I1.6	80000	CT/MRI	Clinical Photo,Notes/CT/MRI/X-Ray Post Op Suture Line Photo Mandatory For Claim
Neurosurgery	S10	Neurosurgical Trauma	S10I13	Depressed Fracture of Skull	S10I13.4	40000	Clinical assessment	Clinical assessment	-
Neurosurgery	S10	Spine	S10I8	Discectomy With Implants Lumbar / Thoracic per level	S10I8.2	75000	?MRI/ CT	?X- Ray/Ct/Mri, Bar Code Stickers
Neurosurgery	S10P	Neurosurgery	S10PM1	Duroplasty	S10PM1.1	12500	CT/MRI	CT/MRI	-
Neurosurgery	S10	Management Of Aneurysms	S10I12	Embolization (Non coil)	S10I12.1	50000	CT/MRI/ DSA	?Post Procedure Clinical Photograph/Ct/Mri/Angio
Neurosurgery	S10	Spinal Surgeries	S10I4	Endoscopic Discectomy	S10I4.5	50000	MRI/ CT	Post Procedure Clinical Photograph/X-Ray/Ct/Mri	-
Neurosurgery	S10	Brain	S10I1	Endoscopic Third Ventriculostomy	S10I1.8	35000	CT/MRI	Clinical Photo, Notes/Ct/Mri
Neurosurgery	S10	Brain	S10I1	Endoscopy Procedures Brain / Spine	S10I1.5	65000	CT/MRI	Endoscopy Picture/Ct/Mri
Neurosurgery	S10	Spinal Surgeries	S10I5	Excision of Benign Orbital Tumour	S10I5.17	40000	?BIOPSY/ CLINICAL AND RADIOLOGICAL EVIDENCE	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Neurosurgery	S10	Brain Tumours	S10I2	Excision Of Brain Abscess	S10I2.11	60000	?CT/MRI	Clinical Photograph/ Hpe/Pus C/S/Ct/Mri
Neurosurgery	S10	Brain	S10I1	Excision Of Lobe (Frontal, Temporal, Cerebellum Etc.)	S10I1.4	40000	CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Brain Tumours	S10I2	External Ventricular Drainage (EVD)	S10I2.13	40000	CT/ MRI	Clinical Photograph / Xray/ Ct/ Mri
Neurosurgery	S10P	Neurosurgery	S10PM1	Foramen Magnum Decompression	S10PM1.12	45000	MRI/CT-Angio	CT-Head	-
Neurosurgery	S10P	Neurosurgery	S10PM1	Intracerebral Hematoma	S10PM1.2	50000	CT/MRI	CT/MRI	-
Neurosurgery	S10	Brain	S10I1	Intra-Cerebral Hematoma Evacuation	S10I1.7	60000	CT/MRI	Clinical Photo, Notes/CT/MRI Post Op Suture Line Photo Mandatory For Claim
Neurosurgery	S10	Brain Surgeries	S10I7	Intracranial pressure probe insertion for moderate to severe brain injuries or Haemorrhage	S10I7.2	80000	CT/MRI	Post op scar CT/MRI Monitoring photograph	-
Neurosurgery	S10	Spinal Surgeries	S10I4	Laminectomy (Cervical / Thoracic / Lumbar)	S10I4.6	40000	MRI/ CT	?Post Procedure Clinical Photograph /X-Ray/Ct/Mri	-
Neurosurgery	S10	Epilepsy Surgery	S10I10	Lesionectomy Type 1	S10I10.2	150000	?MRI, VIDEO EEG, PSYCHOLOGIC ASSESSMENT	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Epilepsy Surgery	S10I10	Lesionectomy Type 2	S10I10.3	150000	?MRI, VIDEO EEG, PSYCHOLOGIC ASSESSMENT	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Trigeminal Neuralgia	S10I11	Micro Vascular Decompression	S10I11.2	60000	CT/MRI	?Post Procedure Clinical Photograph/Ct/Xray
Neurosurgery	S10	Neurosurgical Trauma Consertative	S10I13	Neurosurgical Trauma Consertative Management Stay General Ward @Rs.1500/ Day - 7 days	S10I13.1	10500	?X- RAY/ CT	?Clinical notes	-
Neurosurgery	S10	Neurosurgical Trauma Consertative	S10I4	Neurosurgical Trauma Consertative Management Stay ICU with ventilator -6000 per day - 7 days stay	S10I4.1	42000	?X- RAY/ CT/ MRI	?Clinical notes	-
Neurosurgery	S10	Neurosurgical Trauma Consertative	S10I13	Neurosurgical Trauma Consertative Management Stay In Neuro ICU without ventilator @Rs.4000/Day - 7 days	S10I13.2	28000	?X- RAY/ CT/ MRI	?Clinical notes	-
Neurosurgery	S10	Neurosurgical Trauma	S10I13	Neurosurgical Trauma Surgical Treatment (Up To)	S10I13.3	150000	?X- RAY/CT/MRI	?Post Procedure Clinical Photograph, Lab Investigation	-
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Other Procedures	S10I3.1	40000	CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Brain Tumours	S10I2	Parasagittal Tumour	S10I2.1	50000	CT/MRI	Clinical Photograph/ Ct/Mri, Hpe
Neurosurgery	S10	Soft Tissue And Vascular Injuries	S10I9	Proptosis	S10I9.6	60000	?MRI/ CT	?CT/MRI
Neurosurgery	S10	Trigeminal Neuralgia	S10I11	Radiofrequency Ablation	S10I11.1	30000	CT/MRI	?CT/MRI
Neurosurgery	S10	Brain surgeries	S10I7	Skull base tumors excision	S10I7.6	100000	CT/MRI	CT/MRI/ X Ray and Scar photo	-
Neurosurgery	S10	Spine	S10I8	Spinal Fixation Rods /Plates	S10I8.4	85000	?MRI/ CT	X Ray/Ct/Mri
Neurosurgery	S10	Spinal Surgeries	S10I5	Spinal Fusion Procedure	S10I5.12	50000	MRI/ CT	Post Procedure Clinical Photograph /Xray/Ct/Mri, Bar Code Sticker If Allograft
Neurosurgery	S10	Spinal Surgeries	S10I5	Spine - Extradural Haematoma	S10I5.14	30000	CT/MRI/X-ray	CT/MRI/X-ray	-
Neurosurgery	S10P	Neurosurgery	S10PM1	Spine - Extradural Haematoma with Implant	S10PM1.6	35000	CT/MRI/X-ray	CT/MRI/X-ray	-
Neurosurgery	S10	Spinal Surgeries	S10I5	Spine - Extradural Tumour with fixation	S10I5.13	40000	CT/MRI/X-ray	CT/MRI/X-ray	-
Neurosurgery	S10	Spinal Surgeries	S10I5	Spine - Intradural Haematoma	S10I5.15	35000	CT/MRI	X-ray, Scar Photo	-
Neurosurgery	S10	Other Surgical Procedures	S10I4	Stereotactic assisted brain tumor surgeries -	S10I4.2	75000	?CT/MRI	CT/MRI/HPE	-
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Subdural Tapping	S10I3.5	15000	CT/ MRI	Clinical Photograph / Xray/ Ct/ Mri
Neurosurgery	S10	Brain surgeries	S10I7	Surgery for CSF Rhinorroea / Otorrhoea - Open / Endoscopic	S10I7.7	40000	CT/MRI	CT/MRI/ X Ray Endoscopic Video or scar photo	-
Neurosurgery	S10	Spinal Surgeries	S10I4	Surgery for Spinal Tumours Intramedullary / Extramedullary / Bone	S10I4.7	80000	?MRI/ CT	Clinical Photograph/Xray/ Ct/Mri, Hpe	-
Neurosurgery	S10	Brain Surgeries	S10I7	Surgical procedure of Aneurysm clipping	S10I7.3	150000	CT/MRI/DSA	CT/MRI/DSA with sticker of clip	-
Neurosurgery	S10	Brain Tumours	S10I7	Surgical repair of Meningoencephalocele	S10I7.5	40000	?CT/MRI	?Post Procedure Clinical Photograph/Ct/Xray	-
Neurosurgery	S10	Spine	S10I8	Syringomyelia	S10I8.5	65000	?MRI/ CT	?Post Procedure Clinical Photograph/Ct/Mri
Neurosurgery	S10	Epilepsy Surgery	S10I10	Temporal Lobectomy	S10I10.1	90000	?MRI, VIDEO EEG, PSYCHOLOGIC ASSESSMENT	CT/MRI, Hpe Post Op Suture Line Photo Mandatory For Claim
Neurosurgery	S10	Epilepsy Surgery	S10I10	Temporal Lobectomy Plus Depth Electrodes	S10I10.4	140000	?MRI, VIDEO EEG, PSYCHOLOGIC ASSESSMENT	Clinical Photograph/ CT/MRI/Xray, Hpe
Neurosurgery	S10	Spinal Surgeries	S10I4	Tethered cord syndrome with anomalies of bone, dura and spinal cord	S10I4.3	80000	?X Rsy/ CT/MRI	CT/MRI/X-ray	-
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Thecoperitoneal Shunt	S10I3.9	30000	?CT/MRI	Xray/ CT/MRI
Neurosurgery	S10	Other Surgical Procedures	S10I6	Trans Oral Surgery	S10I6.3	25000	?CT/MRI	Clinical Photograph/ Ct/Mri/Xray, Hpe
Neurosurgery	S10	Other Surgical Procedures	S10I6	Trans Sphenoidal Surgery	S10I6.2	25000	?CT/MRI	Clinical Photograph/ Ct/Mri/Xray, Hpe
Neurosurgery	S10	Spine surgeries	S10I4	Transtoracic Anterolateral decompression with fusion	S10I4.8	100000	CT/MRI	CT/MRI/ X Ray and Scar photo	-
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Twist Drill Craniotomy	S10I3.4	15000	CT/ MRI	Clinical Photograph / Xray/ Ct/ Mri
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Vascular Malformations	S10I3.8	40000	MRI/CT/Angio	CT/MRI/Angio
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Ventricular Tapping	S10I3.6	15000	CT/ MRI	Xray/ CT/MRI
Neurosurgery	S10	Brain Tumours	S10I2	Ventriculoatrial Shunt	S10I2.10	20000	?CT/MRI	?CT/Xray
Neurosurgery	S10	Excision Of Brain Tumours	S10I3	Ventriculoperitoneal / Ventriculo pleural Shunt	S10I3.3	20000	?CT/MRI	Xray/ CT/MRI
Neurosurgery	S10	Neuroendoscopy	S10I14	EATV (Extra Axial Third Ventriculostomy)	S10I14.1	75000	CT Scan / MRI	Clinical Photograph. Post op CT	-
Neurosurgery	S10	Neurovascular Surgeries	S10I14	Encephaloduroangiomyo synangiosis (EDAMS)	S10I14.2	50000	CT Angio / MRI Angio / DSA	Clinical Photograph. Post op CT	-
Neurosurgery	S10	Neurovascular Bypass Surgeries	S10I14	Neurovascular Bypass Surgeries	S10I14.3	80000	CT Angio / MRI Angio / DSA	Clinical Photograph. Post op CT	-
Neurosurgery / Plastic Surgery	S10	Soft Tissue And Vascular Injuries	S10I9	Repair Of Brachial Plexus Injury	S10I9.1	60000	NCV/EMG/CT/MRI	Clinical Photograph/Emg/ Ncv
Neurosurgery/CVTS	S7P	Neurovascular Surgeries	S7PM1	Carotid End arterectomy	S7PM1.21	75000	MR angio/CT Angiography / DSA	Clinical Photo. MR angio/CT Angiography / DSA	-
Ophthalmology Surgery	S3B	Cornea Sclera	S3B5	Amniotic Membrane Graft - Grade 3 Pterigium	S3B5.7	9000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (Graft in photograph)
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B4	Anterior Chamber Reconstruction +Perforating corneo - Scleral Injury + IOL	S3B4.4	15000	Clinical photograph	Post op photograph	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Buckle Removal	S3PM1.1	5000	B.SCAN, FUNDUS PHOTOGRAPH/ Sketch	FUNDUS PHOTOGRAPH/ Sketch	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Canaliculo Dacryocysto Rhinostomy	S3PM1.2	10000	DCG-Dacryocystogram, clinical Photograph	Post procedure evidence of surgery & DCG	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Conjunctival tumour excision + AMG	S3PM1.15	8000	Biopsy and endoscopic report	Endoscopy, CT Scan X-Ray PNS	-
Ophthalmology Surgery	S3B	Cornea Sclera	S3B5	Corneal Patch Graft	S3B5.3	4000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (Graft in photograph)
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Cyclocryotherapy	S3PM1.4	3000	Evidence of Raised IOP & Clinical Notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Cyclophotocoagulation	S3PM1.5	3000	Evidence of Raised IOP & Clinical Notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B4	Dacryocystectomy	S3B4.2	10000	Clinical Photograph, Clinical Notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B3	DCR (Dacryocysto Rhinostomy) with implant	S3B3.1	15000	Clinical Photograph, Clinical Notes	Scar Photo with face visible & Clinical Notes. Implant Photo	-
Ophthalmology Surgery	S3B	Orbit	S3B7	Dermis Fat Graft	S3B7.2	9000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (Graft in photograph)
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Ectropion correction	S3PM1.17	10000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Entropion correction	S3PM1.16	10000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Orbit	S3B7	Enucleation With Orbital Implant	S3B7.4	20000	?CLINICAL PHOTOGRAPH ORBIT	?Post Procedure Clinical Photograph (photograph of implant)
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Evisceration	S3PM1.18	10000	B Scan Preop photograph	Post op photograph	-
Ophthalmology Surgery	S3B	Pediatric Ophthalmic Surgery	S3B10	Glaucoma Filtering Surgery For Paediatric Glaucoma	S3B10.3	15000	Clinical notes	Post Procedure Evidence Of Clinical Photograph
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including postoperative medications for 12 weeks (and wherever surgical or laser procedures required for bleb augmentation and anterior chamber maintenance)	S3PM1.8	10000	Evidence of Raised IOP & Clinical Notes along with field of vision, Optic disc changes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B3	Intravitreal Anti-VEGF For ROP	S3B3.3	10000	Fundus Photograph & Sketch.	Intraoperative Video during injection with face visible.	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Iridectomy- laser	S3PM1.12	4000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Iridectomy- surgical	S3PM1.13	4000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	IRIS Prolapse ? Repair	S3PM1.11	6000	Preop photograph	Post op photograph	-
Ophthalmology Surgery	S3B	Cornea Sclera	S3B5	Lamellar Keratoplasty	S3B5.2	10000	Clinical photograph showing corneal opacity	?Post Procedure Clinical Photograph
Ophthalmology Surgery	S3B	Lid Surgery	S3B9	Lid Reconstruction Surgery	S3B9.1	15000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph of reconstructed lid
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Limbal Dermoid Removal	S3PM1.9	4000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Vitreo	S3B6	Monthly Intravitreal Anti-VEGF For Macular Degeneration - Per Injection (Maximum ? 6)	S3B6.3	10000	Fundus Photograph & Sketch, OCT	Post Procedure Evidence Of Fundus Photo/ Sketch / Optical Coherence Tomography.
Ophthalmology Surgery	S3B	Orbit	S3B7	Orbitotomy	S3B7.3	10000	CT Scan	?Post Procedure Clinical Photograph
Ophthalmology Surgery	S3B	Pediatric Ophthalmic Surgery	S3B10	Pediatric Cataract Surgery - Phacoemulsification ? IOL	S3B10.2	15000	?B.SCAN,	?Post Procedure Clinical Photograph
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B4	Perforating Corneo - Scleral Injury	S3B4.3	10000	Clinical Photograph and clinical notes	Post procedure evidence of surgery & Clinical Notes	-
Ophthalmology Surgery	S3B	Retina	S3B11	Photocoagulation For Diabetic Retinopathy Per Sitting	S3B11.2	1500	Fundus Photograph & Sketch	Post Procedure Evidence Of Fundus Photograph & Sketch
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B4	Photocoagulation for Retinopathy of Prematurity	S3B4.5	15000	Grading of Retinopathy by opthalmologist	Proof of Treatment
Ophthalmology Surgery	S3P	Ophthalmology Surgery	S3PM1	Prophylactic Cryoretinopexy- Closed	S3PM1.3	2500	Fundus Photograph, Retinal Sketch	Fundus Photograph, Retinal Sketch	-
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B4	Pterygium + Conjunctival Autograft	S3B4.1	9000	Clinical Photograph, Clinical Notes	Post procedure evidence of surgery & Clinical Notes (graft)	-
Ophthalmology Surgery	S3B	Squint Correction Surgery	S3B8	Rectus Muscle Surgery Single.	S3B8.1	8500	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (corrected squint)
Ophthalmology Surgery	S3B	Squint Correction Surgery	S3B8	Rectus Muscle Surgery Two/Three	S3B8.2	15000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (corrected squint)
Ophthalmology Surgery	S3B	Squint Correction Surgery	S3B1	Rectus Muscle Surgery Two/Three Plus Oblique	S3B1.1	17000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (corrected squint)	-
Ophthalmology Surgery	S3B	Vitreo	S3B6	Removal Of Silicon Oil Or Gas	S3B6.5	8000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch
Ophthalmology Surgery	S3B	Retina	S3B11	Scleral Buckle For Retinal Detachment	S3B11.1	15000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch
Ophthalmology Surgery	S3B	Cornea Sclera	S3B5	Scleral Patch Graft	S3B5.4	6000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (graft photo)
Ophthalmology Surgery	S3B	Orbit	S3B7	Socket Reconstruction	S3B7.1	7000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph (reconstructed orbit photo)
Ophthalmology Surgery	S3B	Opthalmology Surgery	S3B3	Surgical Excision of Chalazion - Per Chalazion	S3B3.2	4000	Clinical Photograph, Clinical Notes	Clinical Photo, Clinical Notes.	-
Ophthalmology Surgery	S3B	Cornea Sclera	S3B5	Therapeutic / Optical Penetrating Keratoplasty	S3B5.1	20000	Clincial Photograph	?Post Procedure Clinical Photograph
Ophthalmology Surgery	S3B	Vitreo	S3B6	Vitrectomy	S3B6.1	10000	?B.SCAN, Fundus photograph is mandatory at time of preauth	Fundus Photograph(Submitted At The Time Of Preauth)
Ophthalmology Surgery	S3B	Vitreo	S3B2	Vitrectomy - Endolaser , Silicon Oil Or Gas	S3B2.1	25000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch	-
Ophthalmology Surgery	S3B	Vitreo	S3B6	Vitrectomy - Membrane Peeling Endolaser , Silicon Oil Or Gas	S3B6.4	30000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch
Ophthalmology Surgery	S3B	Vitreo	S3B6	Vitrectomy + Membrane Peeling+ Endolaser	S3B6.2	25000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch
Ophthalmology Surgery	S3B	Vitreo	S3B6	Vitrectomy Plus Silicon Oil Or Gas.	S3B6.6	20000	?B.SCAN, FUNDUS PHOTOGRAPH & Sketch	?Fundus Photograph & Sketch
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Accessory bone ? Excision (limbs) ? congenital Accessory digits sometime can be removed (pre-auth)	S5D2.5	6000	X rays of affected limb, clinical photo	X rays of affected limb, clinical photo
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Amputation ? Above Knee	S5D2.49	18000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Amputation - Above/Below Elbow	S5D2.18	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Amputation ? Below Knee	S5D2.26	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Amputation - Wrist	S5D2.25	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopedics	S5D2	Amputations - Forequarter	S5D2.2	30000	?X- RAY	Post Procedure X Ray / Clinical Photgraph
Orthopedic Surgery And Procedures	S5D	Orthopedics	S5D2	Amputations - Hind Quarter And Hemipelvectomy	S5D2.3	40000	x ray	Post Procedure X Ray / Clinical Photgraph
Orthopedic Surgery And Procedures	S5D	Orthopedics Spine Surgery	S5D4	Anterolateral Clearance For Tuberculosis	S5D2.10	60000	?MRI/ Xray	?Biopsy, Post Procedure X Ray
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Application of P.O.P. casts for Upper & Lower Limbs	S5PM1.61	3000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Application of P.O.P. Spikas & Jackets	S5PM1.64	3500	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Arthorotomy of any joint	S5PM1.17	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Ortopaedics	S5D7	Arthoscopy - 2 ligaments repair or reconstruction of knee joint	S5D7.11	70000	MRI	Post Op X Ray, Stickers, scar photo	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone And Joint Surgery Procedures	S5D3	Arthrodesis Of - Major Joints	S5D2.4	30000	?X- RAY	?X- Ray
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone And Joint Surgery Procedures	S5D3	Arthroscopy - ACL / PCL Repair	S5D2.7	30000	MRI/ Xray	Arthoscopic Video Intra Op, Xray
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone And Joint Surgery Procedures	S5D3	Arthroscopy. Operative Meniscectomy	S5D2.6	25000	MRI/ Xray	Arthoscopic Video Intra Op
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone And Joint Surgery Procedures	S5D3	Avascular Necrosis Of Femoral Head (Core Decompression)	S5D2.8	15000	x ray, MRI	Post Procedure X Ray
Orthopedic Surgery And Procedures	S5D	Orthopedics Fracture Correction Surgeries	S5D1	Bone Grafting As Exclusive Procedure	S5D1.1	20000	X ray	Post Procedure X Ray
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Bone Tumour Excision (malignant/ benign) + Joint replacement (depending upon type of joint and implant)	S5PM1.20	150000	Clinical and radiological investigations	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Clavicle fracture management - conservative (daycare)	S5PM1.75	3000	X-Ray, Clinical Notes, Clinical Photograph	X-Ray, Clinical Notes, Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D7	Close Reduction of fractures under Anaesthesia - long bones	S5D7.7	12000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Close Reduction of fractures under Anaesthesia - Short bones	S5D2.12	7000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Closed Interlocking Intramedullary (Matches with Close reduction and percuteneous nailing)	S5D2.19	30000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Closed Reduction and Internal Fixation with Kwire	S5D2.21	6000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Closed Reduction and Percutaneous Nailing	S5D2.24	20000	X-ray	post procedure X-ray	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Closed Reduction and Percutaneous Pinning / Screw fixation	S5D2.23	15000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Closed reduction of dislocation (hip/elbow/knee/Shoulder)	S5D2.16	7000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Correction of club foot per cast	S5D2.28	1000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	CTEV	S5D1	CTEV Neglected. JESS Fixator	S5D1.6	30000	Clinical Photograph	Post Procedure Evidence Of Clinical Photograph, X-Ray
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Duputryen?s Contracture release + rehabilitation	S5PM1.39	10000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Excision Arthoplasty of Femur head	S5D2.15	22500	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone Tumours	S5D6	Excision Of Bone Tumours. Deep With Re-Construction With Conventional Prosthesis	S5D6.1	45000	?MRI/ Xray	?Post Procedure Clinical Photograph, Post Procedure X Ray, Biopsy
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Excision of Bursa	S5PM1.55	3000	Clinical and radiological investigations	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Fracture Correction Surgeries	S5D1	Excision Or Other Operations For Scaphoid Fractures	S5D1.2	20000	?X- RAY	Post Procedure X Ray
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	External fixation - Long bone/pelvis	S5D2.31	20000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	External fixation - Small bone	S5D2.32	15000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Fasciotomy	S5PM1.42	7000	Clinical Photograph	Post Procedure evidence of Surgery	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Foot Amputation (partial)	S5PM1.3	10000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Hand/Foot Amputation ( partial)	S5D2.20	10000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Hand/Foot Amputation (whole)	S5D2.11	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D7	Hemiarthroplasty (Bipolar)	S5D7.8	35000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph, Scar photo	-
Orthopedic Surgery And Procedures	S5D	Ortopaedics	S5D7	High Tibial Osteotomy with miniscus and root repair	S5D7.12	70000	X Ray, Scannogram, MRI	X Ray and sticker	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Fracture Correction Surgeries	S5D1	Ilizarov Ring Fixator Application.	S5D1.5	50000	X ray mandatory requireed clinical photo of part for pre auth	Post Procedure X Ray Mandatory Requireed Clinical Photo Of Part For Claim
Orthopedic Surgery And Procedures	S5D	Ortopaedics	S5D7	Latarjet procedure for recurrent dislocation of shoulder	S5D7.13	40000	MRI, CT Scan, X Ray	Post Op X Ray, Stickers, scar photo	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Limb Lengthening	S5D2.33	20000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Soft Tissue Surgery	S5D5	Neurolysis/Nerve Suture	S5D2.14	25000	Clinical Photograph, Nerve conduction study	Post Procedure Evidence Of Clinical Photograph
Orthopedic Surgery And Procedures	S5D	Orthopedics Fracture Correction Surgeries	S5D1	Open Reduction & Internal Fixation of Fingers & Toes @Rs 6000 Each Up To Maximum Of Rs 15000	S5D1.3	18000	?X- RAY	Post Procedure X Ray
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Open Reduction Internal Fixation (Small Bones) - Calcaneum / Talus and others	S5D2.35	25000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Open Reduction of CDH	S5D2.36	35000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopedics	S5D2	Open Reduction of Dislocations - Shoulder/Elbow/Hip/Knee/Ankle	S5D2.1	30000	x ray	Post Procedure X Ray
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Open Reduction of Small Joint	S5D2.37	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Osteochondroma excision/ Excision of Exostosis	S5PM1.15	15000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Pelvic Osteotomy with fixation with plaster.	S5PM1.53	20000	Clinical and radiological investigations	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary Hip Replacement (with implant) cemented THR (Imported implant)	S5D2.30	60000	Clinical and radiological investigations	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary Hip Replacement (with implant) cemented THR (Indian implant)	S5D2.42	45000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary Hip Replacement (with implant) uncemented THR (Imported implant)	S5D2.38	80000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary Hip Replacement (with implant) uncemented THR (Indian implant)	S5D2.44	65000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary knee replacement (with implant) All poly (imported implant)	S5D2.45	50000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary knee replacement (with implant) All poly (indian implant)	S5D2.43	45000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary knee replacement (with implant) metal back (imported implant)	S5D2.41	60000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Primary knee replacement (with implant) metal back (indian implant)	S5D2.47	45000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Fracture Correction Surgeries	S5D1	Reduction Of Compound Fractures & External Fixation	S5D1.4	20000	X ray mandatory requireed clinical photo of part for pre auth	Post Procedure X Ray Mandatory Requireed Clinical Photo Of Part For Claim
Orthopedic Surgery And Procedures	S5D	Ortopaedics	S5D7	Removal of implants with screws	S5D7.10	10000	Preprocedure X Ray	Post procedure X Ray	-
Orthopedic Surgery And Procedures	S5D	Orthopedics	S5D2	Scoliosis (Rs. 90000) + special spinal brace (Rs. 10000)	S5D2.17	100000	X ray	Post Operative X ray, Clinical Photos, Implant sticker (barcode), bill of spinal brace	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Sequestrectomy of Long Bones + anti-biotics + dressing	S5PM1.56	20000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Skeletal tractions with pins Isolated	S5PM1.62	0	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	skin traction isolated	S5PM1.63	0	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req	-
Orthopedic Surgery And Procedures	S5D	Orthopedics Bone And Joint Surgery Procedures	S5D3	Soft Tissue Reconstruction Procedures For Joints or osteotomy	S5D2.9	30000	x ray & Clinical photgraph	Post Procedure X Ray & Clinical Photgraph Req
Orthopedic Surgery And Procedures	S5D	Orthopedics Spine Surgery	S5D4	Spinal Ostectomy And Internal Fixations	S5D4.1	50000	?MRI/ Xray	Post Procedure X Ray	-
Orthopedic Surgery And Procedures	S5P	Orthopedic Surgery And Procedures	S5PM1	Tendon Grafting (isolated grafting)	S5PM1.45	10000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Tendon Repair (Multiple)	S5D2.34	30000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D7	Tendon Repair (Single)	S5D7.9	20000	?X-Ray , Clinical Photograph	?X-Ray , Clinical Photograph	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Total Hip Replacement hybrid (procedure cost + Imported implant)	S5D2.40	75000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S5D	Orthopaedics	S5D2	Total Hip Replacement hybrid (procedure cost + Indian implant)	S5D2.46	60000	Clinical and radiological investigations (MRI)	Clinical and radiological investigations	-
Orthopedic Surgery And Procedures	S14	Orthopedic Trauma	S14O1	Open Reduction And Internal Fixation Of Long Bone Fractures	S14O1.1	25000	X ray	X Ray, Ot Notes	-
Orthopedic Surgery And Procedures	S5	Orthopedic Surgery And Procedures	S5E11	AC joint reconstruction/ Stabilization/ Acromionplasty Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuri	S5E11.1	25000			-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Anorectal Malformations Stage 1	S8G1.5	45000	?CLINICAL PHOTOGRAPH, Xray Abdomen(Inverted position), Clinical Notes	?Post Procedure Scar Photograph	-
Pediatric Surgery	S8G	Abdomen	S8G8	Surgery for Peritonitis in Children	S8G8.1	40000	X Ray abdomen and USG Abdomen	Scar Photo, Clinical notes	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Anorectal Malformations Stage 2 Open or Laparosopic	S8G1.6	60000	Clinical Photograph, Distal Cologram, USG Abdomen, Xray Lumbosacral spine (inverted position)	Post Procedure Scar Photograph Operative/ Procedure Notes	-
Pediatric Surgery	S8	Abdomen	S8H1	Benign Abdominal Cysts In Paediatric Patient	S8H1.4	45000			-
Pediatric Surgery	S8G	Congenital Malformations - Gi Tract	S8G1	Biliary Atresia & Choledocal Cyst	S8G1.4	60000	?CLINICAL PHOTOGRAPH, LFT, USG/ Imaging	Post Procedure Clinical Photograph Usg, Lft Is Mandatory At Time Of Claims	-
Pediatric Surgery	S8G	Chest	S8G4	Bronchoscopy Foreign Body Removal	S8G4.1	25000	?Imaging/ ENDOSCOPIC VIDEO	?Xray /Scopy Photo/Video Ensure Bronchoscopy Is Done Only Once	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G8	Colostomy closure for ARM or Hirsphsprung's disease / Stage 3	S8G8.2	60000	Clinical Photograph, Distal Cologram, USG Abdomen	Post Procedure Scar Photograph Operative/ Procedure Notes	-
Pediatric Surgery	S8G	Head And Neck	S8G3	Congenital Dermal Sinus	S8G3.2	30000	CT Contrast study /MRI	Post Procedure Clinical Photograph, Biopsy	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Congenital Hydronephrosis	S8G2.1	50000	USG / Renogram	Post Procedure Evidence Of Clinical Photograph	-
Pediatric Surgery	S8G	Head And Neck	S8G3	Cystic Lesions Of The Neck	S8G3.3	25000	USG/MRI /CT, Clinical Photograph	Post Procedure Clinical Photograph, Histopath	-
Pediatric Surgery	S8G	Chest	S8G4	Decortication Open or Thoracoscopic	S8G4.5	50000	USG / CT	Post Procedure Clinical Photograph, Biopsy/Video	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Diaphragmatic Hernia	S8G1.2	60000	?Chest X-ray AP/Lat, USG/CT scan	?Chest Xray Ap/Lat Post Procedure Clinical Photograph	-
Pediatric Surgery	S8P	Pediatric Surgery	S8PM1	Exomphalos/gastroschisis	S8PM1.10	35000	Clinical Photo	Clinical Notes	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Extrophy Bladder Stage 1	S8G2.3	65000	Clinical Photograph/USG, Xray Pelvis	Post Procedure Evidence Of Clinical Photograph	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Extrophy Bladder Stage 2	S8G2.4	60000	Clinical Photograph/USG, Xray Pelvis	Post Procedure Evidence Of Clinical Photograph	-
Pediatric Surgery	S8G	Abdomen	S8G5	Gastric Outlet Obstructions	S8G5.1	35000	Contrast USG, Xray	?Post Procedure Clinical Photograph	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Hamartoma Excision	S8G2.16	20000	CT / Clinical Photograph	Post Procedure Photo, Biopsy Is Mandatory At Time Of Claims	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Hemangioma Excision	S8G2.17	30000	Neuro USG + CT, Colour Doppler	Post Procedure Photo	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Hirschsprung Disease Stage 1	S8G1.7	45000	? CLINICAL PHOTOGRAPH/Imaging/ Biopsy	?Biopsy, Post Procedure Scar Photograph	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Hirschsprung Disease Stage 2 Open or Lap	S8G1.8	60000	? CLINICAL PHOTOGRAPH/ Imaging/ Biopsy	?Biopsy, Post Procedure Scar Photograph	-
Pediatric Surgery	S8G	Pediatric Surgery	S8G7	Hirschsprung?s Disease -Biopsy	S8G7.1	20000	CLINICAL PHOTOGRAPH/Imaging/ Biopsy	BIOPSY, Post procedure photograph	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Hypospadias Single Stage	S8G2.6	40000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G8	Hypospadius Fistula	S8G8.3	25000	DRU (Distal Retrograde Urethrogram)	Clinical photograph showing patient micturating without leakage	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Hypospadius Stage 1	S8G2.15	35000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Hypospadius Stage 2	S8G2.7	35000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Pediatric Surgery	S8G	Pediatric Surgery	S8G7	Inguinal Hernia & Hydrocele	S8G7.2	10000	Clinical Photograph, Clinical Notes	Post Procedure Evidence of Surgery	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Intestinal Atresias & Obstructions	S8G1.3	55000	?X- RAY, Imaging	?Post Procedure Clinical Photograph Usg/Imaging Is Mandatory At Time Of Claims	-
Pediatric Surgery	S8G	Abdomen	S8G5	Intussusception	S8G5.8	40000	?CT/ USG	?Post Procedure Clinical Photograph, Usg	-
Pediatric Surgery	S8G	Abdomen	S8G5	Laparoscopic Choleycystectomy	S8G5.11	40000	USG, Clinical photo	?Post Procedure Clinical Photograph, Histopath, Video	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Lymphangioma Excision	S8G2.18	40000	USG + CT, Clinical photo	Post Procedure Photo	-
Pediatric Surgery	S10	Brain Tumours	S10I2	Meningocele / Meningomyelocele Excision	S10I2.9	35000	?CT/MRI	?Post Procedure Clinical Photograph/Ct/Xray
Pediatric Surgery	S8G	Urogenital	S8G6	Nephrectomy	S8G6.1	40000	USG / CT Clnical Photograph, DMSA scan	?Post Procedure Clinical Photograph, Usg, Biopsy	-
Pediatric Surgery	S8G	Congenital Malformations - GI Tract	S8G1	Oesophageal Atresia	S8G1.1	60000	?X- RAY, TOF test req at time of preauth, Imaging	?Post Procedure Clinical Photograph,	-
Pediatric Surgery	S8G	Urogenital	S8G8	Orchidopexy - Stage 1 - Open / Lap	S8G8.4	30000	USG,Clinical Photograph	Clinical Photograph,Usg,Video	-
Pediatric Surgery	S8G	Urogenital	S8G8	Orchidopexy - Stage 2 - Open / Lap	S8G8.5	30000	USG,Clinical Photograph	Clinical Photograph,Usg,Video	-
Pediatric Surgery	S8G	Abdomen	S8G5	Paediatric Acute Intestinal Obstruction	S8G5.9	45000	?X-ray, CT/ USG	?Post Procedure Clinical Photograph/Scar/Suture Req At The Time Of Claim	-
Pediatric Surgery	S8G	Chest	S8G4	Paediatric Esophageal Obstructions- Surgical Correction	S8G4.2	35000	Contrast UGI	Clinical Photograph	-
Pediatric Surgery	S8G	Chest	S8G4	Paediatric Esophageal Substitutions	S8G4.3	65000	Contrast study	Clinical Photograph	-
Pediatric Surgery	S8G	Abdomen	S8G5	Paediatric Splenectomy (Non Traumatic)	S8G5.3	40000	USG, Heamogram,	?Post Procedure Clinical Photograph, Biopsy, Usg	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Pediatric Tumours	S8G2.8	50000	Imaging / BIOPSY/ tumour markers	Post Procedure Clinical Photograph ,Hp Report At The Time Of Claims	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Posterior Urethral Valves	S8G2.5	30000	MCU / USG	Clinical Notes, Clinical Photo With Catheter	-
Pediatric Surgery	S8G	Urogenital	S8G6	Scrotal Transposition Repair	S8G6.3	30000	CLINICAL PHOTOGRAPH	Post Procedure Photo	-
Pediatric Surgery	S8G	Head And Neck	S8G3	Sinuses & Fistula Of The Neck	S8G3.5	20000	USG/CT contrast study, Clinical Photograph	Post Procedure Clinical Photograph, Biopsy	-
Pediatric Surgery	S8G	Chest	S8G8	Surgery on Thoracic cyst - Open or Thoracoscopic	S8G8.8	40000			-
Pediatric Surgery	S8G	Urogenital	S8G6	Torsion Testis	S8G6.5	30000	clinical photo and colour doppler	Clinical Photo, Notes	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G2	Ureteric Reimplantations	S8G2.2	65000	Clinical Photograph/USG, IVP/MCU	?Post Procedure Clinical Photograph/Scar/Suture Req At The Time Of Claim	-
Pediatric Surgery	S8G	Congenital Malformations ?Urogenital	S8G8	Urinary Diversion (Vasicostomy / Ureterostomy)	S8G8.6	25000	USG, Micturating Cystourethrogram, RFT	Scar Photo, Clinical notes	-
Pediatric Surgery	S8G	Pediatric Surgery	S8G8	Urinary Undiversion	S8G8.7	25000	Clinical Photo, USG abdomen	Scar Photo, Clinical notes	-
Pediatric Surgery	S9P	Pediatric Surgery	S9PM1	Bladder Augmentation	S9PM1.8	40000	USG, CT/MCU	USG /clinical photograph	-
Pediatric Surgery	S1	Abdomen	S1PM1	Mesenteric Cyst Excision	S1PM1.31	16000	USG - Abdomen/CT Scan	Scar Photo	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Cleft Lip	S12M1.1	15000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Cleft Palate	S12M1.2	20000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Corrective Surgery For Congenital Deformity of Hand and foot (Per Hand)	S12M1.14	20000	X-Ray, clinical photograph	Clinical Phoptograph/ Xray	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Corrective surgery for craniosynostosis	S12M1.15	50000	CT, Clinical photograph	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Diabetic Foot ? Surgery	S12M1.20	25000	Clinical Photo,Lab Investigation, X-ray	Clinical Photo	-
Plastic Surgery	S12	Plastic Surgery	S12PM1	Ear Pinna Reconstruction with costal cartilage/ Prosthesis (including the cost of prosthesis /implants).	S12PM1.1	20000	Clinical Photo	Clinical Photo	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Flap Cover For Electrical Burns With Vitals Exposed for each flap	S12M1.17	50000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12PM1	Hemangioma ? Sclerotherapy (under GA)	S12PM1.3	15000	USG	Clinical Photograph	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Hemifacial Microsmia	S12M1.7	50000	CT/ Xray / OPG	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Leprosy Reconstructive Surgery for each procedure	S12M1.8	20000	Clinical photograph	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Microtia/Anotia for each stage	S12M1.5	40000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Nerve And Tendon Repair + Vascular Repair for each limb	S12M1.9	30000	Clinical photograph	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M3	Non healing wound - Diabetic foot dail dressing with skin grafting including antidiabetics	S12M3.2	30000	Clinical Photo,Lab Investigation, X-ray	Clinical Photo	-
Plastic Surgery	S10	Soft Tissue And Vascular Injuries	S10I9	Peripheral Nerve Injury Repair	S10I9.5	40000	?EMG, NERVE CONDUCTION	?Post Procedure Clinical Photograph
Plastic Surgery	S12	Plastic Surgery	S12PM1	Pressure Sore ? Surgery for Malignant and Non malignant conditions	S12PM1.4	30000	Clinical Photo	Clinical Photo	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Reduction Surgery For Filarial Lymphedema	S12M1.18	30000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Syndactyly Of Hand For Each finger	S12M1.4	15000	Clinical photo of affected part	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Vascular Injuries	S12M2	Tendon/Vascular/ nerve Injury Repair - In forearm/leg/foot or hand - Payable maximum upto for each procedure	S12M2.1	25000	Doppler	Doppler / Scar Photo	-
Plastic Surgery	S12	Plastic Surgery	S12PM1	Tissue Expander for disfigurement following burns/ trauma/congenital deformity (including cost of expander / implant)	S12PM1.2	50000	Clinical Photo, Lab Investigations	Clinical Photo	-
Plastic Surgery	S12	Plastic Surgery	S12M1	TM Joint Ankylosis	S12M1.6	40000	Clinical Phoptograph, X-Ray / OPG	Clinical Phoptograph / Opg/ Xray	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Vaginal Atresia	S12M1.12	25000	Clinical notes with sketch	Sketch/ Clinical Photograph	-
Plastic Surgery	S12	Plastic Surgery	S12M3	Vascular Malformations - Major more than 5 Cms	S12M3.1	25000	MR angio/Doppler study	Clinical Photo Of Affected Part	-
Plastic Surgery	S12	Plastic Surgery	S12M1	Vascular Malformations - Minor up to 5 Cms	S12M1.13	25000	MR angio/Doppler study	Clinical Photo Of Affected Part	-
Poly Trauma	S14	Abdomen Conservative Treatment	S14O6	Abdominal Injuries Conservative Stay In General Ward @Rs.1500 - 2 Day stay	S14O6.1	3000	?X-RAY/USG/CT	?Usg	-
Poly Trauma	S14	Abdomen Conservative Treatment	S14O6	Abdominal Injuries Stay In Surgical ICU@Rs.4000/Day- 5 days stay	S14O6.2	20000	?X-RAY/USG/CT	?Usg	-
Poly Trauma	S14	Polytrauma Abdomen	S14O7	Abdominal Injuries Surgical Treatment	S14O7.1	75000	?X-RAY/USG/CT	?Usg, Post Procedure Clinical Photograph	-
Poly Trauma	S14	Orthopedic Trauma	S14O1	Amputation Surgery finger and toes(Per finger per toe)	S14O1.2	5000	?X- RAY	?Post Procedure Clinical Photograph	-
Poly Trauma	S14	Chest Conservative Treatment	S14O4	Chest Injuries Conservative Stay In General Ward @Rs.1500/Day - 5 days stay	S14O4.1	7500	?X- RAY/CT	?Post Procedure Clinical Photograph	-
Poly Trauma	S14	Chest Conservative Treatment	S14O4	Chest Injuries Stay In Respiratory ICU/ICCU@Rs.4000/Day - 5 days stay	S14O4.2	20000	?X- RAY/CT, Clinical photograph	?Post Procedure Clinical Photograph	-
Poly Trauma	S5D	Orthopaedics	S5D7	Degloving injuries of extremities	S5D7.2	20000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Poly Trauma	S14	Orthopedic and Facial Trauma Wound Management For Compound Fractures	S14O11	Flap Cover Surgery For Wound In Compound Fracture	S14O11.2	30000	?CLINICAL PHOTOGRAPH, X- RAY, CT face 3D reconstruction	?Post Procedure Clinical Photograph, Xray Ot Notes	-
Poly Trauma	S14	Orthopedic Trauma	S14O1	Multiple CLWs or incised wounds or crush injuries or Soft Tissue Injury for Debridement & Closure - 3 days stay	S14O1.3	10000	clinical photo	Clinical Photo	-
Poly Trauma	S14	Poly Trauma	S14PM1	Plexus injury along with Vascular injury repair with Graft	S14PM1.1	40000	Pre-op. Doppler study, Nerve Conduction study, + CT	Post-op. Doppler study, Clinical photo showing scar	-
Poly Trauma	S14	Polytrauma Chest	S14O5	Polytrauma Chest Surgical Treatment	S14O5.1	50000	?X-RAY/USG/CT	X-Ray/Usg/Ct	-
Poly Trauma	S5D	Orthopaedics	S5D7	POP cast immobilization of undisplaced fracture without Anaesthesia	S5D7.5	3000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Poly Trauma	S5D	Orthopaedics	S5D7	Post Management of traumatically amputed limb	S5D7.1	20000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Poly Trauma	S5D	Orthopaedics	S5D7	Stabilization before amputation above knee or above elbow	S5D7.6	5000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Poly Trauma	S14	Orthopedic and Facial Trauma Wound Management For Compound Fractures	S14O11	Surgery For Patella Fracture (Fixation / Excision)	S14O11.3	15000	?X- RAY	X Ray Ot Notes	-
Poly Trauma	S14	Orthopedic and Facial Trauma Wound Management For Compound Fractures	S14O11	Surgical Correction Of Pelvic Bone Fractures.	S14O11.6	25000	?X- RAY	?X- Ray Ot Notes	-
Poly Trauma	S14	Emergency Room Procedures	S14O8	Thoracostomy	S14O8.2	3000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Poly Trauma	S14	Emergency Room Procedures	S14O8	Tracheostomy for polytrauma and non polytrauma other causes.	S14O8.1	5000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Poly Trauma	S5D	Orthopaedics	S5D7	Traumatic internal de-arrangement of knee	S5D7.4	5000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Poly Trauma	S5D	Orthopaedics	S5D7	Whole blood or PCV in trauma	S5D7.3	1450	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Burns	S14	Poly Trauma	S14O9	Trauma associated with less than 10 % BURNS (CONSERVATIVE MANAGEMENT)	S14O9.1	5000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Burns	S14	Poly Trauma	S14O2	Trauma associated with less than 10-15 % BURNS (CONSERVATIVE MANAGEMENT)	S14O2.1	8000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O3	Black eye with haemorrhage (day care basis)	S14O3.1	5000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O10	Corneal Foreign Body	S14O10.1	5000	Geotagged Photograph of patient	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O11	Corneal tear operative management	S14O11.1	15000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O11	Corneoscleral tear	S14O11.13	25000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O11	Corneoscleral tear with Intraoccular foreign body	S14O11.4	30000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O3	Hyphaema (Blood in eye) Non-surgical Management	S14O3.2	5000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O3	Hyphaema (Blood in eye) Surgical Management	S14O3.3	10000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O11	Lid tear	S14O11.15	7000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O11	Scleral tear	S14O11.22	25000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O9	Traumatic glaucoma with angle recession	S14O9.2	20000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O9	Traumatic glaucoma without angle recession	S14O9.3	20000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O3	Vitreous haemorrhage Conservative	S14O3.4	10000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Ophthalmology	S14	Poly Trauma	S14O3	Vitreous haemorrhage Surgical Management	S14O3.5	25000	Geotagged Photograph of patient and wounds	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Polytrauma / Orthopedics	S14	Poly Trauma	S14O12	Stabilization of patient with Long Bone Fractures before internal fixation	S14O12.1	7000	Geotagged Photograph of patient/wounds & X ray	Police Information report and Discharge card in prescribed proforma with evidence of investigations and treatment done	-
Prosthesis and Orthosis	S15	Prosthesis Upper Limb Above Elbow	S15P7	Above Elbow Prosthesis Modular	S15P7.6	4000	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis Above Knee(Ak) Prostheses	S15P5	Above Knee(AK) Prostheses Modular	S15P5.3	3500	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis Below Knee(Bk/Ptb)	S15P3	Below Knee(BK/PTB) Prostheses Modular	S15P3.3	3000	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis and Orthosis	S15P11	Rehabilitative management of lower limb deformity & weakness - Calipers HKFO/ KFO/ FO	S15P11.7	7000	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis and Orthosis	S15P11	Rehabilitative management of spine deformity -Milwaukee Brace Plastic Model	S15P11.2	4500	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis Through Knee Prostheses	S15P4	Through Knee Prostheses Modular	S15P4.3	3500	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Prosthesis and Orthosis	S15	Prosthesis and Orthosis	S15P11	Wrist Disarticulation Prosthesis	S15P11.5	10000	?CLINICAL PHOTOGRAPH	?Clinical Photograph Clinical Photograph With Prosthesis Mandatory For Claim	-
Pulmonology	M10	Pulmonology	M10T4	Acute Respiratory Failure (ICU stay With Invasive Ventilator) per day - Rs 6000 - 7 Days stay	M10T4.7	42000	Serum Electrolytes, ABG, ECG, Sputum / Bronchial Washing / ET Suctions for Analysis x ray mandatory for pre auth.	Post Treatment Evidence Of Clinical And Lab Investigations	-
Pulmonology	M10	Pulmonology	M10T4	Acute Respiratory Failure (With NIV Ventilator) per day - Rs 5000 - 7 Days	M10T4.6	35000	Serum Electrolytes, ABG, ECG, Sputum / Bronchial Washing / ET Suctions for Analysis x ray mandatory for pre auth.	Post Treatment Evidence Of Clinical And Lab Investigations	-
Pulmonology	M10	Pulmonology	M10T4	Acute Respiratory Failure (Without Ventilator) 4000 per day ICU stay - 5 Days	M10T4.5	20000	Serum Electrolytes, ABG, ECG, Sputum / Bronchial Washing / ET Suctions for Analysis x ray mandatory for pre auth.	Post Treatment Evidence Of Clinical And Lab Investigations	-
Pulmonology	M10	Pulmonology	M10T4	Bronchiectasis Requiring Hospitalisation - 7 Days Stay	M10T4.8	20000	HR CT - Chest , sputum gram stain	Post Treatment Evidence Of Clinical And Lab Investigations, Sputum Culture /Drug Susceptibility	-
Pulmonology	M10	Pulmonology	M10T4	Interstitial Lung Diseases - 7 Days Stay	M10T4.3	30000	HRCT Chest	Post Treatment Evidence Of Clinical And Lab Investigations, Spirometry	-
Pulmonology	M13	Pulmonology	M13U1	Lower Respiratory Tract Infection 13 Days General ward Stay. Rs 20000 if complete 13 days stay.	M13U1.1	20000	CXR, Sputum gram stain	?Post Procedure Evidance Of Clinical Imrovement , Lab Investigations
Pulmonology	M10	Pulmonology	M10T4	Lung Abscess, Non Resolving - Ct Scan Chest, per day - Rs 2500 - 10 Days stay	M10T4.1	25000	CT Scan Chest,	Post Treatment Evidence Of Clinical And Lab Investigations, Pus C/S	-
Pulmonology	M10	Pulmonology	M10T4	Pneumoconiosis - per day Stay - Rs 2500 - 10 Days stay	M10T4.4	35000	HRCT Chest	Post Treatment Evidence Of Clinical And Lab Investigations	-
Pulmonology	M10	Pulmonology	M10T4	Pneumothorax (Large/Recurrent) HRCT-10 Days Stay	M10T4.2	35000	Chest HRCT	Post Treatment Evidence Of Clinical And Lab Investigations Xray	-
Pulmonology	M10	Pulmonology	M10T4	Treatment of mediastinal/lymphadenopathy requiring EBUS(Endobronchial ultrasound) with 3 days stay	M10T4.10	30000	X Ray chest, CT, Evidence of lab investigations	Post Treatment Evidence Of Clinical And Lab Investigations Xray	-
Pulmonology	M10	Pulmonology	M10T4	Treatment of Pleural diseases requiring Thoracoscopy 3 days stay	M10T4.9	25000	X Ray chest, CT, Evidence of lab investigations	Post Treatment Evidence Of Clinical And Lab Investigations Xray	-
Radiation Oncology	M2L	Specialized Radiation Therapy - 3DCRT (3-D Conformal Radiotherapy)	M2L6	3DCRT-Up upto 30 Fractions In 6 Weeks (Preferably Right breast Cancer Cervix, Endometrium, Rectum, Whole Brain Radiotherapy (WBRT), Stomach, Gastrointestinal Tract (GIT), Early stage glottic (Stage I, II), Testis, Lymphoma, Retroperitonium, Ovarian a	M2L6.1	75000	Biopsy/Histopathology report, USG/CT/X-Ray/Imagings	RT TREATMENT CHARTS	-
Radiation Oncology	M2L	Brachytherapy Intracavitary	M2L3	A) Intracavitary II. HDR Per Application	M2L3.2	10000	Histopatholigy report, USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	Cobalt 60 External Beam Radiotherapy	M2L1	Adjuvant Treatment with Cobalt 60	M2L1.3	20000	?Biopsy/Histopatholigy report,USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	Brachytherapy Interstitial	M2L4	B) Interstitial II. HDR One Application And Multiple Dose Fractions. Non OBGY Malignancie	M2L4.2	40000	Histopatholigy report, USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	Specialized Radiation Therapy - IMRT (Intensity Modulated Radiotherapy)	M2L5	IMRT-Up To 35 Fractions In 8 Weeks - Preferably Pre/Post op head and neck cancer, Cancer Esophagus, Anaplastic Thyroid, Brain, Pituatary, Left Breast, Anal Canal, Lung, Pleura, Urinary bladder.	M2L5.1	100000	Biopsy/Histopatholigy report,USG/CT/X-RAY/Imagings	RT TREATMENT CHARTS	-
Radiation Oncology	M2L	Brachytherapy	M2L9	Interstitial plus Intracavitory per fraction - For OBGY Malignancies	M2L9.3	15000	Biopsy/Histopatholigy report,USG/CT/PET/MRI	? Rt Treatment Charts	-
Radiation Oncology	M2L	Brachytherapy	M2L9	Intraluminal Brachytherapy per fraction	M2L9.1	10000	Biopsy/Histopatholigy report,USG/CT/PET/MRI	? Rt Treatment Charts	-
Radiation Oncology	M2L	Cobalt 60 External Beam Radiotherapy	M2L1	Palliative Treatment with Cobalt 60	M2L1.2	15000	?Biopsy/Histopatholigy report,USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	External Beam Radiotherapy (On Linear Acclerator)	M2L2	Palliative Treatment With Photons	M2L2.2	25000	Histopatholigy report, USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	Cobalt 60 External Beam Radiotherapy	M2L1	Radical Treatment with Cobalt 60	M2L1.1	25000	Histopatholigy report, USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	External Beam Radiotherapy (On Linear Acclerator)	M2L2	Radical Treatment With Photons and Electrons	M2L2.3	50000	Histopatholigy report, USG/CT/X-RAY/Imagings	? Rt Treatment Charts	-
Radiation Oncology	M2L	Specialized Radiation Therapy Rapid Arc Therapy	M2L8	RapidArc/ VMAT/ ART/ Tomotherapy with IGRT Up To 30 Fractions in 6 Weeks - Preferably Radical head and neck cancer, Cancer of liver, Hepatobiliary tract, Pancreas, Prostate, Heart, Pericardium, Great vessels	M2L8.1	150000	?Biopsy/Histopathology report,USG/CT/X-RAY/Imagings	RT TREATMENT CHARTS	-
Radiation Oncology	M2L	Specialized Radiation Therapy - SRS/SRT	M2L7	SRS / SRT upto 5 fractions	M2L7.1	100000	Biopsy/Histopatholigy report,USG/CT/X-RAY/Imagings	RT TREATMENT CHARTS	-
Radiation Oncology	M2L	Brachytherapy	M2L9	Surface mould Brachytherapy for skin tumors and vaginal tumors	M2L9.2	5000	Biopsy/Histopatholigy report,USG/CT/PET/MRI	? Rt Treatment Charts	-
Rheumatology	M12	Rheumatology	M12T6	Antiphospholipid Antibody syndrome 7 days	M12T6.8	20000	Antiphospholipid Antibody, CT/MRI/Color dopplerindicating e/o thrombosis	Clinical notes.	-
Rheumatology	M12	Rheumatology	M12T6	MCTD Mixed Connective Tissue Disorder 7 Days Stay	M12T6.3	20000	ANA, Anti U1 RNP ab, (old or new) /Renal biopsy/ CPK,RA	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology	M12	Rheumatology	M12T6	Osteoporosis - Zoledronic acid injection - One day stay	M12T6.12	5000	DEXA Scan	Clinical notes.	-
Rheumatology	M12	Rheumatology	M12T6	Polymyocitis / Dermatomyocitis 7 days stay	M12T6.7	10000	CPK Total,	EMG, Muscle biosy, Treatment chart	-
Rheumatology	M12	Rheumatology	M12T6	Rheumatoid Arthritis with ILD/ Vasculitis 7 days stay	M12T6.4	20000	RF, Anti CCP antibody, HRCT for ILD, Skin biopsy/NCD for vasculitis	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology	M12	Rheumatology	M12T6	Scleroderma 7 Days Stay	M12T6.2	20000	Anti SCL 70, ANA (old or new) / skin biopsy/ PFT	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology	M12	Rheumatology	M12T6	SLE (Systemic Lupus Erythematosis) 10 Days Stay	M12T6.6	20000	24 Hour urine protein, ACL Antibodies / ANA/ Anti DSDNA/ C3 C4	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology	M12	Rheumatology	M12T6	SLE AIHA / SLE Thrombocytopenia - 10 days stay	M12T6.11	100000	DCT/ICT, CBC	Clinical notes. Empty vials of injections and blister packs. Empty bottles of platelets or PCV	-
Rheumatology	M12	Rheumatology	M12T6	SLE With Sepsis 4 Weeks Stay	M12T6.1	50000	ANA/Anti DSDNA (new or old report), Blood Culture or source of infection	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology	M12	Rheumatology	M12T6	Spondyloarthropathy 5 days stay	M12T6.9	10000	MRI Spine / SI Joint	Clinical notes	-
Rheumatology	M12	Rheumatology	M12T6	Spondyloarthropathy with Biologic therapy - One day	M12T6.10	25000	CRP, ESR, CT/MRI	Clinical notes. Empty vials of injections	-
Rheumatology	M12	Rheumatology	M12T6	Vasculitis 6 Days Stay. Rs 10000 if LOS 6 Days.	M12T6.5	10000	ANCA	Post Treatment Evidence Of Clinical Improvement, Lab Investigation	-
Rheumatology / Neonatal and Pediatric Medical Management	M6P	Pediatrics Medical Management	M6PM1	Rheumatoid arthritis - Rs 2000 per day - 5 days	M6PM1.9	10000	RA Factor	Clinical Notes	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Abdomino Perineal Resection(Non- Malignant)	S6E7.6	50000	?BIOPSY, CT- SCAN, COLONOSCOPY	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Anterior Resection - Rectum and Anus/Large Intestine Open / Laparoscopic	S6E7.4	75000	?BIOPSY, ENDOSCOPY, CT- SCAN, COLONOSCOPY	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Anterior Resection With Ileostomy Open / Laparoscopic	S6E7.5	75000	CT- SCAN/ USG, COLONOSCOPY	?Biopsy,Post Procedure Clinical Photograph, Usg	-
Surgical Gastroenterology	S6E	Small Intestine	S6E1	Bariatric Procedures	S6E1.3	100000	Blood Investigations, Preop Photo	Scar Photo, Operation notes. Barcode of stapler	-
Surgical Gastroenterology	S6E	Gall Bladder	S6E11	Cholecystectomy & Exploration CBD	S6E11.4	40000	?CT/USG, LFT	?Post Procedure Clinical Photograph,Usg,T-Tube Cholangiogram Post Op Hp For Claim	-
Surgical Gastroenterology	S6E	Gall Bladder	S6E11	Choledochoduodenostomy Or Choledocho Jejunostomy Or Hepaticojejunostomy	S6E11.3	50000	?USG, MRCP LFT required for pre auth	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Liver	S6E2	Cyst Excision + Hepatic Jejunostomy	S6E2.7	45000	?CT/USG	Histopath, Clinical Photograph	-
Surgical Gastroenterology	S6E	Stomach	S6E5	Distal Gastrectomy or Gastrojejunostomy For Gastric Outlet Obstruction	S6E5.4	40000	?BIOPSY,USG,ENDOSCOPY,CT- SCAN	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Extended Right Hemicolectomy	S6E7.3	50000	?CT- SCAN/USG COLONOSCOPY	?Biopsy,Post Procedure Clinical Photograph, Usg	-
Surgical Gastroenterology	M14	Oesophagus Injuries	M14V1	Gastro Study Followed By Thoracotomy And Repairs For Oesophageal Injury For Corrosive Injuries/FB	M14V1.21	50000	Gastroscopy	Post Procedure Endoscopic Picture
Surgical Gastroenterology	S6E	Gall Bladder	S6E11	GB+ Calculi CBD Stones Or Dilated CBD	S6E11.1	25000	USG	Post Treatment Evidence Of Clinical Improvement And Usg	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Hartman.S Procedure With Colostomy (for Obstruction)	S6E7.7	45000	?BIOPSY, ENDOSCOPY, CT- SCAN, COLONOSCOPY	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Liver	S6E2	Hydatid Cyst- Excision or Pericystectomy Open / Laparoscopic	S6E2.6	30000	?USG / CT- SCAN	?Biopsy, Clinical Photograph	-
Surgical Gastroenterology	S6E	Ulcerative Colitis Ii Stage Procedure	S6E9	I Stage- Sub Total Colectomy + Ileostomy + J - Pouch	S6E9.1	80000	?COLONOSCOPY	?Biopsy, Clinical Photograph	-
Surgical Gastroenterology	S6E	Ulcerative Colitis Iii Stage Procedure	S6E8	I Stage-Sub Total Colectomy + Ileostomy	S6E8.1	50000	?COLONOSCOPY	?Biopsy, Clinical Photograph	-
Surgical Gastroenterology	S6E	Ulcerative Colitis Ii Stage Procedure	S6E9	II Stage- Ileostomy	S6E9.2	20000	?COLONOSCOPY	?Clinical Photograph	-
Surgical Gastroenterology	S6E	Ulcerative Colitis Iii Stage Procedure	S6E8	II Stage-J - IPAA with Ileostomy	S6E8.2	30000	CLINICAL PHOTOGRAPH , COLONOSCOPY (submitted during stage I)	? Clinical Photograph	-
Surgical Gastroenterology	S6E	Ulcerative Colitis Iii Stage Procedure	S6E8	Ileostomy Closure	S6E8.3	20000	?CT Scan contrast/ USG	?Biopsy, Post Procedure Clinical Photograph, Usg	-
Surgical Gastroenterology	S6E	Oesophagus	S6E4	Lap Fundoplications	S6E4.5	45000	ENDOSCOPY	?Biopsy,Endoscopic Photograph Mandatory	-
Surgical Gastroenterology	S6E	Oesophagus	S6E4	Lap Heller?s Myotomy	S6E4.4	30000	ENDOSCOPY	Biopsy,Endoscopic Photograph Mandatory	-
Surgical Gastroenterology	S6E	Pancreas	S6E3	Lap- Pancreatic Necrosectomy	S6E3.6	100000	?CT- SCAN	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Pancreas	S6E3	Lateral Pancreaticojejunostomy(Non- Malignant)/FREYS PROCEDURE	S6E3.7	100000	?CT- SCAN	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Left Hemicolectomy Open	S6E7.2	30000	?BIOPSY, CT- SCAN, COLONOSCOPY	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Laparoscopic Surgery	S6E1	Left Hemicolectomy Laparoscopic	S6E1.1	50000	CT/USG, Colonoscopic Biopsy report	Scar photo. HPR	-
Surgical Gastroenterology	S6E	Surgical Gastro Enterology	S6E13	Oesophageal Diverticula /Achlasia Cardia	S6E13.1	40000	Barium studies / CT scan	Usg /Scar Photo
Surgical Gastroenterology	S6E	Oesophagus	S6E4	Oesophagectomy	S6E4.2	60000	?BIOPSY, ENDOSCOPY, CT- SCAN	?Clinical Photograph,Usg	-
Surgical Gastroenterology	S6E	Oesophagus	S6E4	Oesophago-Gastrectomy	S6E4.3	75000	?BIOPSY, ENDOSCOPY, CT- SCAN	Biopsy,Endoscopic Photograph Mandatory.	-
Surgical Gastroenterology	S6E	Pancreas	S6E3	Pancreatic Necrosectomy (Open)	S6E3.8	100000	?CT- SCAN serum amylase required for pre auth	?Biopsy, Post Procedure Clinical Photograph	-
Surgical Gastroenterology	S6E	Stomach	S6E5	Partial Gastrectomy	S6E5.1	40000	?BIOPSY, USG, Endoscopic photograph mandatory	Histopath,Clinical Photograph	-
Surgical Gastroenterology	S6E	Large Intestine	S6E7	Right Hemicolectomy	S6E7.1	30000	?BIOPSY, CT- SCAN, COLONOSCOPY	?Biopsy,Clinical Photograph	-
Surgical Gastroenterology	S6E	Liver	S6E2	Rt/Lt Hepatectomy	S6E2.1	75000	?CT, USG	?Clinical Photograph, Usg, Biopsy	-
Surgical Gastroenterology	S6E	Liver	S6E1	Shunt/Devascularization Surgery for PHT	S6E1.2	60000	CT Angio	Scar Photo, Operation notes. Barcode of stapler if used	-
Surgical Gastroenterology	S6E	Spleen	S6E12	Spleenectomy For Space Occupying Lesion/Portal Hypertension/ Hypersplenism etc	S6E12.3	35000	?CT / USG	Clinical Photograph, Usg , Hp Req At The Time Of Claim.	-
Surgical Gastroenterology	S6E	Stomach	S6E5	Surgery For Corrosive Injury Stomach/Esophagus	S6E5.5	60000	ENDOSCOPY /Sketch	Clinical Photograph	-
Surgical Gastroenterology	S6E	Stomach	S6E5	Total Gastrectomy	S6E5.2	50000	?BIOPSY,USG,ENDOSCOPY,CT- SCAN	Histopath,Post Proceedure Clinical Photograph For Claim	-
Surgical Gastroenterology	S6E	Small Intestine	S6E6	Volvulus	S6E6.1	35000	?CT- SCAN/X-RAY ABD	Post Procedure Clinical Photograph Req At The Time Of Claim	-
Surgical Gastroenterology	S6E	Pancreas	S6E3	Whipples Any Type	S6E3.3	140000	?CT/ USG,Clinical Photograph	?Biopsy,Post Procedure Clinical Photograph, Usg	-
Surgical Gastroenterology / General Surgery	S6E	Small Intestine	S6E6	Lap Adhesiolysis	S6E6.3	40000	?CT- SCAN/X-RAY ABD	Post Procedure Clinical Photograph, Usg Req At The Time Of Claim	-
Surgical Oncology	S11	Ca Abdominal Wall Tumour	S11J16	Abdominal Wall Tumour Resection	S11J16.1	35000	?BIOPSY/FNAC, CT/MRI/USG	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J10	Abdomino Perineal Resection (Apr) + Sacrectomy	S11J10.4	50000	?BIOPSY, CT, COLONOSCOPY (optional)	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J12	Abdominoperineal Resection	S11J12.5	40000	?CT, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Adrenal Gland	S11J24	Adrenalectomy	S11J24.2	50000	IMAGING -CT,SERUM METARPHINES, SERUM HORMETAMERPHINES, SERUM CORTIZOL	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours	S11J34	Amputation for soft tissue/Bone Tumours	S11J34.3	60000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J12	Anterior Resection	S11J12.4	40000	?CT, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Urinary Bladder/ Ca - Cervix/Rectum	S11J25	Anterior/Posterior Exenteration	S11J25.1	60000	Biospy, Cystoscopy, CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Axillary Dissection	S11J32.2	15000	?BIOPSY, FNAC, Clinical Photograph	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Gynecology	S11J17	Bilateral Pelvic Lymph Node Dissection(BPLND)	S11J17.1	45000	CT, FNAC, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Urinary Bladder	S11J25	Bilateral Pelvic Lymph Node Dissection(BPLND) for CA Urinary Bladder	S11J25.3	20000	?CT / PATHOLOGY OF PRIMARY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Bone Resection	S11J22.8	30000	BIOPSY, MRI/X-ray	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Breast Reconstruction	S11J32.5	25000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours. Chest Wall	S11J20	Chest Wall Resection	S11J20.1	20000	BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Chest Wall Resection	S11J32.6	20000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours. Chest Wall	S11J20	Chest Wall Resection + Reconstruction	S11J20.2	30000	BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skull base surgery	S11J39	Clival tumor excision	S11J39.14	59700	CT/MRI,HPR	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Ca GIT	S11J10	Closure Of Ileostomy	S11J10.2	20000	Clinical photograph	?Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J12	Colectomy Any Type	S11J12.3	40000	?CT/ USG, ENDOSCOPY, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Composite Resection & Reconstruction	S11J1.1	60000	?BIOPSY,X-Ray Chest, CT scan	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca - Eye/ Maxilla /Para Nasal Sinus	S11J2	Cranio Facial Resection	S11J2.4	70000	??BIOPSY/ CLINICAL AND RADIOLOGICAL EVIDENCE	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Curettage & Bone Cement	S11J22.7	30000	BIOPSY / OR CLINICO RADIOLOGICAL C/O MALIGNANCY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Surgical Oncology	S11J6	Enucleation of pancreatic neoplasm(Other than Neck of Pancreas)	S11J6.3	25000	?CT ,required for pre auth FNAC/ tumour marker	?Biopsy,Post Procedure Clinical Photograph, Usg	-
Surgical Oncology	S1P	General Surgery	S1PM1	Estlander Operation (lip)	S1PM1.46	22000	Clinical Photograph, clinical notes	Scar Photo	-
Surgical Oncology	S1P	Surgical Oncology	S1PM1	Excision of Growth from Tongue	S1PM1.9	25000	Clinical photo	HPE	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	External Hemipelvectomy	S11J22.5	55000	BIOPSY, radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Regional flap	S11J39	Fasciocutaneous flap	S11J39.11	78400	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Forequarter Amputation	S11J22.4	40000	BIOPSY	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oral Cavity	S11J37	Full Thickness Buccal Mucosal Resection & Reconstruction	S11J37.4	50000	Biopsy, CT/MRI(affected area)	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J12	Gastrectomy Any Type	S11J12.2	40000	?CT/ USG, ENDOSCOPY, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Gastro Jejunostomy	S11J29.9	35000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Gastrostomy	S11J29.3	20000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Liver	S11J38	Haemangioma SOL Liver Hepatectomy + Wedge Resection	S11J38.1	75000	?CT- SCAN, USG, FNAC & Tumour marker	?Biopsy, Clinical Photograph	-
Surgical Oncology	S11	Haemostatic Radiotherapy	S11J39	Haemostatic surgery in advanced cancer patient or Haemostatic Radiotherapy	S11J39.1	50000	Evidence of advanced Malignancy, Clinical photo	Intraoperative photo, Clinical documents	-
Surgical Oncology	S11	Head And Neck	S11J1	Hemiglossectomy	S11J1.4	15000	?BIOPSY,X-Ray Chest	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Hemimandibulectomy	S11J1.10	25000	?BIOPSY, OPG/CT scan X-RAY AT TIME OF PREAUTH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Hepatoblastoma	S11J39	Hepatoblastoma - Excision	S11J39.6	102400	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Ileostomy	S11J29.5	20000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Ileotransverse Colostomy	S11J29.10	50000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Intercostal Drainage(ICD)	S11J29.8	3000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Internal Hemipelvectomy	S11J22.6	65000	BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	GIT Malignancy	S11J39	Intersphinctoric Resection Open/ Laparoscopic	S11J39.5	105300	HPR, Clinical photo	Surgery notes. Post op HPR	-
Surgical Oncology	S11	Head And Neck	S11J1	Laryngectomy Any Type	S11J1.8	40000	?BIOPSY, clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Laryngo Pharyngo Oesophagectomy	S11J1.9	75000	?BIOPSY, CT X-RAY AT TIME OF PREAUTH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Ear	S11J5	Lateral Temporal Bone Resection	S11J5.2	30000	Biopsy/FNAC/ Clinical and Radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Muscle tumours	S11J39	Leiomyoma Excision	S11J39.8	100000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Limb Salvage Surgery With Custom Made Prosthesis	S11J22.2	50000	BIOPSY, CT/MRI	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Limb Salvage Surgery With Modular Prosthesis	S11J22.3	75000	BIOPSY, CT/MRI	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Limb Salvage Surgery Without Prosthesis	S11J22.1	40000	BIOPSY, CT/MRI	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Lumpectomy Breast	S11J32.4	3000	?BIOPSY, Clinical Photograph	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Lung	S11J27	Lung Cancer Lobectomy	S11J27.5	50000	CT THORAX, BIOPSY/ CYTOLOGY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Lung	S11J27	Lung Cancer Pnumenectomy	S11J27.4	50000	CT THORAX, BIOPSY/ CYTOLOGY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Lung	S11J27	Lung Metastatectomy. Multiple	S11J27.2	88000	?CT THORAX	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Lung	S11J27	Lung Metastatectomy. Solitary	S11J27.1	60000	?CT THORAX	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S1A	General Surgery	S1A15	Malignant Soft Tissue Tumor ? Excision	S1A15.14	60000	CT,FNAC	BIOPSY,CLINICAL PHOTOGRAPH	-
Surgical Oncology	S11	Oral Cavity	S11J37	Marginal Mandibulectomy	S11J37.1	25000	Biopsy, CT/MRI(affected area)	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Mastectomy Any Type	S11J32.1	25000	?BIOPSY, FNAC, Clinical Photograph	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca - Eye/ Maxilla /Para Nasal Sinus	S11J2	Maxillectomy + Infratemporal Fossa Clearance	S11J2.3	40000	??BIOPSY/ CLINICAL AND RADIOLOGICAL EVIDENCE	Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca - Eye/ Maxilla /Para Nasal Sinus	S11J2	Maxillectomy + Orbital Exenteration	S11J2.2	35000	??BIOPSY/ CLINICAL AND RADIOLOGICAL EVIDENCE	Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Maxillectomy Any Type	S11J1.5	25000	?BIOPSY, clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Thorax, Mediastinum	S11J26	Mediastinal Tumour Resection	S11J26.1	50000	CECT THORAX, CT BX/ TUMOUR MARKER	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Reconstruction	S11J30	Micro Vascular Reconstruction (Free flap)	S11J30.2	60000	Clinical indications, Clinical Photograph	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Reconstruction	S11J30	Myocutaneous / Cutaneous Flap	S11J30.1	25000	Clinical indications, Clinical Photograph	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Neck Dissection Any Type	S11J1.3	25000	?BIOPSY, clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Surgical Oncology	S11J6	Oesophageal stenting including stent cost	S11J6.2	40000	Biopsy Report, Clinical & Radiological Evidence of Oesophageal Malignancy	Sticker along with evidence of stent placement	-
Surgical Oncology	S11	Ca GIT	S11J12	Oesophagectomy Any Type	S11J12.1	60000	?CT, ENDOSCOPY, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oesophagus	S11J28	Oesophagectomy With Three Field Lymphadenectomy	S11J28.2	100000	CT THORAX, ENDOSCOPY, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oesophagus	S11J28	Oesophagectomy With Two Field Lymphadenectomy	S11J28.1	90000	CT THORAX, ENDOSCOPY, BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skull base surgery	S11J39	Orbital decompression	S11J39.13	38300	CT/MRI,HPR	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Ca - Eye/ Maxilla /Para Nasal Sinus	S11J2	Orbital Exenteration	S11J2.1	25000	?BIOPSY/ CLINICAL AND RADIOLOGICAL EVIDENCE	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca - Soft Palate	S11J4	Palatectomy Any Type	S11J4.1	30000	?Biopsy, CT scan	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Parathyroid	S11J9	Parathyroidectomy	S11J9.2	30000	?CT, S.PTH, NUCLEAR SCAN	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Genitourinary	S11J23	Partial Nephrectomy	S11J23.1	55000	RADIOLOGICAL ONDE OF MALIGNANCY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Gall Bladder	S11J13	Radical / Revision Cholecystectomy	S11J13.1	80000	BIOPSY, Clinical and radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	OBGY	S11J39	Radical Trachelectomy	S11J39.9	71600	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Gynecology	S11J17	Radical Vaginectomy and /or Reconstruction	S11J17.4	57800	?BIOPSY/ CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Nasopharynx	S11J3	Resection Of Nasopharyngeal Tumour	S11J3.1	50000	Biopsy/Clinical and radiological evidence?	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Retroperitoneal Tumors	S11J15	Resection Of Retroperitoneal Tumours	S11J15.1	45000	Biopsy, Clinical and radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Abdominal Wall Tumour	S11J16	Resection With Reconstruction of Abdominal Wall Tumour	S11J16.2	45000	?BIOPSY/FNAC, CT/MRI/USG	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Testis Cancer	S11J24	Retro Peritoneal Lymph Node Dissection Rplnd As Part Of Staging	S11J24.4	20000	PATHOLOGY IF PRIMARY OR NODES, CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Testis Cancer	S11J24	Retro Peritoneal Lymph Node Dissection(RPLND) (For Residual Disease)	S11J24.1	60000	?CT ABDOMEN THORAX PELVIS, TUMOUR MARKERS	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Bone tumours	S11J39	Sacral tumor Excision	S11J39.10	80000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Gynecology	S11J31	Salpino Oophorectomy	S11J31.6	25000	?BIOPSYUSG/CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oral Cavity	S11J37	Segmental Mandibulectomy	S11J37.2	25000	Biopsy, CT/MRI(affected area)	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Liver	S11J38	Segmentectomy	S6E2.3	50000	?CT, USG, FNAC/ tumour marker	?Clinical Photograph, Usg, Biopsy	-
Surgical Oncology	S11	Limb Salvage Surgery	S11J22	Shoulder Girdle Resection	S11J22.9	40000	BIOPSY, CT/MRI	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skin Tumours	S11J33	Skin Tumours Amputation	S11J33.3	20000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skin Tumours	S11J33	Skin Tumours Wide Excision	S11J33.1	10000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skin Tumours	S11J33	Skin Tumours Wide Excision + Reconstruction	S11J33.2	20000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skull base surgery	S11J39	Skull base surgery Fisch / Translabyrynthine / Transcochlear approach	S11J39.16	59900	CT/MRI,HPR	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Ca Lung	S11J27	Sleeve Resection Of Lung Cancer	S11J27.3	90000	CT THORAX, BIOPSY/ CYTOLOGY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca GIT	S11J10	Small Bowel Resection	S11J10.1	40000	clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Spleen	S11J14	Splenectomy	S11J14.1	35000	BIOPSY, Clinical and radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Surgical Oncology	S11J6	Submandibular Gland Excision	S11J6.1	20000	Biopsy/FNAC/ Clinical and Radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Skull base surgery	S11J39	Subtotal petrosectomy	S11J39.15	37100	CT/MRI,HPR	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Ca Ear	S11J5	Subtotal Temporal Bone Resection	S11J5.3	50000	Biopsy/FNAC/ Clinical and Radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Gynecology	S11J31	Surgery For Ca Ovary - Omentectomy, Bilateral Salping oophorectomy	S11J31.4	50000	?BIOPSY ,USG/CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J1	Thyroidectomy Any Type	S11J1.6	60000	?BIOPSY/FNAC, clinical & radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Endometrium	S11J19	Total Abdominal Hysterectomy(TAH) + Bilateral Salpingo Ophorectomy (BSO) + Bilateral Pelvic Lymph Node Dissection (BPLND) + Omentectomy	S11J19.1	35000	?CT, ENDOMETRIAL BIOPSY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Rectum	S11J11	Total Exenteration	S11J11.2	75000	?BIOPSY, CT/ COLONOSCOPY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Urinary Bladder	S11J25	Total Exenteration	S11J25.2	75000	?BIOPSY,CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oral Cavity	S11J37	Total Glossectomy + Reconstruction	S11J37.3	40000	Biopsy, CT/MRI(affected area)	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Cervix	S11J18	Total Pelvic Exenteration	S11J18.4	75000	?BIOPSY,CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Genitourinary	S11J23	Total Penectomy	S11J23.7	25000	?BIOPSY /CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Ear	S11J5	Total Temporal Bone Resection	S11J5.4	60000	Biopsy/FNAC/ Clinical and Radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Ca Trachea	S11J8	Tracheal Resection with or without carinal resection	S11J8.2	116200	?Biopsy, CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Oesophageal or Tracheal stenting	S11J39	Tracheal stenting	S11J39.4	99200	HPR, Clinical photo	Procedure video, Surgery notes, Stent sticker	-
Surgical Oncology	S11	Palliative Surgeries	S11J29	Tracheostomy for all malignancies	S11J29.1	5000	?CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Testis Cancer	S11J24	Urinary Diversion	S11J24.3	40000	INMAGING TO SHOW EVIDENCE OF URINARY OBSTRUCTION OR INVOLVEMENT OF LOWER URINARY TRACT IN MALIGNANCY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Spinal Surgeries	S11J39	Vertebral tumor excision and reconstruction	S11J39.12	120000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology	S11	Surgical Oncology	S11PM1	Voice prosthesis (US FDA /CE approved)	S11PM1.1	20000	Evidence of Laryngectomy	Evidence of Use of Prosthesis	-
Surgical Oncology	S11	Gynecology	S11J31	Vulvectomy with reconstruction	S11J31.5	87000	?BIOPSY /ENDOSCOPY, USG/CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Gynec Oncosurgery	S11J39	Wertheim's Hysterectomy	S11J39.3	40000	HPR and CT	Scar photo.Post op HPR	-
Surgical Oncology	S11	Ca GIT	S11J12	Whipples Any Type	S11J12.6	140000	BIOPSY, Clinical and radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours	S11J34	Wide Excision + Reconstruction soft tissue/Bone Tumours	S11J34.2	25000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours	S11J34	Wide Excision for tumour	S11J34.4	25000	?BIOPSY, radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Breast	S11J32	Wide Excision of Breast for Tumour	S11J32.3	5000	?BIOPSY, FNAC, Clinical Photograph, Mamography	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Head And Neck	S11J39	Wide Excision of Tumor	S11J39.2	15000	Biopsy and CT Neck	Scar photo. Post operative HPR	-
Surgical Oncology	S11	Soft Tissue/ Bone Tumours	S11J34	Wide Excision soft tissue/Bone Tumours	S11J34.1	15000	?BIOPSY, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology	S11	Wilm's Tumour	S11J39	Wilm's tumour surgery	S11J39.7	68400	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	ENT	S11J39	Central airway tumor debulking	S11J39.19	42100	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	Lip	S11J39	Cheek advancement	S11J39.22	45000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S2P	ENT	S2PM1	Endoscopic Hypophysectomy	S2PM1.24	59700	CT Scan Skull	Clinical Notes, CT Scan Skull	-
Surgical Oncology / ENT	S2P	ENT	S2PM1	Excision of Pinna for Growths (Squamous/Basal) / Injuries - Total amputation	S2PM1.2	10000	Clinical Photograph	Post procedure evidance of Surgery	-
Surgical Oncology / ENT	S11	Lip	S11J39	Excision of tumor of oral cavity or paranasal sinus or Laryngopharynx with reconstruction	S11J39.24	50000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	Lip	S11J39	Excision of tumor of oral cavity or paranasal sinus or Laryngopharynx without reconstruction	S11J39.23	15000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S2B	ENT Surgery	S2B4	Facial Nerve Decompression	S2B4.7	37100	Clinical photo of facial palsy	Clinical Photo after 2 months
Surgical Oncology / ENT	S11	Skull base surgery	S11J39	Maxillary swing	S11J39.27	38300	CT/MRI,HPR	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	ENT	S11J39	Mediastinal tumour or Lymphadenectomy	S11J39.20	118000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	ENT	S11J39	Open laryngeal framework surgery or Thyroplasty	S11J39.25	6300	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S2B	Throat	S2B2	Parapharyngeal Tumour Excision	S2B2.5	40000	?CT- SCAN /MRI SCAN, FNAC	??histopath,Post Procedure Clinical Photograph
Surgical Oncology / ENT	S11	Head And Neck	S11J1	Parotidectomy Any Type	S11J1.7	25000	?BIOPSY, X- RAY, USG, CLINICAL PHOTOGRAPH	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / ENT	S11	ENT	S11J39	Selective pharyngeal diverticulum excision	S11J39.26	28200	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	ENT	S11J39	Total Pharyngectomy	S11J39.17	80900	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S11	ENT	S11J39	Tracheal stenosis (End to end anastamosis)	S11J39.18	60000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / ENT	S2B	Head And Neck	S2B5	Wedge Excision	S2B5.17	30000	?CLINICAL PHOTOGRAPH	?histopath, Post Procedure Clinical Photograph	-
Surgical Oncology / ENT	S11	Lip	S11J39	Wedge excision and Vermilionectomy	S11J39.21	45000	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / General surgery	S11	Anorectal	S11J39	Excision of rectal polyp	S11J39.28	12500	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / General surgery	S11	Palliative Surgeries	S11J29	Jejunostomy	S11J29.4	20000	?CLINICAL PHOTOGRAPH, Biopsy	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / General surgery	S1P	General Surgery	S1PM1	Scalp tumour Excision with skull bone excision	S1PM1.35	53400	Clinical Photo	Scar Photo	-
Surgical Oncology / Neurosurgery	S10	Soft Tissue and Vascular Injuries	S10I9	Decompression/Excision Of Optic Nerve Lesions	S10I9.4	65000	?MRI/ CT	?Post Procedure Clinical Photograph/CT/MRI
Surgical Oncology / Pediatric Surgery	S8G	Head And Neck	S8G3	Neuroblastoma	S8G3.1	50000	?Imaging / biopsy	Usg,?Biopsy,Post Procedure Clinical Photograph	-
Surgical Oncology / Surgical Gastroenterology	S6E	Oesophagus	S6E4	Colonic Pull Up / Gastric Pull Up	S6E4.1	50000	?BIOPSY, ENDOSCOPY, CT- SCAN	?Clinical Photograph,Usg	-
Surgical Oncology / Surgical Gastroenterology	S6E	Pancreas	S6E3	Distal Pancreatectomy	S6E3.1	100000	?CT required for pre auth	?Biopsy,Post Procedure Clinical Photograph, Usg	-
Surgical Oncology / Surgical Gastroenterology	S6E	Pancreas	S6E3	Distal Pancreatectomy + Splenectomy	S6E3.9	110000	?CT- SCAN	?Biopsy,Clinical Photograph	-
Surgical Oncology / Surgical Gastroenterology	S11	Ca GIT	S11J12	Other Bypasses-Pancreas and others	S11J12.8	50000	?BIOPSY, Clinical and radiological evidence	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Surgical Gastroenterology	S11	Ca GIT	S11J12	Triple Bypass	S11J12.7	50000	?BIOPSY, Clinical and radiological evidence	Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Bilateral Orchidectomy	S11J23.12	20000	BONESCAN, TUMOUR MARKER	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Emasculation	S11J23.4	30000	BIOPSY / IMAGING - CTSCAN OR MRI	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	High Orchidectomy	S11J23.11	15000	TUMOUR MARKERS, CT ABDO PELVIS	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Inguinal Block Dissection One Side	S11J23.9	30000	?CLINICAL PHOTOGRAPH/ BIOPSY/ FNAC	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Nephroureterectomy For Transitional Cell Carcinima Of Renal Pelvis Open / Lap	S11J23.2	50000	PATHOLOGY / URINE CYTOLOGY/ BIOPSY, radiological evidence	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Other Cystectomies	S11J23.6	40000	?BIOPSY,	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Radical Cystectomy	S11J23.5	110000	?BIOPSY, CT ABDO PELVIS	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Radical Nephrectomy	S11J23.3	40000	RADIOLOGICAL ONDE OF MALIGNANCY	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Genitourinary	S11J23	Radical Prostatectomy	S11J23.10	60000	IMAGING - MRI, BIOPSY / FLUNDE PET CT	?Hpe, Operative Notes, Post Procedure Clinical Photograph	-
Surgical Oncology / Urology	S11	Urology	S11J39	Germ cell tumor excision	S11J39.31	53400	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / Urology	S11	Urology	S11J39	Partial Cystectomy	S11J39.32	39300	HPR	Surgery notes, Post op HPR	-
Surgical Oncology / Urology	S11	Urology	S11J39	Radical Urethrectomy	S11J39.30	58400	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / Urology	S11	Urology	S11J39	Ureteric End to end anastamosis	S11J39.29	52800	HPR, Clinical photo	Surgery notes, Post op HPR	-
Surgical Oncology / Urology	S11	Genitourinary	S11K13	Penile preserving Surgery (WLE, Glansectomy, Laser)	S11K13.13	44000			-
Surgical Oncology / Urology	S9H	Urology Corrective Procedures	S9H8	Distal ureterectomy with Reimplantation	S9H8.6	53400	?IVP/ MCU, USG	Intra Op Photo, Post Op Xray
Surgical Oncology/ Cardiac And Cardiothoracic Surgery	S7F	CVTS Lungs	S7F18	Pleurectomy Decortication	S7F18.3	70000	CT Chest	Clinical Photo / Xray	-
Urology	S9H	Urology Corrective Procedures	S9H8	Vasico Vaginal Fistula	S9H8.1	40000	IVP/MCU, Scopy	Clinical Notes,
Urology	S9H	Urology	S9H7	Varicocele-unilateral	S9H7.13	15000	Clinical photograph, USG	Clinical photograph	-
Urology	S9H	Urology	S9H7	Varicocele-bilateral	S9H7.12	20000	Clinical photograph, USG	Clinical photograph	-
Urology	S9H	Lithotripsy	S9H4	URSL	S9H4.4	30000	USG/KUB/IVP/ CT Abd	X Ray/Usg, Clinical Photo
Urology	S9P	Urology (Genitourinary System)	S9PM1	Urinary tract trauma Repair Open/Laparoscopy	S9PM1.22	20000	CT ABDOMEN	USG, CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Urethrovaginal fistula repair (independent procedure)	S9PM1.18	30000	RGU/MCU /URETEROSCOPY	Clinical photograph	-
Urology	S9H	Corrective Procedures	S9H5	Urethroplasty For Stricture Urethra Single Stage	S9H5.1	50000	RGU	Post Procedure Evidence Of Clinical Photograph	-
Urology	S9H	Corrective Procedures	S9H5	Urethroplasty For Stricture Urethra Double Stage Stage-2	S9H5.3	30000	Clinical photo & RGU(submitted during stage I) is mandatory for preauth	Post Procedure Evidence Of Clinical Photograph
Urology	S9H	Corrective Procedures	S9H5	Urethroplasty For Stricture Urethra Double Stage Stage-1	S9H5.2	30000	RGU	Post Procedure Evidence Of Clinical Photograph
Urology	S9P	Urology (Genitourinary System)	S9PM1	Urethral Dilatation- as an independent procedure	S9PM1.12	2500	RGU	Clinical photograph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Uretero-vaginal/uterine fistula repair Open	S9PM1.11	40000	USG, IVP/CT	USG, CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Uretero-ureterostomy Open	S9PM1.7	25000	USG, IVP/CT IVP	USG, CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Ureterotomy (Cutaneous)	S9PM1.9	20000	Usg	CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Ureterocalycostomy Open	S9PM1.6	30000	USG, IVP/CT IVP	USG, CLINICAL PHOTOGRAPH	-
Urology	S9H	Urology	S9H7	Ultrasound guided Perinephric Abscess drainage	S9H7.11	15000	USG	Usg	-
Urology	S9H	Urology Corrective Procedures	S9H8	Transurethral Resection Of Prostate (TURP) / Bladder neck incision	S9H8.9	40000	USG with prostate size, USG WITH POST VOID VOLUME AT TIME OF PREAUTH	Biopsy, Post Op Specimen Photo
Urology	S9H	Bladder Prostate	S9H9	Total Cystectomy / Radical cystectomy	S9H9.4	35000	USG, CT abd	Post Procedure Evidence Of Usg Biopsy Clinical Photo
Urology	S9H	Urology, Testis And Penis	S9H2	Torsion Testis	S9H2.2	15000	?USG	?Post Procedure Clinical Photograph
Urology	S9H	Urology	S9H7	Surgery for correction of ureteric stricture (Ureteric Reimplantation) Unilateral	S9H7.10	60000	USG, IVP/CT	USG, CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Surgery for Bladder injury repair with or without urethral injury (as an independent procedure)	S9PM1.16	25000	USG/CT/RGU/MCU	Clinical photograph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Suprapubic Drainage - Closed/Trocar	S9PM1.17	3000	USG/RGU	Clinical photograph	-
Urology	S9H	Transplantation	S9H1	Renal Transplantation Surgery Including cost of 4,50,000 1. Renal transpalntation - 150000 2. AV fistula - 20000 3. Doner's Nephrectomy - 50000 4. Recipient Investigations such as Blood investigations, HLA typing, CT Scan, Miturating Cystourethrogram	S9H1.2	310000	?RFT, USG, All legal formalities of transplantation of Human Organs Act shall be completed.	Ot Notes, ?Post Procedure Clinical Photograph/ Usg	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Reduction of Paraphimosis	S9PM1.25	2000	Clinical Notes, Clinical Photograph	Clinical Notes, Clinical Photograph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Post Urethral Valve fulguration	S9PM1.23	10000	RGU /MCU	Clinical photograph	-
Urology	S9H	Urology Corrective Procedures	S9H8	Perineal Urethrostomy	S9H8.5	25000	X-Ray, RGU	Post Procedure Evidence Of Clinical Picture
Urology	S9H	Lithotripsy	S9H6	PCNL or RIRS or Push back PCNL for upper ureretic calculus more than 1 cm	S9H6.9	40000	USG/KUB/IVP/ CT Abd	X Ray/Usg, Clinical Photo	-
Urology	S9H	Lithotripsy	S9H4	PCNL or RIRS or Push back PCNL for upper ureretic calculus less than 1 cm	S9H4.2	30000	USG/KUB/IVP/ CT Abd	X Ray/Usg, Clinical Photo
Urology	S9P	Urology (Genitourinary System)	S9PM1	Partial Cysteectomy / Urachal Cyst excision -open	S9PM1.28	25000	USG	USG, CLINICAL PHOTOGRAPH	-
Urology	S9H	Urology, Testis And Penis	S9H2	Orchidopexy Bilateral	S9H2.1	15000	?USG/ Clinical photograph	?Post Procedure Clinical Photograph
Urology	S8G	Urogenital	S8G6	Laparoscopic Orchidopexy Bilateral	S8G6.6	60000	USG,Clinical Photograph	Clinical Photograph,Usg,Video	-
Urology	S9H	Urology Corrective Procedures	S9H8	Optical Urethrotomy	S9H8.4	20000	RGU	Post Procedure Evidence Of Intra Operative Endoscopic Picture
Urology	S9H	Urology	S9H6	Open Ureterolithotomy	S9H6.11	35000	USG / CT scan	Scar photo	-
Urology	S9H	Urology	S9H7	Open simple Nephrectomy	S9H7.3	45000	USG / CT scan	Post Procedure Evidence Of Usg, Biopsy
Urology	S9	Urology Kidney Stone	S9H3	Open Pyelolithotomy	S9H3.1	50000
Urology	S9H	Urology	S9H6	Open Prostatectomy (Millin's )	S9H6.2	40000	X ray, USG, IVP/ CT abd, Renal scan	Clinical Photo	-
Urology	S9H	Bladder Prostate	S9H9	Open Prostatectomy (Freyer's )	S9H9.2	35000	USG with prostate size, PSA	Biopsy, Post Op Specimen Photo
Urology	S9H	Urology	S9H6	Open Partial Nephrectomy	S9H6.8	45000	USG, CT scan	Post Procedure Evidence Of Usg, Biopsy	-
Urology	S9H	Renal Calculi	S9H3	Open Nephrolithotomy	S9H3.2	40000	USG/KUB/IVP/ CT Abd	X Ray/Usg, Clinical Photo
Urology	S9H	Urology	S9H6	Open Nephrectomy Radical	S9H6.7	40000	USG, CT scan	Post Procedure Evidence Of Usg, Biopsy	-
Urology	S9	Genitourinary System	S9H3	Open Cystolithotomy	S9H3.3	15000	USG - Abdomen/CT Scan	Scar Photo
Urology	S9H	Urology Kidney Stone	S9H10	Open Anderson Hynes Pyeloplasty	S9H10.2	50000	X ray, USG, IVP/ CT abd	Clinical Photo
Urology	S9	Adrenal Gland	S9H8	Open Adrenalectomy	S9H8.10	45000			-
Urology	S9H	Urology	S9H7	Nephrostomy	S9H7.1	10000	?IVP/USG/CT Abd	?Usg/Xray Post Op Photo Of Nephrostomy Required For Claim
Urology	S9H	Urology	S9H7	Nephrectomy Pyonephrosis/XGP	S9H7.2	40000	?IVP, USG/CT Abd urine routine microscopy mandatory for pre auth.	?Usg/ Biopsy
Urology	S9P	Urology (Genitourinary System)	S9PM1	Meatotomy	S9PM1.4	3500	Clinical photograph, Clinical Notes	Clinical photograph, Clinical Notes	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Meatoplasty	S9PM1.3	5000	Clinical photograph, Clinical Notes	Clinical photograph, Clinical Notes	-
Urology	S9H	Urology	S9H6	Laparoscopic Ureterolithotomy	S9H6.3	45000	USG / CT scan	Post op USG	-
Urology	S9H	Urology	S9H6	Laparoscopic simple Nephrectomy	S9H6.10	50000	USG / CT scan	Post Procedure Evidence Of Usg, Biopsy	-
Urology	S9H	Urology	S9H7	Laparoscopic Renal Cyst Excision	S9H7.8	20000	?USG/CT Abd	?Usg, Biopsy, Intra Op Photo
Urology	S9H	Renal Calculi	S9H3	Laparoscopic Pyelolithotomy	S9H3.4	40000	USG/KUB/IVP/ CT Abd	X Ray/Usg, Clinical Photo
Urology	S9H	Urology	S9H6	Laparaoscopic Anderson Hynes Pyeloplasty	S9H6.1	60000	X ray, USG, IVP/ CT abd, Renal scan	Clinical Photo	-
Urology	S9H	Urology	S9H7	Lap. Partial Nephrectomy	S9H7.6	50000	USG, CT scan	Post Procedure Evidence Of Usg, Biopsy
Urology	S9H	Urology	S9H7	Lap. Nephrectomy Radical	S9H7.5	45000	USG, CT scan	Post Procedure Evidence Of Usg, Biopsy
Urology	S9P	Urology (Genitourinary System)	S9PM1	Intravesical BCG/Mitomycin 6 induction cycles (weekly for 6 weeks-total cost of 6 cycles)	S9PM1.13	15000	Histopathplogy report	Clinical photograph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Internal Ureterotomy including cystoscopy as an independent procedure	S9PM1.24	10000	RGU	Clinical photograph	-
Urology	S9H	Urology Corrective Procedures	S9H8	Ileal Conduit formation	S9H8.7	30000	CT abd	Post Procedure Evidence Of Clinical Photograph
Urology	S9H	Corrective Procedures	S9H5	Hypospadius Single Stage	S9H5.5	40000	Clinical Photograph	Post Procedure Evidence Of Clinical Photograph	-
Urology	S9H	Corrective Procedures	S9H5	Hypospadius Double Stage - Stage-2	S9H5.7	35000	Clinical Photograph	Post Procedure Evidence Of Clinical Photograph
Urology	S9H	Corrective Procedures	S9H5	Hypospadius Double Stage - Stage-1	S9H5.6	35000	Clinical Photograph	Post Procedure Evidence Of Clinical Photograph
Urology	S9H	Corrective Procedures	S9H5	Hypospadius Adult Double Stage - TURBT	S9H5.8	30000	Clinical photgraph	Clinical Photgraph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Excision of Urethral Caruncle	S9PM1.26	4000	Clinical photograph	Clinical photograph	-
Urology	S9H	Lithotripsy	S9H4	ESWL	S9H4.3	20000	USG/KUB/IVP/ CT Abd	During Procedure Photo . X Ray/Usg
Urology	S9H	Urology Corrective Procedures	S9H6	Epispadiasis - Correction - Stage 2	S9H6.6	45000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph	-
Urology	S9H	Urology Corrective Procedures	S9H8	Epispadiasis - Correction - Stage 1	S9H8.2	45000	?CLINICAL PHOTOGRAPH	?Post Procedure Clinical Photograph
Urology	S9P	Urology (Genitourinary System)	S9PM1	Endoureterotomy (laser/bugbee)	S9PM1.10	25000	USG, IVP/CT	USG, CLINICAL PHOTOGRAPH	-
Urology	S9H	Urology Corrective Procedures	S9H8	Endoscopic Ureterocele incision	S9H8.8	20000	X Ray/ IVP/MCU	Post Procedure Evidence Of Intra Operative Clinical Photograph
Urology	S9H	Urology	S9H7	Endoscope Removal Of Stone In Bladder	S9H7.9	20000	USG/KUB/IVP/ CT Abd	?Endoscopic Photograph, Usg/Xray Kub
Urology	S9P	Urology (Genitourinary System)	S9PM1	Endopyelotomy (anterograde with laser/bugbee)	S9PM1.5	30000	IVP	USG, CLINICAL PHOTOGRAPH	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Emergency management of Acute retention of Urine	S9PM1.27	2000	USG	USG, CLINICAL PHOTOGRAPH	-
Urology	S9H	Urology	S9H6	DJ Stent removal Unilateral / Bilateral	S9H6.5	2000	Preaoperative X Ray	Post operative X ray	-
Urology	S9H	Lithotripsy	S9H4	DJ Stent (One Side)	S9H4.6	5000	USG/KUB/IVP/ CT Abd	?X- Ray
Urology	S9H	Urology Corrective Procedures	S9H8	Closure Of Urethral Fistula	S9H8.3	25000	?Retrograde Urethrogram, Clinical photograph	?Post Procedure Clinical Photograph
Urology	S9H	Urology, Testis And Penis	S9H2	Chordee Correction (Plication)	S9H2.3	20000	Clinical photo	Post Procedure Evidence Of Clinical Photograph
Urology	S9H	Urology, Testis And Penis	S9H6	Chordae Correction (Patch)	S9H6.4	50000	Precorrection photo	Intraoperative photo and post discharge correction photo	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Bladder Neck Reconstruction	S9PM1.19	20000	USG, MCU / CYSTOSCOPY	Clinical photograph	-
Urology	S9P	Urology (Genitourinary System)	S9PM1	Bladder Neck incision-endoscopic	S9PM1.15	15000	USG	USG, CLINICAL PHOTOGRAPH	-
Urology	S9	Urology (Genitourinary System)	S9PM1	Augmentation cystoplasty	S9PM1.2	40000			-
Speciality Name	Speciality Code	Sub Speciality Name	Sub Speciality Code	Surgery Name	Surgery Code	Package Amount	Mandatory Document at the Time of Preauth	Mandatory Document at the Time of Claim	Clinical Protocol Guidelines

9987229960

Surgery List

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