Sl. No 1 2 3 4 5 Category Burns Burns Burns Burns Burns Category Code Sub Category S13 S13 S13 S13 S13 Burns Above 50% Burns Above 50% Burns Above 50% Burns Above 50% Burns Above 50% Sub Category Code S13N1 S13N1 S13N1 S13N1 S13N1 Procedures Procedure 100% code Rates Up To -50% Mixed Burns( With Surgeries) Up To -60% With Scalds ( Conservative) Upto-50% With Scalds(Conservative) Up To -40% With Scalds ( Conservative) Above 60% Mixed Burns( With Surgeries) S13N1.4 S13N1.5 S13N1.3 S13N1.1 S13N1.7 70000 80000 60000 35000 120000 S13N2 Moderate Contracture Surgeries For Functional Improvement (including splints, pressure garments And Physiotherapy) S13N2.2 30000 6 Burns S13 Burns Post Burn Contracture Surgeries For Functional Improvement (Package And Physiotherapy) 7 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 S13N2 Mild Contracture Surgeries For Functional Improvement (including splints, pressure garments And Physiotherapy) S13N2.1 20000 8 Burns S13 Burns Post Burn Contracture Surgeries For Functional Improvement (Package And Physiotherapy) 9 10 Burns Burns S13 S13 Burns Above 50% Burns Above 50% S13N1 S13N1 Up To -60% Mixed Burns( With Surgeries) Upto-40% Mixed Burns( With Surgeries) S13N1.6 S13N1.2 100000 50000 11 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Surgery Without Graft For Arterial Injuries, Venous Injuries S7F24.1 10000 12 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 S7F24.4 20000 13 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 S7F24.3 60000 14 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Vascular Injury In Upper Limbs – Axillary,Branchial,Radial And Ulnar - Repair With Vein Graft - Payable maximum upto S7F24.2 40000 15 Cardiac And Cardiothoracic Surgery S7 Cvts Chest S7F20 Diaphragmatic Eventeration S7F20.1 40000 16 Cardiac And Cardiothoracic Surgery S7 S7F19 Transpleural BPF Closure S7F19.4 50000 17 Cardiac And Cardiothoracic Surgery S7 S7F19 Myoplasty S7F19.3 50000 18 Cardiac And Cardiothoracic Surgery S7 Cvts Chest S7F20 Diaphragmatic Hernia S7F20.2 40000 19 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 ASD Device Closure S7F1.3 80000 20 Cardiac And Cardiothoracic Surgery S7 Diaphragmatic Injuries S7F21 Thoracotomy, Thoraco Abdominal Approach S7F21.1 40000 Surgical Correction Of Bronchopleural Fistula Surgical Correction Of Bronchopleural Fistula Minor Vascular Injury Repair- Tibial Vessels In Leg - Payable maximum upto Major Vascular Injury -In Lower Limbs-Repair - Payable maximum upto Sub Category Code Procedure 100% code Rates Sl. No Category Category Code 21 Cardiac And Cardiothoracic Surgery S7 Cvts Chest S7F20 Oesophageal Diverticula /Achlasia Cardia S7F20.3 40000 22 Cardiac And Cardiothoracic Surgery S7 Surgical Correction Of Bronchopleural Fistula S7F19 Thorocoplasty S7F19.2 50000 23 Cardiac And Cardiothoracic Surgery S7 Cvts Lungs S7F18 Pneumonectomy S7F18.1 50000 24 Cardiac And Cardiothoracic Surgery S7 Cvts Valve Repairs S7F17 Open Mitral Valvotomy S7F17.4 80000 25 Cardiac And Cardiothoracic Surgery S7 Cvts Valve Repairs S7F17 Closed Mitral Valvotomy S7F17.3 20000 26 Cardiac And Cardiothoracic Surgery S7 Cvts Lungs S7F18 Lobectomy S7F18.2 50000 27 Cardiac And Cardiothoracic Surgery S7 Cvts Lungs S7F18 SOL Mediastinum S7F18.5 50000 28 Cardiac And Cardiothoracic Surgery S7 Cvts Lungs S7F18 Lung Cyst S7F18.4 50000 29 Cardiac And Cardiothoracic Surgery S7 Cvts Lungs S7F18 Decortication S7F18.3 50000 30 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Ruptured Sinus Of Valsalva Correction S7F13.13 95000 31 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Surgery For Intracardiac Tumours S7F13.12 75000 32 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 TAPVC Correction S7F13.14 95000 33 Cardiac And Cardiothoracic Surgery S7 Systemic Pulmonary Shunts S7F14 Systemic Pulmonary Shunts Without Graft S7F14.2 20000 34 Cardiac And Cardiothoracic Surgery S7 Systemic Pulmonary Shunts S7F14 Systemic Pulmonary Shunts With Graft S7F14.1 20000 35 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Valve Repair With Prosthetic Ring S7F13.17 100000 36 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 TGA Arterial Switch S7F13.9 150000 37 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoro-Femoral Bypass Without Graft S7F13.8 25000 38 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 TGA Sennings Procedure S7F13.10 120000 39 Cardiac And Cardiothoracic Surgery S7 Ross Procedure Intracardiac Repair Of Complex Congenital Heart Diseases S7F16 Ross procedure - Intracardiac repair of complex congenital heart diseases Without Special Conduits S7F16.1 95000 40 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Carotid Embolectomy S7F13.11 50000 Sub Category Procedures Sub Category Code Procedure 100% code Rates Sl. No Category Category Code 41 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoroileal Bypass With Graft S7F13.5 45000 42 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoroileal Bypass Without Graft S7F13.6 25000 43 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoro Popliteal Bypass Without Graft S7F13.4 30000 44 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Aorto-Aorto Bypass Without Graft S7F13.2 45000 45 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoro Popliteal Bypass With Graft S7F13.3 45000 46 Cardiac And Cardiothoracic Surgery S7 Bronchial Injuries S7F22 Bronchial Foreign Body Removal With Scope S7F22.1 20000 47 Cardiac And Cardiothoracic Surgery S7 Surgical Correction Of Bronchopleural Fistula S7F19 Intracardiac Repair Of ASD S7F19.1 75000 48 Cardiac And Cardiothoracic Surgery S7 Systemic Pulmonary Shunts S7F14 Total Correction Of Tetralogy Of Fallots S7F14.3 95000 49 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Intracardiac Repair Of VSD S7F13.15 75000 50 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Femoro-Femoral Bypass With Graft S7F13.7 45000 51 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Surgery-PDA S7F13.16 20000 52 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 CABG On Pump Without IABP S7F6.1 125000 53 Cardiac And Cardiothoracic Surgery S7 Cardiac Injuries S7F12 Surgery With CPB S7F12.2 75000 54 Cardiac And Cardiothoracic Surgery S7 Cardiac Injuries S7F12 Surgery Without CPB S7F12.1 40000 55 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 Mitral Valve Replacement (With Valve) S7F6.4 120000 56 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 CABG With Aneurysmal Repair S7F6.3 110000 57 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 CABG Off Pump Without IABP S7F6.2 100000 58 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Carotid Artery Bypass With Synthetic Graft S7F9.17 100000 59 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 PDA Stenting S7F1.5 65000 60 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 PDA Device Closure S7F1.6 60000 Sub Category Procedures Sub Category Code Procedure 100% code Rates Sl. No Category Category Code 61 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 Coil Closure Single Coil S7F1.7 20000 62 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Carotid Body Tumour Excision S7F9.16 45000 63 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Brachioradial Bypass With Synthetic Graft S7F9.15 50000 64 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 VSD Device Closure S7F1.4 80000 65 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Intrathoracic Aneurysm-Aneurysm Not Requiring Bypass (With Graft) S7F11.4 65000 66 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Aneurysm Resection & Grafting S7F11.3 125000 67 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Coarctation Of Aorta Repair Without Graft S7F11.2 25000 68 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Annulus Aortic Ectasia With Valved Conduits S7F11.7 150000 69 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Dissecting Aneurysms S7F11.6 75000 70 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Intrathoracic Aneurysm-Aneurysm Requiring Bypass (With Graft) S7F11.5 125000 71 Cardiac And Cardiothoracic Surgery S7 Coarctation Of Aorta Repair S7F11 Coarctation Of Aorta Repair With Graft S7F11.1 32000 72 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Double Valve Replacement (With Valve) S7F9.3 150000 73 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Tricuspid Valve Replacement S7F9.2 120000 74 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Aortic Valve Replacement (With Valve) S7F9.1 120000 75 Cardiac And Cardiothoracic Surgery S7 Pericardium S7F10 Pericardiocentesis S7F10.2 2000 76 Cardiac And Cardiothoracic Surgery S7 Pericardium S7F10 Percardectomy S7F10.1 30000 77 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Percardiostomy S7F9.4 10000 78 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 A V Fistula At Elbow S7F9.21 20000 79 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 A V Fistula At Wrist S7F9.20 10000 80 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Arterial Embolectomy S7F9.19 20000 Sub Category Procedures Sub Category Code Procedure 100% code Rates Sl. No Category Category Code 81 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Small Arterial Aneurysms - Repair S7F9.7 15000 82 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Vascular Tumours S7F9.6 40000 83 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 D V T - IVC Filter S7F9.5 100000 84 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Excision Of AV Malformation Small S7F9.18 40000 85 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 Coronary Bypass Surgery On Pump With IABP S7F6.5 150000 86 Cardiac And Cardiothoracic Surgery S7 Angioplasty S7F5 Vertebral Angioplasty S7F5.3 75000 87 Cardiac And Cardiothoracic Surgery S7 Angioplasty S7F5 Peripheral Angioplasty S7F5.2 60000 88 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Excision Of AV Malformation Large S7F9.22 75000 89 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Peripheral Embolectomy Without Graft S7F9.23 25000 90 Cardiac And Cardiothoracic Surgery S7 Cad S7F6 Coronary Bypass Surgery Off Pump With IABP S7F6.6 125000 91 Cardiac And Cardiothoracic Surgery S7 S7F4 Coarctation Of Aorta Repair With Stent S7F4.1 80000 92 Cardiac And Cardiothoracic Surgery S7 S7F4 Coarctation Of Aorta Repair Without Stent S7F4.2 30000 93 Cardiac And Cardiothoracic Surgery S7 Angioplasty S7F5 Renal Angioplasty S7F5.1 60000 94 Cardiac And Cardiothoracic Surgery S7 Cardiology S7F1 Coil Closure Multiple Coils S7F1.8 30000 95 Cardiac And Cardiothoracic Surgery S7 Cardiology Balloon Procedures S7F2 Balloon Valvotomy S7F2.1 20000 96 Cardiac And Cardiothoracic Surgery S7 Cardiology Balloon Procedures S7F2 Balloon Atrial Septostomy S7F2.2 30000 97 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Axillo Brachial Bypass Using With Synthetic Graft S7F9.14 65000 98 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Aorto Billac - Bifemoral Bypass With Synthetic Graft S7F9.10 125000 99 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Medium Size Arterial Aneurysms With Synthetic Graft S7F9.9 75000 100 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Medium Size Arterial Aneurysms - Repair S7F9.8 50000 Sub Category Coarctation Of Aorta Repair / Aortoplasty Coarctation Of Aorta Repair / Aortoplasty Procedures Sl. No Category Category Code Sub Category Sub Category Code Procedures Procedure 100% code Rates 101 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Femorodistal Bypass With Synthetic Graft S7F9.13 80000 102 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Femorodistal Bypass With Vein Graft S7F9.12 60000 103 Cardiac And Cardiothoracic Surgery S7 Valve Replacement S7F9 Axillo Bifemoral Bypass With Synthetic Graft S7F9.11 100000 104 Cardiac And Cardiothoracic Surgery S7 Cvts S7F13 Aorto-Aorto Bypass With Graft S7F13.1 60000 105 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Neck Vascular Injury - Carotid Vessels - Payable maximum upto S7F24.8 100000 106 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Vascular Injuries Repair With Prosthetic Graft S7F24.7 40000 107 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Surgery With Vein Graft S7F24.6 15000 108 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Abdominal Vascular Injuries - Aorta, Iliac Arteries, IVC, Iliac Veins - Payable maximum upto S7F24.9 100000 109 Cardiac And Cardiothoracic Surgery S7 Cvts Valve Repairs S7F17 Open Pulmonary Valvotomy S7F17.2 75000 110 Cardiac And Cardiothoracic Surgery S7 Cvts Valve Repairs S7F17 Valve Repair Without Prosthetic Ring S7F17.1 85000 111 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 Thoracic Vascular Injuries - Payable maximum upto S7F24.10 150000 112 Cardiac And Cardiothoracic Surgery S7 Vascular Injuries S7F24 113 Cardiac And Cardiothoracic Surgery S7 Oesophagus Injuries S7F23 114 Cardiac And Cardiothoracic Surgery S7 Bronchial Injuries S7F22 115 Cardiac And Cardiothoracic Surgery S7 Ross Procedure Intracardiac Repair Of Complex Congenital Heart Diseases 116 117 118 119 120 121 122 123 124 125 M7 M7 M7 M7 M7 M7 M7 M7 M7 M7 Cardiology Cardiology Angioplasty Cardiology Cardiology Angioplasty Cardiology Pacemaker Implantation Cardiology Pacemaker Implantation Angioplasty Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Minor Vascular Injury Repair - Vessels In Foot - Payable maximum upto Gastro Study Followed By Thoracotomy And Repairs For Oesophageal Injury For Corrosive Injuries/FB S7F24.5 20000 S7F23.1 50000 Bronchial Injuries Due To Foreign Body Repair Surgery S7F22.2 40000 S7F16 Ross procedure - Intracardiac repair of complex congenital heart diseases With Special Conduits S7F16.2 125000 M7T1 M7T1 M7F1 M7T1 M7T1 M7F1 M7F3 M7F3 M7F1 M7T1 Refractory Cardiac Failure Infective Endocarditis Coronary Ballon Angioplasty Pericardial Effusion Tamponade Simple Arrhythmias PTCA Additional Stent Temporary Pacemaker Implantation Permanent Pacemaker Implantation Angioplasty with Stent(PTCA with Stent) Pulmonary Embolism M7T1.5 M7T1.6 M7F1.1 M7T1.10 M7T1.9 M7F1.2 M7F3.2 M7F3.1 M7F1.3 M7T1.7 50000 25000 60000 25000 70000 20000 10000 75000 20000 30000 Sl. No 126 127 128 129 Category Sub Category Sub Category Code M7T1 M7T1 M7T1 M7T1 M7 M7 M7 M7 Cardiology Cardiology Cardiology Cardiology 130 Critical Care M3 Critical Care M3Q1 131 Critical Care M3 Critical Care M3Q1 132 Critical Care M3 Critical Care 133 Critical Care M3 Critical Care 134 Critical Care M3 Critical Care 135 Critical Care M3 Critical Care 136 Critical Care M3 Critical Care 137 Critical Care M3 Critical Care 138 Dermatology 139 Dermatology M11 M11 Dermatology Dermatology 140 Dermatology M11 Dermatology S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 S2 Nose Throat Throat Throat Throat Ear Hearing Aid Ear Ear Throat Nose Nose Nose Throat Throat Nose Nose Nose 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 Cardiology Cardiology Cardiology Cardiology Category Code ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery ENT Surgery Procedures Acute MI Requiring IABP Pump Thrombolytic Therapy for Acute MI Acute MI With Cardiogenic Shock Complex Arrhythmias Acute Bronchitis And Pneumonia With Respiratory Failure, Ventilator 10 Days Stay M7T1.4 M7T1.11 M7T1.3 M7T1.8 50000 15000 30000 95000 M3Q1.3 50000 Septic Shock(ICU Management) With Ventilatory Assistance M3Q1.8 50000 M3Q1.6 120000 M3Q1.7 30000 M3Q1.4 65000 M3Q1.1 45000 M3Q1.2 70000 M3Q1.5 100000 M11T5.1 M11T5.2 30000 20000 M11T5.3 25000 S2B3.4 S2B2.2 S2B2.5 S2B2.4 S2B2.1 S2B1.2 S2P1.1 S2B1.3 S2B1.1 S2B2.6 S2B3.2 S2B3.3 S2B3.1 S2B2.7 S2B2.3 S2B3.7 S2B3.6 S2B3.5 15000 25000 20000 20000 12000 20000 5000 50000 20000 10000 15000 15000 15000 25000 20000 20000 40000 15000 ARDS Plus DIC (Blood & Blood Products) With Ventilatory Care OP Poisoning Requiring Ventilatory Assistance Clinical Photo M3Q1 - 1 Week Stay M3Q1 ARDS With Ventilatory Care 14 Days Stay Acute Severe Asthma With Acute Respiratory Failure 10 Days M3Q1 Stay COPD Respiratory Failure (Infective Exacerbation)14 Days M3Q1 Stay with ventilator support ARDS With Multi Organ Failure With Ventilatory Care 14 M3Q1 Days Stay M11T5 Toxic Epidermal Necrolysis 15 Days Stay M11T5 Stevens- Johnson Syndrome 15 Days Stay Pemphigus / Pemphigoid Tzanck Clinical Protocol 15 Days M11T5 Stay S2B3 Stapedectomy + Veingraft S2B2 Phono Surgery For Vocal Cord Paralysis S2B2 Parapharyngeal Tumour Excision S2B2 Excision Of Tumours In Pharynx S2B2 Microlaryngeal Surgery S2B1 Facial Nerve Decompression S2P1 Behind The Ear Analogue Hearing Aid S2B1 Temporal Bone Excision S2B1 Labyrinthectomy S2B2 Adenoidectomy - Gromet Insertion S2B3 Mastoidectomy S2B3 Tympanoplasty S2B3 Endoscopic Sinus Surgery S2B2 Uvulo-Palato Pharyngoplasty S2B2 Laryngo Fissurectomy S2B3 Endoscopic DCR S2B3 Angiofibroma Nose S2B3 Excision Of Benign Tumour Nose M3Q1 Procedure 100% code Rates Sl. No Category 159 ENT Surgery Category Code S2 Sub Category Ent Sub Procedures Category Code S2B4 Bronchoscopic Foreign Body Removal Procedure 100% code Rates S2B4.1 20000 160 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Cholecystitis - Abd 10 Days Stay M13U1.3 25000 161 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Pyelonephritis 10 Days Stay M13U2.4 20000 162 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Lower Respiratory Tract Infection 10 Days Stay M13U1.1 20000 163 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Fungal Sinusitis Pns 10 Days Stay M13U1.2 40000 164 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Hypopitutarism - 1 Week Stay M13U1.6 100000 Cushings Syndrome Inv - Cortisol Assay After Dexamethasone, Acth Assay, Dheas, Mri Ituitary Ctabd, Ct M13U2.2 M13U2 Chest, Dexa Of Hip Spine 1 Week Stay With Post Treatment Evidence Of Clinical And Lab Investigations Delayed Puberty Hypogonadism (Ex.Turners Synd, Kleinfelter M13U2 M13U2.3 Synd) 5 Days Stay 30000 165 Endocrinology M13 Other Endocrinal Disorders 166 Endocrinology M13 Other Endocrinal Disorders 167 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Cavernous Sinus Thrombosis 10 Days Stay M13U1.4 40000 168 Endocrinology M13 Endocrinology Uncontrolled Diabetes Mellitus With Infectious Emergencies M13U1 Rhinocerebral Mucormycosis 10 Days Stay M13U1.5 40000 169 170 171 172 173 Endocrinology GENERAL MEDICINE GENERAL MEDICINE GENERAL MEDICINE GENERAL MEDICINE M13 M16 M16 M16 M16 Other Endocrinal Disorders Critical Care Gen Medicine Critical Care Gen Medicine Critical Care Gen Medicine Critical Care Gen Medicine M13U2 M16Q1 M16Q1 M16Q1 M16Q1 M13U2.1 M16Q1.1 M16Q1.6 M16Q1.7 M16Q1.8 15000 20000 30000 50000 25000 174 GENERAL MEDICINE M16 Critical Care Gen Medicine M16Q1 M16Q1.5 20000 175 GENERAL MEDICINE M16 Critical Care Gen Medicine M16Q1 M16Q1.9 30000 176 GENERAL MEDICINE M16 Critical Care Gen Medicine M16Q1 M16Q1.2 50000 177 GENERAL MEDICINE M16 Critical Care Gen Medicine M16Q1 M16Q1.4 20000 Pituitary - Acromegaly 1 Week Stay Thrombocytopenia With Bleeding Diathesis TB Meningitis Snake Bite Requiring Ventilator Support Scorpion Sting Requiring Ventilator Support Cerebral Malaria (Falciparum) requiring Ventilatory support and treatment with Blood and Platelet Transfusion, IV antibiotics, IV fluids, Mefloquine, IV quinine or IV artesunate, Paracetamol, Metabolic Coma Requiring Ventilatory Support Haemophilia treatment with IV FPP, Factor VIII /Cryoprecipitate Chelation Therapy For Thalassemia 12000 Sl. No Category Category Code Sub Category Sub Category Code Procedures Other Coagulation Disorders with Von Wili Brand Factor: treatment with IV FPP, Factor VIII /Cryoprecipitate Achalasia Cardia - One Day Stay Obscure GI Bleed - 1 Week Stay Cirrhosis With Hepatic Encephalopathy -11 Days Stay Acute Pancreatitis (Severe) -3 Weeks Stay - Payable maximum upto Chronic Pancreatitis With Severe Pain - 7 Days Stay - Payable maximum upto Cirrhosis With Hepato Renal Syndrome - 10 Days Stay Biliary Stricture 3) Sclerosing Cholangitis 7 Days Stay Oesophageal Perforation- 7 Days Stay Biliary Stricture 1) Post Op Stent 7 Days Stay Oesophageal Varices, Variceal Banding One Day Stay Oesophageal Foreign Body One Day Stay Corrosive Oesophageal Injury 7 Days Stay Oesophageal Varices, Sclerotherapy- One Day Stay Biliary Stricture 2) Post Op Leaks 7 Days Stay Acute Pancreatitis (Mild) - 1 Week Stay With Post Treatment Evidence Of - Payable maximum upto Oesophageal Fistula -3 Days Stay GAVE (Gastric Antral Vascular Ectasia) - 2 Days Stay Acute Pancreatitis With Pseudocyst (Infected) 3 Weeks Stay Payable maximum upto Gastric Varices 3 Days Stay 178 GENERAL MEDICINE M16 Critical Care Gen Medicine M16Q1 179 Gastroenterology 180 Gastroenterology 181 Gastroenterology M14 M14 M14 Gastroenterology Gastroenterology Gastroenterology M14V1 M14V1 M14V1 182 Gastroenterology M14 Gastroenterology M14V1 183 Gastroenterology M14 Gastroenterology M14V1 184 185 186 187 188 189 190 191 192 Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology M14 M14 M14 M14 M14 M14 M14 M14 M14 Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology Gastroenterology M14V1 M14V1 M14V1 M14V1 M14V1 M14V1 M14V1 M14V1 M14V1 193 Gastroenterology M14 Gastroenterology M14V1 194 Gastroenterology 195 Gastroenterology M14 M14 Gastroenterology Gastroenterology M14V1 M14V1 196 Gastroenterology M14 Gastroenterology M14V1 197 Gastroenterology M14 M14V1 198 General Surgery S1 Gastroenterology Abdomen Stomach, Duodenum, Jejunum 199 General Surgery S1 Abdomen Small Intestine S1A8 200 201 202 203 204 General Surgery General Surgery General Surgery General Surgery General Surgery S1 S1 S1 S1 S1 S1A8 S1A8 S1A8 S1A8 S1A8 205 General Surgery S1 S1A7 206 General Surgery S1 207 General Surgery S1 208 General Surgery S1 Abdomen Small Intestine Abdomen Small Intestine Abdomen Small Intestine Abdomen Small Intestine Abdomen Small Intestine Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Small Intestine Operations For Recurrent Intestinal Obstruction (Noble Plication Other) Operation For Haemorrhage Of The Small Intestine Resection & Anastomosis Of Small Intestine Ileostomy Closure Ileostomy Operation For Acute Intestinal Perforation Procedure 100% code Rates M16Q1.3 50000 M14V1.3 7000 M14V1.13 50000 M14V1.14 30000 M14V1.10 150000 M14V1.12 20000 M14V1.15 M14V1.18 M14V1.2 M14V1.16 M14V1.4 M14V1.1 M14V1.20 M14V1.5 M14V1.17 40000 75000 25000 50000 10000 5000 20000 5000 75000 M14V1.9 75000 M14V1.6 M14V1.7 30000 20000 M14V1.11 30000 M14V1.8 15000 S1A7.7 40000 S1A8.5 35000 S1A8.4 S1A8.6 S1A8.8 S1A8.7 S1A8.3 40000 35000 20000 20000 30000 Gastrostomy S1A7.9 20000 S1A7 Pyloromyotomy S1A7.8 20000 S1A7 Gastrostomy Closure S1A7.10 20000 S1A8 Operation For Acute Intestinal Obstruction S1A8.2 30000 S1A7 Partial/Subtotal Gastrectomy For Ulcer Sl. No Category Category Code 209 General Surgery S1 210 General Surgery S1 211 General Surgery S1 212 General Surgery S1 213 General Surgery S1 214 215 216 217 218 219 220 221 General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery S1 S1 S1 S1 S1 S1 S1 S1 222 General Surgery S1 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery Sub Category Abdomen Small Intestine Head And Neck Thyroid Non Malignant Head And Neck Thyroid Non Malignant Head And Neck Thyroid Non Malignant Head And Neck Thyroid Non Malignant Head And Neck Abdomen Hernia Abdomen Hernia Abdomen Hernia Abdomen Hernia Head And Neck Breast Abdomen Hernia Head And Neck Thyroid Non Malignant Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Abdomen Hernia Spleen Spleen Abdomen Large Intestine Adrenals Abdomen Large Intestine Spleen Sub Category Code S1A8 Intussusception Procedures Procedure 100% code Rates S1A8.1 30000 S1A2 Subtotal Thyroidectomy S1A2.5 20000 S1A2 Isthmectomy S1A2.2 20000 S1A2 Partial Thyroidectomy S1A2.3 20000 S1A2 Resection Enucleation S1A2.4 20000 S1A1 S1A4 S1A4 S1A4 S1A4 S1A1 S1A3 S1A4 Parathyroidectomy Femoral Hernia Hiatus Hernia Repair Abdominal Rare Hernias (Spigalion,Obuturator,Sciatic) Epigastric Hernia With Mesh Excision Of Thyroglossal Cyst Fistula Simple Mastectomy(NM) Epigastric Hernia Without Mesh S1A1.18 S1A4.3 S1A4.4 S1A4.5 S1A4.2 S1A1.19 S1A3.1 S1A4.1 30000 15000 35000 20000 30000 15000 20000 15000 S1A2 Hemithyroidectomy S1A2.1 20000 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A1 S1A4 S1A13 S1A13 S1A14 S1A12 S1A14 S1A13 Branchial Sinus Excision Hemimandibulectomy Segmental Mandible Excision Parotid Duct Repair Brachial Cyst Excision Cervical Rib Excision Removal Of Submandibular Salivary Gland Carotid Body-Tumours Excision Wedge Excision& Vermilionectomy Inv Wedge Excision Cystic Hygroma Excision-Major Vermilionectomy Partial Glossectomy Cystic Hygroma Excision-Extensive Abbe Operation Umbilical Hernia Without Mesh Splenectomy For Hypersplenism Splenorenal Anastomosis Colostomy Operation On Adrenal Glands Unilateral For Tumour Colostomy Closure Warren Shunt S1A1.5 S1A1.6 S1A1.7 S1A1.4 S1A1.1 S1A1.2 S1A1.3 S1A1.8 S1A1.13 S1A1.14 S1A1.15 S1A1.12 S1A1.9 S1A1.10 S1A1.11 S1A4.6 S1A13.1 S1A13.2 S1A14.7 S1A12.2 S1A14.8 S1A13.3 20000 25000 25000 20000 20000 15000 10000 30000 20000 15000 20000 15000 15000 20000 15000 15000 35000 60000 20000 25000 20000 60000 Sl. No 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 Category Category Code General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery General Surgery S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 S1 263 General Surgery S1 264 General Surgery S1 265 General Surgery S1 266 General Surgery S1 267 General Surgery S1 268 General Surgery S1 269 270 271 272 273 General Surgery General Surgery General Surgery General Surgery General Surgery S1 S1 S1 S1 S1 274 General Surgery S1 275 276 277 278 S1 S1 S9 S9 General Surgery General Surgery Genitourinary System Genitourinary System Sub Category Abdomen Large Intestine Abdomen Large Intestine Abdomen Large Intestine Abdomen Large Intestine Abdomen Large Intestine Adrenals Liver Gall Bladder Liver Abdomen Rectum And Anus Abdomen Rectum And Anus Gall Bladder Gall Bladder Gall Bladder Gall Bladder Gall Bladder Gall Bladder Abdomen Large Intestine Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Stomach, Duodenum, Jejunum Abdomen Hernia Abdomen Hernia Abdomen Hernia Abdomen Abdomen Head And Neck Thyroid Non Malignant Head And Neck Head And Neck Corrective Procedures Urology Corrective Procedures Sub Category Code S1A14 S1A14 S1A14 S1A14 S1A14 S1A12 S1A10 S1A11 S1A10 S1A9 S1A9 S1A11 S1A11 S1A11 S1A11 S1A11 S1A11 S1A14 Procedures Procedure 100% code Rates Operation Of The Duplication Of The Intestines Operation For Volvulus Of Large Bowel Left Hemi Colectomy Total Colectomy Right Hemi Colectomy Operation Of Adrenal Glands, Bilateral For Tumour Portocaval Anastomosis Cholecystectomy Operation For Hydatid Cyst Liver Pull Through Abdominal Resection Anterior Resection Lap.Cholecystectomy Cystogastrostomy Repair Of CBD Cystojejunostomy Cholecystectomy & Exploration CBD Lap Cholecystostomy With Exploration CBD Mal-Rotation & Volvulus Of The Midgut S1A14.3 S1A14.2 S1A14.4 S1A14.6 S1A14.5 S1A12.1 S1A10.2 S1A11.1 S1A10.1 S1A9.1 S1A9.2 S1A11.2 S1A11.6 S1A11.7 S1A11.5 S1A11.3 S1A11.4 S1A14.1 40000 35000 30000 40000 30000 40000 80000 20000 30000 30000 40000 25000 40000 25000 40000 25000 30000 35000 S1A7 Selective Vagotomy Drainage S1A7.3 40000 S1A7 Duodenal Perforation S1A7.2 20000 S1A7 Vagotomy Pyloroplasty S1A7.4 30000 S1A7 Operation For Bleeding Peptic Ulcer S1A7.6 40000 S1A7 Gastrojejunostomy & Vagotomy S1A7.5 30000 S1A7 Highly Selective Vagotomy S1A7.1 25000 S1A4 S1A4 S1A4 S1A5 S1A5 Ventral and Scar Hernia Without Mesh Umbilical Hernia With Mesh Ventral And Scar Hernia With Mesh AppendIcular Perforation Lap. Appendectomy S1A4.8 S1A4.7 S1A4.9 S1A5.2 S1A5.1 20000 25000 30000 7000 22000 S1A2 Total Thyroidectomy S1A2.6 20000 S1A1 S1A1 S9H5 S9H8 Cystic Hygroma Excision-Minor Excision Of Lingual Thyroid Hypospadius Adult Double Stage - Stage-2 Perineal Urethrostomy S1A1.16 S1A1.20 S9H5.7 S9H8.5 10000 25000 35000 20000 Sl. No Category Category Code Sub Category 279 Genitourinary System 280 Genitourinary System S9 S9 Corrective Procedures Urology Kidney Stone 281 Genitourinary System S9 Urology 282 283 284 285 Genitourinary System Genitourinary System Genitourinary System Genitourinary System S9 S9 S9 S9 Corrective Procedures Bladder Prostate Corrective Procedures Corrective Procedures 286 Genitourinary System S9 Corrective Procedures Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Urology Kidney Stone Renal Calculi Renal Calculi 299 Genitourinary System S9 Urology Testis, Testis And Penis 300 301 302 303 304 305 306 307 308 309 310 311 312 313 Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 Renal Calculi Renal Calculi Lithotripsy Lithotripsy Lithotripsy Lithotripsy Urology Testis, Testis And Penis Urology Corrective Procedures Transplantation Urology Corrective Procedures Urology Corrective Procedures Transplantation Urology Testis, Testis And Penis Urology Testis, Testis And Penis 314 Genitourinary System S9 Transplantation 287 288 289 290 291 292 293 294 295 296 297 298 Sub Procedure 100% Procedures Category code Rates Code S9H5 Hypospadius Adult Double Stage - TURBT S9H5.8 30000 S9H7 Nephrostomy S9H7.1 10000 Post-Transplant Immunosuppressive Treatment From 7th To S9H6 S9H6.1 50000 12 Th Month After Transplantation S9H5 Urethroplasty For Stricture Urethra Double Stage Stage-1 S9H5.2 30000 S9H9 Incontinence Urine (Male) S9H9.7 20000 S9H5 Urethroplasty For Stricture Urethra Double Stage Stage-2 S9H5.3 30000 S9H5 Hypospadius Adult Single Stage S9H5.5 40000 Urethroplasty For Stricture Urethra Double Stage S9H5 S9H5.4 50000 Reconstruction Procedure S9H7 Renal Cyst Excision S9H7.8 15000 S9H7 Bilateral Nephroureterectomy S9H7.7 25000 S9H7 Endoscope Removal Of Stone In Bladder S9H7.9 10000 S9H7 Anderson Hynes Pyeloplasty S9H10.2 40000 S9H7 Anatrophic Pyelolithotomy For Staghorn Calculus S9H10.1 50000 S9H7 Simple Nephrectomy S9H7.3 40000 S9H7 Nephrectomy Pyonephrosis/XGP S9H7.2 40000 S9H7 Lap. Nephrectomy Simple S9H7.4 30000 S9H7 Lap. Partial Nephrectomy S9H7.6 35000 S9H7 Lap. Nephrectomy Radical S9H7.5 40000 S9H3 Open Nephrolithotomy S9H3.2 10000 S9H3 Open Cystolithotomy S9H3.3 10000 Total Amputation Of Penis(Non- Malignant) Inv - Clinical S9H2 Photograph Post Procedure Evidence Of Clinical S9H2.5 25000 Photograph,Biopsy S9H3 Open Pyelolithotomy S9H3.1 10000 S9H3 Laparoscopic Pyelolithotomy S9H3.4 30000 S9H4 ESWL S9H4.3 20000 S9H4 URSL S9H4.4 25000 S9H4 Cystolithotripsy S9H4.1 10000 S9H4 PCNL S9H4.2 30000 S9H2 Partial Amputation Of Penis(Non- Malignant) S9H2.4 15000 S9H8 Closure Of Urethral Fistula S9H8.3 25000 S9H1 A.V. Fistula (Pretransplant Procedure Only) S9H1.1 10000 S9H8 Vasico Vaginal Fistula S9H8.1 40000 S9H8 Epispadiasis - Correction S9H8.2 40000 S9H1 Renal Transplantation Surgery S9H1.2 140000 S9H2 Torsion Testis S9H2.2 12000 S9H2 Chordae Correction S9H2.3 15000 Post-Transplant Immunosuppression Treatment From 1st To S9H1 S9H1.3 50000 6th Month After Transplantation Sl. No 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 Category Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Genitourinary System Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Category Code Sub Category S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 S9 Urology Testis, Testis And Penis Bladder Prostate Bladder Prostate Urology Corrective Procedures Bladder Prostate Bladder Prostate Bladder Prostate Bladder Prostate Urology Corrective Procedures Corrective Procedures Lithotripsy Lithotripsy Urology Corrective Procedures Urology Corrective Procedures Urology Corrective Procedures Corrective Procedures S4 Obstetrics S4 Sub Category Code S9H2 S9H9 S9H9 S9H8 S9H9 S9H9 S9H9 S9H9 S9H8 S9H5 S9H4 S9H4 S9H8 S9H8 S9H8 S9H5 Procedures Procedure 100% code Rates Orchidopexy Bilateral Open Prostatectomy TURP Cyst Lithotripsy Transurethral Resection Of Prostate (TURP) Caecocystoplasty Incontinence Urine (Female) Diverticulectomy Total Cystectomy Ureterocele Urethroplasty For Stricture Urethra Single Stage DJ Stent (One Side) Nephrostomy Optical Urethrotomy Ileal Conduit formation Ureteric Reimplantation Hypospadius Adult Double Stage - Stage-1 S9H2.1 S9H9.2 S9H9.1 S9H8.9 S9H9.3 S9H9.6 S9H9.5 S9H9.4 S9H8.8 S9H5.1 S9H4.6 S9H4.5 S9H8.4 S9H8.7 S9H8.6 S9H5.6 15000 30000 30000 30000 30000 20000 10000 35000 15000 50000 5000 2000 20000 20000 25000 35000 S4C1 Rupture Uterus S4C1.2 25000 Gynaecology S4C2 Slings With Mesh Repair For Prolapse S4C2.7 40000 S4 Gynaecology S4C2 LAVH S4C2.1 30000 S4 Obstetrics S4C1 Abruptioo Placenta With Coagulation Defect - DIC S4C1.4 20000 S4 Obstetrics S4C1 Caesarean Hysterectomy With Bladder Repair S4C1.1 30000 S4 Gynaecology S4C2 Laparoscopic Ovarian Drilling S4C2.12 15000 S4 Gynaecology S4C2 Laparoscopic Myomectomy S4C2.13 25000 S4 Gynaecology S4C2 Laparoscopic Cystectomy S4C2.10 20000 S4 Gynaecology S4C2 Laparoscopic Ectopic Resection S4C2.11 20000 S4 Gynaecology S4C2 Laparoscopic Adhesolysis S4C2.16 25000 S4 Gynaecology S4C2 Vaginal Hysterectomy S4C2.17 15000 S4 Gynaecology S4C2 Laparoscopic Recanalisation S4C2.14 20000 Sl. No 343 344 345 346 347 348 349 350 351 352 353 354 355 Category Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Gynaecology And Obstetrics Surgery Infectious Diseases Infectious Diseases Infectious Diseases Interventional Radiology Category Code Sub Category Sub Category Code Procedures Procedure 100% code Rates S4 Gynaecology S4C2 Laparoscopic Sling Operations S4C2.15 25000 S4 Gynaecology S4C2 Cystocele ,Rectocele & Perineorraphy S4C2.4 15000 S4 Gynaecology S4C2 Pelvic Floor Reconstruction With Mesh S4C2.5 15000 S4 Gynaecology S4C2 Vaginal Hysterectomy With Pelvic Floor Repair S4C2.2 15000 S4 Gynaecology S4C2 Vaginal Hysterectomy With Mesh Repair S4C2.3 20000 S4 Gynaecology S4C2 Vault Prolapse Abdominal Repair S4C2.8 20000 S4 Gynaecology S4C2 Vault Prolapse Abdominal Repair With Mesh S4C2.9 25000 S4 Gynaecology S4C2 Mc Indo-S Repair For Vaginal Atresia S4C2.6 30000 S4 Obstetrics S4C1 Eclampsia With Complication Requiring Ventilatory Support S4C1.3 20000 Tetanus Severe Diphtheria Complicated Cryptococcal Meningitis Preoperative Portal Vein Embolization For Liver Tumors Chemo Embolization For Liver Tumors Using Drug And PVA Or DC Beads Preoperative Prophylactic Tumor Embolization Peripheral Stent Graft For Peripheral Aneurysms And AV Fistulae Embolization Of Caratico-Cavernous Fistula Intracranial Arterial And Venous Stenting Embolization Of AV Malformation Of Brain Per Sitting With Onyx Carotid Stenting Single Stent With Protection Device Balloon Retrograde Transvenous Obliteration Of Bleeding Gastric Varices ( BRTO) Subclavian, Iliac, Superficial Femoral Artery Stenting Each With One Stent Deep Venous Thrombolysis For DVT With IVC Filter Tibial Angioplasty In Critical Limb Ischemia Biliary Drainage Procedures - External Drainage And Stent Placement - Single Metallic Stent M5R1.1 M5R1.2 M5R1.3 M15W1.23 20000 25000 20000 100000 M5 M5 M5 M15 Infectious Diseases Infectious Diseases Infectious Diseases Interventional Radiology M5R1 M5R1 M5R1 M15W1 356 Interventional Radiology M15 Interventional Radiology M15W1 357 Interventional Radiology M15 Interventional Radiology M15W1 358 Interventional Radiology M15 Interventional Radiology M15W1 359 Interventional Radiology 360 Interventional Radiology M15 M15 Interventional Radiology Interventional Radiology M15W1 M15W1 361 Interventional Radiology M15 Interventional Radiology M15W1 362 Interventional Radiology M15 Interventional Radiology M15W1 363 Interventional Radiology M15 Interventional Radiology M15W1 364 Interventional Radiology M15 Interventional Radiology M15W1 365 Interventional Radiology 366 Interventional Radiology M15 M15 Interventional Radiology Interventional Radiology M15W1 M15W1 367 Interventional Radiology M15 Interventional Radiology M15W1 M15W1.24 100000 M15W1.28 100000 M15W1.32 150000 M15W1.33 150000 M15W1.31 150000 M15W1.29 150000 M15W1.30 150000 M15W1.22 100000 M15W1.7 125000 M15W1.6 125000 M15W1.8 120000 M15W1.15 100000 Sl. No Category Category Code Sub Category Sub Category Code Procedures Mesenteric Artery Angioplasty & Stenting In Acute & Chronic Mesenteric Ischemia - Single Stent M15W1 Cortical Venous Sinus Thrombolysis M15W1 Inferior Vena Cava Stenting Single Stent Embolization Of AV Malformation Of Peripheral Extremity, M15W1 Craniofascial And Visceral Per Sitting M15W1 Procedure 100% code Rates 368 Interventional Radiology M15 Interventional Radiology 369 Interventional Radiology 370 Interventional Radiology M15 M15 Interventional Radiology Interventional Radiology 371 Interventional Radiology M15 Interventional Radiology 372 Interventional Radiology M15 Interventional Radiology M15W1 Hepatic Vein Stenting In Budd - Chiari Syndrome Single Stent M15W1.2 125000 373 Interventional Radiology M15 Interventional Radiology M15W1 374 Interventional Radiology M15 Interventional Radiology M15W1 375 Interventional Radiology M15 Interventional Radiology M15W1 376 Interventional Radiology M15 Interventional Radiology M15W1 377 Interventional Radiology M15 Interventional Radiology M15W1 378 Interventional Radiology M15 Interventional Radiology M15W1 379 Interventional Radiology M15 Interventional Radiology M15W1 380 Interventional Radiology M15 Interventional Radiology M15W1 381 382 383 384 Interventional Radiology Interventional Radiology Interventional Radiology Interventional Radiology M15 M15 M15 M15 Interventional Radiology Interventional Radiology Interventional Radiology Interventional Radiology M15W1 M15W1 M15W1 M15W1 385 Interventional Radiology M15 Interventional Radiology M15W1 386 Interventional Radiology M15 Interventional Radiology M15W1 387 Interventional Radiology M15 Interventional Radiology 388 Interventional Radiology M15 Interventional Radiology M15W1 Trans Jugular Intrahepatic Portosystemic Shunt (TIPSS) M15W1.26 150000 Gastrointestinal Visceral Arterial Embolization In Upper And M15W1 M15W1.10 100000 Lower Gastrointestinal Bleeding With Microcatheter 389 Medical Oncology M1 Lymphoma Nhl M1K9 390 Medical Oncology 391 Medical Oncology M1 M1 Multiple Myeloma Multiple Myeloma M1K10 Vincristin, Adriamycin,Dexamethasone (VAD) M1K10 Thalidomide+Dexamethasone(Oral) Renal Artery Embolization With Multiple Coils And Microcatheter Acute Stroke Thrombolysis With rTPA Bronchial Artery Embolization In Hemoptysis Using PVA And Micro Catheter Intra-Arterial Thrombolysis For Acute Ischemic Limbs Uterine Artery Embolization In Severe Menorrhagia Secondary To PPH, Uterine Fibroids And AVM Permanent Tunnelled Catheter Placement As Substitute For AV Fistula In Long Term Dialysis Endovascular Intervention For Salvaging Hemodialysis AV Fistula Central Venous Stenting For Central Venous Occlusion ( Brachiocephalic, Subclavian Vein And Sup Vena Cava) Single Metallic Stent Nephrostomy Tube And Nephroureteral Stent Placement Embolization Of Postoperative And Post Traumatic Bleeding Radiofrequency Tumor Ablation Therapy Inferior Vena Cava Filter Placement Percutaneous Vertebro Plasty/ Cementoplasty (For Each Level) Post Procedure Evidence Of Clinical Photograph And Radiographic Image M15W1.9 110000 M15W1.5 100000 M15W1.1 125000 M15W1.34 90000 M15W1.4 100000 M15W1.3 100000 M15W1.11 60000 M15W1.18 100000 M15W1.17 80000 M15W1.19 40000 M15W1.21 120000 M15W1.20 125000 M15W1.16 M15W1.13 M15W1.12 M15W1.14 60000 100000 120000 100000 M15W1.25 50000 Embolization Of Pulmonary AV Malformation Post Procedure M15W1.27 100000 Evidence Of Clinical Photograph And Radiographic Image Cyclophosphamide Adriamycin Vincristin Prdnisone (CHOP) M1K9.1 3500 M1K10.1 M1K10.2 4000 3000 Sl. No Category Category Code Sub Category Sub Category Code Procedures Procedure 100% code Rates M1K6.2 10000 Bone Tumors/Osteosarcoma Lymphoma, Hodgkin'S Cervix 5- Flurouracil-Oxaliplastin Leucovorin (Folfox) (Stage III Only) M1K7 Cisplastin/Adriamycin M1K8 Adriamycin Bleomycin Vinblastin Dacarbazine (ABVD) M1K13 Cervical Cancer Weekly Cisplastin M1K7.1 M1K8.1 M1K13.1 20000 4000 2000 M1 Childhood B-Cell Lymphomas M1K14 Variable Regimen Inv - Hematology - Payable maximum upto M1K14.1 12000 397 Medical Oncology M1 Neuroblastoma Stage I –Iii M1K15 M1K15.1 9000 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 M1 Multiple Myeloma Wilm'S Tumor Hepatoblastoma -Operable Colon Rectum Breast Breast Breast Breast Breast Breast Small Cell Lung Cancer Oncologyoesophagus Stomach Breast Urinary Bladder M1K10 M1K11 M1K12 M1K6 M1K1 M1K1 M1K1 M1K1 M1K1 M1K1 M1K3 M1K4 M1K5 M1K1 M1K2 M1K10.3 M1K11.1 M1K12.1 M1K6.1 M1K1.4 M1K1.5 M1K1.6 M1K1.1 M1K1.2 M1K1.3 M1K3.1 M1K4.1 M1K5.1 M1K1.7 M1K2.1 1500 7000 15000 4000 9500 1500 85 3000 3100 3000 7000 5000 5000 835 2000 413 Medical Oncology M1 Urinary Bladder M1K2 M1K2.2 5000 414 Medical Oncology M1 Retinoblastoma M1K16 M1K16.1 4000 415 Medical Oncology M1 Febrile Neutropenia Fn High Risk 2 M1K27 M1K27.2 30000 416 Medical Oncology 417 Medical Oncology 418 Medical Oncology M1 M1 M1 Vaginal Cancer Ovary Rectal Cancer Stage 2 And 3 M1K28 M1K29 M1K25 M1K28.1 M1K29.1 M1K25.1 5000 10500 4000 419 Medical Oncology M1 Multiple Myeloma M1K10 Zoledronic Acid Along With Adjuvant Chemotherapy Of AS-I M1K10.4 3000 420 Medical Oncology M1 Febrile Neutropenia Fn High Risk 2 421 Medical Oncology M1 422 Medical Oncology M1 392 Medical Oncology M1 Colon Rectum 393 Medical Oncology 394 Medical Oncology 395 Medical Oncology M1 M1 M1 396 Medical Oncology M1K6 Variable Regimen Inv - X-Ray/CT Scan - Payable maximum upto/Per month Melphalan Prednisone Oral SIOP/NWTS Regimen (Stages I III) - Per month Cisplastin Adriamycin Monthly 5-FU Paclitaxel Cyclophosphamide / Methotraxate / 5flurouracil (CMF) Tamoxifen Tabs - Per month Adriamycin/Cyclophosphamide (Ac) 5- Flurouracil A-C (FAC) AC (AC Then T) Cisplastin/Etoposide (IIIB) Cisplastin- 5FU 5-Fu Leucovorin (MCDONALD Regimen) Aromatase Inhibitors - Per month Bladder Cancer Weekly Cisplastin Methotraxate Vinblastin Adriamycin Cyclophosphamide (MVAC) Carbo/Etoposide/Vincristin 2nd Line Iv Antibiotics And Other Supportive Therapy(Carbapenems, Fourth Generation Cephalosporins, Piperacillin, Anti-Fungal . Azoles Etc.,) Cisplastin/5-FU Carboplastin/ Paclitaxel Xelox Along With Adjuvant Chemotherapy Of AS-I 1st Line Iv Antibiotics And Other Supportive Therapy ( Third Generation Cephalosporin, Aminoglycoside Etc.,) Etoposide - Methotrexate - Actinomycin / Cyclophosphamide Gestational Trophoblast Ds. High Risk M1K32 Avincristine (EMA-CO) Gestational Trophoblast Ds. Low Risk M1K27 M1K31 Actinomycin M1K27.1 9000 M1K32.1 6000 M1K31.2 3000 Sub Category Code Procedure 100% code Rates Category Code Sub Category 423 Medical Oncology M1 Gestational Trophoblast Ds. Low Risk M1K31 Weekly Methotrexate M1K31.1 600 424 425 426 427 428 429 Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology M1 M1 M1 M1 M1 M1 Ovary Germ Cell Tumour Prostate Testis Acute Myeloid Leukemia Acute Myeloid Leukemia Acute Myeloid Leukemia M1K30 M1K34 M1K33 M1K20 M1K20 M1K20 M1K30.1 M1K34.1 M1K33.1 M1K20.1 M1K20.2 M1K20.3 8000 3000 8000 60000 40000 3000 430 Medical Oncology M1 Histocytosis M1K17 Variable Regimen Inv - CT, Biopsy - Payable maximum upto M1K17.1 10000 431 Medical Oncology M1 Rhabdomyosarcoma M1K18 M1K18.1 9000 432 Medical Oncology M1 Ewing'S Sarcoma M1K19 M1K19.1 8000 433 Medical Oncology M1 Unlisted Regimen M1K22 M1K22.1 5000 434 435 436 437 438 M1 M1 M1 M1 M1 Terminally Ill Vulval Cancer Acute Lymphatic Leukemia Acute Lymphatic Leukemia Acute Lymphatic Leukemia M1K23 M1K24 M1K21 M1K21 M1K21 M1K23.1 M1K24.1 M1K21.3 M1K21.1 M1K21.2 3000 5000 3000 50000 20000 439 Nephrology M8 Nephrology M8T2 M8T2.5 15000 440 Nephrology 441 Nephrology 442 Nephrology M8 M8 M8 Nephrology Nephrology Nephrology M8T2 M8T2 M8T2 M8T2.3 M8T2.2 M8T2.4 15000 20000 35000 443 Nephrology M8 Nephrology M8T2 M8T2.6 10000 444 Neurology 445 Neurology 446 Neurology M9 M9 M9 Neurology Neurology Neurology M9T3 M9T3 M9T3 447 Neurology M9 Neurology M9T3 448 Neurology M9 Neurology M9T3 449 Neurology M9 Neurology M9T3 450 Neurology M9 Neurology M9T3 451 Neurology M9 Neurology M9T3 Sl. No Category Medical Oncology Medical Oncology Medical Oncology Medical Oncology Medical Oncology Procedures Bleomycin-Etoposide-Cisplastin (BEP) Hormonal Therapy - Per month Bleomycin-Etoposide-Cisplastin (BEP) Induction Phase - Payable maximum upto Consolidation Phase - Payable maximum upto Maintenance Phase - Per month Vincristin-Actinomycin- Cyclophosphamide (VACTC) Based Chemo - Per month Variable Regimen Inv - Hematology, Biopsy - Payable maximum upto Palliative Chemotherapy -Unlisted Regimen - Payable maximum upto per cycle Palliative And Supportive Therapy - Per month Cisplastin/5-FU Maintenance Phase - Per month Induction 1st And 2 nd Months - Payable maximum upto Induction 3rd, 4th, 5th months - Payable maximum upto Chronic Renal Failure (CRF) - 5 Days Stay for Initial treatment and Dialysis and supportive therapy Nephrotic Syndrome - 4 Days Stay Acute Renal Failure-(ARF) -10 Days Stay In MICU Rapidly Progressive Renal Failure (RPRF)10 Days Maintenance Haemodialysis For CRF- Dialysis and supportive therapy (Minimum of 8 dialysis+monthly Dialysis Panel) - Per Month Neuromuscular (Myasthenia Gravis)-15 Days Stay Immunoglobulin Therapy -5 Days Stay Optic Neuritis - Analysis 3 Days Stay Neuroinfections - Fungal Meningitis- Min 20 Days - ICU, 40 Days - Ward Stay Myopathies - Acquired NCS, 15 Days Stay Neuroinfections - Viral Meningoencephalitis (Including Herpes Encephalitis) - Min 10 Days - ICU, 7 Days - Ward Stay Neuropathies (GBS) - 10 Days – ICU 20 Days - Ward Stay Neuroinfections - Pyogenic Meningitis -Min 10 Days - ICU, 7 Days - Ward Stay M9T3.8 15000 M9T3.11 100000 M9T3.10 10000 M9T3.5 40000 M9T3.4 15000 M9T3.7 25000 M9T3.9 35000 M9T3.6 25000 Sl. No Category Category Code Sub Category 452 Neurology 453 Neurology M9 M9 Neurology Neurology 454 Neurology M9 Neurology 455 Neurology M9 Neurology 456 457 458 459 460 461 462 463 464 465 466 467 468 Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 Epilepsy Surgery Trigeminal Neuralgia Trigeminal Neuralgia Epilepsy Surgery Epilepsy Surgery Epilepsy Surgery Spine Brain Brain Brain Spine Brain Other Surgical Procedures 469 Neurosurgery S10 Other Surgical Procedures 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 Spinal Surgeries Other Surgical Procedures Other Surgical Procedures Other Surgical Procedures Spine Spine Management Of Aneurysms Management Of Aneurysms Brain Tumours Brain Tumours Spinal Surgeries Brain Tumours Brain Tumours Brain Tumours Brain Tumours Brain Tumours Brain Tumours Spinal Surgeries Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Sub Procedure 100% Procedures Category code Rates Code M9T3 ADEM Or Relapse In Multiple Sclerosis 15 Days Stay M9T3.12 20000 M9T3 CIDP -10 Days Stay M9T3.1 8000 Haemorrhagic Stroke/Strokes Management with all necessary M9T3 investigations including 4- vessel cerebral angio (DSA), & M9T3.2 25000 Surgery if necessary Ischemic Strokes-Management with all necessary M9T3 investigations including 4- vessel cerebral angio (DSA), & M9T3.3 20000 Surgery if necessary S10I10 Temporal Lobectomy Plus Depth Electrodes S10I10.4 140000 S10I11 Radiofrequency Ablation S10I11.1 30000 S10I11 Micro Vascular Decompression S10I11.2 60000 S10I10 Temporal Lobectomy S10I10.1 90000 S10I10 Lesionectomy Type 1 S10I10.2 150000 S10I10 Lesionectomy Type 2 S10I10.3 150000 S10I8 Spinal Fixation Rods And Plates, Artificial Discs S10I8.4 85000 S10I1 De-Compressive Craniotomy(Non Traumatic) S10I1.6 50000 S10I1 Endoscopy Procedures S10I1.5 65000 S10I1 Intra-Cerebral Hematoma Evacuation S10I1.7 60000 S10I8 Anterior Discectomy & Bone Grafting S10I8.1 40000 S10I1 Endoscopic Third Ventriculostomy S10I1.8 30000 S10I6 C.V. Junction Fusion S10I6.5 20000 Stereotactic Procedures - Post Procedure Evidence Of Clinical S10I6 S10I6.1 20000 Photograph S10I5 Spinal Fusion Procedure S10I5.12 50000 S10I6 Trans Sphenoidal Surgery S10I6.2 20000 S10I6 Combined Trans Oral Surgery And CV Junction Fusion S10I6.4 30000 S10I6 Trans Oral Surgery S10I6.3 25000 S10I8 Discectomy With Implants S10I8.2 65000 S10I8 Corpectomy For Spinal Fixation S10I8.3 70000 S10I12 Cost Of Each Coil S10I12.2 30000 S10I12 Embolization S10I12.1 50000 S10I2 Aneurysm Clipping S10I2.12 100000 S10I2 Excision Of Brain Abscess S10I2.11 60000 S10I5 Surgery On Cord Tumours S10I5.1 25000 S10I2 External Ventricular Drainage (EVD) S10I2.13 40000 S10I2 Ventriculoatrial Shunt S10I2.10 20000 S10I2 C.S.F. Rhinorrhoea S10I2.7 20000 S10I2 Meningomylocele S10I2.6 25000 S10I2 Meningocele Excision S10I2.9 25000 S10I2 Cranioplasty S10I2.8 30000 S10I5 Anterior Cervical Spine Surgery With Fusion S10I5.8 45000 Sl. No 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 Category Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Neurosurgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Category Code S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S10 S3 S3 S3 S3 S3 S3 Sub Category Spinal Surgeries Spinal Surgeries Spinal Surgeries Spinal Surgeries Spinal Surgeries Spinal Surgeries Spinal Surgeries Spinal Surgeries Brain Tumours Brain Tumours Brain Tumours Excision Of Brain Tumours Brain Tumours Brain Tumours Brain Brain Brain Brain Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Excision Of Brain Tumours Spinal Surgeries Soft Tissue And Vascular Injuries Soft Tissue And Vascular Injuries Soft Tissue And Vascular Injuries Spine Soft Tissue And Vascular Injuries Soft Tissue And Vascular Injuries Soft Tissue And Vascular Injuries Orbit Squint Correction Surgery Cornea Sclera Cornea Sclera Cornea Sclera Vitreo Sub Category Code S10I5 S10I5 S10I5 S10I5 S10I5 S10I5 S10I5 S10I5 S10I2 S10I2 S10I2 S10I3 S10I2 S10I2 S10I1 S10I1 S10I1 S10I1 S10I3 S10I3 S10I3 S10I3 S10I3 S10I3 S10I3 S10I3 S10I3 S10I5 S10I9 S10I9 S10I9 S10I8 S10I9 S10I9 S10I9 S3B7 S3B8 S3B5 S3B5 S3B5 S3B6 Procedures Anterior Cervical Discectomy Laminectomy Anterolateral Decompression Posterior Cervical Discectomy Spina Bifida Surgery Major Spinal Intramedullary Tumours Excision Of Cervical Intervertebral Discs Spina Bifida Surgery Minor Meningoencephalocele Brain Stem Tumour Basal Brain Tumour Other Procedures C P Angle Tumour Parasagittal Tumour Craniotomy And Evacuation Of Hematoma Extradural Craniotomy And Evacuation Of Hematoma Subdural Excision Of Lobe (Frontal, Temporal, Cerebellum Etc.) Evacuation Of Brain Abscess - Burr Hole Vascular Malformations Abscess Tapping Atrial Shunt Peritoneal Shunt Ventricular Tapping Ventriculolateral / Ventriculoperitoneal Shunt Excision Of Brain Tumours Subtentorial Subdural Tapping Twist Drill Craniotomy Discectomy Lumbar Sympathectomy Decompression/Excision Of Optic Nerve Lesions Peripheral Nerve Injury Repair Syringomyelia Repair Of Brachial Plexus Injury Cervical Sympathectomy Proptosis Enuleation With Orbital Implant Rectus Muscle Surgery Single. Corneal Patch Graft Scleral Patch Graft Penetrating Keratoplasty Removal Of Silicon Oil Or Gas Procedure 100% code Rates S10I5.7 S10I5.10 S10I5.9 S10I5.6 S10I5.3 S10I5.2 S10I5.5 S10I5.4 S10I2.5 S10I2.3 S10I2.2 S10I3.1 S10I2.4 S10I2.1 S10I1.2 S10I1.1 S10I1.4 S10I1.3 S10I3.8 S10I3.7 S10I3.10 S10I3.9 S10I3.6 S10I3.3 S10I3.2 S10I3.5 S10I3.4 S10I5.11 S10I9.3 S10I9.4 S10I9.5 S10I8.5 S10I9.1 S10I9.2 S10I9.6 S3B7.4 S3B8.1 S3B5.3 S3B5.4 S3B5.5 S3B6.5 15000 15000 30000 15000 20000 50000 25000 15000 25000 70000 60000 40000 70000 50000 40000 40000 40000 25000 40000 20000 20000 20000 15000 20000 45000 15000 15000 15000 50000 65000 40000 65000 60000 50000 60000 20000 6000 4000 6000 15000 6000 Sl. No Category Category Code Sub Category Sub Procedures Category Code S3B6 Vitrectomy Plus Silicon Oil Or Gas. S3B11 Photocoagulation For Diabetic Retinopathy Per Sitting S3B5 Double Z Plasty Monthly Intravitreal Anti-VEGF For Macular Degeneration S3B6 Per Injection (Maximum – 6) Vitrectomy - Membrane Peeling Endolaser , Silicon Oil Or S3B6 Gas S3B11 Scleral Buckle For Retinal Detachment S3B5 Amniotic Membrane Graft S3B6 Vitrectomy S3B6 Vitrectomy + Membrane Peeling+ Endolaser S3B10 Photocoagulation For Retinopathy Of Prematurity S3B9 Lid Reconstruction Surgery S3B5 Therapeutic Penetrating Keratoplasty S3B10 Pediatric Cataract Surgery - Phacoemulsification – IOL S3B10 Glaucoma Filtering Surgery For Paediatric Glaucoma S3B5 Lamellar Keratoplasty S3B8 Oblique Muscle S3B7 Orbitotomy S3B8 Rectus Muscle Surgery Two/Three S3B7 Socket Reconstruction S3B7 Dermis Fat Graft 529 Ophthalmology Surgery 530 Ophthalmology Surgery 531 Ophthalmology Surgery S3 S3 S3 Vitreo Retina Cornea Sclera 532 Ophthalmology Surgery S3 Vitreo 533 Ophthalmology Surgery S3 Vitreo 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 S3 Retina Cornea Sclera Vitreo Vitreo Pediatric Ophthalmic Surgery Lid Surgery Cornea Sclera Pediatric Ophthalmic Surgery Pediatric Ophthalmic Surgery Cornea Sclera Squint Correction Surgery Orbit Squint Correction Surgery Orbit Orbit 549 Orthopedic Surgery And Procedures S5 Orthopedics Spine Surgery S5D4 550 Orthopedic Surgery And Procedures S5 Orthopedics Bone And Joint Surgery Procedures 551 Orthopedic Surgery And Procedures S5 552 Orthopedic Surgery And Procedures Procedure 100% code Rates S3B6.6 S3B11.2 S3B5.6 20000 1500 4000 S3B6.3 7000 S3B6.4 30000 S3B11.1 S3B5.7 S3B6.1 S3B6.2 S3B10.1 S3B9.1 S3B5.1 S3B10.2 S3B10.3 S3B5.2 S3B8.3 S3B7.3 S3B8.2 S3B7.1 S3B7.2 15000 7000 6000 25000 7500 15000 15000 15000 15000 3000 6000 10000 12000 7000 9000 Spinal Ostectomy And Internal Fixations S5D2.12 40000 S5D3 Arthroscopy. Operative Meniscectomy S5D2.6 25000 Orthopedics Bone Tumours S5D6 Excision Of Bone Tumours. Deep With Re-Construction With Conventional Prosthesis S5D6.1 40000 S5 Orthopedics Soft Tissue Surgery S5D5 Operations For Brachial Plexus & Cervical Rib S5D2.15 30000 553 Orthopedic Surgery And Procedures S5 Orthopedics Spine Surgery S5D4 Costo Transversectomy S5D2.11 30000 554 Orthopedic Surgery And Procedures S5 Orthopedics Bone And Joint Surgery Procedures S5D3 Soft Tissue Reconstruction Procedures For Joints/Osteotomy S5D2.9 30000 555 Orthopedic Surgery And Procedures S5 Orthopedics Spine Surgery S5D4 Anterolateral Clearance For Tuberculosis S5D2.10 50000 556 Orthopedic Surgery And Procedures S5 Orthopedics Soft Tissue Surgery S5D5 Neurolysis/Nerve Suture S5D2.14 25000 557 Orthopedic Surgery And Procedures S5 Orthopedics Fracture Correction Surgeries S5D1 Reduction Of Compound Fractures & External Fixation S5D1.4 15000 Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Ophthalmology Surgery Sl. No Category Category Code 558 Orthopedic Surgery And Procedures S5 559 Orthopedic Surgery And Procedures S5 560 Orthopedic Surgery And Procedures S5 561 Orthopedic Surgery And Procedures S5 562 Orthopedic Surgery And Procedures S5 563 Orthopedic Surgery And Procedures Sub Category Orthopedics Fracture Correction Surgeries Orthopedics Fracture Correction Surgeries Orthopedics Fracture Correction Surgeries Orthopedics Fracture Correction Surgeries Sub Category Code Procedures Procedure 100% code Rates S5D1 Bone Grafting As Exclusive Procedure S5D1.1 20000 S5D1 Open Reduction & Internal Fixation Of Fingers & Toes @Rs5000 Each Up To Maximum Of Rs 15000 S5D1.3 15000 S5D1 Excision Or Other Operations For Scaphoid Fractures S5D1.2 15000 S5D1 Ilizarov Ring Fixator Application. S5D1.5 40000 Orthopedics S5D2 Amputations - Hind Quarter And Hemipelvectomy S5D2.3 40000 S5 Orthopedics Bone And Joint Surgery Procedures S5D3 Arthrodesis Of - Major Joints S5D2.4 30000 564 Orthopedic Surgery And Procedures S5 Orthopedics S5D2 Amputations - Forequarter S5D2.2 30000 565 Orthopedic Surgery And Procedures S5 Orthopedics Fracture Correction Surgeries S5D1 CTEV Neglected. JESS Fixator S5D1.6 30000 566 Orthopedic Surgery And Procedures S5 Orthopedics S5D2 Open Reduction Of Dislocations - Deep S5D2.1 30000 567 Orthopedic Surgery And Procedures S5 Orthopedics Bone And Joint Surgery Procedures S5D3 Arthroscopy - ACL Repair S5D2.7 30000 568 Orthopedic Surgery And Procedures S5 Orthopedics Soft Tissue Surgery S5D5 Nerve Repair With Grafting S5D2.13 25000 569 Orthopedic Surgery And Procedures S5 S5D3 Arthroscopy - Diagnostic S5D2.5 20000 570 Orthopedic Surgery And Procedures S5 S5D3 Avascular Necrosis Of Femoral Head (Core Decompression) S5D2.8 15000 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8 S8G5 S8G1 S8G5 S8G5 S8G5 S8G5 S8G5 S8G5 S8G5 S8G5 S8G6 S8G6 S8G6 S8G6 S8G6 Intussusception Anorectal Malformations Stage 1 Paediatric Acute Intestinal Obstruction Laparoscopic Choleycystectomy Laparoscopic Appendectomy Paediatric Splenectomy (Non Traumatic) Laparoscopic Pull Through Surgeries For HD Surgeries On Adrenal Gland In Children Hydatid Cysts In Paediatric Patient Gastro Esophageal Reflux Correction Undescended Testis Scrotal Transposition Repair Torsion Testis Laparoscopic Varicocele Ligation Laparoscopic Orchidopexy S8G5.8 S8G1.5 S8G5.9 S8G5.11 S8G5.10 S8G5.3 S8G5.2 S8G5.4 S8G5.6 S8G5.5 S8G6.4 S8G6.3 S8G6.5 S8G6.7 S8G6.6 40000 45000 40000 40000 30000 35000 60000 25000 40000 30000 25000 20000 25000 25000 25000 Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Orthopedics Bone And Joint Surgery Procedures Orthopedics Bone And Joint Surgery Procedures Abdomen Congenital Malformations - Gi Tract Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Urogenital Urogenital Urogenital Urogenital Urogenital Sl. No 586 587 588 589 590 591 592 Category Category Code Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery S8 S8 S8 S8 S8 S8 S8 593 Pediatric Surgery S8 594 Pediatric Surgery S8 595 Pediatric Surgery S8 596 Pediatric Surgery S8 597 Pediatric Surgery S8 598 Pediatric Surgery S8 599 Pediatric Surgery S8 600 601 602 603 604 605 Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery S8 S8 S8 S8 S8 S8 606 Pediatric Surgery S8 607 Pediatric Surgery 608 Pediatric Surgery S8 S8 609 Pediatric Surgery S8 610 Pediatric Surgery S8 611 Pediatric Surgery S8 612 Pediatric Surgery S8 613 Pediatric Surgery S8 614 Pediatric Surgery S8 Sub Category Chest Abdomen Abdomen Urogenital Urogenital Chest Chest Congenital Malformations –Urogenital Chest Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Chest Head And Neck Chest Chest Head And Neck Head And Neck Congenital Malformations –Urogenital Head And Neck Head And Neck Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations - Gi Tract Congenital Malformations –Urogenital Congenital Malformations –Urogenital Sub Category Code S8G4 S8G5 S8G5 S8G6 S8G6 S8G4 S8G4 Procedures Procedure 100% code Rates Thoracic Wall Defects- Correction Gastric Outlet Obstructions Laparoscopic Pull Through For Ano Rectal Anomalies Epispadiasis - Correction Nephrectomy Thoracoscopic Decortication Thoracoscopic Cysts Excision S8G4.7 S8G5.1 S8G5.12 S8G6.2 S8G6.1 S8G4.5 S8G4.4 50000 30000 60000 40000 40000 40000 40000 S8G2 Hemangioma Excision S8G2.17 25000 S8G4 Thoracic Duplications S8G4.6 40000 S8G2 Hamartoma Excision S8G2.16 20000 S8G2 Microtia/ Anotia S8G2.13 30000 S8G2 Syndactyly Of Hand For Each Hand S8G2.12 15000 S8G2 Hypospadius Stage 1 S8G2.15 35000 S8G2 TM Joint Ankylosis S8G2.14 40000 S8G4 S8G3 S8G4 S8G4 S8G3 S8G3 Bronchoscopy Foreign Body Removal Sinuses & Fistula Of The Neck Paediatric Esophageal Substitutions Paediatric Esophageal Obstructions- Surgical Correction Encephalocele Neuroblastoma S8G4.1 S8G3.5 S8G4.3 S8G4.2 S8G3.4 S8G3.1 20000 20000 60000 30000 20000 25000 S8G2 Lymphangioma Excision S8G2.18 40000 S8G3 S8G3 Cystic Lesions Of The Neck Congenital Dermal Sinus S8G3.3 S8G3.2 20000 30000 S8G2 Velo-Pharyngial Incompetence S8G2.11 15000 S8G2 Ureteric Reimplantations S8G2.2 65000 S8G2 Extrophy Bladder Stage 1 S8G2.3 65000 S8G1 Hirschsprung Disease Stage 2 S8G1.8 60000 S8G2 Congenital Hydronephrosis S8G2.1 50000 S8G2 Extrophy Bladder Stage 2 S8G2.4 60000 Sl. No Category Category Code Sub Category Sub Category Code Procedures S8 S8 S8 S8 S8 M6 Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations - Gi Tract Congenital Malformations - Gi Tract Congenital Malformations –Urogenital Congenital Malformations –Urogenital Congenital Malformations - Gi Tract Congenital Malformations - Gi Tract Congenital Malformations - Gi Tract Congenital Malformations - Gi Tract Abdomen General Paediatrics Renal S8G1 S8G1 S8G1 S8G1 S8G5 M6S12 629 Pediatrics Medical Management M6 Gen Paediatrics Cvs M6S11 630 Pediatrics Medical Management M6 Gen Paediatrics Cvs M6S11 631 Pediatrics Medical Management M6 Gen Paediatrics Cvs M6S11 632 Pediatrics Medical Management M6 Gen Paediatrics Cvs M6S11 633 Pediatrics Medical Management M6 General Paediatrics Infections M6S14 634 Pediatrics Medical Management 635 Pediatrics Medical Management M6 M6 General Paediatrics Infections General Paediatrics Infections M6S14 M6S14 636 Pediatrics Medical Management M6 General Paediatrics Infections M6S14 Suspected Dengue Shock Syndrome With Thrombocytopenia 637 Pediatrics Medical Management M6 General Paediatrics Severe Anemia 638 Pediatrics Medical Management M6 General Paediatrics Severe Anemia 639 Pediatrics Medical Management M6 General Paediatrics Infections 640 Pediatrics Medical Management M6 General Paediatrics Severe Anemia 615 Pediatric Surgery S8 616 Pediatric Surgery S8 617 Pediatric Surgery S8 618 Pediatric Surgery S8 619 Pediatric Surgery 620 Pediatric Surgery S8 S8 621 Pediatric Surgery S8 622 Pediatric Surgery S8 623 624 625 626 627 628 Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatric Surgery Pediatrics Medical Management Procedure 100% code Rates S8G2 Hypospadius Stage 2 S8G2.7 35000 S8G2 Pediatric Tumours S8G2.8 50000 S8G2 Posterior Urethral Valves S8G2.5 30000 S8G2 Hypospadias Single Stage S8G2.6 40000 S8G1 S8G1 Oesophageal Atresis Diaphragmatic Hernia S8G1.1 S8G1.2 60000 60000 S8G2 Cleft Palate S8G2.10 15000 S8G2 Cleft Lip S8G2.9 10000 S8G1.3 S8G1.6 S8G1.7 S8G1.4 S8G5.7 M6S12.3 50000 60000 45000 55000 50000 10000 M6S11.2 15000 M6S11.1 20000 M6S11.4 15000 M6S11.3 15000 M6S14.3 20000 M6S14.2 M6S14.5 10000 10000 M6S14.4 20000 M6S13.2 20000 M6S13.1 20000 M6S14.1 35000 M6S13.3 10000 Intestinal Atresias & Obstructions Anorectal Malformations Stage 2 Hirschsprung Disease Stage 1 Biliary Atresis & Choledocal Cyst Intestinal Polyposis Surgical Correction Acute Renal Failure 10 Days Stay Congenital Heart Disease With Congestive Cardiac Failure - 7 Days Acute Broncho/ Lobarpneumonia With Pyo Pneumothorax 14 Days Viral Myocarditis 7 Days Stay Acquired Heart Disease With Congestive Cardiac Failure- 7 Days Stay Neuro Tuberculosis With Ventilation- 12 Days Stay - DOTS Rx Free Neuro Tuberculosis- 12 Days Stay - DOTS Rx Free Cerebral Malaria (Falciparum) 7 Days Stay Haemophilia Including treatment with blood & blood products, factor concentrate & 7 Days Stay Thalassemia Major Requiring Chelation Therapy - 7 Days M6S13 Stay - Payable maximum upto M6S14 Pyogenic Meningitis With 10 Days Stay Anaemia Of Unknown Cause treated with Haematinics, Blood M6S13 Transfusion etc for minimum 5 Days Stay - Payable maximum upto M6S13 Sl. No Category Category Code Sub Category Sub Category Code Procedures Acute Broncho/ Lobarpneumonia With Empyema/ Pleural Effusion Febrile Seizures (Atypical- Mechanical Ventilated) Status Epilepticus Acute Gastro Intestinal Bleed Inv - ABG/Upper GI Endoscopy, USG Abdomen 10 Days PICU Stay With Post Treatment Evidence For Clinical Improvement With Lab Investigations Intra Cranial Bleed Infective Endocarditis Cardiogenic Shock Meningo- Encephalitis (Ventilated) Meningo-Encephalitis (Non Ventilated) Snake Bite Requiring Ventilatory Assistance With 10 Days PICU Stay Septic Shock- 10 Days PICU Stay Poison Ingestion/ Aspiration Requiring Ventilatory Assistance 7 Days PICU Stay Scorpion Sting With Myocarditis And Cardiogenic Shock Requiring Ventilatory Assistance 10 Days ICU Stay Acute Hepatitis With Hepatic Encephalopathy – 10 Days PICU Stay Acute Pancreatitis - 10 Days PICU Stay Diabetic Ketoacidosis - 8 Days PICU Stay Acute Renal Failure With Dialysis - 10 Days PICU Stay 641 Pediatrics Medical Management M6 Gen Paediatrics Respiratory M6S10 642 Pediatrics Medical Management 643 Pediatrics Medical Management M6 M6 Pediatric Ic Care Cns Pediatric Ic Care Cns M6S4 M6S4 644 Pediatrics Medical Management M6 Pediatric Ic Care Git M6S5 645 646 647 648 649 Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management M6 M6 M6 M6 M6 Pediatric Ic Care Cns Pediatric Ic Care Cardiovascular Pediatric Ic Care Cardiovascular Pediatric Ic Care Cns Pediatric Ic Care Cns M6S4 M6S3 M6S3 M6S4 M6S4 650 Pediatrics Medical Management M6 Pediatric Ic Care Toxicology M6S9 651 Pediatrics Medical Management M6 Pediatric Ic Care Infection M6S8 652 Pediatrics Medical Management M6 Pediatric Ic Care Toxicology M6S9 653 Pediatrics Medical Management M6 Pediatric Ic Care Toxicology M6S9 654 Pediatrics Medical Management M6 Pediatric Ic Care Git M6S5 655 Pediatrics Medical Management 656 Pediatrics Medical Management 657 Pediatrics Medical Management M6 M6 M6 Pediatric Ic Care Git Pediatric Ic Care Endocrine Pediatric Ic Care Renal M6S5 M6S7 M6S6 658 Pediatrics Medical Management M6 General Paediatrics Neurology M6S15 Convulsive Disorders/Status EpileptICUs (Fits) - 7 Days Stay 659 Pediatrics Medical Management M6 Paediatrics Neonatal M6S1 660 Pediatrics Medical Management M6 Paediatrics Neonatal M6S1 661 Pediatrics Medical Management M6 Paediatrics Neonatal M6S1 662 Pediatrics Medical Management M6 Paediatrics Neonatal M6S1 663 Pediatrics Medical Management M6 Paediatrics Neonatal M6S1 33 To 34 Weeks Preterm Baby Severe Hyaline Membrane Disease Clinical Sepsis Bubble CPAP Hyperbilirubinemia 33 To 34 Weeks Preterm Baby Severe Hyaline Membrane Disease With Clinical Sepsis, Mechanical Ventilation Hyperbilirubinemia Necrotising Enterocolitis, Clinical Sepsis Non Ventilated Hyperbilirubinemia Term Baby, Fulminant Culture Positive Sepsis, Septic Shock, Ventilated, Hyperbilirubinemia Renal Failure 33 To 34 Weeks Preterm Severe Hyaline Membrane Disease Culture Positive Sepsis Mechanical Ventilation/ Bubble CPAP Hyperbilirubinemia.- 6 weeks stay Procedure 100% code Rates M6S10.1 20000 M6S4.4 M6S4.3 25000 30000 M6S5.1 30000 M6S4.5 M6S3.5 M6S3.4 M6S4.2 M6S4.1 40000 50000 50000 60000 40000 M6S9.1 50000 M6S8.1 50000 M6S9.3 40000 M6S9.2 25000 M6S5.3 50000 M6S5.2 M6S7.1 M6S6.1 50000 30000 40000 M6S15.1 10000 M6S1.11 40000 M6S1.12 60000 M6S1.9 25000 M6S1.10 40000 M6S1.15 60000 Sl. No Category Category Code Sub Category 664 Pediatrics Medical Management M6 Paediatrics Neonatal 665 Pediatrics Medical Management M6 Paediatrics Neonatal 666 Pediatrics Medical Management M6 Paediatrics Neonatal 667 Pediatrics Medical Management M6 Paediatrics Neonatal 668 Pediatrics Medical Management M6 Paediatrics Neonatal 669 Pediatrics Medical Management M6 Paediatrics Neonatal 670 Pediatrics Medical Management M6 Paediatrics Neonatal 671 Pediatrics Medical Management M6 Paediatrics Neonatal 672 Pediatrics Medical Management M6 Paediatrics Neonatal 673 Pediatrics Medical Management M6 Paediatrics Neonatal 674 Pediatrics Medical Management M6 Paediatrics Neonatal 675 Pediatrics Medical Management M6 Paediatrics Neonatal 676 677 678 679 680 681 Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management M6 M6 M6 M6 M6 M6 Pediatric Ic Care Cardiovascular Pediatric Ic Care Cardiovascular Pediatric Ic Care Respiratory Pediatric Ic Care Respiratory General Paediatrics Neurology General Paediatrics Neurology 682 Pediatrics Medical Management M6 Pediatric Ic Care Cardiovascular 683 Pediatrics Medical Management 684 Pediatrics Medical Management M6 M6 General Paediatrics Neurology Pediatric Ic Care Respiratory Sub Category Code Procedures 30 To 32 Weeks Preterm Severe Hyaline Membrane Disease Clinical/ Culture Positive Sepsis Mechanical Ventilation Hyperbilirubinemia- 8 weeks stay 35 To 36 Weeks Preterm Mild Hyaline Membrane Disease M6S1 Culture Positive Sepsis Nonventilated Hyperbilirubinemia 33 To 34 Weeks Preterm Mild Hyaline Membrane Disease M6S1 Culture Positive Sepsis – Nonventilated Hyperbilirubinemia <30 Weeks Preterm Severe Hyaline Membrane Disease Clinical/Culture Positive Sepsis Patent Ductus Arteriosus M6S1 Medical Management Mechanical Ventilation Hyperbilirubinemia Term Baby With Persistent Pulmonary Hypertension M6S1 Ventilation- HFO Hyperbilirubinemia Clinical Sepsis Term Baby With Culture Positive Sepsis- Non Ventilated M6S1 Hyperbilirubinemia 30 To 32 Weeks Preterm Severe Hyaline Membrane Disease M6S1 Clinical Sepsis Patent Ductus Arteriosus - Medical Management Mechanical Ventilation Hyperbilirubinemia M6S1 Term Baby Severe Hyperbilirubinemia Clinical Sepsis Term Baby With Seizures Ventilated Inv - Neurosonogram, CT-Scan Brain, Ultrasound Abdomen, CSF Analysis , Blood M6S1 Ammonia , Lactate, Metabolilc Screening-Blood And Urine ABG , Blood Culture, 10 Days Stay With Post Treatment Evidence Of Clinical Improvement And Lab Investigations Term Baby With Severe Perinatal Asphyxia - Non Ventilated M6S1 Clinical Sepsis Hyperbilirubinemia Term Baby With Severe Perinatal Asphyxia - Ventilated M6S1 Clinical Sepsis Hyperbilirubinemia <30 Weeks Preterm Severe Hyaline Membrane Disease M6S1 Clinical/ Culture Positive Sepsis Mechanical Ventilation Hyperbilirubinemia- 10 weeks stay M6S3 Severe Myocarditis M6S3 Congenital Heart Disease With Infection (Non Ventilated) M6S2 ARDS With Multi- Organ Failure M6S2 ARDS Plus DIC (Blood & Blood Products) M6S15 Encephalitis / Encephalopathy - 10 Days Stay M6S15 Stroke Syndrome-14 Days Stay Congenital Heart Disease With Infection And Cardiogenic M6S3 Shock (Ventilated) M6S15 Guillian-Barre Syndrome- 15 Days Stay M6S2 Severe Bronchiolitis (Non Ventilated) M6S1 Procedure 100% code Rates M6S1.16 90000 M6S1.13 35000 M6S1.14 45000 M6S1.3 90000 M6S1.4 80000 M6S1.1 25000 M6S1.2 90000 M6S1.7 25000 M6S1.8 25000 M6S1.5 25000 M6S1.6 40000 M6S1.17 90000 M6S3.1 40000 M6S3.2 30000 M6S2.8 100000 M6S2.9 120000 M6S15.3 15000 M6S15.2 20000 M6S3.3 50000 M6S15.4 M6S2.2 60000 15000 Sl. No Category Category Code Sub Category 685 Pediatrics Medical Management M6 Pediatric Ic Care Respiratory 686 Pediatrics Medical Management M6 Paediatrics Neonatal 687 688 689 690 691 Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management Pediatrics Medical Management M6 M6 M6 M6 M6 Pediatric Ic Care Respiratory Pediatric Ic Care Respiratory Pediatric Ic Care Respiratory Pediatric Ic Care Respiratory Pediatric Ic Care Respiratory 692 Pediatrics Medical Management M6 General Paediatrics Renal 693 Pediatrics Medical Management M6 General Paediatrics Renal 694 Pediatrics Medical Management 695 Plastic Surgery 696 Plastic Surgery M6 S12 S12 General Paediatrics Renal Plastic Surgery Plastic Surgery 697 Plastic Surgery S12 Plastic Surgery 698 699 700 701 702 703 704 705 706 707 708 709 710 711 712 713 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 S12 Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Orthopedic And Facial Trauma Wound Management For Compound Fractures Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Plastic Surgery Sub Procedures Category Code M6S2 Severe Bronchopneumonia (Non Ventilated) 33 To 34 Weeks Preterm Severe Hyaline Membrane Disease Clinical/Culture Positive Sepsis Patent Ductus ArteriosusM6S1 Medical Management Mechanical Ventilation Hyperbilirubinemia M6S2 Severe Bronchiolitis (Ventilated) M6S2 Severe Aspiration Pneumonia (Non Ventilated) M6S2 Severe Aspiration Pneumonia (Ventilated) M6S2 Severe Bronchopneumonia (Ventilated) M6S2 Acute Severe Asthma (Ventilated) Urinary Tract Infection With Complications Like M6S12 Pyelonephritis And Renal Failure - 10 Days Stay Steroid Resistant Nephrotic Syndrome Complicated Or M6S12 Resistant - 2 Weeks Stay M6S12 Acute Renal Failure With Dialysis - 10 Days Stay. S12M1 Cleft Lip S12M1 Cleft Palate Corrective Surgery For Congenital Deformity Of Hand (Per S12M1 Hand) S12M1 Corrective Surgery For Craniosynostosis S12M1 Vaginal Atresia S12M1 Vascular Malformations S12M1 Reduction Surgery For Filarial Lymphedema S12M1 Hemifacial Atrophy S12M1 Cup And Bat Ears S12M1 Flap Cover For Electrical Burns With Vitals Exposed S12M1 Tumour Of Mandible And Maxilla S12M1 Microtia/Anotia S12M1 TM Joint Ankylosis S12M1 Velo-Pharyngial Incompetence S12M1 Syndactyly Of Hand For Each Hand S12M1 Nerve And Tendon Repair + Vascular Repair S12M1 Ptosis S12M1 Hemifacial Microsmia S12M1 Leprosy Reconstructive Surgery 714 Poly Trauma S14 S14O10 Grade I& II 715 Poly Trauma S14 Chest Consertative Treatment S14O4 716 Poly Trauma S14 Orthpedic Trauma S14O1 Chest Injuries Conservative Stay In General Ward @Rs.500/Day Amputation Surgery Procedure 100% code Rates M6S2.3 15000 M6S1.18 70000 M6S2.1 M6S2.6 M6S2.7 M6S2.4 M6S2.5 20000 20000 25000 30000 35000 M6S12.2 15000 M6S12.1 25000 M6S12.4 S12M1.1 S12M1.2 20000 10000 15000 S12M1.14 15000 S12M1.15 S12M1.12 S12M1.13 S12M1.18 S12M1.19 S12M1.16 S12M1.17 S12M1.11 S12M1.5 S12M1.6 S12M1.3 S12M1.4 S12M1.9 S12M1.10 S12M1.7 S12M1.8 50000 25000 25000 20000 30000 20000 50000 40000 30000 40000 15000 15000 30000 25000 50000 20000 S14O10.1 10000 S14O4.1 3000 S14O1.2 5000 Sl. No Category Category Code Sub Category Sub Category Code 717 Poly Trauma S14 Orthpedic Trauma S14O1 718 Poly Trauma S14 S14O1 719 Poly Trauma S14 720 Poly Trauma 721 Poly Trauma 722 Poly Trauma S14 S14 S14 723 Poly Trauma S14 724 Poly Trauma S14 725 Poly Trauma S14 726 Poly Trauma S14 727 Poly Trauma S14 728 Poly Trauma S14 Orthpedic Trauma Orthopedic And Facial Trauma Wound Management For Compound Fractures Emergency Room Procedures Polytrauma Abdomen Emergency Room Procedures Orthopedic And Facial Trauma Wound Management For Compound Fractures Orthopedic And Facial Trauma Wound Management For Compound Fractures Orthopedic And Facial Trauma Wound Management For Compound Fractures Orthopedic And Facial Trauma Wound Management For Compound Fractures Orthopedic And Facial Trauma Wound Management For Compound Fractures Abdomen Consertative Treatment 729 Poly Trauma S14 Neurosurgical Trauma Consertative S14O2 730 Poly Trauma S14 Neurosurgical Trauma Consertative S14O2 731 Poly Trauma S14 Abdomen Consertative Treatment S14O6 732 Poly Trauma 733 Poly Trauma 734 Poly Trauma S14 S14 S14 735 Prostheses S15 736 Prostheses S15 737 Prostheses S15 Chest Consertative Treatment Neurosurgical Trauma Polytrauma Chest Prosthesis Hip Disarticulation Prosthesis Prosthesis Hip Disarticulation Prosthesis Prosthesis Hip Disarticulation Prosthesis Procedures Open Reduction And Internal Fixation Of Long Bone Fractures Soft Tissue Injury Procedure 100% code Rates S14O1.1 15000 S14O1.3 5000 S14O11 Grade -III S14O11.1 20000 S14O8 S14O7 S14O8 S14O8.2 S14O7.1 S14O8.1 3000 75000 3000 S14O11 Facial Bone Fractures (Faciomaxillary Injuries) S14O11.5 15000 S14O11 Surgical Correction Of Pelvic Bone Fractures. S14O11.6 20000 S14O11.4 5000 S14O11.2 20000 S14O11.3 5000 S14O6.2 7000 S14O2.1 6000 S14O2.2 28000 S14O6.1 3000 S14O4 S14O3 S14O5 Abdominal Injuries Stay In Surgical [email protected]/Day Neurosurgical Trauma Consertative Management Stay In General Ward @Rs.500/ Day Neurosurgical Trauma Consertative Management Stay In Neuro [email protected]/Day Abdominal Injuries Conservative Stay In General Ward @Rs.500/Day Chest Injuries Stay In Respiratory ICU/[email protected]/Day Neurosurgical Trauma Surgical Treatment (Up To) Polytrauma Chest Surgical Treatment S14O4.2 S14O3.1 S14O5.1 20000 150000 50000 S15P6 Hip Disarticulation Prosthesis Fibre S15P6.2 3000 S15P6 Hip Disarticulation Prosthesis Modular S15P6.3 6000 S15P6 Hip Disarticulation Prosthesis HDP/PP S15P6.1 2500 S14O11 Thoracostomy Abdominal Injuries Surgical Treatment Tracheostomy Small Bone Fractures K-Wiring (To Be Covered With Other Injuries Only And Not As Exclusive Procedure) S14O11 Flap Cover Surgery For Wound In Compound Fracture S14O11 S14O6 Surgery For Patella Fracture (To Be Covered With Other Injuries Only And Not As Exclusive Procedure) Sl. No Category Category Code Sub Category S15 S15 M10 M10 M10 Prosthesis Above Knee(Ak) Prostheses Prosthesis Above Knee(Ak) Prostheses Prosthesis Through Knee Prostheses Prosthesis Below Knee(Bk/Ptb) Prosthesis Below Knee(Bk/Ptb) Prosthesis Lower Limb Symes Prostheses Prosthesis Lower Limb Symes Prostheses Prosthesis Lower Limb Symes Prostheses Prosthesis Upper Limb Above Elbow Prosthesis Below Knee(Bk/Ptb) Prosthesis Through Knee Prostheses Prosthesis Above Knee(Ak) Prostheses Prosthesis Through Knee Prostheses Prosthesis Upper Limb Above Elbow Prosthesis Upper Limb Above Elbow Prosthesis Upper Limb Whole Upper Limb Prosthesis Upper Limb Whole Upper Limb Prosthesis Upper Limb Whole Upper Limb Prosthesis Upper Limb Above Elbow Prosthesis Hip Disarticulation Prosthesis Prosthesis Upper Limb Above Elbow Prosthesis Upper Limb Above Elbow Pulmonology Pulmonology Pulmonology 763 Pulmonology M10 Pulmonology 764 Pulmonology 765 Pulmonology 766 Pulmonology M10 M10 M10 Pulmonology Pulmonology Pulmonology 738 Prostheses S15 739 Prostheses S15 740 Prostheses 741 Prostheses 742 Prostheses S15 S15 S15 743 Prostheses S15 744 Prostheses S15 745 Prostheses S15 746 Prostheses 747 Prostheses 748 Prostheses S15 S15 S15 749 Prostheses S15 750 Prostheses 751 Prostheses 752 Prostheses S15 S15 S15 753 Prostheses S15 754 Prostheses S15 755 Prostheses S15 756 Prostheses S15 757 Prostheses S15 758 759 760 761 762 Prostheses Prostheses Pulmonology Pulmonology Pulmonology Sub Category Code Procedures Procedure 100% code Rates S15P5 Above Knee(AK) Prostheses Fibre S15P5.2 1800 S15P5 Above Knee(AK) Prostheses Modular S15P5.3 3500 S15P4 S15P3 S15P3 Through Knee Prostheses HDP/PP Below Knee(BK/PTB) Prostheses HDP/PP Below Knee(BK/PTB) Prostheses Fibre S15P4.1 S15P3.1 S15P3.2 1500 1200 1500 S15P2 Lower Limb Symes Prostheses Modular S15P2.3 1500 S15P2 Lower Limb Symes Prostheses HDP/PP S15P2.1 1000 S15P2 Lower Limb Symes Prostheses Fibre S15P2.2 1200 S15P7 S15P3 S15P4 Above Elbow Prosthesis Modular Below Knee(BK/PTB) Prostheses Modular Through Knee Prostheses Fibre S15P7.3 S15P3.3 S15P4.2 4000 3000 1800 S15P5 Above Knee(AK) Prostheses HDP/PP S15P5.1 1500 S15P4 S15P7 S15P7 Through Knee Prostheses Modular Above Elbow Prosthesis Modular Above Elbow Prosthesis Fibre S15P4.3 S15P7.6 S15P7.5 3500 4000 2000 S15P8 Whole Upper Limb Prosthesis Fibre S15P8.2 1200 S15P8 Whole Upper Limb Prosthesis HDP/PP S15P8.1 1000 S15P8 Whole Upper Limb Prosthesis Modular S15P8.3 1500 S15P7 Above Elbow Prosthesis HDP/PP S15P7.1 1500 S15P6 Hip Disarticulation Partial Foot Prostheses S15P6.4 500 S15P7 S15P7 M10T4 M10T4 M10T4 Above Elbow Prosthesis Fibre Above Elbow Prosthesis HDP/PP Acute Respiratory Failure (With Ventilator) 10 Days Stay Interstitial Lung Diseases- 10 Days Stay Bronchiectasis Requiring Hospitalisation - 10 Days Stay S15P7.2 S15P7.4 M10T4.6 M10T4.3 M10T4.8 2000 1500 50000 30000 20000 M10T4 Lung Abscess, Non Resolving - Ct Scan Chest,10 Days Stay M10T4.1 15000 M10T4 Pneumothorax (Large/Recurrent) HRCT-10 Days Stay M10T4 Acute Respiratory Failure (Without Ventilator) 10 Days Stay M10T4 Pneumoconiosis - 10 Days Stay M10T4.2 M10T4.5 M10T4.4 35000 25000 25000 Sl. No Category Category Code Sub Category Cobalt 60 External Beam Radiotherapy Cobalt 60 External Beam Radiotherapy Brachytherapy Intracavity Brachytherapy Interstitial Brachytherapy Intracavity External Beam Radiotherapy (On Linear Acclerator) External Beam Radiotherapy (On Linear Acclerator) External Beam Radiotherapy (On Linear Acclerator) Cobalt 60 External Beam Radiotherapy Specialized Radiation Therapy 3dcrt(3-D Conformational Radiotherapy) Specialized Radiation Therapy - Imrt (Intensity Modulated Radiotherapy) Specialized Radiation Therapy Srs/Srt Specialized Radiation Therapy - Imrt With Igrt Specialized Radiation Therapy Rapid Ax Therapy Sub Category Code 767 Radiation Oncology M2 768 Radiation Oncology M2 769 Radiation Oncology 770 Radiation Oncology 771 Radiation Oncology M2 M2 M2 772 Radiation Oncology M2 773 Radiation Oncology M2 774 Radiation Oncology M2 775 Radiation Oncology M2 776 Radiation Oncology M2 777 Radiation Oncology M2 778 Radiation Oncology M2 779 Radiation Oncology M2 780 Radiation Oncology M2 781 Radiation Oncology M2 Brachytherapy Interstitial M2L4 782 783 784 785 786 787 788 789 790 791 792 793 794 M12 M12 M12 M12 M12 M12 S6 S6 S6 S6 S6 S6 S6 Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology Small Intestine Stomach Stomach Small Intestine Liver Liver Liver M12T6 M12T6 M12T6 M12T6 M12T6 M12T6 S6E6 S6E5 S6E5 S6E6 S6E2 S6E2 S6E2 Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Procedures Procedure 100% code Rates M2L1 Palliative Treatment M2L1.2 10000 M2L1 Radical Treatment M2L1.1 20000 M2L3 M2L4 M2L3 A) Intracavitary II. HDR Per Application B) Interstitial I. LDR Per Application A) Intracavitary I. LDR Per Application M2L3.2 M2L4.1 M2L3.1 2500 15000 4500 M2L2 Palliative Treatment With Photons M2L2.2 20000 M2L2 Adjuvant Treatment With Photons/Electrons M2L2.3 35000 M2L2 Radical Treatment With Photons M2L2.1 50000 M2L1 Adjuvant Treatment M2L1.3 15000 M2L6 3DCRT-Up To 30 Fractions In 6 Weeks M2L6.1 75000 M2L5 IMRT-Up To 40 Fractions In 8 Weeks M2L5.1 100000 M2L7 SRS/SRT-Up To 30 Fractions In 6 Weeks M2L7.1 75000 M2L9 IMRT+IGRT-Up To 40 Fractions In 8 Weeks M2L9.1 150000 M2L8 Rapid Ax Therapy-Up To 40 Fractions In 8 Weeks M2L8.1 150000 M2L4.2 25000 M12T6.4 M12T6.6 M12T6.1 M12T6.3 M12T6.5 M12T6.2 S6E6.2 S6E5.2 S6E5.5 S6E6.1 S6E2.6 S6E2.5 S6E2.7 15000 15000 50000 15000 10000 15000 35000 40000 50000 35000 30000 75000 45000 B) Interstitial II. HDR One Application And Multiple Dose Fractions Primary Sjogren's Syndrome 7 Days Stay SLE (Systemic Lupus Erythematosis) 10 Days Stay SLE With Sepsis 4 Weeks Stay MCTD Mixed Connective Tissue Disorder 7 Days Stay Vasculitis 10 Days Stay Scleroderma 7 Days Stay Malrotation Total Gastrectomy Surgery For Corrosive Injury Stomach Volvulus Hydatid Cyst-Marsupilisation Haemangioma SOL Liver Hepatectomy + Wedge Resection Cyst Excision + Hepatic Jejunostomy Sl. No 795 796 797 798 799 Category Category Code Sub Category Sub Category Code S6E11 S6E11 S6E8 S6E8 S6E9 Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology S6 S6 S6 S6 S6 Gall Bladder Gall Bladder Ulcerative Colitis Iii Stage Procedure Ulcerative Colitis Iii Stage Procedure Ulcerative Colitis Ii Stage Procedure 800 Surgical Gastro Enterology S6 Liver S6E2 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 830 831 832 833 834 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 S6 Ulcerative Colitis Ii Stage Procedure Gall Bladder Pancreas Pancreas Pancreas Pseudocyst Pseudocyst Spleen Spleen Spleen Pancreas Pancreas Pancreas Oesophagus Pancreas Pancreas Oesophagus Oesophagus Oesophagus Oesophagus Emergency Liver Emergency Emergency Pancreas Pancreas Liver Liver Large Intestine Large Intestine Large Intestine Large Intestine Large Intestine Ulcerative Colitis Iii Stage Procedure S6E9 S6E11 S6E3 S6E3 S6E3 S6E14 S6E14 S6E12 S6E12 S6E12 S6E3 S6E3 S6E3 S6E4 S6E3 S6E3 S6E4 S6E4 S6E4 S6E4 S6E1 S6E2 S6E1 S6E1 S6E3 S6E3 S6E2 S6E2 S6E7 S6E7 S6E7 S6E7 S6E7 S6E8 Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Procedures Hepatico Jejunostomy GB+ Calculi CBD Stones Or Dilated CBD III Stage-Ileostomy Closure II Stage-J - Pouch I Stage- Sub Total Colectomy + Ileostomy + J - Pouch Hepato Cellular Carcinoma(Advanced) Radio Frequency Ablation II Stage- Ileostomy Choledochoduodenostomy Or Choledocho Jejunostomy Distal Pancreatectomy + Splenectomy Pancreatic Necrosectomy (Open) Central Pancreatectomy Cysto Gastrostomy Cysto Jejunostomy Splenectomy + Devascularisation + Spleno Renal Shunt Splenectomy Spleenectomy For Space Occupying Lesion Lateral Pancreaticojejunostomy(Non- Malignant) Lap- Pancreatic Necrosectomy Other Bypasses Colonic Pull Up Whipples Any Type Triple Bypass Lap Heller’s Myotomy Lap Fundoplications Oesophagectomy Oesophago-Gastrectomy Diaphragmatic Hernia (Gortex Mesh Repair) Rt Hepatectomy Surgery For Bleeding Ulcers Surgery For Obscure GI Bleed Distal Pancreatectomy Enucleation Of Cyst Lt Hepatectomy Segmentectomy Extended Right Hemicolectomy Anterior Resection Right Hemicolectomy Left Hemicolectomy Hartman.S Procedure With Colostomy I Stage-Sub Total Colectomy + Ileostomy Procedure 100% code Rates S6E11.2 S6E11.1 S6E8.3 S6E8.2 S6E9.1 45000 25000 20000 30000 80000 S6E2.4 60000 S6E9.2 S6E11.3 S6E3.9 S6E3.8 S6E3.10 S6E14.2 S6E14.1 S6E12.2 S6E12.1 S6E12.3 S6E3.7 S6E3.6 S6E3.5 S6E4.1 S6E3.3 S6E3.4 S6E4.4 S6E4.5 S6E4.2 S6E4.3 S6E1.3 S6E2.1 S6E1.1 S6E1.2 S6E3.1 S6E3.2 S6E2.2 S6E2.3 S6E7.3 S6E7.4 S6E7.1 S6E7.2 S6E7.7 S6E8.1 20000 35000 100000 100000 100000 40000 40000 60000 35000 35000 100000 100000 25000 30000 75000 25000 30000 45000 60000 75000 40000 75000 40000 60000 100000 75000 75000 50000 35000 40000 30000 30000 45000 50000 S6 S6 S6 S6 S6 S6 S11 S11 S11 S11 S11 S11 S11 S11 Large Intestine Large Intestine Stomach Stomach Stomach Small Intestine Breast Breast Skin Tumours Breast Breast Ca Git Genitourinary Genitourinary Sub Category Code S6E7 S6E7 S6E5 S6E5 S6E5 S6E6 S11J32 S11J32 S11J33 S11J32 S11J32 S11J10 S11J23 S11J23 849 Surgical Oncology S11 Genitourinary S11J23 850 851 852 853 854 855 856 857 858 859 860 861 862 863 864 865 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 Genitourinary Genitourinary Genitourinary Genitourinary Genitourinary Limb Salvage Surgery Limb Salvage Surgery Limb Salvage Surgery Limb Salvage Surgery Limb Salvage Surgery Genitourinary Limb Salvage Surgery Limb Salvage Surgery Thorax, Mediastinum Lung Urinary Bladder S11J23 S11J23 S11J23 S11J23 S11J23 S11J22 S11J22 S11J22 S11J22 S11J22 S11J23 S11J22 S11J22 S11J26 S11J27 S11J25 866 Surgical Oncology S11 Urinary Bladder S11J25 867 868 869 870 871 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 S11 Esophagus Esophagus Lung Lung Genitourinary S11J28 S11J28 S11J27 S11J27 S11J23 872 Surgical Oncology S11 Testis Cancer S11J24 Sl. No 835 836 837 838 839 840 841 842 843 844 845 846 847 848 Category Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Gastro Enterology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Category Code Sub Category Procedures Anterior Resection With Ileostomy Abdomino Perineal Resection(Non- Malignant) Truncal Vagotomy + Gastro Jejunostomy Distal Gastrectomy For Gastric Outlet Obstruction Partial Gastrectomy Lap Adhesiolysis Mastectomy Any Type Chest Wall Resection Skin Tumours Wide Excision Lumpectomy Breast Breast Reconstruction Small Bowel Resection Emasculation Radical Cystectomy Nephroureterectomy For Transitional Cell Carcinima Of Renal Pelvis Radical Nephrectomy Partial Penectomy Inguinal Block Dissection One Side Other Cystectomies Total Penectomy Internal Hemipelvectomy Curettage & Bone Cement Forequarter Amputation Hemipelvectomy Sacral Resection Partial Nephrectomy Bone Resection Shoulder Girdle Resection Mediastinal Tumour Resection Lung Metastatectomy. Solitary Total Exenteration Bilateral Pelvic Lymph Node Dissection(BPLND) for CA Urinary Bladder Oesophagectomy With Two Field Lymphadenectomy Oesophagectomy With Three Field Lymphadenectomy Lung Metastatectomy. Multiple Sleeve Resection Of Lung Cancer Bilateral Orchidectomy Retro Peritoneal Lymph Node Dissection(RPLND) (For Residual Disease) Procedure 100% code Rates S6E7.5 S6E7.6 S6E5.3 S6E5.4 S6E5.1 S6E6.3 S11J32.1 S11J32.6 S11J33.1 S11J32.4 S11J32.5 S11J10.1 S11J23.4 S11J23.5 50000 50000 40000 40000 40000 40000 25000 20000 10000 3000 25000 40000 30000 60000 S11J23.2 50000 S11J23.3 S11J23.8 S11J23.9 S11J23.6 S11J23.7 S11J22.6 S11J22.7 S11J22.4 S11J22.5 S11J22.10 S11J23.1 S11J22.8 S11J22.9 S11J26.1 S11J27.1 S11J25.2 40000 15000 15000 40000 25000 65000 30000 40000 55000 60000 55000 30000 40000 50000 50000 75000 S11J25.3 20000 S11J28.1 S11J28.2 S11J27.2 S11J27.3 S11J23.12 90000 100000 60000 90000 10000 S11J24.1 60000 Sl. No Category Category Code Sub Category 873 Surgical Oncology 874 Surgical Oncology S11 S11 Genitourinary Genitourinary 875 Surgical Oncology S11 Testis Cancer 876 877 878 879 880 881 882 883 884 885 886 887 888 889 890 891 892 893 894 895 896 897 898 899 900 901 902 903 904 905 906 907 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 Urinary Bladder Testis Cancer Testis Cancer Limb Salvage Surgery Ca Git Ca Git Ca Git Ca Git Ca Spleen Ca Retroperitoneal Tumors Ca Git Ca Gall Bladder Ca Git Ca Rectum Ca Git Ca Git Ca Git Ca Git Ca Rectum Ca Git Ca Cervix Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Head And Neck Oral Cavity Oral Cavity Bronchoplural Fistula 908 Surgical Oncology S11 Bronchoplural Fistula 909 Surgical Oncology 910 Surgical Oncology 911 Surgical Oncology S11 S11 S11 Palliative Surgeries Head And Neck Oral Cavity Sub Procedures Category Code S11J23 Radical Prostatectomy S11J23 High Orchidectomy Retro Peritoneal Lymph Node Dissection Rplnd As Part Of S11J24 Staging S11J25 Anterior Exenteration S11J24 Adrenalectomy S11J24 Urinary Diversion S11J22 Limb Salvage Surgery With Modular Prosthesis S11J12 Whipples Any Type S11J12 Tripple Bypass S11J12 Anterior Resection S11J12 Abdominoperineal Resection S11J14 Splenectomy S11J15 Resection Of Retroperitoneal Tumours S11J12 Other Bypasses-Pancreas S11J13 Radical Cholecystectomy S11J10 Abdomino Perineal Resection (Apr) + Sacrectomy S11J11 Posterior Exenteration S11J10 Closure Of Ileostomy S11J10 Closure Of Colostomy S11J12 Gastrectomy Any Type S11J12 Colectomy Any Type S11J11 Total Exenteration S11J12 Oesophagectomy Any Type S11J18 Supra Levator Exenteration S11J1 Hemiglossectomy S11J1 Maxillectomy Any Type S11J1 Wide Excision for tumour S11J1 Neck Dissection Any Type S11J1 Laryngectomy Any Type S11J1 Laryngo Pharyngo Oesophagectomy S11J1 Thyroidectomy Any Type S11J1 Parotidectomy Any Type S11J37 Marginal Mandibulectomy S11J37 Segmental Mandibulectomy S11J36 Surgical Correction Of Bronchoplural Fistula. Myoplasty Surgical Correction Of Bronchoplural Fistula Trans Plural S11J36 BPF Closure S11J29 Tracheostomy S11J1 Composite Resection & Reconstruction S11J37 Total Glossectomy + Reconstruction Procedure 100% code Rates S11J23.10 60000 S11J23.11 15000 S11J24.4 20000 S11J25.1 S11J24.2 S11J24.3 S11J22.3 S11J12.6 S11J12.7 S11J12.4 S11J12.5 S11J14.1 S11J15.1 S11J12.8 S11J13.1 S11J10.4 S11J11.1 S11J10.2 S11J10.3 S11J12.2 S11J12.3 S11J11.2 S11J12.1 S11J18.5 S11J1.4 S11J1.5 S11J1.2 S11J1.3 S11J1.8 S11J1.9 S11J1.6 S11J1.7 S11J37.1 S11J37.2 S11J36.2 60000 45000 40000 75000 75000 25000 40000 40000 35000 45000 25000 60000 50000 50000 20000 20000 40000 40000 75000 60000 70000 15000 25000 25000 25000 40000 75000 20000 20000 25000 25000 50000 S11J36.3 50000 S11J29.1 S11J1.1 S11J37.3 5000 60000 40000 Sl. No 912 913 914 915 916 917 918 919 920 921 922 923 924 925 926 927 928 929 930 931 932 933 934 935 936 937 938 939 940 941 942 943 944 945 946 947 948 949 950 951 952 Category Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology Category Code S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 S11 Sub Category Oral Cavity Ca.Ear Surgical Oncology Ca.Ear Ca.Ear Ca Trachea Ca Parathyroid Ca.Thyroid Ca Trachea Ca.Eye/ Maxilla /Para Nasal Sinus Ca.Eye/ Maxilla /Para Nasal Sinus Head And Neck Ca.Eye/ Maxilla /Para Nasal Sinus Ca.Soft Palate Ca.Ear Ca.Eye/ Maxilla /Para Nasal Sinus Nasopharynx Bronchoplural Fistula Reconstruction Gynecology Palliative Surgeries Reconstruction Gynecology Gynecology Gynecology Gynecology Palliative Surgeries Palliative Surgeries Palliative Surgeries Palliative Surgeries Palliative Surgeries Palliative Surgeries Palliative Surgeries Palliative Surgeries Soft Tissue /Bone Tumours Soft Tissue /Bone Tumours Skin Tumours Skin Tumours Lung Lung Soft Tissue /Bone Tumours Sub Category Code S11J37 S11J5 S11J6 S11J5 S11J5 S11J8 S11J9 S11J7 S11J8 S11J2 S11J2 S11J1 S11J2 S11J4 S11J5 S11J2 S11J3 S11J36 S11J30 S11J31 S11J29 S11J30 S11J31 S11J31 S11J31 S11J31 S11J29 S11J29 S11J29 S11J29 S11J29 S11J29 S11J29 S11J29 S11J34 S11J34 S11J33 S11J33 S11J27 S11J27 S11J34 Procedures Full Thickness Buccal Mucosal Resection & Reconstruction Total Temporal Bone Resection Submandibular Gland Excision Lateral Temporal Bone Resection Subtotal Temporal Bone Resection Tracheal Resection Parathyroidectomy Tracheal Resection Sternotomy + Superior Mediastinal Dissection Maxillectomy + Orbital Exenteration Maxillectomy + Infratemporal Fossa Clearance Hemimandibulectomy Orbital Exenteration Palatectomy Any Type Sleeve Resection Cranio Facial Resection Resection Of Nasopharyngeal Tumour Surgical Correction Of Bronchoplural Fistula Thoracoplasty Micro Vascular Reconstruction Hysterectomy for Tumour Ileotransverse Colostomy Myocutaneous / Cutaneous Flap Surgery For Ca Ovary Advance Stage Vulvectomy Radical Hysterectomy for Tumour Surgery For Ca Ovary Early Stage Jejunostomy Ileostomy Substernal Bypass Gastrostomy Intercostal Drainage(ICD) Gastro Jejunostomy Colostomy Suprapubic Cystostomy Wide Excision soft tissue/Bone Tumours Wide Excision + Reconstruction soft tissue/Bone Tumours Skin Tumours Wide Excision + Reconstruction Skin Tumours Amputation Lung Cancer Lobectomy Lung Cancer Decortication Amputation for soft tissue/Bone Tumours Procedure 100% code Rates S11J37.4 S11J5.4 S11J6.1 S11J5.2 S11J5.3 S11J8.2 S11J9.2 S11J7.1 S11J8.1 S11J2.2 S11J2.3 S11J1.10 S11J2.1 S11J4.1 S11J5.1 S11J2.4 S11J3.1 S11J36.1 S11J30.2 S11J31.1 S11J29.10 S11J30.1 S11J31.4 S11J31.5 S11J31.2 S11J31.3 S11J29.4 S11J29.5 S11J29.2 S11J29.3 S11J29.8 S11J29.9 S11J29.6 S11J29.7 S11J34.1 S11J34.2 S11J33.2 S11J33.3 S11J27.5 S11J27.6 S11J34.3 50000 60000 20000 30000 50000 40000 30000 52000 45000 35000 40000 25000 25000 30000 25000 70000 50000 50000 45000 25000 50000 25000 40000 15000 30000 25000 20000 20000 35000 20000 3000 35000 20000 10000 15000 25000 20000 20000 50000 50000 20000 Sl. No 953 954 955 956 Category Category Code Sub Category Sub Category Code S11J27 S11J32 S11J32 S11J31 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 Lung Breast Breast Gynecology 957 Surgical Oncology S11 Ca Endometrium S11J19 958 959 960 961 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 S11J18 S11J18 S11J22 S11J22 962 Surgical Oncology S11 963 Surgical Oncology S11 Surgical Oncology Surgical Oncology Surgical Oncology Surgical Oncology S11 S11 S11 S11 Ca Cervix Ca Cervix Limb Salvage Surgery Limb Salvage Surgery Soft Tissue /Bone Tumours. Chest Wall Soft Tissue /Bone Tumours. Chest Wall Gynec Gynec Ca Abdominal Wall Tumour Ca Abdominal Wall Tumour 968 Surgical Oncology S11 Ca Cervix S11J18 969 Surgical Oncology 970 Surgical Oncology 971 Surgical Oncology S11 S11 S11 Ca Cervix Gynec Gynec S11J18 S11J17 S11J17 964 965 966 967 Procedures marked in Orange color are reserved for Government hospitals Procedures Lung Cancer Pnumenectomy Axillary Dissection Wide Excision of Breast for Tumour Salpino Oophorectomy Total Abdominal Hysterectomy(TAH) + Bilateral Salpingo Ophorectomy (BSO) + Bilateral Pelvic Lymph Node Dissection (BPLND) + Omentectomy Posterior Exenteration Total Pelvic Exenteration Limb Salvage Surgery Without Prosthesis Limb Salvage Surgery With Custom Made Prosthesis Procedure 100% code Rates S11J27.4 S11J32.2 S11J32.3 S11J31.6 50000 15000 5000 25000 S11J19.1 35000 S11J18.3 S11J18.4 S11J22.1 S11J22.2 50000 75000 40000 50000 S11J20 Chest Wall Resection S11J20.1 20000 S11J20 Chest Wall Resection + Reconstruction S11J20.2 30000 S11J17 S11J17 S11J16 S11J16 S11J17.1 S11J17.2 S11J16.1 S11J16.2 25000 40000 35000 45000 S11J18.1 45000 S11J18.2 S11J17.3 S11J17.4 60000 40000 45000 Bilateral Pelvic Lymph Node Dissection(BPLND) Radical Trachelectomy Abdominal Wall Tumour Resection Resection With Reconstruction of Abdominal Wall Tumour Radical Hysterectomy +Bilateral Pelvic Lymph Node Dissection (BPLND) + Bilateral Salpingo Ophorectomy (BSO) / Ovarian Transposition Anterior Exenteration Radical Vaginectomy Radical Vaginectomy + Reconstruction
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