Annexure – 2.3 AB-NHPM Packages & Rates
S.No
Specialty
Procedure Name
Final Rate to be proposed
Pre-op Investigations for approval
Post-op Investigations/ Evidence for approval of claim
ALOS (Includin g ICU Days)
1
Cardiology
Balloon Atrial Septostomy
18,000
2D ECHO report
2D ECHO report
2
Cardiology
Balloon Aortic Valvotomy
25,000
2D ECHO report
2D ECHO report
3
Cardiology
Balloon Mitral Valvotomy
27,500
 
2D ECHO report
2D ECHO report
4
Cardiology
Balloon Pulmonary Valvotomy
25,000
 
2D ECHO report
2D ECHO report
5
Cardiology
Vertebral Angioplasty with single stent(medicated)
50,000
2D ECHO + Angiogram report
Post op. Angiogram report +carton of the stent usedapproved by FDA/DCGI only
2
6
Cardiology
Peripheral Angioplasty with balloon
 
25,000
 
2D ECHO, CAG stills showing blocks & Reports
Post procedure Angio stills
2
7
Cardiology
Medical Management of Acute Mi (Conservative Management Without Angiogram) with thrombolysis (third generation thrombolytics)
50,000
2D ECHO, CPK- MB,CAG, ECG with report, TROPONINE-T report
2D ECHO, ECG, Lab Investigation (Troponine – T report)
8
Cardiology
PDA multiple Coil insertion
 
20,000
2D ECHO report
2D ECHO stills showing the device + Report
9
Cardiology
PDA Coil (one) insertion
 
15,000
2D ECHO report
2D ECHO stills showing the coil + Report
10
Cardiology
PDA stenting
 
40,000
2D ECHO , Angiogram report & stills
Post procedure Angio stills
11
Cardiology
Pericardiocentesis
 
15,000
2D ECHO report
2D ECHO report
12
Cardiology
Temporary Pacemaker implantation
5,000
ECG + Report by cardiologist
X Ray showing the pacemaker in situ
13
Cardiology
PTSMA
25,000
ECG, 2D ECHO, CAG stills showing blocks & reports
Post op. Angiogram report, showing stent & post Stent flow + carton of the stents used approved by FDA/DCGI only
14
Cardiology
Pulmonary artery stenting
40,000
2D ECHO , Angiogram report & stills
Post procedure Angio stills
15
Cardiology
Right ventricular outflow tract (RVOT) stenting
 
40,000
 
2D ECHO , Angiogram report & stills
Post procedure Angio stills
16
Cardiology
Thrombolysis for peripheral ischemia
10,000
Peripheral Angiogram /Doppler Report with Stills
Post procedure Angio stills
17
Cardiology
Bronchial artery Embolisation (for Haemoptysis)
25,000
Chest x-Ray/CT Scan, Hb, Serum Creatinine
Chest x-Ray/CT Scan, Hb, Serum Creatinine
2
18
Cardiology
Percutaneous Transluminal Tricuspid Commissurotormy (PTTC)
25,000
 
2D ECHO
2D ECHO
2
19
Cardiology
Embolization – Arteriovenous Malformation (AVM) in the Limbs
40,000
 
Ultrasound, CT PT, INR, Hb, Serum Creatinine
Ultrasound, CT PT, INR, Hb, Serum Creatinine
2
20
Cardiology
Catheter directed Thrombolysis for: Deep vein thrombosis (DVT), Mesenteric Thrombosis & Peripheral vessels
50,000
CT/MRI, Prothrombin Time (PT), International normalized ratio (INR) Hb, Serum Creatinine
CT/MRI, Prothrombin Time (PT), International normalized ratio (INR) Hb, Serum Creatinine
2
21
Cardio Thoracic surgery
Closed Mitral Valvotomy
 
30,000
2D ECHO
ECHO,Post op X Ray ,scar photo
7
22
Cardio Thoracic surgery
Ring for any Valve Repair
 
30,000
 
2D ECHO
ECHO,Post op X Ray ,scar photo
7
23
Cardio Thoracic surgery
Patent Ductus Arteriosus (PDA) Closure
50,000
 
2D ECHO
ECHO,Post op X Ray ,scar photo
24
Cardio Thoracic surgery
Blalock -Thomas – Taussig (BT) Shunt (inclusives of grafts)
30,000
2D ECHO
ECHO,Post op X Ray ,scar photo
25
Cardio Thoracic surgery
Glenn Shunt (without cardiopulmonary bypass)
35,000
2D ECHO
ECHO,Post op X Ray ,scar photo
26
Cardio Thoracic surgery
Central Shunt
50,000
2D ECHO
ECHO,Post op X Ray ,scar photo
27
Cardio Thoracic surgery
Pericardiectomy
30,000
2D ECHO
ECHO,Post op X Ray ,scar photo
28
Cardio Thoracic surgery
Pulmonary AV Fistula surgery
45,000
CT Chest
ECHO,Post op X Ray ,scar photo
29
Cardio Thoracic surgery
Lung Cyst
50,000
CT Chest
ECHO,Post op X Ray ,scar photo
7
30
Cardio Thoracic surgery
Space-Occupying Lesion (SOL) mediastinum
45,000
CT Chest
ECHO,Post op X Ray ,scar photo
31
Cardio Thoracic surgery
Surgical Correction of Bronchopleural Fistula
50,000
CT Chest
ECHO,Post op X Ray ,scar photo
10
32
Cardio Thoracic surgery
Diaphragmatic Eventeration
40,000
CT Chest
ECHO,Post op X Ray ,scar photo
10
33
Cardio Thoracic surgery
Oesophageal Diverticula /Achalasia Cardia
35,000
Barium Study + CT Chest
ECHO,Post op X Ray ,scar photo
10
34
Cardio Thoracic surgery
Diaphragmatic Injuries/Repair
35,000
 
CT Chest
ECHO,Post op X Ray ,scar photo
10
35
Cardio Thoracic surgery
Thoracotomy, Thoraco Abdominal Approach
30,000
CT Chest
Post op X Ray ,scar photo
10
36
Cardio Thoracic surgery
Foreign Body Removal with scope
 
20,000
CT Chest + Bronchoscopy report
Endoscopy Picture
2
37
Cardio Thoracic surgery
Bronchial Repair Surgery for Injuries due to FB
35,000
CT Chest + Bronchoscopy report
Endoscopy Picture
7
38
Cardio Thoracic surgery
Lung Injury repair
 
35,000
 
CT Chest
Post op X Ray ,scar photo
7
39
Cardio Thoracic surgery
Thyomectomy
35,000
 
CT Chest
Post op X Ray ,scar photo
40
Cardio Thoracic surgery
Intercostal Drainage and Management of ICD, Intercostal Block, Antibiotics & Physiotherapy
10,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan
7
41
Cardio Thoracic surgery
Encysted Empyema/Pleural Effusion – Tubercular
10,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan
42
Cardio Thoracic surgery
First rib Excision by transaxillary approach, Excision of cervical rib / fibrous band / muscle by
30,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan ,scar photo
7
cervical approach
43
Cardio Thoracic surgery
Congenital Cystic Lesions
30,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan ,scar photo
7
44
Cardio Thoracic surgery
Pulmonary Sequestration Resection
40,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan ,scar photo
7
45
Cardio Thoracic surgery
Pulmonary artero venous malformation
40,000
Pre Op X-ray / CT Scan
Post Op X-ray / CT Scan ,scar photo
7
46
Cardio Vascular surgery
Thromboembolectomy (pre-auth not required, usually done as emergency)
20,000
Duplex
Scar photo + Post op CT
3
47
Cardio Vascular surgery
Surgery for Arterial Aneurysm Renal Artery
40,000
Renal arterial Doppler,
Doppler Report + scar
48
Cardio Vascular surgery
Operations for Congenital Arteriovenous Fistula
15,000
Regional Angiogram &
Scar photo
49
Cardio Vascular surgery
Operations for Stenosis of Renal Arteries
40,000
 
Renal arterial
Doppler Report + scar
50
Cardio Vascular surgery
Femoro Distal / Femoral – Femoral / Femoral infra popliteal Bypass with vein graft
50,000
Angiogram/spiral CT
Stills showing the
7
51
Cardio Vascular surgery
Brachio – Radial Bypass with Synthetic Graft
30,000
Angiogram/spiral CT
Stills showing the
5
52
Cardio Vascular surgery
Excision of body Tumor with vascular repair
 
35,000
Angiogram/spiral CT
Stills showing the
7
53
Cardio Vascular surgery
Excision of Arterio Venous malformation – Large
50,000
 
Angiogram/spiral CT
Stills showing the
7
54
Cardio Vascular surgery
Excision of Arterio Venous malformation – Small
30,000
Angiogram/spiral CT
Stills showing the
7
55
Cardio Vascular surgery
Carotid endarterectomy
 
32,000
 
Angiogram
Stills showing the
7
56
Cardio Vascular surgery
Bilateral thrombo embolectomy
30,000
Duplex
Duplex ultrasound + scar
7
57
Opthalmology
Buckle Removal
7,000
D
58
Opthalmology
Canaliculo Dacryocysto Rhinostomy
10,000
1
59
Opthalmology
Capsulotomy (YAG)
2,000
D
60
Opthalmology
Corneal Grafting
8,500
D
61
Opthalmology
Cryoretinopexy – Closed
5,000
1
62
Opthalmology
Cyclocryotherapy/Cyclophot ocoagulation
3,500
D
63
Opthalmology
Pterygium + Conjunctival Autograft
9,000
D
64
Opthalmology
Dacryocystectomy with implants
10,000
D
65
Opthalmology
Enucleation
6,000
1
66
Opthalmology
Enucleation with Implant
11,000
1
67
Opthalmology
Exenteration
 
15,000
D
68
Opthalmology
Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including postoperative medications for 12 weeks (and wherever surgical or laser procedures required for bleb augmentation and anterior chamber maintenance)
10,000
D
69
Opthalmology
Intraocular Foreign Body Removal from Anterior Segment
 
4,000
D
70
Opthalmology
Intraocular Foreign Body Removal from Posterior Segment
20,000
D
71
Opthalmology
Lensectomy /pediatric lens aspiration
 
9,000
D
72
Opthalmology
Limbal Dermoid Removal
4,000
D
73
Opthalmology
Surgical Membranectomy
8,000
D
74
Opthalmology
Corneal/Corneo-sclera tear repair
10,000
2
75
Opthalmology
Ptosis (both eye)
15,000
D
76
Opthalmology
Traumatic iris prolapse repair
4,000
D
77
Opthalmology
Retinal Detachment Surgery
 
25,000
2
78
Opthalmology
Small Tumour of Lid “ Excision + Lid Reconstruction
10,000
D
79
Opthalmology
Socket Reconstruction
8,000
 
1
80
Opthalmology
Iridectomy/Iridotomy (Laser)
2,000
D
81
Opthalmology
Iridectomy – Surgical
 
3,000
D
82
Opthalmology
Iris cyst removal
2,500
D
83
Opthalmology
Vitrectomy
 
7,500
 
1
84
Opthalmology
Vitrectomy + Retinal Detachment surgery (pre- auth required)
27,000
1
85
Opthalmology
Cataract with foldable IOL by Phacoemulsification tech. Unilateral
7,000
D
86
Opthalmology
Cataract surgery (SICS) with IOL Unilateral
6,000
 
D
87
Opthalmology
Cataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech + Glaucoma
10,500
88
Opthalmology
Cataract with non-foldable IOL using SICS technique + Glaucoma
6,500
89
Opthalmology
Conjunctival tumour excision + AMG
5,000
D
90
Opthalmology
Entropion correction
4,000
D
91
Opthalmology
Ectropion correction
5,000
D
92
Opthalmology
Evisceration
3,500
D
93
Opthalmology
Laser for retinopathy (per sitting)
1,500
D
94
Opthalmology
Lid tear
5,000
D
95
Opthalmology
Orbitotomy
10,000
D
96
Opthalmology
Squint correction
 
7,000
D
97
Opthalmology
Anterior Chamber Reconstruction +Perforating corneo – Scleral Injury + IOL
11,500
2
98
Opthalmology
Retinal Laser per sitting up to 3 sitting (after which preauthorization is mandatory)
5,000
D
99
OTORHINOLARYNGOLOGY
Aural polypectomy
 
11,000
1
100
OTORHINOLARYNGOLOGY
Labyrinthectomy
 
20,000
 
2
101
OTORHINOLARYNGOLOGY
Mastoidectomy
12,500
 
2
102
OTORHINOLARYNGOLOGY
Mastoidectomy corticol modified/ radical
11,500
2
103
OTORHINOLARYNGOLOGY
Mastoidectomy with tympanoplasty
22,000
2
104
OTORHINOLARYNGOLOGY
Myringoplasty
 
7,500
2
105
OTORHINOLARYNGOLOGY
Myringoplasty with Ossiculoplasty
13,500
2
106
OTORHINOLARYNGOLOGY
Myringotomy – Bilateral
6,000
2
107
OTORHINOLARYNGOLOGY
Myringotomy – Unilateral
3,500
2
108
OTORHINOLARYNGOLOGY
Myringotomy with Grommet – One ear
8,000
2
109
OTORHINOLARYNGOLOGY
Myrinogotomy with Grommet – Both ear
12,000
2
110
OTORHINOLARYNGOLOGY
Ossiculoplasty
 
15,000
2
111
OTORHINOLARYNGOLOGY
Pinna amputation & reconstruction
15,000
1
112
OTORHINOLARYNGOLOGY
Excision of Pinna for Growths (Squamous/Basal) Injuries – Total Amputation & Excision of External Auditory Meatus
8,000
3
113
OTORHINOLARYNGOLOGY
Excision of Pinna for Growths (Squamous/Basal) Injuries Total Amputation
 
6,500
3
114
OTORHINOLARYNGOLOGY
Stapedectomy
 
20,000
3
115
OTORHINOLARYNGOLOGY
Tympanoplasty
9,000
3
116
OTORHINOLARYNGOLOGY
Vidian neurectomy – Micro
9,000
3
117
OTORHINOLARYNGOLOGY
Ear lobe repair – single (daycare)
1,500
 
D
118
OTORHINOLARYNGOLOGY
Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin and Cartilage
5,000
D
119
OTORHINOLARYNGOLOGY
Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin Only
2,500
D
120
OTORHINOLARYNGOLOGY
Pharyngectomy and reconstruction
15,000
2
121
OTORHINOLARYNGOLOGY
Skull base surgery (pre-auth required)*
37,000
Yes
Yes
3
122
OTORHINOLARYNGOLOGY
Total Amputation & Excision of External Auditory Meatus with cul-de-sac closure
50,000
3
123
OTORHINOLARYNGOLOGY
Tympanotomy
4,000
2
124
OTORHINOLARYNGOLOGY
Removal of foreign body from ear
3,000
D
125
OTORHINOLARYNGOLOGY
Aural polypectomy +Tympanoplasty
 
10,000
 
3
126
OTORHINOLARYNGOLOGY
Ant. Ethmoidal artery ligation – open/ endoscopic
11,000
3
127
OTORHINOLARYNGOLOGY
Antrostomy – Bilateral
8,500
3
128
OTORHINOLARYNGOLOGY
Antrostomy – Unilateral
6,000
3
129
OTORHINOLARYNGOLOGY
Cryosurgery
3,000
 
1
130
OTORHINOLARYNGOLOGY
CSF Rhinorrhoea – Repair
14,000
3
131
OTORHINOLARYNGOLOGY
Septoplasty + FESS
25,000
2
132
OTORHINOLARYNGOLOGY
Ethmoidectomy – External
 
11,500
 
2
133
OTORHINOLARYNGOLOGY
Fracture reduction nose with septal correction
18,000
1
134
OTORHINOLARYNGOLOGY
Fracture – setting maxilla
28,000
2
135
OTORHINOLARYNGOLOGY
Fracture – setting nasal bone
12,000
1
136
OTORHINOLARYNGOLOGY
Functional Endoscopic Sinus (FESS)
15,000
1
137
OTORHINOLARYNGOLOGY
Intra Nasal Ethmoidectomy
 
5,000
1
138
OTORHINOLARYNGOLOGY
Rhinotomy – Lateral
 
7,500
2
139
OTORHINOLARYNGOLOGY
Nasal polypectomy – Bilateral
9,000
1
140
OTORHINOLARYNGOLOGY
Nasal polypectomy – Unilateral
6,000
1
141
OTORHINOLARYNGOLOGY
Turbinectomy Partial – Bilateral
3,000
1
142
OTORHINOLARYNGOLOGY
Turbinectomy Partial – Unilateral
2,000
1
143
OTORHINOLARYNGOLOGY
Radical fronto ethmo sphenoidectomy- Endoscopic
35,000
5
144
OTORHINOLARYNGOLOGY
Rhinoplasty
15,000
3
145
OTORHINOLARYNGOLOGY
Septoplasty
15,000
1
146
OTORHINOLARYNGOLOGY
Youngs operation
15,000
1
147
OTORHINOLARYNGOLOGY
Angiofibrom Excision
18,000
 
3
148
OTORHINOLARYNGOLOGY
Cranio-facial resection
22,500
2
149
OTORHINOLARYNGOLOGY
Endoscopic DCR
15,000
 
1
150
OTORHINOLARYNGOLOGY
Endoscopic Hypophysectomy
21,000
2
151
OTORHINOLARYNGOLOGY
Intranasal Diathermy
 
3,000
1
152
OTORHINOLARYNGOLOGY
Rhinosporidiosis
15,000
2
153
OTORHINOLARYNGOLOGY
Septo-rhinoplasty
28,000
2
154
OTORHINOLARYNGOLOGY
Adeno Tonsillectomy
 
25,000
1
155
OTORHINOLARYNGOLOGY
Adenoidectomy
18,000
1
156
OTORHINOLARYNGOLOGY
Arytenoidectomy
25,000
2
157
OTORHINOLARYNGOLOGY
Choanal atresia (newborn requires NICU admission separately)
30,000
2
158
OTORHINOLARYNGOLOGY
Tonsillectomy + Myrinogotomy
10,000
3
159
OTORHINOLARYNGOLOGY
Pharyngeal diverticulum’s Excision
18,000
2
160
OTORHINOLARYNGOLOGY
Laryngectomy with block dissection
25,000
3
161
OTORHINOLARYNGOLOGY
Laryngofissure
5,000
2
162
OTORHINOLARYNGOLOGY
Laryngophayryngectomy
20,000
2
163
OTORHINOLARYNGOLOGY
Maxilla Excision
12,500
2
164
OTORHINOLARYNGOLOGY
Oro Antral fistula with flap repair
30,000
2
165
OTORHINOLARYNGOLOGY
Parapharyngeal Exploration
12,500
2
166
OTORHINOLARYNGOLOGY
Parapharyngeal Abscess Drainage
19,000
2
167
OTORHINOLARYNGOLOGY
Peritonsillor abscess under LA
2,500
D
168
OTORHINOLARYNGOLOGY
Pharyngoplasty
27,000
2
169
OTORHINOLARYNGOLOGY
Retro pharyngeal abscess Drainage
16,000
 
D
170
OTORHINOLARYNGOLOGY
Tonsillectomy + Styloidectomy
23,000
2
171
OTORHINOLARYNGOLOGY
Thyroglossal Fistula/ cyst Excision
7,000
 
2
172
OTORHINOLARYNGOLOGY
Tonsillectomy (Uni/ Bilateral)
22,000
1
173
OTORHINOLARYNGOLOGY
Total Parotidectomy
18,000
2
174
OTORHINOLARYNGOLOGY
Superficial Parotidectomy
 
28,000
4
175
OTORHINOLARYNGOLOGY
Uvulopalatophanyngo Plasty
30,000
2
176
OTORHINOLARYNGOLOGY
Commondo Operation (glossectomy)
17,500
4
177
OTORHINOLARYNGOLOGY
Excision of Branchial Cyst
28,000
3
178
OTORHINOLARYNGOLOGY
Excision of Branchial Sinus
28,000
3
179
OTORHINOLARYNGOLOGY
Excision of Cystic Hygroma Major/ Extensive
45,000
3
180
OTORHINOLARYNGOLOGY
Excision of Cystic Hygroma Minor
32,000
2
181
OTORHINOLARYNGOLOGY
Excision of the Mandible Segmental
 
7,500
3
182
OTORHINOLARYNGOLOGY
Hemi-mandibulectomy with graft
15,000
3
183
OTORHINOLARYNGOLOGY
Hemiglossectomy
6,000
3
184
OTORHINOLARYNGOLOGY
Palatopharyngoplasty
10,000
2
185
OTORHINOLARYNGOLOGY
Partial Glossectomy
5,000
 
3
186
OTORHINOLARYNGOLOGY
Ranula excision
12,000
3
187
OTORHINOLARYNGOLOGY
Removal of Submandibular Salivary gland
25,000
3
188
OTORHINOLARYNGOLOGY
Total Glossectomy
 
15,000
3
189
OTORHINOLARYNGOLOGY
Total Laryngectomy + Neck dissection (pre-auth)*
25,000
 
Yes
Yes
4
190
OTORHINOLARYNGOLOGY
Laryngopharyngectomy with Gastric pull-up/ jejunal graft (pre-auth)*
30,000
Yes
Yes
4
191
OTORHINOLARYNGOLOGY
Excision of CA cheek/ oral cavity + radial forearm flap (pre-auth)*
 
30,000
Yes
Yes
4
192
OTORHINOLARYNGOLOGY
Excision of growth Jaw + free fibular flap reconstruction (pre-auth)*
30,000
 
Yes
Yes
4
193
Orthopaedics
AC joint reconstruction/ Stabilization/ Acromionplasty
25,000
X rays of affected limb, MRI of shoulder
X rays of affected limb
4
Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by- case basis (pre-auth)
194
Orthopaedics
Accessory bone – Excision (limbs) – congenital Accessory digits sometime can be removed (pre-auth)
6,000
X rays of affected limb
X rays of affected limb
3
195
Orthopaedics
Amputation – Below Elbow
15000
5
196
Orthopaedics
Amputation – Above Elbow
20000
 
5
197
Orthopaedics
Amputation – one or more fingers
6,000
1
198
Orthopaedics
Amputation-Intermediate- Wrist
 
15,000
4
199
Orthopaedics
Amputation – one or more toes/digits
 
6,000
1
200
Orthopaedics
Amputation – Below Knee
 
20000
5
201
Orthopaedics
Amputation – Above Knee
20000
 
5
202
Orthopaedics
Foot & Hand Amputation (whole/ partial)
15000
 
5
203
Orthopaedics
Disarticulation (hind & for quarter)
25,000
Clinical and radiological investigations
Clinical and radiological investigations
10-15 days of hospital stay
204
Orthopaedics
Anterior Spine Fixation
35,000
Clinical and radiological
Clinical and radiological investigations
6
investigations
205
Orthopaedics
Posterior Spine Fixation
20,000
Clinical and radiological investigations
Clinical and radiological investigations
5
206
Orthopaedics
Osteochondroma excision/ Excision of Exostosis
10,000
 
Clinical and radiological investigations
Clinical and radiological investigations
4
207
Orthopaedics
Excision Arthoplasty
25,000
Clinical and radiological investigations
Clinical and radiological investigations
4
208
Orthopaedics
Arthorotomy of any joint
15,000
7-10 days hospital stay for 1v antibiotic s
209
Orthopaedics
Arthrodesis Ankle Triple
 
15,000
Clinical and radiological investigations
Clinical and radiological investigations
6
210
Orthopaedics
Excision Arthoplasty of Femur head
22,500
 
6
211
Orthopaedics
Bimalleolar Fracture Fixation
15,000
6
212
Orthopaedics
Bone Tumour Excision + reconstruction using implant (malignant/benign)
50,000
 
Clinical and radiological investigations
Clinical and radiological investigations
4
213
Orthopaedics
Bone Tumour (malignant/ benign) curettage and bone grafting
20,000
Clinical and radiological investigations
Clinical and radiological investigations
214
Orthopaedics
Clavicle fracture management – conservative (daycare)
 
3,000
D
215
Orthopaedics
Close Fixation – Hand Bones
4,000
3
216
Orthopaedics
Close Fixation – Foot Bones
4,000
2
217
Orthopaedics
Close Reduction – Small Joints
4,000
1
218
Orthopaedics
Closed Interlock Nailing + Bone Grafting – femur
19,000
5
219
Orthopaedics
Closed Interlocking Intermedullary
17,500
5
220
Orthopaedics
Closed Interlocking Tibia + Orif of Fracture Fixation
25,000
5
221
Orthopaedics
Closed Reduction and Internal Fixation with K wire
6,000
5
222
Orthopaedics
Closed Reduction and Percutaneous Screw Fixation (neck femur)
15,000
5
223
Orthopaedics
Closed Reduction and Percutaneous Pinning
 
15,000
2
224
Orthopaedics
Closed Reduction and Percutaneous Nailing
 
20,000
5
225
Orthopaedics
Closed Reduction of the Hip (including hip Spika)
7,000
2
226
Orthopaedics
Debridement & Closure of Major injuries – contused lacerated wounds(anti- biotic +dressing-minimum 3 sessions.
7,000
2
227
Orthopaedics
Debridement & Closure of Minor injuries
3000
 
2
228
Orthopaedics
Closed reduction of dislocation (Knee/ Hip)
6,000
 
D
229
Orthopaedics
Closed reduction of dislocation (Shoulder/ Elbow)
5,000
D
230
Orthopaedics
Duputryen Contracture release + rehabilitation
10,000
5
231
Orthopaedics
Exploration and Ulnar nerve Repair
 
10,000
4
232
Orthopaedics
External fixation – Long bone
15,000
4
233
Orthopaedics
External fixation – Small bone
10,000
2
234
Orthopaedics
External fixation – Pelvis
15,000
5
235
Orthopaedics
Fasciotomy
15,000
2
236
Orthopaedics
Fixator with Joint Arthrolysis
20,000
7
237
Orthopaedics
Fracture – Acetabulum
 
30,000
7
238
Orthopaedics
Fracture – Fibula Internal Fixation
10,000
4
239
Orthopaedics
Fracture – Hip Internal Fixation (Intertrochanteric Fracture with implant) + rehabilitation
17,000
7
240
Orthopaedics
Fracture – Humerus Internal Fixation
 
17,000
7
241
Orthopaedics
Fracture – Olecranon of Ulna
10,000
2
242
Orthopaedics
Fracture – Radius Internal Fixation
10,000
 
2
243
Orthopaedics
Fracture – TIBIA Internal Fixation plating
17,000
4
244
Orthopaedics
Fracture – Ulna Internal Fixation
10,000
4
245
Orthopaedics
Head Radius – Excision
 
8,000
3
246
Orthopaedics
High Tibial Osteotomy
 
17,000
5
247
Orthopaedics
Closed reduction + Hip Spica
 
7,000
 
D
248
Orthopaedics
Internal Fixation Lateral Epicondyle
10,000
4
249
Orthopaedics
Internal Fixation of other Small Bones (metatarsals)
10,000
3
250
Orthopaedics
Limb Lengthening
25,000
10
251
Orthopaedics
Llizarov Fixation
10,000
6
252
Orthopaedics
Multiple Tendon Repair
20,000
Clinical + electro- diagnostic studies
Clinical Photographs showing scar
5
253
Orthopaedics
Nerve Repair Surgery
15,000
Clinical + electro- diagnostic studies
Clinical Photographs showing scar
6
254
Orthopaedics
Nerve Transposition/Release/ Neurolysis
8,000
6
255
Orthopaedics
Open Reduction Internal Fixation (2 Small Bones)
 
10,000
3
256
Orthopaedics
Open Reduction Internal Fixation (Large Bone)
20,000
6
257
Orthopaedics
Open Reduction of CDH
30,000
7
258
Orthopaedics
Open Reduction of Small Joint
15,000
 
1
259
Orthopaedics
Open Reduction with bone grafting of nonunion
20,000
3
260
Orthopaedics
Osteotomy -Small Bone
 
17,000
5
261
Orthopaedics
Osteotomy -Long Bone
 
30,000
7
262
Orthopaedics
Patellectomy
 
8,000
 
7
263
Orthopaedics
Pelvic Osteotomy with fixation with plaster
30,000
 
10
264
Orthopaedics
Percutaneous – Fixation of Fracture
7,000
6
265
Orthopaedics
Excision of Bursa
 
3,000
 
2
266
Orthopaedics
Reconstruction of ACL/PCL with implant and brace
30,000
Clinical and radiological investigations
Clinical and radiological investigations
3
267
Orthopaedics
Sequestrectomy of Long Bones + anti-biotics + dressing
25,000
7
268
Orthopaedics
Tendo Achilles Tenotomy
5,000
2
269
Orthopaedics
Tendon Grafting
15,000
2
270
Orthopaedics
Tendon Release/ Tenotomy
5,000
2
271
Orthopaedics
Tenolysis
5,000
2
272
Orthopaedics
Tension Band Wiring Patella
15,000
3
273
Orthopaedics
Application of P.O.P. casts for Upper & Lower Limbs
3,000
D
274
Orthopaedics
Application of P.O.P. Spicas & Jackets with or without GA
4,500
D
275
Orthopaedics
Application of Skeletal Tractions with pin
 
3,000
D
276
Orthopaedics
Application of Skin Traction
1,000
D
277
Orthopaedics
Head radius – Excision + Fracture – Ulna Internal Fixation
20,000
3
278
Orthopaedics
External fixation – both bones of forearms
 
25,000
5
279
Orthopaedics
Fracture intercondylarHumerus + olecranon osteotomy
20,000
5
280
Orthopaedics
Correction of club foot per cast
 
15,000
 
D
281
Orthopaedics
Arthroscopic Meniscus Repair/ Meniscectomy
20,000
Clinical and radiological investigations
Clinical and radiological investigations
3
282
Orthopaedics
Bipolar Hemiarthroplasty (hip & shoulder)
40,000
Clinical and radiological investigations
Clinical and radiological investigations
7
283
Orthopaedics
Unipolar Hemiarthroplasty
30,000
Clinical and radiological investigations
Clinical and radiological investigations
7
284
Orthopaedics
Elbow replacement
40,000
Clinical and radiological investigations
Clinical and radiological investigations
7
285
Orthopaedics
Arthrodesis of shoulder
40,000
Clinical and radiological investigations
Clinical and radiological investigations
7
286
Orthopaedics
Arthrodesis of Knee (with implant)
40,000
Clinical and radiological investigations
Clinical and radiological investigations
7
287
Orthopaedics
Arthrodesis of Wrist (with implant)
 
30,000
Clinical and radiological investigations
Clinical and radiological investigations
7
288
Orthopaedics
Arthrodesis of Ankle (with implant)
30,000
Clinical and radiological investigations
Clinical and radiological investigations
7
289
Polytrauma
Nerve Plexus injuries, Tendon injury repair/reconstruction/ Transfer
50,000
Nerve conduction velocity (NCV) + CT
Clinical Photographs with Graft site +showing scar POST OP ELECTRO DISGNOSTIC STUDR
5-10 Days
290
Polytrauma
Internal fixation with Flap cover Surgery for wound in compound fracture
40,000
PRE OP CLINICAL PICSTURE X-RAY/CT
Post- op. X-ray, Clinical Photograph showing flap cover
5-10 Days
291
Polytrauma
Head injury requiring Facio- Maxillary Injury repairs & fixations(including implants)
 
35,000
 
X-RAY/CT
Clinical Photograph showing scar + post op, XRAY
5-10 Days
292
Polytrauma
Internal fixation of Pelviacetabular fracture
40,000
 
X-RAY/CT
Clinical Photograph showing scar + post op, XRAY
5-10 Days
293
Polytrauma
Visceral injury requiring surgical intervention along with fixation of fracture of single long bone
30,000
Pre-op. X-ray, CT scan + Ultra sound/ X-ray
Post-Op. X-ray + scar photo
5-10 Days
294
Polytrauma
Visceral injury requiring surgical intervention along with fixation o ffracture of 2 or more long bones.
45,000
Pre-op. X-ray, CT scan + Ultra sound/ X-ray
Post-Op. X-ray + scar photo
5-10 Days
295
Polytrauma
Chest injury with one fracture of long bone (with
35,000
Pre-op. X-ray of fracture CHEST XRAY
Post-Op. X-ray + scar photo
5-10 Days
implants)
296
Polytrauma
Chest injury with fracture of 2 or more long bones
45,000
Pre-op. X-ray of fracture
Post-Op. X-ray + scar photo
5-10 Days
297
Polytrauma
Emergency tendons repair ± Peripheral Nerve repair/reconstructive surgery
30,000
Clinical + electro/diagnostic reports
Clinical Photographs with Graft site +Showing scar MRI
5-10 Days
298
Urology
Adrenalectomy-unilateral, open
 
25,000
7
299
Urology
Adrenalectomy-unilateral, Laparoscopic
30,000
3
300
Urology
Adrenalectomy-bilateral, open
32,000
7
301
Urology
Adrenalectomy-biilateral, Laparoscopic
40,000
5
302
Urology
Paraganglioma excision with liver mobilization
50,000
 
303
Urology
Nephrectomy (Benign) Open
25,000
5
304
Urology
Nephrectomy (Benign) Laparoscopic
 
30,000
3
305
Urology
Nephrectomy-Radical (Renal tumor) Open
 
25,000
5
306
Urology
Nephrectomy-Radical (Renal tumor) Laparoscopic
 
30,000
 
3
307
Urology
Nephrectomy-Partial or Hemi, Open
30,000
5
308
Urology
Nephrectomy-Partial or Hemi, Laparoscopic
 
35,000
5
309
Urology
Unilateral Nephroureterectomy Open
35,000
5
310
Urology
Laproscopic Unilateral Nephroureterectomy
 
45,000
3
311
Urology
Nephro ureterectomy with cuff of bladder Open
30,000
5
312
Urology
Nephro ureterectomy with cuff of bladder Laparoscopic
35,000
3
313
Urology
Pyeloplasty/pyeloureterost omy/pyelopyelostomy Open
35,000
3
314
Urology
Pyeloplasty/pyeloureterost omy/pyelopyelostomy Laparoscopic
45,000
2
315
Urology
Endopyelotomy (retrograde with laser/bugbee)
25,000
1
316
Urology
Endopyelotomy (antegrade with laser/bugbee)
28,000
2
317
Urology
Ureterocalycostomy Open
 
25,000
5
318
Urology
Ureterocalycostomy Laparoscopic
30,000
3
319
Urology
Uretero-ureterostomy Open
25,000
3
320
Urology
Uretero-ureterostomy Laparoscopic
35,000
 
3
321
Urology
PCNL (Percutaneous Nephrolithotomy) – Bilateral
40,000
 
3
322
Urology
PCNL (Percutaneous Nephrolithotomy) – Unilateral
30,000
3
323
Urology
Extracoporeal shock-wave Lithotripsy (SWL) stone, with or without stent(one side)
13,000
D (up to 3 sittings)
324
Urology
Extracoporeal shock-wave Lithotripsy (SWL) stone, with or without stent(both sides)
26,000
D (up to 3 sittings)
325
Urology
Pyelolithotomy-Open
21,000
3
326
Urology
Pyelolithotomy- Laparoscopic
35,000
2
327
Urology
Nephrolithotomy-Open
22,000
3
328
Urology
Anatrophic Nephrolithotomy For Staghorn Calculus
50,000
5
329
Urology
Perinephric Abscess drainage (percutaneous)
10,000
2
330
Urology
Perinephric Abscess drainage (Open)
20,000
3
331
Urology
Renal Cyst deroofing or marsupialization-Open
20,000
3
332
Urology
Renal Cyst deroofing or marsupialization- Laparoscopic
30,000
3
333
Urology
Nephrostomy-percutaneous ultrasound guided
 
10,000
D
334
Urology
Ureterolithotomy-Open
 
20,000
3
335
Urology
Ureterolithotomy- Laparoscopic
30,000
 
3
336
Urology
Ureteroscopy+stone removal with lithotripsy, lower ureter, unilateral
20,000
1
337
Urology
Ureteroscopy+stone removal with lithotripsy, upper ureter, unilateral
25,000
 
1
338
Urology
Ureteroscopy+stone removal with lithotripsy, bilateral
30,000
1
339
Urology
Ureterotomy (Cutaneous)
 
20,000
2
340
Urology
Endoureterotomy (laser/bugbee)
20,000
 
1
341
Urology
Ureteric reimplantation- unilateral-open
35,000
3
342
Urology
Ureteric reimplantation- bilateral-open
50,000
3
343
Urology
Ureteric reimplantation- unilateral-Laparoscopic
30,000
3
344
Urology
Ureteric reimplantation- bilateral-Laparoscopic
35,000
3
345
Urology
Uretero-vaginal/uterine fistula repair open
27,000
3
346
Urology
Uretero-vaginal/uterine fistula repair Laparoscopic
37,000
3
347
Urology
Ureterolysis-open, for retroperitoneal fibrosis (with or without omental wrapping)
20,000
3
348
Urology
Ureterolysis-Laparoscopic, for retroperitoneal fibrosis (with or without omental wrapping)
 
30,000
3
349
Urology
Boari flap for ureteric stricture, open
30,000
3
350
Urology
Boari flap for ureteric stricture, Laparoscopic
40,000
3
351
Urology
Ileal replacement for ureteric stricture
40,000
5
352
Urology
DJ stent unilateral including cystoscopy, ureteric catheterization,retrograde pyelogram
10,000
 
D
353
Urology
DJ stent bilateral including cystoscopy, ureteric catheterization, retrograde pyelogram
15,000
D
354
Urology
Ureteric sampling including cystoscopy, ureteric catheterization,retrograde pyelogram
10,000
 
D
355
Urology
Ureterocele incision including cystoscopy, ureteric catheterization,retrograde pyelogram
15,000
1
356
Urology
Urachal Cyst/umbilical sinus excision
20,000
2
357
Urology
Cystolithotomy-open, including cystoscopy
25,000
2
358
Urology
Lithotripsy Complete Upto more than 8 mm, renal and upper ureter (urologist will prescribe and will be done under his supervision only)
16,000
1
359
Urology
TURBT (Transurethral Resection of the Bladder Tumor)
 
35,000
2
360
Urology
TUR-fulgration (Transurethral fulgration of the Bladder Tumor)
18,000
2
361
Urology
Intravesical BCG/Mitomycin 6 induction cycles (weekly for 6 weeks-total cost of 6 cycles)
12,000
D
362
Urology
Intravesical BCG/Mitomycin maintenance for 12 doses (total cost of 12 doses)
24,000
D
363
Urology
Post TURBT – Check Cystoscopy (Per sitting) with or without cold-cup biopsy
 
10,000
D
364
Urology
Cystoscopy Diagnostic with prior approval from IA
 
10,000
D
365
Urology
Bladder Neck incision- endoscopic
15,000
1
366
Urology
Extrophy Bladder repair including osteotomy if needed + epispadias repair + ureteric reimplant
50,000
 
5
367
Urology
Bladder injury repair (as an independent procedure with or without urethral injury)
25,000
3
368
Urology
Bladder injury repair (only to be used if done as a part of ongoing laparotomy/other surgery)
10,000
2
369
Urology
Bladder injury repair with colostomy (as an independent procedure with or without urethral injury
25,000
5
370
Urology
Partial Cystectomy-open
20,000
3
371
Urology
Partial Cystectomy- Laparoscopic
30,000
3
372
Urology
Radical cystectomy with neobladder-open
50,000
7
373
Urology
Radical cystectomy with continent diversion-open
50,000
7
374
Urology
Radical Cystectomy with Ileal Conduit-open
50,000
7
375
Urology
Radical Cystectomy with ureterostomy-open
35,000
 
7
376
Urology
Radical Cystectomy with ureterosigmoidostomy- open
35,000
7
377
Urology
Other Cystectomies
 
30,000
 
2
378
Urology
Suprapubic Cystostomy – Open/Closed
10,000
D
379
Urology
Suprapubic Drainage – Closed/Trocar
 
5,000
D
380
Urology
VVF/Uterovaginal Repair – Transvaginal approach
25,000
5
381
Urology
VVF/Uterovaginal Repair – Abdominal,Open
 
25,000
5
382
Urology
VVF/Uterovaginal Repair – Abdominal, Laparoscopic
30,000
5
383
Urology
Hysterectomy as part of VVF/uterovaginal fistula
5,000
repair (top-up)
384
Urology
Urethrovaginal fistula repair
30,000
3
385
Urology
Y V Plasty of Bladder Neck/Bladder Neck Reconstruction
20,000
5
386
Urology
Augmentation cystoplasty- open
30,000
5
387
Urology
Augmentation cystoplasty- Laparoscopic
40,000
5
388
Urology
Bladder Diverticulectomy
45,000
3
389
Urology
Open simple prostatetctomy for BPH
25,000
3
390
Urology
TURP-Transurethral Resection of the Prostate, BPH,Monopolar/Bipolar/Las er
30,000
2
391
Urology
Holmium Laser Prostatectomy
 
40,000
2
392
Urology
TURP/Laser + Circumcision
30,000
 
2
393
Urology
TURP/Laser + Cystolithotripsy
40,000
2
394
Urology
TURP/Laser + Cystolithotomy-open
 
35,000
2
395
Urology
TURP/Laser + Orchidectomy
 
30,000
2
396
Urology
TURP/Laser + TURBT
30,000
 
2
397
Urology
TURP/Laser + URS with stone removal
40,000
2
398
Urology
TURP/Laser + VIU (visual internal Ureterotomy)
 
40,000
2
399
Urology
TURP/Laser + Hydrocele surgery
40,000
2
400
Urology
TURP/Laser + Hernioplasty
40,000
2
401
Urology
TURP/Laser + Urethral dilatation-non endoscopic
40,000
2
402
Urology
TURP/Laser + Urethral dilatation-endoscopic
40,000
2
403
Urology
Radical prostatectomy – open
50,000
5
404
Urology
Transrectal Ultrasound guided prostate biopsy (minimum 12 core)
10,000
405
Urology
Reduction of Paraphimosis
7,000
D
406
Urology
Excision of Urethral Caruncle
25,000
1
407
Urology
Meatoplasty
7,500
1
408
Urology
Meatotomy
6,000
 
1
409
Urology
Post Urethral Valve fulguration
28,000
1
410
Urology
Urethroplasty-End to end
20,000
3
411
Urology
Urethroplasty-Substitution- single stage
30,000
 
5
412
Urology
Urethroplasty-Substitution- two stage
35,000
5
413
Urology
Urethroplasty-Transpubic
 
30,000
5
414
Urology
Urethroplasty-two stage without substitution
30,000
 
5
415
Urology
Perineal Urethrostomy without closure
20,000
2
416
Urology
Urethrorectal fistula repair
40,000
6
417
Urology
Urethral Dilatation-non endocopic as an independent procedure
2,000
D
418
Urology
Urethral Dilatation- endocopic as an independent procedure
5,000
D
419
Urology
Internal Ureterotomy including cystoscopy as an independent procedure
10,000
1
420
Urology
Single Stage Hypospadias
48,000
3
421
Urology
Hypospadias repair-two or more stage
30,000
3
422
Urology
Orchiopexy-without laparoscopy, unilateral
15,000
2
423
Urology
Orchiopexy-without laparoscopy, bilateral
15,000
2
424
Urology
Orchiopexy-with laparoscopy, unilateral
30,000
2
425
Urology
Orchiopexy-with laparoscopy, bilateral
30,000
 
2
426
Urology
Stress incontinence surgery, open
20,000
4
427
Urology
Stress incontinence surgery, laparoscopic
 
30,000
4
428
Urology
Stress incontinence surgery with slings
35,000
3
429
Urology
Partial Penectomy
 
25,000
 
2
430
Urology
Total Penectomy + Perineal Urethrostomy
50,000
2
431
Urology
Ilio-Inguinal lymphadenectomy- unilateral
15,000
3
432
Urology
Ilio-Inguinal lymphadenectomy-bilateral
 
25,000
 
3
433
Urology
Pelvic lymphadenectomy open, after prior cancer surgery
25,000
3
434
Urology
Pelvic lymphadenectomy laparoscopic, after prior
30,000
3
cancer surgery
435
Urology
Orchiectomy-High inguinal
12,000
1
436
Urology
Orchiectomy-simple
10,000
D
437
Urology
Bilateral Orchiectomy for advance protate CA
25,000
D
438
Urology
Retroperitoneal lymph node dissection-open
25,000
3
439
Urology
Retroperitoneal lymph node dissection-Laparoscopic
35,000
3
440
Urology
Infertility-Scrotal exploration unilateral
10,000
D
441
Urology
Infertility-Scrotal exploration bilateral
12,000
D
442
Urology
Infertility- Vasoepididymostomy, microsurgical, unilateral
15,000
D
443
Urology
Infertility- Vasoepididymostomy, microsurgical, bilateral
20,000
D
444
Urology
Varicocele-unilateral-non microsurgical
 
10,000
1
445
Urology
Varicocele-unilateral- microsurgical
12,000
 
1
446
Urology
Varicocele-bilateral-non microsurgical
15,000
1
447
Urology
Varicocele-bilateral- microsurgical
 
20,000
1
448
Urology
Penile prosthesis insertion, Malleable (Indian implant)
 
30,000
3
449
Urology
Priapism-aspiration/shunt
 
15,000
2
450
Urology
Neurogenic bladder- Package for evaluation/investigation (catheter +ultrasound +
7,500
culture + RGU/ MCU) for 1 month (medicines – antibiotics).Follow up visit once in 3 months
451
Urology
Chronic prostatitis-Package for evaluation/investigation (ultrasound +culture + prostate massage) for 1 month (medicines). Follow up visit once in 3 months.
2,500
452
Urology
Emergency management of Ureteric stone – Package for evaluation/investigation (ultrasound + culture) for 3 weeks (medicines).
3,500
453
Urology
Emergency management of Hematuria
2,000/ DAY
 
454
Urology
Emergency management of Acute retention of Urine
2,000/ DAY
 
455
Urology
Acute management of upper urinary tract trauma conservative
2,000/ DAY
456
Urology
Urinary tract trauma -open surgery (exploratory)
 
20,000
5
457
Urology
Urinary tract trauma – Laparoscopy surgery
30,000
 
5
458
Obstetrics & Gynaecology
Hysterectomy ± Salpingo- oophorectomy(Benign)
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
459
Obstetrics & Gynaecology
Abdominal Myomectomy(Benign)
 
16,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
460
Obstetrics & Gynaecology
Surgeries for Prolapse – Sling Surgeries(Benign)
16,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
461
Obstetrics & Gynaecology
Surgeries for Stress Incontinence
35,000
Clinical/ Histopathological
Post.op ultrasound (pelvis)
5
‘Burch'(Benign)
report
462
Obstetrics & Gynaecology
Hysterotomes – 2nd Trimester abortions(Benign)
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
463
Obstetrics & Gynaecology
Incisional Hernia Repair(Benign)
15,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
464
Obstetrics & Gynaecology
Radical Hysterectomy (Wertheims)-
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
465
Obstetrics & Gynaecology
Laparotomy and proceed for Ovarian Cancers. Omentomy with Bilateral Salpingo-oophorectomy
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
466
Obstetrics & Gynaecology
Non descent vaginal hysterectomy
14,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
4
467
Obstetrics & Gynaecology
Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy
16,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
468
Obstetrics & Gynaecology
Vaginal surgical repair for vesico-vaginal fistula
 
10,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
469
Obstetrics & Gynaecology
Sacrocolpopexy
16,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
7
470
Obstetrics & Gynaecology
Repair for rectovaginal fitulas
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
471
Obstetrics & Gynaecology
Vaginoplasty
 
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
472
Obstetrics & Gynaecology
LLETZ
15,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
473
Obstetrics & Gynaecology
Colpotomy
1,200
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
474
Obstetrics & Gynaecology
Dilation and Evacuation (D&E)
5,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
475
Obstetrics & Gynaecology
Cervical biopsy and Polypectomy
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
476
Obstetrics & Gynaecology
Bartholin cyst removal under anesthesia
5,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
477
Obstetrics & Gynaecology
Vulvectomy simple
15,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
478
Obstetrics & Gynaecology
Radical Vulvectomy
15,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
479
Obstetrics & Gynaecology
Diagnostic laparoscopy
 
11,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
480
Obstetrics & Gynaecology
LAVH/Total laparoscopic hysterectomy with or without BSO/VH with PFR with prior approval from IA
23,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
481
Obstetrics & Gynaecology
Laparoscopic myomectomy
 
22,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
482
Obstetrics & Gynaecology
Laparoscopic cystectomy
15,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
483
Obstetrics & Gynaecology
Laparoscopic ovarotomy
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
484
Obstetrics & Gynaecology
Laparoscopic adhesiolysis
6,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
1
485
Obstetrics & Gynaecology
Laparoscopic tubal surgeries – salpingectomy, salpingotomy
11,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
486
Obstetrics & Gynaecology
Drag hysteroscopy
 
6,000
Post.op ultrasound (pelvis)
1
487
Obstetrics & Gynaecology
Hysteroscopic myomectomies
6,000
Post.op ultrasound (pelvis)
1
488
Obstetrics & Gynaecology
Hysteroscopic adhesiolysis
 
6,000
 
Post.op ultrasound (pelvis)
1
489
Obstetrics & Gynaecology
Hysteroscopic polypectomy
3,000
Post.op ultrasound (pelvis)
2
490
Obstetrics & Gynaecology
Hysteroscopic IUCD removal
3,000
 
Post.op ultrasound (pelvis)
1
491
Obstetrics & Gynaecology
Caesarian Delivery
18,500
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
492
Obstetrics & Gynaecology
Caesarian hysterectomy
16,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
493
Obstetrics & Gynaecology
Manual removal of placenta
6,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
2
494
Obstetrics & Gynaecology
Laparotomy for ectopic rupture/Laparoscopy suction of ectopic pregnancy
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
495
Obstetrics & Gynaecology
MTP > 12 weeks
6,500
Clinical/ Histopathological
Post.op ultrasound (pelvis)
1
report
496
Obstetrics & Gynaecology
MTP upto 12 weeks
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
1
497
Obstetrics & Gynaecology
MTP upto 8 weeks
3,500
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
1
498
Obstetrics & Gynaecology
Mc. Donalds stitch
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
499
Obstetrics & Gynaecology
Shirodkar’s stitch
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
500
Obstetrics & Gynaecology
Tuboplasty
10,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
5
501
Obstetrics & Gynaecology
Laparotomy for broad ligament haematoma
16,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
3
502
Obstetrics & Gynaecology
Trans-vaginal tape/ Trans-obturator tape
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
503
Obstetrics & Gynaecology
Abdominal Perineal neo construction Cx + Uteria + Vagina
 
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
504
Obstetrics & Gynaecology
Ablation of Endometriotic Spot + Adhenolysis
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
505
Obstetrics & Gynaecology
Ablation of Endometriotic Spot +Salpingostomy
 
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
506
Obstetrics & Gynaecology
Adhenolysis + Hernia – Ventral – Lipectomy/Incision
16,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
507
Obstetrics & Gynaecology
Adhenolysis + Abdominal/Lalproscopic Ovarian Cystectomy with prior approval from IA
20,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
508
Obstetrics & Gynaecology
Adhenolysis+ Salpingostomy
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
509
Obstetrics & Gynaecology
Broad Ligment Haemotoma drainage
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
510
Obstetrics & Gynaecology
Brust abdomen repair
14,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
511
Obstetrics & Gynaecology
Cone Biopsy Cervix
1,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
512
Obstetrics & Gynaecology
Conventional Tubectomy
4,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
513
Obstetrics & Gynaecology
Cyst -Vaginal Enucleation
 
4,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
514
Obstetrics & Gynaecology
Cyst-Labial
 
3,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
515
Obstetrics & Gynaecology
Cystocele – Anterior repair
12,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
516
Obstetrics & Gynaecology
Cystocele/Vault prolapse – Anterior Repair + Perineal Repair (post hysterectomy) Not be blocked with hysterectomy with prior approval from IA
18,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
517
Obstetrics & Gynaecology
D&C ( Dilatation &curretage) + Electro Cauterisation Cryo Surgery
4,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
518
Obstetrics & Gynaecology
D&C (Dilatation&curretage)
3,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
519
Obstetrics & Gynaecology
Diagnostic hystereolaproscopy with prior approval from IA
20,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
520
Obstetrics & Gynaecology
Electro Cauterisation Cryo Surgery
4,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
521
Obstetrics & Gynaecology
Exploration of abdominal haematoma (after laparotomy + LSCS)
14,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
522
Obstetrics & Gynaecology
Fractional Curretage
4,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
523
Obstetrics & Gynaecology
Gaping Perineal wound secondary suturing/ episiotomy
2,500
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
524
Obstetrics & Gynaecology
HaematoColpo/Excision – Vaginal Septum
 
5,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
525
Obstetrics & Gynaecology
Hymenectomy& Repair of Hymen
7,000
 
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
526
Obstetrics & Gynaecology
Amniocentesis
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
527
Obstetrics & Gynaecology
Chorionic villus sampling
5,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
528
Obstetrics & Gynaecology
Cordocentesis
5,000
Clinical/ Histopathological
Post.op ultrasound (pelvis)
D
report
529
Obstetrics & Gynaecology
Intrauterine transfusions
10,000
Clinical/ Histopathological report
Post.op ultrasound (pelvis)
D
530
General Surgery
Adventious Burse – Excision
10,000
3
531
General Surgery
Anterior Resection for CA
15,000
4
532
General Surgery
Interval Appendicetomy
20,000
 
2
533
General Surgery
Appendicular Abscess – Drainage
25,000
 
2
534
General Surgery
Arteriovenous (AV) Malformation of Soft Tissue Tumour – Excision
15,000
3
535
General Surgery
Bakers Cyst – Excision
6,000
 
3
536
General Surgery
Bilateral Inguinal block dissection
5,000
3
537
General Surgery
Bleeding Ulcer – Gastrectomy & vagotomy
 
25,000
5
538
General Surgery
Bleeding Ulcer – Partial Gastrectomy
25,000
 
5
539
General Surgery
Block dissection Cervical Nodes
10,000
3
540
General Surgery
Branchial Fistula
14,000
3
541
General Surgery
Breast Lump – Left – Excision
 
5,000
 
2
542
General Surgery
Breast Lump – Right – Excision
6,500
2
543
General Surgery
Branchial Cyst
10,000
2
544
General Surgery
Bursa – Excision
4,000
2
545
General Surgery
Bypass – Inoperable Pancreas
15,000
4
546
General Surgery
Cervial Lymphnodes – Excision
4000
1
547
General Surgery
Colostomy with laprotomy
35,000
4
548
General Surgery
Cyst over Scrotum – Excision
5,000
1
549
General Surgery
Cystic Mass – Excision
3,000
1
550
General Surgery
Dermoid Cyst – Large – Excision
6,000
D
551
General Surgery
Dermoid Cyst – Small – Excision
3,000
D
552
General Surgery
Drainage of Ischio Rectal Abscess under anesthesia
15,000
1
553
General Surgery
Drainage of Large Abscess under anesthesia
10,000
D
554
General Surgery
Drainage of Psoas Abscess
7,500
2
555
General Surgery
Drainage of Subdiaphramatic Abscess
10,000
3
556
General Surgery
Drainage Pericardial Effusion
13,750
5
557
General Surgery
Duodenal Diverticulum
 
20,000
5
558
General Surgery
Duodenal Jejunostomy
 
20,000
 
5
559
General Surgery
Duplication of Intestine
18,000
5
560
General Surgery
Hydrocele + Orchidectomy
 
8,000
2
561
General Surgery
Epidedectomy
 
10,000
 
3
562
General Surgery
Epididymal Swelling – Excision
6,000
2
563
General Surgery
Epidymal Cyst
6,000
D
564
General Surgery
Evacuation of Scrotal Hematoma
8,000
2
565
General Surgery
Excision Benign Tumor – Small intestine
45,000
5
566
General Surgery
Excision Bronchial Sinus
8,000
D
567
General Surgery
Drainage of liver Abscess
8,000
3
568
General Surgery
Excision Filarial Scrotum
12,000
3
569
General Surgery
Excision Mammary Fistula
5,000
2
570
General Surgery
Excision Meckel’s Diverticulum
15,000
3
571
General Surgery
Excision Pilonidal Sinus
12,500
 
2
572
General Surgery
Excision Small Intestinal Fistula
45,000
5
573
General Surgery
Excision of Growth from Tongue only
 
6,000
 
1
574
General Surgery
Excision of Growth from Tongue with neck node dissection
15,000
4
575
General Surgery
Excision of Swelling in Right Cervical Region
 
5,000
1
576
General Surgery
Excision of Large Swelling in Hand
3,000
 
D
577
General Surgery
Excision of Small Swelling in Hand
1,500
 
D
578
General Surgery
Excision of Neurofibroma/Fibroma
7,000
2
579
General Surgery
Exicision of Sinus and Curettage
 
5,000
2
580
General Surgery
Fibroadenoma Breast bilateral – multiple
20,000
2
581
General Surgery
Fibroadenoma – Breast Unilateral – multiple
 
15,000
2
582
General Surgery
Fissurectomy
8,000
2
583
General Surgery
Fissurectomy and Haemorrhoidectomy
16,000
2
584
General Surgery
Eversion of Hydrocele Sac – Bilateral
10,000
2
585
General Surgery
Eversion of Hydrocele Sac – Unilateral
5,000
2
586
General Surgery
Fissurectomy/Sphincteroto my
15,000
2
587
General Surgery
Foreign Body Removal in Deep Region requiring GA
5,000
2
588
General Surgery
Fundoplication
20,000
 
3
589
General Surgery
G J Vagotomy/ Vagotomy + Pyloroplasty
15,000
5
590
General Surgery
Ganglion – large – Excision
 
3,000
1
591
General Surgery
Ganglion – Small – Excision
2,000
 
D
592
General Surgery
Gastrojejunostomy
40,000
4
593
General Surgery
Gastrostomy
18,000
4
594
General Surgery
Surgical management of Duodenal perforation
30,000
5
595
General Surgery
Granuloma – Excision
 
4,000
 
1
596
General Surgery
Haemangioma – Excision (large)
10,000
3
597
General Surgery
Small Haemangioma – Excision
 
10,000
 
2
598
General Surgery
Surgical management For Haemorrhage of The Small Intestine
40,000
3
599
General Surgery
Hepatic Resection (lobectomy)
20,000
7
600
General Surgery
Epigastric Hernia- Open without mesh
25,000
2
601
General Surgery
Hernia – Incisional
15,000
3
602
General Surgery
Hernia – Repair & release of obstruction
15,000
3
603
General Surgery
Umbilical Hernia repair without mesh-open
25,000
3
604
General Surgery
Unilateral Femoral Hernia repair-Open with mesh
25,000
2
605
General Surgery
Hernioplasty – Inguinal
10,000
3
606
General Surgery
Herniorraphy
9,000
2
607
General Surgery
Hiatus Hernia – abdominal
15,000
5
608
General Surgery
Hydatid Cyst of Liver
12,500
 
3
609
General Surgery
Hydrocele Unilateral under GA/Spinal
10,000
 
2
610
General Surgery
Hydrocele Bilateral under GA/Spinal
12,000
2
611
General Surgery
IlieoSigmoidostomy
 
17,000
 
5
612
General Surgery
Infected Bunion Foot – Excision
4,000
1
613
General Surgery
Inguinal Node (dissection) – Unilateral
 
10,000
2
614
General Surgery
Intestinal perforation
 
12,500
5
615
General Surgery
Intestinal Obstruction
 
12,500
5
616
General Surgery
Intussusception
 
15,000
6
617
General Surgery
Jejunostomy
 
10,000
5
618
General Surgery
Gastric Perforation
15,000
5
619
General Surgery
Intestinal Perforation (Resection Anastomosis)
40,000
5
620
General Surgery
Surgical treatment for Appendicular Perforation
28,000
5
621
General Surgery
Burst Abdomen Obstruction
15,000
6
622
General Surgery
Closure of Hollow Viscus Perforation
15,000
5
623
General Surgery
Laryngectomy & Pharyngeal Diverticulum(Throat)
15,000
3
624
General Surgery
Ileostomy Closure without Laprotomy
25,000
4
625
General Surgery
Lipoma excision
 
2,500
D
626
General Surgery
Loop Colostomy Sigmoid
12,000
4
627
General Surgery
Mastectomy
12,000
2
628
General Surgery
Mesenteric Cyst – Excision
16,000
 
3
629
General Surgery
Mesenteric Caval Anastomosis
15,000
5
630
General Surgery
Microlaryngoscopic Surgery
 
15,000
 
3
631
General Surgery
Oeshophagoscopy for foreign body removal
8,500
D
632
General Surgery
Oesophagectomy
 
17,500
 
5
633
General Surgery
Portal Hypertension shunt surgery
18,000
5
634
General Surgery
Pelvic Abscess – Open Drainage
 
10,000
4
635
General Surgery
PancreaticoDuodenectomy
25,000
6
636
General Surgery
Distal Pancreatectomy with PancreaticoJejunostomy t
25,000
7
637
General Surgery
Papilloma Rectum – Excision
4,000
2
638
General Surgery
Haemorroidectomy+ Fistulectomy
10,000
2
639
General Surgery
Growth in the Scalp – Excision
4,000
1
640
General Surgery
Porto Caval Anastomosis
15,000
5
641
General Surgery
Pyeloroplasty
10,000
4
642
General Surgery
Radical Mastectomy
10,000
2
643
General Surgery
Radical Neck Dissection – Excision
15,000
6
644
General Surgery
Hernia – Spigelian
5,000
3
645
General Surgery
Rectal Dilation
2,000
 
1
646
General Surgery
Prolapse of Rectal Mass – Excision
10,000
2
647
General Surgery
Surtured Rectopexy
 
15,000
3
648
General Surgery
Repair of Common Bile Duct
30,000
 
3
649
General Surgery
Resection Anastomosis (Large Intestine)
15,000
7
650
General Surgery
Resection Anastomosis (Small Intestine)
 
15,000
7
651
General Surgery
Retroperitoneal Tumor – Excision
45,000
5
652
General Surgery
Haemorroidectomy
 
5,000
2
653
General Surgery
Salivary Gland – Excision
10,000
 
3
654
General Surgery
Segmental Resection of Breast
10,000
 
3
655
General Surgery
Excision-multiple scrotal swellings (multiple sebaceous cysts)
7,000
2
656
General Surgery
Sigmoid Diverticulum
15,000
6
657
General Surgery
Simple closure – Peptic perforation
15,000
5
658
General Surgery
Sinus – Excision
5,000
2
659
General Surgery
Soft Tissue Tumor (small) – Excision
5,000
2
660
General Surgery
Soft Tissue Tumor (large) – Excision
10,000
3
661
General Surgery
Laproscopic Splenectomy
45,000
6
662
General Surgery
Submandibular Lymph node – Excision
6,000
2
663
General Surgery
Submandibular Mass Excision +Reconstruction
20,000
5
664
General Surgery
Swelling in foot (small) – Excision
1,500
D
665
General Surgery
Swelling in foot (large) – Excision
3,500
1
666
General Surgery
Coloectomy – Total
 
20,000
 
6
667
General Surgery
Pharyngectomy& Reconstruction – Total
20,000
6
668
General Surgery
Tracheal Stenosis (End to end Anastamosis)(Throat)
15,000
6
669
General Surgery
Tracheoplasty (Throat)
 
15,000
 
6
670
General Surgery
Umbilical Sinus – Excision
15,000
 
2
671
General Surgery
Varicose Veins – Excision and Ligation
22,000
3
672
General Surgery
Vasovasostomy
12,000
3
673
General Surgery
Volvlous of Large Bowel
 
25,000
4
674
General Surgery
Cleft lip operation
12,000
2
675
General Surgery
Cleft palate repair
12,000 (for each Stage)
676
General Surgery
Cleft lip and palate repair (bilateral)
15,000 (for each stage)
677
General Surgery
Aneurysm not Requiring Bypass Techniques t
36,000
678
General Surgery
Aneurysm Resection & Grafting
36,000
679
General Surgery
Arterial Embolectomy
10,000
680
General Surgery
Carotid artery aneurysm repair
20,000
 
681
General Surgery
Carotid Body tumour – Excision
20,000
682
General Surgery
Cholecystectomy & Exploration of CBD
 
22,000
6
683
General Surgery
Cholecystostomy
 
10,000
6
684
General Surgery
Congential Arteriovenus Fistula (large)
20,000
 
685
General Surgery
Congential Arteriovenus Fistula (small)
10,000
686
General Surgery
Decortication (Pleurectomy)
 
20,000
687
General Surgery
Dissecting Aneurysms
36,000
688
General Surgery
Distal Abdominal Aorta repair
36,000
689
General Surgery
Estlander Operation (lip)
 
7,000
 
1
690
General Surgery
Excision and Skin Graft of Venous Ulcer
20,000
691
General Surgery
Excision of Parathyroid Adenoma/Carcinoma
22,000
692
General Surgery
Flap Reconstructive Surgery
20,000
693
General Surgery
Split thickness skin grafts – Small (< 4% TBSA)
5,000
D
694
General Surgery
Split thickness skin grafts – Medium (4 – 8% TBSA)
10,000
D
695
General Surgery
Split thickness skin grafts – Large (> 8% TBSA)
15,000
D
696
General Surgery
Free Grafts – Wolfe Grafts
10,000
697
General Surgery
Hemi thyroidectomy
10,000
698
General Surgery
Total thyroidectomy
30,000
699
General Surgery
Laparoscopic Hernia Repair
18,000
3
700
General Surgery
left Hemi colectomy
35,000
5
701
General Surgery
Right Hemi colectomy
35,000
5
702
General Surgery
Lap. Assisted small bowel resection
15,000
3
703
General Surgery
Total Colectomy
40,000
 
5
704
General Surgery
Lap. Cholecystectomy & CBD exploration
35,000
3
705
General Surgery
Lap. For intestinal obstruction
 
15,000
5
706
General Surgery
Lap. Hepatic resection
 
25,000
5
707
General Surgery
Lap. Hydatid of liver surgery
 
20,000
 
5
708
General Surgery
Laparoscopic Adhesinolysis
15,000
 
5
709
General Surgery
Laparoscopic Appendicectomy
25,000
3
710
General Surgery
Open/Laproscopic Cholecystectomy
30,000
5
711
General Surgery
Laparoscopic cystogastrostomy
 
20,000
5
712
General Surgery
Laparoscopic Gastrostomy
12,000
5
713
General Surgery
Hiatus Hernia Repair – Abdominal
40,000
5
714
General Surgery
Laparoscopic Pyloromyotomy
20,000
5
715
General Surgery
Laparoscopic Rectopexy
15,000
5
716
General Surgery
Laparoscopic Spleenectomy
16,500
5
717
General Surgery
Laparoscopic umbilical hernia repair
15,000
5
718
General Surgery
Ventral And Scar Hernia repair with Mesh-Open
 
35,000
5
719
General Surgery
Laparotomy-peritonitis lavage and drainage
10,000
5
720
General Surgery
Ligation of Ankle Perforators
5,000
3
721
General Surgery
Lymphatics Excision of Subcutaneous Tissues In Lymphoedema
10,000
3
722
General Surgery
Repair of Main Arteries of the Limbs
 
25,000
5
723
General Surgery
Mediastinal Tumour
 
20,000
 
724
General Surgery
Oesophagectomy for Carcinoma Oesophagus
25,000
7
725
General Surgery
Operation for Bleeding Peptic Ulcer
45,000
 
5
726
General Surgery
Operation for Carcinoma Lip -Vermilionectomy
10,000
6
727
General Surgery
Operation for Carcinoma Lip – Wedge Excision & vermilionectomy
12,000
6
728
General Surgery
Operation for Carcinoma Lip – Wedge-Excision
 
10,000
 
6
729
General Surgery
Appendicectomy – Appendicular Abscess – Drainage
12,000
5
730
General Surgery
Caecostomy
10,000
731
General Surgery
Closure of Colostomy
25,000
732
General Surgery
Coccygeal Teratoma Excision
15,000
733
General Surgery
Congenital Atresia & Stenosis of Small Intestine
20,000
734
General Surgery
CystoJejunostomy/or Cystogastrostomy
20,000
735
General Surgery
Drainage of perivertebral abscess
10,000
736
General Surgery
Hernia -hiatus-Transthoracic
 
25,000
737
General Surgery
Intercostal drainage
2,000
5
738
General Surgery
Operation for carcinoma lip- cheek advancement Thymectomy
12,000
739
General Surgery
Thymectomy
20,000
 
5
740
General Surgery
Operation of Choledochal Cyst
15,000
5
741
General Surgery
Operations for Acquired Arteriovenous Fistula
15,000
 
742
General Surgery
Operations for Replacement of Oesophagus by colon
25,000
7
743
General Surgery
Parapharyngeal Tumour Excision
27,000
 
744
General Surgery
Partial/Subtotal Gastrectomy for Carcinoma
22,000
745
General Surgery
Patch Graft Angioplasty
 
20,000
746
General Surgery
Pericardiostomy
30,000
747
General Surgery
Pneumonectomy
25,000
748
General Surgery
Removal of Foreign Body from Trachea or Oesophagus
5,000
749
General Surgery
Removal Tumours of Chest Wall
20,000
750
General Surgery
Procedures Requiring Bypass Techniques
35,000
751
General Surgery
Resection Enucleation of Adenoma (lung)
10,000
752
General Surgery
Rib Resection & Drainage
10,000
753
General Surgery
Skin Flaps – Rotation Flaps
6,200
754
General Surgery
Splenectomy
42,000
755
General Surgery
Surgery for Arterial Aneurism Spleen Artery
20,000
756
General Surgery
Surgery for Arterial Aneurism -Vertebral
25,000
757
General Surgery
Sympathetectomy – Cervical
5,000
758
General Surgery
Temporal Bone resection
15,000
759
General Surgery
Thorachostomy
 
10,000
760
General Surgery
Thoracocentesis
 
1,500
761
General Surgery
Thoracoplasty
20,000
762
General Surgery
Thoracoscopic Decortication
25,000
763
General Surgery
Thoracoscopic Hydatid Cyst excision
20,000
764
General Surgery
Thoracoscopic Lobectomy
 
25,000
 
765
General Surgery
Thoracoscopic Pneumonectomy
30,000
766
General Surgery
Thoracoscopic Segmental Resection
25,000
767
General Surgery
Thoracoscopic Sympathectomy
15,000
768
General Surgery
Thrombendarterectomy
15,000
769
General Surgery
Thorax (penetrating wounds)
12,500
770
General Surgery
Total Thyroidectomy and Block Dissection
20,000
771
General Surgery
Trendelenburg Operation
10,000
 
772
General Surgery
Debridement of Ulcer- Leprosy
9,000
773
General Surgery
Tissue Reconstruction Flap Leprosy
25,000
774
General Surgery
Tendon Transfer-Leprosy
25,000
775
General Surgery
Adhenolysis + Appendicectomy
20,000
776
General Surgery
Hernia – Repair & release of obstruction+Hernioplasty
20,000
 
777
General Surgery
Aspiration of cold Abscess of Lymphnode
3,000
778
General Surgery
Aspiration of Empyema
 
2,000
 
779
General Surgery
AV Shunt for dialysis
6,000
780
General Surgery
Vasectomy
 
2500
 
781
Neurosurgery
Anterior Encephalocele
50,000
 
8
782
Neurosurgery
Burr Hole procedure for evacuation of Brain Abscess
45,000
2
783
Neurosurgery
Burr hole with chronic Sub Dural Haematoma (including pre and post Op. CT)
20,000
784
Neurosurgery
Carpal Tunnel Release including pre and post Op. MRI
10,000
3
785
Neurosurgery
Cervical Ribs-Bilateral
35,000
7
786
Neurosurgery
Cervical Ribs-Unilateral
20,000
5
787
Neurosurgery
CranioPlasty – Endogenous graft
20,000
CT Brain
CT + Clinical photograph showing scar
7
788
Neurosurgery
CranioPlasty – Exogenous graft
50000
CT Brain
CT + Clinical photograph showing scar
7
789
Neurosurgery
Craniostenosis
 
28,000
7
790
Neurosurgery
Duroplasty – Endogenous
12,500
5
791
Neurosurgery
Duroplasty – Exogenous
12,500+ cost of implant
792
Neurosurgery
Haematoma – Brain (hypertensive)
50,000
8
793
Neurosurgery
Haematoma (Child subdural) inclusive of General anaesthesia, pre and post Op. CT
50,000
10
794
Neurosurgery
Laminectomy with Fusion and fixation
 
50,000
795
Neurosurgery
Laminectomy with Fusion
 
40,000
 
6
796
Neurosurgery
Local Neurectomy
16,000
 
5
797
Neurosurgery
Lumbar Disc including pre and post Op. MRI
30,000
5
798
Neurosurgery
Meningocele-Anterior
 
36,000
Brain and spinal cord MRI
X-Ray/ Post.op scar
10 (2 day ICU stay)
799
Neurosurgery
Meningocele-Lumbar
36000
Brain and spinal cord MRI
X-Ray/ Post.op scar
10 (2 day ICU stay)
800
Neurosurgery
Meningococcal-Occipital
 
50,000
10
801
Neurosurgery
Micro discectomy-Cervical
40,000
10
802
Neurosurgery
Micro discectomy-Lumbar
40,000
10
803
Neurosurgery
Brachial Plexus-Repair
27,000
7
804
Neurosurgery
Shunt (peritoneal, ventriculo-atrial/ peritoneal, thecopritoneal)
40,000
7
805
Neurosurgery
Skull Traction
8,000
4
806
Neurosurgery
Spine – Canal Stenosis
40,000
6
807
Neurosurgery
Spine – Decompression & Fusion
40,000
6
808
Neurosurgery
Spine – Decompression & Fusion with fixation
50,000
809
Neurosurgery
Spine – Extradural Tumour
30,000
 
7
810
Neurosurgery
Spine – Extradural Tumour with fixation
40,000
 
811
Neurosurgery
Spine – Extradural Haematoma
30,000
7
812
Neurosurgery
Spine – Extradural Haematoma with fixation
 
40,000
813
Neurosurgery
Spine – Intradural Tumour
40,000
7
814
Neurosurgery
Spine – Intradural Tumour with fixation
50,000
 
815
Neurosurgery
Spine – Intradural Haematoma
40,000
 
7
816
Neurosurgery
Spine – Intradural Haematoma with fixation
50,000
817
Neurosurgery
Spine – Intramedullar Tumour
 
50,000
7
818
Neurosurgery
Trans Sphenoidal including pre and post Op. MRI
50,000
6
819
Neurosurgery
Tumours-Supratentorial
 
50,000
CT
CT + Histopathological report
7
820
Neurosurgery
Tumours Meninges-Gocussa
50,000
CT
CT + Histopathological report
7
821
Neurosurgery
Tumours Meninges- Posterior
50,000
CT
CT + Histopathological report
7
822
Neurosurgery
Ventricular Puncture
15,000
3
823
Neurosurgery
Brain Biopsy
32,000
3
824
Neurosurgery
Cranial Nerve Anastomosis
32,000
5
825
Neurosurgery
Depressed Fracture
40,000
7
826
Neurosurgery
Nerve Biopsy excluding Hensens
7,000
2
827
Neurosurgery
Peripheral Neurectomy (Trigeminal)
16,500
5
828
Neurosurgery
R.F. Lesion for Trigeminal Neuralgia
16,500
3
829
Neurosurgery
Twist Drill Craniostomy
30,000
 
2
830
Neurosurgery
Excision of Brain TumorSupratentorial- Parasagital
50,000
CT
CT + Histopathological report
10
831
Neurosurgery
Excision of Brain TumorSupratentorial-Basal
 
50,000
CT
CT + Histopathological report
10
832
Neurosurgery
Excision of Brain TumorSupratentorial- Brainstem
50,000
CT
CT + Histopathological report
10
833
Neurosurgery
Excision of Brain TumorSupratentorial-C P Angle
50,000
CT
CT + Histopathological report
10
834
Neurosurgery
Abscess Tapping single
30,000
 
7
835
Neurosurgery
Abscess Tapping multiple
45,000
7
836
Neurosurgery
External Ventricular Drainage (EVD) including antibiotics
30,000
CT Brain
Post.op CT + Clinical photograph showing scar
837
Neurosurgery
Spinal Fusion Procedure with implant
50,000
MRI
Post.op X-RAY
838
Neurosurgery
Surgical Management of Spina Bifida Major
50,000
10
839
Neurosurgery
Posterior Cervical Discetomy without implant
40,000
840
Neurosurgery
Posterior Cervical Fusion with implant (Lateral mass fixation)
50,000
MRI spine
X-RAY cervical spine +photograph showing scar
841
Neurosurgery
Cervical Disc Multiple level without Fusion
40,000
MRI spine
X-RAY cervical spine +
842
Neurosurgery
Trans oral Surgery
45,000
843
Neurosurgery
Foramen Magnum Decompression
45,000
844
Neurosurgery
Endoscopic CSF Rhinorrhea Repair
30,000+ cost of glue
845
Neurosurgery
Muscle Biopsy with report
15,000
 
846
Neurosurgery
Nerve Decompression
20,000
847
Neurosurgery
Peripheral Nerve Surgery Major
30,000
 
Neuro-diagnostic
Clinical photograph
5
848
Neurosurgery
Peripheral Nerve Surgery Minor
15,000
Neuro-diagnostic
Clinical photograph
3
849
Neurosurgery
Epilepsy Surgery
50,000
CT/ MRI + Neuro-
CT + Clinical photograph
850
Neurosurgery
Arterio venous malformation (AVM) excision (whatever size and location)
50000
MRA/ DSA report
X-RAY + Clinical
851
Neurosurgery
Scalp Arterio venous malformation (AVM)
 
25,000
CT/ MRI
Histopathological report showing scar
852
Neurosurgery
Excision of Orbital Tumour
40,000
CT/ MRI
CT + Histopathological report +Clinical photograph showing scar
853
Interventional Neuroradiology
Parent vessel occlusion
Basic- 30,000 Additional coil (cost per coil) – 24,000, Additional balloon
(cost per balloon) – 11,000.
854
Interventional Neuroradiology
Pre-operative tumour embolization (per session)
40,000
855
Interventional Neuroradiology
Vertebroplasty
40,000
856
Plastic & reconstructive Surgery
Ear Pinna Reconstruction with costal cartilage/ Prosthesis (including the cost of prosthesis/implants). *If requiring multiple stages, each stage will cost Rs. 30,000 provided the operating surgeon demonstrates the photographic results of previous stages.
30,000
5
857
Plastic & reconstructive Surgery
Revascularization of limb/digit
 
25,000
5
858
Plastic & reconstructive Surgery
Hemangioma – Sclerotherapy (under GA)
35,000
 
3
859
Plastic & reconstructive Surgery
Hemangioma – Debulking/ Excision
35,000
 
4
860
Plastic & reconstructive Surgery
Tissue Expander for disfigurement following burns/ trauma/congenital deformity (including cost of expander / implant)
50,000
5
861
Plastic & reconstructive Surgery
Scalp avulsion reconstruction
50,000
5
862
Plastic & reconstructive Surgery
NPWT (Inpatient only)
2,000/per day
863
Plastic & reconstructive Surgery
Pressure Sore – Surgery
30,000
3
864
Plastic & reconstructive
Diabetic Foot – Surgery
30,000
3
Surgery
865
Burns management
% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns) – any % (not requiring admission). Needs at least 5-6 dressing
7,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
D
866
Burns management
% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns): Upto 40 %; Includes % TBSA skin grafted, flap cover, follow- up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone
40,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with alternate day dressings
867
Burns management
% Total Body Surface Area Burns (TBSA) (thermal/ scald/ flame burns): 40 % – 60 %; Includes % TBSA skin grafted, flap cover, follow- up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone.
 
50,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with
alternate day dressings
868
Burns management
Electrical contact burns: Low voltage- without part of limb/limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone.
30,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with alternate day dressings
869
Burns management
Electrical contact burns: Low voltage- with part of limb/limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone.
40,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with alternate
day dressings
870
Burns management
Electrical contact burns: High voltage- without part of limb/limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone.
50,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with alternate day dressings
871
Burns management
Chemical burns: Without significant facial scarring and/or loss of function; Includes % TBSA skin grafted, flap cover, follow- up dressings etc. as deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone.
 
40,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
Moderate to severe burns need initial ICU stay ranging from 2 – 5 days and then 10 – 14 days of ward stay with alternate day dressings
872
Burns management
Post Burn Contracture surgeries for Functional Improvement (Package including splints, pressure garments, silicone-gel sheet and physiotherapy): Excluding Neck contracture, Contracture release with – Split thickness Skin Graft (STSG) / Full Thickness Skin Graft (FTSG)/ Flap cover is done for each joint with post-operative regular dressings for STSG / FTSG / Flap cover.
50,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
873
Burns management
Post Burn Contracture surgeries for Functional Improvement (Package including splints, pressure garments, silicone-gel sheet and physiotherapy):
Neck contracture; Contracture release with – Split thickness Skin Graft (STSG) / Full Thickness Skin Graft (FTSG)/ Flap cover is done for each joint with post-operative regular dressings for STSG / FTSG / Flap cover.
 
50,000
Clinical photograph and diagram with Rule of 9/ L & B Chart for extent of burns
Clinical photograph
874
Oral and Maxillofacial Surgery
Fixation of fracture of jaw with closed reduction (1 jaw) using wires – under LA
 
5,000
D
875
Oral and Maxillofacial Surgery
Fixation of fracture of jaw with open reduction (1 jaw) and fixing of plates/ wire – under GA
12,000
1
876
Oral and Maxillofacial Surgery
TM joint ankylosis of both jaws – under GA
15,000
5
877
Oral and Maxillofacial Surgery
Release of fibrous bands & grafting -in (OSMF) treatment under GA
3,000
2
878
Oral and Maxillofacial Surgery
Extraction of impacted tooth under LA
500
 
D
879
Oral and Maxillofacial Surgery
Cyst & tumour of Maxilla/mandible by enucleation/excision/marsu pialization under LA
2,500
D
880
Oral and Maxillofacial Surgery
Mandible Tumour Resection and reconstruction/Cancer surgery
6,000
3
881
Oral and Maxillofacial Surgery

Cleft lip and palate surgery

15,000 per each stage
3

882
Paediatric surgery
Ankyloglossia Major

15,000
883
Paediatric surgery
Ankyloglossia Minor
 
5,000
884
Paediatric surgery
Hernia & Hydrocele
 
20,000
885
Paediatric surgery
Sacrococcygeal Teratoma
 
20,000
 
886
Paediatric surgery
Undescended Testis(- Bilateral-Palp + Nonpalp)
15,000
887
Paediatric surgery
Undescended Testis – Bilateral Palpable
15,000
 
888
Paediatric surgery
Undescended Testis- Bilateral Non-Palpable
20,000
 
889
Paediatric surgery
Undescended Testis – Reexploration/ Second Stage
20,000
890
Paediatric surgery
Undescended Testis- Unilateral-Palpable
15,000
891
Paediatric surgery
Ano Rectal Malformation – Abd-Perineal PSARP
20,000
892
Paediatric surgery
Ano Rectal Malformation – Anoplasty
20,000
893
Paediatric surgery
Ano Rectal Malformation – Cutback
20,000
894
Paediatric surgery
Ano Rectal Malformation – PSARP
20,000
895
Paediatric surgery
Ano Rectal Malformation – Redo Pullthrough
15,000
896
Paediatric surgery
Ano Rectal Malformation – Transposition
15,000
897
Paediatric surgery
Anti GERD Surgery
10,000
898
Paediatric surgery
Duplication Cyst Excision
 
20,000
899
Paediatric surgery
Fecal Fistula Closure
25,000
900
Paediatric surgery
Gastrostomy + Esophagoscopy+ Threading
20,000
901
Paediatric surgery
GI Tumor Excision
 
30,000
902
Paediatric surgery
Hirschsprung’s Disease – Myectomy
25,000
 
903
Paediatric surgery
Hirschsprung’s Disease – Pull Through
20,000
904
Paediatric surgery
Hirschsprung’s Disease – Retal Biopsy-Punch
10,000
 
905
Paediatric surgery
Low Hirschsprung Disease: rectal biopsy/myomectomy
25,000
906
Paediatric surgery
Hirschsprung’s Disease – Sphinecterotomy
 
15,000
 
907
Paediatric surgery
Intussusception – Non – Operative Reduction in infants
20,000
908
Paediatric surgery
Intussusception – Operative in infants
 
25,000
909
Paediatric surgery
Ladds Procedure
30,000
910
Paediatric surgery
Rectal Polypectomy – Sigmoiescopic (Ga)
8,000
911
Paediatric surgery
Retro- PeritonealLymphangioma Excision
25,000
912
Paediatric surgery
Congenital Diaphragmatic Hernia
25,000
913
Paediatric surgery
Congenital LobarEmphysema
25,000
914
Paediatric surgery
Exomphalos/gastroschisis
25,000
915
Paediatric surgery

Cleft Lip and Palate Surgery
 
15000 per stage

Yes
Yes
3
916
Radio therapy
Cobalt 60 External Beam Radiotherapy (Radical/Adjuvant / Neoadjuvant
20,000
Blood test + CT + Biopsy
Data of RT treatment plan & dose
917
Radio therapy
Cobalt 60 External Beam Radiotherapy (Palliative )
 
10,000
 
Blood test + CT + Biopsy
Data of RT treatment plan & dose
918
Radio therapy
Linear Accelerator External Beam Radiotherapy (Palliative)
20,000
 
Blood test + CT + Biopsy
Data of RT treatment plan & dose
919
Radio therapy
Linear Accelerator, External Beam Radiotherapy 3D CRT/2D Planning (Radical/Adjuvant/ Neoadjuvant
50,000
Blood test + CT + Biopsy
Data of RT treatment plan & dose
920
Radio therapy
Electron beam with Linear accelerator (Radical)
 
50,000
 
Blood test + CT + Biopsy
Data of RT treatment plan & dose
921
Radio therapy
Brachytherapy High Dose Radiation (Intracavitory)
4,500 per fraction (maximum 4 sessions)
Blood test + CT + Biopsy
Data of RT treatment plan & dose
922
Radio therapy
Brachytherapy High Dose Radiation (Interstitial)
30,000 (one
application, multiple dose)
Blood test + CT + Biopsy
Data of RT treatment plan & dose
923
Radio therapy
Brachytherapy High Dose Radiation (Intraluminal)
4,500 per fraction (maximum 4 sessions)
Blood test + CT + Biopsy
Data of RT treatment plan & dose
924
Surgical Oncology
Tracheal resection
25,000
CECT, Biopsy
Clinical photograph showing scar, HPE report
925
Surgical Oncology
Sternotomy with superior mediastinal dissection
40,000
CECT, Biopsy
Clinical photograph showing scar, HPE report
926
Surgical Oncology
Substernal bypass
30,000
Biopsy
Clinical photograph showing scar, HPE
927
Surgical Oncology
Resection of nasopharyngeal tumour
40,000
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
928
Surgical Oncology
Myocutaneous flap
20,000
Biopsy
Clinical photograph showing scar
929
Surgical Oncology
Fasciocutaneous flap
15,000
Biopsy
Clinical photograph showing scar
930
Surgical Oncology
Palatectomy- Soft palate
20,000
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
931
Surgical Oncology
Palatectomy- Hard palate
20,000
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
932
Surgical Oncology
Microvascular reconstruction
45,000
 
Biopsy
Clinical photograph showing scar
933
Surgical Oncology
Composite resection
40,000
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
934
Surgical Oncology
Neck dissection-selective
 
12,000
Biopsy/FNAC
Clinical photograph showing scar, HPE report
935
Surgical Oncology
Neck dissection- comprehensive
16,000
 
Biopsy/FNAC
Clinical photograph showing scar, HPE report
936
Surgical Oncology
Total Maxillectomy
35,000
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
937
Surgical Oncology
Radical Maxillectomy
25,000
 
Biopsy, CECT/MRI
Clinical photograph showing scar, HPE report
938
Surgical Oncology
Radical parotidectomy
25,000
FNAC, CECT/MRI
Clinical photograph showing scar, HPE report
939
Surgical Oncology
Partial laryngectomy ( voice preserving)
 
20,000
Biopsy, CECT
Clinical photograph showing scar, HPE report
940
Surgical Oncology
Voice prosthesis
30,000
 
Biopsy, CECT
Invoice of prosthesis, scar photo
941
Surgical Oncology
Total Thyroidectomy with central compartment LN dissection
20,000
FNAC, CECT
Clinical photograph showing scar, HPE report
942
Surgical Oncology
Total Thyroidectomy with central compartment LN dissection with Lateral LN dissection
25,000
FNAC, CECT
Clinical photograph showing scar, HPE report
943
Surgical Oncology
Axillary dissection
15,000
FNAC/ BIOPSY, CECT
Clinical photograph showing scar, HPE report
944
Surgical Oncology
Breast conserving surgery (lumpectomy + axillary surgery)
30,000
FNAC/ BIOPSY, CECT
Clinical photograph showing scar, HPE report
945
Surgical Oncology
Lung metastectomy- solitary
 
30,000
FNAC/ BIOPSY, CECT
Clinical photograph showing scar, HPE
946
Surgical Oncology
Lung metastectomy- multiple(< four)
50,000
FNAC/ BIOPSY, CECT
Clinical photograph showing scar, HPE
947
Surgical Oncology
Enucleation of pancreatic neoplasm
25,000
CECT
Clinical photograph showing scar, HPE report
948
Surgical Oncology
Abdominal wall tumour resection
25,000
 
CECT
Clinical photograph showing scar, HPE report
949
Surgical Oncology
Abdominal wall tumour resection with reconstruction
35,000
CECT
Clinical photograph showing scar, HPE report
950
Surgical Oncology
Oesophageal stenting including stent cost
40,000
 
CECT
Stent invoice
951
Surgical Oncology
Triple bypass GI tract
30,000
Biopsy, CECT,
Clinical photograph showing scar, HPE report
952
Surgical Oncology
Segmentectomy- hepatobiliary system
50,000
 
CECT/MRI
Clinical photograph showing scar, HPE report
953
Surgical Oncology
Radical Hysterectomy + Bilateral pelvic lymph node dissection + bilateral salpingo ophorectomy ( BSO)/ ovarian transposition
50,000
CECT, biopsy
Clinical photograph showing scar, HPE report
954
Surgical Oncology
Skin Tumours Wide Excision + Reconstruction
 
25,000
955
Surgical Oncology
Skin Tumours Amputation
8,000
956
Surgical Oncology
Radical Vaginectomy
30,000
CECT, biopsy
HPE report
957
Surgical Oncology
Radical Vaginectomy + Reconstruction
35,000
CECT, biopsy
HPE report
958
Surgical Oncology
Bilateral Pelvic Lymph Node Dissection (BPLND)
50,000
CECT, biopsy
Clinical photograph showing scar, HPE report
959
Surgical Oncology
Radical Trachelectomy
40,000
CECT, biopsy
Clinical photograph showing scar, HPE report
960
Surgical Oncology
Vulvectomy with bilateral groin dissection
45,000
Biopsy
HPE report
961
Surgical Oncology
Sacral resection
40,000
Biopsy, CECT/MRI pelvis
Clinical photograph showing scar, HPE report
962
Medical Oncology
Lymphoma, Non-Hodgkin’s
R CHOP Regimen- 25000 per cycle x6 CHOP

Cyclophosphamide – Doxorubicin Vincristine – Prednisone (CHOP)- max 8 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug with batch number and bar code
963
Medical Oncology

Multiple Myeloma
 
Bortezomib+ lenalidomide+ dexamethasone 20,000/ per cycle x6 Bortezomib+ cyclophosphamide+ dexamethasone 10000/per cycle x6 MPT melphalan, thalidomide and prednisolone 6000/per cycle x9 Bortezomib + dexamethasone 6000/per cycle x9
Vincristine, Adriamycin,Dexametha sone(VAD) -cycle max 6 cycles
Bone Marrow Aspiration Report
Chemoth erapy drug with batch number and bar code
964
Medical Oncology

Multiple Myeloma

3,000
Thalidomide+Dexamet hasone(Oral)/ month – max 12 months
Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar
code
965
Medical Oncology

Colon Rectum

10,000
5-Fluorouracil- Oxaliplatin – Leucovorin (FOLFOX) – Max. 6 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
966
Medical Oncology
Bone Tumors/Osteosarcoma/ Hepatoblastoma -Operable
3,000
Cisplatin/carboplatin – Adriamycin- max 6 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
967
Medical Oncology
Lymphoma, Hodgkin’S
ABVD (day 1 and 15) 5000×2=10,000 per cyclex6
Adriamycin Bleomycin VinblastinDacarbazine (ABVD) – max 8 cycles (Per cycle) (Day 1 & Day 15)
Biopsy, CT
Chemoth erapy drug batch number with bar code
968
Medical Oncology
Cervix
 
chemoradiation 5000/per week x 6
Cisplatin/Carboplatin (AUC2) along with RT- max 6 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
969
Medical Oncology
Childhood B-Cell Lymphomas
Remove
Remove
Hematology report + Biopsy
Chemoth erapy drug batch number with bar code
970
Medical Oncology
Neuroblastoma Stage I-III
9,000
Variable Regimen – Neuroblastoma – max 1 year (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
971
Medical Oncology

Multiple Myeloma

1,500
Melphalan -Prednisone (oral) – per month (max 12 months) – Ovarian CA, Bone CA
Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
972
Medical Oncology
Wilm’sTumor
7000

SIOP/National Wilms Tumour Study Group (NWTS) regimen(Stages I – V)- max 6 months (Per month) – Wilm’s tumour
Biopsy, CT
Chemoth erapy drug
973
Medical Oncology

Colon Rectum
 
4,000
Monthly 5-FU
Biopsy, CT
Chemoth erapy drug batch number with bar code
974
Medical Oncology

Breast

4,000
Paclitaxel weekly x 12 weeks
Biopsy, CT
Chemoth erapy drug batch number with bar code
975
Medical Oncology

Breast

1,500
Cyclophosphamide/Me thotrexate/5Fluoroura cil (CMF) (Per cycle)
Biopsy, CT
Chemoth erapy drug
batch number with bar code
976
Medical Oncology

Breast

100

Tamoxifen tabs – maximum 12 cycles (Per month)
Biopsy, CT
Chemoth erapy drug batch number with bar code
977
Medical Oncology

Breast
 
3,000
Adriamycin/Cyclophos phamide (AC) – per cycle (Maximum 4 cycles)
Biopsy, CT
Chemoth erapy drug batch number with bar code
978
Medical Oncology

Breast
 

3,100
5- Fluorouracil A-C (FAC) – per cycle (Maximum 6 cycles)
Biopsy, CT
Chemoth erapy drug batch number with bar code
979
Medical Oncology

Breast

3,000
AC (AC Then Taxol)
Biopsy, CT
Chemoth erapy drug batch number with bar code
980
Medical Oncology
Small Cell Lung Cancer
 
4,000
Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles only)
Biopsy, CT
Chemoth erapy drug batch number with bar
code
981
Medical Oncology
Oncology oesophagus
3,000
Cisplatin + 5 FU(Neoadjuvant Chemotherapy)/Adjuva nt (ADJ)- per cycle (Max. of 6 cycles only)
Biopsy, CT
Chemoth erapy drug batch number with bar code
982
Medical Oncology
Stomach
4,000
Docetaxel +Oxaliplatin+5FU 20,000 per cycle for 4 cycles CapOX- 10,000 per cycle for 8 cycles
Biopsy, CT
Chemoth erapy drug batch number with bar code
983
Medical Oncology

Breast

900
Aromatase Inhibitors (Anastazole/Letrozole/ Exemestane) – maximum 12 cycles (Per month)
Biopsy, CT
Chemoth erapy drug batch number with bar code
984
Medical Oncology

Urinary Bladder
 

2,000
Weekly Cisplatin/Carboplatin- max 6 cycles with RT (Per week)
Biopsy, CT
Chemoth erapy drug batch number with bar code
985
Medical Oncology

Urinary Bladder

5,000
MethotraxateVinblasti n Adriamycin Cyclophosphamide (MVAC)
Biopsy, CT
Chemoth erapy drug batch number with bar code
986
Medical Oncology
Retinoblastoma
4,000
Carbo/Etoposide/Vincr istine-max 6 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
987
Medical Oncology
Febrile Neutropenia
30,000
IV antibiotics and other supportive therapy (Per episode
Haemogram, Blood Culture
Chemoth erapy drug batch number with bar code
988
Medical Oncology
Vaginal/ Vulval Cancer
3,000
 
Cisplastin/5-FU
Biopsy, CT
Chemoth erapy drug batch number with bar code
989
Medical Oncology
Ovary
Taxol+carboplatin 15000/percyclex6 BEP regimen for germ cell tumour 10000/per cyclex4
Carboplatin/Paclitaxel- max 6 cycles (per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
990
Medical Oncology
Rectal Cancer Stage 2 And 3
4,000
Gemcitabine +capecitabine-15,000 per cycle for 6 cycles
Biopsy, CT
Chemoth erapy drug batch number with bar code
991
Medical Oncology

Multiple Myeloma

2,000
Zoledronic acid – Max 12 cycles (Per month)
Biopsy, CT
Chemoth erapy drug
batch number with bar code
992
Medical Oncology
Gestational Trophoblast Ds. High Risk
10,000

Etoposide- Methotrexate- Actinomycin / Cyclophosphamide – Vincristine (EMA-CO)- max 6 cycles (Per cycle)
Beta – HCG report + CT
Chemoth erapy drug batch number with bar code
993
Medical Oncology

Gestational Trophoblast Ds. Low Risk
 
1,000
Actinomycin- max 10 cycles (Per cycle)
Beta – HCG report + CT
Chemoth erapy drug batch number with bar code
994
Medical Oncology

Gestational Trophoblast Ds. Low Risk
 

1,000
Weekly Methotrexate (Per week) max. 10 cycles
Beta – HCG report + CT
Chemoth erapy drug batch number with bar code
995
Medical Oncology
Ovary Germ Cell Tumour
6,000
Bleomycin-Etoposide- Cisplatin (BEP) – max cycles 4 (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
996
Medical Oncology
Prostate
 
3,000
Hormonal Therapy – Per month
Biopsy, CT
Chemoth erapy drug batch number with bar
code
997
Medical Oncology
Testis
BEP regimen for germ cell tumour 10000/per cyclex4
Bleomycin-Etoposide- Cisplatin (BEP)- max cycles 4 (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
998
Medical Oncology

Acute Myeloid Leukemia

Daunomycin and cytosine arabinoside (3:7) 100,000
Induction Phase, up to
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
999
Medical Oncology

Acute Myeloid Leukemia

High dose cytosine arabinoside 75000 x 3-4 cycles
Consolidation Phase, up to
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
1000
Medical Oncology
Histocytosis
 
8000
Variable Regimen- Histocyosis-max 1 year (Per month)
Biopsy, CT
Chemoth erapy drug batch number with bar code
1001
Medical Oncology
Rhabdomyosarcoma
6000
Vincristine- Actinomycin- Cyclophosphamide (VACTC) based chemo – max 1 year (Per month) – Rhabdomyosarcoma
Biopsy, CT
Chemoth erapy drug batch number with bar code
1002
Medical Oncology
Ewing’s Sarcoma
6000
Variable Regimen Inv – Hematology, Biopsy – Payable
Biopsy, CT
Chemoth erapy drug batch number with bar code
1003
Medical Oncology
Unlisted Regimen
5000
Palliative CT- Max 6 cycles (Per cycle)
Biopsy, CT
Chemoth erapy drug batch number with bar code
1004
Medical Oncology
Terminally Ill
3000

Palliative And Supportive Therapy – Per month
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
1005
Medical Oncology

Acute Lymphatic Leukemia
 
5000 per month x 24
Maintenance Phase – Per month
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
1006
Medical Oncology

Acute Lymphatic Leukemia

50000
Induction
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug batch number with bar code
1007
Medical Oncology

Acute Lymphatic Leukemia

50000
Consolidation
Hematology + Bone Marrow Aspiration Report
Chemoth erapy drug
batch number with bar code
1008
Medical Oncology
Head and Neck
3000
 
Tab Geftinib/Erlotinib- Max 1 Year (Per month)
Biopsy, CT
Chemoth erapy drug batch number with bar code
1009
Medical Oncology
Renal cell carcinoma
2500
Sunitinib/ Pazopanib (per day)
Biopsy, CT
Chemoth erapy drug batch number with bar code
1010
Medical Oncology
chronic myeloid leukemia
 
6000/per month x 5 years
Imatinib
Chemoth erapy drug batch number with bar code
1011
Medical Oncology
Gall Bladder Cancer
10,000 per cycle for 6 cycle
Gemcitabine + cisplatin
Chemoth erapy drug batch number with bar code
1012
Emergency Room Packages
Emergency with stable cardiopulmonary status
 
1000
Evaluated, stabilized, arranged referral resuscitated, provided life support
1013
Emergency Room Packages
Emergency consultation: acute colic, high fever, cut, stitches, soft tissue injury, FB removal
1000
Only in Public sector facilities.
1014
Emergency Room Packages
Single bone fracture plaster, nebulization for asthmatic attack, moderate dehydration,hypoglycae mia in a diabetic, Dengue without complication, Syncope, Food poisoning etc
1000
Only in Public sector facilities.
1015
Emergency Room Packages
Animal bites
 
(500+300*4)
Payment after completion of 5th dose
1016
Paediatric medical care
Blood and blood component transfusion (admission for a diagnostic procedure leading to treatment
requiring admission, e.g. bone marrow and bone biopsy, endoscopy, liver biopsy, bronchoscopy, CT/MRI under GA, broncho- alveolar lavage, lumbar puncture, muscle biopsy, FNAC, pleural aspiration, ascitic tapping, neostigmine challenge test etc.)
Rs 1,500 per day (upto a limit of 2 days) – needs mandatory pre-authorization
ICU
1017
Paediatric medical care
Blood and blood component transfusion for indications like Thalassemia/Hemoglobinop athies-
Rs 1,500 per day (up
to a limit of 2 days) –
needs mandatory pre-authorization
ICU
1018
Medical packages
Blood and blood component transfusion (admission for a diagnostic procedure leading to treatment requiring admission ,e.g. bone marrow and bone bronchoscopy,CT/MRI underGS,brobchp- alveolar lavage,lumbar puncture,muscle biopsy,pleural aspiration,ascitic tapping etc.)
Rs 1,500 per day (up to a limit of 2 days) – needs mandatory pre- authorization
1019
Medical packages
Plasmapheresis (pre- auth)
2000 per session
1020
Medical packages
Haemodialysis/Peritoneal Dialysis (only ARF)
2000 per session
 
1021
Neonatal Packages
Special Neonatal Care Package(Babies that require admission to SNCU or NICU.Mother’s stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate
Rs. 2500/day
(maximum of Rs15,000)(Pre- authorization is needed after 4 days)
Babies admitted for short term care for conditions like:• Mild Respiratory Distress/tachypnea• Mild encephalopathy• Severe jaundice requiring intensive phototherapy• Haemorrhagic disease of newborn• Unwell baby requiring monitoring• Some dehydration• Hypoglycaemia
1022
Neonatal Packages
Intensive Neonatal Care Package
Rs. 5,000/day (Maximum of Rs. 50,000) Pre- authorization is needed after 5 days
Babies with birthweight 1500-1799 g or Babies of any birthweight and at least one of the following conditions: • Need for mechanical ventilation for less than 24 hours or non-invasive respiratory support (CPAP, HFFNC) • Sepsis / pneumonia without complications • Hyperbilirubinemia requiring exchange transfusion • Seizures • Major congenital malformations (pre- surgical stabilization, not requiring ventilation) • Cholestasis significant enough requiring work up and in-hospital management • Congestive heart failure or shock Mother’s stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate
1023
Neonatal Packages
Advanced Neonatal Care Package
Rs. 6,000/day (Maximum of Rs 75,000) Pre- authorization is needed after 7 days
Babies with birthweight of 1200-1499 g
or
Babies of any birthweight with at least one of the following conditions:
· Any condition requiring invasive ventilation longer than 24 hours
· Hypoxic Ischemic encephalopathy requiring Therapeutic Hypothermia
· Cardiac rhythm disorders needing intervention (the cost of cardiac surgery or implant will be covered under cardiac surgery packages)
· Sepsis with complications such as meningitis or bone and joint infection, DIC or shock· Renal failure requiring dialysis
· Inborn errors of metabolism
Mother’s stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and
included in the package rate
1024
Neonatal Packages
Critical Care Neonatal Package
Rs. 7,000/day with (Maximum of Rs 1,20,000) Pre-authorization after 10 days
Babies with birthweight of <1200 g or Babies of any birthweight with at least one of the following conditions: · Severe Respiratory Failure requiring High Frequency Ventilation or inhaled Nitric Oxide (iNO) · Multisystem failure requiring multiple organ support including mechanical ventilation and multiple inotropes · Critical congenital heart disease Mother’s stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate
1025
Neonatal Packages
Chronic Care Package-
Rs 3000 per day beyond the usual stay (Maximum of Rs 30,000)
· If the baby requires stay beyond the upper limit of usual stay in Package no 4 or 5 for conditions like severe BPD requiring respiratory support, severe NEC requiring
(Preautho rization is required unless there is a genuine emergenc y such as need for laparoto my for advanced
 
prolonged TPN support
NEC)
1026
Neonatal Packages
High Risk Newborn Post Discharge Care Package (Pre-authorized, Protocol Driven)
Rs.2400
· ROP screening · Developmental assessment · Thyroid Screening · Hearing screening · Early intervention · Nutritional counselling Note-Blood transfusion can be given as an add on package if indicated
(for 4 sessions)
1027
Neonatal Packages
Laser Therapy for Retinopathy of Prematurity
 
Rs.1500 per session (Irrespective of no. of eyes affected)
1028
Neonatal Packages
Advance Surgery for Retinopathy of Prematurity
Rs. 15,000
 
1029
Neonatal Packages
Ventriculoperitoneal Shunt Surgery (VP) or Omaya Reservoir or
Rs.5,000
External Drainage for Hydrocephalus
1030
Mental Disorders Packages
F00-F09
Organic, including symptomatic, mental disorders
Rs. 1500 per day (up to a limit of 2 weeks after which pre-authorization needs to be sought up to a limit of 2 weeks)
Clinical assessment and investigations
Clinical assessment and investigations
Four weeks
1031
Mental Disorders Packages
F10-F19
Mental and Behavioural disorders due to psychoactive substance use
1032
Mental Disorders Packages
F20-F29 Schizophrenia, schizotypal and delusion disorder
1033
Mental Disorders Packages
F30-F39
Mood (affective) disorders


1034
Mental Disorders Packages
F40-F48
Neurotic, stress-related
and somatoform disorders


Four weeks
1035
Mental Disorders Packages
F50-F59
Behavioural syndromes associated with physiological disturbances and physical factors
1036
Mental Disorders Packages

F70-F79 Mental retardation

 
1037
Mental Disorders Packages
F00-F09 Organic, including symptomatic, mental disorder
Rs. 2500 per day (up to a limit of 10 days after which pre-authorization needs to be sought up to a limit of 10
Clinical assessment report / Risk Assessment + Investigation
Clinical assessment & Report
10 Days
1038
Mental Disorders Packages
F10-F19 Mental and Behavioural disorders due to psychoactive
substance use
days)
1039
Mental Disorders Packages
F20-F29 Schizophrenia, schizotypal and delusional disorders
1040
Mental Disorders Packages
F30-F39 Mood (affective) disorders
1041
Mental Disorders Packages
F40-F48
Neurotic, stress-related and somatoform disorders


1042
Mental Disorders Packages
F50-F59 Behavioural syndromes associated with physiological disturbances and physical factors
1043
Mental Disorders Packages

F 70 – 79
Mental Retardation

 
1044
Mental Disorders Packages
Pre- Electro Convulsive Therapy (ECT) and Pre- rTranscranial Magnetic Stimulation (TMS)Package *
Rs. 10,000 /-
Pre-auth
1045
Mental Disorders Packages
Electro Convulsive Therapy (ECT)
 
Rs. 3000/- per session
 
1046
Mental Disorders Packages
Transcranial Magnetic Stimulation (TMS
Rs. 1000/- per session
1047
Burns management
Distant Flap (Abdominal Flap Surgery)
 
30000
4
1048
Burns management
Reduction Surgery for Filarial ymphoedema
39610
 
10
1049
Burns management
Surgical correction for Congenital Deformity of Hand (Per Hand)
23510
3
1050
Burns management
Surgical correction for Vascular malformations
32950
5
1051
Burns management
Surgical Correction of lid deformities requiring bony reconstruction following the excision of Tumour of Mandible And Maxilla
40000
4
1052
Burns management
Surgical Correction of Nerve and Tendon Repair + Vascular Repair
46790
3
1053
Cardiology
Ablation Therapy for Simple Arrythmias
 
50000
5
1054
Cardiology
Medical Management of Acute MI With Cardiogenic Shock (managed with inotropes)
40000
5
1055
Cardiology
Medical Management of Infective Endocarditis with10 days stay
 
35000
5
1056
Cardiology
Medical Management of Pericardial Effusion, Tamponade with Aspiration
16000
3
1057
Cardiology
Medical Management of Pulmonary Embolism including thrombolytics
 
35000
5
1058
Cardiology
Medical Management of Refractory Cardiac Failure
 
40000
 
5
1059
Critical Care
Acute exacerbation of Interstitial Lung Diseases LOS 14 days including HRCT with Contrast investigation
35000
14
1060
Critical Care
ADEM Or Relapse In Multiple Sclerosis
 
37500
 
15
1061
Critical Care
Neck Dissection Any type in Malignant conditions
45000
 
4
1062
Critical Care
Neuroinfections – Pyogenic Meningitis -Min 10 Days – ICU, 10 Days – Ward Stay
40000
20
1063
Critical Care
Sickling Crisis with 6-8 Stay with Hb Electrophoresis,
30000
8
ABG
1064
Dental
Fistulectomy under GA
10300
1
1065
Dental
Fracture of jaw under GA with 2 days stay
15000
2
1066
Dental
Sequestrectomy
8000
1
1067
Dental
Benign Tumour Excision with prior approval from IA
12000
2
1068
Dental
Apisectomy per tooth including LA
1500
D
1069
Dental
Surgical Extraction of tooth including LA
1200
D
1070
Dental
Cyst under LA (Large radiographically more than 2 cm in diameter
5000
D
1071
Dental
Extraction of tooth including LA
300
D
1072
Dental
Fracture wiring including LA
 
8000
 
D
1073
Dental
Gingivectomy per Tooth
300
D
1074
Dental
Intra oral X-ray
 
100
 
D
1075
Dental
Flap operation for multiple teeth (per quadrant, radiographically bone loss more than 4mm)
2500
D
1076
Dental
Extaction of multiple teeth under LA (to be given when 3 or >3 is extracted)
1300
D
1077
Dental
Tooth filling
 
400
 
D
1078
Dental
MTA tooth perforation repair/Apexification
1500
D
1079
Dental
Root canal treatment (with out crown) with prior approval from IA
1200
D
1080
Dental
Fixed Orthodontic Appliance with prior approval from IA
 
10000
D
1081
Dental
Removal Orthodontic Appliance
3000
D
1082
Dental
Extra Oral facial X-ray/OPG
300
D
1083
Dental
Removable complete dentures (Acrylic Base) per arch
2500
D
1084
Dental
Single tooth capping/FPD per unit
1000
D
1085
Dental
Maxillofacial prosthesis and obturator
6000
D
1086
Dental
Biopsy in case of tumour and cyst with HPE
 
800
 
D
1087
Dental
Tooth Scaling for periodontitis with prior approval from IA
1000
D
1088
Dental
Distraction osteogenesis of mandible or maxilla under GA
18000
5
1089
Dental
Preprosthetic surgeries for old patient
500
 
D
1090
Dental
Removal partial denture (RPD)/Unit
100
D
1091
Dental
Fixed partial denture for three units
4500
D
1092
Dental
Gingivectomy per quadrant
 
1200
 
D
1093
Dental
Minor surgical procedure(splinting, frenectomy, growth excision)
1200
D
1094
Dental
Zygomatic Complex Fracture
 
15000
3
1095
Dental
Eminectomy
 
12000
 
3
1096
ENT
Endoscopic Cauterization for epistaxis
8000
0
1097
ENT
Endoscopic excision of Pituitary Tumour
50000
5
1098
ENT
Endoscopic optic nerve decompression
45000
3
1099
ENT
Endoscopic orbital decompression
50000
3
1100
ENT
Foreign body esophagus under GA
10000
2
1101
ENT
Oesophageal/ Trachea stricture with prior approval from IA
25000
2
1102
ENT
Parotid Duct cyst excision
20000
3
1103
ENT
Preauricular sinus- Unilateral
12000
2
1104
ENT
Removal of foreign body from Nose
 
2500
 
D
1105
ENT
Tympanoplasty with Ossiculoplasty including implants/ALLO graft or autograft
18000
2
1106
Medical packages
Leprosy Reaction & Neuritis (T1R & T2R)
8500
5
1107
General Surgery
Inguinal Hernia – Repair & release of obstruction
25000
 
5
1108
General Surgery
Umbilical Hernia repair- Open with mesh
30000
3
1109
General Surgery
Choledochoduodenostomy Or Choledocho Jejunostomy with prior approval from IA
45000
7
1110
General Surgery
Distal Gastrectomy for Gastric Outlet Obstruction
 
40000
7
1111
General Surgery
Drainage of small abscess as Daycare
5000
D
1112
General Surgery
ERCP
 
18000
3
1113
General Surgery
Excision of Lingual Thyroid
 
30000
3
1114
General Surgery
Excision of Superficial Lipoma
5000
 
D
1115
General Surgery
Excision of Thyroglossal Cyst Fistula
30000
3
1116
General Surgery
Excision pilonidal sinus with flap reconstructive surgery with prior approval rom IA
25000
3
1117
General Surgery
Fibroma – Excision (Benign)
7000
2
1118
General Surgery
Fournier gangrene-Surgical debridement
28000
5
1119
General Surgery
Hartman.S Procedure With Colostomy
45000
7
1120
General Surgery
Hemorrhoidectomy 3RD AND 4TH degree
12500
3
1121
General Surgery
Hydrocele EOS under LA
7500
1
1122
General Surgery
II Stage-J – Pouch
50000
7
1123
General Surgery
Incisional Biopsy with HPE
5000
 
D
1124
General Surgery
Lap/open Heller.S Myotomy
30000
5
1125
General Surgery
Laproscopic inguinal hernia repair Bilateral including mesh with prior approval from IA
35000
3
1126
General Surgery
Laproscopic inguinal hernia repair Unilateral including mesh with prior approval from IA
30000
3
1127
General Surgery
Open inguinal hernia repair Bilateral including mesh with prior approval from IA
30000
3
1128
General Surgery
Open inguinal hernia repair unilateral including mesh with prior approval from IA
20000
3
1129
General Surgery
Pancreaticocystogastrostom y
 
40000
7
1130
General Surgery
Parathyroidectomy -Non Malignant
30000
 
3
1131
General Surgery
Rare Hernias repair (Spigalion,Obuturator,Sciati c)
30000
3
1132
General Surgery
Rectopexy with mesh with prior approval from IA
 
25000
5
1133
General Surgery
Sebaceous Cyst – Excision
2000
D
1134
General Surgery
Surgical treatment for Intususception/volvulus (Resection & Anastomosis)
40000
7
1135
General Surgery
Unilateral Adrenelectopmy in nonmalignant conditions
35000
7
1136
General Surgery
Upper GI endoscopy with biopsy
2500
D
1137
Obstetrics & Gynaecology
Colposcopy with biopsy
4000
D
1138
Obstetrics & Gynaecology
Excision (CIN): LEEP/Knife Cone/LEETZ/Laser cone)
7000
1
1139
Obstetrics & Gynaecology
Exploratory Laparotomy/Laparoscopy for TO mass
20000
4
1140
Obstetrics & Gynaecology
Hysteroscopic Operative
 
18000
2
1141
Obstetrics & Gynaecology
Medical Management of Eclampsia with Complications post delivery without ventilatory support
20000
5
1142
Obstetrics & Gynaecology
Missed or Incomplete abortion
6000
 
D
1143
Obstetrics & Gynaecology
Obstetric Hysterectomy (inclusive of C- section/vaginal delivery)
30000
5
1144
Obstetrics & Gynaecology
PPH requiring medical management and blood transfusion (post delivery)
 
18000
4
1145
Obstetrics & Gynaecology
Suction evaculation mole pregnancy
15000
 
2
1146
Obstetrics & Gynaecology
Vaginal Hysterectomy With Pelvic Floor Repair without prior approval from IA
18000
5
1147
Obstetrics & Gynaecology
Vesicular Mole
 
15000
2
1148
Obstetrics & Gynaecology
Vulval tumour-removal under short GA
 
12000
1
1149
Obstetrics & Gynaecology
Normal Delivery/breach/Vaccum/fo rcep
10000
2
1150
Medical packages
Emergency Psychiatric Situation as per ICU-10 (Mental & Behavioral Disorders, care and management in ICU)
2000
1151
Medical packages
RRT(HD , SLED) (PER sitting) for ARF
2500
D
1152
Medical packages
Bone Marrow Aspiration
 
2500
D
1153
Medical packages
Electroenephalogram
 
5800
D
1154
Medical packages
Fibroptic Bronchoscopy with Washing / Biopsy
2000
D
1155
Medical packages
Packed cells per unit transfusion charge only
500
D
1156
Medical packages
Tracheostomy
6000
D
1157
Medical packages
USG Guided Pleural Tap
1200
D
1158
Neurosurgery
Anterior cervical discectomy single level
40000
5
1159
Neurosurgery
Cervical Sympathectomy
 
50000
5
1160
Neurosurgery
Excision Of Cervical Inter- Vertebral Discs
40000
5
1161
Neurosurgery
Lumbar Sympathectomy
45000
 
5
1162
Neurosurgery
Spinal Fusion Procedure plus cost implant
50000
5
1163
Neurosurgery
Subdural Tapping
 
15000
 
3
1164
Neurosurgery
Surgical Management of Meningo Encephalocele
50000
 
5
1165
Medical Oncology
Chemotherapy – per siting plus cost of injections subject to approval (approval can be given for multiple sittings to hospital as per requirement) with prior approval from IA
5000
D
1166
Medical Oncology
Chemotherapy – Per sitting
1500
D
1167
Medical Oncology
Radiotherapy – Per sitting
1500
D
1168
Oncosurgery
Axillary Dissection in malignant conditions
39226
4
1169
Oncosurgery
Craniofacial Resection
22000
5
1170
Oncosurgery
Hemimandibulectomy in malignant conditions
45000
5
1171
Oncosurgery
Mastectomy Any Type in malignant conditions
48000
4
1172
Oncosurgery
Orbital Exenteration in malignant conditions
42090
5
1173
Oncosurgery
Radical Hysterectomy in malignant conditions
 
50000
 
5
1174
Oncosurgery
Sleeve Resection of Ear in malignant conditions
44310
4
1175
Oncosurgery
Surgery For Carcinoma Ovary Advance Stage
 
50000
 
5
1176
Oncosurgery
Unilateral /BilateralSalpingo Oophorectomy in malignant conditions
30000
4
1177
Opthalmology
Acid and alkali burns
 
1500
D
1178
Opthalmology
Blepharoplasty One eye
1000
 
D
1179
Opthalmology
EOG
1500
D
1180
Opthalmology
ERG
1500
 
D
1181
Opthalmology
FFA both eyes
2000
 
D
1182
Opthalmology
GA for ocular surgery after prior approval from IA
1500
D
1183
Opthalmology
Keratoplasty
 
12000
3
1184
Opthalmology
LASIK Anisometropia more than 3D Not for Cosmetic purpose with prior approval from IA
10000
D
1185
Opthalmology
Perimetry both eye
2000
 
D
1186
Opthalmology
Removal Of Silicon Oil Or Gas post Vitrectomy
10000
2
1187
Opthalmology
Vitrectomy – Membrane Peeling – Endolaser – Silicon oil or Gas – with or without belt buckling
30000
2
1188
Opthalmology
Vitrectomy – Membrane
20000
2
Peeling- Endolaser
1189
Opthalmology
Vitrectomy Plus Silicon Oil Or Gas
23000
2
1190
Opthalmology
Ptosis (single eye)
7000
1191
Orthopaedics
Acute Soft Tissue Surgery- Neurolysis / Nerve repair
25000
4
1192
Orthopaedics
Amputation-Intermediate- Ankle
10000
3
1193
Orthopaedics
Arthroscopic subacromial decompression
25000
3
1194
Orthopaedics
Arthroscopy -Acl/PCL Repair
 
42000
3
1195
Orthopaedics
Arthroscopy -loose body removal
25000
3
1196
Orthopaedics
Arthroscopy/open- synovectomy
25000
3
1197
Orthopaedics
Bone Grafting
15000
 
2
1198
Orthopaedics
Bunion Foot – Excision
5500
 
1
1199
Orthopaedics
Carpal tunnel decompression / Ulnar nerve decompression
15000
2
1200
Orthopaedics
Clavicle Nail/Plate
 
20000
 
3
1201
Orthopaedics
CTEV Neglected: above 4 yrs
25000
5
1202
Orthopaedics
CTEV PMSoft tissue release before 18 months
12000
 
3
1203
Orthopaedics
Deformity Correction/malunion/Fractu re and lengthening (nail/plate)
30000
6
1204
Orthopaedics
Direct Laryngoscopy with biopsy with prior approval from IA
7000
1
1205
Orthopaedics
Dislocation Others (small joints) (CMR), With or without short GA
 
6000
D
1206
Orthopaedics
Dislocations (Major Joint, Shoulder/Elbow) Closed
7800
D
Manual Reduction, With or without short GA
1207
Orthopaedics
Excision of deep Bone Tumours and Re- Construction excluding implants
45000
5
1208
Orthopaedics
Exostosis – large bones – Excision
15000
4
1209
Orthopaedics
Exostosis multiple-excision under Preauth
18000
3
1210
Orthopaedics
Exostosis Single – Small bones -Excision
12000
 
2
1211
Orthopaedics
Femoral Neck Fracture cannulated screw fixation ORIF/CRIF
25000
 
4
1212
Orthopaedics
Fracture -closed pinning displaced paediatric fractures- Supracondylar humerus,distal radius, proximal humerus
18000
2
1213
Orthopaedics
Fracture Correction Surgeries /Procedures- Excision or other Operations for Scaphoid Fractures
20000
2
1214
Orthopaedics
Fracture distal femur reconstruction (ORIF)
 
30000
 
4
1215
Orthopaedics
Fracture- Distal radius plating/Olecranon locking plate (ORIF)
20000
 
3
1216
Orthopaedics
Fracture elbow reconstruction (double plating + tension band) (ORIF)
30000
3
1217
Orthopaedics
Fracture -External Fixator – JESS fixator for hand / leg injuries with debridement
20000
2
1218
Orthopaedics
Fracture -External Fixator – Simple frame -single bone- pelvis/femur/ tibia/ humerus/ radius/
25000
2
1219
Orthopaedics
Fracture -External Fixator transarticular
20000
3
1220
Orthopaedics
Fracture Femur OLD Nonunion/Malunion including bone grafting
32000
6
1221
Orthopaedics
Fracture Femur/tibia, Plate/Nail, ORIF/CRIF
 
25000
4
1222
Orthopaedics
Fracture multiple bone hands & feet: K-wire fixation
15000
2
1223
Orthopaedics
Fracture plating ankle-fibula plating+medial malleolus screws (ORIF)
30000
3
1224
Orthopaedics
Fracture Proximal Femoral, plating/nail ORIF/CRIF
 
30000
 
4
1225
Orthopaedics
Fracture Single Bone K wire fixation metacarpals/metatarsals/su pracondyla-fracture humerus
15000
2
1226
Orthopaedics
Fracture -Tension Band Wiring -Patella, olecranon, medial malleolus
 
18000
2
1227
Orthopaedics
Fracture Tibial Condyle (ORIF/CRIF), Tibia Pilon reconstruction single plate
30000
3
1228
Orthopaedics
Fracture Tibial Condyle (ORIF/CRIF), Tibia Pilon reconstruction two plates
35000
4
1229
Orthopaedics
Implant removal (Nail/plate)
 
18000
2
1230
Orthopaedics
Implant removal screw/wire)
10000
1
1231
Orthopaedics
Open reduction of
20000
D
dislocation without fracture
1232
Orthopaedics
Ostectomy
25000
4
1233
Orthopaedics
Paediatric Fracture -Nailing Single bone (CRIF)
15000
3
1234
Orthopaedics
Paediatric Fracture -Nailing two bones (CRIF)
25000
4
1235
Orthopaedics
Pelvic Fracture single column including ICU 3 days stay
49000
9
1236
Orthopaedics
Surgery for Avascular Necrosis Of Femoral Head (Core Decompression)
35000
5
1237
Orthopaedics
Tendon repair major-Tendo achillies, quadriceps, tendon, hand/thumb flexor tendons, triceps
15000
2
1238
Orthopaedics
Tendon repair minor- Tendon injury of hand/feet
10000
 
2
1239
Orthopaedics
Tendon transfers/repair multiple- (ankle/wrist, hand/feet)
20000
2
1240
Orthopaedics
Tennis elbow release
 
15000
2
1241
Orthopaedics
Tenosynovectomy
 
8000
D
1242
Orthopaedics
Tenosynovectomy/excision of bursa
8000
 
1
1243
Orthopaedics
Tibia OLD Nonunion/Malunion including bone grafting (does not include implant removal if done)
26000
5
1244
Paediatric surgery
Adrenal Gland Surgeries In Paediatric patients
 
50000
 
10
1245
Paediatric surgery
Congenital Hernia- Inguinal/hydrocele – Unilateral
20000
1
1246
Paediatric surgery
Congenital Hypertrophic Pyloric Stenosis
25000
3
1247
Paediatric surgery
DJ stent Removal procedure
20000
2
1248
Paediatric surgery
Excision of Lung Hydatid Cyst
40000
5
1249
Paediatric surgery
Excision of thyroglossal Duct/Cyst
30000
2
1250
Paediatric surgery
Laparoscopic Varicocele Ligation
25000
2
1251
Paediatric surgery
Laproscopic Orchidopexy First Stage
25000
2
1252
Paediatric surgery
Laproscopic Orchidopexy Second Stage
30000
3
1253
Paediatric surgery
LARM Anoplasty
25000
2
1254
Paediatric surgery
MCU Cystoscopy under GA
 
15000
1
1255
Paediatric surgery
Meckel Diverticulectomy
 
50000
7
1256
Paediatric surgery
Multistage Anorectal Malformation Second Stage ARM: PSARP/ASARP
50000
5
1257
Paediatric surgery
Operation of the Duplication of Intestines
50000
6
1258
Paediatric surgery
Orchidopexy-Open Bilateral
 
30000
 
3
1259
Paediatric surgery
Orchidopexy-Open Unilateral
25000
2
1260
Paediatric surgery
Patent Urachus/Urachal cyst
 
25000
3
1261
Paediatric surgery
Rectal Prolapse Mesh Repair
25000
 
5
1262
Paediatric surgery
Simple Nephrectomy in pediatric patients
50000
5
1263
Paediatric surgery
Single Stage Laproscopic Orchidopexy
 
30000
0
1264
Paediatric surgery
Single Stage procedure for Hypospadiasis: Urethroplasty
40000
10
1265
Paediatric surgery
Splenectomy without shunt or devascularization
36000
7
1266
Paediatric surgery
Stage 2 procedure for Hypospadiasis
50000
6
Uretheroplasty
1267
Paediatric surgery
Surgical Correction of Epispadiasis
35000
0
1268
Paediatric surgery
Surgical Correction of Esophageal Obstructions In Paediatric Patients
50000
7
1269
Paediatric surgery
Surgical Correction of Liver Hydatid Cysts
50000
5
1270
Paediatric surgery
Surgical correction of Microtia/Anotia In Paediatric Patient
30000
3
1271
Paediatric surgery
Surgical Correction of Scrotal Transposition In Paediatric Patients
 
20000
4
1272
Paediatric surgery
Surgical Correction of Thoracic Duplications Cyst
45000
7
1273
Paediatric surgery
Surgical Correction of Thoracic Wall Defects
 
45000
7
1274
Paediatric surgery
Surgical Management for Torsion of Testis
25000
 
3
1275
Paediatric surgery
Surgical management of Gastric Outlet Obstructions excluding CHPS
40000
8
1276
Paediatric surgery
Surgical management of Branchial Cyst and Fistula
30000
 
5
1277
Paediatric surgery
Surgical Management of Congenital Dermal Sinus
20000
3
1278
Paediatric surgery
Surgical Management of Congenital Hydronephrosis in Paediatric Patients/PUJO
50000
5
1279
Paediatric surgery
Surgical Management of Hemangioma Excision
 
25000
 
3
1280
Paediatric surgery
Surgical Management of Intestinal Atresias (including related complications, fistula)
50000
12
1281
Paediatric surgery
Surgical management of Intestinal obstructions
50000
8
1282
Paediatric surgery
Surgical management of Intestinal Polyposis coli In Paediatric Patients
50000
10
1283
Paediatric surgery
Surgical management of Lymphangioma In Paediatric Patients
32000
5
1284
Paediatric surgery
Surgical management of Obstructed Hernia
30000
3
1285
Paediatric surgery
Surgical Management of Posterior Urethral Valves in Paediatric Patients
40000
7
1286
Paediatric surgery
Surgical Management of Temparo mandibular Joint Ankylosis
35000
5
1287
Paediatric surgery
Torticolis/Sternomastoid Tumour
30000
5
1288
Paediatric surgery
Umbilical Polyp or Sinus excision with Umbilicoplasty
15000
1
1289
Paediatric surgery
Uretheral Fistula
30000
6
1290
Paediatric surgery
Ventilatting Bronchoscope with Optical forceps: Foreign Body removal
15000
1
1291
Paediatric surgery
Vesicostomy/Ureterostomy
 
28000
3
1292
Urology
Closure Of Urethral Fistula
30000
3
1293
Urology
Cystoscopy with Bladder Biopsy
12000
 
1
1294
Urology
Internal Urethrotomy (cannot be repeated within 6 month period) with prior approval from IA
14000
2
1295
Urology
Nephrectomy for Pyonephrosis
40000
5
1296
Urology
Stage 1 Urethroplasty for stricture Double Stage
 
35000
5
1297
Urology
Stage 2 Urethroplasty for stricture Double Stage
35000
7
1298
Urology
Stage-1 Hypospadias
35000
5
1299
Urology
Stage-2 Hypospadias
35000
5
1300
Urology
Stricture Urethroplasty
42000
5
1301
Urology
Surgical correction of Vesicovaginal Fistula
40000
10
1302
Urology
Surgical management of Torsion of Testis
25000
3
1303
Urology
Surgical Procedure for Ileal Conduit Formation with prior approval from IA
45000
5
1304
Urology
Ureteric Catheterization – Cystoscopy under GA
7000
1
1305
Urology
Ureteroscopic Calculi – Bilateral
30000
3
1306
Urology
Ureteroscopic Calculi – Unilateral done by urologist
25000
3
1307
Urology
Ureteroscopic stone Treatment And DJ Stenting Unilateral done by urologist
28000
3
1308
Urology
Urethral Reconstuction
25000
 
4
1309
Urology
URS with contact Lithotripsy with prior approval from IA
25000
3
1310
Urology
Vasoepididymal anastomosis (VEA) unilateral
40000
3
1311
Orthopaedics
Surgical Management of Spina Bifida Minor
 
40000
 
Package Rate
 
Routine
1100
 
HDU
2000
 
ICU (no Ventilation)
2500
 
ICU ( Ventilation support)
4500
 
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F’fetabotic:- Acute Renal Failure. Addjsonian crisis (seen in those u,ith Addisop,s disease). Advanced Dehvdration. Diabetic Coma, Diabetic Ketoacidosis. H-r poglt’cenic Co;ria.. Electrolyte Disturbance., Severe (alorrgruith Deh_vdration. Possible rvith Severe Diarrhea or Vonriting. Clirouic Laxative Abuse. arrd Severe Burns). Flepatic Encephalopathlu. 12″11. Acidosis;, \4alnutrition and Starvarion (as irr Extrelle A,norexia and Bulimia). Thyroid Stornt.
Neurological and Neurosurgical:- Atterrpted ).Jon-fatal Suicide. Cerebroyascular
Accident (stroke), Subalaclinoid Herlorrhaee, Acute Subdural Henratonra.
Coni,ulsion or Seizure. Meningitis, S),ncope (Fainting), ,A.cute Spinal Cord Complession.
Ps1’chiatric:- Ps;,chotic episode. Suicidat Ideatiorr.
Ophthalmological:- Acute Arrgle-closLrre G lauconra, Orbital perforation or Penetration, Retinal Detachnrent .
Respiratory:- Agonal Breathing. Asphyxia, i\ngioedema. choking, Droq,nilg_ Sntoke inhalation, Acute Asthma. Epiglottitis or Severe Croup. pneumothorar. Pu I nr onar’y, Eru b.oI isrr. Respi r.ator1, Fai Iure
Shock:- Anaphl,laxis, cardiogenic Sriock. Hypovolemic Shock (Due to Hernorrhage). Neurogerric Shock, obstructive Shock (e.g., Massive pulnrona6, Errbolisnr or Cardiac Tanrponade), $eptic Shocl<.
,obstetrics :- Ectopic Pregnancy. Ecrarnpsia, pre-eclanrpsia, HELLp S),ndronre. Fetal Distress, Obstetrical Henrorr)rage. Placental Abruption, Prolapsed Cord- Puerper-al Sepsis, Shoulder Dystocia, Uterine Rupture.
urological, Andrological, and Gynecologic :- ovarian Torsiolr. Gynecologic Herliorrhage. Paraphinosis- Priapisnr, Sexual z\ssault (rape). Testicular Torsion. Ulinary Retention.
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