JSS Package Rate List for Tertiary Healthcare Treatments _Benefit Packages.pdf · Sl. No Annexure 3 Procedures Arogya Karnataka Code CEA Code Rates Semi private ward rate Private

Sl. No Annexure 3 Procedures

Arogya

Karnataka

Code

CEA Code Rates Semi private

ward rate

Private ward

ratePre-op Investigations Post-op investigations

1

Post Burn Contracture surgeries for

functional improvement involving

soft tissue and bone(Package

including splints, pressure garments

and phsiotherapy)

- Severe*

3A.1 2370 70000 77000 87500

Clinical Photograph,

Diagram with Rule of 9 for

extent of burns

Clinical Photograph

BF1 Post Burns Follow up - 1 3A.BF1 NA 800 880 1000



2Second degree burns - Thermal (16%

to 30%)4A.1 2263, 2264 25000 27500 31250



extent of burns

Clinical Photograph

3Second degree burns - Thermal (30%

to 50%)4A.2

2249, 2250,

2242, 224350000 55000 62500



extent of burns

Clinical Photograph

4Between 50% to 60% Burns -

Thermal 4A.3 2244, 2245 70000 77000 87500



extent of burns

Clinical Photograph

5 More than 60% Burns - Thermal 4A.4 2245 100000 110000 125000



extent of burns

Clinical Photograph

6Chemical Burns/Acid Burns

(Moderate ) (Grafting not required)4A.5 537 30000 33000 37500 Clinical Photograph Clinical Photograph

7 Chemical Burns (Severe) 4A.6 537 75000 82500 93750 Clinical Photograph Clinical Photograph

8 Electrical Burns(Moderate) 4A.7 2255 30000 33000 37500 Clinical Photograph Clinical Photograph

9 Electrical Burns(Severe) 4A.8 2255 70000 77000 87500 Clinical Photograph Clinical Photograph

10

Any degree burn with inhalational

injury, with 72 hours ventilator

support

4A.9 2857 60000 66000 75000 Clinical Photo Clinical photograph

BURNS

JSS Package Rate List for Tertiary Healthcare Treatments

POST BURNS FOLLOWUP

BURNS-EMERGENCY CODES


Arogya

Karnataka

Code


ward rate

Private ward


11PTCA - one stent (non-medicated,

elective) *3A.2 1287 48000 52800 60000

ECG, 2D ECHO, CAG stills

showing blocks & Reports

Angioplasty stills showing

stent & post Stent flow

12 PTCA - 2 stent (non-medicated) * 3A.3 1288 55000 60500 68750ECG, 2D ECHO, CAG stills



stents & post Stent flow

13PTCA - one stent (Drug Eluting Stent ,

elective) *3A.4 1287 60000 66000 75000



1.Angioplasty stills showing

stents & post Stent flow,2.

Cartons of the stents used

approved by FDA/CE/DCGI

only

14PTCA - Two stent (Drug Eluting Stents

, elective) *3A.5 1288 85000 93500 106250







only

15 Balloon Mitral Valvotomy * 3A.6 1262 30000 33000 37500 2D ECHO report 2D ECHO report + stills of

ECHO

16 Balloon Pulmonary Valvotomy 3A.7 1263 25000 27500 31250 2D ECHO report 2D ECHO report + stills of

ECHO

17 Balloon Aortic Valvotomy* 3A.8 1258 25000 27500 31250 2D ECHO report 2D ECHO report + stills of

ECHO

18 Coarctation dilatation* 3A.9 1425 25000 27500 31250 2D ECHO report 2D ECHO report + stills of

ECHO

19Peripheral Angioplasty with stent

(non-medicated) *3A.10 1367 60000 66000 75000

2D ECHO , ANGIOGRAM

report & stills , ABI

Post procedure Angio stills,

ABI

20Renal Angioplasty with stent (non-

medicated) *3A.11 1365 55000 60500 68750

2D ECHO , ANGIOGRAM

report & stills Post procedure Angio stills

21Both sided renal Angioplasty with

stent (non-medicated) *3A.12 1365 80000 88000 100000

2D ECHO , ANGIOGRAM

report & stills Post procedure Angio stills

CARDIOLOGY


Arogya

Karnataka

Code


ward rate

Private ward


22Vertebral Angioplasty (non-

medicated) *3A.13 1315 55000 60500 68750

2D ECHO , ANGIOGRAM

report & stillsPost procedure Angio stills

23

Permanent pacemaker implantation

(only VVI single chamber) including

Pacemaker value/pulse generator

replacement

3A.14 1310 75000 82500 93750

ECG + Report by

cardiologist + Anigiogram

report if done

X Ray showing the

pacemaker in situ

24

Permanent pacemaker implantation

(DDR, dual chamber) including

Pacemaker value/pulse generator

replacement

3A.15 1309 120000 132000 150000

ECG + Report by


report if done

X Ray showing the

pacemaker in situ

25 Pulse Generator replacement 3A.16 NA 50000 55000 62500

ECG + Report by


report if done

X Ray showing the

pacemaker in situ

26 Septostomy 3A.17 1271, 1418 20000 22000 25000 2D ECHO report 2D ECHO report + stills of

the ECHO

27 PDA Device Closure * 3A.18 1280 80000 88000 100000 2D ECHO report 2D ECHO stills showing the

device + Report

28 ASD Device Closure * 3A.19 1272, 1275 88000 96800 110000 2D ECHO report 2D ECHO stills showing the

device + Report

29Ventricular Septal Defect Device

Closure *3A.20

1279, 1280,

1281, 1282,

1283

88000 96800 110000 2D ECHO report 2D ECHO stills showing the

device + Report

30 PDA Coil (one) insertion 3A.21 1281 25000 27500 31250 2D ECHO report 2D ECHO stills showing the

coil + Report

31 PDA Multiple coil insertion 3A.22 1282 30000 33000 37500 2D ECHO report 2D ECHO stills showing the

coil + Report

32Intravascular ultrasound

(IVUS)/Fractional Flow Reserve (FFR)3A.23 1442 20000 22000 25000 Angiogram Report IVUS/FFR report

33 Electrophysiological Study (EP study) 3A.24 1427 10000 11000 12500ECG with report + 2D ECHO

reportEP study report+ ECG

34Radiofrequency Ablation (RF

Ablation)3A.25 1863 25000 27500 31250

ECG with report + 2D ECHO

report RF ablation report +ECG


Arogya

Karnataka

Code


ward rate

Private ward


35 3D Mapping + Ablation 3A.26 NA 50000 55000 62500ECG with report + 2D ECHO

report

3D mapping report+ECG

with report

36Rotablation+ PTCA (non-medicated

Stent )*3A.27 1421 63000 69300 78750

CAG Report with stills

showing blocks

CAG stills with stents and

stills with post flow

37Rotablation+ PTCA (One Drug Eluting

Stent)*3A.28 1421 80000 88000 100000







only

38 Rotablation+ Balloon Angioplasty 3A.29 1421 45000 49500 56250CAG Report with stills

showing blocks

CAG stills with balloon and


39 Peripheral Angioplasty with balloon * 3A.30 1366 40000 44000 50000ECG, 2D ECHO, CAG stills






only

40Renal Angioplasty with stent (Drug

Eluting ) *3A.31 1365 65000 71500 81250







only

41 Venous stenting* 3A.32 NA 50000 55000 625002D ECHO , Angiogram

Report & Stills Post procedure Angio stills

42 PDA stenting* 3A.33 1279 50000 55000 62500 2D ECHO , Angiogram


43 Coarctoplasty with stenting* 3A.34 1323 75000 82500 93750 2D ECHO , Angiogram



Arogya

Karnataka

Code


ward rate

Private ward


44Right ventricular outflow tract

(RVOT) stenting3A.35 NA 50000 55000 62500

2D ECHO, Angiogram


45 Pulmonary artery stenting 3A.36 NA 50000 55000 62500 2D ECHO , Angiogram


46Vertebral Angioplasty (non-

medicated) - with stent3A.37 NA 70000 77000 87500

2D ECHO , Angiogram

Report & Stills Angiogram-DSA/MRA/CTA

47Paravalvular leak/ Ruptured sinus of

Valsalva aneurysm (RSOV)3A.38 1374 88000 96800 110000 2D ECHO Report

2D ECHO stills showing the

device + Report

48 Carotid angioplasty with stent* 3A.39 1441 150000 165000 187500Angiogram report & Film

showing the lesion

Post procedure Angio stills

+ XRAY + Doppler

49Coronary Balloon

Angioplasty/PTSMA*4A.10 2961 30000 33000 37500




Balloon & post flow

50

PTCA - one stent (non-medicated,

emergency, inclusive of angiogram)

at the same admission.*

4A.11 1286, 1287 48000 52800 60000ECG, 2D ECHO, CAG stills




51

PTCA - one Drug Eluting stent (


at the same admission. *







only

52

PTCA - two bare metal stents ( non-

medicated, emergency, inclusive of

angiogram) at the same admission. *




stent & post Stent flow

53

PTCA - two Drug Eluting stents (


at the same admission. *





CARDIOLOGY- EMERGENCY CODES


Arogya

Karnataka

Code


ward rate

Private ward


54Medical treatment of Acute MI with

Thrombolysis4A.15 2720 15000 16500 18750

2D ECHO, CPKMB,CAG, ECG

with report, TROPONINE-T

reports

2D ECHO, ECG, LAB

INVESTIGATION (Trop T

report)

55 Arrythmias 4A.16 2725, 2726 7000 7700 8750 CAG CAG

56 Stuck valve with Thrombolysis 4A.17 1960 20000 22000 25000ECHO/TEE, PT/INR, RFT,

CBC

ECHO/TEE, PT/INR, RFT,

CBC

57Medical management of unstable

angina/non STS4A.18 2730, 2731 7500 8250 9375

ECG,ECHO,Cardiac

Enzymes, RFT, CBCECG, RFT, CBC

58 Cardiac failure 4A.192670, 2672,

2674 7500 8250 9375

ECG,ECHO,Chest X-ray,

RFT, CBC

ECHO, CHEST X RAY, RFT,

CBC

59 CVA secondary to Cardiac conditions 4A.201337, 2603,

2604 10000 11000 12500

ECHO, CT Brain/ MRI

Brain,, RFT, CBCPT/INR, RFT, CBC

60Emergency dialysis for cardiac

conditions4A.21 1791, 1792 15000 16500 18750 ECHO, RFT, CBC RFT, CBC

61 ICU with ventilator with dialysis 4A.22 2646 15000 16500 18750ECHO, Chest X Ray, RFT,

CBC, ABG

CHEST X RAY RFT,RFT, CBC,

ABG

62Acute respiratory distress - ventilator

support4A.23 2560, 2561 15000 16500 18750

ECHO, Chest X Ray, RFT,

CBC, ABG

CHEST X RAY, RFT, CBC,

ABG

63 Pulmonary edema 4A.24 2732 10000 11000 12500ECG, ECHO,Chest X Ray,

RFT, CBC, ABG

ECHO, CHEST X RAY, RFT,

CBC, ABG

64

Laryngoscopy / Bronchoscopy with

dilatation of trachea with gum elastic

bogie

4A.25 NA 5000 5500 6250 CT / Bronchoscopy report CT / Bronchoscopy report

65

Intercostal Drainage and

Management of ICD, Intercostal

Block, Antibiotics & Physiotherapy

4A.26 1407 15000 16500 18750 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

66 Temporary Pacemaker implantation 4A.27 1307, 1308 10000 11000 12500ECG + Report by

cardiologist

X Ray showing the

pacemaker in situ

67 Creation of AV fistula for dialysis 4A.28 1346, 1347 7500 8250 9375 DuplexClinical photos showing the

AV fistula

68 Pericardiostomy with balloon 4A.29 1298 20000 22000 25000 2D ECHO report 2D ECHO report + stills of

the ECHO

69 Pericardiocentesis 4A.30 1297 10000 11000 12500 2D ECHO report 2D ECHO report


Arogya

Karnataka

Code


ward rate

Private ward


70 Thrombolysis for peripheral ischemia 4A.31 1960 30000 33000 37500Peripheral Angiogram

/Doppler Report with StillsPost procedure Angio stills

71Coronary artery bypass grafting

(CABG) *3A.40 1295 95000 104500 118750 2D ECHO , CAG Report

ECHO,Post op X Ray ,scar

photo


(CABG) with additional arterial graft*3A.41 NA 100000 110000 125000 2D ECHO , CAG Report

ECHO,Post op X Ray ,scar

photo + scar photo of graft

area

73

Coronary artery bypass grafting

(CABG) with Intra-aortic balloon

pump (IABP) *

3A.42 1293 125000 137500 156250 2D ECHO , CAG ReportECHO,Post op X Ray ,scar

photo


(CABG) + Valve Replacement *3A.43 1296 115000 126500 143750

2D ECHO with stills , CAG

Report

Post op X Ray , 2D ECHO

with stills, scar photo

75


(CABG) + Valve Replacement + Intra-

aortic balloon pump (IABP) *

3A.44 1296 145000 159500 181250 2D ECHO with stills , CAG

Report

Post op X Ray , 2D ECHO

with stills, scar photo


(CABG) with Aneurysmal repair *3A.45 1294 95000 104500 118750


Report

ECHO with stills,Post op X

Ray ,scar photo


(CABG) with Mitral Valve repair *3A.46 1296 95000 104500 118750


Report


Ray ,scar photo

78


(CABG) with post MI Ventricular

Septal Defect (Ventricular Septal

Defect) repair with IABP*

3A.47 NA 120000 132000 150000 2D ECHO with stills , CAG

Report


Ray ,scar photo

79 Open Mitral Valvotomy * 3A.48 1262 80000 88000 100000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo

80 Open Aortic Valvotomy * 3A.49 1266 80000 88000 100000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo

81 Open Pulmonary Valvotomy * 3A.50 1263 80000 88000 100000 2D ECHO Report with stills2D ECHO Report + stills of

ECHO,scar photo

82 Closed Mitral Valvotomy * 3A.51 1259 30000 33000 37500 2D ECHO Report with stills

2D ECHO Report + stills of

ECHO + Post Op X-ray,scar

photo

CARDIO THORACIC SURGERY


Arogya

Karnataka

Code


ward rate

Private ward


83 Mitral Valve Repair * 3A.52 1262 80000 88000 100000 2D ECHO Report with stills



photo

84 Tricuspid Valve Repair * 3A.53 NA 80000 88000 100000 2D ECHO Report with stills



photo

85 Aortic Valve Repair * 3A.54 NA 80000 88000 100000 2D ECHO Report with stills



photo

86 Ring for any Valve Repair * 3A.55 1264 20000 22000 25000 2D ECHO Report with stills



photo

87 Mitral Valve Replacement * 3A.56 1269 130000 143000 162500 2D ECHO Report with stills



photo

88 Aortic Valve Replacement * 3A.57 1266 130000 143000 162500 2D ECHO Report with stills



photo

89 Pulmonary Valve Replacement* 3A.58 1263 120000 132000 150000 2D ECHO Report


ECHO + post Op X-ray,scar

photo

90 Tricuspid Valve Replacement * 3A.59 1270 130000 143000 162500 2D ECHO Report with stills



photo

91Valve Replacement with Intra-aortic

balloon pump (IABP) *3A.60 1266 140000 154000 175000 2D ECHO Report with stills



photo

92 Double Valve Replacement * 3A.61 1265 150000 165000 187500 2D ECHO Report with stills



photo

93 Ross Procedure * 3A.62 1261 110000 121000 137500 2D ECHO Report with stills



photo

94 Atrial septal defect (ASD) * 3A.63 1272 90000 99000 112500 2D ECHO Report with stills



photo


Arogya

Karnataka

Code


ward rate

Private ward


95 Ventricular Septal Defect (VSD) * 3A.64 1273 90000 99000 112500 2D ECHO Report with stills



photo

96

Atrioventricular septal defect

(AVentricular Septal Defect)/

Atrioventricular (AV) Canal Defect *

3A.65 1272 90000 99000 112500 2D ECHO Report with stills



photo

97 Intracardiac repair (ICR) for

Tetralogy of Fallot (TOF) *3A.66 1277 90000 99000 112500 2D ECHO Report with stills



photo

98

Pulmonary Valvotomy + Right

Ventricular Outflow Tract (RVOT)

Resection *




photo

99Aortopulmonary Window (AP

Window) *3A.68 NA 90000 99000 112500 2D ECHO Report with stills



photo

100Surgery for Hypertrophic Obstructive

Cardiomyopathy (HOCM) *3A.69 NA 90000 99000 112500

2D ECHO/TEE Report +

Chest Xray AP view

/Cardiac MRI



photo

101 Ebsteins * 3A.70 NA 90000 99000 112500 ECG, 2D ECHO Report



photo

102 Fontan * 3A.71 1416 100000 110000 125000 2D ECHO Report with stills



photo

103Total Anomalous Pulmonary Venous

Connection (TAPVC) *3A.72 1278 120000 132000 150000 2D ECHO Report with stills



photo

104Pulmonary Atresia with or without

Ventricular Septal Defect *3A.73 NA 105000 115500 131250 2D ECHO Report with stills



photo

105Transposition of the great arteries

(TGA) -Arterial Switch Operation*3A.74 1284, 1285 120000 132000 150000 2D ECHO Report with stills



photo

106 Double Switch Operation * 3A.75 1414 120000 132000 150000 2D ECHO Report with stills



photo


Arogya

Karnataka

Code


ward rate

Private ward


107 Sennings * 3A.76 NA 120000 132000 150000 2D ECHO Report with stills



photo

108 Mustards * 3A.77 NA 120000 132000 150000 2D ECHO Report with stills



photo

109Rastelli procedure -Pulmonary

Conduit *3A.78 NA 120000 132000 150000 2D ECHO Report with stills



photo

110 Truncus Arteriosus Surgery * 3A.79 1325 120000 132000 150000 2D ECHO Report with stills



photo

111

Root Replacement (Aortic Aneurysm/

Aortic Dissection) / Bental Procedure

*




photo

112 Aortic Arch Replacement* 3A.81 1342 150000 165000 187500 2D ECHO Report with stills



photo

113

Aortic Aneurysm Repair without

using Cardiopulmonary bypass (CPB)

with/without graft*

3A.82 1342 70000 77000 87500 CT Angio ReportScar photo + Intra op

photo

114

Aortic Aneurysm Repair using

Cardiopulmonary bypass (CPB)

with/without graft*


photo

115

Intrathoracic Aneurysm (without

graft)-Aneurysm not Requiring

Bypass Techniques*

3A.84 1324 65000 71500 81250 CT Angio ReportScar photo + Post op intra

op photo

116Pulmonary Embolectomy /

Endarterectomy*3A.85 1317 150000 165000 187500

2D ECHO with stills + ABG

report + CT Chest report



photo

117Patent Ductus Arteriosus (PDA)

Closure3A.86 1280 30000 33000 37500 2D ECHO Report with stills


ECHO + Post Op X-ray, scar

photo

118 Coarctation Repair* 3A.87 1322 30000 33000 37500 2D ECHO with stills + CAG

report

Doppler report + Stills of

Doppler

119 Coarctation Repair with graft * 3A.88 1328 70000 77000 87500 2D ECHO with stills + CAG

report

Doppler report + Stills of

Doppler


Arogya

Karnataka

Code


ward rate

Private ward


120Blalock–Thomas–Taussig (BT) Shunt

(inclusives of grafts)3A.89 1417 60000 66000 75000 2D ECHO Report with stills



photo

121 Glenn Shunt 3A.90 NA 60000 66000 75000 2D ECHO Report with stills



photo

122 Central Shunt 3A.91 NA 60000 66000 75000 2D ECHO Report with stills



photo

123 Pericardiectomy 3A.92 1299 50000 55000 62500 2D ECHO Report with stills



photo

124 Thoracoscopic surgery 3A.93 1408 35000 38500 43750 CT Chest report


ECHO + Post Op X-ray,

photo of scar, port

insertion

125 Pericardiostomy Surgery 3A.94 1298 10000 11000 12500 2D ECHO report



photo

126 Thyomectomy 3A.95 1411 35000 38500 43750 CT Chest report X-RAY, scar photo

127 Lobectomy 3A.96 1390 70000 77000 87500 CT Chest report Post Op X-ray,scar photo

128 Pneumonectomy 3A.97 1391 60000 66000 75000 CT Chest report Post Op X-ray,scar photo

129 Pleurectomy 3A.98 NA 50000 55000 62500 CT Chest report Post Op X-ray,scar photo

130 Decortication 3A.99 1397 50000 55000 62500 CT Chest report Post Op X-ray,scar photo

131 Mediastinotomy 3A.100 NA 40000 44000 50000 CT Chest report Post Op X-ray,scar photo

132 Pulmonary AV Fistula surgery 3A.101 NA 45000 49500 56250 CT Chest report Post Op X-ray,scar photo

133 Lung Cyst 3A.102 1389 60000 66000 75000 CT Chest report Post Op X-ray,scar photo

134Space-Occupying Lesion (SOL)

mediastinum3A.103 1395 60000 66000 75000 CT Chest report Post Op X-ray,scar photo


Arogya

Karnataka

Code


ward rate

Private ward


135Surgical Correction of

Bronchopleural Fistula.3A.104 1398 70000 77000 87500 CT Chest report



photo

136 Diaphragmatic Eventeration 3A.105 1401 50000 55000 62500 CT Chest report



photo

137Oesophageal Diverticula /Achalasia

Cardia3A.106 1387 50000 55000 62500

Barium Study + CT Chest

report



photo

138 Diaphragmatic Injuries/Repair 3A.107 1402 35000 38500 43750 CT Chest report



photo

139Thoracotomy, Thoraco Abdominal

Approach3A.108 1388 40000 44000 50000 CT Chest report Post Op X-ray,scar photo

140Bronchial Repair Surgery for Injuries

due to Foreign body3A.109 1394 40000 44000 50000

CT Chest report +

Bronchoscopy reportENDOSCOPY PICTURE

141

Gastro Study Followed by

Thoracotomy & Repairs of

Oesophageal Injury for Corrosive

Injuries/FB

3A.110 1388 50000 55000 62500 Gastroscopy ReportENDOSCOPY PICTURE, scar

photo

142 Oesophageal tumour removal 3A.111 NA 50000 55000 62500Endoscopy Report + Biopsy

ReportBiopsy report, scar photo

143 Oesophagectomy 3A.112 1994, 2015 60000 66000 75000 Biopsy , CT , Endoscopy

reportsBiopsy report, scar photo

144Encysted Empyema/Pleural Effusion -

Tubercular3A.113 1393 20000 22000 25000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

145

First rib Excision by transaxillary

approach Excision of cervical rib /

fibrous band / muscle by cervical

approach

3A.114 64 40000 44000 50000 Pre Op X-ray / CT ScanPost Op X-ray / CT Scan

,scar photo

146Thorocotomy and resection of pluera

with Lung3A.115 1404 50000 55000 62500

Pre Op X-ray / CT Scan,

Bronchoscopy Report

Post Op X-ray / CT Scan

,scar photo

147

Tracheoplasty and introduction of

montegomary T-tube (Tracheal

stenting)

3A.116 80 40000 44000 50000 CT / Bronchoscopy report CT / Bronchoscopy report


Arogya

Karnataka

Code


ward rate

Private ward


148 Congenital Hypoplasia of the lung 3A.117 Na 40000 44000 50000 Pre Op X-ray / CT ScanPost Op X-ray / CT Scan

,scar photo

149 Congenital Cystic Lesions 3A.118 NA 40000 44000 50000 Pre Op X-ray / CT ScanPost Op X-ray / CT Scan

,scar photo

150 Pulmonary Sequestration 3A.119 NA 40000 44000 50000 Pre Op X-ray / CT ScanPost Op X-ray / CT Scan

,scar photo

151Pulmonary artero venous

malformation3A.120 NA 40000 44000 50000 Pre Op X-ray / CT Scan


,scar photo

152Thoracotomy & Excision and fixation

of the Spine3A.121 NA 65000 71500 81250 Pre Op X-ray / CT Scan


,scar photo

153 Hiatus Hernia Repair 3A.122 212, 213 40000 44000 50000 USG, UGI ENDOSCOPYScar photo + Intra op

photo

154Intrathoracic Aneurysm (with graft) -

Requiring Bypass Techniques*3A.123 1324, 1329 110000 121000 137500 CT Angio Report

Scar photo + Intra op

photo

Rotablation+ Balloon Angioplasty 3A.29 1421 45000 49500 56250CAG Report with stills

showing blocks

CAG stills with balloon and


Peripheral Angioplasty with stent

(non-medicated) *3A.10 1367 60000 66000 75000

2D ECHO , ANGIOGRAM

report & stills , ABI

Post procedure Angio stills,

ABI

155 Foreign Body Removal with scope 4A.32 296 20000 22000 25000CT Chest report +

Bronchoscopy reportENDOSCOPY PICTURE

156

Surgery for Cardiac Tumour/ Left

Atrial (LA) Myxoma/ Right Atrial (RA)

Myxoma

4A.33 1300 95000 104500 118750 2D ECHO with stills + CT

Chest report



photo

157 Lung Injury repair 4A.34 1394 50000 55000 62500 CT Chest report X-RAY, scar photo

158Management of Mediastinitis /

mediastinal bleeding4A.35 1395 40000 44000 50000 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan

159 Pericardiostomy without balloon 3A.124 1298 10000 11000 12500 2D ECHO report 2D ECHO report + stills of

the ECHO

160Thromboembolectomy - unilat

singular3A.125

1318, 1316,

1317, 131930000 33000 37500

Duplex/Angio Report &

stills


photo

161Thromboembolectomy - bilat /multi

level3A.126

1318, 1316,

1317, 131940000 44000 50000


stills


photo

CARDIO THORACIC SURGERY- EMERGENCY CODES

CARDIO VASCULAR SURGERY


Arogya

Karnataka

Code


ward rate

Private ward


162

Aortic Aneurysm Repair without

using Cardiopulmonary bypass (CPB)

including graft*


photo

163

Aortic Aneurysm Repair using

Cardiopulmonary bypass (CPB)

including graft*


photo

164Surgery for Arterial Aneursysm -

Abdominal aorta3A.129 1333 90000 99000 112500


stills


photo

165Surgery for Arterial Aneurysm Renal

Artery3A.130 1372 50000 55000 62500

Renal arterial Doppler,

Angiogram with stills


photo

166Operations for Stenosis of Renal

Arteries3A.131 1373 20000 22000 25000

Renal arterial

Doppler,angiogram & Stills

Doppler Report + scar

photo

167Femoropopliteal by pass procedure

with graft (inclu. Graft)3A.132 1349 70000 77000 87500 Angiogram Report

Clinical Photographs

Duplex, ABI, scar photo

168Aorto Bi lliac / Bi femoral /Axillo bi

femoral bypass with Synthetic Graft3A.133 1351 90000 99000 112500

Angiogram/spiral CT

Angiogram reports

Stills showing the

procedure with graft + scar

photo

169

Femoro Distal / Femoro-popliteal/

Femoral infra popliteal Bypass with

Vein Graft

3A.134 1354 50000 55000 62500Angiogram/spiral CT

Angiogram reports

Stills showing the

procedure with graft

+Duplex scan, scar photo

170

Carotid- carotid/Carotid- Subclavian/

Femoro Distal / Femoral - Femoral /

Femoral infra popliteal Bypass with

Synthetic Graft


Angiogram reports

Stills showing the



171

Axillo Brachial Bypass using Synthetic

Graft/Brachial Artery to Auxillary

Vein/Basilic Vein grafting using PTFE

graft


Angiogram reports

Stills showing the



172 Brachio - Radial Bypass (with vein) 3A.137 1356 40000 44000 50000Angiogram/spiral CT

Angiogram reports

Stills showing the




Arogya

Karnataka

Code


ward rate

Private ward


173Excision of Carotid body Tumor with

/ without vascular repair3A.138 1379 35000 38500 43750

Angiogram/spiral CT

Angiogram reports

Stills showing the

procedure +Duplex scan,

scar photo

174Carotid artery bypass with Synthetic

Graft3A.139 1337 60000 66000 75000

Angiogram/spiral CT

Angiogram reports

Stills showing the



175Excision of Arterio Venous

malformation - Large3A.140 1330 50000 55000 62500

Angiogram/spiral CT

Angiogram reports

Stills showing the


photo

176

Excision of Arterio Venous

malformation - Small

(Congenital/Acquired)


Angiogram reports

Stills showing the


photo

177Carotid/other peripheral

endarterectomy3A.142 1926 40000 44000 50000 Angiogram report

Stills showing the


photo,

178Carotid/other endarterectomy with

patch3A.143 1926 50000 55000 62500 Angiogram report

Stills showing the

procedure with graft +

scar photo

179 Aortic Angioplasty 3A.144 Na 40000 44000 50000ECG, 2D ECHO, CAG stills



Balloon & post flow, scar

photo

180Aortic/ iliac Angioplasty with one

stent3A.145 na 60000 66000 75000




Balloon & post flow, scar

photo

181Aortic Angioplasty with two stents /

Iliac angioplasty with stent Bilateral3A.146 na 90000 99000 112500




Balloon & post flow,scar

photo

182

Deep Vein Thrombosis (DVT) -

Inferior Vena Cava (IVC) filter

(Recurrent DVD - (includes removal

of filter)

3A.147 1332 65000 71500 81250 Color doppler Plain X-ray abdomen

showing the filter

183Aneurysm infra renal aorta /aorto

iliac(including graft)3A.148 1325 90000 99000 112500

ANGIO/ Spiral CT

Angiogram Report


photo


Arogya

Karnataka

Code


ward rate

Private ward


184 Aorto uni iliac/uni femoral bypass 3A.149 1350 70000 77000 87500

Angiogram/ Computed

Tomography Angiography

(3D-CTA)/Magnetic

Resonance Angiography

Duplex scan, scar photo

185 Peripheral arterial aneurysms 3A.150 1369, 1370 50000 55000 62500 Angiogram Report & Stills Intra op photo

First rib Excision by transaxillary

approach Excision of cervical rib /

fibrous band / muscle by cervical

approach

3A.114 64 40000 44000 50000 Pre Op X-ray / CT ScanPost Op X-ray / CT Scan

,scar photo

Venous stenting* 3A.32 NA 50000 55000 625002D ECHO , Angiogram


186Bronchial artery Embolisation (for

Haemoptysis)3A.151 2904 25000 27500 31250

Chest x-Ray/CT Scan, Hb,

Serum Creatinine

Chest x-Ray/CT Scan, Hb,

Serum Creatinine

187Percutaneous Transluminal Tricuspid

Commissurotormy (PTTC)3A.152 NA 25000 27500 31250 2D ECHO report with stills

2D ECHO report + stills of

the ECHO

188 Balloon Atrial Septostomy 3A.153 1271 25000 27500 31250 2D ECHO report with stills2D ECHO report + stills of

the ECHO

189Coiling - Pseudoaneurysms of

Abdomen3A.154 NA 55000 60500 68750

CT/MRI or Angiogram,

Prothrombin Time (PT),

International normalized

ratio (INR) Hb, Serum

Creatinine

CT, PT,INR, Hb, Serum

Creatinine

190Embolisation - Arteriovenous

Malformation (AVM) in the Limbs3A.155 1897 40000 44000 50000

USG, CT PT, INR, Hb, Serum

Creatinine

USG abd/CT PT,INR, Hb,

Serum Creatinine

CARDIOLOGY/ CVS/ INTERVENTIONAL RADIOLOGICAL THERAPEAUTIC PROCEDURE


Arogya

Karnataka

Code


ward rate

Private ward


191

Catheter directed Thrombolysis for:

Deep vein thrombosis (DVT),

Mesenteric Thrombosis & Peripheral

vessels*

3A.156 2739 50000 55000 62500

CT/MRI, Prothrombin Time

(PT), International

normalized ratio (INR) Hb,

Serum Creatinine

CT/MRI, PT,INR, Hb, Serum

Creatinine

192 Inferior Vena Cava (or IVC) Stenting 3A.157 NA 60000 66000 75000

USG, clotting Time (CT),

Prothrombin Time (PT),

International normalized

ratio (INR), Hb, Serum

Creatinine

USG, CT,PT,INR, Hb, Serum

Creatinine

Pericardiostomy without balloon 3A.124 1298 10000 11000 12500 2D ECHO report 2D ECHO report + stills of

the ECHO

CVSF1 Post Cardiac surgery Followup-1 3A.CVSF1 NA 0 0 0





193 Open Pyelolithotomy* 3A.158 1572 36000 39600 45000 CT KUB with Contrast Scar Photo,X-Ray/USG KUB

194 Open Nephrolithotomy* 3A.159 1569 36000 39600 45000 USG/X-ray KUB Scar Photo,X-Ray/USG KUB

195 Pyeloplasty* 3A.160 1581 40000 44000 50000USG & IVP/CT with

ContrastScar Photo

196PCNL (Percutaneous Nephro

Lithotomy)* (Inclusive of stent)3A.161 1636 38000 41800 47500 CT KUB with Contrast/IVU Scar Photo +X-ray KUB

197 Nephrostomy (PCN)* 3A.162 1571 10000 11000 12500 USGScar Photo With

Nephrostomy Tube

198 Simple Nephrectomy 3A.163 1530 35000 38500 43750USG, CT KUB /Isotope

Renogram

Scar & Specimen Photo

+HPE report

199 Lap. Nephrectomy Simple 3A.164 1585, 1530 45000 49500 56250USG & CT KUB /Isotope

RenogramScar Photo + HPE Report

POST CARDIO SURGERY FOLLOW-UP

GENITO URINARY


Arogya

Karnataka

Code


ward rate

Private ward


200 Lap. Nephrectomy Radical 3A.1652042,

153050000 55000 62500

USG & CT KUB with

Contrast / Isotope

Renogram

Scar Photo + HPE Report

201 Lap. Partial Nephrectomy 3A.166 1584 60000 66000 75000

USG & CT KUB with

Contrast / Isotope

Renogram

Scar Photo + HPE Report

202 Open partial Nephrectomy 3A.167 2041 50000 55000 62500USG & CT KUB with

ContrastScar Photo + HPE Report

203Open Anatrophic Nephrolithotomy (

For Staghorn Stone)3A.168 1574 45000 49500 56250 USG, CT KUB with Contrast Scar Photo +X-Ray Kub

204

Retrograde Intra Renal surgery (RIRS

with laser) – for renal and PUJ

calculi*

3A.169 1593 50000 55000 62500 CT KUB with ContrastC ARM Picture with Patient

Details, X-ray KUB/USG

205 URSL* (Inclusive of stent) 3A.1701594, 1738,

1739, 174022500 24750 28125 CT KUB X-ray KUB

206 DJ stent (One side) 3A.171 1651 7500 8250 9375 USG /X-ray KUB X-ray KUB

207 URSL-LASER* 3A.1721594, 1741,

1742, 174325000 27500 31250 CT KUB

X-ray KUB, Purchase

Voucher for Laser machine

208 DJ stent (Bilateral) 3A.173 1651 10000 11000 12500 X-ray KUB & USG X-ray KUB & USG

209 Ureterolithotomy-Open* 3A.174 1601 30000 33000 37500 CT KUB with Contrast Scar Photo +X-Ray Kub

210 Ureterolithotomy-LAP* 3A.175 1601 35000 38500 43750 CT KUB with Contrast Scar Photo +X-Ray Kub

211 Open Boari Flap-Uretaric stricture 3A.1761600, 1601,

25742000 46200 52500 CT KUB/IVP Clinical Picture, Scar Photo

212Open Ureteral Reimplantation

(Unilateral)3A.177 1597 ,1599 38000 41800 47500 CT KUB/IVP/MCU Scar photo

213 Deflux for VUR* 3A.178 1599 50000 55000 62500 USG,MCU Post -op MCU

214 Ureterocoele incision 3A.179 1805 25000 27500 31250 IVU/CTENDO Picture With patient

details

215 TURP 3A.180 1654 30000 33000 37500USG/CT

KUB,UroflowmetryHPE Report,P.O USG

216 Open Prostatectomy 3A.181 1656 35000 38500 43750 USG, Uroflowmetry Scar Photo + HPE Report

217 Bladder Neck Incision 3A.182 1628 22500 24750 28125 USG & UroflowmetryUroflowmetry,ENDO

Picture

218 TRUS biopsy of prostate 3A.183 1821 6000 6600 7500 PSA,Transrectal USG HPE Report


Arogya

Karnataka

Code


ward rate

Private ward


219 Open Cystolithotomy 3A.184 1610 18000 19800 22500 USG/X ray KUB Scar Photo,X-Ray/USG KUB

220 UVF/VVF Repair* 3A.185774, 775,

77740000 44000 50000 USG/X ray KUB NIL

221 Cystolithotripsy 3A.1861606, 1608,

160917000 18700 21250 X-ray KUB/USG X-ray KUB

222 TURBT 3A.187 1613 30000 33000 37500 USG/CT KUB with ContrastCystoscopy Finding/ HPE

Report, P.O USG

223 Laparoscopic VVF Repair 3A.188 773 40000 44000 50000 Cystoscopy,CECT KUB/ IVPClinical Photograph/

Cystogram

224 Bladder Augmentation 3A.189 1539 42000 46200 52500 USG , Cystogram/MCUScar Photo, Post OP

Cystogram

225Post TURBT BCG (Per Cycle Per

Week)3A.190 1707, 1708 1000 1100 1250 HPE report Endo Picture

226Post TURBT Check Cystoscopy (Per

Sitting)3A.191 no code 5000 5500 6250 USG & urine cytology

Cystoscopy Finding, X-Ray

KUB

227 Partial cystectomy* 3A.192 1630 40000 44000 50000 CT KUB with Contrast Procedure Picture

228 Bladder diverticulectomy -open/lap* 3A.193 1615 30000 33000 37500 CT KUBEndo Picture/Operative

Picture

229Urethroplasty for Stricture Diseases-

single stage*3A.194 1634, 1635 45000 49500 56250 RGU Scar photo,


First Stage3A.195 1637 30000 33000 37500 RGU & MCU Scar photo,


Second Stage*3A.196 1638 25000 27500 31250 RGU & MCU Scar photo,

232 Hypospadiasis(Adult)* 3A.197 1544, 35000 38500 43750 Clinical Photograph Scar photo,

233 Hypospadiasis(Adult) First Stage 3A.198 1545 25000 27500 31250 Clinical Photograph Scar photo,

234 Hypospadiasis(Adult) Second Stage 3A.199 1546 25000 27500 31250 Clinical Photograph Scar photo,

235 Perineal Urethrostomy 3A.200 1632 25000 27500 31250 RGU& MCU Scar photo,

236 Visual Internal Urethrotomy 3A.201 1633, 1670 12000 13200 15000 USG & RGUUroflowmetry/ENDO

PICTURE

237Open Orchidectomy (Simple /

Radical)3A.202 235 20000 22000 25000 USG Scrotum SCAR PHOTO , HPE report

238Repair of stress incontinence - lap or

open colpo suspension* 3A.203

752, 753,

75445000 49500 56250 Clinical Notes

Endo Picture / Operative

Picture

239 Adenoma Excision- Adrenals 3A.204 1457, 1755 12000 13200 15000 X-ray nasopharynx Clinical photograph


Arogya

Karnataka

Code


ward rate

Private ward


240ESWL (Extra carporial shock-wave

lithotripsy)*3A.205 1704 8500 9350 10625 CT KUB with Contrast X-ray KUB/USG

241

ESWL (Extra corporial shock-wave

lithotripsy) above 1 cm to 2 cm-

Single Side*

3A.206 1704 18000 19800 22500 CT KUB with Contrast X-ray KUB

242 Renal biopsy – Percutaneous 3A.207 NA 7500 8250 9375CBC,RFT, USG ABD,

HIV,HBsAg,HCV,Urine R/EHPR

GUF1 Post Genito Urinary Follow up-1 3A.GUF1 NA 0 0 0



243Hemodialysis for acutekidney injury

(intiation phase)4A.36

1789, 1791,

17925000 5500 6250

CBC,RFT,USG

Abd,HIV,HBsAg,HCV,Urine

R/E

CBC,RFT,USG


R/E

244Subsequent Hemodialysis - per

session4A.37

1789, 1791,

17921000 1100 1250 RFT, Urine R/E RFT, Urine R/E

245

Acutekidney injury without

hemodialysis, inclusive of pre-op

inv,post -op inv,procedure

cost,wards stay,and medication for

10 days

4A.38 2644, 2646, 10000 11000 12500

CBC,RFT,USG


R/E, LFT,Lipid Profile

CBC,RFT,USG



246

Acutekidney injury with

hemodialysis, inclusive of pre-op

inv,post -op inv,procedure

cost,ICU/wards stay,and medication

for 15 days

4A.39 2645 25000 27500 31250

CBC,RFT,USG



CBC,RFT,USG



247Trochar SPC FOR ARU/Acute Urethral

injury4A.40 1606 2000 2200 2500 RGU,MCU RGU,MCU

248 Reduction of Paraphimosis 4A.41 248 1500 1650 1875 Clinical Photograph Clinical Photograph

POST GENITO URINARY FOLLOW-UP

GENITO URINARY-EMERGENCY CODES


Arogya

Karnataka

Code


ward rate

Private ward


249 Supraglottoplasty 3A.208 NA 25000 27500 31250 Endoscopy photo/CT

Clinical Photograph

showing scar / endoscopy

picture

250 Esophageal substitution surgery 3A.209 1484 110000 121000 137500Contrast X ray/endoscopy

findings,

Clinical Photograph

showing scar

251 Thoracic Duplication cyst 3A.210 1389, 1396 50000 55000 62500 CT, Chest X ray Biopsy Report.

252 Thoracic Wall defects Correction 3A.211 1473 60000 66000 75000 CT/MRI, X ray Clinical Photograph

253 Omphalocele-Minor 3A.212 1476, 1478 40000 44000 50000 Clinical PhotographClinical Photograph

showing scar

254 Splenectomy - Child 3A.213189, 192,

19345000 49500 56250 Hemogram,USG

Clinical Photograph

showing scar

255Shunt surgery for portal

hypertension3A.214 108, 191 50000 55000 62500 USC/CT/MRI

Clinical Photograph

showing scar

256 Surgery for chronic pancreatitis 3A.215 NA 70000 77000 87500 CT/MRIClinical Photograph

showing scar

257 Colostomy formation 3A.216 136, 137 20000 22000 25000 X-RayClinical Photograph

showing scar

258 Biliary Atresia 3A.217 1513 65000 71500 81250 CT AbdomenClinical Photograph

showing scar

259Excision of choledochal cyst with

hepatic jejunostomy3A.218 1514 85000 93500 106250 USG/CT/MRCP Scar photo,HPE Report

260 Oesophageal Atresia 3A.219 1481 110000 121000 137500 X-RayClinical Photograph

showing scar

261 Diaphragmatic Hernia - Paed 3A.220 1529, 220 110000 121000 137500 X-RayClinical Photograph

showing scar+Post op X ray

262Unilateral Inguinal Hernia- Age less

than 1 year3A.221 219, 220 15000 16500 18750 Clinical photograph, USG HPR, Clinical photograph

263Bilateral Inguinal Hernia for age < 1

year3A.222 218 22500 24750 28125 Clinical Photograph

Clinical Photograph

showing scar

264 Ureteric Reimplantations Bilateral * 3A.223 1536 70000 77000 87500 MCU, USGClinical Photograph

showing scar

265 Ureteric Reimplantations Unilateral * 3A.224 1536, 1597 45000 49500 56250 MCU, USGClinical Photograph

showing scar

266 Exstropy Bladder Stage 2 3A.225 1536, 1597 70000 77000 87500 MCU Clinical Photograph

NEONATAL AND PAEDIATRIC SURGERY


Arogya

Karnataka

Code


ward rate

Private ward


267 Urinary Diversion - Temporary 3A.226 2044 25000 27500 31250 MCU, USGClinical Photograph

showing scar

268 Urinary Diversion - Permanent 3A.227 2044 45000 49500 56250 MCU, USGClinical Photograph

showing scar

269 Urinary Diversion - Undiversion 3A.228 2044 35000 38500 43750 MCU, USGClinical Photograph

showing scar

270 Continence Stage 1 (Epispadias) 3A.229 1547 40000 44000 50000Clinical photo showing the

meatal openingNil

271Stage 2 Incontinence for epispadias

including bladder neck repair3A.230 1647, 1648 40000 44000 50000 USG/MCU Clinical Photograph

272 Insertion of Hickman Catheter 3A.231 1346, 1347 10000 11000 12500Lab reports confirming

cancer

Clinical Photograph

showing catheter

273 Insertion of Chemo port 3A.232 1346, 1347 20000 22000 25000Lab reports confirming

cancer

Clinical Photograph

showing chemo Port

274Congenital Hydronephrosis

Open/Lap*3A.233 1535 50000 55000 62500 USG, Renal Isotope Scan

Clinical Photograph

showing scar

275 Feminising genitoplasty 3A.234 1558 55000 60500 68750 Clinical PhotographClinical Photograph

showing scar

276 Undescended Testis (Palpable) 3A.235 1549 15000 16500 18750 USG,Clinical photo Nil

277Unsescended Non palpable testis

stage 13A.236 NA 20000 22000 25000 USG abdomen Scar photo

278Undescended Non palpable testis

stage 2 (definitve repair)3A.237 NA 25000 27500 31250

USG/OT notes of previous

surgeryScar photo

279Anorectal Malformations Definite

Repair3A.238

1510, 1494

(multiple

codes)

60000 66000 75000

Colostogram pic for males,

Photo of perineum region

for females

Clinical Photograph

showing scar

280 Anorectal Malformations Stage 3 3A.239

1499, 1501,

1502

(multiple

code)

45000 49500 56250 Clinical PhotographClinical Photograph

showing scar

281 Anorectal malformation- Low variant 3A.240

152, 1506,

(Multiple

codes)

30000 33000 37500Photo of the perineum

regionScar photo


Arogya

Karnataka

Code


ward rate

Private ward


282 Hirschsprungs Disease stage 1 3A.241

1496, 1495,

1501

(Multiple

codes)

40000 44000 50000 Rectal biopsy/ X-

Ray/Contast Enema

Clinical photo showing scar

+ Biopsy Report.

283

Hirschsprungs Disease stage

2/Definitive Repair (Including

Staplers)

3A.242

1511, 1507

(Multiple

coddes)

60000 66000 75000 Contrast Enema / BiopsyClinical Photograph

showing scar

284Heller's Cardiomyotomy with

fundoplication3A.243 89 50000 55000 62500

Contrast X ray/endoscopy

findings

Clinical Photograph

showing scar

285 Simple Fundoplication 3A.244 1154 35000 38500 43750Contrast X ray/endoscopy

findings

Clinical Photograph

showing scar

286Intussusception

pneumatic/hydrostatic reduction3A.245 108 18000 19800 22500 USG/Xray Post op USG, Post op X Ray

287 Pyloromyotomy 3A.246 89 35000 38500 43750 USG/Contrast X rayClinical Photograph

showing scar

288 Bladder Augumentation 3A.247 1539 80000 88000 100000 MCU/USG Clinical photo

289 Hypospadias First Stage 3A.248 1545 30000 33000 37500 Clinical photo showing the

meatal openingNil

290Hypospadias Definitive Repair -

proximal penile3A.249 1544 60000 66000 75000

Clinical photo showing the

meatal openingNil

291Hypospadias Definitive Repair - mid

penile3A.250 1544, 50000 55000 62500


meatal openingNil

292Hypospadias Definitive Repair - distal

penile3A.251 1544, 1546 40000 44000 50000


meatal openingNil

293 Hypospadias Re-Do 3A.252 NA 40000 44000 50000 Clinical photo showing the

meatal openingNil

294 Fistula Closure Hypospadiacs 3A.253 NA 20000 22000 25000 Clinical Photograph Nil

295Cystoscopic fulguration of posterior

urethral valves3A.254 1770 30000 33000 37500 MCU, USG

Clinical

Photograph/Endoscopic

picture

296 Stent Removal 3A.255 1703 5000 5500 6250 X Ray Post op X Ray


Arogya

Karnataka

Code


ward rate

Private ward


297Laparotomy and excision of cyst (For

Paediatric benign abdominal cyst)3A.256 320 30000 33000 37500 USG/CT Scar Photo, HPE Report

298 Polydactly (One finger) 3A.257 2324 20000 22000 25000 Clinical photo Clinical photo

299 Club hands Stage 1 / Club Foot 3A.2582394, 1088,

232440000 44000 50000 Clinical photo Clinical photo

300 Club hands Stage 2 3A.2592394, 1088,


301 Syndactly 3A.2602394, 1088,


302 Meningo Encephalocele * 3A.261 1850 40000 44000 50000 MRI Report

Post Op CT Report and

film, Clinical Photograph

showing Scar

303 Meningomyelocele * 3A.2621837,

183840000 44000 50000 CT report


film, scar photo

304 Faciomaxillary surgery 3A.2631931, 2321,

232235000 38500 43750 X-RAY/CT scan

Clinical Photograph

showing scar + post op.

XRAY

305 Respiratory distress syndrome 3A.264 NA 75550 83105 94437.5Clinical notes confirming

digonosis

clinical notes in relevant

reports

306 Meconium Aspiration syndrome 3A.265 NA 50900 55990 63625Clinical notes confirming

digonosis


reports

307 Septicemia not requiring ventilation 3A.266 2693, 2695 49200 54120 61500Clinical notes confirming

digonosis


reports

308 VLBW not requiring ventilation 3A.267 2658, 2661 119900 131890 149875Clinical notes confirming

digonosis


reports

309Neonatal jaundice requiring

exchange transfusion3A.268 2610, 2611 31250 34375 39062.5

Clinical notes confirming

digonosis


reports

310 Asphyxia with convulsions 3A.269 2650 73400 80740 91750Clinical notes confirming

digonosis


reports

311Cochlear Implant Surgery excluding

implant(Including AV therapy)3A.270 2406 130000 143000 162500


digonosis


reports

312Thalessemia/Sickle Cell anaemia

(Quaterly per child per year)3A.271 NA 25000 27500 31250


digonosis


reports

Decortication 3A.99 1397 50000 55000 62500 CT Chest report Post Op X-ray,scar photo

Hiatus Hernia Repair 3A.122 212, 213 40000 44000 50000 USG, UGI ENDOSCOPYScar photo + Intra op

photo


Arogya

Karnataka

Code


ward rate

Private ward


Lobectomy 3A.96 1390 70000 77000 87500 CT Chest report Post Op X-ray,scar photo

Pneumonectomy 3A.97 1391 60000 66000 75000 CT Chest report Post Op X-ray,scar photo

Thoracoscopic surgery 3A.93 1408 35000 38500 43750 CT Chest report


ECHO + Post Op X-ray,

photo of scar, port

insertion

313Bronchoscospy for foreign body

removal4A.42

428, 1405,

156525000 27500 31250 X Ray OT Notes/ X Ray

314Airway Reconstruction for benign

conditions4A.43 1458 50000 55000 62500 Endoscopic Picture OT notes

315 Anorectal Malformations Stage 1 4A.44 1501, 1495 35000 38500 43750 USG OT notes

316 Neonatal Intestinal Atresias 4A.45 1490 110000 121000 137500 USG OT Notes, Scar Photo

317Paediatric intestinal obstruction

>1month4A.46 112 65000 71500 81250 USG OT notes

318 Laparotomy for peritonitis 4A.47 1488, 1489 50000 55000 62500 USG OT notes, Scar Picture

319 Omphalocele-Major/Gastroschisis 4A.48 1478, 1479 70000 77000 87500 USG OT notes

320 Intussusception operative reduction 4A.49 1493 30000 33000 37500 USG OT notes

321 Bowel resection and anastomosis 4A.50 88 55000 60500 68750 USG OT notes

322 Exstropy Bladder Stage 1 4A.51 1605 80000 88000 100000 USG OT notes

323

Transoral surgery /Anterior/

Posterior/CV Junction (with

Stabilization)

3A.272 1884 80000 88000 100000 MRI Report + XRAYPost Op X-ray report and

film

324 Trans oral Surgery 3A.273 1884 30000 33000 37500 CT report Post Op X-ray Report and

film, HPE report

325 RF Lesions for Trigminal Neuralgia 3A.274 NA 15000 16500 18750 MRI Report CD of Procedure

326 Foramen Magnum Decompression 3A.275 1956 45000 49500 56250 CT/MRI reportClinical Photographs

showing scar

327 Endoscopic CSF Rhinorrhea Repair 3A.276 1937 45000 49500 56250 CT/MRI reportClinical Photographs

showing scar

328Fetal Surgery for

Myelomeningocoele3A.277 NA 75000 82500 93750 Ultrasound abdomen

Ultrasound + scar

photograph

NEONATAL AND PAEDIATRIC SURGERY-EMERGENCY CODES

Neuro Surgery - Atlanto Axial Dislocation (AAD)


Arogya

Karnataka

Code


ward rate

Private ward


329 Nerve Biopsy with report 3A.278 1914 10000 11000 12500

Nerve Conduction Velocity

(Nerve conduction velocity

(NCV)) and

Electromyography (EMG)

reports

Clinical Photograph + HPE

report

330 Neuroblastoma 3A.279 1456, 2148 40000 44000 50000 Biopsy, CT Clinical photograph

331 Nerve Decompression 3A.280 360, 1922 20000 22000 25000 Nerve Conductions studyClinical Photographs

showing scar

332 Peripheral Nerve Surgery Major 3A.281 1868 45000 49500 56250

Nerve Conduction Velocity

(Nerve conduction velocity

(NCV)) and

Electromyography (EMG)

reports


showing scar

333 Carotid Endarterectomy 3A.282 1926 45000 49500 56250 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray

334 Stereotactic Lesioning 3A.283 1888 60000 66000 75000Neuro Psychologist report,

Neurologist report, MRI


showing scar , CT Brain

report and film

335 Epilepsy Surgery 3A.284 1939 50000 55000 62500

EEG, Neuro Psychologist

report, Neurologist report,

CT/MRI

CT + Clinical Photographs

showing scar

336 CTS 3A.285 1954 10000 11000 12500 Nerve Conductions studyClinical Photographs

showing scar

NEUROSURGERY - GENERAL NEUROSURGERY


Arogya

Karnataka

Code


ward rate

Private ward


337 Guillain Barre Syndrome 3A.286 NA 75000 82500 93750

Nerve conduction studies

report, confirmed by

Neurologist

Photo of patient with

venouscathetor in situ,

photo of plasma filters with

number and patient's

name , bills for purchase of

plasma filters, albumin and

fresh flozen plasma, viral

markers report - Hbs

antigen, HIV 1 & 2, Anti -

HCV antibodies

338Excision of Brain Tumor

Supratentorial-Parasagital *3A.287 1842 80000 88000 100000

CT report /MRI Clinical

features


film, Clinical Photographs

showing the scar + HPE

report


Supratentorial-Basal *3A.288 1839 80000 88000 100000 CT report




report


Supratentorial-Brainstem *3A.289 1839 80000 88000 100000 CT report




report


Infratentorial-C P Angle * 3A.290 1841 80000 88000 100000 CT report




report

NEURO-SURGERY BRAIN


Arogya

Karnataka

Code


ward rate

Private ward



Supratentorial & others *3A.291 1842 50000 55000 62500 CT report




report

343Excision of Brain Tumors -

Subtentorial *3A.292 1846 55000 60500 68750 MRI Report



report

344 Abscess Tapping Single 3A.293 1831 15000 16500 18750 CT reportPost Op CT Report,film and

scar photo

345 C.S.F. Rhinorrhoea 3A.294 1852 43000 47300 53750 CT reportClinical Photograph with

Scar

346 Cranioplasty 3A.295 1847 30000 33000 37500 CT report



showing the scar

347 Aneurysm Clipping * 3A.296 1872 110000 121000 137500 MRI/CT Angio / DSA report Post Op CT Report and

film, scar photo

348 Stereotaxic Procedures 3A.297 1888 25000 27500 31250 CT/ MRI reportPost Op CT Report and film

+ HPE report

349Trans Sphenoidal Surgery -

Routine/Endoscopic3A.298 1871 40000 44000 50000 CT/MRI Report HPE report

350MVD (Micro Vascular

Decompression)3A.299 NA 50000 55000 62500 MRI Report Clinical Photographs

351

Arterio venous malformation (AVM)

excision (whatever size and location)

*/ Cavernoma

3A.300 1330, 1331 100000 110000 125000 MRI Angio/DSA report CT report and film,scar

photo

352

Superficial Temporal Artery (STA):

middle Cerebral Artery (MCA) or

(Other EC : IC) Bypass Procedure

3A.301 NA 100000 110000 125000 MRI Angio/DSA reportCT Report and film,scar

photo

353 Endoscopic venticulostomy 3A.302 1851 30000 33000 37500 CT report

Clinical Photograph

showing scar, DT Brain film

and report

354 Endoscopic colloid cyst excision 3A.303 NA 50000 55000 62500 CT report

Clinical Photograph

showing scar, Post CT

report and film


Arogya

Karnataka

Code


ward rate

Private ward


355 Endoscopic Tumour Removal 3A.3041839, 1840,

1841, 184250000 55000 62500 CT report

Clinical Photograph

showing scar + HPE, Post-

op CT report and film

356 Excision of Orbital Tumour* 3A.305 1971 50000 55000 62500 CT/MRI Report

CT, Clinical Photograph

showing scar + HPE report,

Post-op CT report and film

357 Cranio Facial Resection 3A.306 2071 70000 77000 87500 CT/MRI Report

CT report and film, Clinical

Photograph showing scar +

HPE report

358Elevation/Excision of depressed

fracture3A.307 1953 30000 33000 37500 CT report



report and film

359 Decompressive craniotomy 3A.308 1830 40000 44000 50000 CT report



report and film

360 Craniostenosis 3A.309 1899 50000 55000 62500 CT/MRI Report Post-op CT report and film

361

Gamma Knife radiosurgery

(GKRS)/SRS for

Tumours/Arteriovenous

malformation (AVM)

3A.310 1962, 1963 75000 82500 93750 CT/MRI Report Clinical Photographs

362Scalp Arteriovenous malformation

(AVM)3A.311 1973 25000 27500 31250 CT/MRI Report

Clinical Photograph

showing scar + HPE report

363 Skull lesion including cranioplasty 3A.312 1847 40000 44000 50000 CT/MRI Report

Clinical Photograph


+ Xray - Skull

364 Skull Lesion without Cranioplasty 3A.313 1847 25000 27500 31250 CT/MRI Report

Clinical Photograph


+ Xray - Skull

365 Cranioplasty with mesh 3A.314 1847 40000 44000 50000 CT report



showing the scar


Arogya

Karnataka

Code


ward rate

Private ward


Carotid angioplasty with stent* 3A.39 1441 150000 165000 187500Angiogram report & Film

showing the lesion

Post procedure Angio stills

+ XRAY + Doppler

Meningo Encephalocele * 3A.261 1850 40000 44000 50000 MRI Report



showing Scar

366Craniotomy and Evacuation of

Haematoma -Subdural *4A.52 1828 60000 66000 75000 CT Report , X Ray

OT Notes, CT Report,

Clinical Photograph

367Craniotomy and Evacuation of

Haematoma -Extradural *4A.53 1829 50000 55000 62500 CT Report

CT Report, Scar Photo, X

Ray

368Ventriculoatrial

/Ventriculoperitoneal Shunt4A.54 1947 27000 29700 33750 CT Report

CT Report, Scar Photo, X

Ray

369 Subdural Tapping/Burr 4A.55 1824 18000 19800 22500 CT Report CT Report, Scar Photo

370 Twist Drill Craniostomy 4A.56 1823 15000 16500 18750 CT report Film and scar photo

371 Abscess Tapping multiple 4A.57 1826 20000 22000 25000 CT reportPost Op CT Report,film and

scar photo

372 Excision of Brain Abcess 4A.58 1831, 1832 50000 55000 62500 CT report



showing the scar

373 External Ventricular Drainage (EVD) 4A.59 1855 15000 16500 18750 CT report



showing Scar

374 Spinal Cord Tumours* 3A.315 1858 45000 49500 56250 MRI Report Biopsy report + HPE

Report + scar photo

375Anterior Cervical Discectomy Single

level *3A.316 1881 30000 33000 37500

Clinical findings, MRI

Report

Post Op X-ray, Clinical

Photograph showing scar

376Anterior Cervical Discectomy

Multiple level with Implants*3A.317 1887 60000 66000 75000


Report

Photo showing the scar +

XRAY showing the implants

NEURO-SURGERY SPINE

NEURO-SURGERY -EMERGENCY CODES


Arogya

Karnataka

Code


ward rate

Private ward


377 Laminectomy-Cervical * 3A.318 1925 30000 33000 37500Clinical findings, MRI

Report photo showing scar

378Spinal Fusion Procedure + cost of

implant *3A.319 1006, 1883 60000 66000 75000


Report

Post Op X-Ray Report and

film, + Showing scar +


379 Spinal Intra Medullary Tumours* 3A.320 1859 40000 44000 50000 MRI ReportPost Op X-ray Report and

film + HPE report

380 Spina Bifida Surgery Major * 3A.321 1861, 1862 40000 44000 50000 MRI ReportClinical Photographs

showing scar

381Corpectomy for Spinal Fixation + cost

of implant *3A.322 1882 70000 77000 87500 MRI Report


showing scar + X-ray

Report and film showing

the implants

382Posterior Cervical Discetomy without

implant *3A.323 1891, 1881 30000 33000 37500 MRI report


showing scar

383Posterior Cervical Fusion with

implant (Lateral mass fixation) *3A.324 1887 60000 66000 75000 MRI report


showing scar + X-ray -

Cervical spine

384 Theco Peritoneal Shunt 3A.325 1854 20000 22000 25000 CT report Clinical Photographs

385Cervical Disc Multiple level without

Fusion3A.326 1881 35000 38500 43750 CT/MRI report


showing scar + X-ray-

Cervical Spine

386

Thoracic/Lumbar Corpectomy with

fusion inclusive of implant /Trans

thoracic *

3A.327 1881 70000 77000 87500 CT/MRI Clinical Photographs

showing scar + Xray

387

Spinal Fusion Procedure + cost of

implant * Cost of next + Multiple

level

3A.328 1883 70000 77000 87500Clinical findings, MRI

Report

Post Op X-Ray Report and

film, + Showing scar +


Meningomyelocele * 3A.2621837,

183840000 44000 50000 CT report


film, scar photo


Arogya

Karnataka

Code


ward rate

Private ward


NSBF1 Post Brain surgery Follow up-1 3A.NSBF1 NA 3000 3300 3750




NSSF1 Post Spine surgery Follow up-1 3A.NSSF1 NA 3000 3300 3750



388 Lung metastatectomy - solitary 3A.329 1997 30000 33000 37500Biopsy/FNAC ,CT report

and Film

Clinical Photograph


+ XRAY Chest

389 Lung metastatectomy - Multiple 3A.330 1998 50000 55000 62500Biopsy/FNAC ,CT report

and Film

Clinical Photograph


+ XRAY Chest

390 Sleeve resection of Lung cancer 3A.331 1999 90000 99000 112500Biopsy/FNAC ,CT report

and Film

Clinical Photograph


+ XRAY Chest

391 Mediastinal tumor resection 3A.332 2003 50000 55000 62500Biopsy/FNAC ,CT report

and Film

Clinical Photograph


+ XRAY Chest

392VATS/Laparoscopy ( for deep seated

biopsy)3A.333 2121 10000 11000 12500 CT report with film Scar Photo

393

Linear accelerator teletherapy,

3DCRT,IMRT,VMAT

Adjuvant/Definitive

3A.334 2227, 2228 75000 82500 93750Biopsy/FNAC ,CT report

and Film

Photo with RT Machine , RT

treatment chart

394Brachytherapy - Intraluminal HDR

per fraction (max 4 session)3A.335 2226 4500 4950 5625

Biopsy/FNAC ,CT report

and Film


treatment chart, RT

planning data

395 Definitive, Adjuvant, SRS/SRT 3A.336 2229 75000 82500 93750Biopsy/FNAC ,CT report

and Film


treatment chart RT

planning Data

POST NEURO SURGERY FOLLOW-UP

ONCOLOGY - LUNGS


Arogya

Karnataka

Code


ward rate

Private ward


396

Cobalt 60 External Beam

Radiotherapy, Definitive,

Neoadjuvant, Adjuvant

3A.337 2221 20000 22000 25000Biopsy/FNAC ,CT report

and Film


treatment chart RT

planning Data

397Cisplatin/Etoposide (IIIB)- Max. 6

cycles only (Per cycle)3A.338 2175 7000 7700 8750


and Film

Chemotherapy drug batch

number with bar code

398

Paclitaxel + Cisplatin / Carboplatin 2.

Gemcitabine D1 & D8 + Cisplatin /

Carboplatin -Max. 6 cycles only (Per

cycle)


and Film



399

Pemetrexed +Carboplatin/Cisplatin

(Stage IIIB, IV Adenocarcinoma)-

Max. 6 cycles only (Per cycle)


and Film,



400Variable Regimen maximum 6 cycles

(Per cycle)(Amount as per drug cost)3A.341 2177 8000 8800 10000


and Film



Lobectomy 3A.96 1390 70000 77000 87500 CT Chest report Post Op X-ray,scar photo

Pneumonectomy 3A.97 1391 60000 66000 75000 CT Chest report Post Op X-ray,scar photo

Cobalt 60 teletherapy, Palliative 3A.505 2220 10000 11000 12500 CT report and Film, Biopsy


treatment chart RT

planning Data

Growth Factor / Pegrafil (Per cycle)

(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,

Mammography/USG, chest

Xray




Palliative3A.509 2223 20000 22000 25000 CT report and Film, Biopsy


treatment chart

Palliative CT- Max 6 cycles (Per cycle) 3A.406 2163 8000 8800 10000

Biopsy/FNAC ,


Xray



Zoledronic acid - Max 12 cycles (Per

month)3A.512 2163 3000 3300 3750

CT/PET /Bone scan/ Xray,

Biopsy if required




Arogya

Karnataka

Code


ward rate

Private ward


Tab Geftinib/Erlotinib-Max 1 Year

(Per month)3A.554 2176, 2177 6000 6600 7500 CT report and Film, Biopsy



401Limb salvage surgery for Bone

Tumors with Prosthesis3A.342 2079 75000 82500 93750

CT-Local part/MRI, CT

Chest with film, ,Bone Scan

report + Biopsy Report

Clinical Photograph XRAY

Showing prosthesis + HPE

report

402 Forequarter amputation 3A.343 2083 30000 33000 37500 CT-Local part/MRI with

film + Biopsy Report

Clinical Photograph

showing scar+ HPE report

403 Shoulder Girdle Resection 3A.344 2081 40000 44000 50000

CT-Local part including

chest /MRI report with

film + Biopsy Report

Clinical Photograph


404 Hemipelvectomy 3A.345 2084 65000 71500 81250 CT/MRI Pelvis with film

Clinical Photograph

showing scar / HPE report

+ XRAY

405 Sacral Resection 3A.346 2082 60000 66000 75000 CT/MRI Pelvis with film

Clinical Photograph

showing scar / HPE report

+ XRAY

406Wide excision - for skin, soft tissue

and bone tumors - minor3A.347 2091 15000 16500 18750

Biopsy of the primary

tumour

Clinical Photograph


407Wide excision - for skin, soft tissue

and bone tumors - Major3A.348 2091 30000 33000 37500


tumour

Clinical Photograph


408Wide excision + Reconstruction for

soft tissue and bone tumors3A.349 2092 50000 55000 62500


tumour + CT/MRI with film

Clinical Photograph


409Amputation for bone / soft tissue

tumours (Minor)3A.350 2080 25000 27500 31250



Clinical Photograph


410Amputation for bone / soft tissue

tumours (Major)3A.351 2080 35000 38500 43750



Clinical Photograph


ONCOLOGY - SKIN/BONE AND SOFT TISSUE


Arogya

Karnataka

Code


ward rate

Private ward


411Chest wall resection for SOFT tissue

bone tumors3A.352 2005 40000 44000 50000 CT Chest with film, biopsy

Clinical Photograph


412Chest wall resection +

Reconstruction3A.353 2006 40000 44000 50000 CT Chest with film, biopsy

Clinical Photograph


413


Definitive, Neoadjuvant, Adjuvant

3DCRT/IMRT

3A.354

2222,

2224,2227,2

228

50000 55000 62500 CT report and film, biopsy Photo with RT machine, RT

treatment chart

414

Cisplatin/Adriamycin+ifosmide (IAP)-

max 6 cycles (Per cycle) -Adj/Neo

adjuvant/Palliative (Osteosarcoma)

3A.355 2136 15000 16500 18750 Biopsy , CT-Scan with film


chemotherapy drug batch


415 High Dose Methotrexate (MTX)- max

6 cycles (Per cycle)3A.356 2168 15000 16500 18750 Biopsy , CT-Scan with film




416

Variable Regimen -Ewings Sarcoma-

max 17 cycles in 1 year (Per

cycle)(Amount as per drug cost)

3A.357 2137 10000 11000 12500 X-Ray,CT Scan with film,

Biopsy




417IFS + ADR-max 6 cycles (Per cycle) -

Adj/Neo adjuvant/Palliative3A.358 2136 15000 16500 18750 Biopsy , CT-Scan with film






treatment chart RT

planning Data

Brachytherapy/ Interstitial HDR one

application, multiple doses

Definitive/Boost

3A.544 2226 30000 33000 37500CT/MRI report and Film,

Biopsy


treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray




Arogya

Karnataka

Code


ward rate

Private ward





treatment chart


Biopsy/FNAC ,


Xray




month)3A.512 2163 3000 3300 3750


Biopsy if required




Radiotherapy, Definitive3A.545 2219, 2221 20000 22000 25000 CT report and Film, Biopsy


treatment chart RT

planning Data

418Induction/1st Phase-AML ( 2nd

Induction - permitted in adults only)3A.359 2155 50000 55000 62500

Haematology, Bone

Marrow Aspitation/ Flow

cytometry




419Consolidation 1 to 4 phases(per

phase)- AML3A.360 2157 33000 36300 41250

Haematology, Bone


cytometry




420

Induction, Intensification &

Consolidation / ALL and

Lymphoblastic NHL

3A.3612159, 2160,

2162100000 110000 125000

Haematology, Bone


cytometry




421

CNS directed therapy - RT/CT (10

fractions) (CT- for age below 3 years;

all others -RT)

3A.3622222,2223,2

224,15000 16500 18750

Hematology + Biopsy/FNAC

report


treatment chart

422Maintenance ( Paed and adults) - ALL

(Per month)3A.363 2158, 3000 3300 3750

Haematology, Bone


cytometry




423Adult ALL -Hyper CVAD/BFM - 4

cycles ( Each cycle= A + B)3A.364 NA 36000 39600 45000

Haematology, Bone


cytometry




ONCOLOGY - BLOOD - PAEDIATRICS AND OTHERS


Arogya

Karnataka

Code


ward rate

Private ward


424

D'angelo's for CNS primary and

secondary lymphomas -(Max. 6

months) (Per month)

3A.365 NA 20000 22000 25000 Haematology +

Cytoflowmetry report




425

Salvage CT - GDP (Gemcitabine -

Cisplatin- Dexamethasone)-

Maximum 6 cycles (Per cycle)

3A.366 2181 12000 13200 15000 Hematology +

Biopsy/FNAC report




426

Salvage CT - ICE (Ifosfamide-

Carboplatin-Etoposide)- Maximum 6

cycles (Per cycle)

3A.367 2149 15000 16500 18750 Hematology +

Biopsy/FNAC report




427

Salvage CT -DHAP (cytosine

arabinoside-cisplatin-

dexamethasone) - Maximum 6

cycles (Per cycle)

3A.368 NA 25000 27500 31250 Hematology +

Biopsy/FNAC report




428

Imatinib Min 400 mg/day-max 12

cycles per year (Per month) - AML,

CML

3A.369 2196 5000 5500 6250 Hematology + FNAC report

/Cytogenetics/ BCR-ABL




429

Second generation Tab TKI - max 12

cycles per year (Per month) - (Failure

of Imatinib)

3A.370 NA 6000 6600 7500 Hematology + FNAC report

/Cytogenetics/ BCR-ABL




430Bendamustine- max 6 cycles (Per

cycle) - CLL3A.371 2193 10000 11000 12500

Hematology +

Biopsy/FNAC report




431

Bendamustine + Ritumaxib- 6-8

cycles (Per cycle) - CLL (Available only

at select centres)

3A.372 2199 20000 22000 25000 Hematology +

Biopsy/FNAC report




432

Doxorubicin - Bleomycin - Vinblastine

Dacarbazine (DBVD)-max 6-8 cycles

(Per cycle) (Day1 & Day15) -

Hodgkins Lymphoma

3A.373 2137 12000 13200 15000 Biopsy, CT





Arogya

Karnataka

Code


ward rate

Private ward


433

Cyclophosphamide - Doxorubicin

Vincristine - Prednisone (CHOP)- max

8 cycles (Per cycle) - NHL/Lymphoma

3A.374 2138 6000 6600 7500 Biopsy, CT report with film




434 R-CHOP -max 6 cycles (Per cycle) 3A.375 2188 20000 22000 25000 Biopsy, CT report with film




435

Variable Regimen-Non

Lymphoblastic NHL, (Per cycle) max.

8 cycles.(Amount as per drug cost)

3A.376 2147 20000 22000 25000Hematology + Biopsy/FNAC

report




436Linear accelerator, less than 20

fractions/3DCRT/IMRT3A.377 2224 25000 27500 31250

Hematology + Biopsy/FNAC

report


treatment chart

437


Radiotherapy,Involved-Site

Radiotherapy (ISRT)/Involved Field

Radiation Therapy (IFRT)


report


treatment chart

438

Linear accelerator,Involved-Site

Radiotherapy (ISRT)/Involved field

radiation therapy

(IFRT)/3DCRT/IMRT


report


treatment chart

439

Vincristine, Adriamycin,

Dexamethasone(VAD)-cycle max 6

cycles - Multiple myeloma

3A.380 2141 5000 5500 6250

Bone Marrow Aspiration

Report, Serum Protein

electrophoresis, CRAB

criteria




440

Thalidomide+Dexamethasone(Oral)-

/month max 12 months - Multiple

myeloma

3A.381 2142 4000 4400 5000




criteria




441Melphalan -Prednisone (oral)-Month

max 12 months -- Multiple myeloma3A.382 2143 1500 1650 1875




criteria





Arogya

Karnataka

Code


ward rate

Private ward


442

Plasma cell Leukemia / Multiple

Myeloma - Thaladomide,

Dexamethasone, Bortezomib - max 6

cycles

3A.383 2142 20000 22000 25000



electrophoresis




443

Zoledronic acid along with Adjuvant

Chemotherapy of AS-I- Maximum 12

cycles ( Bone metastasis)

3A.384 2166 3000 3300 3750Bone Marrow Aspiration

Report




444

SIOP/NATIONAL WILMS TUMOUR

STUDY GROUP(NWTS)

regimen(Stages I - V)- max 6 months

(Per month) - Wilm's tumour

3A.385 2144 8000 8800 10000CT report with film,

biopsy/FNAC




445

Variable Regimen-Neuroblastoma-

max 1 year (Per cycle)(Amount as per

drug cost)

3A.386 2148 10000 11000 12500CT report with film,

biopsy/FNAC




446Carbo/Etoposide/Vincristine-max 6

cycles (Per cycle) - Retinoblastoma3A.387 2149 5000 5500 6250

Biopsy , CT report with

film




447

Variable Regimen- LCH-max 1 year

(Per month)(Amount as per drug

cost)

3A.388 2147 8000 8800 10000Biopsy,IHC , CT report with

film




448

Vincristine-Actinomycin-

Cyclophosphamide(Vact C) based

chemo - max 1 year (Per cycle)-

Rhabdomyosarcoma

3A.389 2153 9000 9900 11250 Biopsy , CT report with

film




449Palliative and Supportive Therapy

(Per month)3A.390 2165 3000 3300 3750

Biopsy , CT report with

filmClinical Photograph

450Salvage CT- max 6 cycles ( Per cycle)

only paediatrics3A.391 NA 12000 13200 15000

Hematology +

Biopsy/FNAC report





(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray




Arogya

Karnataka

Code


ward rate

Private ward



Biopsy/FNAC ,


Xray



VATS/Laparoscopy ( for deep seated


451 Mastectomy +Axillary Dissection 3A.392 2089 25000 27500 31250

Biopsy/FNAC ,


Xray

HPE report, scar photo ( if

patient consents)

452Mastectomy +Axillary

Dissection+Defect Closure with Flap3A.393 2089 2090 40000 44000 50000

Biopsy/FNAC ,


Xray

HPE report, scar photo ( if

patient consents)

453 Axillary Dissection 3A.394 2011 15000 16500 18750

Biopsy/FNAC ,


Xray

Clinical Photograph


454 Breast Conserving Surgery 3A.395 228 25000 27500 31250

Biopsy/FNAC ,


Xray

Clinical Photograph


455 Bilateral oophorectomy 3A.396 687 25000 27500 31250ERPR positive report,

Biopsy of CA breastHPE report

456Accelerated partial breast irradiation

(APBI) any type/ LINAC/3DCRT/IMRT3A.397

2222, 2228,

222450000 55000 62500

Biopsy/FNAC ,


Xray


treatment chart

4575- Fluorouracil A-C (FAC)(Maximum 6

cycles) (Per cycle)3A.398 2150 5000 5500 6250

Biopsy/FNAC ,


Xray



458 AC (Maximum 4 cycles) (Per cycle) 3A.399 2127 5000 5500 6250

Biopsy/FNAC ,


Xray



459FEC (Epirubicin based)(Maximum 6

cycles) (Per cycle)3A.400 2150 8000 8800 10000

Biopsy/FNAC ,


Xray



460Paclitaxel/docetaxel(Maximum

4cycles) (Adjuvant) (Per cycle)3A.401 2139, 2201 9000 9900 11250

Biopsy/FNAC ,


Xray



ONCOLOGY - BREAST


Arogya

Karnataka

Code


ward rate

Private ward


461Cyclophosphamide/Methotrexate/5F

luorouracil (CMF) (Per cycle)3A.402 2151 1500 1650 1875

Biopsy/FNAC ,


Xray



462

1. TC Docetaxel +

Cyclophosphamide. 2. TAC Docetaxel

+ Doxorubicin + Cyclophosphamide.

3. Gemcitabine D1 & D8 +/-

Cisplatin/ Carboplatin - maximum 6

cycles (Per cycle)

3A.4032127,2182,

2145, 215012000 13200 15000

Biopsy/FNAC ,


Xray



463Tamoxifen tabs- maximum 12 cycles

(Per month)3A.404 2164 100 110 125

Biopsy/FNAC ,


Xray



464

Aromatase Inhibitors (

Anastazole/Letrozole/ Exemestane)-

maximum 12 cycles (Per month)

3A.405 2171 900 990 1125

Biopsy/FNAC ,


Xray



465 Palliative CT- Max 6 cycles (Per cycle) 3A.406 2163 8000 8800 10000

Biopsy/FNAC ,


Xray



466

Variable Regimen - maximum 6

cycles (Per cycle) (Amount as per

drug cost)

3A.407 2150, 2127 8000 8800 10000

Biopsy/FNAC ,


Xray



467 Paclitaxel weekly x 12 weeks 3A.408 2139 4500 4950 5625

Biopsy/FNAC ,


Xray





treatment chart RT

planning Data



Definitive/Boost


Biopsy


treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray






treatment chart


Arogya

Karnataka

Code


ward rate

Private ward



month)3A.512 2163 3000 3300 3750


Biopsy if required



Definitive, Adjuvant, SRS/SRT 3A.336 2229 75000 82500 93750Biopsy/FNAC ,CT report

and Film


treatment chart RT

planning Data




treatment chart RT

planning Data

468

Capetabine (Day 1-14) - 6 cycles

(Palliative/Adjuvant); As Concurrent

as RT sensitizor with all RT

3A.409 2187 4000 4400 5000CT/USG report and Film,

Xray, Biopsy



469Variable Regimen maximum 6 cycles

(Per cycle) (Amount as per drug cost)3A.410

2180, 2181,

2182, 21848000 8800 10000 CT report and Film, Biopsy



470Oesophagectomy with Two field

Lymphadenectomy3A.411 2016 75000 82500 93750

UGI Endoscopy with film,

biopsy, CT report with film

Clinical Photograph


471Oesophagectomy with Three field

Lymphadenectomy3A.412 2017 90000 99000 112500

UGI Endoscopy with film,


Clinical Photograph


472 Gastrectomy - any type 3A.413 2019 50000 55000 62500Endoscopy with film,


Clinical Photograph


473 Small bowel resection 3A.414 2022 40000 44000 50000 CT/ X ray with film , biopsy Clinical Photograph


474 Closure of Ileostomy/ Colostomy 3A.415 2028 2029 30000 33000 37500 Colonoscopy with film,

Biopsy

Clinical Photograph

showing scar

475 Colectomy - any type 3A.416 2023 40000 44000 50000Endoscopy with film,


Clinical Photograph


476Anterior Resection ( inclusive of

staplers)3A.417 2031 70000 77000 87500

Endoscopy with film,


Clinical Photograph


ONCOLOGY - GI TRACT AND OESOPHAGUS


Arogya

Karnataka

Code


ward rate

Private ward


477 Abdominoperinial Resection 3A.418 2030 50000 55000 62500Endoscopy with film,


Clinical Photograph


478

Feeding

procedure(Gastrostromy/Jejunostom

y)

3A.419 2027 2020 20000 22000 25000Biopsy of the primary

tumor

Clinical Photograph of

operated site

479 Ileostomy 3A.420 2026 20000 22000 25000Biopsy of the primary + CT

Scan with film


operated site

480 Colostomy 3A.421 2025 20000 22000 25000Biopsy of the primary + CT

Scan with film


operated site

481 Gastro Jejunostomy 3A.422 2021 30000 33000 37500Biopsy of the primary + CT

Scan with film

Clinical photograph

showing scar

482 Ileotransverse Colostomy 3A.423 2024 30000 33000 37500Biopsy of the primary + CT

Scan with film

Clinical photograph with

scar

483 Distal Pancreatectomy 3A.424 2036 60000 66000 75000 CT / MRI with film/IHC

report

Clinical Photograph


484 Enucleation of Cyst 3A.425 1190 50000 55000 62500 CT report and Film Clinical Photograph


485Whipples surgery ( inclusive of

staplers)3A.426 1197 80000 88000 100000 CT / MRI/IHC

Clinical Photograph


486 Radical Cholecystectomy 3A.427 2034 60000 66000 75000 CT /MRI report and Film,

biopsy

Clinical Photograph


report +USG Report

487 Resection of Retroperitoneal Tumors 3A.428 2040 50000 55000 62500 CT abdomen with film,

FNAC

Clinical Photograph


488 Abdominal wall tumor Resection 3A.429 2038 35000 38500 43750 CT abdomen report and

Film

Clinical Photograph



Arogya

Karnataka

Code


ward rate

Private ward


489Abdominal wall Resection with

reconstruction/mesh3A.430 2039 45000 49500 56250

CT abdomen report and

Film

Clinical Photograph


490 GI Stenting including stent cost 3A.431 1205 40000 44000 50000 CT abdomen report and

FilmStent invoice

491 Triple Bypass -GI Tract 3A.432 1191 40000 44000 50000 Biopsy , CT , Endoscopy Clinical Photograph


492 Hepatectomy (right or left) 3A.433 1180 1181 85000 93500 106250 CT /MRI report and Film

Clinical Photograph

showing scar, USG and HPE

Report

493Segmentectomy-Hepato Billiary

System3A.434 1179 50000 55000 62500 CT /MRI report and Film

Clinical Photograph

showing scar, USG and HPE

Report

494 Substernal bypass 3A.435 2018 35000 38500 43750 Biopsy of the primary

Clinical Photograph

showing the

procedure/scar

495


Definitive, 3DCRT/IMRT - for

inoperable oesophagus cancer

without metastsis.

3A.436 2228 2227 75000 82500 93750 CT report and film, biopsy Photo with RT machine, RT

treatment chart

496Cisplatin/Carboplatin- 5FU (Per cycle)

-Oesophageal CA3A.437 2128 6000 6600 7500





497 Epirubicin+Cisplatin+5FU (Per cycle) 3A.438 2128 8000 8800 10000Endoscopy with film,




498

Hepatoblastoma - Variable regime,

max 6 cycles (per cycle) as per drug

cost

cisplatin/carboplatin+adriamycin

3A.439 2146 5000 5500 6250 CT scan, Tumour markersChemotherapy drug batch


499

Docetaxel+Cisplatin+5FU OR

Capcetabine + Oxaloplatin

(Neoadjuvant Chemotherapy

maximum 3 cycles/pallative

maximum 6 cycles) (Per cycle)

3A.440 2186 10000 11000 12500Endoscopy with film,





Arogya

Karnataka

Code


ward rate

Private ward


500EOX (Epirubicin + Oxaloplatin +

Capcetabine) - Max 6 cycles3A.441 2180 12000 13200 15000





501Monthly 5-Fluorouracil(FU) (Per

cycle) -Colorectal cancer3A.442 2132 3000 3300 3750 CT report and Film, Biopsy



502

5-Fluorouracil-Oxaliplatin -

Leucovorin (FOLFOX)- Day 1 and 2;

Max. 12 cycles for adjuvant (Per

cycle) -Colorectal cancer

3A.443 2134 8000 8800 10000 CT report and Film, BiopsyChemotherapy drug batch


503

5-Fluorouracil-Oxaliplatin -

Leucovorin (FOLFOX)- Day 1 and 2;

Max. 6 cycles for palliative (Per cycle)

-Colorectal cancer



504Imatinib -Max for 6 months (Per

month)3A.445 2183 5000 5500 6250 CT report and Film, Biopsy



505Gemcitabine+Cisplatin(Day 1,Day 8 )-

max 6 cycles (Per cycle)3A.446 2182 10000 11000 12500 CT report and Film, Biopsy



506Tab Sorafenib- max 12 months (Per




507

Oxiplatin+Capecitabine- max. of 6

cycles for palliative only or 8 cycles

for adjuvant (Per cycle)

3A.448 5 8000 8800 10000 CT/MRI with film, BiopsyChemotherapy drug batch


508

Second line palliative CT - FOLFERI

(Day 1, 2 every 14 days) max 6 cycles

OR CAPIRI ( Capcetabine D1 -14,

Irinotecam D1, D8) (Metastatic, after

failure of CAPOX, Capcetabine)

3A.449 NA 10000 11000 12500CT/USG report and Film,

Xray, Biopsy





treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray




Arogya

Karnataka

Code


ward rate

Private ward





treatment chart


Biopsy/FNAC ,


Xray




month)3A.512 2163 3000 3300 3750


Biopsy if required






Definitive, Neoadjuvant, Adjuvant

3DCRT/IMRT

3A.354

2222,

2224,2227,2

228

50000 55000 62500 CT report and film, biopsy Photo with RT machine, RT

treatment chart

Brachytherapy - Intraluminal HDR



and Film


treatment chart, RT

planning data


Radiotherapy, Definitive,

Neoadjuvant, Adjuvant


and Film


treatment chart RT

planning Data

509 Radical Nephrectomy - Open/Lap * 3A.450 2042 45000 49500 56250

Ultrasound abd /CT Scan

abd with film, Isotope

Renogram if required

Clinical Photograph


510 Partial Nephrectomy 3A.451 2041 55000 60500 68750

CT report with film,

Isotope renogram if

required

Clinical Photograph


+USG Report

511

Nephro- ureterectomy for

Transitional Cell Carcinoma of renal

pelvis (one side)

3A.452 2043 45000 49500 56250


Isotope renogram if

required

Clinical Photograph


512Radical Cystectomy with Ileal conduit

*3A.453 2047 75000 82500 93750 CT report and Film, Biopsy

Clinical Photograph


ONCOLOGY - GENITO URINARY SURGERY


Arogya

Karnataka

Code


ward rate

Private ward


513 Other cystectomies * 3A.454 2046 40000 44000 50000 CT report and Film, BiopsyClinical Photograph


514 High Orchidectomy * 3A.455 2049 15000 16500 18750 USG scrotum, Tumour

markers

Clinical Photograph

showing scar ( if patient

consents)+ HPE report

515 Bilateral Orchidectomy * 3A.456 2102 15000 16500 18750

Biopsy Reports /PSA with

evidence of bone

metastasis

Clinical Photograph



516 Partial Penectomy * 3A.457 2051 15000 16500 18750 Biopsy Reports

Clinical Photograph



517 Total Penectomy * 3A.458 2097 25000 27500 31250 Biopsy Reports

Clinical Photograph



518 Inguinal Block Dissection-one side * 3A.459 2115 2012 20000 22000 25000 Biopsy ReportsClinical Photograph


519 Inguinal Block Dissection-Bilateral 3A.460 2116 40000 44000 50000 Biopsy ReportsClinical Photograph


520

Radical Prostatectomy with Bilateral

pelvic lymph Node

Dissection(BPLND) *

3A.461 2048 75000 82500 93750 CT report and Film, BiopsyClinical Photograph, HPE

report

521 Anterior Exenteration 3A.462 2109 70000 77000 87500 Cystoscopy, biopsy, CT

report and Film

Clinical Photograph


522 Total Exenteration 3A.463 2110 75000 82500 93750 Cystoscopy, biopsy, CT

report and Film

Clinical Photograph


523 Suprapubic Cystostomy 3A.464 2045 10000 11000 12500Biopsy of the primary

tumor

Clinical Photograph

showing procedure/scar


Arogya

Karnataka

Code


ward rate

Private ward


524 Urinary diversion 3A.465 2044 40000 44000 50000 Biopsy, USG Scrotum

report and Film

Clinical Photograph

showing scar, post op USG

525 Adrenalectomy * 3A.466 1980 1981 45000 49500 56250 CT/MRI report with film,

Urinary hormones

Clinical Photograph


526Retro Peritoneal Lymph Node

Dissection(RPLND)3A.467 2013 80000 88000 100000 CT report and film, biopsy

Clinical photograph

showing scar, HPE report

527Linear accelerator teletherapy,

3DCRT 3A.468 2228 75000 82500 93750 CT report and Film, Biopsy


treatment chart, RT

planning Data

528IMRT/VMAT/SBRT (Radical radiation

alone for prostate) 3A.469 2227 90000 99000 112500 CT report and Film, Biopsy


treatment chart, RT

planning Data

529Linear accelerator, Curative less than

20 fractions3A.470 2224 20000 22000 25000

CT report and Film,

Biopsy/Tumour markers


treatment chart

530Weekly Cisplatin/Carboplatin- max 6

cycles with RT (Per week)3A.471 2133 2000 2200 2500 CT report and Film, Biopsy



531

Gemcitabine+ Cisplatin(Day 1,Day

8)(Palliative /Adjuvant)-max 6 cycles

(Per cycle)

3A.472 2182 10000 11000 12500 CT report and Film, Biopsy




532Hormonal therapy with Abiratarone-

monthly3A.473 2126 8000 8800 10000

CT report and Film,

Biopsy,PSA with evidence

of bone metastasis




533Hormone therapy - Bicalutamide -

50mg OD monthly (per month)3A.474 2126 5000 5500 6250

CT report and Film,

Biopsy,PSA with evidence

of bone metastasis





Arogya

Karnataka

Code


ward rate

Private ward


534Carboplatin(AUC more than 5) (Per

cycle)3A.475 2145 5000 5500 6250 CT report and Film, Biopsy




535

Bleomycin-Etoposide-Cisplatin (BEP)-

max cycles 4 (Per cycle) Germ cell

tumours, extra gonadal tumour

3A.476 2175 10000 11000 12500CT report and Film,





536

Taxol,Ifophomide,Cisplatin/Carbopla

tin(TIP)/Vinblastine,Ifosphimide,Cispl

atin(VeIP)- max cycles 4 (Per cycle)

3A.477 2200 20000 22000 25000CT report and Film,





537Tab Sorafenib-max 12 months (Per


Clinical

Photograph,chemotherapy

drug batch number with

bar code

538

Palliative CT - (5FU +

Cisplatin/Carboplatin) - Max 6 cycles

(Per cycle)

3A.479 2128 6000 6600 7500CT/USG report and Film,

Xray, Biopsy




539Palliative CT-Docetaxel- Max 6 cycles

(Per cycle)3A.480 2201 9000 9900 11250

CT/USG report and Film,

Xray, Biopsy




540

Variable Regimen maximum 6 cycles

(Per cycle)MVAC- Mitomycin,

Vincristine, Adriamycin,

Cyclophosphamide





541

Urinary bladder CA-

Gemcitabine/Cisplatin as radio

sensitizer weekly - max 8 weeks -

(cost per week)







treatment chart RT

planning Data


Arogya

Karnataka

Code


ward rate

Private ward




Definitive/Boost


Biopsy


treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray






treatment chart


month)3A.512 2163 3000 3300 3750


Biopsy if required



542 Radical Trachelectomy 3A.483 2056 40000 44000 50000 CT report and Film, Biopsy Clinical Photograph


543

Radical Hysterectomy +Bilateral

Pelvic Lymph Node Dissection

(BPLND) + Bilateral Salpingo

Ophorectomy (BSO) / Ovarian

transposition

3A.484 2060 50000 55000 62500 CT report and Film, Biopsy Clinical Photograph


544Anterior / Posterior Exenteration

(Gynaec)3A.485 2061 2062 70000 77000 87500 CT report and Film, Biopsy

Clinical Photograph


545 Total Pelvic Exenteration 3A.486 2063 75000 82500 93750 CT report and Film, Biopsy Clinical Photograph


546Bilateral pelvic lymph Node

Dissection(BPLND)3A.487 2105 30000 33000 37500 CT report and Film, Biopsy

Clinical Photograph


547 Surgery for Ca Ovary - early stage 3A.488 2052 40000 44000 50000 USG/CT Reports with

film,CA 125

Clinical Photograph


+ USG report

548

Surgery for Ca Ovary - advance stage

with Mesenteric/Peritoneal/Omental

Metastatsis

3A.489 2055 60000 66000 75000 USG/CT Reports with

film,CA 125

Clinical Photograph


+ USG report

ONCOLOGY - GYNAECOLOGY


Arogya

Karnataka

Code


ward rate

Private ward


549 Radical vaginectomy 3A.490 2065 40000 44000 50000 CT report and Film, Biopsy HPE report

550Radical vaginectomy +

Reconstruction3A.491 2066 45000 49500 56250 CT report and Film, Biopsy HPE report

551 Vulvectomy 3A.492 2067 30000 33000 37500 Biopsy Reports HPE report

552

Linear accelerator

teletherapy,Definitive, Neoadjuvant,

Adjuvant 3DCRT/IMRT

3A.4932222 2224

2228 222750000 55000 62500 CT report and film, biopsy

Photo with RT machine, RT

treatment chart

553Brachytherapy/ Interstitial LDR ,

adjuvant3A.494 2225 15000 16500 18750

CT / MRI report with film,

Biopsy


treatment chart RT

planning Data

554Cisplatin/Carboplatin (AUC2)- Max.

of 6 cycles only (Per cycle)3A.495 2145 2000 2200 2500 CT report and Film, Biopsy




555Carboplatin/Paclitaxel-max 6 cycles

(Per cycle)3A.496 2145 12000 13200 15000 CT report and Film, Biopsy




556

Bleomycin-Etoposide-Cisplatin (BEP)

(Per cycle) - Germ cell tumours, extra

gonadal tumour





557Weekly Methotrexate (Per week)

max. 10 cycles3A.498 2168 1000 1100 1250

B HCG report,CT report and

Film




558Actinomycin- max 10 cycles (Per

cycle)3A.499 2172 1000 1100 1250

B HCG report,CT report and

Film




559

Etoposide-Methotrexate-

Actinomycin / Cyclophosphamide -

Vincristine (EMA-CO)-max 6 cycles

(Per cycle)

3A.500 2174 8000 8800 10000B HCG report,CT report and

Film





Arogya

Karnataka

Code


ward rate

Private ward


560Variable Regimen (Amount as per

drug cost)- max 6 cycles (Per cycle)3A.501 2163 2165 8000 8800 10000 CT report and Film, Biopsy




561

Gemcitabine+ Carboplatin/

Liposomal Doxorubicin/ Albumin

bound Paclitaxel ( Adjuvant), max 6

cycles







treatment chart RT

planning Data



Definitive/Boost


Biopsy


treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray






treatment chart


Biopsy/FNAC ,


Xray




month)3A.512 2163 3000 3300 3750


Biopsy if required





Brachytherapy - Intraluminal HDR



and Film


treatment chart, RT

planning data




treatment chart RT

planning Data


Arogya

Karnataka

Code


ward rate

Private ward


562 X Knife, Gamma Knife, Cyber knife 3A.503 1962 1963 90000 99000 112500CT/MRI report and Film,

Biopsy


treatment chart RT

planning Data

563


Radiotherapy, Definitive+Tab

Temozolomide along with RT

3A.5042220

2219,219835000 38500 43750 CT report and Film, Biopsy


treatment chart

564 Cobalt 60 teletherapy, Palliative 3A.505 2220 10000 11000 12500 CT report and Film, Biopsy


treatment chart RT

planning Data


Definitive+Tab Temozolamide3A.506

2224,2222,2

198, 55000 60500 68750 CT report and film, biopsy

Photo with RT machine, RT

treatment chart, RT

planning data

566


3DCRT, Definitive along with

+concurrent Tab Temozolamide

along with RT

3A.507 2228, 2198, 80000 88000 100000 CT report and Film, Biopsy


treatment chart RT

planning Data

567

Linear accelerator teletherapy, IMRT

/VMAT, Definitive along with

+concurrent Tab Temozolamide

along with RT.

3A.508 2227, 2198 105000 115500 131250 CT report and Film, Biopsy


treatment chart RT

planning Data




treatment chart

569Palliative CT- Max 6 cycles (Per cycle)

For Primary and secondary tumours3A.510 2163 8000 8800 10000

CT/USG report and Film,

Xray, Biopsy



570Variable regimen - Max 6 cycles (Per

cycle)3A.511 2163 2165 8000 8800 10000 CT/MRI , HPE report



571Zoledronic acid - Max 12 cycles (Per

month)3A.512 2163 3000 3300 3750


Biopsy if required



ONCOLOGY - BRAIN AND SPINE


Arogya

Karnataka

Code


ward rate

Private ward


572Tab Temozolemide for 6 months

(5days every month x 6 months)3A.513 2198 45000 49500 56250 CT report and Film, Biopsy

Pharmacy Bill/Invoice with

batch no. of the drug strip

573Growth Factor / Pegrafil (Per cycle)

(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray



574 Tracheal Resection and anastomosis 3A.515 1996 18000 19800 22500 CT report and Film, Biopsy Clinical Photograph


575Sternotomy + Superior Mediastinal

Dissection3A.516 2004 12000 13200 15000 CT report and Film, Biopsy

Clinical Photograph


report

576Microlaryngeal Surgery including

Phonosurgery3A.517 397, 398 11000 12100 13750 Clinical Photograph

Clinical Photograph, HPE

report

577 Resection of Nasopharyngeal Tumor 3A.518 1991 50000 55000 62500CT/MRI report and Film,

Biopsy


report

578 Myocutaneous / cutaneous flap 3A.519 2093 25000 27500 31250 Biopsy of the primary Clinical Photograph

showing scar

579 Palatectomy 3A.520 1989 30000 33000 37500CT/MRI report and Film,

Biopsy


report

580 Micro vascular reconstruction 3A.521 2008 45000 49500 56250 Biopsy of the primary Clinical Photograph

showing scar

581 Temporal bone resection (Any Type) 3A.522 2074 60000 66000 75000CT/MRI report and Film,

Biopsy

Clinical Photograph


582 Composite Resection 3A.523 2094, 2076 50000 55000 62500 CT report and Film, Biopsy Clinical Photograph


583Composite Resection and

Reconstruction3A.524 2094 65000 71500 81250 CT report and Film, Biopsy

Clinical Photograph


584Composite Resection + Micro

vascular reconstruction3A.525 2094 2008 80000 88000 100000 CT report and Film, Biopsy

Clinical Photograph


ONCOLOGY - HEAD AND NECK


Arogya

Karnataka

Code


ward rate

Private ward


585 Neck Dissection - any type 3A.526 2009 25000 27500 31250Biopsy , USG/CT of neck

with film

Clinical Photograph


586 Hemiglossectomy 3A.527 1985 25000 27500 31250CT/MRI report and Film if

required/ Biopsy

Clinical Photograph


587 Maxillectomy 3A.528 2070 40000 44000 50000 CT report and Film, Biopsy Clinical Photograph


588 Parotidectomy 3A.529 1987 40000 44000 50000 FNAC,CT Clinical Photograph


589Laryngectomy - any type, with neck

node dissection3A.530 1993 2009 40000 44000 50000 CT report and Film, Biopsy

Clinical Photograph


590 Voice Prosthesis 3A.531 NA 40000 44000 50000CT report, Biopsy,

+Photograph with AM

Invoice of prosthesis, scar

photo

591 Laryngopharyngo Oesophagectomy 3A.532 1994 70000 77000 87500 CT report and Film, Biopsy Clinical Photograph


592 Hemimandibulectomy 3A.533 2068 25000 27500 31250CT report and Film if

required/ Biopsy

Clinical Photograph


593 Wide excision of lesion 3A.534 2101 25000 27500 31250

CT/MRI report and Film if

required, Biopsy, clinical

picture

Clinical Photograph


594 Thyroidectomy any type 3A.535 1978 25000 27500 31250FNAC/CT/MRI report and

Film

Clinical Photograph


595 Laser Surgery of Larynx 3A.536 NA 30000 33000 37500 Clinical Photograph

Photos with laser machine,

CD of procedure/intra op

stills + HPE report

596 Submandibular Gland Excision 3A.537 1988 25000 27500 31250CT/MRI/USG report and

Film if required/ Biopsy

Clinical Photograph



Arogya

Karnataka

Code


ward rate

Private ward


597 Parathyroidectomy 3A.538 1979 30000 33000 37500CT Scan Functional

scan/PTH reports/USG

Clinical Photograph


598Pharyngectomy & Reconstruction -

Total3A.539 71 12000 13200 15000 CT Neck,USG

HPE, X Ray Neck, Scar

Photo

599 Parapharyngeal Tumour Excision 3A.540 403 11000 12100 13750 USG, CT Neck USG,HPE,Scar Photo

600Linear accelerator (Photons)

teletherapy, Adjuvant3A.541 2224 50000 55000 62500

CT/MRI report and Film,

Biopsy


treatment chart

601Linear accelerator teletherapy

3DCRT, Definitive, Adjuvant 3A.542 2228 75000 82500 93750


Biopsy


treatment chart RT

planning Data

602Linear accelerator teletherapy IMRT

/VMAT, Definitive, Adjuvant3A.543 2227 100000 110000 125000


Biopsy


treatment chart RT

planning Data

603



Definitive/Boost


Biopsy


treatment chart RT

planning Data

604Cobalt 60 External Beam



treatment chart RT

planning Data

605Radioiodine Treatment < 100

Millicuries3A.546 NA 20000 22000 25000 Biopsy/FNAC

Radioiodine original

treatment chart and

Thyroid scan, Biopsy/HPE

606Radioiodine Treatment > 100

Millicuries3A.547 NA 30000 33000 37500 Biopsy/FNAC

Radioiodine original

treatment chart and

Thyroid scan , Biopsy/HPE

607Cisplatin/Carboplatin (AUC2) along

with RT- max 6 cycles (Per cycle)3A.548 2173, 2202 2000 2200 2500 CT report and Film, Biopsy




Arogya

Karnataka

Code


ward rate

Private ward


608

Carboplatin/cisplatin +

Paclitaxel/Docetaxel (Neoadjuvant

Chemotherapy)-Max. of 4 cycles only

(Per cycle) -For stage III and IVA



609

Cisplatin + 5 FU(Neoadjuvant

Chemotherapy)/Palliative - Max. of 4

cycles only (Per cycle)

3A.5502128, 2130,

21356000 6600 7500 CT report and Film, Biopsy



610Cisplatin + 5FU + Taxol/Docitaxel (

only hypopharynx)3A.551 2184 11000 12100 13750 CT report and Film, Biopsy

Clinical Photograph


611

Palliative CT (Paclitaxel + Cisplatin or

5 FU + Cisplatin) - Max 6 cycles (Per

cycle)

3A.552 2163 8000 8800 10000CT / USG report and Film, X

ray, Biopsy



612

Palliative CT 1. Docetaxel +

Cisplatin / Carboplatin. 2.

Gemcitabine D1& D8 + Cisplatin /

Carboplatin - max 6 cycles (Per

cycle)



613Tab Geftinib/Erlotinib-Max 1 Year

(Per month)3A.554 2176, 2177 6000 6600 7500 CT report and Film, Biopsy



614Tab Sorefinib- max 12 months (Per

month)3A.555 2205 8000 8800 10000


Biopsy





treatment chart RT

planning Data


(Maximum 4 cycles)3A.514 2163, 2165 2000 2200 2500

Biopsy/FNAC ,


Xray






treatment chart


Arogya

Karnataka

Code


ward rate

Private ward


615

IV antibiotics and other supportive

therapy For Febrile Neutropenia (Per

episode)

4A.60 2169 10000 11000 12500Haemogram for each

episode


Discharge summary (with

details of drugs given)

616 Exploratomy laparotomy 4A.61 346 20000 22000 25000Endoscopy with film,


Clinical Photograph


617Prostate surgery (Code 592) -

additional cost3A.556 NA 25000 27500 31250 CT report and Film, Biopsy


report

618Nephrectomy – partial (Code 660)-

additional cost3A.557 NA 25000 27500 31250


Isotope renogram if

required

Clinical Photograph


+USG Report

619Low AR and APR (Code 638, 639) -

additional cost3A.558 NA 25000 27500 31250



Clinical Photograph


620

Radical hysterectomy for CA cervix

and CA endometrium ( Code 648)-

additional cost

3A.559 NA 20000 22000 25000 CT report and Film, Biopsy Clinical Photograph


OF1 Post Oncology Follow up-1 3A.OF1 NA 500 550 625

OF2 Post Oncology Follow up-2 3A.OF2 NA 600 660 750

OF3a Post Oncology Follow up-3 3A.OF3a NA 600 660 750

OF3b Post Oncology Follow up-3 with CECT 3A.OF3b NA 50000 55000 62500

621Tendon injury requiring repair

moderate3A.560

2231,989,96

8,965, 96010000 11000 12500

X-ray Films/ Clinical Picture

+ detail notesClinical photo showing Scar

622 Tendon injury requiring repair major 3A.561 967968 20000 22000 25000

Xray Films(if relevant)+

Clinical Picture(Mandatory)

+ detail notes

Clinical photo showing Scar

623 Nerve injuries minor 3A.562

2231,

953,1868,19

04 ,

15000 16500 18750



+ detail notes


ROBOTIC SURGERY - ALLOWED IN SELECTED CENTRES ONLY

ONCOLOGY -EMERGENCY CODES

POST ONCOLOGY FOLLOW-UP

POLYTRAUMA


Arogya

Karnataka

Code


ward rate

Private ward


624 Nerve injuries major 3A.563952, 954,

955, 193120000 22000 25000



+ detail notes


625 Nerve plexus injuries 3A.5641000 , 1866

, 186750000 55000 62500

MRI + Xray Films(if

relevant)+ Clinical

Picture(Mandatory) +

detail notes


626 Vascular peripheral/minor injuries 3A.565 2231, 10000 11000 12500

Pre-operative Doppler

study, CT angio(Optional)+

Films+ detailed Clinical

notes

Post-operative Doppler

study, Clinical photo

showing scar

627Vascular central/severe

injuries(major)3A.566 2231 50000 55000 62500

Pre-operative Doppler

study+ CT Angio(optional)

+ detailed Clinical notes

Post-operative Doppler

study, Clinical photo

showing scar

628 Flap surgery (Simple) 3A.567 2542 15000 16500 18750X-ray Films + detail notes+

pre-op clinical photoClinical photo showing Scar

629 Complex flap surgery 3A.568 2364, 2365 30000 33000 37500 X-ray Films + detail notes Clinical photo showing Scar

630 Visceral injuries moderate 3A.569 610 40000 44000 50000Pre-op. of X-ray/CT scan /

Ultra sound

Post-Operative X-ray, scar

photo

631 Visceral injuries severe 3A.570 510611 60000 66000 75000Pre-op. of X-ray/CT scan /

Ultra sound

Post-Operative X-ray, scar

photo

632 Chest injuries with ICD bilateral 3A.5712002, 1471,

297711000 12100 13750 X-ray /ultra sound

Post-Operative chest X-ray

with ICD in situ

633 Chest injuries with ICD + ICU 3A.572 2391, 2398 , 20000 22000 25000 X-ray /ultra soundPost-Operative chest X-ray

with ICD in situ

634Chest injuries with ICD + ICU +

Ventilator3A.573 2398 , 26600 29260 33250 X-ray /ultra sound

Post-Operative chest X-ray

with ICD in situ


Arogya

Karnataka

Code


ward rate

Private ward


635 Acetabular definitive treatment 3A.574 1036, 26600 29260 33250 X-RAY/CT scan

Clinical Photograph

showing scar + post op.

XRAY

636Illizarov/Orthofix/hybrid external

fixator application3A.575

2961, 1125,

106126600 29260 33250 X-ray

Post op X-ray, Pt photo

with applicator

637Skin Grafting Major- Injuries(Add on

code)3A.576

2352, 2354,

96118000 19800 22500 X-ray

X-ray + post-operative scar

photo

638

Arthroscopic BANKARTS Repair for

recurrent dislocation of shoulder

(without cost of suture anchors)**

3A.577 986 16600 18260 20750 X-rayPatient Photo with

Arthroscopic incision

639

Total knee replacement(Unilateral)

Procedure + Impant including

cement cost. Incase of bilateral in

same sitting only implant cost will be

paid. In case of next sitting 50% of

procedure cost & implant will be

paid.**

3A.578942, 949,

95065000 71500 81250 X-ray Post-op X-ray, Scar photo

640

Total hip replacement Uncemented

implant(Procedure cost + implant

cost)**

3A.579 947, 948 69100 76010 86375 X-ray Post-op X-ray, Scar photo

641

Total hip replacement cemented

implant((Procedure cost + implant

cost)**

3A.580 947, 948 60100 66110 75125 X-ray Post-op X-ray, Scar photo

642Total hip replacement Hybrid

((Procedure cost + implant cost)**3A.581 947, 948 100000 110000 125000 X-ray Post-op X-ray, Scar photo

* Procedures requiring Follow Up as per Annexure 3 ** Super speciality procedures that shall be restricted to PHIs and Medical colleges (Public & Private)

Documents

JSS Package Rate List for Tertiary Healthcare Treatments _Benefit Packages.pdf · Sl. No Annexure 3 Procedures Arogya Karnataka Code CEA Code Rates Semi private ward rate Private