APPENDIX-I

MEDICAL INSURANCE SCHEME FOR STATE

EMPLOYEES AND PENSIONERS (MEDISEP)

Finance Department

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 MEDICAL INSURANCE SCHEME FOR STATE EMPLOYEES  AND PENSIONERS
(MEDISEP) 
Government of Kerala hereby makes the following Scheme, namely:­ 

1. SHORT TITLE, COMMENCEMENT AND APPLICABILITY

A.  This  Scheme  may  be  called   the  MEDICAL  INSURANCE   SCHEME  FOR  STATE
EMPLOYEES AND PENSIONERS (MEDISEP).
 B.  This Scheme shall come into force on  01.07.2022.

C.  Subject to the provisions contained therein this Scheme shall apply to  all serving
employees of the State  Government including  the High Court of Kerala,  and their
family who are covered under the existing Kerala Government Servants   Medical
Attendant Rules [KGSMA Rules, 1960], Part time contingent employees, Part time
teachers, teaching and non­teaching staff of aided schools and colleges and their
family   and   pensioners   and   their   spouses   and     family   pensioners   on   compulsory
basis, and   All India Service officers serving under the Government of Kerala   on
optional   basis.  In   addition   to   the   above   mentioned   categories,   employees   and
pensioners of the Universities which receive Grant­in­Aid from the State Government
and Local Self Government Institutions and the directly recruited Personal staff of
the Chief Minister, Ministers, Leader of Opposition, Chief Whip, Speaker, Deputy
Speaker,   Chairmen   of   the   Financial   Committees     and   personal   staff   pensioners/
family   pensioners   shall   also   be   considered   as   beneficiary   for   this   scheme.  Not
withstanding the above, the authority have the discretion to include or exclude any
categories of beneficiaries to/from the coverage of the scheme at any stage of the
scheme.

2. DEFINITIONS
 In this Scheme unless the context otherwise requires: ­­

i. “Additional Coverage” means the additional sum  insured for specified diseases.

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 ii. “Authority” means Additional Chief Secretary, Finance Department, Government of
Kerala.

iii. “Beneficiaries” means all serving employees of the State  Government including the
High Court of Kerala and their family who are covered under the existing Kerala
Government Servants   Medical Attendant Rules [KGSMA Rules, 1960],   part time
contingent employees, part time  teachers, teaching  & non­teaching  staff of aided
schools and colleges and their family and pensioners and their spouses and  family
pensioners on compulsory    basis, and   all   All India Service officers serving under
the Government of Kerala on optional basis. In addition to the above mentioned
categories, employees and pensioners of the Universities which receive Grant­in­Aid
from the State Government and Local Self Government Institutions and the directly
recruited personal staff of the Chief Minister, Ministers, Leader of Opposition, Chief
Whip, Speaker, Deputy Speaker, Chairmen of the Financial Committees and Personal
staff pensioners/ family pensioners shall also be considered as beneficiary for this
scheme. 

iv.   “Cashless   facility”   means   a   facility   provided   to   the     insured   by   the   Insurance
Company, to make payments of treatment costs directly to the hospital in respect of
treatment undergone in a network provider, to the extent of approval given where
such treatment is in accordance with the policy terms and conditions.  

v. “Catastrophic  illness” means severe  illness requiring prolonged  hospitalization  for

recovery.   These   illness   (speciality   and   super   speciality)   involve   high   costs   for
treatment   and   may   incapacitate   the   person   from   working,   creating   a   financial
hardship.    

vi. “Day   Care   Centre”   means   any   registered   institution   established   for   day   care
treatment of illness and/or injuries or a medical set up with a hospital and is under
supervision of a registered and qualified medical practitioner and must comply with
all minimum criterion.

vii. “Day one” means the date on which the scheme will come into force.

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 viii. “Dependant”  means those who are dependant on the employee for their       
livelihood.

ix. “Empanelled   Hospitals”   means   those   hospitals   fulfilling   the   minimum   prescribed
standards and thereby tied up as network hospitals by the insurer.

x. “Enrolment” means registration of beneficiaries to the scheme.

xi. “Enrolment Period” means the period given for the registration of the beneficiaries to
the scheme.

xii. “Family” means all or any of the following relatives of an insured person, namely:

  A.  In the case of an insured employee:

            a) Legal spouse of the employee (who do not have the eligibility to enrol in this     
      scheme).
           b) Minor or adopted child/children dependant upon the insured, till they get         
     employed, married or attained the age of 25 years whichever is earlier.
           c) Physically challenged/mentally challenged  children of the employee without any 
     age restriction on the grounds of Bench Mark Disability. (certificate should be 
      produced as specified in Annexure 4 of the scheme).
            d) Dependant parents of the employee .   
                     B. In the case of insured pensioner:
Legal Spouse (who do not have the eligibility to enrol in this scheme) and physically
challenged/mentally   challenged   children   of   the   pensioner   without   any   age
restriction   on   the   grounds   of  Bench   Mark   Disability  .   (certificate   should   be
produced as specified in Annexure 4  of the scheme).   
                     C. In the case of insured family pensioner.
Physically challenged/mentally challenged   children of the pensioner without any
age   restriction   on   the   grounds   of  Bench   Mark   Disability.  (certificate   should   be
produced as specified in Annexure 4 of the scheme).   

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 xiii. “Government” means Government of Kerala.

xiv. “Medical insurance policy” is a contract between an Insurer and the Government in
which the Insurer agrees to provide specified health insurance cover to the employees and
pensioners at a particular “premium”.

xv. “Hospital”   means   any   institution   established   for   in­patient   care   and   day   care
treatment of illness and/or injuries and which has been registered as a hospital with
the local authorities under relevant Act, having the standards and benchmarks for
hospitalisation that provides network prescribed by IRDAI.

xvi. “Hospitalisation” means admission in a Hospital for a minimum period of 24
consecutive   'In­patient   Care'   hours   except   for   specified   procedures/treatments,
where such admission could be for a period of less than 24 consecutive hours.

xvii. “Inpatient care” means treatment for which the insured person has to stay in
a     hospital for more than 24 hours for a covered event.

xviii. “Insurer” means Insurance Company registered under IRDAI and selected by
Government of Kerala.

xix.“Insured   Person”   means   a   person   who   has   got   insurance   coverage   under   the
scheme.

xx. “Medical Board” means standing medical board constituted by the Director of Health
Services consisting of not less than 3 members.

xxi.“Medical Expenses” means those expenses that an Insured Person has necessarily
incurred for medical treatment on account of illness or Accident on the advice of a
Medical Practitioner.

xxii. “New Born Benefit” means the benefit given to the new born child/children
along   with the insured mother.

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 xxiii. “New born baby” means baby born during the Policy Period.

xxiv. “Period   of   Contract”   means   three   years     and   3   months   from   the   date   of
signing of  MoU/Agreement between the Government and the Insurer.

xxv. “Period of Insurance” means three years from the date of commencement of
the   Scheme.

xxvi. “Pre–existing disease” is a medical condition/disease that existed before the
commencement of the insurance coverage obtained from the health insurance policy.

xxvii. “Pre­hospitalization/Post­hospitalisation   Medical   Expenses”  means   medical

expenses incurred in the same hospital where agreed Medical Treatment or Surgical
Procedure is carried out during  15  days  before hospitalisation  and  15  days  after
discharge.   The   final   package   cost   is   inclusive   of   pre   and   post   hospitalisation
expenses.  

xxviii. “Premium”  means   the   payment   made   on   behalf   of   the   insured   persons   as
consideration for the policy. The Premium of the employee shall be deducted from
their salary in monthly instalments and the premium of the pensioner shall be met
from their monthly entitlement. 

xxix. “Policy plan period” means the three year period from the date which the
scheme starts.

xxx. “Provider Network” means hospitals or health care providers enlisted by an
insurer, to provide medical services to an insured by cashless facility.

xxxi. “State Nodal Cell” means the implementation and monitoring mechanism for
MEDISEP under the Authority.

xxxii. “Sum Assured” means the total benefit coverage provided by the insurer.

xxxiii. “HDU” means High Definition Unit.

xxxiv. “ICU” means Intensive Care Unit.

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3.  SCOPE OF THE  SCHEME :

The   scope   of   the  scheme  shall   be   to   provide   coverage   for   the   eligible   expenses
incurred   by   the  beneficiary  for   the   listed   procedures   under   the   basic   benefit   package
including day care packages and additional package which includes transplant/catastrophic
procedures   listed   as   Annexure­2.   The   benefit   package   coverage     includes   the   cost   of
medicines,  procedures,  doctor   and   attendant   fees,   room   charges,   diagnostic   charges,
implant   charges,   dietary   charges   availed   from   empanelled   hospitals.     The   scheme   will
provide cashless facility for the enlisted procedures and will cover all  pre­existing diseases.
The coverage is restricted only to the empanelled public and private hospitals under the
scheme. However, the coverage of the medical assistance under the scheme shall also be
extended in respect of accident /emergency cases where the patient is treated for approved
treatment / surgery undergone in non­empanelled hospitals. In such cases, treatment cost
shall   be   reimbursed   by   the   insurance   company   to   beneficiary   based   on   the   approved
rates/package of the scheme.
However   the   Out  Patient  Treatment   will  not   be  covered   under  this   scheme.   Out
Patient Treatment will be  catered through  the existing Medical Reimbursement System in
such a way that the said facility will be limited to the treatments in the Government Sector
Hospitals   and   super   speciality   institutions   including     Sree   Chithra   Institute   of   Medical
Sciences   and   Technology   Thiruvananthapuram,   Regional   Cancer   Center
Thiruvananthapuram, Malabar Cancer Center and Cochin Cancer Center. 

4.  ELIGIBILITY

i. All   serving   employees   of   State   Government   including   teaching   and   non­teaching

staff of Aided Schools and Colleges by remitting prescribed premium.  In addition to
the above mentioned categories, employees of the Universities which receive Grant­
in­Aid from the State Government and Local Self Government Institutions and the
directly recruited personal staff of the Chief Minister, Ministers, Leader of Opposition
and   Chief   Whip,   Speaker,   Deputy   Speaker   and   the   Chairmen   of   the   Financial
Committees shall also be considered as beneficiary for this scheme. Not withstanding

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 the above, the Authority have the discretion to include or exclude any categories of
beneficiaries to / from the coverage of the Scheme at any stage of the Scheme.    
ii. Newly appointed employees who joined service during the policy period of three
years shall join the scheme by remitting the premium from the month of joining and
can avail Rupees One Lakh Fifty Thousand per annum as Basic Sum Insured. Newly
joined employees may get enrolled either by paying full year premium for  that year
and avail the benefit package in total or join the scheme in subsequent year. If they
join from second year, the block period Sum Insured (SI) available  would   be   only
Six Lakh and so on.
iii. All service pensioners including teaching and non­teaching staff of aided schools and
colleges by deduction from monthly entitlement. In addition to the above­mentioned
categories pensioners of the Universities which receive Grant­ in ­Aid from the State
Government   and   Local   Self   Government   Institutions   and   the   directly   recruited
personal staff pensioners/family pensioners shall also be considered as beneficiary
for this scheme. 

iv. Those who avail LWA under Appendix XII A, XII B and XII C Part I KSR shall not
have the eligibility to join/continue in the scheme during the policy period.

v. Those who avail Leave Without Allowance for a short spell not exceeding the period
of one year during the policy period shall have the option to remit the premium in
advance during the tenure of the leave but before the date of renewal of the policy. 

vi. Employees joining back from leave without pay may get enrolled for current year, by
paying the full year premium. If they join from 2 nd year or 3rd year , the block period
Sum Insured (SI) would only be available corresponding to the number of years full
premium is paid (e.g. if an employee pays only 2 years full premium, block period
Sum   Insured   (SI)   of   Rs.6   Lakh   only   would   be   available,   similarly   for   one   year
premium, Sum Insured (SI)  available would be Rs. 3 Lakh). 

vii. If an employee opts out in between the policy period (LWA/resignation), Eligibility
criteria   would   be  as  under:   (a)  if  no   claims   are   made  during   service  period,   no

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 impact is on premium collection. (b) if claims were made only up to the basic SI and
up to block period SI, then full year(s) premium is to be paid.

viii. In the case of employees under deputation and employees not drawing salary
through   SPARK,   the   Drawing   and   Disbursing   Officer   concerned   shall   deduct   the
premium and remit the same to the head of account to be opened for this purpose.
The remittance details shall be forwarded to Finance(Health Insurance) Department.
(Detailed instructions in this regard will be issued separately).

ix. Pensioners under National Pension System (NPS) have the option to enrol in the
scheme by remitting the prescribed premium.
x.   If   an   employee   is   under   suspension,   the   premium   during   the   period   shall   be
deducted from the subsistence allowance admissible.

xi.  If an employee is dismissed or terminated from service as a part of major penalty,
he/she shall cease to be the beneficiary of the scheme with effect from the date of
order of such dismissal/termination.
xii. If an employee retires/superannuates during the policy period, the membership of
his/her policy shall sustain and remittance towards the premium payment will be
deducted from his/her entitlement  as a pensioner.

xiii. Those who remit the full premium amount for the entire policy period of 3
years is only eligible for the additional benefit package for catastrophic illness.

5.  ENROLLMENT OF BENEFICIARY 

i) The   beneficiaries   must   mandatorily   fulfil   their   enrolment   procedure   as

prescribed by Government within the duration of enrolment Period.
ii) Enrolment of such beneficiaries shall not be allowed after the expiry of the
enrolment period.
iii) In case of pensioners the prescribed enrolment procedure shall be followed as
specified by Government from time to time.
iv) The database of beneficiaries will be maintained by the State Nodal Cell and
will be shared with the selected insurer for initiating the enrolment process.

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 The   enrolment   of   the   beneficiaries   and   issuance   of     ID   cards   would   be
undertaken by the insurer.
v) The date of expiry of policy shall be co­terminus for all the beneficiaries.
vi) Insured   will   have   the   option   to   change   the   details   regarding   dependant
beneficiary.
vii) Every   employee/pensioner   will   be   notified   regarding   enrolment   with
Permanent Employee Number/Pension Payment Order Number.  
viii) The   empanelled   Hospitals/Nursing   Homes/Day   Care   Clinics   and   the
beneficiaries   shall   have   the   access   to   the   dedicated   website   to   see   their
relevant information.
ix) The beneficiaries falling under the category of compulsory enrolment shall
remain   the   member   of   the   scheme   with   future   renewals   automatically
awarded. The beneficiaries falling under the category of optional enrolment,
if wish to opt out of the scheme, shall be required to submit the declaration to
the Finance Department for discontinuation from the Scheme at the time of
next renewal of the Scheme. In such cases the benefits shall cease on the
expiry of the policy.
x) No fresh enrolment of the serving employees and pensioners shall be allowed
after the date of expiry of enrolment period.
xi) The   scheme   shall   also   be   compulsory   to   new   government   employees   who
would be joining after the date of expiry of enrolment period of the scheme.
xii) The   enrolment   of   new   employees,   who   join   after   the   date   of   expiry   of
Enrolment Period, shall continue throughout the policy plan period.  

6. FAMILY ENROLLMENT

       The Scheme shall cover a family and dependants as follows.
A.  In the case of an insured employee:

     i)   Legal   spouse   of   the   employee   (who   do   not   have   the   eligibility   to   enrol   in   this  
scheme).

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    ii) Minor or adopted child/children dependant upon the insured, till they get employed, 
married or attained the age of 25 years whichever is earlier.
    iii)  Physically challenged/mentally challenged  child/children of the employee without 
any age restriction on the grounds of Bench Mark Disability.(Certificate should be 
produced as specified in Annexure 4 of the scheme).
     iv)  Dependant parents of the employee.

 B. In the case of insured pensioner:

       Legal  Spouse (who do not have the eligibility to enrol in this scheme) and physically
challenged/mentally challenged child/children of the pensioner without any age restriction
on the grounds of  Bench Mark Disability.  (certificate should be produced as specified in
Annexure 4 of the scheme).

  C. In the case of insured family pensioner:
Physically challenged/mentally challenged child/ children of the pensioner without any age
restriction on the grounds of  Bench Mark Disability.   (certificate should be produced as
specified in Annexure 4 of the scheme).   

7. ADDITION & DELETION OF FAMILY MEMBERS
A. Addition to the family is allowed in following contingencies during the policy period. 
       (1) Marriage of the beneficiary (requiring inclusion of spouse’s name)
       (2) Children born during policy period  
     (3)If an employee retires/superannuates from service or die­ in­harness the dependants
of   that   employee   can   be   added   as   the   dependants   of   his/her   spouse   if   he/she   is   an
employee enrolled under the scheme subject to the eligibility of dependency.
 B. Deletion from Family is allowed in following contingencies
(1) Death of covered beneficiary.
(2) Divorce of the spouse.
(3) Member becoming ineligible (on condition of dependency)

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8. BENEFIT PACKAGE

The scheme envisages cashless treatment facility to beneficiaries through an insurance
company and a network of empanelled hospitals for the benefit package given below.

1. Basic  Benefit Package ­  The Insurer  shall pay  all  expenses (as per  package costs

specified) incurred in course of medical treatment availed by the beneficiaries in
empanelled hospitals (24 hours admission clause) for the medical, surgical and day
care procedures as enlisted in Annexure 1.
2. Additional Benefit Package: The Insurance coverage given over and above the basic
coverage for catastrophic illness specified enlisted in Annexure 2.
3. Coverage of Pre­existing diseases: All diseases under the Scheme shall be covered
from day one and there shall not be any waiting period.
4. Pre & Post hospitalization benefit:    means medical expenses incurred in the same
hospital where agreed Medical Treatment or Surgical Procedure is carried out during
15 days before hospitalisation and 15 days after discharge. The final package cost is
inclusive of pre and post hospitalisation expenses.  
5. Newborn child/children to an insured mother would be covered from day one up to
the expiry of the current policy plan period. However, next year the child/children
could   be   covered   as   a   regular   member   of   the   family.   All   Congenital   diseases   of
newborn child/children shall be covered under the scheme.
6.  The insurance coverage shall start from day one and continue till the expiry of the
policy plan period.
7.   ‘Unspecified Procedures’ should be covered under Basic Benefit package based on the
pre­authorization process initiated by Insurance Company and Authority, which will be
limited to Rs.1.5 lakh per annum during the block period of three years. New diseases
like COVID­19 will also be covered based on the regulatory provisions issued by IRDAI
from time to time.

9. BENEFIT PACKAGE RATES

The   Expert   Committee   has   also   recommended   the   benefit   package   rates   for   all   the
procedures which are part of the Basic and Additional Benefit Package. The costing of the

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basic benefit package includes three components (1) Procedure Cost (2) Implant Cost if
any (3) Room charges.

1.  Procedure Charges­ The first component of the package cost includes procedure costs
which would include all cost components related to medical consultation and treatment.
The procedure charges include pre hospitalization expenses, medicine and consumables,
diagnostic and laboratory investigations, procedures including surgeries if any, doctor,
and nursing charges, discharge medicines and post hospitalization review if required. The
procedure costs will thus follow the approach of a ‘bundled rates’ covering all input cost
related to conducting the surgical procedures and managing the medical conditions.

2.    Implant  Cost­   Certain  procedures   require  single   or  multiple   implants,   the  cost   of
which is variable. Hence the implant cost is separate from the procedure costs, wherever
it is applicable. In such cases, the price of Implant / High­End Consumable will be added
over and above the procedure price based on either the actual usage or the maximum
capping of Implant / High­End Consumable defined (whichever is less). The cost of the
implants   will   be   based   on   the   maximum   ceiling   price   fixed   by   the   National
Pharmaceutical Authority of India (NPPA). The insurance company can use the implant
list   and   costs   suggested   by   the   National   Health   Authority   as   the   reference   point   for
MEDISEP.

3.   Room Charges  – The third component of the package cost is room charges and the

following room charges as applicable. For General Ward up to Rs.1000; For Semiprivate
Ward up to Rs.1500 and Private Ward up to Rs.2000. As all the procedures require a pre­
authorization process, the insurance company will have to fix the average length of stay
for all procedures, and accordingly the total charges would be calculated. Any charge over
and above the ceiling rates prescribed would have to be borne by the patient. In case, a
hospital   has   room   rent   less   than   the   patient's   eligibility,   then   only   the   actual   rates
applicable for each category room should be claimed from that hospital. The room charge
details   are   given   in   Annexure­3.   However   where   the   hospital   stay   gets   prolonged   on
account of medical/surgical complications, the attendant treatment charges will also get
covered   and   the   Insurance  Company/Empanelled   Health   Care   Provider  cannot   charge

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additional amount from the beneficiary.

The final package cost of any procedure enlisted in the Annexure­1 will be inclusive of the
above three components.

For calculating the final package cost, three components are to be included. To cite an
example, if the package is PTCA, then the total cost would include the procedure cost
which is Rs.40,600 + Implant Cost for Drug­Eluting Stent which is Rs.31,600 and the
room charges for three days in a private ward which is Rs.6000. The final package cost of
any   procedure   enlisted   in   the   Annexure­1   will   be   inclusive   of   the   above   three
components.

The costing of the catastrophic package list specified in Annexure­2 is inclusive of all the
four components i.e. Procedure Charges; Implant Costs; Room Charges and Investigation
costs. All the packages will have a single package rate and any additional expense above
the   ceiling   rates   will   have   to   be   borne   by   the   beneficiary.   This   is   irrespective   of   the
number   of   days   of   hospital  stay   of   the  patient  and   the   attendant   medical  or   surgical
complications will also get covered in the package and insurance company / Empanelled
Health Care Provider cannot charge additional amount from the beneficiary.

10.   AGE LIMIT.

   There   shall   be   no   age   limit   for   the   beneficiaries/dependants   except   dependent

child/children for admitting into the scheme.

11. SUM INSURED ON FAMILY FLOATER BASIS.

As mentioned in the previous section, the coverage of the scheme will be provided as
follows.

i)   Basic Benefit Package Coverage : This caters to the benefit package list mentioned in
Annexure­1    in which medical, surgical and day care procedures will be covered up to a
sum of Rs. 3 lakh per annum for a block period of three years. Out of the annual coverage
of Rs. 3 lakh, Rs.1.5 lakh are fixed in nature and Rs.1.5 lakh can be availed on a floater

14
basis each year. The first component of Rs.1.5 lakh is fixed for each year and will lapse at
the end of each year. The floater component, if not exhausted, can be carried over to the
subsequent years of the policy.

ii).  Additional   Package   Coverage   :  In   addition   to   the   Basic   Benefit   Package   coverage
mentioned   above,   all   procedures   mentioned   in   the  Annexure­2  will   be   covered   by   the
policy.
Corpus fund for Catastrophic illness :  An additional sum of not less than Rs. 35
crore   for   three   years   shall   be   provided   by   the   Insurer   as   a   corpus   fund   for   providing
coverage to Additional Packages enlisted in Annexure­2. The corpus fund can also be used
for reimbursement of expenses to insurance company, in case there is any new catastrophic
illness and a treatment package for the same, which is not listed in the benefit package, but
recommended for inclusion after detailed review by the Health Department.

12. PAYMENT OF PREMIUM

      The   Government   of   Kerala   will   pay   the   insurance   premium   on   behalf   of   the
employees/pensioners   to   the   Insurance   Company   in   advance.     For   the   first   year,   the
premium   will   be   initially   calculated   based   on   the   number   of   beneficiaries   in   position
covered under the Scheme as on date of implementation. Of this amount, 25% will be paid
as the first instalment on signing the agreement and commencement of the Scheme. During
the implementation, the actual premium will be arrived at based on the number of identity
cards distributed. The remaining 75% will be calculated as per the premium amount and
will be paid in three equal instalments after the successful completion of three months of
the scheme and before the end of the first policy year. 

The same payment schedule will be continued during the second and third year. For these
years, the total annual premium will be calculated based on number of identity cards or
certificates of Pay Drawing Officers issued under the Scheme. The payment of premium will
be based on the data made available by the department. 

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13.   PREMIUM 

i. The  annual   premium   of   the   employees   and   the  pensioners   will   be   Rs.4800/­
+18% GST for the policy period of 2022­2025. The monthly premium will be
rounded   as   Rs.500   (including   GST)   for   the   above   policy   period.   The   annual
premium thus collected beyond which quoted by the insurer will be kept as a
buffer fund and will be utilized for the treatment of catastrophic illness listed in
Annexure­2 upon exhaustion of the corpus fund of Rs. 35 Crore kept exclusively
for such expenses by the Insurance Company. For this the company has to meet
the catastrophic procedure expense by own which crosses the limit of Rs. 35
Crore and seek the reimbursement of the same from the Authority.

ii. The Annual Premium on behalf of the  employees and pensioners shall be paid
by the Government in advance as per the terms and conditions of the agreement
between the Government and the Insurer.

iii. The Annual Premium paid by the Government on behalf of the employee will be
deducted from their salary in  twelve equal instalments. (Detailed instructions in
this regard will be issued separately) 

iv. The premium of the pensioner    shall be met from their monthly entitlement.

(Detailed instructions in this regard will be issued separately)  

14.  ENROLMENT PERIOD

Enrolment Period shall start with immediate effect from the date of notification of
the scheme and will complete by the date which will be announced later.

15.  PERIOD OF INSURANCE AND PERIOD OF CONTRACT

i) The   scheme   will   be   introduced     from     the   date   mutually   agreed   between
Government of Kerala and the insurer  for the period of 3 years.
ii) The   period   of   insurance   contract   will   be   effective   from   the   day/date   of   signing
agreement between the Government of Kerala and the Insurance Company selected.

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 iii) The period of agreement shall expire three months after the date of expiry of policy
plan   period   or   at   completion   of   all   the   obligations   of   the   insurance   company,
whichever is later.
iv) The   Government   of   Kerala   reserves   the   right   to   terminate   the   contract   with   the
insurance company for any reasons whatsoever. (If the insurance company defaults
in delivery of services or it is found that it has misrepresented any fact during the
tender   process   to   attain   qualification   or   breaches   any   of   the   conditions   of   the
contract)

v) In   case   the   contract   is   terminated   after   the   expiry   of   the   policy   plan   period   the
Insurer shall continue to remain liable for making payments in respect of all the
claims lodged with  it or the TPA  in respect of all the claims/ invoices of Provider
Network and Beneficiaries on or before the date of expiry of the policy plan period.

16.  EMPANELLED PROVIDER NETWORK

     The empanelled provider network for MEDISEP will include public and private hospitals
which will be empanelled by the insurer. All the secondary and tertiary public hospitals
should be empanelled as providers of the scheme. The insurer will also have to empanel the
super speciality institutions which includes Regional Cancer Center (RCC), Malabar Cancer
Center (MCC), Cochin Cancer Center (CCC) and Sree Chitra Thirunal Institute of Medical
Sciences   and   Technology   (SCTIMST),   and   the   package   rates   specified   for   accredited
institutions will be applicable to the treatments undergone by the beneficiaries in the above
listed super speciality institutions.
The   insurer   shall   empanel   private   hospitals   as   network   hospitals   fulfilling   the   required
infrastructure   and   human   resources   criteria   laid   down   for   as   part   of   the   empanelment
process. The network hospitals shall also agree to the package rates of the scheme for the
procedures of various specialities under MEDISEP. Based on the clinical specialities, private
hospitals will be divided into three categories.

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(1)  Category ­1  General Purpose Hospitals:­ These are hospitals having 25 or more beds
with   the   following   specialities:   General   Medicine,   General   Surgery,   Obstetrics   and
Gynaecology, Paediatrics, Orthopaedics, ENT, Dermatology, ICU and Critical Care units.

(2)  Category­ 2  Speciality and Super Speciality Hospitals:­ Hospitals having 50 or more

beds   can   be   empanelled   as   a   speciality   hospital,   provided   they   have   at   least   10   beds
earmarked   for   the   speciality.   The   specialities   include   Cardiology,   Cardiovascular   and
Cardiothoracic   surgery,   Genito   Urinary   Surgery,   Gastroenterology,   Ophthalmology,
Pulmonology,   Poly   Trauma   &   Critical   Care,   Plastic   Surgery,   Neurosurgery,   Neurology,
Paediatric   Surgery,   Nephrology,   Rheumatology,   Endocrinology   etc.   In   this   category,   the
insurer can also empanel single­specialty hospitals with a minimum bed strength of 20 beds
(Example:   Ophthalmology,   Gastroenterology   etc).   In   addition   to   this,   if   the   insurance
company empanelling only specific departments in a super speciality hospital, they should
ensure that all services related to that department are provided as per the contract.

(3) Category­3: Hospitals for Transplant Surgery:­ Hospitals with experience in conducting
transplant surgeries (Kidney, Liver, Heart Transplant etc.)
   The Insurance Company shall ensure the availability of a minimum of five hospitals in
category   one   (excluding   government   hospitals)   in   each   district   of   the   State   and   the
availability of a minimum 25 network hospitals (excluding government hospitals) in the
areas under each cluster of districts indicated below.
In category 2, (excluding government hospitals) the Insurance Company should ensure a
minimum of five hospitals for each speciality group of the benefit package in each cluster.
In   category   3,  (excluding   government   hospitals)  the  Insurance  Company   shall  ensure   a
minimum of two hospitals for transplant surgeries mentioned in additional benefit package
in each cluster.
The Insurance Company can empanel all specialities or a group of specialities depending on
availability   of   each   specialities   in   a   network   hospital.   If   the   insurance   company   is
empanelling specific departments in a super specialty hospital, they should ensure that all
services related to that department are provided as per the contract. To illustrate, if the

18
insurance   company   is   empanelling   the   Oncology   Department   of   a   hospital,   then   the
hospital will have to provide medical, surgical, and radiation oncology services. Along with
this, the hospital also needs to ensure treatment for any comorbidity while the patient is
admitted to that facility.
The   insurer   is   bound   to   ensure   empanelment   of   at   least   two   hospitals   having   full
accreditation of NABH in the cities of Kozhikode, Ernakulam, and Thiruvananthapuram for
all specialities available at such health care providers.
A network hospital can be empanelled for all three categories or for any one of the three
categories specified above.
Cluster­1  (Northern   Districts):   Kasaragod,   Kannur,   Wayanad,   Kozhikode,   Malappuram,
Palakkad.
Cluster­2 (Central Districts): Thrissur, Ernakulam, Kottayam, Idukki.
Cluster­3 (Southern Districts): Alappuzha, Pathanamthitta, Kollam, Thiruvananthapuram.
If  any  district or cluster  does not  have the  number  of  hospitals as  specified  above, the
successful insurance company can seek specific exemption for that district or cluster and
the same will be considered by the Authority after verification of the available qualified
hospitals in that district or cluster.
In addition to this, the Insurer shall try to ensure the empanelment of a minimum one of
each network hospitals situated in Mangalore, Coimbatore, Mumbai, Chennai and Delhi. In
addition, the insurer may empanel additional hospitals outside the State.

The Insurer shall consider the list of hospitals which are part of the medical reimbursement
scheme   of   Government   of   Kerala   and   empanelled   hospitals   under   CGHS   or   other
central/state insurance schemes in Kerala, while conducting the empanelment process for
MEDISEP.
Notwithstanding above, the clustering of hospitals as mentioned above shall not restrict the
choice of the insured to seek treatment in hospitals outside the cluster which belongs to
his/her residence.   The guidelines/operational procedures of de­empanelment of network
hospitals   whose   services   are   not   satisfactory   as   per   the   requisite   standards   should   be
developed   and   executed   by   the   Insurer   at   any   stage   of   the   scheme   based   on   the

19
recommendations of the Authority provided after affording reasonable opportunity to be
heard to all concerned.
The benefit package rates for empanelled providers will be classified based on the quality
accreditation/certification   of   hospitals   as   recommended   by   the   Expert   Committee   on
revision of procedures and costing. Based on the quality certification, empanelled hospitals
will be classified into three (a) Normal rate for hospitals without any quality certification
(b)  a  Base   rate  i.e.  5%  incentive  for  the  hospitals  which   have  NABH/NQAS   entry­level
certification and (c) Accredited Rate i.e. 10% rate (from the base rates applicable to NABH
entry­level hospitals) for hospitals having NABH/NQAS full certification. The incentive will
apply only to the procedure cost of the package and not to other items like implant cost,
room charges, etc. The base package rates of MEDISEP would be the rates that apply to the
NABH entry­level hospital.
In   the   case   of   NABH   full   accreditation,   where   hospitals   get   a   10%   higher   rate   for
procedures,   the   additional   amount   from   the   base   price   has   to   be   borne   by   the
beneficiary.  To cite an example, the procedure cost for Laparoscopic Appendicectomy is
Rs.22,100 in a hospital without quality certification (Normal Rate) and the Rs.23,200 (Base
Rate) in a hospital with entry level quality certification and this will be the base package
rate.   In   both   these   cases,   the   procedure   charges   will   be   reimbursed   by   the   insurance
company. But in the third case, i.e. hospitals with full accreditation (Accredited Rates),
where  there   is  an  increase   of   10%  over  the  base  package  price,   (accredited   rate  being
Rs.25,500),   the  difference  of  Rs.2300   from  the  base   rate   will  have   to   be  borne  by   the
beneficiary.

17. PRE­AUTHORIZATION AND CLAIM SETTLEMENT

  The   insurer   should   establish   a   comprehensive   process   flow   and   mechanisms

regarding pre­authorization and claims settlement of procedures under the scheme. The
process   of   pre­authorization   should   be   done   electronically   through   e­preauthorization
mode. The insurer shall appoint enough number of medical auditors for scrutinizing the
said process. The pre­authorization must be done round the clock and the process would be
monitored   by   the   State   Nodal   Cell.   The   Insurer   shall   ensure   that   in   all   cases   pre­
authorisation request related decisions are communicated to the EHCP within 12 working

20
hours for all normal cases and within one working hour for emergencies. If there is no
response from the Insurer within 12 working hours of an EHCP filing the pre­authorisation
request,   the   request   of   the   EHCP   shall   be   deemed   to   be   automatically   authorised.   A
provision   for   emergency   intimation   and   approval   should   also   be   established   subject   to
proper approval later. In instance of dispute, the final decision on pre­authorization rest
with the Authority. 

18. ESTABLISHMENT OF 24*7 CALL CENTER

The insurer shall set up a 24 X 7, 365 days a year toll free helpline with online work
flow.   The   call   centre   should   be   set   up   in   Thiruvananthapuram   city   limits   and   shall   be
available   to   all   the   beneficiaries   for   taking   any   information/   clarification   regarding
enrolment, benefits available under the Scheme, exclusions, list of empanelled private as
well   as   government   hospitals,   process   to   be   followed   for   lodging   claim   with   Insurance
Company   or   with   State   Government   and   for   redressal   of   any   complaint   regarding
enrolment, treatment, exclusions, benefits etc. available under the Scheme. The complaint
will be redressed in a time bound manner.

19. DISPUTE RESOLUTION AND GRIEVANCE REDRESSAL:

If any dispute arises between the parties namely Insurer & beneficiary, Insurer &
empanelled hospital, beneficiary & empanelled hospital during the  the policy plan period
or   thereafter,  in  connection  with  the  validity,  interpretation,   implementation   or  alleged
breach of any provision of the scheme etc. it will be settled in the following way.

a. District Level Grievance Redressal Committee
A   Grievance   Redressal   committee   shall   be   set   up   in   each   District   for
redressing   of   grievance   of   beneficiaries/Network   provider   by   the   Insurer.   The
committee will constitute following members:
 i) District Collector / Representative (Convener)
                      ii) District Medical Officer

                     iii) Representative of insurer

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                      iv) Finance Officer of District Collectorate 

The Committee will resolve the Grievance within 30 days from the date of receiving
the   application.  The  aggrieved,  if  not  satisfied   with   the  decision  of  the  committee,  can
approach to the State Level Committee.

b. State Level Grievance Redressal Committee
 A State Level GRC consisting of the following members will be set up to examine the
grievances which could not be solved in the DGRC.
            i) Additional Secretary,  Finance Health Insurance Department (Convener)
           ii) Additional Secretary (Health & Family Welfare Department)
          iii) Additional Director of Health Services (Medical)
         iv) Representative of Insurer.
The Committee will resolve the Grievance within 30 days from the date of receiving
the   application.  The  aggrieved,  if  not  satisfied   with   the  decision  of  the  committee,  can
approach the Appellate Authority for arbitration.

c. Appellate Authority.
The appellate authority will consist of the following members.

         i) Additional Chief Secretary/Principal Secretary (Finance) (Convener)
        ii) Additional Chief Secretary/Principal Secretary (Health & Family Welfare)
       iii) Director of Health Services.
       iv) Director of Medical Education.
The decision of Appellate Authority will be final & binding to all the parties. In case
of disputes arising between the Government of Kerala and the Insurer, in respect of the
validity, interpretation, implementation or alleged breach of any provision of the scheme
etc, can directly be taken up with the appellate authority for resolution.
The   civil   courts   situated   in   Thiruvananthapuram,   Kerala   shall   have   exclusive
jurisdiction of any disputes which remain unresolved by any of the above procedure.

20. IDENTITY CARDS

Beneficiaries shall be identified by electronic " ID Card" issued by the Insurer/ TPA which

22
would   contain Unique Insurance Identification Number along with Permanent Employee
Number (PEN)/ Pension Payment Order Number (PPO) and all relevant details of MEDISEP
members. This card  would  be used  at  the Provider Network to  access health  insurance
benefits.

21. PROCESS MANUAL FOR SCHEME IMPLEMENTATION

The insurer will publish a detailed manual for the “MEDISEP" which shall include
operational   guidelines   and   details   of   the   scheme   in   consultation   with   Authority,   with
provision   to   update   and   modify   the   same.   The   insurer   shall   follow   the   guidelines   and
instructions   given   in   the   manual   while   implementing   the   scheme.   All   guidelines   and
relevant   information   regarding   MEDISEP   shall   be   also   made   available   on   the   official
website of the scheme.

22. CLAIM SETTLEMENT

The empanelled Hospital shall be reimbursed the cost of treatment as per agreed
MEDISEP package rates with hospitals. The Insurance Company shall settle the claims of
the empanelled hospitals within 15 working days of receipt of the complete documents
along with the discharge summary of the patient. The claim settlement progress will be
scrutinized and reviewed by the Authority. The Insurer shall decide on the acceptance or
rejection of any Claim received from an Empanelled Health Care Provider. In case of any
claim   is   found   untenable,   the   TPA/   Insurer   shall   communicate   reasons   to   the   Health
provider and Designated Authority of the State / Nodal Department for this purpose with a
copy to the beneficiary. The Empanelled Health Care Provider can send reconsideration
request to Insurance Company and if still not resolved Empanelled Health Care Provider
can approach relevant Grievance Redressal Committee against such decision to reject such
claim. All such claims shall be reviewed by the State Government on monthly  basis.

23. INFORMATION TECHNOLOGY PLATFORM

The insurer shall develop a dedicated information technology platform by means of
suitable web portal and data base & management information system for supporting the

23
implementation   of   MEDISEP   and   provide   real   time   access   to   State   Nodal   Cell   for
monitoring the scheme performance. The information technology platform is expected to
include the following parameters.

i. Database of beneficiaries.
ii. Database of Enrolment.
iii. Package details in the network hospitals.
iv.   e­   Health   database:   This   database   will   maintain   the   patient   details   along   with   the
diagnosis   and   treatment   details.   This   Database   will   also   be   linked   to   the   Enrolment
Database & Claims Transaction Database to form the Central Database.
v.   e­Preauthorization:   The   Hospital   will   require   a   Pre­Authorization   e­form   to   be   filled
before going in for the treatment.
vi.   Claim   processing   and   settlement   Data   Base:   The   claims   processing   database   should
include   claim   intimation,   scrutiny   of   claims   and   status   update   and   upon   verification,
settlement of claims.
vii. MIS Reporting: Real­time reporting on performance and monitoring indicators.
viii. Accounting system: Payment Reconciliation.
ix. Third Party Integration: This will include (a) Electronic clearance of bills with payment
gateway (b) SMS Gateway.
The   web   portal   for   MEDISEP   shall   provide   information   on   the   scheme   details,   List   of
empanelled and de­empanelled Hospitals, claims status, grievance redressal mechanisms,
and   other   relevant   information   about   the   scheme.   The   insurer   shall   be   responsible   for
ensuring the regular backup of data in collaboration with the State Nodal Cell.

The IT platform developed for the implementation of the scheme will be owned by the
Government of Kerala and at the shared information of beneficiaries and claims should be
used only for the said purpose. The insurer should strictly maintain the confidentiality of
any form of data or information shared by the Authority and protect information created,
disclosed or acquired in the context of the client and health service provider relationship.

24
24. PERFORMANCE MONITORING

The Insurer shall furnish a Fortnightly / Monthly / Quarterly / Annual report to the
Authority   with   heads   of   department   /   organization   wise   details   of   the   number   of
subscribers enrolled, number of claims received and the total amount disbursed ­ diseases,
treatments and surgeries­wise. Moreover, heads of department / organization wise monthly
report detailing the opening balance of number of employees of the month, additions and
deletions   during   the   month   shall   be   furnished.   Similarly,   heads   of   department   /
organization wise monthly report shall reveal the opening balance of number of Identity
Cards, number of Identity Cards issued during the month and balance yet to be issued.
Regarding the scheme performance, the insurer shall furnish details of preauthorization,
claims settlement, complaints redressal, claims ratio and any other parameters decided by
the government.

25. PENALTY CLAUSE

  Failure to abide by the terms of the Scheme as stipulated in the tender document
will attract penalty as may be determined by the Government of Kerala but not limited to
the following. The details and the modalities of the penalty will be part of the agreement
with the insurance company.

 Grievance Redressal: It is mandated that all orders of the grievance redressal committee
is carried out within 30 days unless stayed by the next higher level. Any failure to comply
with  the  direction  of  the Grievance Redressal Committee  at any  level will meet with   a
penalty   of   Rs.   25,000/­   per   decision   for   the   first   month   and   Rs.50,000/­   per   month
thereafter during which the decision remains un­complied. The amount shall be paid by the
insurance company to the Authority. 

Apart from the above, in the event of non­compliance of guidelines and agreement leading to
disruption of the project will attract a penalty subject to a maximum of 75% of estimated
annual project cost.

25
 ANNEXURE-1

List of Basic Benefit Package (Procedure charges excluding implants and room rent)

Base Rate
Normal Rate Hospital with Accreditation Rate
Hospital without Entry level Hospital With full
Sl. No.. Procedure Name
Quality Certification (5% NABH (10% than Base
Certification than Normal Rate)
Rate)

General Surgery
1 Excision of Ganglion - large 10,300 10,800 11,900
2 Excision of Ganglion - Small 10,600 11,100 12,200
3 Ganglion Sclerotherapy 2,000 2,100 2,300
4 Laproscopic-Lumbar Sympathectomy 26,200 27,500 30,300
5 Hemithyroidectomy 26,200 27,500 30,300
6 Laproscopic Hemi Thyroidectomy 28,900 30,400 33,400
7 Total Thyroidectomy 31,500 33,100 36,400
8 Laproscopic Total Thyroidectomy 29,400 30,900 34,000
9 Excision of Lingual Thyroid 30,900 32,400 35,700
10 Excision of Thyroglossal Cyst Fistula 30,900 32,400 35,700
11 Parathyroidectomy -Non Malignant 31,500 33,100 36,400
12 Resection Enucleation - Thyroid 26,800 28,100 31,000
13 Subtotal Thyroidectomy 29,200 30,700 33,700
14 Laproscopic Sub total Thyroidectomy 28,400 29,800 32,800
15 Laproscopic Thyroid Nodule Excision 28,400 29,800 32,800
16 Isthmectomy 25,500 26,800 29,500
17 Partial Thyroidectomy 25,400 26,700 29,400
18 Laproscopic Isthmectomy 29,300 30,700 33,800
Bilateral Adrenalectomy in
19
nonmalignant conditions 43,000 45,200 49,700
Unilateral Adrenelectopmy in
20
nonmalignant conditions 37,100 39,000 42,900
Laproscopic Right Hemi Colectomy in
21
non malignant conditions 40,300 42,300 46,500
22 Laproscopic Left Hemicolectomy 33,000 34,600 38,100
23 Excision of large growth from Tongue 20,600 21,600 23,800
24 Excision of Small growth from Tongue 17,400 18,200 20,100
25 Partial Glossectomy 28,500 29,900 32,900
26 Parotid Duct Repair 28,300 29,700 32,600
27 Excision of Salivary Gland 23,400 24,500 27,000
Removal Of Submandibular Salivary
28
Gland 25,700 27,000 29,700
29 Superficial Parotoidectomy (Non- 23,400 24,500 27,000

26
 malignant)
30 Wedge Excision of Lip 15,900 16,700 18,400
Wedge Excision of Lip &
31
Vermilionectomy(27.43) 19,200 20,200 22,200
32 Vermilionectomy 22,400 23,500 25,800
33 ABBE Operation 21,800 22,900 25,200
34 Excision of Branchial Cyst 25,500 26,800 29,500
35 Excision of Branchial Sinus 24,900 26,100 28,800
36 Excision and Ligation of Varicose Veins 25,600 26,900 29,600
37 Splenorenal Anastomosis 71,500 75,100 82,600
38 Warren Shunt for Portal Hypertension 71,200 74,800 82,200
39 Portocaval Anastomosis 81,800 85,900 94,500
40 Excision of Carotid Body Tumours 36,300 38,100 42,000
41 Hemangioma Scleotherapy 9,200 9,600 10,600
42 Lymph Node Biopsy 8,800 9,200 10,100
43 Axillary Lymph Node Dissection 28,400 29,800 32,800
44 Excision of Cystic Hygroma -Extensive 24,700 26,000 28,600
45 Excision of Cystic Hygroma -Major 25,500 26,800 29,500
46 Cystic Hygroma Excision - Minor 10,900 11,400 12,600
47 Splenectomy For Hypersplenism 42,100 44,200 48,600
Laproscopic Splenectomy - For other
48
Indications 55,600 58,400 64,200
49 Gastrostomy 21,200 22,300 24,500
50 Pyloromyotomy 32,100 33,700 37,100
Partial/Subtotal Gastrectomy with
51
anastomosis to Esophagus for ulcer 41,200 43,300 47,600
52 Highly Selective Vagotomy 27,100 28,500 31,300
53 Pyloroplasty & Vagotomy 50,100 52,600 57,900
54 Selective Vagotomy drainage 49,200 51,700 56,800
55 Operation for bleeding peptic ulcer 48,900 51,300 56,500
Surgical management For Haemorrhage
56
Of The Small Intestine 49,800 52,300 57,500
57 Gastrojejunostomy & Vagotomy 40,900 42,900 47,200
Surgical management of
58
Duodenalperforation 50,100 52,600 57,900
Laproscopic Surgical treatment
59
forDuodenal Perforation 48,900 51,300 56,500
60 Gastrostomy Closure 23,800 25,000 27,500
Resection & Anastomosis Of Small
61
Intestine(45.9) 50,100 52,600 57,900
Surgical treatment for Duodenal
62
Diverticulum 32,100 33,700 37,100
63 Excision of Meckel's Diverticulum 41,500 43,600 47,900
Surgical treatment for Acute Intestinal
64
obstrucion 50,100 52,600 57,900
65 Duodenectomy 40,200 42,200 46,400
Surgical treatment for Duplication Of
66
Intestines 50,400 52,900 58,200

27
67 Right Hemi Colectomy 40,300 42,300 46,500
68 Left Hemi Colectomy 40,900 42,900 47,200
Laproscopic colectomy (Total
69
Colectomy) 61,200 64,300 70,700
70 Total Colectomy 62,100 65,200 71,700
71 Colostomy 20,900 21,900 24,100
72 Ileostomy 20,900 21,900 24,100
73 Loop Colostomy Sigmoid 22,100 23,200 25,500
74 Illieo Sigmoidostomy 50,100 52,600 57,900
75 Ileostomy Closure 25,900 27,200 29,900
76 Colostomy Closure 25,900 27,200 29,900
Surgical treatment For Recurrent
77 Intestinal obstruction (Noble Plication
Other) 50,100 52,600 57,900
78 Cecopexy 31,800 33,400 36,700
Surgical treatment for Acute Intestinal
79
perforation 50,100 52,600 57,900
80 Excision Small Intestinal Fistula 51,500 54,100 59,500
81 Surgical treatment for Intususception 50,100 52,600 57,900
Surgical treatment for Mal-Rotation &
82
Volvulus Of The Midgut 50,100 52,600 57,900
Surgical treatment for Volvulus of Large
83
bowel 50,100 52,600 57,900
84 Laproscopic Appendicectomy 22,100 23,200 25,500
85 Open Appendicectomy 18,700 19,600 21,600
Surgical treatment for Appendicular
86
Perforation 27,700 29,000 31,900
Laproscopic Surgical treatment for
87
Appendicular Mass-Abscess 30,900 32,400 35,700
88 Excision of Prolapse of Rectal Mass 27,200 28,500 31,400
89 Anorectoplasty 28,200 29,600 32,500
90 Excision of Papilloma Rectum 21,200 22,200 24,400
91 Pull Through Abdominal Resection 52,100 54,700 60,200
92 Anterior Resection of Rectum 52,100 54,700 60,200
93 Fistulectomy 15,600 16,400 18,000
Rectopexy Open with Mesh for Rectal
94
Prolapse 41,800 43,900 48,300
Laproscopic Rectopexy With Mesh for
95
Rectal Prolapse 51,800 54,400 59,800
Rectopexy Open without Mesh for
96
Rectal Prolapse 31,800 33,400 36,700
97 Laproscopic Rectopexy With Repair 41,200 43,300 47,600
98 Drainage of Ischio Rectal Abscess 16,500 17,300 19,100
99 Fissurectomy 15,600 16,400 18,000
100 Lord's Procedure for Haemorrhoids 10,300 10,800 11,900
101 Haemorroidectomy 22,700 23,800 26,200
Haemorroidectomy+
102
Fistulectomy(49.12) 27,600 29,000 31,900
103 Excision of liver Abscess 32,100 33,700 37,100

28
 Surgical treatment For Hydatid cyst of
104
Liver 40,300 42,300 46,500
105 Cholecystostomy 31,800 33,300 36,700
106 Repair Of CBD 49,500 52,000 57,200
107 Cholecystectomy With CBD Exploration 41,800 43,900 48,300
Laproscopic Cholecystectomy With CBD
108
Exploration (51.41) 30,600 32,100 35,300
109 Cholecystectomy 25,300 26,600 29,200
110 Laproscopic Cholecystectomy 30,300 31,800 35,000
Laproscopic Cholecystectomy With
111
Gargrene 30,600 32,100 35,300
Laproscopic Cholecystectomy For
112
Calculus 30,600 32,100 35,300
Laproscopic Cholecystectomy With CBD
113
Repair 40,600 42,600 46,900
114 Pancreaticocystojejunostomy 51,800 54,400 59,800
115 Pancreaticocystogastrostomy 43,400 45,600 50,200
Herinoplasty without Mesh for Direct
116
Inguinal Hernia 20,900 21,900 24,100
Herinoplasty with Mesh Direct Inguinal
117
Hernia 25,900 27,200 29,900
Laproscopic Surgical treatment for
118
Unilateral Femoral Hernia With Mesh 30,600 32,100 35,300
Rare Hernias repair
119
(Spigalion,Obuturator,Sciatic) 21,500 22,600 24,800
Laproscopic Surgical treatment for
120
Unilateral Femoral Hernia Without Mesh 40,600 42,600 46,900
121 Unilateral Femoral Hernia repair 26,500 27,800 30,600
122 Umbilical Hernia repair with Mesh 31,500 33,100 36,400
Laproscopic Surgical treatment for -
123
Umbilical Hernia With Mesh 50,600 53,100 58,400
124 Umbilical Hernia repair without Mesh 26,500 27,800 30,600
Laproscopic Surgical treatment for
125
Incisional Hernia without Mesh 30,600 32,100 35,300
126 Epigastric Hernia repair without Mesh 26,500 27,800 30,600
Ventral And Scar Hernia repair without
127
Mesh 31,500 33,100 36,400
Laproscopic Surgical treatment for
128
Incisional Hernia with Mesh 40,600 42,600 46,900
Laproscopic Surgical treatment for
129
Epigastric Hernia repair with Mesh 50,600 53,100 58,400
130 Epigastric Hernia repair with Mesh 41,500 43,600 47,900
Ventral And Scar Hernia repair with
131
Mesh 41,500 43,600 47,900
Laproscopic Surgical treatment for
132
Hiatus Hernia With Mesh 50,600 53,100 58,400
133 Hiatus Hernia Repair - Abdominal 49,800 52,300 57,500
134 Drainage of Perigastric Abscess 37,200 39,100 43,000
135 Drainage of Subdiaphragmatic Abscess 31,700 33,200 36,600
136 Open Drainage of Pelvic Abscess 30,100 31,600 34,700
137 Laproscopic Surgical treatment for Intra 35,600 37,400 41,100

29
 Abdominal Abscess
138 Excision of Umbillical Sinus 18,200 19,100 21,000
139 Excision of Mesenteric Cyst 33,700 35,300 38,900
Surgical treatment for Minor Abdominal
140
Injuries 21,500 22,600 24,800
Surgical treatment for Major Abdominal
141
Injuries 52,100 54,700 60,200
142 Surgical treatment for Burst Abdomen 51,500 54,100 59,500
Treatment with Self Expanding Metalic
143
Stent (SEMS) 21,000 22,100 24,300
Surgical treatment for Unilateral
144
Hydrocoele 18,400 19,300 21,300
Surgical treatment for Bilateral
145
Hydrocoele 20,100 21,100 23,300
Surgical treatment for Fourniers
146
Gangrene 34,200 35,900 39,500
147 Surgical treatment for Filarial Scrotum 27,100 28,500 31,300
148 Excision of multiple Scrotal swellings 9,100 9,600 10,500
149 Evacuation of Scrotal Hematoma 20,700 21,700 23,900
150 Excision of multiple Scrotal Cysts 8,600 9,000 9,900
151 Orchidectomy -Unilateral 23,500 24,700 27,100
152 Orchidectomy + Herniorraphy(53.00) 31,500 33,100 36,400
153 Orchidopexy with Eversion of Sac 27,100 28,500 31,300
154 Laproscopic Excision of Varicocele Cyst 41,200 43,300 47,600
155 Excision of Epididymal Cyst 16,200 17,000 18,700
156 Epididectomy 15,900 16,700 18,400
157 Circumcision 8,500 8,900 9,800
Dorsal Slit and Reduction of
158
Paraphimosis 9,400 9,900 10,900
Rectovaginal fistula Management
159
without Colostomy 40,900 42,900 47,200
160 Hemimandibulectomy 45,800 48,100 52,900
161 Segmental Mandible Excision 37,100 39,000 42,900
Surgical treatment for Infected Bunion
162
Foot 4,800 5,000 5,500
163 Excision of Cervical Rib 28,400 29,800 32,800
164 Drainage of Psoas Abscess 19,500 20,400 22,500
165 Excision of Mammary Fistula 16,100 16,900 18,600
166 Wide Excision of Mammary Fistula 14,000 14,700 16,200
167 Excision of Bilateral Fibroadenoma 15,600 16,400 18,000
168 Excision of Unilateral Fibroadenoma 10,300 10,800 11,900
169 Unilateral Lumpectomy 10,600 11,100 12,200
170 Bilateral Lumpectomy 15,900 16,700 18,400
171 Breast Conservation Surgery 16,200 17,000 18,700
172 Segmental Resection of Breast 15,800 16,500 18,200
173 Simple Mastectomy (Non Malignant) 32,100 33,700 37,100
Surgical repair of bilateral
174
Gynaecomastia 12,700 13,300 14,700
175 I & D of Breast Abscess 9,200 9,700 10,700

30
176 Drainage of large Abscess 20,100 21,100 23,200
177 Paronychia Drainage 6,800 7,200 7,900
178 Excision of swelling Neck 11,400 12,000 13,200
179 Excision of Granuloma 10,500 11,000 12,100
180 Surgical treatment for Carbuncle back 30,500 32,000 35,200
181 Excision of Sebaceous Cyst 9,300 9,700 10,700
182 Excision of Keloid 28,000 29,400 32,300
183 Excision of Pyogenic Granuloma 8,300 8,700 9,600
184 Excision of Large Corn 5,700 6,000 6,600
185 Excision of Large Swelling in Hand 15,700 16,500 18,200
186 Excision of Small Swelling in Hand 11,100 11,600 12,800
187 Excision of Fibro Lipoma 9,300 9,700 10,700
188 Excision of Fibroma 9,200 9,600 10,600
189 Excision of Sinus 18,100 19,000 20,800
190 Excision of Large Dermoid Cyst 11,300 11,800 13,000
191 Excision of Small Dermoid Cyst 7,200 7,600 8,400
192 Wide Local Excision (Non - malignant) 36,600 38,400 42,200
193 Foreign Body Removal in Deep Region 30,700 32,300 35,500
194 Skin Grafting 18,400 19,300 21,300
195 Excision of Pilonidal Sinus 19,300 20,200 22,200
196 Surgical treatment for Ingrowing Nail 7,000 7,300 8,000
197 Surgical treatment for Cut Throat Injury 35,400 37,100 40,900
ENT Surgery
198 Facial Nerve Decompression 20,600 21,600 23,800
199 Endoscopic Surgery for Dacrocystitis 10,500 11,000 12,100
200 Surgical treatment for Preauricular sinus 18,600 19,500 21,400
201 Cryosurgery 11,300 11,800 13,000
Partial amputation of Pinna (malignancy
202
perichondritis) 19,500 20,500 22,500
203 Myringoplasty 16,600 17,400 19,100
204 Myringoplasty with ossiculoplasty (19.3) 17,300 18,200 20,000
205 Tympanoplasty 17,400 18,300 20,100
206 Stapedectomy - Veingraft 18,900 19,800 21,800
207 Myringotomy with grommet for one ear 10,300 10,800 11,900
Myrinogotomy with-grommet for both
208
ears 15,600 16,400 18,000
209 Mastoidectomy 18,600 19,500 21,500
210 Aural polypectomy 17,400 18,300 20,100
211 Labyrinthectomy 20,000 21,000 23,100
212 lateral Rhinotomy 15,600 16,400 18,000
213 Excision of Benign tumours of Nose 17,400 18,300 20,100
214 Surgery for Angiofibroma 42,100 44,200 48,600
215 Septo rhinoplasty 19,100 20,000 22,000
216 Youngs operation 14,600 15,300 16,900
217 Surgical treatment for Choanal atresia 15,000 15,800 17,300
218 Endoscopic Sinus Surgery 18,300 19,200 21,100

31
219 Caldwell-luc(unilateral) 18,200 19,100 21,000
220 Surgical treatment for Oro antral fistula 15,000 15,800 17,300
Surgical treatment for release of tongue
221
tie 10,000 10,500 11,500
222 Excision of Benign Parotid gland tumor 20,600 21,600 23,800
223 Drainage Parapharyngeal abscess 10,300 10,800 11,900
224 Uvulo ¿ Palato - Pharyngoplasty 26,200 27,500 30,200
Surgical treatment for Pararetro
225
pharyngeal abscess 10,000 10,500 11,500
226 Adeno tonsillectomy 12,000 12,600 13,900
227 Adenoidectomy Gromet insertion 12,100 12,700 14,000
228 Exision of Tumors In Pharynx 20,900 21,900 24,100
229 Exision of Parapharyngeal Tumour 21,500 22,600 24,800
Laryngectomy in nonmalignant
230
conditions 43,000 45,100 49,700
231 Phono Surgery For Vocal Cord Paralysis 27,400 28,800 31,600
232 Laryngo Fissurectomy 27,300 28,700 31,600
233 Microlaryngeal Surgery 19,400 20,400 22,500
Surgical treatment for Laryngotracheal
234
stenosis 20,900 21,900 24,100
235 Bilateral Styloidectomy 15,900 16,700 18,400
236 Temporal Bone Excision 52,100 54,700 60,200
237 Exision of Maxilla 39,500 41,500 45,600
238 Removal of Impacted Ear wax 9,700 10,200 11,200
239 Rhinorrhoea- repair 25,600 26,900 29,600
240 CSF rhinorrhoea - Endoscopic repair 25,600 26,900 29,600
Bronchoscopy Foreign Body Removal
241
from Oesophagus 10,600 11,100 12,200
242 Removal of foreign body in Ear 10,600 11,100 12,200
Bronchoscopy Foreign Body Removal
243
from Bronchous 24,600 25,800 28,400
OPTHALMOLOGY
Decompression/Excision Of Optic Nerve
244
Lesions 78,900 82,800 91,100
245 Surgical treatment for Ankyloblepharon 14,400 15,100 16,600
246 Drainage of Lid Abscess 9,500 9,900 10,900
Surgical treatment for disorders of
247
Eyelid 11,000 11,600 12,700
248 Exision of Small tumour of lid 10,700 11,300 12,400
249 Surgical correction of Ptosis 30,600 32,100 35,300
250 Ectropion correction 17,700 18,600 20,400
251 Entropion correction 15,300 16,100 17,700
252 Lid Reconstruction surgery 10,400 10,900 12,000

253 Lagophthalmos correction

13,200 13,900 15,300
254 Epicanthus repair 7,100 7,500 8,200
255 Surgery for Congenital dacrocystitis 10,800 11,400 12,500
256 Dacrocystectomy 8,100 8,500 9,400

32
257 Congenital NLD probing 11,000 11,600 12,700
258 External Dacryocysto rhinostomy 15,000 15,700 17,300
Canaliculo/conjuctivo Dacryocysto
259
rhinostomy 13,400 14,100 15,500
260 Fornix forming sutures 11,300 11,900 13,000
261 Surgical treatment for Symblepharon 4,800 5,000 5,500
262 Corneal Patch Graft 17,700 18,600 20,500
263 Pterygium repair 7,600 8,000 8,800
264 Pterigium + conjunctival autograft 12,100 12,700 14,000
265 Double Z-Plasty 4,300 4,500 5,000
266 Lamellar Keratoplasty 22,800 23,900 26,300
267 Penetrating Keratoplasty 18,700 19,600 21,500
268 Therapeutic Penetrating Keratoplasty 19,800 20,800 22,900
269 Amniotic Membrane Graft for Cornea 11,900 12,500 13,700
270 Intraocular foreign body removal 33,700 35,400 39,000
271 Iridectomy-Iridotomy 7,900 8,300 9,100
Surgical treatment for Other disorders of
272
iris and ciliary body 7,300 7,700 8,400
273 Surgical treatment for Iris prolapse 7,300 7,700 8,400
274 Exision of tumours of iris 21,300 22,400 24,600
275 Glaucoma Surgery 9,100 9,500 10,500
276 Cyclocryotherapy 12,700 13,300 14,600
Glaucoma Filtering Surgery For
277
Paediatric Glaucoma 10,200 10,700 11,800
278 Surgical treatment for Scleral wound 11,300 11,900 13,100
Surgical treatment for Perforating scleral
279
injury 23,400 24,500 27,000
280 Scleral Patch Graft 21,500 22,600 24,900
281 Amniotic Membrane Graft for Sclera 18,200 19,100 21,100
282 Removal of blood clot 7,500 7,900 8,700
283 Anterior chamber reconstruction 8,600 9,000 9,900
Bandage contact lens with glue
284
application 7,100 7,400 8,200
285 Cataract surgery phacoemulsification 20,000 21,000 23,100
286 Lensectomy 12,800 13,500 14,800
287 Posterior capsulotomy/polishing 11,700 12,300 13,500
288 Yag laser capsulotomy 8,200 8,600 9,500
Cataract surgery phacoemulsification
289
+IOL 22,500 23,600 25,900
Cataract surgery SICS +
290
IOL(ECCE+IOL) 15,300 16,100 17,700
Paediatric Cataract Surgery
291
(Phacoemulsification IOL) 19,200 20,100 22,100
Secondary IOL-scleral fixation-sulcus
292
fixation of lens ACIOL 22,600 23,700 26,100
293 Scleral buckle procedure for Retinal 30,500 32,000 35,200
294 Photocoagulation for Retinopathy 2,000 2,100 2,300
Photocoagulation For Retinopathy Of
295
Prematurity 10,300 10,800 11,900

33
296 Cryoretinopexy - closed 13,200 13,800 15,200
297 Cryoretinopexy - open 11,900 12,500 13,700
Vitrectomy - Membrane Peeling-
298
Endolaser 21,400 22,400 24,700
299 Vitrectomy 24,200 25,400 28,000
Vitrectomy Plus Silicon Oil Or Gas
300
-14.75 24,800 26,100 28,700
Vitrectomy -Membrane peeling -
301 Endolaser _Silicon oil or Gas - with or
without belt bulking 32,400 34,000 37,400
Monthly Intravitreal Anti-Vegf
302 ForMacular Degeneration - Per Injection
(Maximum - 6) 16,400 17,200 18,900
Removal Of Silicon Oil Or Gas post
303
Vitrectomy 10,600 11,200 12,300
304 Rectus Muscle Surgery(Single) 8,500 8,900 9,800
305 Oblique muscle surgery 8,300 8,700 9,600
306 Rectus Muscle Surgery(Twohree) 11,300 11,900 13,000
307 Orbitotomy 27,400 28,800 31,600
Evisceration /Enucleation with Orbital
308
implant 16,100 16,900 18,600
309 Exenteration of Orbit 13,500 14,200 15,600
310 Dermis Fat Graft 24,100 25,300 27,800
311 Socket Reconstruction 26,700 28,100 30,900
312 Endoscopic orbital decompression 9,100 9,500 10,500
Excision of Benign neoplasm of Eye and
313
Adnexa 10,000 10,500 11,600
314 Surgical Management of Proptosis 60,900 63,900 70,300
315 Dermoid cyst excision 14,500 15,200 16,800
Gynecology and Obstretrics
PPH-Conservative Surgical
316
management 33,100 34,800 38,200
317 Surgical management of pelvic abscess 28,200 29,700 32,600
318 Laparoscopic Adhesiolysis 31,800 33,400 36,700
319 Purandares Sling operations - Open 26,100 27,400 30,100
320 Laparoscopic Sling Operations 33,100 34,800 38,200
Surgical Management of Ovarian
321
Tumours 33,300 34,900 38,400
322 Ovarian cystectomy 33,300 34,900 38,400
323 Laparoscopic Cystectomy 25,500 26,800 29,500
Surgical Management of Tubal Ovarian
324
mass 30,000 31,500 34,700
325 Laparoscopic Ectopic Resection 22,700 23,900 26,300
326 Laparoscopic Recanalisation 33,600 35,300 38,800
327 Encirclage 11,300 11,800 13,000
328 Cryo Surgery 3,100 3,200 3,600
329 Surgical Management of Cervical Tears 11,600 12,200 13,400
330 Hysterectomy - abdominal 25,400 26,700 29,400
331 Vaginal Hysterectomy 26,200 27,500 30,300

34
 Vaginal Hysterectomy With Pelvic Floor
332
Repair(70.79) 31,800 33,400 36,700
333 Hysteroscopic septal resection 17,500 18,400 20,200
334 Ablation of Endometrium 11,300 11,800 13,000
335 Laparoscopic Myomectomy 30,600 32,100 35,300
Hysteroscopic submucus fibroid
336
resection 15,300 16,100 17,700
337 Myomectomy 27,600 29,000 31,900
338 Polypectomy 13,100 13,700 15,100
339 Laproscopic Vaginal Hysterectomy 30,600 32,100 35,300
340 D&C (Dilatation & Curettage) 6,300 6,600 7,300
Surgical Management of Endometriosis
341
- Excision of Chocolate Cyst 23,600 24,800 27,300
Incomplete Abortion + inevitable
342
abortion Management 9,200 9,600 10,600
Surgical Management of Missed
343
abortion 9,900 10,400 11,400
344 Surgical Management of Septic Abortion 11,400 12,000 13,200
Surgical Management of Vesicular
345
moles (Benign GTD) D & C 14,900 15,600 17,200
Manchesters Operation + Cervical
346
amputation(67.4) 25,600 26,900 29,600
347 Intra Uterine Insemination 10,000 10,500 11,600
Repair of Cystocele ,Rectocele
348
&Perineorraphy (71.71) 20,900 21,900 24,100
Haemato Colpo Surgical management
349
or Hymenectomy 15,600 16,400 18,000
Surgical Management of Cystocoele -
350
Repair 14,800 15,600 17,100
351 Mc Indoe's operation For Vaginal Atresia 42,000 44,100 48,500
352 Surgical Management of Vaginal Tear 13,600 14,300 15,700
353 Abdominal Repair for Vault Prolapse 36,200 38,000 41,800
Laproscopic Sacrospinocolpopexy for
354
vault prolapse 45,900 48,200 53,000
Abdominal Repair With Mesh for Vault
355
Prolapse 41,200 43,300 47,600
356 Vulvectomy for tumors 22,700 23,800 26,200
Surgical Treatment for Vulval
357
Heamatoma 14,100 14,800 16,300
Surgery for Bartholin
358
cyst(Marsupilasation,cyst removal) 10,300 10,800 11,900
359 Instrumental Vaginal Delivery 15,500 16,300 17,900
360 Normal Vaginal Delivery 15,100 15,900 17,500
Normal Vaginal Delivery with Epidural
361
Anesthesia 20,600 21,600 23,800
Normal Vaginal Delivery In Rh-Negative
362
Mother With Rh-Positive Baby 18,600 19,500 21,500
Normal Vaginal Delivery in
363
Twins(Multiple pregnency) 16,400 17,200 19,000
364 Normal Vaginal Delivery HIV +ve Mother 22,100 23,200 25,500
365 Caesarean Section 15,600 16,400 18,000

35
 Caesarean Section In Rh-Negative
366
Mother With Rh-Positive Baby 17,400 18,300 20,100
Caesarean Section in Twins(Multiple
367
pregnency) 17,400 18,300 20,100
368 Cesarean Section in HIV+ve Mother 21,200 22,300 24,500
Surgical Management of Ectopic
369
pregnancy 21,800 22,900 25,200
Caesarean Hysterectomy with Bladder
370
Repair 49,200 51,600 56,800
Surgery for Rupture Uterus with
371
Tubectomy 33,700 35,400 38,900
Surgical Management of Abruptio-
372
Placenta with Coagulation Defects(Dic) 27,700 29,100 32,000
Obstetric Hysterectomy
373 (AtonicPPH,Traumatic PPH , Rupture-
RuptureUterus,Abnormal Placentation) 32,300 33,900 37,300
First Trimester Medically Induced
374
Abortion 4,400 4,600 5,000
Termination of pregnancies for foetal
375
anamolies + IUD 9,200 9,700 10,600
Retained Placenta with Manual
376
Removal 30,900 32,500 35,700
377 Complete perineal tear repair 19,400 20,400 22,400
Management of Eclampsia with
378 Complications Requiring Ventilatory
Support 41,200 43,300 47,600
LNG-IUS (Levonorgestrene Intautrine
379
system) 14,000 14,700 16,200
380 Intra abdominal IUCD retrival - Open 21,200 22,300 24,500
381 Intra abdominal IUCD retrival - Lap 25,600 26,900 29,600
382 Hysteroscopic FB removal 10,600 11,100 12,200
383 Medical Management of PPH 11,400 11,900 13,100
Medical Management of Haemorragic
384
shock in pregnancy 37,900 39,800 43,800
385 Medical Management of Fibroids 8,900 9,300 10,300
Medical Management of Polycystic
386
Ovarian Syndrome 11,600 12,200 13,400
Medical Management of Pelvic
387
Inflammatory Disease 8,900 9,300 10,300
388 Medical Management of Endometriosis 8,000 8,400 9,200
389 Medical Management of DUB 11,200 11,800 12,900
Heart disease complicating pregnancy
390
Management 22,100 23,200 25,500
391 Pre- eclampsia / PIH Management 42,400 44,500 48,900
HELLP Syndrome Management in
392
pregnancy 22,100 23,200 25,500
Eclampsia Management without
393
ventilator support 32,400 34,000 37,400
394 Hyperemisis Gravidarum Management 9,200 9,600 10,600
Diabetes complicating pregnancy
395
Management 22,100 23,200 25,500
Hepatic Disorder Management in
396
pregnancy 22,100 23,200 25,500

36
 Moderate Anaemia Management in
397
pregnancy 12,300 12,900 14,200
Severe Anemia Management in
398
pregnancy 25,900 27,200 29,900
Intra Uterine Growth Retardation
399
Management 23,000 24,200 26,600
400 Acute Poly Hydramnios Management 21,500 22,600 24,800
Placenta Previa-type III to IV
401
Management 21,200 22,300 24,500
ORTHOPEDIC SURGERY AND PROCEDURES
Surgery for Brachial Plexus & Cervical
402
Rib 46,300 48,600 53,400
403 Neurolysis / Nerve Suture 26,500 27,800 30,600
404 Obturatorneurectomy 20,600 21,600 23,800
405 Nerve Repair With Grafting 43,100 45,300 49,800
406 Sequestrectomy&Saucerizations 40,700 42,700 47,000
407 Sequestrectomy& bone grafting 40,800 42,900 47,100
408 Excision of Accessory bone 21,500 22,600 24,800
Bone tumor surgery reconstruction with
409
internal fixation(78.59) 50,400 52,900 58,200
Long bone osteotomy with POP
410
application & k-wires 31,800 33,400 36,700
Long bone osteotomy with internal
411
fixation 31,500 33,100 36,400
412 Costo Transversectomy(77.39) 41,600 43,700 48,100
413 Corrective osteotomy Acetabulum 42,400 44,500 49,000
414 High tibial osteotomy 33,400 35,100 38,600
Anterolateral Clearance For
415
Tuberculosis 61,500 64,600 71,000
Excision of deep Bone Tumours and Re-
416 Construction With Conventional
Prosthesis 51,800 54,400 59,800
Bone tumor curettage and bone
417
graft(78.00) 31,500 33,100 36,400
418 Bone tumor curettage 25,300 26,600 29,300
419 Bone curettage and bone cement(84.56) 31,500 33,100 36,400
Surgical Management of Exostosis of
420
small joints 23,500 24,700 27,100
Surgical Management of Exostosis of
421
long bones 28,900 30,300 33,400
422 Excision of Fracture fragment 87,000 91,400 1,00,500
423 Excision of Scaphoid 23,900 25,100 27,600
424 Excision of Radial head 24,500 25,700 28,300
425 Excision of Lower end Ulna 24,500 25,700 28,300
Excision Or Other Operations For
426
Scaphoid Fractures 16,500 17,300 19,100
Spinal Ostectomy And Internal
427
Fixations(78.59) 49,400 51,900 57,100
428 Excision of Patella 17,200 18,100 19,900
429 Bone Grafting As Exclusive Procedure 20,900 21,900 24,100
430 Phemister grafting 27,500 28,900 31,800

37
431 Limb lengthening 43,000 45,200 49,700
432 Neglected CTEV. Jess Fixator 37,800 39,700 43,700
433 Tension band wirings 26,200 27,500 30,300
Cancecllous screw/pins fixations for
434
fracture neck of Femur 37,100 39,000 42,900
435 Clavicle surgery 25,900 27,200 29,900
Internal fixation lateral epicondyle for
436
non union Humerus 28,000 29,400 32,300
437 Reconstruction around Radial head 33,800 35,500 39,000
438 Removal of implants plates and nail 16,200 17,000 18,700
439 Removal of implants wires and screws 15,600 16,400 18,000
Surgery for Avascular Necrosis Of
440
Femoral Head (Core Decompression) 30,800 32,300 35,600
Reduction Of Compound Fractures &
441
External Fixation(78.10) 26,500 27,800 30,600
Closed reduction with percutaneous k-
442
wire fixation(78.10) 16,300 17,100 18,800
Closed reduction with percutaneous
443
screw fixation(78.10) 17,600 18,500 20,300
Open reduction & Internal Fixation Of
444
Fingers & Toes 16,400 17,200 18,900
445 Open reduction of Deep dislocations 32,400 34,000 37,400
446 Closed reduction of Shoulder dislocation 8,100 8,500 9,400
447 Closed reduction of Elbow dislocation 8,400 8,800 9,700
448 Closed reduction of Wrist dislocation 8,100 8,500 9,400
Closed reduction of fingers small joint
449
dislocation 8,100 8,500 9,400
450 Closed reduction of Hip dislocation 8,100 8,500 9,400
451 Closed reduction of Knee dislocation 8,400 8,800 9,700
452 Closed reduction of Ankle dislocation 8,400 8,800 9,700
Acromioclavicular joint dislocation open
453
reconstruction 26,700 28,000 30,800
454 Arthrotomy and joint lavage 37,100 39,000 42,900
455 Diagnostic Arthroscopy 24,900 26,100 28,800
456 Arthroscopy . Operative Meniscectomy 25,900 27,200 29,900
457 Subacromial decompression 31,500 33,100 36,400
458 Release of Stiff Elbow 31,500 33,100 36,400
459 Synovectomy 37,100 39,000 42,900
Surgical management
460
Dequerenstenosynovities 6,500 6,800 7,500
Mossmiami instrumentation for vertebral
461
fractures 51,900 54,500 59,900
462 Arthrodesis of foot Small joints 15,300 16,100 17,700
463 Congenital ankle deformity correction 54,200 56,900 62,600
464 Arthrodesis of major joints 30,300 31,800 35,000
465 Flexion construction of hip release 41,500 43,600 47,900
Scoliosis and kyphosis
466
correction(81.05+33.4) 97,100 1,02,000 1,12,200
467 Excision arthroplasty(81.8) 31,500 33,100 36,400

38
468 Shoulder replacement 41,200 43,300 47,600
469 Ankle arthrodesis 37,100 39,000 42,900
470 Triple arthrodesis 36,800 38,600 42,500
471 Subtalar arthrodesis 37,400 39,300 43,200
472 Arthrodesis of Hip 37,100 39,000 42,900
473 Arthrodesis of Knee 36,800 38,600 42,500
474 Arthrodesis of Shoulder 37,400 39,300 43,200
475 Arthrodesis of Elbow 36,800 38,600 42,500
Arthrodesis of hand Small
476
joint(81.27/81.28) 15,600 16,400 18,000
477 Arthrodesis of Wrist 36,800 38,600 42,500
478 Release of Stiff knee 36,800 38,600 42,500
Anterior cruciate ligamentl
479
reconstruction 26,500 27,800 30,600
Posterior cruciate ligament
480
reconstruction 26,500 27,800 30,600
Bipolar hemiarthroplastyof Hip without
481
cement 40,400 42,400 46,700
482 Hemiarthroplasty of Hip uncemented 36,200 38,000 41,800
Bipolar hemiarthroplasty of Hip with
483
cement 44,400 46,600 51,300
484 Hemiarthroplasty of Hip cemented 36,800 38,700 42,500
Reconstruction procedure for recurrent
485
dislocation shoulder 31,200 32,800 36,000
486 Arthroplasty of Shoulder 42,400 44,500 49,000
487 Elbow replacement 41,500 43,600 47,900
Joint reconstruction/intraarticular
488
fractures 36,800 38,600 42,500
489 Trigger Finger release 6,500 6,800 7,500
490 Dupuytrens contracture release 21,200 22,300 24,500
491 Tendon transfer procedure for claw hand 33,800 35,500 39,000
492 Maxpage release for Volkmann 31,500 33,100 36,400
Synovial cyst excision/ganglion/Bakers
493
Cyst 20,100 21,100 23,200
494 Excision of Retrocalcaneal bursa 15,900 16,700 18,400
495 Adductor release 15,900 16,700 18,400
496 Tenotomy 16,500 17,300 19,100
497 Fasciotomy 21,500 22,600 24,800
498 Fasciotomy with skin graft 25,900 27,200 29,900
499 Rotator cuff repair 31,200 32,800 36,000
500 Tendon transfer procedure around ankle 34,100 35,800 39,400
501 Tendon transfer with graft 33,200 34,900 38,300
502 CTEV correction 50,900 53,400 58,800
503 Hamstrings release 16,500 17,300 19,100
504 Quadricepsplasty 37,100 39,000 42,900
505 Tricepsplasty 32,100 33,700 37,100
506 Fasciotomy with skin graft with fixator 42,700 44,800 49,300
507 Drainage of cold abscess 31,200 32,800 36,000

39
508 Drainage of acute osteomyelitis 29,500 31,000 34,100
509 Fingers amputations 10,600 11,100 12,200
510 Disarticulation at wrist level 24,500 25,700 28,300
511 Orif-long bones with locking plates 36,200 38,000 41,800
512 Below Elbow amputations 24,500 25,700 28,300
513 Disarticulation at elbow level 25,900 27,200 29,900
514 Above Elbow amputations 26,800 28,100 31,000
515 Disarticulation at Shoulder level 41,500 43,600 47,900
516 Amputations - Forequarter 39,500 41,400 45,600
517 Disarticulations at small joints Foot 10,000 10,500 11,600
518 Disarticulation at ankle level 26,200 27,500 30,300
519 Below Knee amputations 28,700 30,100 33,100
520 Disarticulations at knee level 27,000 28,400 31,200
521 Above Knee amputations 28,800 30,200 33,300
522 Disarticulation at Hip level 42,100 44,200 48,600
Amputations - Hind Quarter And
523
Hemipelvectomy 52,100 54,700 60,200
524 Limb reconstruction system(lrs) 40,400 42,400 46,700
525 Ilizarov Ring Fixator Application 46,400 48,700 53,600
526 Ilizarov fixator with joint arthrolysis 52,100 54,700 60,200
527 Excision of Sinus over Sacrum 16,300 17,100 18,800
Soft Tissue Reconstruction Procedures
528
For Joints/Osteotomy 31,500 33,100 36,400
529 CDH soft tissue reconstruction 36,500 38,300 42,200
530 Hip spica 8,600 9,000 9,900
Cervical spine injury(skull traction)
531
treatment 21,500 22,600 24,800
532 Application of skeletal traction 6,300 6,600 7,300
533 Application of skin traction 4,500 4,700 5,200
534 Application of functional cast brace 2,500 2,600 2,900
535 U-slab application 7,100 7,500 8,200
536 Synthetic cast application above Elbow 5,000 5,300 5,800
537 Synthetic cast application below Elbow 5,600 5,800 6,400
538 Synthetic cast application above Knee 6,500 6,800 7,500
539 Synthetic cast application below Knee 5,000 5,300 5,800
540 Synthetic cast cutting 500 500 600
541 POP application above Elbow 4,300 4,500 5,000
542 POP application below Elbow 3,300 3,500 3,800
543 POP application above Knee 5,300 5,600 6,100
544 POP application below Knee 4,300 4,500 5,000
Bandages and strapping procedures for
545
fractures 6,800 7,100 7,900
SURGICAL GASTROENTEROLOGY
546 Surgery For Portal Hypertension Bleed 1,02,100 1,07,200 1,17,900
547 Splenectomy 36,500 38,300 42,200
Splenectomy + Devascularisation
548
+Spleno Renal Shunt(39.1) 79,300 83,200 91,500

40
 Spleenectomy For Space Occupying
549
Lesion 42,300 44,400 48,800
550 Open Hellers Myotomy 81,200 85,300 93,800
551 Laproscopic Hellers Myotomy 29,600 31,100 34,200
Surgery For Oesophageal Perforation
552 Stage 1 Cervical Exclusion And Chest
Tube And Feeding Jejunostomy 1,26,800 1,33,100 1,46,500
Surgery For Oesophageal Perforation
553
Stage 2 Definitive Surgery 1,02,400 1,07,500 1,18,300
Surgery For Oesophageal Perforation
554 -Single Staged Foreign Body, Iatrogenic
& Spontaneous 1,02,400 1,07,500 1,18,300
555 Oesophagectomy 91,200 95,800 1,05,300
556 Colonic Pull Up 61,500 64,600 71,000
557 Surgery for Corrosive Injury Stomach 61,200 64,300 70,700
Partial Gastrectomy with anastomosis to
558
esophagus 41,200 43,300 47,600
Partial Gastrectomy with anastomosis to
559
duodenum 41,200 43,300 47,600
Distal Gastrectomy For Gastric Outlet
560
Obstruction 41,200 43,300 47,600
Partial/Subtotal Gastrectomy with
561
anastomosis to jejunum For Ulcer 33,200 34,800 38,300
562 Total Gastrectomy 41,800 43,900 48,300
563 Oesophago-Gastrectomy 91,200 95,800 1,05,300
Truncal Vagotomy + Gastro
564
Jejunostomy(44.3) 48,900 51,300 56,500
565 Surgery For Bleeding Ulcers 48,900 51,300 56,500
566 Surgery For Obscure Gi Bleed 72,900 76,500 84,200
Gastro Jejuno-Colic Fistula Surgical
567
Management 62,100 65,200 71,700
568 Lap Fundoplications 54,300 57,000 62,700
569 Extended Right Hemicolectomy 48,300 50,700 55,800
I Stage-Sub Total Colectomy +
570
Ileostomy(46.2) 60,300 63,300 69,600
I Stage- Sub Total Colectomy +
571
Ileostomy + J - Pouch 96,300 1,01,100 1,11,200
572 II Stage-J - Pouch 50,300 52,800 58,100
573 II Stage- Ileostomy Closure 25,900 27,200 29,900
574 III Stage-Ileostomy Closure 26,800 28,100 31,000
575 Surgical management of Volvulus 49,200 51,700 56,800
576 Surgical management of Malrotation 49,200 51,700 56,800
577 Abdomino Perineal Resection of rectum 53,100 55,700 61,300
578 Hartman.S Procedure With Colostomy 54,300 57,000 62,700
579 Anterior Resection of Large Intestine 40,900 42,900 47,200
580 Anterior Resection With Ileostomy 60,300 63,300 69,600
581 Anal Sphincter Repair -With Colostomy 35,100 36,800 40,500
Anal Sphincter Repair -Without
582
Colostomy 32,500 34,100 37,600
583 Rt.Hepatectomy 86,900 91,200 1,00,300

41
584 Lt.Hepatectomy 90,300 94,800 1,04,300
585 Hepatectomy For Cholangiocarcinoma 1,51,800 1,59,400 1,75,300
586 Hydatid Cyst-Marsupilisation 40,300 42,300 46,500
Haemangioma Sol Liver Hepatectomy +
587
Wedge Resection 90,300 94,800 1,04,300
Hepato Cellular Carcinoma(Advanced)
588
Radio Frequency Ablation 72,300 75,900 83,500
589 Segmentectomy 60,300 63,300 69,600
Radical Extended Cholecystectomy For
590
Ca Gall Bladder 1,02,400 1,07,500 1,18,300
Cyst Excision+Hepatic
591
Jejunostomy(51.37) 56,100 58,900 64,800
592 Hepatico Jejunostomy 67,600 70,900 78,000
Choledochoduodenostomy Or
593
Choledocho Jejunostomy 42,100 44,200 48,600
GB+ Calculi CBD Stones Or Dilated
594
CBD 50,300 52,800 58,100
595 Benign Biliary Stricture Repair 1,02,100 1,07,200 1,17,900
596 Enucleation Of Cyst 91,500 96,100 1,05,700
597 Triple Bypass -Pancreas 61,500 64,600 71,000
Lateral Pancreaticojejunostomy(Non-
598
Malignant) 1,03,000 1,08,200 1,19,000
599 Other Bypasses -Pancreas 40,800 42,800 47,100
600 Whipples Any Type 1,02,700 1,07,800 1,18,600
601 Laproscopic Pancreatic Necrosectomy 1,14,900 1,20,600 1,32,700
602 Open Pancreatic Necrosectomy 1,23,100 1,29,200 1,42,100
603 Distal Pancreatectomy 1,21,500 1,27,600 1,40,300
Distal Pancreatectomy
604
+Splenectomy(41.5) 1,21,500 1,27,600 1,40,300
605 Central Pancreatectomy 1,21,500 1,27,600 1,40,300
Diaphragmatic Hernia (Gortex Mesh
606
Repair) 49,200 51,700 56,800
Rectovaginal fistula Management with
607
Colostomy 41,400 43,500 47,800
Cardiology and Cardiothoracic Surgery
607 ASD Device Closure 38,400 40,300 44,300
608 Balloon Aortic Valvotomy 29,300 30,700 33,800
609 Balloon Atrial Septostomy 30,500 32,000 35,200
Balloon Dilatation of Coartication of
610
Aorta 48,300 50,700 55,700
Balloon Dilatation of Pulmonary Artrey
611
Stenosis 48,300 50,700 55,700
612 Balloon Mitral Valvotomy 41,300 43,300 47,600
613 Balloon Pulmonary Valvotomy 29,300 30,700 33,800
Bronchial artery Embolisation (for
614
Haemoptysis) 41,000 43,100 47,400
615 Electrophysiological Study 25,000 26,300 28,900
Electrophysiological Study with Radio
616
Frequency Ablation 25,000 26,300 28,900
617 Left Heart Catheterization 6,300 6,600 7,200

42
618 PDA Device Closure 27,500 28,900 31,800
619 PDA stenting 46,400 48,700 53,600
Percutaneous Transluminal Septal
620
Myocardial Ablation 42,600 44,800 49,200
621 Peripheral Angioplasty 46,800 49,100 54,000
622 PTCA, inclusive of diagnostic angiogram 50,800 53,300 58,600
623 Right Heart Catheterization 6,300 6,600 7,200
624 Systemic Thrombolysis (for MI) 22,400 23,500 25,800
625 VSD Device Closure 38,400 40,300 44,300
Permanent Pacemaker Implantation -
626
Double Chamber 33,800 35,400 39,000
Permanent Pacemaker Implantation -
627
Single Chamber 25,000 26,300 28,900
628 Temporary Pacemaker implantation 24,000 25,200 27,700
629 Pericardiocentesis 15,100 15,900 17,500
Catheter directed Thrombolysis for Deep
630 vein thrombosis (DVT) 38,500 40,400 44,500
Catheter directed Thrombolysis for
631
Mesenteric Thrombosis 38,500 40,400 44,500
Catheter directed Thrombolysis for
632
Peripheral vessels 38,500 40,400 44,500
Aortic Aneurysm 1,8
633
7,500 1,96,900 2,16,600
Aortic Aneurysm Repair using
634
Cardiopulmonary bypass (CPB) 1,50,000 1,57,500 1,73,300
Aortic Aneurysm Repair using Left Heart
635
Bypass 1,50,000 1,57,500 1,73,300
Aortic Aneurysm Repair without using
636 Cardiopulmonary bypass
(CPB) 87,500 91,900 1,01,100
Aortic Aneurysm Repair without using
637
Left Heart Bypass 87,500 91,900 1,01,100
638 Aortic Arch Replacement using bypass 1,87,500 1,96,900 2,16,600
639 Aortic Dissection 1,87,500 1,96,900 2,16,600
640 Aortic Valve 1,40,000 1,47,000 1,61,700
Aortic Valve Repair/ Aortic Valve
Replacement / Mitral Valve Repair /
641 Mitral Valve Replacement / Tricuspid
Valve Repair /
Tircuspid Valve Replacement 1,87,500 1,96,900 2,16,600
Aortic Valve Repair/ Aortic Valve
Replacement / Mitral Valve Repair /
642 Mitral Valve Replacement / Tricuspid
Valve Repair /
Tircuspid Valve Replacement 1,87,500 1,96,900 2,16,600
643 Aorto - carotid bypass 62,500 65,600 72,200
644 Aorto - subclavian bypass 62,500 65,600 72,200
645 Aorto femoral bypass - B/L 87,500 91,900 1,01,100
646 Aorto femoral bypass - U/L 87,500 91,900 1,01,100
647 Aorto lliac bypass - B/L 87,500 91,900 1,01,100
648 Aorto lliac bypass - U/L 87,500 91,900 1,01,100

43
649 AP window repair 1,87,500 1,96,900 2,16,600
Arch interruption Repair with VSD
650
closure 1,87,500 1,96,900 2,16,600
Arch interruption Repair without VSD
651
closure 1,87,500 1,96,900 2,16,600
652 Arterial switch operation 1,87,500 1,96,900 2,16,600
653 ASD Closure + Infundibular procedure 1,50,000 1,57,500 1,73,300
654 ASD Closure + Mitral procedure 1,50,000 1,57,500 1,73,300
ASD closure + Partial Anomalous
655
Venous Drainage Repair 1,50,000 1,57,500 1,73,300
656 ASD Closure + Pulmonary procedure 1,50,000 1,57,500 1,73,300
657 ASD Closure + Tricuspid procedure 1,50,000 1,57,500 1,73,300
658 Atrial septectomy + Glenn 1,50,000 1,57,500 1,73,300
659 Atrial septectomy + PA Band 1,50,000 1,57,500 1,73,300
660 AVR + Root enlargement 1,87,500 1,96,900 2,16,600
661 Axillary aneurysm repair 62,500 65,600 72,200
662 Axillo - Brachial Bypass 62,500 65,600 72,200
663 Axillo - femoral bypass - B/L 62,500 65,600 72,200
664 Axillo - femoral bypass - U/L 62,500 65,600 72,200
665 Bental Procedure 1,87,500 1,96,900 2,16,600
666 Brachial aneurysm repair 62,500 65,600 72,200
667 Carotid - endearterectomy 62,500 65,600 72,200
668 Carotid aneurysm repair 62,500 65,600 72,200
669 Carotid Body Tumor Excision 62,500 65,600 72,200
670 Carotido - axillary bypass 62,500 65,600 72,200
671 Carotido - subclavian bypass 62,500 65,600 72,200
672 Carotio - carotid Bypass 62,500 65,600 72,200
Closed Mitral Valvotomy including
673
thoracotomy 71,300 74,800 82,300
674 Coarctation repair 1,25,000 1,31,300 1,44,400
675 Complete AV canal repair 1,87,500 1,96,900 2,16,600
676 Coronary artery bypass grafting (CABG) 1,47,600 1,55,000 1,70,500
677 DORV Repair 1,87,500 1,96,900 2,16,600
678 Double switch operation 1,87,500 1,96,900 2,16,600
679 Ebstien repair 1,87,500 1,96,900 2,16,600
Excessive bleeding requiring re-
680
exploration 12,500 13,100 14,400
681 Femoral - popliteal Bypass 62,500 65,600 72,200
682 Femoral aneurysm repair 62,500 65,600 72,200
683 Femoro - Femoral Bypass 62,500 65,600 72,200
684 Fontan procedure 1,87,500 1,96,900 2,16,600
685 Glenn procedure 1,25,000 1,31,300 1,44,400
686 Immediate reoperation (within 5 days)
687 Infundibular PS repair 1,50,000 1,57,500 1,73,300
688 Intermediate AV canal repair 1,50,000 1,57,500 1,73,300
Isolated Secundum Atrial Septal Defect
689
(ASD) Repair 1,25,000 1,31,300 1,44,400

44
690 Konno procedure 1,87,500 1,96,900 2,16,600
Low Cardiac Output syndrome requiring
691 IABP insertion post -
operatively 62,500 65,600 72,200
692 Mitral Valve 1,40,000 1,47,000 1,61,700
693 Mustard Operation 1,87,500 1,96,900 2,16,600
694 Norwood procedure 1,87,500 1,96,900 2,16,600
695 Partial AV canal repair 1,50,000 1,57,500 1,73,300
Patent Ductus Arteriosus (PDA) Closure
696
via thoracotomy 71,300 74,800 82,300
697 Pericardial window (via thoracotomy) 37,500 39,400 43,300
698 Pericardiectomy 83,800 87,900 96,700
Peripheral arterial injury repair (without
699
bypass) 37,500 39,400 43,300
700 Popliteal aneurysm repair 62,500 65,600 72,200
701 Pulmonary Artery Banding 1,25,000 1,31,300 1,44,400
702 Pulmonary Embolectomy 1,76,300 1,85,100 2,03,600
703 Pulmonary Resection 87,500 91,900 1,01,100
704 Rastelli Procedure 1,87,500 1,96,900 2,16,600
705 Re-do sternotomy 25,000 26,300 28,900
706 Ross Procedure 1,74,400 1,83,100 2,01,400
707 Senning Operation 1,87,500 1,96,900 2,16,600
Sinus of Valsalva aneurysm repair with
708
aortic valve procedure 1,50,000 1,57,500 1,73,300
Sinus of Valsalva aneurysm repair
709 without aortic valve
procedure 1,50,000 1,57,500 1,73,300
710 Sub-aortic membrane resection 1,50,000 1,57,500 1,73,300
711 Subclavian aneurysm repair 62,500 65,600 72,200
712 Supravalvular AS repair 1,87,500 1,96,900 2,16,600
Surgery for Hypertrophic Obstructive
713 Cardiomyopathy (HOCM) 1,38,800 1,45,700 1,60,300
714 Systemic - Pulmonary shunt 1,25,000 1,31,300 1,44,400
715 TAPVC Repair 1,87,500 1,96,900 2,16,600
716 Tetralogy of Fallot Repair 1,87,500 1,96,900 2,16,600
717 Thoracic Outlet syndrome Repair 62,500 65,600 72,200
Thoracoabdominal aneurysm Repair
718
using bypass 1,87,500 1,96,900 2,16,600
719 Thromboendarterectomy 1,76,300 1,85,100 2,03,600
720 Tricuspid Valve 1,40,000 1,47,000 1,61,700
721 Truncus arteriosus repair 1,87,500 1,96,900 2,16,600
722 Unifocalization of MAPCA 1,25,000 1,31,300 1,44,400
723 Valve sparing root replacement 1,87,500 1,96,900 2,16,600
724 Valvular PS repair 1,50,000 1,57,500 1,73,300
725 Vascular Ring division 1,25,000 1,31,300 1,44,400
726 VSD + Aortic procedure 1,87,500 1,96,900 2,16,600
727 VSD + Coarctation repair 1,87,500 1,96,900 2,16,600
728 VSD + Infundibular procedure 1,87,500 1,96,900 2,16,600

45
729 VSD + Mitral procedure 1,87,500 1,96,900 2,16,600
730 VSD + Pulmonary procedure 1,87,500 1,96,900 2,16,600
731 VSD + Tricuspid procedure 1,87,500 1,96,900 2,16,600
732 VSD closure 1,50,000 1,57,500 1,73,300
733 VSD closure + RV - PA conduit 1,87,500 1,96,900 2,16,600
734 Foreign Body Removal with scope 25,000 26,300 28,900
Isolated Intercostal Drainage and
735 Management of ICD, Intercostal Block,
Antibiotics & Physiotherapy 12,500 13,100 14,400
Space - Occupying Lesion (SOL)
736
mediastinum 81,900 86,000 94,600
737 Thromboembolectomy 35,000 36,800 40,400
738 Decortication 56,300 59,100 65,000
739 Diaphragmatic Repair 37,500 39,400 43,300
740 Hydatid cyst 56,300 59,100 65,000
741 Lung cyst exision 56,300 59,100 65,000
Other simple lung procedure excluding
742
lung resection 56,300 59,100 65,000
Thoracotomy, Thoraco Abdominal
743
Approach 37,500 39,400 43,300
744 Surgery for Cardiac Tumour 1,18,800 1,24,700 1,37,200
Surgical Correction of Bronchopleural
745
Fistula 81,300 85,300 93,800
746 Lung Resection 50,000 52,500 57,750
747 Aortic Stenting (Single) 5,00,000 5,25,000 5,77,500
748 AVR+ Pneumonectomy 2,00,000 2,10,000 2,31,000
749 ALCAPA repair 1,75,000 1,83,750 2,02,125
Tetralogy of Fallot - Systemic Pulmonary
750 41,800
Shunts with Graft 43,890 48,279
Tetralogy of Fallot - Systemic Pulmonary
751 55,400
Shunts without Graft 58,170 63,987
752 Tetralogy of Fallot - Total Correction 95,000 99,750 1,09,725
Tetralogy of Fallot (Comple) - Total
753 1,35,000
Correction 1,41,750 1,55,925
Tetralogy of Fallot (Simple) - Total
754 1,10,500
Correction 1,16,025 1,27,628
755 Thoracic Vascular Injuries 1,00,000 1,05,000 1,15,500
756 Transposition of Great Arteries 1,05,000 1,10,250 1,21,275
Transposition of Great Arteries - Arterial
757 1,50,000
Switch 1,57,500 1,73,250
Transposition of Great Arteries - Carotid
758 70,000
Embolectomy 73,500 80,850
Primary Angioplasty with thrombus
759 90,000
aspiration with one DES 94,500 1,03,950
Primary Angioplasty with thrombus
760 1,20,000
aspiration with two DES 1,26,000 1,38,600
FFR + Angioplasty with 1 drug eluting
761 1,05,000
stent 1,10,250 1,21,275
FFR + Angioplasty with 2 drug eluting
762 1,35,000
stent 1,41,750 1,55,925
763 FFR + Angioplasty with 3 drug eluting 1,65,000 1,73,250 1,90,575

46
 stent
IABP + Angioplasty with 1 drug eluting
764 1,05,000
stent 1,10,250 1,21,275
IABP + Angioplasty with 2 drug eluting
765 1,35,000
stent 1,41,750 1,55,925
IABP + Angioplasty with 3 drug eluting
766 1,65,000
stent 1,73,250 1,90,575
767 angioplasty needing covered stent 1,20,000 1,26,000 1,38,600
768 IVUS 70,000 73,500 80,850
769 FFR 40,000 42,000 46,200
770 IABP 40,000 42,000 46,200
PERCUTANEOUS SEPTAL
771 MYOCARDIAL ABLATION (PTSMA) 1,00,000
REQUIRING PPI VVI 1,05,000 1,15,500
PERCUTANEOUS SEPTAL
772 MYOCARDIAL ABLATION (PTSMA) 2,20,000
REQUIRING PPI DDD 2,31,000 2,54,100
Peripheral Angioplasty with single non
773 1,40,000
collapsible stent /covered stent 1,47,000 1,61,700
774 Vascular plugs 80,000 84,000 92,400
775 Bioptome assisted coil embolisation 60,000 63,000 69,300
PAEDIATRIC SURGERIES
776 Surgical management of Encephalocele 43,000 45,100 49,600
777 Surgical management of Neuroblastoma 48,400 50,800 55,900
Adrenal Gland Surgeries In Paediatric
778
patients(07.3&07.4) 50,300 52,800 58,100
779 Execision of pediatric tumors 53,600 56,300 61,900
Surgical treatment for Preauricular sinus
780
in pediatric patient 10,600 11,100 12,200
Surgical correction of Microtia/Anotia In
781
Paediatric Patient 35,800 37,600 41,400
782 Excision of Retention Cyst Lip 3,100 3,200 3,500
Surgical correction of Cleft Lip in
783
children 27,100 28,400 31,300
784 Surgical correction of Cleft Palate 28,000 29,400 32,300
Surgical corection of Velo-Pharyngeal
785
Incompetence 38,900 40,900 45,000
Surgical management of Sinuses &
786
Fistula of the neck in Paediatric Patient 21,800 22,900 25,100
787 Excision ofThoracoscopic cysts 41,500 43,600 47,900
Open excision of Lung cyst In Paediatric
788
Patient 41,200 43,300 47,600
Mediastinal Cyst Excision In Paediatric
789
Patients 66,900 70,200 77,300
Empyema decortication In Paediatric
790
Patients 32,100 33,700 37,100
791 Empyema-ICD drainage In Paediatric 10,900 11,400 12,600
Thoracoscopic Decortication In
792
Paediatric 49,500 52,000 57,200
Surgical Correction of Thoracic Wall
793
defects 65,900 69,200 76,100
794 Excision of Haemangioma 19,100 20,100 22,100

47
 Surgical management of
795
Lymphangioma In Paediatric Patients 49,200 51,600 56,800
796 Paediatric Splenectomy (Non Traumatic) 44,700 46,900 51,600
Surgical management of Oesophageal
797
Atresia In Paediatric Patients 64,600 67,800 74,600
Surgical Correction of Thoracic
798
Duplications In Paediatric Patients 47,200 49,600 54,600
Surgical Correction of
799 EsophagealObstructions In Paediatric
Patients 60,000 63,000 69,300
Surgical Correction of Esophageal
800
Substitutions In Paediatric Patients 76,200 80,000 88,000
Surgical management of - Gastric Outlet
801
Obstructions In Paediatric Patients 31,200 32,800 36,000
Surgical management of Gastro
802 Esophageal Reflux In Paediatric
Patients 38,200 40,100 44,100
Surgical Management of Intestinal
803 Atresias & Obstructions In Paediatric
Patients 65,900 69,200 76,100
Surgical management of Intestinal
804
Polyposis In Paediatric Patients 61,500 64,600 71,000
Meckel's Diverticulectomy In Paediatric
805
Patients 43,000 45,200 49,700
Stage 2 procedure for Anorectal
806
Malformations In Paediatric Patients 62,100 65,200 71,700
Stage 1 procedure for Anorectal
807
Malformations In Paediatric Patients 49,500 52,000 57,200
Stage 1 procedure for Hirschprungs
808
Disease In Paediatric Patients 48,600 51,000 56,100
Feeding Jejunostomy In Paediatric
809
Patients 30,400 31,900 35,100
810 Ileostomy closure In Paediatric Patients 26,800 28,100 30,900
Stage 2 procedure for Hirschprungs
811
Disease In Paediatric Patients 73,500 77,200 84,900
812 Colostomy closure In Paediatric Patients 25,900 27,200 29,900
Surgical mangement of Acute Intestinal
813
Obstruction In Paediatric Patients 51,000 53,600 58,900
Rectal polypectomy In Paediatric
814
Patients 8,300 8,700 9,600
Laparoscopic Pull Through For Ano
815
Rectal Anomalies In Paediatric Patients 73,800 77,500 85,200
Laparoscopic Pull Through Surgeries
816 For Hirschprungs Disease In Paediatric
Patients 73,500 77,200 84,900
Surgical mangement of Anal Fissure and
817
Fistula In Paediatric Patients 24,100 25,300 27,800
Surgical Management of Biliary Atresia
818 & Choledochal Cyst In Paediatric
Patients 71,900 75,500 83,000
819 Pancreatic surgery in Paediatric Patients 76,500 80,300 88,400
Unilateral Inguinal Hernia repair In
820
Paediatric Patients 15,300 16,100 17,700

48
 Bilateral Inguinal Hernia repair In
821
Paediatric Patients 20,300 21,300 23,400
Lumbar Hernia repair In Paediatric
822
Patients 16,800 17,600 19,400
Femoral Hernia repair In Paediatric
823
Patients 15,300 16,100 17,700
Umbilical Hernia repair In Paediatric
824
Patients 20,300 21,300 23,400
Incisional Hernia repair In Paediatric
825
Patients 32,700 34,300 37,800
Open repair of diaphragmatic hernia in
826
Paediatric patients 75,600 79,400 87,400
Correction of Vitello intestinal duct
827
anomalies in Paediatric Patients 40,000 42,000 46,200
828 Repair of Abdominal wall defects 76,500 80,300 88,400
Surgical management of Abdominal
829
trauma in Paediatric Patients 62,400 65,500 72,100
Surgical management of peritonitis in
830
Paediatric Patients 40,900 42,900 47,200
Correction of Duplications of alimentary
831
tract in Paediatric Patients 48,700 51,100 56,200
832 Simple Nephrectomy 41,200 43,300 47,600
Surgical Management of Congenital
833
Hydronephrosis in Paediatric Patients 56,200 59,000 64,900
834 Open ureterolithotomy 30,300 31,800 35,000
835 Ureterostomy in Paediatric Patients 33,900 35,500 39,100
836 Ureteric Reimplantations 36,600 38,400 42,200
837 Ureteric Implantation with tailoring 43,700 45,900 50,500
Vesical calculi-vesicolithotomy in
838
Paediatric Patients 25,100 26,400 29,000
Supra pubic drainage- open in
839
Paediatric Patients 11,200 11,800 12,900
840 Vesicostomy 27,300 28,600 31,500
Vesicotomy closure in Paediatric
841
Patients 28,700 30,100 33,200
Stage 1 procedure for Exstrophy
842
Bladder in Paediatric Patients 75,300 79,100 87,000
Stage 2 procedure for Exstrophy
843
Bladder in Paediatric Patients 71,700 75,300 82,800
844 Bladder augmentation 54,400 57,200 62,900
Repair of Urethral injuries in Paediatric
845
Patients 27,500 28,900 31,800
Surgical Management of Posterior
846
Urethral Valves 32,100 33,700 37,100
Single Stage procedure for
847
Hypospadiasis 43,900 46,100 50,700
848 Stage 1 procedure for Hypospadiasis 31,500 33,000 36,300
849 Stage 2 procedure for Hypospadiasis 31,700 33,300 36,600
850 Surgical Correction of Epispadiasis 43,700 45,800 50,400
Surgical Correction of Scrotal
851
Transposition In Paediatric Patients 20,900 21,900 24,100

49
 Surgical management of Undescended
852
Testis In Paediatric Patients 25,900 27,200 29,900
Laparoscopic Orchidopexy In Paediatric
853
Patients 27,100 28,500 31,300
854 Laparoscopic Varicocele Ligation 41,200 43,300 47,600
855 Open Varicocele ligation 32,700 34,300 37,800
Hydrocele high ligation In Paediatric
856
Patients 15,300 16,100 17,700
Surgical Management for Torsion of
857
Testis 27,000 28,400 31,200
Surgical Management of Phimosis and
858
Paraphimosis 8,600 9,000 9,900
859 Intersex-Genitoplasty surgery(70.6) 47,500 49,900 54,800
Surgical Management of Tempero
860
mandibular Joint Ankylosis 47,200 49,600 54,600
Management Of Tmj Dysfunction
861
Syndrome (76.94) 1,100 1,100 1,300
862 Execision of cogental dermal sinus 30,600 32,100 35,300
Surgical Management of Torticollis in
863
Paediatric Patient 16,100 16,900 18,600
Excision of External angular dermoid in
864
Paediatric Patient 8,400 8,800 9,600
Surgical Management (excision) of
865
Congenital Dermal Sinus 30,600 32,100 35,300
Excision of Sebacencyst Lipoma in
866
Paediatric Patient 6,100 6,400 7,100
867 Excision of hamartoma 20,600 21,600 23,800
868 Execision of cysti lesions of neck 27,100 28,500 31,300
Surgical correction of Syndactyly of
869 Hand For Each Hand in Paediatric
Patient 27,100 28,400 31,300
Syndactoly correction-multiple correction
870
in Paediatric Patient 29,500 31,000 34,100
Anal Dilatation
871
5,300 5,600 6,100
GENITO URINARY SURGERIES
872 Renal angio embolization 36,100 37,900 41,700
A.V. Fistula surgery (creation) [Pre-
873
Transplant Procedure Only 10,900 11,400 12,600
Balloon dialatation of transplant Renal
874
Artery stenosis 34,100 35,800 39,400
875 AV Fistula 12,500 13,100 14,400
876 Open post transplant lymphocele 30,800 32,400 35,600
877 Laproscopic post transplant lymphocele 32,900 34,500 38,000
Uni-lateral illioinguinal block dissection
878
in non malignant conditions 31,500 33,100 36,400
Bi-lateral illioinguinal block dissection in
879
non malignant conditions 65,400 68,600 75,500
Surgery for Retroperitoneal Fibrosis
880
Open/Lap 40,900 43,000 47,300
881 Parapelvic Cyst Excision-Open/Lap 33,800 35,500 39,000

50
882 Open Nephrolithotomy 25,900 27,200 29,900
883 Nephrostomy - Renal 13,900 14,600 16,100
884 Percutaneous Nephrolithotomy 36,400 38,200 42,000
885 Nephrectomy for Pyonephrosis/Xgp 40,900 42,900 47,200
886 Laproscopic Partial Nephrectomy 62,400 65,500 72,100
887 Laproscopic Simple Nephrectomy 52,400 55,000 60,500
888 Laproscopic Radical Nephrectomy 63,100 66,200 72,900
a)Haemodialysis 1500 1500 1500
889*
b)Peritoneal Dialysis 1800 1800 1800
890 Nephropexy 37,900 39,800 43,700
Revascularization procedure for
891
renovascular hypertension 29,900 31,400 34,600
892 Open Pyelolithotomy 23,000 24,100 26,500
893 Laparoscopic Pyelolithotomy 43,000 45,200 49,700
Anatrophic Peylolithotomy For Staghorn
894
Caliculus 51,800 54,400 59,800
895 Partial stag horn caluculi 35,300 37,000 40,700
896 Complete stag horn caluculi 40,100 42,100 46,300
897 Renal Cyst Excision 24,700 26,000 28,600
898 Radical Nephro-Ureterectomy 52,100 54,700 60,200
899 Bilateral Nephroureterectomy 82,100 86,200 94,800
Laproscopic unilateral
900
Nephroureterectomy 50,900 53,400 58,800
901 Open unilateral Nephroureterectomy 47,400 49,800 54,700
902 Hemi- Nephroureterectomy 47,100 49,500 54,400
903 Post transplant graft Nephrectomy 37,100 39,000 42,900
904 Renal auto transplantation 61,500 64,600 71,000
Surgical Management of Congenital
905
Hydronephrosis 37,100 39,000 42,900
906 Anderson Hynes Pyeloplasty 49,500 52,000 57,200
907 Retrograde Intrarenal Surgery(RIRS) 32,500 34,100 37,500
908 Laparoscopic deroofing of Renal Cyst 33,000 34,600 38,100
909 URSL 26,200 27,500 30,300
910 Laparoscopic ureterolithotromy 31,500 33,100 36,400
911 Surgical corrrection of Ureterocele 24,600 25,800 28,400
Excision of Ureterocele with Ureteric
912
Implantation 43,900 46,100 50,700
Surgical Procedure for Ileal Conduit
913
Formation 42,200 44,300 48,700
Post transplant revision Ureteroneo
914
cystostomy/Pyelo Ureterostomy 39,400 41,300 45,500
915 Ureteric replacement 46,400 48,700 53,600
916 Uretero ureterostomy 34,000 35,700 39,300
917 Balloon dilatation of Ureteric stricture 20,700 21,700 23,900
918 Cystolithotripsy 14,200 14,900 16,400
919 Endoscope removel of stone in bladder 14,900 15,600 17,200
920 Partial Cystectomy 35,400 37,100 40,800
921 Total Cystectomy 47,100 49,500 54,400

51
922 Open Cystolithotomy 20,900 22,000 24,200
923 Mitrafanoff procedure 49,000 51,400 56,500
Transurethral resection of bladder
924
tumour (TURBT) 39,900 41,900 46,100
Transurethral resection of bladder
925 tumour (TURBT) with intravesical
Mitomycin instillation 35,900 37,700 41,500
926 Excision of Urachal cyst 36,200 38,000 41,800
927 Bladder Diverticulectomy 34,000 35,700 39,300
Laproscopic radical cystectomy with
928
Ilealconduit diversion 1,26,500 1,32,800 1,46,100
Laproscopic radical cystectomy with
929
Ureterosigmoidostomy(57.88) 59,700 62,700 68,900
Open radical cystectomy with
930
Ureterosigmoidostomy (57.88) 48,000 50,400 55,400
Laproscopic radical cystectomy with
931
Continent Urinary diversion(56.7) 65,600 68,800 75,700
Open radical cystectomy with Continent
932
Urinary diversion 53,000 55,700 61,200
Surgical correction of Vesicovaginal
933
Fistula 45,800 48,100 52,900
Transvaginal repair of Vesicovaginal
934
Fistula 37,900 39,800 43,800
Trans abdominal repair of Vesicovaginal
935
Fistula with omentoplasty 55,800 58,600 64,400
936 Caecocystoplasty 44,800 47,100 51,800
937 Bladder neck incision 25,300 26,600 29,300
Bladder neck reconstruction for
938
Incontinence 62,100 65,200 71,700
939 Perineal Urethrostomy 33,200 34,800 38,300
940 Optical Urethrotomy 22,400 23,600 25,900
BMG Urethroplasty for pan Urethral
941
stricture 66,500 69,800 76,800
942 Dilatation for Urethra stenosis 10,900 11,400 12,600
943 Excision of Urethral Caruncle 16,600 17,400 19,100
944 Urethral Fistula closure 31,500 33,100 36,400
945 Single stage- Urethroplasty for Stricture 53,300 56,000 61,600
Double stage Urethroplasty
946 (Reconstruction Procedure) for stricture
Urethra. 40,200 42,200 46,400
947 Meatoplasty 12,600 13,200 14,500
Transpubic Urethroplasty with
948
Omentoplasty 68,600 72,000 79,200
949 Urethroplasty doblestage stage I 40,800 42,800 47,100
950 Urethroplasty doublestage stageII 40,200 42,200 46,400
Nephrolysis/surgery for Chyluria
951
Open/Lap 41,800 43,900 48,300
Surgical Management of Incontinence
952
Urine (Male) 26,800 28,100 31,000
Surgical Management of Incontinence
953
Urine (Female) 22,900 24,000 26,400

52
 MMK/birch colpo suspension for stress
954
urinary Incontinence 42,100 44,200 48,600
955 Dj Stent (One Side) 5,300 5,600 6,100
956 CAPD-Tenchkoff catheter insertion 38,600 40,600 44,600
957 Drainage of Perinephric Abscess 40,100 42,100 46,300
Mid urethral sling procedure for stress
958
urinary incontinence 31,500 33,100 36,400
959 Open Prostatectomy 34,500 36,200 39,800
960 Laproscopic radical Prostratectomy 57,100 60,000 66,000
961 Open radical Prostratectomy 50,900 53,400 58,800
962 Laser Prostatectomy 41,500 43,600 47,900
Transurethral Resection of Prostate
963
(TURP) 31,500 33,100 36,400
Transurethral Resection of Prostate
964
(TURP) Cyst Lithotripsy 30,900 32,400 35,700
965 Bipolar TURP 41,500 43,600 47,900
966 Scrotal/Perineal Injuries 29,600 31,000 34,100
967 Orchidopexy Bilateral 24,700 25,900 28,500
968 Vasectomy reversal 23,900 25,100 27,600
969 Partial amputation of penis 38,200 40,100 44,100
970 Surgical correction of Chordee 34,700 36,400 40,000
Surgical Correction of Chordee without
971
Hypospadiasis 34,400 36,100 39,800
972 Surgical Management of Penile Injuries 26,200 27,500 30,300
Plaque Excision/Plasty for Penile
973
curvature/Peyronies disease 42,100 44,200 48,600
974 Surgery for Priapism 37,100 39,000 42,900
975 Difficult vascular access/graft 31,500 33,100 36,400
976 CAPD-Tenchkoff catheter removal 36,000 37,800 41,600
977 CAPD bags per month 8,500 8,900 9,800
978 Cystoscopy/ Stent removal 9,400 9,900 10,900
Extracorporeal shockwave lithotripsy
979
(ESWL) 20,600 21,600 23,800
Post Renal Transplant
980 Immunosuppressive Treatment From 1st
To 6th Months 91,700 96,300 1,05,900
Post Renal Transplant
981 Immunosuppressive Treatment From 7th
To 12 Th Month. 61,200 64,300 70,700
982 Intravesical BCG Induction therapy 10,100 10,600 11,600
983 Intravesical BCG maintenance 18,100 19,000 20,900
NEURO SURGERY
984 Twist Drill Craniostomy 15,600 16,400 18,000
985 Subdural Tapping 19,500 20,500 22,500
986 Ventricular Tapping 15,000 15,800 17,300
Burr Hole procedure for evacuation of
987
Brain Abscess 32,700 34,300 37,700
988 Endoscopy Procedures -Brain 79,800 83,800 92,200
989 Craniotomy And Evacuation of Subdural 66,000 69,300 76,200

53
 Haematoma
Craniotomy And Evacuation of
990
Extradural Haematoma 60,000 63,000 69,300
De-Compressive Craniectomy (Non
991
Traumatic) 80,600 84,600 93,100
992 Tapping of Brain Abscess 40,000 42,000 46,200
993 Evacuation of Intra-Cerebral Hematoma 72,000 75,600 83,200
Temporal Lobectomy Plus Depth
994
Electrodes 1,40,300 1,47,300 1,62,000
995 Temporal Lobectomy 75,600 79,400 87,300
Excision of
996
Lobe(frontal,temporal,cerebellum Etc.) 40,300 42,300 46,500
997 Excision of Parasagital Brain tumour 70,400 73,900 81,300
998 Excision of Basal Brain tumour 70,300 73,800 81,200
999 Excision of Brain Stem Brain tumour 70,900 74,400 81,900
1000 Excision of C P Angle Brain tumour 80,300 84,300 92,700
1001 Excision of Other Brain tumours 48,600 51,000 56,100
1002 Lesionectomy Type 1 57,200 60,000 66,000
1003 Lesionectomy Type 2 57,400 60,200 66,200
1004 Excision of Subtentorial Brain Tumours 48,600 51,000 56,100
1005 Evacuation of Brain Abscess 60,000 63,000 69,300
Surgical Management of
1006
Meningomyelocele 40,600 42,600 46,900
1007 Intra Ventricular Tumours 60,600 63,600 70,000
1008 Meningocele Excision 40,300 42,300 46,500
1009 Excision of brain abscess 70,300 73,800 81,200
1010 Cranioplasty 30,300 31,800 35,000
1011 Depressed / Elevated Fracture 30,300 31,800 35,000
1012 Endoscopic Third Ventriculostomy 30,900 32,400 35,700
1013 Cranioplasty With Impants 30,300 31,800 35,000
1014 Cranioplasty With Titanium Mesh 31,900 33,500 36,900
Surgical Management of Meningo
1015
Encephalocele 40,600 42,600 46,900
Surgical Management of C.S.F.
1016
Rhinorrhoea 40,600 42,600 46,900
1017 Ventriculo Atrial Shunt 21,500 22,600 24,800
1018 Atrial shunt 20,000 21,000 23,100
1019 Ventriculo Peritoneal Shunt 30,000 31,500 34,700
Ventriculoatrial / Ventriculoperitonial
1020
shunt 20,000 21,000 23,100
1021 External Ventricular Drainage (EVD) 40,000 42,000 46,200
1022 Selective Posterior Rhizotomy 30,300 31,800 35,000
1023 Surgery for Cord Tumours 38,900 40,800 44,900
Surgical Management of Intra Medullary
1024
Spinal Tumours 51,200 53,800 59,100
1025 Surgical Management of Syringomyelia 60,600 63,600 70,000
1026 Laminectomy 27,300 28,600 31,500
1027 Laminoplasty With Implants 30,800 32,300 35,600

54
1028 Endoscopy - Spinal 29,900 31,400 34,500
1029 Meningo Myelocele Spinal Procedure 25,600 26,900 29,600
Surgical Management of Spina Bifida
1030
Major 35,600 37,400 41,100
Surgical Management of Spina Bifida
1031
Minor 30,300 31,800 35,000
1032 Facet, Nerve Root Blocks 10,000 10,500 11,600
Radiofrequency Ablation For Trigeminal
1033
Neuralgia 30,600 32,100 35,300
Radio Surgery For Brain Tumours &
1034 Vascular Malformations/ Trigeminal
Neuralgia 25,300 26,600 29,200
Surgical treatment for brachial plexus
1035
injuries 72,900 76,500 84,200
Microvascular Decompression For
1036
Trigeminal Neuralgia 60,300 63,300 69,600
Surgical management Carpal tunnel
1037
syndrome 10,000 10,500 11,600
1038 Peripheral Nerve Injury Repair 40,900 42,900 47,200
1039 Cervical Sympathectomy 31,200 32,800 36,000
1040 Lumbar Sympathectomy 31,500 33,100 36,400
1041 Trans Sphenoidal Surgery 40,300 42,300 46,500
1042 Carotid Endarterectomy 40,600 42,600 46,900
1043 Intra Cranial Vascular Bypass 1,00,900 1,05,900 1,16,500
1044 Aneurysm Clipping 1,10,000 1,15,500 1,27,100
Other Vascular Malformations (Other
1045 Than AVM) - Cavernomas, AV Fistulas,
Sinus Pericranii 60,900 63,900 70,300
1046 Embolization of Aneurysm 76,500 80,300 88,400
1047 Brain Tumour Embolisation 28,300 29,700 32,700
Coil Embolization of Aneurysm (each
1048
coil cost) 30,000 31,500 34,700
Surgical Management of Vascular
1049
Malformations 60,600 63,600 70,000
Spinal Fixation Rods And Plates,
1050
Artificial Discs 85,600 89,900 98,900
1051 Anterior Lateral Decompression 31,200 32,800 36,000
1052 Postirior cervical disectomy 27,300 28,600 31,500
Excision Of Cervical Inter-Vertebral
1053
Discs 31,200 32,800 36,000
1054 Anterior Discectomy & Bone Grafting 41,200 43,300 47,600
1055 Discectomy With Implants 65,600 68,900 75,800
1056 Anterior Cervical Discectomy 27,600 28,900 31,800
1057 Disectomy 27,000 28,300 31,100
1058 Corpectomy For Spinal Fixation 75,600 79,400 87,300
1059 Spinal Fusion Procedure 50,600 53,100 58,400
1060 Trans Oral Surgery 40,300 42,300 46,500
Combined Trans-Oral Surgery & Cv
1061
Junction Fusion 51,800 54,400 59,800
1062 C.V. Junction Fusion 40,600 42,600 46,900

55
 Anterior Cervical Spine Surgery With
1063
Fusion 45,600 47,900 52,700
1064 Excision Of Scalp Lesions 10,000 10,500 11,600
1065 Stereotactic Procedures 20,600 21,600 23,800
SURGICAL ONCOLOGY
Thyroidectomy any type in malignant
1066
conditions 31,200 32,800 36,000
Parathyroidectomy in malignant
1067
conditions 36,200 38,000 41,800
Excision of Solitory Thyroid nodule in
1068
malignant conditions 37,200 39,000 43,000
Thyroidectomy for solitary nodule in
1069
malignant conditions 38,800 40,800 44,900
Laparoscopic Biilateral adrenalectomy in
1070
malignant conditions 41,100 43,100 47,400
Unilateral Adrenalectomy in malignant
1071
conditions 67,100 70,500 77,500
Maxillectomy + Orbital Exenteration in
1072
malignant conditions 55,700 58,500 64,300
Orbital Exenteration in malignant
1073
conditions 44,200 46,400 51,000
Laproscopic Right Hemicolectomy in
1074
malignant conditions 40,000 42,000 46,200
Hartman procedure in malignant
1075
conditions 51,300 53,900 59,200
Laparoscopic Left Hemicolectomy in
1076
malignant conditions 40,000 42,000 46,200
Sleeve Resection of Ear in malignant
1077
conditions 47,300 49,700 54,600
Hemiglossectomy in malignant
1078
conditions 43,400 45,500 50,100
Total Glossectomy + Reconstruction in
1079
malignant conditions(25.59) 59,400 62,300 68,500
Parotidectomy any type in malignant
1080
conditions 26,200 27,500 30,300
Excision of Submandibular gland in
1081
malignant conditions 26,900 28,200 31,100
Palatectomy any type in malignant
1082
conditions 41,000 43,000 47,300
Full Thickness Buccal Mucosal
1083 Resection & Reconstruction in malignant
conditions(27.59) 65,100 68,400 75,200
Excision of Parapharyngeal tumours in
1084
malignant conditions 48,900 51,400 56,500
Resection of Nasopharyngeal Tumor in
1085
malignant conditions 79,300 83,300 91,600
Laryngectomy Any Type in malignant
1086
conditions 69,700 73,200 80,500
Laryngopharyngo Oesophagectomy in
1087
malignant conditions 99,100 1,04,100 1,14,500
Tracheal Resection in malignant
1088
conditions - CA Thyroid/CA Trachea 66,800 70,100 77,200
1089 Sleeve Resection of Lung Cancer 1,10,100 1,15,600 1,27,200
1090 Lobectomy for Carcinoma Lung 77,900 81,800 90,000

56
1091 Pneumonectomy for Carcinoma Lung 81,200 85,200 93,800
1092 Icd + pleurodesis 21,500 22,600 24,800
Solitary Lung Metastatectomy in
1093
malignant conditions 70,000 73,500 80,800
Lung Metastatectomy multiple in
1094
malignant conditions 78,900 82,800 91,100
Resection of mediastinal tumors in
1095
malignant conditions 64,700 67,900 74,700
Superior Mediastinal
1096 Dissection+Sternotomy in malignant
conditions(77.31) 61,700 64,700 71,200
Intercostal Drainage(Icd) in malignant
1097
conditions 3,300 3,500 3,800
Surgical Resection of Soft tissue /Bone
1098
tumors of Chest wall 31,200 32,800 36,000
Surgical Resection and Reconstruction
1099 of Soft tissue /Bone tumors of Chest
wall in malignant conditions 71,200 74,800 82,200
Full Thickness Buccal Mucosal
1100 Resection & Reconstruction in malignant
conditions(27.59) 75,900 79,700 87,700
IVC thrombectomy in malignant
1101
conditions 54,300 57,000 62,700
IVC filters for tumour thrombus in
1102
malignant conditions 58,500 61,400 67,500
Vascular reconstruction with synthetic
1103
graft in malignant conditions 71,900 75,400 83,000
Vascular reconstruction with auto graft in
1104
malignant conditions 78,000 81,900 90,000
1105 Microvascular reconstruction 92,800 97,400 1,07,200
Vascular isolation and perfusion in
1106
malignant conditions 55,400 58,200 64,000
Neck Dissection Any Type in malignant
1107
conditions 34,000 35,700 39,300
Retro Peritoneal Lymph Node
1108 Dissection RPLND As Part Of Staging in
malignant conditions 41,800 43,900 48,300
Uni-lateral Inguinal Block Dissection in
1109
malignant conditions 31,300 32,800 36,100
Bi-lateral Ilioinguinal block disection in
1110
malignant conditions 65,400 68,600 75,500
Axillary Dissection in malignant
1111
conditions 41,300 43,400 47,700
Bilateral Pelvic Lymph Node
1112 Dissection(Bplnd) in malignant Bilateral
Pelvic Lymph Node 41,800 43,900 48,300
Bilateral pelvic lymph node
1113 dissection(bplnd)(CA. URINARY
BLADDER) 41,800 43,900 48,300
Retro Peritoneal Lymph Node
1114 Dissection(Rplnd) (For Residual
Disease) in malignant conditions 80,100 84,100 92,500
Popliteal lymphadenectomy in malignant
1115
conditions 30,900 32,400 35,700
1116 Splenectomy in malignant conditions 43,700 45,900 50,500

57
 Transhiatal oesophagectomy in
1117
malignant conditions 82,100 86,200 94,800
Oesophagectomy With Two Field
1118 Lymphadenectomy in malignant
conditions(40.59) 1,18,800 1,24,700 1,37,200
Oesophagectomy With Three Field
1119 Lymphadenectomy in malignant
conditions(40.59) 1,21,500 1,27,600 1,40,300
Substernal Gastric Bypass in malignant
1120
conditions 51,900 54,500 59,900
1121 Gastrostomy in malignant conditions 20,000 21,000 23,100
Laparoscopic mobilization of stomach
1122 with distal gastrectomy with billroth i/ii
anastomosis in malignant conditions 1,01,800 1,06,900 1,17,600
Thoracoscopic Mobilization of
Oesophagus + Laparoscopic
1123
Mobilization of stomach + Gastric Pull-
up in malignant conditions 1,20,600 1,26,600 1,39,300
Gastrectomy Any Type in malignant
1124
conditions 51,200 53,800 59,100
Gastro Jejunostomy in malignant
1125
conditions 50,900 53,400 58,800
Small Bowel Resection in malignant
1126
conditions 49,200 51,700 56,800
Colectomy Any Type in malignant
1127
conditions 54,100 56,800 62,500
Ileotransverse Colostomy in malignant
1128
conditions 60,900 64,000 70,400
1129 Colostomy in malignant conditions 21,200 22,300 24,500
1130 Ileostomy in malignant conditions 33,200 34,900 38,400
1131 Jejunostomy in malignant conditions 31,900 33,400 36,800
Laparoscopic anterior/low resection with
1132 stapplers with diversion covering
ileostomy in malignant conditions 1,00,000 1,05,000 1,15,500
Ileostomy Closure in malignant
1133
conditions 25,900 27,200 29,900
Colostomy Closure in malignant
1134
conditions 25,900 27,200 29,900
Laparoscopic abdominoperineal
1135
resection in malignant conditions 1,00,000 1,05,000 1,15,500
Abdomino Perineal Resection (Apr) +
1136 Sacrectomy in malignant
conditions(77.99) 61,500 64,600 71,000
Anterior Resection of rectum in
1137
malignant conditions 51,500 54,100 59,500
Posterior Exenteration for Carcinoma
1138
Rectum 61,500 64,600 71,000
Total Exenteration for Carcinoma
1139
Rectum 1,00,100 1,05,100 1,15,600
1140 Hepatectomies in malignant conditions 1,01,500 1,06,600 1,17,200
Radical Cholecystectomy in malignant
1141
conditions 79,800 83,800 92,200
Distal Pancreatectomy in malignant
1142
conditions 1,01,800 1,06,900 1,17,600

58
 Other Bypasses-Pancreas in malignant
1143
conditions 52,300 54,900 60,400
Inoperable Laparotomy in malignant
1144
conditions 37,800 39,700 43,600
Abdominal Wall Tumor Resection in
1145
malignant conditions 54,300 57,000 62,700
Resection With Reconstruction of
1146 Abdominal wall Tumors in malignant
conditions 61,100 64,200 70,600
Resection Of Retroperitoneal Tumors in
1147
malignant conditions 61,500 64,600 71,000
Diagnostic Laparoscopy in malignant
1148
conditions 22,700 23,900 26,300
1149 Open Partial Nephrectomy 42,100 44,200 48,600
Laproscopic radical nephrectomy in
1150
malignant conditions 1,00,000 1,05,000 1,15,500
1151 Radical Nephrectomy 52,100 54,700 60,200
Nephroureterectomy For Transitional
1152 Cell Carcinoma Of Renal Pelvis in
malignant conditions 66,500 69,800 76,800
Urinary Diversion in malignant
1153
conditions(56.6/56.7) 64,800 68,000 74,800
Other Cystectomies in malignant
1154
conditions 89,100 93,600 1,03,000
1155 Suprapubic cystostomy 18,500 19,400 21,400
Open radical cystectomy with
1156
Ilealconduitdiversion 1,02,100 1,07,200 1,17,900
Anterior Exenteration (CA. Urinary
1157
Bladder) 61,500 64,600 71,000
1158 Total Exenteration (CA. Urinary Bladder) 76,800 80,600 88,700
Radical Prostatectomy in malignant
1159
conditions 89,100 93,500 1,02,900
1160 Channel TURP 41,100 43,100 47,400
1161 Scrotectomy in malignant conditions 41,700 43,800 48,200
1162 High Orchidectomy 22,900 24,000 26,400
1163 Bilateral Orchidectomy 25,200 26,400 29,000
1164 Emasculation in malignant conditions 41,800 43,900 48,200
1165 Total Penectomy 38,800 40,700 44,800
Surgery For Carcinoma Ovary Early
1166
Stage 33,900 35,600 39,100
Excision of Complex ovarian mass in
1167
malignant conditions 53,100 55,700 61,300
Ovarian cystectomy in malignant
1168
conditions 53,000 55,700 61,200
Unilateral Salpingo Oophorectomy in
1169
malignant conditions 31,500 33,100 36,400
Surgery For Carcinoma Ovary Advance
1170
Stage 54,100 56,800 62,500
Bilateral Salpingo Oophorectomy
1171
inmalignant conditions 30,900 32,400 35,700
Radical Trachelectomy in malignant
1172
conditions 52,400 55,000 60,500
1173 Radical Hysterectomy in malignant 59,600 62,500 68,800

59
 conditions
Laparoscopic pelvic exenteration in
1174
malignant conditions 1,20,000 1,26,000 1,38,600
Anterior Exenteration - Carcinoma
1175
Cervix 86,900 91,200 1,00,300
Posterior Exenteration - Carcinoma
1176
Cervix 67,100 70,500 77,500
Total Pelvic Exenteration - Carcinoma
1177
Cervix 1,00,100 1,05,100 1,15,600
Supra Levator Exenteration - Carcinoma
1178
Cervix 92,100 96,700 1,06,400
Laparoscopic extraFACIAL
1179 hysterectomy + multiple biopsies +
omentectomy in malignant conditions 47,600 49,900 54,900
Laparoscopic ExtraFACIAL
1180 Hysterectomy with Bilateral pelvic node
dissection in malignant conditions 48,300 50,700 55,800
1181 Hysterectomy in malignant conditions 34,000 35,700 39,300
Total Abdominal Hysterectomy(Tah) +
Bilateral Salpingo Ophorectomy (Bso) +
1182 Bilateral Pelvic Lymph Node Dissection
(Bplnd) + Omentectomy in malignant
conditions 64,200 67,400 74,200
Radical Hysterectomy +Bilateral Pelvic
Lymph Node Dissection (Bplnd) +
1183 Bilateral Salpingo Ophorectomy
(Bso) /Ovarian Transposition in
malignant conditions 52,100 54,700 60,200
Laparoscopic wertheim hysterectomy in
1184
malignant conditions 56,200 59,000 64,900
Radical Vaginectomy in malignant
1185
conditions 55,200 58,000 63,800
Radical Vaginectomy +
1186
Reconstruction(70.62) 62,600 65,800 72,300
1187 Vulvectomy in malignant conditions 47,400 49,700 54,700
Cranio Facial Resection in malignant
1188
conditions 93,100 97,700 1,07,500
Resection of Lateral Temporal Bone in
1189
malignant conditions 69,900 73,400 80,800
Subtotal Resection of Temporal Bone in
1190
malignant conditions 73,500 77,200 84,900
Total Resection of Temporal Bone in
1191
malignant conditions 79,500 83,500 91,800
Hemimandibulectomy in malignant
1192
conditions 39,300 41,200 45,300
Marginal Mandibulectomy in malignant
1193
conditions 48,000 50,400 55,500
Maxillectomy Any Type in malignant
1194
conditions 32,900 34,500 38,000
Maxillectomy + Infratemporal Fossa
1195
Clearance in malignant conditions 67,500 70,900 77,900
1196 Bone Resection in malignant conditions 44,200 46,400 51,000
Bone and Soft TissueTumors
1197
Amputation malignant conditions 29,800 31,300 34,400

60
 Surgery (removal) for Bone/Soft tissue
1198 tumors-Without Prosthesis in malignant
conditions(83.49) 51,300 53,800 59,200
Surgery (removal) for Bone / Soft tissue
1199 tumors-With Custom Made Prosthesis in
malignant conditions(83.49+84.40) 87,600 92,000 1,01,200
Surgery (removal) for Bone / Soft tissue
1200 tumors-With Modular Prosthesis in
malignant conditions(83.49+84.40) 99,500 1,04,500 1,14,900
Shoulder Girdle Resection in malignant
1201
conditions 56,300 59,100 65,000
1202 Sacral Resection in malignant conditions 61,500 64,600 71,000
Soft tissue and bone tumour wide
1203
exision 16,800 17,600 19,400
Soft tissue And Bone tumors wide
1204
excision reconstruction 26,800 28,100 31,000
1205 Head and Neck - Wide Excision 41,100 43,100 47,400
Forequarter Amputation in malignant
1206
conditions 79,100 83,100 91,400
1207 Hemipelvectomy in malignant conditions 80,100 84,100 92,500
Internal Hemipelvectomy in malignant
1208
conditions 80,800 84,900 93,400
Curettage & Bone Cement in malignant
1209
conditions 52,600 55,300 60,800
Mastectomy Any Type in malignant
1210
conditions 30,900 32,400 35,700
1211 Breast Reconstruction Surgery 43,300 45,500 50,000
1212 Lumpectomy 3,400 3,600 3,900
Wide Excision - Breast in malignant
1213
conditions 5,800 6,000 6,600
Skin Tumors Wide Excision in malignant
1214
conditions 36,600 38,400 42,200
Skin Tumors wide Excision +
1215 Reconstruction in malignant
conditions(86.6/86.7) 41,800 43,900 48,300
Wide local excision in malignant
1216
conditions 64,600 67,800 74,600
1217 Wide local excision + reconstruction 67,000 70,400 77,400
Skin Tumors amputation in malignant
1218
conditions 26,200 27,500 30,200
Reconstructon with Myocutaneous /
1219
Cutaneous Flap in malignant conditions 39,300 41,200 45,400
Composite Resection & Reconstruction -
1220
Head & Neck in malignant conditions 69,000 72,400 79,600
Isolated limb perfusion-hyperthermia in
1221
malignant conditions 62,100 65,200 71,800
MEDICAL ONCOLOGY
1222 Prostate Cancer with Hormonal Therapy 3,700 3,900 4,300
Chemotherapy for Breast Cancer with
1223
Adriamycin / Cyclophosphamide (Ac) 4,200 4,400 4,800
Chemotherapy for Bladder Cancer with
1224
Weekly Cisplatin. 2,000 2,100 2,300

61
 Chemotherapy for Bladder Cancer with
1225 Methotrexate Vinblastine Adriamycin
Cyclophosphamide (Mvac) 6,000 6,300 6,900
Chemotherapy for Breast Cancer with 5-
1226
Fluorouracil A-C (Fac) 4,200 4,400 4,800
Chemotherapy for Non SMAL cell Lung
1227
Cancer with Cisplatin/Etoposide (Iiib) 7,900 8,300 9,100
Chemotherapy for Non SMAL cell Lung
1228
Cancer with Erlotinib 15,000 15,800 17,300
Chemotherapy for Non SMAL cell Lung
1229
Cancer with GEFITINIB 7,100 7,400 8,200
Chemotherapy for Non SMAL cell Lung
1230
Cancer with Paclitaxel /Carboplatin 10,300 10,800 11,900
Chemotherapy for Non SMAL cell Lung
1231
Cancer with PEM + Cisplatin 20,300 21,300 23,400
Chemotherapy for Oesophageal Cancer
1232
with Cisplatin/5fu 7,400 7,800 8,500
Chemotherapy for Gastric Cancer with
1233
5- Fu Leucovorin (Mcdonald Regimen) 5,300 5,600 6,100
Chemotherapy for Vulval Cancer with
1234
Cisplatin/5-Fu 5,900 6,200 6,800
Chemotherapy for Gastric Cancer with
1235
EOX 15,600 16,400 18,000
Chemotherapy for Gastric Cancer with
1236
Gemcitabine+Oxaliplatin 16,300 17,100 18,800
Chemotherapy for Gastric Cancer with
1237
Gemcitabine / Cisplatin 12,600 13,200 14,600
1238 Ac (Ac Then T) 4,500 4,700 5,200
Chemotherapy for Gastric Cancer with
1239
Imatinib(CML) 5,600 5,900 6,500
Chemotherapy for Gastric Cancer with
1240
Dcf 18,300 19,200 21,100
Chemotherapy for Colorectal Cancer
1241
with Monthly 5-Fu 6,400 6,700 7,400
Chemotherapy for Colorectal Cancer
1242 with 5-Fluorouracil-Oxaliplatin
Leucovorin (Folfox) (Stage III) Only 12,400 13,000 14,300
Chemotherapy for Colorectal Cancer
1243 with Capecitabine + bevacizumab
(metastatic) 8,300 8,700 9,600
Chemotherapy for Colorectal Cancer
1244 with Capecitabine + Oxalipantia
(adjuvant) and metastatic 12,600 13,200 14,500
Chemotherapy for Vaginal Cancer with
1245
Cisplatin/5-Fu 6,900 7,200 8,000
Chemotherapy for Colorectal Cancer
1246
with Capacitabine 7,300 7,700 8,400
Chemotherapy for Bone Tumors with
1247
Cisplatin/Adriamycin 7,600 8,000 8,800
Chemotherapy for Bone Tumors -
Hodgkin Lymphoma disease with
1248
Adriamycin Bleomycin Vinblastine
Dacarbazine (Abvd) 5,600 5,900 6,500

62
 Chemotherapy for Non Hodgkin
Lymphoma with Cyclophosphamide
1249
Adriamycin Vincristine Prednisone
(Chop) 5,100 5,400 5,900
Chemotherapy for Breast Cancer with
1250
Paclitaxel 7,600 8,000 8,800
Chemotherapy for Non Hodgkin
1251
Lymphoma with R - chop 45,300 47,600 52,300
Chemotherapy for Multiple Myeloma
1252 with Vincristine,
Adriamycin,Dexamethasone(Vad) 4,600 4,800 5,300
Chemotherapy for Multiple Myeloma
1253
with Thalidomide+Dexamethasone(Oral) 5,000 5,200 5,800
Chemotherapy for Multiple Myeloma
1254
with Melphalan Prednisone (Oral) 4,800 5,000 5,500
Chemotherapy for Wilms Tumor with
1255
Siopwts Regimen(Stages I-III) 7,300 7,700 8,400
Chemotherapy for Ovarian cancer with
1256
Carboplatin / Paclitaxel 11,300 11,900 13,000
Chemotherapy for Hepatoblastoma
1257
operable with Cisplatin -Adriamycin 5,300 5,600 6,100
Chemotherapy for Childhood B cell
1258
Lymphoma with variable regimen 22,100 23,200 25,500
Chemotherapy for Neuroblastoma
1259
(Stages I-III ) with Variable Regimen 11,500 12,100 13,300
Chemotherapy for Neuroblastoma
1260
(Stages I-III ) PCV (medulloblastoma) 5,600 5,900 6,500
Chemotherapy for Retinoblastoma with
1261
Carbo/Etoposide/Vincristine 5,600 5,900 6,500
Chemotherapy for Breast Cancer with
1262 Cyclophosphamide/ Methotrexate /
5fluorouracil (Cmf) 2,000 2,100 2,300
Chemotherapy for Histiocytosis with
1263
Variable Regimen 5,300 5,600 6,100
Chemotherapy for Rhabdomyosarcoma
1264 with Vincristine-Actinomycin-
Chemotherapy for Rhabdomyosarcoma 9,600 10,100 11,100
Chemotherapy for Ewings Sarcoma with
1265
Variable Regimen 5,300 5,600 6,100
Chemotherapy for Acute Myeloid
1266
Variable Regimen 69,000 72,400 79,700
Chemotherapy for Ovarian cancer with
1267 Germ Cell Tumor Bleomycin-Etoposide-
Cisplatin (Bep) 8,600 9,000 9,900
Chemotherapy for Acute Myeloid
1268
Leukemia with Consolidation Phase 66,300 69,600 76,600
Chemotherapy for Acute Myeloid
1269
Leukemia with Maintenance phase 3,000 3,100 3,500
Chemotherapy for Acute Lymphoblastic
1270 Leukemia with Induction 1st And 2nd
Months 1,09,000 1,14,400 1,25,900
Chemotherapy for Acute Lymphoblastic
1271
Leukemia with Induction 3rd, 4th, 5th 10,900 11,400 12,600

63
 Chemotherapy for Acute Lymphoblastic
1272
Leukemia with Induction Maintenance 12,300 12,900 14,200
Palliative Chemotherapy for unlisted
1273
Regimen 5,600 5,900 6,500
Chemotherapy for Breast Cancer with
1274
Tamoxifen Tabs 500 500 600
Palliative And Supportive Therapy for
1275
terminally ill cancer patient 3,600 3,800 4,100
Chemotherapy for Acute Myeloid
1276 Leukemia with Xelox Along With
Adjuvant Chemotherapy Of As-I 12,000 12,600 13,800
Chemotherapy for Multiple myeloma
1277 with Zoledronic Acid Along With
Adjuvant Chemotherapy Of As-I 3,300 3,500 3,800
Chemotherapy for low risk Gestational
1278 trophoblast DS with Weekly
Methotrexate 2,300 2,400 2,600
Chemotherapy for Multiple myeloma
1279
with Lenalidomide dexa 10,000 10,500 11,500
Chemotherapy for Multiple myeloma
1280
with MPT(myeloma) 5,400 5,600 6,200
Chemotherapy for Multiple myeloma
1281
with Imatinib (GSIT) 7,000 7,300 8,100
Supportive Therapy ( Third Generation
1282
Cephalosporin, Aminoglycoside Etc.,) 5,300 5,600 6,100
Chemotherapy for Febrile Neutropenia
with 2nd Line Iv Antibiotics And Other
1283 Supportive Therapy(Carbapenems,
Fourth Generation Cephalosporins,
Piperacillin, Anti-Fungal . Azoles Etc.,) 44,200 46,400 51,000
Chemotherapy for Chronic lymphoid
1284
leukemia with Benadamustine 16,300 17,100 18,800
Chemotherapy for Chronic lymphoid
1285
leukemia with Chilorambucil 3,000 3,100 3,500
Chemotherapy for Breast Cancer with
1286
Aromatase Inhibitors 1,200 1,200 1,400
Chemotherapy for Chronic lymphoid
1287
leukemia with IA 10,600 11,100 12,200
Chemotherapy for Chronic lymphoid
1288
leukemia with Imatinib(CML) 7,000 7,300 8,100
Chemotherapy for low risk Gestational
1289
trophoblast DS with Actinomycin 5,300 5,600 6,100
Chemotherapy for Chronic lymphoid
1290
leukemia with Sunitinib 15,000 15,700 17,300
Chemotherapy With
1291
Temozolamide(brain tumours) 10,000 10,500 11,600
Chemotherapy With Benadamustin -
1292
RITUXIMAB 60,000 63,000 69,300
1293 Chemotherapy With TIP(GCT 2nd line) 20,000 21,000 23,100
Chemotherapy for Breast Cancer with
1294
Docetaxel 10,300 10,800 11,900
Chemotherapy for Cervical Cancer with
1295
Weekly Cisplatin 2,000 2,100 2,300

64
 Chemotherapy for high risk Gestational
trophoblast DS with Etoposide-
1296
Methotrexate -Actinomycin /
Cyclophosphamide Vincristine (Ema-Co) 7,600 8,000 8,800
Chemotherapy for Testicular Cancer
1297 with Bleomycin with Etoposide-Cisplatin
(Bep) 8,600 9,000 9,900
Chemotherapy Chemotherapy for
1298 Hepatoblastoma operable with
Sorafenib 10,000 10,500 11,500
1299 Chemotherapy with Capeiri(metastatic) 8,300 8,700 9,600
Chemotherapy with Capeox(adjuvant)
1300
and metastatic 7,800 8,200 9,000
Radiation Oncology
1301 Acute lymphoblastic leukemia: radiation 5,500 5,800 6,400
Hodgkin Lymphoma (Favorable group):
1302
radiation 11,000 11,600 12,700
Hodgkin Lymphoma (unfavorable
1303
group): radiation 16,500 17,300 19,100
1304 Retinoblastoma (Intraocular): radiation 11,000 11,600 12,700
1305 Retinoblastoma (extraocular): radiation 11,000 11,600 12,700
1306 Brain tumors: radiation 33,000 34,700 38,100
1307 Wilms tumors: radiation 5,500 5,800 6,400
Bone tumors/soft tissue sarcomas
1308
:radiation 27,500 28,900 31,800
Bone tumors/soft tissue sarcomas
1309
:surgery (inlcuding prosthesis) 2,58,500 2,71,400 2,98,600
Cobalt 60 External Beam Radiotherapy
1310
(Radical/Adjuvant / Neoadjuvant) 22,000 23,100 25,400
Cobalt 60 External Beam Radiotherapy
1311
(Palliative) 11,000 11,600 12,700
Linear Accelerator External Beam
1312
Radiotherapy (Palliative) 22,000 23,100 25,400

Linear Accelerator, External Beam

1313
Radiotherapy 3D CRT/2D Planning
(Radical/Adjuvant/Neoadjuvant) 55,000 57,800 63,500
Linear Accelerator, External Beam
Radiotherapy IMRT (Intensity
1314
Modulated Radiotherapy)
(Radical/Adjuvant/Neoadjuvant) 82,500 86,600 95,300
Linear Accelerator External Beam
Radiotherapy IGRT (Image Guided
1315
radiotherapy)
(Radical/Adjuvant/Neoadjuvent) 1,32,000 1,38,600 1,52,500
1316 SRT(Stereota1036ic radiotherapy) 82,500 86,600 95,300
1317 SRS (Streotactic radiosurgery) 77,000 80,900 88,900
Respiratory Gating along with Linear
1318
Accelerator planning 77,000 80,900 88,900
Electron beam with Linear accelerator
1319 (Radical)Tomotherapy(Radical/Adjuvant/
Neoadjuvant) 55,000 57,800 63,500
1320 Tomotherapy(Radical/Adjuvant/Neoadju 55,000 57,800 63,500

65
 vant)
Brachytherapy High Dose
1321 Radiation(Intracavitory) - per fraction,
maximum of 4 sessions 5,000 5,200 5,700
Brachytherapy High Dose Radiation
1322 (Interstitial) - for one application, multiple
dose 33,000 34,700 38,100
Brachytherapy High Dose Radiation
1323 (Intraluminal) - per fraction, maximum 4
sessions 5,000 5,200 5,700
Cobalt 60 External Beam
1324 Radiotherapy,Definitive, Neoadjuvant,
Adjuvant 22,000 23,100 25,400
Brachytherapy/ Interstitial LDR ,
1325
adjuvant 16,500 17,300 19,100
Linear accelerator teletherapy,
1326
Definitive+Tab Temozolamide 60,500 63,500 69,900
Linear accelerator teletherapy, 3DCRT,
1327 Definitive along with +concurrent Tab
Temozolamide along with RT 88,000 92,400 1,01,600
Linear accelerator (Photons)
1328
teletherapy,Adjuvant 55,000 57,800 63,500
Cobalt 60 External Beam
1329
Radiotherapy,Definitive 22,000 23,100 25,400
1330 Radioiodine Treatment < 100 Millicuries 22,000 23,100 25,400
1331 Radioiodine Treatment > 100 Millicuries 33,000 34,700 38,100
Accelerated partial breast irradiation
1332
(APBI) any type/ LINAC/3DCRT/IMRT 55,000 57,800 63,500
Linear accelerator,Involved-Site
1333 Radiotherapy (ISRT)/Involved field
radiation therapy(IFRT)/3DCRT/IMRT 27,500 28,900 31,800
Linear accelerator, less than 20
1334
fractions/3DCRT/IMRT 27,500 28,900 31,800
Linear accelerator
1335 teletherapy,3DCRT,IMRT,VMAT
Adjuvant/Definitive 82,500 86,600 95,300
Brachytherapy/ Interstitial HDR one
1336 application, multiple doses
Definitive/Boost 33,000 34,700 38,100
1337 Cobalt 60 teletherapy, Palliative 11,000 11,600 12,700
1338 Linear accelerator teletherapy, Palliative 22,000 23,100 25,400
PLASTIC SURGERY
1339 Skull base surgery 1,02,400 1,07,500 1,18,300
1340 Surgical correction for Craniosynostosis 92,100 96,700 1,06,300
Surgical Correction of Nerve and
1341 Tendon Repair + Vascular Repair
(82.4+39.3) 49,800 52,300 57,500
1342 Sequalae of brachial plexus injuries 42,700 44,800 49,300
Conservative treatment for brachial
1343
plexus injuries 10,900 11,400 12,600
Corrective surgery for Hyperchalonism
1344
elecanthes 55,400 58,200 64,000

66
 Tarsorrhaphy surgery to prevent
exposure keratitis to prevent loss or
1345
impairment of vision especially in facial
burns 10,900 11,400 12,600
1346 Ear reconstruction 44,900 47,100 51,800
Reconstruction or prosthetic appliance
1347
for absent ear 33,000 34,600 38,100
Surgical Correction of anamolies of Ear
1348
(cup & bat ears) 28,600 30,000 33,000
1349 Nose fractures with implants 47,400 49,800 54,700
Nose deformities with functional
1350
disturbances 61,800 64,900 71,400
1351 Macroglossia Correction 47,400 49,800 54,700
1352 Micrognathia - pierre robbinsequalae 68,300 71,700 78,900
1353 Tessier¿s cleft 54,800 57,500 63,300
1354 Palatal fistula Repair 43,100 45,200 49,800
1355 Surgical Management Of Cleft Lip 27,400 28,800 31,600
1356 Cleft lip nasal deformity correction 76,800 80,600 88,700
1357 Secondary correction of cleft lip/palate 61,800 64,900 71,400
Surgical correction for Vascular
1358
malformations 35,900 37,700 41,500
1359 Hypospadias cripples 42,700 44,800 49,300
1360 Epispadias / exstrophy 22,000 23,100 25,400
1361 Vasovasalanastamosis 63,000 66,200 72,800
1362 Penis reconstruction - pedicled 76,500 80,300 88,400
1363 Penis reconstruction - micro vascular 1,26,200 1,32,500 1,45,800
1364 Tuboplasty/Open Tubal Recanalisation 27,200 28,500 31,400
Reconstructive procedures for vaginal
1365
atresia 40,500 42,500 46,700
Functional corrective surgery for sequel
1366
of facial injuries 72,700 76,300 84,000
Orthognathic surgeries involving facial
1367
bones 82,700 86,800 95,500
Panfacial fractures combination with
1368
polytrauma 1,05,800 1,11,100 1,22,200
Frontonasoethmoid fractures with
1369
implants 1,01,800 1,06,900 1,17,600
Surgical Correction of lid retraction with
1370
Tumour of Mandible And Maxilla 62,500 65,600 72,100
1371 Corrcetion of lid retraction 27,700 29,100 32,000
1372 Zygoma/ Orbital Fractures 80,900 84,900 93,400
1373 Maxilla fractures lefort II 74,400 78,100 85,900
1374 Surgical Correction Of Fracture Lefort III 53,500 56,200 61,800
1375 Maxilla fractures lefort III 76,900 80,700 88,800
Facial bone fractures - mandible
1376
fracture single with implants 53,600 56,300 61,900
Facial bone fractures - mandible fracture
1377
multiple with implants 76,500 80,300 88,300
1378 Alveolar bone grafting with bone graft 32,700 34,400 37,800
1379 Polydactyly Repair 31,900 33,500 36,900

67
1380 Calvarial reconstruction 77,700 81,600 89,700
Treatment for trisser
1381
fingerenosynovitis(82.2) 32,000 33,600 37,000
Aplasia / hypoplasia / post traumatic
1382 loss of thumb for reconstruction -
conventional surgery 66,500 69,900 76,900
Aplasia / hypoplasia / post traumatic
1383 loss of thumb for reconstruction -
microsurgery 86,700 91,100 1,00,200
Surgical Correction of Leprosy
1384
Reconstructive Surgery 23,500 24,700 27,100
Surgical correction for Congenital
1385
Deformity of Hand (Per Hand) 26,500 27,800 30,600
1386 Tendon transfer procedure for wrist drop 34,400 36,100 39,700
1387 Cleft hand / foot Correction 55,500 58,300 64,100
1388 Mallet finger Surgery 29,700 31,200 34,300
1389 Boutonnierie¿s deformity Repair 38,900 40,800 44,900
1390 Finger tip injuries Repair 20,400 21,400 23,600
1391 Compressive neuropathies 32,800 34,400 37,900
1392 Treatment for supparativechondritis 33,300 35,000 38,500
Post cabg(sternal dehiscence/osdo
1393
Repair 44,700 46,900 51,600
1394 Free functional muscle transfer 78,200 82,100 90,300
Corrective surgery for congenital
1395
deformities of foot (per foot) 53,000 55,700 61,200
1396 Post Burn Contracture Surgeries - Mild 43,100 45,200 49,700
Post Burn Contracture Surgeries -
1397
Moderate 45,100 47,300 52,100
Post Burn Contracture Surgeries -
1398
Severe 51,600 54,200 59,600
Mgt of electrical burns with vital
1399
expossed with flapcover 59,900 62,900 69,200
Amputation of hand / fore arm / arm /
1400
foot / leg / thigh with skin cover (84.1) 41,600 43,700 48,100
Amputation of digit with skin
1401
cover(84.11) 26,200 27,500 30,300
1402 Disarticulation through shoulder 39,200 41,200 45,300
1403 Disarticulation through thigh 43,300 45,500 50,000
Reimplantation / revascularization -
1404
multiple digits per finger 86,000 90,300 99,400
Reimplantation / revascularization -
1405
single digit 86,600 91,000 1,00,000
1406 Reimplantation / revascularization - wrist 86,600 90,900 1,00,000
1407 Toe transfer 87,100 91,400 1,00,500
1408 Breast reduction for gynacomastia-male 40,000 42,000 46,200
Breast reduction for gigantomachia
1409
female 52,300 54,900 60,400
Post mastectomy breast reconstruction
1410
with flap and tissue expandor 87,600 92,000 1,01,200
1411 Nipple areola reconstruction 41,800 43,900 48,300
1412 Reduction Surgery For Filarial 44,100 46,300 50,900

68
 Lymphoedema
Any raw area which needs skin grafting -
1413
mild<5% 35,900 37,700 41,500
Any raw area which needs skin grafting -
1414
moderate 5-10% 40,300 42,300 46,500
Any raw area which needs skin grafting -
1415
major - >10 % 55,000 57,700 63,500
Debridement and primary closure for
1416
avulsion injuries(86.59) 58,300 61,200 67,300
Debridement and skin grafting for
1417
avulsion injuries(86.63) 77,100 81,000 89,100
Surgical Management of 40% mixed
1418
burns 78,500 82,400 90,700
Surgical Management of 50% mixed
1419
burns 1,33,300 1,39,900 1,53,900
Surgical Management of 60% mixed
1420
burns 1,56,000 1,63,800 1,80,200
Surgical Management of above 60%
1421
mixed burns 1,54,100 1,61,800 1,78,000
Eyelid injuries / avulsions - major (more
1422
than 25% either in thickness or length) 62,100 65,200 71,700
Nose injuries / avulsions- primary
1423
closure/ skin graft(86.6) 42,100 44,200 48,600
Ear injuries / avulsions - primary
1424
closure/ skin graft(86.6) 42,100 44,200 48,600
Lip injuries / avulsions - primary
1425
closure/ skin graft(86.6) 42,100 44,200 48,600
Sub mucosal fibrosis - surgical
1426
management with grafts 62,400 65,500 72,100
Extensive degloving injuries / lacerations
1427 of the face in rta / animal bites with
exposure of vital structures 77,400 81,300 89,400
Surgical management for keloid &
1428
hypertrophic scar requiring flap cover 28,000 29,400 32,300
1429 Pedicle flap 72,300 75,900 83,400
Sub mucosal fibrosis - surgical
1430
management with flap 51,700 54,300 59,700
Flap cover for trauma of the hand /
forearm / arm / foot / leg / thigh etc.,
with exposure of the underlying vital
1431
structures like tendons, nerves, vessels,
bone, with or without any fracture - flap
division 62,000 65,100 71,600
Crush injury hand involving loss of skin
1432
and vital parts requiring flap cover 51,600 54,200 59,600
Flap cover for trauma of the hand /
forearm / arm / foot / leg / thigh etc.,
with exposure of the underlying vital
1433
structures like tendons, nerves, vessels,
bone, with or without any fracture- flap
insert 61,800 64,900 71,400
Micro vascular reconstruction flap (post
1434 burns, post neoplastic, trauma, post
traumatic, congenital) 92,400 97,000 1,06,700
1435 Nose injuries / avulsions -flap cover 36,100 37,900 41,700

69
1436 Ear injuries / avulsions - flap cover 38,100 40,000 44,000
1437 Lip injuries / avulsions - flap cover 36,000 37,800 41,600
Scar revision procedures involving
1438
natural orifices 31,300 32,800 36,100
Reconstructive surgery for facial palsy -
1439
micro vascular 81,400 85,500 94,100
Surgical Correction of Hemifacial
1440
Atrophy 92,200 96,800 1,06,500
Reconstructive surgery for facial palsy
1441
-conventional 82,300 86,400 95,000
Surgical Correction of hemifacial
1442
microsomia 84,000 88,200 97,000
Post traumatic squeal like contractures,
1443 severe hypertrophy, unstable scars,
non-healing ulcers etc., 42,100 44,200 48,600
Surgical Management of Syndactyly of
1444
Hand For Each Hand 36,600 38,500 42,300
1445 Tissue expansion -for functional purpose 48,200 50,600 55,600
Conservative management of 40%
1446
burns 69,000 72,500 79,700
Conservative management of 50%
1447
burns 1,38,000 1,44,900 1,59,400
Conservative management of 60%
1448
burns 2,13,500 2,24,200 2,46,600
Injection treatment - each sitting for
1449 keloid,haemangioma, lymphangioma
and vascular malformations 22,100 23,200 25,500
POLYTRAUMA
Surgical Treatment (Up To) for Neuro
1450
Surgical Trauma 1,51,500 1,59,100 1,75,000
1451 Tracheostomy 6,200 6,500 7,200
1452 Thoracostomy 11,400 12,000 13,200
1453 Surgical Treatment for Chest injuries 30,600 32,100 35,400
Surgical Management for Abdominal
1454
Injuries 77,100 81,000 89,100
Surgical treatement of fascial bone
1455
fracture 16,500 17,300 19,100
Surgical management with K-Wiring for
Small bone fractures (To Be Covered
1456
Along With Other Injuries Only And Not
As Exclusive Procedure) 5,000 5,300 5,800
Surgical Management of Patella
Fracture (To Be Covered Along With
1457
Other Injuries Only And Not As
Exclusive Procedure) 5,000 5,300 5,800
Surgical Correction Of Pelvic Bone
1458
Fractures. 36,700 38,500 42,400
Surgical Correction Of Longbone
1459
Fracture 31,500 33,100 36,400
Surgical Management of Grade I&II
1460
Compound Fractures 16,500 17,300 19,100
Surgical Management of Grade III
1461
Compound Fractures 27,800 29,200 32,100

70
 Surgical Management of wound In
1462 Compound Fracture with Flap
cover(86.7) 26,600 27,900 30,700
1463 Management of Soft Tissue Injury 6,800 7,100 7,900
1464 Toes Amputation 10,600 11,100 12,200
1465 Amputation surgery 10,600 11,100 12,200
Intesive care management for Chest
1466
injuries in RICU Rs. 4000/- per day 35,000 36,800 40,400
Intesive care managementof Neuro
1467 Surgical Trauma in Neuro Icu
@Rs.4000/Day 48,000 50,400 55,400
Intesive care management for
1468 Abdominal Injuries In Surgical
[email protected]/Day 31,000 32,600 35,800
Medical management of Neurosurgical
1469
troma in general ward @900/- day 12,300 12,900 14,200
Conservative management of chest
1470
injuries in general ward @900/- day 6,900 7,200 8,000
Conservative management of Abdominal
1471 surgical in general ward Major @900/-
day 6,900 7,200 8,000
Dental Surgery
Surgical Management of Naso
1472
Ethmoidal Floor Fracture - G.A 19,500 20,500 22,600
1473 Surgical Closure Oro-Nasal Fistula 7,500 7,800 8,600
1474 Sinus Lift Procedure Without Grafting 17,100 18,000 19,800
1475 Sinus Lift Procedure With Grafting 18,700 19,700 21,600
1476 Simple Extraction Of Tooth 300 300 300
Application Of Pit & Fissure Sealants
1477
(Pedo) 600 600 700
1478 Amalgam Restoration Per Tooth 300 400 400
1479 Temporary Filling Per Tooth 300 300 300
1480 Tooth Coloured Restoration Per Tooth 500 500 500
Fabrication & Cementation Of Inlay &
1481
Onlay-Ceramic 2,600 2,800 3,000
Fabrication & Cementation Of Inlay &
1482
Onlay-Metal 1,700 1,700 1,900
1483 Flouride Gel Application (Pedo) 1,400 1,500 1,600
1484 Treatment Under Conscious Sedation 800 900 1,000
Vital Bleaching Procedure For 8 Upper
1485
Teeth 1,100 1,200 1,300
Restoration With Composite Veneers
1486
(Pertooth) 600 600 700
Preparation & Cementation Of Anterior
1487
All Ceramic Laminates 3,200 3,400 3,700
1488 Atraumatic Restorative Treatment 800 800 900
1489 Pulpotomy & Pulpectomy With Ssc 900 900 1,000
1490 Management Of Avulsed Tooth 900 1,000 1,100
Surgical Placement Of Dental Implants
1491
Under L.A 11,200 11,800 13,000
1492 Treatment with Micro Implants (Each) 600 600 700

71
 Surgical Placement Of Eye Prosthesis
1493
With Implants 40,400 42,500 46,700
Surgical Placement Of Nose Prosthesis
1494
With Implants 36,000 37,800 41,600
Surgical Placement Of Zygomatic
1495
Implants Under G.A 1,30,500 1,37,000 1,50,700
Root Canal Treatment - Deciduous
1496
Tooth 900 900 1,000
1497 Anterior Root Canal Treatment 2,000 2,100 2,300
1498 Apicoectomy 2,000 2,100 2,300
Root Canal Treatment With Hemisection
1499
Of Root 4,000 4,200 4,600
1500 Posterior Root Canal Treatment 2,000 2,100 2,300
1501 Apicoectomy With Grafting (76.91) 2,200 2,300 2,600
1502 Root Resection 1,900 2,000 2,200
Extraction Of III Molar / Impacted Toot
1503
Under L.A 2,000 2,100 2,300
1504 Surgical Extraction Of Tooth 1,500 1,600 1,700
Extraction Of Deep Bony Impacted
1505
Tooth Under G.A. 10,000 10,500 11,600
Preparation And Cementation Of Acrylic
1506
Crown 400 400 500
Fabrication & Cementation Of Metal
1507
Ceramic Crown (Per Unit) 1,400 1,400 1,600
Preparation & Cementattion Of Anterior
1508
All Ceramic Crown 3,100 3,200 3,500
Placement Of Stainless Steel Crown
1509
(Per Tooth) 700 700 800
Fibre Post & Core Restoration With
1510
Anterior All Ceramic Crown (23.4) 3,600 3,700 4,100
Fibre Post & Core Restoration With
1511
Metal Ceramic Crown (23.4) 2,300 2,400 2,600
Metal Post & Core Restoration With
1512
Metal Ceramic Crown (23.4) 2,300 2,400 2,600
Placement Of Fixed Habit Breaking
1513
Appliances 2,100 2,200 2,400
1514 Tretament With Expansion Plate 1,600 1,700 1,900
Fabrication & Insertion Of Removable
1515
Habit Breaking Appliance 1,500 1,600 1,800
Fabrication & Insertion Of Removable
1516
Appliance (Upper / Lower ) 1,600 1,600 1,800
Fabrication & Insertion Of Removable
1517
Functional Appliance 2,900 3,000 3,300
Fabrication & Insertion Of Removable
1518
Partial Denture- Single Tooth 600 600 600
Fabrication & Insertion Of Removable
1519
Retainers-Each Arch 700 700 800
Fabrication & Insertion Of Fixed Space
1520
Maintainers / Space Retainer 1,300 1,300 1,500
Fabrication & Insertion Of Removable
1521
Space Maintainers (Pedo) 1,000 1,100 1,200
1522 Treatment With Inclined Plane 900 900 1,000

72
 Fabrication Of Occlusal Night Guard
1523
(Hard Or Soft) 1,000 1,100 1,200
1524 Operculectomy 400 500 500
1525 Sub Gingival Curretage Per Quadrant 800 900 1,000
1526 Gingivectomy (Per Quadrant) 1,200 1,200 1,400
1527 Gingivectomy-Single Tooth 600 700 700
1528 Flap Surgery - Single Tooth 700 800 900
1529 Crown Lengthening Procedure (24.6) 1,000 1,000 1,100
1530 Root Coverage Procedure (Per Tooth) 1,600 1,700 1,900
1531 Osseous Surgery 3,500 3,600 4,000
1532 Flap Surgery (Per Quadrant) 1,700 1,800 2,000
Flap Surgery With Bone Grafting (Per
1533
Quadrant) 2,100 2,200 2,400
1534 Free Gingival Graft-Gum Surgery 2,300 2,400 2,600
1535 Gingival De Pigmentation Procedure 1,500 1,600 1,800
Local Drug Delivery -Periodontal
1536
Treatments 1,000 1,100 1,200
Pre Prosthetic Surgery - Ridge
1537
Augmentation(Full mouth) 20,900 21,900 24,100
1538 Resection And Reconstruction (Tumor) 21,500 22,500 24,800
Surgical Managemant Of Cyst(<2.5 cm)
1539
Under L.A. 1,700 1,800 2,000
1540 Excision Of Growth Under L.A. 3,300 3,500 3,800
Surgical Managemant Of Cyst(> 2.5 cm)
1541
Under G.A. 10,700 11,200 12,300
1542 Excision Of Growth Under G.A. 14,800 15,600 17,100
Excision Of Precancerous Lesions
1543
Under L.A 6,200 6,500 7,200
Excision Of Precancerous Lesions
1544
Under G.A 10,500 11,000 12,100
Excision Of Precancerous Lesions With
1545
Grafting (76.91) 13,200 13,900 15,300
1546 Surgical Excision With Grafting (76.91) 22,100 23,200 25,500
1547 Enucleation Of Cyst/ Tumor 10,800 11,300 12,400
1548 Alveoloplasty (Quadrant) 700 700 800
Rapid Maxillary Expansion With Hyrax
1549
Screwifr Palatal Expanders 4,700 5,000 5,500
Treatment With Temporary Anchorage
1550
Devices 1,900 2,000 2,200
Treatment With Fixed Functional
1551
Appliances 3,600 3,800 4,100
Fixed Orthodontics Treatment-Ceramic
1552
Braces 5,100 5,400 5,900
Fixed Orthodontics Treatment-Metal
1553
Braces 10,700 11,200 12,300
1554 Treatment With Fixed Retainers 1,000 1,100 1,200
Fabrication Of Acrylic Splinting Arch ( In
1555
Auto Polymerizing Acrylic) 1,100 1,100 1,200
Fabrication & Insertion Of Feeding Plate
1556
(Acrylic) 900 1,000 1,100
1557 Fabrication & Insertion Of Obturator - 900 900 1,000

73
 Acrylic
Fabrication & Insertion Of Obturator &
1558
Speech Bulb-Acrylic 2,000 2,100 2,300
Relining / Rebasing of Complete
1559
Denture 900 1,000 1,100
Vestibuloplasty - Maxilla / Mandible-
1560
G.A. 26,000 27,300 30,100
1561 Vestibuloplasty - Maxilla / Mandible- L.A 13,200 13,900 15,300
1562 Sulcus Extention Procedure 2,300 2,500 2,700
1563 Surgical Placement Of Nose Prosthesis 2,000 2,100 2,400
1564 Surgical Placement Of Ear Prosthesis 2,200 2,300 2,500
1565 Frenectomy 700 700 800
1566 Surgical Removal Of Sialolith -L.A. 25,600 26,900 29,600
1567 Surgical Removal Of Sialolith -G.A. 35,900 37,700 41,500
Incision & Drainage of Simple Abscess
1568
(per Tooth) 700 700 800
Incision & Drainage of Facial Abscess
1569
Under G.A 8,300 8,700 9,600
Incision & Drainage of Facial Abscess
1570
Under L.A 3,500 3,700 4,000
Sequestrectomy & Saucerization Of
1571
Osteomyelitis Of Maxilla & Mandible 30,000 31,500 34,700
1572 Marginal Mandibulectomy- Osteomyelitis 21,200 22,200 24,500
1573 Coronoidectomy 12,000 12,600 13,800
1574 Segmental Osteotomy Mandible 13,900 14,600 16,000
1575 Vertical Sub Sigmoid Osteotomy 7,500 7,800 8,600
Bilateral Sagittal Split Osteotomy Of
1576
Mandible (BSSO) 30,100 31,600 34,700
Anterior Segmental Osteotomy -
1577
Maxilla / Mandible (ASO) 24,700 25,900 28,500
1578 Segmental Osteotomy Maxilla 13,600 14,300 15,800
1579 Zygoma/orbital fractures 76,900 80,700 88,800
Surgical Management Of Combined
1580 Fracture Of Mandible & Maxilla
(76.74/76.75/76.76) 33,400 35,000 38,500
1581 Surgical Correction Of Fracture Lefort II 40,400 42,400 46,600
Open Reduction & Internal Fixation Of
1582
Jaw Fractures Under G.A. (76.76) 12,800 13,400 14,800
Closed Reduction & Immobilisation Of
1583
Mandibular Fracture Under L.A. 1,900 2,000 2,200
Surgical Correction Of Fracture Lefort I -
1584
G.A. (76.76) 39,300 41,300 45,400
Surgical Management Of TMJ
1585
Dislocation (G.A.) (76.94) 15,300 16,100 17,700
Distraction Osteogenesis- Mandible-
1586
G.A. 37,400 39,300 43,200
1587 Distraction Osteogenesis- Maxilla- G.A. 37,600 39,500 43,400
1588 Alveolar Distraction L.A. 5,400 5,700 6,300
Surgical Management Of TMJ Ankylosis
1589
(G.A.) 17,900 18,800 20,700

74
 Radio Frequency & Thermo Coagulaton
1590
For Treatment Of Trigeminal Neuralgia 15,900 16,700 18,400
1591 Cryosurgery In Dental Procedures 10,800 11,400 12,500
Laser Treatment For Precancerous
1592
Lesions 1,100 1,100 1,200
1593 Chin Cup Thepary 4,400 4,600 5,000
1594 Head Gear Therapy 4,200 4,400 4,800
1595 Face Mask Therapy 3,500 3,600 4,000
Intermaxillary Fixation(IMF) For Alveolar
1596
Fractures Under L.A. 4,200 4,400 4,800
1597 Splinting Of Teeth Under L.A(24.7) 1,000 1,000 1,100
1598 Surgical Placement Of Eye Prosthesis 2,500 2,600 2,900
Oral Prophylaxis - Extrinsic Stains
1599
(Upper/ Lower) 400 500 500
Oral Prophylaxis - Calculi (Upper/
1600
Lower) 600 600 600
Fabrication & Insertion Of Complete
1601
Denture (U & L) 5,700 6,000 6,500
Fabrication & Insertion Of Complete
1602
Denture (Upper / Lower) 3,200 3,300 3,700
Fabrication & Insertion of Soft Liner
1603
Denture 7,500 7,800 8,600
Fabrication & Insertion Of Cast Partial
1604 Dentures Framework With Precission
Attachments 9,800 10,300 11,300
Fabrication Of Over Dentures Without
1605
Attachments 5,900 6,200 6,800
Fabrication Of Over Dentures -Implant
1606
Supported (2 units) 26,400 27,700 30,400
Fabrication Of Over Dentures With
1607
Attachments 11,200 11,700 12,900
Fabrication & Insertion Of Cast Partial
1608
Dentures Framework Per Unit 4,800 5,100 5,600
Medical Management Of Trigeminal
1609
Neuralgia 8,000 8,400 9,200
1610 Medical Management of Oral Ulcers 5,000 5,300 5,800
Hesters Opener Procedure -
1611
Management of OSMF 25,000 26,300 28,900
Combination Of Intralesional Injection
1612
For Oral Submucous Fibrosis 3,000 3,200 3,500
1613 Medical Management of OSMF
3,000 3,200 3,500
1614 Medical Management of Leukoplakia
3,000 3,200 3,500
Medical Management of Premalignant
1615 Lesions And Conditions (Antioxidant
Therapy) ( K13.29/K13.5) 5,000 5,300 5,800
1616 Medical Management Of Lichen Planus
1,100 1,200 1,300
Mdical Management Of TMJ
1617
Dysfunction Syndrome (76.94) 5,000 5,300 5,800
Medical Management Of Myo FACIAL
1618
Pain Dysfunction Syndrome (MPDS) 5,000 5,300 5,800

75
Medical - Critical Care
Medical Management of Acute
1619 Bronchitis with Pneumonia and
Respiratory Failure 61,500 64,600 71,000
Medical Management of COPD with
1620 Respiratory Failure (Infective
Exacerbation) 81,800 85,900 94,500
Medical Management of Acute Severe
1621
Asthma With Acute Respiratory Failure 51,800 54,400 59,800
1622 Medical Management of ARDS 1,02,100 1,07,200 1,17,900
Medical Management of ARDS with
1623
Multi Organ failure (R65.1) 1,15,000 1,20,800 1,32,800
Medical Management of ARDS with DIC
1624
(Blood & Blood Products) (D65) 1,43,000 1,50,200 1,65,200
Intensive care management of Septic
1625
Shock 63,000 66,100 72,800
Medical Management of Poisioning
1626
Requiring Ventilatory Assistance 51,500 54,100 59,500
Medical-General Medicine
Medical Management of Typhoid And
1627
Paratyphoid Fevers 21,800 22,900 25,200
Medical Management of Acute
1628
Gastroenteritis 15,900 16,700 18,400
1629 Medical Management of Tb Meningitis 32,400 34,000 37,400
1630 Medical Management of Dengue Fever 26,500 27,800 30,600
Medical Management of Dengue
1631
Haemorrhagic Fever 36,800 38,600 42,500
Medical Management of Falciparum
1632
Malaria 11,500 12,100 13,300
Medical Management of Cerebral
1633
Malaria 27,100 28,500 31,300
1634 Medical Management of Vivax Malaria 11,500 12,100 13,300
Medical Management of Myelodysplastic
1635
Syndromes 33,000 34,700 38,100
Medical Management of Chelation
1636
Therapy For Thalassemia Major 16,200 17,000 18,700
1637 Medical Management of Pancytopenia 31,500 33,100 36,400
Medical Management of Anaemias
1638
(Less Than 7 Gms)/ Heart Failure 31,200 32,800 36,000
Medical Management of Hemophilia
1639
(D67/D68.0) 61,500 64,600 71,000
Medical Management of
1640 Thrombocytopenia With Bleeding
Diathesis 32,100 33,700 37,100
Medical Management of Other
1641
Coagulation Disorders 45,200 47,500 52,200
Medical Management of Periodic
1642
Paralysis 16,200 17,000 18,700
Medical Management of Metabolic
1643
Encephalopathy 36,800 38,600 42,500
1644 Medical Management of Acute 17,100 18,000 19,800
Rheumatic Fever
1645 Medical Management of Hypertensive 21,800 22,900 25,200

76
 Emergencies
Medical Management of Metabolic
1646
Coma Requiring Ventilatory Support 37,400 39,300 43,200
Medical Management of Snake Bite
1647
Requiring Ventilator Support 63,000 66,200 72,800
Medical Management of Scorpion Sting
1648
Requiring Ventilator Support 28,000 29,400 32,300
Medical-Infectious Diseases
1649 Medical Management of Severe Tetanus 29,500 30,900 34,000
Medical Management of Complicated
1650
Diphtheria 28,900 30,300 33,400
Medical Management of Cryptococcal
1651
Meningitis 31,900 33,500 36,800
Medical -Pediatrics
Medical Management of Enteric Fever
1652
Complicated in Paediatric patient 12,200 12,800 14,100
Medical Management of Acute gastritis
1653
in Paediatric patient 9,800 10,300 11,400
Medical Management of Pulmonary
1654 koch's with complications in Paediatric
patient 11,500 12,100 13,300
Medical Management of Neuro
1655
Tuberculosis in Paediatric patient 17,400 18,300 20,100
Medical Management of Neuro
1656 Tuberculosis With Ventilation in
Paediatric patient 26,800 28,100 31,000
Medical Management of Tetanus in
1657
Paediatric patient 16,600 17,400 19,100
Medical Management of Diphtheria in
1658
Paediatric patient 18,600 19,500 21,500
Medical Management of Viral
1659 haemmaragic fever with complicatons in
Paediatric patient 27,100 28,400 31,300
Medical Management of Viral hepatitis in
1660
Paediatric patient 13,000 13,700 15,000
Medical Management of Auto immune
1661
hemolytic anemia in Paediatric patient 17,700 18,600 20,400
Medical Management of Anemia Of
1662
Unknown Cause in Paediatric patient 11,500 12,100 13,300
Medical Management of Haemophillia
1663 Including Von Willibrands disease in
Paediatric patients 22,100 23,200 25,500
Medical Management of Henoch
1664
-schonlein purpura in Paediatric patient 17,400 18,200 20,100
Medical Management of Idiopathic
1665 thrombocytopenic purpura in Paediatric
patient 28,600 30,000 33,000
Medical Management of Diabetic
1666
Ketoacidosis in Paediatric patient 30,000 31,500 34,700
Medical Management of Rickets in
1667
Paediatric patient 9,200 9,700 10,600
Medical Management of Meningo-
1668 Encephalitis in Paediatric patients (Non
Ventilated) 40,000 42,000 46,200

77
 Medical Management of Meningo-
1669 Encephalitis in Paediatric patients
(Ventilated) 60,000 63,000 69,300
Medical Management of Encephalitis
1670
/Encephalopathy in Paediatric patient 28,300 29,700 32,700
Medical Management of Status
1671
Epilepticus 23,000 24,200 26,600
Medical Management of Convulsive
1672 Disorders/Status Epilepticus (Fits)in
Paediatric patient 11,800 12,400 13,600
Medical Management of Stroke
1673
Syndrome in Paediatric patient 24,200 25,400 28,000
Medical Management of Muscular
1674
dystrophy in Paediatric patient 18,000 18,900 20,800
Medical Management of Acute flaccid
1675
paralysis in Paediatric patient 37,400 39,300 43,200
Medical Management of Rheumatic
1676
heart disease in Paediatric patient 17,100 18,000 19,800
Medical Management of Infective
1677
Endocarditis 29,200 30,700 33,700
Medical Management of Severe
1678
Myocarditis in Paediatric patient 40,000 42,000 46,200
Medical Management of Viral
1679
Myocarditis in Paediatric patient 22,100 23,200 25,500
Acquired heart disease with congestive
1680
cardiac failure 17,100 18,000 19,800
Medical Management of Intra Cranial
1681
Bleed in Paediatric patient 50,000 52,500 57,800
Medical Management of Croup in
1682
Paediatric patient 11,500 12,100 13,300
Medical Management of Acute pharyngo
1683
tonsillitis in Paediatric patient 6,200 6,500 7,200
Medical Management of Acute Broncho
Lobar pneumonia With Empyema/
1684
Pleural Effusion in Paediatric
patients(J18.1/J43/J90) 29,200 30,700 33,700
Medical Management of Acute Broncho
Lobar pneumonia With
1685
PyoPneumothorax in Paediatric
patient(J18.1/J86/J93) 24,200 25,400 28,000
Medical Management of Acute Hepatitis
1686 With Hepatic Encephalopathy in
Paediatric patient 50,000 52,500 57,800
Medical Management of Portal
1687
hypertension in Paediatric patient 18,300 19,200 21,100
Medical management of Acute
1688
Pancreatitis (Mild) 52,100 54,700 60,200
Medical Management of Acute Gastro
1689
Intestinal Bleed in Paediatric patients 25,000 26,300 28,900
Medical Management of Rheumatoidn
1690
Arthritis Requiring Hospitalisation 33,000 34,700 38,100
Medical Management of Acute
1691
glomerulonephritis in Paediatric patient 11,800 12,400 13,600

78
 Medical Management of Steroid
Resistant Nephrotic Syndrome
1692
Complicated Or Resistant in Paediatric
patients 29,200 30,700 33,700
Medical Management of Nephrotic
1693 syndrome-non steriod resistant in
Paediatric patient 18,300 19,200 21,100
Medical Management of Acute Renal
1694
Failure in Paediatric patient 20,000 21,000 23,100
Medical Management of Acute Renal
1695 Failure With Dialysis in Paediatric
patients 43,000 45,200 49,700
Medical Management of Renal Tubular
1696
Acidosis 19,900 20,900 23,000
Medical Management of UTI (Urinary
1697
Tract Infection) 18,100 19,000 20,900
Medical Management of Urinary Tract
Infection With Complications Like
1698
Pyelonephritis And Renal Failure in
Paediatric patient(N13.6/N17.9) 16,600 17,400 19,100
Newborn (suspected to be) affected by
maternal renal and urinary tract
1699 diseasesNewborn (suspected to be)
affected by maternal conditions
classifiable to N00-N39 19,100 20,000 22,000
Medical Management of Severe Hyaline
Membrane disease with clinically
evident septicemia , Hyperbilirubinemia
1700
in 30 To 34 Weeks Preterm baby not
requiring ventilatory support.
(A41.9+P59.9) 35,000 36,700 40,400
Medical Management of severe Hyaline
Membrane Disease, Culture Positive
Sepsis,Perinatal asphyxia, Hyper
1701
bilirubinemia in above 34 Weeks
Preterm baby not requiring ventilatory
support. (A41.9+P59.9) 35,000 36,800 40,400
Medical Management of severe Hyaline
Membrane Disease, Culture Positive
Sepsis,Perinatal asphyxia, Hyper
1702
bilirubinem ia in above 34 Weeks
Preterm baby requiring ventilatory
support.(A41.9+P59.9+P21.9) 50,000 52,500 57,800
Medical Management of Patent
DuctusArteriosus/ Severe Hyaline
Membranedisease with clinically evident
1703
septicemia,Hyperbilirubinemia requiring
ventilatorysupport in 30 To 34 Weeks
Preterm baby.(A41.9+P59.9+Q25.0) 60,000 63,000 69,300
Medical management of pre-term Baby
of<30 weeks severe Hyline
MembranceDisease septi cemia
1704
culturepositive,Hyperbili rubinemia
patientDuctus Arteriosus requiring
MechanicalVentilation. 90,000 94,500 1,03,900

79
 Medical Management of Severe
1705 respiratory distress in paediatric patient
not requiring ventilatory support 15,000 15,800 17,300
Medical Management of Severe
1706 respiratory distress in paediatric patient
requiring ventilatory support. 20,000 21,000 23,100
Medical Management of Cyanotic heart
1707
disease in Paediatric patient 12,100 12,700 14,000
Medical Management of Congenital
1708 Heart Disease With Congestive Cardiac
Failure in Paediatric patients 17,100 18,000 19,800
Medical Management of Congenital
1709 Heart Disease With Infection
(NonVentilated) in Paediatric patient 25,000 26,300 28,900
Medical Management of Congenital
Heart Disease With Infection And
1710
Cardiogenic Shock (Ventilated)
inPaediatric patients 50,000 52,500 57,800
Medical Management of Febrile
1711 Seizures (Atypical- Mechanical
Ventilated) in Paediatric patients 25,000 26,300 28,900
Medical Management of Cardiogenic
1712
Shock in Paediatric patients 50,000 52,500 57,800
Medical Management of Scorpion Sting
With Myocarditis And Cardiogenic Shock
1713
Requiring Ventilatory Assistance in
Paediatric patients 40,000 42,000 46,200
Medical Management of Poison
Ingestion/ Aspiration Requiring
1714
Ventilatory Assistance in Paediatric
patients 40,000 42,000 46,200
Medical- Cardiology
Medical Management of Accelerated
1715
Systemic Hypertension 10,000 10,500 11,600
Medical Management of CAD - Chronic
1716
Stable Angina 8,300 8,700 9,600
Management Of Acute MI without
1717
Angiogram 10,600 11,100 12,200
Management Of Acute MI With
1718
Angiogram 30,600 32,100 35,300
Medical Management of Acute MI-AHF-
1719
Not Requiring Ventilator 25,900 27,200 29,900
Medical Management of CAD-Acute MI
1720 With Pulmonary Edema - Requiring
Ventilator 35,900 37,700 41,500
Medical Management of Acute MI With
1721
Cardiogenic Shock 30,600 32,100 35,300
Medical Management of Acute MI
1722
Requiring IABP Pump 55,900 58,700 64,600
Medical Management of Pulmonary
1723
Embolism 35,600 37,400 41,100
Medical Management Of Pericardial
1724
Effusion-Without Aspiration 5,300 5,600 6,100
Medical Management of Pericardial
1725
Effusion, Tamponade without Aspiration 16,600 17,400 19,200

80
 Medical Management of Complex
1726
Arrhythmias 1,40,600 1,47,600 1,62,400
1727 Ablation Therapy for Simple Arrythmias 91,600 96,200 1,05,800
Medical Management Of Simple
1728
Arrhythmias 8,300 8,700 9,600
CHF-Acute Decompensation-Medical
1729
Management Without Ventilator 10,300 10,800 11,900
CHF-Acute Decompensation-Medical
1730
Management With Ventilator 20,600 21,600 23,800
Medical Management of Chronic Heart
1731
Failure 5,300 5,600 6,100
Medical Management of Refractory
1732
Cardiac Failure 40,600 42,600 46,900
Medical Management Of Aortic
1733
Dissection 15,600 16,400 18,000
Medical Management of Deep Vein
1734
Thrombosis 26,800 28,100 31,000
Medical Management Of Vascular
1735
Embolisation 15,600 16,400 18,000
1736 Medical Management Of Aortoarteritis 15,000 15,800 17,300
Medical Management Cardiogenic
1737
Shock (Non AMI) With Out Angiogram 15,900 16,700 18,400
Medical Management Cardiogenic
1738
Shock (Non AMI) With Angiogram 20,900 21,900 24,100
Medical- Nephrology
Medical Management of Post Transplant
1739
Sepsis 38,900 40,800 44,900
1740 CAPD Peritonitis 49,800 52,300 57,500
Medical Management of Acute
1741
Glomerulo Nephritis 27,500 28,900 31,800
Medical Management of Nephrotic
1742
Syndrome 18,400 19,300 21,200
Medical Management of Rapidly
1743
Progressive Renal Failure 33,200 34,800 38,300
Medical Management of AKI Without
1744
Dialysis 22,400 23,500 25,900
Medical Management of CKD Stage-V
1745
With Complications 32,100 33,700 37,000
Maintanence of CKD with
1746
Haemodialysis 12,500 13,100 14,400
management with immuno globulin
1747
therapy - IV 75,500 79,300 87,200
Medical Management of Epilepsy -
1748 Idiopathic Neurocysticercosis
Tuberculoma 16,900 17,700 19,500
Medical Management of Wilson'S
1749
Disease 16,600 17,500 19,200
1750 Medical Management of Dementia 12,900 13,600 14,900
Medical Management of Neuroinfections
1751
- Pyogenic Meningitis(Bacterial) 30,400 31,900 35,100
Medical-Neurology
Medical Management of Neuroinfections
1752
- Fungal Meningitis 56,400 59,200 65,200

81
1753 Medical Management of ADEM 21,500 22,600 24,800
Medical Management of Neuroinfections
1754 - Viral Meningoencephalitis (Including
Herpes Encephalitis) 39,600 41,600 45,700
1755 Medical Management of Parkinsonism 13,700 14,400 15,800
1756 Medical Management of Migraine 4,800 5,000 5,500
Medical Management of Guillian-Barre
1757
Syndrome 84,500 88,700 97,600
Medical Management of Chronic
1758 Inflammatory Demyelinating
Polyneuropathy(CIDP) 17,000 17,900 19,700
Medical Management of Neuromuscular
1759
disorders (Myasthenia Gravis) 23,400 24,600 27,100
Medical Management of Myopathies -
1760
Heriditary 10,800 11,400 12,500
Medical Management of Acquired
1761
Myopathies 21,600 22,600 24,900
1762 Medical Management of Optic Neuritis 12,100 12,700 14,000
Medical Management of Hemorrhagic
1763
Stroke/Strokes(I61/I62/I63/I64) 32,200 33,800 37,200
Medical Management of Ischemic
1764
Strokes 21,500 22,600 24,800
Medical- Pulminology
Medical Management of Cold Abscess
1765
Chest Wall 14,000 14,700 16,200
1766 Medical Management of Aspergilloma 26,400 27,700 30,400
Medical Management of A.B.P.A (Alergic
1767
Broncho Pulmonary Aspergillosis) 42,100 44,200 48,600
1768 Medical Management of Sarcoidosis 18,000 18,900 20,800
1769 Medical Management of Cystic Fibrosis 21,800 22,900 25,200
Medical Management of Pulmonary
1770
Vasculitis 22,100 23,200 25,500
1771 Medical Management of Pneumonias 33,000 34,700 38,100
Medical Management of Emphysema
1772
Without Respirative Failure 17,100 18,000 19,800
Medical Management of COPD Acute
1773
Exacerbation 16,500 17,300 19,100
Medical Management of Chronic
1774
Persistent Asthama 16,200 17,000 18,700
Medical Management of Bronchial
1775
Asthma (Acute and Chronic Severe) 16,800 17,600 19,400
Medical Management of Bronchiectasis
1776 with Repeated Hospitalisation>6per
Year 33,000 34,700 38,100
Medical Management of
1777
Pneumoconiosis 37,400 39,300 43,200
1778 Medical Management of Inhalational 21,500 22,600 24,800
Lung Injuries
Medical Management of Interstitial Lung
1779
Diseases 32,100 33,700 37,100
Medical Management of Lung
1780
Abscess ,Non Resolving 38,000 39,900 43,900
1781 Medical Management of Empyema 33,000 34,700 38,100

82
1782 Medical Management of Pleural Effusion 32,100 33,700 37,100
Medical Management of Pneumothorax
1783
Recurrent 33,000 34,600 38,100
Medical Management of Pneumothorax
1784
(Large/Recurrent) 33,300 35,000 38,500
Medical Management of Acute
1785
Respiratory Failure (Without Ventilator) 26,500 27,800 30,600
Medical Management of Acute
1786
Respiratory Failure (With Ventilator) 53,000 55,700 61,200
Medical Management of Haemoptysis
1787
For Evaluation 32,700 34,300 37,800
Medical- Dermatology
Medical Management of Leprosy
1788 Reactions & Deformities (Type I & Type
Ii) 23,000 24,200 26,600
Medical Management of Chlamydial
1789
Tests 31,200 32,700 36,000
Medical Management of Herpes Zoster
1790
Post Herpetic Neuralgia 14,500 15,200 16,800
Medical Management of
1791
Electro/Cryocautery For Warts 9,400 9,900 10,900
Medical Management of Cutaneous
1792
Malignancies -Malignant Melanoma 15,500 16,300 17,900
Medical Management of Cutaneous
1793 Malignancies (Sq. Cell Ca
,Bcc,Lymphomas ) 15,500 16,300 17,900
1794 Medical management of Pemphigus 30,800 32,300 35,500
Medical Management of Bullous
1795
Disorders (Pemphigoid/Pemphigois) 25,900 27,200 29,900
Medical Management of Acute Contact
1796
Allergic Dermatitis 16,500 17,300 19,100
Medical Management of Pustular
1797
Psoriasis 29,200 30,700 33,700
Medical Management of Adverse Drug
1798
Reactions 14,900 15,700 17,300
1799 Medical Management of Acute Urticaria 20,600 21,600 23,800
Medical Management of Erythema
1800
Multiforme 10,100 10,600 11,700
Medical management of Stevens-
1801
Johnson Syndrome 23,800 24,900 27,400
Medical management of Toxic Epidermal
1802
Necrolysis 42,300 44,400 48,900
1803 Medical Management of Erythroderma 22,100 23,200 25,500
Medical Management of Vitiligo Medical
1804
(OP Management) 15,300 16,100 17,700
Medical Management of Cutaneous
1805
Vasculitis 22,100 23,200 25,500
Medical Management of
1806
Dermatomyositis 21,800 22,900 25,200
Medical Management of Connective
1807
Tissue Disorders - Systemic Sclerosis 22,100 23,200 25,500
Medical Management of Connective
1808 Tissue Disorders - Dermatomyositis /
Polymyositis 23,200 24,400 26,800

83
Medical-RHEUMATOLOGY
Medical Management of Anti Phospho
1809
Lipid Antibody Syndrome With Ischemia 52,100 54,700 60,200
Medical Management of Vasculitis
1810
Including Undifferentiated 32,100 33,700 37,100
Medical Management of Severe Lupus
1811
Erythamatosis 52,100 54,700 60,200
1812 Medical management of Scleroderma 32,100 33,700 37,100
Medical Management of Severe
1813
Psoriatic Arthritis 22,100 23,200 25,500
Medical Management of Juvenile
1814
Idiorpathic Arthritis 23,000 24,200 26,600
Medical Management of Juvenile
1815
Idiorpathic Arthritis with systemic onset 32,100 33,700 37,100
1816 Medical Management of Gout 11,500 12,100 13,300
Medical Management of Infection
1817
Related Arthrites 11,200 11,700 12,900
Medical Management of Undifferentiated
1818
Inflammatory Arthritis 32,100 33,700 37,100
Medical Management of SLE (Systemic
1819
Lupus Erythematosis) 27,800 29,100 32,100
Medical management of SLE (Systemic
1820
Lupus Erythematosis) with sepsis 73,400 77,000 84,700
Medical management of Primary
1821
Sjogren'S Syndrome 22,100 23,200 25,500
Medical Management of MCTD (Mixed
1822
Connective Tissue Disorder) 27,400 28,800 31,600
Medical Management of Undifferentiated
1823
Connective Tissue Disorder 22,400 23,500 25,900
Medical Management of Severe
1824
Spondylo Arthropathies 26,900 28,200 31,000
Medical Management of Inflamatory
1825
Myositis 31,500 33,100 36,400
Medical Management of Severe Myositis
1826
Requiring IVIG 31,500 33,100 36,400
Medical Management of Osteoporosis
1827
With Recent Painful Yertebral Fracture 15,900 16,700 18,400
17,400
1828 Medical Management of Osteomalacia
15,100 15,800
Medical-ENDOCRINOLOGY
Medical management of Rhinocerebral
1829
Mucormycosis 54,600 57,400 63,100
Medical Management of Grave'S
1830
Disease 11,600 12,100 13,400
Medical management of Pyelonephritis
1831
in uncontrolled Diabetes melitus 23,600 24,800 27,300
Medical management of Cavernous
1832 Sinus Thrombosis in uncontrolled
Diabetes melitus 44,000 46,200 50,800
Hormonal therapy for Pituitary -
1833
Acromegaly 20,500 21,600 23,700

84
 Initial evaluation and management of
1834
Hypopituitarism without growth harmone 17,200 18,000 19,800
Hypopiturasim Initial Evaluation And
1835
Management With Growth Hormone 28,400 29,800 32,800
Hypopiturasim Maintanance Phase
1836
Monthly Package For Growth Hormone 13,600 14,200 15,700
Medical Management of Cushing
1837
Syndrome 32,100 33,700 37,100
Medical Management of Precocious
1838
Puberty 16,800 17,600 19,400
Medical management of Lower
1839
Respiratoy Tract Infection 25,400 26,700 29,300
1840 Medical management of Fungal Sinusitis 43,900 46,100 50,800
1841 Medical management of Cholecystitis 32,700 34,300 37,800
1842 Medical Management of Osteoporosis 12,000 12,600 13,800
Hormonal therapy for Delayed Puberty
1843
Hypogonadism-Turners Syndrome 16,300 17,100 18,800
Hormonal therapy for Delayed Puberty
1844
Hypogonadism - Kleinfelter Syndrome 16,300 17,100 18,800
General- Gastroentrology
Medical Management of Other Bacterial
1845
Intestinal Infections 19,300 20,200 22,200
Medical Management of Viral And Other
1846
Specified Intestinal Infections 18,700 19,600 21,500
Medical Management of Infective
1847
Proctitis entero Colitis 18,100 19,000 20,800
Medical Management of Abdominal
1848
Tuberculosis 23,000 24,200 26,600
Medical Management - SEMS (Stent)
1849 For Paliation Of Advanced Biliary
Malignancy 52,600 55,200 60,700
Medical Management- SEMS (Stent)
1850 For Paliation Of Advanced Pancreatic
Malignancy 52,600 55,200 60,700
Medical Management - SEMS (Stent)
1851 For Paliation Of Advanced GI
Malignancy 34,800 36,600 40,200
Medical Management of Budd-Chiari
1852
Syndrome 37,800 39,700 43,700
1853 Medical Management of Haemorrhoids 11,000 11,600 12,700
Medical Management of Oesophageal
1854
Varices with Sclerotherapy 10,700 11,200 12,400
Medical Management of Oesophageal
1855
Varices using Variceal Banding 12,500 13,100 14,400
1856 Medical management of Gastric Varices 15,500 16,300 17,900
1857 Medical management of Oesophageal 30,900 32,400 35,700
Fistula
Medical Management of Infective
1858
Oesophagitis (Candida Viralbacterial) 14,200 14,900 16,400
Medical Management of Gastro
1859
Esophageal Reflux Disease 8,000 8,400 9,300
Medical management of Achalasia
1860
Cardia 14,800 15,500 17,100

85
1861 Oesophageal Injury 23,400 24,600 27,100
1862 Oesophageal Foreign Body 8,500 9,000 9,900
Conservative management of of
1863
Oesophageal Foreign Body 51,200 53,800 59,100
Medical Management of Oesophageal
1864 Perforation, Conservative Management
With Stent 35,100 36,800 40,500
Medical Management of Mallory Weiss
1865
Tear 10,900 11,400 12,600
1866 Medical Management of Duodenal Ulcer 12,400 13,100 14,400
1867 Medical Management of Gastric Ulcer 12,500 13,100 14,400
Medical Management of Erosive
1868
Gastritis 11,500 12,100 13,300
Medical Management of Gastric Outlet
1869
Obstruction 13,200 13,900 15,300
1870 Medical Management of Gastric Polyp 12,300 12,900 14,200
Medical management of GAVE(Gastric
1871
Antral Vascular Ectasia) 20,900 21,900 24,100
Medical Management of Crohn'S
1872
Disease 43,500 45,700 50,300
Medical Management of Ulcerative
1873
Colitis 26,300 27,600 30,300
Medical Management of Ischaemic
1874
Bowel Disease 29,600 31,100 34,200
1875 Medical Management of Fissure 5,600 5,900 6,500
Medical Management of Rectal Polyp
1876
¿ Medical Management 7,900 8,300 9,200
Medical Management of Colorectal
1877
Polyps 10,900 11,400 12,600
Medical Management of Solitary Rectal
1878
Ulcer Syndrome 10,800 11,400 12,500
Medical Management of Radiation
1879
Proctitis 10,800 11,300 12,500
Conservative management of Cirrhosis
1880
with Hepatic Encephalopathy 41,200 43,300 47,600
Medical Management of Acute Liver
1881
Failure 51,000 53,600 58,900
Medical Management of Chronic
1882 Hepatitis (Viral , Alchohol, NASH,
Drug,auto Immune, metabolic) 23,600 24,700 27,200
1883 Chronic hepatitis, unspecified 15,000 15,800 17,300
Medical Management of Cirrhosis
1884 Decompensated Including SBP, Portal
HTN, Bleed 38,400 40,300 44,300
Medical Management of Compensated
1885
Cirrhosis 25,700 27,000 29,600
Medical Management of Liver Abscess
1886
(Amoebic, Pyogenic & Misc. Infections) 31,200 32,800 36,000
Medical Management of Acute Hepatitis
1887
(Viral, Alcohol, Drugs, Misc. Infections) 15,900 16,700 18,400
Medical management of Cirrhosis with
1888
Hepato Renal Syndrome 41,200 43,300 47,600

86
 Medical Management of Gall Stone
1889 Diseases(Biliary Colic,
cholangitis,cholecystitis) 23,600 24,800 27,300
Medical management of Sclerosing
1890
Cholangitis 76,500 80,300 88,400
1891 Medical Management of Billiary Stricture 14,600 15,300 16,800
Medical management of Acute
1892
Pancreatitis (Severe) 1,52,100 1,59,700 1,75,700
Conservative management of Chronic
1893
Pancreatitis with Severe Pain 31,200 32,800 36,000
Conservative management of Acute
1894
Pancreatitis With Pseudocyst (Infected) 31,500 33,100 36,400
Medical Management of Chronic
1895
Pancreatitis With Pseudocyst Infected 31,200 32,800 36,000
Medical Management of Malabsorption
1896
Syndrome 33,500 35,100 38,600
Medical Management of Chronic
1897
Pancreatitics With Maldigestion 11,200 11,800 12,900
1898 Medical management of Post op stent 48,300 50,800 55,800
1899 Medical management of Post op leaks 48,800 51,300 56,400
1900 Medical Management of Upper GI Bleed 46,100 48,400 53,200
1901 Medical Management of Lower GI Bleed 47,500 49,800 54,800
Conservative management of Obscure
1902
GI Bleed 50,900 53,400 58,800
Medical Management of Ascities Of Any
1903 Etiology (Tubercolor,
Melignant,Pancreatic, Biliary) 16,200 17,000 18,700
PSYCHIATRY
1904 Medical Management of Schizophrenia 32,900 34,500 38,000
Medical Management of Acute Psychotic
1905
Episode 28,000 29,400 32,300
Medical Management of Bipolar
Affective Disorder (A. Type-1)
1906
35,000 36,800 40,400
Interventional Neuro Radiology
Coil embolization for aneurysms
(includes cost of first 3 coils + balloon
1907
and/ or stent if used) 1 to 20 coils may
be required as per need 1,10,000 1,15,500 1,27,100
Additional coil for coil embolization for
1908 aneurysms 26,400 27,700 30,500
1909 Dural AVMs/AVFs (per sitting) with glue 77,000 80,900 88,900
1910 Dural AVMs/AVFs (per sitting) with onyx 1,65,000 1,73,300 1,90,600
Carotico-cavernous Fistula (CCF)
embolization with coils. [includes 5 coils,
1911
guide catheter, micro-catheter, micro-
guidewire, general items] 1,65,000 1,73,300 1,90,600
1912 Carotid-cavernous Fistula (CCF) 82,500 86,600 95,300
embolization with balloon (includes one
balloon, guide
catheter, micro-catheter, micro-
guidewire, general items)

87
1913 Cerebral & Spinal AVM embolization
(per sitting). Using Histoacryl 1,10,000 1,15,500 1,27,100
1914 Parent vessel occlusion - Basic 33,000 34,700 38,100
Additonal coil for Parent Vessel
1915
Occlusion 26,400 27,700 30,500
Additonal balloon for Parent Vessel
1916 Occlusion 12,100 12,700 14,000
1917 Balloon test occlusion 77,000 80,900 88,900
Intracranial balloon angioplasty with
1918 stenting 1,76,000 1,84,800 2,03,300
1919 Intracranial thrombolysis / clot retrieval 1,76,000 1,84,800 2,03,300
Pre-operative tumour embolization (per
1920 session) 44,000 46,200 50,800

Note 1: The cost of the implants will be based on the maximum ceiling price fixed by the
National Pharmaceutical Authority of India (NPPA).

2. The insurance company can use the implant list and costs suggested by the

National Health Authority as the reference point for MEDISEP.

88
 ANNEXURE-2

Additional Benefit Package for Catastrophic Illnesses

The Insurance coverage given over and above the basic coverage for catastrophic illnesses
specified enlisted in Annexure -2

Catastrophic Packages Package Cost

Liver Transplantation 18,00,000
Bone Marrow Transplantation / Stem Cell
Transplantation (related) 9,46,000
Bone Marrow Transplantation / Stem Cell
Transplantation (unrelated/Haploidentical) 17,00,000
Cochlear Implantation 6,39,000
Renal Transplantation 3,00,000
Knee Joint Replacement 3,00,000
Total Hip Replacement 4,00,000
Auditory Brain Stem Implant 18,24,100
Isolated Heart / Isolated Lung Transplant 15,00,000
Heart Lung Transplant / Double Lung
Transplant 20,00,000
CARDIAC RESYNCHRONISATION THERAPY 6,00,000
[CRT] with defibrillator
ICD-DUAL CHAMBER 5,00,000

The costing of the catastrophic package list specified in Annexure- 2 is inclusive of all the
four components i.e. Procedure Charges; Implant Costs; Room Charges and Investigation
costs. All the packages will have a single package rate and any additional expense above
the ceiling rates will have to borne by the beneficiary. This is irrespective of the number of
days of hospital stay of the patient and the attendant medical or surgical complications will
also get covered in the package and insurance company cannot charge additional amount
from the beneficiary.

89
 ANNEXURE- 3 : Ward Charges and Ceiling Limit

Sl. Ceiling
No Type of Ward Limit (INR)
1 General Ward 1000
2 Semiprivate Ward 1500
3 Private Ward 2000
ICU/ITU/CCU/NICU/PICU (INCLUDING
OXYGENECG/SPO2/NIBP/IBPMONITORING
12 NURSING GNM NURSING ROUND
THECLOCK DOCTOR (RESIDENT ONSPOT)
4 DIET SYRINGE PUMP) 5000

VENTILATOR CHARGE (INCLUDING

5 ACCESSORIES) PER DAY 2000

PNEUPACK VENTILATOR INNURSERY (PER

6 DAY) 1000
HIGH DEFINITION UNIT/ STEPDOWN
1500
7 (INCLUDING OXYGEN)
8 EXCHANGE TRANSFUSION 1200
O.T. CHARGES FOR EXCHANGE
400
9 TRANSFUSION
10 CRIB (CRITICAL WARD BED) 1000

90
 ANNEXURE ­4

MEDICAL CERTIFICATE

[Medical Board…………………………………………………………………….]

Certified   that   Shri/Smt…………………………………………………………………..

(address) aged ……… years has been examined by the Board.  The Board is of the  opinion
that   he/she   is   physically   crippled/disabled/   is   suffering
from………………...disorder/disability of mind …..............(% of disability) and that this
disability has rendered him/her unable to earn his/her living.

Identification Marks

1………………………………………………………………………………………………………

2………………………………………………………………………………………………………

Members of Medical Board

1………………………………………………………………………………………………

2………………………………………………………………………………………………

3.................................................................................................................................

Chairman……………………………………………………………………………………

Date…………………………                                                         (Seal)

91