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15 -ാം േകരള നിയമസഭ


13 -ാം സേ ളനം


ന ചിmമിş േചാദ5ം നം. 507

25-03-2025 - ൽ മ പടി ്


െമഡിെസи് പ തി


േചാദ5ം

ീ. സനീഷ് മാർ േജാസഫ്,

ീ. എം. വിൻെസ ് ,

ീ. ടി. െജ. വിേനാദ്,

ീ. ടി. സിeിഖ്


(എ) െമഡിെസи് പ തി െട വിശദാംശം ലഭ5മാ േമാ; ചികി ാ െചലവിെ പരിധി നിяയി ിgേaാ;


(എ)

ഉ രം


ീ െക എൻ ബാലേഗാപാൽ

(ധനകാര5 വ и് മ ി)


23.06.2022 -െല സ.ഉ.(പി)70/2022-ധന കാരം നിലവിൽ വm െമഡിെസപ് പ തിയിൽ േകരള സർ ാർ ജീവന ാ െട െമഡി ൽ അ٨ൻഡ ് ചş ൾ ് (KGSMA Rules 1960) വിേധയരായ സം ാന സർ ാർ ജീവന ാർ, പാർş് ൈടം കaിജ ് ജീവന ാർ, പാർş് ൈടം അ 5ാപകർ, എയിഡഡ് gകളിേല ൾെиെട ø അ 5ാപക- അന 5ാപക ജീവന ാർ, െപൻഷൻകാർ,

gംബെപൻഷൻകാർ എmിവ ം അവ െട

ആ ിത ം സം ാന സർ ാരിെ ധനസഹായം സ ീകരി m സർവകലാശാലകളിേല ം,

തേeശസ യംഭരണ ാപന ളിേല ം ജീവന ാർ /

െപൻഷൻകാർ / gംബ- െപൻഷൻകാർ എmിവ ം

ഖ5മ ി, മ٨് മ ിമാർ, തിപ േനതാവ്, ▇▇▇▇ ▇▇▇▇, ീ ർ, െഡപgşി ീ ർ, ധനകാര5

ക ി٨ികgെട െചയർമാൻമാർ എmിവ െട േനരിş് നിയമിതരായ േപºണൽ uാഫ്, േപºണൽ uാഫ്

െപൻഷൻകാർ / gംബെപൻഷൻകാർ എmിവ ം ഇവ െട ആ ിത ം ഈ പ തി െട

ണേഭാ ാ ളാണ്. നിലവിൽ 11.5 ല ിലധിക വ m ജീവന ാ ം െപൻഷൻകാ ം അവ െട

ആ ിത ം ഉൾെиെട ഏകേദശം 30 ല ം േപർ ് ഈ പ തി െട ആ ല5ം ലഭി mതാണ്. പ തി നട ിиിനായി ഓറിയ ൽ ഇൻ റൻസ്

ക നിെയയാണ് െതരെ g ിരി mത്. a വർഷമാണ് പ തി കാലാവധി. വാർഷിക അടി ാന ഇൻ റൻസ് പരിര 3 ല ം പയാണ്. 18% ജി.എസ്.ടി. ഉൾെиെട തിവർഷ ീമിയം 5664/-

പയാണ്.

െമഡിെസപ് പ തിയിൽ എ ാനൽ െച ആ പ ിയിൽ നടøm ചികി കൾ ാണ് പണരഹിത ഇൻ റൻസ് പരിര ലഭ5മാ mത്. സർ ാ ം ഇൻ റൻസ് ക നി മാ ø ധാരണാപ ം കാരം ആ പ ികെള എംപാനൽ

െച mത് ഇൻ റൻസ് ക നി െട yമതലയാണ്.

എംപാനൽെച ആ പ ിയിൽ/ വിഭാഗ ളിൽ പണരഹിത ചികി ലഭ5മാ mതിന്

ആ പ ികളിൽ നിaø Pre-authorization

Registration ഉം ടർa ഇൻ റൻസ് ക നിയിൽ നിaം Pre-authorization അംഗീകാരyം നിർബvമാണ്. ഇൻ റൻസ് ക നി

yമതലെиg ിയിgø ടി.പി.എ. (Third Party

Administrators) െ യിമിെ അർഹത പരിേശാധി പാേ ജ് നിര ് കാര ø ക അംഗീകരി ക ം

െ യിം ക ആ പ ി െട അ ൗaിേല ് നൽ ക മാണ് െച mത്.

എmാൽ @ദയാഘാതം, പ ാഘാതം, വാഹനാപകടം എmിവ മായി ബvെиş് േനാൺ- എംപാനൽഡ് ആ പ ികളിൽ നടøm അടിയ ര സാഹചര5 ളിെല ചികി ് െമഡിെസപ് പാേ ജ്

കാര ø ക ക നി റീ-ഇംേപഴ്സ്െമ ായി അ വദി a a്. ഇതിനായി ണേഭാ ാവ്

ഇൻഷ റൻസ് ക നി ് അേപ നൽേകa a്. 23/06/2022 -െല സ.ഉ.(പി)നം.70/2022/ധന

▇ ▇▇▇▇▇, 17/02/2023 -െല സർ ലർ നം. 18/2023/ധന, 05/01/2024 െല 01/2024/ധന ന ർ സർ ല കളിgം ഇത് സംബvി നടപടി മ ൾ വ5 മാ ിയിga്. 3.3.2025 യിെല കണ ് കാരം

7.74 േകാടി പ ഈയിന ിൽ അ വദി ിga്.

വാർഷിക ിമിയം 4800+ 18% GST ഉൾെиെട 5664/- പയാണ്, ാഥമിക ണേഭാ ാ gെട എa ിന് ആ പാതികമായ ിമിയം ക സർ ാർ

ൻ റായി നാല് ഗ ളായി ക നി ് നൽ ക ം

ണേഭാ ാ ളിൽ നിaം തിമാസം ഈടാ m

500/- പയിൽ 472/- പ ക നി ് നൽകിയ

ൻ ർ ക മീകരി mതിന് േവaി

വിനിേയാഗി ക ം, ബാ ി ø 28/- പ 8449-00- 120-81 എm അ ൗaിൽ g ി ് അവയവമാ٨

ശ ിയ ായി ഇൻ റൻസ് ക നി നീ ിവേ a

35 േകാടി (േകാർиസ് ഫa്) വിനിേയാഗി ് തീർm

റ ് നൽ കെയm മാണ് കരാറിെല വ5വ . പ തി ആരംഭി ് 6 മാസ ി øിൽ േകാർиസ് ഫa് ഇന ിൽ ക തിവ ി m 35 േകാടി പ അവയവമാ٨ ശ ിയകൾ ായി വിനിേയാഗി ്

തീർm സാഹചര5ം പരിേശാധി േശഷം ş് മാ٨ി വ ൽ, ഇgെи ് മാ٨ി വ ൽ ശ ിയകൾ 01/04/2023 തൽ സർ ാർ ആ പ ികളിൽ മാ മായി പരിമിതെиgøക ം 08/09/2023 െല സ.ഉ.(സാധാ)നം. 6416/2023/ധന ഉ രവിെല

വ5വ കൾ ് വിേധയമായി ഇൻ റൻസ് ക നി ലഭ5മാ m തര േരാഗ/അവയവമാ٨ ചികി ാ

െ യി കgെട അർഹത പരിേശാധി ് േകാർиസ് ഫaിൽ നിaം സമയബvിതമായി ക അ വദി ് വ ക ം െച a. െമഡിെസപ് പ തി മായി ബvെപş ഉ രyകൾ, പരിപ ൾ, എ ാനൽ

െച ിgø ആ പ ികgെട ലിu് (ജി തിരി ്), ചികി ാ പാേ കൾ, അവ െട നിര കൾ,

ഇ വെര ø െ യിം uാ٨സ്, ണേഭാ ാ gെട എaം, ീവൻസ് uാ٨സ് ട ി എ ാ വിവര gം ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇.▇▇▇▇▇▇.▇▇▇.▇▇/# എm െവബ

ൈസ٨ിൽ ലഭ5മാണ്. ൻ ർ ൈവദ5 പരിേശാധന ഇ ാെത ം ായ ിന സരിg ിമിയ ിൽ വ5ത5ാസമി ാെത ം ഏ٨yം റ ിമിയ ിൽ പരമാവധി 20 ല ം പ വെര പരിര ലഭ5മാ m ‘risk pooling’ െച ് െകാgø െമഡിെസപ്

പ തിയിൽ സ ാഭാവികമായി നടиിൽ വ øm cost control mechanism ിെ ഭാഗമായി ചികി ാ െചലyകൾ ് പരിധി നിяയിചിga്.

സർ ാർ നിേയാഗി െമഡി ൽ എ ്െപർş് ക ി٨ി ശിപാർശ െച ത് കാരമാണ് 30 വിഭാഗ ളിലായി 1920ചികി ാ പാേ ം 12 തര/ അവയവ മാ٨ ചികി ാ പാേ ം വ5വ കgം അവ െട നിര ം നിяയി ിgøത്. ആയതിെ വിശദാംശ ൾ 23.06.2022 -െല സ.ഉ.(പി)70/2022-ധന ഉ രവിെല അ ബvമായി േചർ ിga്.


(ബി)

ത പ തി െട െ യി കൾ

െവşി റ ് ഇൻ റൻസ് ക നി ലാഭ aാ mതാ ø സാഹചര5ം പരിേശാധി ിgേaാ;

(ബി)


ആ പ ിയിൽ നിaം െതെരെ g m പാേ ജിെ ചികി ാ േരഖകൾ ഇൻ റൻസ് ക നി yമതലെиg ിയിgø ടി.പി.എ. -കൾ

പരിേശാധി ് പാേ ജ് നിര ് കാര ø െ യിം അംഗീകരി കയാണ് െച mത്. ആയതിനാൽ, ഇൻഷ റൻസ് ക നി െ യി കൾ െവşി റ ്

ലാഭ aാ m സാഹചര5ം ഉøതായി സർ ാരിെ

യിൽെиşിşി . െമഡിെസиിൽ 1920 ചികി ാ പാേ ം 12 അധിക പാേ ം അവ െട നിര ം

നിяയി ിga്. ത പാേ ജ് നിര കൾ അംഗീകരി m ആ പ ികെള പ തിയിൽ എംപാനൽ െച a. സർ ാ ം ഇൻഷ റൻസ് ക നി മായി ഒ വ ധാരണാപ ം കാരം

ണേഭാ ാ gെട എaം അ സരി ് ീമിയം കണ ാ ി ൻ റായി നാല് ഗ ളായി ക നി ് നൽ ക ം, പിmീട് ണേഭാ ാ ളിൽ നിaം

തിമാസം ീമിയം ഈടാ ി മീകരി ക മാണ്

െച വ mത്. പ തി ആരംഭി ് നാളി വെര 18%

ജി.എസ്.ടി. ഉൾെиെട 2025 മാർ ് മാസം വെര ø

ിമിയം കയായ 1783 േകാടി പയാണ് സർ ാർ ഇൻഷ റൻസ് ക നി ് അ വദി ത്. ഇതിൽ ▇▇.എസ്.ടി. കഴിgø ീമിയം ക 1462.07 േകാടി

പയാണ്. 03-03-2025 വെര ø കണ കൾ

കാരം 8,43,005 െ യി കൾ ് 1604.32 േകാടി

പ െട അ മതി നൽകിയതായി ഇൻഷ റൻസ് ക നി അറിയി ിga്. നിലവിെല claim ratio 109.72% ആണ്. െമഡിെസи് പ തിയി െട അംഗീകാരം നൽകിയ െ ▇▇▇ ▇ െട 98.8 % -yം ആ പ ി ് ഇൻ റൻസ് ക നി ൈകമാറിയിga്. കണ കൾ െമഡിെസപ് െവബ് ൈസ٨ിെല 'ഡാഷ്

േബാർഡിൽ' ലഭ5മാണ്.


(സി)

െമഡിെസи് പ തി കാര ø

െ യി കളിൽ ക അ വദി mത് സംബvി വിഷയ ളിൽ അേന ഷണം നടøേമാെയm് അറിയി ാേമാ?

(സി)

െ യിം ക അ വദി m മായി ബvെиg ഉയർa വ m പരാതികൾ ൈദ വാര അവേലാകന േയാഗ ളിൽ ക നി െട

യിൽെиg ി പരിഹരി ാ a്. ടാെത ചില േകpകളിൽ ക നി െട വിശദീകരണyം ആരായാ a്. ആ പ ികൾ ധാരണാ പ ിൽ നിaം വ5തിചലി mത് യിൽ

െപşാൽ 11.09.2023 തീയതിയിെല സ.ഉ.(പി)നം.97/2023/ധന

കാരം സെ ൻഷൻ ഉൾെиെട ø നടപടികൾ

സ ീകരി mതാണ്. ഈ ഉ രവിെ അടി ാന ിൽ

െമഡിെസപ് ആ ല5ം നിേഷധി m മായി ബvെиş് നിരവധി പരാതികൾ ഉയർm് വm ഇ.എം.എസ്. േഹാ ി٨ൽ മല റം, േഡാ. െക.എം.െചറിയാൻ േഹാ ി٨ൽ െച ർ, ഉപാസന േഹാ ി٨ൽ െകാ ം, മൗലാന േഹാസിപി٨ൽ

െപരി ൽമa, െമഡി ൽ su് െകാ ി, രാജഗിരി േഹാ ി٨ൽ

െകാ ി, ▇▇.എസ്. മിഷൻ േഹാ ി٨ൽ െകാ ി എmീ ആ പ ികെള പ തിയിൽ നിaം താൽ ാലികമായി സെ ൻഡ് െച വാൻ 23/12/2023 തീയതിയിെല HI-

3/145/2023-Fin േഖന ഇൻ റൻസ് ക നി ് നിർേeശം നൽ ക ം ആയത് കാരം ഇൻ റൻസ് ക നി 10

ദിവസേ ് ത ആ പ ികെള സെ ൻഡ് െച ക ം സെ ൻഷൻ കാലാവധി കഴി ് െകാ ി രാജഗിരി േഹാ ി٨ൽ ഒഴിെക മ 6 ആ പ ികgം പ തിയിൽ തിരിg വരിക ം

െച ിga്.

ഇത് ടാെത സർ ാർ െമഡി ൽ േകാേള കളിെല

െമഡിെസപ് ണേഭാ ാ ൾ േനരിgm ъ ൾ കെa ി പരിഹരി mതിനായി െമഡിെസപ്-േu٨് േനാഡൽ െസ ിെല മാേനജർ (േമാണി٨റിംഗ് ആ ് ഇവാലgേവഷൻ), അസിu ് മാേനജർ (അ ൗa്സ്) എmിവരട ിയ ഒ ടീം

സം ാനെ നാല് െമഡി ൽ േകാേള കളിൽ േനരിş് സmർശിg അേന ഷണം നട ി റിേиാർş് സമർиി ി a. ടി റിേиാർş് അ ബvമായി േചർ a. റിേиാർşിൽ ശിപാർശ

െച കാര ø നടപടികൾ സ ീകരി ിga്. ഇൻ റൻസ് ക നി നടേ a medical audit, hospital audit എmിവ

ടാെത അേതാറി٨ി െലവലിെല audits of audit undertaken by insurer , direct audit (claim audit ) concurrent audit , spot checks ഉം ധാരണ പ ിൽ ഉൾെиg ിയിga്. ഈ ആഡി٨് നിരി ണ gെട അടി ാന ിൽ പ തി gതൽ

െമ െиgømതി ø നടപടികgം സർ ാർ സ ീകരി ാ a്.


െസ ൻ ഓഫീസർ

APPENDIX-I


MEDICAL INSURANCE SCHEME FOR STATE EMPLOYEES AND PENSIONERS (MEDISEP)



Finance Department



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.

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.

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).


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.

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.

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

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 2nd 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

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.

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).

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)

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

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 ▇▇▇▇ up to Rs.1000; For Semiprivate ▇▇▇▇ up to Rs.1500 and Private ▇▇▇▇ 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

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 ▇▇▇▇ 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

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.

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.

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.

(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

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

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. PRE-AUTHORIZATION 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

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

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

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

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. 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.

ANNEXURE-1


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




Sl. No..


Procedure Name


Normal Rate Hospital without Quality Certification


Base Rate Hospital with Entry level Certification (5% than Normal Rate)


Accreditation Rate Hospital With full NABH (10% than Base 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

19

Bilateral Adrenalectomy in

nonmalignant conditions


43,000


45,200


49,700

20

Unilateral Adrenelectopmy in

nonmalignant conditions


37,100


39,000


42,900

21

Laproscopic Right Hemi Colectomy in

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

28

Removal Of Submandibular Salivary

Gland


25,700


27,000


29,700

29

Superficial Parotoidectomy (Non-

23,400

24,500

27,000


malignant)




30

Wedge Excision of Lip

15,900

16,700

18,400

31

Wedge Excision of Lip &

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

▇▇▇▇▇▇ 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

48

Laproscopic Splenectomy - For other

Indications


55,600


58,400


64,200

49

Gastrostomy

21,200

22,300

24,500

50

Pyloromyotomy

32,100

33,700

37,100

51

Partial/Subtotal Gastrectomy with 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

56

Surgical management For Haemorrhage Of The Small Intestine


49,800


52,300


57,500

57

Gastrojejunostomy & Vagotomy

40,900

42,900

47,200

58

Surgical management of

Duodenalperforation


50,100


52,600


57,900

59

Laproscopic Surgical treatment

forDuodenal Perforation


48,900


51,300


56,500

60

Gastrostomy Closure

23,800

25,000

27,500

61

Resection & Anastomosis Of Small

Intestine(45.9)


50,100


52,600


57,900

62

Surgical treatment for Duodenal

Diverticulum


32,100


33,700


37,100

63

Excision of ▇▇▇▇▇▇'▇ Diverticulum

41,500

43,600

47,900

64

Surgical treatment for Acute Intestinal

obstrucion


50,100


52,600


57,900

65

Duodenectomy

40,200

42,200

46,400

66

Surgical treatment for Duplication Of

Intestines


50,400


52,900


58,200

67

Right Hemi Colectomy

40,300

42,300

46,500

68

Left Hemi Colectomy

40,900

42,900

47,200

69

Laproscopic colectomy (Total

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


77

Surgical treatment For Recurrent Intestinal obstruction (Noble Plication

Other)


50,100


52,600


57,900

78

Cecopexy

31,800

33,400

36,700

79

Surgical treatment for Acute Intestinal

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

82

Surgical treatment for Mal-Rotation &

Volvulus Of The Midgut


50,100


52,600


57,900

83

Surgical treatment for Volvulus of Large

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

86

Surgical treatment for Appendicular

Perforation


27,700


29,000


31,900

87

Laproscopic Surgical treatment for 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

94

Rectopexy Open with Mesh for Rectal

Prolapse


41,800


43,900


48,300

95

Laproscopic Rectopexy With Mesh for

Rectal Prolapse


51,800


54,400


59,800

96

Rectopexy Open without Mesh for

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

102

Haemorroidectomy+

Fistulectomy(49.12)


27,600


29,000


31,900

103

Excision of liver Abscess

32,100

33,700

37,100

104

Surgical treatment For Hydatid cyst of

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

108

Laproscopic Cholecystectomy With CBD

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

111

Laproscopic Cholecystectomy With

Gargrene


30,600


32,100


35,300

112

Laproscopic Cholecystectomy For

Calculus


30,600


32,100


35,300

113

Laproscopic Cholecystectomy With CBD

Repair


40,600


42,600


46,900

114

Pancreaticocystojejunostomy

51,800

54,400

59,800

115

Pancreaticocystogastrostomy

43,400

45,600

50,200

116

Herinoplasty without Mesh for Direct

Inguinal Hernia


20,900


21,900


24,100

117

Herinoplasty with Mesh Direct Inguinal

Hernia


25,900


27,200


29,900

118

Laproscopic Surgical treatment for Unilateral Femoral Hernia With Mesh


30,600


32,100


35,300

119

Rare Hernias repair

(Spigalion,Obuturator,Sciatic)


21,500


22,600


24,800

120

Laproscopic Surgical treatment for 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

123

Laproscopic Surgical treatment for - Umbilical Hernia With Mesh


50,600


53,100


58,400

124

Umbilical Hernia repair without Mesh

26,500

27,800

30,600

125

Laproscopic Surgical treatment for Incisional Hernia without Mesh


30,600


32,100


35,300

126

Epigastric Hernia repair without Mesh

26,500

27,800

30,600

127

Ventral And Scar Hernia repair without

Mesh


31,500


33,100


36,400

128

Laproscopic Surgical treatment for

Incisional Hernia with Mesh


40,600


42,600


46,900

129

Laproscopic Surgical treatment for Epigastric Hernia repair with Mesh


50,600


53,100


58,400

130

Epigastric Hernia repair with Mesh

41,500

43,600

47,900

131

Ventral And Scar Hernia repair with

Mesh


41,500


43,600


47,900

132

Laproscopic Surgical treatment for

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


Abdominal Abscess




138

Excision of Umbillical Sinus

18,200

19,100

21,000

139

Excision of Mesenteric Cyst

33,700

35,300

38,900

140

Surgical treatment for Minor Abdominal

Injuries


21,500


22,600


24,800

141

Surgical treatment for Major Abdominal

Injuries


52,100


54,700


60,200

142

Surgical treatment for Burst Abdomen

51,500

54,100

59,500

143

Treatment with Self Expanding Metalic

Stent (SEMS)


21,000


22,100


24,300

144

Surgical treatment for Unilateral

Hydrocoele


18,400


19,300


21,300

145

Surgical treatment for Bilateral

Hydrocoele


20,100


21,100


23,300

146

Surgical treatment for Fourniers

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

158

Dorsal Slit and Reduction of

Paraphimosis


9,400


9,900


10,900

159

Rectovaginal fistula Management

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

162

Surgical treatment for Infected Bunion

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

174

Surgical repair of bilateral

Gynaecomastia


12,700


13,300


14,700

175

I & D of Breast Abscess

9,200

9,700

10,700

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

202

Partial amputation of Pinna (malignancy

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

208

Myrinogotomy with-grommet for both

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

▇▇▇▇▇▇ 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

219

▇▇▇▇▇▇▇▇-▇▇▇(unilateral)

18,200

19,100

21,000

220

Surgical treatment for Oro antral fistula

15,000

15,800

17,300

221

Surgical treatment for release of tongue

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

225

Surgical treatment for Pararetro

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

230

Laryngectomy in nonmalignant

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

234

Surgical treatment for Laryngotracheal

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

241

Bronchoscopy Foreign Body Removal

from Oesophagus


10,600


11,100


12,200

242

Removal of foreign body in Ear

10,600

11,100

12,200

243

Bronchoscopy Foreign Body Removal

from Bronchous


24,600


25,800


28,400

OPTHALMOLOGY

244

Decompression/Excision Of Optic Nerve

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

247

Surgical treatment for disorders of

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

257

Congenital NLD probing

11,000

11,600

12,700

258

External Dacryocysto rhinostomy

15,000

15,700

17,300

259

Canaliculo/conjuctivo Dacryocysto

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

272

Surgical treatment for Other disorders of

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

277

Glaucoma Filtering Surgery For

Paediatric Glaucoma


10,200


10,700


11,800

278

Surgical treatment for Scleral wound

11,300

11,900

13,100

279

Surgical treatment for Perforating scleral

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

284

Bandage contact lens with glue

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

289

Cataract surgery phacoemulsification

+IOL


22,500


23,600


25,900

290

Cataract surgery SICS +

IOL(ECCE+IOL)


15,300


16,100


17,700

291

Paediatric Cataract Surgery

(Phacoemulsification IOL)


19,200


20,100


22,100

292

Secondary IOL-scleral fixation-sulcus

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

295

Photocoagulation For Retinopathy Of

Prematurity


10,300


10,800


11,900

296

Cryoretinopexy - closed

13,200

13,800

15,200

297

Cryoretinopexy - open

11,900

12,500

13,700

298

Vitrectomy - Membrane Peeling-

Endolaser


21,400


22,400


24,700

299

Vitrectomy

24,200

25,400

28,000

300

Vitrectomy Plus Silicon Oil Or Gas

-14.75


24,800


26,100


28,700


301

Vitrectomy -Membrane peeling - Endolaser _Silicon oil or Gas - with or

without belt bulking


32,400


34,000


37,400


302

Monthly Intravitreal Anti-Vegf ForMacular Degeneration - Per Injection

(Maximum - 6)


16,400


17,200


18,900

303

Removal Of Silicon Oil Or Gas post

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

308

Evisceration /Enucleation with Orbital

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

313

Excision of Benign neoplasm of Eye and

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

316

PPH-Conservative Surgical

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

321

Surgical Management of Ovarian

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

324

Surgical Management of Tubal Ovarian

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

332

Vaginal Hysterectomy With Pelvic Floor

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

336

Hysteroscopic submucus fibroid

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

341

Surgical Management of Endometriosis

- Excision of Chocolate Cyst


23,600


24,800


27,300

342

Incomplete Abortion + inevitable

abortion Management


9,200


9,600


10,600

343

Surgical Management of Missed

abortion


9,900


10,400


11,400

344

Surgical Management of Septic Abortion

11,400

12,000

13,200

345

Surgical Management of Vesicular

moles (Benign GTD) D & C


14,900


15,600


17,200

346

Manchesters Operation + Cervical

amputation(67.4)


25,600


26,900


29,600

347

Intra Uterine Insemination

10,000

10,500

11,600

348

Repair of Cystocele ,Rectocele

&Perineorraphy (71.71)


20,900


21,900


24,100

349

Haemato Colpo Surgical management

or Hymenectomy


15,600


16,400


18,000

350

Surgical Management of Cystocoele -

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

354

Laproscopic Sacrospinocolpopexy for

vault prolapse


45,900


48,200


53,000

355

Abdominal Repair With Mesh for Vault

Prolapse


41,200


43,300


47,600

356

Vulvectomy for tumors

22,700

23,800

26,200

357

Surgical Treatment for Vulval

Heamatoma


14,100


14,800


16,300

358

Surgery for Bartholin

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

361

Normal Vaginal Delivery with Epidural

Anesthesia


20,600


21,600


23,800

362

Normal Vaginal Delivery In Rh-Negative Mother With Rh-Positive Baby


18,600


19,500


21,500

363

Normal Vaginal Delivery in

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

366

Caesarean Section In Rh-Negative Mother With Rh-Positive Baby


17,400


18,300


20,100

367

Caesarean Section in Twins(Multiple

pregnency)


17,400


18,300


20,100

368

Cesarean Section in HIV+ve Mother

21,200

22,300

24,500

369

Surgical Management of Ectopic

pregnancy


21,800


22,900


25,200

370

Caesarean Hysterectomy with Bladder

Repair


49,200


51,600


56,800

371

Surgery for Rupture Uterus with

Tubectomy


33,700


35,400


38,900

372

Surgical Management of Abruptio- Placenta with Coagulation Defects(Dic)


27,700


29,100


32,000


373

Obstetric Hysterectomy (AtonicPPH,Traumatic PPH , Rupture-

RuptureUterus,Abnormal Placentation)


32,300


33,900


37,300

374

First Trimester Medically Induced

Abortion


4,400


4,600


5,000

375

Termination of pregnancies for foetal

anamolies + IUD


9,200


9,700


10,600

376

Retained Placenta with Manual

Removal


30,900


32,500


35,700

377

Complete perineal tear repair

19,400

20,400

22,400


378

Management of Eclampsia with Complications Requiring Ventilatory

Support


41,200


43,300


47,600

379

LNG-IUS (Levonorgestrene Intautrine

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

384

Medical Management of Haemorragic

shock in pregnancy


37,900


39,800


43,800

385

Medical Management of Fibroids

8,900

9,300

10,300

386

Medical Management of Polycystic

Ovarian Syndrome


11,600


12,200


13,400

387

Medical Management of Pelvic

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

390

Heart disease complicating pregnancy

Management


22,100


23,200


25,500

391

Pre- eclampsia / PIH Management

42,400

44,500

48,900

392

HELLP Syndrome Management in

pregnancy


22,100


23,200


25,500

393

Eclampsia Management without

ventilator support


32,400


34,000


37,400

394

Hyperemisis Gravidarum Management

9,200

9,600

10,600

395

Diabetes complicating pregnancy

Management


22,100


23,200


25,500

396

Hepatic Disorder Management in

pregnancy


22,100


23,200


25,500

397

Moderate Anaemia Management in

pregnancy


12,300


12,900


14,200

398

Severe Anemia Management in

pregnancy


25,900


27,200


29,900

399

Intra Uterine Growth Retardation

Management


23,000


24,200


26,600

400

Acute Poly Hydramnios Management

21,500

22,600

24,800

401

Placenta Previa-type III to IV

Management


21,200


22,300


24,500

ORTHOPEDIC SURGERY AND PROCEDURES

402

Surgery for Brachial Plexus & Cervical

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

409

Bone tumor surgery reconstruction with

internal fixation(78.59)


50,400


52,900


58,200

410

Long bone osteotomy with POP

application & k-wires


31,800


33,400


36,700

411

Long bone osteotomy with internal

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

415

Anterolateral Clearance For

Tuberculosis


61,500


64,600


71,000


416

Excision of deep Bone Tumours and Re- Construction With Conventional

Prosthesis


51,800


54,400


59,800

417

Bone tumor curettage and bone

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

420

Surgical Management of Exostosis of

small joints


23,500


24,700


27,100

421

Surgical Management of Exostosis of

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

426

Excision Or Other Operations For

Scaphoid Fractures


16,500


17,300


19,100

427

Spinal Ostectomy And Internal

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

▇▇▇▇▇▇▇▇▇ grafting

27,500

28,900

31,800

431

Limb lengthening

43,000

45,200

49,700

432

Neglected CTEV. ▇▇▇▇ ▇▇▇▇▇▇▇

37,800

39,700

43,700

433

Tension band wirings

26,200

27,500

30,300

434

Cancecllous screw/pins fixations for

fracture neck of Femur


37,100


39,000


42,900

435

Clavicle surgery

25,900

27,200

29,900

436

Internal fixation lateral epicondyle for

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

440

Surgery for Avascular Necrosis Of Femoral Head (Core Decompression)


30,800


32,300


35,600

441

Reduction Of Compound Fractures &

External Fixation(78.10)


26,500


27,800


30,600

442

Closed reduction with percutaneous k-

wire fixation(78.10)


16,300


17,100


18,800

443

Closed reduction with percutaneous

screw fixation(78.10)


17,600


18,500


20,300

444

Open reduction & Internal Fixation Of

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

449

Closed reduction of fingers small joint

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

453

Acromioclavicular joint dislocation open

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

460

Surgical management

Dequerenstenosynovities


6,500


6,800


7,500

461

Mossmiami instrumentation for vertebral

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

466

Scoliosis and kyphosis

correction(81.05+33.4)


97,100


1,02,000


1,12,200

467

Excision arthroplasty(81.8)

31,500

33,100

36,400

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

476

Arthrodesis of hand Small

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

479

Anterior cruciate ligamentl

reconstruction


26,500


27,800


30,600

480

Posterior cruciate ligament

reconstruction


26,500


27,800


30,600

481

Bipolar hemiarthroplastyof Hip without

cement


40,400


42,400


46,700

482

Hemiarthroplasty of Hip uncemented

36,200

38,000

41,800

483

Bipolar hemiarthroplasty of Hip with

cement


44,400


46,600


51,300

484

Hemiarthroplasty of Hip cemented

36,800

38,700

42,500

485

Reconstruction procedure for recurrent

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

488

Joint reconstruction/intraarticular

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 ▇▇▇▇▇▇▇▇

31,500

33,100

36,400

493

Synovial cyst excision/ganglion/Bakers

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

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

523

Amputations - Hind Quarter And

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

▇▇▇▇▇▇▇▇ fixator with joint arthrolysis

52,100

54,700

60,200

527

Excision of Sinus over Sacrum

16,300

17,100

18,800

528

Soft Tissue Reconstruction Procedures

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

531

Cervical spine injury(skull traction)

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

545

Bandages and strapping procedures for

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

548

Splenectomy + Devascularisation

+Spleno Renal Shunt(39.1)


79,300


83,200


91,500

549

Spleenectomy For Space Occupying

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


552

Surgery For Oesophageal Perforation Stage 1 Cervical Exclusion And Chest

Tube And Feeding Jejunostomy


1,26,800


1,33,100


1,46,500

553

Surgery For Oesophageal Perforation Stage 2 Definitive Surgery


1,02,400


1,07,500


1,18,300


554

Surgery For Oesophageal Perforation

-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

558

Partial Gastrectomy with anastomosis to

esophagus


41,200


43,300


47,600

559

Partial Gastrectomy with anastomosis to

duodenum


41,200


43,300


47,600

560

Distal Gastrectomy For Gastric Outlet

Obstruction


41,200


43,300


47,600

561

Partial/Subtotal Gastrectomy with 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

564

Truncal Vagotomy + Gastro

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

567

Gastro Jejuno-Colic Fistula Surgical

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

570

I Stage-Sub Total Colectomy +

Ileostomy(46.2)


60,300


63,300


69,600

571

I Stage- Sub Total Colectomy +

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

▇▇▇▇▇▇▇.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

582

Anal Sphincter Repair -Without

Colostomy


32,500


34,100


37,600

583

Rt.Hepatectomy

86,900

91,200

1,00,300

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

587

Haemangioma Sol Liver Hepatectomy +

Wedge Resection


90,300


94,800


1,04,300

588

Hepato Cellular Carcinoma(Advanced) Radio Frequency Ablation


72,300


75,900


83,500

589

Segmentectomy

60,300

63,300

69,600

590

Radical Extended Cholecystectomy For

Ca Gall Bladder


1,02,400


1,07,500


1,18,300

591

Cyst Excision+Hepatic

Jejunostomy(51.37)


56,100


58,900


64,800

592

Hepatico Jejunostomy

67,600

70,900

78,000

593

Choledochoduodenostomy Or

Choledocho Jejunostomy


42,100


44,200


48,600

594

GB+ Calculi CBD Stones Or Dilated

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

598

Lateral Pancreaticojejunostomy(Non-

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

604

Distal Pancreatectomy

+Splenectomy(41.5)


1,21,500


1,27,600


1,40,300

605

Central Pancreatectomy

1,21,500

1,27,600

1,40,300

606

Diaphragmatic Hernia (Gortex Mesh

Repair)


49,200


51,700


56,800

607

Rectovaginal fistula Management with

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

610

Balloon Dilatation of Coartication of

Aorta


48,300


50,700


55,700

611

Balloon Dilatation of Pulmonary Artrey

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

614

Bronchial artery Embolisation (for

Haemoptysis)


41,000


43,100


47,400

615

Electrophysiological Study

25,000

26,300

28,900

616

Electrophysiological Study with Radio

Frequency Ablation


25,000


26,300


28,900

617

Left Heart Catheterization

6,300

6,600

7,200

618

PDA Device Closure

27,500

28,900

31,800

619

PDA stenting

46,400

48,700

53,600

620

Percutaneous Transluminal Septal

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

626

Permanent Pacemaker Implantation -

Double Chamber


33,800


35,400


39,000

627

Permanent Pacemaker Implantation -

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

630

Catheter directed Thrombolysis for Deep vein thrombosis (DVT)


38,500


40,400


44,500

631

Catheter directed Thrombolysis for

Mesenteric Thrombosis


38,500


40,400


44,500

632

Catheter directed Thrombolysis for

Peripheral vessels


38,500


40,400


44,500

633

Aortic Aneurysm

1,8

7,500


1,96,900


2,16,600

634

Aortic Aneurysm Repair using

Cardiopulmonary bypass (CPB)


1,50,000


1,57,500


1,73,300

635

Aortic Aneurysm Repair using Left Heart

Bypass


1,50,000


1,57,500


1,73,300


636

Aortic Aneurysm Repair without using Cardiopulmonary bypass (CPB)


87,500


91,900


1,01,100

637

Aortic Aneurysm Repair without using

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


641

Aortic Valve Repair/ Aortic Valve Replacement / Mitral Valve Repair / Mitral Valve Replacement / Tricuspid Valve Repair /

Tircuspid Valve Replacement


1,87,500


1,96,900


2,16,600


642

Aortic Valve Repair/ Aortic Valve Replacement / Mitral Valve Repair / 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

649

AP window repair

1,87,500

1,96,900

2,16,600

650

Arch interruption Repair with VSD

closure


1,87,500


1,96,900


2,16,600

651

Arch interruption Repair without VSD

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

655

ASD closure + Partial Anomalous

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 + ▇▇▇▇▇

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

673

Closed Mitral Valvotomy including

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

680

Excessive bleeding requiring re-

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

▇▇▇▇▇ 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

689

Isolated Secundum Atrial Septal Defect

(ASD) Repair


1,25,000


1,31,300


1,44,400

690

Konno procedure

1,87,500

1,96,900

2,16,600


691

Low Cardiac Output syndrome requiring 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

▇▇▇▇▇▇▇ procedure

1,87,500

1,96,900

2,16,600

695

Partial AV canal repair

1,50,000

1,57,500

1,73,300

696

Patent Ductus Arteriosus (PDA) Closure

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

699

Peripheral arterial injury repair (without

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

▇▇▇▇▇▇▇▇ Procedure

1,87,500

1,96,900

2,16,600

705

Re-do sternotomy

25,000

26,300

28,900

706

▇▇▇▇ Procedure

1,74,400

1,83,100

2,01,400

707

Senning Operation

1,87,500

1,96,900

2,16,600

708

Sinus of Valsalva aneurysm repair with

aortic valve procedure


1,50,000


1,57,500


1,73,300


709

Sinus of Valsalva aneurysm repair 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

713

Surgery for Hypertrophic Obstructive 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

718

Thoracoabdominal aneurysm Repair

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

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


735

Isolated Intercostal Drainage and Management of ICD, Intercostal Block,

Antibiotics & Physiotherapy


12,500


13,100


14,400

736

Space - Occupying Lesion (SOL)

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

742

Other simple lung procedure excluding

lung resection


56,300


59,100


65,000

743

Thoracotomy, Thoraco Abdominal

Approach


37,500


39,400


43,300

744

Surgery for Cardiac Tumour

1,18,800

1,24,700

1,37,200

745

Surgical Correction of Bronchopleural

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

750

Tetralogy of Fallot - Systemic Pulmonary

Shunts with Graft

41,800


43,890


48,279

751

Tetralogy of Fallot - Systemic Pulmonary

Shunts without Graft

55,400


58,170


63,987

752

Tetralogy of Fallot - Total Correction

95,000

99,750

1,09,725

753

Tetralogy of Fallot (Comple) - Total

Correction

1,35,000


1,41,750


1,55,925

754

Tetralogy of Fallot (Simple) - Total

Correction

1,10,500


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

757

Transposition of Great Arteries - Arterial

Switch

1,50,000


1,57,500


1,73,250

758

Transposition of Great Arteries - Carotid

Embolectomy

70,000


73,500


80,850

759

Primary Angioplasty with thrombus

aspiration with one DES

90,000


94,500


1,03,950

760

Primary Angioplasty with thrombus

aspiration with two DES

1,20,000


1,26,000


1,38,600

761

FFR + Angioplasty with 1 drug eluting

stent

1,05,000


1,10,250


1,21,275

762

FFR + Angioplasty with 2 drug eluting

stent

1,35,000


1,41,750


1,55,925

763

FFR + Angioplasty with 3 drug eluting

1,65,000

1,73,250

1,90,575


stent




764

IABP + Angioplasty with 1 drug eluting

stent

1,05,000


1,10,250


1,21,275

765

IABP + Angioplasty with 2 drug eluting

stent

1,35,000


1,41,750


1,55,925

766

IABP + Angioplasty with 3 drug eluting

stent

1,65,000


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


771

PERCUTANEOUS SEPTAL MYOCARDIAL ABLATION (PTSMA)

REQUIRING PPI VVI


1,00,000


1,05,000


1,15,500


772

PERCUTANEOUS SEPTAL MYOCARDIAL ABLATION (PTSMA)

REQUIRING PPI DDD


2,20,000


2,31,000


2,54,100

773

Peripheral Angioplasty with single non collapsible stent /covered stent

1,40,000


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

778

Adrenal Gland Surgeries In Paediatric

patients(07.3&07.4)


50,300


52,800


58,100

779

Execision of pediatric tumors

53,600

56,300

61,900

780

Surgical treatment for Preauricular sinus

in pediatric patient


10,600


11,100


12,200

781

Surgical correction of Microtia/Anotia In

Paediatric Patient


35,800


37,600


41,400

782

Excision of Retention Cyst Lip

3,100

3,200

3,500

783

Surgical correction of Cleft Lip in

children


27,100


28,400


31,300

784

Surgical correction of Cleft Palate

28,000

29,400

32,300

785

Surgical corection of Velo-Pharyngeal

Incompetence


38,900


40,900


45,000

786

Surgical management of Sinuses & Fistula of the neck in Paediatric Patient


21,800


22,900


25,100

787

Excision ofThoracoscopic cysts

41,500

43,600

47,900

788

Open excision of Lung cyst In Paediatric

Patient


41,200


43,300


47,600

789

Mediastinal Cyst Excision In Paediatric

Patients


66,900


70,200


77,300

790

Empyema decortication In Paediatric

Patients


32,100


33,700


37,100

791

Empyema-ICD drainage In Paediatric

10,900

11,400

12,600

792

Thoracoscopic Decortication In

Paediatric


49,500


52,000


57,200

793

Surgical Correction of Thoracic Wall

defects


65,900


69,200


76,100

794

Excision of Haemangioma

19,100

20,100

22,100

795

Surgical management of Lymphangioma In Paediatric Patients


49,200


51,600


56,800

796

Paediatric Splenectomy (Non Traumatic)

44,700

46,900

51,600

797

Surgical management of Oesophageal Atresia In Paediatric Patients


64,600


67,800


74,600

798

Surgical Correction of Thoracic Duplications In Paediatric Patients


47,200


49,600


54,600


799

Surgical Correction of EsophagealObstructions In Paediatric

Patients


60,000


63,000


69,300

800

Surgical Correction of Esophageal Substitutions In Paediatric Patients


76,200


80,000


88,000

801

Surgical management of - Gastric Outlet Obstructions In Paediatric Patients


31,200


32,800


36,000


802

Surgical management of Gastro Esophageal Reflux In Paediatric

Patients


38,200


40,100


44,100


803

Surgical Management of Intestinal Atresias & Obstructions In Paediatric

Patients


65,900


69,200


76,100

804

Surgical management of Intestinal Polyposis In Paediatric Patients


61,500


64,600


71,000

805

▇▇▇▇▇▇'▇ Diverticulectomy In Paediatric

Patients


43,000


45,200


49,700

806

Stage 2 procedure for Anorectal Malformations In Paediatric Patients


62,100


65,200


71,700

807

Stage 1 procedure for Anorectal Malformations In Paediatric Patients


49,500


52,000


57,200

808

Stage 1 procedure for Hirschprungs Disease In Paediatric Patients


48,600


51,000


56,100

809

Feeding Jejunostomy In Paediatric

Patients


30,400


31,900


35,100

810

Ileostomy closure In Paediatric Patients

26,800

28,100

30,900

811

Stage 2 procedure for Hirschprungs Disease In Paediatric Patients


73,500


77,200


84,900

812

Colostomy closure In Paediatric Patients

25,900

27,200

29,900

813

Surgical mangement of Acute Intestinal Obstruction In Paediatric Patients


51,000


53,600


58,900

814

Rectal polypectomy In Paediatric

Patients


8,300


8,700


9,600

815

Laparoscopic Pull Through For Ano Rectal Anomalies In Paediatric Patients


73,800


77,500


85,200


816

Laparoscopic Pull Through Surgeries For Hirschprungs Disease In Paediatric

Patients


73,500


77,200


84,900

817

Surgical mangement of Anal Fissure and Fistula In Paediatric Patients


24,100


25,300


27,800


818

Surgical Management of Biliary Atresia & Choledochal Cyst In Paediatric

Patients


71,900


75,500


83,000

819

Pancreatic surgery in Paediatric Patients

76,500

80,300

88,400

820

Unilateral Inguinal Hernia repair In

Paediatric Patients


15,300


16,100


17,700

821

Bilateral Inguinal Hernia repair In

Paediatric Patients


20,300


21,300


23,400

822

Lumbar Hernia repair In Paediatric

Patients


16,800


17,600


19,400

823

Femoral Hernia repair In Paediatric

Patients


15,300


16,100


17,700

824

Umbilical Hernia repair In Paediatric

Patients


20,300


21,300


23,400

825

Incisional Hernia repair In Paediatric

Patients


32,700


34,300


37,800

826

Open repair of diaphragmatic hernia in

Paediatric patients


75,600


79,400


87,400

827

Correction of ▇▇▇▇▇▇▇ intestinal duct anomalies in Paediatric Patients


40,000


42,000


46,200

828

Repair of Abdominal wall defects

76,500

80,300

88,400

829

Surgical management of Abdominal trauma in Paediatric Patients


62,400


65,500


72,100

830

Surgical management of peritonitis in

Paediatric Patients


40,900


42,900


47,200

831

Correction of Duplications of alimentary tract in Paediatric Patients


48,700


51,100


56,200

832

Simple Nephrectomy

41,200

43,300

47,600

833

Surgical Management of Congenital 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

838

Vesical calculi-vesicolithotomy in

Paediatric Patients


25,100


26,400


29,000

839

Supra pubic drainage- open in

Paediatric Patients


11,200


11,800


12,900

840

Vesicostomy

27,300

28,600

31,500

841

Vesicotomy closure in Paediatric

Patients


28,700


30,100


33,200

842

Stage 1 procedure for Exstrophy Bladder in Paediatric Patients


75,300


79,100


87,000

843

Stage 2 procedure for Exstrophy Bladder in Paediatric Patients


71,700


75,300


82,800

844

Bladder augmentation

54,400

57,200

62,900

845

Repair of Urethral injuries in Paediatric

Patients


27,500


28,900


31,800

846

Surgical Management of Posterior

Urethral Valves


32,100


33,700


37,100

847

Single Stage procedure for

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

851

Surgical Correction of Scrotal Transposition In Paediatric Patients


20,900


21,900


24,100

852

Surgical management of Undescended Testis In Paediatric Patients


25,900


27,200


29,900

853

Laparoscopic Orchidopexy In Paediatric

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

856

Hydrocele high ligation In Paediatric

Patients


15,300


16,100


17,700

857

Surgical Management for Torsion of

Testis


27,000


28,400


31,200

858

Surgical Management of Phimosis and

Paraphimosis


8,600


9,000


9,900

859

Intersex-Genitoplasty surgery(70.6)

47,500

49,900

54,800

860

Surgical Management of Tempero

mandibular Joint Ankylosis


47,200


49,600


54,600

861

Management Of Tmj Dysfunction

Syndrome (76.94)


1,100


1,100


1,300

862

Execision of cogental dermal sinus

30,600

32,100

35,300

863

Surgical Management of Torticollis in

Paediatric Patient


16,100


16,900


18,600

864

Excision of External angular dermoid in

Paediatric Patient


8,400


8,800


9,600

865

Surgical Management (excision) of

Congenital Dermal Sinus


30,600


32,100


35,300

866

Excision of Sebacencyst Lipoma in

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


869

Surgical correction of Syndactyly of Hand For Each Hand in Paediatric

Patient


27,100


28,400


31,300

870

Syndactoly correction-multiple correction

in Paediatric Patient


29,500


31,000


34,100


871

Anal Dilatation


5,300


5,600


6,100

GENITO URINARY SURGERIES

872

Renal angio embolization

36,100

37,900

41,700

873

A.V. Fistula surgery (creation) [Pre- Transplant Procedure Only


10,900


11,400


12,600

874

Balloon dialatation of transplant Renal

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

878

Uni-lateral illioinguinal block dissection in non malignant conditions


31,500


33,100


36,400

879

Bi-lateral illioinguinal block dissection in non malignant conditions


65,400


68,600


75,500

880

Surgery for Retroperitoneal Fibrosis

Open/Lap


40,900


43,000


47,300

881

Parapelvic Cyst Excision-Open/Lap

33,800

35,500

39,000

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

889*

a)Haemodialysis

b)Peritoneal Dialysis

1500

1800

1500

1800

1500

1800

890

Nephropexy

37,900

39,800

43,700

891

Revascularization procedure for

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

894

Anatrophic Peylolithotomy For Staghorn

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

900

Laproscopic unilateral

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 ▇▇▇▇▇▇▇▇▇▇▇

37,100

39,000

42,900

904

Renal auto transplantation

61,500

64,600

71,000

905

Surgical Management of Congenital

Hydronephrosis


37,100


39,000


42,900

906

▇▇▇▇▇▇▇▇ ▇▇▇▇▇ 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

912

Excision of Ureterocele with Ureteric

Implantation


43,900


46,100


50,700

913

Surgical Procedure for Ileal Conduit

Formation


42,200


44,300


48,700

914

Post transplant revision Ureteroneo 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

922

Open Cystolithotomy

20,900

22,000

24,200

923

Mitrafanoff procedure

49,000

51,400

56,500

924

Transurethral resection of bladder

tumour (TURBT)


39,900


41,900


46,100


925

Transurethral resection of bladder 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

928

Laproscopic radical cystectomy with

Ilealconduit diversion


1,26,500


1,32,800


1,46,100

929

Laproscopic radical cystectomy with Ureterosigmoidostomy(57.88)


59,700


62,700


68,900

930

Open radical cystectomy with

Ureterosigmoidostomy (57.88)


48,000


50,400


55,400

931

Laproscopic radical cystectomy with Continent Urinary diversion(56.7)


65,600


68,800


75,700

932

Open radical cystectomy with Continent

Urinary diversion


53,000


55,700


61,200

933

Surgical correction of Vesicovaginal

Fistula


45,800


48,100


52,900

934

Transvaginal repair of Vesicovaginal

Fistula


37,900


39,800


43,800

935

Trans abdominal repair of Vesicovaginal 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

938

Bladder neck reconstruction for

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

941

BMG Urethroplasty for pan Urethral

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


946

Double stage Urethroplasty (Reconstruction Procedure) for stricture

Urethra.


40,200


42,200


46,400

947

Meatoplasty

12,600

13,200

14,500

948

Transpubic Urethroplasty with

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

951

Nephrolysis/surgery for Chyluria

Open/Lap


41,800


43,900


48,300

952

Surgical Management of Incontinence

Urine (Male)


26,800


28,100


31,000

953

Surgical Management of Incontinence

Urine (Female)


22,900


24,000


26,400

954

MMK/birch colpo suspension for stress

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

958

Mid urethral sling procedure for stress

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

963

Transurethral Resection of Prostate

(TURP)


31,500


33,100


36,400

964

Transurethral Resection of Prostate

(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

971

Surgical Correction of Chordee without

Hypospadiasis


34,400


36,100


39,800

972

Surgical Management of Penile Injuries

26,200

27,500

30,300

973

Plaque Excision/Plasty for Penile

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

979

Extracorporeal shockwave lithotripsy

(ESWL)


20,600


21,600


23,800


980

Post Renal Transplant Immunosuppressive Treatment From 1st

To 6th Months


91,700


96,300


1,05,900


981

Post Renal Transplant 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

987

▇▇▇▇ Hole procedure for evacuation of

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


Haematoma




990

Craniotomy And Evacuation of

Extradural Haematoma


60,000


63,000


69,300

991

De-Compressive Craniectomy (Non

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

994

Temporal Lobectomy Plus Depth

Electrodes


1,40,300


1,47,300


1,62,000

995

Temporal Lobectomy

75,600

79,400

87,300

996

Excision of

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

1006

Surgical Management of

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

1015

Surgical Management of Meningo

Encephalocele


40,600


42,600


46,900

1016

Surgical Management of C.S.F.

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

1020

Ventriculoatrial / Ventriculoperitonial

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

1024

Surgical Management of Intra Medullary

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

1028

Endoscopy - Spinal

29,900

31,400

34,500

1029

Meningo Myelocele Spinal Procedure

25,600

26,900

29,600

1030

Surgical Management of ▇▇▇▇▇ Bifida

Major


35,600


37,400


41,100

1031

Surgical Management of ▇▇▇▇▇ Bifida

Minor


30,300


31,800


35,000

1032

Facet, Nerve Root Blocks

10,000

10,500

11,600

1033

Radiofrequency Ablation For Trigeminal

Neuralgia


30,600


32,100


35,300


1034

Radio Surgery For Brain Tumours & Vascular Malformations/ Trigeminal

Neuralgia


25,300


26,600


29,200

1035

Surgical treatment for brachial plexus

injuries


72,900


76,500


84,200

1036

Microvascular Decompression For

Trigeminal Neuralgia


60,300


63,300


69,600

1037

Surgical management Carpal tunnel

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


1045

Other Vascular Malformations (Other 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

1048

Coil Embolization of Aneurysm (each

coil cost)


30,000


31,500


34,700

1049

Surgical Management of Vascular

Malformations


60,600


63,600


70,000

1050

Spinal Fixation Rods And Plates,

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

1053

Excision Of Cervical Inter-Vertebral

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

1061

Combined Trans-Oral Surgery & Cv

Junction Fusion


51,800


54,400


59,800

1062

C.V. Junction Fusion

40,600

42,600

46,900

1063

Anterior Cervical Spine Surgery With

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

1066

Thyroidectomy any type in malignant

conditions


31,200


32,800


36,000

1067

Parathyroidectomy in malignant

conditions


36,200


38,000


41,800

1068

Excision of Solitory Thyroid nodule in

malignant conditions


37,200


39,000


43,000

1069

Thyroidectomy for solitary nodule in

malignant conditions


38,800


40,800


44,900

1070

Laparoscopic Biilateral adrenalectomy in

malignant conditions


41,100


43,100


47,400

1071

Unilateral Adrenalectomy in malignant

conditions


67,100


70,500


77,500

1072

Maxillectomy + Orbital Exenteration in

malignant conditions


55,700


58,500


64,300

1073

Orbital Exenteration in malignant

conditions


44,200


46,400


51,000

1074

Laproscopic Right Hemicolectomy in

malignant conditions


40,000


42,000


46,200

1075

▇▇▇▇▇▇▇ procedure in malignant

conditions


51,300


53,900


59,200

1076

Laparoscopic Left Hemicolectomy in

malignant conditions


40,000


42,000


46,200

1077

Sleeve Resection of Ear in malignant

conditions


47,300


49,700


54,600

1078

Hemiglossectomy in malignant

conditions


43,400


45,500


50,100

1079

Total Glossectomy + Reconstruction in malignant conditions(25.59)


59,400


62,300


68,500

1080

Parotidectomy any type in malignant

conditions


26,200


27,500


30,300

1081

Excision of Submandibular gland in

malignant conditions


26,900


28,200


31,100

1082

Palatectomy any type in malignant

conditions


41,000


43,000


47,300


1083

Full Thickness Buccal Mucosal Resection & Reconstruction in malignant

conditions(27.59)


65,100


68,400


75,200

1084

Excision of Parapharyngeal tumours in

malignant conditions


48,900


51,400


56,500

1085

Resection of Nasopharyngeal Tumor in

malignant conditions


79,300


83,300


91,600

1086

Laryngectomy Any Type in malignant

conditions


69,700


73,200


80,500

1087

Laryngopharyngo Oesophagectomy in

malignant conditions


99,100


1,04,100


1,14,500

1088

Tracheal Resection in malignant 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

1091

Pneumonectomy for Carcinoma Lung

81,200

85,200

93,800

1092

Icd + pleurodesis

21,500

22,600

24,800

1093

Solitary Lung Metastatectomy in

malignant conditions


70,000


73,500


80,800

1094

Lung Metastatectomy multiple in

malignant conditions


78,900


82,800


91,100

1095

Resection of mediastinal tumors in

malignant conditions


64,700


67,900


74,700


1096

Superior Mediastinal

Dissection+Sternotomy in malignant conditions(77.31)


61,700


64,700


71,200

1097

Intercostal Drainage(Icd) in malignant

conditions


3,300


3,500


3,800

1098

Surgical Resection of Soft tissue /Bone

tumors of Chest wall


31,200


32,800


36,000


1099

Surgical Resection and Reconstruction of Soft tissue /Bone tumors of Chest

wall in malignant conditions


71,200


74,800


82,200


1100

Full Thickness Buccal Mucosal Resection & Reconstruction in malignant

conditions(27.59)


75,900


79,700


87,700

1101

IVC thrombectomy in malignant

conditions


54,300


57,000


62,700

1102

IVC filters for tumour thrombus in

malignant conditions


58,500


61,400


67,500

1103

Vascular reconstruction with synthetic graft in malignant conditions


71,900


75,400


83,000

1104

Vascular reconstruction with auto graft in

malignant conditions


78,000


81,900


90,000

1105

Microvascular reconstruction

92,800

97,400

1,07,200

1106

Vascular isolation and perfusion in

malignant conditions


55,400


58,200


64,000

1107

Neck Dissection Any Type in malignant

conditions


34,000


35,700


39,300


1108

Retro Peritoneal Lymph Node Dissection RPLND As Part Of Staging in

malignant conditions


41,800


43,900


48,300

1109

Uni-lateral Inguinal Block Dissection in

malignant conditions


31,300


32,800


36,100

1110

Bi-lateral Ilioinguinal block disection in

malignant conditions


65,400


68,600


75,500

1111

Axillary Dissection in malignant

conditions


41,300


43,400


47,700


1112

Bilateral Pelvic Lymph Node Dissection(Bplnd) in malignant Bilateral

Pelvic Lymph Node


41,800


43,900


48,300


1113

Bilateral pelvic lymph node dissection(bplnd)(CA. URINARY

BLADDER)


41,800


43,900


48,300


1114

Retro Peritoneal Lymph Node Dissection(Rplnd) (For Residual

Disease) in malignant conditions


80,100


84,100


92,500

1115

Popliteal lymphadenectomy in malignant

conditions


30,900


32,400


35,700

1116

Splenectomy in malignant conditions

43,700

45,900

50,500

1117

Transhiatal oesophagectomy in

malignant conditions


82,100


86,200


94,800


1118

Oesophagectomy With Two Field Lymphadenectomy in malignant

conditions(40.59)


1,18,800


1,24,700


1,37,200


1119

Oesophagectomy With Three Field Lymphadenectomy in malignant

conditions(40.59)


1,21,500


1,27,600


1,40,300

1120

Substernal Gastric Bypass in malignant

conditions


51,900


54,500


59,900

1121

Gastrostomy in malignant conditions

20,000

21,000

23,100


1122

Laparoscopic mobilization of stomach with distal gastrectomy with billroth i/ii

anastomosis in malignant conditions


1,01,800


1,06,900


1,17,600


1123

Thoracoscopic Mobilization of Oesophagus + Laparoscopic Mobilization of stomach + Gastric Pull-

up in malignant conditions


1,20,600


1,26,600


1,39,300

1124

Gastrectomy Any Type in malignant

conditions


51,200


53,800


59,100

1125

Gastro Jejunostomy in malignant

conditions


50,900


53,400


58,800

1126

Small Bowel Resection in malignant

conditions


49,200


51,700


56,800

1127

Colectomy Any Type in malignant

conditions


54,100


56,800


62,500

1128

Ileotransverse Colostomy in malignant

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


1132

Laparoscopic anterior/low resection with stapplers with diversion covering

ileostomy in malignant conditions


1,00,000


1,05,000


1,15,500

1133

Ileostomy Closure in malignant

conditions


25,900


27,200


29,900

1134

Colostomy Closure in malignant

conditions


25,900


27,200


29,900

1135

Laparoscopic abdominoperineal resection in malignant conditions


1,00,000


1,05,000


1,15,500


1136

Abdomino Perineal Resection (Apr) + Sacrectomy in malignant

conditions(77.99)


61,500


64,600


71,000

1137

Anterior Resection of rectum in

malignant conditions


51,500


54,100


59,500

1138

Posterior Exenteration for Carcinoma

Rectum


61,500


64,600


71,000

1139

Total Exenteration for Carcinoma

Rectum


1,00,100


1,05,100


1,15,600

1140

Hepatectomies in malignant conditions

1,01,500

1,06,600

1,17,200

1141

Radical Cholecystectomy in malignant

conditions


79,800


83,800


92,200

1142

Distal Pancreatectomy in malignant

conditions


1,01,800


1,06,900


1,17,600

1143

Other Bypasses-Pancreas in malignant

conditions


52,300


54,900


60,400

1144

Inoperable Laparotomy in malignant

conditions


37,800


39,700


43,600

1145

Abdominal Wall Tumor Resection in

malignant conditions


54,300


57,000


62,700


1146

Resection With Reconstruction of Abdominal wall Tumors in malignant

conditions


61,100


64,200


70,600

1147

Resection Of Retroperitoneal Tumors in

malignant conditions


61,500


64,600


71,000

1148

Diagnostic Laparoscopy in malignant

conditions


22,700


23,900


26,300

1149

Open Partial Nephrectomy

42,100

44,200

48,600

1150

Laproscopic radical nephrectomy in

malignant conditions


1,00,000


1,05,000


1,15,500

1151

Radical Nephrectomy

52,100

54,700

60,200


1152

Nephroureterectomy For Transitional Cell Carcinoma Of Renal Pelvis in

malignant conditions


66,500


69,800


76,800

1153

Urinary Diversion in malignant

conditions(56.6/56.7)


64,800


68,000


74,800

1154

Other Cystectomies in malignant

conditions


89,100


93,600


1,03,000

1155

Suprapubic cystostomy

18,500

19,400

21,400

1156

Open radical cystectomy with

Ilealconduitdiversion


1,02,100


1,07,200


1,17,900

1157

Anterior Exenteration (CA. Urinary

Bladder)


61,500


64,600


71,000

1158

Total Exenteration (CA. Urinary Bladder)

76,800

80,600

88,700

1159

Radical Prostatectomy in malignant

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

1166

Surgery For Carcinoma Ovary Early

Stage


33,900


35,600


39,100

1167

Excision of Complex ovarian mass in

malignant conditions


53,100


55,700


61,300

1168

Ovarian cystectomy in malignant

conditions


53,000


55,700


61,200

1169

Unilateral Salpingo Oophorectomy in

malignant conditions


31,500


33,100


36,400

1170

Surgery For Carcinoma Ovary Advance

Stage


54,100


56,800


62,500

1171

Bilateral Salpingo Oophorectomy

inmalignant conditions


30,900


32,400


35,700

1172

Radical Trachelectomy in malignant

conditions


52,400


55,000


60,500

1173

Radical Hysterectomy in malignant

59,600

62,500

68,800


conditions




1174

Laparoscopic pelvic exenteration in

malignant conditions


1,20,000


1,26,000


1,38,600

1175

Anterior Exenteration - Carcinoma

Cervix


86,900


91,200


1,00,300

1176

Posterior Exenteration - Carcinoma

Cervix


67,100


70,500


77,500

1177

Total Pelvic Exenteration - Carcinoma

Cervix


1,00,100


1,05,100


1,15,600

1178

Supra Levator Exenteration - Carcinoma

Cervix


92,100


96,700


1,06,400


1179

Laparoscopic extraFACIAL hysterectomy + multiple biopsies +

omentectomy in malignant conditions


47,600


49,900


54,900


1180

Laparoscopic ExtraFACIAL 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


1182

Total Abdominal Hysterectomy(Tah) + Bilateral Salpingo Ophorectomy (Bso) + Bilateral Pelvic Lymph Node Dissection (Bplnd) + Omentectomy in malignant

conditions


64,200


67,400


74,200


1183

Radical Hysterectomy +Bilateral Pelvic Lymph Node Dissection (Bplnd) + Bilateral Salpingo Ophorectomy (Bso) /Ovarian Transposition in

malignant conditions


52,100


54,700


60,200

1184

Laparoscopic wertheim hysterectomy in

malignant conditions


56,200


59,000


64,900

1185

Radical Vaginectomy in malignant

conditions


55,200


58,000


63,800

1186

Radical Vaginectomy +

Reconstruction(70.62)


62,600


65,800


72,300

1187

Vulvectomy in malignant conditions

47,400

49,700

54,700

1188

Cranio Facial Resection in malignant

conditions


93,100


97,700


1,07,500

1189

Resection of Lateral Temporal Bone in

malignant conditions


69,900


73,400


80,800

1190

Subtotal Resection of Temporal Bone in

malignant conditions


73,500


77,200


84,900

1191

Total Resection of Temporal Bone in

malignant conditions


79,500


83,500


91,800

1192

Hemimandibulectomy in malignant

conditions


39,300


41,200


45,300

1193

Marginal Mandibulectomy in malignant

conditions


48,000


50,400


55,500

1194

Maxillectomy Any Type in malignant

conditions


32,900


34,500


38,000

1195

Maxillectomy + Infratemporal Fossa Clearance in malignant conditions


67,500


70,900


77,900

1196

Bone Resection in malignant conditions

44,200

46,400

51,000

1197

Bone and Soft TissueTumors

Amputation malignant conditions


29,800


31,300


34,400


1198

Surgery (removal) for Bone/Soft tissue tumors-Without Prosthesis in malignant

conditions(83.49)


51,300


53,800


59,200


1199

Surgery (removal) for Bone / Soft tissue tumors-With Custom Made Prosthesis in

malignant conditions(83.49+84.40)


87,600


92,000


1,01,200


1200

Surgery (removal) for Bone / Soft tissue tumors-With Modular Prosthesis in

malignant conditions(83.49+84.40)


99,500


1,04,500


1,14,900

1201

Shoulder Girdle Resection in malignant

conditions


56,300


59,100


65,000

1202

Sacral Resection in malignant conditions

61,500

64,600

71,000

1203

Soft tissue and bone tumour wide

exision


16,800


17,600


19,400

1204

Soft tissue And Bone tumors wide

excision reconstruction


26,800


28,100


31,000

1205

Head and Neck - Wide Excision

41,100

43,100

47,400

1206

Forequarter Amputation in malignant

conditions


79,100


83,100


91,400

1207

Hemipelvectomy in malignant conditions

80,100

84,100

92,500

1208

Internal Hemipelvectomy in malignant

conditions


80,800


84,900


93,400

1209

Curettage & Bone Cement in malignant

conditions


52,600


55,300


60,800

1210

Mastectomy Any Type in malignant

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

1213

Wide Excision - Breast in malignant

conditions


5,800


6,000


6,600

1214

Skin Tumors Wide Excision in malignant

conditions


36,600


38,400


42,200


1215

Skin Tumors wide Excision + Reconstruction in malignant

conditions(86.6/86.7)


41,800


43,900


48,300

1216

Wide local excision in malignant

conditions


64,600


67,800


74,600

1217

Wide local excision + reconstruction

67,000

70,400

77,400

1218

Skin Tumors amputation in malignant

conditions


26,200


27,500


30,200

1219

Reconstructon with Myocutaneous / Cutaneous Flap in malignant conditions


39,300


41,200


45,400

1220

Composite Resection & Reconstruction - Head & Neck in malignant conditions


69,000


72,400


79,600

1221

Isolated limb perfusion-hyperthermia in

malignant conditions


62,100


65,200


71,800

MEDICAL ONCOLOGY

1222

Prostate Cancer with Hormonal Therapy

3,700

3,900

4,300

1223

Chemotherapy for Breast Cancer with Adriamycin / Cyclophosphamide (Ac)


4,200


4,400


4,800

1224

Chemotherapy for Bladder Cancer with

Weekly Cisplatin.


2,000


2,100


2,300


1225

Chemotherapy for Bladder Cancer with Methotrexate Vinblastine Adriamycin

Cyclophosphamide (Mvac)


6,000


6,300


6,900

1226

Chemotherapy for Breast Cancer with 5- Fluorouracil A-C (Fac)


4,200


4,400


4,800

1227

Chemotherapy for Non SMAL cell Lung Cancer with Cisplatin/Etoposide (Iiib)


7,900


8,300


9,100

1228

Chemotherapy for Non SMAL cell Lung

Cancer with Erlotinib


15,000


15,800


17,300

1229

Chemotherapy for Non SMAL cell Lung Cancer with GEFITINIB


7,100


7,400


8,200

1230

Chemotherapy for Non SMAL cell Lung Cancer with Paclitaxel /Carboplatin


10,300


10,800


11,900

1231

Chemotherapy for Non SMAL cell Lung Cancer with PEM + Cisplatin


20,300


21,300


23,400

1232

Chemotherapy for Oesophageal Cancer

with Cisplatin/5fu


7,400


7,800


8,500

1233

Chemotherapy for Gastric Cancer with 5- Fu Leucovorin (▇▇▇▇▇▇▇▇ Regimen)


5,300


5,600


6,100

1234

Chemotherapy for Vulval Cancer with

Cisplatin/5-Fu


5,900


6,200


6,800

1235

Chemotherapy for Gastric Cancer with

EOX


15,600


16,400


18,000

1236

Chemotherapy for Gastric Cancer with Gemcitabine+Oxaliplatin


16,300


17,100


18,800

1237

Chemotherapy for Gastric Cancer with

Gemcitabine / Cisplatin


12,600


13,200


14,600

1238

Ac (Ac Then T)

4,500

4,700

5,200

1239

Chemotherapy for Gastric Cancer with

Imatinib(CML)


5,600


5,900


6,500

1240

Chemotherapy for Gastric Cancer with

Dcf


18,300


19,200


21,100

1241

Chemotherapy for Colorectal Cancer

with Monthly 5-Fu


6,400


6,700


7,400


1242

Chemotherapy for Colorectal Cancer with 5-Fluorouracil-Oxaliplatin

Leucovorin (Folfox) (Stage III) Only


12,400


13,000


14,300


1243

Chemotherapy for Colorectal Cancer with Capecitabine + bevacizumab

(metastatic)


8,300


8,700


9,600


1244

Chemotherapy for Colorectal Cancer with Capecitabine + Oxalipantia

(adjuvant) and metastatic


12,600


13,200


14,500

1245

Chemotherapy for Vaginal Cancer with

Cisplatin/5-Fu


6,900


7,200


8,000

1246

Chemotherapy for Colorectal Cancer

with Capacitabine


7,300


7,700


8,400

1247

Chemotherapy for Bone Tumors with

Cisplatin/Adriamycin


7,600


8,000


8,800


1248

Chemotherapy for Bone Tumors - Hodgkin Lymphoma disease with Adriamycin Bleomycin Vinblastine

Dacarbazine (Abvd)


5,600


5,900


6,500


1249

Chemotherapy for Non Hodgkin Lymphoma with Cyclophosphamide Adriamycin Vincristine Prednisone

(Chop)


5,100


5,400


5,900

1250

Chemotherapy for Breast Cancer with

Paclitaxel


7,600


8,000


8,800

1251

Chemotherapy for Non Hodgkin

Lymphoma with R - chop


45,300


47,600


52,300


1252

Chemotherapy for Multiple Myeloma with Vincristine,

Adriamycin,Dexamethasone(Vad)


4,600


4,800


5,300

1253

Chemotherapy for Multiple Myeloma with Thalidomide+Dexamethasone(Oral)


5,000


5,200


5,800

1254

Chemotherapy for Multiple Myeloma with Melphalan Prednisone (Oral)


4,800


5,000


5,500

1255

Chemotherapy for Wilms Tumor with Siopwts Regimen(Stages I-III)


7,300


7,700


8,400

1256

Chemotherapy for Ovarian cancer with

Carboplatin / Paclitaxel


11,300


11,900


13,000

1257

Chemotherapy for Hepatoblastoma operable with Cisplatin -Adriamycin


5,300


5,600


6,100

1258

Chemotherapy for Childhood B cell Lymphoma with variable regimen


22,100


23,200


25,500

1259

Chemotherapy for Neuroblastoma (Stages I-III ) with Variable Regimen


11,500


12,100


13,300

1260

Chemotherapy for Neuroblastoma (Stages I-III ) PCV (medulloblastoma)


5,600


5,900


6,500

1261

Chemotherapy for Retinoblastoma with Carbo/Etoposide/Vincristine


5,600


5,900


6,500


1262

Chemotherapy for Breast Cancer with Cyclophosphamide/ Methotrexate /

5fluorouracil (Cmf)


2,000


2,100


2,300

1263

Chemotherapy for Histiocytosis with

Variable Regimen


5,300


5,600


6,100


1264

Chemotherapy for Rhabdomyosarcoma with Vincristine-Actinomycin-

Chemotherapy for Rhabdomyosarcoma


9,600


10,100


11,100

1265

Chemotherapy for ▇▇▇▇▇▇ Sarcoma with

Variable Regimen


5,300


5,600


6,100

1266

Chemotherapy for Acute Myeloid

Variable Regimen


69,000


72,400


79,700


1267

Chemotherapy for Ovarian cancer with Germ Cell Tumor Bleomycin-Etoposide-

Cisplatin (Bep)


8,600


9,000


9,900

1268

Chemotherapy for Acute Myeloid Leukemia with Consolidation Phase


66,300


69,600


76,600

1269

Chemotherapy for Acute Myeloid Leukemia with Maintenance phase


3,000


3,100


3,500


1270

Chemotherapy for Acute Lymphoblastic Leukemia with Induction 1st And 2nd

Months


1,09,000


1,14,400


1,25,900

1271

Chemotherapy for Acute Lymphoblastic Leukemia with Induction 3rd, 4th, 5th


10,900


11,400


12,600

1272

Chemotherapy for Acute Lymphoblastic Leukemia with Induction Maintenance


12,300


12,900


14,200

1273

Palliative Chemotherapy for unlisted

Regimen


5,600


5,900


6,500

1274

Chemotherapy for Breast Cancer with

Tamoxifen Tabs


500


500


600

1275

Palliative And Supportive Therapy for

terminally ill cancer patient


3,600


3,800


4,100


1276

Chemotherapy for Acute Myeloid Leukemia with Xelox Along With

Adjuvant Chemotherapy Of As-I


12,000


12,600


13,800


1277

Chemotherapy for Multiple myeloma with Zoledronic Acid Along With

Adjuvant Chemotherapy Of As-I


3,300


3,500


3,800


1278

Chemotherapy for low risk Gestational trophoblast DS with Weekly

Methotrexate


2,300


2,400


2,600

1279

Chemotherapy for Multiple myeloma

with Lenalidomide dexa


10,000


10,500


11,500

1280

Chemotherapy for Multiple myeloma

with MPT(myeloma)


5,400


5,600


6,200

1281

Chemotherapy for Multiple myeloma

with Imatinib (GSIT)


7,000


7,300


8,100

1282

Supportive Therapy ( Third Generation Cephalosporin, Aminoglycoside Etc.,)


5,300


5,600


6,100


1283

Chemotherapy for Febrile Neutropenia with 2nd Line Iv Antibiotics And Other Supportive Therapy(Carbapenems, Fourth Generation Cephalosporins,

Piperacillin, Anti-Fungal . Azoles Etc.,)


44,200


46,400


51,000

1284

Chemotherapy for Chronic lymphoid leukemia with Benadamustine


16,300


17,100


18,800

1285

Chemotherapy for Chronic lymphoid leukemia with Chilorambucil


3,000


3,100


3,500

1286

Chemotherapy for Breast Cancer with

Aromatase Inhibitors


1,200


1,200


1,400

1287

Chemotherapy for Chronic lymphoid

leukemia with IA


10,600


11,100


12,200

1288

Chemotherapy for Chronic lymphoid leukemia with Imatinib(CML)


7,000


7,300


8,100

1289

Chemotherapy for low risk Gestational trophoblast DS with Actinomycin


5,300


5,600


6,100

1290

Chemotherapy for Chronic lymphoid

leukemia with Sunitinib


15,000


15,700


17,300

1291

Chemotherapy With

Temozolamide(brain tumours)


10,000


10,500


11,600

1292

Chemotherapy With Benadamustin -

RITUXIMAB


60,000


63,000


69,300

1293

Chemotherapy With TIP(GCT 2nd line)

20,000

21,000

23,100

1294

Chemotherapy for Breast Cancer with

Docetaxel


10,300


10,800


11,900

1295

Chemotherapy for Cervical Cancer with

Weekly Cisplatin


2,000


2,100


2,300


1296

Chemotherapy for high risk Gestational trophoblast DS with Etoposide- Methotrexate -Actinomycin /

Cyclophosphamide Vincristine (Ema-Co)


7,600


8,000


8,800


1297

Chemotherapy for Testicular Cancer with Bleomycin with Etoposide-Cisplatin

(Bep)


8,600


9,000


9,900


1298

Chemotherapy Chemotherapy for Hepatoblastoma operable with

Sorafenib


10,000


10,500


11,500

1299

Chemotherapy with Capeiri(metastatic)

8,300

8,700

9,600

1300

Chemotherapy with Capeox(adjuvant)

and metastatic


7,800


8,200


9,000

Radiation Oncology

1301

Acute lymphoblastic leukemia: radiation

5,500

5,800

6,400

1302

Hodgkin Lymphoma (Favorable group):

radiation


11,000


11,600


12,700

1303

Hodgkin Lymphoma (unfavorable

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

1308

Bone tumors/soft tissue sarcomas

:radiation


27,500


28,900


31,800

1309

Bone tumors/soft tissue sarcomas

:surgery (inlcuding prosthesis)


2,58,500


2,71,400


2,98,600

1310

Cobalt 60 External Beam Radiotherapy (Radical/Adjuvant / Neoadjuvant)


22,000


23,100


25,400

1311

Cobalt 60 External Beam Radiotherapy

(Palliative)


11,000


11,600


12,700

1312

Linear Accelerator External Beam Radiotherapy (Palliative)


22,000


23,100


25,400


1313


Linear Accelerator, External Beam Radiotherapy 3D CRT/2D Planning (Radical/Adjuvant/Neoadjuvant)


55,000


57,800


63,500


1314

Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy)

(Radical/Adjuvant/Neoadjuvant)


82,500


86,600


95,300


1315

Linear Accelerator External Beam Radiotherapy IGRT (Image Guided 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

1318

Respiratory Gating along with Linear

Accelerator planning


77,000


80,900


88,900


1319

Electron beam with Linear accelerator (Radical)Tomotherapy(Radical/Adjuvant/

Neoadjuvant)


55,000


57,800


63,500

1320

Tomotherapy(Radical/Adjuvant/Neoadju

55,000

57,800

63,500


vant)





1321

Brachytherapy High Dose Radiation(Intracavitory) - per fraction,

maximum of 4 sessions


5,000


5,200


5,700


1322

Brachytherapy High Dose Radiation (Interstitial) - for one application, multiple

dose


33,000


34,700


38,100


1323

Brachytherapy High Dose Radiation (Intraluminal) - per fraction, maximum 4

sessions


5,000


5,200


5,700


1324

Cobalt 60 External Beam Radiotherapy,Definitive, Neoadjuvant,

Adjuvant


22,000


23,100


25,400

1325

Brachytherapy/ Interstitial LDR ,

adjuvant


16,500


17,300


19,100

1326

Linear accelerator teletherapy,

Definitive+Tab Temozolamide


60,500


63,500


69,900


1327

Linear accelerator teletherapy, 3DCRT, Definitive along with +concurrent Tab

Temozolamide along with RT


88,000


92,400


1,01,600

1328

Linear accelerator (Photons)

teletherapy,Adjuvant


55,000


57,800


63,500

1329

Cobalt 60 External Beam

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

1332

Accelerated partial breast irradiation (APBI) any type/ LINAC/3DCRT/IMRT


55,000


57,800


63,500


1333

Linear accelerator,Involved-Site Radiotherapy (ISRT)/Involved field

radiation therapy(IFRT)/3DCRT/IMRT


27,500


28,900


31,800

1334

Linear accelerator, less than 20

fractions/3DCRT/IMRT


27,500


28,900


31,800


1335

Linear accelerator

teletherapy,3DCRT,IMRT,VMAT Adjuvant/Definitive


82,500


86,600


95,300


1336

Brachytherapy/ Interstitial HDR one 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


1341

Surgical Correction of Nerve and 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

1343

Conservative treatment for brachial

plexus injuries


10,900


11,400


12,600

1344

Corrective surgery for Hyperchalonism

elecanthes


55,400


58,200


64,000


1345

Tarsorrhaphy surgery to prevent exposure keratitis to prevent loss or impairment of vision especially in facial

burns


10,900


11,400


12,600

1346

Ear reconstruction

44,900

47,100

51,800

1347

Reconstruction or prosthetic appliance

for absent ear


33,000


34,600


38,100

1348

Surgical Correction of anamolies of Ear

(cup & bat ears)


28,600


30,000


33,000

1349

Nose fractures with implants

47,400

49,800

54,700

1350

Nose deformities with functional

disturbances


61,800


64,900


71,400

1351

Macroglossia Correction

47,400

49,800

54,700

1352

Micrognathia - ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇▇▇

68,300

71,700

78,900

1353

▇▇▇▇▇▇▇¿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

1358

Surgical correction for Vascular

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

1365

Reconstructive procedures for vaginal

atresia


40,500


42,500


46,700

1366

Functional corrective surgery for sequel

of facial injuries


72,700


76,300


84,000

1367

Orthognathic surgeries involving facial

bones


82,700


86,800


95,500

1368

Panfacial fractures combination with

polytrauma


1,05,800


1,11,100


1,22,200

1369

Frontonasoethmoid fractures with

implants


1,01,800


1,06,900


1,17,600

1370

Surgical Correction of lid retraction with ▇▇▇▇▇▇ 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

▇▇▇▇▇▇▇ fractures ▇▇▇▇▇▇ II

74,400

78,100

85,900

1374

Surgical Correction Of Fracture ▇▇▇▇▇▇ III

53,500

56,200

61,800

1375

Maxilla fractures ▇▇▇▇▇▇ III

76,900

80,700

88,800

1376

Facial bone fractures - mandible

fracture single with implants


53,600


56,300


61,900

1377

Facial bone fractures - mandible fracture 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

1380

Calvarial reconstruction

77,700

81,600

89,700

1381

Treatment for trisser

fingerenosynovitis(82.2)


32,000


33,600


37,000


1382

Aplasia / hypoplasia / post traumatic loss of thumb for reconstruction -

conventional surgery


66,500


69,900


76,900


1383

Aplasia / hypoplasia / post traumatic loss of thumb for reconstruction -

microsurgery


86,700


91,100


1,00,200

1384

Surgical Correction of Leprosy

Reconstructive Surgery


23,500


24,700


27,100

1385

Surgical correction for Congenital 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

▇▇▇▇▇▇▇▇▇▇▇▇¿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

1393

Post cabg(sternal dehiscence/osdo

Repair


44,700


46,900


51,600

1394

Free functional muscle transfer

78,200

82,100

90,300

1395

Corrective surgery for congenital

deformities of foot (per foot)


53,000


55,700


61,200

1396

Post Burn Contracture Surgeries - Mild

43,100

45,200

49,700

1397

Post Burn Contracture Surgeries -

Moderate


45,100


47,300


52,100

1398

Post Burn Contracture Surgeries -

Severe


51,600


54,200


59,600

1399

Mgt of electrical burns with vital

expossed with flapcover


59,900


62,900


69,200

1400

Amputation of hand / fore arm / arm / foot / leg / thigh with skin cover (84.1)


41,600


43,700


48,100

1401

Amputation of digit with skin

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

1404

Reimplantation / revascularization -

multiple digits per finger


86,000


90,300


99,400

1405

Reimplantation / revascularization -

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

1409

Breast reduction for gigantomachia

female


52,300


54,900


60,400

1410

Post mastectomy breast reconstruction 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


Lymphoedema




1413

Any raw area which needs skin grafting -

mild<5%


35,900


37,700


41,500

1414

Any raw area which needs skin grafting -

moderate 5-10%


40,300


42,300


46,500

1415

Any raw area which needs skin grafting -

major - >10 %


55,000


57,700


63,500

1416

Debridement and primary closure for

avulsion injuries(86.59)


58,300


61,200


67,300

1417

Debridement and skin grafting for

avulsion injuries(86.63)


77,100


81,000


89,100

1418

Surgical Management of 40% mixed

burns


78,500


82,400


90,700

1419

Surgical Management of 50% mixed

burns


1,33,300


1,39,900


1,53,900

1420

Surgical Management of 60% mixed

burns


1,56,000


1,63,800


1,80,200

1421

Surgical Management of above 60%

mixed burns


1,54,100


1,61,800


1,78,000

1422

Eyelid injuries / avulsions - major (more than 25% either in thickness or length)


62,100


65,200


71,700

1423

Nose injuries / avulsions- primary

closure/ skin graft(86.6)


42,100


44,200


48,600

1424

Ear injuries / avulsions - primary

closure/ skin graft(86.6)


42,100


44,200


48,600

1425

Lip injuries / avulsions - primary

closure/ skin graft(86.6)


42,100


44,200


48,600

1426

Sub mucosal fibrosis - surgical

management with grafts


62,400


65,500


72,100


1427

Extensive degloving injuries / lacerations of the face in rta / animal bites with

exposure of vital structures


77,400


81,300


89,400

1428

Surgical management for keloid & hypertrophic scar requiring flap cover


28,000


29,400


32,300

1429

Pedicle flap

72,300

75,900

83,400

1430

Sub mucosal fibrosis - surgical

management with flap


51,700


54,300


59,700


1431

Flap cover for trauma of the hand / forearm / arm / foot / leg / thigh etc., with exposure of the underlying vital structures like tendons, nerves, vessels, bone, with or without any fracture - flap

division


62,000


65,100


71,600

1432

Crush injury hand involving loss of skin and vital parts requiring flap cover


51,600


54,200


59,600


1433

Flap cover for trauma of the hand / forearm / arm / foot / leg / thigh etc., with exposure of the underlying vital structures like tendons, nerves, vessels, bone, with or without any fracture- flap

insert


61,800


64,900


71,400


1434

Micro vascular reconstruction flap (post 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

1436

Ear injuries / avulsions - flap cover

38,100

40,000

44,000

1437

Lip injuries / avulsions - flap cover

36,000

37,800

41,600

1438

Scar revision procedures involving

natural orifices


31,300


32,800


36,100

1439

Reconstructive surgery for facial palsy -

micro vascular


81,400


85,500


94,100

1440

Surgical Correction of Hemifacial

Atrophy


92,200


96,800


1,06,500

1441

Reconstructive surgery for facial palsy

-conventional


82,300


86,400


95,000

1442

Surgical Correction of hemifacial

microsomia


84,000


88,200


97,000


1443

Post traumatic squeal like contractures, severe hypertrophy, unstable scars,

non-healing ulcers etc.,


42,100


44,200


48,600

1444

Surgical Management of Syndactyly of

Hand For Each Hand


36,600


38,500


42,300

1445

Tissue expansion -for functional purpose

48,200

50,600

55,600

1446

Conservative management of 40%

burns


69,000


72,500


79,700

1447

Conservative management of 50%

burns


1,38,000


1,44,900


1,59,400

1448

Conservative management of 60%

burns


2,13,500


2,24,200


2,46,600


1449

Injection treatment - each sitting for keloid,haemangioma, lymphangioma

and vascular malformations


22,100


23,200


25,500

POLYTRAUMA

1450

Surgical Treatment (Up To) for Neuro

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

1454

Surgical Management for Abdominal

Injuries


77,100


81,000


89,100

1455

Surgical treatement of fascial bone

fracture


16,500


17,300


19,100


1456

Surgical management with K-Wiring for Small bone fractures (To Be Covered Along With Other Injuries Only And Not

As Exclusive Procedure)


5,000


5,300


5,800


1457

Surgical Management of Patella Fracture (To Be Covered Along With Other Injuries Only And Not As

Exclusive Procedure)


5,000


5,300


5,800

1458

Surgical Correction Of Pelvic Bone

Fractures.


36,700


38,500


42,400

1459

Surgical Correction Of Longbone

Fracture


31,500


33,100


36,400

1460

Surgical Management of Grade I&II

Compound Fractures


16,500


17,300


19,100

1461

Surgical Management of Grade III

Compound Fractures


27,800


29,200


32,100


1462

Surgical Management of wound In 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

1466

Intesive care management for Chest injuries in RICU Rs. 4000/- per day


35,000


36,800


40,400


1467

Intesive care managementof Neuro Surgical Trauma in Neuro Icu

@Rs.4000/Day


48,000


50,400


55,400


1468

Intesive care management for Abdominal Injuries In Surgical

ICU@Rs.4000/Day


31,000


32,600


35,800

1469

Medical management of Neurosurgical troma in general ▇▇▇▇ @900/- day


12,300


12,900


14,200

1470

Conservative management of chest injuries in general ▇▇▇▇ @900/- day


6,900


7,200


8,000


1471

Conservative management of Abdominal surgical in general ▇▇▇▇ Major @900/-

day


6,900


7,200


8,000

Dental Surgery

1472

Surgical Management of Naso

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

1477

Application Of Pit & Fissure Sealants

(Pedo)


600


600


700

1478

Amalgam Restoration Per Tooth

▇▇▇

▇▇▇

▇▇▇

1479

Temporary Filling Per Tooth

300

300

300

1480

Tooth Coloured Restoration Per Tooth

500

500

500

1481

Fabrication & Cementation Of Inlay &

Onlay-Ceramic


2,600


2,800


3,000

1482

Fabrication & Cementation Of Inlay &

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

1485

Vital Bleaching Procedure For 8 Upper

Teeth


1,100


1,200


1,300

1486

Restoration With Composite Veneers

(Pertooth)


600


600


700

1487

Preparation & Cementation Of Anterior

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

1491

Surgical Placement Of Dental Implants

Under L.A


11,200


11,800


13,000

1492

Treatment with Micro Implants (Each)

600

600

700

1493

Surgical Placement Of Eye Prosthesis

With Implants


40,400


42,500


46,700

1494

Surgical Placement Of Nose Prosthesis

With Implants


36,000


37,800


41,600

1495

Surgical Placement Of Zygomatic

Implants Under G.A


1,30,500


1,37,000


1,50,700

1496

Root Canal Treatment - Deciduous

Tooth


900


900


1,000

1497

Anterior Root Canal Treatment

2,000

2,100

2,300

1498

Apicoectomy

2,000

2,100

2,300

1499

Root Canal Treatment With Hemisection

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

1503

Extraction Of III Molar / Impacted Toot

Under L.A


2,000


2,100


2,300

1504

Surgical Extraction Of Tooth

1,500

1,600

1,700

1505

Extraction Of Deep Bony Impacted

Tooth Under G.A.


10,000


10,500


11,600

1506

Preparation And Cementation Of Acrylic

Crown


400


400


500

1507

Fabrication & Cementation Of Metal Ceramic Crown (Per Unit)


1,400


1,400


1,600

1508

Preparation & Cementattion Of Anterior

All Ceramic Crown


3,100


3,200


3,500

1509

Placement Of Stainless Steel Crown

(Per Tooth)


700


700


800

1510

Fibre Post & Core Restoration With Anterior All Ceramic Crown (23.4)


3,600


3,700


4,100

1511

Fibre Post & Core Restoration With Metal Ceramic Crown (23.4)


2,300


2,400


2,600

1512

Metal Post & Core Restoration With Metal Ceramic Crown (23.4)


2,300


2,400


2,600

1513

Placement Of Fixed Habit Breaking

Appliances


2,100


2,200


2,400

1514

Tretament With Expansion Plate

1,600

1,700

1,900

1515

Fabrication & Insertion Of Removable Habit Breaking Appliance


1,500


1,600


1,800

1516

Fabrication & Insertion Of Removable Appliance (Upper / Lower )


1,600


1,600


1,800

1517

Fabrication & Insertion Of Removable

Functional Appliance


2,900


3,000


3,300

1518

Fabrication & Insertion Of Removable Partial Denture- Single Tooth


600


600


600

1519

Fabrication & Insertion Of Removable

Retainers-Each Arch


700


700


800

1520

Fabrication & Insertion Of Fixed Space Maintainers / Space Retainer


1,300


1,300


1,500

1521

Fabrication & Insertion Of Removable Space Maintainers (Pedo)


1,000


1,100


1,200

1522

Treatment With Inclined Plane

900

900

1,000

1523

Fabrication Of Occlusal Night Guard

(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

1533

Flap Surgery With Bone Grafting (Per

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

1536

Local Drug Delivery -Periodontal

Treatments


1,000


1,100


1,200

1537

Pre Prosthetic Surgery - Ridge

Augmentation(Full mouth)


20,900


21,900


24,100

1538

Resection And Reconstruction (Tumor)

21,500

22,500

24,800

1539

Surgical Managemant Of Cyst(<2.5 cm)

Under L.A.


1,700


1,800


2,000

1540

Excision Of Growth Under L.A.

3,300

3,500

3,800

1541

Surgical Managemant Of Cyst(> 2.5 cm)

Under G.A.


10,700


11,200


12,300

1542

Excision Of Growth Under G.A.

14,800

15,600

17,100

1543

Excision Of Precancerous Lesions

Under L.A


6,200


6,500


7,200

1544

Excision Of Precancerous Lesions

Under G.A


10,500


11,000


12,100

1545

Excision Of Precancerous Lesions With

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

1549

Rapid Maxillary Expansion With Hyrax Screwifr Palatal Expanders


4,700


5,000


5,500

1550

Treatment With Temporary Anchorage

Devices


1,900


2,000


2,200

1551

Treatment With Fixed Functional

Appliances


3,600


3,800


4,100

1552

Fixed Orthodontics Treatment-Ceramic

Braces


5,100


5,400


5,900

1553

Fixed Orthodontics Treatment-Metal

Braces


10,700


11,200


12,300

1554

Treatment With Fixed Retainers

1,000

1,100

1,200

1555

Fabrication Of Acrylic Splinting Arch ( In Auto Polymerizing Acrylic)


1,100


1,100


1,200

1556

Fabrication & Insertion Of Feeding Plate

(Acrylic)


900


1,000


1,100

1557

Fabrication & Insertion Of Obturator -

900

900

1,000


Acrylic




1558

Fabrication & Insertion Of Obturator &

Speech Bulb-Acrylic


2,000


2,100


2,300

1559

Relining / Rebasing of Complete

Denture


900


1,000


1,100

1560

Vestibuloplasty - Maxilla / Mandible-

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

1568

Incision & Drainage of Simple Abscess

(per Tooth)


700


700


800

1569

Incision & Drainage of Facial Abscess

Under G.A


8,300


8,700


9,600

1570

Incision & Drainage of Facial Abscess

Under L.A


3,500


3,700


4,000

1571

Sequestrectomy & Saucerization Of 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

1576

Bilateral Sagittal Split Osteotomy Of

Mandible (BSSO)


30,100


31,600


34,700

1577

Anterior Segmental Osteotomy -

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


1580

Surgical Management Of Combined Fracture Of Mandible & Maxilla

(76.74/76.75/76.76)


33,400


35,000


38,500

1581

Surgical Correction Of Fracture ▇▇▇▇▇▇ II

40,400

42,400

46,600

1582

Open Reduction & Internal Fixation Of Jaw Fractures Under G.A. (76.76)


12,800


13,400


14,800

1583

Closed Reduction & Immobilisation Of Mandibular Fracture Under L.A.


1,900


2,000


2,200

1584

Surgical Correction Of Fracture ▇▇▇▇▇▇ I -

G.A. (76.76)


39,300


41,300


45,400

1585

Surgical Management Of TMJ

Dislocation (G.A.) (76.94)


15,300


16,100


17,700

1586

Distraction Osteogenesis- Mandible-

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

1589

Surgical Management Of TMJ Ankylosis

(G.A.)


17,900


18,800


20,700

1590

Radio Frequency & Thermo Coagulaton For Treatment Of Trigeminal Neuralgia


15,900


16,700


18,400

1591

Cryosurgery In Dental Procedures

10,800

11,400

12,500

1592

Laser Treatment For Precancerous

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

1596

Intermaxillary Fixation(IMF) For Alveolar

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

1599

Oral Prophylaxis - Extrinsic Stains

(Upper/ Lower)


400


500


500

1600

Oral Prophylaxis - Calculi (Upper/

Lower)


600


600


600

1601

Fabrication & Insertion Of Complete

Denture (U & L)


5,700


6,000


6,500

1602

Fabrication & Insertion Of Complete

Denture (Upper / Lower)


3,200


3,300


3,700

1603

Fabrication & Insertion of Soft Liner

Denture


7,500


7,800


8,600


1604

Fabrication & Insertion Of Cast Partial Dentures Framework With Precission

Attachments


9,800


10,300


11,300

1605

Fabrication Of Over Dentures Without

Attachments


5,900


6,200


6,800

1606

Fabrication Of Over Dentures -Implant

Supported (2 units)


26,400


27,700


30,400

1607

Fabrication Of Over Dentures With

Attachments


11,200


11,700


12,900

1608

Fabrication & Insertion Of Cast Partial Dentures Framework Per Unit


4,800


5,100


5,600

1609

Medical Management Of Trigeminal

Neuralgia


8,000


8,400


9,200

1610

Medical Management of Oral Ulcers

5,000

5,300

5,800

1611

▇▇▇▇▇▇▇ Opener Procedure -

Management of OSMF


25,000


26,300


28,900

1612

Combination Of Intralesional Injection 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


1615

Medical Management of Premalignant 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

1617

Mdical Management Of TMJ

Dysfunction Syndrome (76.94)


5,000


5,300


5,800

1618

Medical Management Of Myo FACIAL Pain Dysfunction Syndrome (MPDS)


5,000


5,300


5,800

Medical - Critical Care


1619

Medical Management of Acute Bronchitis with Pneumonia and

Respiratory Failure


61,500


64,600


71,000


1620

Medical Management of COPD with Respiratory Failure (Infective

Exacerbation)


81,800


85,900


94,500

1621

Medical Management of Acute Severe 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

1623

Medical Management of ARDS with Multi Organ failure (R65.1)


1,15,000


1,20,800


1,32,800

1624

Medical Management of ARDS with DIC (Blood & Blood Products) (D65)


1,43,000


1,50,200


1,65,200

1625

Intensive care management of Septic

Shock


63,000


66,100


72,800

1626

Medical Management of Poisioning Requiring Ventilatory Assistance


51,500


54,100


59,500

Medical-General Medicine

1627

Medical Management of Typhoid And

Paratyphoid Fevers


21,800


22,900


25,200

1628

Medical Management of Acute

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

1631

Medical Management of Dengue

Haemorrhagic Fever


36,800


38,600


42,500

1632

Medical Management of Falciparum

Malaria


11,500


12,100


13,300

1633

Medical Management of Cerebral

Malaria


27,100


28,500


31,300

1634

Medical Management of Vivax Malaria

11,500

12,100

13,300

1635

Medical Management of Myelodysplastic

Syndromes


33,000


34,700


38,100

1636

Medical Management of Chelation Therapy For Thalassemia Major


16,200


17,000


18,700

1637

Medical Management of Pancytopenia

31,500

33,100

36,400

1638

Medical Management of Anaemias (Less Than 7 Gms)/ Heart Failure


31,200


32,800


36,000

1639

Medical Management of Hemophilia

(D67/D68.0)


61,500


64,600


71,000


1640

Medical Management of Thrombocytopenia With Bleeding

Diathesis


32,100


33,700


37,100

1641

Medical Management of Other

Coagulation Disorders


45,200


47,500


52,200

1642

Medical Management of Periodic

Paralysis


16,200


17,000


18,700

1643

Medical Management of Metabolic

Encephalopathy


36,800


38,600

Document Metadata

Filed: March 25th, 2025