Specialty code |
Package Code |
Package name |
Package Amount |
Preauth Required or Not (Y/N) |
Mandatory investigations for pre-auth |
Post-Op investigations for claims submission |
Average length of Stay (Including Days in intensive care units) |
Govt Reserved Procedure (Y/N) |
Medical (M) or Surgical (S) |
S12 |
0001 |
Balloon Atrial Septostomy |
18,000 |
Y |
2D ECHO report |
2D ECHO report |
|
N |
S |
S12 |
0002 |
Balloon Aortic Valvotomy |
25,000 |
Y |
2D ECHO report |
2D ECHO report |
|
N |
S |
S12 |
0003 |
Balloon Mitral Valvotomy |
27,500 |
Y |
2D ECHO report |
2D ECHO report |
|
N |
S |
S12 |
0004 |
Balloon Pulmonary Valvotomy |
25,000 |
Y |
2D ECHO report |
2D ECHO report |
|
N |
S |
S12 |
0005 |
Vertebral Angioplasty with single stent (medicated) |
50,000 |
Y |
2D ECHO |
Post op. Angiogram report |
2 |
N |
S |
Angiogram report |
Carton of the stent used approved by FDA/DCGI only |
S12 |
0006 |
Vertebral Angioplasty with double stent(medicated) |
65,000 |
Y |
2D ECHO |
Post op. Angiogram report |
2 |
N |
S |
Angiogram report |
Carton of the stents used approved by FDA/DCGI only |
S12 |
0007 |
Carotid angioplasty with stent (medicated) |
130,000 |
Y |
Angiogram report & film showing the lesion |
Post lesion |
2 |
N |
S |
X Ray |
Doppler |
carton of the stent used approved by FDA/DCGI only |
S12 |
0008 |
Renal Angioplasty with single stent (medicated) |
50,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
2 |
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0009 |
Renal Angioplasty with double stent (medicated) |
65,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
2 |
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0010 |
Peripheral Angioplasty with balloon |
25,000 |
Y |
2D ECHO |
Post procedure Angio stills |
2 |
N |
S |
CAG stills showing blocks & Reports |
|
S12 |
0011 |
Peripheral Angioplasty with stent (medicated) |
50,000 |
Y |
2D ECHO |
Post procedure Angio stills |
2 |
N |
S |
Angiogram report & stills |
carton of the stents used approved by FDA/DCGI only |
S12 |
0012 |
Coarctation dilatation |
25,000 |
Y |
2D ECHO report |
2D ECHO report + stills of ECHO |
|
N |
S |
S12 |
0013 |
Medical treatment of Acute MI with Thrombolysis /Stuck Valve Thrombolysis |
10,000 |
Y |
2D ECHO |
2D ECHO |
|
N |
S |
CPK-MB |
ECG |
CAG |
Lab Investigation (Troponine - T report) |
ECG with report |
|
TROPONINE-T report |
|
S12 |
0014 |
ASD Device Closure |
80,000 |
Y |
2D ECHO report - TRPG |
2D ECHO stills showing the device + Report |
|
N |
S |
S12 |
0015 |
VSD Device Closure |
80,000 |
Y |
2D ECHO report - TRPG |
2D ECHO stills showing the device + Report |
|
N |
S |
S12 |
0016 |
PDA Device Closure |
40,000 |
Y |
2D ECHO report |
2D ECHO stills showing the device + Report |
|
N |
S |
S12 |
0017 |
PDA multiple Coil insertion |
20,000 |
Y |
2D ECHO report |
2D ECHO stills showing the coil + Report |
|
N |
S |
S12 |
0018 |
PDA Coil (one) insertion |
15,000 |
Y |
2D ECHO report |
2D ECHO stills showing the coil + Report |
|
N |
S |
S12 |
0019 |
PDA stenting |
40,000 |
Y |
2D ECHO |
Post procedure Angio stills |
|
N |
S |
Angiogram report & stills |
|
S12 |
0020 |
Pericardiocentesis |
4,000 |
Y |
2D ECHO report |
2D ECHO report |
|
N |
S |
S12 |
0021 |
Temporary Pacemaker implantation |
10,000 |
Y |
ECG |
X Ray showing the pacemaker in situ |
|
N |
S |
Report by cardiologist |
|
|
S12 |
0022 |
Permanent pacemaker implantation (only VVI) including Pacemaker value/pulse generator replacement (DOUBLE CHAMBER) |
60,000 |
Y |
ECG |
X Ray showing the pacemaker in situ |
7 (2-day ICU stay) |
N |
S |
Report by cardiologist |
|
Anigiogram report if done |
|
S12 |
0023 |
Permanent pacemaker implantation (only VVI) including Pacemaker value/pulse generator replacement (SINGLE CHAMBER) |
50,000 |
Y |
ECG |
X Ray showing the pacemaker in situ |
7 (2-day ICU stay) |
N |
S |
Report by cardiologist |
|
Anigiogram report if done |
|
S12 |
0024 |
PTCA - single stent (medicated, inclusive of diagnostic angiogram) |
65,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
3 |
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0025 |
PTCA - double stent (medicated, inclusive of diagnostic angiogram) |
90,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
3 |
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0026 |
PTCA - additonal stent (linked to package no:0025) |
28,849 |
Y |
CAG stills showing blocks & Reports |
carton of the stents used approved by FDA/DCGI only |
|
N |
S |
S12 |
0027 |
PTSMA |
25,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
3 |
N |
S |
2D ECHO |
Carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & reports |
|
S12 |
0028 |
Pulmonary artery stenting |
40,000 |
Y |
2D ECHO |
Post procedure Angio stills |
|
N |
S |
Angiogram report & stills |
|
S12 |
0029 |
Pulmonary artery stenting (double) |
65,000 |
Y |
2D ECHO |
Post procedure Angio stills |
|
N |
S |
Angiogram report & stills |
|
S12 |
0030 |
Right ventricular outflow tract (RVOT) stenting |
40,000 |
Y |
2D ECHO |
Post procedure Angio stills |
|
N |
S |
Angiogram report & stills |
|
S12 |
0032 |
Rotablation+ Balloon Angioplasty + 1 stent (medicated) |
100,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
|
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0033 |
Rotablation+ Balloon Angioplasty + 2 stent (medicated) |
125,000 |
Y |
ECG |
Post op. Angiogram report, showing stent & post Stent flow |
|
N |
S |
2D ECHO |
carton of the stents used approved by FDA/DCGI only |
CAG stills showing blocks & Reports |
|
S12 |
0034 |
Thrombolysis for peripheral ischemia |
10,000 |
Y |
Peripheral Angiogram /Doppler Report with Stills |
Post procedure Angio stills |
|
N |
S |
S12 |
0035 |
Bronchial artery Embolisation (for Haemoptysis) |
25,000 |
Y |
Chest x-Ray/CT Scan |
Chest x-Ray/CT Scan |
2 |
N |
S |
Hb |
Hb |
Serum Creatinine |
Serum Creatinine |
S12 |
0036 |
Percutaneous Transluminal Tricuspid Commissurotormy (PTTC) |
25,000 |
Y |
2D ECHO |
2D ECHO |
2 |
N |
S |
S12 |
0037 |
Coiling - Pseudoaneurysms of Abdomen |
55,000 |
Y |
Prothrombin Time (PT) |
CT |
2 |
N |
S |
International normalized ratio (INR) |
Prothrombin Time (PT) |
Hb |
International normalized ratio (INR) |
Serum Creatinine |
Hb |
|
Serum Creatinine |
S12 |
0038 |
Embolization - Arteriovenous Malformation (AVM) in the Limbs |
40,000 |
Y |
Ultrasound |
Ultrasound |
2 |
N |
S |
CT |
CT |
Prothrombin Time (PT) |
Prothrombin Time (PT) |
INR |
INR |
Hb |
Hb |
Serum Creatinine |
Serum Creatinine |
S12 |
0039 |
Catheter directed Thrombolysis for: Deep vein thrombosis (DVT), Mesenteric Thrombosis & Peripheral vessels with Tenecteplase |
50,000 |
Y |
CT/MRI |
CT/MRI |
2 |
N |
S |
Prothrombin Time (PT) |
Prothrombin Time (PT) |
International normalized ratio (INR) |
International normalized ratio (INR) |
Hb |
Hb |
Serum Creatinine |
Serum Creatinine |
S12 |
0040 |
Peripheral Embolectomy without Graft |
30000 |
Y |
ANGIOGRAM , Spiral CT Angiogram |
Color Doppler |
|
N |
S |
S12 |
0041 |
Small Arterial Aneurysms -Repair |
18000 |
Y |
ANGIOGRAM , Spiral CT Angiogram |
Color Doppler |
|
N |
S |
S12 |
0042 |
Medium size Arterial Aneurysms-Repair |
60000 |
Y |
ANGIOGRAM , Spiral CT Angiogram |
Color Doppler |
|
N |
S |
S12 |
0043 |
Medium size Arterial Aneurysms with synthetic graft |
90000 |
Y |
ANGIOGRAM , Spiral CT Angiogram |
Color Doppler |
|
N |
S |