| Specialty code | Package Code | Site | 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) |
| M5 | 0001 | Lymphoma, Non-Hodgkin’s | Lymphoma, Non-Hodgkin’s: Cyclophosphamide - Doxorubicin Vincristine - Prednisone (CHOP)- max 8 cycles (Per cycle) | R CHOP Regimen-25000 per cycle x6 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0002 | Multiple Myeloma | Vincristine, Adriamycin,Dexamethasone(VAD) -cycle max 6 cycles | Bortezomib+ lenalidomide+ dexamethasone 20,000/ per cycle x6 Bortezomib+ cyclophosphamide+ dexamethasone 10000/per cycle x6 MPT melphalan, thalidomide and prednisolone 6000/per cycle x9 Bortezomib + dexamethasone 6000/per cycle x9 |
Y | Bone Marrow Aspiration Report | Chemotherapy drug batch number with bar code |
N | M | |
| M5 | 0003 | Multiple Myeloma | Thalidomide+Dexamethasone(Oral)/ month - max 12 months | 3000 | Y | Bone Marrow Aspiration Report | Chemotherapy drug batch number with bar code |
N | M | |
| M5 | 0004 | Colon Rectum | 5-Fluorouracil-Oxaliplatin - Leucovorin (FOLFOX) - Max. 6 cycles (Per cycle) | 10000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0005 | Bone Tumors/Osteosarcoma/ Hepatoblastoma -Operable | Cisplatin/carboplatin - Adriamycin- max 6 cycles (Per cycle) | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0006 | Lymphoma, Hodgkin'S | Adriamycin Bleomycin VinblastinDacarbazine (ABVD) - max 8 cycles (Per cycle) (Day 1 & Day 15) | ABVD (day 1 and 15) 5000x2=10,000 per cycle x 6 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0007 | Cervix | Cisplatin/Carboplatin (AUC2) along with RT- max 6 cycles (Per cycle) | chemo radiation 5000/per week x 6 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0008 | Neuroblastoma Stage I –III | Variable Regimen – Neuroblastoma - max 1 year (Per cycle) | 9000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0009 | Wilm'sTumor | SIOP/National Wilms Tumour Study Group (NWTS) regimen(Stages I - V)- max 6 months (Per month) - Wilm's tumour | 7000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0010 | Colon - rectum | Monthly 5-FU | 4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0011 | Breast | Paclitaxel weekly x 12 weeks | 4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0012 | Breast | Cyclophosphamide/Methotrexate/5Fluorouracil (CMF) (Per cycle) | 1500 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0013 | Breast | Tamoxifen tabs - maximum 12 cycles (Per month) | 100 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0014 | Breast | Adriamycin/Cyclophosphamide (AC) – per cycle (Maximum 4 cycles) | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0015 | Breast | 5- Fluorouracil A-C (FAC) – per cycle (Maximum 6 cycles) | 3100 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0016 | Breast | AC (AC Then Taxol) | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0017 | Small Cell Lung Cancer | Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles only) | 4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0018 | Oncology oesophagus | Cisplatin + 5 FU(Neoadjuvant Chemotherapy)/Adjuvant (ADJ)- per cycle (Max. of 6 cycles only) | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0019 | Stomach | Docetaxel +Oxaliplatin+5FU 20,000 per cycle for 4 cycles CapOX- 10,000 per cycle for 8 cycles |
4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0020 | Breast | Aromatase Inhibitors (Anastazole/Letrozole/Exemestane) - maximum 12 cycles (Per month) | 900 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0021 | Urinary Bladder | Weekly Cisplatin/Carboplatin- max 6 cycles with RT (Per week) | 2000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0022 | Urinary Bladder | MethotraxateVinblastin Adriamycin Cyclophosphamide (MVAC) | 5000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0023 | Retinoblastoma | Carbo/Etoposide/Vincristine-max 6 cycles (Per cycle) | 4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0024 | Febrile Neutropenia | IV antibiotics and other supportive therapy (Per episode) | 30000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0025 | Vaginal/ Vulval Cancer | Cisplastin/5-FU | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0026 | Ovary | Carboplatin/Paclitaxel-max 6 cycles (Per cycle) | Taxol+carboplatin 15000/percyclex6 BEP regimen for germ cell tumor 10000/per cyclex4 |
Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0027 | Multiple Myeloma | Melphalan -Prednisone (oral) – per month (max 12 months) - Ovarian CA, Bone CA | 1500 | Y | Bone Marrow Aspiration Report | Chemotherapy drug batch number with bar code |
N | M | |
| M5 | 0028 | Rectal Cancer Stage 2 And 3 | Gemcitabine +capecitabine-15,000 per cycle for 6 cycles | 4000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0029 | Multiple Myeloma | Zoledronic acid - Max 12 cycles (Per month) | 2000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0030 | Gestational Trophoblast Ds. High Risk | Etoposide-Methotrexate-Actinomycin / Cyclophosphamide -Vincristine (EMA-CO)-max 6 cycles (Per cycle) | 10000 | Y | Beta - HCG report | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0031 | Gestational Trophoblast Ds. Low Risk | Actinomycin- max 10 cycles (Per cycle) | 1000 | Y | Beta - HCG report | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0032 | Gestational Trophoblast Ds. Low Risk | Weekly Methotrexate (Per week) max. 10 cycles | 1000 | Y | Beta - HCG report | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0033 | Ovary Germ Cell Tumour | Bleomycin-Etoposide-Cisplatin (BEP) - max cycles 4 (Per cycle) | 6000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0034 | Prostate | Hormonal Therapy - Per month | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0035 | Testis | Bleomycin-Etoposide-Cisplatin (BEP)- max cycles 4 (Per cycle) | BEP regimen for germ cell tumour 10000/per cyclex4 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0036 | Acute Myeloid Leukemia | Induction Phase, up to | Daunomycin and cytosine arabinoside (3:7) 100,000 | Y | Hematology | Chemotherapy drug batch number with bar code |
N | M | |
| Bone Marrow Aspiration Report | ||||||||||
| M5 | 0037 | Acute Myeloid Leukemia | Consolidation Phase, up to | High dose cytosine arabinoside 75000 x 3-4 cycles | Y | Hematology | Chemotherapy drug batch number with bar code |
N | M | |
| Bone Marrow Aspiration Report | ||||||||||
| M5 | 0038 | Histocytosis | Variable Regimen-Histocyosis-max 1 year (Per month) | 8000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0039 | Rhabdomyosarcoma | Vincristine-Actinomycin-Cyclophosphamide (VACTC) based chemo - max 1 year (Per month) - Rhabdomyosarcoma | 6000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0040 | Ewing’s Sarcoma | Variable Regimen Inv - Hematology, Biopsy – Payable | 6000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0041 | Unlisted Regimen | Palliative CT- Max 6 cycles (Per cycle) | 5000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0042 | Terminally Ill | Palliative And Supportive Therapy - Per month | 3000 | Y | N | M | |||
| M5 | 0043 | Acute Lymphatic Leukemia | Maintenance Phase - Per month | 5000 per month x 24 | Y | Hematology | Chemotherapy drug batch number with bar code |
N | M | |
| Bone Marrow Aspiration Report | ||||||||||
| M5 | 0044 | Acute Lymphatic Leukemia | Induction | 50000 | Y | Hematology | Chemotherapy drug batch number with bar code |
N | M | |
| Bone Marrow Aspiration Report | ||||||||||
| M5 | 0045 | Acute Lymphatic Leukemia | Consolidation Phase | 50000 | Y | Hematology | Chemotherapy drug batch number with bar code |
N | M | |
| Bone Marrow Aspiration Report | ||||||||||
| M5 | 0046 | Head and Neck | Tab Geftinib/Erlotinib-Max 1 Year (Per month) | 3000 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0047 | Renal cell carcinoma | Sunitinib/ Pazopanib (per day) | 2500 | Y | Biopsy | Chemotherapy drug batch number with bar code |
N | M | |
| CT | ||||||||||
| M5 | 0048 | chronic myeloid leukemia | Imatinib | 6000/per month x 5 years | Y | Chemotherapy drug batch number with bar code |
N | M | ||
| M5 | 0049 | Gall Bladder Cancer | Gemcitabine + cisplatin | 10,000 per cycle for 6 cycle | Y | Chemotherapy drug batch number with bar code |
N | M | ||