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) |
S4 |
0001 |
Hysterectomy ± Salpingo-oophorectomy |
20,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0002 |
Abdominal Myomectomy |
16,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0003 |
Surgeries for Prolapse - Sling Surgeries |
16,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0004 |
Surgeries for Stress Incontinence 'Burch' |
35,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0005 |
Hysterotomes - 2nd Trimester abortions |
5,000 |
Y |
Ultrasound |
|
D |
|
S |
S4 |
0006 |
Incisional Hernia Repair |
15,000 |
Y |
Clinical Picture |
|
3 |
|
S |
S4 |
0007 |
Radical Hysterectomy (Wertheims) |
25,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0008 |
Laparotomy and proceed for Ovarian Cancers. Omentomy with Bilateral Salpingo-oophorectomy |
25,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0009 |
Non descent vaginal hysterectomy |
14,000 |
Y |
Ultrasound |
|
4 |
|
S |
S4 |
0010 |
Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy |
16,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0011 |
Vaginal surgical repair for vesico-vaginal fistula |
20,000 |
Y |
Cystography |
|
5 |
|
S |
S4 |
0012 |
Sacrocolpopexy |
16,000 |
Y |
Ultrasound |
|
7 |
|
S |
S4 |
0013 |
Repair for rectovaginal fitulas |
10,000 |
Y |
Ultrasound |
|
3 |
|
S |
S4 |
0014 |
Vaginoplasty |
10,000 |
Y |
|
|
3 |
|
S |
S4 |
0015 |
LLETZ |
3000 |
Y |
Clinical Picture |
|
3 |
|
S |
S4 |
0016 |
Colpotomy |
1,200 |
N |
|
|
D |
|
S |
S4 |
0017 |
Dilation and Evacuation (D&E) |
1,000 |
N |
|
|
D |
|
S |
S4 |
0018 |
Cervical biopsy and Polypectomy |
3,000 |
N |
|
|
D |
|
S |
S4 |
0019 |
Bartholins Cyst Enucleation/ Incision drainage |
3,000 |
N |
|
|
D |
|
S |
S4 |
0020 |
Vulvectomy simple |
15,000 |
Y |
CT Scan |
|
3 |
|
S |
S4 |
0021 |
Radical Vulvectomy |
20,000 |
Y |
CT Scan |
|
3 |
|
S |
S4 |
0022 |
Diagnostic laparoscopy |
4,000 |
N |
Ultrasound |
|
3 |
|
S |
S4 |
0023 |
Laparoscopic hysterectomy (TLH) |
20,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0024 |
Laparoscopic myomectomy |
15,000 |
Y |
Ultrasound |
|
3 |
|
S |
S4 |
0025 |
Laparoscopic cystectomy |
15,000 |
Y |
Ultrasound |
|
5 |
|
S |
S4 |
0026 |
Laparoscopic ovarotomy |
10,000 |
Y |
Ultrasound |
|
3 |
|
S |
S4 |
0027 |
Laparoscopic adhesiolysis |
6,000 |
Y |
Ultrasound |
|
1 |
|
S |
S4 |
0028 |
Laparoscopic tubal surgeries - salpingectomy, salpingotomy |
11,000 |
Y |
Ultrasound |
|
3 |
|
S |
S4 |
0029 |
Drag hysteroscopy |
6,000 |
Y |
Ultrasound |
|
1 |
|
S |
S4 |
0030 |
Hysteroscopic myomectomies |
6,000 |
Y |
Ultrasound |
|
1 |
|
S |
S4 |
0031 |
Hysteroscopic adhesiolysis |
6,000 |
Y |
Ultrasound |
|
1 |
|
S |
S4 |
0032 |
Hysteroscopic polypectomy |
3,000 |
Y |
Ultrasound |
|
2 |
|
S |
S4 |
0033 |
Hysteroscopic IUCD removal |
3,000 |
Y |
Ultrasound |
|
1 |
|
S |
S4 |
0034 |
Caesarian Delivery |
6,500 |
N |
|
|
5 |
|
S |
S4 |
0035 |
Caesarian hysterectomy |
20,000 |
N |
|
|
5 |
|
S |
S4 |
0036 |
High risk delivery: Pre-mature delivery |
9,000 |
N |
|
|
3 |
|
|
S4 |
0037 |
High risk delivery: Expected Gestation at delivery less than 35 weeks |
9,000 |
N |
|
|
3 |
|
|
S4 |
0038 |
High risk delivery: Mothers with eclampsia or imminent eclampsia |
9,000 |
N |
|
|
3 |
|
|
S4 |
0039 |
High risk delivery: Obstructed labour |
9,000 |
N |
|
|
3 |
|
|
S4 |
0040 |
High risk delivery: Major Fetal malformation requiring intervention immediately after birth |
9,000 |
N |
|
|
3 |
|
|
S4 |
0041 |
High risk delivery: Mothers with severe anaemia (<7 g/dL) |
9,000 |
N |
|
|
3 |
|
|
S4 |
0042 |
High risk delivery: Other maternal and fetal conditions as per guidelines-Such as Rh haemolytic disease, uncontrolled diabetes, severe growth retardation etc that qualify for high risk delivery etc. |
9,000 |
N |
|
|
3 |
|
|
S4 |
0043 |
Manual removal of placenta |
5,000 |
N |
|
|
2 |
|
S |
S4 |
0044 |
Laparotomy for ruptured ectopic |
10,000 |
N |
|
|
5 |
|
S |
S4 |
0045 |
MTP > 12 weeks |
6,500 |
N |
|
|
1 |
|
S |
S4 |
0046 |
MTP upto 12 weeks |
5,000 |
N |
|
|
1 |
|
S |
S4 |
0047 |
MTP upto 8 weeks |
3,500 |
N |
|
|
1 |
|
S |
S4 |
0048 |
McDonald's stitch |
4,000 |
N |
|
|
D |
|
S |
S4 |
0049 |
Shirodkar's stitch |
4,000 |
N |
|
|
D |
|
S |
S4 |
0050 |
Tuboplasty |
10,000 |
N |
|
|
5 |
|
S |
S4 |
0051 |
Laparotomy for broad ligament haematoma |
16,000 |
Y |
Ultrasound |
|
3 |
|
S |
S4 |
0052 |
Trans-vaginal tape/ Trans-obturator tape |
5,000 |
Y |
Ultrasound |
|
D |
|
S |
S4 |
0053 |
Abdominal Perineal neo construction Cx + Uteria + Vagina |
20,000 |
Y |
CT Scan |
|
|
|
S |
S4 |
0054 |
Ablation of Endometriotic Spot + Adhenolysis |
10,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0055 |
Ablation of Endometriotic Spot +Salpingostomy |
10,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0056 |
Adhenolysis + Hernia - Ventral - Lipectomy/Incision |
16,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0057 |
Adhenolysis+ Ovarian Cystectomy |
10,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0058 |
Adhenolysis+ Salpingostomy |
10,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0059 |
Broad Ligment Haemotoma drainage |
10,000 |
Y |
Ultrasound |
|
|
|
S |
S4 |
0060 |
Brust abdomen repair |
14,000 |
N |
|
|
|
|
S |
S4 |
0061 |
Cone Biopsy Cervix |
1,000 |
N |
|
|
|
|
S |
S4 |
0062 |
Conventional Tubectomy |
1,000 |
N |
|
|
|
|
S |
S4 |
0063 |
Cyst -Vaginal Enucleation |
1,000 |
N |
|
|
|
|
S |
S4 |
0064 |
Cyst-Labial |
1,000 |
N |
|
|
|
|
S |
S4 |
0065 |
Cystocele - Anterior repair |
1,000 |
N |
|
|
|
|
S |
S4 |
0066 |
Cystocele - Anterior Repair + Perineal Tear Repair |
13,000 |
Y |
Cystography |
|
|
|
S |
S4 |
0067 |
D&C (Dilatation &curretage) + Electro Cauterisation Cryo Surgery |
1,500 |
N |
|
|
|
|
S |
S4 |
0068 |
D&C (Dilatation&curretage) |
1,000 |
N |
|
|
|
|
S |
S4 |
0069 |
Diagnostic laparoscopy & hysteroscopy for infertility |
5,000 |
N |
|
|
|
|
S |
S4 |
0070 |
Electro Cauterisation Cryo Surgery |
1,500 |
N |
|
|
|
|
S |
S4 |
0071 |
Exploration of abdominal haematoma (after laparotomy + LSCS) |
14,000 |
N |
|
|
|
|
S |
S4 |
0072 |
Fractional Curretage |
1,000 |
N |
|
|
|
|
S |
S4 |
0073 |
Gaping Perineal wound secondary suturing/ episiotomy |
2,500 |
N |
|
|
|
|
S |
S4 |
0074 |
HaematoColpo/Excision - Vaginal Septum |
5,000 |
N |
|
|
|
|
S |
S4 |
0075 |
Hymenectomy& Repair of Hymen |
1,000 |
N |
|
|
|
|
S |
S4 |
0076 |
Amniocentesis |
5,000 |
Y |
Clinical investigations |
|
D |
|
S |
S4 |
0077 |
Chorionic villus sampling |
5,000 |
Y |
Clinical investigations |
|
D |
|
S |
S4 |
0078 |
Cordocentesis |
5,000 |
Y |
Clinical investigations |
|
D |
|
S |
S4 |
0079 |
Intrauterine transfusions |
10,000 |
Y |
Clinical investigations |
|
D |
|
S |