| 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) |
| M3 | 0001 | Basic neonatal care package (maximum 2500): Babies that can be managed by side of mother in postnatal ward without requiring admission in SNCU/NICU: • Any newborn needing feeding support • Babies requiring closer monitoring or short-term care for conditions like: o Birth asphyxia (need for positive pressure ventilation; no HIE) o Moderate jaundice requiring phototherapy o Large for dates (>97 percentile) Babies o Small for gestational age (less than 3rd centile) |
Rs.500 per day | N | Blood sugar | clinical notes | Less than 5 days | N | M |
| Blood group | |||||||||
| Complete blood count | |||||||||
| Coombs test | |||||||||
| others as requires | |||||||||
| M3 | 0002 | Special Neonatal Care Package (maximum of 18000 - pre-auth after 4 days): Babies that required admission to SNCU or NICU: Babies admitted for short term care for conditions like: • Mild Respiratory Distress/tachypnea • Mild encephalopathy • Severe jaundice requiring intensive phototherapy • Haemorrhagic disease of newborn • Unwell baby requiring monitoring • Some dehydration • Hypoglycaemia Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate |
Rs.3000 per day | Y (after 4 days) | Blood sugar Complete Blood Picture Blood group Bilirubin Coombs Test Chest X ray CRP Micro ESR Blood Culture Electrolytes Renal function tests Coagulation profile Others as required |
clinical notes | less than 7 days | N | M |
| M3 | 0003 | Intensive Neonatal Care Package (maximum Rs: 50,000 – pre-auth is needed after 5 days) Babies with birthweight 1500-1799 g or Babies of any birthweight and at least one of the following conditions: • Need for mechanical ventilation for less than 24 hours or non-invasive respiratory support (CPAP, HFFNC) • Sepsis / pneumonia without complications • Hyperbilirubinemia requiring exchange transfusion • Seizures • Major congenital malformations (pre-surgical stabilization, not requiring ventilation) • Cholestasis significant enough requiring work up and in-hospital management • Congestive heart failure or shock Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate |
Rs.5000 per day | Y ( after 5 days) | Blood sugar Complete Blood Counts Blood group Bilirubin Coombs Test Chest X ray Blood Gas CRP Micro ESR Blood Culture CSF Studies Electrolytes Renal function tests Liver Function tests Serum Calcium Serum Magnesium USG abdomen USG Cranium Echocardiogram EEG MRI Brain Coagulation profile Others as required Screening |
clinical notes | 7 to 14 days | N | M |
| M3 | 0004 | Advanced Neonatal Care Package (maximum of Rs. 75,000 – pre-auth is needed after 7 days): Babies with birthweight of 1200-1499 g or Babies of any birthweight with at least one of the following conditions: • Any condition requiring invasive ventilation longer than 24 hours • Hypoxic Ischemic encephalopathy requiring Therapeutic Hypothermia • Cardiac rhythm disorders needing intervention (the cost of cardiac surgery or implant will be covered under cardiac surgery packages) • Sepsis with complications such as meningitis or bone and joint infection, DIC or shock • Renal failure requiring dialysis • Inborn errors of metabolism Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate |
Rs.6000 per day | Y ( after 5 days) | Blood sugar Complete Blood Counts Blood group Bilirubin Coombs Test Chest X ray Other X-rays Blood Gas CRP Micro ESR Blood Culture CSF studies Other Body Fluid Cultures Electrolytes Renal function tests Liver Function tests Serum Calcium Serum Magnesium USG abdomen USG Cranium Echocardiogram EEG ECG MRI Brain Coagulation profile Metabolic Screen Others as required Screening |
clinical notes | 14 to 21 days | N | M |
| M3 | 0005 | Critical Care Neonatal Package (maximum of Rs. 1,20,000 – pre-auth after 10 days): Babies with birthweight of <1200 g or Babies of any birthweight with at least one of the following conditions: • Severe Respiratory Failure requiring High Frequency Ventilation or inhaled Nitric Oxide (iNO) • Multisystem failure requiring multiple organ support including mechanical ventilation and multiple inotropes • Critical congenital heart disease Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in the package rate |
Rs.7000 per day | Y | Blood sugar Complete Blood Counts Blood group Bilirubin Coombs Test Chest X ray Other X-rays Blood Gas CRP Micro ESR Blood Culture CSF studies Other Body Fluid Cultures Electrolytes Renal function tests Liver Function tests Serum Calcium Serum Magnesium USG abdomen USG Cranium Echocardiogram EEG ECG MRI Brain Coagulation profile Metabolic Screen Others as required Screening |
clinical notes | 21 to 42 days | N | M |
| M3 | 0006 | Chronic Care Package (maximum of Rs. 30,000): If the baby requires stay beyond the upper limit of usual stay in Package no 4 or 5 for conditions like severe BPD requiring respiratory support, severe NEC requiring prolonged TPN support | Rs.3000 per day | Y | clinical notes | clinical notes | N | M | |
| M3 | 0007 | High Risk Newborn Post Discharge Care Package (Protocol Driven) | 2400 | Y | clinical notes | clinical notes | N | M | |
| M3 | 0008 | Laser Therapy for Retinopathy of Prematurity (Irrespective of no. of eyes affected) | 1500 per session | Y | N | S | |||
| M3 | 0009 | Advanced Surgery for Retinopathy of Prematurity | 15000 | Y | N | S | |||
| M3 | 0010 | Ventriculoperitoneal Shunt Surgery (VP) or Omaya Reservoir or External Drainage for Hydrocephalus | 5000 | Y | N | S |