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) |
S5 |
0001 |
AC joint reconstruction/ Stabilization/ Acromionplasty (Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis) |
25,000 |
Y |
X rays of affected limb |
X rays of affected limb |
4 |
N |
S |
MRI of shoulder |
S5 |
0002 |
Accessory bone – Excision (limbs) – congenital, Accessory digits sometime can be removed |
3,000 |
Y |
X rays of affected limb |
X rays of affected limb |
S |
N |
S |
|
S5 |
0003 |
Amputation - Below Elbow |
10,000 |
N |
|
|
5 |
N |
S |
S5 |
0004 |
Amputation - Above Elbow |
10,000 |
N |
|
|
5 |
N |
S |
S5 |
0005 |
Amputation – one or more fingers |
3,000 |
N |
|
|
1 |
N |
S |
S5 |
0006 |
Amputation – Wrist |
10,000 |
N |
|
|
4 |
N |
S |
S5 |
0007 |
Amputation - one or more toes/ digits |
3,000 |
N |
|
|
1 |
N |
S |
S5 |
0008 |
Amputation – Below Knee |
15,000 |
N |
|
|
5 |
N |
S |
S5 |
0009 |
Amputation – Above Knee |
18,000 |
N |
|
|
5 |
N |
S |
S5 |
0010 |
Foot & Hand Amputation (whole/ partial) |
10,000 |
N |
|
|
5 |
N |
S |
S5 |
0011 |
Disarticulation (hind & for quarter) |
25,000 |
N |
|
Clinical report |
10-15 days of hospital stay |
N |
S |
|
radiological investigations |
S5 |
0012 |
Anterior Spine Fixation |
35,000 |
N |
|
Clinical report |
6 |
N |
S |
|
radiological investigations |
S5 |
0013 |
Posterior Spine Fixation |
25,000 |
N |
|
Clinical report |
5 |
N |
S |
|
radiological investigations |
S5 |
0014 |
Osteochondroma excision/ Excision of Exostosis |
10,000 |
Y |
Clinical report |
Clinical report |
4 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0015 |
Excision Arthoplasty |
15,000 |
Y |
Clinical report |
Clinical report |
4 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0016 |
Arthorotomy of any joint |
10,000 |
N |
|
Clinical report, Radiological Investigations |
7-10 days hospital stay for iv antibiotics |
N |
S |
S5 |
0017 |
Arthrodesis Ankle Triple |
15,000 |
Y |
Clinical report |
radiological investigations |
6 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0019 |
Bimalleolar Fracture Fixation |
15,000 |
N |
|
|
6 |
N |
S |
S5 |
0020 |
Bone Tumour Excision + reconstruction using implant (malignant/ benign) |
70,000 |
Y |
Clinical report |
Clinical report |
4 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0021 |
Bone Tumour (malignant/ benign) curettage and bone grafting |
20,000 |
Y |
Clinical report |
Clinical report |
|
N |
S |
radiological investigations |
radiological investigations |
S5 |
0022 |
Bone Tumour Excision (malignant/ benign) + Joint replacement (depending upon type of joint and implant) |
1,50,000 |
Y |
Clinical report |
Clinical report |
|
N |
S |
radiological investigations |
radiological investigations |
S5 |
0023 |
Clavicle fracture management - conservative (daycare) |
1,000 |
N |
|
|
D |
N |
S |
S5 |
0024 |
Closed reduction - Hand Bones |
3,000 |
N |
|
|
3 |
N |
S |
S5 |
0025 |
Close reduction - Foot Bones |
3,000 |
N |
|
|
2 |
N |
S |
S5 |
0026 |
Close Reduction - Small Joints |
3,000 |
N |
|
|
1 |
N |
S |
S5 |
0027 |
Interlock Nailing + Bone Grafting – femur/tibia |
19,000 |
N |
|
|
5 |
N |
S |
S5 |
0028 |
Closed Interlocking Intermedullary- tibia/femur |
17,500 |
N |
|
|
5 |
N |
S |
S5 |
0030 |
Closed Reduction and Internal Fixation with K wire |
6,000 |
N |
|
|
5 |
N |
S |
S5 |
0031 |
Closed Reduction and Percutaneous Screw Fixation (neck femur) |
15,000 |
N |
|
|
5 |
N |
S |
S5 |
0034 |
Closed Reduction of the Hip (including hip Spika) |
7,000 |
N |
|
|
2 |
N |
S |
S5 |
0035 |
Debridement & Closure of Major injuries - contused lacerated wounds (anti-biotic + dressing) - minimum of 3 sessions |
7,000 |
N |
|
|
2 |
N |
S |
S5 |
0036 |
Debridement & Closure of Minor injuries |
1,000 |
N |
|
|
2 |
N |
S |
S5 |
0037 |
Closed reduction of dislocation (Knee) |
4,000 |
N |
|
|
D |
N |
S |
S5 |
0038 |
Closed reduction of dislocation (Shoulder/ Elbow) |
3,000 |
N |
|
|
D |
N |
S |
S5 |
0039 |
Duputryen’s Contracture release + rehabilitation |
10,000 |
N |
|
|
5 |
N |
S |
S5 |
0040 |
Ulnar nerve Repair |
10,000 |
N |
|
|
4 |
N |
S |
S5 |
0041 |
External fixation - Long bone |
15,000 |
N |
|
|
4 |
N |
S |
S5 |
0042 |
External fixation - Small bone |
10,000 |
N |
|
|
2 |
N |
S |
S5 |
0043 |
External fixation - Pelvis |
15,000 |
N |
|
|
5 |
N |
S |
S5 |
0044 |
Fasciotomy |
7,000 |
N |
|
|
2 |
N |
S |
S5 |
0045 |
Fixator with Joint Arthrolysis |
20,000 |
N |
|
|
7 |
N |
S |
S5 |
0046 |
Fracture - Acetabulum Open Reduction Internal Fixation |
30,000 |
N |
|
|
7 |
N |
S |
S5 |
0047 |
Fracture - Fibula Internal Fixation |
8,000 |
N |
|
|
4 |
N |
S |
S5 |
0048 |
Fracture - Hip Internal Fixation (Intertrochanteric Fracture with implant) + rehabilitation |
17,000 |
N |
|
|
7 |
N |
S |
S5 |
0049 |
Fracture - Humerus Internal Fixation |
17,000 |
N |
|
|
7 |
N |
S |
S5 |
0050 |
Fracture - Olecranon of Ulna |
8,000 |
N |
|
|
2 |
N |
S |
S5 |
0051 |
Fracture - Radius Internal Fixation with plate |
10,000 |
N |
|
|
2 |
N |
S |
S5 |
0052 |
Fracture - TIBIA Internal Fixation with plating |
17,000 |
N |
|
|
4 |
N |
S |
S5 |
0053 |
Fracture - Ulna Internal Fixation |
8,000 |
N |
|
|
4 |
N |
S |
S5 |
0054 |
Head Radius – Excision |
8,000 |
N |
|
|
3 |
N |
S |
S5 |
0055 |
High Tibial Osteotomy |
17,000 |
N |
|
|
5 |
N |
S |
S5 |
0057 |
Internal Fixation Lateral Epicondyle |
10,000 |
N |
|
|
4 |
N |
S |
S5 |
0058 |
Internal Fixation of other Small Bones (metatarsals) |
10,000 |
N |
|
|
3 |
N |
S |
S5 |
0059 |
Limb Lengthening |
25,000 |
N |
|
|
10 |
N |
S |
S5 |
0060 |
Llizarov Fixation |
15,000 |
N |
|
|
6 |
N |
S |
S5 |
0061 |
Multiple Tendon Repair |
20,000 |
Y |
Clinical report |
Clinical Photographs Showing scar |
5 |
N |
S |
electro-diagnostic studies |
|
S5 |
0062 |
Nerve Repair Surgery |
15,000 |
Y |
Clinical |
Clinical Photographs Showing scar |
6 |
N |
S |
electro-diagnostic studies |
electro-diagnostic studies |
S5 |
0063 |
Nerve Transposition/Release/ Neurolysis |
8,000 |
Y |
electro-diagnostic studies |
|
6 |
N |
S |
S5 |
0064 |
Open Reduction Internal Fixation (Fracture both bone forearm) |
10,000 |
N |
|
|
3 |
N |
S |
S5 |
0065 |
Open Reduction Internal Fixation (Large Bone) |
20,000 |
N |
|
|
6 |
N |
S |
S5 |
0066 |
Open Reduction of CDH |
30,000 |
N |
|
|
7 |
N |
S |
S5 |
0067 |
Open Reduction of Small Joint |
15,000 |
N |
|
|
1 |
N |
S |
S5 |
0068 |
Open Reduction with bone grafting of nonunion |
20,000 |
N |
|
|
3 |
N |
S |
S5 |
0069 |
Osteotomy -Small Bone |
10,000 |
N |
|
|
5 |
N |
S |
S5 |
0070 |
Osteotomy -Long Bone |
17,000 |
N |
|
|
7 |
N |
S |
S5 |
0071 |
Patellectomy |
8,000 |
N |
|
|
7 |
N |
S |
S5 |
0072 |
Pelvic Osteotomy with fixation with plaster |
30,000 |
N |
|
|
10 |
N |
S |
S5 |
0074 |
Excision of Bursa |
2,000 |
N |
|
|
2 |
N |
S |
S5 |
0075 |
Reconstruction of ACL/PCL with implant and brace |
30,000 |
Y |
Clinical report |
Clinical report |
3 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0076 |
Sequestrectomy of Long Bones + anti-biotics + dressing |
15,000 |
N |
|
|
7 |
N |
S |
S5 |
0077 |
Tendo Achilles Tenotomy |
2,000 |
N |
|
|
2 |
N |
S |
S5 |
0078 |
Tendon Grafting |
15,000 |
N |
|
|
2 |
N |
S |
S5 |
0079 |
Tendon Release/ Tenotomy |
2,000 |
N |
|
|
2 |
N |
S |
S5 |
0080 |
Tenolysis |
3,000 |
N |
|
|
2 |
N |
S |
S5 |
0081 |
Tension Band Wiring Patella |
10,000 |
N |
|
|
3 |
N |
S |
S5 |
0082 |
Application of P.O.P. casts for Upper & Lower Limbs |
3,000 |
N |
|
|
D |
N |
S |
S5 |
0083 |
Application of P.O.P. Spikas& Jackets |
3,500 |
N |
|
|
D |
N |
S |
S5 |
0084 |
Application of Skeletal Tractions with pin |
3,000 |
N |
|
|
D |
N |
S |
S5 |
0085 |
Application of Skin Traction |
1,000 |
N |
|
|
D |
N |
S |
S5 |
0086 |
Head radius - Excision + Fracture - Ulna Internal Fixation |
15,000 |
N |
|
|
3 |
N |
S |
S5 |
0087 |
External fixation - both bones of forearms |
15,000 |
N |
|
|
5 |
N |
S |
S5 |
0088 |
Fracture intercondylarHumerus + olecranon osteotomy |
25,000 |
N |
|
|
5 |
N |
S |
S5 |
0089 |
Correction of club foot per cast |
3,000 |
N |
|
|
D |
N |
S |
S5 |
0090 |
Arthroscopic Meniscus Repair/ Meniscectomy |
20,000 |
Y |
Clinical report |
Clinical |
3 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0091 |
Total Hip Replacement (cemented) |
75,000 |
Y |
Clinical report |
Clinical |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0092 |
Total Hip Replacement (cementless) |
90,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0093 |
Total Hip Replacement (hybrid) |
75,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0094 |
Bipolar Hemiarthroplasty (hip & shoulder) |
40,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0095 |
Unipolar Hemiarthroplasty |
30,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0097 |
Elbow replacement |
40,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0098 |
Arthrodesis of shoulder |
40,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0099 |
Arthrodesis of Knee (with implant) |
40,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0100 |
Arthrodesis of Wrist (with implant) |
30,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0101 |
Arthrodesis of Ankle (with implant) |
30,000 |
Y |
Clinical report |
Clinical report |
7 |
N |
S |
radiological investigations |
radiological investigations |
S5 |
0102 |
Arthrotomy+ synevectomy |
15000 |
|
|
|
|
N |
S |
S5 |
0103 |
Calcaneal Supr- Excision |
2000 |
|
|
|
|
N |
S |
S5 |
0104 |
Clavicle surgery |
15000 |
|
|
|
|
N |
S |
S5 |
0108 |
Decompresion of carpal Tunnel syndrome |
4500 |
|
|
|
|
N |
S |
S5 |
0111 |
Drainage of absces cold |
1250 |
|
|
|
|
N |
S |
S5 |
0112 |
Epiphyseal stimulation |
10000 |
|
|
|
|
N |
S |
S5 |
0115 |
Fractured fragment excision |
7500 |
|
|
|
|
N |
S |
S5 |
0119 |
Laminectomy/Discectomy |
18000 |
|
|
|
|
N |
S |
S5 |
0122 |
Sinus over sacrum excision |
7500 |
|
|
|
|
N |
S |
S5 |
0126 |
Synovial cyst -excision |
7500 |
|
|
|
|
N |
S |
S5 |
0128 |
Trigger thumb |
2500 |
|
|
|
|
N |
S |
S5 |
0129 |
Application of functional cast brace |
1200 |
|
|
|
|
N |
S |
S5 |
0131 |
Aspiration & intra articular injections |
1000 |
|
|
|
|
N |
S |
S5 |
0132 |
Bandage &Stapping for fractures |
600 |
|
|
|
|
N |
S |
S5 |
0133 |
internal wire fixation of mandible &Maxilla |
9500 |
|
|
|
|
N |
S |
S5 |
0134 |
Reducation of compound fractures |
4000 |
|
|
|
|
N |
S |
S5 |
0135 |
Rducation of facial fractures of maxilla |
8500 |
|
|
|
|
N |
S |
S5 |
0136 |
Reducation of fractures of mandible & maxilla -cast netal splints |
5500 |
|
|
|
|
N |
S |
S5 |
0137 |
Reducation of fractures of mandible & maxilla -eye let splinting |
5500 |
|
|
|
|
N |
S |
S5 |
0138 |
Reducation of fractures of mandible & maxilla -gumming splints |
5500 |
|
|
|
|
N |
S |
S5 |
0139 |
Fistulectomy +Sequestrectomy |
14500 |
|
|
|
|
N |
S |
S5 |
0142 |
Above elbow post -slab for sogt tisue injury |
550 |
|
|
|
|
N |
S |
S5 |
0143 |
Below knee post -slab for sogt tisue injury |
750 |
|
|
|
|
N |
S |
S5 |
0144 |
Colles fracture ant.pr post,slab |
750 |
|
|
|
|
N |
S |
S5 |
0145 |
Colles fracture Below elbow |
950 |
|
|
|
|
N |
S |
S5 |
0146 |
Colles fracture full plaster |
1700 |
|
|
|
|
N |
S |
S5 |
0147 |
Fingers (post, slab) |
250 |
|
|
|
|
N |
S |
S5 |
0148 |
Fingers full plaster |
300 |
|
|
|
|
N |
S |
S5 |
0149 |
Minerva Jacket |
1500 |
|
|
|
|
N |
S |
S5 |
0150 |
Plaster jacket |
1500 |
|
|
|
|
N |
S |
S5 |
0152 |
Strapping Ankle |
300 |
|
|
|
|
N |
S |
S5 |
0153 |
Strapping Ball Bandage |
450 |
|
|
|
|
N |
S |
S5 |
0154 |
Strapping Chest |
450 |
|
|
|
|
N |
S |
S5 |
0155 |
Strapping colar anf cuff sling |
300 |
|
|
|
|
N |
S |
S5 |
0156 |
strapping elbow |
300 |
|
|
|
|
N |
S |
S5 |
0157 |
straping figure of 8 bandage |
450 |
|
|
|
|
N |
S |
S5 |
0158 |
strapping finger |
200 |
|
|
|
|
N |
S |
S5 |
0159 |
strapping knee |
350 |
|
|
|
|
N |
S |
S5 |
0160 |
Strapping nasal bone fracture |
400 |
|
|
|
|
N |
S |
S5 |
0161 |
strapping shoulder |
250 |
|
|
|
|
N |
S |
S5 |
0162 |
strapping toes |
150 |
|
|
|
|
N |
S |
S5 |
0163 |
strapping wrist |
300 |
|
|
|
|
N |
S |
S5 |
0164 |
Tube plaster(or plster cylinder) |
1050 |
|
|
|
|
N |
S |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|