Specialty code |
Package Code |
Package name |
Package Amount |
Preauth Required or Not (Y/N) |
Pre-auth documents |
Post-Op documents |
Average length of Stay (Including Days in intensive care units) |
Govt Reserved Procedure (Y/N) |
Medical (M) or Surgical (S) |
M6 |
0001 |
Cobalt 60 External Beam Radiotherapy (Radical/Adjuvant / Neoadjuvant) |
20,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0002 |
Cobalt 60 External Beam Radiotherapy (Palliative) |
10,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0003 |
Linear Accelerator External Beam Radiotherapy (Palliative) |
20,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0004 |
Linear Accelerator, External Beam Radiotherapy 3D CRT/2D Planning (Radical/Adjuvant/ Neoadjuvant) |
50,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0005 |
Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) (Radical/Adjuvant/Neoadjuvant) |
75,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0006 |
Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) (Radical/Adjuvant/Neoadjuvent) |
120,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0007 |
SRT(Stereotactic radiotherapy) |
70,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0008 |
SRS (Streotactic radiosurgery) |
70,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0009 |
Respiratory Gating along with Linear Accelerator planning |
70,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0010 |
Electron beam with Linear accelerator (Radical) |
50,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0011 |
Tomotherapy(Radical/Adjuvant/Neoadjuvant) |
75,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0012 |
Brachytherapy High Dose Radiation (Intracavitory) - per fraction, maximum of 4 sessions |
4,500 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0013 |
Brachytherapy High Dose Radiation (Interstitial) - for one application, multiple dose |
30,000 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|
M6 |
0014 |
Brachytherapy High Dose Radiation (Intraluminal) - per fraction, maximum 4 sessions |
4,500 |
Y |
Blood test |
Data of RT treatment plan & dose |
|
N |
M |
CT |
|
Biopsy |
|