AEGON Religare Health Plan Insured Guide Book

Index
Particulars 1. Insured Guide Book

Page Nos.

Health is Wealth Health Guide

Page 1 Page 2 Page 3 Page 5 Page 10

2. Customer Information Sheet 3. Black Listed Hospitals 4. Surgery List

Health is wealth
Health is the most important asset you have. Every aspect of your life is dependent on your good health. When you work hard to meet your aspirations, sometimes you tend to forget about your health. Modern day stress, eating habits, sedate life style and family conditions all cause serious damage to your health. You should always be careful about your health. Take simple and effective steps to ensure your wellness.

Healthy Lifestyles
Here we are highlighting the importance of healthy lifestyles, and the ways to follow them, for you to have a healthy heart and to live long

Eat Healthy Eating healthy diet is important, as diet modifications prevent heart disease.

Avoid Junk foods- Pizza, Burger, Chips will increase your calories and risk for hypertension, obesity and heart disease Avoid Aerated drinks- Pepsi, Coca cola etc Avoid SMOKING and ALCOHOL Eat lots of Fruits and Vegetables Eat FIBRE RICH diet Eat 3 times a day Breakfast is essential The last meal [Dinner] has to be taken 3 hours before going to bed Eat Fruits as part of your meals but after an hour from the main course Avoid more Sweets and Chocolates Drink atleast 1.5 to 2 litres of water everyday Take the Stairs instead of the Escalator Walking for at least 30 min a day helps to regulate your Blood Circulation and general health Do exercise, eat less and eat right- Basic steps to lead a healthy life

Deep breathing, Meditation, Yoga & Music: Breathing Exercises

It is an easy stress reliever It oxygenates the blood- which wakes up the brain, relaxes muscles & calms the mind You can do them anywhere, and they work quickly so you can de-stress in a flash

Music

It is one of the most relaxing and spiritually boosting factors in life Soft or classical music is relaxing When dealing with stress, the right music can lower your BP, relax your body and calm your Mind Music therapy has shown numerous health benefits for people with conditions ranging from mild [like stress] to severe [like cancer]

Smile

SOUNDS simple- many people tend to miss it and frown instead It takes 17 muscles to smile and 41 muscles to frown Smile is contagious Smile relieves stress; it increases your life span Eat healthy diet Exercise regularly Get enough sleep- 7 hours a day Think Positive, do Yoga, Meditation Have massages Be soft and polite De-stress to avoid distress

Take care of your body

Have a hearty laugh to keep your heart healthy.

Health Guide
Availing of the Services
Visit any hospital of your choice, either in the network hospitals or outside the network. If you opt for a network hospital you get the benefit of Cashless Services while in case of a non-network hospital, you have to settle the bills and claim reimbursement.

Claim Procedures
1. Hospitalisation in Network Hospitals (Definition explained later in this booklet) - Cashless

Emergency
Step 1 Get admitted into the hospital by producing your Health ID card & photo ID to the hospital. (Refer to the list of photo IDs accepted by TPA below). Step 2 Inform the TPA within 24 hours of hospitalisation but prior to discharge. Step 3 A) In case of a very short stay at the hospital or if the authorisation for Cashless Service was not received from the TPA or if Cashless Service was denied by the TPA ; You need to:

Planned
Please coordinate with your doctor and the hospital and send in all the details of your planned hospitalisation. This includes the plan of treatment, cost estimates, photocopy of Health ID card & photo ID (Refer to the list of photo IDs accepted by TPA below). Also mention the address or fax number where the authorisation is to be sent along with the mobile no. to receive updates on your claims and authorisations. This should be sent to the TPA at least seven days prior to the admission A) If authorisation for Cashless Service from the TPA has been received by you

Settle the hospital bills in full and collect all the bills, documents, reports and Payment Receipt; and Lodge your claim with the TPA for processing and reimbursement OR

At the time of admission, hand in the authorisation letter and a photocopy of your Health ID card and a photo ID to the hospital. At the time of discharge: a) Verify the bills and sign on all the bills b) Pay for bill amount exceeding (if any) the product benefit amount paid by us. c) Leave a copy of discharge summary and other investigations reports with the hospital. d) Sign the Claim Form.

B) If authorisation for Cashless Service from the TPA has been received at the time of discharge

Verify the bills and sign on all the bills and the authorisation letter. Pay for bill amount exceeding the product benefit amount paid by us. Leave a copy of the discharge summary and other investigations reports with the hospital. Sign the Claim Form.

B)

In case Cashless Service was denied by the TPA; You need to :

Settle the hospital bills in full and collect all the bills, documents, reports and Payment Receipt. Lodge your claim with our TPA for processing and reimbursement.

2. Hospitalisation in Non-Network Hospitals (Definition explained later in this guide) - Reimbursement

Emergency
Step 1 Get admitted into the hospital. Step 2 Inform TPA within 24 hours of hospitalisation Step 3 At the time of discharge, settle the hospital bills in full and collect all the bills, documents, reports and Payment Receipt. Step 4 Lodge your claim with the TPA for processing and reimbursement along with a photocopy of your Health ID card & Photo ID (Refer to the list of photo IDs accepted by TPA below).

Planned
Step 1 Inform TPA about the planned hospitalisation atleast 48 hours prior to the admission Step 2 Get admitted into the hospital. Step 3 At the time of discharge, settle the hospital bills in full and collect all the bills, documents, reports and Payment Receipt Step 4 Lodge your claim with the TPA for processing and reimbursement along with a photocopy of your Health ID card & Photo ID (Refer to the list of photo IDs accepted by TPA below).

Lodging a claim for processing and reimbursement Within 21 days after discharge, please lodge your claim with the TPA for processing your claim. Send the filled and signed Claim Form. You can download the Claim Form from our or TPAs website www.paramounttpa.com/aegonreligare. When lodging your claim with the TPA, please make sure that all the documents listed below are submitted. The following documents are required for processing of the claim for different kinds of expenses. Check list of documents for submission of claims 1. Claim form duly filled in bearing the signature of the Policyholder & attested by the hospital wherever requested 2. Copy of the AEGON Religare Health ID card or Current Policy Copy 3. Copy of photo ID proof. (Refer to the list of Photo IDs accepted by TPA below) 4. Attested Photocopies (from treating hospital) of Discharge Card / Summary 5. 7. Attested Photocopies (from treating hospital) of the Hospital final Bill with detailed break up of charges Medico Legal Certificate (MLC) in accidental case 6. If Package Treatment, break up of details of Package bill 8. Copies of all investigations done with the respective bills & reports 9. Copies of all bills for medicines supported by relevant prescriptions

Note : TPA or the Company reserves the right to demand any other document(s), information from the Policy Holder
List of documents accepted for Photo ID:

Voters ID card Passport ID issued by Employer / College / School

PAN card Driving License Debit/ Credit Photo card

Key Definitions
Cashless Service With our cashless service, you dont have to pay hospitalisation expenses or the hospital bills at the end of treatment / discharge except for expenses insured beyond the limit of the plan and/or beyond the T&C of the policy. This facility is available only at the network hospitals. To avail the Cashless Service you need to get an authorisation from the TPA. The network hospital will coordinate the authorisation for cashless services with the TPA on your behalf.

The authorisation along with a copy of the Health ID card issued by AEGON Religare Life Insurance & Photo ID (Refer to the list of Photo IDs accepted by TPA ) has to be given to the network hospital at the time of admission. The cashless access at the network hospital is merely a facility extended to the insured and does not guarantee the availability, quality and outcome of the treatment. Choosing of a network or a nonnetwork hospital is the prerogative of the patient / insured. Note: Cashless Service/ Authorisation is subject to Policy Holder complying all the requirements for availing such service. The TPA may deny cashless authorisation.

Third Party Administrator (TPA) TPA shall mean a Third Party Administrator who is licensed by the Insurance Regulatory and Development Authority (IRDA) and is engaged, for a fee or remuneration with an insurance company, for administration of health insurance policies.

Network Hospitals Network providers are hospitals and nursing homes who have contracted with our TPA to provide cashless service for inpatient treatment, for ailments, diseases and medical conditions covered under the AEGON Religare Health Plan, to all those who are insured. The list of our network hospitals is provided in a booklet along with the policy document. Please note that the TPA adds or deletes network hospitals regularly; hence to get the most recent list of network hospitals, please call the TPA toll free line at 1800-22-6655 or log on to their website http://www.paramounttpa.com/AegonReligare

Cashless Authorisation It means a written approval by the TPA for a cashless service to the network provider for the covered expenses. Intimation A communication by the Policy Holder or his/her representatives to the TPA appointed by AEGON Religare Life Insurance for a prospective claim or treatment mentioning the details of treatment, estimated costs, place of treatment, date and duration of treatment. Reimbursement Claim For all types of claims where the Policy Holder has paid for treatments especially at non-network hospitals and has not availed the cashless service at the network hospital, the Policy Holder can claim for reimbursement of the eligible expenses up to the limit of the plan and within the terms and conditions of the policy. In case of planned hospitalisation, the policyholder is required to intimate the TPA 48 hours prior to the hospitalisation. In case of emergency hospitalisation, intimation has to be within 24 hours of such hospitalisation. Please Note: The TPA will authorise Cashless Service but it may be denied in the following circumstances e.g. In case of any ambiguity in the coverage of the present ailment with respect to the policy terms and conditions based on the documents / information sent to the TPA or AEGON Religare Life Insurance.

Any false, manipulated or forged documents and information presented to the TPA. The ailment / condition etc. not being covered under the Health plan. The insured amount not being sufficient to cover the hospitalisation expenses. If the request for preauthorisation is not received by the TPA in time. If the information / documents sent to the TPA is insufficient to confirm coverage.

Denial of Cashless Service is not denial of treatment. The Policy Holder can continue with the treatment, pay for the services to the hospital, and later send the claim to the TPA for processing and reimbursement. It will be processed and reimbursed as per Terms and Conditions of the Policy.

We appreciate your trust in choosing AEGON Religare Health Plan as your Health Insurance provider. We wish good health to you and your family.

Third Party Administrator (TPA) contact details

Toll - free Number Help Line Number Website Email id Address 1800 22 6655 (Serviced 24 hours, 7 days a week for MTNL, BSNL, & TATA users across India, also
for Vodafone & Airtel users in Mumbai & Delhi )

022 - 66620 808 (Serviced 24 Hours, 7 days a week for all users) www.paramounttpa.com/aegonreligare contact.phs@paramounttpa.com Paramount Health Services Pvt. Ltd. Elite Auto House, A-54, 1st Floor, M. Vasanji Road, Off Andheri - Kurla Road, Chakala, Andheri (East), Mumbai - 400 093

Customer information sheet

The information mentioned below is illustrative and not exhaustive. Information must be read in conjunction with the product brochures and policy document. In case of any conflict between the Key Features Document and the policy document the terms and conditions mentioned in the policy document shall prevail.

Title What am I covered for

Description a. Daily Hospitalisation Cash Benefit - Provides for a lumpsum benefit for hospitalisation for a period greater than 24 hrs b. Intensive Care Unit Benefit - Provides for a lumpsum benefit for hospitalisation in an Intensive Care Unit for a period greater than 8 hrs c. Surgical Cash Benefit - Provides for a lumpsum benefit as per the plan and grade for surgeries listed in the health guide d. Day-Care procedures-Medical Expenses for the listed Day care procedures which do not require 24 hours hospitalisation e. Critical Illness Benefit (if applicable) - Provides for lumpsum benefit if the Insured suffers from any of the Critical Illnesses specified in the Policy Document

Refer to Policy Clause Number 3.1 3.2 3.3 3.4 3.5

What are the major exclusions in the policy

Following is a partial list of the policy exclusions. Please refer to the policy 6.0 wording for the complete list of exclusions.Any claim occurring as a result of Pre-existing Conditions or their resultant complications unless stated in the proposal form and specifically accepted by Usand recorded in the Policy Schedule, AIDS, HIV related complications or any sexually transmitted diseases, attempted suicide or self inflicted injury, irrespective of the mental condition, hazardous sports or activities including but not limited to bungee jumping, mountaineering etc. Any flying activity other than as a bonafide passenger, alcohol, drugs or any substance not prescribed by a Medical Practitioner, war, riots, civil commotion, strikes, civil war or service in the military or paramilitary forces of a country at war, criminal, unlawful or illegal activity participation, exposure to radioactive or nuclear fuel, diagnosis or treatment taken outside India, psychiatric or mental illness, circumcision or any cosmetic procedure or plastic surgery, pregnancy, childbirth or any complications arising therefrom, abortion, medical termination of pregnancy, infertility or sex change operation, organ donation (donor costs), rehabilitation or convalescent care or admission in hospital beyond necessary length of stay, any non-allopathic treatment, purely investigative procedure not resulting in any treatment or unreasonable failure to seek medical advice, congenital conditions, genetic disorders or birth defects unless specifically covered. a. 90 days for all illnesses (except accident) b. 2 years for specific surgeries 5.2 3.1 3.2

Waiting Period Minimum

a. 24 hours to claim Daily Cash Benefit hospitalizaton b. 8 hours to claim Intensive Care Unit Benefit period

Title Payout basis No Claim Benefit

Description Cashless or Reimbursement of covered expenses upto specified limits. If no claim in respect of an Insured has been made under the Policy during a Policy Year, the benefits under Clauses 3.1, 3.2 and 3.3 for that Insured will be increased by 10% of the amount specified in the Benefit Table for the next Policy Year provided that the maximum increase for any Insured shall not exceed 50% of the initial amount specified in the Benefit Table. If no claim in respect of an Insured has been made under the Policy during a Policy Year, then the Annual Limit and the Lifetime Limit will increase by 10%, provided that the maximum increase for any Insured shall not exceed 50% of the Annual Limit or Lifetime Limit respectively. a. 24 hours in case of Emergency Hospitalisation b. 48 hours in case of Planned Hospitalisation Note: Intimation is mandatory for both cashless and reimbursement claims. Intimation can be made to the TPA through any of the modes mentioned under Third Party Administrator (TPA) contact details

Refer to Policy Clause Number 5.3

Hospitalisation Intimation to TPA

List of Surgeries
Sr No. Procedure Name Grade Day Care Surgeries Laparotomy for grading Lymphoma with Splenectomy/ Liver/Lymph Node Biopsy 2 3 4 5 6 7 8 Major Repair/Removal to treat multiple ruptures in the abdominal cavity Resection of Recurrent Intra-Abdominal Tumour Simple Repair of Ruptured Viscus in the Abdominal Cavity Drainage with/without Laparotomy of Retro-Peritoneum Abscess Removal of Retro-Peritoneum Tumour Therapeutic Laparoscopy with Laser Adenoidectomy Corrective Surgery with Osteotomy Alone to treat deformity in bones of upper limb 4 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 4 4 5 X X X 4 4 4 X X X X X X 4 X X 4 Waiting Period

Abdomen
1 X

Adenoids Arm
9

Axilla
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Wedge Excision with Drainage to treat Axillary Hyperhidrosis 5 Kelly's Operation to treat Stress Incontinence Catheterisation of Bladder Major graft (multiple) to treat blood vessel defect Large artery repair with grafting Repair of small artery injury Ligation for various leisions of artery Reapair of major artery damaged due to trauma Endarterectomy to treat thrombosis in arteries other than those in extremity Excision of large arterio-venous fistula arterio venous fistula Embolectomy to treat embolism in artery Arterial anastomosis to treat trauma/resection of artery
1

Bladder/Kidney
4 5 2 3 3 3 3 3 3

Blood vessels

Endarterectomy to treat thrombosis in arteries of extremity 3 Excision and insertion of graft to treat aortic arch anueurysm 3

Dissection and Repair with Restoration of Continuity to treat 3 3 3

Sr No. 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X X X

Blood vessels
Microvascular graft to treat resection of vein Bypass/graft to treat various lesions in artery Transluminal Arterioplasty to treat various lesions in artery 3 3 3 X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Ligation to treat aneurysm/arterio-venous fistula in carotid artery 3 Carotid endarterectomy to treat atherosclerosis in carotid artery 3 Pulmonary Embolism, Pulmonary Embolectomy using Cardiopulmonary Bypass to treat pulmonary embolism Repair of damage in major vein due to trauma Repair (multiple) of small artery injury Microvascular Repair of lesions in artery of distal extremity/digit Endarterectomy to treat thrombosis in femoral & iliac artery 4 Excision of Small Arterio-venous Fistula Arterial Patch Graft to repair gap in artery Ligation and stripping of veins for varicosity Excision of Carotid Body Tumour Endarterectomy to treat carotid artery thrombosis Transantral Ligation of maxillary artery Multiple Repair of Injury to Small Vein Single Repair of Injury to Small Vein Dissection and Ligation of Arterio-venous Fistula Bypass/Graft for various lesions in Vein Saphenous to Femoral Cross-leg Bypass Graft for Vein Sub-fascial Ligation of Multiple Perforators to treat Varicosity Plication/Ligation to treat various lesions of Inferior Vena Cava Biopsy ofTemporal Artery for Various Lesions External Arterio-venous Shunt Periarterial Sympathectomy to treat Ischaemia/Peripheral Vascular Disease Endarterectomy to treat thrombosis in femoral artery Large vessels repair with autogenour vein grafting
2

3 3 4 4

4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 4 4 2

Arterio-venous Fistula Creation to treat various lesions in artery 4

Bilateral Stripping/Excision/Multiple Ligations to treat Varicosity 4

Blood vessels-Gastro-intestinal tract

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X

Bone
55 56 57 58 59 Wide/Major resection and reconstruction surgery to treat malignant bone tumour Open Reduction and Internal Fixation to treat Fracture/ Dislocation of Clavicle/Scapula Closed reduction of fracture, sub-luxation or epiphyseolysis 4 Marrow Harvesting for Various Lesions Excision of Bursirtis Surgery to treat arachnoid cyst in brain and spine Chemopallidectomy/Other Stereotactic Procedure to treat various lesions of the brain 63 64 65 66 Craniectomy and Drainage for the treatment of intracranial abscess Drainage via Burr-hole for the treatment of intracranial abscess 4 Excision of Intracranial Abscess Biopsy/Drainage via Burr-hole of Intracranial Tumor/ Intracranial Cyst 4 4 X X X 4 X 5 5 3 3 X X X X 4 X 1 X

Bone-joints related Brain

60 61 62 Excision of Acoustic Tumour/Cerebello-Pontine Angle Tumour 3

Brain-blood vessels
67 68 Clipping of Aneurysm/Arterio-Venous Malformation in brain 3 Clipping/ Reinforcement of Sac of Aneurysm/ArterioVenous Malformation in Brain 3 X X X X

Breast
69 70 71 72 73 74 75 Excision of single breast lump Excision of multiple/bilateral breast lumps Lumpectomy/Segmental Mastectomy with Axillary Lymph Node Clearance for malignant breast tumour Simple Mastectomy for malignant breast tumour Simple Mastectomy with Axillary Sampling for malignant breast tumour Incision of breast abscess 5 X 4 4 X X X X 4 4 4 X X X X X X X

Lumpectomy/Segmental Mastectomy for malignant breast tumour 4

Sr No. 76 77 78

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X Y

Breast
Modified Radical Mastectomy/Simple Mastectomy with Axillary Clearance to treat malignant breast tumour Radical Mastectomy to treat malignant breast tumour 3 X 3 X

Cervix / Uterus-related
Curettage with Colposcopy/Biopsy/Diathermy/Cryosurgery/ 5 Laser Therapy of Cervix for Various Lesions of Uterus

Chest
79 Thoracotomy with Pulmonary Decortication to treat various 3 lesions in the thorax X X

Ear
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 Intact Wall Mastoidectomy with removal of Koerners septum, to view the middle ear structures Stapedectomy to treat various lesions in middle ear Total Amputation, Microvascular Reconstruction of Ear Fenestration Operation to treat various lesions in ear Myringoplasty (post-aura/endaural approach) to treat various lesions in Ear Myringoplasty (simple) to treat various lesions in Ear to treat various lesions in Ear Transmastoid Decompression to treat various lesions of endolymphatic sac Labyrinthotomy to treat destruction of Labyrinth Segmental Resection with Bone Graft to treat various lesions of Mandible Cortical Mastoidectomy to treat various lesions of Mastoid Mastoidectomy (radical/modified) to treat various lesions of Mastoid Mastoidectomy (radical/modified) with Myringoplasty to treat various lesions of Mastoid Revision Mastoidectomy to treat various lesions of Mastoid 4 X X 4 X X 4 4 X X X X 4 4 X X X X 4 X X 4 X X X Ossicular Chain Reconstruction with/without Myringoplasty 4 4 4 4 4 X X X X X X X X X X 4 X X

Total Amputation, Staged Reconstruction (each stage) of Ear 4 Meatoplasty with Split Skin Graft to treat various lesions in Ear 4

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X

Ear
96 97 Round Window Repair to treat Perforation of Tympanic Membrane 4 Reconstruction of external auditory canal Canaloplasty of external auditory meatus Construction [reconstruction] of external meatus of ear: osseous portion skin-lined portion (with skin graft) 98 99 101 102 103 104 105 106 107 Exploration and Tympanotomy Insertion of Tube for Drainage (including Myringotomy) Partial Amputation and Reconstruction of Ear Excision of Preauricular Sinus Tympanoplasty Excision of Bony Fragment in Elbow Fracture Tennis Elbow Release Biopsy/Excision of various lesions in adrenal Excision of various lesions in Parathyroid Exenteration/Flap Reconstruction to treat orbit tumour Reconstruction including Orbital Shift and Soft Tissue (craniofacial approach) to treat various lesions of orbit 110 111 112 113 114 115 Corneal Transplantation with cataract extraction and intraocular lens implantation Repair of Perforating Wound in Eye (with incarceration/ prolapse of uveal tissue/lens/vitreous) Enucleation with Insertion of Implant to treat various lesions in the eye Correction of Eyelid Ptosis by Levator Palpebrae Superioris 4 Resection (bilateral) Correction of Eyelid Ptosis by Fascia Lata Graft (bilateral) Reconstruction using Full Thickness Flap to treat various lesions of eyelid 4 4 X X X 4 X X 4 X X 4 5 5 5 5 5 5 5 5 4 4 3 3 X X X X X X X X X X X X X X X X X X X 5 X

100 Removal of Keratosis Obturans

Elbow

Endocrine

Eye
108 109

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X

Eye
116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 Simple Vitrectomy (pars plana) Vitrectomy (pars plana/Removal of silicone oil) Vitrectomy (pars plana/sclerotomy/ lensectomy/endolaser) Vitrectomy (pars plana/sclerotomy/ silicone oil/giant tears) Irrigation of Anterior Chamber to treat Hyphaema Vitreous Removal from Anterior Chamber Anterior chamber Paracentesis to treat glaucoma Diathermy/Cryotherapy to treat retinal tear. Laser Photocoagulation to treat Ratinal Tear Excision of Periorbital Dermoid Excision of Tumour in Iris Needling to treat cataract Cataract Extraction with Intra-ocular Lens Implant Cataract Extraction with Intra-ocular Lens Implant and Trabeculectomy Cataract Extraction with Trabeculectomy Anterior Orbitotomy Bilateral Decompression of Orbit Unilateral Decompression of Orbit Exenteration of Orbit Lateral Orbitotomy to treat various lesions of orbit. Reconstruction of Floor/Roof of Orbit with Silastic Repair of Complex Retinal Detachment Resection/Buckling Operation/Revision Operation with Single Plomb to treat Retinal Detachment Removal of Limbic Tumour in Conjunctiva Removal of Pinguecula in Conjunctiva Removal of Pterygium with conjunctival graft Epikeratophakia Operation Conjunctival Peritomy/Repair by Conjunctival Flap to treat Corneal Laceration Transplantation (superficial/lamellar/full thickness) for Cornea 5 Corneal Transplantation (superficial/lamellar/full thickness) 5
6

4 4 4 4 5 5 5 5 5 5 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5

X X X X X X X X X X X X X X X

Conjunctival Graft over Cornea to treat Corneal Laceration 5

147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171

Unilateral Retractor Recessions to treat Exophthalmos due to Thyrotoxicosis, Cyclodiathermy/Cyclocryotherapy to treat Glaucoma Filtering and Allied Operations to treat Glaucoma Goniotomy/Trabeculotomy to treat Glaucoma Removal of Intraocular Foreign Body from Anterior Segment of Eye Removal of Intraocular Foreign Body from Posterior Segment of Eye Repair of Perforating Wound in eye not involving intraocular structures Enucleation of Eye without Implant Evisceration of Eye Laser Trabeculoplasty Resuturing of wound following Intraocular procedures Correction (unilateral - one lid) of Ectropion/Entropion (complicated), Correction (unilateral - two lids) - Ectropion/Entropion (complicated)

5 5 5 5 5 5 5 5 5 5 5 5 5

X X

X X X X X X X X X X X X X X X X X X X X X X X X X

Correction (unilateral - one lid) - Ectropion/Entropion (simple) 5 Correction (unilateral - two lids) - Ectropion/Entropion (simple) 5 Correction (bilateral)- Ectropion/Entropion Repair of Full Thickness Laceration of Eyelids Bilateral Fasanella Correction of Ptosis Unilateral Fasanella Correction of Ptosis Unilateral Correction of Levator Palpebrae Superioris Resection to treat Ptosis Unilateral Correction of Ptosis with Fascia Lata Graft Cryotherapy to treat Trichiasis Excision and Repair with Full Thickness Skin Grafting for Tumour in Eyelids Excision and Repair with Local Flap for Tumour of Eyelids Blepharoplasty (combined upper and lower) for various lesions of the eyelid
7

5 5 5 5 5 5 5 5 5 5

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period

Eye
172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 Blepharoplasty (lower/upper) for various lesions of the eyelid Composite Graft (chondro-cutaneous/ chondro-mucosal) for various lesions of Eyelids Full Thickness Wedge Resection with Repair for various lesions of Eyelids Whole Thickness Reconstruction (other than direct suture only) for various lesions of Eyelids Laser Iridotomy Surgical Iridectomy/Iridotomy Immediate Repair of Various Lesions in Lacrimal Gland (Canaliculus) Excision of Various Lesions in Lacrimal Gland (Lacrimal Sac) 5 Snip Operation for various lesions of Lacrimal Gland (Punctum) 5 Dacryocystorhinostomy for various lesions of Lacrimal Gland 5 Dacryocystorhinostomy with Lester Jones Tube for various 5 lesions of Lacrimal Gland Extraction of Lens for Various Lesions Removal of Intra-ocular Artificial Lens Secondary Insertion of Intra-ocular Lens Enucleation/Removal of Tumour/Foreign Body in Orbit Full Thickness Repair of Laceration in Skin and Subcutaneous Tissue (ear/nose/eyelid) 5 5 5 5 5 X X X X X X X 5 5 5 X X X 5 X X 5 X X 5 5 X X X

Eyes/ Ears / Nose

Face
188 189 190 191 192 193 Osteotomy to treat Lefort III fracture of Maxilla Reduction and fixation to treat Lefort III fracture of Maxilla Reduction and fixation using craniofacial approach to treat Lefort III fracture of Maxilla Open Reduction and Internal Fixation for fracture in facial bones (more than 2) Major Drainage and Sequestrectomy for infection/ osteomyelitis in facial bones Simple Drainage and Sequestrectomy for infection/ osteomyelitis in facial bones
8

3 3 3 4 4 4

X X X X X X

X X X X X X

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X

Face
194 195 196 197 198 199 201 Excision of large intraosseous tumour in facial bones Excision of small intraosseous tumour in facial bones Excision of Small Soft Tissue Tumors in Head-Face Complex Osteotomy/Ostectomy to treat various lesions of Mandible (excluding alveolar margins) Osteotomy including Segmental Osteotomy with/without Grafting to treat various lesions of Mandible and Maxilla Condylectomy to treat Condylar Lesions in Mandible Closed Reduction and Fixation of Fracture of Mandible 4 4 4 4 X X X X X X X X X X X X X X X X X 200 Condylotomy to treat Condylar Lesions in Mandible 202 Open Reduction and Fixation of Fracture of Mandible Mandible 204 Coronoidectomy to treat various lesions of Mandible 205 Mandibular Ramus/Body Ostectomy/Osteotomy with Segmental Osteotomy to treat various lesions of Mandible 206 Mandibular Ramus/Body Ostectomy/Osteotomy without Segmental Osteotomy to treat various lesions of Mandible 207 Reconstruction with Bone Graft to treat various lesions of Mandible 4 208 Segmental Ostectomy/Osteotomy (one segment only) to treat various lesions of Mandible 209 Complex Ostectomy/Osteotomy to treat various lesions in Maxilla (excluding alveolar margins) and/or Zygoma 210 211 212 213 214 215 Bone Graft and Closure of Naso Buccal Fistula to treat Bilateral Complete Alveolar Cleft in Maxilla Bone Graft to treat Bilateral Incomplete Alveolar Cleft in Maxilla 4 Osteotomy to treat Lefort I Fracture in Maxilla 4 Reduction and Fixation of Complex Lefort II Fracture of Maxilla 4 Closed Reduction and Fixation of Lefort II Fracture of Maxilla 4 Osteotomy to treat Lefort II Fracture in Maxilla 4 4 4 4 4 4 4 4 X 4 4 4 4 X X X X

203 Alveoloplasty with Epithelial Graft to treat various lesions of 4

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X

Eye
216 217 218 219 Ostectomy/Osteotomy (more than one segment) to treat various lesions in Maxilla Resection/Hemimaxillectomy to treat various lesions in Maxilla Segmental Ostectomy/Osteotomy (one segment only) to treat various lesions of Maxilla Composite Grafting (chondro-cutaneous/ chondro-mucosal) to treat various lesions of Nose 220 Parotidectomy to treat Parotid Tumour 221 222 223 224 225 226 227 228 229 Total Parotidectomy with Parapharyngeal Space Resection and Flap Reconstruction to treat Parotid Tumour Ostectomy/Articular Eminectomy/ Augmentation to treat Fracture of Zygoma Elevation of Zygomatic Fracture Caldwell Luc procedure Enucleation to treat Odontogenic Cyst (Smaller than 10 mm) in Mandible Marsupialization to treat Odontogenic Cyst in Mandible Enucleation to treat Odontogenic Cyst (Larger than 20 mm) in Mandible Removal of Plates and Wires under General Anaesthesia in old fractures of mandible 230 Complex Genioplasty (not as a combined procedure) 231 232 233 234 235 236 237 238 Insertion of Transmandibular Implant/ Subperiosteal Implant Simple Genioplasty (not as a combined procedure) Closed Reduction and Fixation to treat Farcture of Maxilla 5 5 5 5 X X X X X X X 5 5 5 X 4 5 5 X 4 X 4 4 X X 4 X 4 4 X X 4 X

Enucleation to treat Odontogenic Cyst (11-20mm) in Mandible 5

Closed Reduction and Fixation to treat Lefort I Farcture of Maxilla 5 Pharyngotomy (lateral) with excision of tongue and reconstruction to treat lesion in mouth Partial pharyngectomy and radical neck dissection with flap Pharyngotomy (lateral) with excision of tongue and reconstruction to treat lesion in pharynx Glossectomy with radical neck dissection
10

Face & neck

2 2 2 2

Sr No. 239

Procedure Name

Grade

Day Care Surgeries

Waiting Period X

Face & neck

Total Parotidectomy with Preservation/ Reconstruction Facial Nerve/Radical Neck Dissection to treat parotid tumour 240 Suprahyoid Pharyngotomy to treat oropharyngeal and hypopharyngeal tumours 241 242 243 Lateral Pharyngotomy with Excision of Tongue Small Excision of Neurofibromatosis of Face and Neck Radical excision of intra oral tumour with resection of mandible and lymph nodes 4 5 5 2 X X X X X X X 3 X

Fallopian tube/female-reproductive system related

244 Salpingotomy 5 3 3 4 4 4 4 4 4 4 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Female genitals
245 Repair/Vaginal Vault Suspension (abdominal) to treat vaginal enterocele 246 Radical Vulvectomy to treat malignant condition nof vulva 247 248 Repair of Vaginal fistula, complicated Complete Vaginectomy for Malignant Condition

249 Partial Vaginectomy for Malignant Condition 250 Colpotomy and Drainage to treat Pelvic Abscess 251 252 253 254 255 256 257 258 259 Colporrhaphy with Amputation of Cervix (Manchester) for Vaginal Prolapse Colporrhaphy with Repair of Pelvic Floor for Vaginal Prolapse Vaginal Obliteration to treat Vagina Prolapse of Vulva Simple Vulvectomy without using Laser to treat Malignant Condition of Vulva Simple Repair of Fistula in Vagina Removal of Simple Tumour/Gartner's Cyst in Vagina Excision of Bartholin Cyst using Laser Excision of Bartholin Cyst without use of Laser

Simple Vulvectomy using Laser to treat Malignant Condition 4 4 5 5 5 5 5 3 4

11

260 Evacuation of Complicated Vulvar Haematoma

Female reproductive system

261 262 Extended Hysterectomy to treat uterine malignancy Laparoscopic Ovarian Cystectomy

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period

Female reproductive system

263 264 265 266 267 268 269 271 272 273 274 275 Salpingo-Oophorectomy via Laparotomy Replantation of multiple fingers Replantation of single finger Replantation/Transplantation of single finger Free pulp transfer to restore pulp loss in finger Synovectomy with Soft Tissue Reconstruction for various lesions in finger Microsurgical Reconstruction of Thumb Trigger finger release (multiple) Trigger finger release (single) Microvascular Repair of various lesions in veins of distal extremity/digit. Reconstruction of Deformity/Defect in Nail Bed Multiple Repair of Laceration in Nail Bed Triple Arthrodesis of foot Wound debridement in complex crush Injuries of foot Reconstruction Surgery for Hallux Valgus/Hammer Toes Floating Osteotomy for Various Lesions of Foot Arthrodesis of toe due to various lesions Debridement with Repair/Reconstruction of Complex Injuries in the Foot 5 4 4 X X X 5 5 4 5 5 5 5 5 X X X X X X X X X X X X X 4 4 4 4 4 X X X X X X X X 270 Pollicisation of thumb 4 4 4 4 4 4 X X X X X X X X X X X

Finger

Foot
276 277 278 279 281 282

280 Amputation of multiple toes due to various lesions

Gall Bladder
283 284 Cholecystectomy Cholecystectomy and Choledocho-Jejunostomy/ Duodenostomy/Gastrostomy/Exploration Common Bile Duct

Gall Bladder/ Gastro-intestine related

Gastrointestinal tract
285 286 287 288 289 Right Hemicolectomy for appendix tumour Surgical Reduction of volvulus Radical Operation with Resection to treat Ano-Rectal Prolapse 3 4 4 X X X X X X X X Laparotomy including Colostomy/Enterostomy/Gastrostomy 4

Radical Operation without Resection to treat Ano-Rectal Prolapse 4

12

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X

Gastrointestinal tract
290 Fistulectomy & Colostomy to treat Fistula-in-ano (high) 291 292 293 294 295 296 297 298 299 301 302 303 305 Hemorrhoidectomy Laser Excision of Hemorrhoids Appendicectomy with/without Drainage Choledocho-Duodenostomy/ Choledocho-Gastrostomy to treat various lesions in bile duct Hepatico-Jejunostomy to treat various lesions in bile duct Choledochotomy (Exploration Common Bile Duct only) Closure of colostomy Resection and reanastomosis of colon Bypass operation to treat trauma in duodenum Pancreatico-Duodenectomy to treat tumour in duodenum Partial Gastrectomy to treat duodenal ulcer Gastroenterostomy/Gastroduodenostomy to treat various lesions in duodenum 306 Esophagoscopy with insertion of prosthesis 307 Esophagoscopy, gastroscopy, duodenoscopy with injection of esophageal/gastric varices 308 Esophagoscopy, gastroscopy, duodenoscopy with polypectomy/ 4 removal of foreign body/diathermy of bleeding lesions 309 Bypass with Stomach/Intestine to treat tumour in esophagus 310 311 312 313 314 315 316 317 Laser Fulguration to treat tumour in esophagus Total Esophagectomy to treat tumour in esophagus Esophageal/Transection with Splenectomy to treat esophageal varices Gastro-Esophageal Devascularisation with Esophageal Transection to treat esophageal varices Transgastric Ligation to treat esophageal varices Closure of Enterostomy Laparotomy and Reduction of Intussusception
13

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

X X X X X X X X X X X X X X X X X X X X

Choledocho-Jejunostomy to treat various lesions in bile duct 4

300 Colectomy for various lesions of colon

304 Vagotomy (all types) to treat duodenal ulcer

4 4 4 4 4 4 4 4

Cervical Esophagostomy to treat various lesions of esophagus 4

Sr No. 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 341 342 343 344 345 346 347 348

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Gastrointestinal tract
Reduction of Intussusception by Fluid Resection of Intussusception Hartmann's Procedure to treat Various Lesions of Rectum Ileostomy Revision due to Stenosis Resection of various lesions in the small bowel. Revision Gastrectomy to manage Post-Gastrectomy Complications Pyloroplasty to treat Pyloric Stenosis Gastrojejunostomy to treat Tumour/Ulcer of Stomach Endoscopic Laser Coagulation to treat Stomach Ulcer Vagotomy - all types Partial/Subtotal Gastrectomy Total/Proximal Gastrectomy with/ without Splenectomy Wedge Resection for various lesions in Stomach Excision/Lateral Sphincterotomy to treat Anal Fissure Excision/Fistulectomy to treat Fistula-in-ano (low/high) Cryosurgery to treat Hemorrhoids Removal of External Anal Tags to treat Hemorrhoids Saucerisation/Drainage of Perineal Abscess Repair of Anus Stricture Fibreoptic Colonoscopy with removal of polyps Esophagoscopy with dilatation 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 X X X X X X X X X 4 4 4 4 4 4 X X X X X X X

Entero-enterostomy due to various lesions in the small bowel 4

340 Dilatation of Stricture in Esophagus

Gastrointestinal Endoscopy (GI)/Laser Treatment for tumours 5 Laser Vaporisation/Endoscopic Fulguration of Rectal Tumour 5 Transphincteric Removal of various lesions in rectum of the Gastric Cardia Repair of Rectocele Abdomino perineal resection to treat anal tumour Abdominal-Perineal Pull Through Resection with Colo-Anal Anastomosis to treat various lesions of rectum Incision of a pilonidal sinus
14

Endoscopic YAG Laser Surgery/Vaporisation to treat Tumour 5 5 3 3 5

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period

Genital Organs
349 350 351 352 353 354 355 356 357 358 359 Repair of scrotum and tunica vaginalis Microsurgical Vasoepididymostomy Radical Excision of malignant tumour in bones of upper limb Radical excision of soft tissue tumour of upper limb Toe to Hand Transfer in amputation of digits of hand Grafting/Interfascicular Repair/ Neurovascular Transfer to treat upper limb nerve defect Composite Tissue Transplant to treat major defects in upper limb 3 Major Replantation to treat major trauma in upper limb bone in upper limb Corrective Surgery to treat bony deformity in upper limb Osteotomies with Plate Fixation and Fluoroscopy to treat bony deformity in upper limb 360 Extensive Curettage/Debridement to treat Osteomyelitis/ Septic Arthritis in upper limb 361 362 363 364 365 366 367 368 369 370 371 Major Excision of benign bone tumour in Upper Limb Wide excision of malignant bone tumour in Upper Limb Vascularised Bone Transfer to treat various lesions in bones of upper limb Free Vascularised Bone Graft to treat various lesions in bones 4 of upper limb Reconstruction surgery for delayed union or non-union of fracture of carpus Open Reduction and Internal Fixation of Fracture/Dislocation 4 of Carpus Open Reduction and Internal Fixation of Fracture/Dislocation 4 of elbow Arthrotomy to treat septic arthritis/effusion of elbow Hemiarthroplasty to treat various lesions of elbow Open Reduction and Fixation (single) of Closed Fracture/ Dislocation of Hand
15

5 5 1 1 3 3

X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X

Hand

Implantation of Bone Stimulator to treat defect/ non union of 4 4 4 4 4 4 4

4 4 4

Synovectomy with Reconstruction for various lesions of elbow 4

Sr No. 372 373 374 375 376 377 378 379

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X

Hand
Microsurgical Repair/Reconstruction of Complex Injuries in Hand 4 Major Reconstructive Procedures for Deformities in Hand Osteotomy to correct deformity in hand Intrinsic Muscle Release/Transfer/Extensor Relocation to treat deformity in hand Insertion of Silastic Rod(s) to treat Flexor Tendon Injuries in hand 4 Open Reduction and Internal Fixation (multiple) to treat Fractures/Dislocation in Hand Excision with Dissection of Neurovascular Bundle of Tumours in Hand Open Reduction and Internal Fixation of Fracture/Dislocation 4 of Humerus 380 Open Reduction and Internal Fixation of Intercondylar Fracture of Humerus 381 382 383 384 385 386 387 388 389 Bilateral Release Surgery with Endoneurolysis to treat Carpal Tunnel Syndrome. Unilateral Release Surgery with Endoneurolysis to treat Carpal Tunnel Syndrome. Grafting to treat nerve defect in upper limb Bilateral Decompression of Nerve Entrapment Syndrome in Upper Limb Unilateral Decompression of Nerve Entrapment Syndrome in 4 Upper Limb Decompression with Nerve Transposition/Endoneurolysis to treat Nerve Entrapment Syndrome in Upper Limb Multiple Microsurgical Repair of Major Nerver Injury in Upper Limb 4 Excision of Head of Radius Reconstruction of Delayed/Non-union of Radius and Ulna of Radius and Ulna 391 392 Minor Release of Various Soft Tissue Lesions in Lower Limb Wide excision of malignant soft tissue tumour in upper limb 4 4 X X 4 4 X X X X 4 X X 4 4 X X 4 X 4 X 4 X X 4 X 4 X X 4 4 4 X X X X

390 Open Reduction and Internal Fixation of Fracture/Dislocation 4

16

Sr No. 393 394 395 396 397 398 399

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X

Hand
Single tendon transfer to treat various lesions in the tendons of upper limb Tenolysis to treat adhesion in Extensor-Tendon of Upper Limb (Multiple) Tenolysis to treat adhesion in Extensor-Tendon of Upper Limb (Single) Multiple Repair of Extensor-Tendon Injury in Upper Limb Single Repair of Disruption of Flexor Tendon in Lower Limb Tenolysis to treat adhesion in Flexor-Tendon of Upper Limb (Multiple) 400 Tenolysis to treat adhesion in Flexor-Tendon of Upper Limb (Single) 401 Multiple grafting to treat defect of Flexor Tendon in Upper Limb 4 4 4 4 4 4 X X X X X X X X X X X X X X X X 402 Single grafting to treat defect of Flexor Tendon in Upper Limb 4 403 Multiple Repair of Injury of Flexor Tendon in Upper Limb 404 Single Repair of Injury of Flexor Tendon in Upper Limb 405 Tendon Graft to treat Injury of Flexor Tendon in Upper Limb 407 Manipulation and Reduction to treat Fracture/Dislocation of Upper Limb 408 Fasciotomy to treat Upper Limb Ischaemia Upper Limb 410 411 412 413 414 415 416 417 Amputation - Upper Limb Composite Tissue Transfer - Upper Limb Forequarter Amputation - Upper Limb Free Muscle Transfer - Upper Limb Wound Debridement in Fractures/Dislocations, Upper Limb Bone Curettage with Bone Grafting for Cyst/Benign Tumour in Upper Limb Bone Bone Grafting for Defect in Upper Limb Bone. Excision of Exostosis in Upper Limb Bone
17

4 4 4 4 4 4 4

X X X X X X X

Multiple Repair for Disruption of Flexor Tendon in Lower Limb 4

406 Major Reconstruction Surgery of Upper Limb in Cerebral Palsy 4

409 Multiple Tendon Transfer to treat Nerve Injuries/Ischaemia in 4 4 4 4 4 5 5 5 5

Sr No. 418 419 421 422 423 424 425 426 427 428 429

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Hand
Simple Drainage for Osteomyelitis/Septic Arthritis in Upper Limb Bone Removal of Plates and Screws/Nails fixed in Upper Limb Bone Fasciectomy (multiple) to treat Dupuytren's Contracture Fasciectomy (single) to treat Dupuytren's Contracture Reconstruction of Defect/Contracture (single) in Finger Debridement of Injury - Finger Correction for Ring Constriction (multiple) Terminalisation of single finger damaged by trauma Amputation of multiple fingers Ray Amputation of single finger Debridement with Repair/Reconstruction of Complex Injuries in Hand 430 Wound Debridement of Complex Crush Injuries in Hand 431 432 433 434 435 436 437 438 439 Removal of deep seated foreign body in hand with mobilisation of neurovascular bundle Removal of superficial foreign body in hand with mobilisation 5 of neurovascular bundle Scar revision surgery in hand Excision of soft tissue tumour in hand Hand/Digit, Stump, Revision Wrist Arthrodesis Repair of Rupture of Upper Limb Muscles 5 5 5 5 5 X X X X X 5 5 X X 5 5 5 5 5 5 5 5 5 5 5 X X X X X X X 420 Fasciectomy to treat recurrent Dupuytren's Contracture 5 X

Wide Excision to treat various lesions in the upper limb muscles 5 Single Graft using microsurgical techniques to treat Defect in 5 Upper Limb Nerve 5 5 5 5 5 5 4
18

440 Single Microsurgical Repair to treat Injury to major nerves of upper limb 441 442 443 445 Drainage of abscess in Soft Tissue (Palmar Space) Major Excision of Benign Soft Tissue Tumours in Upper Limb Tenotomy to treat Contracture in Tendon (Upper Limb) Surgery For Carpal Tunnel Syndrome

444 Repair of Extensor Tendon, Upper Limb

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X

Hand
446 Pulley Reconstruction to treat Bowstringing/Entrapment 447 448 Release surgery to treat unilateral De Quervain's Tenosynovitis 449 Surgical Drainage to treat Tenosynovitis in multiple tendons of upper limb 450 Surgical Drainage to treat Tenosynovitis in single tendon of upper limb 451 Floating Osteotomy for Various Lesions of Hand Radical Excision of malignant tumour in skull. Caraniotomy and removal/hemisphrectomy for intracranial extracerebral tumour. 454 455 456 457 458 459 461 462 463 Craniotomy to treat epilepsy /Removal of tumour in Intracerebral Tumour Transphenoidal Hypophysectomy/ Excision of Tumour in various lesions of pituitary Transsphenoidal Hypophysectomy with Resection of Nasal Septum & Grafting in various lesions of pituitary Major Excision of benign bone tumour in skull Wide excision of malignant bone tumour in skull Revision/Removal of Shunt in treatment of Hydrocdephalus Spino-peritoneal Shunt in treatment of Hydrocephalus Transmastoid Removal with Extended Mastoidectomy to treat Auditory Meatus (Internal) Tumour 4 4 4 4 4 4 X X X X X 3 X 3 X 3 X X Craniotomy for the purpose of Biopsy and/or Decompression 3 4 1 1 X X X 4 X 4 X 4 4 X X X Release surgery to treat bilateral De Quervain's Tenosynovitis 4

Head
452 453

460 External Ventricular Drainage to treat Hydrocephalus

Head / Brain
464 Surgery to treat Compound Fracture of Skull with Dural Penetration and Brain Damage 465 Cranioplasty and Repair to treat Skull Fracture with Rhinorrhoea/Otorrhoea 3 X X 3 X X

Head / Face
466 Craniofacial Approach Reduction and Fixation with Bone Graft to trat head-face trauma
19

Sr No. 467

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X

Heart
Pulley Reconstruction to treat Bowstringing/Entrapment 4 1 1 1 2 2 3 3 4 4 4 4 X X X X X X X X X X 468 Coronary Artery Bypass Graft 469 Aortic aneurysm resection without coronary artery bypass 470 Heart Transplanatation 471 472 473 474 475 476 477 478 479 Transluminal Coronary Angioplasty Open heart surgery on more than valve ivolving more than one chamber Insertion/Replacement of Transvenous Pacemaking electrode to treat heart block Open Heart Surgery to treat Valvular Heart Disease Insertion/Removal of Intra-aortic Balloon Coronary Angiography Pericardiectomy to treat pericardial disease Left/Right Heart Catheterisation (direct) to treat various lesions in heart.

Aortic root replacement with coronary artery reimplantation 2

Heart/Lung
480 Heart and Lung Transplantation 1 4 4 4 4 4 1 2 4 4 X X X X X X X X X X X X X X X X X X

Hip Bone
481 482 483 Open Reduction of Hip Dislocation Hip Disarticulation to treat various lesions in the lower limb fracture of pelvis 485 Open Reduction and Internal Fixation ofPelvic Fracture Hindquarter Amputation to treat various lesions in the lower limb 4

484 Open Reduction and Internal Fixation for double column

Joints
486 Therapeutic Arthroscopy

Kidney
487 Kidney Transplant 488 Radical nephrectomy 490 Lithotripsy/Nephrolithotomy for renal calculus 491 Excision of renal cyst

489 Nephroureterectomy to treat various lesions in kidney and ureter 4

20

Sr No. 492 493 495 497

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X

Kidney
Repair of injury to Kidney Nephropexy Nephrostomy/Pyelostomy to treat Pyonephrosis Exploration of various lesions in Kidney 4 4 5 4 4 4 4 3 3 4 4 4 4 4 4 1 2 2 3 3 3 3 4 4 4 4 X X X X X X X X X X X X X X X X X X X X X X X X X X

494 Open Biopsy of Kidney 496 Drainage of Pyonephrosis/Perinephric Abscess 498 Nephrectomy to treat verious lesions in the Kidney 499 Enlargement Cystoplasty with Bowel to treat various lesions of urinary bladder 500 Total Cystectomy to treat various lesions of urinary bladder 501 502 503 505 Repair of Cystocele Major Microsurgery without Reconstruction to treat various lesions of larynx and trachea. Surgery to treat fracture of larynx Laryngectomy (hemi/partial/total) to treat various lesions of larynx including tumour 506 Microlaryngoscopy with/without removal of tumour 504 Larynogofissure

Larynx ( Voice Box)

Leg
507 Knee Joint Replacement 508 Total ankle joint replacement 509 Radical excision of soft tissue tumours of lower limb 510 511 512 513 514 515 516 517 518 Radical excision of malignant bone tumour in lower limbs Debridement with Repair of Bone and Soft Tissues to treat Crush Injuries (extensive) of lower limb Major replantation in traumatic amputation of lower limb Major Reconstruction with Repair and/or Neurovascular transfer to treat treat any disruption of lower limb nerve Open Reduction of ankle dislocation Open Reduction and Internal Fixation of Ankle Fracture Arthrodesis of ankle joint Synovectomies to treat various lesions of ankle
21

Excision/Interposition Arthroplasty in various lesions of ankle 4

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X

Leg
519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 541 Arthroscopic knee reconstruction Curettage with Bone Grafting to treat cyst/benign tumour of bone in lower limb Implantation of Bone Stimulator to treat defect/ non union of 4 bone in lower limb Corrective Surgery with Osteotomy Alone to treat deformity in bones of lower limb Corrective Surgery with Plate Fixation and Fluoroscopy Irrigation to treat deformity in bones of lower limb Manipulation and Kirschner Wire Fixation to treat Fracture/ Dislocation in bones of lower limb Wide excision of benign bone tumour in lower limb Reconstruction of Delayed/Non-Union of fracture in Femur Open Reduction and Internal Fixation with Plates and Screws of fracture in femur Reconstruction and Repair of Disrupted Knee Ligaments of Knee Arthrodesis to treat various lesions of Knee Arthrotomy to treat various lesions of Knee Excision/Interposition Arthroplasty to treat various lesions of Knee Menisectomy with/without Arthroscopy to treat various lesions of Knee Debridement with Repair of Bone and Soft Tissues to treat Crush Injuries (limited) of lower limb Epiphysiodesis to treat lower limb deformities Open Reduction and Fixation with Repair of Arterial Injuries to treat fractures in lower limb Lengthening Procedures to treat lower limb length discrepancies 4 Shortening Procedures to treat lower limb length discrepancies 4 4 4 Amputation to treat various lesions in the lower limb
22

4 4

X X X X X X X X X X X X X X X X X X X X X X X

4 4 4 4 4 4 4

Open Reduction with Repair of Ligaments to treat Dislocation 4 4 4 4 4 4 4 4

Arthrotomy and Synovectomy to treat various lesions of Knee 4

540 External Fixation to treat open fractures in lower limb

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X X

Leg
542 Repair of Disruption in Muscle (Quadriceps)/Tendon of Lower Limb 543 Major Repair (single) of disruption in lower limb nerve 544 Decompression of Nerve Entrapment Syndrome in Lower Limb 545 Open Reduction and Internal Fixation of Fracture in Patella 546 Patella Reconstruction Surgery to treat Recurrent Dislocation/Chondromalacia 547 Patellectomy 548 Major Release of Soft Tissue Contracture in Lower Limb 549 Minor Release of Soft Tissue Contracture in Lower Limb 550 Wide excision of benign soft tissue tumour in lower limb 551 Major Release of Various Soft Tissue Lesions in Lower Limb 552 Reconstruction surgery to treat peroneal tendon subluxation 553 Repair of disruption in Achilles Tendon 554 Reconstruction of Tibia( Delayed/Non-Union) 555 Open Reduction and Internal Fixation with Intramedullary Rod to treat Fracture of Tibia 556 Open Reduction and Internal Fixation with Plates and Screws to treat Fracture of Tibia 557 Arthroscopic knee evaluation/aspiration/joint toilet 558 Wound Debridement in Fractures/Dislocations, Lower Limb Bone 559 Wound Debridement in Major Crush Injury, Lower Limb Bone 560 Drainage with Curettage and Irrigation to treat Osteomyelitis (lower limb) 561 Simple Drainage for Osteomyelitis treat Bone (Lower Limb) 562 Removal of Plates and Screws/Nails of Bone (Lower Limb) 563 Debridement with Repair of Bone and Soft Tissues of Lower Limb damaged in extensive crush injury 564 Debridement with Repair of Bone and Soft Tissues of Lower Limb damaged in limited crush injury 565 Repair of Rupture of Lower Limb Muscles 566 Wide Excision to treat various lesions in the lower limb muscles. 567 Marginal Excision of Tumour/Tumour-like Lesions in Soft Tissue (Lower Limb) 568 Endarterectomy to treat thrombosis in other arteries of lower extremity 569 Corrective Surgery with Osteotomy Alone to treat deformity in bones of lower limb
23

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5

X X X X X X X X X X X X X X X X X X X X X

4 4

X X

X X

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X

Liver
570 571 572 573 574 575 576 577 578 579 Liver Transplant Extended Lobectomy of liver (5 segments or more) Lobectomy (3-4 segments) to treat various lesions of liver Endoscopic dilation of biliary stricture Endoscopic insertion of biliary stent Trans-Abdominal Drainage of Liver Abscess Repair of major laceration of liver Repair of minor laceration of liver Partial Lobectomy/Segmental Resection of Liver Wedge/Local Excision of Liver 1 2 3 4 4 4 4 4 4 4 5 5 5 4 4 4 3 X X X X X X X X X X X X

Lung
580 Foreign Body Removal (Bronchoscopic) from Bronchus 581 582 583 584 585 586 Foreign Body Removal from Bronchus via Bronchotomy Laser Application from Bronchus Various Lesions Bronchoplastic Procedure for various lesions in bronchus Pneumonectomy/Lobectomy/Segmental Resection/Repeat/ Multiple Resection to treat various lesions in Lungs Wedge Resection for various lesions in Lungs Excision with Wedge Resection of Lung to treat tumour of diaphragm

Lungs-Chest region

Lymph Node
587 588 589 591 592 593 594 595 596 Limited Excision of Axillary Lymph Node Radical Excision of Axillary Lymph Node Excision Biopsy of Cervical Lymph Node Radical Block Dissection of Cervical Lymph Node Limited Excision of Inguinal Lymph Node Radical Excision of Inguinal Lymph Node Limited Excision of Retroperitoneal Lymph Node Incision and drainage of scrotum and tunica vaginalis Medically necessary Circumcision
24

5 5 5 5 5 5 5 5 5 5

X X X X

X X X X X X X X X

590 Limited Block Dissection of Cervical Lymph Node

Male & Female -Genital Male Genital

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X X

Male Genital
597 598 599 601 Removal of Hydrocele/Varicocele Reconstruction (2nd Stage) of penis damaged due to trauma Insertion of Penile Prosthesis 5 3 3 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 1 5 5 X X X X X X X X X X X X X X X X X X X X X X Microvascular Reattachment of penis to treat trauma (amputation) 3

600 Amputation (Total) of penis with Block Dissection to treat tumour 3 602 Repair of Laceration/Fracture of Penis Involving Cavernous Tissue 5 603 Microsurgical Varicocelectomy

Male reproductive system

604 Simple Orchidectomy 605 Orchidectomy with Complete Excision of Spermatic Cord 606 Non-congenital Orchidopexy 607 Penis Reconstruction 608 Repair of Penile Avulsions 609 Partial Amputation of Penis due to Tumour 610 611 612 613 614 615 616 617 618 619 Total Amputation of Penis due to Tumour Repair of Diaphragmatic/Hiatus Hernia Excision of diaphragmatic Hernia Excision and destruction of a lingual tonsil Excision or Biopsy of lesion of tonsil and adenoid Excision of Lymphangioma in upper limb Limited Excision of Lymphangiectasis Radical Excision of Lymphangiectasis

Miscellaneous

Extensive and Complex Excision of Lymphoedema Surgery for treatment for secondary Lymphoedema (secondary to radiation therapy) 620 Large Excision of Lymphoedema 621 Moderate Excision of Lymphoedema 622 Smal Excision of Lymphoedema 623 Wide excision of soft tissue tumour.

Mouth
624 625 626 Wide excision and major reconstruction of mouth to treat malignant tumour Removal of Mucous Cyst/Mucocele in Lip Full Thickness Wedge Excision with Repair/ Vermilionectomy
25

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period

Mouth
627 628 629 631 632 633 634 Removal of deep seated foreign body from mouth Removal of Mucous Cyst/Ranula of Floor of Mouth Cryosurgical Application for Various Lesions of Oral Mucosa Alveolectomy (per quadrant) Removal of Parotid Calculus, Partial resection of a salivary gland Free Composite Tissue Graft to treat various lesions in Musculoskeletal System 5 5 5 5 5 5 5 4 X X X X X X X X X X

630 Laser Application for various lesions of Mouth

Mouth-Salivary gland

Muscles and Bones

Neck
635 636 637 638 639 641 642 643 External carotid-internal caritid bypass Laryngectomy with radical neck dissection/block dissection. Trachea Laser Application for various lesions of Larynx and Pharynx Direct Examination with Removal of Tumour in Larynx Endoscopic Resection/Removal of Pharangeal Pouch Flap/Pharyngoplasty for various lesions in Pharynx Partial Pharyngectomy with Primary Closure 5 5 5 5 5 5 5 5 4 5 5 5 5 5 5 X X X X X X X X X X X X X X X X X X X X X 2 2 X X X X X X

Major Plastic Operation to treat various lesions of Larynx and 3

640 Removal of Pharyngeal/Vallecular Cyst

644 Removal of Lingual/Lateral Pharyngeal Bands

Nerves
645 647 Removal of Lingual/Lateral Pharyngeal Bands Grafting for Peripheral Nerve Defect 646 Multiple Microsurgical Repair of Digital Nerve Injury 648 Primary Suture to treat Cutaneous Nerve Injury 649 Single Microsurgical Repair of Digital Nerve Injury 650 Primary Repair of Digital Nerve Injury 651 652 653 Excision of tumour in peripheral nerve (superficial) Bilateral Sympathectomy to treat various lesions in Sympathetic Nerves
26

Decompression of Entrapment of Mastoid Portion of Facial Nerve 5

Sr No. 654 655 656 657 658 659

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X X X X

Nerves
Unilateral Sympathectomy to treat various lesions in Sympathetic Nerves Injection with alcohol/ Radiotherapy Ganglionotomy to treat Trigeminal Neuralgia Transposition of ulnar nerve to treat entrapment Primary/Secondary Suture to treat various nerve lesions Microvascular Decompression/Neurectomy to treat various lesions in cranial nerves Total Decompression of the facial nerve (microsurgical - Stage 1) 661 662 663 Free fascia and nerve grafting to treat Facial Nerve Paralysis (microsurgical - Stage 2) Free fascia grafting to treat Facial Nerve Paralysis Combined Middle Fossa and Transmastoid Facial Nerve Decompression 664 Excision of Deep Peripheral Nerve Tumour 665 Exploration of Brachial Plexus Injury 4 4 4 5 5 5 5 5 5 5 5 5 3 X X X X X 4 4 X X 4 X 4 4 X X 660 Free fascia and nerve grafting to treat Facial Nerve Paralysis 5 4 4 X X X 5 5 X

Nervous system

Nose
666 Endoscopic, insertion of nasal biliary drain 667 Lysis of adhesions of nose 668 Excision of Nasolabial Cyst 669 Haemostasis (packing)/Cryotherapy to treating Epistaxis 670 Repair of Full Thickness Laceration of Nose 671 672 673 674 675 676 677 Removal of Complex Polypi from Nose Laser Application in the post nasal space Excision of Rhinophyma Submucous Resection/Turbinectomy for turbinate lesions Antral Drainage of Haematoma/Abscess in Nasal Sinuses Whipple Operation/Total Pancreatectomy to treat various lesions of pancres Anastomosis of Pancreatic Duct to Bowel to treat Pancreatitis 4
27

Pancreas

Sr No. 678 679 681 682 683

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X

Pancreas
Pancreatic Cyst/Pseudocyst Anastomosis to Stomach/Intestine Distal Pancreatectomy Excision of Tumour in Parapharyngeal Space Retropubic/Endoscopic Drainage of Abscess in Prostate Endoscopic Biopsy of Prostate 4 4 4 4 5 5 4 4 4 X X X X X X

680 External Drainage to treat various lesions in Pancreas

Prostate Gland
684 Open Prostatectomy to treat various lesions of Prostate Gland 685 Total Open Prostatectomy to treat various lesions of Prostate Gland 686 Transurethral Resection of Prostrate to treat various lesions of Prostate Gland

Renal
687 Anterior exenteration in female to treatbladder tumour 2 4 X X X

Reproductive System
688 Therapeutic Laparoscopy except for retrieval and placement of gametes and placement of embryos

Shoulder
689 Osteotomy to treat Shoulder Deformity 690 Anterior Acromioplasty to treat Shoulder Impingement Syndrome 691 692 693 Anterior Acromioplasty with Rotation to treat Shoulder Impingement Syndrome Arthrotomy to treat septic arthritis/effusion of Shoulder Joint Hemiarthroplasty of Shoulder 4 4 4 X X X X X X X X X X 4 X X 4 4 X X X X

Sinus
694 Intranasal Operation of Sinuses 695 697 External operation to treat various lesions of ethmoidal sinus 4 Functional Sinuscopic Drainage of Ethmoidal/Maxillary Sinuses 4 4 4 4

696 Radical Obliteration to treat various lesions in Frontal Sinuses 4 698 Functional Sinuscopic Ethmoidectomy 699 Radical Antrostomy to treat various lesions in Nasal Sinuses 700 Fronto-nasal Ethmoidectomy with/without Sphenoidectomy to treat various lesions in Nasal Sinuses
28

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X

Skin
701 Free Graft (Split Skin Graft - Extensive/Inlay Graft using a mould) to treat deep defect in skin and subcutaneous tissue 702 Excision and Reconstruction to treat malignant tumour of skin and subcutaneous tissue 703 Excision with Immediate Block Dissection to treat malignant tumour of skin and subcutaneous tissue 704 Wide Excision and Skin Grafting to treat Leukoplakia 705 Excision and Major Flap Repair of Skin and Subcutaneous Tissue damaged due to Burns 706 Excision and Major Full Thickness Graft of Skin and Subcutaneous Tissue damaged due to Burns 707 Excision and Small Full Thickness Graft of Skin and Subcutaneous Tissue damaged due to Burns 708 Direct Flap (cross arm/ radial fore arm/ abdominal/ similar) to treat Deep Defect in Skin and Subcutaneous Tissue 709 Direct Flap Repair (cross leg) to treat Deep Defect in Skin and Subcutaneous Tissue 710 711 712 713 714 715 716 717 718 Free Flaps to treat Deep Defect in Skin and Subcutaneous Tissue 4 Free Full Thickness Graft to treat Skin and Subcutaneous Tissue Defect in Multiple Digits Direct Flap (cross finger/ similar flaps) to treat defect in Skin and Subcutaneous Tissue Free Grafts (Split Skin Graft 2 to less than 5%) to treat defect in Skin and Subcutaneous Tissue Free Grafts (Split Skin Graft 5 to less than 10%) to treat defect 4 in Skin and Subcutaneous Tissue Free Grafts (Split Skin Graft More than 10%) to treat defect in Skin and Subcutaneous Tissue Single Staged Local Flap (complicated/ large) to treat defect in Skin and Subcutaneous Tissue Single Staged Local Flap (simple/ small) to treat defect in Skin 4 and Subcutaneous Tissue Staged Local Flap to Multiple Digits (cross finger/thenar/ flag/ rotation flap) to treat defect in Skin and Subcutaneous Tissue
29

3 3 3 4 4 4 4 4 4

X X X X X X X X X X X X X X X X X X

4 4 4

4 4

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X X X

Skin
719 Repair of Skin and Subcutaneous Tissue, Laceration (deep)/ Multiple Lacerations 720 Repair dissection of Skin and Subcutaneous Tissue, Laceration (deep)/Multiple Lacerations 721 722 723 724 725 726 727 728 729 730 731 732 733 734 735 736 737 738 739 Excision of Skin and Subcutaneous Tissue to treat Neurofibromatosis of Face and Neck(extensive and complex) Excision of Skin and Subcutaneous Tissue to treat Neurofibromatosis of Face and Neck(large and complicated) Excision of Skin and Subcutaneous Tissue to treat Neurofibromatosis of Face and Neck(large) Excision of Skin and Subcutaneous Tissue to treat Neurofibromatosis of Face and Neck(moderate) Extensive Escharotomy to treat Burns in Skin and Subcutaneous Tissue Debridement of Deep/Extensive Contaminated Wound in Skin and Subcutaneous Tissue Staged Distant Flap to treat Skin and Subcutaneous Tissue Defect 5 Staged Local Flap to treat Skin and Subcutaneous Tissue Defect in Multiple Digits Free Full Thickness Graft to treat Skin and Subcutaneous Tissue Defect in Single Digit Free Grafts (Split Skin Graft 1/2 to less than 2%) to treat Skin and Subcutaneous Tissue Defect Repair of Skin and Subcutaneous Tissue Laceration (superficial) of less than 7cm Repair of Skin and Subcutaneous Tissue Laceration (superficial) of morethan 7cm Excision of deep sinus in Skin and Subcutaneous Tissue Excision of Scar Tissue in Burns (2% to 10%) Excision of Scar Tissue in Burns (More than10%) Excision Biopsy for various skin lesions (4 and above) Limited Abrasive Therapy for Various Skin Lesions 5 5 5 5 5 X Excision of Tumour/Cyst/Ulcer in Skin and Subcutaneous Tissue 5 5 X 5 5 5 5 5 5 X 4 X 4 X 4 X 4 X 4 X 4 X

Insertion of Multiple Tissue Expander for Various Skin Lesions 5

30

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period

Skin
740 Insertion of Single Tissue Expander for Various Skin Lesions 5 4 4 4 4 4 4 4 4 4 2 2 3 X X X X X X X X X X X X X X X X X X X X X X X X X

Skull
741 742 743 744 745 746 747 748 749 750 751 752 Craniofacial Approach Reduction and Fixation of Fracture in Head-Face Surgery to treat compound fracture of skull without dural penetration Surgery to treat Craniostenosis (Multiple Sutures) Surgery to treat Craniostenosis (Single Sutures) Surgery to elevate Depressed/Comminuted Fracture of Skull Bilateral Burr-hole Craniotomy to treat Intracranial Haemorrhage Unilateral Burr-hole Craniotomy to treat Intracranial Haemorrhage Osteoplastic Craniotomy/Extensive Craniectomy to treat Intracranial Haemorrhage Craniectomy to treat Osteomyelitis in Skull Major resection and reconstruction (microsurgical) of malignant soft tissue tumour Radical excision of malignant soft tissue tumours Radio Frequency Ablation with or without Electrophysiology study

Soft tissue

Spinal Cord
753 754 755 756 757 758 759 761 762 Percutaneous Cordotomy to treat Intractable Pain Laminoplasty fo various lesions in cervical spine Excision of Cervical Rib Corrective Osteotomy of Spine Open Reduction and Stabilisation of Fracture-Dislocation of Spine Anterior Drainage and Fusion in Spine Infection Chemonucleolysis to treat Prolapsed Disc Excision of Various Lesions in Coccyx Manipulation to treat Chronic Pain/Stiffness of Spine
31

4 4 4 4 4 4 4 4 5 5

X X X X X X X X

X X X X X X Y X X X

760 Surgical Correction of Scoliosis

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X

Spine
763 764 765 766 767 Laminectomy/Fenestration with Discectomy to treat Prolapsed Disc Laminectomy and Posterior Fossa Decompression and Drainage to treat Syringomyelia Decompression Laminectomy to treat various lesions of Spine Anterior Decompression and Fusion (multiple levels) for various lesions of Cervical Spine Anterior Decompression and Fusion (single level) for various lesions of Cervical Spine 4 X 3 4 X X 3 X 3 X

Spine-Blood vessel
768 Clipping/ Reinforcement of Sac to treat Aneurysm/ Arterio-Venous Malformation in Spinal Cord 3 X X

Spleen
769 Splenectomy to treat Hypersplenism/Massive Enlargement of Spleen 770 Splenectomy to treat trauma/various non traumatic lesions of Spleen 4 X X 4 X X

Stomach / Liver
771 Endoscopy, sphincterotomy with/without extraction of stones from common bile duct 4

Stomach/abdomen region
772 773 774 775 776 777 778 779 Repair of Epigastric/Umbilical Hernia Unilateral Herniorrhaphy to repair umbilical hernia Bilateral Herniorrhaphy to repair Inguinal/Femoral Hernia Surgical Repair of Strangulated/Obstructed Hernia with Bowel Resection Surgical Repair of Strangulated/Obstructed Hernia without Bowel Resection Surgical Repair of Ventral/Incisional/Recurrent Hernia Excision of ruptured abdominal aorta and insertion of graft 4 2 3 X X X X X X 4 X 4 4 4 4 X

Stomach - Blood vessel

Excision and insertion of graft to treat abdominal aortic aneurysm 3 aneurysm
32

780 Excision and insertion of graft to treat descending aortic

Sr No. 781 782 783

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X

Testies
Microsurgical Exploration and Testicular Biopsy for various lesions in Vas Deferens Excision/Eversion of hydrocele Retroperitoneal Lymph Node Dissection following Orchidectomy to treat Testicular Tumour 5 5 X 4 X

Thorax
784 785 786 787 788 789 Drainage of Subphrenic Abscess Resection of Rib and Open Drainage of Empyema Resection of Mediastinal Tumour Complete Thoracoplasty Thoracotomy 4 4 4 4 4 5 4 4 4 4 4 4 5 4 4 4 5 5 5 4 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Intrathoracic Operation on Lungs/Bronchial Tree/Mediastinum 4

790 Thoracoplasty (in stages) - each stage

Thyroid gland
791 792 793 794 795 796 797 798 799 Excision of thyroid tumour Hemithyroidectomy/Partial Thyroidectomy Total/Subtotal Thyroidectomy Total/Subtotal Thyroidectomy with Block Dissection Hemi/Total Glossectomy to treat Tumour in Tongue Partial Excision of Tongue Tonsillectomy Tonsilloadenoidectomy Resection of Tonsillar tumor with Reconstruction

Tongue

Tonsils

Trachea
800 Trachea Reconstruction 801 Bronchoscopy with dilatation of tracheal stricture 802 Laser Application in Trachea for Various Lesions 803 Tracheostomy for Various Lesions

Ureter/ Kidney
804 Pyeloplasty/Ureterocalycostomy to treat Pelvi-ureteric Junction Obstruction 805 Ultrasound Lithotripsy, Ureterolithotomy to treat ureteric calculus 4
33

Sr No.

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X X X X X X X X X X X

Ureter/ Kidney
806 Closure of Cutaneous Ureterostomy 807 Revision of previous diversion in ureter 808 Intestinal Conduit Surgery 809 Reduction Ureteroplasty 810 811 812 813 814 815 816 817 818 819 Reimplantation/Repair of Ureter Excision for Urethral Diverticulum Repair/Urethroplasty of Anterior Urethra in case of Injury Anterior Urethroplasty Excision Various Lesions in Urethre Posterior/Transpubic Urethroplasty Cystoscopic removal of foreign body/ureteric stent Cystoscopy with controlled hydrodilatation of the bladder Urethrotomy to treat Urethral Stricture Urethrotomy to treat Various Lesions in Urethra 4 4 4 4 4 4 4 4 4 4 5 5 5 5 4 4 4 4 X X X X X X X X X X X X

Urinary bladder / Kidney

820 Cystoscopy and insertion of double J stent 821 822 823 824 825 Cystoscopy and external sphincterotomy for neurogenic bladder neck obstruction Cystoscopy with endoscopic removal/manipulation of ureteric calculus Cystoscopy with endoscopic resection/incision of bladder neck Cystoscopy with resection of bladder tumor (more than 1.5 cm) 4 Cystoscopy with ureteric meatotomy/with resection of Ureterocele 4

Urinary bladder
826 827 828 829 831 Wedge Excision to treat Urinary Bladder Neck Contracture, (Acquired) Vesicolithotomy/Litholapaxy/Ultrasonic Lithotripsy to treat Urinary Bladder Calculus Excision of Urinary Bladder Diverticulum Closure/Correction of Fistula in Urinary Bladder Partial excision of various lesions in Urinary Bladder
34

4 4 4 4 4 4

X X X X

X X X X X

830 Surgical Correction of Urinary Bladder Incontinence

Sr No. 832 833 834 835 836 837 838 839

Procedure Name

Grade

Day Care Surgeries

Waiting Period X X X X X X X X X

Uterus
Closure of Cutaneous Ureterostomy Anterior/posterior pelvic exenteration of uterus to treat malignancy Total pelvic exenteration of uterus to treat malignancy Wertheim's operation to treat uterine malignancy Hysterectomy to treat broad ligament tumour or chronic pelvic inflammation Myomectomy, complicated Myomectomy, simple Repair of Perforated Uterus treat Uterine Prolapse 841 842 843 Ventrosuspension to treat retroverted uterus Repair of Ruptured Uterus, complicated Repair of Ruptured Uterus, simple of Uterus 4 4 4 5 X X X 4 4 4 4 X X X X 2 2 4 X X X 4 2 X X

840 Vaginal Hysterectomy with/without Pelvic Floor Repair to

844 Curettage with/without Dilatation for Various Lesions

Uterus / Ovaries
845 Total/Subtotal Hysterectomy with/without SalpingoOophorectomy for Benign/Malignant Conditions in Uterus 4 X

Uterus/female reproductive system

846 Therapeutic Hysteroscopy 847 Therapeutic Hysteroscopy with Laser 848 Excision of Polyp in Cervix 849 Conization of cervical canal 5 5 5 5 X X X X

35

Procedures / Treatment not covered in below Hospitals & Medical Practitioners

Further, in continuation of Section 6 of the Policy Document, We shall not offer cashless/reimbursement of costs pertaining to any procedure or treatment undertaken by Insured Person(s) in any of the Hospital(s) or from any of the Medical practitioner(s) specified below, under this Policy. Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Hospital Adarsh Hospital ( Dr. Dinesh Patel ) Adarsh Hospital (2nd Unit) Aditya Multispeciality Hospital Chandramani Hospital Devasya Superspeciality Kidney Hospital Dr. Joshi Maternity and Gynaec Hospital Hetvi Hospital Indus Hospital And Iccu Pvt. Ltd. Indus Hospital And Iccu Pvt. Ltd. J J HOSPITAL Lifeline Hospital And Children And Healthcare Hospital Pvt Ltd Maitri Hospital Matru Hospital Metalia Heart & Medical Hospital Polyclinic Sarveshwari Charitable Trust and General Hos- Pital Sharda Clinic And Hospital Tapan Hospital Tapan Hospital Virendra Hospital Chamundi Hospital Maruthi Hospital Address 6,Ambica society,Nr.Vidyanagar high school, Usmanpura, Ahmedabad - 380013 14, Vadgram Society, Opp. Nerinath Society, Ranip, Ahmedabad, Gujarat F-1, Centre Plaza, Satadhar Char Rasta, Sola Road, Ahmedabad Gidharnagar, Shahibaug, Ahmedabad New Vadaj Road, NR. Bhimajipura Cross Roads, Ahmedabad, Gujarat-380013 60, Brahma Mitra Mandal Society, Ellisbridge, Ahmedabad-380006 11, Varsha State Bank Society, Chanakyapuri Rly. Crossing, Ghatlodia, Ahmedabad 3rd Floor, Shally Complex, Opp. Sal Hospital, Near Surdhara Circle, Thaltej, Ahmedabad, Gujarat Opp. Adani CNG Punp, Near Octroi Booth, Sabarmati, Ahmedabad, Gujarat Sector -6, Chankyapuria Society, Ghatlodia, Ahmedabad-380061 304, Lifeline Complex, Near Bhimjipura Cross Road, Nava Wadaj, Ahmedabad Gopal Park Society,Nr. Maya Cinema, Kubernagar, Ahmedabad 198/1272, Opp. Ambaji Temple, Jodka, Nr. Gol Limda, Dargah Road, Hardasnagar, Bapunagar, Ahmedabad-380024 Bapunagar Char Rasta,Ahmedabad-380024 Kasturbanagar, Milan Cinema Road, Saraspur, Ahmedabad 5/102, Laxmi Nagar, Near Satyamnagar, Ameriawadi, Ahmdabad, Gujarat Nr.Dena Bank,Asarwa Chakla,Ahmedabad 7/75,Vallabh Flats, Bapunagar Char Rasta,Ahmedabad 7/75,Vallabh Flats,Bapunagar Char Rasta,Ahmedabad-380024 Stanley Road, Next of Mishra Bhawan, Civil Lines, Allahabad -211001 Cholanayakanahalli Main Road, Chamundi Nagar, Bangalore-560032 No:14, Maruthi Nagar,Near Maruthi Temple, Nagarabhavi Main Road, Bangalore

Patadia Hospital And Pathology Lab 119-120,Bharvi Tower, Near Petrol Pump,Nh-8,Ctm, Ahmedabad

Maruthi Nursing & Maternity Home Iyyanna Shetty Layout, Byatarayanapura, Opp Kavika, Mysore Road, Bangalore
1

Sr. No. 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

Hospital

Address

Parimala Hospital & Research Center Bilekahalli, Bannerghatta Road, Bangalore Satya Hospital Shreyas Hospital Shridevi Hospital Shah Hospital Trupti Nursing Home Aakash Hospital Amma Hospital Beach Chennai Hospital Kumaran Hospital Meera Nursing Home Nichanis Hospital Noble Hospital Sampat Nursing Home Sri Devi Hospital Sri Kumaran Health Centre SSS Hospital Alaknanda Hospital Aashirwad Hospital Abhi Hospital & Trauma Centre Adinath Hospital Agarwal Medical Centre Anuradha Hospital And Trauma Centre ARIHANT HOSPITAL Atithi Hospital Pvt Ltd (Multispeciality Re- Search & Trauma Centre) Chanderlok Hospital Dhar Medical Centre J M S S Hospital, Najaf-Garh Road Kavita Medical Centre Lokpriya Hospital Kammanahalli Main Road, Sri Ramaiah Layout Hsbr Layout, Bangalore-54 Opp Kamakshi Theatre, Magadi Road, Bangalore No:14, Maruthi Nagar, Nagarabhavi Main Road,Bangalore First Floor, Behind Janta Market,Panchbatti, Bharuch First Floor, Behind Janta Market,Panchbatti, Bharuch 210/2005, 395, T H Road, Chennai No 1, Sowrastha Nagar, 7th Street, Choolaimedu, Chennai #4 Lig, Colony, Cross Road, New Washermenpet, Chennai No. 214, Evr Periyar Salai, Beside To San-Gam Hospital, Ph Road, Kilpauk, Chennai #142/9, Purasalwalkam High Road, Kellys, Chennai 10, Arthoon Road, Royapuram, Chen- Nai-600013 4, Audiappa Street, Purusawalkam, Chennai 600084 4, Nachiappa Street, Mylapore, Chennai 600004 1620a, 16th Main Road, Annanagar (W), Chennai 1419-A, 200, Feet Inner Ring Road, Rettari Junction, Kolathur 600 099 No: 924, T. H. Road, Near Ellaiamman Koil, Thiruvottivur, Chennai-600019 35, Mansarover Colony, Rajpur Road,Dehradun G-121, Oriental Villa, Sushant Lok-Iii, Gurgaon 330, Gyan Khand - I, Indirapuram, Gha- Ziabad Gyan Khand 1st,Indirapuram,Ghaziabad E-234, Greater Kailash Part 1, Delhi D-635,60 Feet Road,Near Shiv Mandir Chawla Colony, Ballabhgarh-121004 G-121 ; Oriental Villae, G-121, 122 ; Sushant Lok Iii, Sector 57, Gurgaon,122002 A-135, Shalimar Gar-Den Extn-Ii, (Sahibabad), Near S.M.Wor,Ghaziabad-201005 Gurdwara Road, Near Disposal, Jawahar Colony, Faridabad. C-111,Sector-39, Noida. Nagli Dairy Colony, Near State Bank of India, Najafgarh Road, New Delhi 110043 Centrehouse No: 5, Sector-29, (Near Mother Dairy), Faridabad 121008 Maliwara Road, Ghaziabad

50 51 52 53 54 55

Gupta Hospital & Mater-Nity Centre Prem Vihar, Khora Colony, Noida

Sr. No. 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

Hospital Nawal Hospital Nirmal Hospital Park Hospital Rana Hospital And MaterNity Centre Sadbhawana Medical Centre Sanjay Medicare Pvt Ltd Saraswati Hospital And Cancer Care Centre Sharad Nursing Home Sharad Nursing Home Tewari Medical Centre Uttam Hospital Vaishno Medical Centre Vansh Hospital Anwar Memorial Hos- Pital Dr Anji Reddy Multispeci-Ality Hospitals Pvt Ltd Ayush Multi Speciality Hospital Gagan Mahal Nh / Cdr Womens Centre Hari Prasad Memorial Hospital K G H The Family Hospital KGH The Family Hospital Leela Hospital Mother Theresa Nursing Home Nihar Orthopaedic & Multi Speciality Hospital Raghavendra Hospital Saidurga Multi Hospital Saluja Multispeciality Hospital Padmavathi Hospital Sri Balaji Maternity & Sur-Gical Nursing Home Surya Nursing Home

Address Khandsa Road, Behind Police Post, Gurgaon. C-6/241-243, Main Police Station Road,Sultanpuri,Delhi -110086 1 Palam Gurgaon Road, Dundahera,Gurgaon Idgah Road,Opp: Rashid Ali Gate,Loni,,Ghaziabad-201102 23/5, Mathura Road, Ballabgarh Sarfarabad, Sec-73 Noida A-2, Adhyapak Nagar, (Near Hanuman Mandir), Najafgarh Road, Nangloi, Delhi- 110043 537, Ganesh Market, Najafgarh Road,Nangloi House No.275;Block-D Extension-2 Nangloi Bhangel, Noida Uttam Hospitale-230, Sector-9 New Vijay Nagar, Ghaziabad-201001 75, S K Iii Indiapuram, Ghaziabad, Uttar Pradesh A-135/A-1, Shalimar Garden Extn - Ii, Ghaziabad Santhosh Lane, Aluva, Ernakulam, Dist. Aluva , Ernakulam 16/682 Piduguralla Main Raod, Gun- Tur-522413, Andhra Pradesh Opp. Seven Hills Appartment, Nizampet Road, Kukatpally, Hyderabad - 500072 1-2-379 , Domalguda, Himayatnagar, Hyderabad 21-1-684 & 685, Rikab Gunj, Patter Gatti, Hyderaba 1611-45/B, Saleem Nagar Colony,Malakpet, Hyderabad 16-11-16-45/B,Malakpet ,Beside Hdfc Bank, Hyderabad Plot No. 112 / D, Opp. Seven Hills High School, Moti Nagar, Erragadda, Hyderabad - 500018 Rajeev Chowk, Dammaiguda, Rangareddi, Hyderabad 500083 8-3-214/2, Murthy Mansion, Srinivas Na- Gar (W), Ameerpet , Hyderabad - 500038, Dist:Hyderabad, Andhra Pradesh 1-7-100 Kamal Nagar Ecil X Road, Hyderabad 23-35/12/1, Ramachandra Reddy Nagar, Ramachandrapuram , Hyderabad - 500032, Dist:Hyderabad, Andhra Pradesh Lane Opp. In-Gare of Secbad Railway Station, Regimental Bazar, Secunderabad 500025 3-1-293, Beside Civil Hospital, Karimnagar Civil Hospital Road, Jammikunta, Karimnagar Curn Road, Opp: Missron Hospital, Karimnagar

Gandhi Hospital & Diagnostic Centre Near Over Bridge, Mayuri Centre,Khammam, Ap

Sr. No. 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111

Hospital Ayush Hospital Neel Kamal Nursing Home Agrawal Clinic Dr Kunnure Hospital And Iccu

Address 3/158, Rajni Khand, Near-Power House, Sharada Nagar, Lucknow, Sharada Nagar Neel Kamal Nursing Homenauchandi Shaeed Gate, Garh Road., Meerat 49 Daftary Road Malad (E) Mumbai - 400097 F-2,D-2,Sector 9, Main Road,Vashi, Navi Mumbai 400703

Fracture Care Hospital & Diagnostic Ratan Apartment, Gr Floor,Shimpli Road Near, Dattapada Subway Centre, Borivali(W), Mumbai 400092 Gurukul Hospital Kaustubh Nursing Home Mallika Hospital Mohit Hospital Ms Maternity & General Hospital National Hospital Parakh Hospital Sai Aashirwad Hospital Iccu & Policlinic Plot No 07,Sec-12a,Opp.Kalash Udyan,Near Govind Appt, Koparkhairane, Navi Mum- Bai,400705 Plot No. 76, Sector No. 6, Behind Ganesh Market & Post Office, Koperkhairane, Navi Mumbai- 400709 Sharma Estate Next To Diwan Shopping. Centre, S.V.Road, Jogeshwari (W), Mum- Bai-400 102. Koyna, Shantivan Complex, Near National Park, Borivali (E). Mumbai 400066 10-A, Miniland Tank Road, Bhandup(W), Mumbai 400078. Matruashish,Next To Madhav Hall,M.C Road,Borivli-66 Khokani Lane,Opp.Ghatkopar Railway Stn. (E), Mumbai 400077 Navghar Road, Bhayander ( E), Mumbai 401105

Sapna Health Care Cen- Tre Pvt Ltd 1st Floor, Bhaveshwar Plaza, A Wing, L.B.S. Marg, Ghatkopar (W), Mumba-400086 Shaishav Children Hos- Pital & Neonatal Care Nursery Gurukrupa Hospital Suman Hospital Bollineni Superspeciality Hospital Vijaya Hospital Riya Heart And Medical Hospital Sanjivani Nursing Home Dayal Maternity & Nursing Home Ganesan Hospital Nathan Super Speciality Hospital Dr R K Hota Lk Hospital Pvt Ltd Santram Road, Beside Hdfc Bank, Opp. Ifcowala Hall, Nadiad-387001 Sarvadnya Sankul, 1, Floor, Peth Naka, Pan- Chavati, Nashik, Maharashtra 422004 Shivneri, 1st Floor, Near Rane Nagar Bus Stop, Mumbai - Agra Road, Nasik - 422009 Dargamitta, Nellore - 524003 ; Dist:Nellore, Andhra Pradesh Raghava Cine Complex Road,Pogathota,Nellore -524001, Dist:Nellore,Andhra Pradesh B-Raliya Chambers,Nr.Bhagwati Nagar Society, Nr.Bus Stand-384265 Pratapgarh,201366 982/23, D.L.F. Colony Chowk, Rohtak - 124001 50-2-C, Gandhi Road, Salem-636004 Advaitha Ashram Road, Opp New Busstand, Opp Holy Flower School,Salem 636004, Dist:Salem,Tamil Nadu Mahanadi Vihar(Behind Lath Bagicha), Aintha Pali, Sambalpur-768002 4-159, 4-172 , Maruthi Nagar, Geeta Nagar, Malkajgiri

Sr. No. 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129

Hospital Dikshit Hospital Aarzoo Hospital Shubham Hospital Galaxy Hospitals Raghavendra Hospital Bharadwaj Nursing Home

Address Bazar Madho Dass, B.S.R, Sikandrabad 262403 Opp Lb Cinema Bhatar Road, Surat 106, Shankar Apartments, Bhakti Mandir Road, Opp. Spinach Shop, Near Hariniwas Circle, Thane(W) 400607 110e/20/1, North By-Pass Road,Tirunelveli -627003, Dist:Tirunelveli, Tamil Nadu 49-5410/2/A, Balayyasastry Layout,Vishakapatnam -530013, Dist:Vishakhapatnam, Andhra Pradesh Beside Bus Stand,Thorrur - 506163,Dist:Warangal, Andhra Pradesh

Dr Narshimarao Memorial Hospital H. No: 6-3-23, Near Vijaya Talkies Road, Sahodar Reddy Complex, Hanamkonda, Warangal-Andhra Pradesh Padmavathi Multi SpecialIty Nursing Home Pradhan Nursing Home Jeevan Jyoti Hospital Royal Nursing Home Panipat Cath Lab & Heart Care Centre (Panipat) Sheetla Hospital & Eye Institute Pvt Ltd Nandal Maternity & Nursing Home Lakshmi Memorial Hospital & Research Centre R.K.Hospital Sparsh Multispeciality Hospital Rama Hospital Beside Bus Stand, Thorrur, Dist Warangal H.No. 3-84, Main Road, Bhupalpally, Warangal 506168, Dist. Andhra Pradesh 162, Bai Ka Bagh, Lowther Roa Uttarpradesh Plot# 7, Sector# 1, Airoli, Navi Mumbai-400708. Aka Prem Hospital, 2nd Floor, Hospital Bishan Sarup Colony, Opp Bus Stand Panipat 132103, Haryana New Railway Road Gurgaon 122001, Haryana 112/29, Basant Vihar, Opp: Chhotu Ramstadium, Sone, Haryana 1/2 New Palasia,Indore, Madhya Pradesh 3-C, 59 Bp, N.I.T, E S I Hospital Chowk,Nh - 3, Near Metro Cinema, Faridabad, Haryana 120 Feet,Gidc Road, Near Udhna Citizen Coperative Bank, Surat S Rama Multispeciality Hospital, Sonepat Road, Bahalgarh, Sonepat, Haryana-131039

*Please note that this list is subject to frequent changes. Hence to get the most recent list of non-covered hospitals, please call the TPA toll free on 1800226655 or log on to www.paramounttpa.com/aegonreligare