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S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
S1 GENERAL SUGERY
Routine Histopathological Examination, Clinical
1 04.06.1 S1 Excision of Ganglion - large Clinical Photograph, X-Ray 10280 10580 12850 13225
Photograph
Routine Histopathological Examination, Clinical
2 04.06.3 S1 Excision of Ganglion - Small Clinical Photograph, X-Ray 10600 11200 13250 14000
Photograph
3 04.92 S1 Ganglion Sclerotherapy Clinical Photograph Clinical Photograph 2000 2000 2500 2500
USG Abdomen,Chest X-Ray PA View(1 Routine Histopathological Examination, Doppler
4 05.23.2 S1 Laproscopic-Lumbar Sympathectomy Film),Doppler Scan Study Of Both Lower Limb Scan Study Of Both Lower Limb Arterial 26200 27400 32750 34250
Arterial System/Doppler, Clinical Photograph System/Doppler
T3, T4, TSH,USG Neck , Fine Needle
5 06.2.1 S1 Hemithyroidectomy Aspiration Cytology (FNAC),Clinical Routine Histopathological Examination 26200 27400 32750 34250
Photograph
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination,
6 06.2.2 S1 Laproscopic Hemi Thyroidectomy Aspiration Cytology (FNAC), Clinical 28930 29530 36163 36913
WEBEX
Photograph
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination, Scar
7 06.4.1 S1 Total Thyroidectomy Aspiration Cytology (FNAC), Clinical 31500 33000 39375 41250
Photo
Photograph
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination,
8 06.4.2 S1 Laproscopic Total Thyroidectomy Aspiration Cytology (FNAC), Clinical 29410 30010 36763 37513
WEBEX
Photograph
T3, T4, TSH,USG Neck / Thyroid Uptake
Measurements With 131-Iodine, Fine Needle
9 06.6 S1 Excision of Lingual Thyroid Routine Histopathological Examination 30900 31800 38625 39750
Aspiration Cytology (FNAC), Clinical
Photograph, Case sheet with clinical History
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination, Scar
10 06.7 S1 Excision of Thyroglossal Cyst Fistula Aspiration Cytology (FNAC), Clinical 30900 31800 38625 39750
Photo
Photograph, Fistulogram
USG Neck ,Serum Calcium Levels, P.T.H
Routine Histopathological Examination, Scar
11 06.8.1 S1 Parathyroidectomy -Non Malignant Assay (Parathyroid Assay), Fine Needle 31500 33000 39375 41250
Photo
Aspiration Cytology (FNAC)
T3, T4, TSH,USG Neck , Fine Needle Routine Histopathological Examination, Scar
12 06.31.1 S1 Resection Enucleation - Thyroid 26800 28600 33500 35750
Aspiration Cytology (FNAC) Photo
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination, Scar
13 06.31.2 S1 Subtotal Thyroidectomy Aspiration Cytology (FNAC), Clinical 29200 30400 36500 38000
Photo
Photograph
Routine Histopathological Examination,
14 06.31.3 S1 Laproscopic Sub total Thyroidectomy T3, T4, TSH,USG Neck 28380 28980 35475 36225
WEBEX
Routine Histopathological Examination,
15 06.31.4 S1 Laproscopic Thyroid Nodule Excision T3, T4, TSH,USG Neck 28370 28970 35463 36213
WEBEX
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination, Intra OP
16 06.39.1 S1 Isthmectomy Aspiration Cytology (FNAC),Clinical 25500 26700 31875 33375
photo
Photograph
T3, T4, TSH,USG Neck , Fine Needle
Routine Histopathological Examination, Scar
17 06.39.2 S1 Partial Thyroidectomy Aspiration Cytology (FNAC), Clinical 25420 26620 31775 33275
Photo
Photograph
T3, T4, TSH,USG Neck , Fine Needle
18 06.39.3 S1 Laproscopic Isthmectomy Aspiration Cytology (FNAC), Clinical Routine Histopathological Examination 29270 29870 36588 37338
Photograph
Adrenal function test,Urinary VMA, Urinary
Metanephrine/Nor metanephrine,Urinary
Bilateral Adrenalectomy in nonmalignant Catecholamines,Aldosterone - Urine,24 hour USG Abdomen, Routine Histopathological
19 07.3.1 S1 43000 46000 53750 57500
conditions free cortisol,USG Abdomen / CT Scan Examination, Scar Photo
Abdomen With Contrast / MRI Abdomen With
Contrast
Adrenal function test,Urinary VMA, Urinary
Metanephrine/Nor metanephrine,Urinary
Unilateral Adrenelectopmy in Catecholamines,Aldosterone - Urine,24 hour USG Abdomen, Routine Histopathological
20 07.22.1 S1 37100 39200 46375 49000
nonmalignant conditions free cortisol,USG Abdomen / CT Scan Examination, Scar Photo
Abdomen With Contrast / MRI Abdomen With
Contrast
Laproscopic Right Hemi Colectomy in USG Abdomen/CT Scan Lower Abdomen With USG Abdomen, Routine Histopathological
21 17.33.1 S1 40300 40600 50375 50750
non malignant conditions Contrast,Colono Scopy, Biopsy report Examination , Scar Photo, WEBEX
USG Abdomen/CT Scan Lower Abdomen With USG Abdomen, Routine Histopathological
22 17.35.3 S1 Laproscopic Left Hemicolectomy 32960 34160 41200 42700
Contrast,Colono Scopy, Biopsy report Examination , WEBEX
Routine Histopathological Examination, Clinical
23 25.1.1 S1 Excision of large growth from Tongue Biopsy report, Clinical Photograph 20590 21490 25738 26863
Photograph
Routine Histopathological Examination, Clinical
24 25.1.2 S1 Excision of Small growth from Tongue Biopsy report, Clinical Photograph 17370 18270 21713 22838
Photograph
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Routine Histopathological Examination, Clinical
25 25.2.1 S1 Partial Glossectomy Biopsy report, Clinical Photograph 28450 30250 35563 37813
Photograph
26 26.4 S1 Parotid Duct Repair Silography Silography, Intra OP photo 28250 30350 35313 37938
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Intra OP
27 26.30.2 S1 Excision of Salivary Gland 23360 25460 29200 31825
Clinical Photograph, X-ray photo
Removal Of Submandibular Salivary Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Intra OP
28 26.30.3 S1 25680 26280 32100 32850
Gland Clinical Photograph photo
Superficial Parotoidectomy (Non- USG Neck, Fine Needle Aspiration Cytology Routine Histopathological Examination, Intra OP
29 26.31 S1 23360 25460 29200 31825
malignant) (FNAC), Clinical Photograph photo
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Intra OP
30 27.42.1 S1 Wedge Excision of Lip 15930 17130 19913 21413
Clinical Photograph photo
Wedge Excision of Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Intra OP
31 27.42.2 S1 19230 20730 24038 25913
Lip&Vermilionectomy(27.43) Clinical Photograph photo
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Intra OP
32 27.43.2 S1 Vermilionectomy 22370 23570 27963 29463
Clinical Photograph photo
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
33 27.54.2 S1 ABBE Operation 21800 23600 27250 29500
Clinical Photograph Photograph
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Scar
34 29.2 S1 Excision of Branchial Cyst 25500 27000 31875 33750
Clinical Photograph, X-ray Photo
X-ray, Clinical Photograph with IV canula in Routine Histopathological Examination, Clinical
35 29.52.1 S1 Excision of Branchial Sinus 24900 25800 31125 32250
situ Photograph
36 38.5 S1 Excision and Ligation of Varicose Veins Venous Doppler, Clinical Photograph Case Sheet with operation Notes 25620 27120 32025 33900
Upper GI endoscopy , USG Abdomen,
Color Doppler Sonography Single Study,USG
37 39.1.1 S1 Splenorenal Anastomosis Complete Haemogram, LFT(liver function 71500 73000 89375 91250
Abdomen
tests)
Upper GI endoscopy , USG Abdomen,
38 39.1.2 S1 Warren Shunt for Portal Hypertension Color Doppler Sonography Single Study 71200 72400 89000 90500
LFT(liver function tests)
Upper GI endoscopy , Procedure CD, USG USG Abdomen, Color Doppler Sonography
39 39.1.3 S1 Portocaval Anastomosis 81800 83600 102250 104500
Abdomen, LFT(liver function tests) Single Study
ACT Angiography Neck (Cartotid
Colour Doppler Study Of Neck Vessels, Routine
40 39.8.1 S1 Excision of Carotid Body Tumours Angiography)/ MRI Neck/Colour Doppler 36330 38730 45413 48413
Histopathological Examination
Study Of Neck Vessels
Routine Histopathological Examination, Clinical
41 39.92 S1 Hemangioma Scleotherapy USG local area, Clinical Photograph 9150 9150 11438 11438
Photograph
42 40.11 S1 Lymph Node Biopsy Fine Needle Aspiration Cytology (FNAC) Routine Histopathological Examination 8770 8770 10963 10963
Fine Needle Aspiration Cytology (FNAC),USG
43 40.23 S1 Axillary Lymph Node Dissection Routine Histopathological Examination 28420 29020 35525 36275
local area
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Fine Needle Aspiration Cytology (FNAC)//USG
44 40.29.1 S1 Excision of Cystic Hygroma -Extensive Routine Histopathological Examination 24740 26240 30925 32800
local area/ CT Local Area, Clinical Photograph
Resection & Anastomosis Of Small CT Scan Abdomen With Contrast, Abdomen USG Abdomen, CT Scan Abdomen With
61 45.3.2 S1 50100 52200 62625 65250
Intestine(45.9) Radiograph Supine Or Erect(1 Film) Contrast, Routine Histopathological Examination
Surgical treatment for Duodenal CT Scan Abdomen With Contrast,Upper GI Intra OP photo, Routine Histopathological
62 45.31 S1 32110 34210 40138 42763
Diverticulum endoscopy , Barium Meal Follow Through Examination, USG Abdomen
Abdomen Radiograph Supine Or Erect(1
63 45.33.1 S1 Excision of Meckel's Diverticulum Film),CT Scan Abdomen With Contrast/USG Routine Histopathological Examination 41500 43000 51875 53750
Abdomen
Abdomen Radiograph Supine Or Erect(1 USG Abdomen , Intra OP photo, Routine
Surgical treatment for Acute Intestinal
64 45.34.1 S1 Film),Barium Upper GI Study(Double Contrast) Histopathological Examination , Clinical 50100 52200 62625 65250
obstrucion
/ USG Abdomen, Clinical Photograph Photograph
Magnetic Resonance
Cholangiopancreatography (MRCP)/ERCP/ CT USG Abdomen, Intra OP photo, Routine
65 45.62 S1 Duodenectomy 40150 41650 50188 52063
Scan Abdomen With Contrast /USG Abdomen, Histopathological Examination
Biopsy
CT Scan Abdomen With Contrast/ USG
Surgical treatment for Duplication Of
66 45.63 S1 Abdomen, Abdomen Radiograph Supine Or Intra OP photo 50400 52800 63000 66000
Intestines
Erect(1 Film)
USG Abdomen, CT Scan Abdomen With
USG Abdomen , Routine Histopathological
67 45.73 S1,S6 Right Hemi Colectomy Contrast /Barium Studies/Lower GI Endoscopy, 40300 40600 50375 50750
Examination
Biopsy
USG Abdomen, CT Scan Abdomen With
USG Abdomen , Routine Histopathological
68 45.75 S1,S6 Left Hemi Colectomy Contrast /Barium Studies/Lower GI Endoscopy, 40900 41800 51125 52250
Examination
Biopsy
Barium Enema (Single Contrast\Double
Contrast), Colono Scopy, CT Scan Abdomen USG Abdomen , Routine Histopathological
69 45.81 S1 Laproscopic colectomy (Total Colectomy) 61200 62400 76500 78000
With Contrast, Chest X-Ray PA View(1 Film), Examination, WEBEX
Biopsy
USG Abdomen , CT Scan Abdomen With USG Abdomen , Routine Histopathological
70 45.82 S1 Total Colectomy 62100 64200 77625 80250
Contrast, Colonoscopy, Clinical Photograph Examination
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, Barium Studies/CT Scan Clinical Photograph of Colostomy Along With
71 46.1.1 S1 Colostomy 20890 21790 26113 27238
Abdomen With Contrast /Lower GI Endoscopy Face
Lower GI Endoscopy/USG Abdomen,CT Scan Clinical Photograph of Ileostomy Along With
72 46.2.2 S1 Ileostomy 20900 21800 26125 27250
Abdomen With Contrast Face, Routine Histopathological Examination
CT Scan Abdomen With Contrast /Barium
Clinical Photograph, Routine Histopathological
73 46.03 S1 Loop Colostomy Sigmoid Studies,Colono Scopy, Abdomen Radiograph 22100 24200 27625 30250
Examination
Supine Or Erect(1 Film)
CT Scan Abdomen With Contrast,
CT Scan Abdomen With Contrast, Routine
74 46.23 S1 Illieo Sigmoidostomy Colonoscopy, Barium Enema (Single 50100 52200 62625 65250
Histopathological Examination
Contrast\Double Contrast)
USG Abdomen, Abdomen Radiograph Supine
75 46.51.2 S1 Ileostomy Closure Or Erect(1 Film), Clinical Photograph, Case Scar Photo 25890 26790 32363 33488
sheet with clinical History
USG Abdomen, Abdomen Radiograph Supine
76 46.52.2 S1 Colostomy Closure Scar Photo 25900 26800 32375 33500
Or Erect(1 Film), Clinical Photograph
Surgical treatment For Recurrent
CT Scan Abdomen With Contrast, Abdomen USG Abdomen, Intra OP photo, Routine
77 46.62 S1 Intestinal obstruction (Noble Plication 50100 52200 62625 65250
Radiograph Supine Or Erect(1 Film) Histopathological Examination
Other)
Barium Enema (Single Contrast\Double
78 46.64 S1 Cecopexy USG Abdomen, Intra OP photo 31800 33600 39750 42000
Contrast), Colonoscopy
Surgical treatment for Acute Intestinal Abdomen Radiograph Supine Or Erect(1
79 46.73 S1 Intra OP photo 50100 52200 62625 65250
perforation Film),USG Abdomen
Fistulogram, Barium Meal Follow Through,
80 46.74 S1 Excision Small Intestinal Fistula USG Abdomen 51500 53000 64375 66250
Clinical Photograph
USG Abdomen, Abdomen Radiograph Supine Scar Photo, Routine Histopathological
81 46.80.1 S1,S8 Surgical treatment for Intususception 50100 52200 62625 65250
Or Erect(1 Film) Examination
Surgical treatment for Mal-Rotation & CT Scan Abdomen With Contrast,Abdomen Abdomen Radiograph Supine Or Erect(1 Film),
82 46.81 S1 50100 52200 62625 65250
Volvulus Of The Midgut Radiograph Supine Or Erect(1 Film) USG Abdomen
CT Scan Abdomen With Contrast, Abdomen
Surgical treatment for Volvulus of Large CT Scan Abdomen With Contrast,Abdomen
83 46.82 S1 Radiograph Supine Or Erect(1 Film),USG 50100 52200 62625 65250
bowel Radiograph Supine Or Erect(1 Film)
Abdomen
USG Abdomen, WEBEX, Scar Photo,
USG Abdomen, Complete Blood Picture
84 47.01 S1,S8 Laproscopic Appendicectomy Specimen Photo, Routine Histopathological 22110 23310 27638 29138
[CBP], Case sheet with clinical History
Examination
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, Abdomen Radiograph Supine
Clinical Photograph, Routine Histopathological
85 47.09.1 S1 Open Appendicectomy Or Erect(1 Film), Case sheet with clinical 18680 19880 23350 24850
Examination
History, Complete Blood Picture
Surgical treatment for Appendicular USG Abdomen, Scar Photo, Specimen Photo,
86 47.09.2 S1 USG Abdomen 27660 29460 34575 36825
Perforation Routine Histopathological Examination
Laproscopic Surgical treatment for USG Abdomen, Abdomen Radiograph Supine
87 47.19 S1 USG Abdomen, WEBEX 30900 31800 38625 39750
Appendicular Mass-Abscess Or Erect(1 Film)
Clinical Photograph, Routine Histopathological
88 48.3 S1 Excision of Prolapse of Rectal Mass Clinical Photograph 27170 28670 33963 35838
Examination
89 48.9 S1 Anorectoplasty USG Abdomen, Clinical Photograph Clinical Photograph 28150 30250 35188 37813
Clinical Photograph, Proctoscopy, USG Clinical Photograph, Routine Histopathological
90 48.35 S1 Excision of Papilloma Rectum 21160 22660 26450 28325
Abdomen, Colonoscopy Examination
Barium Enema (Single Contrast\Double
91 48.49 S1 Pull Through Abdominal Resection Contrast), Invertogram AP/ LAT, Clinical USG Abdomen, Clinical Photograph 52100 54200 65125 67750
Photograph
Colonoscopy/Barium Enema (Single
Routine Histopathological Examination, Intra OP
92 48.62.1 S1 Anterior Resection of Rectum Contrast\Double Contrast),Barium Studies, 52100 54200 65125 67750
photo
Clinical Photograph, Biopsy
Clinical Photograph, Routine Histopathological
93 48.73 S1 Fistulectomy Fistulogram, Clinical Photograph 15600 16200 19500 20250
Examination
Barium Enema (Single Contrast\Double
Rectopexy Open with Mesh for Rectal
94 48.75.1 S1,S6,S8 Contrast), Sigmoidoscopy (REGID), USG USG Abdomen 41800 43600 52250 54500
Prolapse
Abdomen, Clinical Photograph
Laproscopic Rectopexy With Mesh for Colonoscopy/Sigmoidoscopy (REGID), USG
95 48.75.2 S1,S6,S8 USG Abdomen, Clinical Photograph, WEBEX 51800 53600 64750 67000
Rectal Prolapse Abdomen, Clinical Photograph
Colonoscopy/Sigmoidoscopy (REGID) /
Rectopexy Open without Mesh for Rectal
96 48.75.3 S1,S6,S8 Defacogram, USG Abdomen, Clinical USG Abdomen, Clinical Photograph 31800 33600 39750 42000
Prolapse
Photograph
USG Abdomen, CT Pelvis ,Colonoscopy, Chest USG Abdomen, Clinical Photograph, WEBEX,
97 48.75.5 S1 Laproscopic Rectopexy With Repair 41200 42400 51500 53000
X-Ray PA View(1 Film) Routine Histopathological Examination
USG Abdomen, PUS Culture & Sensitivity,
98 49.01 S1 Drainage of Ischio Rectal Abscess Screening for Human Immunodeficiency Virus Intra OP photo 16500 18000 20625 22500
(HIV) 1 & 2, HBsAg
99 49.3 S1 Fissurectomy Proctosopy Routine Histopathological Examination 15600 16200 19500 20250
100 49.45 S1 Lord's Procedure for Haemorrhoids USG Abdomen, Proctoscopy,Colonoscopy Intra OP photo 10290 10590 12863 13238
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Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, Routine Histopathological
101 49.46.1 S1 Haemorroidectomy Proctosopy, Clinical Photograph 22670 24170 28338 30213
Examination
Lower GI Endoscopy, Abdomen Radiograph
102 49.46.2 S1 Haemorroidectomy+ Fistulectomy(49.12) Routine Histopathological Examination 27640 30040 34550 37550
Supine Or Erect(1 Film),USG Abdomen
103 50.29.1 S1 Excision of liver Abscess USG Abdomen USG Abdomen 32100 34200 40125 42750
Surgical treatment For Hydatid cyst of Routine Histopathological Examination, USG
104 50.29.2 S1,S8 USG Abdomen, LFT(liver function tests) 40300 40600 50375 50750
Liver Abdomen
CT Scan Abdomen Without Contrast, USG Routine Histopathological Examination, CT
105 51.02 S1 Cholecystostomy 31760 33860 39700 42325
Abdomen, Chest X-Ray PA View(1 Film) Scan Abdomen Without Contrast
Magnetic Resonance
Cholangiopancreatography (MRCP) /USG
106 51.7 S1 Repair Of CBD USG Abdomen 49500 51000 61875 63750
Abdomen/CT scan Lower Abdomen Without
Contrast
USG Abdomen, MR Cholangiography, CT scan
USG Abdomen, CT scan Lower Abdomen
Cholecystectomy With CBD Exploration Lower Abdomen Without Contrast/CT Scan
107 51.22.1 S1 Without Contrast/CT Scan Abdomen Without 41800 43600 52250 54500
(51.41) Abdomen Without Contrast, Routine
Contrast, LFT(liver function tests)
Histopathological Examination
Routine Histopathological Examination, USG
USG Abdomen, CT scan Lower Abdomen
Laproscopic Cholecystectomy With CBD Abdomen/CT scan Lower Abdomen Without
108 51.22.2 S1 Without Contrast/CT Scan Abdomen Without 30600 31200 38250 39000
Exploration (51.41) Contrast/CT Scan Abdomen Without Contrast,
Contrast, LFT(liver function tests)
CT Scan Abdomen With Contrast , WEBEX
Routine Histopathological Examination, CT scan
USG Abdomen, CT scan Lower Abdomen
Lower Abdomen Without Contrast/CT Scan
109 51.22.3 S1,S6 Cholecystectomy Without Contrast/CT Scan Abdomen Without 25300 25600 31625 32000
Abdomen Without Contrast, CT Scan Abdomen
Contrast, LFT(liver function tests)
With Contrast ,
USG Abdomen, Showing Calculus, LFT(liver Routine Histopathological Examination, USG
110 51.22.4 S1,S6,S8 Laproscopic Cholecystectomy 30300 30600 37875 38250
function tests) Abdomen, WEBEX
Laproscopic Cholecystectomy With Routine Histopathological Examination, USG
111 51.22.5 S1 USG Abdomen, LFT(liver function tests) 30600 31200 38250 39000
Gargrene Abdomen, WEBEX
USG Abdomen/CT scan Lower Abdomen
Laproscopic Cholecystectomy For Without Contrast/CT Scan Abdomen Without Routine Histopathological Examination, USG
112 51.22.6 S1 30600 31200 38250 39000
Calculus Contrast, CT Scan Abdomen With Contrast , Abdomen
LFT(liver function tests)
USG Abdomen/CT scan Lower Abdomen
Laproscopic Cholecystectomy With CBD Without Contrast/CT Scan Abdomen Without Routine Histopathological Examination, USG
113 51.22.7 S1 40600 41200 50750 51500
Repair Contrast, CT Scan Abdomen With Contrast , Abdomen
LFT(liver function tests)
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
CT scan Lower Abdomen Without Contrast/CT
Routine Histopathological Examination, CT scan
Scan Abdomen Without Contrast, ERCP, Upper
114 52.4.2 S1,S6 Pancreaticocystojejunostomy Lower Abdomen Without Contrast/CT Scan 51800 53600 64750 67000
GI endoscopy, USG Abdomen , LFT(liver
Abdomen With Contrast ,USG Abdomen,
function tests)
CT scan Lower Abdomen Without Contrast/CT
CT scan Lower Abdomen Without Contrast/CT
Scan Abdomen Without Contrast, USG
Scan Abdomen Without Contrast, CT Scan
115 52.4.4 S1,S6 Pancreaticocystogastrostomy Abdomen, Magnetic Resonance 43430 44930 54288 56163
Abdomen With Contrast, USG Abdomen ,
Cholangiopancreatography (MRCP), USG
Routine Histopathological Examination
Abdomen, LFT(liver function tests)
Herinoplasty without Mesh for Direct USG Abdomen,Chest X-Ray PA View(1 Film),
116 53.01 S1 Scar Photo 20900 21800 26125 27250
Inguinal Hernia Clinical Photograph
USG Abdomen/CT scan Lower Abdomen
Herinoplasty with Mesh Direct Inguinal USG Abdomen,Chest X-Ray PA View(1 Film), Without Contrast/CT Scan Abdomen Without
117 53.03 S1 25900 26800 32375 33500
Hernia Clinical Photograph Contrast/CT Scan Abdomen With Contrast,
Mesh Fixation Photo With Face
Routine Histopathological Examination, USG
Abdomen Radiograph Supine Or Erect(1 Film),
Abdomen/CT scan Lower Abdomen Without
Laproscopic Surgical treatment for USG Abdomen, CT scan Lower Abdomen
118 53.04 S1 Contrast/CT Scan Abdomen Without 30600 31200 38250 39000
Unilateral Femoral Hernia With Mesh Without Contrast, CT Scan Of Lower Abdomen
Contrast/CT Scan Abdomen With Contrast,
& Scrotum, USG Scrotum, Clinical Photograph
WEBEX
USG Abdomen, CT scan Lower Abdomen
Rare Hernias repair Without Contrast/CT Scan Abdomen Without
119 53.9.1 S1 USG Abdomen 21500 23000 26875 28750
(Spigalion,Obuturator,Sciatic) Contrast/CT Scan Abdomen With Contrast,
ECHO Cardiogram, Clinical Photograph
USG Abdomen/CT scan Lower Abdomen
USG Abdomen/CT scan Lower Abdomen
Laproscopic Surgical treatment for Without Contrast/CT Scan Abdomen Without
120 53.29.1 S1 Without Contrast, MRI Abdomen Without 40600 41200 50750 51500
Unilateral Femoral Hernia Without Mesh Contrast/CT Scan Abdomen With Contrast,
Contrast
WEBEX
USG Abdomen/CT Scan Abdomen With
121 53.29.2 S1 Unilateral Femoral Hernia repair USG Abdomen, Clinical Photograph 26500 28000 33125 35000
Contrast, Routine Histopathological Examination
USG Abdomen/CT scan Lower Abdomen USG Abdomen/CT scan Lower Abdomen
Without Contrast/CT Scan Abdomen Without Without Contrast/CT Scan Abdomen Without
122 53.41 S1 Umbilical Hernia repair with Mesh 31490 32990 39363 41238
Contrast/CT Scan Abdomen With Contrast, Contrast/CT Scan Abdomen With Contrast,
Clinical Photograph WEBEX
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S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, CT scan Lower Abdomen Routine Histopathological Examination, USG
Laproscopic Surgical treatment for - Without Contrast/CT Scan Abdomen Without Abdomen/CT scan Lower Abdomen Without
123 53.42.1 S1 50600 51200 63250 64000
Umbilical Hernia With Mesh Contrast, ECHO Cardiogram, Clinical Contrast/CT Scan Abdomen With Contrast/CT
Photograph Scan Abdomen Without Contrast
USG Abdomen/CT scan Lower Abdomen
124 53.49.1 S1 Umbilical Hernia repair without Mesh USG Abdomen, Clinical Photograph Without Contrast/CT Scan Abdomen With 26490 27990 33113 34988
Contrast/CT Scan Abdomen Without Contrast
Routine Histopathological Examination, USG
Laproscopic Surgical treatment for USG Abdomen, ECHO Cardiogram, Clinical Abdomen/CT scan Lower Abdomen Without
125 53.51.1 S1 30600 31200 38250 39000
Incisional Hernia without Mesh Photograph Contrast/CT Scan Abdomen With Contrast/CT
Scan Abdomen Without Contrast, WEBEX
USG Abdomen/CT scan Lower Abdomen
126 53.59.1 S1 Epigastric Hernia repair without Mesh USG Abdomen, Clinical Photograph Without Contrast/CT Scan Abdomen With 26500 28000 33125 35000
Contrast/CT Scan Abdomen Without Contrast
USG Abdomen/CT scan Lower Abdomen
USG Abdomen/CT scan Lower Abdomen
Ventral And Scar Hernia repair without Without Contrast/CT Scan Abdomen With
127 53.59.2 S1 Without Contrast/CT Scan Abdomen With 31500 33000 39375 41250
Mesh Contrast/CT Scan Abdomen Without Contrast,
Contrast/CT Scan Abdomen Without Contrast
Clinical Photograph
USG Abdomen/CT scan Lower Abdomen USG Abdomen/CT scan Lower Abdomen
Laproscopic Surgical treatment for Without Contrast/CT Scan Abdomen Without Without Contrast/CT Scan Abdomen Without
128 53.62 S1 40600 41200 50750 51500
Incisional Hernia with Mesh Contrast, ECHO Cardiogram, Clinical Contrast/CT Scan Abdomen With Contrast,
Photograph WEBEX
Routine Histopathological Examination, USG
USG Abdomen/CT scan Lower Abdomen
Abdomen/CT scan Lower Abdomen Without
Laproscopic Surgical treatment for Without Contrast/CT Scan Abdomen Without
129 53.63 S1 Contrast/CT Scan Abdomen Without 50600 51200 63250 64000
Epigastric Hernia repair with Mesh Contrast, ECHO Cardiogram, Clinical
Contrast/CT Scan Abdomen With Contrast,
Photograph
WEBEX
USG Abdomen/CT scan Lower Abdomen
USG Abdomen/CT scan Lower Abdomen
Without Contrast/CT Scan Abdomen With
130 53.69.1 S1 Epigastric Hernia repair with Mesh Without Contrast/CT Scan Abdomen With 41490 42990 51863 53738
Contrast/CT Scan Abdomen Without Contrast,
Contrast/CT Scan Abdomen Without Contrast
Clinical Photograph
USG Abdomen/CT scan Lower Abdomen
USG Abdomen/CT scan Lower Abdomen
Ventral And Scar Hernia repair with Without Contrast/CT Scan Abdomen With
131 53.69.2 S1 Without Contrast/CT Scan Abdomen With 41500 43000 51875 53750
Mesh Contrast/CT Scan Abdomen Without Contrast,
Contrast/CT Scan Abdomen Without Contrast
Clinical Photograph
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S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, CT scan Lower Abdomen USG Abdomen/CT scan Lower Abdomen
Laproscopic Surgical treatment for Hiatus Without Contrast/CT Scan Abdomen Without Without Contrast/CT Scan Abdomen With
132 53.71.1 S1 50600 51200 63250 64000
Hernia With Mesh Contrast, ECHO Cardiogram, Clinical Contrast/CT Scan Abdomen Without Contrast,
Photograph WEBEX
USG Abdomen, CT scan Lower Abdomen USG Abdomen/CT scan Lower Abdomen
133 53.72 S1 Hiatus Hernia Repair - Abdominal Without Contrast/CT Scan Abdomen Without Without Contrast/CT Scan Abdomen Without 49800 51600 62250 64500
Contrast Contrast/CT Scan Abdomen With Contrast
Chest X-Ray PA View(1 Film), Abdomen
USG Abdomen/CT scan Lower Abdomen
Radiograph Supine Or Erect(1 Film)/USG
134 54.0.1 S1 Drainage of Perigastric Abscess Without Contrast/CT Scan Abdomen With 37230 39330 46538 49163
Abdomen/CT scan Lower Abdomen Without
Contrast, Routine Histopathological Examination
Contrast
Abdomen Radiograph Supine Or Erect(1 Film),
USG Abdomen, CT scan Lower Abdomen
135 54.0.2 S1 Drainage of Subdiaphragmatic Abscess USG Abdomen 31660 34060 39575 42575
Without Contrast/CT Scan Abdomen Without
Contrast , Chest X-Ray PA View(1 Film)
USG Abdomen, CT Pelvis, Abdomen
136 54.0.3 S1 Open Drainage of Pelvic Abscess Radiograph Supine Or Erect(1 Film), CT Scan USG Abdomen 30060 32760 37575 40950
Abdomen Without Contrast
USG Abdomen/CT scan Lower Abdomen
Laproscopic Surgical treatment for Intra USG Abdomen, Routine Histopathological
137 54.0.4 S1 Without Contrast/CT Scan Abdomen Without 35600 36200 44500 45250
Abdominal Abscess Examination, WEBEX
Contrast/CT Scan Abdomen With Contrast
USG Abdomen/CT scan Lower Abdomen
USG Abdomen, Fine Needle Aspiration
138 54.3.4 S1 Excision of Umbillical Sinus Without Contrast/CT Scan Abdomen Without 18200 19700 22750 24625
Cytology (FNAC)
Contrast, Routine Histopathological Examination
Routine Histopathological Examination, USG
USG Abdomen, CT scan Lower Abdomen
139 54.4.1 S1 Excision of Mesenteric Cyst Abdomen/CT scan Lower Abdomen Without 33660 36060 42075 45075
Without Contrast, Plain Abdomen X-Ray
Contrast/CT Scan Abdomen With Contrast
USG Abdomen/CT scan Lower Abdomen
Surgical treatment for Minor Abdominal Without Contrast/CT Scan Abdomen With
140 54.7.2 S1 USG Abdomen 21490 22690 26863 28363
Injuries Contrast/CT Scan Abdomen Without Contrast/
ECHO Cardiogram, Plain Abdomen X-Ray
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen/CT scan Lower Abdomen
Without Contrast/CT Scan Abdomen With
Surgical treatment for Major Abdominal
141 54.7.3 S1 Contrast/CT Scan Abdomen Without Contrast, USG Abdomen 52100 54200 65125 67750
Injuries
Abdomen Radiograph Supine Or Erect(1 Film),
Plain Abdomen X-Ray
USG Abdomen/CT scan Lower Abdomen Routine Histopathological Examination, USG
Without Contrast/CT Scan Abdomen With Abdomen/CT scan Lower Abdomen Without
142 54.7.4 S1 Surgical treatment for Burst Abdomen 51500 53000 64375 66250
Contrast/CT Scan Abdomen Without Contrast, Contrast/CT Scan Abdomen With Contrast/CT
Plain Abdomen X-Ray Scan Abdomen Without Contrast
Treatment with Self Expanding Metalic Venous Doppler, ECHO Cardiogram, High
143 54.99.1 S1 CT Scan Scan,USG, Biopsy report 21020 21620 26275 27025
Stent (SEMS) Resolution CT Chest
Surgical treatment for Unilateral USG Abdomen, CT Scan Of Lower Abdomen USG Abdomen, Routine Histopathological
144 61.2.1 S1 18410 19910 23013 24888
Hydrocoele & Scrotum, Clinical Photograph Examination
Surgical treatment for Bilateral USG Abdomen, CT Scan Of Lower Abdomen
145 61.2.2 S1 Routine Histopathological Examination 20140 21640 25175 27050
Hydrocoele & Scrotum, Clinical Photograph
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, Routine Histopathological
146 61.3.2 S1 Surgical treatment for Fourniers Gangrene 34190 38390 42738 47988
With Contrast, Clinical Photograph Examination
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, Routine Histopathological
147 61.3.3 S1 Surgical treatment for Filarial Scrotum 27100 29200 33875 36500
With Contrast, Clinical Photograph Examination
USG Abdomen, Routine Histopathological
148 61.3.4 S1 Excision of multiple Scrotal swellings USG Abdomen, Clinical Photograph 9130 9430 11413 11788
Examination
USG Abdomen, CT Scan Of Lower Abdomen USG Abdomen, CT Scan Of Lower Abdomen &
149 61.92 S1 Evacuation of Scrotal Hematoma 20660 22760 25825 28450
& Scrotum Scrotum
USG Abdomen, CT Scan Of Lower Abdomen
150 61.99 S1 Excision of multiple Scrotal Cysts Routine Histopathological Examination 8550 8850 10688 11063
& Scrotum, Clinical Photograph
USG-Doppler Abdomen, CT Scan Of Lower
Abdomen & Scrotum, Abdomen And Pelvis For USG Abdomen, Routine Histopathological
151 62.3.1 S1,S9 Orchidectomy -Unilateral 23500 25000 29375 31250
Kidneys, Ureters, And Bladder (KUB), Clinical Examination
Photograph
USG Abdomen, CT Scan Of Lower Abdomen USG Abdomen, Routine Histopathological
152 62.3.4 S1 Orchidectomy + Herniorraphy(53.00) 31500 33000 39375 41250
& Scrotum, Clinical Photograph Examination
USG-Doppler Abdomen, CT Scan Of Lower USG Abdomen, Routine Histopathological
153 62.5.1 S1 Orchidopexy with Eversion of Sac 27100 29200 33875 36500
Abdomen & Scrotum, Clinical Photograph Examination
USG Abdomen/ CT Scan Lower Abdomen USG Abdomen, Routine Histopathological
154 63.1.4 S1 Laproscopic Excision of Varicocele Cyst 41200 42400 51500 53000
With Contrast/ CT Pelvis, Clinical Photograph Examination, WEBEX
CT Scan Of Lower Abdomen & Scrotum, USG
155 63.2 S1 Excision of Epididymal Cyst Routine Histopathological Examination 16200 17400 20250 21750
Abdomen
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CT Scan Of Lower Abdomen & Scrotum, USG
CT Scan Of Lower Abdomen & Scrotum, USG
156 63.4 S1 Epididectomy Abdomen, Routine Histopathological 15900 16800 19875 21000
Abdomen
Examination
157 64.0 S1 Circumcision USG Abdomen, Clinical Photograph Routine Histopathological Examination 8500 8800 10625 11000
Dorsal Slit and Reduction of
158 64.91 S1 USG Penis, Clinical Photograph Routine Histopathological Examination 9440 10040 11800 12550
Paraphimosis
Rectovaginal fistula Management without CT scan Lower Abdomen Without Contrast/
159 70.73.2 S1,S4,S6 USG Abdomen 40900 43000 51125 53750
Colostomy USG Abdomen, Colonoscopy
X-Ray Facial Bones/ Routine Histopathological
160 76.31.1 S1 Hemimandibulectomy X-Ray Facial Bones 45780 48780 57225 60975
Examination
X-Ray Facial Bones, Orthopantomography X-Ray Facial Bones/ Routine Histopathological
161 76.31.4 S1,S11 Segmental Mandible Excision 37140 39540 46425 49425
(OPG) Examination
Surgical treatment for Infected Bunion
162 77.5 S1 X- Ray Foot, Clinical Photograph X- Ray Foot, Clinical Photograph 4800 5100 6000 6375
Foot
Color Doppler Sonography Single Study / X- Color Doppler Sonography Single Study / X-Ray
163 77.91 S1 Excision of Cervical Rib 28380 29880 35475 37350
Ray Thoracic inlet- AP view Dorso Lumbar Spine
X-Ray, X-Ray Dorso Lumbar Spine, USG Routine Histopathological Examination, Contrast
164 83.95.1 S1 Drainage of Psoas Abscess 19470 21570 24338 26963
Abdomen Enhanced USG
Routine Histopathological Examination, Clinical
165 85.21.1 S1 Excision of Mammary Fistula Fistulogram, Clinical Photograph 16140 18240 20175 22800
Photograph
Chest X-Ray PA View(1 Film), USG Breast,
166 85.21.2 S1 Wide Excision of Mammary Fistula Clinical Photograph 14020 15220 17525 19025
CT Local Area, Clinical Photograph
Fine Needle Aspiration Cytology (FNAC) ,
167 85.21.3 S1 Excision of Bilateral Fibroadenoma Chest X-Ray PA View(1 Film), USG Breast, Routine Histopathological Examination 15600 16200 19500 20250
Clinical Photograph
Fine Needle Aspiration Cytology (FNAC) ,
168 85.21.4 S1 Excision of Unilateral Fibroadenoma Routine Histopathological Examination 10300 10600 12875 13250
Clinical Photograph
Chest X-Ray PA View(1 Film)/ X- Ray
169 85.21.5 S1 Unilateral Lumpectomy Routine Histopathological Examination 10600 11200 13250 14000
Mammogram, Clinical Photograph
Chest X-Ray PA View(1 Film)/ X- Ray
170 85.21.6 S1 Bilateral Lumpectomy Routine Histopathological Examination 15900 16800 19875 21000
Mammogram, Clinical Photograph
Chest X-Ray PA View(1 Film), USG Breast,
171 85.21.7 S1 Breast Conservation Surgery Clinical Photograph 16200 17400 20250 21750
Clinical Photograph
Fine Needle Aspiration Cytology (FNAC), X-
172 85.22.2 S1 Segmental Resection of Breast Routine Histopathological Examination 15760 16660 19700 20825
Ray Mammogram, Clinical Photograph
X- Ray Mammogram / USG Breast, Fine
173 85.41.1 S1 Simple Mastectomy (Non Malignant) Routine Histopathological Examination 32100 34200 40125 42750
Needle Aspiration Cytology (FNAC)
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Hospitals Hospitals Hospitals Hospitals
Fine Needle Aspiration Cytology (FNAC) ,
174 85.44 S1 Surgical repair of bilateral Gynaecomastia Clinical Photograph 12700 13600 15875 17000
USG Breast, Clinical Photograph
Fine Needle Aspiration Cytology (FNAC) ,
175 85.91 S1 I & D of Breast Abscess Clinical Photograph 9240 9540 11550 11925
USG Breast, Clinical Photograph
176 86.01.1 S1 Drainage of large Abscess Contrast Enhanced USG, Clinical Photograph Clinical Photograph 20120 21920 25150 27400
177 86.01.2 S1 Paronychia Drainage Clinical Photograph Clinical Photograph 6820 6820 8525 8525
Fine Needle Aspiration Cytology (FNAC), USG
178 86.3.3 S1 Excision of swelling Neck Routine Histopathological Examination 11430 11730 14288 14663
Neck, Clinical Photograph
179 86.3.5 S1 Excision of Granuloma Contrast Enhanced USG, Clinical Photograph Routine Histopathological Examination 10510 11110 13138 13888
Fine Needle Aspiration Cytology (FNAC),
180 86.3.6 S1 Surgical treatment for Carbuncle back Clinical Photograph 30490 34690 38113 43363
Clinical Photograph, RBS
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
181 86.3.7 S1 Excision of Sebaceous Cyst 9270 9570 11588 11963
Clinical Photograph, RBS Photograph
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
182 86.3.8 S1 Excision of Keloid 28000 30700 35000 38375
Clinical Photograph,RBS Photograph
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
183 86.3.9 S1 Excision of Pyogenic Granuloma 8310 8910 10388 11138
Clinical Photograph,RBS Photograph
Routine Histopathological Examination, Clinical
184 86.3.12 S1 Excision of Large Corn Clinical Photograph 5720 6020 7150 7525
Photograph
185 86.3.16 S1 Excision of Large Swelling in Hand X-Ray, Clinical Photograph Routine Histopathological Examination, X-Ray 15720 16020 19650 20025
186 86.3.17 S1 Excision of Small Swelling in Hand X-Ray, Clinical Photograph Routine Histopathological Examination, X-Ray 11070 11370 13838 14213
Contrast Enhanced USG, X-Ray, Clinical
187 86.3.18 S1 Excision of Fibro Lipoma Routine Histopathological Examination 9250 9550 11563 11938
Photograph
188 86.3.19 S1 Excision of Fibroma Contrast Enhanced USG, Clinical Photograph Routine Histopathological Examination 9180 9180 11475 11475
189 86.3.20 S1 Excision of Sinus Sinography, Clinical Photograph Routine Histopathological Examination 18050 19250 22563 24063
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
190 86.3.21 S1 Excision of Large Dermoid Cyst 11280 12180 14100 15225
Clinical Photograph Photograph
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Clinical
191 86.3.22 S1 Excision of Small Dermoid Cyst 7230 7530 9038 9413
Clinical Photograph Photograph
Fine Needle Aspiration Cytology (FNAC),
192 86.4.4 S1 Wide Local Excision (Non - malignant) Routine Histopathological Examination 36550 38650 45688 48313
Clinical Photograph, RBS
Contrast Enhanced USG, CT local Area,
193 86.05 S1 Foreign Body Removal in Deep Region Contrast Enhanced USG, CT local Area 30720 32820 38400 41025
Clinical Photograph
194 86.6 S1 Skin Grafting Clinical Photograph Clinical Photograph 18420 20520 23025 25650
Routine Histopathological Examination, Clinical
195 86.21.1 S1 Excision of Pilonidal Sinus Clinical Photograph 19250 21350 24063 26688
Photograph, Scar Photo
196 86.23 S1 Surgical treatment for Ingrowing Nail X-Ray, Clinical Photograph Clinical Photograph 6950 7250 8688 9063
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Code
Hospitals Hospitals Hospitals Hospitals
Contrast Enhanced USG, X-Ray, Clinical
197 86.89.1 S1 Surgical treatment for Cut Throat Injury Clinical Photograph 35380 37480 44225 46850
Photograph
S2 ENT SURGERY
198 04.42.2 S2 Facial Nerve Decompression 3D CT Facial Bones,Nerve conduction study Case Sheet with operation Notes 20590 21190 25738 26488
NLD probing(single eye), Endoscopic
199 09.53 S2 Endoscopic Surgery for Dacrocystitis NLD probing(single eye),Dacryocystography 10500 11100 13125 13875
Photograph, DNE Photo
200 18.21.1 S2 Surgical treatment for Preauricular sinus Clinical Photograph Scar Photo 18550 18550 23188 23188
201 18.29 S2 Cryosurgery Case sheet with clinical History Intra OP photo 11260 11560 14075 14450
Partial amputation of Pinna (malignancy
202 18.39 S2 CT Scan Ear Routine Histopathological Examination 19520 21620 24400 27025
perichondritis)
203 19.4.1 S2 Myringoplasty Pure Tone Audiometry Pure Tone Audiometry 16580 18080 20725 22600
Pure Tone Audiometry, Impedances
Audiometry(With Stepedeal Reflex) , X-Ray Of
204 19.4.2 S2 Myringoplasty with ossiculoplasty (19.3) X-Ray Of Both Mastoids 17300 17600 21625 22000
Both Mastoids, OTO endoscopy/ OTO
Endoscopy Photos
Pure Tone Audiometry, Impedances
Audiometry(With Stepedeal Reflex) , X-Ray Of
205 19.5 S2 Tympanoplasty Pure Tone Audiometry, Scar and Graft Photos 17400 18300 21750 22875
Both Mastoids, OTO endoscopy/ OTO
Endoscopy Photos
Impedances Audiometry(With Stepedeal
Pure Tone Audiometry After 3 Weeks, Clinical
206 19.11 S2 Stapedectomy - Veingraft Reflex), Pure Tone Audiometry, OTO 18890 19790 23613 24738
Photo With Piston + Vein Graft
endoscopy/ OTO Endoscopy Photos
Pure Tone Audiometry, Impedances Pure Tone Audiometry, Impedances
207 20.01.1 S2 Myringotomy with grommet for one ear Audiometry(With Stepedeal Reflex) ,OTO Audiometry(With Stepedeal Reflex) , Grommet 10300 10600 12875 13250
endoscopy/ OTO Endoscopy Photos in Positoin Photo.
Pure Tone Audiometry, Impedances Pure Tone Audiometry, Impedances
Myrinogotomy with-grommet for both
208 20.01.2 S2 Audiometry(With Stepedeal Reflex) ,OTO Audiometry(With Stepedeal Reflex) , Grommet 15600 16200 19500 20250
ears
endoscopy/ OTO Endoscopy Photos in Positoin Photo.
Pure Tone Audiometry, Impedances
Pure Tone Audiometry, Impedances
Audiometry(With Stepedeal Reflex) , X-Ray Of
209 20.4 S2 Mastoidectomy Audiometry(With Stepedeal Reflex) , X-Ray Of 18600 20700 23250 25875
Both Mastoids, OTO endoscopy/ OTO
Both Mastoids After 6 Weeks, Scar Photo.
Endoscopy Photos
Pure Tone Audiometry, OTO endoscopy/ OTO Routine Histopathological Examination, OTO
210 20.51 S2 Aural polypectomy 17400 18300 21750 22875
Endoscopy Photos endoscopy/ OTO Endoscopy Photos
Pure Tone Audiometry, MRI Scan Head &
211 20.79.1 S2 Labyrinthectomy Case Sheet with operation Notes 19990 19990 24988 24988
Neck Without Contrast
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Code
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Scar Photo, Routine Histopathological
212 21.1 S2 lateral Rhinotomy CT of Nose \ Nasopharynx 15600 16200 19500 20250
Examination
CT of Nose \ Nasopharynx, CT PNS With
Contrast9,DNL(Direct Nasal Laryngoscopy) \ Routine Histopathological Examination, DNE
213 21.3 S2 Excision of Benign tumours of Nose 17390 19790 21738 24738
DNE -Including Biopsy Under GI , Nasal Photo , WEBEX
Endoscopy
CT of Nose \ Nasopharynx, CT PNS With CT of Nose \ Nasopharynx, CT PNS With
214 21.32 S2 Surgery for Angiofibroma Contrast9,DNL(Direct Nasal Laryngoscopy) \ Contrast9,Routine Histopathological 42100 44200 52625 55250
DNE -Including Biopsy Under GI Examination , WEBEX
X-Ray Nasopharynx, DNE PHOTO 3 WEEKS
215 21.84 S2 Septo rhinoplasty X-Ray Nasopharynx, PRE DNE PHOTO 19090 19690 23863 24613
AFTER SURGERY , WEBEX Video.
216 21.88 S2 Youngs operation PRE DNE PHOTO Clinical Photograph 14600 15200 18250 19000
217 21.99 S2 Surgical treatment for Choanal atresia Nasal endoscopy Nasal endoscopy,WEBEX 15000 15000 18750 18750
CT Scan Of Nasal Sinus,CT PNS Without
218 22.5 S2 Endoscopic Sinus Surgery X-Ray PNS, WEBEX, Nasal endoscopy 18290 20090 22863 25113
Contrast, Nasal endoscopy
CT Scan Of Nasal Sinus,CT PNS Without Routine Histopathological Examination,
219 22.39 S2,S18 Caldwell-luc(unilateral) Contrast,DNL(Direct Nasal Laryngoscopy) DNL(Direct Nasal Laryngoscopy) \DNE - 18190 19390 22738 24238
\DNE -Including Biopsy Under GI Including Biopsy Under GI , WEBEX
220 22.71 S2 Surgical treatment for Oro antral fistula X-Ray Nasopharynx, PRE DNE PHOTO X-Ray Nasopharynx 15000 15000 18750 18750
Surgical treatment for release of tongue
221 25.93 S2,S8,S14 Clinical Photograph Clinical Photograph 9990 9990 12488 12488
tie
Fine Needle Aspiration Cytology (FNAC), Routine Histopathological Examination, Scar
222 26.2 S2 Excision of Benign Parotid gland tumor 20590 21190 25738 26488
Clinical Photograph Photo
X-Ray Nasopharynx, Clinical Photograph, PUS
223 27.0 S2 Drainage Parapharyngeal abscess X-Ray Nasopharynx 10300 10600 12875 13250
Culture & Sensitivity
Poly Somnograph, DNL(Direct Nasal
DNL(Direct Nasal Laryngoscopy) \ DNE -
224 27.7 S2 Uvulo ¿ Palato - Pharyngoplasty Laryngoscopy) \ DNE -Including Biopsy Under 26190 27390 32738 34238
Including Biopsy Under GI
GI
Surgical treatment for Pararetro X-Ray Nasopharynx, Clinical Photograph, PUS
225 27.49.1 S2 X-Ray Nasopharynx 9990 9990 12488 12488
pharyngeal abscess Culture & Sensitivity
226 28.3 S2 Adeno tonsillectomy Surgical profile report Clinical Photograph 12000 12000 15000 15000
Pure tone audiometry, Impedances audiometry, Pure tone audio metry, impedances audiometry,
227 28.6.1 S2 Adenoidectomy Gromet insertion 12100 14200 15125 17750
OTO endoscopy/ OTO Endoscopy Photos Post OP Grommet in Positoin Photo
Laryngoscopy, CT of Nose \ Nasopharynx, Routine Histopathological Examination, Scar
228 29.39.1 S2 Exision of Tumors In Pharynx 20890 21790 26113 27238
WEBEX Photo
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Code
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DNL(Direct Nasal Laryngoscopy) \ DNE -
Laryngoscopy, CT of Nose \ Nasopharynx,
229 29.39.2 S2 Exision of Parapharyngeal Tumour Including Biopsy Under GI,Routine 21500 23000 26875 28750
WEBEX
Histopathological Examination
CT Scan Neck Includes Chest And Larynx
,DNL(Direct Nasal Laryngoscopy) / DNE -
230 30.3 S2 Laryngectomy in nonmalignant conditions Including Biopsy Under GI,DNL(Direct Nasal Routine Histopathological Examination 42990 45990 53738 57488
Laryngoscopy) / DNE -Including Biopsy Under
GI
CT Scan Neck Includes Chest And Larynx/
Dynamic MRI/Functional MRI, DNL(Direct
Nasal Laryngoscopy)/ DNE -Including Biopsy DNL(Direct Nasal Laryngoscopy) \ DNE -
231 30.22 S2 Phono Surgery For Vocal Cord Paralysis 27400 29800 34250 37250
Under GI, DNL(Direct Nasal Laryngoscopy)/ Including Biopsy Under GI, WEBEX
DNE -Including Biopsy Under GI, Nasal
Endoscopy . WEBEX
CT Scan Neck Includes Chest And Larynx,
DNL(Direct Nasal Laryngoscopy) \ DNE -
232 31.62 S2 Laryngo Fissurectomy DNL(Direct Nasal Laryngoscopy) / DNE - 27320 29720 34150 37150
Including Biopsy Under GI
Including Biopsy Under GI
DNL(Direct Nasal Laryngoscopy) \ DNE - DNL(Direct Nasal Laryngoscopy) \ DNE -
233 31.98.1 S2 Microlaryngeal Surgery 19440 20640 24300 25800
Including Biopsy Under GI, Nasal endoscopy Including Biopsy Under GI
CT Scan Neck Includes Chest And Larynx,
Surgical treatment for Laryngotracheal DNL(Direct Nasal Laryngoscopy) \ DNE -
234 31.98.2 S2 DNL(Direct Nasal Laryngoscopy) \ DNE - 20900 21800 26125 27250
stenosis Including Biopsy Under GI
Including Biopsy Under GI
3D CT Facial Bones/ MRI Local Area,Routine
235 76.5.1 S2 Bilateral Styloidectomy 3D CT Facial Bones. 15900 16800 19875 21000
Histopathological Examination.
236 76.45 S2 Temporal Bone Excision 3D CT Facial Bones 3D CT Facial Bones/MRI Local Area 52100 54200 65125 67750
237 76.79 S2 Exision of Maxilla 3D CT Facial Bones 3D CT Facial Bones 39490 42490 49363 53113
238 96.52 S2 Removal of Impacted Ear wax Clinical Photograph Clinical Photograph 9700 10300 12125 12875
239 96.53.1 S2 Rhinorrhoea- repair CT PNS Without Contrast, Clinical Photograph CT PNS Without Contrast, Clinical Photograph 25590 26190 31988 32738
240 96.53.2 S2 CSF rhinorrhoea - Endoscopic repair Clinical Photograph Clinical Photograph 25590 26190 31988 32738
Bronchoscopy Foreign Body Removal Routine Histopathological Examination, Clinical
241 98.02 S2 X-ray chest, Clinical Photograph 10600 11200 13250 14000
from Oesophagus Photograph, WEBEX
242 98.11 S2 Removal of foreign body in Ear Clinical Photograph Clinical Photograph 10590 11190 13238 13988
Bronchoscopy Foreign Body Removal
243 98.15.2 S2 X-ray chest, Clinical Photograph Clinical Photograph, WEBEX 24600 25200 30750 31500
from Bronchous
S3 OPHTHAMOLOGY
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Code
Hospitals Hospitals Hospitals Hospitals
Decompression/Excision Of Optic Nerve Visual field (Perimetry) Visual acuity,
244 04.42.1 S3,S10 Case Sheet with operation Notes 78900 79800 98625 99750
Lesions Fundoscopy
245 08.0 S3 Surgical treatment for Ankyloblepharon ICE Pack test with chin elevation Clinical Photograph 14370 14670 17963 18338
246 08.01 S3 Drainage of Lid Abscess Clinical Photograph Clinical Photograph 9460 10060 11825 12575
247 08.2.1 S3 Surgical treatment for disorders of Eyelid Clinical Photograph Clinical Photograph 11030 12530 13788 15663
248 08.2.2 S3 Exision of Small tumour of lid CT Orbits With Contrast Routine Histopathological Examination 10740 11640 13425 14550
249 08.3 S3 Surgical correction of Ptosis Clinical Photograph Clinical Photograph 30600 31200 38250 39000
250 08.4.1 S3 Ectropion correction Clinical Photograph Clinical Photograph 17700 20400 22125 25500
251 08.4.2 S3 Entropion correction Clinical Photograph Clinical Photograph 15300 15600 19125 19500
252 08.7 S3 Lid Reconstruction surgery Clinical Photograph Clinical Photograph 10350 10650 12938 13313
253 08.38 S3 Lagophthalmos correction T3, T4, TSH, Clinical Photograph Clinical Photograph 13210 13210 16513 16513
254 08.59 S3 Epicanthus repair Clinical Photograph Clinical Photograph 7110 7410 8888 9263
255 09.4 S3 Surgery for Congenital dacrocystitis NLD probing(single eye) ,Dacryocystography NLD probing(single eye) 10810 11710 13513 14638
256 09.21 S3 Dacrocystectomy Dacryocystography Case Sheet with operation Notes, Intra OP photo 8140 8440 10175 10550
257 09.43 S3 Congenital NLD probing NLD probing(single eye) NLD probing(single eye) 11010 11910 13763 14888
258 09.81 S3 External Dacryocysto rhinostomy NLD probing(single eye),Dacryocystography NLD probing(single eye) 14950 15850 18688 19813
Canaliculo/conjuctivo Dacryocysto
259 09.82 S3 X-Ray Orbit,Dacryocystography DNE Photo 13430 14030 16788 17538
rhinostomy
260 10.6 S3 Fornix forming sutures CT Orbits Without Contrast, X-Ray Orbit Clinical Photograph 11290 11890 14113 14863
261 10.41 S3 Surgical treatment for Symblepharon NLD probing(single eye) Swab Culture and Sensitivity 4760 5060 5950 6325
262 11.6 S3 Corneal Patch Graft Clinical Photograph Clinical Photograph 17720 18020 22150 22525
263 11.31 S3 Pterygium repair NLD probing(single eye) Intra OP photo 7600 7900 9500 9875
264 11.32 S3 Pterigium + conjunctival autograft NLD probing(single eye) Clinical Photograph 12080 12380 15100 15475
265 11.59.1 S3 Double Z-Plasty Clinical Photograph Clinical Photograph 4300 4600 5375 5750
266 11.61 S3 Lamellar Keratoplasty B-Scan Case Sheet with operation Notes 22790 23090 28488 28863
267 11.63 S3 Penetrating Keratoplasty Clinical Photograph Clinical Photograph 18650 19550 23313 24438
268 11.64 S3 Therapeutic Penetrating Keratoplasty B-Scan Swab Culture and Sensitivity 19800 20100 24750 25125
269 11.69 S3 Amniotic Membrane Graft for Cornea Clinical Photograph Clinical Photograph 11900 12800 14875 16000
270 12.0 S3 Intraocular foreign body removal Fundus floroscence Fundus floroscence 33730 34930 42163 43663
271 12.1 S3 Iridectomy-Iridotomy Fundus floroscence Fundus floroscence 7900 8800 9875 11000
Surgical treatment for Other disorders of
272 12.4 S3 Amplitude Modulation Scan (A-Scan) Fundus floroscence 7300 7600 9125 9500
iris and ciliary body
273 12.13 S3 Surgical treatment for Iris prolapse Fundus floroscence Fundus floroscence 7300 7600 9125 9500
274 12.41 S3 Exision of tumours of iris Fundus floroscence Fundus floroscence 21340 21640 26675 27050
275 12.54.1 S3 Glaucoma Surgery Fundus floroscence Fundus floroscence 9080 9980 11350 12475
276 12.72 S3 Cyclocryotherapy Fundus floroscence Fundus floroscence 12680 13280 15850 16600
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Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Glaucoma Filtering Surgery For Paediatric Fundus or Iris flouroscien angiography, Fundus
277 12.79 S3 Fundus floroscence 10190 11090 12738 13863
Glaucoma floroscence
278 12.81.1 S3 Surgical treatment for Scleral wound Fundus floroscence Fundus floroscence 11340 12240 14175 15300
Surgical treatment for Perforating scleral
279 12.81.2 S3 Fundus floroscence Fundus floroscence 23360 25460 29200 31825
injury
280 12.87.1 S3 Scleral Patch Graft Case sheet with clinical History Clinical Photograph 21540 23940 26925 29925
281 12.87.2 S3 Amniotic Membrane Graft for Sclera Clinical Photograph Clinical Photograph 18230 20330 22788 25413
282 12.89 S3 Removal of blood clot Fundus floroscence Fundus floroscence, Clinical Photograph 7500 7800 9375 9750
283 12.99 S3 Anterior chamber reconstruction USG local area, X-Ray Orbit Fundus floroscence 8590 9490 10738 11863
Bandage contact lens with glue
284 13.7 S3 USG local area, X-Ray Orbit Fundus floroscence 7080 7980 8850 9975
application
285 13.41 S3 Cataract surgery phacoemulsification Fundus floroscence Fundus floroscence 20000 20000 25000 25000
286 13.42 S3 Lensectomy Fundus floroscence Fundus floroscence, Clinical Photograph 12820 13720 16025 17150
287 13.64.1 S3 Posterior capsulotomy/polishing USG local area, X-Ray Orbit Fundus floroscence 11690 12590 14613 15738
288 13.64.2 S3 Yag laser capsulotomy USG local area, X-Ray Orbit Fundus floroscence 8190 9090 10238 11363
Cataract surgery phacoemulsification Amplitude Modulation Scan (A-Scan),B-Scan ,
289 13.71.1 S3 Fundus floroscence 22450 22750 28063 28438
+IOL Fundus floroscence
290 13.71.2 S3 Cataract surgery SICS + IOL(ECCE+IOL) Fundus floroscence Fundus floroscence 15300 15600 19125 19500
Paediatric Cataract Surgery
291 13.71.3 S3 Fundus floroscence Fundus floroscence 19150 20950 23938 26188
(Phacoemulsification IOL)
Secondary IOL-scleral fixation-sulcus X-Ray Orbit,Amplitude Modulation Scan (A-
292 13.72 S3 Fundus floroscence 22600 23200 28250 29000
fixation of lens ACIOL Scan)
Scleral buckle procedure for Retinal
293 14.4 S3 B-Scan, Fundus floroscence Fundus floroscence 30500 32900 38125 41125
detachment
294 14.25.1 S3 Photocoagulation for Retinopathy B-Scan, Fundus floroscence Fundus floroscence 2000 2000 2500 2500
Photocoagulation For Retinopathy Of
295 14.25.2 S3 Fundus floroscence Fundus floroscence 10330 10930 12913 13663
Prematurity
296 14.52.1 S3 Cryoretinopexy - closed Fundus floroscence Fundus floroscence 13150 14050 16438 17563
297 14.52.2 S3 Cryoretinopexy - open Fundus floroscence Fundus floroscence 11880 12180 14850 15225
Vitrectomy - Membrane Peeling-
298 14.72 S3 B-Scan, Fundus floroscence Fundus floroscence 21380 22580 26725 28225
Endolaser
299 14.74.1 S3 Vitrectomy B-Scan, Fundus floroscence Fundus floroscence 24220 25420 30275 31775
Vitrectomy Plus Silicon Oil Or Gas
300 14.74.2 S3 Fundus floroscence Fundus floroscence 24830 26330 31038 32913
(14.75)
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Vitrectomy -Membrane peeling -
301 14.74.3 S3 Endolaser _Silicon oil or Gas - with or Fundoscopy, Random Blood Sugar (RBS) Test Case Sheet with operation Notes 32400 34800 40500 43500
without belt bulking
Monthly Intravitreal Anti-Vegf For
Fundus floroscence,Fundus or Iris flouroscien
302 14.75 S3 Macular Degeneration - Per Injection Fundus floroscence 16390 18490 20488 23113
angiography,Optical coherence tomography
(Maximum - 6)
Removal Of Silicon Oil Or Gas post
303 14.79 S3 Fundus floroscence Fundus floroscence 10630 11530 13288 14413
Vitrectomy
304 15.2.1 S3 Rectus Muscle Surgery(Single) Clinical Photograph Clinical Photograph 8520 9120 10650 11400
305 15.2.2 S3 Oblique muscle surgery Clinical Photograph Clinical Photograph 8320 8920 10400 11150
306 15.4 S3 Rectus Muscle Surgery(Twohree) Clinical Photograph Clinical Photograph 11290 11890 14113 14863
307 16.0 S3 Orbitotomy CT Orbits Without Contrast ,3D CT Skull Clinical Photograph 27400 27700 34250 34625
Evisceration /Enucleation with Orbital
308 16.3 S3 CT Orbits With Contrast ,3D CT Skull Clinical Photograph 16110 16710 20138 20888
implant
CT Orbits With Contrast ,3D CT Skull/ MRI
309 16.5 S3 Exenteration of Orbit Routine Histopathological Examination 13480 14980 16850 18725
Orbits With Contrast
CT Orbits With Contrast /MRI Orbits With
310 16.63 S3 Dermis Fat Graft Routine Histopathological Examination 24090 25290 30113 31613
Contrast
311 16.64 S3 Socket Reconstruction Case sheet with clinical History Intra OP photo 26720 27920 33400 34900
CT Orbits Without Contrast / MRI Orbits
312 16.81 S3 Endoscopic orbital decompression Routine Histopathological Examination 9050 9050 11313 11313
Without Contrast
Excision of Benign neoplasm of Eye and CT Orbits With Contrast /MRI Orbits With
313 16.92 S3 Routine Histopathological Examination 10020 10320 12525 12900
Adnexa Contrast
CT Orbits Without Contrast, MRI Orbits
314 16.99 S3,S10 Surgical Management of Proptosis Clinical Photograph 60900 61800 76125 77250
Without Contrast, Clinical Photograph
Triple Markers/Immunohistochemistry (IHC)
Fine Needle Aspiration Cytology (FNAC), CT
315 86.3.11 S3 Dermoid cyst excision Three Markers, Routine Histopathological 14520 14820 18150 18525
local Area, Clinical Photograph
Examination, Clinical Photograph
S4 GYNAECOLOGY & OBSTETRICS
USG Abdomen,Bleeding Time And Clotting
Time,Platelet Count ,Blood Coagulation
316 38.86 S4 PPH-Conservative Surgical management USG Abdomen, Case Sheet with operation Notes 33100 35200 41375 44000
Analyzer (BCA) Or Coagulation Profile ,
Complete Blood Picture [CBP], HB%
Abdomen X-Ray (Lateral View), USG
317 54.03 S4 Surgical management of pelvic abscess Rapid AFB Culture, WEBEX 28240 30340 35300 37925
Abdomen
318 54.51 S4,S6 Laparoscopic Adhesiolysis USG Abdomen USG Abdomen 31800 33600 39750 42000
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Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, Papsmear, Endometrial Biopsy
319 59.4.3 S4 Purandares Sling operations - Open USG Abdomen, WEBEX 26050 26650 32563 33313
HPE
USG Abdomen, Papsmear, Endometrial Biopsy
320 59.4.4 S4 Laparoscopic Sling Operations USG Abdomen, WEBEX 33100 33700 41375 42125
HPE
USG Abdomen, CT scan Lower Abdomen
Without Contrast, CT Scan Abdomen With
Surgical Management of Ovarian Contrast/ Ca 125 (Cancer Antigen 125 Or USG Abdomen, Routine Histopathological
321 65.21 S4 33260 34760 41575 43450
Tumours Carbohydrate Antigen 125), Routine Examination, WEBEX
Histopathological Examination, USG-Doppler
Abdomen
USG Abdomen, CT scan Lower Abdomen
USG Abdomen, Routine Histopathological
Without Contrast, ECHO Cardiogram, CT
322 65.22 S4 Ovarian cystectomy Examination, Specimen Photo with face, 33260 34760 41575 43450
Scan Abdomen With Contrast, Ca 125 (Cancer
WEBEX
Antigen 125 Or Carbohydrate Antigen 125)
USG Abdomen, Cystoscopy, CT Scan Lower CT Scan Lower Abdomen With Contrast, USG
897 57.59 S9 Bladder Diverticulectomy Abdomen With Contrast, Abdomen And Pelvis Abdomen, Cystoscopy, Routine 34000 35800 42500 44750
For Kidneys, Ureters, And Bladder (KUB) Histopathological Examination
USG Abdomen, CT Scan Lower Abdomen With
Laproscopic radical cystectomy with CT Scan Lower Abdomen With Contrast, USG
898 57.71.1 S9,S11 Contrast, Routine Histopathological 126500 128000 158125 160000
Ilealconduit diversion Abdomen
Examination, WEBEX
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, CT Scan Lower Abdomen With
Laproscopic radical cystectomy with CT Scan Lower Abdomen With Contrast, USG
899 57.71.3 S9 Contrast, Routine Histopathological 59670 62670 74588 78338
Ureterosigmoidostomy(57.88) Abdomen
Examination, WEBEX
Open radical cystectomy with CT Scan Lower Abdomen With Contrast, USG USG Abdomen, CT Scan Lower Abdomen With
900 57.71.4 S9 48000 51000 60000 63750
Ureterosigmoidostomy (57.88) Abdomen, Cystoscopy, Biopsy Contrast, Routine Histopathological Examination
USG Abdomen, CT Scan Lower Abdomen With
Laproscopic radical cystectomy with CT Scan Lower Abdomen With Contrast, USG
901 57.71.5 S9 Contrast, Routine Histopathological 65560 66460 81950 83075
Continent Urinary diversion(56.7) Abdomen, Cystoscopy, Biopsy
Examination, WEBEX
Open radical cystectomy with Continent CT Scan Lower Abdomen With Contrast, USG USG Abdomen, CT Scan Lower Abdomen With
902 57.71.6 S9 53000 56000 66250 70000
Urinary diversion Abdomen, Cystoscopy, Biopsy Contrast, Routine Histopathological Examination
Retrograde Urethrogram, USG Abdomen/ Intra USG Abdomen, CT Scan Lower Abdomen With
Surgical correction of Vesicovaginal
903 57.84.1 S9 Veneous Pyelogram, CT Scan Lower Abdomen Contrast, Routine Histopathological 45800 47600 57250 59500
Fistula
With Contrast, Cystoscopy Examination, WEBEX
Transvaginal repair of Vesicovaginal CT Scan Lower Abdomen With Contrast, USG USG Abdomen, CT Scan Lower Abdomen With
904 57.84.2 S9 37930 40030 47413 50038
Fistula Abdomen Contrast
Trans abdominal repair of Vesicovaginal CT Scan Lower Abdomen With Contrast, USG USG Abdomen, CT Scan Lower Abdomen With
905 57.84.4 S9 55800 59100 69750 73875
Fistula with omentoplasty Abdomen, Cystoscopy Contrast
USG Abdomen, Cystoscopy, CT Scan Lower CT Scan Lower Abdomen With Contrast, USG
906 57.88 S9 Caecocystoplasty 44840 47840 56050 59800
Abdomen With Contrast Abdomen, Scar Photo
CT Scan Lower Abdomen With Contrast, USG Abdomen, CT Scan Lower Abdomen With
907 57.91.1 S9 Bladder neck incision 25340 26540 31675 33175
Cystoscopy, USG Abdomen, Cystourethroscopy Contrast
Bladder neck reconstruction for USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
908 57.91.2 S9 62100 64200 77625 80250
Incontinence With Contrast, Case sheet with clinical History Contrast
Retrograde Urethrogram, Abdomen And Pelvis
For Kidneys, Ureters, And Bladder (KUB),
USG Abdomen, CT Scan Lower Abdomen With
909 58.0 S9 Perineal Urethrostomy USG Abdomen, Intra Veneous Pyelogram, CT 33150 34650 41438 43313
Contrast, Scar Photo
Scan Lower Abdomen With Contrast, Clinical
Photograph
Retrograde Urethrogram, USG Abdomen, CT USG Abdomen, CT Scan Lower Abdomen With
910 58.5.1 S9 Optical Urethrotomy Scan Lower Abdomen With Contrast/ Intra Contrast, Intra OP photo, Endoscopic 22430 23930 28038 29913
Veneous Pyelogram Photograph showing Receptoscope in situ
BMG Urethroplasty for pan Urethral Retrograde Urethrogram, USG Abdomen, CT USG Abdomen, CT Scan Lower Abdomen With
911 58.5.2 S9 66500 68000 83125 85000
stricture Scan Lower Abdomen With Contrast Contrast, Clinical Photograph
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
912 58.6 S9 Dilatation for Urethra stenosis 10870 11170 13588 13963
With Contrast Contrast
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
913 58.31 S9 Excision of Urethral Caruncle 16560 17160 20700 21450
With Contrast, Clinical Photograph Contrast
914 58.43 S9 Urethral Fistula closure Retrograde Urethrogram, Clinical Photograph Scar Photo 31500 33000 39375 41250
Retrograde Urethrogram, USG Abdomen, CT
USG Abdomen, CT Scan Lower Abdomen With
915 58.45.5 S9 Single stage- Urethroplasty for Stricture Scan Lower Abdomen With Contrast, Clinical 53300 56600 66625 70750
Contrast
Photograph
Double stage Urethroplasty Retrograde Urethrogram, USG Abdomen, CT
USG Abdomen, CT Scan Lower Abdomen With
916 58.46 S9 (Reconstruction Procedure) for stricture Scan Lower Abdomen With Contrast, Clinical 40200 42900 50250 53625
Contrast
Urethra. Photograph
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
917 58.47 S9 Meatoplasty 12580 12880 15725 16100
With Contrast, Clinical Photograph Contrast
Retrograde Urethrogram, USG Abdomen, CT
Transpubic Urethroplasty with USG Abdomen, CT Scan Lower Abdomen With
918 58.49 S9 Scan Lower Abdomen With Contrast, Clinical 68600 72200 85750 90250
Omentoplasty Contrast
Photograph
Retrograde Urethrogram, USG Abdomen, CT USG Abdomen, CT Scan Lower Abdomen With
919 58.49.1 S9 Urethroplasty doblestage stage I 40770 42870 50963 53588
Scan Lower Abdomen With Contrast Contrast
Retrograde Urethrogram, USG Abdomen, CT USG Abdomen, CT Scan Lower Abdomen With
920 58.49.2 S9 Urethroplasty doublestage stageII 40200 42900 50250 53625
Scan Lower Abdomen With Contrast Contrast
Nephrolysis/surgery for Chyluria USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
921 59.02 S9 41800 43600 52250 54500
Open/Lap With Contrast Contrast, WEBEX
Cystoscopy, USG Abdomen, CT Scan Lower
Surgical Management of Incontinence
922 59.4.1 S9 Abdomen With Contrast, Case sheet with USG Abdomen, Clinical Photograph 26800 28000 33500 35000
Urine (Male)
clinical History
Cystoscopy, USG Abdomen, CT Scan Lower
Surgical Management of Incontinence USG Abdomen, CT Scan Lower Abdomen With
923 59.4.2 S9 Abdomen With Contrast, Case sheet with 22900 23800 28625 29750
Urine (Female) Contrast
clinical History
MMK/birch colpo suspension for stress USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
924 59.5 S9 42100 44200 52625 55250
urinary Incontinence With Contrast, Case sheet with clinical History Contrast
USG Abdomen/CT Scan Lower Abdomen With USG Abdomen, CT Scan Lower Abdomen With
925 59.8.1 S9 Dj Stent (One Side) Contrast, Intra Veneous Pyelogram, Renal Contrast, Abdomen And Pelvis For Kidneys, 5300 5600 6625 7000
Profile Ureters, And Bladder (KUB), Renal Profile
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
926 59.8.2 S9 CAPD-Tenchkoff catheter insertion 38620 40720 48275 50900
With Contrast, Renal Profile Contrast
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Abdomen, CT Scan Lower Abdomen
With Contrast, Renal Profile, Abdomen And USG Abdomen, CT Scan Lower Abdomen With
927 59.09 S9 Drainage of Perinephric Abscess 40060 42160 50075 52700
Pelvis For Kidneys, Ureters, And Bladder Contrast
(KUB)
Mid urethral sling procedure for stress USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
928 59.79 S9 31500 33000 39375 41250
urinary incontinence With Contrast, Case sheet with clinical History Contrast
USG Abdomen, CT Scan Lower Abdomen With
USG Abdomen, CT Scan Lower Abdomen
929 60.3 S9 Open Prostatectomy Contrast, Routine Histopathological 34500 36000 43125 45000
With Contrast, Cystoscopy, Cystouretroscopy
Examination, Scar Photo
USG Abdomen, CT Scan Lower Abdomen
With Contrast, Routine Histopathological USG Abdomen, CT Scan Lower Abdomen With
930 60.5.1 S9 Laproscopic radical Prostratectomy 57100 59200 71375 74000
Examination, Prostate-Specific Antigen (PSA), Contrast, Routine Histopathological Examination
Cystouretroscopy
USG Abdomen, CT Scan Lower Abdomen
USG Abdomen, CT Scan Lower Abdomen With
931 60.5.2 S9 Open radical Prostratectomy With Contrast, Prostate-Specific Antigen 50900 51800 63625 64750
Contrast, Routine Histopathological Examination
(PSA), Cystouretroscopy
Uroflowmetry, USG Abdomen, CT Scan Lower
USG Abdomen, CT Scan Lower Abdomen With
932 60.21 S9 Laser Prostatectomy Abdomen With Contrast, Cystoscopy, Prostate- 41500 43000 51875 53750
Contrast
Specific Antigen (PSA), Cystouretroscopy
Transurethral Resection of Prostate Cystoscopy, USG Abdomen, CT Scan Lower USG Abdomen, CT Scan Lower Abdomen With
933 60.29.1 S9 31500 33000 39375 41250
(TURP) Abdomen With Contrast, Cystouretroscopy Contrast, Routine Histopathological Examination
USG Abdomen, CT Scan Lower Abdomen
Transurethral Resection of Prostate USG Abdomen, CT Scan Lower Abdomen With
934 60.29.2 S9 With Contrast, Prostate-Specific Antigen 30900 31800 38625 39750
(TURP) Cyst Lithotripsy Contrast, Routine Histopathological Examination
(PSA), Cystouretroscopy
Uroflowmetry, USG Abdomen, CT Scan Lower
USG Abdomen, CT Scan Lower Abdomen With
935 60.29.3 S9 Bipolar TURP Abdomen With Contrast, Cystoscopy, 41500 43000 51875 53750
Contrast, Routine Histopathological Examination
Cystouretroscopy
USG Abdomen, CT Scan Lower Abdomen USG Abdomen, CT Scan Lower Abdomen With
936 61.4 S9 Scrotal/Perineal Injuries 29560 31660 36950 39575
With Contrast, Clinical Photograph Contrast, Scar Photo
USG Abdomen, CT Scan Lower Abdomen With
USG Abdomen, CT Scan Lower Abdomen
937 62.5 S9 Orchidopexy Bilateral Contrast, Routine Histopathological 24670 26470 30838 33088
With Contrast, Clinical Photograph
Examination,
CT Scan Of Lower Abdomen & Scrotum, USG CT Scan Of Lower Abdomen & Scrotum, USG
938 63.92 S9 Vasectomy reversal 23910 24810 29888 31013
Abdomen, Semen Analysis Abdomen, Semen Analysis
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
USG Penis,CT Scan Of Lower Abdomen & USG Penis,CT Scan Of Lower Abdomen &
939 64.3.1 S9,S11 Partial amputation of penis 38170 39670 47713 49588
Scrotum, Biopsy Scrotum, Routine Histopathological Examination
USG Penis,CT Scan Of Lower Abdomen & USG Penis,CT Scan Of Lower Abdomen &
940 64.42.1 S9 Surgical correction of Chordee 34660 36460 43325 45575
Scrotum, Clinical Photograph Scrotum
Surgical Correction of Chordee without USG Penis,CT Scan Of Lower Abdomen & USG Penis,CT Scan Of Lower Abdomen &
941 64.42.2 S9 34420 36520 43025 45650
Hypospadiasis Scrotum Scrotum
CT Scan Of Lower Abdomen &
CT Scan Of Lower Abdomen & Scrotum, USG
942 64.41 S9,S8 Surgical Management of Penile Injuries Scrotum/Doppler And Scrotum & Testes, USG 26200 27400 32750 34250
Penis
Penis, Clinical Photograph
CT Scan Of Lower Abdomen &
Plaque Excision/Plasty for Penile CT Scan Of Lower Abdomen & Scrotum, USG
943 64.43 S9 Scrotum/Doppler And Scrotum & Testes, USG 42100 44200 52625 55250
curvature/Peyronies disease Penis
Penis,
USG Penis,CT Scan Of Lower Abdomen & USG Penis,CT Scan Of Lower Abdomen &
944 64.98 S9 Surgery for Priapism 37100 39200 46375 49000
Scrotum Scrotum
Colour Doppler Of Specific Limb, Clinical
945 86.75 S9 Difficult vascular access/graft Colour Doppler Of Specific Limb 31500 33000 39375 41250
Photograph
Abdomen And Pelvis For Kidneys, Ureters,
Abdomen And Pelvis For Kidneys, Ureters, And
946 97.64 S9 CAPD-Tenchkoff catheter removal And Bladder (KUB), USG Abdomen, Clinical 36040 38140 45050 47675
Bladder (KUB), USG Abdomen, Scar Photo
Photograph
947 97.64.1 S9 CAPD bags per month Clinical Photograph CAPD bags Photo 8520 8520 10650 10650
Abdomen And Pelvis For Kidneys, Ureters, Abdomen And Pelvis For Kidneys, Ureters, And
948 97.65 S9 Cystoscopy/ Stent removal And Bladder (KUB), USG Abdomen, Clinical Bladder (KUB), USG Abdomen, Clinical 9400 9700 11750 12125
Photograph Photograph
Intra Veneous Pyelogram, Abdomen And Pelvis Abdomen And Pelvis For Kidneys, Ureters, And
Extracorporeal shockwave lithotripsy
949 98.51 S9 For Kidneys, Ureters, And Bladder (KUB), Bladder (KUB), USG Abdomen, Clinical 20600 21200 25750 26500
(ESWL)
Contrast Enhanced USG/ CT local Area Photograph
Post Renal Transplant
Renal Profile, USG Abdomen, Latest Color Renal Profile, Latest Color Dopplar of
950 99.23.1 S9 Immunosuppressive Treatment From 1st 91670 91670 114588 114588
Dopplar of Transplant Area Transplant Kidney
To 6th Months
Post Renal Transplant
Renal Profile, USG Abdomen, Latest Color Renal Profile, Latest Color Dopplar of
951 99.23.2 S9 Immunosuppressive Treatment From 7th 61200 61200 76500 76500
Dopplar of Transplant Area Transplant Kidney
To 12 Th Month.
Price for Semi Price for Price for Semi Price for
Applicable
Procedure private ward - Private ward - private ward - Private ward -
S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Urine Cytology For Malignant Cells , Urine
Culture & Sensitivity, Renal Profile, LFT(liver
function tests), Alkaline Phosphatase Levels,
952 99.28.1 S9 Intravesical BCG Induction therapy Cystoscopy, Case Sheet with operation Notes 10050 10350 12563 12938
Cystoscopy, Triple
Markers/Immunohistochemistry (IHC) Three
Markers
Urine Cytology For Malignant Cells , Urine
953 99.28.2 S9 Intravesical BCG maintenance Culture & Sensitivity, Cystoscopy, Case sheet Case Sheet with operation Notes, Intra OP photo 18120 19320 22650 24150
with clinical History
S10 NEURO SURGERY
CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
954 01.09.1 S10 Twist Drill Craniostomy 15600 16200 19500 20250
Brain(Head)/MRI Brain Without Contrast Brain(Head)/MRI Brain Without Contrast
CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
955 01.09.2 S10 Subdural Tapping 19510 19510 24388 24388
Brain(Head) /MRI Brain Without Contrast Brain(Head) /MRI Brain Without Contrast
CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
956 01.09.3 S10 Ventricular Tapping 15000 15000 18750 18750
Brain(Head) Brain(Head)
CT-Scan Brain Plain With Bone Window, CT
Burr Hole procedure for evacuation of PUS/Granulation For HPE - , Endoscopic
957 01.13 S10 Angio Of Brain(Head) /MRI Brain Without 32680 32680 40850 40850
Brain Abscess Photograph
Contrast
CT-Scan Brain Plain And Contrast ,CT Angio T-Scan Brain Plain And Contrast, CT Angio Of
958 01.18 S10 Endoscopy Procedures -Brain 79800 81600 99750 102000
Of Brain(Head) /MRI Brain Without Contrast Brain(Head)
Craniotomy And Evacuation of Subdural CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
959 01.24.1 S10 66000 66000 82500 82500
Haematoma Brain(Head) Brain(Head)
Craniotomy And Evacuation of CT Scan Head Without Contrast ,CT Angio Of CT Scan Head Without Contrast, CT Angio Of
960 01.24.2 S10 60000 60000 75000 75000
Extradural Haematoma Brain(Head) /MRI Brain Without Contrast Brain(Head)
CT Scan Head Without Contrast,CT Angio Of
De-Compressive Craniectomy (Non CT Scan Head Without Contrast,CT Angio Of
961 01.25 S10 Brain(Head) /MRI Brain Without Contrast After 80600 81200 100750 101500
Traumatic) Brain(Head) /MRI Brain Without Contrast
3 weeks
CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
962 01.31 S10 Tapping of Brain Abscess 40000 40000 50000 50000
Brain(Head) /MRI Brain Without Contrast Brain(Head) /MRI Brain Without Contrast
CT Scan Head Without Contrast, CT Angio Of
Brain(Head) /MRI Brain Without Contrast EEG (Electroencephalogram) \ Video
963 01.39 S10 Evacuation of Intra-Cerebral Hematoma 72000 72000 90000 90000
,EEG (Electroencephalogram) \ Video EEG, EEG,PUS/Granulation For HPE
Case sheet with clinical History
CT Scan Temporal Bones Without CT Scan Temporal Bones Without Contrast5,CT
Temporal Lobectomy Plus Depth
964 01.53.1 S10 Contrast5,CT Angio Of Brain(Head) /MRI Angio Of Brain(Head) /MRI Brain Without 140300 140600 175375 175750
Electrodes
Brain Without Contrast Contrast
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S No Speciality Procedure Name Preauth Evidence Claim Evidence
ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
CT Scan Temporal Bones Without CT Scan Temporal Bones Without Contrast5,CT
965 01.53.2 S10 Temporal Lobectomy Contrast5,CT Angio Of Brain(Head) /MRI Angio Of Brain(Head) /MRI Brain Without 75600 76200 94500 95250
Brain Without Contrast Contrast , Case Sheet with operation Notes
Excision of Lobe(frontal,temporal,cerebe CT-Scan Brain Plain And Contrast / MRI Brain CT-Scan Brain Plain And Contrast / MRI Brain
966 01.53.3 S10 40300 40600 50375 50750
llum Etc.) Without Contrast Without Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
967 01.59.1 S10 Excision of Parasagital Brain tumour Scan Brain Plain And Contrast, CT Angio Of 70390 71890 87988 89863
Of Brain(Head)/MRI Brain With Contrastt
Brain(Head)/MRI Brain With Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
968 01.59.2 S10 Excision of Basal Brain tumour Scan Brain Plain And Contrast, CT Angio Of 70300 70600 87875 88250
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
969 01.59.3 S10 Excision of Brain Stem Brain tumour Scan Brain Plain And Contrast, CT Angio Of 70900 71800 88625 89750
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
970 01.59.4 S10 Excision of C P Angle Brain tumour Scan Brain Plain And Contrast, CT Angio Of 80300 80600 100375 100750
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
971 01.59.5 S10 Excision of Other Brain tumours Scan Brain Plain And Contrast, CT Angio Of 48550 48850 60688 61063
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
CT-Scan Brain Plain And Contrast, CT Angio Intra EEG (Electroencephalogram) \ Video EEG
972 01.59.6 S10 Lesionectomy Type 1 57160 57460 71450 71825
Of Brain(Head)/MRI Brain With Contrast ,Routine Histopathological Examination
CT-Scan Brain Plain And Contrast, CT Angio Intra EEG (Electroencephalogram) \ Video EEG
973 01.59.7 S10 Lesionectomy Type 2 57350 57650 71688 72063
Of Brain(Head)/MRI Brain With Contrast ,Routine Histopathological Examination
CT-Scan Brain Plain And Contrast, CT Angio Routine Histopathological Examination, CT-
974 01.59.8 S10 Excision of Subtentorial Brain Tumours Of Brain(Head)/MRI Brain With Contrast, EEG Scan Brain Plain And Contrast, CT Angio Of 48550 48850 60688 61063
(Electroencephalogram) \ Video EEG Brain(Head)/MRI Brain With Contrast
CT-Scan Brain Plain And Contrast, CT Angio CT-Scan Brain Plain And Contrast, CT Angio Of
975 01.59.9 S10 Evacuation of Brain Abscess 60000 60000 75000 75000
Of Brain(Head)/MRI Brain With Contrast Brain(Head)/MRI Brain With Contrast
CT Scan Head Without Contrast, CT Angio Of
Surgical Management of CT Scan Head Without Contrast, CT Angio Of
976 01.59.10 S10 Brain(Head) /MRI Brain Without Contrast 40600 41200 50750 51500
Meningomyelocele Brain(Head) /MRI Brain Without Contrast
,Routine Histopathological Examination
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
977 01.59.11 S10 Intra Ventricular Tumours Scan Brain Plain And Contrast, CT Angio Of 60600 61200 75750 76500
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
978 01.59.12 S10 Meningocele Excision Scan Brain Plain And Contrast, CT Angio Of 40300 40600 50375 50750
Of Brain(Head) /MRI Brain Without Contrast
Brain(Head) /MRI Brain Without Contrast
Routine Histopathological Examination, CT-
CT-Scan Brain Plain And Contrast, CT Angio
979 01.59.13 S10 Excision of brain abscess Scan Brain Plain And Contrast, CT Angio Of 70300 70600 87875 88250
Of Brain(Head)/MRI Brain With Contrast
Brain(Head)/MRI Brain With Contrast
CT Scan Head Without Contrast,CT Angio Of CT Scan Head Without Contrast,CT Angio Of
980 02.0 S10 Cranioplasty Brain(Head), ECHO Cardiogram,ECG (Electro Brain(Head)/MRI Brain Without Contrast , X- 30300 30600 37875 38250
Cardiogram), ECHO CD Ray Skull
CT Scan Head Without Contrast, CT Angio Of X-Ray Skull/CT Scan Head Without Contrast,
981 02.02 S10 Depressed / Elevated Fracture 30300 30600 37875 38250
Brain(Head) /MRI Brain Without Contrast CT Angio Of Brain(Head)
CT-Scan Brain Plain And Contrast, CT Angio Of
CT-Scan Brain Plain And Contrast, CT Angio
982 02.2 S10 Endoscopic Third Ventriculostomy Brain(Head) /MRI Brain Without Contrast , 30900 31800 38625 39750
Of Brain(Head) /MRI Brain Without Contrast
Endoscopic Dilatation-Video/Photo
CT Scan Head Without Contrast, CT Angio Of
983 02.05 S10 Cranioplasty With Impants X-Ray Skull 30300 30600 37875 38250
Brain(Head)
CT-Scan Brain Plain With Bone Window, CT
X-Ray Skull/CT-Scan Brain Plain With Bone
984 02.06 S10 Cranioplasty With Titanium Mesh Angio Of Brain(Head) /MRI Brain Without 31930 32230 39913 40288
Window, CT Angio Of Brain(Head)
Contrast
Surgical Management of Meningo CT-Scan Brain Plain And Contrast, CT Angio CT-Scan Brain Plain And Contrast, CT Angio Of
985 02.12 S10 40600 41200 50750 51500
Encephalocele Of Brain(Head) /MRI Brain Without Contrast Brain(Head) /MRI Brain Without Contrast
CT Scan Head Without Contrast, CT Angio Of
Surgical Management of C.S.F. Brain(Head) /MRI Brain Without Contrast / CT Scan Head Without Contrast, CT Angio Of
986 02.31 S10 40600 41200 50750 51500
Rhinorrhoea Radionuclide Cisternography /Radio Brain(Head) /MRI Brain Without Contrast
Scintography
CT Scan Head Without Contrast, CT Angio Of
CT Scan Head Without Contrast, CT Angio Of
987 02.32 S10 Ventriculo Atrial Shunt Brain(Head) /MRI Brain Without Contrast / 21500 23000 26875 28750
Brain(Head) /MRI Brain Without Contrast
Neurosonogram(NSG)
CT Scan Head Without Contrast, CT Angio Of CT Scan Head Without Contrast, CT Angio Of
988 02.32.1 S10 Atrial shunt Brain(Head) /MRI Brain Without Contrast / Brain(Head) /MRI Brain Without Contrast , Case 20010 20010 25013 25013
Neurosonogram(NSG) Sheet with operation Notes
CT Scan Head Without Contrast, CT Angio Of Scan Head Without Contrast, CT Angio Of
989 02.34 S10 Ventriculo Peritoneal Shunt Brain(Head) /MRI Brain Without Contrast , X Brain(Head) /MRI Brain Without Contrast 30000 30000 37500 37500
Ray scull Cerebrospinal Fluid (CSF) Analysis Cell Count
CT Scan Head Without Contrast, CT Angio Of Scan Head Without Contrast, CT Angio Of
Ventriculoatrial / Ventriculoperitonial
990 02.34.1 S10 Brain(Head) /MRI Brain Without Contrast , X Brain(Head) /MRI Brain Without Contrast 20010 20010 25013 25013
shunt
Ray scull Cerebrospinal Fluid (CSF) Analysis Cell Count
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
CT Scan Head Without Contrast, CT Angio Of Scan Head Without Contrast, CT Angio Of
991 02.39 S10 External Ventricular Drainage (EVD) 40000 40000 50000 50000
Brain(Head) /MRI Brain Without Contrast Brain(Head) /MRI Brain Without Contrast
992 03.1 S10 Selective Posterior Rhizotomy Case sheet with clinical History Case Sheet with operation Notes 30300 30600 37875 38250
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
993 03.4.1 S10 Surgery for Cord Tumours Routine Histopathological Examination 38900 39800 48625 49750
Without Contrast /MRI Spine
Surgical Management of Intra Medullary CT Spine (Cervical,Dorsal,Lumbar,Sacral) Routine Histopathological Examination, X-Ray
994 03.4.2 S10 51200 52400 64000 65500
Spinal Tumours Without Contrast /MRI Local Area Dorso Lumbar Spine
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
995 03.4.3 S10 Surgical Management of Syringomyelia Without Contrast, Case Sheet with operation 60600 61200 75750 76500
Without Contrast /MRI Local Area
Notes
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
996 03.09.1 S10 Laminectomy Without Contrast /MRI Local Area,X-Ray X-Ray Dorso Lumbar Spine 27250 27850 34063 34813
Dorso Lumbar Spine
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
997 03.09.2 S10 Laminoplasty With Implants Without Contrast /MRI Local Area,X-Ray X-Ray Dorso Lumbar Spine 30780 31380 38475 39225
Dorso Lumbar Spine
998 03.39 S10 Endoscopy - Spinal Endoscopic Photograph Case Sheet with operation Notes 29900 30800 37375 38500
X-Ray Dorso Lumbar Spine,
999 03.52 S10 Meningo Myelocele Spinal Procedure Case Sheet with operation Notes 25600 26200 32000 32750
Neurosonogram(NSG), Clinical Photograph
X-Ray Dorso Lumbar Spine,CT Spine
Surgical Management of Spina Bifida
1000 03.59.1 S10 (Cervical,Dorsal,Lumbar,Sacral) Without X-Ray Dorso Lumbar Spine 35600 36200 44500 45250
Major
Contrast /MRI Local Area
X-Ray Dorso Lumbar Spine,CT Spine
Surgical Management of Spina Bifida
1001 03.59.2 S10 (Cervical,Dorsal,Lumbar,Sacral) Without X-Ray Dorso Lumbar Spine 30300 30600 37875 38250
Minor
Contrast /MRI Local Area
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
1002 03.96 S10 Facet, Nerve Root Blocks Case Sheet with operation Notes 10000 10000 12500 12500
Without Contrast /MRI Local Area
ENMG (Elektroneuromyography) ,Nerve
Radiofrequency Ablation For Trigeminal ENMG (Elektroneuromyography) ,Nerve
1003 04.2 S10 conduction study, Case Sheet with operation 30600 31200 38250 39000
Neuralgia conduction study
Notes
Radio Surgery For Brain Tumours &
CT-Scan Brain Plain And Contrast/MRI Brain CT-Scan Brain Plain And Contrast/MRI Brain
1004 04.02 S10 Vascular Malformations/ Trigeminal 25300 25600 31625 32000
Without Contrast Without Contrast
Neuralgia
MRI Local Area/CT Scan Limbs Without ENMG (Elektroneuromyography) ,Nerve
Surgical treatment for brachial plexus
1005 04.5.2 S10 Contrast,ENMG (Elektroneuromyography) conduction study, Intra OP photo, Case Sheet 72900 73800 91125 92250
injuries
,Nerve conduction study, Clinical Photograph with operation Notes
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Microvascular Decompression For ENMG (Elektroneuromyography) ,Nerve
1006 04.41 S10 Nerve conduction study(NCS) 60300 60600 75375 75750
Trigeminal Neuralgia conduction study, MRI Local Area
CT Scan Limbs Without Contrast /MRI Of Both
Surgical management Carpal tunnel
1007 04.43 S10,S5 Hands,ENMG (Elektroneuromyography) ,Nerve Scar Photo, Case Sheet with operation Notes 10000 10000 12500 12500
syndrome
conduction study
ENMG (Elektroneuromyography) ,Nerve
ENMG (Elektroneuromyography) ,Nerve
1008 04.76.1 S10 Peripheral Nerve Injury Repair conduction study, Case Sheet with operation 40900 41800 51125 52250
conduction study
Notes
ENMG (Elektroneuromyography) , MRI
1009 05.22 S10 Cervical Sympathectomy Cervical Spine Without Contrast ,Nerve Routine Histopathological Examination 31200 32400 39000 40500
conduction study
ENMG (Elektroneuromyography) ,Nerve
1010 05.23.1 S10 Lumbar Sympathectomy Routine Histopathological Examination 31500 33000 39375 41250
conduction study,MRI Of Dorsolumbar Spine
CT-Scan Brain Plain And Contrast / MRI Brain Routine Histopathological Examination, X-Ray
1011 07.62 S10 Trans Sphenoidal Surgery 40300 40600 50375 50750
With Contrast Skull
CT Local Area,CT Angiography
1012 38.12.2 S10 Carotid Endarterectomy Neck\Chest(Cartotid Angiography), Colour Colour Doppler Study Of Neck Vessels 40600 41200 50750 51500
Doppler Study Of Neck Vessels
1013 39.28 S10 Intra Cranial Vascular Bypass CT Angio Of Brain(Head) CT-Scan Brain Plain And Contrast 100900 101800 126125 127250
CT Angio Of Brain(Head)/Dynamic
1014 39.51 S10 Aneurysm Clipping CT Angio Of Brain(Head) MRI/Functional MRI, X Ray scull with Marked 110000 110000 137500 137500
clips
Other Vascular Malformations (Other
Extremities , Bones & Joints AP & Lateral
1015 39.53.2 S10 Than AVM) - Cavernomas, AV Fistulas, Renal Profile, USG local area 60900 61800 76125 77250
View(2 Film), Scar Photo
Sinus Pericranii
CT Angio Of Brain(Head)/ MRI Angiography CT Angio Of Brain(Head)/ MRI Angiography
1016 39.72.1 S10 Embolization of Aneurysm 76500 78000 95625 97500
With Contrast With Contrast
1017 39.72.2 S10 Brain Tumour Embolisation MRI Brain With Contrast CT Angio Of Brain(Head) 28300 28600 35375 35750
Coil Embolization of Aneurysm (each coil CT Angio Of Brain(Head)/ MRI Brain With Color Doppler Sonography Single Study,
1018 39.79.1 S10 30000 30000 37500 37500
cost) Contrast Routine Histopathological Examination
Surgical Management of Vascular MRI Angiography With Contrast /Digital CT Local Area /Dynamic MRI/Functional MRI,
1019 39.79.2 S10 60600 61200 75750 76500
Malformations Subtraction Angiogram/CT Local Area Routine Histopathological Examination
Spinal Fixation Rods And Plates, CT Spine (Cervical,Dorsal,Lumbar,Sacral)
1020 78.19 S10 X-Ray 85600 86200 107000 107750
Artificial Discs Without Contrast /MRI Spine
MRI Brain With Contrast/CT Scan Brain Plain X-Ray, Routine Histopathological Examination /
1021 80.5.1 S10 Anterior Lateral Decompression 31200 32400 39000 40500
and contrast Gram stain/ Zn stain Report
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
CT Spine (Cervical,Dorsal,Lumbar,Sacral) CT Spine (Cervical,Dorsal,Lumbar,Sacral)
1022 80.51.1 S10 Postirior cervical disectomy 27250 27850 34063 34813
Without Contrast, X-Ray Dorso Lumbar Spine Without Contrast, X-Ray Dorso Lumbar Spine
CT Spine (Cervical,Dorsal,Lumbar,Sacral)
1032 81.01.3 S10 C.V. Junction Fusion X-Ray Dorso Lumbar Spine 40600 41200 50750 51500
Without Contrast, X-Ray Dorso Lumbar Spine
Medical Management of MCTD (Mixed Skin Biopsy, Muscle Biopsy -HPE, Serum Cpk-
1801 M35.1 M10 Case Sheet with treatment details 27400 29800 34250 37250
Connective Tissue Disorder) Mb Levels, Lactate Dehydrogenase (LDH)
Medical Management of Undifferentiated Anti Nuclear Anti Body (ANA) Titres, Case
1802 M35.8 M10 Case Sheet with treatment details 22390 24490 27988 30613
Connective Tissue Disorder sheet with clinical History
X-Ray Dorso Lumbar Spine, Human Leukocyte
Medical Management of Severe Spondylo Antigen (HLA) B27, Complete Haemogram ,
1803 M48.9 M10 Case sheet with clinical improvement 26850 28950 33563 36188
Arthropathies MRI Spine / MRI Ankle Both Joints Without
Contrast, Clinical Photograph
Medical Management of Inflamatory Serum Cpk-Mb Levels/ENMG
1804 M60.9.A M10 Case Sheet with treatment details 31500 33000 39375 41250
Myositis (Elektroneuromyography), Clinical Photograph
(Elektroneuromyography), Anti Nuclear Anti
Medical Management of Severe Myositis
1805 M60.9.B M10 Body (ANA) Titres, Double Stranded (DS) Case Sheet with treatment details 31500 33000 39375 41250
Requiring IVIG
DNA, Collagen Profile, Clinical Photograph
Extremities , Bones & Joints AP & Lateral
View(2 Film), Alkaline Phosphatase Levels,
Bone Mineral Density \Densitometry (BMD) -
Medical Management of Osteoporosis
1806 M80.9 M10 Three Sites(Spine,Hip&Extremity), Serum X-Ray, Serum Calcium Levels 15910 17710 19888 22138
With Recent Painful Yertebral Fracture
Vitamin D3 Levels, P.T.H Assay (Parathyroid
Assay), Dexa Scan (Hip & Spine / Heel) (Bone
Scan), Serum Calcium Levels
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Extremities , Bones & Joints AP & Lateral
View(2 Film), Serum Calcium Levels, Serum Serum Calcium Levels, Serum Vitamin D3
1807 M83 M10 Medical Management of Osteomalacia 15050 17150 18813 21438
Phosphorus Levelss, Serum Vitamin D3 Levels, Levels
P.T.H Assay (Parathyroid Assay)
M11 ENDOCRINOLOGY
Medical management of Rhinocerebral CT-Scan Brain Plain And Contrast, HB
1808 B46.1 M11 Case sheet with clinical improvement 54620 57620 68275 72025
Mucormycosis A1c(Glycosylated Hemoglobin)
1809 E05.0 M11 Medical Management of Grave'S Disease T3, T4, TSH Case Sheet with treatment details 11560 13060 14450 16325
USG Abdomen, Urine Culture & Sensitivity ,
Renal Profile,CUE (pH , Specific Gravity ,
Medical management of Pyelonephritis in
1810 E11.2 M11 Sugar , Protein And Microscopy), HB Case sheet with clinical improvement 23610 25710 29513 32138
uncontrolled Diabetes melitus
A1c(Glycosylated Hemoglobin),CT Scan
Abdomen With Contrast
Medical management of Cavernous Sinus
MR Venogram, HB A1c(Glycosylated
1811 E11.5 M11 Thrombosis in uncontrolled Diabetes Case sheet with clinical improvement 44020 47020 55025 58775
Hemoglobin),
melitus
Hormonal therapy for Pituitary -
1812 E22.0 M11 Clinical Photograph Case sheet with clinical improvement 20540 22640 25675 28300
Acromegaly
T3, T4, TSH, Basal Cortisol Levels (Adrenal
Initial evaluation and management of Corticotrophin Stimulation Test), Cortisol
1813 E23.0 M11 T4 ,Case sheet with clinical improvement 17180 19280 21475 24100
Hypopituitarism without growth harmone Assay After Dexamethasone,Growth Hormone
(Basal, Post Glucose Load)
T3, T4, TSH, Basal Cortisol Levels (Adrenal
Hypopiturasim Initial Evaluation And Corticotrophin Stimulation Test), Cortisol
1814 E23.1 M11 T4, Case sheet with clinical improvement 28400 30800 35500 38500
Management With Growth Hormone Assay After Dexamethasone,Growth Hormone
(Basal, Post Glucose Load),
T3, T4, TSH, Basal Cortisol Levels (Adrenal
Hypopiturasim Maintanance Phase Corticotrophin Stimulation Test), Cortisol
1815 E23.2 M11 T4 ,Case sheet with clinical improvement 13560 13560 16950 16950
Monthly Package For Growth Hormone Assay After Dexamethasone,Growth Hormone
(Basal, Post Glucose Load)
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Blood cortisol level/24 hours cortisol level,
Cortisol LDDS(Low-Dose Dexamethasone
Suppression), Adrenocorticotrophic(ACTH)
Assay, Basal Cortisol Levels (Adrenal
Blood cortisol level/24 hours cortisol level,
Corticotrophin Stimulation Test), Inferior
Adrenocorticotrophic(ACTH) Assay, Complete
petrosal sinus sampling (IPSS), CT Scan Chest
Blood Picture [CBP], Serum Potassium ,
With Contrast/CT Scan Chest With Contrast,
Medical Management of Cushings Random Blood Sugar (RBS) Test, Serum
1816 E24.9 M11 MRI Chest With Contrast -/MRI Chest Without 32100 34200 40125 42750
Syndrome Cholesterol Levels, Triglycerides, Prothrombin
Contrast -, CT-Scan Brain Plain And Contrast,
Time - , Serum Free Testosterone Levels, Case
MRI Brain With Contrast/MRI Brain Without
sheet with clinical improvement, Clinical
Contrast, Complete Blood Picture [CBP],
Photograph
Serum Potassium , Random Blood Sugar (RBS)
Test, Serum Cholesterol Levels, Triglycerides,
Prothrombin Time - , Serum Free Testosterone
Levels, Clinical Photograph
FSH(Follicle-Stimulating Hormone) Levels,
Medical Management of Precocious Luteinizing Hormone (Lh) Levels, Serum Free Serum Luteinizing Hormone (Lh) Levels, Case
1817 E30.1 M11 16800 18600 21000 23250
Puberty Testosterone Levels/ Estradiol Levels, T3, T4, sheet with clinical improvement
TSH, Skeletal Survey , X-Ray Skull
Throat Swab For KLB, HB A1c(Glycosylated
Medical management of Lower
1818 J22 M11 Hemoglobin), CT scan Lower Abdomen Case sheet with clinical improvement 25400 27800 31750 34750
Respiratoy Tract Infection
Without Contrast
CT scan Lower Abdomen Without Contrast,
1819 J32.9 M11 Medical management of Fungal Sinusitis Fluid for Fungal Stain, HB A1c(Glycosylated Case sheet with clinical improvement 43940 46940 54925 58675
Hemoglobin)
CT scan Lower Abdomen Without
Contrast/USG Abdomen, Complete Blood
1820 K81 M11 Medical management of Cholecystitis Case sheet with clinical improvement 32690 35690 40863 44613
Picture [CBP], HB A1c(Glycosylated
Hemoglobin)
Serum Calcium Levels, Serum Phosphorus
Dexa Scan (Hip & Spine / Heel) (Bone Scan)/
Levelss, Serum Vitamin D3 Levels, P.T.H Assay
1821 M82.1 M11 Medical Management of Osteoporosis Bone Mineral Density\Densitometry -Whole 11990 12890 14988 16113
(Parathyroid Assay), Case sheet with clinical
Body
improvement
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Serum Free Testosterone Levels, ECHO
Cardiogram, FSH(Follicle-Stimulating
Hormone) Levels, Luteinizing Hormone (Lh)
Hormonal therapy for Delayed Puberty
1822 Q96 M11 Levels, MRI Brain DEXA scan, T3, T4, TSH, Case sheet with clinical improvement 16300 18100 20375 22625
Hypogonadism-Turners Syndrome
Chest X-Ray PA View(1 Film), Skeletal Survey
, USG Abdomen, USG Pelvis-, Karyo Typing-
Cytogenetics, X-Ray Skull, Estradiol Levels
Medical Management of Viral And Other Upper GI endoscopy/Colono Scopy, Stool For
1825 A08.4 M12 Endoscopic Photograph 18650 20150 23313 25188
Specified Intestinal Infections Microscopy , Case sheet with clinical History
Medical Management of Infective Stool For Microscopy, Sigmoidoscopy
1826 A09.0.A M12 Endoscopic Photograph 18050 18950 22563 23688
Proctitis entero Colitis (REGID)
Colono Scopy, Upper GI endoscopy, Routine
Histopathological Examination, Barium Routine Histopathological Examination/ X-Ray
Medical Management of Abdominal
1827 A18.3 M12 Studies/Ascitic Fluid Analysis- Routine / CT PA View(1 Film), Ascitic Fluid Analysis- 23000 26000 28750 32500
Tuberculosis
scan Lower Abdomen Without Contrast (Any Routine
One)
Medical Management - SEMS (Stent) For
1828 C24 M12 Paliation Of Advanced Biliary CT Scan Abdomen With Contrast Endoscopic Photograph 52560 53460 65700 66825
Malignancy
Medical Management- SEMS (Stent) For
1829 C25 M12 Paliation Of Advanced Pancreatic CT Scan Abdomen With Contrast Endoscopic Photograph 52560 53460 65700 66825
Malignancy
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ICD Code Non NABH Non NABH NABH NABH
Code
Hospitals Hospitals Hospitals Hospitals
Medical Management - SEMS (Stent) For
1830 C26.9 M12 CT Scan Abdomen With Contrast Endoscopic Photograph 34820 35720 43525 44650
Paliation Of Advanced GI Malignancy