Revised Rate List

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)

001 General01001001

150/-01001002 SpecialistsConsultation(OPD)by 200/-

01001003 200/-01001004 250/-

01001005 250/-01001006 Pre-operativeConsultationAnaesthetic 200/-01001007 75/-01001008 150/-01001009 75/-01001010 1700/-01001011 SuturingDressingswithoutLargelocal 160/-01001012 400/-010010130100101401001015 1200/-1100/-500/-01001016 1000/-

01001017 Therapeutic 1300/-

0100101801001019 1200/-1500/-01001020 1500/-01001021 Strapping 100/-0100102201001023 300/-60/-01001024 1500/-

Revised Rate List under the West Bengal Health Scheme, 2008(Notification No. 796-F (MED) dated 31-01-2011)

01 – PROCEDURES

NAME OF TREATMENT Rate (INR)

Consultation by MedicalOfficer (OPD)

Visit/ Revisit/ Consultation(Maximumby Specialiststwo visits(Indoor)perConsultationday admissible)by Super-Visit/SpecialistsRevisit/ Consultation(OPD)by Super-Specialists(Indoor)(Maximum two visits perday admissible)

ParamedicalSpecial NursingConsultationCharge(per shift of 12 hrs.)Aya/(perAttendantshift of 12Chargehrs.)Delayed primary suture

Suturinganesthesiaof wounds withRemovalDebridementlocalofanesthesiaBenignof woundsTumorAspirationTherapeuticPlural Effusion -Abdominal Aspiration -

Removal of F.B.Bone MarrowSuperficialAspirationJoints Aspiration

RemovalVenesectionof StitchesPhimosis Under LA

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01001025 700/-01001026 1500/-01001027 1000/-

01001028 Veins 1300/-01001029 Catheterisation 120/-01001030 1100/-01001031 600/-01001032 1500/-01001033 1800/-01001034 2400/-01001035 100/-

1200/-01002001 600/-01002002 600/-01002003 600/-01002004 600/-01002005 I/DExcisionInjectionofKeloidCornsof 550/-01002006 300/-01002007 120/-01002008 1700/-01002009 Liipoma 2400/-

2450/-01003001 sessionRemovalSpeechofof30-40therapyforeignminutesperbody 200/-

01003002 1500/-

01003003 250/-01003004 Syringing 300/-01003005 800/-01003006 1600/-01003007 Therapy 250/-

1

Scheme, 2008dated 31-01-2011)


Lumbar punctureSternal punctureInjection for HaemorrhoidsInjection for Varicose

Dilatation of UrethraIncision & DrainageIntercostal DrainageRemovalPeritonealof softdialysistissue orregionalgeneral anaesthesiablock underSecondaryDressingsutureSmall of

01001036002 woundsSkinExcision of MolesExcision of WartsExcisioncontagiosumof MolluscumExcision of Veneral Warts

ChemicalAcneCautery (perExcisionsittings)of SebaceousExcisionCystsof Superficial

01002010003 Excision ofE.N.T.Dermoid Cysts

From Nose/ Ear/ Throat(Day care package)

Swallowing Therapy

PolypPeritonsillarremovalabscessunder LATinnitusdrainageRetrainingunder LA

CODE0100300801003009

010030100100301101003012010030130100301401003015010030160100301701003018

0100301901003020010030210100302201003023010030240100302501003026010030270100302801003029010030300100303101003032010030330100303401003035

01003036

01003037010030380100303901003040

010030410100304201003043010030440100304501003046

Revised Rate List under the West Bengal Health Scheme, 2008

Annexure-I

MaximumApproved

PROCEDURE (Rupees)Myringoplasty 10700/-Staepedectomy 12000/-

6000/-1000/-

Tympanotomy 8000/-Paracentesis 4300/-Tympanoplasty 14000/-Mastoidectomy 15600/-Otoplasty 16500/-Labyrinthectomy 15600/-

50000/-

Decompression 20000/-Septoplasty 10200/-SubmucousFractureRhinoplastySepto-rhinoplastycosmetic)ReductionResection(non- 12000/-15000/-10800/-9000/-

9600/-6000/-13000/-15000/-15000/-

LateralAntrumRhinotomyPuncture 3000/-1350/-28000/-

Ethamoidectomy 17600/-12000/-18000/-

EndoscopicHypophysectomy 25000/-

Decompression 32000/-30000/-9600/-8100/-

Lithotomy 9700/-Adenoidectomy 8000/-Palatopharyngoplasty 15100/-

16000/-Pharyngoplasty 18000/-Styloidectomy 11500/-

Health Scheme, 2008(Notification No. 796-F (MED) dated 31-01-2011)


Myringotomy withEndoscopicGrommet Removalinsertion ofFish Bone

Skull Base surgeryFacial Nerve

IntraTurbinectomyNasal DiathermyEndoscopic DCREndoscopicSeptal Perf.SurgeryRepair

Cranio-facial resection

Caldwell Luc SurgeryAngiofibroma Excision

Endoscopic Optic Nerve

Decompression of OrbitRanula ExcisionTongue Tie excisionSub Mandibular Duct

Cleft Palate repair

MaximumApproved

CODE PROCEDURE (Rupees)01003047 Uvulo-palatoplasty 20000/-01003048 Tympanomastoidectomy 15600/-01003049 Dacunisation 7000/-01003050 Tonsillectomy 11200/-01003051 Adenotonsillectomy 13500/-01003052 Synichiolysis 4200/-01003053 4000/-01003054 Simple 11200/-

01003055 13500/-01003056 FESS 11200/-01003057 4000/-01003058 5000/-01003059 6000/-004 Opthalmology01004001 200/-01004002 300/-01004003 Eye 200/-01004004 300/-01004005 200/-

01004006 300/-01004007 Paracentesis 800/-01004008 300/-01004009 Refraction/Fundoscopy 90/-01004010 100/-01004011 100/-

01004012 Eye 800/-

01004013 1000/-01004014 100/-01004015 100/-01004016 Pterygium 2200/-01004017 Orbitotomy 9000/-01004018 6500/-01004019 3600/-01004020 700/-

2


SubmucosalNasal Mass DiathermyExcision-

Nasal Mass Excision-Endoscopic Removal

Anterior Nasal PackingPost Nasal PackingNasal Bone Reduction

ulcer/subconjuctivalinjectionCauterisationCauterisation- One eyeofofRetrobularinjectionulcer/subconjuctivalInjection- Both eyes- One

RetrobularEyesInjection - BothSyringing-ForofoneLacrimaleye SacSyringing of Lacrimal Sac- For both eyes

Foreign body removal

Ortho-optic exercisesPlepoptic ExercisesChalazion operation -One

Chalazion operation -Both EyesDressing (Eye)Clinical Photography

Ptosis correction.Ectropion CorrectionXenon Arc Laser

CODE

010040210100402201004023

010040240100402501004026010040270100402801004029010040300100403101004032010040330100403401004035010040360100403701004038010040390100404001004041

01004042010040430100404401004045010040460100404701004048


Annexure-I

MaximumApproved

PROCEDURE (Rupees)

rhinostomy) 5700/-ECCE/ICCE 6000/-

2100/-

eye) 4000/-14000/-6000/-

TrabeculotomyIridectomy 2400/-5700/-2400/-14000/-1100/-

Vitrectomy 11000/-Enucleation 4000/-Eviseration 3800/-

7500/-3000/-5700/-5000/-

Caliculoplasty 3000/-3000/-7000/-

surgery 7000/-EctropionEctropionsurgery-surgery-onebothlid 3000/-

4000/-tumors 8000/-

4000/-9000/-

Lasik 18000/-



D C R (Dacryo custo-

Epicanthus correction.Squint Correction (one

SquintKeratoplastyCorrectioneyes) (both

ScleralGoniotomyBukling (RetinalDetachment Surgery)Syringing & Probing

CataractEntropionlenswithextra)correctionIOL(Cost ofGlucomaFistulectomysurgery withGlucoma valves

PtosisDacryocystectomysurgeryresectionwith LPSPtosis surgery with Sling

Cheek rotationlids flap for lid

Telecanthus correctionFracture orbital repair

Annexure-I

MaximumApproved


01004049 4000/-

01004050 keratectomy 9000/-

01004051 1000/-01004052 LidOrbitalAbscessAbscessdrainageincisionincisionand 3000/-01004053 4000/-01004054 Cyclodiathermy 2000/-01004055 4000/-

01004056 14500/-

01004057 600/-01004058 600/-01004059 1000/-01004060 HVF 500/-01004061 Cryopexy 1200/-01004062 2000/-01004063 Medicine 3600/-01004064 150/-01004065 CyclodiathermyCyclocryo/ 500/-01004066 800/-01004067 4000/-01004068 4000/-01004069 3500/-01004070 2400/-

3


TTT- Transpupillarythermal therapyPTK- Phototherapeutic

Iris cyst removal

and drainage

Perforating injury repairPhacoFoldable+ IOL& Non-foldable(inclusive oflens) PackageYAG Laser Capsulotomyper sittingYAG LaserArgonsittingIridectomyLaser perTrabeculoplasty(per sitting)(ALT)

ICGICG-includingDouble includingMedicine

Electrolysis (Per sitting)

D.C.T. (OPD)Silicone Oil (1000)Silicone Oil (C 5)Silicone Oil RemovalPneumo Retinopexy

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees) CODE01004071 1500/- 0100409201004072 1000/- 01004093

01004073 2400/- 0100409401004074 SF 6 Gas 2400/- 01004095

01004075 C 8 Gas 2400/- 01004096

0100407601procedurePhPFCLeye 15000/-2400/-procedurePhotodynamiccharges-Therapyboth 01005002

01004078 eyes 25000/- 0100500301004079 85000/- 01005004

01004080 100000/- 00601006001

01004081 6000/- 010060020100600301006004

01004082 injection-single) 4000/- 010060050100600601006007

01004083 injection-single) 4000/- 0100600801006009

01004084 antibioticsmedicines(costextra)of 2000/- 0100601001006011

01004085 Removal 4000/- 01006012007

01004086 6500/-01007001

01004087 1600/-01007002

01004088 3200/-01007003

01004089 IVTCA 800/- 0100700401004090 2400/- 01007005

01004091 5000/- 01007006



FGE/ FAEIndirect Laser

Endo Laser

3F

01005001005

Photodynamic Therapy(single eye)Photodynamic Therapy(both eyes)Intravitreal Avastin(including single)cost of injection-Intravitreal Lucentis(excluding cost of

Intravitreal Macugen(excluding cost of

Intravitreal injections of

Retinal Foreign Body

PPV/ Victerectomy

Endo Diathermy

Belt Buckle

Membrane Peeling

Anterior Vitrectomy

MaximumApproved

PROCEDURE (Rupees)Lensectomy 7500/-

16000/-

Membrane) 3600/-2400/-

linking 15000/-

4000/-BiopsyGeneralprocedureAnaesthesiaunder 6000/-

8000/-FNAC 3500/-

200/-200/-360/-400/-400/-400/-500/-450/-450/-450/-450/-450/-

Traction

sitting) 70/-

sitting) 90/-

70/-90/-90/-

sitting) 90/-

4

Bengal Health Scheme, 2008dated 31-01-2011)


Orbitotomy (Multiple Wall)ERM (Epi Retinal

Reti BlueCorneal Collagen Cross-

Biopsies includingHistopathologicalBiopsyLocal(Package)procedureAnaesthesiaunderreport

BiopsyEndoscopyprocedure under

Strapping (includingBandage & materials)Strapping of FingerStrapping of ToesStrapping of WristStrapping of ElbowStrapping of KneeStrapping of AnkleStrapping of ChestStrapping of ShoulderNasal bone fractureFigure of 8 bandageColar and cuff slingPhysiotheraphyBall bandage &

Ultrasonic therapy (per

S.W. Diathermy (per

Electrical stimulation(therapeutic) (per sitting)Infra red (per sitting)U.V. Therapeutic(per sitting) doseElectric vibrator (per

Annexure-I

MaximumApproved


01007007 90/-

01007008 90/-

01007009 70/-01007010 CervicalCombinedsitting)tractionLumbar(per& 70/-01007011 50/-01007012 70/-

01007013 sitting) 90/-

01007014 sitting) 60/-

01007015 sitting) 70/-

01007016 90/-

01007017 sitting) 60/-

01007018 Session) 80/-

01007019 150/-

01007020 100/-01007021 100/-

01007022 200/-

01007023 140/-

01007024 200/-

01007025 Exercises 260/-

01007026 SWD 260/-

01007027 150/-

01007028 60/-01007029 Fraction 100/-



Vibrator belt massage(per sitting)Intra Lumbar Traction(per sitting)Intermittent Cervicaltraction (per sitting)

Wax bath (per sitting)Hot pack (per sitting)Whirl pool bath (per

Obesity Exercises (per

Breathing Exercises &Postural Drainage (per

Cerebral Palsy – Massage(per sitting)Post – polio exercise (per

Basic Gait Training (Per

Traction + IFT

Traction + StimulationTraction + SWD

Traction + SWD + IFT

Traction + US

Traction + US + IFTTraction + US + IFT +

Traction + US + IFT +

IFT + PWB

PWBExercise-+ KneeperJointsittingSpad

Annexure-I

MaximumApproved


01007030 100/-

01007031 100/-

01007032 200/-01007033 100/-01007034 100/-

01007035 200/-

01007036 100/-

01007037 100/-

01007038 100/-

01007039 100/-

01007040 100/-

01007041 Session 150/-

01007042 Session 150/-

01007043 100/-01007044 Tens 80/-008 Dental

01008001 120/-

01008002 250/-01008003 500/-01008004 300/-01008005 300/-01008006 500/-

01008007 LA 800/-01008008 1000/-

01008009 80/-01008010 1400/-

5

Scheme, 2008


SWD + IFT

US + IFT

US + IFT + StimulationUS + KneeFractionJoint + SpadUS + PWB

US + SW + Traction

US + Tens

US + Stimulation

Knee Joints Spad FractionElectronic Tilt Training-Per Session

Interferential TherapyLaser Treatment- Per

Microwave Diathermy- Per

Quadriceps Chair Training(Per Session)

Extraction of toothincluding LAComplicated Ext. perTooth including LAFlap Operation per ToothGingivectomy per toothCyst under LA (small)Cyst under LA (large)Impacted Molar including

Apisectomy including LAFracture wiring includingReductionLA &immobilisationMaxilla underof fracture-LA

Annexure-I

MaximumApproved


01008011 3000/-

01008012 GA 2000/-

01008013 4000/-01008014 6000/-

01008015 6000/-

01008016 2000/-

01008017 11000/-Hemi-mandibulectomy

01008018 7000/-Hemi-mandibulectomy

01008019 4000/-Segmental-

01008020 (package) 6000/-Segmental-

01008021 2000/-01008022 5000/-

01008023 4000/-

01008024 5000/-Alvelolectomy,

01008025 1150/-01008026 380/-

01008027 (compound) 450/-

01008028 (regular) 380/-

01008029 2250/-01008030 380/-0100803101 1150/-380/-

01008033 1900/-



Reduction &immobilisation of fracture-Mandible under LASplints/ Circummandibular wiring under

Internal wire fixation/ platefixation of MaxillaLA underInternalfixationwireof GAMaxillafixation/underplateInternalfixation ofwireMandiblefixation/underplateCyst & TumourLA/GAof Maxilla/mandible by enucleation/excision (package)TM joint ankylosis- underGA (package)

with graft (package)

without graft (package)

mandibulectomy with graft

mandibulectomy withoutgraft (package)Maxillectomy-graft (package)partial withMaxillectomy- partialwithout graft (package)Maxillo-facial prosthesis(sal/ auricular/ orbital/facial lost part) (package)

Frenectomy per QuadrantAlvelolectomy (minor)Amalgam Filling/tooth

Amalgam Filling/tooth

Apicoectomy Molar ToothArch Bar RemovalCastBite Plate/Rpd (perRetainersTooth)Davis Crown/ radicularScrew supported

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01008034 200/-

01008035 1500/-

01008036 (category1) 230/-

01008037 1150/-01008038 230/-01008039 950/-01008040 2000/-01008041 Core 1900/-

01008042 sitting) 400/-

01008043 400/-

01008044 1150/-

01008045 Regeneration) 1900/-

01008046 Quadrant 750/-

01008047 400/-01008048 450/-01008049 1150/-

01008050 900/-

01008051 1500/-

01008052 Splinting/la 950/-

01008053 Extra 1150/-

01008054 Retained.comp.core) 750/-

01008055 Preformedamalgm.Carbonate 550/-01008056 750/-

Scheme, 2008


De Sensitising per sittingDento Alveolar FractureReduction & Splinting/l.a.Denture Repair

Dialation of WhartonsDuct under L.A.Direct/Cappingindirect PulpDrain.EnucleationAbsce.of Dento(ex.ofOral)AlveolarCyst ofFibre PostOralBasedCavityPost &

Floride Application (per

Extraction of ImpactedTooth By Operation

Extraction of MISP Toothby Operation (Open Meth)GTR (Guided Tissue

Gingivectomy per

Glass Ionomer FillingGlass Ionomes FillingInterdental WiringIntra Articular Inj. ofSteroids in TMJ

Jacket Crown AcrylicMinor Dento-alveolarTracture Reduction &

Post Core/ tooth (castPost) lab Metal Chgs.

Post Core/ tooth (pin

Post Core/ toothScrew/pin Retain.

Jacket Crown

Annexure-I

MaximumApproved


01008058 Pulpotomy 750/-

0100805901 3400/-1400/-01008061 Removal(1stPartialTooth)Denture 400/-

01008062 230/-

01008063 Bar) 750/-0100806401TissueRepairRepairTissueLacerationofofLacerationFacialFacial(minor)SoftSoft 1150/-750/-01008066 1150/-

01008067 400/-

01008068 extra) 3600/-01008069 400/-

01008070 Stones 115/-

01008071 1150/-

01008072 (package) 1500/-

01008073 1150/-

01008074 (package) 1150/-

009ICU/ITU/CCU/NICU/PICUECG/SPO(including:-/NIBP/IBPOxygen;

01009001 2400/-



Preformed Steel Crown

Reduction of DislocationReimplantationof TmjTooth)(Under LA.)(per

Removable PartialDenture (Additional Tooth)Removable PartialDenture per Tooth (Palatal

Root(UptoCanal4 Sitting)TreatmentRoot Canal Treatment(Extra Sitting)Root Canal Treatmentwith Filling and Crown(package) (Lab. Charges

Scaling per SittingSialolithotomy for Small

Surgical Extraction orSurgical Removal ofImpact (package)Surgical Removal of BeninReoplasm of Oral

Surgical Removal of SoftTissue Lesion (package)Surgical Removal ofImpact Mesiod.tuber

ITU/CCU CHARGES(Special Care Cases)

monitoring; 1:22 Nursing ëGNM Nursing; Round thespot);Clock Diet;DoctorSyringe(ResidentPump)on

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)(includingVentilatoraccessories)charge

01009002 1000/-

01009003 800/-01009004 HighDownDefinition(includingUnit/Oxygen)Step 1500/-01009005 1200/-01009006 400/-010

01010001 60/-01101011001 700/-

01011002 700/-

01011003 medicines) 700/-

01011004 700/-

01011005 1500/-

01011006 1500/-

01011007 Oxygen) 1500/-

01201012001 12000/-01012002 12000/-01012003 14000/-01012004 20000/-01012005 22000/-

7

Scheme, 2008


per dayPneupack Ventilator inNursery (per day)

ExchangeO.T. ChargesTransfusionforExchange transfusionOxygen ChargesPrivate/ Semi-private/General Ward per hourBurn CasesdressingDressinguptomedicines)30%materials(excludingBurns 1standSubsequentupto 30% DressingBurns(excluding dressingmaterials and medicines)30% to 50% Burns 1stDressing (excludingdressing materials and

30% to 50% BurnsSubsequent Dressing(excluding dressingmaterials and medicines)Extensive Burn above50% Frist Dressing(excluding dressingmaterials and medicines)Extensive Burn above50% Subsequent dressing(excluding dressingmaterials and medicines)Burn Unit Bed (including

Obstetric &Gynaecology CasesNormalEpisiotomydelivery& P.orrepairwithLow ForcepsLow midcavity forcepsCesarean SectionCesarean Hysterectomy

CODE PROCEDURE

01012006

01012007 ClosureLaparotomy-peritonitis

01012008Laparotomy-failed

0101200901012010 Salphingectomy01012011 Salphingo-Oophorectomy0101201201012013 Oopherctomy

01012014

01012015

01012016

0101201701012018

010120190101202001012Burst-abdomenanaesthesiaRepair01012022 GapingSecondaryParenealSuturingWound01012023 GapingSecondaryabdominalSuturingwound010120240101202501012026

01012027

01012028


NAME OF TREATMENT

Rupture Uterus- closure &repair with Tubal LigationPerforation of Uterus afterD/E Laparotomy &

Lavage and Drainage

laparoscopy to explore

Ovarean Cystectomy

Broad LigmentHaemotoma DrainageExploration of perinealHaematoma & Resuturingof EpisiotomyExploration of abdominalHaematoma (afterlaparotomy + LUCS)Internal podalic versionand extractionManualPlacentaRemoval ofMRP3rd stagefor outsideComplicationdeliveryExaminationetc under

Completerepairperineal tear-Explorationrepairof PPH-tearDestructive OperationSuction evacuationvesicular mole, Missedabortion D/EColpotomy-drainage P/Vneedling EUA

Annexure-I

Maximum MaximumApproved Approved

(Rupees) CODE PROCEDURE (Rupees)

22000/- 01012029 4200/-

01012030 caruncle 4000/-18000/- 01012031 6100/-

16000/- 01012032 stich 3700/-

6100/- 01012033 Laparotomy 20000/-14000/-18000/- 01012034 22000/-18000/- 01012035 22000/-15000/-

01012036 Myomectomy 22000/-12000/-

01012037 Vaginoplasty 22000/-Vulvectomy

12000/- 01012038 (Simple/Radical) 25000/-

01012039 25000/-12000/-

01012040 25000/-12000/-3700/- 01012041 20000/-

01012042 Perineorrhaphy 14700/-4900/- 01012043 Colporraphy 14400/-2500/-3300/- 01012044 16900/-2500/- 01012045 10200/-3700/- 01012046 2700/-2500/- 01012047 3400/-4200/- 01012048 3400/-12000/-

01012049 Polypectomy 3600/-

5900/- 01012050 3600/-

4200/- 01012051 3900/-

8

West Bengal Health Scheme, 2008

Rate (INR) NAME OF TREATMENT Rate (INR)

Repair of post-coital tear,perineal injuryExcision of urethral

Laparoscopy (Gynae)Shirodhkar, Mc. Donalds

Abdominal HysterectomyVaginal Hysterectomy

RVF Repair

Other Major Operations

Manchester Operations

Modified GilliamShirodkar’s OperationDiagnostic CurettageFractional CurettageD & C and Cervical Biopsy

Other-Minor OperationExcision VaginalCyst/Burtholin Cyst

Annexure-I

MaximumApproved


01012052 5900/-

01012053 6000/-01012054 7300/-01012055 12000/-01012056 25000/-01012057 10800/-01012058 Adhesiolysis 17400/-

01012059 pregnancy 20000/-

01012060 11500/-

01012061 IUCD 5500/-

01012062 Septum 11500/-

01012063 7300/-01012064 30000/-01012065 4700/-01012066 6000/-01012067 3900/-01012068 4200/-01012069 3200/-01012070 4800/-01012071 28000/-01301013001 2000/-01013002 2400/-0101300301 2400/-3100/-



Excision Vaginal Septum

Laparoscopy DiagnosticLaparoscopy SterilisationLaparoscopy OperativeLaparoscopy LAVHDrilling of Ovary

Management of Ectopic

Hysteroscopy TCREHysteroscopy Removal of

Hysteroscopy Removal of

Hysteroscopy DiagnosticWerthimasfor CancerHystrectomycervixSterilisation Post PertumSterilisation IntravaginalAbortion- D & CAbortion- EvacuationMTP- 1st TrimesterMTP - 2nd TrimesterExtended HysterectomyGeneral SurgeryDrainage of AbscessAspirationDressingofundercold AbscessG.A.Aspirationof Lymphnodeof Empyema

Annexure-I

MaximumApproved


01013005 Abscess 3000/-

01013006 10000/-01013007 10000/-01013008 DrainageAbscessof 8000/-01013009 SubdiaphragmaticAbscess 14000/-01013010 14000/-01013011 12000/-

01013012 Abscess 8000/-

01013013 8000/-

01013014 Abscess 8000/-

01013015 10000/-Fissurectomy/Haemorroidectomy/

01013016 16000/-01013017 16000/-01013018 2800/-01013019 25000/-01013020 4000/-01401501015001 9700/-01015002 Breast 9600/-01015003 12000/-016 GASTROENTROLOGY01016001 30000/-

9

Scheme, 2008


Aspiration of Liver

Open Drainage of LiverDrainageAbscessof PelvicDrainageAbscessof Ischiorectal

PerinephericOpen DrainageAbscessofDrainageAbscessof PerigastricDrainage of Perotid

Drainage ofRetropharyngeal AbscessOpen Drainage of Psoas

Open Drainage ofPerivertebral Abscess

Haemorroidectomy/CorrectionCorrection ofof PilesPiles(costwith ofStaplerGun extra)GunExcisionNeurofibromaof SuperficialVaricose VeinsExcision of CarbuncleInjury OfTissuesSuperficial SoftInterestical (Implant)Head & Neck

Soft Tissue Sarcome

Capsule Endoscopy

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees) CODE

01016002 Enteroscopy 18000/- 01016025

01016003 Evaluation 30000/- 01016026

01016004 (Major) 5000/- 01016027

01016005 6500/- 01016028

01016006 (Minor) 2200/- 01016029

01016007 3000/- 0101603001016008 3500/- 0101603101016009 5500/- 0101603201016010 1000/- 0101603301016011 1600/- 0101603401016012 16000/- 0101603501016013 23000/- 0101603601016014 13300/- 0101603701016015 18000/- 0101603801016016 15000/- 0101603901016017 9000/- 0101604001016018 3000/- 01016041

01016019 4200/- 0101604201016020 3500/- 0101604301016021 1500/- 0101604401016022 3000/- 01016045

01016023 (BS) 4200/- 0101604601016024 1200/- 01016047



Complete Double Baloon

Complete Small Bowel

Argan Plasma Coa

Argan Plasma Coa(Major) (BS)Argan Plasma Coa

Argan Plasma Coa(Minor) (BS)Band LigationBand Ligation (BS)Biliary BrushingBiliary Brushing (BS)Biliary Pancreatic (M)Biliary Pancreatic (M) (BS)Biliary Pancreatic (P)Biliary Pancreatic (P) (BS)Cre Ballon Dilatation (BS)Cre Balloon DilatationDilatation (Stricture)

Dilatation (Stricture) (BS)EMG Charge (Large)EMG Charge (Small)Endoscopic Tube PlaceEndoscopic Tube Place

Oesophageal Transit

MaximumApproved

PROCEDURE (Rupees)

7000/-

11000/-

4500/-

7000/-

7000/-

7000/-10000/-

Hepatonorm 700/-4000/-6000/-4000/-6000/-3200/-4500/-12000/-18000/-3000/-

(BS) 4200/-6500/-8200/-12000/-

(BS) 17500/-3200/-

10

Health Scheme, 200831-01-2011)


Gastrostomy (PEG)

Gastrostomy (PEG) (BS)

Glue Injection

Glue Injection (BS)

Hemosta by Glod Probe

Hemostatic ClipHemostatic Clip (BS)

Injection HemostasisInjection Hemostasis (BS)LGI ManometryLGI Manometry (BS)UGI ManometryUGI Manometry (BS)Nasobiliary DrainageNasobiliary Drainage (BS)Nasojejunal Tube PlacNasojejunal Tube Plac

Papilla Cannu MinorPapilla Cannu Minor (BS)Pappu Stnt Spingt (M)Pappu Stnt Spingt (M)

Polypectomy (Colonic)

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01016048 Polypectomy(BS)(Colonic) 4800/-0101604901 4500/-3000/-

01016051 4500/-01016052 7500/-01016053 9000/-01016054 16000/-01016055 Sclerotherapy 3000/-

01016056 3800/-01016057 14000/-01016058 Sphincterotomy 10500/-01016059 16000/-01016060 12000/-01016061 17000/-01016062 2500/-01016063 25000/-01016064 10000/-01701017001 600/-

01017002 ExcisionInjuries)ofSkinPinnaOnlyfor 4500/-

01017003 Cartilage 6000/-01017004 6000/-01017005 7500/-



PolypectomyPolypectomy(BS)(Upper(Upper GI)GI)

Pre CuttingPre Cutting (BS)Pseudocyst DrainagePseudocyst Drainage (BS)

Sclerotherapy (BS)Small Bowel Enteroscp

Sphincterotomy (BS)Stone ExtractionStone Extraction (BS)Gastric EmptyingMechanical LithotripsyERCP (Stenting)Head & NeckEar Lobe Repair one sideExcision of Pinna forGrowth (Squamous/Basal/

Growth (Squamous/Basal/Injuries) Skin and

Partial AmputationPinna ofTotal Amputation of Pinna

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01017006 ExcisionTotalAuditoryAmputationofMeatusExternal& 10250/-01017007 ExcisionExcisionHygromaofofMinorCysticCystic 5500/-01017008 8000/-01017009 12300/-01017010 11000/-01017011 11000/-01017012 MandibulectomyDiverticulum 12200/-01017013 25000/-01017014 30000/-01017015 Pharyngectomy 35000/-01017016 17000/-01017017 27000/-01017018 20300/-01017019 PharyngectomyReconstruction& 40000/-01017020 10000/-01017021 10000/-

01017022 Vermilonectomy 12000/-01017023 9700/-01017024 12000/-01017025 10200/-01017026 23300/-01017027 Segmental 18100/-01017028 Hemimandibulectomy 27200/-01017029 6100/-01017030 Hemiglossectomy 13500-01017031 TotalParotidectomyGlossectomy- 25000/-01017032 Superficial 24000/-

11

Scheme, 2008


Hygroma MajorHygromaExcision Extensiveof CysticExcisionExcisionof Branchialof BranchialCystExcisionSinusof Pharyngeal

Operation for Cervical Rib

Stenosis ExcisionCommando OperationCervicalBlock DissectionLymph Nodesof

OperationLip - Wedgefor CarcinomaExcisionOperationLip - Vermilionectomyfor CarcinomaLipOperation- WedgeforExcisionCarcinomaand

Estlander OperationAbbe OperationCheek AdvancementExcisionExcisionofofthetheMandibleMaxilla -

Partial Glossectomy

Annexure-I

MaximumApproved


01017033 Conservative 19700/-

01017034 22000/-

01017035 15000/-

01017036 20400/-

01017037 gland 10000/-

01017038 Hemithyroidectomy 15000/-01017039 16000/-01017040 Subtotal(ToxicThyroidectomyGoitre) 22000/-01017041 23000/-01017042 12500/-01017043 Isthmectomy 12600/-01017044 31400/-01017045 25650/-01017046 15000/-01017047 25600/-01017048 Laryngectomy 37150/-

01017049 43500/-01017050 14000/-01017051 8000/-0101705201HyoidGenioplastySuspension 12000/-12000/-0101705401DirectPhonosurgeryLaryngoscopy 15400/-5400/-01017056 3000/-01017057 11000/-01017058 Laryngofissure 17500/-01801018001 11000/-01018002 27600/-01018003 28500/-



Parotidectomy -

Parotidectomy - Radical

Parotidectomy - Total

Repair of Parotid DuctRemoval ofSubmandibular Salivary

Partial Thyroidectomy

Total ThyroidectomyResectionAdenomaEnucleation of

TotalBlockThyroidectomyDissection andExcisionThyroidof LingualExcisionCyst/Fistulaof ThyroglossalExcisionAdenoma/Carcinomaof Parathyroid

Laryngo PharyngectomySinus & Fistula repairLymph Node Excision

Fibroptic LaryngoscopyMicrolaryngeal Surgery

Head & Neck CancerBenign Tumour ExcisionsTemporal Bone resectionRadical Neck Dissection

Annexure-I

MaximumApproved


01018004 36000/-01018005 39050/-

01018006 Surgery 42800/-

01018007 Excision 32000/-

01018008 30000/-019 Breast01019001 7000/-01019002 10000/-

01019003 (Simple) 13500/-01019004 28000/-01019005 16000/-01019006 18300/-01019007 30000/-020 CardioProceduresRespiratory01020001 ThoracotomyTracheostomy(Penetrating 3700/-01020002 17500/-01020003 Decorticationempyema 5400/-01020004 (Pleurectomy) 37000/-01020005 Thoracoplasty 37000/-01020006 Pneumonectomy 37000/-01020007 Lobectomy 37000/-01020008 37000/-01020009 37000/-01020010 LungthoracoscopicvolumeSurgeriesreductionlung 37000/-

01020011 Bilateral) 37000/-Thoracoscopic

01020012 Decortication 37000/-Thoracoscopic

01020013 Pneumonectomy 37000/-01020014 37000/-

12

Scheme, 2008


Carotid Body Excision(cost of Graft extra)Total LaryngectomyFlap Reconstructive

Parapharyngeal Tumour

Total Thyroidectomy

Drainage of AbscessExcision of LumpsLocal Mastectomy

Radical(Formal Mastectomyor Modified)ExcisionFistulaof MammarySegmentalBreastResection ofBreast Cancerexcision)(Tumour

IntercostalWounds)Drainage of

Segmental ResectionHydatidVideo-assistedCyst- Removal

surgery (Unilateral/

Thoracoscopic Lobectomy

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)0102001501ThoracoscopicThoracoscopicCystResectionexcisionSegmental 37000/-37000/-01020017 SympathectomyThoracoscopic 37000/-

01020018 Reconstruction 37000/-

01020019 37000/-

01020020 37000/-0102002101DecorticationDecorticationThoracoplastyThoracoplastyResection++Lung+ 37000/-37000/-01020023 18000/-01020024 Medicistinoscopy(cervical) 15000/-01020025 thoracoscopyVideo-assisted(VATS) 36960/-

0102002601 37000/-37000/-01020028 37000/-

Extrapleural01020029 Pneumonectomy 37000/-

01020030 37000/-

01020031 37000/-01020032 TrachealTrachealResectionTumourfor 37000/-01020033 Segmentectomy 37000/-01020034 LungWedgeResectionResectionwith 37000/-01020035 37000/-01020036 37000/-



Chest Wall TumorExcision with

Repair of CongenitalChest Wall Defermities

Multiple Lobectomy

Open Lung Biopsy

SurgeryThoracotomyforLungDestroyedfor BPFSleeveLobectomyResection with

Tracheal Stenosis SurgeryRepair of TracheoInnuminete Fistula

ParatrachealLungResectionResectionL. NodewithChest Wall Invasion

Annexure-I

CODE010200370102003801020039

01020040

01020041

0210102100101021002

01021003

0102100401021005

01021006

0102100701021008

01021009010210100102101101021012

Scheme, 2008

PROCEDURE

Bronchotomy

Mediostonoscopy

CoronaryProfile)Balloon

Profile)

Profile)(includingTAPVCProfile)CorrectionPre-Surgery

ValvotomyOpenSurgeryAortic(includingProfile)ValvotomyPre-(includingProfile)Pre-Surgery

NAME OF TREATMENT

DissectionSurgeryLung ResectionStationsforof LymphRecurrentwithNodeSurgeryPnemothoraxicfor Aspergillosis(Lung Cavities)

Cardiac / CardioThoracic ProceduresCoronaryCoronary(including(includingpost Profile)AngioplastyBypassBypassPre-SurgeryPre-SurgerySurgery-Surgery

(ExcludingAngioplastyCost of Stents)Profile)(including(4 days’Pre-Surgerypackage)Balloon angioplasty withValvotomyOpenSurgeryHeart(includingProceduresProfile) Pre-(includingTotal CorrectionProfile)Pre-SurgeryofTetralogy of Fallot(including Pre-Surgery

RSUV Correction(including Pre-Surgery

Open ASD VSD (includingPre-SurgeryOpen PulmonaryProfile)

Blalock Taussig Operation

MaximumApproved

(Rupees)37000/-37000/-37000/-

37000/-

15000/-

150000/-150000/-

66000/-

90000/-150000/-

150000/-

150000/-150000/-

150000/-150000/-150000/-72000/-

13

Rate (INR)

Annexure-I

MaximumApproved


Profile)01021031

01021013 72000/- 0102103201021033

01021014 Profile) 150000/- 010210340102101501 160000/-150000/- 010210350102103

0102104001021041

01021017 150000/-01021042

0102101801PericardiostomyPericardiectomyP150000/-54000/-72001021043010210401021023 ImplantationPermanentPericard3900/- 010210490102105

0102105201021024 19400/-

010210530102105401021055

01021025 Pacemaker) 12600/-01021026 Embolectomy 19800/-

010210560102102701 96000/-2000/-01021029 Thorachostomy 5400/- 02201021030 37000/-



(including Pre-Surgery

Mitral ValvotomyMitral(Excluding(includingValveProfile)CostPre-SurgeryReplacementof Valve)(including Pre-Surgery

AorticCost(ExcludingReplacement(includingPre-SurgeryofDoubleValveValves)Profile)CostPre-SurgeryReplacementValve(ExcludingProfile)(includingof Valve)Thoraco-Abdomi AortaReplacement (includingPre-Surgery Profile)Coarctation-Arota Repair

Cost of Pacemaker)(4 days’ package)Temporary Pacing LeadImplantation (Includinguse of Temporary

Aneurysm- Resection &GraftingThoracocentesisextra)(cost of Graft likeNote:-ValveCABGReplacementif done alongetc. willwithattractother Heartthe sameSurgeriesrate as

Exploratory Thorocotomy

PROCEDURE

Profile)RemovalfromOesophagusofTracheaForeignorBody

(Pacemaker(PacemakerPermanentPermanentIntraDirectiolImplantation(4HeartGunshot(Biventricular)days’ImplantationcoronaryFontentransplantatherectomyCostpackage)PacemakerPacemakerCostinjury(DDD)stentingextra)extra)(4FemoralIliacfemoraldays’Poplitialpackage)BypassBypass

Bypass

CABG.Oesophagus

Bengal Health Scheme, 2008(MED) dated 31-01-2011)

NAME OF TREATMENT

Unifocalization with Shunt(including Pre-Surgery

Rib Resection & DrainageMediastinal Tumour(Excluding(ExcludingASDPDAThymectomyEPDeviceDeviceDSACostCostSTUDYClosureClosureofof Device)Device)3D RF AblationMini EP StudyCoronary Angiography(1 day’s package)

Aorto Bifemoral BypassCarotid Subclavian

PA BandingBD GlenThoracic Aorta/ ArchReplacement (includingPre-Surgery Profile)

MaximumApproved

(Rupees)

150000/-6000/-11500/-35000/-35000/-40000/-32000/-5400/-8400/-40000/-5000/-

11700/-277000/-170000/-58000/-52000/-98000/-25000/-30000/-75000/-75000/-75000/-

75000/-55000/-55000/-

150000/-

14

Rate (INR)

Annexure-I

MaximumApproved


01022001 29700/-

01022002 38000/-01022003 CarcinomaOesophagectomyEasophagusfor 38000/-

01022004 15500/-

01022005 Transthoracic 29700/-01022006 AchalasiaAbdominalCarida 14600/-01022007 38000/-01022008 1500/-

01022009 Oesophagus 38000/-

01022010 procedure 38000/-01022011 38000/-01022012 5000/-

38000/-01023001 Gastroscopy 1300/-01023002 1700/-01023003 Pyleromyotomy 10000/-01023004 Gastrostomy 12000/-

01023005 15000/-01023006 30000/-01023007 Duodenojejunostomy 25000/-01023008 GastrectomyPartial/SubtotalCarcinomafor 30000/-

Partial/Subtotal01023009 30000/-



Atresia of Oesophagusand TracheoOesophageal FistulaOperations forOesophagusReplacementby Colonof

Oesophageal Intubation(Mausseau Barbin Tube)Achalasia Carida

OesophagusOesophagofor mid 1/3GastrectomyDilatationlesion ofColon-InterStricture- positionper visitorReplacement of

Oesophago Gastrectomy– Lower Corringers

InstallationEsophagealSurgeryofPerforationRyles TubeEsophagealin Ca EsophagusDirecticulum

01022013023AbdomenSurgery

BiopsyGastric(Endoscopic)& Duodenal

Simple Closure ofPerforated peptic UlcerVagotomyGastro JejunostomyPyleroplasty /

Gastrectomy for Ulcer

Annexure-I

MaximumApproved


01023010 25000/-

01023011 Vagotomy 27000/-01023012 25000/-01023013 35000/-

01023014 Vagotomy 25000/-

01023015 Drainage 25000/-01023016 CongenitalHerniaDiaphragmatic 30000/-01023017 30000/-01023018 Transthoracic 30000/-01023019 12900/-01023020 15000/-01023021 15000/-

01023022 Repair 18000/-01023023 Herniorraphy-InguinalInguinalHerniaHerniaunilateral– 15000/-01023024 22000/-01023025 22000/-01023026 25000/-01023027 25000/-

01023028 Hypersplenism 25000/-01023029 40000/-01023030 40000/-

01023031 Hypertension 30000/-01023032 MesentericocavalAnastomosis 35000/-01023033 35000/-01023034 36000/-

15

Scheme, 2008


Operation for BleedingPeptic UlcerGastrojejunostomy &

GastrojejunalOperation forUlcerTotal GastrectomyCancer forHighly Selective

Selective Vagotomy &

HiatusHiatusAbdominalHerniaHernia RepairRepair

Exploratory LaparotomyEpigastric Hernia RepairUmbilical Hernia RepairVentral and Scar Hernia

Hernioplasty-unilateralwith mesh-FemoralRare HerniasHernia- RepairRepair(Spigalion,Lumbar, Obturator,Sciatic)SplenectomyTrauma - ForSplenectomy - For

Splenorenal AnastomosisPortocaval AnastomosisOesophagusDirect Operationfor Portalon

Warren ShuntPancerato Duodenectomy

Annexure-I

MaximumApproved


01023035 Pancreas 30000/-

01023036 Cystogastrostomy 30000/-0102303701 18000/-22000/-0102303901 20000/-25000/-01023041 Cholecystostomy 14200/-

01023042 28000/-

01023043 35000/-

01023044 Tumour 20000/-

01023045 Appendicitis 20000/-

01023046 18000/-01023047 12000/-0102304801 18000/-5100/-01023050 Jejunostomy 18000/-01023051 Ileostomy 18000/-0102305201 20000/-25000/-

01023054 20000/-

01023055 22000/-

01023056 Deverticulum 22000/-01023057 18000/-

01023058 Obstruction 25000/-

01023059 perforation 25000/-



By Pass Procedure forInoperable Carcinoma of

Cystojejunostomy or

CholecystectomyExplorationCholecystectomyof CBD&OperationRepair ofofforDuctCommonLiverHydatidBileCyst

Hepatic Resections(Lobectomy Hepatectomy)Operation on AdrenalGlands - BilateralOperation on AdrenalGlands - Unilateral for

Appendicectomy for Acute

Appendicectomy forChronic AppendicitisAppendicularDrainageAbscess –MesentericPeritonioscopy/LaparoscopyCyst- Excision

StenosisCongenitalMuconiumof SmallAtresiaileusIntestine&Mal-rotation & Volvulus ofthe MidgutResection & Anastomosisof Small IntestineExcision of Meckle’s

Duodenal DiverticulumOperation for Intestinal

Operation for Intestinal

Annexure-I

CODE PROCEDURE

01023060 Intestine

01023061 Fistula

01023062 HaemorrhageOperationsIntestinesofofthetheSmall01023063

01023064 Adhesions)01023065 Ilieosigmoidostomy0102306601023067 Caecostomy

01023068010230690102307001023071010230720102307301023074010230750102307601023077 Fissurectomy01023078 RectalHaemorrhoidsOperationPolyp-Excision-Lordsof01023079 procedure

01023080 Fistulectomy

01023081 Fistulectomy

01023082 Colostomy

01023083

01023084

Scheme, 2008

NAME OF TREATMENT

Benign Tumours of Small

Excision of Small Intestine

Operations for

Operations(NobleIntestinalDuplicationIntestinesPlicationObstructionfor Recurrentof&theOtherOperations for the

Ilieotransverse Colostomy

Loop ColostomyTransverse SigmoidTerminal ColostomyClosure of ColostomyRight Hemi-ColectomyLeft Hemi-ColectomyTotal ColectomyOperationsLargeforBowelVolvulus ofOperationsDiverticulitisfor SigmoidFissureFissurein Anoin -AnoDilatation-

Fistula in Ano - High

Fistula in Ano - Low

Imperforat Anus -

Imperforate Anus - PullThrough OperationProlapse Rectum -Theirch Wiring

MaximumApproved

(Rupees)

25000/-

25000/-

25000/-32000/-

28000/-22000/-22000/-10000/-

20000/-24000/-24000/-24000/-24000/-39000/-25200/-22000/-6800/-16000/-8000/-10000/-

20000/-

12000/-

16000/-

22000/-

15000/-

16

Rate (INR)

Annexure-I

MaximumApproved


01023085 Rectopexy 10000/-

01023086 22000/-

01023087 22000/-01023088 12300/-01023089 26700/-01023090 rectum 26300/-

01023091 Resection 22000/-

01023092 Neuroblastoma 22000/-

01023093 12000/-

01023094 Hernioctomy 21000/-

024 Genitourinary01024001 25000/-01024002 Nephrolithotomy 25000/-01024003 Pyelolithotomy 25000/-01024004 25000/-01024005 15000/-01024006 20400/-01024007 Kidney 25000/-01024008 Ureterolithotomy 20000/-0102400901 30000/-20000/-

01024011 27000/-

01024012 28000/-0102401301 20000/-20000/-01024015 22000/-01024016 5000/-01024017 6000/-



Prolapse Rectum -

Prolapse Rectum -Grahams OperationOperations forHirschsprungs DiseaseExcision of Pilonidal SinusAnteriorExcisionAbdomino-PerinealResectionof Rectumof

Pull Through Abdominal

Operations for

Fistula/ Fistulotomy

Nephrology /

Partial Nephrectomy

HydronephrosisOperations forPerinephricOpen DrainageAbscessofOperationsCavernostomyfor Cyst of the

OperationsNephroureterectomyDoubleforUretersUreter for -Operations for Ureter -forEctopia of Single UreterOperations for Vesico-ureteric RefluxUretero-ColicUreterostomyanastomosis- CutaneousFormationConduitof an IlealUreteric CatheterisationDormiaCalculusExtraction of

Annexure-I

MaximumApproved


01024018 (Cystoscopic) 6000/-

01024019 15000/-01024020 Litholapexy 15000/-

01024021 30000/-01024022 SuprapubicVesicostomy)(Cystostomy/Drainage 12000/-01024023 35000/-01024024 Diverticulectomy 32000/-

01024025 25000/-

01024026 Neck 25000/-01024027 Cystoplasty 28000/-

01024028 40000/-01024029 25000/-01024030 25000/-01024031 25000/-

01024032 25000/-01024033 500/-01024034 Urethra 30000/-01024035 15000/-01024036 32000/-01024037 16000/-01024038 Male 25000/-

01024039 Female 25000/-01024040 CircumcisionParaphimosisReduction(underof 2450/-01024041 6000/-01024042 Meatotomy 3500/-01024043 OperationsMeatoplastyfor 6800/-01024044 15000/-

17

Scheme, 2008


Biopsy of Bladder

Diathermy Destruction ofBladder Neoplasm

Operations for Injuries ofthe Bladder

Total Cystectomy

Open Resection of theBladder NeckY-V Plasty of the Bladder

Operations for Extrophy ofthe BladderRepair of UreterocoelSuprapubic ProstatectomyRetropubic ProstatectomyTransurethral Resection ofProstate (TURP)/ TURIntravesicalBladder TumourBCGinstillationOperationsextra)(Costfor Injuryof BCGto

Internal urethrotomyOperationUrethral Reconstructionfor CongenitalIncontinenceValvesOperationsof Urethraof forUrine -

Operations forIncontinence of Urine -

General Anaesthesia)

Hypospadias - Chordee

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)Correction

01024045 Repair 24000/-01024046 22000/-01024047 14000/-

0102404801 14000/-20000/-01024050 20000/-

Adreneclectomy

01024051 30000/-

01024052 Unilateral 8000/-01024053 12000/-

01024054 Testis 15000/-01024055 Vasovasostomy 18000/-01024056 15000/-

01024057 25000/-

01024058 32000/-01024059 Scrotum 16000/-

01024060 1200/-

0102406101SubclavianFistula/ShuntPuncture 1800/-8000/-

01024063 1500/-

01024064 Inclusive) 1500/-01024065 DoubleClavianLumenCatheterSub 3000/-

01024066 CAVD 17000/-01024067 1850/-01024068 1750/-



Operations forHypospadiasStage or One- SecondStage

Operations for EpispadiasPartial AmputationPenis of theTotal amputation of theOrchidectomy-Penis SimpleOrchidectomy- Radical

Unilateral/Bilateral forTumour/For CarcinomaOperations for Hydrocele -

OperationsBilateralfor Hydrocele -Operation for Torsion of

Operations for VaricoceleBlock Dissection ofInguinal Nodes - One SideBlock Dissection ofInguinal Nodes - BothExcisionSidesof Filarial

Emergency DialysisFemoral PunctureEmergency Dialysis

Dialysis FemoralCatheterisation BilateralHaemo Dialysis (All

Continuous Arterio VenusHaemofiltration (CAVH)/

Subclavian AccessFemoral Access

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01024069 2500/-01024070 50000/-01024071 250000/-01024072 4200/-01024073 Lymphocoel 4300/-01024074 35000/-01024075 Nephrouretectomy 35000/-01024076 35000/-01024077 removal) 8000/-01024078 30000/-01024079 PCNL-III 46000/-01024080 7300/-01024081 12600/-01024082 5100/-01024083 4350/-01024084 Gil-Verner’sPyelolithotomyExtended 22000/-

01024085 Adhesions 50000/-

01024086 Pyeloroplasty 25000/-

01024087 Repair 30000/-01024088 44000/-01024089 26000/-01024090 25000/-01024091 Nephrostomy 22000/-01024092 25000/-01024093 28000/-01024094 Epididymectomy 12000/-01024095 30000/-01024096 28000/-01024097 28000/-01024098 15000/-01024099 20000/-01024100 Suprapubic 15000/-

01024101 18000/-

01024102 Endoscopic 18000/-

18

Scheme, 2008


Plasma ExchangeDonor NephrectomyRenal TransplantationUreteric Reimplant

Transplant Nephrectomy

VascularCAPDProsthetic(insertion Graft&

PCNLPCNL -–UnilateralBilateral/

Palomo’s UnilateralPalomo’s BilateralEndoscopic Teflon InjectTesticular Biopsy

Radical NephrectomyComplicated Tumour or

Anderson Hynes

Vasico Vaginal Fistula

Radical CystectomyCaeco CystoplastyNephrectomy Simple

Ureteric ReimplantPartial Cystectomy

TURP CystolithotripsyOpen ProstatectomyClosure of Urethral FistulaOrchidopexy - UnilateralOrchidopexyCystolithotomy- Bilateral-

Endoscopic Removal ofStone in BladderResection Bladder Neck

Annexure-I

MaximumApproved


01024103 40000/-01024127

01024104 18000/-

01024105 14000/- 0102412801024106 18000/- 0102412901024107 10000/- 0102413001024108 15000/- 01024131

02501024109 4000/- 01025001

0102500201024110 Anesthesia 2200/-

Retroperitoneoscopy 0102500301024111 Nephrectomy 40000/- 0102500401024112 35000/- 0102500501024113 Retroperitoneoscopicnephrolith 35000/- 0102500601024114 Retroperitoneoscopicpyelolitho 35000/- 0102500701024115 35000/- 01025008

0102500901024116 35000/- 0102501001024117 Retroperitoneoscopicureterolit 35000/- 0102501101024118 LaproscopyNephroureteroectom35000/- 0102501201024119 22000/- 0102501301024120 varicocele 20000/- 0102501401024121 12000/- 0102501501024122 Lithotripsy/(Complete)ESWL 30000/- 0102501601024123 18000/- 01025017

0102501801024124 23000/- 0102501901024125 4000/- 0102502001024126 40000/-



Ureteroscopic Removal-with LASERUreteroscopic Removal-without LASER

Urethroplasty 1st StageOptical UrethrotomyExploratory ScrototomyPerineal UrethrostomyDilatation of StrictureUrethra under G.A.Dilatation of StrictureUrethra without

Retroperitoneoscopypartial Nephrectomy

RetroperitoneoscopicHyderonephrosisoperation for

surgeryRetroperitoneoscopicRetroperitoneoscopicfor Renal cyst

Laproscopicorchidopexyoperation for

CystoscopicUrethraBasketing of

Lithotripsy-1/Care)SMSL (DayLithotripsy-2/3/ SMSLSlow Efficiency(Day Care)DialysisProsthetic(SLED)Surgery forurinary incontinence

PROCEDURE

Ganglion

Haemangioma

CrossFinger

AbdominalThoracic

Bengal Health Scheme, 2008(MED) dated 31-01-2011)

NAME OF TREATMENT

Hilioum Laser Prostratesurgery/ Optical Internalurethrotomy/ CHigh Intensity FocusUltrasound (HIFU) Roboticfor CarcinomaCRRT ProcedureTURP with LASERLithoclast (Day Care)Plastic SurgeryPrimary Suture of WoundInjection of Keloids -

Injection of Keloids -

Free Grafts - Wolfe GraftsFreeFreeSmallGraftsGraftsArea-- LargeTheirech5% Area-Free Grafts10%- Very LargeSkin FlapsArea 20%- RotationSkinFlapsFlaps -Advancement FlapsSkinLegSkinFlapsFlaps-FlapsFlap- Direct-Cross- Armcross

Skin Flaps -Skin Flaps -SubcutaneousSkin Flaps - Pedicle Arm Etc.SubcutaneousFlaps RaisingPedicleSubcutaneousFlaps DelayPedicleFlaps TransferReductionCartilage Graftingof FacialReductionFractures ofof FacialNoseFractures of Maxilla

MaximumApproved

(Rupees)

30000/-

150000/-11000/-32000/-16000/-

3200/-

2700/-

6100/-18000/-18500/-30000/-32400/-28750/-31650/-35500/-35500/-35500/-34400/-35500/-28500/-27750/-28500/-29700/-9000/-13800/-

19

Rate (INR)

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01025021 27000/-01025022 27000/-

0102502301 27000/-32000/-

0102502501 33800/-32400/-

01025027 34550/-01025028 32600/-

01025029 31350/-01025030 17550/-01025031 30000/-

01025032 10000/-01025033 20000/-01025034 10000/-

0102503501 32000/-20000/-

01025037 Mammoplasty 22550/-

026 Procedure01026001 7500/-



ReductionMandibleLet &SplintingofMaxillaFractures- EyeofMandibleReductionNetal&ofMaxillaSplintsFractures- CastofReductionMandibleof&FracturesMaxilla - ofInternalMandibleGummingWire&FixationSplintsMaxilla of

CleftCleftSeverePalateLip Degree- repair.Repair

PrimaryCleftBoneLip PalateGrafting ofSecondaryCleft Lip DeformitySurgery for

Secondary Surgery forCleft PalateReconstructionReconstructionDefects - Minorofof EyelidEyelidDefects - MajorPlastic Surgery ofDifferent Regions of thePlasticEar Surgery- Minor ofDifferentEarRegions- Major of thePlasticNoseSurgery- Minorof thePlastic Surgery of thePlasticParalysisReanimation)NoseSurgery(Support- Majorfor FacialwithPendulous Breast -

Orthopaedic Surgery

Applicationfor Upper &ofLowerP.O.PLimbsCasts

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)01026002 7500/-01026003 ApplicationApplicationTractionofofSkeletalSkin 1650/-01026004 4450/-01026005 1150/-01026006 Injections 950/-01026007 6000/-01026008 7500/-01026009 10000/-01026010 18000/-

01026011 28000/-

01026012 27000/-

01026013 6000/-

01026014 18000/-01026015 28000/-01026016 -Deep 40000/-01026017 10000/-01026018 OperationsSequestrectomyExcisionFracturesfororScaphoidother& 25000/-

01026019 Superficial 20000/-

01026020 30000/-

01026021 35000/-

20

Scheme, 2008


ApplicationCast ofBraceFunctional

BandageTractions& Strappings forAspirationFractures& Intra Articular

ApplicationCloseSpicesReduction& Jacketsof P.O.PofFractures of Limb & P.O.POpenReductionReductionFracturesof Compound& InternalFixationfractureOpenofofReductionFingursLong Bones&ofToesofUpper / Lower Limb -Nailing & External FixationOpen Reduction offractureUpperProcedures/ ofLowerLongLimbBones-AOof

Tension Band Wirings

ExcisionBoneof BoneGraftingTumoursExcision-Superficialof Bone Tumours

Excision of Ganglion

Saucerizations -

Sequestrectomy &Saucerizations -DeepSequestrectomy &SaucerizationsArthrotomy -

Annexure-I

MaximumApproved


01026023 35000/-

01026024 35000/-01026025 35000/-

MuscleFracturePedicleNeckGraftFemurand01026026 ClosedInternalReductionFixationsof 35000/-01026027 10000/-01026028 20000/-

01026029 30000/-

01026030 35000/-

01026031 25000/-

01026032 32000/-

01026033 Graft 35000/-TendonLengthening/Tendon

01026034 Sutures 25000/-01026035 35000/-

01026036 40000/-

0102603701 32000/-60000/-DecompressionAntereolateraland

01026039 45000/-01026040 30000/-01026041 15000/-



S.P.NailingNeck Femurfor FractureMultiple Pinning FractureNeck FemurNail Plate Fixations forFracture Neck FemurProceduresOpenA.O.CompressionNeckReductionFemurfor Fractureof

OpenDislocationsReduction ofDislocations - SuperficialOpen Reduction ofDislocations - DeepOpen Reduction ofFracture Dislocation &Internal Fixation

Neurolysis/Nerve Suture

Nerve Repair with GraftingTendon with Transplant or

Tendon TransferLaminectomy, ExcisionDisc (Prosthesis extra)Laminectomy,Disc and TumoursExcisionAnterolateral(Prosthesisfor tuberculosisClearanceextra)

Spinal FusionCosto TransversectomyInternalCorrectiveFixationOstectomy- Minor&

Annexure-I

MaximumApproved


01026043 Joints 15000/-

01026044 Joints 30400/-01026045 25000/-01026046 25000/-01026047 40000/-01026048 32000/-

01026049 Knee

01026050 Elbow 25000/-

01026051 Knee 35000/-

01026052 Elbow 30000/-

01026053 Forequarter 40000/-

01026054 Hemipelvectomy 44000/-01026055 30000/-01026056 20000/-01026057 10450/-01026058 40200/-01026059 24250/-01026060 24000/-01026061 24000/-01026062 Screw 10000/-01026063 15000/-01026064 60000/-

21

Scheme, 2008


InternalCorrectiveFixationOstectomy- Major&Arthrodisis of -Minor

Arthrodisis of -Major

SoftSoft TissueTissueC.T.E.V.OperationsOperations forforPartialPolio (instrumentationHipextra)Replacement(CostOperationsof Prosthesisfor Brachialextra)Plexus & Cervical RibAmputations -Below

Rs 25000/-

Amputations - Below

Amputations - Above

Amputations - Above

Amputations -

Amputations -HindQuarter and

Disarticulations - MajorDisarticulationsArthrography- &MinorSpinalOsteomedullographyOstectomy andInternal FixationsSoftArthroscopyTissue Operation- OperativeonMyocutaneousKnee andRemovalProceduresFasciocutaneousof Nails,for LimbsWiresFlat &

TotalRemovalHip Replacement-of PlatesUnilateral (Excluding

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)Implants)

Replacement-Unilateral01026065 23000/-01026066 55000/-

01026067 55000/-

(excludinginjuries)-majorperipheral(abovelimb01026068 100000/-

01026069 60000/-01026070 SternalRepairDehisences 25000/-01026071 SternalReconstructionDehisences 55000/-

01026072 300/-

0102607301 1200/-300/-01026075 2000/-01026076 1000/-01026077 1000/-

01026078 700/-

01026079 1000/-

01026080 750/-01026081 1450/-

01026082 2400/-



Total Finger Joint

(ExcludingTotal KneeImplants)JointReplacement-Unilateral(Excluding Implants)ReplacementAny Other(e.g.Jointelbow,shoulder, etc.)- Unilateral(Cost of Implants extra)Multiple fractures repair

threeimplantsfractures)extra)(cost of(excludingMultiple fracturesperipheralrepairlimbinjuries)-medium (abovetwo fractures) (cost ofimplants extra)

Fingers (post, slab)

CollesFingersFractureelbowfull plaster- BelowColles Fractureplaster - FullCollespost.fractureslabAnt. OrAbove elbow full plaster

Above Knee post-slab

Below Knee full plaster

Below Knee post-slabTube Plastercylinder)(or plaster

Above knee full plaster

Annexure-I

MaximumApproved


01026083 2200/-

01026084 4000/-01026085 3050/-01026086 3350/-

01026087 3100/-

01026088 3800/-01026089 45000/-01026090 35000/-

01026091 12500/-

01026092 22000/-027

01027001 -Subdural 70000/-

01027002 70000/-01027003 80000/-01027004 ExcisionTemporal,ofetc.)BrainCerebeliumTumours 80000/-01027005 80000/-01027006 -Subtentorial 80000/-

01027007 60000/-Ventriculoatrial/Ventriculoperitoneal

01027008 Shunt 40000/-01027009 50000/-

01027010 Lumbar 18000/-

01027011 Cervical 18000/-

22

Scheme, 2008


Above knee full slab

Minerva JacketPlaster JacketShoulder spica

Single Hip spica

Double Hip spicaResection of First RibResection of Cerical Rib

Rib Resection

Ligament ReconstructionCraniotomyNeuro-SurgeryandEvacuation of Haematoma

Craniotomy andEvacuationEvacuation-Extraduralof Haematomaof BrainExcisionAbscessof Lobe (Frontal,

Excision-Supratentotialof Brain Tumours

Surgery of Cord Tumours

ExcisionVertebralof CervicalDiscsInter-Sympathetectomy -

Sympathetectomy -

Annexure-I

MaximumApproved


01027012 30000/-01027013 15000/-

01027014 12000/-

01027015 15000/-01027016 - 15000/-

0102701701 15000/-3400/-01027019 LumberMonitoringPressure 10000/-01027020 100000/-01027021 15000/-0102702201MeningoAtrialEncephalocoelShunt 52000/-15000/-01027024 Meningomyelocoel 42000/-0102702501C.S.F.CranioplastyRhinorrhaea 55000/-55000/-01027027 PosteriorDissectomyCervical 50000/-01027028 AnteriorDissectomyCervical 50000/-

01027029 50000/-

01027030 Decompression 40000/-01027031 Peripheral(Tirgeminal)Neurectomy 45000/-01027032 35000/-

01027033 60000/-

01027034 45000/-

01027035 50000/-

01027036 Minor 40000/-

0102703701 100000/-15000/-

01027039 Investigation) 18000/-01027040 60000/-



Twist Drill CraniostomySubdural Tapping

Ventricular Tapping

PlacementAbscessofTappingICP Monitor

Urokinase Therepy forSkull TractionICH Application-

Vascular MalformationsPeritoneal Shunt

Brachial PlexusExploration MicrosuturingMedian Nerve

Trigeminal Rhiotomy

Cranial Nerve Astomosis

Meningocoele ExcisionPeripheral Nerve Surgery– MajorPeripheral Nerve Surgery

Ventriculo-Atrial ShuntNerve(Exclud.+ BiopsyInvestigation)Cost(Procedureof valve)Brain Biopsy (Procedure +

AnteriorSurgeryCervicalwith fusionSpine

Annexure-I

MaximumApproved


01027041 Decompression 60000/-01027042 2400/-

01027043 Laminectomy 45000/-

01027044 110000/-01027045 80000/-01027046 40000/-01027047 Discectomy 45000/-01027048 50000/-01027049 30000/-01027050 90000/-01027051 65000/-01027052 65000/-01027053 65000/-01027054 StereotaxicMinorProcedures- 55000/-01027055 22000/-01027056 65000/-01027057 110000/-

01027058 Electrode 100000/-01027059 100000/-

Endoscopic01027060 Adueductoplasty 100000/-

01027061 reconstruction 50000/-

01027062 sinuses 80000/-

01027063 75000/-

01027064 35000/-01027065 30000/-01027066 60000/-

01027067 Hemishpherectomy 80000/-

23

Scheme, 2008


Anterior Lateral

Brain MappingCervical or Dorsal

Combined Trans-oralSurgeryFusion& CV JunctionC.V. Junction FusionDepressed Fracture

R.F. LesionEndarterectomyfor TrigeminalNeuralgia -Spasticity Surgery -SpinalSpinalFusionIntra MedullaryProcedureSpinalTumoursBifida SurgerySpina/ BifidaMajorSurgery

biopsy/ aspirationTrans Sphenoidal SurgeryTrans Oral SurgeryImplantation of DBS- one

ImplantationElectrodesof DBS- two

Facial nerve

Recanelisation of venous

Carotid stenting

Cervical disc arthroplastyLumbar disc arthroplastyCorpus Callosectomy

Annexure-I

MaximumApproved


01027068 50000/-

01027069 60000/-

01027070 meningomas 60000/-

01027071 80000/-0102707201 40000/-40000/-01027074 60000/-01027075 60000/-0102707601 80000/-80000/-01027078 70000/-01027079 Stereotacticcraniotomyguided 70000/-01027080 60000/-01027081 40000/-

Endoscopic01027082 sympathectomy 18000/-01027083 Externaldrainageventricular 12000/-

01027084 60000/-01027085 60000/-

surgery/Biopsy/aspiration/01027086 60000/-

01027087 60000/-

01027088 80000/-

01027089 80000/-



Endoscopic CSFrhinorrhea repairMicrosurgical excision ofAcoustic tumourMicrosurgical excision of

Epilepsy surgeryLateralRFCervicallesionmasssyndromelaminoplastyforC1-C2facet painscrewdecompressionMicrosurgicalfixation forCerebellarTrigemilstimulationnerve forCerebellarotherhemifacialneuralgiacranialstimulationspasmnerve forIC EC bypass procedures

implantationincludingmovementBaclofenParkinsonismlesioningdisorderpump forProgrammable shunt

Image guided surgeryExcision of tethoredventriculostomyEndoscopic 3rdEndoscopic cranial

aneurysm coiling

Endoscopic discectomy

Aneurysm coilingEndoscopic spilprocedure- aneurysm

Annexure-I

MaximumApproved

CODE PROCEDURE (Rupees)coiling

01027090 coiling 80000/-

01027091 decompression 40000/-

01027092 90000/-01027093 60000/-01027094 forForamenbrainknife/pathologyGamma)magnum(X 120000/-01027095 decompressionForamendecompressionmagnumwith 60000/-01027096 60000/-01027097 50000/-01027098 60000/-01027099 100000/-01027100 70000/-

01027101 100000/-01027102 50000/-

01027103 130000/-

01027104 110000/-

01027105 50000/-

01027106 15000/-028

24

Scheme, 2008


Surgery for grooving skullfractures- aneurysm

Carpel Tunnel

Clipping of intracranialaneurysm with use of clipStereotacticEndoscopicintracerebellarhaematomaRadiosurgeryaspiration of

Dorsalforsyringosubarachnoidbachachecolumnshuntstimulationin failedSurgerybackforsyndromerecurrent discprolapse/Surgery epiduralfor brainfibrosisstemhemishphericalDecompressivecranectomytumours foracuteIntra arterialsubduralthrombolysiswith RTPA for ischemicstroket RTPA-acuteintracerebralStereotactic aspirationhaematomaof

Complex Brain Surgery

Complex Spine Surgery

Dorsal SympathectomyNeuro rehabilitisation-package for 25 sittings(bed charges extra)Vascular Surgery

Annexure-I

MaximumApproved


01028001 50000/-01028002 50000/-01028003 Thrombendarterectomy 50000/-

01028004 50000/-

01028005 Fistula 27700/-

01028006 80000/-

01028007 42500/-

01028008 50000/-01028009 Implant 150000/-01028010 30000/-

01028011 17400/-01028012 15500/-

01028013 22100/-01028014 30000/-

01028015 30000/-01028016 16800/-

01028017 40200/-

01028018 40200/-

029



Patch Graft AngioplastyOperationsRenalforArteriesStenosis of

Operations for AcquiredArteriovenous FistulaCongenital Arterio Venous

Surgery for ArterialAneursysm -VertebralSurgery for ArterialAneursysm CarotidSurgery for ArterialAneursysmDissectingof theAneurysmsMainLimbArteries+

StrippingSephenousof ShortVeinsor LongLigation of AnkleExcisionPerforatorsand Skin Graft ofVenous Ulcer

VenousLymphaticsThromoectomyExcision ofSubcutaneousLymphoedemaTissues In

Trendelenburg OperationsVascularMinorProcedure –Surgery for ArterialAneursysm Spleen ArterySurgery for ArterialAneursysm Renal Artery

Paediatric Surgery

Annexure-I

MaximumApproved


01029001 Duct/Cyst 30000/-01029002 35000/-

01029003 Surgery) 40000/-

01029004 Oesophagus 40000/-

01029005 Excision 30000/-

01029006 Duct- Excision 30000/-

01029007 30000/-

01029008 28000/-01029009 30000/-01029010 24000/-01029011 24000/-01029012 24000/-01029013 22000/-01029014 25000/-01029015 Stenosis-Duodenal-CongenitaloperationPyloricAtresia 27000/-01029016 Operation 35000/-01029017 45000/-01029018 30000/-01029019 32000/-01029020 Rectal(Megacolon)Biopsy 25000/-

01029021 28000/-

01029022 28000/-

01029023 Disease) 35000/-01029024 22000/-

25

Scheme, 2008


Excision of thyroglossal

DiaphragmaticAbdominalRepair (ThoracicApproach)HerniaorTracheoFistula Oesophageal(Correction

Colon Replacement of

Omphalo Mesenteric Cyst

Omphalo Mesenteric

Meckels Diverticulectomy

OmphaloceleOmphalocele(Hernia Repair)1st2ndStageStge(Hernia Repair)Gastrochisis RepairInguinal HerniotomyCongenital HydroceleHydrocele of CordTorsion Testis Operation

Pancreatic Ring OperationMeconium Ileus OperationMalrotationOperationof Intestines

Colostomy Transverse

Colostomy Left IliacAbdominal Perineal PullThrough (Hirschaprugis

Imperforate Anus Low

Annexure-I

MaximumApproved


01029025 28000/-01029026 25000/-01029027 21000/-01029028 35000/-

01029029 35000/-01029030 35000/-

01029031 Pyonephrosis 35000/-

01029032 Hydronephrosis 35000/-

01029033 35000/-

01029034 Tumour 40000/-

01029035 30000/-

01029036 NeuroblastomaNeuroblastomaDebulkingTotal 32000/-01029037 Excision 36000/-01029038 40000/-

01029039 AcidOesophagusStructure 65000/-

01029040 500/-



Anomaly -Cut BackImperforateOperationAnus LowAnomaly - PerinealInperforateAnoplastyAnus HighAnomalyPerineal-SacroabdominoPull ThroughInperforateAnomalyColostomy- AnusClosureHighofIntususception OperationCholedochoduodenostomy for Atresia of ExtraHepatic Billiary DuctOperation ofCystCholedochal

Nephrectomy for -

Nephrectomy for -

NephrectomyTumourfor -WilmsLymphadenoctomyNephrectomyParaorticfor Wilmswith

Sacro- CoccygealTeratoma Excision

ColonRhabdomyosarcomaTransplant/Excision ConduitwideManagement following

Umbilical Line

Annexure-I

MaximumApproved


01029041 800/-01029042 LP 300/-01029043 500/-01029044 800/-01029045 600/-

01029046 NeonatePhototherapyRoomingperindaywith 400/-01029047 600/-01029048 1600/-

03001030001 6600/-

Laproscopic01030002 Pyloromyotomy 18000/-01030003 21000/-01030004 25000/-01030005 LaproscopicPyleroplasty/jejunostomyVagotomygastro 24000/-

01030006 20000/-

01030007 repair 25000/-01030008 30000/-01030009 26000/-01030010 28000/-

01030011 28000/-

01030012 resection 30000/-

01030013 obstruction 30000/-

26

Scheme, 2008


Peripheral Long Line

Peritoneal TappingChest Drainage(includingGeneral Nurseryetc.)NursingCareCare

motherof Nursingper day care)(inclusiveSNCULaproscopic/Care(SickUnit)New BornEndoscopic OperationsIn Gen. Surgery /Gastrohepatic / Nephro-Diagnostic Laproscopy

Laproscopic GastrostomyLaproscopicPerforated pepticClosureulcerof

Laproscopic umbilicalhernia repairLaproscopic ventral hernia

Lap.cystogastrostomyCholecystectomyLaproscopic &CBD explorationLap. Hydatidsurgeryof liver

Lap. Hepatic resectionLap. Assisted small bowel

Lap. For intestinal

CODE PROCEDURE

01030014 perforation0103001501Lap.Lap.HemicolectomyHemicolectomyAssistedAssistedRightleft01030017

01030018

Abdominoperineal01030019

01030020 resectionLaproscopic

01030021 CholecystectomyLaproscopic

01030022 Appendicectomy

0103002301

01030025Laproscopic

01030026 AdrenalectomyLaproscopic

01030027 ThyroidectomyLaproscopic

01030028 Spleenectomy0103002901030030010300310101030035 HysterectomyLaparoscopic0103003601030037


NAME OF TREATMENT

Lap. For intestinal

Lap.ColectomyAssisted Total

Laproscopic RectopexyLap. Asisted

Resection of rectumLap. Assisted anterior

Laaproscopic HerniaLaproscopicRepairRepairHiatus Hernia

Laproscopic Adhesiolysis

Laproscopic ColectomyLaproscopic NephrectomyLap UreterolithotomyOvarianInguinalPyelolithotomy(Laproscopic)LaproscopicCystectomyHernia

Laparoscopic EctopicForeign body removal

Annexure-I

MaximumApproved

(Rupees) CODE

28000/- 0103003832000/-32000/- 0103003937000/- 01030040

32000/- 01030041

0103004237000/-

0103004337000/-

0103004425000/-

0103004521000/-

0103004621000/-30000/- 01030047

0103004801030049

32000/- 01030050

32000/- 01030051

32000/- 0103005235000/-40000/- 0103005322000/-30000/-2200025000/- 0103100122000/- 010310024000/- 01031003

Health Scheme, 200831-01-2011)

Rate (INR)

Rs 18000/-

01030054031

PROCEDURE

NephrolithotomyHydronephrosis-OperationsOperationsPyeloplastyforforEndopyelotomyHydronephrosis-antegrade

Kidney

URSL

Nephroureterectomy

Diverticulectomy

OperationsOperationsPalomo’s-forforUnilateralVaricoceleVaricocele

Nephrostomy

Prostratectomy

NAME OF TREATMENT

Operations for Cyst of the

Operations for Vesico-ureteric Reflux

Repair of Ureterocoel

Palomo’s- Bilateral

Orchidopexy- Unilateral

Orchidopexy- Bilateral

Laparoscopic Uro stoneRadioIncisionalNuclearRadiotherapyChemotherapy(packages)IsotopeMedicines-HernioplastyTherapy&131- Iodine15mCiTherapy <131- IodinemCiTherapy 15-50131- Iodine100 TherapymCi 51-

MaximumApproved

(Rupees)

35000/-35000/-35000/-

40000/-

25000/-

50000/-

40000/-

22000/-

35000/-20000/-30000/-16000/-

25000/-

30000/-

45000/-

30000/-35000/-5200/-16900/-16900/-

27

Rate (INR)

Annexure-I

MaximumApproved


01031004 100mCi 19500/-01031005 7200/-

01031006 palliation 10700/-03201032001 70000/-01032002 16000/-01032003 15000/-01032004 25000/-01032005 5000/-

0330103300101 6000/-5000/-01033003 IntensityTherapyModulated(IMRT)Radio 105000/-01033004 ImageTherapyGuided(IGRT)Radio 150000/-01033005 7000/-01033006 65000/-01033007 75000/-01033008 90000/-01033009 85000/-01033010 70000/-01033011 100000/-01033012 25000/-



131- Iodine Therapy >

Strontiummetastaticpalliationtherapybone painforSamarium-153metastatic bonetherapypainfor

Cobalt 60 TherapyRadical TherapyImmobilisationAdjustment Therapy-techniquePalliativethan 10Therapyfractions)(lessPalliativefractions)Therapy (10-25Palliativefraction)Therapy (single

Linear Accelerators3-D2-D PlanningPlanningCobalt-60)Cobalt-60)(L.(L. Acc.Acc. oror

IGRT Single Fraction3D-CRTTherapy)(Confirmal Radio3D-CRT with IGRT4D-CRT with IGRTStereotacticSurgery (SRS)RadioStereotacticTherapy (SRT)RadioRapid Arc with IMRT rateTherapyPalliativeuptoRadiation15 fractions

Annexure-I

MaximumApproved


01033013 35000/-01033014 PalliativeConventionalfractionRadiationRadiationsingle 10000/-01033015 35000/-01033016 45000/-

01033017 10000/-01033018 40500/-01033019 Fractions) 9000/-01033020 2500/-034

01034001 insertion 5500/-01034002 Luminal2ndIntraInterstitialandCavitary/insertionBrachytherapy-subsequentBrachyIntra 3000/-01034003 Therapy-Interstitial1stBrachyinsertion 15000/-01034004 10000/-035 Chemotherapy01035001 Neoadjuvant 1000/-01035002 Adjuvant 1000/-01035003 1000/-01035004 Multiplemalignantdrugbraintherapytumoursper 20000/-01035005 day 900/-01035006 1000/-01035007 1000/-

28

Scheme, 2008


Palliative RadiationTherapy upto 25 fractions

ConventionalTherapy withRadiationCTTherapy CBCTinterventionalSRS/ SRT Neurocharge/ElectroncaseBeam (>10ElectronFractions)Beam (<10

Pre-radiation profileBrachyIntra CavitaryTherapyBrachytherapy- 1st

Therapy- 2nd insertion

ChemotherapyInfusional Chemotherapywafers for

Targeted therapyChemoport facility

CODE PROCEDURE

01035008 Canulisation)036010360010103600201036003

01036004

Charges

037010370010103700201037003 Cabin

038 Institurions0103800101038002 F.F.P.0103800301038004010380050103800601038007 Crypoprecipitate01038008


NAME OF TREATMENT

PICC line (PeripherallyInserted Central

Room RentGeneral WardSemi-Private WardPrivate WardDay Care/ Minor (OPD)Surgeries (all categories)Admissible Blood

For treatment inGovernment HospitalsGeneral BedsPaying Beds

For treatment inrecognised PrivateHospitals/ NursingHomes/ Aided

Whole Blood

Platelet ConcentratePlatelet Rich PlasmaPacked CellFrozen Plasma

Washed RBC

Annexure-I

MaximumApproved

(Rupees)

1000/-

600/-1200/-1800/-

600/-

50/-100/-140/-

500/-400/-400/-400/-400/-350/-300/-400/-

29

Health Scheme, 2008 31-01-2011)

Rate (INR)

(Per day)

CODE

0200100202001003020010040200100502001006020010070200100802001009

020020010200200202002003

020020040200200502002006020020070200200802002009

020020100200201102002012020020130200201402002015

020020160200201702002018

RATES OF INVESTIGATIONS :

02 – INVESTIGATIONS

02001001001

02001010002

Diagnostic

BonePericardialMarrowAspirationAspiration

JointsE.C.G.Aspiration

E.E.G.StressLumbartestpuncture(TMT)


RATES OF INVESTIGATIONS :

02 – INVESTIGATIONS

INVESTIGATIONNAME OF

AspirationGeneralPlural Effusion -

AbdominalDiagnosticAspiration -

SternalE.N.T.puncture

Pure Tone AudiogramImpedenceSISI, Tone& Decayother tests&Difference timesassessmentMultipletesthearingto Adults

Hearing Aid SelectionHearing Aid AnalysisSpeech DiscriminationScoreSpeech AssessmentColdVestibularCaloriefunctionTest for

Audiometry (MHC)ABR (Threshold Est.)Acoustic Reflex DecayEustachian Tube FuncIMP AudiometryOtoacoustic Est. (OAE)

PEAD Audio AssessmentSRT & SDSSwallowing Assest

Annexure-I

Maximum

Approved

CODE INVESTIGATION (Rupees)Maximum 02002019 Tympanometry 150/-Approved 02002020 250/-Rate(Rupees)(INR)02002021 850/-

02002022 ENG 1300/-02002023 600/-

750/- 02002024 Nasopharyngoscopy 600/-900/- 1400/-1200/-800/- 02003001 Refraction/Fundoscopy 150/-

02003002 150/-750/-140/- 02003003 400/-

02003004 100/-800/- 02003005 Electrooculogram 500/-1000/-850/- 02003006 ERG 400/-

02003007 800/-800/- 02003008 A-Scan 200/-

02003009 450/-300/- 02003010 VER 300/-300/- 02003011 150/-250/- 02003012 200/-450/- 02003013 1000/-

1000/-100/- 02003014400/- 02003015 CornealAutomatedendothelialPerimetrycell 450/-200/- 02003016 count 200/-200/- 02003017 200/-180/- 02003018 200/-

100/-250/- 02003019 studies650/- 02003020 60/-100/- 02003021 180/-100/- 02003022 Scan 600/-300/- 600/-550/- 02003023 Scan

150/-200/- 02003024 studies150/- 02003025 200/-30/-

30

Health Scheme, 2008

NAME OF Rate (INR)

Voice AssestEndo Laryngoscopy

Nasal Endoscopy

02002025003 LV DyssynchronyEye Study

Ortho-optic check upPerimetry/field testClinical Photography

Flourescein Angioraphy

Tono Graphy

Goldmen PerimetrySpecularIndo cyaningreenmicrosopyAngiography of RetinaIndo cyaningreenAngiography - IRIS

Corneal topographyRetinalCornealnervepachymetryfilm analyzer

Auto RefrectemetryUltrasoundBiometrystudies - A

Ultrasound studies -- B

Retinal/Meter function

PAN ACUITY METER

CODE02003026020030270200302802003029020030300200303102003032020030330200303402003035020030360200303702003038020030390200304002003041

020030420200304300402004001

00502005001020050020200500302005004

006

020060010070200700102007002

020070030200700402007005

INVESTIGATION

Biometry-corp-Single

NCT

TTTVEP

PhotographyUSGPhysiotheraphy

Dental

Image)Genetics

Occlusal

film)


NAME OF

Laser interferometryEKG, EOGDacryocystographyOrbital Angio studies(DGC)Digital Biometry ReadingBiometry(Single)(Both Eye)

Biometry-corp (Both)

Pachymetry (Both Eye)MultifocalPachymetryERG (Single)(One Eye)

OCT- NFL AnalyserSchiotz Tonometer

Anterior Segment (Fundus)

Musclediagnostictesting and

Intra oral X-ray (Digital)Opg CephalogramOpg Standard ViewRadio Visiograph (per

Fragile X Decet & Karyo ofPeri Bld CellX-Ray (Digital X Ray)Fluroscopy chest

Abdomen AP or Erect (oneAbdomen Lateralfilm) view (one

Abdomen for Pregnancy

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)1000/- 02007006 130/-500/- 02007007 130/-500/-500/- 02007008 150/-180/- 02007009 140/-350/- 02007010 140/-

140/-400/- 02007011 film)300/- 02007012 140/-400/- 02007013 250/-800/-200/- 02007014 250/-160/- 02007015 250/-1600/- 02007016 700/-250/- 02007017 750/-

Cystography/ 1120/-2500/- 02007018 Urethrography600/- 02007019 Hystero-Salpaingography 1110/-300/- 02007020 Arthrography 840/-

02007021 1080/-550/- 720/-

02007022 Cholecystography100/- 02007023 1160/-

960/-02007024 Lower

80/- 02007025 Bronchography 1260/-210/- 02007026 1350/-210/- 02007027 Myelography 1500/-110/- 02007028 1120/-

02007029 1230/-Cerebral/Femoral 2000/-

02007030 Angiography3500/- 02007031 100/-

1300/-120/- 02007032 Cont.)130/- 02007033 750/-130/- 02007034 750/-

02007035 1400/-130/- 02007036 700/-130/- 02007037 700/-

02007038 Micturating 750/-

31

Health Scheme, 2008

Rate (INR) NAME OF Rate (INR)

Chest PA view (one film)Chest Oblique(One film)or LateralMastoids (one film)Extremities,(onebonesfilm) & JointsPelvis (One film)Paranasal sinuses (One

T.M. Joints (One film)AbdomenK.U.B.& pelvis forSkull A.P. & LateralSpine A.P. & LateralBarium SwallowSinography/ Sialography

Retrograde PyelographyOral or I.V.

BariumBariumMealEnemaUpper or

I.V. Urography/ I.V.P.

Pneumo EncephalographyBarium meal Complete

Periapical X-RayBarium Enema (Double

Barium IC JunctionGastro Conray MealIntravenous PyelogramT-Tube CholangiogramPTBD Gram

CODE INVESTIGATION

0200703902007040

02007041 charge

02007042

02007043008

0200800102008002 Occlusal02008003

02008004 film)02008005

02008006

0200800702008008

020080090200801002008011 film)0200801202008013020080140200801502008016

0200801702008018 UrethrographyCystography/02008019 Hystero-Salpaingography02008020 Arthrography0200802102008022


NAME OF

Cystourethrogram (MCU)VUR/ CystourethrographySmall Bowel EnemaAnymachine-addlXRAY usinghandlingportable

Any other XRAY- singleFilm (Small)

Any otherFilm XRAY-(Large)single

Conventional X-Ray (70%of Digital X-Ray rates)Fluroscopy chest

Abdomen APfilm)or Erect (oneAbdomen Lateral view (one

Abdomen for Pregnancy

Chest PA view (one film)Chest Oblique or Lateral(One film)Mastoids (one film)Extremities, bones & Joints(one film)ParanasalPelvis (Onesinusesfilm)(One

T.M. Joints (One film)AbdomenK.U.B.& pelvis forSkull A.P. & LateralSpine A.P. & LateralBarium SwallowSinography/ Sialography

Retrograde PyelographyCholecystographyOral or I.V.

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)02008023 810/-

2600/- 02008024 670/-1150/- 02008025 Bronchography 880/-300/- 02008026

02008027 Myelography02008028 780/-

130/- 02008029 860/-Cerebral/Femoral

160/- 02008030 Angiography 1180/-02008031 70/-

02008032 Cont.) 910/-90/- 02008033 530/-90/- 02008034 530/-90/- 02008035 980/-90/- 02008036 490/-

02008037 490/-90/- Micturating

02008038 530/-90/-90/- 02008039 1820/-

02008040 810/-100/-90/- 02008041 machine-addlchargehandling 300/-

90/-90/- 02008042 90/-

90/- 110/-170/- InvestigationsUltrasound160/-170/- 02009001 500/-490/- 800/-520/- 02009002 Pelvis

780/- 02009003 600/-02009004 Neurosonogram 900/-

590/- 350/-760/- 02009005 Screening510/-

32

Health Scheme, 2008


Barium EnemaBarium MealLowerUpper or

I.V. Urography/ I.V.P. Rs 950/-Rs 1050/-

Pneumo EncephalographyBarium meal Complete

Periapical X-RayBarium Enema (Double

Barium IC JunctionGastro Conray MealIntravenous PyelogramT-Tube CholangiogramPTBD Gram

Cystourethrogram (MCU)

VUR/ CystourethrographySmall Bowel EnemaAny XRAY using portable

Any other XRAY- singleFilm (Small)Any other XRAY- singleFilm (Large)

02008043009Obstetric First Scan/Follow upUSG: Lower Abdomen/

Upper abdomen FirstScan/Ultrasound-Follow up

Rs 780/-USG- Neurosonogram-

CODE INVESTIGATION0200900602009007

02009008

02009009

02009010

02009011

02009012 Transrectal0200901302009014

02009015020090160200901702009018

02009019020090200200902102009022020090230200902402009025

02009026020090270200902802009029020090300200903102009032 Anomaly0200903302009034

02009035010020100010201000202010003


NAME OF

TotalMultipleAbdominalorgansurveystudy orSpecialAspirationproceduresetc. &

Image Intensifiers

USG: Neck

USG: KUB

USG: Whole AbdomenUSG: Whole Abdomen +

USG: ScrotumUSG: TestisUltrasound Bladder

Ultrasound Kidney/ RenalUSG: Pregnancy + DopplerUSG: Joint (Unilateral)

USG: Joint (Bilateral)USG: MusculoskeletalUSG: TransrectalUSG: Breast UnilateralUSG: Breast BilateralUSG: ThyroidUSG: ChestUSG: ProstateUSG: Single OrganUSG: Follicular StudyUSG: Guided ProcedureUSG: FNACUSG: Follow-up OvulationUSG: For Congenital

Ultrasound ParotidUltrasound ThighAny USG using portablemachine- handling chargeClinicalUrinePathologyroutineQuantitative Albumin/SugarUrine Bile Pigment and

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)950/- 02010004 50/-1230/- 02010005 50/-

02010006 50/-700/-

02010007 100/-850/-

02010008 100/-800/-

02010009 100/-950/-1500/- 02010010 90/-

02010011 60/-900/- 02010012 60/-600/- 100/-600/- 02010013 examination

02010014 100/-600/-2200/- 240/-900/- 02010015

1800/- 02010016 cells 200/-800/- 02010017 110/-800/- 02010018 400/-700/- 3500/-1050/- 02010019800/- 02010020 Electrophoresis 2800/-700/- 5000/-550/- 02010021 Electrophoresis550/- 02010022 600/-1250/- 02010023 100/-600/- 02010024 280/-900/- 02010025 250/-600/- 02010026 60/-1800/- 02010027 70/-

02010028 60/-800/- 02010029 200/-800/- 250/-200/- 02010030 Sensitivity

02010031 KaryotypeAnalysisChromosome 2400/-60/- 02010032 Genotyping 5000/-50/- 02010033 Glucotyping 5000/-50/- 02010034 200/-

33

Health Scheme, 2008


Urine UrobilinogenSaltUrine KetonesUrine Occult Blood

Urine total proteins

Urine Sodium

Urine Chloride

Bence Jones proteinStool routineStool occult bloodPost coital smear

Smear analysisBody fluid (CSF/AsciticFluid etc.) Chemistry,Sugar, Protein etc.Body fluid for Malignant

Urinary PorphobilinogenUrinary MyoglobinUrine forImmunoelectrophoresisUrine for Protein

CRK ISO Enzyme

Hb ElectrophoresisChyle TestSemen AnalysisIVF Semen AnalysisStool Reducing SubstanceStool for OVA, ParasiteStool for ParasiteStool Culture & SensitivityUrine for Culture &

Urine for Electrolytes

CODE INVESTIGATION02010035020100360201003702010038 Ratio02010039020100400201004102010042 Pre/Post-DialysisCreatinine02010043 Pre/Post-DialysisPotassium0201004402010045

011 Haematology02011001

02011002 Differential(TLC)Leucocytic0201100302011004 E.S.R.0201100502011006

0201100702011008

0201100902011010 PeripheralExaminationSmear020110110201101202011013 ClotR.B.C.RetractionFragilityTimeTest02011014020110150201101602011017020110180201101902011020


NAME OF

Urine Amino-aciduriaUrine for PhosphorusUrineUrineProtein/Creatininefor Z-N Stain

Opiates SerumUrine RandomOpiatesUrine AmminoRandomAcid,UrineQualitative, 2 Dimensional

Pre/Post-Dialysis SodiumPre/Post-Dialysis Urea

Haemoglobin (Hb)Total Leucocytic Count

Count (DLC)

Total Red Cell countPlatelet count

Reticulocyte countAbsolute Eosinophil count

Packed Cell Volume (PCV)

SmearBleedingfor &MalariaClottingparasiteTime

Foetal HaemoglobinL.E. Cell (Hb-F)

ProthrombinComplete HaemogramTime (P.T.)

BoneExminationMarrow SmearPartial Thromboplastin

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)150/- 220/-220/- 02011021250/-60/- 02011022 50/-

450/- 02011023 1350/-450/-700/- 02011024 1350/-

100/- 02011025 120/-100/- 40/-100/- 0201102680/- 40/-

02011027

50/- 900/-02011028

50/-50/- 02011029 280/-

50/- 02011030 280/-60/-80/- 120/-

0201103170/-60/- Fibrinogen 400/-

0201103250/-70/- 02011033 FDP 150/-70/-60/- 190/-

02011034100/-50/- 1000/-

02011035250/-120/- 02011036 1200/-

150/-180/- 02011037 2500/-

400/- 02011038 4000/-200/-

34

Health Scheme, 2008


Glucose 6 PhosphateDehydrogenase (G, 6PD)P.C.V. Haematocrit

RBC FolateWhole Blood Folate

Sickling TestBleeding Time

Clotting Time

D-Dimer Semi Quantitative

Scurose Lysis Test

Red CellwithOsmoticIncubatoFrag.

Heinz Body Test

Plasma Haemoglobin

Factor VIII Studies

Factor IX Functional

Factor V Functional

Factor VAnalysisLieden Mutation

CODE INVESTIGATION

0201103902011040 AbsoluteCountLymphocytes02011041020110420201104302011044

0201104502011046

02011047

02011048

02011049

02011050

02011051

0201105202011053

02011054

02011055

02011056


NAME OF

TC, DC, ESR

HB, TC, DCBone Marrow [Perls Stain]Cell Type & Cell CountNasalEosinophilsSmear for

CSF Cell Counts [TC/DC]Complete[CBP]Blood Picture

MCV MCH MCHC

Investigation of ABO/RH

Sinovial Fluid for Analysis

Blood Parasites

Malaria Parasite

Malarial Antigen Detection

Filaria Antigen W. Bancrofti

Lap Score

BAL Cell Count

Cold Agglutination

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)120/- 650/-

0201105780/- 02011058 650/-120/- 02011059 50/-750/- 02011060 120/-320/- 02011061 10000/-90/- 02011062 5000/-

6000/-170/- 02011063180/- 02011064 120/-

02011065 200/-180/- Immunofixation 7200/-

02011066 Electroporesis360/- 012

02012001 140/-400/- 02012002 50/-

450/-70/- 02012003 Charges

450/-02012004

70/- 200/-02012005 Indirect

320/- 02012006 200/-02012007 250/-

560/- 02012008 450/-450/-

400/- 02012009450/-

02012010 Charges100/- 450/-

02012011 Charges450/-

150/- 02012012 Charges450/-

02012013

35

Health Scheme, 2008


AT III

AT III Anti ThrombinAbsolute Neutrophil CountOsmotic FragilityHLA TypingT-Cell Cross MatchingKaryotyping for BoneMarrow Cancer (RELSucrose Lysis TestAPTT (50:50)

Blood BankBlood Group & RHO TypeCross matchPacked Cells- Proc.

Saline Washed PackedCells: Proc. ChargesCoomb’s Test Direct/

Australia AntigenRHO, Antibody titerPlatelet richChargesPlasma-Proc.Whole Human Blood-I.P.-Proc. ChargesFresh frozen Plasma: Proc.

Cryoprecipitate: Proc.

Platelet Concent- Proc.

Therapeutic Phlebotomy:Proc. Charges


013 Bio-Chemistry

0201300102013002

02013003

02013004

0201300502013006020130070201300802013009020130100201301102013012

S.G.P.T.02013013 S.G.O.T.02013014020130150201301602013017 Triglyceride02013018

02013019 C.P.K.L.D.H.

0201302002013021 L.D.-1

0201302202013023 T3

02013024 T4TSH

0201302502013026

FSH0201302702013028 LH

02013029


NAME OF

GranulocyteChargesConc.: Proc.

Glucose blood- Fasting/PP/ RandomBlood UreaUreaNitrogen/ Blood

Serum Creatinine

Serum Uric Acid

Serum Bilirubin total/ directSerum IronSerum CholesterolTotal Iron Binding CapacityCK MBSerum CalciumSerum PhosphorusTotal Protein Alb/Glo Ratio

Serum amylaseSerum Electrolyte

Glucose Tolerance(GTT) Test

LDH & LD-1

T3, T4, TSH

FSH & LH

Prolactin020130300201303102013032

Blood gas analysisBlood electrolytesgas analysis with

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)450/- 02013033 Cortisol 650/-

02013034 200/-

70/- 02013035 170/-02013036 ALDL 480/-

80/- 02013037 700/-02013038 750/-

100/-02013039 150/-

110/-02013040 300/-

130/-220/- 02013041 600/-120/- 02013042 170/-300/- 02013043 500/-390/- 02013044 250/-120/- 02013045 250/-120/- 02013046 150/-140/- 160/-120/- 02013047 Phosphorous120/- 02013048 750/-

Serum250/- 02013049 Carbamazepine/Tegretol 1400/-250/- 02013050 Carbamazepine 600/-220/- 02013051 1400/-300/- 02013052 Calcitonin 1200/-

02013053 2400/-270/-210/- 02013054 800/-

02013055 500/-320/-470/- 02013057 700/-

02013058 120/-300/-

02013059 720/-300/-300/- 02013060 600/-

02013061 240/-700/-420/- 02013062 720/-

02013063 1100/-410/-

02013064 400/-670/-

Health Scheme, 2008


HDL Cholestrol

VLDL Cholesterol

Lipid ProfileLFT [Liver Function Test]

Alkaline Phosphatase

Acid PhosphataseLeucocyte AlkalinePhosphatase ScoreSerum MagnesiumSerum CopperSerum LithiumSerum LipaseSerum ChlorideSerum Inorganic

Serum Ceruloplasmin

Serum Calcitonin

Myoglobin Serum

Serum C PeptideSerum C Peptide (PP)

Serum Eption/PhenytoinAlbumin (Serum)

Serum Ferritin

Serum B12 LevelSerum Sodium

Serum FolateFolate & Vitamin 12 Serum

Serum Aldolase

470/- 02013065 650/-02013066 550/-

400/-500/- 02013067 1200/-

02013068 250/-

36

Serum AcetaminophenSerum Growth HormoneParathyroid Hormone(PTH), IntactSerum Osmolality

CODE INVESTIGATION0201306902013070 SerumSerumParathormoneTIBC02013071

02013072 SerumLevelIndividual02013073 Phospolipids-TLC020130740201307502013076020130770201307802013079020130800201308102013082 Marker02013083

020130840201308502013086 CSF-OligoclinalElectropherisisBand0201308702013088 Analysis0201308902013090 SodiumCSFBicarbonateProfile02013091 Mucopolysaccharidoses02013092 Renin(MPS)ActivityScreeningPlasma,U02013093 PlasmaPRAAmmonia02013094 Fructosamine0201309502013096 Transaminase02013097 Globulin02013098 Estradiol02013099


NAME OF

Serum Potassium

Serum Homocystine/LevelHomocystine/ Homocystine

Serum/PlasmaSerum HaptoglobinBicarbonateSerum TestosteroneSerum Thyroglobulin

Lactate PlasmaCA-19-9CA 125CA 15.3CA 72.4 Gastric Cancer

CSF Sugar

CSF ProteinLactateCSF Protein(CSF)

CSF forAnalysisBiochemical

CSF Chloride

GGT-Gamma Glutamyl

Estradiol (E2)

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)150/- 02013100 Glycosylated[HBA1C]Haemoglobin 520/-900/-280/- 02013101 1200/-

02013102 Insulin-P.P./RandomFasting/ 650/-750/- 02013103 550/-

02013104 SerumDHEA-SDigoxin/(Sulphate)Serum 800/-450/- 02013105 700/-850/-350/- 02013106 900/-500/- 02013107 Progesterone 450/-1360/- 02013108 650/-

550/- 02013109 TrophoblasticMarkerCancer 600/-1000/-800/- 02013110 450/-160/- 02013111 640/-1050/- 02013112 1430/-

02013113 1050/-100/-

100/- 02013114 IGM 750/-800/-400/- 02013115 550/-

02013116 Alpha-FetoCancerProteinMarker(AFP) 650/-2000/- 02013117 600/-280/- 02013118 950/-150/- 02013119 Anti-ThyroidAbAntibodies-TG 900/-3200/-100/- 02013120 Bicarbonate 150/-500/- 02013121 650/-4000/- 02013122 1700/-400/- 02013123 350/-200/- 02013124 350/-320/- 02013125 Trop-T 820/-

02013126 400/-120/- 02013127 120/-520/- 02013128 80/-420/- 220/-

02013129

37

Health Scheme, 2008


Alpha I Anti Trypsin Assay

Lactose Tolerance Test

Digoxin LevelSerum Gastrin

Beta HCG (B-HCG)Beta HCG Quantitative

Cardiac EnzymesLDH Heat Stable FractionLDH IsoenzymesAntiphospolipidIGG & IGMAntibody

Antiphospolipid Antibody

Anti-Sperm Antibody/ ABS

Carcino Embryonic[CEA] AntigenAnti-Thyroid Antibodies

Anti CardiolipinIgG/ IgMAntibody-Anti CardiolipinProfile AntibodyC_Peptide AssayCyst Fluid for Analysis

Troponin T-QualitativeIntracellular CalciumPleural/ PeritonealSugar Fluid forPeritoneal Dialysis Fluid forSugar & Urea

CODE INVESTIGATION0201313002013131 BloodFreeAcetone/KetoneTestosterone0201313202013133020131340201313502013136020131370201313802013139020131400201314102013142

0201314302013144 Phenobarbitone0201314502013146 AntiACTHTG02013147020131480201314902013150 IGFI02013151 IGF-IB-2(Somatomedin-C)Microglobulin020131520201315302013154 Valproate020131550201315602013157020131580201315902013160 Biochemistry02013161020131620201316302013164


NAME OF

Apolipo Proteins

Pleural Fluid for ProteinPleural Fluid for LDHPleural Fluid for AmylaseFluid for LDHFluid for AmylaseFluid for CreatinineFluid for LipaseFluid for CholesterolPhenytoin Level24KetogenicH KetosteroidSteroid&Angio Tension ConvertingEnzyme (ACE)

Anti ThyroidTPO AntibodiesAb

ACTH PlasmaIntact PTH

Valproic Acid

Sex Hormone BindingVitamine B-12 LevelVitamin D 25 Hydroxy17 HydroxyLipoproteinCorticostiroids(a)Synovial Fluid for

Plasma CatecholaminesSerum IgASerum IgGSerum IgM

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)500/- 02013165 360/-240/-600/- 02013166 100/-

450/-80/- 02013167 Biochemistry200/- 02013168 Aldosterone 1150/-180/- 02013169 1800/-160/- 02013170 2800/-130/- 02013171 3200/-110/- 02013172 1400/-130/- 02013173 380/-150/- 02013174 Transferrin 780/-720/- 02013175 5000/-1700/- 02013176 780/-780/- 02013177 500/-

02013178 1600/-720/- 02013179 1200/-900/- 2800/-550/-960/- 02014001 240/-

960/- 02014002 250/-700/- 015350/- 02015001 Smearexaminationgram-strain 100/-2800/-960/- 02015002 100/-

100/-520/- 02015003 Examination520/- 02015004 V.D.R.L. 120/-1200/- 02015005 180/-800/- 02015006 300/-1400/- 02015007 250/-400/-580/- 02015008 200/-

02015009 C.R.P. 220/-480/- 02015010 250/-5500/- 02015011 400/-220/- 02015012 250/-220/- 02015013 250/-400/- 02015014 350/-

38

Health Scheme, 2008


PericardialBiochemistryFluid forPericardial Fluid TestPeritoneal Fluid-

Galactosemia ProfileFISH (NH)FISH for BCR/ ABLFluid for TVPCRSerum Cortisone

Chromogranin ACryo Globulin ScreeningCocaine Metabolite ScreenCyclosporine COCytokeratin/ Erythropoietin

02013180014 ProteinHistopathologyC/ S, FunctionalPap SmearHistopathology exam pertissue typeBactriology & Serology

Sputum smear A.F.B. stainVaginal Smear

Widal testRheumatoid Factor testCulture specimens)& Sensitivity (otherUrine pregnancy test

ASO TiterQuantitative H.C.G.Blood culture & sensitivityVibro cholera cultureCAPD Fluid for Culture &

CODE INVESTIGATIONSensitivity

020150150201501602015017020150180201501902015020020150210201502202015023020150240201502502015026 [Semen]02015027020150280201502902015030

02015031020150320201503302015034 Stain020150350201503602015037 NailNailforClippingFungalforCultureKOH02015038 preparation0201503902015040

020150410201504202015043


NAME OF

CAPD Fluid for FungalStain/ Gram StainCAPD Fluid-CytologyRapid Urease TestASO (Antistreptoysin “O”)High Sensitivity-CRPPUS for Fungal CulturePUS for Fungal StainPUS for Gram StainPUS for Z-N StainCulture & Sensitivity [PUS]CultureCulture& Sensitivity& Sensitivity[CSF]

CultureCulture& Sensitivity& Sensitivity[Fluid]Culture[Sputum]& Sensitivity[Throat Swab]CultureVaginal& SensitivitySwab forCulture & Sensitivity forCultureAspirated& SensitivityFluidWound[WoundSwabSwab]for FungalWound SwabStainfor Gram

WoundCultureSwab& Sensitivityfor Z-N Stain[Rectal Swab]

Blood CultureAnaerobic& Sensitivity-SensitivityBlood for(Paediatric)Culture &Tissue for Culture &Mitral SensitivityValve Tissue forAorticCultureValve& SensitivityTissue for

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)

100/- 02015044 250/-200/- 02015045 600/-250/-360/- 02015046 Sensitivity 250/-400/- 02015047 500/-250/- 02015048 150/-100/- 02015049 100/-100/- 02015050 100/-100/- 02015051 100/-250/- 02015052 150/-250/- 02015053 UrinePleuralforFluidAFBforCultureAFB 500/-250/- 02015054 Culture 500/-250/-250/- 02015055 1200/-

02015056 3000/-250/- 02015057 100/-250/- 02015058 100/-

02015059 150/-250/- 02015060 1200/-250/- 02015061 350/-100/-100/- 02015062 300/-

02015063 IGM/IGG 1000/-100/- 02015064 1500/-250/- 02015065 SerumEnzy.Angitens.AssayConv. 400/-100/-200/- 02015066 P-ANCA 800/-

02015067 C-ANCA 800/-600/- 02015068 80/-600/- 02015069 600/-

02015070 200/-250/- 02015071 400/-250/- 02015072 400/-250/-

39

Health Scheme, 2008


Arterial Line Tip for Culture& SensitivityAscitic FluidSensitivityfor Culture &AC Tap for Culture &

Sputum for AFB CultureSputum for Fungal CultureSputum for Fungal StainSputum for Z-N StainSputum for Grams StainEsophagealCandidaSmear for

CulturePleural AFBFluid-AntibioticTBPCRSensitivity- 5 Drug PanelUrine for Gram StainThroat Swab for KLBFungus CultureClostridium Difficile&B Toxin AYeastSusceptibilityIdentification andSerologyNonIdentificationFermenterfor Mumps

Torch Profile

ElisaAldehydeTest forSerumEcinococcusTestAntibody DetecAscitic Fluid Cell CountAntiAustralia-Antigen)HBS (Antibody toHepatitisAntibodyB Surface

CODE INVESTIGATION0201507302015074020150750201507602015077 Immunoglobulin-IGA02015078020150790201508002015081

020150820201508302015084

0201508502015086 CysticercosisAntibodyAntibody/IgG

020150870201508802015089

0201509002015091

02015092 II)02015093

02015094

02015095

020150960201509702015098 Aspergillus(IGG/IGM)Antibody0201509902015100020151010201510202015103 IgM0201510402015105


NAME OF

Anti-HBC CoreIgM AntibodySerum ImmunoglobulinImmunoglobulin IGEIGE Allergy Individual

Immunoglobulin IGMAnti-HAV-IGM-AntibodyImmunoglobulin IGG

Compliment C3

Compliment C4Toxoplasma- IgGToxoplasma- IgG

Toxoplasma- IgG + IgM

Cytomegalovirus, PCRPCR for AFBHerpes I(IgG)(HSV Type I)Herpes I(IgM)(HSV Type I)

Herpes II (IgG)(HSVII) TypeHerpes II (IgM)(HSV Type

Herpes I + II (IgG)Herpes I + II (IgM)

TPHA (TreponemaPallidum Haemagglutinat

Hydatid CystHBsAgfor IgG Elisa

Anti HCV IgG/IgMAnti HEV IgG/IgMAllergy Screening- AdultDengueDengueAntibodiesElisa IgG +

Dengue NS1 Ag TestScreening for C-Pylori

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)550/-600/- 02015106 [IGG/IGM/IGA] 350/-500/- 02015107 Febrile[Widal.Weli-FElAgglutinins 400/-600/- 550/-600/- 02015108600/- 02015109 CMV)Antibody(Cytomegalo[IGM]Virus 350/-1000/-600/- 02015110 420/-

2400/-350/- 02015111 HER2/NEU

350/- 02015112 Elisa 350/-370/- 600/-370/- 02015113

02015114 700/-700/-600/- 02015115 Elisa 600/-

02015116 630/-2000/-1350/- 02015117 Antibody) 450/-300/- 450/-300/- 02015118 Antibody)

300/- 02015119 Antibody) 520/-300/- 02015120 600/-

02015121 350/-300/- 500/-300/- 02015122

Anti-Mitochondrial 750/-340/- 02015123

450/-02015124

420/-600/- 02015125 960/-Anti-Native

1000/- 02015126 700/-820/- 02015127 650/-840/- 02015128 360/-1200/- 02015129 650/-1000/- 02015130 1000/-600/- 02015131 IgM 1400/-600/- 840/-200/- 02015132 IGM/IGG

40

Health Scheme, 2008


Elisa for[RUT]Tuberculosis

HBe Antigen Detection(HBe Ag)

Brucella AntibodyBreast Cancer ERPR and

Anti HCV IIIrd Generation

Epstein Bar Virus IGM[VCA Elisa]HEV IgM ElisaLegionella Pneumophila-

Elisa for PregnancyElisa for Mumps (IgG

Elisa for Measles (IgG

Mumps Elisa (IgM

HIV P24 AntigenVivax AntigenAnti Smooth MuscleAntibody (ASMA)

Antibody-M2 (AMA-M2)Anti-Nuclear Antibody/ANF/ ANAANA IFA (HEP-2) Method

DeoxyribonucleicDNA) Acid (Ds-Antismith AntibodyRubella IgG/IgM AntibodyRubella IgG & IgMRubeolaRubeola IgG/IgMAntibodiesAntibodyIgG &

Leptospira Antibody

CODE INVESTIGATION02015133020151340201513502015136020151370201513802015139020151400201514102015142 AmnioticSpingomylFluid-Lecithin02015143

020151440201514502015146020151470201514802015149020151500201515102015152020151530201515402015155

0201515602015157 Crossmatch0201515802015159

020151600201516102015162


NAME OF

Leptospira AntibodyIGM IGG &CryptococcusLatex DetectionAntigen-(CSF)FalciparumADA (AdenosineAntigenDeaminase- Body Fluid)Anti MantouxHAV-TotalTest(IGG &CytomegaloIGM)Virus (CMV)Antibody [IGG]CMV IgM + IgGChopra Aldehyde Test

AmoebiaisScreeningAntibodies [IHA]Amoebic SerologyKOH Mount for FungalCampylobacterElements DetectionJejieniAntigen Detection IHIV Test (1 & 2)Typhi DOT-M(HBCHepatitistotal,B-Core,IGG + IGM)totalAnti HBC Antibody (IgM)Anti HBC Antibody (Total)Anti HBEHepatitis Be AntibodyHepatitis D Virus AntibodyHLA-B27,HLA B27DiseaseCHNAssociation, FlowHLA-ABCCytometry& DR Tissue

HCV RNA PCR QualitativeHepatitisGenotype,C ViralLIPARNAVaricella- Zoster Virus IGGVarcillaTitresZoster IgMVarcilla Zoster IgG & IgM

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)1650/- 02015163 820/-1300/- 02015164 1500/-360/- 02015165 HIVPeriodQualitativeDetection)(Window 1200/-450/- 02015166 1300/-150/- 02015167 Panel-Comprehensive(MolecularCNSDia 6800/-720/- 02015168 1100/-320/- 02015169 1900/-600/- 3000/-100/- 02015170 Qualitative400/- 02015171 900/-280/- 02015172 1500/-800/- 02015173 1000/-100/- 02015174 1100/-360/- 02015175 720/-

02015176 520/-450/- 02015177 840/-160/- 02015178 2000/-720/- 02015179 720/-720/ 02015180 1500/-720/ 3800/-550/- 02015181 CD550/- 02015182 350/-1450/- 02015183 3200/-920/- 02015184 1100/-1500/- 02015185 IgA 720/-2000/- 02015186 700/-

02015187 1200/-2500/- 02015188 920/-9500/- 02015189 920/-520/- 02015190 920/-720/- 02015191 6000/-1400/- 02015192 5500/-

41

Health Scheme, 2008


AntiMicrosomal-1)LKM-1 (LiverAntiboKidneyViable MTBPCRDetection-

Anti Sclero 70/ SCL 70

HIV ProviralQualitativeDNA DetectorHepatitisQuantitativeB PCRHepatitis B Virus PCR

Anti GBM Antibody+HSV DNA PCRAnti RNP-Sm AntibodyAntibodyProteinto RibonucleoIgGNBT Reduction TestAnti Jo AntibodyAnti Jo-1 AntibodiesAntibody to SSA/SSBJapaneseAntibody Encepahilitsto SSB/LAVirus PCR (JE Virus PRT-PCRHIV-1 RNSwithQuantitativeCD-3, CD-4,

RNS Study/ DecrementHIV Viral Load CD4 & CD8AntiAntiEndomysialRNP- SmAntibodyIgG

CD-4, CD-8CD 10CD 20CD 3CD 30HCV RNAViralQuantitative/LoadHBV Quantitative

CODE INVESTIGATION0201519302015194 MycobacteriumIgA/IgG/IgM02015195 MycobacteriumIgG/IgMSerology0201519602015197 TreponematuberculosisPallidumPCR)0201519802015199 AutoimmuneFTPA-ABFHepatitis020152000201520102015202020152030201520402015205 HSVSerum(1+2)PrealbuminIgG/IgM02015206 Antibodies020152070201520802015209020152100201521102015212020152130201521402015215020152160201521702015218 ProstrateProstaticMicroscopySpecificSecretionAntigenfor02015219 (PSA)


NAME OF

HBV DNA Qualitative

TuberculosisTB PCRMycobacterium(MycobacteriumSerology EL

TreponemalAntibody DetectionPallisum,

AntinuclearPanelantibody Panel(14 antibody panel)Anti CCP AntibodyAnti Centromere AntibodySerum Procalcitonin

HSV (1+2)(1+2)IgGIgMand HSVChikungunya TestANA/ ANF in DilutionBronchialCulture &AspirationSensitivityforBronchialBronchialAFBAspirationAspirationCulture forforBronchialFungalAspirationStain forBronchialGramAspirationStain forCVP TipTBPCRfor Culture &DialysisSensitivityCatheter Tip forEar/ Eye/ Nasal/C/S TongueSwabSensitivityfor Culture &

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)1900/- 016600/- 02016001 Examinationanaesthesiaunder 2430/-500/- 02016002 6060/-1900/- 8000/-850/-300/- 600/-2000/- 02017002 500/-900/- 02017003 350/-1100/- 02017004 800/-

018450/-800/- 0192000/- Procedures550/- 4380/-280/- 02019002 Bronchoscopy 2400/-550/- 02019003 Mediastinoscopy 2880/-500/- 02019004 3630/-1000/- 02019005 Thoracoscopy 6600/-300/- 02019006 700/-500/- 02019007 700/-100/- 02019008 1620/-100/- 02019009 Dilutioncapacitywithstudiesdiffusion 1620/-1400/-300/- 02019010 940/-300/- 02019011 100/-

02019012 1000/-300/- 02019013 Cardioversion 1400/-150/- 02019014 400/-500/-

42

Health Scheme, 2008


Obstetric Cases

Lap.LaparoscopyDye Test with(Gynae)removal02016003017 processingBiopsiesof adhesionsper(Specimentissue type)02017001 Biopsy [Large]

Biopsy [Medium]Biopsy [Small]Biopsy [Extra Large]Head & Neck Cancer

Cardio Respiratory

02019001 Direct Laryngoscopy

Pleural Biopsy

PulmonaryBMRfunction testSpirometrySpirometrywith HeliumSpirometryDilutionwith Helium

Pulmonery exercise testingPunctal CauteryNT Pro BNP

Cardiac Troponin I

CODE INVESTIGATION0201901502019016 Testicular02019017 FlexibleFlexibleDiagnostic-Bronchoscopy-Bronchoscopy-TBNA02019018 FlexibleTherapeuticBronchoscopy-02019019 Glue

02019020

02019021 Toileting

02019022 Diagnostic

0201902302019024

02019025020

Procedures02020001

02020002020200030202000402020005020200060202000702020008

02020009 Specification)

02020010


NAME OF

TEE with Anesthesia

Flexible Bronchoscopy-Baloon TampeteFlexible Bronchoscopy-

Rigid Bronchoscopy-

Rigid Bronchoscopy-Massive HaemoplysisFibroptic bronchoscopyFibroptic BronchoscopyCardiacwith Washing/Biopsy/ Cardio Thoracic

Test of PacemakerStress Myocardial Study(MBI/ TR)Echo ScreeningStress Echo/EchoDobutamineFoetal Echocardiography2CardioD EchoTocographywith colourDoppler/Cardiography2D EchoTransHolterOesophaedralAnalysis(TEE) & HolterEchoReport (with Prd.

Cardiac Cath Angiography(Without Coronary

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)2500/- Angioplasty)800/- 02020011 Aortogram 3900/-10000/-2500/- 02020012 410/-4000/- 02020013 3600/-

4000/- 02020014 1440/-

2600/- 02020015 EchoMugaColour(Stress)Doppler 1800/-

5000/- 02020016 1440/-

6200/- 02020017 7000/-021 Gastroentrology

2100/- 02021001 Gastroscopy 1170/-1560/-

2500/- 02021002 (Endoscopic)

580/- 02021003 ERCP 4000/-

7200/-720/- 02021004 2200/-1950/- 1100/-1320/- 02021005360/- 02021006 1300/-1320/- 02021007 1400/-840/- 02021008 1200/-

1470/- Oesophagoscopy 1100/-02021009

13200/-

43

Health Scheme, 2008


PackageCardiovascularinvestigationcharges forStress Thallium

Muga (Resting)

CheckAbdomen/Angio

Gastric & Duodenal Biopsy

ERCP FluroscopyUpper G.I. Endoscopy

Upper G.I.BiopsyEndoscopy withSigmoidoscopy (rigid)Sigmoidoscopy (flexible)

CODE INVESTIGATION

02021010 Colonoscopy

02021011

02021012

02021013

022Genitourinary

02022001

02022002 Urethroscopy02022003

02022004 Diagnostics02022005 VisuallyUroflowEvokedStudyPotential02022006 (Micturometry)

02022007 Cystoscopy(Cystometry)with

02022008 CystoscopyUnilateralwith

02022009 Bilateral0202201002022011 Cortisol-blood02022012 Voiding-cysto-urethrogram02022013 RenalEvaluationTransplant

023

02023001 Osteomedullography02023002024 Neurology0202400102024002 Monitoring


NAME OF

Colonoscopy-FullPKG) (GAS-

24 H PH Metry

24 H PH Metry (BS)

Nephrology /

Biopsy(Cystoscopic)of Bladder

Glomerular Filtration Rate

Urethral dialatation-

Urodynamic Study

Retrograde Catheter

Retrograde Catheter

Cystoscopy Diagnostic

Orthopaedic Surgery

ArthrographyProcedure &

Arthroscopy - Diagnostic

PlacementLumberofPressureICP Monitor -

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)02024003 8500/-

1800/- 02024004 8500/-02024005 3000/-

2000/- 02024006 5000/-02024007 500/-02024008 650/-

4000/- 02024009 900/-02024010 480/-

5500/- 02024011 900/-02024012 500/-02024013 EMG-Facial 500/-

02024014 NCV-Facial 500/-8000/- 02024015 NCV+EMG-Facial 950/-

550/-6000/- 02024016 Spincter-EMG500/- 02024017 500/-

550/-1000/- 02024018

02024019 550/-500/- 02024020 SSEP-UL/LL 1000/-600/- 02024021 550/-

550/-02024022

1200/- 02024023 200/-02024024 250/-

4000/- 02024025 550/-02024026 1000/-

6000/- 02024027 200/-5000/- 02024028 300/-240/- 02024029 850/-360/- 02024030 450/-1500/- 02024031 650/-

02024032 SSR 700/-

11000/- 02024033 Monitoring 1500/-02024034 1200/-

11000/- 025 Breast02025001

6000/- 02025002 800/-6100/- sides) 1500/-

44

Health Scheme, 2008


Nerve BiopsyBrain BiopsyBrain MappingAmbulatory Electro EnceBlink ReflexDecrement TestEMG Four LimbsEMG Two LimbsNCV Four LimbsNCV Two Limbs

H Reflex

SSEP (Lower Limbs)SSEP (Upper Limbs)

VEP (Flash)

VEP (PR)Counsl of INH PatientSpl Edu AssessmentBaer StudyBaer/ ThresholdCouncelling & TherapyIQ AssessmentNeuro Psychological TPersonality & IQ ChildPersonality Development T

Lumbar puncture with CSF

HER-2/ NEU

Mammography (SingleMammographyside) (Both

CODE INVESTIGATION026 Gynae,ChargesOperation

02026001

02026002

02026003027020270010280202800102028002

0202800302028004

02028005

02028006

(Cervical,Dorsal,02028007 Lumbar,Sacral)

02028008020280090202801002028011

0202801202028013020280140202801502028016020280170202801802028019


NAME OF

Diagnostic Curettage

Fractional Curettage

LaproscopicHysteroscopyOperationsDiagnosticGastrohepaticIn Gen. Surgery/ Nephro-/Diagnostic LaproscopySpecialisedInvestigations/ProceduresC.T. Scan/C.T.Cat ScanHead (C.T.)Scan Involv.HeadSpl. Investigation

C.T. Scan BrainHRCT Chest Thorax

C.T. Chest (HRCT)

C.T. Scan ChestC.T. Spine

CT Angiogram of Cervicaland IntraReconstructionC.T. Cervical C.T.only3D--C.T. Guided BiopsyC.T. Guidedcath drainagepercutaneousC.T. Myelogram(Cervical Spine)(LumbarC.T. MyelogramSpine or D/S)CT Pelvis with Hip JointsCT KUB (Plain)CT Sacro Iliac JointCT Pituitary/ SellaCT CisternographyCT Petrous Temporal Bone

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)02028020 3500/-02028021 3000/-

3000/-02028022 3000/-

3400/-02028023 5000/-

7500/-02028024 Joint/OtherElbowJointJoint/(Plain)Any 3500/-

7000/- 02028025 2000/-02028026 3000/-

1600/- 02028027 2000/-2300/- 02028028 3000/-

1600/- Leg/Forearm/Tibia-Fibula/Radius-Ulna/Thigh/6000/- 02028029 4500/-

02028030 2500/-4000/-

02028031 2000/-3500/-

02028032 10000/-02028033 2000/-

3500/-02028034 Sinus 3000/-

7200/-1200/- 02028035 2500/-2000/- 02028036 5400/-2500/- 02028037 10000/-

3500/-3500/-3000/- 02028038 Visipaque 6500/-3500/- 02028039 5000/-2500/- 02028040 Limbs 10000/-2500/-1600/- 02028041 5000/-3000/-

02028042 6000/-

45

Health Scheme, 2008


CT Sacrum & CoccyxC.T. Scan Upper Abdomen

C.T. Scan Lower Abdomen

C.T. Scan Whole AbdomenC.T. Shoulder Joint/ Knee

CT Base of NeckC.T. ScanSoft NeckTissue)(ThyroidCT Ankle with FootC.T. Scan Orbits/EyeCT Arm/ Humerus/

Femur (Single) PlainC.T. Scan Limbs

CT Both Thigh

C.T. Scan Whole BodyCT ExtremitiesC.T. Scan of Para Nasal

CT AngiographyCT guided FNACof Brain/Carotid/ Thorax/ NeckCTAngiography64 CoronaryCT Angiography of Brain/Carotid/ Thorax/ Neck/area/Abdomen/RenalPulmonaryarea/Extremities/Peripheralarea with

CTCTRenalAngioAngiographyBoth Lower

CT Angiography of NeckCT AngiographyVessels ofAbdomen/ Extremities/Renal area/ Peripheral

CODE INVESTIGATION

02028043 (includingGlucose)Flurodeoxy

02028044

02028045

020280460202804702028048 C.C.)02028049

0202805002028051 C.C.)

0202805202902029001 Protocol/InternalCSFEarStudy/

020290020202900302029004

02029005 PNS

020290060202900702029008 MRIMRIThyroid/PituitaryCranio-02029009

02029010 MRI(Unilateral)Venography/02029011 Angiography

0202901202029013


NAME OF

area/ Pulmonary areaPET CT Scan(Whole Body)

Therapeutic Aspiration- CT

Diagnostic Aspiration- CT

Ionic Contrast (20 C.C.)IonicNon-ionicContrastContrast(50 C.C.)(10

Non-ionicC.C.)Contrast (25Non-ionic Contrast (50Non-ionicC.C.)Contrast (100

3D Reconstruction chargeMRI Brain/MRIBrain with

MRI Base of SkullMRI OrbitsMRI FaceMRI Nasopharynx and

MRI PharynxMRI Neck

Vertebral (C.V.) Junction/MRI Temporal Bones

MRI Arm/ Fore Arm/ Thigh/Femur/ Leg/ FootMRI Arm (Humerus) (Left/

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)

02029014 5400/-02029015 9000/-

20000/- 02029016 MRIMRISacroSpineIliac(Cervical/Joints 5400/-

3000/-02029017 Lumbo-Sacral) 5400/-

1600/-02029018 6000/-

270/- 02029019 9000/-675/- 02029020 13000/-500/- 02029021 1500/-750/- 02029022 MRIMRIDiffusionSpectroscopyTensor 1500/-

02029023 1500/-1250/- 02029024 1500/-2100/- 02029025 6000/-

02029026 5400/-1200/- 02029027 6000/-

02029028 MRCP 5000/-6000/- 02029029 6000/-

02029030 MRCP 6000/-5400/-6000/- 02029031 5000/-5400/-

02029032 6000/-6000/-

02029033 5400/-5400/-6000/- 02029034 Abdomen 7000/-5400/- 02029035 9000/-5000/- 02029036 Pelvis 5400/-6000/- 02029037 6000/-

02029038 5400/-5400/- 02029039 5400/-

02029040 5400/-5400/- 02029041 5400/-5400/-

46

Health Scheme, 2008


MRI- Single JointMRI- Both Joints

Dorsal/ Lumbar/ Cervico-Dorsal/ Dorso-Lumbar/

MRI Lumbar Spine &Sacroiliac JointDouble Region& Spine)Plain (BrainTripple Region& Spine)Plain (BrainMRI CSF Flow Study

MRI SWIImaging(Susceptibility(DTI)Weighted Image)MRI HipMRI UrogramMRI Pelvis

MRI UpperMRI ExtremitiesAbdomen with

MRI TemporomandibularSingle JointMRI TemporomandibularDouble Joints

MRI Upper AbdomenMRI Upper Thigh & Lower

MRIMRI LowerWholeAbdomen/Abdomen

MRI BreastMRI Thoracic OutletMRI Spine ScreeningMRI Brachial PlexusMRI Chest


02029044

02029045 MRINervePerfusionEvaluationStudy0202904602029047

02029048 Films

020290490202905002029051020290520300203000102030002 BoneOxygenDensitometrySaturationSingle02030003 site

02030004

0203000502030006 body02030007031 Immunology

02031001

020310020320203200102032002 Scan02032003020320040203200502032006


NAME OF

MRISpectroscopyBrain withMRI Brain with PerfusionMRI Brain with Orbit/ PNS/Angio/ Neck Angio(DiffusionMRI BrainTensorwithImaging)/DTIWeightedSWI (SusceptibilityImage)/ Cranial

MRI ScreeningScreening Single Area with

Screening Double Areawith FilmsMRI Small PartMRI Other RegionContrast (Ionic/ Non-ionic)Other InvestigationsFluoroscopic Screening

Bone Densitometry TwoBone Densitometrysites Threesites ( Spine , Hip & oneBone Densitometryextremity) Whole

A.V. Fistula

Hepatitis B DNAHBV DNA Quantitative/NuclearViralMedicinesLoad

Gallium-67Isotope VenographyScan/Ghallium

Iodine-131ThyroidThyroidScan ScanThyroid (Tc99m) ScanPara Thyroid Scan

Annexure-I


(Rupees) CODE INVESTIGATION (Rupees)6000/- 02032007 9000/-7300/- 02032008 11000/-

6500/- 02032009 5500/-02032010 2000/-02032011 WholeRefluxBody(Indirect)Tc-V-DMSA 3000/-

6000/- 02032012 Scan 3500/-3500/-5400/- 02032013 TumourImaging)Immagery 2500/-

02032014 5000/-1500/-

02032015 Region) 1800/-3000/-4000/- 02032016 2700/-5400/- 02032017 body) 3000/-2500/- 02032018 2000/-

033 Profiles120/- 02033001 700/-120/- 02033002 TotalThyroidDiabeticProfileProfile 1200/-800/- 02033003 1000/-

02033004 850/-1200/- 02033005 550/-

02033006 750/-1600/- 02033007 PreDialysisDialysisProfileSerology 600/-2200/- 02033008 500/-3000/- 02033009 3000/-

02033010 1800/-

5200/- 02033011 2000/-02033012 900/-

6000/- 02033013 1800/-

3500/- 02033014 Comprehensive(BMP)Metabolic 320/-8500/- 02033015 AnaemiaPanelScreen(CMP)(HAEM1) 500/-1800/- 02033016 2800/-2500/- 02033017 (HAEM2) 3400/-1800/- 02033018 2700/-6000/- 02033019 2000/-

47

Health Scheme, 2008


Spect MyocardialThallium ScanPerfusionScan (Thalium/ Tetro)Spect Myo Perfusion RestScan (Thalium/ Tero/ MieNuclearRadio-IsotopeBlood PoolUretericScan

Brain Spect (Tumour

Bone Scan Spect (Single

Bone Scan- three phaseBone(SingleScan SpectRegion)(whole

Tc 99m DMSA Renal Scan

Lipid Profile

Pre Cath Profile

Coagulation ProfileLFT [Liver Function Test]

Hepatitis B ProfileHepatitis Panel

Neuro ProfileSeptic Profile

Paediatric Septic ProfileBasic Metabolic Panel

Thrombocytopenia Screen

Mycloma Screen (HAEM3)Lymphoma Screen

CODE INVESTIGATION(HAEM4)

02033020

02033021

0203302202033023 CRBSI0203302402033025020330260203302702033028020330290203303002033031


NAME OF

Polycythaemia (HAEM5)Thallasaemia PatientScreen (HAEM6)Thallasaemia CounsellingSerum (HAEM7)

ACTH StimGrowth Hormone StimMale GnRH StimFemale GnRH StimBone Marrow ProfileEP Screening ProfileTorch ProfileRenal Profile

Annexure-I

MaximumApproved

(Rupees)

1800/-

3000/-

1200/-550/-1900/-2000/-3500/-3300/-550/-1100/-1500/-330/-

48

Health Scheme, 2008

Rate (INR)

CODE00103001001030010020300100303001004030010050300100603001007

0300100803001009

0300101003001011030010120300101303001014030010150300101603001017030010180020300200103002002


RATES FOR IMPLANTS03- IMPLANTS

Annexure-I

etc.)

Opthalmology


NAME OF THE ITEMCardiology Implantation DevicesPacemaker (Single Chamber)- Ordinary (SSI Autocapture)Pacemaker (Single Chamber)- With rate modulation (SSIR)Pacemaker (Dual Chamber) (DDD/DDDR/VDDR)CRT (Cardiac Resynchronization Therapy)AICD (Automatic Implantable Cardioverter Defibrillater)CRT + AICD combinationBMS (Bare Metal Stent)(made of Steel)BMS (Bare Metal Stent)(made of alloy e.g. Cobalt, Chromium,

DES (Drug Eluting Stent)- Sirolimus-eluting e.g. Cypher, etc.DES (Drug Eluting Stent)- Higher Sirolimus derivatives e.g.Endeavour, Promus, Xcience, etc.DES (Drug Eluting Stent)- Paclitaxel-eluting e.g. Taxus, etc.PDA- closure deviceASD/ VSD- closure deviceMitral Baloon, e.g. Inoue BaloonPulmonary Valvoplasty BaloonMitral/ Aortic Heart ValveTTK Chitra (Mitral/ Aortic Heart Valve)Heart Valves- Annuloplasty Ring

Hydrophobic Foldable IOLSilicon Foldable IOL

(Rupees)

5,000/-

49

31-01-2011)

Maximum Approved Rate (INR)

45,000/-whicheveror the actualis less cost,68,000/-cost, whichever+ VAT or theis lessactual1,20,000/-cost, whichever+ VAT oristhelessactual2,50,000/-whicheveror theisactualless cost,3,50,000/-whicheveror theisactualless cost,5,00,000/-whicheveror theisactualless cost,30,000/-cost, whichever+ VAT or theis lessactual40,000/- + VAT or the actualcost, whichever is less95,000/-cost, whichever+ VAT or theis lessactual1,05,000/- + VAT or the actualcost, whichever is less80,000/-cost, whichever+ VAT or theis lessactual50,000/-whichever+ VAT or theis lessactual cost,80,000/-whichever+ VAT or theis lessactual cost,40,000/-cost, whichever+ VAT or theis lessactual20,000/-cost, whichever+ VAT or theis lessactual50,000 whichever+ VAT or theis lessactual cost,30,000 whichever+ VAT or theis lessactual cost,24,000/-whichever+ VAT or theis lessactual cost,

4,000 /-

CODE0300200303002004003030030010300300203003003004

03004001

03004002

03004003

03004004

03004005

005

03005001

03005002

03005003

03005004

03005005

03005006

03005007

03005008

03005009

03005010

03005011

03005012

03005013

03005014

03005015

03005016

03005017


ENT


NAME OF THE ITEMHydrophilic Acrylic LensPMMA IOL

One-sided Hearingin theAidcanal(Bodytypeworn/Pocket/Behind(conventional) the ear type orBilateral Hearing AidDigital HearingWestAidBengal(to beHealthpurchasedSchemewith Authority)the permission of theNeuro ImplantsType of Neuro-implantDBS ImplantsIntra-thecal Pumps

Spinal Cord Stimulators

CPAP MachineBIPAP MachineOrthopaedic implantsDepuy (TKR) KneeZimmer (USA) KneeCemented Bipolar Hip (Zimmer)Uncemented Total Hip (Zimmer)Cemented Bipolar Hip (Depuy)Uncemented Total Hip (Depuy)Cemented Total Hip (Depuy)DHS Plate ScrewProximal Femur NailLocking Plate & Screw- for HumerousLocking Plate & Screw- for Distal TibiaLocking Plate & Screw- for Proximal TibiaLocking Plate & Screw- for Proximal FemurLocking Plate & Screw- for Shaft FemurLocking Plate & Screw- for Radius UlnaLocking Plate & Screw- forJointDistal Humerous & ElbowLocking Plate & Screw- for Shaft Humerous

Annexure-I

CeilingRate3,60,000/-2,62,000/-

2,62,000/-

31-01-2011)Maximum Approved Rate (INR)

Prescribing AuthorityNeurologisthospitalof a recognisedAny two specialists ofconcerned speciality/ HoDAnaesthesiologyNeurosurgery/of Neurology/ ofrecognized hospital

Maximum Ceiling Rates

(Rupees)

500/-

10,000/-20,000/-30,000/-

years3-5 2,50,000/-2,25,000/-

years3-5 2,00,000/-

50,000/-1,00,000/-(Rupees)75,000/-74,880/-41,080/-69,992/-38,500/-77,000/-46,500/-3,500/-5,720/-5,500/-6,500/-5,500/-6,500/-9,000/-2,500/-4,500/-5,500/-

50

6,000 /-

BatteryLife ofBatteryCost of

7 years

CODE03005018

03005019

03005020

03005021

03005022

03005023

03005024

03005025

03005026

03005027

03005028

03005029

03005030

03005031

03005032

03005033


Annexure-I

(Rupees)5,500/-2,500/-3,500/-8,000/-3,500/-3,500/-5,500/-4,500/-3,500/-20,000/-4,500/-2,500/-6,500/-7,000/-7,000/-7,000/-

51

Health Scheme, 2008(Notification No. 796-F (MED) dated 31-01-2011)Maximum Approved Rate (INR)NAME OF THE ITEMLocking Plate & Screw- for Buttress Plate & ScrewISO-Elastic Nail (Per Piece)Interlocking Nail for Tibia & FemurPFN Nail for Proximal FemurDHS Plate Screw for Trochanteric FractureHumerous PlateHumerous locking Plate & ScrewHumerous locking T- Buttress Plates & ScrewElbow Joint- fixation by locking Plate & ScrewReplacement of Elbow JointRadius Ulna- Locking Plates & ScrewWrist joint with locking Plate & ScrewSoldier Joint- With Jess FixatorExternal & ILLIZAROV- FemurExternal & ILLIZAROV- TibiaExternal & ILLIZAROV- Pelvis

Revised Rate List

Documents

Transcript of Revised Rate List