Page 1
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
1 Sequestrectomy 2B.1 7313 2435 X Ray film with report X Ray film with report
2 Drainage of parotid abscess 2B.2 5250 2982 X Ray film with report X Ray film with report, Clinical Photograph
3 Fixation of fracture of jaw including implants 2B.3 7500 2321 X Ray film with report X Ray film with report
4 Tumour excision 2B.4 5625 2436X Ray film with report,Clinical
Photograph,X Ray film with report, Clinical Photograph
5 Excision of mandible 2B.5 9000 61 X Ray film with report X Ray film with report, Clinical Photograph
6 Repair of parotid duct 2B.6 11250 39 X Ray film with report X Ray film with report, Clinical Photograph
7 Condylectomy 2B.7 1125 NA X Ray film with report X Ray film with report, Clinical Photograph
8 Fistula closure 2B.8 263 2313 X Ray film with report X Ray film with report, Clinical Photograph
9 Treatment of malocclusion through wiring 2B.9 6000 2447X Ray film with report,Clinical
Photograph,Clinical Photograph
10 Peadiatric caries (Full mouth) 2B.10 3750 NAX Ray film with report,Clinical
Photograph,X Ray film with report/Clinical Photograph
11 Management of puerperal sepsis 2B.11 4125 NA
Ultrasonography, X Ray, ECG,
LFT,RFT, FBS,PPBS,
T3,T4,THS,Routine investigation
Clinical Notes
12 Threatened rupture Uterus With Tubectomy 2B.13 8438 737 Clinical Notes OT notes
13 Lap. Salphingo-oophorectomy 2B.14 7500 688 USG, CA 125 HPE
14 Lap. Assisted Vaginal Hysterectomy (LAVH) 2B.15 8625 710
Ultrasonography, X Ray, ECG,
LFT,RFT, FBS,PPBS, T3,T4,THS/
Endometrial Biopsy/Cervical biopsy
HPR,OT notes
15 Lap. Total Abdominal Hysterectomy 2B.16 8625 711Ultrasonography, X Ray, ECG,
LFT,RFT, FBS,PPBS, T3,T4,THSHPR,OT notes
16Vaginal Hysterectomy With Pelvic Floor Repair
(Cystocele, Rectocele & Perineorraphy)2B.17 11250 709
Ultrasonography, X Ray, ECG,
LFT,RFT, FBS,PPBS, T3,T4,THS,
Endometrial biopsy , Cervical biopsy
Ultrasonography
17 Laparoscopic Ovarian Cystectomy 2B.18 6000 685 USG, Routine investigations and CA 125 HPE
Government hospitals package rate list
Complex Secondary Healthcare TreatmentsDENTAL
OBSTETRICS AND GYNAECOLOGY
Page 2
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
18 Laparoscopic Ectopic Resection 2B.19 9450 804Serum Beta HCG, USG, CBC, Routine
investigationOT notes
19 Laparoscopic Myomectomy 2B.20 9000 717 Ultrasonography/ Tubal patency test HPE, OT notes
20 Laparoscopic Sling Operations 2B.21 10425 712 Clinical Notes, USG OT Notes
21Vesico vaginal Fistula/recto vaginal fistula-
Repair2B.22 10500 775
Clinical Notes, USG/KUB/Urology
opinionOT notes
22 Tuboplasty 2B.23 7125 741Ultrasonography, X Ray, ECG,
LFT,RFT, FBS,PPBS, T3,T4,THSOT Notes
23 Vulvectomy 2B.24 6750 770 Clinical Notes, USG/CT/MRI OT Notes, HPE
24 Shirodhkar Mc. Donalds stitch 2B.25 2100 824 Clinical Notes OT Notes
25Gestational [pregnancy-induced] hypertension
with significant proteinuria2B.26 563/day 2601
Clinical Notes with relevant
investigationsTreatment Notes
26 Low Forceps/Vaccum delivery 2B.27 4125 791, 790 Clinical Notes Delivery notes
27Chest injuries with intercostal drainage (ICD)
unilateral2B.28 6000 16 17 X-ray X-ray
28 Amputation-Forearm 2B.29 13500 911 X-ray X-ray
29 Amputation-Wrist Axillary Node Dissection 2B.30 9000 912 X-ray X-ray
30 Amputation-Arm 2B.31 13500 930 X-ray X-ray
31 Amputation-Thigh 2B.32 15000 929 X-ray X-ray
32Maysers muscle pedicle graft for Non-union
fracture neck femur (orthroplasty)2B.33 15000 1027 X Ray film with report X Ray film with report
33 Facio-Maxillary Injury repairs & fixations 2B.34 11250 2401 X-RAY/CT scan Clinical Photograph showing scar + post op.
XRAY
34 Decompression and Stabilization with Steffiplate 2B.35 15000 1015 X Ray film with report X Ray film with report
35 Harrington Instrumentation 2B.36 11250 1066 X Ray film with report X Ray film with report
36 Leg Lengthening 2B.37 11250 1044 Clinical Photograph Scar Photo, Clinical Photograph
37 Nerve Transplant/Release 2B.38 10125 955 Clinical Photograph, MRI, Clinical Notes Clinical Photograph showing scar
38
Simple frame -Single bone-
femur,tibia,humerus,radius including six schanz
pins,1 rod and 6 clamps implant
2B.39 15750 1061 X Ray film with report X Ray film with report, Scar Photo
ORTHOPAEDICS
Page 3
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
39Pelvis/transarticular including implants
Procedure 2B.40 13800 2385 X Ray film with report X Ray film with report, Scar Photo
40 Soft Tissue Reconstruction Procedures For Joints 2B.41 5400 980 MRI Clinical photograph
41Anterior instrumentations + Cage fixations
including implants procedure 2B.42 22500 1006 X-ray X-ray
42 Anterolateral Clearance For Tuberculosis 2B.43 13500 1001 MRI X Ray film with report, Clinical Photograph
43 Cervical Rib Excision 2B.44 10725 64 MRI X Ray film with report, Clinical Photograph
44 Long bone (two) external/internal fixation 2B.45 22500
1032,1029,862
,863,864,1073,
1061, 1051
X-RAY/CT scan(If Required) Post-operative X-ray, Clinical Photograph
showing scar
45 Pelvic injuries external/Internal fixation 2B.46 15000 2385 X Ray film with report X Ray film with report
46Arthroscopic Anterior cruciate ligament (ACL)
Reconstruction2B.47 14250 971 MRI MRI
47Posterior cruciate ligament (PCL)
Reconstruction2B.48 13275 972 MRI MRI
48 Discectomy-Dorso Lumbar 2B.49 19110 1902 Clinical findings, MRI Report Clinical photograph showing scar
49 Discectomy-Lumbar 2B.50 18600 1902 Clinical findings, MRI Report Clinical photograph showing scar
50 Lumbar Laminectomy (no discectomy) 2B.51 13500 1857 CT/MRI reportClinical Photographs showing scar + X-ray-
Lumbar Spine
51Closed fracture reduction under anaesthesia for
first and additional fracture2B.52 3000 858, 859 X-ray X-ray, scar photo
52Simple/compound fracture with internal/external
fixation along with implants 2B.53 15750 1051 X-ray X-ray, scar photo, Invoice of implants
53 Blunt injury abdomen 2B.54 7500 NA USG USG
54 Surgery for GI Bleeding Ulcers 2B.55 15000 1152 Endoscopy Endoscopy Picture
55 Lap. Adhesiolysis 2B.56 9750 1257 CT , X-Ray Abdomen HPR , Clinical photograph
56 Resection & Anastomosis Of Small Intestine 2B.57 13500 113 CT , X-Ray Abdomen HPR , Clinical photograph
57Operations For Recurrent Intestinal Obstruction
(Noble Plication Other)2B.58 11250 112 CT-Contrast HPR , Clinical photograph
SURGICAL GASTRO ENTEROLOGY
Page 4
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
58Upper GI Therapeutic(including Varicose
Intervention)2B.59 1500 2844 Endoscopy Endoscopy
59
Endoscopic Retrograde Cholangio
Pancreatography (Endoscopic Retrograde
Cholangio Pancreatography (ERCP) with
Interventions
2B.60 3000 1224 Liver function test (LFT), USG Liver function test (LFT), USG
60 Plane / Anterior Vitrectomy 2B.61 3675 491 Slit lamp findings Clinical notes
61Vitrectomy - Membrane Peeling - Endolaser -
Silicon oil or Gas - with or without belt buckling2B.62 9000 492 Indirect Opthalmoscopy report
62 Vitrectomy - Membrane Peeling- Endolaser 2B.63 9375 493 Indirect Opthalmoscopy report Fundus Photograph
63 Vitrectomy Plus Silicon Oil Or Gas 2B.64 9375 494 Indirect Opthalmoscopy report Clinical Photograph
64 Removal Of Silicon Oil Or Gas 2B.65 2625 495 B Scan, Fundus Photograph B Scan, Fundus Photograph
65 Scleral buckle procedure for retinal detachment 2B.66 7500 497 B Scan , Fundus Photograph Fundus Photograph
66 Intraocular foreign body removal with vitrectomy 2B.67 5775 528 B Scan Report Clinical Photograph
67 Socket Reconstruction 2B.68 4125 507 Clinical Photograph Clinical Photograph
68 Dermis Fat Graft 2B.69 3675 508 Clinical Photograph Clinical Photograph
69 Orbitotomy 2B.70 4950 509 Clinical Photograph Clinical Photograph
70 Decompression/Excision of optic nerve lesions 2B.71 10125 511, 1893 CT , MRI Clinical Photograph
71 Proptosis,orbitotomy 2B.72 6000 1889, 509 CT/MRI Clinical Photograph
72
Paediatric Opthalmic treatment---
Photocoagulation For Retinopathy Of
Prematurity upto 3 sittings (complete package)
2B.73 6375 499 Fundoscopy Report Fundoscopy Report
73Photocoagulation for Retinopathy for 3 sittings-
Complete package2B.74 1500 498 Fundoscopy Report Clinical Photograph
74 Laser treatment for Retinopathy one sitting 2B.75 990 498 Fundoscopy Report Clinical Photograph
75Pan retinal photocoagulation (PRP)/ FOCAL /
GRID / YAG /Laser per eye for one sitting 2B.76 750 498 Fundoscopy Report Clinical Photograph
OPHTHALMOLOGY
Page 5
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
76PRP / FOCAL / GRID / YAG / Laser per eye for
three sitting2B.77 2250 498 Fundoscopy Report Clinical Photograph
77PRP / FOCAL / GRID / YAG / Laser for both
eyes one sitting2B.78 2250 498 Fundoscopy Report Clinical Photograph
78PRP / FOCAL / GRID / YAG /Laser for both
eyes three sitting 2B.79 6750 498 Fundoscopy Report Clinical Photograph
79 Radial Keratotomy 2B.80 3375 533 Refratcive power Refratcive power
80Cauterisation of ulcer/subconjuctival injection -
both eye2B.81 225 538 Clinical Photograph Clinical Photograph
81Cauterisation of ulcer/subconjuctival injection -
One eye2B.82 150 539 Clinical Photograph Clinical Photograph
82Anterior Chamber Reconstruction +Cataract –
Unilateral2B.83 6563 519, 503 Clinical Note / slit lamp report Clinical Note / slit lamp report
83 Trabeculectomy + Vitrectomy 2B.84 6300 624, 491 Clinical Note / Slit lamp report Clinical Note / Slit lamp report
84Anterior Chamber Reconstruction +Perforating
Corneo - Scleral Injury2B.85 6900 519, 488 Clinical Note / Slit lamp report Clinical Note / Slit lamp report
85 Therapeutic Penetrating Keratoplasty 2B.86 2475 484 B Scan Report Clinical Photograph
86 Lamellar Keratoplasty 2B.87 2475 560 B Scan Report Clinical Photograph
87 Corneal Patch Graft 2B.88 3750 485 Clinical Photograph Clinical Photograph
88 Scleral Patch Graft 2B.89 6000 NA Clinical Photograph Clinical Photograph
89 Double Z-Plasty 2B.90 3000 486 Clinical Photograph Clinical Photograph
90Cataract surgery with anterior vitrectomy with
Intraocular Lens (IOL) 2B.91 2625 503, 491 A Scan Report Clinical Photograph
91 Enucleation (Incl. of implant) 2B.92 6000 609 CT Skull , Clinical Photograph , Orbit Clinical Photograph
92 Rectus Muscle Surgery (Single) 2B.93 4125 513 Clinical Photograph Clinical Photograph
93 Rectus Muscle Surgery (Two/Three) 2B.94 8250 515 Clinical Photograph Clinical Photograph
94 Oblique Muscle 2B.95 8250 514 Clinical Photograph Clinical Photograph
95 Lid Reconstruction Surgery 2B.96 3375 516 Clinical Photograph Clinical Photograph
96 Ptosis 2B.97 825 600 Clinical Photograph Clinical Photograph
97 Trabeculectomy (Glaucoma surgery) 2B.98 2475 624 Intraocular Pressure reading Clinical Photograph
98DCR ( Dacryocystorhinostomy)
Endoscopic/Laser2B.99 5625 566 Lacrimal Syringing Report Clinical Photograph
Page 6
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
99Paediatric Cataract Surgery (Phacoemulsification-
Iol Under General Anaesthesia)2B.100 7800 505
Slit lamp Examination report
&Fundoscopy Fundus Photograph
100Glaucoma Filtering Surgery For Paediatric
Glaucoma2B.101 6375 506 Intraocular Pressure reading Clinical Photograph
101Scleral fixation Intraocular Lens (IOL) with
cataract surgery2B.102 6000 654 A Scan Report Clinical Photograph
102Pupilloplasty with cataract surgery with
Intraocular Lens (IOL)2B.103 4500 680 A Scan Report Clinical Photograph
103 Iridodyalisis repair 2B.104 4500 657 Slit lamp examination report Clinical Photograph
104 Iridodyalisis repair with Intraocular Lens (IOL) 2B.105 6750 657, 680 Slit lamp examination report Clinical Photograph
105 Repair of globe rupture 2B.106 7500 NA Slit lamp examination report Clinical Photograph
106 Iridectomy 2B.107 6375 535 Clinical Note / slit lamp report Clinical Note / Slit lamp report
107Pterygium + Conjunctival Autograft +Glaucoma
surgery (trabeculectomy)2B.108 5363 525, 624 Clinical Photograph Clinical Photograph
108Abscess Drainage of Lid +Cryoretinopexy -
Closed2B.109 3938 517 Clinical Photograph Clinical Photograph
Page 7
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
109 Operation for Double Ureter 2B.110 11813 1730 IVP/CT KUB with Contrast Scar Photo
110 Pyelolithotomy 2B.111 10125 1572 IVP/CT KUB with Contrast Scar Photo
111 Excision of Urethral Caruncle 2B.112 3750 834 Clinical Notes Clinical Photograph
112 Urachal Cyst 2B.113 3000 1629 USG/CT KUB HPR
113 Acute tubulo-interstitial nephritis 2B.114 563/day 2609Clinical Notes with relevant
investigationsTreatment Notes
114 Styloidectomy - Both side 2B.115 5625 458X Ray Skull Lateral View film with
report X Ray Skull Lateral View film with report
115 Styloidectomy - One side 2B.116 5625 459X Ray Skull Lateral View film with
report X Ray Skull Lateral View film with report
116 Tonsillectomy + Styloidectomy 2B.117 9375 460X Ray Skull Lateral View film with
report X Ray Skull Lateral View film with report
117 Rhinosporosis 2B.118 5250 455 X Ray Nasopharynx film with report HPR
118 Septo-rhinoplasty 2B.119 4950 456 X Ray PNS film with report Clinical Photograph
119 Laryngofissure 2B.120 2625 399 USG Neck USG
120 Parotidectomy - Conservative 2B.121 525040, 41, 42,
1987USG HPR
121
Excision of Pinna for Growths (Squamous/Basal)
Injuries - Total Amputation & Excision of
External Auditory Meatus and Reconstruction
2B.122 6375 385, 387, 388 Clinical Photograph HPR/Clinical photograph
122 Oro Antral fistula 2B.123 7500 414 Fistulogram/Clinical photograph Clinical Photograph
123 Commando Operation ( glossectomy) 2B.124 1050047, 49, 48,
1985, 1986CT Skull, HPE Clinical Photograph
124 Cortical Mastoidectomy 2B.125 4688 362, 363X-ray manastoidis , Pure Tone
Audiometry Report X-Ray Mastoids
125 Radical / Modified Radical Mastoidectomy 2B.126 6525 363CT Temporal Bone , Pure Tone
Audiometry Report X-Ray Mastoids
126 Myringoplasty 2B.127 3750 367 Pure Tone Audiometry Report, Pure Tone Audiometry Report
127 Ossiculoplasty 2B.128 5625 373Pure Tone Audiometry Report and
Impedance Audiometry Report
Pure Tone Audiometry Report and Impedance
Audiometry Report
UROLOGY
ENT
Page 8
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
128 Myringotomy - Bilateral 2B.129 1875 369Pure Tone Audiometry Report and
Impedance Audiometry Report
Pure Tone Audiometry Report and Impedance
Audiometry Report
129 Myringotomy - Unilateral 2B.130 1425 370Pure Tone Audiometry Report and
Impedance Audiometry Report
Pure Tone Audiometry Report and Impedance
Audiometry Report
130 Myringotomy with Grommet - One ear 2B.131 2325 371Pure Tone Audiometry Report and
Impedance Audiometry Report
Pure Tone Audiometry Report and Impedance
Audiometry Report
131 Myrinogotomy with Grommet - Both ear 2B.132 2813 372Pure Tone Audiometry Report and
Impedance Audiometry Report
Pure Tone Audiometry Report and Impedance
Audiometry Report
132 Stapedectomy 2B.133 6000 378Pure Tone Audiometry Report and
Impedance Audiometry Report
Clinical Photograph With Piston , Pure Tone
Audiometry Report
133Functional Endoscopic Sinus Surgery (FESS)
Unilateral2B.134 6900 437, 464
CT PNS , Direct Nasal Endoscopic Photo
graph Endoscopy Photo
134Functional Endoscopic Sinus Surgery (FESS)
Bilateral2B.135 9000 437, 464
CT PNS , Direct Nasal Endoscopic Photo
graph Endoscopy Photo
135 Excision Of Benign Tumour Nose 2B.136 4688 320CT PNS , Direct Nasal Endoscopic Photo
graphHPE
136 Microlaryngeal Surgery 2B.137 8250 397 Endoscopy Photo Endoscopy Photo
137 Phono Surgery For Vocal Cord Paralysis 2B.138 14063 398 CT-Scan / MRI Scan/Endo photo Clinical Photograph, Endo Picture
138 Uvulo-Palato-Pharyngoplasty. 2B.139 8250 405 Polysomnography Clinical Photograph
139 Partial amputation and reconstruction of Pinna 2B.140 2250 374 Clinical Photograph Clinical Photograph
140 Tympanoplasty+ Ossiculoplasty 2B.141 6000 376, 373CT Mastoid, Pure Tone Audiometry
ReportPure Tone Audiometry Report
141 Ant. Ethmoidal artery ligation 2B.142 9270 434 CT PNS Clinical Photograph
142 Antrostomy – Bilateral 2B.143 4875 429 CT PNS Clinical Photograph
143 Antrostomy – Unilateral 2B.144 3375 430 CT PNS Clinical Photograph
144 Caldwell - luc – Bilateral 2B.145 6000 431 CT PNS Clinical Photograph
145 Caldwell - luc- Unilateral 2B.146 3450 432 CT PNS Clinical Photograph
146 Cryosurgery(Nose) 2B.147 5400 435 DNE Photo DNE Photo
147Septoplasty + Functional endoscopic sinus
surgery (FESS) / polypectomy2B.148 7875 437
X Ray film with report with report with
reportPNSEndo Picture, HPR
148 Ethmoidectomy - External 2B.149 6900 439, 450 CT PNS Endo Picture, HPR
Page 9
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
149 Fracture - setting maxilla 2B.150 6563
2281,2282,
2283, 2284,
2285, 2286,
2287
X Ray film with report with report with
reportPNSX Ray PNS
150 Pharyngeal diverticulum's – Excision 2B.151 9000 413 USG Neck USG
151 Excision of Cystic Hygroma 2B.152 4500 73, 74, 75 USG HPR
152 Microlaryngoscopic Surgery 2B.153 9375 397 DL scopy findings HPE, Clinical Notes, Scar Photo
153Laryngectomy & Pharyngeal Diverticulum
(Throat)2B.154 7500 413 CT Neck,USG
X Ray film with report, Clinical
Photograph,HPE
154 Laryngectomy with Block Dissection (Throat) 2B.155 9000 68 CT Neck,USGX Ray film with report, Clinical
Photograph,HPE
155 Drainage of Subdiaphramatic Abscess 2B.156 6000 287 USG/Clinical Notes Scar photo
156 Duplication of Intestine 2B.157 12750 125 USG Scar Photo
157 Mesenteric Caval Anastomosis 2B.158 7500 310 CT abdomen/USG OT NOtes
158 Endoscopic mucosal resection 2B.159 1163 1201 Clinical Notes Investigation Report
159 Duodenal stricture dilation 2B.160 743 1212 Clinical Notes Investigation Report
160 Colonic stenting 2B.161 1875 1220 Clinical Notes Investigation Report
161 Endoscopic sphincterotomy 2B.162 1800 1226 Clinical Notes Investigation Report
162 Common bile duct (CBD) stricture dilatation 2B.163 4388 1228 CT CT
163 Biliary stenting (plastic and metallic) 2B.164 3600 1229 Clinical Notes Investigation Report
164 Endoscopic cysto gastrostomy 2B.165 6038 1235 Clinical Notes Investigation Report
165 Balloon dilatation of papilla 2B.166 4650 1236 Clinical Notes Investigation Report
166 Parotid Duct Repair 2B.167 5625 39 Silography, Routine Blood Inv Silography
167 Parathyroidectomy 2B.168 10125 34 USG, Routine Blood Investigations HPR , Clinical photograph
168 Lap. Hiatus Hernia Repair Abdominal 2B.169 15000 214 Clinical photograph, Routine Blood Inv Clinical photograph
169 Rare Hernias (Spigalion,Obuturator,Sciatic) 2B.170 11250 215USG Abdomen , UGI Endoscopy,
Routine Blood Inv. Endoscopy picture
170Arteriovenous (AV) Malformation of Soft Tissue
Tumour - Excision2B.171 15000 274 Clinical Photograph Scar photo
171Distal Pancrcatectomy with Pancreatico
Jejunostomy2B.172 12750 1192, 1194 USG Scar photo
172 Diverticulectomy 2B.173 11250 1491 USG Scar photo
GENERAL SURGERY
Page 10
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
173 Lap. Hydatid of liver surgery 2B.174 13500 174 USG Clinical Photograph
174 Laproscopic Adrenalectomy 2B.175 22500 38 USG Clinical Photograph
175 Laproscopic Appendicectomy 2B.176 7500 194 USG USG
176 Laproscopic Colostomy 2B.177 12750 NA USG Clinical Photograph
177 Laproscopic cystogastrostomy 2B.178 11250 183 USG Clinical Photograph
178 Laproscopic donor Nephrectomy 2B.179 22500 1577 CT CT
179 Laproscopic Gastrostomy 2B.180 7875 90 USG Clinical Photograph
180 Laproscopic Pyelolithotomy 2B.181 11250 1573 USG Clinical Photograph
181 Laproscopic Pyloromyotomy 2B.182 9375 89 USG Clinical Photograph
182 Laproscopic Spleenectomy 2B.183 9000 1142 USG Clinical Photograph
183 Laproscopic Thyroidectomy 2B.184 9000 27 USG Clinical Photograph
184 Laproscopic umbilical hernia repair 2B.185 9000 208 USG Clinical Photograph
185 Laproscopic ureterolithotomy 2B.186 10500 1758 USG Clinical Photograph
186 Laprotomy-peritonitis lavage and drainage 2B.187 5250 827 USG/X Ray Scar photo
187 Ligation of Ankle Perforators 2B.188 7875 333 Doppler OT Notes
188Lymphatics Excision of Subcutaneous Tissues In
Lymphoedema2B.189 6000 2241 Clinical Photograph Clinical Photograph
189 Coccygeal Teratoma Excision 2B.190 11475 1566 Clinical Photograph Clincial Nortes, photo
190 Drainage of perinephric abscess 2B.191 5625 1652 USG Scar photo
191 Thorax ( penetrating wounds) 2B.192 7500 1412 X Ray film with report Clinical Photograph
192 Trendelenburg Operation 2B.193 7875 332 Clinical notes Clinical Photograph
193 Fibroadenoma Breast - Multiple 2B.194 4875 293, 294 FNAC, USG, Routine Blood Inv HPR
194 Lap. Rectopexy 2B.195 13500 150 Clinical photograph Clinical photograph
195 Hemimandibulectomy 2B.196 8250 60X Ray film with report, Routine Blood
InvX Ray film with report
196 Segmental Mandible Excision 2B.197 11250 61X Ray film with report, Routine Blood
InvX Ray film with report
197 Lap. Ventral And Scar Hernia (Non incl. Mesh) 2B.198 13500 209Clinical photograph , USG, Routine
Blood Inv Clinical photograph
198 Lap. Inguinal Hernia Repair (Non incl. Mesh)-
Unilateral2B.199 11250 220, 1523
Clinical photograph , USG, Routine
Blood InvClinical photograph
199 Appendicular Perforation 2B.200 9000 195 USG, Routine Blood Inv HPR , Clinical photograph
200 Duodenal / Gastric Perforation 2B.201 15000 92, 93 USG, Routine Blood Inv HPR , Clinical photograph
Page 11
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
201Resection & Anastomosis Of Small
Intestine(includes ileostomy)2B.202 8438 113 Endoscopy , USG , X-Ray Abdomen HPR , Clinical photograph
202 Colectomy(Right,Left,SubTotal) includes
colostomy2B.203 12750 130 Endoscopy , USG , X-Ray Abdomen HPR , Clinical photograph
203 Lap.Cholecystectomy 2B.204 9000 177 CT , LFT , USG HPR, Clinical photograph , USG
204 Cholecystectomy & Exploration Cbd 2B.205 10125 178 CT , LFT , USG HPR, Clinical photograph , USG
205 Ileostomy 2B.206 13125 1165, 1166 Biopsy , Endoscopy , USG Clinical photograph
206 Colostomy Closure 2B.207 9375 132 Barium , CT , Endoscopy , USG Clinical photograph
207 Bleeding Ulcer - Gastrectomy 2B.208 15000 88 Endoscopy Scar photo, HPR
208 Drainage Pericardial Effusion 2B.209 8250 2733, 2723 X Ray film with report X Ray film with report
209 Duodenal Diverticulum 2B.210 11250 94 USG/CT Scan Scar Photo
210 Excision Benign Tumor -Small intestine 2B.211 11250 117 USG HPE Report
211 Excision Mammary Fistula 2B.212 4125 233 USG Scar Photo
212 Excision Meckel's Diverticulum 2B.213 11250 118 USG Scar Photo
213 Excision Small Intestinal Fistulla 2B.214 9000 116 USG Scar Photo
214 Gastro jejuno Colic Fistula 2B.215 9375 96 USG Scar Photo
215 Gastrotomy 2B.216 11250 90 USG Clinical Photograph
216 Ilieo Sigmoidostomy 2B.217 9750 138 USG Scar photo
217 Intestinal Perforation (Resection Anastomosis) 2B.218 22500 110 Erect abdomen X Ray/CT Abdomen OT Notes
218 Anorectoplasty 2B.219 10500 152 Clinical Notes OT Notes
219 Oesophagus Portal Hypertension 2B.220 13500 108 USG/MRI OT notes
220 Pelvic Abscess - Open Drainage 2B.221 6000 288 USG Scar Picture
221 Repair of Common Bile Duct 2B.222 9375 na
CT/MRI Abdomen, Endoscopic
Retrograde Cholangio Pancreatography
(ERCP)
OT Notes
222 Abbe Operation 2B.223 5625 51 Clinical photograph Clinical photograph
223 Lap. For intestinal obstruction 2B.224 18750 121 USG Clinical Photograph
224 Lap. Hepatic resection 2B.225 22500 1187 USG Clinical Photograph
225 Drainage of perivertebral abscess 2B.226 5250 2982 USG Clinical Photograph
226 Splenorenal Anastomosis 2B.227 15000 190 CT Abdomen Clinical Notes
227 Thorachostomy 2B.228 7875 2381 Chest X Ray film with report Chest X Ray film with report
228 Thoracoplasty 2B.229 22500 2106 Chest X Ray film with report Chest X Ray film with report
Page 12
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
229 Cleft lip and palate 2B.230 75002289, 2290,
1461, 1463Clinical Photograph Clinical Photograph
230 Simple mastectomy 2B.231 6750 66 Biopsy ,Clinical Photograph ,
Mammography, FNAC USGBiopsy ,Clinical Photograph
231 Branchial Fistula/Sinus 2B.232 9750 57, 58 CT scan clinical
232 Caecopexy 2B.233 9750 140 USG Scar photo
233 Cavernostomy 2B.234 9750 1764 USG/CT Scan Scar Photo
234 Colocystoplasty 2B.235 11250 133 USG Scar photo
235 Drainage of Peripheral Gastric Abscess 2B.236 6000 285 USG/Clinical Notes Scar photo
236 Duodenal Jejunostomy 2B.237 11250 107 Barrium,USG/CT Scan Scar Photo
237 Excision of Small Growth from Tongue 2B.238 1125 55 Clinical Photograph Clinical Photograph
238 Excision of Swelling in Right Cervial Region 2B.239 3000 65 FNAC HPR
239 Facial Decompression 2B.240 11250 360 EMG, Galvanic Stimulation EMG
240 Gastrojejunostomy 2B.241 11250 86 USG,barrium ( vagotomy to be repeted) Scar Photo, HPE
241 Graham's Operation 2B.242 9375 303 X-ray abdomen/CT, USG USG, Scar Photo
242 Hydatid Cyst of Liver 2B.243 7500 170 USG Scar photo
243 Mesenteric Cyst - Excision 2B.244 6750 309 USG Scar photo
244 Oeshophagoscopy for foreign body removal 2B.245 4500 311 Endoscopy Clinical notes, endo picture
245 Thyroplasty 2B.246 8250 33 CT/MRI Clinical Photograph, OT Notes
246 Vasco Vasostomy 2B.247 8250 256Clinical notes (should have pre-op exam
of vasectomy site)Clinical photo
247 Warren's Shunt 2B.248 11250 191 Endoscopy Endoscopic picture
248 Thymectomy 2B.249 17250 1411 USG Clinical Photograph
249 Resection Enucleation of Adenoma 2B.250 5625 1755 Clinical Photograph Clinical Photograph
250 Rib Resection & Drainage 2B.251 5625 1406 Clinical Photograph Clinical Photograph
251 Tissue Reconstruction Flap Leprosy 2B.252 16500 2362 Clinical Photograph Clinical Photograph
252 Tendon Transfer-Leprosy 2B.253 16500 2961 Clinical Photograph, Clinical Notes Clinical Photograph
253 Bronchial Cyst 2B.254 3750 31 X-ray, CT 0
254 Cystic Mass - Excision 2B.255 3000 280 X-ray, CT 0
255 Splenectomy 2B.256 17250 193 USG Scar photo
256 Removal of Foreign Body from Trachea 2B.257 1875 1204 Clinical phto, endoscopy Clinical phto
257 Thoracocentesis 2B.258 900 1407 X-ray, CT X-ray
258 Urtheral Dilatation 2B.259 375 2961 CT Scan Clinical Photograph
Page 13
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Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
259 Varicose veins - injection 2B.260 375 13 Clincial photo Clincial photo
260 cleft lip 2B.261 1875 1461, 2251 Clinical Photograph Clinical Photograph
261 Lung abscess /Empema 2B.262 563/day 2773Clinical Notes with relevant
investigationsTreatment Notes
262 Pneumothorax 2B.263 563/day 2774, Clinical Notes with relevant
investigationsTreatment Notes
263 Porto Caval Anastomosis 2B.264 37500 171 CT 0
264 Acute Pneumonia-/ consolidation Bacterial 2B.265 563/day
2594, 2596,
2598, 2599,
2783
Clinical Notes with relevant
investigationsTreatment Notes
265Gestational [pregnancy-induced] hypertension
without significant proteinuria2B.266 563/day 2600
Clinical Notes with relevant
investigationsTreatment Notes
266 Interstitial lung diseases 2B.267 563/day 2772Clinical Notes with relevant
investigationsTreatment Notes
267Lower respiratory tract infection (LRTI)
management2B.268 563/day 2783
Clinical Notes with relevant
investigationsTreatment Notes
268 Endocarditis 2B.269 563/day2612, 2682,
2724
Clinical Notes with relevant
investigationsTreatment Notes
Page 14
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
269Conservative management ICU stay with
ventilator 2B.270 2625 2562
Clinical Notes with relevant
investigationsTreatment Notes
270 Epiduro-fluroscopy Adhesiolysis (3 days stay) 2B.271 563/day 818Clinical Notes with relevant
investigationsTreatment Notes
271 Upper GI bleeding ( endoscopic treatment) 2B.272 563/day 1153Clinical Notes with relevant
investigationsTreatment Notes
272
Medical Management of Steroid Resistant
Nephrotic Syndrome Complicated Or Resistant
in Paediatric patients
2B.273 563/day 2643Complete blood count (CBC), Renal
function test (RFT)
Complete blood count (CBC), Renal function test
(RFT)
273 Torticollis release 2B.274 9375 1561 X-ray X-ray
274 Tennis elbow release 2B.275 4500 NA Clinical photograph Clinical photograph of wound
275
Medical Management of Acute Broncho Lobar
pneumonia With Empyema/ Pleural Effusion in
Paediatric patients
2B.276 563/day 2637Clinical Notes with relevant
investigationsTreatment Notes
276
Medical Management of Acute Broncho Lobar
pneumonia With Pyo Pneumothorax in
Paediatric patient
2B.277 563/day 2638Clinical Notes with relevant
investigationsTreatment Notes
277Medical Management of Auto immune
hemolytic anemia in Paediatric patient2B.278 563/day 2702
Clinical Notes with relevant
investigationsTreatment Notes
278
Medical Management of Congenital Heart
Disease With Congestive Cardiac Failure in
Paediatric patients
2B.279 563/day 2670Clinical Notes with relevant
investigationsTreatment Notes
279Medical Management of Diphtheria in Paediatric
patient2B.280 563/day 2699
Clinical Notes with relevant
investigationsTreatment Notes
280Medical Management of Enteric Fever
Complicated in Paediatric patient2B.281 563/day 2625
Clinical Notes with relevant
investigationsTreatment Notes
281Medical Management of Guillian-Barre
Syndrome2B.282 563/day 2679
Clinical Notes with relevant
investigationsTreatment Notes
282Medical Management of Neuro Tuberculosis in
Paediatric patient2B.283 563/day 2626
Clinical Notes with relevant
investigationsTreatment Notes
283Medical Management of Stroke Syndrome in
Paediatric patient2B.284 563/day 2633
Clinical Notes with relevant
investigationsTreatment Notes
Page 15
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
284
Medical Management of Urinary Tract Infection
With Complications Like Pyelonephritis And
Renal Failure in Paediatric patient
2B.285 563/day 2646Clinical Notes with relevant
investigationsTreatment Notes
285Medical Management of Viral Myocarditis in
Paediatric patient2B.286 563/day 2635
Clinical Notes with relevant
investigationsTreatment Notes
286 Neonatal Cholestasis 2B.287 563/day 1513Clinical Notes with relevant
investigationsTreatment Notes
287 Severe Pancratitis 2B.288 563/day 2893Clinical Notes with relevant
investigationsTreatment Notes
288 Control of diabetic ketoacidosis 2B.289 11250 2629Clinical Notes with relevant
investigationsTreatment Notes
289Neonatal jaundice management due to other
excessive haemolysis2B.290 563/day 2610
Clinical Notes with relevant
investigationsTreatment Notes
290Neonatal jaundice management from other and
unspecified causes2B.291 563/day 2611
Clinical Notes with relevant
investigationsTreatment Notes
291Medical Management of Acquired Heart Disease
With Congestive Cardiac Failure2B.292 1125/day 2688
Clinical Notes with relevant
investigationsTreatment Notes
292Small Area grafting (upto 10% of body area )
Medium Area grafting (upto 10% to 20%)2B.293 22500 2350 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
293Large Area grafting (greater than 10% > 20% of
body area)2B.294 22500 2350 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
294
Post Burn Contracture surgeries for Functional
Improvement (Package including splints,
pressure garments and physiotherapy)- Mild
2B.295 15000 2370 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
295
Post Burn Contracture surgeries for Functional
Improvement involving only skin (Package
including splints,pressure garment and
physiotherapy- Moderate
2B.296 22500 2370 CBC/Electrolytes/RFJ, Clincal photo Post-op photo
296 Muscle Biopsy with report 2B.297 7500 343 Reports of relevant investigation HPE Report
297 Diagnostic Laproscopy 2B.298 3000 NA USG Scar photo
298 Three phase whole body Bone Scan 2B.299 2325 NA Clinical Notes Investigation Report
Page 16
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
299 Sclerotherapy of oesophageal varices 2B.300 1875 NA Clinical Notes Investigation Report
300 Pyloric balloon dilatation 2B.301 1800 NA Clinical Notes Investigation Report
301 Mechanical lithotripsy of CBD stones 2B.302 6000 NA Clinical Notes Investigation Report
302 Cystoscopy with Retrograde Catheter -Unilateral 2B.303 1950 NA Clinical Notes Investigation Report
303 Cystoscopy with Retrograde Catheter - Bilateral 2B.304 2475 NA Clinical Notes Investigation Report
304 Cystoscopy Diagnostic 2B.305 1200 NA Clinical Notes Investigation Report
305 Cystoscopy with Bladder Biopsy 2B.306 1500 NA Clinical Notes Investigation Report
306 USG guided intervention - nephrostomy 2B.307 600 NA Clinical Notes Investigation Report
307
Endoscopic Retrograde Cholangio
Pancreatography (ERCP) (Endoscopic
Retrograde Cholangio – Pancreatography)
2B.308 1688 NA LFT, USG USG
Page 17
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
308
Post Burn Contracture surgeries for functional
improvement involving soft tissue and
bone(Package including splints, pressure
garments and phsiotherapy)
- Severe*
3A.1 52500 2370 Clinical Photograph Clinical Photograph
BF1 Post Burns Follow up - 1 3A.BF1 NA
BF2 Post Burns Follow up - 2 3A.BF2 NA
BF3 Post Burns Follow up - 3 3A.BF3 NA
309 PTCA - one stent (non-medicated, elective) * 3A.2 48000 1287ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing stent & post Stent
flow
310 PTCA - 2 stent (non-medicated) * 3A.3 55000 1288ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing stents & post Stent
flow
311PTCA - one stent (Drug Eluting Stent , elective)
*3A.4 60000 1287
ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
312PTCA - Two stent (Drug Eluting Stents ,
elective) *3A.5 85000 1288
ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
313 Balloon Mitral Valvotomy * 3A.6 30000 1262 2D ECHO report 2D ECHO report + stills of ECHO
314 Balloon Pulmonary Valvotomy 3A.7 25000 1263 2D ECHO report 2D ECHO report + stills of ECHO
315 Balloon Aortic Valvotomy* 3A.8 25000 1258 2D ECHO report 2D ECHO report + stills of ECHO
316 Coarctation dilatation* 3A.9 25000 1425 2D ECHO report 2D ECHO report + stills of ECHO
317Peripheral Angioplasty with stent (non-
medicated) *3A.10 60000 1367
2D ECHO , ANGIOGRAM report &
stills , ABIPost procedure Angio stills, ABI
318 Renal Angioplasty with stent (non-medicated) * 3A.11 55000 13652D ECHO , ANGIOGRAM report &
stills Post procedure Angio stills
319Both sided renal Angioplasty with stent (non-
medicated) *3A.12 80000 1365
2D ECHO , ANGIOGRAM report &
stills Post procedure Angio stills
Teritary Healthcare TreatmentsBURNS
POST BURNS FOLLOWUP
CARDIOLOGY
Page 18
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
320 Vertebral Angioplasty (non-medicated) * 3A.13 55000 1315 2D ECHO , ANGIOGRAM report &
stillsPost procedure Angio stills
321
Permanent pacemaker implantation (only VVI
single chamber) including Pacemaker
value/pulse generator replacement
3A.14 75000 1310ECG + Report by cardiologist +
Anigiogram report if doneX Ray showing the pacemaker in situ
322
Permanent pacemaker implantation (DDR, dual
chamber) including Pacemaker value/pulse
generator replacement
3A.15 120000 1309ECG + Report by cardiologist +
Anigiogram report if doneX Ray showing the pacemaker in situ
323 Pulse Generator replacement 3A.16 50000 NAECG + Report by cardiologist +
Anigiogram report if doneX Ray showing the pacemaker in situ
324 Septostomy 3A.17 20000 1271, 1418 2D ECHO report 2D ECHO report + stills of the ECHO
325 PDA Device Closure * 3A.18 80000 1280 2D ECHO report 2D ECHO stills showing the device + Report
326 ASD Device Closure * 3A.19 88000 1272, 1275 2D ECHO report 2D ECHO stills showing the device + Report
327 Ventricular Septal Defect Device Closure * 3A.20 88000
1279, 1280,
1281, 1282,
1283
2D ECHO report 2D ECHO stills showing the device + Report
328 PDA Coil (one) insertion 3A.21 25000 1281 2D ECHO report 2D ECHO stills showing the coil + Report
329 PDA Multiple coil insertion 3A.22 30000 1282 2D ECHO report 2D ECHO stills showing the coil + Report
330Intravascular ultrasound (IVUS)/Fractional Flow
Reserve (FFR)3A.23 20000 1442 Angiogram Report IVUS/FFR report
331 Electrophysiological Study (EP study) 3A.24 10000 1427 ECG with report + 2D ECHO report EP study report+ ECG
332 Radiofrequency Ablation (RF Ablation) 3A.25 25000 1863 ECG with report + 2D ECHO report RF ablation report +ECG
333 3D Mapping + Ablation 3A.26 50000 NA ECG with report + 2D ECHO report 3D mapping report+ECG with report
334 Rotablation+ PTCA (non-medicated Stent )* 3A.27 63000 1421 CAG Report with stills showing blocks CAG stills with stents and stills with post flow
335 Rotablation+ PTCA (One Drug Eluting Stent)* 3A.28 80000 1421ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
336 Rotablation+ Balloon Angioplasty 3A.29 45000 1421 CAG Report with stills showing blocks CAG stills with balloon and stills with post flow
Page 19
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Arogya
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
337 Peripheral Angioplasty with balloon * 3A.30 40000 1366ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
338 Renal Angioplasty with stent (Drug Eluting ) * 3A.31 65000 1365ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
339 Venous stenting* 3A.32 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
340 PDA stenting* 3A.33 50000 1279 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
341 Coarctoplasty with stenting* 3A.34 75000 1323 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
342 Right ventricular outflow tract (RVOT) stenting 3A.35 50000 NA 2D ECHO, Angiogram Report & Stills Post procedure Angio stills
343 Pulmonary artery stenting 3A.36 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
344Vertebral Angioplasty (non-medicated) - with
stent3A.37 70000 NA 2D ECHO , Angiogram Report & Stills Angiogram-DSA/MRA/CTA
345Paravalvular leak/ Ruptured sinus of Valsalva
aneurysm (RSOV)3A.38 88000 1374 2D ECHO Report 2D ECHO stills showing the device + Report
346 Carotid angioplasty with stent* 3A.39 150000 1441Angiogram report & Film showing the
lesion Post procedure Angio stills + XRAY + Doppler
347 Coronary artery bypass grafting (CABG) * 3A.40 95000 1295 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
348Coronary artery bypass grafting (CABG) with
additional arterial graft*3A.41 100000 NA 2D ECHO , CAG Report
ECHO,Post op X Ray ,scar photo + scar photo of
graft area
349Coronary artery bypass grafting (CABG) with
Intra-aortic balloon pump (IABP) *3A.42 125000 1293 2D ECHO , CAG Report ECHO,Post op X Ray ,scar photo
350Coronary artery bypass grafting (CABG) +
Valve Replacement *3A.43 115000 1296 2D ECHO with stills , CAG Report Post op X Ray , 2D ECHO with stills, scar photo
351
Coronary artery bypass grafting (CABG) +
Valve Replacement + Intra-aortic balloon pump
(IABP) *
3A.44 145000 1296 2D ECHO with stills , CAG Report Post op X Ray , 2D ECHO with stills, scar photo
CARDIO THORACIC SURGERY
Page 20
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
352Coronary artery bypass grafting (CABG) with
Aneurysmal repair *3A.45 95000 1294 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo
353Coronary artery bypass grafting (CABG) with
Mitral Valve repair *3A.46 95000 1296 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo
354
Coronary artery bypass grafting (CABG) with
post MI Ventricular Septal Defect (Ventricular
Septal Defect) repair with IABP*
3A.47 120000 NA 2D ECHO with stills , CAG Report ECHO with stills,Post op X Ray ,scar photo
355 Open Mitral Valvotomy * 3A.48 80000 1262 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo
356 Open Aortic Valvotomy * 3A.49 80000 1266 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo
357 Open Pulmonary Valvotomy * 3A.50 80000 1263 2D ECHO Report with stills 2D ECHO Report + stills of ECHO,scar photo
358 Closed Mitral Valvotomy * 3A.51 30000 1259 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
359 Mitral Valve Repair * 3A.52 80000 1262 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
360 Tricuspid Valve Repair * 3A.53 80000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
361 Aortic Valve Repair * 3A.54 80000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
362 Ring for any Valve Repair * 3A.55 20000 1264 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
363 Mitral Valve Replacement * 3A.56 130000 1269 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
364 Aortic Valve Replacement * 3A.57 130000 1266 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
365 Pulmonary Valve Replacement* 3A.58 120000 1263 2D ECHO Report2D ECHO Report + stills of ECHO + post Op X-
ray,scar photo
366 Tricuspid Valve Replacement * 3A.59 130000 1270 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
367Valve Replacement with Intra-aortic balloon
pump (IABP) *3A.60 140000 1266 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
Page 21
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
368 Double Valve Replacement * 3A.61 150000 1265 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
369 Ross Procedure * 3A.62 110000 1261 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
370 Atrial septal defect (ASD) * 3A.63 90000 1272 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
371 Ventricular Septal Defect (VSD) * 3A.64 90000 1273 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
372
Atrioventricular septal defect (AVentricular
Septal Defect)/ Atrioventricular (AV) Canal
Defect *
3A.65 90000 1272 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
373 Intracardiac repair (ICR) for Tetralogy of Fallot
(TOF) *3A.66 90000 1277 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
374Pulmonary Valvotomy + Right Ventricular
Outflow Tract (RVOT) Resection *3A.67 90000 1263 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
375 Aortopulmonary Window (AP Window) * 3A.68 90000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
376Surgery for Hypertrophic Obstructive
Cardiomyopathy (HOCM) *3A.69 90000 NA
2D ECHO/TEE Report + Chest Xray AP
view /Cardiac MRI
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
377 Ebsteins * 3A.70 90000 NA ECG, 2D ECHO Report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
378 Fontan * 3A.71 100000 1416 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
379Total Anomalous Pulmonary Venous Connection
(TAPVC) *3A.72 120000 1278 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
380Pulmonary Atresia with or without Ventricular
Septal Defect *3A.73 105000 NA 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
381Transposition of the great arteries (TGA) -
Arterial Switch Operation*3A.74 120000 1284, 1285 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
382 Double Switch Operation * 3A.75 120000 1414 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
383 Sennings * 3A.76 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
Page 22
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
384 Mustards * 3A.77 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
385 Rastelli procedure -Pulmonary Conduit * 3A.78 120000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
386 Truncus Arteriosus Surgery * 3A.79 120000 1325 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
387Root Replacement (Aortic Aneurysm/ Aortic
Dissection) / Bental Procedure *3A.80 150000 1325 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
388 Aortic Arch Replacement* 3A.81 150000 1342 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
389
Aortic Aneurysm Repair without using
Cardiopulmonary bypass (CPB) with/without
graft*
3A.82 70000 1342 CT Angio Report Scar photo + Intra op photo
390Aortic Aneurysm Repair using Cardiopulmonary
bypass (CPB) with/without graft*3A.83 90000 1339 CT Angio Report Scar photo + Intra op photo
391Intrathoracic Aneurysm (without graft)-
Aneurysm not Requiring Bypass Techniques*3A.84 65000 1324 CT Angio Report Scar photo + Post op intra op photo
392 Pulmonary Embolectomy / Endarterectomy* 3A.85 150000 1317 2D ECHO with stills + ABG report +
CT Chest report
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
393 Patent Ductus Arteriosus (PDA) Closure 3A.86 30000 1280 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray, scar photo
394 Coarctation Repair* 3A.87 30000 1322 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
395 Coarctation Repair with graft * 3A.88 70000 1328 2D ECHO with stills + CAG report Doppler report + Stills of Doppler
396Blalock–Thomas–Taussig (BT) Shunt
(inclusives of grafts)3A.89 60000 1417 2D ECHO Report with stills
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
397 Glenn Shunt 3A.90 60000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
398 Central Shunt 3A.91 60000 NA 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
399 Pericardiectomy 3A.92 50000 1299 2D ECHO Report with stills2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
Page 23
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
400 Thoracoscopic surgery 3A.93 35000 1408 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray, photo of scar, port insertion
401 Pericardiostomy Surgery 3A.94 10000 1298 2D ECHO report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
402 Thyomectomy 3A.95 35000 1411 CT Chest report X-RAY, scar photo
403 Lobectomy 3A.96 70000 1390 CT Chest report Post Op X-ray,scar photo
404 Pneumonectomy 3A.97 60000 1391 CT Chest report Post Op X-ray,scar photo
405 Pleurectomy 3A.98 50000 NA CT Chest report Post Op X-ray,scar photo
406 Decortication 3A.99 50000 1397 CT Chest report Post Op X-ray,scar photo
407 Mediastinotomy 3A.100 40000 NA CT Chest report Post Op X-ray,scar photo
408 Pulmonary AV Fistula surgery 3A.101 45000 NA CT Chest report Post Op X-ray,scar photo
409 Lung Cyst 3A.102 60000 1389 CT Chest report Post Op X-ray,scar photo
410 Space-Occupying Lesion (SOL) mediastinum 3A.103 60000 1395 CT Chest report Post Op X-ray,scar photo
411 Surgical Correction of Bronchopleural Fistula. 3A.104 70000 1398 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
412 Diaphragmatic Eventeration 3A.105 50000 1401 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
413 Oesophageal Diverticula /Achalasia Cardia 3A.106 50000 1387 Barium Study + CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
414 Diaphragmatic Injuries/Repair 3A.107 35000 1402 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
415 Thoracotomy, Thoraco Abdominal Approach 3A.108 40000 1388 CT Chest report Post Op X-ray,scar photo
416Bronchial Repair Surgery for Injuries due to
Foreign body3A.109 40000 1394 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE
417
Gastro Study Followed by Thoracotomy &
Repairs of Oesophageal Injury for Corrosive
Injuries/FB
3A.110 50000 1388 Gastroscopy Report ENDOSCOPY PICTURE, scar photo
418 Oesophageal tumour removal 3A.111 50000 NA Endoscopy Report + Biopsy Report Biopsy report, scar photo
419 Oesophagectomy 3A.112 60000 1994, 2015 Biopsy , CT , Endoscopy reports Biopsy report, scar photo
420Encysted Empyema/Pleural Effusion -
Tubercular3A.113 20000 1393 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
Page 24
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
421
First rib Excision by transaxillary approach
Excision of cervical rib / fibrous band / muscle
by cervical approach
3A.114 40000 64 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
422 Thorocotomy and resection of pluera with Lung 3A.115 50000 1404Pre Op X-ray / CT Scan, Bronchoscopy
ReportPost Op X-ray / CT Scan ,scar photo
423Tracheoplasty and introduction of montegomary
T-tube (Tracheal stenting)3A.116 40000 80 CT / Bronchoscopy report CT / Bronchoscopy report
424 Congenital Hypoplasia of the lung 3A.117 40000 Na Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
425 Congenital Cystic Lesions 3A.118 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
426 Pulmonary Sequestration 3A.119 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
427 Pulmonary artero venous malformation 3A.120 40000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
428Thoracotomy & Excision and fixation of the
Spine3A.121 65000 NA Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
429 Hiatus Hernia Repair 3A.122 40000 212, 213 USG, UGI ENDOSCOPY Scar photo + Intra op photo
430Intrathoracic Aneurysm (with graft) -Requiring
Bypass Techniques*3A.123 110000 1324, 1329 CT Angio Report Scar photo + Intra op photo
Rotablation+ Balloon Angioplasty 3A.29 45000 1421 CAG Report with stills showing blocks CAG stills with balloon and stills with post flow
Peripheral Angioplasty with stent (non-
medicated) *3A.10 60000 1367
2D ECHO , ANGIOGRAM report &
stills , ABIPost procedure Angio stills, ABI
431 Pericardiostomy without balloon 3A.124 10000 1298 2D ECHO report 2D ECHO report + stills of the ECHO
432 Thromboembolectomy - unilat singular 3A.125 300001318, 1316,
1317, 1319Duplex/Angio Report & stills Scar photo + Intra op photo
433 Thromboembolectomy - bilat /multi level 3A.126 400001318, 1316,
1317, 1319Duplex/Angio Report & stills Scar photo + Intra op photo
434Aortic Aneurysm Repair without using
Cardiopulmonary bypass (CPB) including graft*3A.127 70000 1342 CT Angio Report Scar photo + Intra op photo
435Aortic Aneurysm Repair using Cardiopulmonary
bypass (CPB) including graft*3A.128 90000 1339 CT Angio Report Scar photo + Intra op photo
436Surgery for Arterial Aneursysm -Abdominal
aorta3A.129 90000 1333 Duplex/Angio Report & stills Scar photo + Intra op photo
CARDIO VASCULAR SURGERY
Page 25
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
437 Surgery for Arterial Aneurysm Renal Artery 3A.130 50000 1372Renal arterial Doppler, Angiogram with
stillsScar photo + Intra op photo
438 Operations for Stenosis of Renal Arteries 3A.131 20000 1373Renal arterial Doppler,angiogram &
StillsDoppler Report + scar photo
439Femoropopliteal by pass procedure with graft
(inclu. Graft)3A.132 70000 1349 Angiogram Report Clinical Photographs Duplex, ABI, scar photo
440Aorto Bi lliac / Bi femoral /Axillo bi femoral
bypass with Synthetic Graft3A.133 90000 1351 Angiogram/spiral CT Angiogram reports
Stills showing the procedure with graft + scar
photo
441Femoro Distal / Femoro-popliteal/ Femoral infra
popliteal Bypass with Vein Graft3A.134 50000 1354 Angiogram/spiral CT Angiogram reports
Stills showing the procedure with graft +Duplex
scan, scar photo
442
Carotid- carotid/Carotid- Subclavian/ Femoro
Distal / Femoral - Femoral / Femoral infra
popliteal Bypass with Synthetic Graft
3A.135 75000 1354 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex
scan, scar photo
443
Axillo Brachial Bypass using Synthetic
Graft/Brachial Artery to Auxillary Vein/Basilic
Vein grafting using PTFE graft
3A.136 50000 1355 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex
scan, scar photo
444 Brachio - Radial Bypass (with vein) 3A.137 40000 1356 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex
scan, scar photo
445Excision of Carotid body Tumor with / without
vascular repair3A.138 35000 1379 Angiogram/spiral CT Angiogram reports
Stills showing the procedure +Duplex scan, scar
photo
446 Carotid artery bypass with Synthetic Graft 3A.139 60000 1337 Angiogram/spiral CT Angiogram reportsStills showing the procedure with graft +Duplex
scan, scar photo
447Excision of Arterio Venous malformation -
Large3A.140 50000 1330 Angiogram/spiral CT Angiogram reports
Stills showing the procedure with graft + scar
photo
448Excision of Arterio Venous malformation -
Small (Congenital/Acquired)3A.141 30000 1331 Angiogram/spiral CT Angiogram reports
Stills showing the procedure with graft + scar
photo
449 Carotid/other peripheral endarterectomy 3A.142 40000 1926 Angiogram reportStills showing the procedure with graft + scar
photo,
450 Carotid/other endarterectomy with patch 3A.143 50000 1926 Angiogram reportStills showing the procedure with graft + scar
photo
451 Aortic Angioplasty 3A.144 40000 NaECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing Balloon & post flow,
scar photo
Page 26
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
452 Aortic/ iliac Angioplasty with one stent 3A.145 60000 naECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing Balloon & post flow,
scar photo
453Aortic Angioplasty with two stents / Iliac
angioplasty with stent Bilateral3A.146 90000 na
ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing Balloon & post
flow,scar photo
454
Deep Vein Thrombosis (DVT) - Inferior Vena
Cava (IVC) filter (Recurrent DVD - (includes
removal of filter)
3A.147 65000 1332 Color doppler Plain X-ray abdomen showing the filter
455Aneurysm infra renal aorta /aorto iliac(including
graft)3A.148 90000 1325 ANGIO/ Spiral CT Angiogram Report Scar photo + Intra op photo
456 Aorto uni iliac/uni femoral bypass 3A.149 70000 1350
Angiogram/ Computed Tomography
Angiography (3D-CTA)/Magnetic
Resonance Angiography
Duplex scan, scar photo
457 Peripheral arterial aneurysms 3A.150 50000 1369, 1370 Angiogram Report & Stills Intra op photo
First rib Excision by transaxillary approach
Excision of cervical rib / fibrous band / muscle
by cervical approach
3A.114 40000 64 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan ,scar photo
Venous stenting* 3A.32 50000 NA 2D ECHO , Angiogram Report & Stills Post procedure Angio stills
458 Bronchial artery Embolisation (for Haemoptysis) 3A.151 25000 2904Chest x-Ray/CT Scan, Hb, Serum
CreatinineChest x-Ray/CT Scan, Hb, Serum Creatinine
459Percutaneous Transluminal Tricuspid
Commissurotormy (PTTC)3A.152 25000 NA 2D ECHO report with stills 2D ECHO report + stills of the ECHO
460 Balloon Atrial Septostomy 3A.153 25000 1271 2D ECHO report with stills 2D ECHO report + stills of the ECHO
461 Coiling - Pseudoaneurysms of Abdomen 3A.154 55000 NA
CT/MRI or Angiogram, Prothrombin
Time (PT), International normalized ratio
(INR) Hb, Serum Creatinine
CT, PT,INR, Hb, Serum Creatinine
462Embolisation - Arteriovenous Malformation
(AVM) in the Limbs3A.155 40000 1897 USG, CT PT, INR, Hb, Serum Creatinine USG abd/CT PT,INR, Hb, Serum Creatinine
463
Catheter directed Thrombolysis for: Deep vein
thrombosis (DVT), Mesenteric Thrombosis &
Peripheral vessels*
3A.156 50000 2739
CT/MRI, Prothrombin Time (PT),
International normalized ratio (INR) Hb,
Serum Creatinine
CT/MRI, PT,INR, Hb, Serum Creatinine
CARDIOLOGY/ CVS/ INTERVENTIONAL RADIOLOGICAL THERAPEAUTIC PROCEDURE
Page 27
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
464 Inferior Vena Cava (or IVC) Stenting 3A.157 60000 NA
USG, clotting Time (CT), Prothrombin
Time (PT), International normalized ratio
(INR), Hb, Serum Creatinine
USG, CT,PT,INR, Hb, Serum Creatinine
Pericardiostomy without balloon 3A.124 10000 1298 2D ECHO report 2D ECHO report + stills of the ECHO
CVSF1 Post Cardiac surgery Followup-1 3A.CVSF1 #N/A NA
CVSF2 Post Cardiac surgery Followup-2 3A.CVSF2 #N/A NA
CVSF3 Post Cardiac surgery Followup-3 3A.CVSF3 #N/A NA
CVSF4 Post Cardiac surgery Followup-4 3A.CVSF4 #N/A NA
CVSF5 Post Cardiac surgery Followup-5 3A.CVSF5 #N/A NA
465 Open Pyelolithotomy* 3A.158 27000 1572 CT KUB with Contrast Scar Photo,X-Ray/USG KUB
466 Open Nephrolithotomy* 3A.159 27000 1569 USG/X-ray KUB Scar Photo,X-Ray/USG KUB
467 Pyeloplasty* 3A.160 30000 1581 USG & IVP/CT with Contrast Scar Photo
468PCNL (Percutaneous Nephro Lithotomy)*
(Inclusive of stent)3A.161 28500 1636 CT KUB with Contrast/IVU Scar Photo +X-ray KUB
469 Nephrostomy (PCN)* 3A.162 7500 1571 USG Scar Photo With Nephrostomy Tube
470 Simple Nephrectomy 3A.163 26250 1530 USG, CT KUB /Isotope Renogram Scar & Specimen Photo +HPE report
471 Lap. Nephrectomy Simple 3A.164 33750 1585, 1530 USG & CT KUB /Isotope Renogram Scar Photo + HPE Report
472 Lap. Nephrectomy Radical 3A.165 37500 2042, 1530USG & CT KUB with Contrast / Isotope
RenogramScar Photo + HPE Report
473 Lap. Partial Nephrectomy 3A.166 45000 1584USG & CT KUB with Contrast / Isotope
RenogramScar Photo + HPE Report
474 Open partial Nephrectomy 3A.167 37500 2041 USG & CT KUB with Contrast Scar Photo + HPE Report
475Open Anatrophic Nephrolithotomy ( For
Staghorn Stone)3A.168 33750 1574 USG, CT KUB with Contrast Scar Photo +X-Ray Kub
POST CARDIO SURGERY FOLLOW-UP
GENITO URINARY
Page 28
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
476Retrograde Intra Renal surgery (RIRS with
laser) – for renal and PUJ calculi*3A.169 37500 1593 CT KUB with Contrast
C ARM Picture with Patient Details, X-ray
KUB/USG
477 URSL* (Inclusive of stent) 3A.170 168751594, 1738,
1739, 1740CT KUB X-ray KUB
478 DJ stent (One side) 3A.171 5625 1651 USG /X-ray KUB X-ray KUB
479 URSL-LASER* 3A.172 187501594, 1741,
1742, 1743CT KUB
X-ray KUB, Purchase Voucher for Laser
machine
480 DJ stent (Bilateral) 3A.173 7500 1651 X-ray KUB & USG X-ray KUB & USG
481 Ureterolithotomy-Open* 3A.174 22500 1601 CT KUB with Contrast Scar Photo +X-Ray Kub
482 Ureterolithotomy-LAP* 3A.175 26250 1601 CT KUB with Contrast Scar Photo +X-Ray Kub
483 Open Boari Flap-Uretaric stricture 3A.176 315001600, 1601,
257CT KUB/IVP Clinical Picture, Scar Photo
484 Open Ureteral Reimplantation (Unilateral) 3A.177 28500 1597 ,1599 CT KUB/IVP/MCU Scar photo
485 Deflux for VUR* 3A.178 37500 1599 USG,MCU Post -op MCU
486 Ureterocoele incision 3A.179 18750 1805 IVU/CT ENDO Picture With patient details
487 TURP 3A.180 22500 1654 USG/CT KUB,Uroflowmetry HPE Report,P.O USG
488 Open Prostatectomy 3A.181 26250 1656 USG, Uroflowmetry Scar Photo + HPE Report
489 Bladder Neck Incision 3A.182 16875 1628 USG & Uroflowmetry Uroflowmetry,ENDO Picture
490 TRUS biopsy of prostate 3A.183 4500 1821 PSA,Transrectal USG HPE Report
491 Open Cystolithotomy 3A.184 13500 1610 USG/X ray KUB Scar Photo,X-Ray/USG KUB
492 UVF/VVF Repair* 3A.185 30000 774, 775, 777 USG/X ray KUB NIL
493 Cystolithotripsy 3A.186 127501606, 1608,
1609X-ray KUB/USG X-ray KUB
494 TURBT 3A.187 22500 1613 USG/CT KUB with Contrast Cystoscopy Finding/ HPE Report, P.O USG
495 Laparoscopic VVF Repair 3A.188 30000 773 Cystoscopy,CECT KUB/ IVP Clinical Photograph/ Cystogram
496 Bladder Augmentation 3A.189 31500 1539 USG , Cystogram/MCU Scar Photo, Post OP Cystogram
497 Post TURBT BCG (Per Cycle Per Week) 3A.190 750 1707, 1708 HPE report Endo Picture
498 Post TURBT Check Cystoscopy (Per Sitting) 3A.191 3750 no code USG & urine cytology Cystoscopy Finding, X-Ray KUB
499 Partial cystectomy* 3A.192 30000 1630 CT KUB with Contrast Procedure Picture
500 Bladder diverticulectomy -open/lap* 3A.193 22500 1615 CT KUB Endo Picture/Operative Picture
501Urethroplasty for Stricture Diseases-single
stage*3A.194 33750 1634, 1635 RGU Scar photo,
Page 29
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
502 Urethroplasty for Stricture Diseases-First Stage 3A.195 22500 1637 RGU & MCU Scar photo,
503Urethroplasty for Stricture Diseases-Second
Stage*3A.196 18750 1638 RGU & MCU Scar photo,
504 Hypospadiasis(Adult)* 3A.197 26250 1544, Clinical Photograph Scar photo,
505 Hypospadiasis(Adult) First Stage 3A.198 18750 1545 Clinical Photograph Scar photo,
506 Hypospadiasis(Adult) Second Stage 3A.199 18750 1546 Clinical Photograph Scar photo,
507 Perineal Urethrostomy 3A.200 18750 1632 RGU& MCU Scar photo,
508 Visual Internal Urethrotomy 3A.201 9000 1633, 1670 USG & RGU Uroflowmetry/ENDO PICTURE
509 Open Orchidectomy (Simple / Radical) 3A.202 15000 235 USG Scrotum SCAR PHOTO , HPE report
510Repair of stress incontinence - lap or open colpo
suspension* 3A.203 33750 752, 753, 754 Clinical Notes Endo Picture / Operative Picture
511 Adenoma Excision- Adrenals 3A.204 9000 1457, 1755 X-ray nasopharynx Clinical photograph
512 ESWL (Extra carporial shock-wave lithotripsy)* 3A.205 6375 1704 CT KUB with Contrast X-ray KUB/USG
513ESWL (Extra corporial shock-wave lithotripsy)
above 1 cm to 2 cm- Single Side*3A.206 13500 1704 CT KUB with Contrast X-ray KUB
514 Renal biopsy – Percutaneous 3A.207 5625 NACBC,RFT, USG ABD,
HIV,HBsAg,HCV,Urine R/EHPR
GUF1 Post Genito Urinary Follow up-1 3A.GUF1 #N/A NA
GUF2 Post Genito Urinary Follow up-2 3A.GUF2 #N/A NA
GUF3 Post Genito Urinary Follow up-3 3A.GUF3 #N/A NA
POST GENITO URINARY FOLLOW-UP
Page 30
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
515 Supraglottoplasty 3A.208 18750 NA Endoscopy photo/CT Clinical Photograph showing scar / endoscopy
picture
516 Esophageal substitution surgery 3A.209 82500 1484 Contrast X ray/endoscopy findings, Clinical Photograph showing scar
517 Thoracic Duplication cyst 3A.210 37500 1389, 1396 CT, Chest X ray Biopsy Report.
518 Thoracic Wall defects Correction 3A.211 45000 1473 CT/MRI, X ray Clinical Photograph
519 Omphalocele-Minor 3A.212 30000 1476, 1478 Clinical Photograph Clinical Photograph showing scar
520 Splenectomy - Child 3A.213 33750 189, 192, 193 Hemogram,USG Clinical Photograph showing scar
521 Shunt surgery for portal hypertension 3A.214 37500 108, 191 USC/CT/MRI Clinical Photograph showing scar
522 Surgery for chronic pancreatitis 3A.215 52500 NA CT/MRI Clinical Photograph showing scar
523 Colostomy formation 3A.216 15000 136, 137 X-Ray Clinical Photograph showing scar
524 Biliary Atresia 3A.217 48750 1513 CT Abdomen Clinical Photograph showing scar
525Excision of choledochal cyst with hepatic
jejunostomy3A.218 63750 1514 USG/CT/MRCP Scar photo,HPE Report
526 Oesophageal Atresia 3A.219 82500 1481 X-Ray Clinical Photograph showing scar
527 Diaphragmatic Hernia - Paed 3A.220 82500 1529, 220 X-Ray Clinical Photograph showing scar+Post op X ray
528 Unilateral Inguinal Hernia- Age less than 1 year 3A.221 11250 219, 220 Clinical photograph, USG Clinical Photograph showing scar
529 Bilateral Inguinal Hernia for age < 1 year 3A.222 16875 218 Clinical Photograph Clinical Photograph showing scar
530 Ureteric Reimplantations Bilateral * 3A.223 52500 1536 MCU, USG Clinical Photograph showing scar
531 Ureteric Reimplantations Unilateral * 3A.224 33750 1536, 1597 MCU, USG Clinical Photograph showing scar
532 Exstropy Bladder Stage 2 3A.225 52500 1536, 1597 MCU Clinical Photograph
533 Urinary Diversion - Temporary 3A.226 18750 2044 MCU, USG Clinical Photograph showing scar
534 Urinary Diversion - Permanent 3A.227 33750 2044 MCU, USG Clinical Photograph showing scar
535 Urinary Diversion - Undiversion 3A.228 26250 2044 MCU, USG Clinical Photograph showing scar
536 Continence Stage 1 (Epispadias) 3A.229 30000 1547Clinical photo showing the meatal
openingNil
537Stage 2 Incontinence for epispadias including
bladder neck repair3A.230 30000 1647, 1648 USG/MCU Clinical Photograph
538 Insertion of Hickman Catheter 3A.231 7500 1346, 1347 Lab reports confirming cancer Clinical Photograph showing catheter
539 Insertion of Chemo port 3A.232 15000 1346, 1347 Lab reports confirming cancer Clinical Photograph showing chemo Port
540 Congenital Hydronephrosis Open/Lap* 3A.233 37500 1535 USG, Renal Isotope Scan Clinical Photograph showing scar
NEONATAL AND PAEDIATRIC SURGERY
Page 31
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
541 Feminising genitoplasty 3A.234 41250 1558 Clinical Photograph Clinical Photograph showing scar
542 Undescended Testis (Palpable) 3A.235 11250 1549 USG,Clinical photo Nil
543 Unsescended Non palpable testis stage 1 3A.236 15000 NA USG abdomen Scar photo
544Undescended Non palpable testis stage 2
(definitve repair)3A.237 18750 NA USG/OT notes of previous surgery Scar photo
545 Anorectal Malformations Definite Repair 3A.238 45000
1510, 1494
(multiple
codes)
Colostogram pic for males, Photo of
perineum region for femalesClinical Photograph showing scar
546 Anorectal Malformations Stage 3 3A.239 33750
1499, 1501,
1502
(multiple
code)
Clinical Photograph Clinical Photograph showing scar
547 Anorectal malformation- Low variant 3A.240 22500
152, 1506,
(Multiple
codes)
Photo of the perineum region Scar photo
548 Hirschsprungs Disease stage 1 3A.241 30000
1496, 1495,
1501 (Multiple
codes)
Rectal biopsy/ X-Ray/Contast Enema Clinical photo showing scar + Biopsy Report.
549Hirschsprungs Disease stage 2/Definitive Repair
(Including Staplers)3A.242 45000
1511, 1507
(Multiple
coddes)
Contrast Enema / Biopsy Clinical Photograph showing scar
550 Heller's Cardiomyotomy with fundoplication 3A.243 37500 89 Contrast X ray/endoscopy findings Clinical Photograph showing scar
551 Simple Fundoplication 3A.244 26250 1154 Contrast X ray/endoscopy findings Clinical Photograph showing scar
552 Intussusception pneumatic/hydrostatic reduction 3A.245 13500 108 USG/Xray Post op USG, Post op X Ray
553 Pyloromyotomy 3A.246 26250 89 USG/Contrast X ray Clinical Photograph showing scar
554 Bladder Augumentation 3A.247 60000 1539 MCU/USG Clinical photo
555 Hypospadias First Stage 3A.248 22500 1545 Clinical photo showing the meatal
openingNil
556 Hypospadias Definitive Repair - proximal penile 3A.249 45000 1544 Clinical photo showing the meatal
openingNil
557 Hypospadias Definitive Repair - mid penile 3A.250 37500 1544, Clinical photo showing the meatal
openingNil
Page 32
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
558 Hypospadias Definitive Repair - distal penile 3A.251 30000 1544, 1546 Clinical photo showing the meatal
openingNil
559 Hypospadias Re-Do 3A.252 30000 NA Clinical photo showing the meatal
openingNil
560 Fistula Closure Hypospadiacs 3A.253 15000 NA Clinical Photograph Nil
561Cystoscopic fulguration of posterior urethral
valves3A.254 22500 1770 MCU, USG Clinical Photograph/Endoscopic picture
562 Stent Removal 3A.255 3750 1703 X Ray Post op X Ray
563Laparotomy and excision of cyst (For Paediatric
benign abdominal cyst)3A.256 22500 320 USG/CT Scar Photo, HPE Report
564 Polydactly (One finger) 3A.257 15000 2324 Clinical photo Clinical photo
565 Club hands Stage 1 / Club Foot 3A.258 300002394, 1088,
2324Clinical photo Clinical photo
566 Club hands Stage 2 3A.259 300002394, 1088,
2324Clinical photo Clinical photo
567 Syndactly 3A.260 187502394, 1088,
2324Clinical photo Clinical photo
568 Meningo Encephalocele * 3A.261 30000 1850 MRI Report Post Op CT Report and film, Clinical
Photograph showing Scar
569 Meningomyelocele * 3A.262 30000 1837, 1838 CT report Post Op CT Report and film, scar photo
570 Faciomaxillary surgery 3A.263 262501931, 2321,
2322X-RAY/CT scan
Clinical Photograph showing scar + post op.
XRAY
571 Respiratory distress syndrome 3A.264 56663 NA Clinical notes confirming digonosis clinical notes in relevant reports
572 Meconium Aspiration syndrome 3A.265 38175 NA Clinical notes confirming digonosis clinical notes in relevant reports
573 Septicemia not requiring ventilation 3A.266 36900 2693, 2695 Clinical notes confirming digonosis clinical notes in relevant reports
574 VLBW not requiring ventilation 3A.267 89925 2658, 2661 Clinical notes confirming digonosis clinical notes in relevant reports
575Neonatal jaundice requiring exchange
transfusion3A.268 23438 2610, 2611 Clinical notes confirming digonosis clinical notes in relevant reports
576 Asphyxia with convulsions 3A.269 55050 2650 Clinical notes confirming digonosis clinical notes in relevant reports
577Cochlear Implant Surgery excluding
implant(Including AV therapy)3A.270 97500 2406 Clinical notes confirming digonosis clinical notes in relevant reports
578Thalessemia/Sickle Cell anaemia (Quaterly per
child per year)3A.271 18750 NA Clinical notes confirming digonosis clinical notes in relevant reports
Decortication 3A.99 37500 1397 CT Chest report Post Op X-ray,scar photo
Page 33
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
Hiatus Hernia Repair 3A.122 30000 212, 213 USG, UGI ENDOSCOPY Scar photo + Intra op photo
Lobectomy 3A.96 52500 1390 CT Chest report Post Op X-ray,scar photo
Pneumonectomy 3A.97 45000 1391 CT Chest report Post Op X-ray,scar photo
Thoracoscopic surgery 3A.93 26250 1408 CT Chest report2D ECHO Report + stills of ECHO + Post Op X-
ray, photo of scar, port insertion
579Transoral surgery /Anterior/ Posterior/CV
Junction (with Stabilization)3A.272 60000 1884 MRI Report + XRAY Post Op X-ray report and film
580 Trans oral Surgery 3A.273 22500 1884 CT report Post Op X-ray Report and film, HPE report
581 RF Lesions for Trigminal Neuralgia 3A.274 11250 NA MRI Report CD of Procedure
582 Foramen Magnum Decompression 3A.275 33750 1956 CT/MRI report Clinical Photographs showing scar
583 Endoscopic CSF Rhinorrhea Repair 3A.276 33750 1937 CT/MRI report Clinical Photographs showing scar
584 Fetal Surgery for Myelomeningocoele 3A.277 56250 NA Ultrasound abdomen Ultrasound + scar photograph
585 Nerve Biopsy with report 3A.278 7500 1914
Nerve Conduction Velocity (Nerve
conduction velocity (NCV)) and
Electromyography (EMG) reports
Clinical Photograph + HPE report
586 Neuroblastoma 3A.279 30000 1456, 2148 Biopsy, CT Clinical photograph
587 Nerve Decompression 3A.280 15000 360, 1922 Nerve Conductions study Clinical Photographs showing scar
588 Peripheral Nerve Surgery Major 3A.281 33750 1868
Nerve Conduction Velocity (Nerve
conduction velocity (NCV)) and
Electromyography (EMG) reports
Clinical Photographs showing scar
589 Carotid Endarterectomy 3A.282 33750 1926 Ultrasound CT/MRI/DSA Clinical Photographs+ X-ray
590 Stereotactic Lesioning 3A.283 45000 1888Neuro Psychologist report, Neurologist
report, MRI
Clinical Photographs showing scar , CT Brain
report and film
591 Epilepsy Surgery 3A.284 37500 1939EEG, Neuro Psychologist report,
Neurologist report, CT/MRICT + Clinical Photographs showing scar
592 CTS 3A.285 7500 1954 Nerve Conductions study Clinical Photographs showing scar
Neuro Surgery - Atlanto Axial Dislocation (AAD)
NEUROSURGERY - GENERAL NEUROSURGERY
Page 34
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
593 Guillain Barre Syndrome 3A.286 56250 NANerve conduction studies report,
confirmed by Neurologist
Photo of patient with venouscathetor in situ,
photo of plasma filters with number and patient's
name , bills for purchase of plasma filters,
albumin and fresh flozen plasma, viral markers
report - Hbs antigen, HIV 1 & 2, Anti - HCV
antibodies
Page 35
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
594Excision of Brain Tumor Supratentorial-
Parasagital *3A.287 60000 1842 CT report /MRI Clinical features
Post Op CT Report and film, Clinical
Photographs showing the scar + HPE report
595 Excision of Brain Tumor Supratentorial-Basal * 3A.288 60000 1839 CT reportPost Op CT Report and film, Clinical
Photographs showing the scar + HPE report
596Excision of Brain Tumor Supratentorial-
Brainstem *3A.289 60000 1839 CT report
Post Op CT Report and film, Clinical
Photographs showing the scar + HPE report
597Excision of Brain Tumor Infratentorial-C P
Angle * 3A.290 60000 1841 CT report
Post Op CT Report and film, Clinical
Photographs showing the scar + HPE report
598Excision of Brain Tumor Supratentorial & others
*3A.291 37500 1842 CT report
Post Op CT Report and film, Clinical
Photographs showing the scar + HPE report
599 Excision of Brain Tumors -Subtentorial * 3A.292 41250 1846 MRI ReportClinical Photographs showing the scar + HPE
report
600 Abscess Tapping Single 3A.293 11250 1831 CT report Post Op CT Report,film and scar photo
601 C.S.F. Rhinorrhoea 3A.294 32250 1852 CT report Clinical Photograph with Scar
602 Cranioplasty 3A.295 22500 1847 CT report Post Op CT Report and film, Clinical
Photograph showing the scar
603 Aneurysm Clipping * 3A.296 82500 1872 MRI/CT Angio / DSA report Post Op CT Report and film, scar photo
604 Stereotaxic Procedures 3A.297 18750 1888 CT/ MRI report Post Op CT Report and film + HPE report
605 Trans Sphenoidal Surgery -Routine/Endoscopic 3A.298 30000 1871 CT/MRI Report HPE report
606 MVD (Micro Vascular Decompression) 3A.299 37500 NA MRI Report Clinical Photographs
607Arterio venous malformation (AVM) excision
(whatever size and location) */ Cavernoma3A.300 75000 1330, 1331 MRI Angio/DSA report CT report and film,scar photo
608
Superficial Temporal Artery (STA): middle
Cerebral Artery (MCA) or (Other EC : IC)
Bypass Procedure
3A.301 75000 NA MRI Angio/DSA report CT Report and film,scar photo
NEURO-SURGERY BRAIN
Page 36
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
609 Endoscopic venticulostomy 3A.302 22500 1851 CT reportClinical Photograph showing scar, DT Brain film
and report
610 Endoscopic colloid cyst excision 3A.303 37500 NA CT reportClinical Photograph showing scar, Post CT
report and film
611 Endoscopic Tumour Removal 3A.304 375001839, 1840,
1841, 1842 CT report
Clinical Photograph showing scar + HPE, Post-
op CT report and film
612 Excision of Orbital Tumour* 3A.305 37500 1971 CT/MRI ReportCT, Clinical Photograph showing scar + HPE
report, Post-op CT report and film
613 Cranio Facial Resection 3A.306 52500 2071 CT/MRI ReportCT report and film, Clinical Photograph showing
scar + HPE report
614 Elevation/Excision of depressed fracture 3A.307 22500 1953 CT reportClinical Photographs showing scar, Post CT
report and film
615 Decompressive craniotomy 3A.308 30000 1830 CT reportClinical Photographs showing scar, Post CT
report and film
616 Craniostenosis 3A.309 37500 1899 CT/MRI Report Post-op CT report and film
617Gamma Knife radiosurgery (GKRS)/SRS for
Tumours/Arteriovenous malformation (AVM)3A.310 56250 1962, 1963 CT/MRI Report Clinical Photographs
618 Scalp Arteriovenous malformation (AVM) 3A.311 18750 1973 CT/MRI Report Clinical Photograph showing scar + HPE report
619 Skull lesion including cranioplasty 3A.312 30000 1847 CT/MRI ReportClinical Photograph showing scar + HPE report
+ Xray - Skull
620 Skull Lesion without Cranioplasty 3A.313 18750 1847 CT/MRI ReportClinical Photograph showing scar + HPE report
+ Xray - Skull
621 Cranioplasty with mesh 3A.314 30000 1847 CT report Post Op CT Report and film, Clinical
Photograph showing the scar
Carotid angioplasty with stent* 3A.39 112500 1441Angiogram report & Film showing the
lesion Post procedure Angio stills + XRAY + Doppler
Meningo Encephalocele * 3A.261 30000 1850 MRI Report Post Op CT Report and film, Clinical
Photograph showing Scar
622 Spinal Cord Tumours* 3A.315 33750 1858 MRI Report Biopsy report + HPE Report + scar photo
623 Anterior Cervical Discectomy Single level * 3A.316 22500 1881 Clinical findings, MRI Report Post Op X-ray, Clinical Photograph showing
scar
NEURO-SURGERY SPINE
Page 37
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
624Anterior Cervical Discectomy Multiple level
with Implants*3A.317 45000 1887 Clinical findings, MRI Report
Photo showing the scar + XRAY showing the
implants
625 Laminectomy-Cervical * 3A.318 22500 1925 Clinical findings, MRI Report photo showing scar
626 Spinal Fusion Procedure + cost of implant * 3A.319 45000 1006, 1883 Clinical findings, MRI ReportPost Op X-Ray Report and film, + Showing scar
+ XRAY showing the implants
627 Spinal Intra Medullary Tumours* 3A.320 30000 1859 MRI Report Post Op X-ray Report and film + HPE report
628 Spina Bifida Surgery Major * 3A.321 30000 1861, 1862 MRI Report Clinical Photographs showing scar
629Corpectomy for Spinal Fixation + cost of implant
*3A.322 52500 1882 MRI Report
Clinical Photographs showing scar + X-ray
Report and film showing the implants
630 Posterior Cervical Discetomy without implant * 3A.323 22500 1891, 1881 MRI report Clinical Photographs showing scar
631Posterior Cervical Fusion with implant (Lateral
mass fixation) *3A.324 45000 1887 MRI report
Clinical Photographs showing scar + X-ray -
Cervical spine
632 Theco Peritoneal Shunt 3A.325 15000 1854 CT report Clinical Photographs
633 Cervical Disc Multiple level without Fusion 3A.326 26250 1881 CT/MRI reportClinical Photographs showing scar + X-ray-
Cervical Spine
634Thoracic/Lumbar Corpectomy with fusion
inclusive of implant /Trans thoracic *3A.327 52500 1881 CT/MRI Clinical Photographs showing scar + Xray
635Spinal Fusion Procedure + cost of implant * Cost
of next + Multiple level3A.328 52500 1883 Clinical findings, MRI Report
Post Op X-Ray Report and film, + Showing scar
+ XRAY showing the implants
Meningomyelocele * 3A.262 30000 1837, 1838 CT report Post Op CT Report and film, scar photo
NSBF1 Post Brain surgery Follow up-1 3A.NSBF1 #N/A NA
NSBF2 Post Brain surgery Follow up-2 3A.NSBF2 #N/A NA
NSBF3 Post Brain surgery Follow up-3 3A.NSBF3 #N/A NA
NSBF4 Post Brain surgery Follow up-4 3A.NSBF4 #N/A NA
NSSF1 Post Spine surgery Follow up-1 3A.NSSF1 #N/A NA
POST NEURO SURGERY FOLLOW-UP
Page 38
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
NSSF2 Post Spine surgery Follow up-2 3A.NSSF2 #N/A NA
NSSF3 Post Spine surgery Follow up-3 3A.NSSF3 #N/A NA
636 Lung metastatectomy - solitary 3A.329 22500 1997 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +
XRAY Chest
637 Lung metastatectomy - Multiple 3A.330 37500 1998 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +
XRAY Chest
638 Sleeve resection of Lung cancer 3A.331 67500 1999 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +
XRAY Chest
639 Mediastinal tumor resection 3A.332 37500 2003 Biopsy/FNAC ,CT report and FilmClinical Photograph showing scar + HPE report +
XRAY Chest
640 VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo
641Linear accelerator teletherapy,
3DCRT,IMRT,VMAT Adjuvant/Definitive 3A.334 56250 2227, 2228 Biopsy/FNAC ,CT report and Film Photo with RT Machine , RT treatment chart
642Brachytherapy - Intraluminal HDR per fraction
(max 4 session)3A.335 3375 2226 Biopsy/FNAC ,CT report and Film
Photo with RT Machine , RT treatment chart,
RT planning data
643 Definitive, Adjuvant, SRS/SRT 3A.336 56250 2229 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT treatment chart RT
planning Data
644Cobalt 60 External Beam Radiotherapy,
Definitive, Neoadjuvant, Adjuvant3A.337 15000 2221 Biopsy/FNAC ,CT report and Film
Photo with RT Machine , RT treatment chart RT
planning Data
645Cisplatin/Etoposide (IIIB)- Max. 6 cycles only
(Per cycle)3A.338 5250 2175 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code
646
Paclitaxel + Cisplatin / Carboplatin 2.
Gemcitabine D1 & D8 + Cisplatin / Carboplatin -
Max. 6 cycles only (Per cycle)
3A.339 9000 2178 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code
647
Pemetrexed +Carboplatin/Cisplatin (Stage IIIB,
IV Adenocarcinoma)- Max. 6 cycles only (Per
cycle)
3A.340 11250 2179 Biopsy/FNAC ,CT report and Film, Chemotherapy drug batch number with bar code
648Variable Regimen maximum 6 cycles (Per
cycle)(Amount as per drug cost)3A.341 6000 2177 Biopsy/FNAC ,CT report and Film Chemotherapy drug batch number with bar code
Lobectomy 3A.96 52500 1390 CT Chest report Post Op X-ray,scar photo
ONCOLOGY - LUNGS
Page 39
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
Pneumonectomy 3A.97 45000 1391 CT Chest report Post Op X-ray,scar photo
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
Tab Geftinib/Erlotinib-Max 1 Year (Per month) 3A.554 4500 2176, 2177 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
649Limb salvage surgery for Bone Tumors with
Prosthesis3A.342 56250 2079
CT-Local part/MRI, CT Chest with film,
,Bone Scan report + Biopsy Report
Clinical Photograph XRAY Showing prosthesis
+ HPE report
650 Forequarter amputation 3A.343 22500 2083 CT-Local part/MRI with film + Biopsy
Report Clinical Photograph showing scar+ HPE report
651 Shoulder Girdle Resection 3A.344 30000 2081 CT-Local part including chest /MRI
report with film + Biopsy ReportClinical Photograph showing scar + HPE report
652 Hemipelvectomy 3A.345 48750 2084 CT/MRI Pelvis with filmClinical Photograph showing scar / HPE report +
XRAY
653 Sacral Resection 3A.346 45000 2082 CT/MRI Pelvis with filmClinical Photograph showing scar / HPE report +
XRAY
654Wide excision - for skin, soft tissue and bone
tumors - minor3A.347 11250 2091 Biopsy of the primary tumour Clinical Photograph showing scar + HPE report
655Wide excision - for skin, soft tissue and bone
tumors - Major3A.348 22500 2091 Biopsy of the primary tumour Clinical Photograph showing scar + HPE report
656Wide excision + Reconstruction for soft tissue
and bone tumors3A.349 37500 2092
Biopsy of the primary tumour + CT/MRI
with filmClinical Photograph showing scar + HPE report
657Amputation for bone / soft tissue tumours
(Minor)3A.350 18750 2080
Biopsy of the primary tumour + CT/MRI
with filmClinical Photograph showing scar + HPE report
ONCOLOGY - SKIN/BONE AND SOFT TISSUE
Page 40
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
658Amputation for bone / soft tissue tumours
(Major)3A.351 26250 2080
Biopsy of the primary tumour + CT/MRI
with filmClinical Photograph showing scar + HPE report
659Chest wall resection for SOFT tissue bone
tumors3A.352 30000 2005 CT Chest with film, biopsy Clinical Photograph showing scar + HPE report
660 Chest wall resection + Reconstruction 3A.353 30000 2006 CT Chest with film, biopsy Clinical Photograph showing scar + HPE report
661Linear accelerator teletherapy, Definitive,
Neoadjuvant, Adjuvant 3DCRT/IMRT3A.354 37500
2222,
2224,2227,222
8
CT report and film, biopsy Photo with RT machine, RT treatment chart
662
Cisplatin/Adriamycin+ifosmide (IAP)- max 6
cycles (Per cycle) -Adj/Neo adjuvant/Palliative
(Osteosarcoma)
3A.355 11250 2136 Biopsy , CT-Scan with film Clinical Photograph, chemotherapy drug batch
number with bar code
663 High Dose Methotrexate (MTX)- max 6 cycles
(Per cycle)3A.356 11250 2168 Biopsy , CT-Scan with film
Clinical Photograph, chemotherapy drug batch
number with bar code
664
Variable Regimen -Ewings Sarcoma- max 17
cycles in 1 year (Per cycle)(Amount as per drug
cost)
3A.357 7500 2137 X-Ray,CT Scan with film, Biopsy Clinical Photograph, chemotherapy drug batch
number with bar code
665IFS + ADR-max 6 cycles (Per cycle) -Adj/Neo
adjuvant/Palliative3A.358 11250 2136 Biopsy , CT-Scan with film
Clinical Photograph, chemotherapy drug batch
number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
Cobalt 60 External Beam Radiotherapy,
Definitive3A.545 15000 2219, 2221 CT report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
Page 41
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
666Induction/1st Phase-AML ( 2nd Induction -
permitted in adults only)3A.359 37500 2155
Haematology, Bone Marrow Aspitation/
Flow cytometry
Clinical Photograph, chemotherapy drug batch
number with bar code
667 Consolidation 1 to 4 phases(per phase)- AML 3A.360 24750 2157 Haematology, Bone Marrow Aspitation/
Flow cytometry
Clinical Photograph, chemotherapy drug batch
number with bar code
668Induction, Intensification & Consolidation / ALL
and Lymphoblastic NHL3A.361 75000
2159, 2160,
2162
Haematology, Bone Marrow Aspitation/
Flow cytometry
Clinical Photograph, chemotherapy drug batch
number with bar code
669CNS directed therapy - RT/CT (10 fractions)
(CT- for age below 3 years; all others -RT)3A.362 11250
2222,2223,222
4,Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart
670Maintenance ( Paed and adults) - ALL (Per
month)3A.363 2250 2158,
Haematology, Bone Marrow Aspitation/
Flow cytometry
Clinical Photograph, chemotherapy drug batch
number with bar code
671Adult ALL -Hyper CVAD/BFM - 4 cycles (
Each cycle= A + B)3A.364 27000 NA
Haematology, Bone Marrow Aspitation/
Flow cytometry
Clinical Photograph, chemotherapy drug batch
number with bar code
672D'angelo's for CNS primary and secondary
lymphomas -(Max. 6 months) (Per month)3A.365 15000 NA Haematology + Cytoflowmetry report
Clinical Photograph, chemotherapy drug batch
number with bar code
673Salvage CT - GDP (Gemcitabine - Cisplatin-
Dexamethasone)- Maximum 6 cycles (Per cycle)3A.366 9000 2181 Hematology + Biopsy/FNAC report
Clinical Photograph, chemotherapy drug batch
number with bar code
674Salvage CT - ICE (Ifosfamide-Carboplatin-
Etoposide)- Maximum 6 cycles (Per cycle)3A.367 11250 2149 Hematology + Biopsy/FNAC report
Clinical Photograph, chemotherapy drug batch
number with bar code
675
Salvage CT -DHAP (cytosine arabinoside-
cisplatin-dexamethasone) - Maximum 6 cycles
(Per cycle)
3A.368 18750 NA Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch
number with bar code
676Imatinib Min 400 mg/day-max 12 cycles per year
(Per month) - AML, CML3A.369 3750 2196
Hematology + FNAC report
/Cytogenetics/ BCR-ABL
Clinical Photograph, chemotherapy drug batch
number with bar code
677Second generation Tab TKI - max 12 cycles per
year (Per month) - (Failure of Imatinib)3A.370 4500 NA
Hematology + FNAC report
/Cytogenetics/ BCR-ABL
Clinical Photograph, chemotherapy drug batch
number with bar code
678 Bendamustine- max 6 cycles (Per cycle) - CLL 3A.371 7500 2193 Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch
number with bar code
679Bendamustine + Ritumaxib- 6-8 cycles (Per
cycle) - CLL (Available only at select centres)3A.372 15000 2199 Hematology + Biopsy/FNAC report
Clinical Photograph, chemotherapy drug batch
number with bar code
ONCOLOGY - BLOOD - PAEDIATRICS AND OTHERS
Page 42
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
680
Doxorubicin - Bleomycin - Vinblastine
Dacarbazine (DBVD)-max 6-8 cycles (Per cycle)
(Day1 & Day15) - Hodgkins Lymphoma
3A.373 9000 2137 Biopsy, CTClinical Photograph, chemotherapy drug batch
number with bar code
681
Cyclophosphamide - Doxorubicin Vincristine -
Prednisone (CHOP)- max 8 cycles (Per cycle) -
NHL/Lymphoma
3A.374 4500 2138 Biopsy, CT report with filmClinical Photograph, chemotherapy drug batch
number with bar code
682 R-CHOP -max 6 cycles (Per cycle) 3A.375 15000 2188 Biopsy, CT report with filmClinical Photograph, chemotherapy drug batch
number with bar code
683
Variable Regimen-Non Lymphoblastic NHL,
(Per cycle) max. 8 cycles.(Amount as per drug
cost)
3A.376 15000 2147 Hematology + Biopsy/FNAC reportClinical Photograph, chemotherapy drug batch
number with bar code
684Linear accelerator, less than 20
fractions/3DCRT/IMRT3A.377 18750 2224 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart
685
Cobalt 60 External Beam Radiotherapy,Involved-
Site Radiotherapy (ISRT)/Involved Field
Radiation Therapy (IFRT)
3A.378 11250 2221 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart
686
Linear accelerator,Involved-Site Radiotherapy
(ISRT)/Involved field radiation therapy
(IFRT)/3DCRT/IMRT
3A.379 18750 2221 Hematology + Biopsy/FNAC report Photo with RT Machine , RT treatment chart
687Vincristine, Adriamycin, Dexamethasone(VAD)-
cycle max 6 cycles - Multiple myeloma3A.380 3750 2141
Bone Marrow Aspiration Report, Serum
Protein electrophoresis, CRAB criteria
Clinical Photograph, chemotherapy drug batch
number with bar code
688Thalidomide+Dexamethasone(Oral)-/month max
12 months - Multiple myeloma3A.381 3000 2142
Bone Marrow Aspiration Report, Serum
Protein electrophoresis, CRAB criteria
Clinical Photograph, chemotherapy drug batch
number with bar code
689Melphalan -Prednisone (oral)-Month max 12
months -- Multiple myeloma3A.382 1125 2143
Bone Marrow Aspiration Report, Serum
Protein electrophoresis, CRAB criteria
Clinical Photograph, chemotherapy drug batch
number with bar code
690
Plasma cell Leukemia / Multiple Myeloma -
Thaladomide, Dexamethasone, Bortezomib -
max 6 cycles
3A.383 15000 2142Bone Marrow Aspiration Report, Serum
Protein electrophoresis
Clinical Photograph, chemotherapy drug batch
number with bar code
Page 43
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
691
Zoledronic acid along with Adjuvant
Chemotherapy of AS-I- Maximum 12 cycles (
Bone metastasis)
3A.384 2250 2166 Bone Marrow Aspiration ReportClinical Photograph, chemotherapy drug batch
number with bar code
692
SIOP/NATIONAL WILMS TUMOUR STUDY
GROUP(NWTS) regimen(Stages I - V)- max 6
months (Per month) - Wilm's tumour
3A.385 6000 2144 CT report with film, biopsy/FNACClinical Photograph, chemotherapy drug batch
number with bar code
693Variable Regimen-Neuroblastoma- max 1 year
(Per cycle)(Amount as per drug cost)3A.386 7500 2148 CT report with film, biopsy/FNAC
Clinical Photograph, chemotherapy drug batch
number with bar code
694Carbo/Etoposide/Vincristine-max 6 cycles (Per
cycle) - Retinoblastoma3A.387 3750 2149 Biopsy , CT report with film
Clinical Photograph, chemotherapy drug batch
number with bar code
695Variable Regimen- LCH-max 1 year (Per
month)(Amount as per drug cost)3A.388 6000 2147 Biopsy,IHC , CT report with film
Clinical Photograph, chemotherapy drug batch
number with bar code
696
Vincristine-Actinomycin-
Cyclophosphamide(Vact C) based chemo - max
1 year (Per cycle)- Rhabdomyosarcoma
3A.389 6750 2153 Biopsy , CT report with filmClinical Photograph, chemotherapy drug batch
number with bar code
697 Palliative and Supportive Therapy (Per month) 3A.390 2250 2165 Biopsy , CT report with film Clinical Photograph
698Salvage CT- max 6 cycles ( Per cycle) only
paediatrics3A.391 9000 NA Hematology + Biopsy/FNAC report
Clinical Photograph, chemotherapy drug batch
number with bar code
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo
699 Mastectomy +Axillary Dissection 3A.392 18750 2089Biopsy/FNAC , Mammography/USG,
chest Xray HPE report, scar photo ( if patient consents)
700Mastectomy +Axillary Dissection+Defect
Closure with Flap3A.393 30000 2089 2090
Biopsy/FNAC , Mammography/USG,
chest Xray HPE report, scar photo ( if patient consents)
701 Axillary Dissection 3A.394 11250 2011Biopsy/FNAC , Mammography/USG,
chest XrayClinical Photograph showing scar + HPE report
ONCOLOGY - BREAST
Page 44
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
702 Breast Conserving Surgery 3A.395 18750 228Biopsy/FNAC , Mammography/USG,
chest XrayClinical Photograph showing scar + HPE report
703 Bilateral oophorectomy 3A.396 18750 687ERPR positive report, Biopsy of CA
breastHPE report
704Accelerated partial breast irradiation (APBI) any
type/ LINAC/3DCRT/IMRT3A.397 37500
2222, 2228,
2224
Biopsy/FNAC , Mammography/USG,
chest XrayPhoto with RT Machine , RT treatment chart
7055- Fluorouracil A-C (FAC)(Maximum 6 cycles)
(Per cycle)3A.398 3750 2150
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
706 AC (Maximum 4 cycles) (Per cycle) 3A.399 3750 2127Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
707FEC (Epirubicin based)(Maximum 6 cycles) (Per
cycle)3A.400 6000 2150
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
708Paclitaxel/docetaxel(Maximum 4cycles)
(Adjuvant) (Per cycle)3A.401 6750 2139, 2201
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
709Cyclophosphamide/Methotrexate/5Fluorouracil
(CMF) (Per cycle)3A.402 1125 2151
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
710
1. TC Docetaxel + Cyclophosphamide. 2. TAC
Docetaxel + Doxorubicin + Cyclophosphamide.
3. Gemcitabine D1 & D8 +/- Cisplatin/
Carboplatin - maximum 6 cycles (Per cycle)
3A.403 90002127,2182,
2145, 2150
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
711Tamoxifen tabs- maximum 12 cycles (Per
month)3A.404 75 2164
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
712Aromatase Inhibitors ( Anastazole/Letrozole/
Exemestane)- maximum 12 cycles (Per month)3A.405 675 2171
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
713 Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
714Variable Regimen - maximum 6 cycles (Per
cycle) (Amount as per drug cost)3A.407 6000 2150, 2127
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
715 Paclitaxel weekly x 12 weeks 3A.408 3375 2139Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Page 45
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
Definitive, Adjuvant, SRS/SRT 3A.336 56250 2229 Biopsy/FNAC ,CT report and FilmPhoto with RT Machine , RT treatment chart RT
planning Data
Cobalt 60 External Beam Radiotherapy,
Definitive3A.545 15000 2219, 2221 CT report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
716
Capetabine (Day 1-14) - 6 cycles
(Palliative/Adjuvant); As Concurrent as RT
sensitizor with all RT
3A.409 3000 2187 CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code
717Variable Regimen maximum 6 cycles (Per
cycle) (Amount as per drug cost)3A.410 6000
2180, 2181,
2182, 2184CT report and Film, Biopsy Chemotherapy drug batch number with bar code
718Oesophagectomy with Two field
Lymphadenectomy3A.411 56250 2016
UGI Endoscopy with film, biopsy, CT
report with film Clinical Photograph showing scar+ HPE report
719Oesophagectomy with Three field
Lymphadenectomy3A.412 67500 2017
UGI Endoscopy with film, biopsy, CT
report with film Clinical Photograph showing scar+ HPE report
720 Gastrectomy - any type 3A.413 37500 2019Endoscopy with film, biopsy, CT report
with filmClinical Photograph showing scar + HPE report
721 Small bowel resection 3A.414 30000 2022 CT/ X ray with film , biopsy Clinical Photograph showing scar + HPE report
722 Closure of Ileostomy/ Colostomy 3A.415 22500 2028 2029 Colonoscopy with film, Biopsy Clinical Photograph showing scar
723 Colectomy - any type 3A.416 30000 2023Endoscopy with film, biopsy, CT report
with film Clinical Photograph showing scar + HPE report
724 Anterior Resection ( inclusive of staplers) 3A.417 52500 2031Endoscopy with film, biopsy, CT report
with film Clinical Photograph showing scar + HPE report
725 Abdominoperinial Resection 3A.418 37500 2030Endoscopy with film, biopsy, CT report
with film Clinical Photograph showing scar + HPE report
ONCOLOGY - GI TRACT AND OESOPHAGUS
Page 46
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
726 Feeding procedure(Gastrostromy/Jejunostomy) 3A.419 15000 2027 2020 Biopsy of the primary tumor Clinical Photograph of operated site
727 Ileostomy 3A.420 15000 2026Biopsy of the primary + CT Scan with
filmClinical Photograph of operated site
728 Colostomy 3A.421 15000 2025Biopsy of the primary + CT Scan with
filmClinical Photograph of operated site
729 Gastro Jejunostomy 3A.422 22500 2021Biopsy of the primary + CT Scan with
filmClinical photograph showing scar
730 Ileotransverse Colostomy 3A.423 22500 2024Biopsy of the primary + CT Scan with
filmClinical photograph with scar
731 Distal Pancreatectomy 3A.424 45000 2036 CT / MRI with film/IHC report Clinical Photograph showing scar + HPE report
732 Enucleation of Cyst 3A.425 37500 1190 CT report and Film Clinical Photograph showing scar + HPE report
733 Whipples surgery ( inclusive of staplers) 3A.426 60000 1197 CT / MRI/IHC Clinical Photograph showing scar + HPE report
734 Radical Cholecystectomy 3A.427 45000 2034 CT /MRI report and Film, biopsyClinical Photograph showing the scar + HPE
report +USG Report
735 Resection of Retroperitoneal Tumors 3A.428 37500 2040 CT abdomen with film, FNAC Clinical Photograph showing scar + HPE report
736 Abdominal wall tumor Resection 3A.429 26250 2038 CT abdomen report and Film Clinical Photograph showing scar + HPE report
737Abdominal wall Resection with
reconstruction/mesh3A.430 33750 2039 CT abdomen report and Film Clinical Photograph showing scar + HPE report
738 GI Stenting including stent cost 3A.431 30000 1205 CT abdomen report and Film Stent invoice
739 Triple Bypass -GI Tract 3A.432 30000 1191 Biopsy , CT , Endoscopy Clinical Photograph showing scar + HPE report
740 Hepatectomy (right or left) 3A.433 63750 1180 1181 CT /MRI report and FilmClinical Photograph showing scar, USG and HPE
Report
741 Segmentectomy-Hepato Billiary System 3A.434 37500 1179 CT /MRI report and FilmClinical Photograph showing scar, USG and HPE
Report
742 Substernal bypass 3A.435 26250 2018 Biopsy of the primary Clinical Photograph showing the procedure/scar
Page 47
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
743
Linear accelerator teletherapy, Definitive,
3DCRT/IMRT - for inoperable oesophagus
cancer without metastsis.
3A.436 56250 2228 2227 CT report and film, biopsy Photo with RT machine, RT treatment chart
744Cisplatin/Carboplatin- 5FU (Per cycle) -
Oesophageal CA3A.437 4500 2128
Endoscopy with film, biopsy, CT report
with filmChemotherapy drug batch number with bar code
745 Epirubicin+Cisplatin+5FU (Per cycle) 3A.438 6000 2128Endoscopy with film, biopsy, CT report
with filmChemotherapy drug batch number with bar code
746
Hepatoblastoma - Variable regime, max 6 cycles
(per cycle) as per drug cost
cisplatin/carboplatin+adriamycin
3A.439 3750 2146 CT scan, Tumour markers Chemotherapy drug batch number with bar code
747
Docetaxel+Cisplatin+5FU OR Capcetabine +
Oxaloplatin (Neoadjuvant Chemotherapy
maximum 3 cycles/pallative maximum 6 cycles)
(Per cycle)
3A.440 7500 2186Endoscopy with film, biopsy, CT report
with filmChemotherapy drug batch number with bar code
748EOX (Epirubicin + Oxaloplatin + Capcetabine) -
Max 6 cycles3A.441 9000 2180
Endoscopy with film, biopsy, CT report
with filmChemotherapy drug batch number with bar code
749Monthly 5-Fluorouracil(FU) (Per cycle) -
Colorectal cancer3A.442 2250 2132 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
750
5-Fluorouracil-Oxaliplatin -Leucovorin
(FOLFOX)- Day 1 and 2; Max. 12 cycles for
adjuvant (Per cycle) -Colorectal cancer
3A.443 6000 2134 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
751
5-Fluorouracil-Oxaliplatin -Leucovorin
(FOLFOX)- Day 1 and 2; Max. 6 cycles for
palliative (Per cycle) -Colorectal cancer
3A.444 7500 2134 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
752 Imatinib -Max for 6 months (Per month) 3A.445 3750 2183 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
753Gemcitabine+Cisplatin(Day 1,Day 8 )-max 6
cycles (Per cycle)3A.446 7500 2182 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
754 Tab Sorafenib- max 12 months (Per month) 3A.447 6000 2205 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
755
Oxiplatin+Capecitabine- max. of 6 cycles for
palliative only or 8 cycles for adjuvant (Per
cycle)
3A.448 6000 5 CT/MRI with film, Biopsy Chemotherapy drug batch number with bar code
Page 48
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
756
Second line palliative CT - FOLFERI (Day 1, 2
every 14 days) max 6 cycles OR CAPIRI (
Capcetabine D1 -14, Irinotecam D1, D8)
(Metastatic, after failure of CAPOX,
Capcetabine)
3A.449 7500 NA CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo
Linear accelerator teletherapy, Definitive,
Neoadjuvant, Adjuvant 3DCRT/IMRT3A.354 37500
2222,
2224,2227,222
8
CT report and film, biopsy Photo with RT machine, RT treatment chart
Brachytherapy - Intraluminal HDR per fraction
(max 4 session)3A.335 3375 2226 Biopsy/FNAC ,CT report and Film
Photo with RT Machine , RT treatment chart,
RT planning data
Cobalt 60 External Beam Radiotherapy,
Definitive, Neoadjuvant, Adjuvant3A.337 15000 2221 Biopsy/FNAC ,CT report and Film
Photo with RT Machine , RT treatment chart RT
planning Data
757 Radical Nephrectomy - Open/Lap * 3A.450 33750 2042Ultrasound abd /CT Scan abd with film,
Isotope Renogram if required Clinical Photograph showing scar + HPE report
758 Partial Nephrectomy 3A.451 41250 2041 CT report with film, Isotope renogram if
required
Clinical Photograph showing scar+ HPE report
+USG Report
759Nephro- ureterectomy for Transitional Cell
Carcinoma of renal pelvis (one side)3A.452 33750 2043
CT report with film, Isotope renogram if
requiredClinical Photograph showing scar+ HPE report
760 Radical Cystectomy with Ileal conduit * 3A.453 56250 2047 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
ONCOLOGY - GENITO URINARY SURGERY
Page 49
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
761 Other cystectomies * 3A.454 30000 2046 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
762 High Orchidectomy * 3A.455 11250 2049 USG scrotum, Tumour markersClinical Photograph showing scar ( if patient
consents)+ HPE report
763 Bilateral Orchidectomy * 3A.456 11250 2102Biopsy Reports /PSA with evidence of
bone metastasis
Clinical Photograph showing scar ( if patient
consents)+ HPE report
764 Partial Penectomy * 3A.457 11250 2051 Biopsy ReportsClinical Photograph showing scar ( if patient
consents)+ HPE report
765 Total Penectomy * 3A.458 18750 2097 Biopsy ReportsClinical Photograph showing scar ( if patient
consents)+ HPE report
766 Inguinal Block Dissection-one side * 3A.459 15000 2115 2012 Biopsy Reports Clinical Photograph showing scar + HPE report
767 Inguinal Block Dissection-Bilateral 3A.460 30000 2116 Biopsy Reports Clinical Photograph showing scar + HPE report
768Radical Prostatectomy with Bilateral pelvic
lymph Node Dissection(BPLND) *3A.461 56250 2048 CT report and Film, Biopsy Clinical Photograph, HPE report
769 Anterior Exenteration 3A.462 52500 2109 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+ HPE report
770 Total Exenteration 3A.463 56250 2110 Cystoscopy, biopsy, CT report and Film Clinical Photograph showing scar+ HPE report
771 Suprapubic Cystostomy 3A.464 7500 2045 Biopsy of the primary tumor Clinical Photograph showing procedure/scar
772 Urinary diversion 3A.465 30000 2044 Biopsy, USG Scrotum report and Film Clinical Photograph showing scar, post op USG
773 Adrenalectomy * 3A.466 33750 1980 1981 CT/MRI report with film, Urinary
hormonesClinical Photograph showing scar+ HPE report
774Retro Peritoneal Lymph Node
Dissection(RPLND)3A.467 60000 2013 CT report and film, biopsy Clinical photograph showing scar, HPE report
775 Linear accelerator teletherapy, 3DCRT 3A.468 56250 2228 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart, RT
planning Data
776IMRT/VMAT/SBRT (Radical radiation alone
for prostate) 3A.469 67500 2227 CT report and Film, Biopsy
Photo with RT Machine , RT treatment chart, RT
planning Data
777Linear accelerator, Curative less than 20
fractions3A.470 15000 2224
CT report and Film, Biopsy/Tumour
markersPhoto with RT Machine , RT treatment chart
Page 50
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
778Weekly Cisplatin/Carboplatin- max 6 cycles with
RT (Per week)3A.471 1500 2133 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
779Gemcitabine+ Cisplatin(Day 1,Day 8)(Palliative
/Adjuvant)-max 6 cycles (Per cycle)3A.472 7500 2182 CT report and Film, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
780 Hormonal therapy with Abiratarone- monthly 3A.473 6000 2126CT report and Film, Biopsy,PSA with
evidence of bone metastasis
Clinical Photograph, chemotherapy drug batch
number with bar code
781Hormone therapy - Bicalutamide -50mg OD
monthly (per month)3A.474 3750 2126
CT report and Film, Biopsy,PSA with
evidence of bone metastasis
Clinical Photograph, chemotherapy drug batch
number with bar code
782 Carboplatin(AUC more than 5) (Per cycle) 3A.475 3750 2145 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch
number with bar code
783
Bleomycin-Etoposide-Cisplatin (BEP)- max
cycles 4 (Per cycle) Germ cell tumours, extra
gonadal tumour
3A.476 7500 2175CT report and Film, Biopsy/Tumour
markers
Clinical Photograph, chemotherapy drug batch
number with bar code
784
Taxol,Ifophomide,Cisplatin/Carboplatin(TIP)/Vi
nblastine,Ifosphimide,Cisplatin(VeIP)- max
cycles 4 (Per cycle)
3A.477 15000 2200CT report and Film, Biopsy/Tumour
markers
Clinical Photograph, chemotherapy drug batch
number with bar code
785 Tab Sorafenib-max 12 months (Per month) 3A.478 6000 2205 CT report and Film, Biopsy Clinical Photograph,chemotherapy drug batch
number with bar code
786Palliative CT - (5FU + Cisplatin/Carboplatin) -
Max 6 cycles (Per cycle)3A.479 4500 2128 CT/USG report and Film, Xray, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
787Palliative CT-Docetaxel- Max 6 cycles (Per
cycle)3A.480 6750 2201 CT/USG report and Film, Xray, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
788
Variable Regimen maximum 6 cycles (Per
cycle)MVAC- Mitomycin, Vincristine,
Adriamycin, Cyclophosphamide
3A.481 6000 2140 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch
number with bar code
789
Urinary bladder CA- Gemcitabine/Cisplatin as
radio sensitizer weekly - max 8 weeks - (cost per
week)
3A.482 1500 2182 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch
number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
Page 51
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
Page 52
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
790 Radical Trachelectomy 3A.483 30000 2056 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
791
Radical Hysterectomy +Bilateral Pelvic Lymph
Node Dissection (BPLND) + Bilateral Salpingo
Ophorectomy (BSO) / Ovarian transposition
3A.484 37500 2060 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
792 Anterior / Posterior Exenteration (Gynaec) 3A.485 52500 2061 2062 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
793 Total Pelvic Exenteration 3A.486 56250 2063 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
794 Bilateral pelvic lymph Node Dissection(BPLND) 3A.487 22500 2105 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
795 Surgery for Ca Ovary - early stage 3A.488 30000 2052 USG/CT Reports with film,CA 125 Clinical Photograph showing scar + HPE report
+ USG report
796Surgery for Ca Ovary - advance stage with
Mesenteric/Peritoneal/Omental Metastatsis3A.489 45000 2055 USG/CT Reports with film,CA 125
Clinical Photograph showing scar + HPE report
+ USG report
797 Radical vaginectomy 3A.490 30000 2065 CT report and Film, Biopsy HPE report
798 Radical vaginectomy + Reconstruction 3A.491 33750 2066 CT report and Film, Biopsy HPE report
799 Vulvectomy 3A.492 22500 2067 Biopsy Reports HPE report
800Linear accelerator teletherapy,Definitive,
Neoadjuvant, Adjuvant 3DCRT/IMRT3A.493 37500
2222 2224
2228 2227CT report and film, biopsy Photo with RT machine, RT treatment chart
801 Brachytherapy/ Interstitial LDR , adjuvant 3A.494 11250 2225 CT / MRI report with film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
802Cisplatin/Carboplatin (AUC2)- Max. of 6 cycles
only (Per cycle)3A.495 1500 2145 CT report and Film, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
803 Carboplatin/Paclitaxel-max 6 cycles (Per cycle) 3A.496 9000 2145 CT report and Film, Biopsy Clinical Photograph, chemotherapy drug batch
number with bar code
804Bleomycin-Etoposide-Cisplatin (BEP) (Per
cycle) - Germ cell tumours, extra gonadal tumour3A.497 7500 2156 CT report and Film, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
805 Weekly Methotrexate (Per week) max. 10 cycles 3A.498 750 2168 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch
number with bar code
ONCOLOGY - GYNAECOLOGY
Page 53
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
806 Actinomycin- max 10 cycles (Per cycle) 3A.499 750 2172 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch
number with bar code
807
Etoposide-Methotrexate-Actinomycin /
Cyclophosphamide -Vincristine (EMA-CO)-max
6 cycles (Per cycle)
3A.500 6000 2174 B HCG report,CT report and FilmClinical Photograph, chemotherapy drug batch
number with bar code
808Variable Regimen (Amount as per drug cost)-
max 6 cycles (Per cycle)3A.501 6000 2163 2165 CT report and Film, Biopsy
Clinical Photograph, chemotherapy drug batch
number with bar code
809
Gemcitabine+ Carboplatin/ Liposomal
Doxorubicin/ Albumin bound Paclitaxel (
Adjuvant), max 6 cycles
3A.502 9000 2182 CT report and Film, BiopsyClinical Photograph, chemotherapy drug batch
number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
Palliative CT- Max 6 cycles (Per cycle) 3A.406 6000 2163Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
VATS/Laparoscopy ( for deep seated biopsy) 3A.333 7500 2121 CT report with film Scar Photo
Brachytherapy - Intraluminal HDR per fraction
(max 4 session)3A.335 3375 2226 Biopsy/FNAC ,CT report and Film
Photo with RT Machine , RT treatment chart,
RT planning data
Cobalt 60 External Beam Radiotherapy,
Definitive3A.545 15000 2219, 2221 CT report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
810 X Knife, Gamma Knife, Cyber knife 3A.503 67500 1962 1963 CT/MRI report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
811Cobalt 60 External Beam Radiotherapy,
Definitive+Tab Temozolomide along with RT 3A.504 26250
2220
2219,2198CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
ONCOLOGY - BRAIN AND SPINE
Page 54
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
812 Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
813Linear accelerator teletherapy, Definitive+Tab
Temozolamide3A.506 41250
2224,2222,219
8, CT report and film, biopsy
Photo with RT machine, RT treatment chart, RT
planning data
814
Linear accelerator teletherapy, 3DCRT,
Definitive along with +concurrent Tab
Temozolamide along with RT
3A.507 60000 2228, 2198, CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
815
Linear accelerator teletherapy, IMRT /VMAT,
Definitive along with +concurrent Tab
Temozolamide along with RT.
3A.508 78750 2227, 2198 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
816 Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
817Palliative CT- Max 6 cycles (Per cycle) For
Primary and secondary tumours3A.510 6000 2163 CT/USG report and Film, Xray, Biopsy Chemotherapy drug batch number with bar code
818 Variable regimen - Max 6 cycles (Per cycle) 3A.511 6000 2163 2165 CT/MRI , HPE report Chemotherapy drug batch number with bar code
819 Zoledronic acid - Max 12 cycles (Per month) 3A.512 2250 2163CT/PET /Bone scan/ Xray, Biopsy if
requiredChemotherapy drug batch number with bar code
820Tab Temozolemide for 6 months (5days every
month x 6 months)3A.513 33750 2198 CT report and Film, Biopsy
Pharmacy Bill/Invoice with batch no. of the drug
strip
821Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
822 Tracheal Resection and anastomosis 3A.515 13500 1996 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
823 Sternotomy + Superior Mediastinal Dissection 3A.516 9000 2004 CT report and Film, Biopsy Clinical Photograph showing the scar + HPE
report
824 Microlaryngeal Surgery including Phonosurgery 3A.517 8250 397, 398 Clinical Photograph Clinical Photograph, HPE report
825 Resection of Nasopharyngeal Tumor 3A.518 37500 1991 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
826 Myocutaneous / cutaneous flap 3A.519 18750 2093 Biopsy of the primary Clinical Photograph showing scar
827 Palatectomy 3A.520 22500 1989 CT/MRI report and Film, Biopsy Clinical Photograph, HPE report
828 Micro vascular reconstruction 3A.521 33750 2008 Biopsy of the primary Clinical Photograph showing scar
ONCOLOGY - HEAD AND NECK
Page 55
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
829 Temporal bone resection (Any Type) 3A.522 45000 2074 CT/MRI report and Film, Biopsy Clinical Photograph showing scar + HPE report
830 Composite Resection 3A.523 37500 2094, 2076 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
831 Composite Resection and Reconstruction 3A.524 48750 2094 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
832Composite Resection + Micro vascular
reconstruction3A.525 60000 2094 2008 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
833 Neck Dissection - any type 3A.526 18750 2009 Biopsy , USG/CT of neck with film Clinical Photograph showing scar + HPE report
834 Hemiglossectomy 3A.527 18750 1985CT/MRI report and Film if required/
Biopsy Clinical Photograph showing scar + HPE report
835 Maxillectomy 3A.528 30000 2070 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
836 Parotidectomy 3A.529 30000 1987 FNAC,CT Clinical Photograph showing scar + HPE report
837Laryngectomy - any type, with neck node
dissection3A.530 30000 1993 2009 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
838 Voice Prosthesis 3A.531 30000 NA CT report, Biopsy, +Photograph with AM Invoice of prosthesis, scar photo
839 Laryngopharyngo Oesophagectomy 3A.532 52500 1994 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
840 Hemimandibulectomy 3A.533 18750 2068 CT report and Film if required/ Biopsy Clinical Photograph showing scar + HPE report
841 Wide excision of lesion 3A.534 18750 2101CT/MRI report and Film if required,
Biopsy, clinical pictureClinical Photograph showing scar + HPE report
842 Thyroidectomy any type 3A.535 18750 1978 FNAC/CT/MRI report and Film Clinical Photograph showing scar + HPE report
843 Laser Surgery of Larynx 3A.536 22500 NA Clinical PhotographPhotos with laser machine, CD of procedure/intra
op stills + HPE report
844 Submandibular Gland Excision 3A.537 18750 1988CT/MRI/USG report and Film if
required/ BiopsyClinical Photograph showing scar + HPE report
845 Parathyroidectomy 3A.538 22500 1979CT Scan Functional scan/PTH
reports/USGClinical Photograph showing scar + HPE report
Page 56
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
846 Pharyngectomy & Reconstruction - Total 3A.539 9000 71 CT Neck,USG HPE, X Ray Neck, Scar Photo
847 Parapharyngeal Tumour Excision 3A.540 8250 403 USG, CT Neck USG,HPE,Scar Photo
848Linear accelerator (Photons) teletherapy,
Adjuvant3A.541 37500 2224 CT/MRI report and Film, Biopsy Photo with RT Machine , RT treatment chart
849Linear accelerator teletherapy 3DCRT,
Definitive, Adjuvant 3A.542 56250 2228 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
850Linear accelerator teletherapy IMRT /VMAT,
Definitive, Adjuvant3A.543 75000 2227 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
851Brachytherapy/ Interstitial HDR one application,
multiple doses Definitive/Boost3A.544 22500 2226 CT/MRI report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
852Cobalt 60 External Beam Radiotherapy,
Definitive3A.545 15000 2219, 2221 CT report and Film, Biopsy
Photo with RT Machine , RT treatment chart RT
planning Data
853 Radioiodine Treatment < 100 Millicuries 3A.546 15000 NA Biopsy/FNACRadioiodine original treatment chart and Thyroid
scan, Biopsy/HPE
854 Radioiodine Treatment > 100 Millicuries 3A.547 22500 NA Biopsy/FNACRadioiodine original treatment chart and Thyroid
scan , Biopsy/HPE
855Cisplatin/Carboplatin (AUC2) along with RT-
max 6 cycles (Per cycle)3A.548 1500 2173, 2202 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
856
Carboplatin/cisplatin + Paclitaxel/Docetaxel
(Neoadjuvant Chemotherapy)-Max. of 4 cycles
only (Per cycle) -For stage III and IVA
3A.549 9000 2145 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
857
Cisplatin + 5 FU(Neoadjuvant
Chemotherapy)/Palliative - Max. of 4 cycles only
(Per cycle)
3A.550 45002128, 2130,
2135CT report and Film, Biopsy Chemotherapy drug batch number with bar code
858Cisplatin + 5FU + Taxol/Docitaxel ( only
hypopharynx)3A.551 8250 2184 CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
859Palliative CT (Paclitaxel + Cisplatin or 5 FU +
Cisplatin) - Max 6 cycles (Per cycle)3A.552 6000 2163 CT / USG report and Film, X ray, Biopsy Chemotherapy drug batch number with bar code
860
Palliative CT 1. Docetaxel + Cisplatin /
Carboplatin. 2. Gemcitabine D1& D8 + Cisplatin
/ Carboplatin - max 6 cycles (Per cycle)
3A.553 7500 2182 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
Page 57
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
861 Tab Geftinib/Erlotinib-Max 1 Year (Per month) 3A.554 4500 2176, 2177 CT report and Film, Biopsy Chemotherapy drug batch number with bar code
862 Tab Sorefinib- max 12 months (Per month) 3A.555 6000 2205 CT/MRI report and Film, Biopsy Chemotherapy drug batch number with bar code
Cobalt 60 teletherapy, Palliative 3A.505 7500 2220 CT report and Film, BiopsyPhoto with RT Machine , RT treatment chart RT
planning Data
Growth Factor / Pegrafil (Per cycle)
(Maximum 4 cycles)3A.514 1500 2163, 2165
Biopsy/FNAC , Mammography/USG,
chest XrayChemotherapy drug batch number with bar code
Linear accelerator teletherapy, Palliative 3A.509 15000 2223 CT report and Film, Biopsy Photo with RT Machine , RT treatment chart
863 Prostate surgery (Code 3A.561) - additional cost 3A.556 18750 NA CT report and Film, Biopsy Clinical Photograph, HPE report
864Nephrectomy – partial (Code 3A.451)-
additional cost3A.557 18750 NA
CT report with film, Isotope renogram if
required
Clinical Photograph showing scar+ HPE report
+USG Report
865Low AR and APR (Code 3A.417, 3A.418) -
additional cost3A.558 18750 NA
Endoscopy with film, biopsy, CT report
with film Clinical Photograph showing scar + HPE report
866Radical hysterectomy for CA cervix and CA
endometrium ( Code 3A.484)- additional cost3A.559 15000 NA CT report and Film, Biopsy Clinical Photograph showing scar + HPE report
OF1 Post Oncology Follow up-1 3A.OF1 #N/A NA
OF2 Post Oncology Follow up-2 3A.OF2 #N/A NA
OF3a Post Oncology Follow up-3 3A.OF3a #N/A NA
OF3b Post Oncology Follow up-3 with CECT 3A.OF3b #N/A NA
867 Tendon injury requiring repair moderate 3A.560 75002231,989,968,
965, 960
X-ray Films/ Clinical Picture + detail
notesClinical photo showing Scar
868 Tendon injury requiring repair major 3A.561 15000 967968Xray Films(if relevant)+ Clinical
Picture(Mandatory) + detail notesClinical photo showing Scar
869 Nerve injuries minor 3A.562 11250
2231,
953,1868,1904
,
Xray Films(if relevant)+ Clinical
Picture(Mandatory) + detail notesClinical photo showing Scar
ROBOTIC SURGERY - ALLOWED IN SELECTED CENTRES ONLY
POST ONCOLOGY FOLLOW-UP
POLYTRAUMA
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
870 Nerve injuries major 3A.563 15000952, 954, 955,
1931
Xray Films(if relevant)+ Clinical
Picture(Mandatory) + detail notesClinical photo showing Scar
871 Nerve plexus injuries 3A.564 375001000 , 1866 ,
1867
MRI + Xray Films(if relevant)+ Clinical
Picture(Mandatory) + detail notesClinical photo showing Scar
872 Vascular peripheral/minor injuries 3A.565 7500 2231,
Pre-operative Doppler study, CT
angio(Optional)+ Films+ detailed
Clinical notes
Post-operative Doppler study, Clinical photo
showing scar
Page 59
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
873 Vascular central/severe injuries(major) 3A.566 37500 2231Pre-operative Doppler study+ CT
Angio(optional) + detailed Clinical notes
Post-operative Doppler study, Clinical photo
showing scar
874 Flap surgery (Simple) 3A.567 11250 2542X-ray Films + detail notes+ pre-op
clinical photoClinical photo showing Scar
875 Complex flap surgery 3A.568 22500 2364, 2365 X-ray Films + detail notes Clinical photo showing Scar
876 Visceral injuries moderate 3A.569 30000 610 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
877 Visceral injuries severe 3A.570 45000 510611 Pre-op. of X-ray/CT scan / Ultra sound Post-Operative X-ray, scar photo
878 Chest injuries with ICD bilateral 3A.571 82502002, 1471,
2977X-ray /ultra sound Post-Operative chest X-ray with ICD in situ
879 Chest injuries with ICD + ICU 3A.572 15000 2391, 2398 , X-ray /ultra sound Post-Operative chest X-ray with ICD in situ
880 Chest injuries with ICD + ICU + Ventilator 3A.573 19950 2398 , X-ray /ultra sound Post-Operative chest X-ray with ICD in situ
881 Acetabular definitive treatment 3A.574 19950 1036, X-RAY/CT scan Clinical Photograph showing scar + post op.
XRAY
882Illizarov/Orthofix/hybrid external fixator
application3A.575 19950
2961, 1125,
1061 X-ray Post op X-ray, Pt photo with applicator
883 Skin Grafting Major- Injuries(Add on code) 3A.576 135002352, 2354,
961X-ray X-ray + post-operative scar photo
884
Arthroscopic BANKARTS Repair for recurrent
dislocation of shoulder (without cost of suture
anchors)**
3A.577 12450 986 X-ray Patient Photo with Arthroscopic incision
885
Total knee replacement(Unilateral) Procedure +
Impant including cement cost. Incase of bilateral
in same sitting only implant cost will be paid. In
case of next sitting 50% of procedure cost &
implant will be paid.**
3A.578 48750 942, 949, 950 X-ray Post-op X-ray, Scar photo
886Total hip replacement Uncemented
implant(Procedure cost + implant cost)**3A.579 51825 947, 948 X-ray Post-op X-ray, Scar photo
887Total hip replacement cemented
implant((Procedure cost + implant cost)**3A.580 45075 947, 948 X-ray Post-op X-ray, Scar photo
Page 60
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
888Total hip replacement Hybrid ((Procedure cost +
implant cost)**3A.581 75000 947, 948 X-ray Post-op X-ray, Scar photo
* Procedures requiring Follow Up as per Annexure 3
** Super speciality procedures that shall be restricted to PHIs and Medical colleges (Public & Private)
Page 61
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
889 Second degree burns - Thermal (16% to 30%) 4A.1 18750 2263, 2264Clinical Photograph, Diagram with Rule
of 9 for extent of burnsClinical Photograph
890 Second degree burns - Thermal (30% to 50%) 4A.2 375002249, 2250,
2242, 2243
Clinical Photograph, Diagram with Rule
of 9 for extent of burnsClinical Photograph
891 Between 50% to 60% Burns - Thermal 4A.3 52500 2244, 2245Clinical Photograph, Diagram with Rule
of 9 for extent of burnsClinical Photograph
892 More than 60% Burns - Thermal 4A.4 75000 2245Clinical Photograph, Diagram with Rule
of 9 for extent of burnsClinical Photograph
893Chemical Burns/Acid Burns (Moderate )
(Grafting not required)4A.5 22500 537 Clinical Photograph Clinical Photograph
894 Chemical Burns (Severe) 4A.6 56250 537 Clinical Photograph Clinical Photograph
895 Electrical Burns(Moderate) 4A.7 22500 2255 Clinical Photograph Clinical Photograph
896 Electrical Burns(Severe) 4A.8 52500 2255 Clinical Photograph Clinical Photograph
897Any degree burn with inhalational injury, with
72 hours ventilator support4A.9 45000 2857 Clinical Photo Clinical photograph
898 Coronary Balloon Angioplasty/PTSMA* 4A.10 30000 2961ECG, 2D ECHO, CAG stills showing
blocks & ReportsAngioplasty stills showing Balloon & post flow
899PTCA - one stent (non-medicated, emergency,
inclusive of angiogram) at the same admission.*4A.11 48000 1286, 1287
ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing stents & post Stent
flow
900PTCA - one Drug Eluting stent ( emergency,
inclusive of angiogram) at the same admission. *4A.12 60000 1286, 1287
ECG, 2D ECHO, CAG stills showing
blocks & Reports
1.Angioplasty stills showing stents & post Stent
flow,2. Cartons of the stents used approved by
FDA/CE/DCGI only
901
PTCA - two bare metal stents ( non-medicated,
emergency, inclusive of angiogram) at the same
admission. *
4A.13 55000 1288, 1289ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing stent & post Stent
flow
902PTCA - two Drug Eluting stents ( emergency,
inclusive of angiogram) at the same admission. *4A.14 85000 1288, 1289
ECG, 2D ECHO, CAG stills showing
blocks & Reports
Angioplasty stills showing stents & post Stent
flow
Emergency procedures TERTIARY EMERGENCY
BURNS
CARDIOLOGY
Page 62
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
903Medical treatment of Acute MI with
Thrombolysis4A.15 15000 2720
2D ECHO, CPKMB,CAG, ECG with
report, TROPONINE-T reports
2D ECHO, ECG, LAB INVESTIGATION
(Trop T report)
904 Arrythmias 4A.16 7000 2725, 2726 CAG CAG
905 Stuck valve with Thrombolysis 4A.17 20000 1960 ECHO/TEE, PT/INR, RFT, CBC ECHO/TEE, PT/INR, RFT, CBC
906Medical management of unstable angina/non
STS4A.18 7500 2730, 2731
ECG,ECHO,Cardiac Enzymes, RFT,
CBCECG, RFT, CBC
907 Cardiac failure 4A.19 75002670, 2672,
2674ECG,ECHO,Chest X-ray, RFT, CBC ECHO, CHEST X RAY, RFT, CBC
908 CVA secondary to Cardiac conditions 4A.20 100001337, 2603,
2604
ECHO, CT Brain/ MRI Brain,, RFT,
CBCPT/INR, RFT, CBC
909 Emergency dialysis for cardiac conditions 4A.21 15000 1791, 1792 ECHO, RFT, CBC RFT, CBC
910 ICU with ventilator with dialysis 4A.22 15000 2646 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY RFT,RFT, CBC, ABG
911 Acute respiratory distress - ventilator support 4A.23 15000 2560, 2561 ECHO, Chest X Ray, RFT, CBC, ABG CHEST X RAY, RFT, CBC, ABG
912 Pulmonary edema 4A.24 10000 2732ECG, ECHO,Chest X Ray, RFT, CBC,
ABGECHO, CHEST X RAY, RFT, CBC, ABG
913Laryngoscopy / Bronchoscopy with dilatation of
trachea with gum elastic bogie4A.25 5000 NA CT / Bronchoscopy report CT / Bronchoscopy report
914Intercostal Drainage and Management of ICD,
Intercostal Block, Antibiotics & Physiotherapy4A.26 15000 1407 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
915 Temporary Pacemaker implantation 4A.27 10000 1307, 1308 ECG + Report by cardiologist X Ray showing the pacemaker in situ
916 Creation of AV fistula for dialysis 4A.28 7500 1346, 1347 Duplex Clinical photos showing the AV fistula
917 Pericardiostomy with balloon 4A.29 20000 1298 2D ECHO report 2D ECHO report + stills of the ECHO
918 Pericardiocentesis 4A.30 10000 1297 2D ECHO report 2D ECHO report
919 Thrombolysis for peripheral ischemia 4A.31 30000 1960Peripheral Angiogram /Doppler Report
with StillsPost procedure Angio stills
920 Foreign Body Removal with scope 4A.32 20000 296 CT Chest report + Bronchoscopy report ENDOSCOPY PICTURE
921Surgery for Cardiac Tumour/ Left Atrial (LA)
Myxoma/ Right Atrial (RA) Myxoma4A.33 95000 1300 2D ECHO with stills + CT Chest report
2D ECHO Report + stills of ECHO + Post Op X-
ray,scar photo
922 Lung Injury repair 4A.34 50000 1394 CT Chest report X-RAY, scar photo
CARDIO THORACIC SURGERY
Page 63
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
923Management of Mediastinitis / mediastinal
bleeding4A.35 40000 1395 Pre Op X-ray / CT Scan Post Op X-ray / CT Scan
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
924Hemodialysis for acutekidney injury (intiation
phase)4A.36 3750
1789, 1791,
1792
CBC,RFT,USG
Abd,HIV,HBsAg,HCV,Urine R/E
CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
R/E
925 Subsequent Hemodialysis - per session 4A.37 7501789, 1791,
1792RFT, Urine R/E RFT, Urine R/E
926
Acutekidney injury without hemodialysis,
inclusive of pre-op inv,post -op inv,procedure
cost,wards stay,and medication for 10 days
4A.38 7500 2644, 2646,
CBC,RFT,USG
Abd,HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile
CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
R/E, LFT,Lipid Profile
927
Acutekidney injury with hemodialysis, inclusive
of pre-op inv,post -op inv,procedure
cost,ICU/wards stay,and medication for 15 days
4A.39 18750 2645
CBC,RFT,USG
Abd,HIV,HBsAg,HCV,Urine R/E,
LFT,Lipid Profile
CBC,RFT,USG Abd,HIV,HBsAg,HCV,Urine
R/E, LFT,Lipid Profile
928 Trochar SPC FOR ARU/Acute Urethral injury 4A.40 1500 1606 RGU,MCU RGU,MCU
929 Reduction of Paraphimosis 4A.41 1125 248 Clinical Photograph Clinical Photograph
930 Bronchoscospy for foreign body removal 4A.42 18750428, 1405,
1565X Ray OT Notes/ X Ray
931 Airway Reconstruction for benign conditions 4A.43 37500 1458 Endoscopic Picture OT notes
932 Anorectal Malformations Stage 1 4A.44 26250 1501, 1495 USG OT notes
933 Neonatal Intestinal Atresias 4A.45 82500 1490 USG OT Notes, Scar Photo
934 Paediatric intestinal obstruction >1month 4A.46 48750 112 USG OT notes
935 Laparotomy for peritonitis 4A.47 37500 1488, 1489 USG OT notes, Scar Picture
936 Omphalocele-Major/Gastroschisis 4A.48 52500 1478, 1479 USG OT notes
937 Intussusception operative reduction 4A.49 22500 1493 USG OT notes
938 Bowel resection and anastomosis 4A.50 41250 88 USG OT notes
939 Exstropy Bladder Stage 1 4A.51 60000 1605 USG OT notes
940Craniotomy and Evacuation of Haematoma -
Subdural *4A.52 45000 1828 CT Report , X Ray OT Notes, CT Report, Clinical Photograph
941Craniotomy and Evacuation of Haematoma -
Extradural *4A.53 37500 1829 CT Report CT Report, Scar Photo, X Ray
NEUROSURGERY
GENITO URINARY
NEONATAL AND PAEDIATRIC SURGERY
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
942 Ventriculoatrial /Ventriculoperitoneal Shunt 4A.54 20250 1947 CT Report CT Report, Scar Photo, X Ray
943 Subdural Tapping/Burr 4A.55 13500 1824 CT Report CT Report, Scar Photo
944 Twist Drill Craniostomy 4A.56 11250 1823 CT report Film and scar photo
945 Abscess Tapping multiple 4A.57 15000 1826 CT report Post Op CT Report,film and scar photo
946 Excision of Brain Abcess 4A.58 37500 1831, 1832 CT report Post Op CT Report and film, Clinical
Photograph showing the scar
947 External Ventricular Drainage (EVD) 4A.59 11250 1855 CT report Post Op CT Report and film, Clinical
Photograph showing Scar
948 IV antibiotics and other supportive therapy For
Febrile Neutropenia (Per episode)4A.60 7500 2169 Haemogram for each episode
Clinical Photograph, Discharge summary (with
details of drugs given)
949 Exploratomy laparotomy 4A.61 15000 346Endoscopy with film, biopsy, CT report
with filmClinical Photograph showing scar + HPE report
950 Electric Shock 4A.62 3000 2255 Clinical Notes Clinical Notes
951 Peritonsillor abscess under LA 4A.63 1125 420 Clinical Photograph Clinical Photograph
952 Removal of foreign body from Ear 4A.64 488 393 Clinical Photograph, Otoscopic findings Clinical Photograph
953 Fracture reduction of nasal bone 4A.65 3750 2279 X Ray Nasal Bones film with reportPost op X Ray Nasal Bone film with report ,
clinical photo
954 Removal of foreign body from Nose 4A.66 488 466Clinical findings/ X Ray nose lateral
view film with report Clinical photograph
955 Drowning 4A.67 3000 NA Clinical Notes Clinical Notes
956 Bullgore Injury 4A.68 3000 NA Clinical Notes Clinical Notes
957Injuries caused while operating agricultural
equipments4A.69 3000 NA Clinical Notes Clinical Notes
958 Acute meningitis - fungal 4A.70 563/day 2753Clinical Notes with relevant
investigationsTreatment Notes
959 Acute meningitis - pyogenic 4A.71 563/day 2752Clinical Notes with relevant
investigationsTreatment Notes
ONCOLOGY
SECONDARY EMERGENCY PROCEDURES
BURNS
ENT
GENERAL EMERGENCY
GENERAL MEDICINE
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Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
960Acute Myocardial infarction ( conservative
management)4A.72 563/day 2720
Clinical Notes with relevant
investigationsTreatment Notes
961 Acute renal failure 4A.73 563/day 2745Clinical Notes with relevant
investigationsTreatment Notes
962Acute renal failure ( plus dialysis ) -
maintenance dialysis4A.74 563/day 2745, 2748
Clinical Notes with relevant
investigationsTreatment Notes
963 Acute respiratory failure ( including ventilator ) 4A.75 2625/day 2776Clinical Notes with relevant
investigationsTreatment Notes
964 Intracerebral haemorrhage (ICU) 4A.76 563/day 1976Clinical Notes with relevant
investigationsTreatment Notes
965 Mngt of Hemorrhagic Stroke/Strokes 4A.77 563/day 2604Clinical Notes with relevant
investigationsTreatment Notes
966Subarachnoid haemorrhage (ICU) - Conservative
management 4A.78 563/day 2602
Clinical Notes with relevant
investigationsTreatment Notes
967 Acute Exarcebation of COPD 4A.79 563/day 2854Clinical Notes with relevant
investigationsTreatment Notes
968 Acute Hypertension - medical management 4A.80 563/day 2592, 2621Clinical Notes with relevant
investigationsTreatment Notes
969 Asthma Acute Status 4A.81 563/day 2856, 2668Clinical Notes with relevant
investigationsTreatment Notes
970 Chicken pox- complicated 4A.82 563/day NAClinical Notes with relevant
investigationsTreatment Notes
971 COPD+ Respiratory Failure 4A.83 563/day 2558, 2557Clinical Notes with relevant
investigationsTreatment Notes
972 Food poisoning 4A.84 563/day NAClinical Notes with relevant
investigationsTreatment Notes
973 Heat stroke 4A.85 563/day NAClinical Notes with relevant
investigationsTreatment Notes
974 Malaria - complicated 4A.86 563/day 2566Clinical Notes with relevant
investigationsTreatment Notes
975 Management of Pneumothorax 4A.87 563/day 2638Clinical Notes with relevant
investigationsTreatment Notes
976 Scorpion sting 4A.88 563/day 2675Clinical Notes with relevant
investigationsTreatment Notes
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Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
977 Transforaminal Block 4A.89 563/day NAClinical Notes with relevant
investigationsTreatment Notes
978 Upper GI bleeding ( conservative) 4A.90 563/day 2901Clinical Notes with relevant
investigationsTreatment Notes
979 Control of diabetic ketoacidosis 4A.91 563/day 2629Clinical Notes with relevant
investigationsTreatment Notes
980 Cerebral infarction 4A.92 563/day 2604Clinical Notes with relevant
investigationsTreatment Notes
981 Emphysema Acute Exacerbation 4A.93 563/day 2608Clinical Notes with relevant
investigationsTreatment Notes
982 Mngt of Ischemic Strokes 4A.94 563/day 2762Clinical Notes with relevant
investigationsTreatment Notes
983 Dengue haemorrhagic fever 4A.95 563/day 2585Clinical Notes with relevant
investigationsTreatment Notes
984Dengue h'agic fever ( plus packed cell
transfusion)4A.96 563/day 2585
Clinical Notes with relevant
investigationsTreatment Notes
985 Hyper Osmolar Non Ketotic Coma 4A.97 563/day NAClinical Notes with relevant
investigationsTreatment Notes
986 Meningitis 4A.98 563/day 2613, 2624Clinical Notes with relevant
investigationsTreatment Notes
987Other Coagulation disorders ( plus blood
tranfusion units costs)4A.99 563/day 2569
Clinical Notes with relevant
investigationsTreatment Notes
988 Septic shock 4A.100 563/day 2562Clinical Notes with relevant
investigationsTreatment Notes
989 Septicemia 4A.101 563/day 2661, 2662Clinical Notes with relevant
investigationsTreatment Notes
990 Viral meningitis 4A.102 563/day 2613Clinical Notes with relevant
investigationsTreatment Notes
991 Accidental orgono phosphorus poisoining 4A.103 563/day 2563Clinical Notes with relevant
investigationsTreatment Notes
992 Acute asthamic attack 4A.104 563/day 2856Clinical Notes with relevant
investigationsTreatment Notes
993 Status epilepsy 4A.105 563/day 2764 Clinical Notes Clinical Notes
994 Staus asthamaticus 4A.106 563/day 2856 Clinical Notes Clinical Notes
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
995 TB Meningitis 4A.107 563/day 2565Clinical Notes with relevant
investigationsClinical Notes with relevant investigations
996 Tetanus 4A.108 563/day 2622Clinical notes confirming
diagnosis,spatula test
997 Snake bite 4A.109 7875/day 2687 Clinical notes, photo of bite mark
998Medical Management of Cerebral Malaria
(Falciparum)4A.110 563/day 2566, 2692 CBC, CT CBC, CT
999
Medical Management of Convulsive
Disorders/Status Epilepticus (Fits)in Paediatric
patient
4A.111 563/day 2684, 2632 EEG EEG
1000Medical Management of Encephalitis /
Encephalopathy in Paediatric patient4A.112 563/day 2631 CT CT
1001Medical Management of Neuro Tuberculosis
With Ventilation in Paediatric patient4A.113 563/day 2626 CBC, CT CBC,CT
1002 Multi System Organ Failure 4A.114 563/day 2680, 2564 CBC, CT CBC,CT
1003 Kerosene Ingestion 4A.115 563/day NAClinical Notes with relevant
investigationsTreatment Notes
1004Suspected Dengue Shock Syndrome With
Thrombocytopenia4A.116 563/day 2585 CBC
1005Medical Management of Acute Renal Failure in
Paediatric patient4A.117 563/day 2644 CBC, RFT CBC, RFT
1006Medical Management of Acute Renal Failure
With Dialysis in Paediatric patients4A.118 1125/day 2645 CBC, RFT CBC, RFT
1007 Acute Stridor/Foreign Body Obstruction 4A.119 563/day NA X-ray X-ray
1008 Radical fronto ethmo sphenodectomy 4A.120 11625 446 X-Ray PNS,CT scan of sinuses CT scan of sinuses
1009 Instestinal perforation 4A.121 6750 110 X-Ray of abdomen/CT (Upright position) Scar photo
1010 Intestinal Obstruction 4A.122 6750 112X-Ray abdomen /CT , Complete Blood
Count,USGUSG, Scar Photo
1011 Intussusception 4A.123 9375 1493USG/CT , Clinical history and physical
examination notesScar photo
GENERAL PAEDIATRICS
GENERAL SURGERY
Page 69
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Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
1012 Gastric Perforation 4A.124 9375 92, 93 X Ray abdomen ,USG Scar photo
1013 Eclampsia With Complications 4A.125 11250 810 Ultrasonography, Cinical NotesClinical Photograph,Ultrasonography, Clinical
Notes
1014Eclampsia With Complications Requiring
Ventilatory Support4A.126 21000 810 Ultrasonography Ultrasonography
1015Abruptio-Placenta With Coagulation Defects(
Disseminated Intravascular Coagulation (DiC))4A.127 18750 792
Arterial Blood Gas
(ABG),APTT(activated partial
thromboplastin
time),CHE,LFT,RFT,Haematocrit,
platelet count, S fibrogen
Biochemical investigations
1016Tension free Vaginal Tape (TVT) Repair (Stress
Urine Incontinence) {Non incl. implant}4A.128 11250 753
APTT(activated partial thromboplastin
time) , Heamatocrit , PT (Prothrombin
time), Platelet Count , S.Fibrinogen Level
, USG
Clinical Photograph of Retroplacental clots ,
USG
1017 Open Ectopic Gestation 4A.129 11250 803Serum Beta HCG, USG, CBC, Routine
investigationOT notes
1018 Manual Removal of Placenta 4A.130 3188 NA Clinical Notes/USG Clinical Notes
1019
Emergency Casearean delivery - To be provided
in private hospital only when a PHI in same
taluka does not has the medical capability.
4A.131 5175 787Clinical photograph,Clinical notes
confirming emergencyScar photo
1020 Repair of post coital tear, perineal injury 4A.132 2063 823 Clinical Notes Clinical Notes
1021 Laprotomy for ectopic repture 4A.133 9563 745, 746 Clinical Notess, USG OT Notes, HPE
1022Perforation of Uterus after D/E laprotomy and
closure4A.134 9563 728 Clinical Notes, Ultrassonography OT Notes
1023 Broad Ligment Haemotoma drainage 4A.135 5738 828 Clinical Notes, Ultrasonography OT Notes
1024 Perforating corneo - Scleral Injury 4A.136 4950 488 Scar photo
1025 Acid and alkali burns 4A.137 563 537 Clinical photograph,Rule of 9 Scar photo
1026 Deglove injury of extremities 4A.138 9000 2360, 2390complete blood count,clinical
photograph, X ray of affected partScar photo
OBSTETRICS AND GYNAECOLOGY
OPHTHALMOLOGY
POLYTRAUMA - RTA
Page 70
Sl. No Procedure Name
Arogya
Karnataka
Code
Package
Rate (in Rs.)CEA Code Pre-op Investigations Post-op investigations
1027 Inter costal drainage (icd) one side 4A.139 60001406, 2002,
2977, 17X-ray X-ray
1028 Inter costal drainage (icd)bilateral (flail chest) 4A.140 82501406, 2002,
2977, 17X-ray X-ray
1029Inter costal drainage (icd)bilateral (flail chest)
with icu stay4A.141 9000
1406, 2002,
2977, 17X-ray X-ray
1030Inter costal drainage (icd)bilateral (flail chest)
with icu stay with ventilator4A.142 10500
1406, 2002,
2977, 17X-ray X-ray
1031 Blunt injury abdomen with icu stay 4A.143 9000 NA USG USG
1032 Supra pubic cystostomy in fracture pelvis 4A.144 6000 1734, 2045 X-ray X-ray
1033 Immobilization for suspected spine injuries 4A.145 1500 1013 X-ray, CT X-ray, CT
1034 Spine injuries - with ct/mri 4A.146 5250 1013 CT/MRI CT/MRI
1035 Tracheostomy 4A.147 3750 1995 Clinical photo Clinical photo
1036 Head injury with icu (conservative)) 4A.148 5250 NA CT
1037 Head injury with icu stay (with ventilator) 4A.149 11250 NA CT
1038 Head injury with minimal surgical intervention 4A.150 18750 NA CT
1039RTA injuries associated with burns
(conservative management)4A.151 3000 2360 HB, Clinical photo
1040Simple/Compound fracture with fixator along
with implants for bones of Foot & Hand4A.152 9000
2364, 2383,
2386X-ray X-ray
1041 ICU stay other than head injury 4A.153 3000 2392, 2393 X-ray
1042Fasciotomy of upper and lower limb for
compartment syndrome4A.154 11250 956, 957, 958 complete blood count,clinical photograph Scar photo
* Procedures requiring Follow Up as per Annexure 3
POLYTRAUMA