HimCare Scheme Opthalmology Package

Specialty code Package Code Package name Package Amount Preauth Required or Not (Y/N) Mandatory investigations for pre-auth Post-Op investigations for claims submission Average length of Stay (Including Days in intensive care units) Govt Reserved Procedure (Y/N) Medical (M) or Surgical (S)
S3 0001 Buckle Removal 5,000 Y Clinical Record   D N S
S3 0002 Canaliculo Dacryocysto Rhinostomy 7,000 Y Clinical Record   1 N S
S3 0003 Capsulotomy (YAG) 1,500 Y Clinical Record   D N S
S3 0004 Corneal Grafting 15,000 Y Clinical Record   3 N S
S3 0005 Prophylactic Cryoretinopexy- Closed 2,500 Y Clinical Record   1 N S
S3 0006 Cyclocryotherapy/Cyclophotocoagulation 3,000 Y Clinical Record   D N S
S3 0007 Pterygium + ConjunctivalAutograft 9,000 Y Clinical Record   D N S
S3 0008 Dacryocystectomy with implants 10,000 Y Clinical Record   D N S
SS 0009 Enucleation 6,000 Y Clinical Record   1 N S
S3 0010 Enucleation with Implant 11,000 Y Clinical Record   1 N S
S3 0011 Exenteration 15,000 Y Clinical Record   D N S
S3 0012 Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including postoperative medications for 12 weeks (and wherever surgical or laser procedures required for bleb augmentation and anterior chamber maintenance) 13,000 Y IOP   D N S
S3 0013 Intraocular Foreign Body Removal from Anterior Segment 4,000 N     D N S
S3 0014 Intraocular Foreign Body Removal from Posterior Segment 20,000 N     D N S
S3 0015 Lensectomy /pediatric lens aspiration 9,000 Y Clinical Record   D N S
S3 0016 Limbal Dermoid Removal 4,000 Y Clinical Record   D N S
S3 0017 Surgical Membranectomy 8,000 Y Clinical Record   D N S
S3 0018 Perforating Corneo – Scleral Injury 10,000 N     2 N S
S3 0019 Ptosis Surgery 10,000 Y Clinical Record   D N S
S3 0020 IRIS Prolapse – Repair 4,000 Y Clinical Record   D N S
S3 0021 Retinal Detachment Surgery 15,000 Y Clinical Record   2 N S
S3 0022 Small Tumour of Lid – Excision + Lid Reconstruction 8,000 Y Clinical Record   D N S
S3 0023 Socket Reconstruction with amniotic membrane 8,000 Y Clinical Record   1 N S
S3 0024 Iridectomy – Laser 2,000 Y Clinical Record   D N S
S3 0025 Iridectomy – Surgical 3,000 Y Clinical Record   D N S
S3 0026 Iris cyst removal  2,500 Y Clinical Record   D N S
SS 0027 Vitrectomy 7,500 Y Clinical Record   1 N S
S3 0028 Vitrectomy + Retinal Detachment surgery (pre-auth required) 17,500 Y Clinical Record   1 N S
S3 0029 Cataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech 7,500 Y Clinical Record   D N S
S3 0030 Cataract with non-foldable IOL using SICS technique 5,000 Y Clinical Record   D N S
S3 0031 Cataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech + Glaucoma 10,500 Y Clinical Record     N S
S3 0032 Cataract with non-foldable IOL using SICS technique + Glaucoma 6,500 Y Clinical Record     N S
S3 0033 Conjunctival tumour excision + AMG 5,000 Y Clinical Record   D N S
S3 0034 Entropion correction 4,000 Y Clinical Record   D N S
S3 0035 Ectropion correction  5,000 Y Clinical Record   D N S
SS 0036 Evisceration 3,500 Y Clinical Record   D N S
S3 0037 Laser for retinopathy (per sitting) 1,500 Y Clinical Record   D N S
S3 0038 Lid tear 5,000 Y Clinical Record   D N S
SS 0039 Orbitotomy 10,000 Y Clinical Record   D N S
S3 0040 Squint correction (per muscle) 4,000 Y Clinical Record   D N S
S3 0041 Anterior Chamber Reconstruction +Perforating corneo – Scleral Injury + IOL 11,500 N     2 N S
S3 0043 Abscess Drainage of lid 550 N       N S
S3 0044 Cryoretinopexy-Open 5500 Y Clinical Record     N S
S3 0045 Endoscopic Optic nerve Decompression 5500 Y Clinical Record     N S
S3 0046 Endoscopic Optic orbital Decompression 8800 Y Clinical Record     N S
S3 0047 Keratoplasty 3300 Y Clinical Record     N S
S3 0049 Tumours of IRIS 2000 Y Clinical Record     N S
S3 0050 Acid and alkali burns 500 Y Clinical Record     N S
S3 0051 Cauterisation of ulcer/subconjuctival injection-both eye 300 Y Clinical Record     N S
S3 0052 Cauterisation of ulcer/subconjuctival injection-one eye 200 Y Clinical Record     N S
S3 0053 Chalazion-both eye 600 Y Clinical Record     N S
S3 0054 Chalazion-one eye 400 Y Clinical Record     N S
S3 0055 Conjuntival Melanoma 1100 Y Clinical Record     N S
S3 0058 Epicantuhus correction 2200 Y Clinical Record     N S
S3 0060 ERG 800 Y Clinical Record     N S
S3 0061 Laser inter ferometry 1650 Y Clinical Record     N S
S3 0063 Abscess Drainage of lid +Cryoretinopexy -closed 5250 Y Clinical Record     N S
S3 0066 Syringing of lacrimal sac for both eyes 350 Y       N S
S3 0067 Syringing of lacrimal sac for one eyes 250 Y       N S

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