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) |
S5 | 0001 | AC joint reconstruction/ Stabilization/ Acromionplasty (Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis) | 25,000 | Y | X rays of affected limb | X rays of affected limb | 4 | N | S |
MRI of shoulder |
S5 | 0002 | Accessory bone – Excision (limbs) – congenital, Accessory digits sometime can be removed | 3,000 | Y | X rays of affected limb | X rays of affected limb | S | N | S |
|
S5 | 0003 | Amputation – Below Elbow | 10,000 | N | | | 5 | N | S |
S5 | 0004 | Amputation – Above Elbow | 10,000 | N | | | 5 | N | S |
S5 | 0005 | Amputation – one or more fingers | 3,000 | N | | | 1 | N | S |
S5 | 0006 | Amputation – Wrist | 10,000 | N | | | 4 | N | S |
S5 | 0007 | Amputation – one or more toes/ digits | 3,000 | N | | | 1 | N | S |
S5 | 0008 | Amputation – Below Knee | 15,000 | N | | | 5 | N | S |
S5 | 0009 | Amputation – Above Knee | 18,000 | N | | | 5 | N | S |
S5 | 0010 | Foot & Hand Amputation (whole/ partial) | 10,000 | N | | | 5 | N | S |
S5 | 0011 | Disarticulation (hind & for quarter) | 25,000 | N | | Clinical report | 10-15 days of hospital stay | N | S |
| radiological investigations |
S5 | 0012 | Anterior Spine Fixation | 35,000 | N | | Clinical report | 6 | N | S |
| radiological investigations |
S5 | 0013 | Posterior Spine Fixation | 25,000 | N | | Clinical report | 5 | N | S |
| radiological investigations |
S5 | 0014 | Osteochondroma excision/ Excision of Exostosis | 10,000 | Y | Clinical report | Clinical report | 4 | N | S |
radiological investigations | radiological investigations |
S5 | 0015 | Excision Arthoplasty | 15,000 | Y | Clinical report | Clinical report | 4 | N | S |
radiological investigations | radiological investigations |
S5 | 0016 | Arthorotomy of any joint | 10,000 | N | | Clinical report, Radiological Investigations | 7-10 days hospital stay for iv antibiotics | N | S |
S5 | 0017 | Arthrodesis Ankle Triple | 15,000 | Y | Clinical report | radiological investigations | 6 | N | S |
radiological investigations | radiological investigations |
S5 | 0019 | Bimalleolar Fracture Fixation | 15,000 | N | | | 6 | N | S |
S5 | 0020 | Bone Tumour Excision + reconstruction using implant (malignant/ benign) | 70,000 | Y | Clinical report | Clinical report | 4 | N | S |
radiological investigations | radiological investigations |
S5 | 0021 | Bone Tumour (malignant/ benign) curettage and bone grafting | 20,000 | Y | Clinical report | Clinical report | | N | S |
radiological investigations | radiological investigations |
S5 | 0022 | Bone Tumour Excision (malignant/ benign) + Joint replacement (depending upon type of joint and implant) | 1,50,000 | Y | Clinical report | Clinical report | | N | S |
radiological investigations | radiological investigations |
S5 | 0023 | Clavicle fracture management – conservative (daycare) | 1,000 | N | | | D | N | S |
S5 | 0024 | Closed reduction – Hand Bones | 3,000 | N | | | 3 | N | S |
S5 | 0025 | Close reduction – Foot Bones | 3,000 | N | | | 2 | N | S |
S5 | 0026 | Close Reduction – Small Joints | 3,000 | N | | | 1 | N | S |
S5 | 0027 | Interlock Nailing + Bone Grafting – femur/tibia | 19,000 | N | | | 5 | N | S |
S5 | 0028 | Closed Interlocking Intermedullary- tibia/femur | 17,500 | N | | | 5 | N | S |
S5 | 0030 | Closed Reduction and Internal Fixation with K wire | 6,000 | N | | | 5 | N | S |
S5 | 0031 | Closed Reduction and Percutaneous Screw Fixation (neck femur) | 15,000 | N | | | 5 | N | S |
S5 | 0034 | Closed Reduction of the Hip (including hip Spika) | 7,000 | N | | | 2 | N | S |
S5 | 0035 | Debridement & Closure of Major injuries – contused lacerated wounds (anti-biotic + dressing) – minimum of 3 sessions | 7,000 | N | | | 2 | N | S |
S5 | 0036 | Debridement & Closure of Minor injuries | 1,000 | N | | | 2 | N | S |
S5 | 0037 | Closed reduction of dislocation (Knee) | 4,000 | N | | | D | N | S |
S5 | 0038 | Closed reduction of dislocation (Shoulder/ Elbow) | 3,000 | N | | | D | N | S |
S5 | 0039 | Duputryen’s Contracture release + rehabilitation | 10,000 | N | | | 5 | N | S |
S5 | 0040 | Ulnar nerve Repair | 10,000 | N | | | 4 | N | S |
S5 | 0041 | External fixation – Long bone | 15,000 | N | | | 4 | N | S |
S5 | 0042 | External fixation – Small bone | 10,000 | N | | | 2 | N | S |
S5 | 0043 | External fixation – Pelvis | 15,000 | N | | | 5 | N | S |
S5 | 0044 | Fasciotomy | 7,000 | N | | | 2 | N | S |
S5 | 0045 | Fixator with Joint Arthrolysis | 20,000 | N | | | 7 | N | S |
S5 | 0046 | Fracture – Acetabulum Open Reduction Internal Fixation | 30,000 | N | | | 7 | N | S |
S5 | 0047 | Fracture – Fibula Internal Fixation | 8,000 | N | | | 4 | N | S |
S5 | 0048 | Fracture – Hip Internal Fixation (Intertrochanteric Fracture with implant) + rehabilitation | 17,000 | N | | | 7 | N | S |
S5 | 0049 | Fracture – Humerus Internal Fixation | 17,000 | N | | | 7 | N | S |
S5 | 0050 | Fracture – Olecranon of Ulna | 8,000 | N | | | 2 | N | S |
S5 | 0051 | Fracture – Radius Internal Fixation with plate | 10,000 | N | | | 2 | N | S |
S5 | 0052 | Fracture – TIBIA Internal Fixation with plating | 17,000 | N | | | 4 | N | S |
S5 | 0053 | Fracture – Ulna Internal Fixation | 8,000 | N | | | 4 | N | S |
S5 | 0054 | Head Radius – Excision | 8,000 | N | | | 3 | N | S |
S5 | 0055 | High Tibial Osteotomy | 17,000 | N | | | 5 | N | S |
S5 | 0057 | Internal Fixation Lateral Epicondyle | 10,000 | N | | | 4 | N | S |
S5 | 0058 | Internal Fixation of other Small Bones (metatarsals) | 10,000 | N | | | 3 | N | S |
S5 | 0059 | Limb Lengthening | 25,000 | N | | | 10 | N | S |
S5 | 0060 | Llizarov Fixation | 15,000 | N | | | 6 | N | S |
S5 | 0061 | Multiple Tendon Repair | 20,000 | Y | Clinical report | Clinical Photographs Showing scar | 5 | N | S |
electro-diagnostic studies | |
S5 | 0062 | Nerve Repair Surgery | 15,000 | Y | Clinical | Clinical Photographs Showing scar | 6 | N | S |
electro-diagnostic studies | electro-diagnostic studies |
S5 | 0063 | Nerve Transposition/Release/ Neurolysis | 8,000 | Y | electro-diagnostic studies | | 6 | N | S |
S5 | 0064 | Open Reduction Internal Fixation (Fracture both bone forearm) | 10,000 | N | | | 3 | N | S |
S5 | 0065 | Open Reduction Internal Fixation (Large Bone) | 20,000 | N | | | 6 | N | S |
S5 | 0066 | Open Reduction of CDH | 30,000 | N | | | 7 | N | S |
S5 | 0067 | Open Reduction of Small Joint | 15,000 | N | | | 1 | N | S |
S5 | 0068 | Open Reduction with bone grafting of nonunion | 20,000 | N | | | 3 | N | S |
S5 | 0069 | Osteotomy -Small Bone | 10,000 | N | | | 5 | N | S |
S5 | 0070 | Osteotomy -Long Bone | 17,000 | N | | | 7 | N | S |
S5 | 0071 | Patellectomy | 8,000 | N | | | 7 | N | S |
S5 | 0072 | Pelvic Osteotomy with fixation with plaster | 30,000 | N | | | 10 | N | S |
S5 | 0074 | Excision of Bursa | 2,000 | N | | | 2 | N | S |
S5 | 0075 | Reconstruction of ACL/PCL with implant and brace | 30,000 | Y | Clinical report | Clinical report | 3 | N | S |
radiological investigations | radiological investigations |
S5 | 0076 | Sequestrectomy of Long Bones + anti-biotics + dressing | 15,000 | N | | | 7 | N | S |
S5 | 0077 | Tendo Achilles Tenotomy | 2,000 | N | | | 2 | N | S |
S5 | 0078 | Tendon Grafting | 15,000 | N | | | 2 | N | S |
S5 | 0079 | Tendon Release/ Tenotomy | 2,000 | N | | | 2 | N | S |
S5 | 0080 | Tenolysis | 3,000 | N | | | 2 | N | S |
S5 | 0081 | Tension Band Wiring Patella | 10,000 | N | | | 3 | N | S |
S5 | 0082 | Application of P.O.P. casts for Upper & Lower Limbs | 3,000 | N | | | D | N | S |
S5 | 0083 | Application of P.O.P. Spikas& Jackets | 3,500 | N | | | D | N | S |
S5 | 0084 | Application of Skeletal Tractions with pin | 3,000 | N | | | D | N | S |
S5 | 0085 | Application of Skin Traction | 1,000 | N | | | D | N | S |
S5 | 0086 | Head radius – Excision + Fracture – Ulna Internal Fixation | 15,000 | N | | | 3 | N | S |
S5 | 0087 | External fixation – both bones of forearms | 15,000 | N | | | 5 | N | S |
S5 | 0088 | Fracture intercondylarHumerus + olecranon osteotomy | 25,000 | N | | | 5 | N | S |
S5 | 0089 | Correction of club foot per cast | 3,000 | N | | | D | N | S |
S5 | 0090 | Arthroscopic Meniscus Repair/ Meniscectomy | 20,000 | Y | Clinical report | Clinical | 3 | N | S |
radiological investigations | radiological investigations |
S5 | 0091 | Total Hip Replacement (cemented) | 75,000 | Y | Clinical report | Clinical | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0092 | Total Hip Replacement (cementless) | 90,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0093 | Total Hip Replacement (hybrid) | 75,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0094 | Bipolar Hemiarthroplasty (hip & shoulder) | 40,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0095 | Unipolar Hemiarthroplasty | 30,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0097 | Elbow replacement | 40,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0098 | Arthrodesis of shoulder | 40,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0099 | Arthrodesis of Knee (with implant) | 40,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0100 | Arthrodesis of Wrist (with implant) | 30,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0101 | Arthrodesis of Ankle (with implant) | 30,000 | Y | Clinical report | Clinical report | 7 | N | S |
radiological investigations | radiological investigations |
S5 | 0102 | Arthrotomy+ synevectomy | 15000 | | | | | N | S |
S5 | 0103 | Calcaneal Supr- Excision | 2000 | | | | | N | S |
S5 | 0104 | Clavicle surgery | 15000 | | | | | N | S |
S5 | 0108 | Decompresion of carpal Tunnel syndrome | 4500 | | | | | N | S |
S5 | 0111 | Drainage of absces cold | 1250 | | | | | N | S |
S5 | 0112 | Epiphyseal stimulation | 10000 | | | | | N | S |
S5 | 0115 | Fractured fragment excision | 7500 | | | | | N | S |
S5 | 0119 | Laminectomy/Discectomy | 18000 | | | | | N | S |
S5 | 0122 | Sinus over sacrum excision | 7500 | | | | | N | S |
S5 | 0126 | Synovial cyst -excision | 7500 | | | | | N | S |
S5 | 0128 | Trigger thumb | 2500 | | | | | N | S |
S5 | 0129 | Application of functional cast brace | 1200 | | | | | N | S |
S5 | 0131 | Aspiration & intra articular injections | 1000 | | | | | N | S |
S5 | 0132 | Bandage &Stapping for fractures | 600 | | | | | N | S |
S5 | 0133 | internal wire fixation of mandible &Maxilla | 9500 | | | | | N | S |
S5 | 0134 | Reducation of compound fractures | 4000 | | | | | N | S |
S5 | 0135 | Rducation of facial fractures of maxilla | 8500 | | | | | N | S |
S5 | 0136 | Reducation of fractures of mandible & maxilla -cast netal splints | 5500 | | | | | N | S |
S5 | 0137 | Reducation of fractures of mandible & maxilla -eye let splinting | 5500 | | | | | N | S |
S5 | 0138 | Reducation of fractures of mandible & maxilla -gumming splints | 5500 | | | | | N | S |
S5 | 0139 | Fistulectomy +Sequestrectomy | 14500 | | | | | N | S |
S5 | 0142 | Above elbow post -slab for sogt tisue injury | 550 | | | | | N | S |
S5 | 0143 | Below knee post -slab for sogt tisue injury | 750 | | | | | N | S |
S5 | 0144 | Colles fracture ant.pr post,slab | 750 | | | | | N | S |
S5 | 0145 | Colles fracture Below elbow | 950 | | | | | N | S |
S5 | 0146 | Colles fracture full plaster | 1700 | | | | | N | S |
S5 | 0147 | Fingers (post, slab) | 250 | | | | | N | S |
S5 | 0148 | Fingers full plaster | 300 | | | | | N | S |
S5 | 0149 | Minerva Jacket | 1500 | | | | | N | S |
S5 | 0150 | Plaster jacket | 1500 | | | | | N | S |
S5 | 0152 | Strapping Ankle | 300 | | | | | N | S |
S5 | 0153 | Strapping Ball Bandage | 450 | | | | | N | S |
S5 | 0154 | Strapping Chest | 450 | | | | | N | S |
S5 | 0155 | Strapping colar anf cuff sling | 300 | | | | | N | S |
S5 | 0156 | strapping elbow | 300 | | | | | N | S |
S5 | 0157 | straping figure of 8 bandage | 450 | | | | | N | S |
S5 | 0158 | strapping finger | 200 | | | | | N | S |
S5 | 0159 | strapping knee | 350 | | | | | N | S |
S5 | 0160 | Strapping nasal bone fracture | 400 | | | | | N | S |
S5 | 0161 | strapping shoulder | 250 | | | | | N | S |
S5 | 0162 | strapping toes | 150 | | | | | N | S |
S5 | 0163 | strapping wrist | 300 | | | | | N | S |
S5 | 0164 | Tube plaster(or plster cylinder) | 1050 | | | | | N | S |
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