HimCare Scheme Orthopaedics 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)
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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