MHD Tariff2019 PDF

EMERGENCY
Schedule of Charges
2018-19
Index
Policy and guidelines 00
Package Inclusions & Exclusions 00
Department of Cardiac Sciences 00
- Cardiology 00
- CTVS 00
Department of Women & Child Care 00
- Obs & Gynae 00
- Paediatrics 00
Department of Neuro Sciences 00
- Neurology 00
- Neuro sciences 00
Department of Orthopaedics & Joint Replacement 00
- Orthopaedics 00
Department of Renal Sciences (header in one page) 00
- Nephrology 00
- Urology 00
Department of Oncology Sciences 00
- Medical Oncology 00
- Onco Surgery 00
- Radiation Oncology 00
Department of Gastroenterology 00
- Medical Gastroenterology 00
Other departments and services 00
- GI General Surgery Sciences 00
- Vascular Surgery 00
- Plastic Surgery 00
- ENT 00
- Ophthalmology 00
- Critical Care 00
- Pulmonology 00
- Anaesthesia & Pain Management 00
- IVF 00
- Psychiatry 00
- Internal medicine & Diabetes 00
- Dermatology 00
- Dental 00
- Emergency 00
- Consultation 00
- Lab diagnostics 00
- Radiology 00
- Nuclear Medicine 00
- Physiotherapy 00
- Administration 00
- In Patient Services 00
- Medical Equipment 00
- Yoga 00
- Home Care 00
1
Policy and Guidelines
1. Outpatient Consultation: OPD Consultation charges shall follow the following Bands:
Bands Slab (Rs.)
Speciality Consultants 700
Super Speciality Consultants 900
2. Registration Charges
a) Rs. 150 per registration to be charged from all patients coming to Manipal Hospital for the first time.
b) One follow-up visit for OPD is free within 3 days and One Post-op discharge visit is free within 7 days.
3. Admission & Documentation Charges
One time admission charges of Rs 1000 to be charged for every IP admissions except Daycare and New Borns. In
case TPA patient, Documentation charges ofRs500 be extra for filing and applicable for all admission except Day
Care and New Borns.
4. MLC Charges
In MLC cases an additional charges of Rs. 1,000 shall be levied to cover extra cost incurred by hospitals. This
shall only be applicable for MLC cases where patient gets admitted to our hospital and also applicable for Outside
registered MLC cases. This shall not be applicable for cases where there is direct discharge from Triage/ER
5. Triage Policy
c) Triage/ER be charges will be charged @ Rs. 500 per hour however first 3 hour of stay shall not be charged.
d) Triple Room Bed Tariff will be applicable for mapping all other services including the consultant visit,
investigations, procedures etc.
e) If the patient gets admitted as inpatient from emergency, Triage bed charges and EMO Consultation will not be
levied and Charges in such cases will be levied based on the selected room category
f) During day time (8am to 8 pm), Consultation by specialists and super specialists will be charged as per OPD
rates.
6. Emergency Visit
a) Night Emergency Timings are from 8:00PM to 8:00AM.
b) Emergency Consultant Charges (Full Day) will be charged at Rs. 750.
c) During Night,Specialists OR Super specialist Consultation will be charged at twice the day time charges.
d) If the Specialist Doctor is present in theOPD during non emergency hours, no extra charge for Emergency
reference except for normal tariff will be levied.
7. Day Care Policy
a) Day Care room charges will be Rs 3000
b) Consultant Visit Charges, Surgeon fee, Procedure fee and other charges will be charged as per Triple Room
bed category.
c) In case of Day Care surgical procedures, Primary Surgeon shall charge consultation for one visit only.
8. Billing Cycle
a) Billing cycle will start from the time of admission and is from 12 noon to 12 noon. Therefore, 12 noon is the
checkout time for discharge. This policy however is not applicable in case of Day care.
b) At the time of discharge, a grace period of three (3) hours will be given and shall not attract additional charges,
however beyond 3 hrs grace period, full day bed charges shall be levied for that day.
c) Bed and Inpatient Consultation Charges:
Sl No Bed Category Bed Charges Consultant Charges

1 Triple Room 3700 1100
2 Double Room 5900 1300
3 Single Room 9800 1700
4 Daycare Room Charges 3000 1100
5 ICU/CCU/CTICU 13300 2500
2
Sl No Bed Category Bed Charges Consultant Charges
6 PICU 13300 2500
7 NICU - High Intensive 13300 2500
8 NICU - Low Intensive 11600 2500
9 HDU 11600 1700
9. Room Policy
a) Room tariff includes standard fittings in the room according to the type of Occupancy / Laundry Services /
Food & Beverage for Patients only / House-keeping services.
b) Any additional Food & Beverage for anybody other than Patient will be charged as per our cafeteria tariff. Any
additional Food & Beverage for Patient will be charged extra as per the cafeteria tariff.
c) If the Patient’s Attendant retains the room while the Patient is in HDU/ICU/NICU/PICU additional charges
for the Room and Food & Beverage would be levied. In such cases Room would be provided subject to
availability.
d) ICU bed tariff includes Room rent, RMO charges, Nursing Charges,Infusion/ Syringe Pump , Oxygen, Pulse
Oxymeter and Cardiac Monitoring. ICU bed tariff does not include Specialty Doctors Visit, Intensivist Charges,
Ventilator / Bipap(Initiation or Maintenance Charges), DVT Pump , Alpha Bed , any special monitoring/
equipment, Investigations, Procedures, Consumables and Medicines.
e) Single Room Tariff will be applicable for mapping of all the charges like procedures, surgeries, investigations
etc with ICU Bed category.
f) If a new born baby with mother is admitted, the charges levied for the mother shall be applicable in the baby’s
case New born baby shall be charged as per the bed category of mother for all the services rendered.
10. IP Consultation Policy
a) In IPD, the admitting doctor (Primary Consultant) will be entitled to maximum of two IP visits per day. Doctor
charges are twice a day either by doctor / unit / team.
b) IP Night Visit Charges (8pm to 8 am) are applicable as per bed category where consultants come in night and
admission takes place which is twice the normal rates.
c) In ICU/CCU/CTICU/HDU, One visit will be charged by respective critical care unit (Intensivist) and one visit will
be charged by admitting consultant.
d) Paediatrician consult for new born will be charged as per mother’s category.
e) In case of surgery, up to first 24 hrs of surgery, no IPD consult of primary surgeon or unit will be charged to
patient. Thereafter, they may be charged up to two visits per day.
f) Dietician Charges as per Bed Category will be applicable once during patient stay in the hospital and shall be
ordered at the beginning. It shall be charged from Inpatient admissions excluding Day Care, NICU and other
patients where this service is not availed.
11. Surgery / Anesthesia Charges
Description % of Surgeon fee
OT/Cath Lab Charges 110%
Anesthesia Charges 25%
Minor OT Charges (Ground Floor) 2500 per sitting
b) Standby Charges for Anesthetist will be charged at 20% of the Professional Fee for all surgeries and
procedures, wherever applicable.
c) If standby Anesthetist is required during MRI/CT Rs 1000 shall be levied and shall be charged over and above
the respective procedure charges.
12. Policy Related to Surgery
a) In case of multiple surgeries, the surgery with the higher surgeon fee will be considered as Primary surgery and
all other charge related calculations will be based on this Primary Surgery.
b) If the same surgeon performs more than one procedure in the same sitting, on the same area of body and is
related, then the surgery costing the higher shall be billed as 100% followed by the Surgeries costing lesser
at 50 % each. If the surgeries are carried out on different body parts and is unrelated by the same/different
surgeons then the both the surgeries will be charged full as per the schedule. However Prior approval from
DMS would be required for charging second surgery.
3
c) In case a surgeon requires the presence of another surgeon – Co opted surgeon (This does not mean an
assistant surgeon and is a surgeon of different department whose services are sought for surgery) may be
levied. However, in special cases and with concurrence of DMS, additionally for routine cases 25% of the
surgical fee and for emergency 50% of the surgical fee will be charged. Patients in such cases should be
informed beforehand about this additional charge during surgery.
d) If two or more surgeons perform two or more different surgeries / procedures, they shall be entitled to their
individual full surgeon’s fee for their respective procedures. The Procedure charges shall be levied for each
procedure.
13. Redo / Re exploration Policy
a) For Redo/ Reexploration Surgery within 24 hrs, only consumables shall be charged (no extra cost for Surgeon
Fee, OT or Anaesthesia) with prior approval from DMS.
b) For Redo/ Re-explorationSurgery after 24 hrs, 100% of surgeon fee. However, OT charges, Anaesthesia fee
shall be charges as per the tariff. consumables & pharmacy will be charged as per actuals.
14. Change of Category of Bed
a) In case a patient is transferred from a lower to a higher category of room after the surgery / procedure, all the
charges including surgery / procedure/ investigations will be charged according to the higher bed category
however the bed charges and the doctors visit charges would be as per the higher room category from the
day of transfer.
b) In case the patient is transferred from higher to lower category of room after the surgery / procedure, all
thecharges including surgery / procedure / investigations and other particulars till the time of transfer will be
charged according to the original / higher room category however the bed charges and the doctor’s visit
charge would be as per the opted/ lower bed category from the day & time of transfer.
c) When a patient is admitted directly to an ICU bed, the charges for procedure/ surgery / investigations shall be
according to Single room category during the stay in ICU. However, if the patient opts for occupancy higher
than the Single room category at the time of transfer from ICU, the procedure/ surgery / investigation shall be
charged according to the higher category from the day of transfer.
d) At the time of transfer from ICU, if the patient opts for a bed category lower than the Single Room, the cost of
procedure/ surgery/ investigations already done shall be charged as per Single Room category only.
e) If the patient is transferred to ICU during the course of IP stay, then the surgery / procedure/ investigations shall
remain same as per original Bed occupied charges. However, ICU charges will be levied during actual duration
of stay in the ICU.
f) In case of packages if up gradation of bed is done the package would be charged as per higher bed category.
g) Where a patient is to be admitted and the desired category of bed is not available, the patient may be admitted
in the next available higher category bed & would be shifted to the desired bed category as soon as available.
Patient will be charged as per the desired bed category. In case patient refuses to shift and choose to stay in
the provided higher category then the complete bill will be as per the higher bed category.
15. Equipment Charging Policy:
a) Wherever any special equipment will be used for the surgery or procedure, it will be charged additional for the
below mentioned list @ 20% of surgeon fees
b) For equipments other than mentioned below shall be charged as mentioned in SOC.
c) In case of Multiple surgeries, the special equipment charges would be taken as per higher Surgeon Fees.
d) If More than one In-house equipment is used for the patient in one sitting, then only one equipment (higher
value) will be charged.
e) In case C arm is used along with any other equipment, then the charges for C-Arm shall also be levied in
addition to the other equipment charge.
f) If outsourced (rental) equipment is also used with in-house equipment, then both will be charged.
g) Disposable and handheld accessories for special equipment will be charged additional as per actuals
16. Advance Policy:
Minimum Advance to be collected as per Room Category
Single room - Rs 50,000/-
Double room - Rs 30,000/-
Triple room - Rs 15,000/-
Day Care - Rs 10,000/-
4
1. CASH PATIENTS
A. Medical / Conservative Management
80% Of the Total estimate given to the patient is to be deposited at the time of Admission.
OR Minimum Advance Deposit as per Room Category
B. Surgical Management
100% of the Estimated expenses to be taken as an advance at the time of admission /before giving OT
clearance.Cases where package rates are applicable, entire package cost is to be taken as Advance.
2. TPA PATIENTS
A. Medical /Conservative Management
• In cases where TPA full approval has been received- minimum Rs 5000/- is to be taken against the non
payable items.
• In cases where approval received is lesser than the estimate provided- differential amount to be collected at
the time of Admission (80% of the total estimate or the Minimum advance against Room category).
• In cases where approval is not received then it will be treated as Cash patient till approval is received and
minimum advance is deposited as per Room Category highlighted above.
B. Surgical Management
• In cases where TPA full approval has been received- minimum Rs 5000/- is to be taken against the non
payable items.
• In cases where approval received is lesser than the estimate provided- differential amount to be collected at
the time of Admission (100% of the total estimate).
• In cases where approval is not received then it will be treated as Cash patient till approval is received and
100% of the estimated expenses to be taken as an advance. Cases where package rates are applicable, entire
package cost is to be taken as Advance.
Note:
In all cases where inappropriate advance is deposited by patient (after approved by the concerned authority-AMS/
MOD) an UNDERTAKING FROM PATIENT IS MANDATORY.
LIFE THREATNING CASES (also during silent hours) do not require mandatory advance deposit at the time of
admission. In all cases where proper advance is not taken, an UNDERTAKING will be taken by patient/attendant after
receiving approval from the DMS/MOD.
16. Refund Policy:

Any refund of amount less than Rs 5000/- would be made in cash. Any refund of amount for Rs 5000/- or more
would be made by cheque or NEFT in the name of the patient /attendant only. Refund cheques can be collected after
settlement of bill on submission of original advance receipt.
17. Other Rules
• All implants used in the surgery / package will be charged as per hospital policy
• For Radiology investigations, patient will get CD’s instead of films, however Film charges for the procedure /
investigation will be charged extra if asked for.CD’s will be provided along with the report.
• No discounts are applicable on Packages and Outsource Investigations or TPA cases etc.
• No separate invoice will be provided in any circumstances.Implant sticker (if any) will be provided as per
request andapproval by DMS.
• High Risk Policy , separate surgical codes for high risk cases
• Any tax as per Government policy will be levied as per actual e.g. Service tax on cosmetic surgery procedures,
TDS, TCS etc.
Note(s):
This policy is applicable only for prevailing Financial Year and schedule of charges is liable to change without prior
notice
5
Inclusions / Exclusion
6
Obs & Gyn Packages
7
Service Billing Billing Triple Double Single
Package name
code Group Subgroup Bed Room Room
OBG
KOBG003 NORMAL DELIVERY -PACKAGE Package 60000 67000 75000
PACKAGE
Ward Stay upto 2 days,Admission charges, Procedure Fees, Consultation by Obs & Gyn during package days, Labour Room Charges,
Inclusions
Investigation as specified in Annexure - 1a, Continuous Fetal Monitoring, Pharmacy & Consumable upto 7000.
Stay above Package days will be billed as per actuals, Investigations and Blood & blood Products and any other service not
Exclusions
specified, Cross referral visit ,High value medicine, Epidural Analgesia not included.
OBG
KOBG004 NORMAL DELIVERY -BABY PACKAGE Package 1 1 1
PACKAGE
Stay alongwith mother for 2 days, Paediatric resuscitation charges, Consultations by the paediatrician during package days,
Inclusions Vaccination of baby (OPV+Hep.B+ BCG), Pulse oxymetry Screening for Critical Congenital Heart Disease, New Born Screening,
Investigation as specified in Annexure 1b- Pharmacy & Consumable upto Rs 1000.
Stay above Package days and stay in NICU will be billed as per actuals , Investigations and Blood & blood Products and any other
Exclusions
service not specified in inclusion, Cross referral visit ,High value medicine not included.
OBG
KOBG023 INSTRUMENTAL DELIVERY -PACKAGE Package 62000 70000 80000
PACKAGE
Ward Stay upto 2 days,Admission charges, Procedure Fees, Consultation by Obs & Gyn during package days, Labour Room Charges,
Inclusions
Investigation as specified in Annexure - 1a, Continuous Fetal Monitoring, Pharmacy & Consumable upto 7000.
Stay above Package days will be billed as per actuals, Investigations and Blood & blood Products and any other service not
Exclusions
specified, Cross referral visit ,High value medicine, Epidural Analgesia not included.
OBG
KOBG024 INSTRUMENTAL DELIVERY -BABY PACKAGE Package 1 1 1
PACKAGE
Stay alongwith mother for 2 days, Paediatric resuscitation charges, Consultations by the paediatrician during package days,
Inclusions Vaccination of baby (OPV+Hep.B+ BCG), Pulse oxymetry Screening for Critical Congenital Heart Disease, New Born Screening,
Investigation as specified in Annexure 1b- Pharmacy & Consumable upto Rs 1000.
Exclusions
OBG
KKOBG005 CAESARIAN SECTION - PACKAGE Package 67000 75000 85000
PACKAGE
Ward Stay upto 3 days, Surgeon fees, Anaesthetist Fees, OT and Anasthsesia charge,Consultation by the operating surgeon during
Inclusions
package days, Continuous Fetal Monitoring, Investigation as specified in Annexure 1a, Pharmacy & Consumable upto Rs 15000.
Stay beyond limit, Investigation , Blood & Blood Products and any other service not specified , Epidural Analgesia not included
Exclusions
,Pediatric package as per Delivery Baby Charges.Cross Referral Visit
OBG
KOBG006 CAESARIAN SECTION - BABY PACKAGE Package 1 1 1
PACKAGE
Room stay alongwith mother up to 3 days, Paediatric resuscitation charges, Consultations by the paediatrician during package
Inclusions days, Vaccination of baby (OPV+Hep.B+ BCG), Pulse oxymetry Screening for Critical Congenital Heart Disease, New Born Screening,
Investigation as specified in Annexure 1b, Pharmacy & Consumable upto Rs 1000.
Exclusions
OBG
KKOBG025 CAESARIAN SECTION - PACKAGE- M Package 80000 90000 105000
PACKAGE
Inclusions
8
Service Billing Billing Triple Double Single
Package name
code Group Subgroup Bed Room Room
Stay beyond limit, Investigation , Blood & Blood Products and any other service not specified , Pulse oxymetry Screening for Critical
Exclusions Congenital Heart Disease, New Born Screening, Epidural Analgesia not included ,Pediatric package as per Delivery Baby Charges.
Cross Referral Visit
OBG
KOBG026 CAESARIAN SECTION - BABY PACKAGE-M Package 1 1 1
PACKAGE
Exclusions
OBG
KKOBG027 CAESARIAN SECTION - PACKAGE-High Risk Package 84000 94000 106000
PACKAGE
Inclusions
Stay beyond limit, Investigation , Blood & Blood Products and any other service not specified , Epidural Analgesia not included
Exclusions
,Pediatric package as per Delivery Baby Charges.Cross Referral Visit
OBG
KOBG028 CAESARIAN SECTION - BABY PACKAGE -High Risk Package 1 1 1
PACKAGE
Exclusions
OBG
KKOBG010 D & C OR MTP UNDER GA - PACKAGE Package 15000 17000 20000
PACKAGE
Room Stay upto 1 day , Surgeon Fees, Anaesthetist Fees, OT & Anaesthesia Charges ,PAC,Routine Pharmacy & consumable up to Rs
Inclusions
2500.
Stay beyond limit, Investigations ,Blood and Blood products and any other service not specified in inclusions. Pharmacy &
Exclusions
Consumable over and above the limit defined, Cross referral visit.
Annexure
Annexure: 1 a Investigation: Mother QTY
H0014 Complete Blood Counts (Automated) 1
H0059 Prothrombin Time - PT (Automated/ Clotting Assay ) 1
POBG029 CONTINUOUS FETAL MONITORING 1
Annexure: 1 b Investigation: New Born

PCYT53 New Born screenings - CYT(7 Days) 1
PPED069 OAE SCREENING 1
B0107 Neonatal Blood Grouping & AB Screening 1
9
Ortho Packages
10
Service Billing Double Single
Package name Billing Subgroup Triple Bed
code Group Room Room
ORTHOPAEDICS
KKORT016 TOTAL KNEE REPLACEMENT - UNILATERAL - PACKAGE Package 169990 187000 203980
PACKAGE
Ward Stay upto 7 days, Admission charges, Procedure Fees, Consultation by Orthopaedic, Cardiology , Internal Medicine during
Inclusions package days, OT Charges, Investigation as specified in Annexure , OT Pharmacy & Consumable upto Rs 13,000 , OT Consumables
upto Rs 20,000 , Physiotherapy during days, Radiology upto Rs 2,200.
Stay above Package days will be billed as per actuals, ICU Stay ,Investigations and Blood & blood Products and any other service not
Exclusions
specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication
ORTHOPAEDICS
KKORT019 TOTAL KNEE REPLACEMENT - BILATERAL - PACKAGE Package 316790 348500 380150
PACKAGE
upto Rs 30,000 , Physiotherapy during package days, Radiology upto Rs 4,000.
Exclusions
specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication
ORTHOPAEDICS
KKORT017 TOTAL HIP REPLACEMENT - UNILATERAL - PACKAGE Package 200890 221000 241070
PACKAGE
upto Rs 20,000 , Physiotherapy during package days, Radiology upto Rs 2,600.
Exclusions
specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication.
ORTHOPAEDICS
KKORT020 TOTAL HIP REPLACEMENT - BILATERAL - PACKAGE Package 285890 314500 343060
PACKAGE
upto Rs 30,000 , Physiotherapy for package days, Radiology upto Rs 3,600.
Exclusions
specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined.
Annexure
LAB INVESTIGATIONS COVERED QTY
B0036 Packed RBC/RCC - Reserve/Crossmatch 2
H0006 APTT ( Automated / Clotting Assay ) 1
H0029 Haemoglobin ( Automated ) 2
H0052 PCV (Packed Cell Volume) ( Automated ) 2
H0059 Prothrombin Time -PT ( Automated/ Clotting Assay ) 2
H0090 Urine Routine and Microscopy ( Qualitative Method) 2
C0432 Renal Panel - I - Random 1
H0014 Complete Blood Counts (Automated) 1
M0089 HBSAG (Rapid Test) 1
M0115 HIV I & II (Rapid Test) 1
M0180 Urine Culture 1
PROCEDURES - AS PER BELOW LIST QTY
DCAR001 E C G - Adult 1
DCAR003 Echo-Cardiogram 1
PANA001 PATIENT CONTROLLED ANALGESIA 1
11
CTVS Package
12
Double Single
Service code Package name Triple Bed
Room Room
KCTS003 CABG + VALVE SURGERY PACKAGE 3,35,210 3,99,050 4,62,900
Stay upto 8 days, OT /Ward Pharmacy Rs 67,000/- OT /Ward Stock upto Rs. 1,00,600/- , Surgeon Fees, Anaesthetist Fees, OT &
Inclusion
Anaesthesia Charges, Lab Services Rs 33,500 , Radiology Services - Rs 10,100/- , Oxygen , Ventillator , Cardiac Monitor Charges
Stay more than limit, Pharmacy/ Consumables/Investigation/blood more than the limit specified, Vist of any other speciality
Exclusion doctor, Cost of Graft/implant extra, Cell Saver, IABP, Valve, Hemofilter, Swan Ganz catheter, Maze Procedure additional , Discharge
Medication
KCTS045 CABG PACKAGE 2,74,810 3,02,320 3,29,780
Stay upto 8 days, OT /Ward Pharmacy Rs 55,000/- OT /Ward Stock upto Rs. 82,400/- , Surgeon Fees, Anaesthetist Fees, OT
Inclusion
& Anaesthesia Charges, Lab Services Rs 27,500 , Radiology Services - Rs 8,200/- , Oxygen , Ventillator , Cardiac Monitor Charges
Medication
KCTS004 CLOSURE OF ASD PACKAGE 3,26,030 3,88,130 4,50,230
Inclusion
Exclusion doctor, Cost of Graft/implant extra, Cell Saver, IABP, Valve, Hemofilter, Swan Ganz catheter, Maze Procedure additional, Discharge
Medication
KCTS005 CLOSURE OF PDA PACKAGE 2,30,880 2,74,850 3,18,830
Inclusion
Medication
KCTS014 HEART SURGERY - (CLOSED) PACKAGE 2,51,650 2,99,580 3,47,510
Inclusion
Meedication
KCTS015 HEART SURGERY - (OPEN) PACKAGE 4,14,660 4,93,640 5,72,620
Inclusion
Medication.
KCTS032 VALVE MULTIPLE PACKAGE 3,59,240 4,27,660 4,96,090
Inclusion
13
Double Single
Service code Package name Triple Bed
Room Room
Medication
KCTS034 VALVE SINGLE PACKAGE 2,93,430 3,49,320 4,05,210
Inclusion
Medication
14
Cardiology Packages
15
Service Triple Double Single
Package name
code Bed Room Room
KCAR002 ANGIOGRAM CORONARY PACKAGE 17,080 18,790 20,500
Stay upto 1 day, Pharmacy & consumables during package days , Surgeon fee, Cath lab charge and investigations as specified in
Inclusion
Annexure.
Stay more than limit, Pharmacy/ Consumables/Investigation more than specified days, Vist of any other speciality doctor,
Exclusion Physiotherapy, Cost of Stent/Graft/Valve Implant extra, General Anesthesia /Regional Anesthesia charges additional if required , High
Value Medicine ,Discharge Medication.
KCAR006 ANGIOGRAM PERIPHERAL PACKAGE 16,670 19,840 23,020
Inclusion
Annexure.
KCAR007 ANGIOGRAM RENAL/CAROTID PACKAGE 16,670 19,840 23,020
Inclusion
Annexure.
KCAR012 ANGIOPLASTY PTCA - SINGLE VESSEL PACKAGE 1,06,950 1,17,650 1,28,340
Stay upto 3 days, Pharmacy & consumables during package days, 1 Balloon ,Surgeon fee, Cath lab charge and investigations as
Inclusion
specified in Annexure.
KCAR011 ANGIOPLASTY PTCA - MULTIPLE VESSEL PACKAGE 2,03,950 2,42,800 2,81,650
Inclusion
KCAR010 ANGIOPLASTY PRIMARY - SINGLE VESSEL PACKAGE 2,02,860 2,41,500 2,80,140
Inclusion
KCAR008 ANGIOPLASTY PERIPHERAL PACKAGE 1,03,850 1,23,630 1,43,410
Inclusion
KCAR023 PERMANENT PACEMAKER IMPLANTATION - SINGLE CHAMBER PACKAGE 70,500 83,900 97,400
16
Package name
code Bed Room Room
Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in
Inclusion
Annexure.
KCAR022 PERMANENT PACEMAKER IMPLANTATION - DOUBLE CHAMBER PACKAGE 81,000 96,400 1,11,900
Inclusion
Annexure.
KCAR014 BIVENTRICULAR PACING PACKAGE 2,03,470 2,42,220 2,80,980
Inclusion
Annexure.
KCAR021 EPS DIAGNOSTIC PACKAGE 54,830 65,270 75,710
Inclusion
Annexure.
KCAR026 RF ABLATION SIMPLE PACKAGE 81,510 97,040 1,12,560
Inclusion
Annexure.
KCAR029 RF ABLATION COMPLEX PACKAGE 1,18,700 1,41,310 1,63,920
Inclusion
Annexure.
KCAR018 DEVICE CLOSURE - PDA PACKAGE 73,060 86,970 1,00,890
Inclusion
Annexure.
KCAR017 DEVICE CLOSURE - ASD PACKAGE 1,06,990 1,27,370 1,47,750
Inclusion
Annexure.
17
Package name
code Bed Room Room
KCAR013 BALLON SEPTOSTOMY PACKAGE 74,990 89,270 1,03,560
Inclusion
Annexure.
KCAR015 BPV/BAV PACKAGE 78,850 93,870 1,08,890
Inclusion
Annexure.
INVESTIGATION ANNEXURES: (Any of the investigation from the below mentioned)
Subgroup Service Name Service Code

HAEMATOLOGY APTT ( Automated / Clotting Assay ) H0006
HAEMATOLOGY Complete Blood Counts (Automated) H0014
HAEMATOLOGY Prothrombin Time -PT ( Automated/ Clotting Assay ) H0059
MICROBIOLOGY HBSAG (Rapid Test) M0089
MICROBIOLOGY Hepatitis B Surface Antigen (Hbsag) - Elisa M0101
MICROBIOLOGY Hepatitis C Virus Antibody (Elisa) M0103
MICROBIOLOGY HIV I & II (Rapid Test) M0115
MICROBIOLOGY Human Immuno Virus (HIV I + II) - Elisa M0128
BIOCHEMISTRY Bilirubin - Direct C0042
BIOCHEMISTRY Bilirubin -Total C0043
BIOCHEMISTRY Bilirubin Total/Direct C0044
BIOCHEMISTRY Blood Gas Analysis C0052
BIOCHEMISTRY Cholesterol - Hdl C0079
BIOCHEMISTRY Cholestrol - Ldl C0082
BIOCHEMISTRY Electrolytes (Na, K & Cl) C0142
BIOCHEMISTRY Lipid Profile C0214
BIOCHEMISTRY Liver Function Test C0218
BIOCHEMISTRY T.Chol/Hdl.Chol Ratio C0320
BIOCHEMISTRY Transferrin Saturation C0334
BIOCHEMISTRY Renal Panel - I - Fasting C0429
BIOCHEMISTRY Renal Panel - II - Fasting C0430
BIOCHEMISTRY Renal Panel - III - Fasting C0431
18
Subgroup Service Name Service Code
BIOCHEMISTRY Renal Panel - I - Random C0432
BIOCHEMISTRY Renal Panel - II - Random C0433
BIOCHEMISTRY Renal Panel - III - Random C0434
CARDIOLOGY Echo-Cardiogram DCAR003
XRAY Plain Xray Dept/Portable Xray Dept DRAD114
HAEMATOLOGY Differential Count( Automated Cell Counter ) H0018
HAEMATOLOGY ESR ( Automated ) H0019
HAEMATOLOGY Haemoglobin ( Automated ) H0029
HAEMATOLOGY Hb,TLC, DLC ( Automated ) H0034
HAEMATOLOGY Platelet Count ( Automated ) H0055
HAEMATOLOGY Bleeding and Clotting Time( Ivys & Lee Method ) H0008
HAEMATOLOGY RBC Count ( Automated ) H0060
HAEMATOLOGY TC (Total Count)( Automated ) H0074
HAEMATOLOGY Urine Routine and Microscopy ( Qualitative Method) H0090
BIOCHEMISTRY Bun (Blood Urea Nitrogen) C0059
BIOCHEMISTRY Calcium - Total C0066
BIOCHEMISTRY Cholesterol - Total C0080
BIOCHEMISTRY Cholesterol - Vldl C0081
BIOCHEMISTRY Creatinine- Serum C0105
BIOCHEMISTRY Glucose - Fasting C0168
BIOCHEMISTRY Glucose - Post Prandial (Ppbs) C0169
BIOCHEMISTRY Glucose (Urine Random) C0170
BIOCHEMISTRY Glucose ( Spot ) C0172
BIOCHEMISTRY Phosphorus - Serum C0263
BIOCHEMISTRY Potassium - Serum C0290
BIOCHEMISTRY Protein Total C0297
BIOCHEMISTRY SGOT ( Ast ) C0311
BIOCHEMISTRY SGPT ( Alt ) C0312
BIOCHEMISTRY Sodium - Serum C0315
BIOCHEMISTRY Total Protein/ Albumin / Globulin /A:G C0332
BIOCHEMISTRY Uric Acid - Serum C0341
BLOOD BANK Blood Grouping Rh Typing & Antibody B0007
CARDIOLOGY E C G - Adult DCAR001
19
Department of
Cardiac Sciences
20
Cardiology
21
Cardiology
Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL
CARDIOLOGY ANGIO
KCAR006 ANGIOGRAM PERIPHERAL PACKAGE Package 0 16670 19840 23020
PACKAGE
CARDIOLOGY ANGIO
KCAR007 ANGIOGRAM RENAL/CAROTID PACKAGE Package 0 16670 19840 23020
PACKAGE
CARDIOLOGY ANGIO
KCAR002 ANGIOGRAM CORONARY PACKAGE Package 0 17080 18790 20500
PACKAGE
CARDIOLOGY ANGIO
KCAR004 ANGIOGRAM DAYCARE PACKAGE Package 0 17080 18790 20500
PACKAGE
ANGIOGRAM CORONARY + PERIPHERAL CARDIOLOGY ANGIO

KCAR003 Package 0 29710 35370 41030
PACKAGE PACKAGE
CARDIOLOGY PLASTY
KCAR008 ANGIOPLASTY PERIPHERAL PACKAGE Package 0 103850 123630 143410
PACKAGE
ANGIOPLASTY PRIMARY - SINGLE CARDIOLOGY PLASTY

KCAR010 Package 0 202860 241500 280140
VESSEL PACKAGE PACKAGE
ANGIOPLASTY PTCA - SINGLE VESSEL CARDIOLOGY PLASTY

KCAR012 Package 0 106950 117650 128340
PACKAGE PACKAGE
ANGIOPLASTY PTCA - MULTIPLE VESSEL CARDIOLOGY PLASTY

KCAR011 Package 0 203950 242800 281650
PACKAGE PACKAGE
DIAGNOSTIC PAEDIATRIC CARDIOLOGY ANGIO

KCAR020 Package 0 37800 45000 52200
CATHETERIZATION PACKAGE PACKAGE
KCAR030 FRACTIONAL FLOW RESERVE Package CARDIOLOGY PACKAGE 0 26090 31050 36020
KCAR033 FFR- Cath Procedure Package CARDIOLOGY PACKAGE 0 30550 36370 42190
KCAR035 IVUS-Cath Procedure Package CARDIOLOGY PACKAGE 0 36230 43130 50030
KCAR021 EPS DIAGNOSTIC PACKAGE Package CARDIOLOGY PACKAGE 0 54830 65270 75710
KCAR018 DEVICE CLOSURE - PDA PACKAGE Package CARDIOLOGY PACKAGE 0 73060 86970 100890
KCAR017 DEVICE CLOSURE - ASD PACKAGE Package CARDIOLOGY PACKAGE 0 106990 127370 147750
KCAR013 BALLON SEPTOSTOMY PACKAGE Package CARDIOLOGY PACKAGE 0 74990 89270 103560
KCAR015 BPV/BAV PACKAGE Package CARDIOLOGY PACKAGE 0 78850 93870 108890
KCAR024 PTMC / PTMV PACKAGE Package CARDIOLOGY PACKAGE 0 81510 97040 112560
KCAR025 PTSMA PACKAGE Package CARDIOLOGY PACKAGE 0 152630 181700 210780
KCAR026 RF ABLATION SIMPLE PACKAGE Package CARDIOLOGY PACKAGE 0 81510 97040 112560
KCAR029 RF ABLATION COMPLEX PACKAGE Package CARDIOLOGY PACKAGE 0 118700 141310 163920
CARDIOLOGY PLASTY
KCAR016 CARTO PACKAGE Package 0 161690 192490 223280
PACKAGE
PERMANENT PACEMAKER
KCAR023 IMPLANTATION - SINGLE CHAMBER Package CARDIOLOGY PACKAGE 0 70500 83900 97400
PACKAGE
22
Cardiology
PERMANENT PACEMAKER
KCAR022 IMPLANTATION - DOUBLE CHAMBER Package CARDIOLOGY PACKAGE 0 81000 96400 111900
PACKAGE
CARDIOLOGY PLASTY
KCAR014 BIVENTRICULAR PACING PACKAGE Package 0 203470 242220 280980
PACKAGE
DCAR001 ECG- Adult Procedure CARDIOLOGY 360 360 400 440
DCAR020 6 MINUTE CARDIAC WALK Procedure CARDIOLOGY 610 640 770 890
PCAR008 FLASH CARD ANALYSIS Procedure CARDIOLOGY 760 800 950 1110
PCAR010 LIFE STYLE COUNSELLING Procedure CARDIOLOGY 760 800 950 1110
PCAR011 PACEMAKER ANALYSIS Procedure CARDIOLOGY 960 1010 1200 1390
DCAR018 EVENT RECORDER - CARDIOLOGY Procedure CARDIOLOGY 1100 1150 1370 1590
PACEMAKER INTERROGATION /
DCAR013 Procedure CARDIOLOGY 1780 1860 2220 2570
PROGRAMME - Single Chamber
PCAR001 COMPACT DISC - COST Procedure CARDIOLOGY 1910 2010 2390 2770
PACEMAKER INTERROGATION /
DCAR014 Procedure CARDIOLOGY 2330 2440 2910 3370
PROGRAMME - Dual chamber
DCAR003 Echo-Cardiogram Procedure CARDIOLOGY 3000 3000 3300 3600
DCAR019 ECHO CARDIOGRAM - (N) Procedure CARDIOLOGY 3830 4030 4790 5560
DCAR002 Echo-Cardiogram - Paediatrics Procedure CARDIOLOGY 2600 2730 3250 3770
PCAR006 ECHO-SCREENING Procedure CARDIOLOGY 960 1010 1200 1390
DCAR023 3D - ECHO Procedure CARDIOLOGY 3560 3740 4450 5160
DCAR012 Tread Mill Test Procedure CARDIOLOGY 2500 2500 2750 3000
PCAR009 HOLTER Procedure CARDIOLOGY 2740 2880 3430 3970
DCAR022 STRESS ECHO Procedure CARDIOLOGY 3560 3740 4450 5160
TEE - TRANSOESOPHAGEAL
PCAR012 Procedure CARDIOLOGY 4240 4450 5290 6140
ECHOCARDIOGRAPHY
DCAR024 CRT ECHO ( PRE & POST ECHOS) Procedure CARDIOLOGY 4240 4450 5290 6140
DCAR021 ANGIODEFENDER Procedure CARDIOLOGY 3140 3300 3930 4560
DCAR015 BIVENTRICULAR PACING / CRT Procedure CARDIOLOGY 3420 3590 4270 4960
DCAR016 EXTENDED HOLTER Procedure CARDIOLOGY 3420 3590 4270 4960
DCAR017 AMBULATORY BP RECORDER Procedure CARDIOLOGY 3560 3740 4450 5160
PCAR013 PERICARDIAL ASPIRATION Procedure CARDIOLOGY 11480 12060 14350 16650
PCAR014 T P I (TEMPORARY PACING) Procedure CARDIOLOGY 11480 12060 14350 16650
PCAR015 IABP Procedure CARDIOLOGY 39620 41600 49530 57450
23
CTVS
24
CTVS
Billing
Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL
Group
CARDIOTHORACIC
KCTS014 HEART SURGERY - (CLOSED) PACKAGE Package 0 251650 299580 347510
SURGERY PACKAGE
CARDIOTHORACIC
KCTS015 HEART SURGERY - (OPEN) PACKAGE Package 0 414660 493640 572620
SURGERY PACKAGE
CARDIOTHORACIC
KCTS005 CLOSURE OF PDA PACKAGE Package 0 230880 274850 318830
SURGERY PACKAGE
CARDIOTHORACIC
KCTS004 CLOSURE OF ASD PACKAGE Package 0 326030 388130 450230
SURGERY PACKAGE
CARDIOTHORACIC
KCTS045 CABG PACKAGE Package 0 274810 302320 329780
SURGERY PACKAGE
CABG + VALVE SURGERY (DIABETIC) CARDIOTHORACIC
KCTS036 Package 0 354040 421480 488920
PACKAGE SURGERY PACKAGE
CARDIOTHORACIC
KCTS003 CABG + VALVE SURGERY PACKAGE Package 0 335210 399050 462900
SURGERY PACKAGE
CARDIOTHORACIC
KCTS034 VALVE SINGLE PACKAGE Package 0 293430 349320 405210
SURGERY PACKAGE
CARDIOTHORACIC
KCTS032 VALVE MULTIPLE PACKAGE Package 0 359240 427660 496090
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP01 ARTERIAL SWITCH OPERATION - PAED Package 0 307070 365560 424050
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP26 VALVE SINGLE - PAED Package 0 326030 388130 450230
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP04 CLOSURE OF PDA - PAED Package 0 246460 293400 340340
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP02 BT SHUNT - PAED Package 0 252980 301160 349350
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP05 CLOSURE OF VSD - SIMPLE - PAED Package 0 337140 401350 465570
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP28 CoA - COARCTATION OF AORTA - PAED Package 0 351510 418460 485410
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP10 GLENN OPERATION ON BYPASS - PAED Package 0 351510 418460 485410
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP06 COMPLEX TOF - PAED Package 0 354040 421480 488920
SURGERY PACKAGE
TAPVC - TOTAL ANOMALOUS CARDIOTHORACIC
KCTSP27 Package 0 360560 429240 497920
PULOMNARY VENOUS DRAINAGE - PAED SURGERY PACKAGE
CARDIOTHORACIC
KCTSP08 FONTAN OPERATION - PAED Package 0 374330 445630 516930
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP03 CLOSURE OF ASD - PAED Package 0 374930 446350 517760
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP15 REPAIRS OF AV CANAL - PAED Package 0 379520 451810 524100
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP31 COMPLEX VSD - PAED Package 0 381450 454110 526770
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP22 TRUNCUS ARTERIOSUS - PAED Package 0 395820 471220 546610
SURGERY PACKAGE
CARDIOTHORACIC
KCTSP12 HEART SURGERY - (OPEN) - PAED Package 0 451850 537920 623980
SURGERY PACKAGE
25
Department of
Women & Child Care
26
Obstetrics
& Gynaecology
27
Obstetrics & Gynaecology
Surgery Billing Billing

Code Description MHDOP MHDTRP MHDDOU MHDSIGL
Level Group Subgroup
CAESARIAN SECTION - BABY -
KOBG006 Package OBG PACKAGE 0 1 1 1
PACKAGE
KOBG004 NORMAL DELIVERY - BABY- PACKAGE Package OBG PACKAGE 0 1 1 1
KKOBG010 D & C OR MTP UNDER GA - PACKAGE Package OBG PACKAGE 0 15000 17000 20000
KOBG003 NORMAL DELIVERY - PACKAGE Package OBG PACKAGE 0 60000 67000 75000
KKOBG005 CAESARIAN SECTION - PACKAGE Package OBG PACKAGE 0 67000 75000 85000
New INSTRUMENTAL DELIVERY PACKAGE Package OBG PACKAGE 0 62000 70000 80000
New CAESARIAN SECTION -M- PACKAGE Package OBG PACKAGE 0 80000 90000 105000
CAESARIAN SECTION -(High Risk)-
New Package OBG PACKAGE 0 84000 94000 106000
PACKAGE
KOBG015 NORMAL DELIVERY - TWINS PACKAGE Package OBG PACKAGE 0 71730 85390 99050
KKOBG017 CAESARIAN SECTION - TWINS PACKAGE Package OBG PACKAGE 0 97810 116440 135070
KRKOBG004 ROBOTIC SURGERY PACKAGE - 2 - OBG Package OBG PACKAGE 0 374930 446350 517760
FETAL
KKFET003 Laser Ablation Package Package MEDICINE 0 65210 77630 90050
PACKAGE
KKOBG009 HYSTERECTOMY - PACKAGE Package OBG PACKAGE 0 86100 102500 118900
NST OBSERVATION IN MATERNITY - PER
POBG032 Procedure OBG 280 290 350 410
HOUR
POBG033 REMOTE FETAL MONITORING - NST Procedure OBG 1780 1860 2220 2570
POBG013 FETAL MONITORING Procedure OBG 640 670 800 920
POBG029 CONTINUOUS FETAL MONITORING Procedure OBG 1180 1240 1470 1710
POBG024 VAGINAL SWAB - OBG Procedure OBG 360 380 450 520
POBG011 EARLY PREGNANCY / NUCHAL SCAN - A Procedure OBG 960 1010 1200 1390
POBG003 COST OF CD- EXTRA - USG D&C/MTP Procedure OBG 1180 1240 1470 1710
POBG001 CAUTERISATION UNDER LA Procedure OBG 2050 2150 2560 2970
POBG020 US GUIDED ASPIRATION OF CYST - A Procedure OBG 2330 2440 2910 3370
POBG022 US GUIDED MTP - D&C - 1 Procedure OBG 2330 2440 2910 3370
POBG038 IUCD REMOVAL Procedure OBG 2600 2730 3250 3770
POBG004 CRYO SURGERY Procedure OBG 2740 2880 3430 3970
EXAMINATION UNDER ANAESTHESIA -
POBG
POBG006 CYST ASPIRATION - B - OBG Procedure OBG 3420 3590 4270 4960
POBG023 US GUIDED MTP - D&C - 2 Procedure OBG 3420 3590 4270 4960
POBG021 US GUIDED ASPIRATION OF CYST - B Procedure OBG 3830 4030 4790 5560
POBG034 REMOTE FETAL MONITORING - CTG Procedure OBG 4370 4590 5470 6340
MTP - MEDICAL TERMINATION OF
PREGNANCY (CHEMICAL) POBG
POBG015 HYSTEROSCOPY & D&C UNDER LA Procedure OBG 4930 5170 6160 7140
POBG005 CYST ASPIRATION - A - OBG Procedure OBG 5740 6030 7180 8330
28

POBG019 MID TRIMESTER MTP - POBG Procedure OBG 7650 8030 9560 11090
POBG042 COPPER T INSERTION Procedure OBG 8740 9180 10930 12680
POBG018 IUI (PER SESSION) Procedure OBG 8740 9180 10930 12680
POBG014 GARTNERS CYST EXCESSION - POBG Procedure OBG 9840 10330 12300 14260
POBG031 MID TRIMESTER MTP - PRO Procedure OBG 12850 13490 16060 18630
POBG040 CERVICAL CAUTERISATION Procedure OBG 17080 17940 21350 24770
POBG041 VULVAL BIOPSY Procedure OBG 17080 17940 21350 24770
COLPOSCOPY WITH/WITH OUT CERVIX
BIOPSY
POBG037 MIRENA INSERTION Procedure OBG 17760 18650 22200 25750
POBG035 VABC Procedure OBG 19130 20090 23910 27740
FETAL
PFET006 EMERGENCY SCAN / UNSCHEDULED Procedure 340 360 420 490
MEDICINE
FETAL
PFET079 FOLLICULAR IMAGING - SINGLE SITTING Procedure 640 670 800 920
MEDICINE
FETAL
PFET017 LIQUOR SERIAL Procedure 660 690 820 960
MEDICINE
FETAL
PFET001 COUNSELLING Procedure 760 800 950 1110
MEDICINE
FETAL
PFET018 LIQUOR / BPP SERIAL Procedure 1040 1090 1300 1510
MEDICINE
FETAL
PFET027 RECORDING AND CD - A Procedure 1040 1090 1300 1510
MEDICINE
FETAL
PFET080 USG EQUIPMENT CHARGES Procedure 1100 1150 1370 1590
MEDICINE
FETAL
PFET002 COUNSELLING GENETIC Procedure 1180 1240 1470 1710
MEDICINE
FETAL
PFET019 LIQUOR / BPP / DOP SERIAL Procedure 1300 1370 1630 1890
MEDICINE
EARLY PREGNANCY SCAN ROUTINE FETAL
PFET003 Procedure 1510 1590 1890 2190
(TAS OR TVS) MEDICINE
FETAL
PFET010 GYNAEC SCAN TAS SIMPLE Procedure 1510 1590 1890 2190
MEDICINE
FETAL
PFET070 REPEAT EARLY PREGNANCY SCAN Procedure 1510 1590 1890 2190
MEDICINE
FETAL
PFET020 DOPPLER STUDY Procedure 1650 1730 2060 2390
MEDICINE
FETAL
PFET007 FOLLICULAR IMAGING [ A ] Procedure 1910 2010 2390 2770
MEDICINE
EARLY PREGNANCY SCAN DETAILED FETAL
PFET004 Procedure 2050 2150 2560 2970
(TAS & TVS) MEDICINE
FETAL
PFET011 GYNAEC SCAN TAS COMPLEX Procedure 2050 2150 2560 2970
MEDICINE
29

FETAL
PFET021 NUCHAL TRANSLUCENCY SCAN Procedure 2190 2300 2740 3170
MEDICINE
TRIMESTER SCAN THIRD - WITH BASIC FETAL
PFET084 Procedure 2190 2300 2740 3170
DOPPLER - A MEDICINE
FETAL
PFET005 EARLY PREGNANCY SCAN + GYNAEC Procedure 2470 2590 3080 3570
MEDICINE
NUCHAL TRANSLUCENCY SCAN + FETAL
PFET022 Procedure 2470 2590 3080 3570
DOPPLER MEDICINE
TRIMESTER SCAN THIRD - WITH BASIC FETAL
PFET035 Procedure 2470 2590 3080 3570
DOPPLER MEDICINE
FETAL
PFET071 EARLY PREGNANCY SCAN - TWINS Procedure 2600 2730 3250 3770
MEDICINE
FETAL
PFET012 GYNAEC SCAN DETAILED - A Procedure 2600 2730 3250 3770
MEDICINE
FETAL
PFET029 TRIMESTER SCAN MID Procedure 2600 2730 3250 3770
MEDICINE
FETAL
PFET008 FOLLICULAR IMAGING [ B ] Procedure 2740 2880 3430 3970
MEDICINE
TRIMESTER SCAN THIRD - WITH FETAL
PFET036 Procedure 2740 2880 3430 3970
COMPLETE DOPPLER MEDICINE
EARLY PREGNANCY SCAN + GYNAEC FETAL
PFET081 Procedure 3140 3300 3930 4560
-B MEDICINE
EARLY PREGNANCY SCAN - MULTIPLE FETAL
PFET072 Procedure 3140 3300 3930 4560
GESTATION MEDICINE
FETAL
PFET013 GYNAEC SCAN DETAILED - B Procedure 3280 3450 4100 4760
MEDICINE
NUCHAL TRANSLUCENCY SCAN FETAL
PFET023 Procedure 3280 3450 4100 4760
COMPLEX MEDICINE
TRIMESTER SCAN MID - WITH UTA FETAL
PFET030 Procedure 3280 3450 4100 4760
DOPPLER MEDICINE
FETAL
PFET068 ULTRSOUND GUIDED D&C Procedure 3280 3450 4100 4760
MEDICINE
FETAL
PFET050 AMNIOCENTESIS - A Procedure 3560 3740 4450 5160
MEDICINE
FETAL
PFET060 INTRAMNIOTIC PROCEDURE - A Procedure 3560 3740 4450 5160
MEDICINE
FETAL
PFET009 FOLLICULAR FRESH (GYNAEC + CYCLE) Procedure 3700 3880 4620 5360
MEDICINE
FETAL
PFET024 NUCHAL TRANSLUCENCY SCAN TWINS Procedure 3700 3880 4620 5360
MEDICINE
FETAL
PFET014 GYNAEC SCAN COMPLEX Procedure 3830 4030 4790 5560
MEDICINE
FETAL
PFET031 TRIMESTER SCAN MID - COMPLEX Procedure 3830 4030 4790 5560
MEDICINE
FETAL
PFET085 ULTRSOUND GUIDED D&C - B Procedure 3830 4030 4790 5560
MEDICINE
30

FETAL
PFET015 GYNAEC SCAN COMPLEX 3D - SIMPLE Procedure 4240 4450 5290 6140
MEDICINE
FETAL
PFET082 TRIMESTER SCAN MID - COMPLEX - B Procedure 4240 4450 5290 6140
MEDICINE
FETAL
PFET032 TRIMESTER SCAN MID - FETAL ECHO Procedure 4240 4450 5290 6140
MEDICINE
FETAL
PFET026 NUCHAL TRANSLUCENCY SCAN 3D Procedure 4510 4740 5640 6540
MEDICINE
NUCHAL TRANSLUCENCY SCAN FETAL
PFET025 Procedure 4510 4740 5640 6540
MULTIPLE GEST MEDICINE
TRIMESTER SCAN MID - MULTIPLE FETAL
PFET033 Procedure 4510 4740 5640 6540
GEST MEDICINE
FETAL
PFET051 AMNIOCENTESIS - B Procedure 5190 5450 6490 7530
MEDICINE
TRIMESTER SCAN MID - FETAL ECHO FETAL
PFET034 Procedure 5740 6030 7180 8330
ABNORMAL MEDICINE
TRIMESTER SCAN MID - TWINS FETAL
PFET074 Procedure 5740 6030 7180 8330
COMPLEX MEDICINE
FETAL
PFET053 CHORION VILLUS SAMPLING - A Procedure 6160 6470 7700 8930
MEDICINE
FETAL
PFET055 CORDOCENTESIS - A Procedure 6280 6600 7850 9110
MEDICINE
FETAL
PFET061 INTRAMNIOTIC PROCEDURE - B Procedure 6280 6600 7850 9110
MEDICINE
TRIMESTER SCAN MID - FETAL ECHO FETAL
PFET083 Procedure 6280 6600 7850 9110
ABNORMAL - B MEDICINE
GYNAEC SCAN COMPLEX 3D - FETAL
PFET016 Procedure 6420 6740 8030 9310
COMPLEX MEDICINE
FETAL
PFET073 TRIMESTER SCAN MID - TRIPLETS Procedure 6420 6740 8030 9310
MEDICINE
FETAL
PFET052 AMNIOCENTESIS - C Procedure 7390 7760 9230 10710
MEDICINE
FETAL
PFET065 SONOHYSTEROGRAM Procedure 7390 7760 9230 10710
MEDICINE
FETAL
PFET037 TRIMESTER SCAN - 3D/4D - A Procedure 7650 8030 9560 11090
MEDICINE
FETAL
PFET054 CHORION VILLUS SAMPLING - B Procedure 9300 9760 11620 13480
MEDICINE
FETAL
PFET056 CORDOCENTESIS - B Procedure 9570 10050 11960 13880
MEDICINE
FETAL
PFET066 SONOHYSTEROGRAM WITH CD Procedure 9570 10050 11960 13880
MEDICINE
FETAL
PFET067 SONOSALPINGOGRAM Procedure 9570 10050 11960 13880
MEDICINE
FETAL
PFET069 CYST ASPIRATION Procedure 10110 10620 12640 14660
MEDICINE
31

FETAL
PFET038 TRIMESTER SCAN - 3D/4D - B Procedure 10670 11200 13330 15460
MEDICINE
FETAL
PFET057 FETAL REDUCTION - LEVEL1 Procedure 11480 12060 14350 16650
MEDICINE
FETAL
PFET062 INTRAUTERINE TRANSFUSION -LEVEL1 Procedure 11760 12350 14700 17050
MEDICINE
FETAL
MEDICINE
FETAL
MEDICINE
FETOSCOPIC CORD COAGULATION - FETAL
PFET075 Procedure 20500 21520 25620 29720
LEVEL 1 MEDICINE
FETAL
MEDICINE
FETAL
MEDICINE
FETOSCOPIC CORD COAGULATION - FETAL
PFET076 Procedure 31420 32990 39280 45560
LEVEL 2 MEDICINE
FETAL
PFET077 LASER ABLATION - LEVEL 1 Procedure 31420 32990 39280 45560
MEDICINE
FETAL
PFET078 LASER ABLATION - LEVEL 2 Procedure 42360 44480 52950 61420
MEDICINE
BARTHOLINS ABSCESS DRAINAGE
LOBG001 L1 Surgery OBG SURGERY 0 4500 5360 6220
(OBG) # L1
Bartholin's cyst excision /
marsupialisation (OBG) # L1
LOBG002 BIOPSY VAGINAL (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG003 CAUTERISATION UNDER LA (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG005 CERVICAL CAUTERISATION (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG014 Cervical dilatation (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
CERVICAL POLYPECTOMY/BIOPSY (OBG)
# L1
COLPOSCOPY WITH/WITH OUT CERVIX
BIOPSY (OBG) # L1
LOBG013 Cryosurgery (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
EUA (AS SOLE PROCEDURE) WITH/WITH
OUT ABSCESS DRAINAGE (OBG) # L1
LOBG008 IUCD INSERTION (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG009 IUCD REMOVAL (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG010 MIRENA INSERTION (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG012 Multiload Insertion (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG011 VAGINAL DILATATIONS (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220
LOBG029 AMPUTATION OF CERVIX (OBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380
32

LOBG021 CERVICAL ENCIRCLAGE (OBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380
CERVICAL / VAGINAL TEAR REPAIR
(LOBG) # L2
Diagnostic hysteroscopy (As Sole
Procedure) (OBG) # L2
DILATATION & CURETTAGE WITH
MIRENA INSERTION (OBG) # L2
FENTONS/HYMENECTOMY OPERATION
(OBG) # L2
Hysteroscopic Removal of IUCD (OBG)
# L2
Hysteroscopy and cervical biopsy (OBG)
# L2
MANUAL REMOVAL OF PLACENTA (OBG)
# L2
PERINEAL TEAR REPAIR - 2ND DEGREE
(OBG) # L2
REMOVAL OF VAGINAL CYSTS (LOBG)
# L2
LOBG020 SECONDARY SUTURE (LOBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380
LOBG030 CONISATION OF CERVIX (OBG) # L3 L3 Surgery OBG SURGERY 0 10820 12880 14940
Hysteroscopy with D & C with or
without cervical biopsy (OBG) # L3
PERINEAL TEAR REPAIR - 3RD DEGREE
(OBG) # L3
TUBECTOMY - OPEN (AS SOLE
PROCEDURE) (OBG) # L3
LOBG052 Hysteroscopic polypectomy (LOBG) # L4 L4 Surgery OBG SURGERY 0 12350 14700 17060
Suction evacuation molar pregnancy
# L4
LOBG044 Anterior Colporraphy (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
Diagnostic Hysterolaparoscopy +/- CPT
(OBG) # L4
Diagnostic laparoscopy with/without
LOBG043 chromopertubation/D & C/Drilling (OBG) L4 Surgery OBG SURGERY 0 14790 17610 20420
# L4
DIAGNOSTIC LAPAROTOMY WITH/
LOBG038 WITHOUT LAVAGE/BIOPSY (AS SOLE L4 Surgery OBG SURGERY 0 14790 17610 20420
Hysteroscopic Myomectomy (LOBG)
# L4
Hysteroscopic Resection of
endometrium (OBG) # L4
Hysteroscopic Resection of fibroid polyp
(OBG) # L4
33

Hysteroscopic Resection of Synechae
(OBG) # L4
Hysteroscopic septum resection (OBG)
# L4
LAPAROTOMY ADHESIOLYSIS (AS SOLE
LOBG035 LAP OVARIAN BIOPSY (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
LOBG036 LAP STERILISATION + MTP (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
LOBG046 Perineal floor repair (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
LOBG045 Posterior Colporraphy (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
Sacropinous fixation Unilateral (OBG)
# L4
SALPHINGO-OOPHERECTOMY
UNILATERAL - OPEN (LOBG) # L4
UNILATERAL - OPEN (OBG) # L4
Salpingo oophorectomy Unilateral /
Bilateral - Laparoscopic (OBG) # L4
SCAR ENDOMETRIOSIS WIDE EXCISION
(OBG) # L4
LOBG042 TUBOPLASTY UNILATERAL (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420
LOBG057 ABDOMINAL CERVICOPEXY (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
Diagnostic Hysterolaparoscopy +
drilling (OBG) # L5
LOBG058 FOTHERGILLS OPERATION (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
Hysterolaparoscopy and adhesiolysis
and/or CPT (OBG) # L5
Hysterolaparoscopy and cystectomy
and\or CPT (OBG) # L5
Hysteroscopic Resection of polyp with
endometrial curettage (OBG) # L5
LOBG077 Laparoscopic Circlage (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
Laparoscopic myomectomy Single
(OBG) # L5
Laparoscopic ovarian cystectomy (OBG)
# L5
LAPAROSCOPIC SALPHINGO-
OOPHERECTOMY (UL/BL) (OBG) # L5
Laparoscopy adhesiolysis with/without
biopsy (As Sole Procedure) (OBG) # L5
Laparoscopy for ovarian fixation (OBG)
# L5
Laparoscopy for ovarian torsion (OBG)
# L5
34

Laparoscopy for ruptured ovarian cyst
(OBG) # L5
LOBG075 Laparoscopy for TO MASS (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LAPAROTOMY ECTOPIC GESTATION
(OBG) # L5
Laparotomy for Ovarian cyst torsion
(OBG) # L5
LAPAROTOMY + OVARIAN
CYSTECTOMY (OBG) # L5
LAPAROTOMY + SALPHINGECTOMY
(UL/BL) (OBG) # L5
Lap ectopic unruptured / ruptured
(OBG) # L5
LOBG083 Mesh repair Anterior (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG084 Mesh repair Posterior (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG048 Myomectomy - OPEN (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG082 NDVH (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
BILATERAL - OPEN (OBG) # L5
SCAR ENDOMETRIOSIS WIDE EXCISION
AND MESH REPAIR (OBG) # L5
Surgery for Ectopic pregnancy (OBG)
# L5
LOBG087 Surgery for TO Mass (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
TAH with/with out adhesiolysis (OBG)
# L5
LOBG131 TOT Sling Procedure (URO-OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG130 TVT Sling Procedure (URO-OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG081 Vaginal hysterectomy (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG066 VULVECTOMY SIMPLE (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870
LOBG095 LSCS WITH TUBECTOMY (LOBG) # L5B L5B Surgery OBG SURGERY 0 21870 26030 30200
INTERNAL ILIAC ARTERY LIGATION -
BILATERAL (SS) (OBG) # L6
SACROCOLPOPEXY - OPEN (SS) (OBG)
# L6
LOBG094 VVF REPAIR (SS) (OBG) # L6 L6 Surgery OBG SURGERY 0 23160 27570 31980
LOBG076 Burch colpo suspension (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LOBG097 Classical Caesarian Section (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
Hysteroscopic Myomectomy under LAP
guidance (OBG) # L6
Laparoscopic myomectomy multiple
(OBG) # L6
35

LOBG098 LSCS for TWINS (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LSCS @ MICU / pre or post MICU (OBG)
# L6
LOBG100 LSCS + myomectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LOBG099 LSCS + ovarian cystectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LSCS + PPH + B Lynch/Internal illiac
artery ligation (OBG) # L6
Myomectomy MULTIPLE - OPEN (OBG)
# L6
Sacropinous fixation bilateral (OBG) #
L6
LOBG101 Surgery for ruptured uterus (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
TAH + bilateral salpingectomy/
Salphingo-oopherectomy (OBG) # L6
LOBG107 TAH + cystectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LOBG109 TAH + cystocele repair (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LOBG108 TAH + sacrocolpopexy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
LOBG065 TUBOPLASTY BILATERAL (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290
Vaginal Hysterectomy with AP repair
(OBG) # L6
Vaginal hysterectomy with
Sacrospinous fixation (OBG) # L6
Vaginal hysterectomy with SO (OBG)
# L6
VAULT PROLAPSE OPERATION
LOBG093 - SACROSPINOUS FIXATION - L6 Surgery OBG SURGERY 0 27010 32150 37290
UNILATERAL (OBG) # L6
HYSTERECTOMY (LOBG) [RS 5 days
LOBG027RS LR Surgery OBG SURGERY 0 29590 35220 40850
Package] # LR
MYOMECTOMY (LOBG) [RS 5 days
Package] # LR
SACROCOLPOPEXY - (LOBG) (RS 5 days
Package) # LR
SACROCOLPOPEXY - LAPAROSCOPIC
(SS) (OBG) # L7
Laparoscopic BURCH Coloposuspension
(OBG) # L7
Laparoscopic surgery for endometriosis
(OBG) # L7
LOBG118 OBSTETRIC HYSTERECTOMY # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730
LOBG115 RVF REPAIR (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730
LOBG116 SCHAUTA'S OPERATION (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730
36

TAH + BS/BSO + sacrocolpopexy (OBG)
# L7
LOBG122 TAH + omentectomy , PLND (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730
Unification procedure for septate uterus

(OBG) # L7
VAULT PROLAPSE OPERATION -

LOBG117 SACROSPINOUS FIXATION - BILATERAL L7 Surgery OBG SURGERY 0 36010 42870 49730
(OBG) # L7
LAP ASSISTED VAGINAL

HYSTERECTOMY (LAVH) (OBG) # L6
WERTHIM'S HYSTRECTOMY RADICAL

(SS) (OBG) # L8
LOBG124 VAGINOPLASTY (LOBG) # L8 L8 Surgery OBG SURGERY 0 45010 53580 62150
LOBG125 PELVIC EXTENTERATION (SS) (OBG) # L9 L9 Surgery OBG SURGERY 0 46300 55120 63930
37
Paediatrics
38
Paediatrics

PAEDIATRIC
PPDE001 DASII SCALE Procedure 2870 3010 3580 4160
DEVELOPMENT
PAEDIATRIC
PPDE002 CAT / CLAMS Procedure 2330 2440 2910 3370
DEVELOPMENT
PAEDIATRIC
PPDE003 MCHAT Procedure 1040 1090 1300 1510
DEVELOPMENT
PAEDIATRIC
PPDE004 CARS Procedure 1180 1240 1470 1710
DEVELOPMENT
PAEDIATRIC
PPDE005 ADHD Procedure 1910 2010 2390 2770
DEVELOPMENT
PAEDIATRIC
PPDE006 INFANIB SCALE Procedure 820 860 1030 1190
DEVELOPMENT
AGES & STAGES DEVELOPMENTAL PAEDIATRIC
PPDE007 Procedure 1650 1730 2060 2390
SCREENING DEVELOPMENT
PAEDIATRIC
LPSR001 EUA (AS SOLE PROCEDURE) (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR002 CYSTOSCOPY-DIAGNOSTIC (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR003 GENITOGRAM UNDER GA (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
INTERCOSTAL TUBE DRAINAGE (PSR) PAEDIATRIC
LPSR004 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
PAEDIATRIC
LPSR005 MUSCLE BIOPSY (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR006 ON TABLE M C U (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR007 DJ STENT REMOVAL (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR008 CENTRAL LINE REMOVAL (PSR) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
PAEDIATRIC
LPSR009 Chemoport removal (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR010 INCISION AND DRAINAGE (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR011 LYMPH NODE BIOPSY-S (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR012 SKIN GRAFTING SIMPLE (LPSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR013 SKIN SUTURING (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
SUTURING OF MINOR INJURIES (PSR) PAEDIATRIC
LPSR014 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
PAEDIATRIC
LPSR015 TONGUE TIE RELEASE (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR016 wedge excision toe nail (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
39
Paediatrics

PAEDIATRIC
LPSR017 CIRCUMCISION (LPSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR018 CYSTOSCOPY DYE STUDY (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR019 LABIAL SEPERATION (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR020 MEATOPLASTY (LPSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
COLECTOMY TOTAL (LPSR) [RS 10 PAEDIATRIC
LPSR020RS LR Surgery 0 29590 35220 40850
days Package] # LR SURGERY
PAEDIATRIC
LPSR021 NEONATAL CIRCUMCISION (PSR) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
PAEDIATRIC
LPSR022 RECTAL BIOPSY (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR023 RECTAL POLYP EXCISION (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
PAEDIATRIC
LPSR024 SUPRPUBIC CYSTOSTOMY (PSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
ACCESSORY FINGER OR TOE EXCISION PAEDIATRIC
LPSR025 L2 Surgery 0 8240 9810 11380
(PSR) # L2 SURGERY
MAJOR WOUND DEBRIDEMENT (PSR) PAEDIATRIC
LPSR026 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
PAEDIATRIC
LPSR027 CYST EXCISION (PSR) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
FULL/PARTIAL THICKNESS RECTAL PAEDIATRIC
LPSR028 L3 Surgery 0 10820 12880 14940
BIOPSY (PSR) # L3 SURGERY
HERNIOTOMY INGUINAL/FEMORAL -UL PAEDIATRIC
LPSR029 L3 Surgery 0 10820 12880 14940
- (PEDIATRIC) (PSR) # L3 SURGERY
PAEDIATRIC
LPSR030 INFANT HERNIA -UL (PSR) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
SKIN GRAFTING INTERMEDIATE (LPSR) PAEDIATRIC
LPSR031 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
THIERSCHS WIRING FOR RECTALSE PAEDIATRIC
LPSR032 L3 Surgery 0 10820 12880 14940
(PSR) # L3 SURGERY
BRONCHOSCOPY- DIAGNOSTIC WITH PAEDIATRIC
LPSR033 L3 Surgery 0 10820 12880 14940
OR WITHOUT BIOPSY (PSR) # L3 SURGERY
GASTROSTOMY/JEJUNOSTOMY (PSR) PAEDIATRIC
LPSR034 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
PAEDIATRIC
LPSR035 TRACHEOSTOMY (LPSR) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
PAEDIATRIC
LPSR036 CENTRAL LINE INSERTION (PSR) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
'HERNIA SIMPLE UMBLICAL, EPI (LPSR) PAEDIATRIC
LPSR037 L4 Surgery 0 14790 17610 20420
' # L4 SURGERY
HYPOSPADIAS FISTULA CLOSURE PAEDIATRIC
LPSR038 L4 Surgery 0 14790 17610 20420
(PSR) # L4 SURGERY
40
Paediatrics

PRE-AURICULAR SINUS EXCISION PAEDIATRIC
LPSR039 L4 Surgery 0 14790 17610 20420
(PSR) # L4 SURGERY
SYNDACTYLY RELEASE UNILATERAL PAEDIATRIC
LPSR040 L4 Surgery 0 14790 17610 20420
(PSR) # L4 SURGERY
PAEDIATRIC
LPSR041 APPENDICECTOMY - OPEN (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
BRONCHOSCOPY + BRANCHOGRAM PAEDIATRIC
LPSR042 L4 Surgery 0 14790 17610 20420
(PSR) # L4 SURGERY
BRONCHOSCOPY + FB REMOVAL (PSR) PAEDIATRIC
LPSR043 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
GASTRECTOMY RADICAL (LPSR) [RS PAEDIATRIC
LPSR043RS LR Surgery 0 29590 35220 40850
10 days Package] # LR SURGERY
CHEMOPORT/HICKMAN CATHETER PAEDIATRIC
LPSR044 L4 Surgery 0 14790 17610 20420
INSERTION (PSR) # L4 SURGERY
PAEDIATRIC
LPSR045 CYSTOSCOPY DEFLUX INJ. (PSR) # L5 L5 Surgery 0 8370 9200 10040
SURGERY
PAEDIATRIC
LPSR046 CYSTOSCOPY PUV FULG (PSR) # L5 L5 Surgery 0 8370 9200 10040
SURGERY
LAPAROTOMY ADHESIOLYSIS - SOLE PAEDIATRIC
LPSR047 L4 Surgery 0 14790 17610 20420
PROCEDURE (PSR) # L4 SURGERY
ORCHIDOPEXY UNILATERAL (LPSR) PAEDIATRIC
LPSR048 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
ORCHIDOPEXY-SF-II-UNILATERAL PAEDIATRIC
LPSR049 L5 Surgery 0 18010 21440 24870
(PSR) # L5 SURGERY
ORCHIDOPEXY-SF-I-UNILATERAL (PSR) PAEDIATRIC
LPSR050 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
ORCHIDECTOMY UNILATERAL (PSR) PAEDIATRIC
LPSR051 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
PERIANAL FISTULA EXCISION (PSR) PAEDIATRIC
LPSR052 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
PAEDIATRIC
LPSR053 SKIN GRAFTING MAJOR (LPSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
STERNOMASTOID TENOTOMY (PSR) PAEDIATRIC
LPSR054 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
PAEDIATRIC
LPSR055 SURGERY OF RANULA (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
PAEDIATRIC
LPSR056 VESICOSTOMY (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
PAEDIATRIC
LPSR057 VESICOSTOMY CLOSURE (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
CUTANEOUS URETEROSTOMY PAEDIATRIC
LPSR058 L4 Surgery 0 14790 17610 20420
UNILATERAL (LPSR) # L4 SURGERY
CUT-URETEROSTOMY CLOSURE - PAEDIATRIC
LPSR059 L4 Surgery 0 14790 17610 20420
UNILATERAL (PSR) # L4 SURGERY
HERNIOTOMY -INGUINAL/FEMORAL PAEDIATRIC
LPSR060 L4 Surgery 0 14790 17610 20420
-BL (PSR) # L4 SURGERY
41
Paediatrics

PAEDIATRIC
LPSR061 ANOPLASTY (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
PAEDIATRIC
LPSR062 HYPOSPADIAS - CHORDEE (PSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
MULTIPLE ACCESSORY FINGERS PAEDIATRIC
LPSR063 L4 Surgery 0 14790 17610 20420
EXCISION (PSR) # L4 SURGERY
PAEDIATRIC
LPSR064 INFANT HERNIA - BL (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
PAEDIATRIC
LPSR065 ORCHIDECTOMY RADICAL (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
ORCHIDECTOMY UNILATERAL - PAEDIATRIC
LPSR066 L5 Surgery 0 18010 21440 24870
LAPAROSCOPIC (PSR) # L5 SURGERY
SUBMANDIBULAR GLAND EXCISION PAEDIATRIC
LPSR067 L5 Surgery 0 18010 21440 24870
(LPSR) # L5 SURGERY
SUPRAPUBIC CYSTOLITHOTOMY PAEDIATRIC
LPSR068 L5 Surgery 0 18010 21440 24870
INCLUDING CYSTOSCOPY (PSR) # L5 SURGERY
BRANCHIAL/THYROGLASSAL FISTULA PAEDIATRIC
LPSR069 L5 Surgery 0 18010 21440 24870
CERVICAL ESOPHAGOSTOMY (PSR) PAEDIATRIC
LPSR070 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
PAEDIATRIC
LPSR071 CLITOROPLASTY (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
PAEDIATRIC
LPSR072 COLOSTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
COLOSTOMY CLOSURE/REVISION PAEDIATRIC
LPSR073 L5 Surgery 0 18010 21440 24870
(LPSR) # L5 SURGERY
LAPROTOMY OP CHOLANGIO (PSR) PAEDIATRIC
LPSR074 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
LYMPHATIC CYST EXCISION MINOR PAEDIATRIC
LPSR075 L5 Surgery 0 18010 21440 24870
(PSR) # L5 SURGERY
PAEDIATRIC
LPSR076 MAJOR SKIN GRAFTING (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
PAEDIATRIC
LPSR077 ORCHIDOPEXY BILATERAL (LPSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
ORCHIDOPEXY-SF-I-BILATERAL (PSR) PAEDIATRIC
LPSR078 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
ORCHIDOPEXY-SF-II-BILATERAL (PSR) PAEDIATRIC
LPSR079 L5B Surgery 0 21870 26030 30200
# L5B SURGERY
PAEDIATRIC
LPSR080 PYLOROMYOTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
RECTAL PROLAPSE SURGERY (PSR) PAEDIATRIC
LPSR081 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
SYNDACTYLY RELEASE BILATERAL PAEDIATRIC
LPSR082 L5 Surgery 0 18010 21440 24870
(PSR) # L5 SURGERY
PAEDIATRIC
LPSR083 UMBILICAL EXPLORATION (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
42
Paediatrics

PAEDIATRIC
LPSR084 URETEROLITHOTOMY (LPSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
CYSTOSCOPY URETROCOLE WITH OR
PAEDIATRIC
LPSR085 WITHOUR URETERIC REIMPLANTATION L5 Surgery 0 8370 9200 10040
SURGERY
- UNILATERAL (PSR) # L5
PAEDIATRIC
LPSR086 HYPOSPADIAS - MATHIEU (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
HYPOSPADIAS - SNODGRASS (PSR) PAEDIATRIC
LPSR087 L5B Surgery 0 21870 26030 30200
# L5B SURGERY
HYPOSPADIAS 2ND STG PAEDIATRIC
LPSR088 L5B Surgery 0 21870 26030 30200
URETHROPLASTY (PSR) # L5B SURGERY
PAEDIATRIC
LPSR089 LAP APPENDICECTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
PAEDIATRIC
LPSR090 ORCHIDECTOMY BILATERAL (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
PAEDIATRIC
LPSR091 CUT BACK VAGINOPLASTY (PSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
CYSTOSCOPY URETROCOLE WITH OR
PAEDIATRIC
LPSR092 WITHOUR URETERIC REIMPLANTATION L5 Surgery 0 18010 21440 24870
SURGERY
- BILATERAL (PSR) # L5
PAEDIATRIC
LPSR093 LAP SPLEENECTOMY (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
PAEDIATRIC
LPSR094 SPLENECTOMY - OPEN (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
URETERIC REIMPLANTATION PAEDIATRIC
LPSR095 L6 Surgery 0 27010 32150 37290
UNILATERAL (PSR) # L6 SURGERY
ADRENELECTOMY UNILATERAL (LPSR) PAEDIATRIC
LPSR096 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
PAEDIATRIC
LPSR097 BLADDER NECK REPAIR (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
CUTANEOUS URETEROSTOMY PAEDIATRIC
LPSR098 L6 Surgery 0 27010 32150 37290
BILATERAL (LPSR) # L6 SURGERY
CUT-URETEROSTOMY CLOSURE - PAEDIATRIC
LPSR099 L6 Surgery 0 27010 32150 37290
BILATERAL (PSR) # L6 SURGERY
GASTRIC BYPASS
PAEDIATRIC
LPSR100 GASTROJEJJUNOYLOROPLASTY (PSR) L6 Surgery 0 27010 32150 37290
SURGERY
# L6
PAEDIATRIC
LPSR101 PYELOPLASTY - INFANT (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
PAEDIATRIC
LPSR102 MAGPI (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
CYSTIC HYGROMA EXCISION - SMALL PAEDIATRIC
LPSR103 L6 Surgery 0 27010 32150 37290
(PSR) # L6 SURGERY
NEPHRECTOMY SIMPLE/BENIGN - PAEDIATRIC
LPSR104 L5 Surgery 0 18010 21440 24870
UNILATERAL - SPSR (PSR) # L5 SURGERY
ORCHIDECTOMY BILATERAL - PAEDIATRIC
LPSR105 L6 Surgery 0 27010 32150 37290
LAPAROSCOPIC (PSR) # L6 SURGERY
43
Paediatrics

PAEDIATRIC
LPSR106 PYELOPLASTY (LPSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
REPAIR OF MYELOMENIGOCELE (PSR) PAEDIATRIC
LPSR107 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
PAEDIATRIC
LPSR108 THYROIDECTOMY PARTIAL (LPSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
PAEDIATRIC
LPSR109 URETEROURETEROSTOMY (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
URTEROCELE UNILATERAL EXCISION PAEDIATRIC
LPSR110 L6 Surgery 0 27010 32150 37290
(PSR) # L6 SURGERY
VATS VIDEO ASSISTED
PAEDIATRIC
LPSR111 THORACOSCOPY SURGERY (LPSR) # L6 Surgery 0 27010 32150 37290
SURGERY
L6
PAEDIATRIC
LPSR112 COLECTOMY PARTIAL (LPSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
REPAIR OF EXAMPHALOS MINOR (PSR) PAEDIATRIC
LPSR113 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
PAEDIATRIC
LPSR114 ANAL TRANSPOSITION (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
HERNIA COMPLICATED DIAPH/ PAEDIATRIC
LPSR115 L6 Surgery 0 27010 32150 37290
REGIONAL/HIATUS (PSR) # L6 SURGERY
PAEDIATRIC
LPSR116 OVARIAN TUMOURS (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
THORACOTOMY DECORTICATION (PSR) PAEDIATRIC
LPSR117 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
PAEDIATRIC
LPSR118 KASAIS PROCEDURE (PSR) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
CONDUIT OPERATIONS - Construction
PAEDIATRIC
LPSR119 of ileal conduit including ureteric L7 Surgery 0 36010 42870 49730
SURGERY
implantation (LPSR) # L7
CYSTIC HYGROMA EXCISION - LARGE PAEDIATRIC
LPSR120 L7 Surgery 0 36010 42870 49730
(PSR) # L7 SURGERY
PAEDIATRIC
LPSR121 NEPHROURETERECTOMY (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR122 PENAS OPERATION (PSARP) (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
REPAIR OF EXTROPHY OF BLADDER (I/ PAEDIATRIC
LPSR123 L7 Surgery 0 36010 42870 49730
II) (PSR) # L7 SURGERY
PAEDIATRIC
LPSR124 THYROIDECTOMY TOTAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
BILATERAL URETEROCELE EXCISION PAEDIATRIC
LPSR125 L7 Surgery 0 36010 42870 49730
(PSR) # L7 SURGERY
CHOLEDOCHEL CYST EXCISION (LPSR) PAEDIATRIC
LPSR126 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
PAEDIATRIC
LPSR127 EPISPADIAS REPAIR STAGE I (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
44
Paediatrics

EPISPADIAS REPAIR STAGE II (LPSR) PAEDIATRIC
LPSR128 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
PAEDIATRIC
LPSR129 GASTRECTOMY PARTIAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR130 MAJOR Z-PLASTY (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR131 NEPHRECTOMY RADICAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR132 RADICAL PAROTIDECTOMY (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR133 REPAIR OF GASTROSCHISIS (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
RETROPERITONEAL TUMOR EXCISION PAEDIATRIC
LPSR134 L7 Surgery 0 36010 42870 49730
(PSR) # L7 SURGERY
SURGERY OF BLADDER EXTEROPHY PAEDIATRIC
LPSR135 L7 Surgery 0 36010 42870 49730
(TOT. CORR) (PSR) # L7 SURGERY
SURGERY OF EXOMPHALOS MAJOR PAEDIATRIC
LPSR136 L7 Surgery 0 36010 42870 49730
(PSR) # L7 SURGERY
SURGERY OF GASTROSCHISIS (TOTAL PAEDIATRIC
LPSR137 L7 Surgery 0 36010 42870 49730
CORRECTION) (PSR) # L7 SURGERY
URETERIC REIMPLANTATION PAEDIATRIC
LPSR138 L7 Surgery 0 36010 42870 49730
BILATERAL (PSR) # L7 SURGERY
URETHROPLASTY SINGLE STAGE PAEDIATRIC
LPSR139 L7 Surgery 0 36010 42870 49730
(LPSR) # L7 SURGERY
PAEDIATRIC
LPSR140 COLECTOMY TOTAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
PAEDIATRIC
LPSR141 LADDS PRACEDURE (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
LAPAROTOMY INTESTINAL RESECTION PAEDIATRIC
LPSR142 L7 Surgery 0 36010 42870 49730
(PSR) # L7 SURGERY
PAEDIATRIC
LPSR143 NISSENS FUNDOPLICATION (PSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
ADRENELECTOMY BILATERAL (PSR) PAEDIATRIC
LPSR144 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
DEFINITIVE SURGERY FOR T E F (PSR) PAEDIATRIC
LPSR145 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
PAEDIATRIC
LPSR146 FEMINISING GENITOPLASTY (PSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
PAEDIATRIC
LPSR147 GASTRECTOMY RADICAL (PSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
GASTRECTOMY TOTAL/SUBTOTAL PAEDIATRIC
LPSR148 L8 Surgery 0 45010 53580 62150
(LPSR) # L8 SURGERY
HIRSPRUNGS PULL THROUGH (PSR) PAEDIATRIC
LPSR149 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
OESOPHAGEAL REPLACEMENT (PSR) PAEDIATRIC
LPSR150 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
45
Paediatrics

PAEDIATRIC
LPSR151 THORACTOMY MED MASS (PSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
PAEDIATRIC
LPSR152 VAGINOPLASTY (LPSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
LOBECTOMY/PNEUMONECTOMY (PSR) PAEDIATRIC
LPSR153 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
PAEDIATRIC
LPSR154 PANCREATECTOMY (PSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
SACROCOCCYGEAL TERATOMA PAEDIATRIC
LPSR155 L8 Surgery 0 45010 53580 62150
PAEDIATRIC
LPSR156 PORTA SYSTEMATIC SHUNT (PSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
PAEDIATRIC
LPSR157 HEPATECTOMY (PSR) # L9 L9 Surgery 0 54020 64300 74590
SURGERY
SURGERY FOR CRANIOSYNOSTOSIS PAEDIATRIC
LPSR158 L9 Surgery 0 54020 64300 74590
(PSR) # L9 SURGERY
CIRCUMCISSION WITH HERNIA PAEDIATRIC
LPSR160 L5B Surgery 0 21870 26030 30200
OPERATION (PSR) # L5B SURGERY
PAEDIATRIC
PPSR001 ARTERIAL LINE - PERIPHERAL - PSR Procedure SURGERY 900 950 1130 1310
PROCEDURE
PAEDIATRIC
PPSR002 ASCITIC TAP - PSR Procedure SURGERY 590 620 740 860
PROCEDURE
PAEDIATRIC
BIOPSY-1 LIVER,KIDNEY,PLEURA
PPSR003 Procedure SURGERY 1180 1240 1470 1710
EXCLUDING HISTOLOGY & USC - PSR
PROCEDURE
PAEDIATRIC
BIOPSY-2 FINE NEEDLE GLAND BIOPSY
BONE MARROW - PSR
PROCEDURE
PAEDIATRIC
PPSR005 BRONCHOSCOPY - FLEXIBLE Procedure SURGERY 5610 5890 7010 8130
PROCEDURE
PAEDIATRIC
PPSR006 CENTRAL LINE - PSR Procedure SURGERY 1510 1590 1890 2190
PROCEDURE
PAEDIATRIC
CONTINUOUS ARTERIO-VENOUS
HAEMO-FILTRATI - PSR
PROCEDURE
PAEDIATRIC
PPSR008 CRANIAL U/s - PSR Procedure SURGERY 610 640 770 890
PROCEDURE
PAEDIATRIC
PPSR009 DIALYSIS PERITONEAL - PSR Procedure SURGERY 6160 6470 7700 8930
PROCEDURE
PAEDIATRIC
ENDOTRACHEAL INTUBATION (NOT IN
ICU) - PSR
PROCEDURE
46
Paediatrics

PAEDIATRIC
EXCHANGE TRANSFUSION EXCLUDING
BLOOD,DRUGS,TUBES,SYR,OT - PSR
PROCEDURE
PAEDIATRIC
PPSR012 EXCHANGE TRANSFUSION REPEAT Procedure SURGERY 2870 3010 3580 4160
PROCEDURE
PAEDIATRIC
PPSR013 HICKMAN REMOVAL - PSR Procedure SURGERY 2330 2440 2910 3370
PROCEDURE
PAEDIATRIC
INFUSION OF VASOACTIVE DRUGS -
PSR
PROCEDURE
PAEDIATRIC
PPSR015 INHALED NITRIC OXIDE - PSR Procedure SURGERY 3700 3880 4620 5360
PROCEDURE
PAEDIATRIC
PPSR017 INTERCOSTAL DRAINAGE - PSR Procedure SURGERY 1240 1300 1540 1790
PROCEDURE
PAEDIATRIC
PPSR018 LUMBAR PUNCTURE - PSR Procedure SURGERY 560 580 690 810
PROCEDURE
PAEDIATRIC
MISCELLANEOUS PROCEDURE - NOT
IN ICU - PPSR
PROCEDURE
PAEDIATRIC
PPSR020 MISCELLANEOUS PROCEDURE ICU Procedure SURGERY 590 620 740 860
PROCEDURE
PAEDIATRIC
MONITORS FOR 24 HRS OR LESS -NOT
IN ICU - PPSR
PROCEDURE
PAEDIATRIC
NEBULIZER FOR ASTHMA EXCL O2 &
DRUGS (Is
PROCEDURE
PAEDIATRIC
NEBULIZER FOR WHOLE DAY (MORE
THAN 4 TREATMENTS) - PSR
PROCEDURE
PAEDIATRIC
NEBULIZER TREATMENT FOR ASTHMA
(REPEAT TREATMENT)
PROCEDURE
PAEDIATRIC
NEONATAL CARE DURING ROP
SURGERY - PSR
PROCEDURE
PAEDIATRIC
PPSR026 NEONATAL HEARING TEST - PSR Procedure SURGERY 1910 2010 2390 2770
PROCEDURE
PAEDIATRIC
NEURODEVELOPMENT ASSESSMENT
- PSR
PROCEDURE
47
Paediatrics

PAEDIATRIC
OBSERVATION NURSERY DAILY OR
LESS CHARGES - PSR
PROCEDURE
PAEDIATRIC
PPSR030 PICU INTENSIVE CHARGES - HIGH Procedure SURGERY 1300 1370 1630 1890
PROCEDURE
PAEDIATRIC
PPSR031 PICU INTENSIVE CHARGES - LOW Procedure SURGERY 960 1010 1200 1390
PROCEDURE
PAEDIATRIC
PLASMA PARTIAL EXCHANGE TRANS
- PSR
PROCEDURE
PAEDIATRIC
PPSR033 PLASMA PHERESIS - PSR Procedure SURGERY 2050 2150 2560 2970
PROCEDURE
PAEDIATRIC
PLEURAL PERICARDIAL/SUBDURAL/
VENTRICULAR TAPS - PSR
PROCEDURE
PAEDIATRIC
PPSR035 RESPIRATORY THERAPY / WEEK - PSR Procedure SURGERY 1780 1860 2220 2570
PROCEDURE
PAEDIATRIC
PPSR036 RESUSCIATION - BABY CARE - LSCS Procedure SURGERY 2190 2300 2740 3170
PROCEDURE
PAEDIATRIC
PPSR037 RESUSCIATION - BABY CARE - ND Procedure SURGERY 1650 1730 2060 2390
PROCEDURE
PAEDIATRIC
PPSR038 SEDATION INTERMEDIATE - PSR Procedure SURGERY 1180 1240 1470 1710
PROCEDURE
PAEDIATRIC
PPSR039 SPIROMETRY - PAEDIATRIC - PPSR Procedure SURGERY 1180 1240 1470 1710
PROCEDURE
PAEDIATRIC
PPSR040 SUPRAPUBIC BLADDER TAP - PSR Procedure SURGERY 560 580 690 810
PROCEDURE
PAEDIATRIC
PPSR041 SURFACTANT THERAPY - PSR Procedure SURGERY 6020 6320 7520 8730
PROCEDURE
PAEDIATRIC
TOTAL PARENTRAL NUTRITION
PLANNING & FORMULATION - PSR
PROCEDURE
PAEDIATRIC
PPSR043 TRANSFUSION - PSR Procedure SURGERY 1100 1150 1370 1590
PROCEDURE
PAEDIATRIC
PPSR044 UMBILICAL ARTERIAL LINE - PSR Procedure SURGERY 1240 1300 1540 1790
PROCEDURE
48
Paediatrics

PAEDIATRIC
PPSR045 UMBILICAL VENOUS LINE - PSR Procedure SURGERY 900 950 1130 1310
PROCEDURE
PAEDIATRIC
PPSR046 VENESECTION - PSR Procedure SURGERY 820 860 1030 1190
PROCEDURE
PAEDIATRIC
VENTILATION THERAPY - HI
FREQUENCY - PSR
PROCEDURE
PAEDIATRIC
PPSR048 WARMER TREATMENT - PSR Procedure SURGERY 140 150 180 210
PROCEDURE
PAEDIATRIC
PPSR049 HYDROSTATIC REDUCTION (PSR) Procedure SURGERY 10390 10910 12990 15060
PROCEDURE
PPED001 ARTERIAL LINE PERIPHERAL Procedure PAEDIATRICS 780 810 970 1120
PPED002 ASCITIC TAP - PED Procedure PAEDIATRICS 510 540 640 740
BABY CARE CHARGES INCLUDING
PPED003 Procedure PAEDIATRICS 130 140 160 190
ROOM AFTER DELIVERY/DAY
BIOPSY-1 LIVER,KIDNEY,PLEURA
EXCLUDING HISTOLOGY & USC - PED
BIOPSY-2 FINE NEEDLE GLAND BIOPSY
BONE MARROW - PED
PPED006 BRONCHOSCOPY FLEXIBLE - PED Procedure PAEDIATRICS 3790 3980 4730 5490
BRONCHOSCOPY FLEXIBLE - (W/O
SEDATION)
BRONCHOSCOPY FLEXIBLE - (WITH
SEDATION)
PPED009 CAUTERY OF UMBILICAL GRANULOMA Procedure PAEDIATRICS 210 220 260 310
PPED010 CENTRAL LINE - PED Procedure PAEDIATRICS 1340 1410 1670 1940
CONTINUOUS ARTERIO-VENOUS
HAEMO-FILTRATI - PED
PPED012 CRANIAL U/S - PED Procedure PAEDIATRICS 430 450 540 620
PPED013 CYSTOSCOPY+RGP Procedure PAEDIATRICS 1370 1440 1720 1990
PPED014 CYSTOSCOPY-DIAGNOSTIC - PPED Procedure PAEDIATRICS 1040 1090 1300 1510
PPED015 CYSTOSCOPY-FULGURATION Procedure PAEDIATRICS 2870 3010 3580 4160
PPED016 DEV.ASST NICU GRADUATE Procedure PAEDIATRICS 420 440 520 610
PPED017 DEV.ASST PICU GRADUATE Procedure PAEDIATRICS 420 440 520 610
PPED018 DIALYSIS PERITONEAL - PED Procedure PAEDIATRICS 5580 5860 6980 8090
ENDOTRACHEAL INTUBATION (NOT IN
ICU) - PED
PPED020 EXCHANGE TRANFUSIONS REPEAT Procedure PAEDIATRICS 2870 3010 3580 4160
EXCHANGE TRANSFUSION EXCLUDING
BLOOD,DRUGS,TUBES,SYR,OT - PED
49
Paediatrics

PPED022 HICKMAN REMOVAL - PED Procedure PAEDIATRICS 2330 2440 2910 3370
PPED023 HYDROSTATIC REDUCTION (PED) Procedure PAEDIATRICS 10390 10910 12990 15060
INFUSION OF VASOACTIVE DRUGS -
PED
INFUSION PUMP (NOT IN ICU) 24 HRS
OR LES
PPED026 INHALED NITRIC OXIDE - PED Procedure PAEDIATRICS 3240 3400 4040 4690
PPED028 INTERCOSTAL DRAINAGE - PED Procedure PAEDIATRICS 1120 1180 1400 1620
PPED029 LACTATION COUNSELING Procedure PAEDIATRICS 740 780 920 1070
PPED030 LUMBAR PUNCTURE - PED Procedure PAEDIATRICS 500 520 620 720
PPED031 MISCELLANEOUS PROCEDURE Procedure PAEDIATRICS 510 540 640 740
MISCELLANEOUS PROCEDURE -
MINOR
MISCELLANEOUS PROCEDURE - NOT
IN ICU - PPED
MONITORS FOR 24 HRS OR LESS -NOT
IN ICU - PPED
NEBULIZER FOR ASTHMA EXCL O2 &
DRUGS
NEBULIZER FOR WHOLE DAY (MORE
THAN 4 TREATMENTS) - PED
NEONATAL CARE DURING ROP
SURGERY - PED
PPED039 NEONATAL HEARING TEST - PED Procedure PAEDIATRICS 740 780 920 1070
NEURODEVELOPMENT ASSESSMENT
- PED
PPED041 NEW BORN BABY PACKAGE (N.D) Procedure PAEDIATRICS 2050 2150 2560 2970
PPED042 NEW BORN BABY PACKAGE (CAE) Procedure PAEDIATRICS 3420 3590 4270 4960
OBSERVATION NURSERY DAILY OR
LESS CHARGES - PED
PPED046 PICU HIGH INTENSIVE CHARGES Procedure PAEDIATRICS 1300 1370 1630 1890
PPED047 PICU LOW INTENSIVE CHARGES Procedure PAEDIATRICS 960 1010 1200 1390
PLASMA PARTIAL EXCHANGE TRANS
- PED
PPED049 PLASMA PHERESIS - PED Procedure PAEDIATRICS 2050 2150 2560 2970
PLEURAL PERICARDIAL/SUBDURAL/
VENTRICULAR TAPS - PED
PPED051 RESPIRATORY THERAPY / WEEK - PED Procedure PAEDIATRICS 1530 1610 1920 2220
PPED052 RESUSCITATION - BABY CARE (ND) Procedure PAEDIATRICS 1450 1530 1820 2110
RESUSCITATION ACTIVE DURING
CAESAREAN SECTION
50
Paediatrics

PPED054 RESUSCITATION NORMAL DELIVERY Procedure PAEDIATRICS 790 830 980 1140
PPED055 SEDATION INTERMEDIATE - PED Procedure PAEDIATRICS 1050 1100 1310 1520
PPED056 SPIROMETRY - PED Procedure PAEDIATRICS 1100 1150 1370 1590
PPED057 SPIROMETRY - PAEDIATRIC - PPED Procedure PAEDIATRICS 1100 1150 1370 1590
PPED058 SUPRAPUBIC BLADDER TAP - PED Procedure PAEDIATRICS 480 500 590 690
PPED059 SURFACTANT THERAPY - PED Procedure PAEDIATRICS 5170 5430 6460 7490
PPED060 SUTURE REMOVAL - PPED Procedure PAEDIATRICS 260 270 320 370
TOTAL PARENTRAL NUTRITION
PLANNING & FORMULATION - PED
PPED062 TRANSFUSION - PED Procedure PAEDIATRICS 950 1000 1180 1370
PPED063 UMBILICAL ARTERIAL LINE - PED Procedure PAEDIATRICS 1120 1180 1400 1620
PPED064 UMBILICAL VENOUS LINE - PED Procedure PAEDIATRICS 780 810 970 1120
PPED065 VENESECTION - PED Procedure PAEDIATRICS 740 780 920 1070
VENTILATION THERAPY - HI
FREQUENCY - PED
PPED067 WARMER TREATMENT - PED Procedure PAEDIATRICS 130 140 160 190
PPED068 WOUND DRESSING Procedure PAEDIATRICS 280 290 350 410
PPED069 OAE SCREENING Procedure PAEDIATRICS 680 720 850 990
PPED070 ABR SCREENING & TYMPANOMETRY Procedure PAEDIATRICS 610 640 770 890
OAE, ABR SCREENING &
TYMPANOMETRY
PPED084 SWEAT TEST ANALYSIS Procedure PAEDIATRICS 1780 1860 2220 2570
PHOTOTHERAPY CHARGES PER DAY
- PED
OBSERVATION CHARGES PER HOUR
(NICU)
BAYLEY NEURODEVELOPMENT
ASSESSMENT < 24 Months
BAYLEY NEURODEVELOPMENT
ASSESSMENT >24 Month
PPED089 SKIN BIOPSY - PED Procedure PAEDIATRICS 6420 6740 8030 9310
PPED090 CRYO - A - PED Procedure PAEDIATRICS 640 670 800 920
PPED091 CRYO - B - PED Procedure PAEDIATRICS 1240 1300 1540 1790
PPED092 CRYO - C - PED Procedure PAEDIATRICS 2330 2440 2910 3370
PPED093 CRYO - D - PED Procedure PAEDIATRICS 4370 4590 5470 6340
PPED094 CURETTAGE - PED Procedure PAEDIATRICS 1650 1730 2060 2390
PPED095 INTRA LESIONAL INJECTION - PED Procedure PAEDIATRICS 1510 1590 1890 2190
51
Department of
Neuro Sciences
52
Neurology
53
Neurology
Billing
Group
PNEU046 TRACHEOSTOMY TUBE CHANGE - NEU Procedure NEUROLOGY 760 800 950 1110
PNEU008 COUNSELLING -PER SESSION Procedure NEUROLOGY 1240 1300 1540 1790
PNEU015 EMG NEEDLE - DISPOSABLE Procedure NEUROLOGY 1240 1300 1540 1790
PNEU016 EMG ONE MUSCLE Procedure NEUROLOGY 1240 1300 1540 1790
PNEU031 MMSE ASSESSMENT Procedure NEUROLOGY 1240 1300 1540 1790
PNEU036 NCV SINGLE NERVE Procedure NEUROLOGY 1370 1440 1720 1990
PNEU002 ARTERIAL LINE - NEU Procedure NEUROLOGY 1510 1590 1890 2190
PNEU041 RESUSCITATION ACTIVE - NEU Procedure NEUROLOGY 1510 1590 1890 2190
PNEU042 SEDATION CHARGE - NEU Procedure NEUROLOGY 1650 1730 2060 2390
PNEU007 CENTRAL LINE - NEU Procedure NEUROLOGY 1780 1860 2220 2570
BONE MARROW ASPIRATION BIOPSY (A) -
PNEU003 Procedure NEUROLOGY 1910 2010 2390 2770
PNEU
DEMYLINATING/ AUTOIMMUNE DISEASE
MANAGEMENT
PNEU054 EEG SCREENING Procedure NEUROLOGY 1910 2010 2390 2770
PNEU018 EP BAER Procedure NEUROLOGY 1910 2010 2390 2770
PNEU039 NEUROMUSCULAR DISEASE MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770
PNEU024 SEIZURE / EPILEPSY MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770
PNEU043 STROKE MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770
PNEU022 EP V E P Procedure NEUROLOGY 2050 2150 2560 2970
PNEU020 EP S S E P (1 NERVE) Procedure NEUROLOGY 2330 2440 2910 3370
PNEU037 NEOSTIGMINE TEST Procedure NEUROLOGY 2330 2440 2910 3370
PNEU010 EEG Procedure NEUROLOGY 2500 2500 2750 3000
PNEU055 ENCEPHALOPATHY MANAGEMENT Procedure NEUROLOGY 2870 3010 3580 4160
PNEU019 EP BAER (DIFFERENT STIMULI) Procedure NEUROLOGY 2870 3010 3580 4160
PNEU023 EP V E P (DIFF STIMULI)_ Procedure NEUROLOGY 2870 3010 3580 4160
PNEU005 BRAIN MAPPING Procedure NEUROLOGY 3010 3160 3760 4360
PNEU001 ADVANCED EMG/MISC ELECTROPHYSIOLOGY Procedure NEUROLOGY 3560 3740 4450 5160
PNEU009 DETAILED HIGHER FUNCTION ASSESSMENT Procedure NEUROLOGY 3560 3740 4450 5160
PNEU017 EMG UPTO 3 MUSCLES Procedure NEUROLOGY 3560 3740 4450 5160
PNEU026 ICU PROCEDURES CHARGES Procedure NEUROLOGY 3560 3740 4450 5160
PNEU050 INTENSIVE CARE MONITORING CHARGES Procedure NEUROLOGY 3560 3740 4450 5160
PNEU045 TENSILON TESTING Procedure NEUROLOGY 3560 3740 4450 5160
PNEU021 EP S S E P (MORE THAN ONE NERVE) Procedure NEUROLOGY 3830 4030 4790 5560
PNEU034 NCV - UPTO 4 NERVES Procedure NEUROLOGY 3970 4170 4960 5760
PNEU030 LUMBAR PUNCHURE CHARGES Procedure NEUROLOGY 4370 4590 5470 6340
PNEU011 EEG PORTABLE Procedure NEUROLOGY 4650 4880 5810 6740
PNEU004 BOTOLINIUM TOXIN INJECTION Procedure NEUROLOGY 4790 5030 5980 6940
PNEU006 CARPAL TUNNEL INJECTION Procedure NEUROLOGY 4790 5030 5980 6940
PNEU014 EMG MORE THAN 3 MUSCLES Procedure NEUROLOGY 5880 6180 7350 8530
PNEU013 EEG PORTABLE UPTO 4 HRS Procedure NEUROLOGY 7110 7470 8890 10310
54
Neurology
Billing
Group
PNEU027 IMMUNOTHERAPY - NEU Procedure NEUROLOGY 7110 7470 8890 10310
PNEU029 LUMAR PUNCTURE PRESSURE MONITORING Procedure NEUROLOGY 7110 7470 8890 10310
PNEU032 MUSCLE BIOPSY Procedure NEUROLOGY 7110 7470 8890 10310
PNEU035 NCV MORE THAN 4 NERVES Procedure NEUROLOGY 7110 7470 8890 10310
NEUROLOGICAL INFECTION / INFLAMMATION
MANAGEMENT
PARKINSON'S DISEASE/MOVEMENT
DISORDER MANAGEMENT
PNEU038 NERVE BIOPSY Procedure NEUROLOGY 7390 7760 9230 10710
PNEU047 VIDEO MONITERING -UPTO 4 HOURS Procedure NEUROLOGY 8200 8610 10250 11890
PNEU051 VIDEO EEG less than 4 hrs Procedure NEUROLOGY 8480 8900 10600 12290
PNEU012 EEG PORTABLE MORE THAN 4 HRS Procedure NEUROLOGY 9570 10050 11960 13880
PNEU052 VIDEO EEG 4 hrs- 12 hrs Procedure NEUROLOGY 9570 10050 11960 13880
PNEU057 Intra Operative DBS monitoring Procedure NEUROLOGY 11500 12080 14380 16680
PNEU053 VIDEO EEG 12 hrs- 24 hrs Procedure NEUROLOGY 11760 12350 14700 17050
PNEU049 VIDEO MONITORING-4-12 HRS Procedure NEUROLOGY 14350 15060 17930 20800
PNEU025 EPILEPSY SURGERY WORKUP Procedure NEUROLOGY 17760 18650 22200 25750
STROKE REVASCULARISATION WORKUP/
MONITORING
PNEU048 VIDEO MONITORING -12-24 HOURS Procedure NEUROLOGY 23910 25110 29890 34670
PNPSY05 Cognitive Stimulation Per Session Procedure NEUROPSYCHOLOGY 260 270 320 370
PNPSY07 Brief Psychological Assessment Procedure NEUROPSYCHOLOGY 500 520 620 720
PNPSY04 Counseling NPSY Procedure NEUROPSYCHOLOGY 520 550 650 760
PNPSY08 Developmental / Behavioral Assessment Procedure NEUROPSYCHOLOGY 760 800 950 1110
PNPSY18 Psychotherapy Per Session NPSY Procedure NEUROPSYCHOLOGY 760 800 950 1110
PNPSY09 Aptitude Test / Career Guidance Procedure NEUROPSYCHOLOGY 960 1010 1200 1390
PNPSY12 Assessment of Cognition/Attitudes Procedure NEUROPSYCHOLOGY 960 1010 1200 1390
PNPSY13 Assessment of Memory/Intelligence Procedure NEUROPSYCHOLOGY 1240 1300 1540 1790
PNPSY10 Disability/ SLD Assessment Procedure NEUROPSYCHOLOGY 1240 1300 1540 1790
PNPSY19 Couple / Family Therapy( per session) Procedure NEUROPSYCHOLOGY 1370 1440 1720 1990
PNPSY14 Assessment of Cognitive Functions Procedure NEUROPSYCHOLOGY 1510 1590 1890 2190
PNPSY15 Assessment of Personality & IPR Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770
PNPSY11 Child & Adolescent Assessment Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770
PNPSY17 Couple / Family Assessment Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770
Neuropsychological Assessment Specific
PNPSY01 Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770
Domain
PNPSY16 Psycho diagnostic Assessment Procedure NEUROPSYCHOLOGY 2470 2590 3080 3570
PNPSY06 Cognitive Retraining Up to 5 Sessions Procedure NEUROPSYCHOLOGY 3280 3450 4100 4760
Neuropsychological Assessment Partial /
Diagnostic
Neuropsychological Assessment Complete
Profile
55
Neuro Surgery
56
Neuro Surgery
Surgery Billing
Level Group
NEUROSURGERY
PNSR015 COGNITIVE STIMULATION - NSR Procedure 420 440 520 610
PROCEDURE
NEUROSURGERY
PNSR028 WOUND REPAIR - MINOR Procedure 480 500 590 690
PROCEDURE
ASSESSMENT - PSYCHOLOGICAL NEUROSURGERY
PNSR007 Procedure 560 580 690 810
MISC PROCEDURE
NEUROSURGERY
PNSR003 ASSESSMENT - DEVELOPMENTAL Procedure 640 670 800 920
PROCEDURE
ASSESSMENT - SPECIFIC NEUROSURGERY
PNSR008 Procedure 640 670 800 920
PSYCHOLOGICAL FUNCTIONS PROCEDURE
NEUROSURGERY
PNSR012 COGNITIVE BEHAVIOUR THERAPY Procedure 640 670 800 920
PROCEDURE
NEUROSURGERY
PNSR014 COGNITIVE RETRAINING - NSR Procedure 640 670 800 920
PROCEDURE
NEUROSURGERY
PNSR010 BLOCK Procedure 660 690 820 960
PROCEDURE
NEUROSURGERY
PNSR020 PARKINSONS ASSESSMENT Procedure 760 800 950 1110
PROCEDURE
NEUROSURGERY
PNSR019 LUMBAR DRAIN Procedure 960 1010 1200 1390
PROCEDURE
NEUROSURGERY
PNSR009 BIOPSY NEUROSURGERY Procedure 1100 1150 1370 1590
PROCEDURE
NEUROSURGERY
PNSR027 WOUND REPAIR - MAJOR Procedure 1100 1150 1370 1590
PROCEDURE
COGNITIVE FUNCTIONS NEUROSURGERY
PNSR013 Procedure 1240 1300 1540 1790
ASSESSMENT - NSR PROCEDURE
PERSONALITY & INTERPERSONAL NEUROSURGERY
PNSR023 Procedure 1300 1370 1630 1890
RELATIONS - NSR PROCEDURE
ASSESSMENT - GENERAL NEUROSURGERY
PNSR005 Procedure 2050 2150 2560 2970
PSYCHOLOGICAL PROCEDURE
NEUROSURGERY
PNSR022 PERCUTANEOUS PROCEDURE - SI Procedure 2050 2150 2560 2970
PROCEDURE
NEUROSURGERY
PNSR026 ULTRASOUND (NEUROSURGERY) Procedure 2600 2730 3250 3770
PROCEDURE
NEUROSURGERY
PNSR017 FAZET CHIZOTOMY Procedure 2740 2880 3430 3970
PROCEDURE
NEUROSURGERY
PNSR025 TCD Procedure 2870 3010 3580 4160
PROCEDURE
ICU PROCEDURE CHARGES NEUROSURGERY
PNSR018 Procedure 3140 3300 3930 4560
(NEUROSURGERY) PROCEDURE
ASSESSMENT - NEURO NEUROSURGERY
PNSR006 Procedure 3700 3880 4620 5360
PSYCHOLOGICAL PROCEDURE
LUMBAR PUNCHURE (NEURO NEUROSURGERY
PNSR030 Procedure 3830 4030 4790 5560
SURGERY) PROCEDURE
RF LESION FOR TRIGEMINAL NEUROSURGERY
PNSR024 Procedure 3970 4170 4960 5760
NEURALGIA PROCEDURE
57
Neuro Surgery
Surgery Billing
Level Group
NEUROSURGERY
PNSR021 PERCUTANEOUS PROCEDURE - CO Procedure 4100 4300 5120 5940
PROCEDURE
NEUROSURGERY
PNSR002 ANGIOGRAPHY - RESTRICTED Procedure 6020 6320 7520 8730
PROCEDURE
NEUROSURGERY
PNSR001 ANGIOGRAPHY - 4 VESSEL - PNSR Procedure 12570 13200 15720 18230
PROCEDURE
NEUROSURGERY
PNSR011 BONE MARROW ASPIRATION Procedure 26650 27980 33310 38640
PROCEDURE
CARPAL TUNNEL INJECTION (LNSR) NEURO
LNSR300 L1 Surgery 0 4500 5360 6220
# L1 SURGERY
NEURO
LNSR301 CHAMBER ASPIRATION (LNSR) # L1 L1 Surgery 0 4500 5360 6220
SURGERY
NEURO
LNSR302 CISTERNAL PUNCTURE (LNSR) # L1 L1 Surgery 0 4500 5360 6220
SURGERY
LUMBAR PUNTURE IN OT (LNSR) NEURO
LNSR303 L1 Surgery 0 4500 5360 6220
# L1 SURGERY
LUMBAR TAP DIAGNOSTIC (LNSR) NEURO
LNSR304 L1 Surgery 0 4500 5360 6220
# L1 SURGERY
SECONDARY SUTURING (LNSR) NEURO
LNSR305 L1 Surgery 0 4500 5360 6220
# L1 SURGERY
SUTURE REMOVAL UNDER GA NEURO
LNSR306 L1 Surgery 0 4500 5360 6220
(LNSR) # L1 SURGERY
WOUND DEBRIDEMENT AND NEURO
LNSR307 L1 Surgery 0 4500 5360 6220
REPAIR (LNSR) # L1 SURGERY
NEURO
LNSR308 BIOPSY MUSCLE (LNSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
NEURO
LNSR309 BIOPSY NERVE (LNSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
NEURO
LNSR310 CSF LEAK REPAIR (LNSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
EXTERNAL LUMBAR DRAIN (LNSR) NEURO
LNSR311 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
HEMATOMA SUBDURAL ACUTE NEURO
LNSR312 L2 Surgery 0 8240 9810 11380
(POST-OP) (LNSR) # L2 SURGERY
LUMBAR TAP DIAGNOSTIC + NEURO
LNSR313 L2 Surgery 0 8240 9810 11380
PRESSURE MONITOR (LNSR) # L2 SURGERY
NEURO
LNSR314 NEUROLYSIS (LNSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
NEURO
LNSR315 STA BIOPSY (LNSR) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
STELLATE GANGLION BLOCK NEURO
LNSR316 L2 Surgery 0 8240 9810 11380
(LNSR) # L2 SURGERY
VENTRICULAR PUNCTURE (LNSR) NEURO
LNSR317 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
58
Neuro Surgery
Surgery Billing
Level Group
ANGIOGRAPHY DIAGNOSTIC A)
NEURO
LNSR404 SINGLE/TWO VESSEL (LNSR) - L3 Surgery 0 10820 12880 14940
SURGERY
CATH # L3
CARPAL TUNNEL RELEASE (LNSR) NEURO
LNSR318 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
NERVE ENTRAPMENT RELEASE NEURO
LNSR319 L3 Surgery 0 10820 12880 14940
(LNSR) # L3 SURGERY
SCALP TUMOR EXCISION (LNSR) NEURO
LNSR320 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
ANGIOGRAM SPINAL DIAGNOSTIC NEURO
LNSR432 L4 Surgery 0 14790 17610 20420
SINGLE ARTERY (LNSR) # L4 SURGERY
ANGIOGRAPHY DIAGNOSTIC B) NEURO
LNSR405 L4 Surgery 0 14790 17610 20420
FOUR VESSEL (LNSR) - CATH # L4 SURGERY
ANGIOGRAPHY SPINAL (LNSR) - NEURO
LNSR406 L4 Surgery 0 14790 17610 20420
CATH # L4 SURGERY
BURR HOLE - DIAGNOSTIC (LNSR) NEURO
LNSR321 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
CARPAL TUNNEL RELEASE - NEURO
LNSR322 L4 Surgery 0 14790 17610 20420
MICROSCOPIC (LNSR) # L4 SURGERY
MICROSCOPIC NERVE
NEURO
LNSR323 ENTRAPMENT RELEASE (LNSR) L4 Surgery 0 14790 17610 20420
SURGERY
# L4
NEURO
LNSR324 TRACHEOSTOMY (LNSR) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
TRANS VENOUS ANGIOGRAM NEURO
LNSR407 L4 Surgery 0 14790 17610 20420
(LNSR) - CATH # L4 SURGERY
VENTRICULAR TAP (DONE IN OT) NEURO
LNSR325 L4 Surgery 0 14790 17610 20420
(LNSR) # L4 SURGERY
BRAIN BIOPSY BURR HOLE (LNSR) NEURO
LNSR326 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
CAROTID LIGATION (as sole NEURO
LNSR327 L5 Surgery 0 18010 21440 24870
procedure) (LNSR) # L5 SURGERY
NEURO
LNSR328 CYST TAPPING (LNSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
NEURO
LNSR329 EVD (LNSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
NEURO
LNSR330 ICP MONITORING (LNSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
NEUROMA EXCISIONS - NEURO
LNSR331 L5 Surgery 0 18010 21440 24870
PERIPHERAL NERVE (LNSR) # L5 SURGERY
NEURO
LNSR332 RF LESIONING (LNSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
NEURO
LNSR333 SYMPATHECTOMY (LNSR) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
WADA TEST - CATH (LNSR) - CATH NEURO
LNSR409 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
59
Neuro Surgery
Surgery Billing
Level Group
ANGIOGRAPHY THERAPEUTIC,
NEURO
LNSR408 stent, clips, balloons etc (LNSR) - L5 Surgery 0 21870 26030 30200
SURGERY
CATH # L5
EMBOLIZATION B) AVM (INCLUDING
NEURO
LNSR418 ANGIO) - STAGED PROCEDURE - Surgery 0 21870 26030 30200
SURGERY
CATH
INTRA ARTERIAL DRUG INFUSION NEURO
LNSR415 L8 Surgery 0 21870 26030 30200
(LNSR) - CATH # L8 SURGERY
INTRACRANIAL THROMBOLYSIS NEURO
LNSR413 L8 Surgery 0 21870 26030 30200
MECHANICAL (LNSR) - CATH # L8 SURGERY
INTRACRANIAL VENOUS SINUS NEURO
LNSR414 L8 Surgery 0 21870 26030 30200
SAMPLING (LNSR) - CATH # L8 SURGERY
BURR HOLE AND SUBDURAL NEURO
LNSR334 L6 Surgery 0 27010 32150 37290
LAVAGE (LNSR) # L6 SURGERY
BURR HOLE ICP MONITORING NEURO
LNSR335 L6 Surgery 0 27010 32150 37290
(LNSR) # L6 SURGERY
BURR HOLES FRONTOPARIETAL NEURO
LNSR336 L6 Surgery 0 27010 32150 37290
AND LAVAGE (LNSR) # L6 SURGERY
CAROTID ANGIOPLASTY (LNSR) - NEURO
LNSR412 L6 Surgery 0 27010 32150 37290
CATH # L6 SURGERY
EMBOLIZATION A) TUMOUR (LNSR) NEURO
LNSR410 L6 Surgery 0 27010 32150 37290
- CATH # L6 SURGERY
RESERVOIR PLACEMENT (LNSR) NEURO
LNSR337 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
SHUNT PROCEDURES - VP/TP NEURO
LNSR338 L6 Surgery 0 27010 32150 37290
(LNSR) # L6 SURGERY
TWIST DRILL CRANIOSTOMY NEURO
LNSR339 L6 Surgery 0 27010 32150 37290
(LNSR) # L6 SURGERY
ANGIOGRAM SPINAL DIAGNOSTIC NEURO
LNSR428 L7 Surgery 0 36010 42870 49730
MULTIPLE ARTERIES (LNSR) # L7 SURGERY
ANGIOGRAPHY THERAPEUTIC - NEURO
LNSR417 L7 Surgery 0 36010 42870 49730
COILS - CATH # L7 SURGERY
BONE FLAP REPLACEMENT (LNSR) NEURO
LNSR340 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
NEURO
LNSR341 ETV (LNSR) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
MICROSCOPIC CAROTID NEURO
LNSR342 L7 Surgery 0 36010 42870 49730
ENDARTERECTOMY (LNSR) # L7 SURGERY
MICROSCOPIC THIRD NEURO
LNSR343 L7 Surgery 0 36010 42870 49730
VENTRICULOSTOMY (LNSR) # L7 SURGERY
MINI CRANIOTOMY FOR SDH NEURO
LNSR344 L7 Surgery 0 36010 42870 49730
(LNSR) # L7 SURGERY
NEURO ENDOSCOPIC PROCEDURES NEURO
LNSR345 L7 Surgery 0 36010 42870 49730
(LNSR) # L7 SURGERY
RE-EXPLORATION CRANIOTOMY NEURO
LNSR346 L7 Surgery 0 36010 42870 49730
(LNSR) # L7 SURGERY
60
Neuro Surgery
Surgery Billing
Level Group
SHUNT PROCEDURES -SYRINX/ NEURO
LNSR347 L7 Surgery 0 36010 42870 49730
PROGRAMMABLE (LNSR) # L7 SURGERY
SPINAL UNILATERAL APPROACH
NEURO
LNSR423 AND BILATERAL DECOMPRESSION L7 Surgery 0 36010 42870 49730
SURGERY
(LNSR) # L7
BRACHIAL PLEXUS EXPLORATION NEURO
LNSR422 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
CARNIOTOMY FOR CHRONIC SDH NEURO
LNSR348 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
CAROTID BODY TUMOR EXCISION NEURO
LNSR349 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
NEURO
LNSR350 CORTICAL MAPPING (LNSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
CRANIOPLASTY ACRYLIC (LNSR) NEURO
LNSR351 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
NEURO
LNSR352 CRANIOPLASTY MESH (LNSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
CRANIOPLASTY WITH BONE FLAP NEURO
LNSR353 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
CRANIOTOMY ACUTE SDH (LNSR) NEURO
LNSR354 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
CRANIOTOMY AND
MICROVASCULAR NEURO
LNSR355 L8 Surgery 0 45010 53580 62150
DECOMPRESSION FOR TRIGEMINAL SURGERY
NEURALGIA (LNSR) # L8
CRANIOTOMY FOR BRAIN ABSCESS NEURO
LNSR356 L8 Surgery 0 45010 53580 62150
LIKE LESIONS (LNSR) # L8 SURGERY
CRANIOTOMY FOR CONTUSIONS NEURO
LNSR357 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
CRANIOTOMY FOR CONVEXITY NEURO
LNSR358 L8 Surgery 0 45010 53580 62150
LESIONS (LNSR) # L8 SURGERY
CRANIOTOMY FOR CSF NEURO
LNSR359 L8 Surgery 0 45010 53580 62150
RHINORRHEA REPAIR (LNSR) # L8 SURGERY
CRANIOTOMY FOR
NEURO
LNSR361 DECOMPRESSION OF INFECTIVE L8 Surgery 0 45010 53580 62150
SURGERY
DISORDERS (LNSR) # L8
CRANIOTOMY FOR
NEURO
LNSR360 DECOMPRESSION OF MALIGNANT L8 Surgery 0 45010 53580 62150
SURGERY
INFARCTS (LNSR) # L8
CRANIOTOMY FOR DEPRESSED NEURO
LNSR362 L8 Surgery 0 45010 53580 62150
FRACTURE (LNSR) # L8 SURGERY
CRANIOTOMY FOR EDH (LNSR) # NEURO
LNSR363 L8 Surgery 0 45010 53580 62150
L8 SURGERY
NEURO
LNSR364 CRANIOTOMY FOR ICH (LNSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
61
Neuro Surgery
Surgery Billing
Level Group
CRANIOTOMY FOR
NEURO
LNSR365 INTRAVENTRICULAR LESIONS L8 Surgery 0 45010 53580 62150
SURGERY
(LNSR) # L8
CRANIOTOMY FOR SELLAR
NEURO
LNSR366 SUPRASELLAR LESIONS (LNSR) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
CRANIOTOMY FOR
NEURO
LNSR367 SUPRATENTORIAL LESIONS (LNSR) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
DECOMPRESSIVE CRANIOTOMY NEURO
LNSR368 L8 Surgery 0 45010 53580 62150
(LNSR) # L8 SURGERY
EMBOLIZATION B) AVM (INCLUDING
NEURO
LNSR419 ANGIO)- SINGLE STAGE - CATH # L8 Surgery 0 45010 53580 62150
SURGERY
L8
ENDOSCOPIC CSF REPAIR (LNSR) NEURO
LNSR369 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
ENDOSCOPIC HEMATOMA NEURO
LNSR421 L8 Surgery 0 45010 53580 62150
EVACUATION(LNSR) # L8 SURGERY
ENDOVASCULAR STROKE NEURO
LNSR427 L8 Surgery 0 45010 53580 62150
INTERVENTION (LNSR) # L8 SURGERY
OPEN NEURAL TUBE DEFECTS
NEURO
LNSR370 (MENINGOMYELOCOELE/ L8 Surgery 0 45010 53580 62150
SURGERY
MENINGOCOLE/) (LNSR) # L8
STEREOTACTIC EVACUATION OF NEURO
LNSR372 L8 Surgery 0 45010 53580 62150
ICH (LNSR) # L8 SURGERY
STEREOTACTIC SURGERY (LNSR) NEURO
LNSR373 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
STEREOTAXY FOR MOVEMENT NEURO
LNSR374 L8 Surgery 0 45010 53580 62150
DISORDERS (LNSR) # L8 SURGERY
NEURO
LNSR371 STERIOTACTIC BIOPSY (LNSR) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
STEROTACTIC ASPIRATION OF NEURO
LNSR375 L8 Surgery 0 45010 53580 62150
CYSTS (LNSR) # L8 SURGERY
TRANSPHENOIDAL MICROSCOPIC
NEURO
LNSR376 SURGERY FOR SELLAR LESIONS L8 Surgery 0 45010 53580 62150
SURGERY
(LNSR) # L8
BRAIN BYPASS PROCEDURES NEURO
LNSR379 L9 Surgery 0 54020 64300 74590
(LNSR) # L9 SURGERY
CLIPPING OF ANEURYSM (LNSR) NEURO
LNSR380 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
CLOSED NEURAL TUBE
DEFECTS (DIASTOMETAMYELIA/ NEURO
LNSR381 L9 Surgery 0 54020 64300 74590
LIPOMENINGOCOELE/TETHERED SURGERY
CORD) (LNSR) # L9
CRANIOFACIAL ADVANCEMENT FOR NEURO
LNSR424 L9 Surgery 0 54020 64300 74590
CRANIOSYNOSTOSIS (LNSR) # L9 SURGERY
CRANIOTOMY FOR BRAIN STEM NEURO
LNSR383 L9 Surgery 0 54020 64300 74590
62
Neuro Surgery
Surgery Billing
Level Group
CRANIOTOMY FOR CEREBELLAR NEURO
LNSR384 L9 Surgery 0 54020 64300 74590
CRANIOTOMY FOR CLIVAL/ NEURO
LNSR385 L9 Surgery 0 54020 64300 74590
PETROUS TUMORS (LNSR) # L9 SURGERY
CRANIOTOMY FOR CP ANGLE NEURO
LNSR386 L9 Surgery 0 54020 64300 74590
TUMORS (LNSR) # L9 SURGERY
CRANIOTOMY FOR EPILEPSY/ NEURO
LNSR387 L9 Surgery 0 54020 64300 74590
FUNCTIONAL SURGERY (LNSR) # L9 SURGERY
CRANIOTOMY FOR PINEAL REGION NEURO
LNSR388 L9 Surgery 0 54020 64300 74590
CRANIOTOMY FOR POSTERIOR NEURO
LNSR391 L9 Surgery 0 54020 64300 74590
FOSSA TUMORS (LNSR) # L9 SURGERY
CRANIOTOMY FOR POST. FOSSA NEURO
LNSR389 L9 Surgery 0 54020 64300 74590
HEMATOMAS (LNSR) # L9 SURGERY
CRANIOTOMY FOR POST. FOSSA NEURO
LNSR390 L9 Surgery 0 54020 64300 74590
INFARCTS (LNSR) # L9 SURGERY
DEEP BRAIN STIMULATION (LNSR) NEURO
LNSR392 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
ENDOSCOPIC CRANIO FACIAL NEURO
LNSR425 L9 Surgery 0 54020 64300 74590
CORRECTIVE SURGERY (LNSR) # L9 SURGERY
ENDOSCOPIC SELLAR REGION NEURO
LNSR426 L9 Surgery 0 54020 64300 74590
MASS EXCISION (LNSR) # L9 SURGERY
ENDOSCOPIC SELLAR NEURO
LNSR394 L9 Surgery 0 54020 64300 74590
SUPRASELLAR LESION (LNSR) # L9 SURGERY
ENDOVASCULAR ANEURYSM NEURO
LNSR431 L9 Surgery 0 54020 64300 74590
COILING (LNSR) # L9 SURGERY
ENDOVASCULAR FLOW DIVERTER NEURO
LNSR430 L9 Surgery 0 54020 64300 74590
PROCDURE (LNSR) # L9 SURGERY
NEURO
LNSR395 EXCISION OF AVM (LNSR) # L9 L9 Surgery 0 54020 64300 74590
SURGERY
EXCISION OF SPINAL AVM (LNSR) NEURO
LNSR396 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
SPINAL ENDOVASCULAR NEURO
LNSR429 L9 Surgery 0 54020 64300 74590
PROCEDURE (LNSR) # L9 SURGERY
ANEURYSM WITH AVM SURGERY NEURO
LNSR377 L9 Surgery 0 63010 75010 87020
(LNSR) # L9 SURGERY
ANEURYSM WITH
NEURO
LNSR378 RECONSTRUCTION SURGERY L9 Surgery 0 63010 75010 87020
SURGERY
(LNSR) # L9
GIANT MENINGIOMA SURGERY (>5 NEURO
LNSR397 L9 Surgery 0 63010 75010 87020
CM in DIAMETER) (LNSR) # L9 SURGERY
MULTICENTRIC GLIOMAS
NEURO
LNSR400 SURGERY(TWO PATHOLOGIES AT L9 Surgery 0 63010 75010 87020
SURGERY
TWO LOCATIONS) (LNSR) # L9
63
Neuro Surgery
Surgery Billing
Level Group
COMPLEX BYPASS PROCEDURES
SURGERY (OA/JUMP GRAFTS/HIGH NEURO
LNSR382 L9 Surgery 0 72020 85740 99450
FLOW/ANEURYSM WITH BYPASS) SURGERY
(LNSR) # L9
COMPLEX CEREBRAL ARTERY NEURO
LNSR420 L9 Surgery 0 72020 85740 99450
ANEURYSM CLIPPING # L9 SURGERY
DUAL LEVEL SPLIT CORDS
NEURO
SURGERY
Evacuation of SDH & NEURO
LNSR433 Surgery 0 72020 85740 99450
Decompressive carniectomy SURGERY
Evacuation of SDH +
Decompressive craniectomy + NEURO
LNSR434 L9 Surgery 0 72020 85740 99450
Bone Flap placement in Abdomen SURGERY
# L9
GIANT PITUITARY SURGERY (>5 CM NEURO
LNSR398 L9 Surgery 0 72020 85740 99450
in DIAMETER) (LNSR) # L9 SURGERY
GUIDED /MONITORED CRANIOTOMY
FOR BRAIN TUMORS(NEURO NEURO
LNSR399 L9 Surgery 0 72020 85740 99450
NAVIGATION/INTRA OPERATIVE SURGERY
MONITORING) (LNSR) # L9
MULTIPLE ANEURYSMS SURGERY NEURO
LNSR401 L9 Surgery 0 72020 85740 99450
(LNSR) # L9 SURGERY
SPLIT CORD WITH TIGHT FILUM
NEURO
SURGERY
TETHERED CORD WITH SPLIT CORD
NEURO
SURGERY
ANGIOGRAPHY DIAGNOSTIC B) STROKE
LNSR436 FOUR VESSEL (PARI) (LNSR) - CATH L4 Surgery INTERVENTION 0 14790 17610 20420
# L4 SURGERY
STROKE
ENDOVASCULAR STROKE
LNSR435 L8 Surgery INTERVENTION 0 45010 53580 62150
INTERVENTION (PARI) (LNSR) # L8
SURGERY
64
Department of Orthopaedics
& Joint Replacement
65
Orthopaedics
66
Orthopaedics
Surgery Billing
Level Group
TOTAL KNEE REPLACEMENT - ORTHOPAEDICS
KKORT016 Package 0 169990 187000 203980
UNILATERAL - PACKAGE PACKAGE
TOTAL HIP REPLACEMENT - ORTHOPAEDICS
KKORT017 Package 0 200890 221000 241070
UNILATERAL - PACKAGE PACKAGE
TOTAL HIP REPLACEMENT - ORTHOPAEDICS
KKORT020 Package 0 285890 314500 343060
BILATERAL - PACKAGE PACKAGE
TOTAL KNEE REPLACEMENT - ORTHOPAEDICS
KKORT019 Package 0 316790 348500 380150
BILATERAL - PACKAGE PACKAGE
PORT007 CONTINUOUS PASSIVE MOVEMENT Procedure ORTHOPAEDICS 115 120 145 165
PORT010 DRESSING CHARGE (MINOR) Procedure ORTHOPAEDICS 125 130 155 180
PORT009 DRESSING CHARGE (MEDIUM) Procedure ORTHOPAEDICS 210 220 265 305
PORT008 DRESSING CHARGE (MAJOR) Procedure ORTHOPAEDICS 230 240 290 335
PORT055 SUTURE REMOVAL - MEDIUM - ORT Procedure ORTHOPAEDICS 210 220 265 305
PLASTER POST SLAB - ELBOW
PORT034 Procedure ORTHOPAEDICS 230 240 290 335
ABOVE
PORT048 STRAPPING FINGER Procedure ORTHOPAEDICS 230 240 290 335
PORT052 STRAPPING TOES Procedure ORTHOPAEDICS 230 240 290 335
PORT054 SUTURE REMOVAL - MAJOR - ORT Procedure ORTHOPAEDICS 230 240 290 335
COLLES FRACTURE ANTERIOR OR
POST SLAB 5.4
PLASTER POST SLAB - KNEE
BELOW
PORT039 SKIN TRACTION Procedure ORTHOPAEDICS 275 290 345 400
PORT040 ST PIN REMOVAL Procedure ORTHOPAEDICS 275 290 345 400
STRAPPING COLAR AND CUFF
SLING
INTER ARTICULAR INJECTION -
MINOR
PORT022 JOINT ASPIRATION - MINOR - PORT Procedure ORTHOPAEDICS 335 350 420 485
PORT025 K-WIRES REMOVAL - MINOR Procedure ORTHOPAEDICS 335 350 420 485
PORT056 SUTURE REMOVAL - MINOR - ORT Procedure ORTHOPAEDICS 335 350 420 485
ORTHOPAEDIC AND FINGERS -
PLASTER FULL
ORTHOPAEDIC AND FINGERS -
POST SLAB
MEDIUM
PORT021 JOINT ASPIRATION - MEDIUM Procedure ORTHOPAEDICS 440 460 550 640
PORT024 K-WIRES REMOVAL - MEDIUM Procedure ORTHOPAEDICS 440 460 550 640
PORT042 STRAPPING ANKLE Procedure ORTHOPAEDICS 440 460 550 640
PORT046 STRAPPING ELBOW Procedure ORTHOPAEDICS 440 460 550 640
67
Orthopaedics
Surgery Billing
Level Group
PORT049 STRAPPING KNEE Procedure ORTHOPAEDICS 440 460 550 640
PORT053 STRAPPING WRIST Procedure ORTHOPAEDICS 440 460 550 640
PORT028 PLASTER FULL - ELBOW ABOVE Procedure ORTHOPAEDICS 505 530 630 730
PORT044 STRAPPING CHEST Procedure ORTHOPAEDICS 505 530 630 730
MAJOR
PORT020 JOINT ASPIRATION - MAJOR Procedure ORTHOPAEDICS 590 620 740 855
COLLES FRACTURE BELOW ELBOW
5.3.1
EXTERNAL FIXATOR REMOVAL -
MINOR
PORT029 PLASTER FULL - KNEE ABOVE Procedure ORTHOPAEDICS 640 670 800 930
PORT030 PLASTER FULL SLAB - KNEE ABOVE Procedure ORTHOPAEDICS 640 670 800 930
PORT043 STRAPPING BALL BANDAGE Procedure ORTHOPAEDICS 640 670 800 930
PORT051 STRAPPING SHOULDER Procedure ORTHOPAEDICS 640 670 800 930
PORT047 STRAPPING FIGURE OF 8 BANDAGE Procedure ORTHOPAEDICS 670 705 840 970
STRAPPING NASAL BONE
FRACTURE
PORT036 PT BRACING - PORT Procedure ORTHOPAEDICS 800 840 1000 1160
PLASTER OF PARIS APPLICATION -
MINOR - ORT
MEDIUM
PORT018 JACKET - MINERVA 5.12 Procedure ORTHOPAEDICS 1240 1300 1550 1800
PORT023 K-WIRES REMOVAL - MAJOR Procedure ORTHOPAEDICS 1240 1300 1550 1800
PORT041 STERNAL MARROW ASPIRATION Procedure ORTHOPAEDICS 1240 1300 1550 1800
MEDIUM - ORT
PORT057 TUBE PLASTER 5.9 Procedure ORTHOPAEDICS 1365 1435 1705 1980
CLOSED REDUCTION OF
FRACTURES - MINOR
MAJOR
MAJOR - ORT
PORT006 COLLES FRACTURE FULL PLASTER Procedure ORTHOPAEDICS 2155 2265 2695 3125
PORT019 JACKET - PLASTER 5.13 Procedure ORTHOPAEDICS 2300 2415 2875 3335
PORT037 SHOULDER SPIKA 5.14 Procedure ORTHOPAEDICS 2300 2415 2875 3335
PORT038 SINGLE HIP SPIKA ADULT CHILD Procedure ORTHOPAEDICS 2300 2415 2875 3335
CLOSED REDUCTION OF
FRACTURES - MEDIUM
68
Orthopaedics
Surgery Billing
Level Group
SUPRA
CLOSED REDUCTION OF
FRACTURES - MAJOR - PORT
BONE BIOPSY - MINOR (Needle
ORTHOPEDICS
LORT001 Biopsy from subcutaneous bone ) L1 Surgery 4505 4730 5630 6530
SURGERY
(ORT) # L1
CLOSED REDUCTION OF
DISLOCATIONS INCLUDING
ORTHOPEDICS
LORT002 PLASTER APPLICATION - L1 Surgery 4505 4730 5630 6530
SURGERY
MINOR (Closed reduction of
Interphalangeal dislocations
IMPLANT REMOVAL MINOR
(Removal of percutaneous pins/ ORTHOPEDICS
LORT003 L1 Surgery 4505 4730 5630 6530
wires and change of plaster) (ORT) SURGERY
# L1
INCISION & DRAINAGE - MINOR
ORTHOPEDICS
LORT004 (Subcutaneous Abcesses or L1 Surgery 4505 4730 5630 6530
SURGERY
Haematoma) (ORT) # L1
JOINT ASPIRATION - MINOR
ORTHOPEDICS
LORT005 (Aspiration of small superficial L1 Surgery 4505 4730 5630 6530
SURGERY
joint) (ORT) # L1
WOUND DEBRIDEMENT MINOR
(Debridement of Gustilo Type 1 ORTHOPEDICS
LORT006 L1 Surgery 4505 4730 5630 6530
compound injuries or equivalent) SURGERY
(ORT) # L1
ORTHOPEDICS
LORT007 WOUND DRESSING (ORT) # L1 L1 Surgery 4505 4730 5630 6530
SURGERY
AMPUTATION TOE, DIGIT - MINOR ORTHOPEDICS
LORT008 L2 Surgery 0 8655 10305 11955
(Single) (ORT) # L2 SURGERY
ARTHROTOMY INTER (Arthrotomy
ORTHOPEDICS
LORT009 of small joints of hands and feet) L2 Surgery 0 8655 10305 11955
SURGERY
(ORT) # L2
BONE BIOPSY - INTER (Open Biopsy
ORTHOPEDICS
LORT010 of Subcutaneous Bones (Eg: Ulna, L2 Surgery 0 8655 10305 11955
SURGERY
Tibia)) (ORT) # L2
BOTOX INJECTION ONE SITE ORTHOPEDICS
LORT011 L2 Surgery 0 8655 10305 11955
(ORT) # L2 SURGERY
CLOSED REDUCTION OF
ORTHOPEDICS
LORT012 PLASTER APPLICATION INTER L2 Surgery 0 8655 10305 11955
SURGERY
(Closed Reduction of TM joint,
wrist, MCP or MTP jo
CLOSED REDUCTION OF
FRACTURES INTER INCLUDING
ORTHOPEDICS
LORT013 PLASTER APPLICATION (Closed L2 Surgery 0 8655 10305 11955
SURGERY
Reduction of Distal Radius) (ORT)
# L2
69
Orthopaedics
Surgery Billing
Level Group
CLUB FOOT MANIPULATION/
PERCUTANEOUS TENOTOMY ORTHOPEDICS
LORT014 L2 Surgery 0 8655 10305 11955
INCLUDING CAST APPLICATION - SURGERY
UNILATERAL (ORT) # L2
DEQUERVAIN'S RELEASE (SORT) ORTHOPEDICS
LORT015 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
ORTHOPEDICS
LORT016 EPIDURAL INJECTION (ORT) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
FOREIGN BODY REMOVAL - ORTHOPEDICS
LORT017 L2 Surgery 0 8655 10305 11955
SURFACE (NON CAVITY) (ORT) # L2 SURGERY
IMPLANT REMOVAL INTER
(Removal of Deep seated K-wires,
ORTHOPEDICS
LORT018 TBWs,TENS nails and Rush L2 Surgery 0 8655 10305 11955
SURGERY
Pins, Screws alone including
Dynamizatio
INCISION & DRAINAGE - INTER
(Subfascial or Intra/intermuscular ORTHOPEDICS
LORT019 L2 Surgery 0 8655 10305 11955
abscesses or Haematoma) (ORT) SURGERY
# L2
INTRA-ARTICULAR INJECTION ORTHOPEDICS
LORT020 L2 Surgery 0 8655 10305 11955
(ORT) # L2 SURGERY
JOINT ASPIRATION INTER WITH
ORTHOPEDICS
LORT021 INTRA-ARTICULAR INJECTION L2 Surgery 0 8655 10305 11955
SURGERY
(ORT) # L2
M U A (Manipulation under GA of a
ORTHOPEDICS
LORT022 stiff joint- Shoulder, Elbow, Knee) - L2 Surgery 0 8655 10305 11955
SURGERY
AS SOLE PROCEDURE (ORT) # L2
OSTEOMYELITIS SURGERY MINOR
ORTHOPEDICS
LORT023 (Removal of subcutaneous L2 Surgery 0 8655 10305 11955
SURGERY
sequestrum) (ORT) # L2
SECONDARY SUTURING MINOR
ORTHOPEDICS
LORT024 (Wound size 5cm or less) (ORT) L2 Surgery 0 8655 10305 11955
SURGERY
# L2
ORTHOPEDICS
LORT025 SKELETAL TRACTION (ORT) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
SKIN GRAFTING MINOR (Wound ORTHOPEDICS
LORT026 L2 Surgery 0 8655 10305 11955
size 5cm or less) (ORT) # L2 SURGERY
WOUND DEBRIDEMENT INTER
LORT027 L2 Surgery 0 8655 10305 11955
compound injuries or equivalent) SURGERY
(ORT) # L2
WOUND DRESSING WITH CHANGE ORTHOPEDICS
LORT028 L2 Surgery 0 8655 10305 11955
OF PLASTER (ORT) # L2 SURGERY
ADDUCTOR TENOTOMY (SORT) # ORTHOPEDICS
LORT029 L3 Surgery 0 11365 13530 15695
L3 SURGERY
AMPUTATIONS - INTER
(Amputations of Digits/ ORTHOPEDICS
LORT030 L3 Surgery 0 11365 13530 15695
Toes (Multiple) excuding Ray SURGERY
amputation) (ORT) # L3
70
Orthopaedics
Surgery Billing
Level Group
ARTHROGRAM - HIP - ONE JOINT ORTHOPEDICS
LORT031 L3 Surgery 0 11365 13530 15695
(ORT) # L3 SURGERY
ORTHOPEDICS
LORT032 BICEPS TENOTOMY (ORT) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
BONE GRAFTING AUTOGENOUS ORTHOPEDICS
LORT033 L3 Surgery 0 11365 13530 15695
ILIAC CREST (ORT) # L3 SURGERY
Bone /Soft tissue Tumour Surgery
Inter (Curretage of Bone Tumours ORTHOPEDICS
LORT034 L3 Surgery 0 11365 13530 15695
of Digits/ Excisional Biopsy of Soft SURGERY
tissue tumours <5
BOTOX INJECTION TWO SITES ORTHOPEDICS
LORT035 L3 Surgery 0 11365 13530 15695
(ORT) # L3 SURGERY
CARPAL TUNNEL RELEASE ORTHOPEDICS
LORT036 L3 Surgery 0 11365 13530 15695
(UNILATERAL) (ORT) # L3 SURGERY
EXTERNAL FIXATOR REMOVAL ORTHOPEDICS
LORT037 L3 Surgery 0 11365 13530 15695
(ORT) # L3 SURGERY
FASCIOTOMY - FOREARM OR LEG ORTHOPEDICS
LORT038 L3 Surgery 0 11365 13530 15695
(ORT) # L3 SURGERY
ORTHOPEDICS
LORT039 GANGLION EXCISION (ORT) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
MUA WITH INTRA-ARTICULAR ORTHOPEDICS
LORT040 L3 Surgery 0 11365 13530 15695
INJECTION (ORT) # L3 SURGERY
Open/Closed Reduction &
Percutaneous/Internal Fixation ORTHOPEDICS
LORT041 L3 Surgery 0 11365 13530 15695
of Fractures- Inter including Cast SURGERY
application,(including Phalang
OPEN REDUCTION OF DISLOCATION
- INTER INCLUDING CAST ORTHOPEDICS
LORT042 L3 Surgery 0 11365 13530 15695
APPLICATION (Open Reduction of SURGERY
small joints of hands and feet) (ORT
SECONDARY SUTURING INTER
ORTHOPEDICS
LORT043 (Wound size exceeding 5 cm) (ORT) L3 Surgery 0 11365 13530 15695
SURGERY
# L3
SKIN GRAFTING INTER (Wound size ORTHOPEDICS
LORT044 L3 Surgery 0 11365 13530 15695
5-15 cm) (ORT) # L3 SURGERY
ORTHOPEDICS
LORT045 SYNOVIAL BIOPSY (ORT) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
TENDON REPAIR INTER (Tendon ORTHOPEDICS
LORT046 L3 Surgery 0 11365 13530 15695
gap less than 2 cm) (ORT) # L3 SURGERY
TRIGGER FINGER RELEASE (SORT) ORTHOPEDICS
LORT047 L3 Surgery 0 11365 13530 15695
# L3 SURGERY
ARTHRODESIS INTER WITH
INTERNAL FIXATION & CAST ORTHOPEDICS
LORT048 L4 Surgery 0 15535 18495 21455
APPLICATION (Arthrodesis of SURGERY
Interphalangeal joints) (ORT) # L4
ARTHROSCOPY -DIAGNOSTIC - AS ORTHOPEDICS
LORT049 L4 Surgery 0 15535 18495 21455
SOLE PROCEDURE (ORT) # L4 SURGERY
71
Orthopaedics
Surgery Billing
Level Group
ARTHROTOMY MAJOR (Arthrotomy
ORTHOPEDICS
LORT050 of Major joints- Hip, Knee, ankle, L4 Surgery 0 15535 18495 21455
SURGERY
shoulder, elbow, wrist) (ORT) # L4
BONE GRAFTING INTER
-AUTOGENOUS (Bone Grafting
ORTHOPEDICS
LORT051 -AUTOGENOUS from Proximal ulna, L4 Surgery 0 15535 18495 21455
SURGERY
Proximal Tibia or Distal radius)
(ORT) #
BOTOX INJECTION THREE OR ORTHOPEDICS
LORT052 L4 Surgery 0 15535 18495 21455
MORE SITES IN A LIMB (ORT) # L4 SURGERY
CLOSED REDUCTION OF
ORTHOPEDICS
LORT053 PLASTER APPLICATION MAJOR L4 Surgery 0 15535 18495 21455
SURGERY
(Closed Reduction of Major Joints
-Shoulder, Elbow,
CLOSED REDUCTION OF
FRACTURES - MAJOR - SORT
ORTHOPEDICS
LORT054 INCLUDING PLASTER APPLICATION L4 Surgery 0 15535 18495 21455
SURGERY
(Closed Reduction of Radius &
Ulna, Humerus,
CLUB FOOT MANIPULATION/
PERCUTANEOUS TENOTOMY ORTHOPEDICS
LORT055 L4 Surgery 0 15535 18495 21455
INCLUDING CAST APPLICATION - SURGERY
BILATERAL (ORT) # L4
CONGENITAL DISLOCATION
CLOSED REDUCTION -and
ORTHOPEDICS
LORT056 Frog POP (including dynamic L4 Surgery 0 15535 18495 21455
SURGERY
arthrogram, traction and soft tissue
release) (
ORTHOPEDICS
LORT139 Excision Arthroplasty Hip Surgery 0 15535 18495 21455
SURGERY
FASCIA RELEASE SURGERY (ORT) ORTHOPEDICS
LORT057 L4 Surgery 0 15535 18495 21455
# L4 SURGERY
FOREIGN BODY REMOVAL - DEEP ORTHOPEDICS
LORT058 L4 Surgery 0 15535 18495 21455
(CAVITY) (ORT) # L4 SURGERY
IMPLANT REMOVAL MAJOR
(Removal of Plate & screws, ORTHOPEDICS
LORT059 L4 Surgery 0 15535 18495 21455
intramedullary nails excluding Rush SURGERY
pins & TENS nails) (ORT) # L4
ORTHOPEDICS
LORT060 JOINT DEBRIDEMENT (ORT) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
- MAJOR INCLUDING INTERNAL
ORTHOPEDICS
LORT061 FIXATION & CAST APPLICATION L4 Surgery 0 15535 18495 21455
SURGERY
(Open Reduction of Major Joints
-Sh
OSTEOMYELITIS SURGERY INTER
(Curettage, Debridement and/or ORTHOPEDICS
LORT062 L4 Surgery 0 15535 18495 21455
Sequestrectomy of Bones of hands SURGERY
and feet excluding Talus & C
72
Orthopaedics
Surgery Billing
Level Group
OSTEOTOMIES INTER WITH
INTERNAL FIXATION AND
ORTHOPEDICS
LORT063 CAST APPLICATION (Corrective L4 Surgery 0 15535 18495 21455
SURGERY
osteotomies of Phalanges ,
Metacarpals and Met
SOFT TISSUE CORRECTION OF
DEFORMITIES -INTER WITH ORTHOPEDICS
LORT064 L4 Surgery 0 15535 18495 21455
INTERNAL FIXATION & CAST SURGERY
APPLICATION (ORT) # L4
SURGERY FOR POLIO CEREBRAL
PALSY - INTER INCLUDING CAST ORTHOPEDICS
LORT065 L4 Surgery 0 15535 18495 21455
APPLICATION (TENOTOMY/TENDON SURGERY
RELEASE) (ORT) # L4
TORTICOLLIS-UNIPOLAR RELEASE ORTHOPEDICS
LORT066 L4 Surgery 0 15535 18495 21455
(ORT) # L4 SURGERY
WOUND DEBRIDEMENT MAJOR
LORT067 L4 Surgery 0 15535 18495 21455
(including subtypes) compound SURGERY
injuries or equivalent) (ORT) # L4
ORTHOPEDICS
LORT068 AC JOINT EXCISION (ORT) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ORTHOPEDICS
LORT069 AC JOINT FIXATION (ORT) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ARTHROSCOPIC SURGERY - MAJOR
(Arthroscopic Meniscal surgeries, ORTHOPEDICS
LORT070 L5 Surgery 0 18910 22515 26115
synovectomy, Debridement, SURGERY
Microdrilling, Cartilage Biopsy
BICEPS TENODESIS -OPEN (ORT) ORTHOPEDICS
LORT071 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
Bone /Soft tissue Tumour Surgery
Major (Curretage of Bone Tumours ORTHOPEDICS
LORT072 L5 Surgery 0 18910 22515 26115
of Long bones including cast SURGERY
application/ Excisional B
CARPAL TUNNEL RELEASE ORTHOPEDICS
LORT073 L5 Surgery 0 18910 22515 26115
(BILATERAL) (ORT) # L5 SURGERY
CLUB FOOT SURGERY INCLUDING
CAST APPLICATION (PMSTR/ ORTHOPEDICS
LORT074 L5 Surgery 0 18910 22515 26115
LATERAL COLUMN PROCEDURES/ SURGERY
JESS) (ORT) # L5
CORE DECOMPRESSION FOR AVN ORTHOPEDICS
LORT075 L5 Surgery 0 18910 22515 26115
(ORT) # L5 SURGERY
ORTHOPEDICS
LORT076 EXCISION RADIAL HEAD (ORT) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
EXTERNAL FIXATOR APPLICATION ORTHOPEDICS
LORT077 L5 Surgery 0 18910 22515 26115
(ORT) # L5 SURGERY
HEMIARTHROPLASTY - HIP OR ORTHOPEDICS
LORT078 L5 Surgery 0 18910 22515 26115
SHOULDER (ORT) # L5 SURGERY
ORTHOPEDICS
LORT079 INTER LOCKING NAILING (ORT) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
73
Orthopaedics
Surgery Billing
Level Group
Opn/Clos Reductn & Percutan/Intnl
Fixatn of Maj Lng Bones incdg Cast ORTHOPEDICS
LORT080 L5 Surgery 0 18910 22515 26115
applicatn (incdg Plating/TENS nailg SURGERY
of Lng bones,Bi
OSTEOMYELITIS SURGERY MAJOR
(Curettage, Debridement and/ ORTHOPEDICS
LORT081 L5 Surgery 0 18910 22515 26115
or Sequestrectomy of Major long SURGERY
bones Bones including Talus & ca
ORTHOPEDICS
LORT082 PATELLECTOMY (ORT) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
Posterior decompression of dorsal ORTHOPEDICS
LORT083 L5 Surgery 0 18910 22515 26115
Spine Multiple levels (ORT) # L5 SURGERY
Posterior decompression of dorsal ORTHOPEDICS
LORT084 L5 Surgery 0 18910 22515 26115
Spine - Single level (ORT) # L5 SURGERY
SHOULDER ROTATOR CUFF REPAIR ORTHOPEDICS
LORT085 L5 Surgery 0 18910 22515 26115
(ORT) # L5 SURGERY
SKIN GRAFTING MAJOR (Wound ORTHOPEDICS
LORT086 L5 Surgery 0 18910 22515 26115
size > 15 cm) (ORT) # L5 SURGERY
SLIPPED CAPITAL FEMORAL
EPIPHYSIS- PROPHYLACTIC ORTHOPEDICS
LORT087 L5 Surgery 0 18910 22515 26115
PINNING INCLUDING CAST SURGERY
PALSY - MAJOR INCLUDING CAST
ORTHOPEDICS
LORT088 APPLICATION - SINGLE SITE SOFT L5 Surgery 0 18910 22515 26115
SURGERY
TISSUE RELEASE/SINGLE TENDON
TRAN
TENDON LENGTHENING (ORT)
ORTHOPEDICS
LORT089 INCLUDING CAST APPLICATION L5 Surgery 0 18910 22515 26115
SURGERY
(ORT) # L5
TENDON REPAIR MAJOR
INCLUDING CAST APPLICATION
ORTHOPEDICS
LORT090 (Repair of Tendoachilles, patellar L5 Surgery 0 18910 22515 26115
SURGERY
tendon or quadriceps tendon) (ORT)
#L
TORTICOLLIS-BIPOLAR RELEASE ORTHOPEDICS
LORT091 L5 Surgery 0 18910 22515 26115
(ORT) # L5 SURGERY
AMPUTATIONS - MAJOR
(Amputations- Lisfrancs, Symes, ORTHOPEDICS
LORT092 L6 Surgery 0 28355 33755 39155
Transtibial, Transfemoral, Forearm SURGERY
& Transhumeral) (ORT) # L6
ARTHRODESIS MAJOR INCLUDING
INTERNAL FIXATION & CAST ORTHOPEDICS
LORT093 L6 Surgery 0 28355 33755 39155
APPLICATION (Arthrodesis of Major SURGERY
Joints including Shoulder, elcow,
ARTHROSCOPIC FROZEN ORTHOPEDICS
LORT094 L6 Surgery 0 28355 33755 39155
SHOULDER RELEASE (ORT) # L6 SURGERY
ARTHROSCOPIC SUBACROMIAL ORTHOPEDICS
LORT095 L6 Surgery 0 28355 33755 39155
DECOMPRESSION (ORT) # L6 SURGERY
74
Orthopaedics
Surgery Billing
Level Group
AUTOLOGOUS CHONDROCYTE ORTHOPEDICS
LORT096 L6 Surgery 0 28355 33755 39155
IMPLANTATION (ORT) # L6 SURGERY
CONGENITAL DISLOCATION
OPEN REDUCTION and Frog POP
ORTHOPEDICS
LORT097 (including traction and innominate/ L6 Surgery 0 28355 33755 39155
SURGERY
femoral ostetotomy/pelvic &
femora
CORE DECOMPRESSION FOR AVN ORTHOPEDICS
LORT098 L6 Surgery 0 28355 33755 39155
WITH ABI (ORT) # L6 SURGERY
CORRECTIVE SURGERIES FOR
CONGENITAL DISLOCATIONS- ORTHOPEDICS
LORT099 L6 Surgery 0 28355 33755 39155
MAJOR INCLUDING CAST SURGERY
CORRECTIVE SURGERIES FOR
CONGENITAL VERTICAL TALUS, ORTHOPEDICS
LORT100 L6 Surgery 0 28355 33755 39155
INCLUDING CAST APPLICATION SURGERY
(ORT) # L6
DISARTICULATION - HIP, KNEE OR ORTHOPEDICS
LORT101 L6 Surgery 0 28355 33755 39155
SHOULDER (ORT) # L6 SURGERY
HIGH TIBIAL OSTEOTOMY
ORTHOPEDICS
LORT102 INCLUDING INTERNAL FIXATION & L6 Surgery 0 28355 33755 39155
SURGERY
CAST APPLICATION (ORT) # L6
LIGAMENT RECONSTRUCTION- ORTHOPEDICS
LORT103 L6 Surgery 0 28355 33755 39155
MAJOR JOINT (ORT) # L6 SURGERY
NERVE SURGERY MAJOR
(Neurolysis with or without ORTHOPEDICS
LORT104 L6 Surgery 0 28355 33755 39155
Transposition of peripheral nerves, SURGERY
nerve suturing) (ORT) # L6
- SUPRA INCLUDING INTERNAL ORTHOPEDICS
LORT105 L6 Surgery 0 28355 33755 39155
FIXATION AND CAST APPLICATION SURGERY
(Open reduction of Old unreduced
OSTEOTOMIES MAJOR INCLUDING
INTERNAL FIXATION AND CAST
ORTHOPEDICS
LORT106 APPLICATION (Osteotomies of L6 Surgery 0 28355 33755 39155
SURGERY
major long bones including Talus,
cal
PATELLA RECURRENT
ORTHOPEDICS
LORT107 DISLOCATION INCLUDING CAST L6 Surgery 0 28355 33755 39155
SURGERY
SHOULDER RECURRENT
ORTHOPEDICS
LORT108 DISLOCATION-CORRECTIVE L6 Surgery 0 28355 33755 39155
SURGERY
SURGERY (ORT) # L6
SHOULDER RESURFACING ORTHOPEDICS
LORT109 L6 Surgery 0 28355 33755 39155
ARTHROPLASTY (ORT) # L6 SURGERY
SLIPPED CAPITAL FEMORAL
EPIPHYSIS- OPEN REDUCTION/
ORTHOPEDICS
LORT110 SURGICAL DISLOCATION L6 Surgery 0 28355 33755 39155
SURGERY
INCLUDING CAST APPLICATION
(ORT) # L6
75
Orthopaedics
Surgery Billing
Level Group
SURGERY FOR NON UNION OF
FRACTURES MAJOR INCLUDING ORTHOPEDICS
LORT111 L6 Surgery 0 28355 33755 39155
TENDON TRANSFER INCLUDING
ORTHOPEDICS
LORT112 CAST APPLICATION - SINGLE (ORT) L6 Surgery 0 28355 33755 39155
SURGERY
# L6
TOTAL KNEE ARTHROPLASTY (ORT) ORTHOPEDICS
LORT113 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
AC JOINT RECONSTRUCTION (ORT) ORTHOPEDICS
LORT114 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
ARTHROSCOPIC BICEPS ORTHOPEDICS
LORT115 L7 Surgery 0 37815 45020 52220
TENODESIS (ORT) # L7 SURGERY
ARTHROSCOPIC LABRAL REPAIR
ORTHOPEDICS
LORT116 MAJOR (eg: isolated pathology) L7 Surgery 0 37815 45020 52220
SURGERY
(ORT) # L7
ARTHROSCOPIC SLAP REPAIR (ORT) ORTHOPEDICS
LORT117 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
ARTHROSCOPIC SURGERY -
SUPRA (Arthroscopic Ligament
ORTHOPEDICS
LORT118 Reconstruction, OATS, including L7 Surgery 0 37815 45020 52220
SURGERY
additional meniscal surgeries)
(ORT)
BONE TUMOUR SURGERY SUPRA
(Tumour Excision and Limb
ORTHOPEDICS
LORT119 preservation including Bone L7 Surgery 0 37815 45020 52220
SURGERY
grafting & internal Fixation) (ORT)
# L7
CORE DECOMPRESSION FOR AVN
ORTHOPEDICS
LORT120 WITH FIBULAR BONE GRAFTING L7 Surgery 0 37815 45020 52220
SURGERY
(ORT) # L7
ILIZAROV/ DISTRACTOR FOR UPPER ORTHOPEDICS
LORT121 L7 Surgery 0 37815 45020 52220
LIMB (ORT) # L7 SURGERY
ORTHOPEDICS
LORT122 LIMB LENGTHENING (ORT) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
OPEN REDUCTION AND INTERNAL
FIXATION OF FRACTURES - SUPRA ORTHOPEDICS
LORT123 L7 Surgery 0 37815 45020 52220
INCLUDING CAST APPLICATION SURGERY
(ORT) # L7
PELVIC OSTEOTOMY/ ORTHOPEDICS
LORT124 L7 Surgery 0 37815 45020 52220
ACETABULOPLASTY (ORT) # L7 SURGERY
SURGERY FOR NON UNION OF
FRACTURES SUPRA INCLUDING ORTHOPEDICS
LORT125 L7 Surgery 0 37815 45020 52220
TOTAL JOINT REPLACEMENTS
ORTHOPEDICS
LORT126 (KNEE, HIP, SHOULDER & ELBOW, L7 Surgery 0 37815 45020 52220
SURGERY
PRIMARY) (ORT) # L7
76
Orthopaedics
Surgery Billing
Level Group
AMPUTATIONS - SUPRA
ORTHOPEDICS
LORT127 (Forequarter, Hindquarter, L8 Surgery 0 47265 56270 65270
SURGERY
Hemipelvectomy) (ORT) # L8
ARTHROSCOPIC LABRAL REPAIR
ORTHOPEDICS
LORT128 - SUPRA (Eg: BANKART + SLAP L8 Surgery 0 47265 56270 65270
SURGERY
REPAIR) (ORT) # L8
ARTHROSCOPIC SUBACROMIAL
ORTHOPEDICS
LORT129 DECOMPRESSION + ACJ EXCISION L8 Surgery 0 47265 56270 65270
SURGERY
(ORT) # L8
CEREBRAL PALSY- MULTILEVEL
SURGERY IN ONE LIMB (BONY ORTHOPEDICS
LORT130 L8 Surgery 0 47265 56270 65270
AND SOFT TISSUE DEFORMITY SURGERY
CORRECTION) (ORT) # L8
ORTHOPEDICS
LORT131 CERVICAL RIB EXCISION (ORT) # L8 L8 Surgery 0 47265 56270 65270
SURGERY
REVISION PAEDIATRIC HIP ORTHOPEDICS
LORT132 L8 Surgery 0 47265 56270 65270
SURGERY (ORT) # L8 SURGERY
REVISION TOTAL HIP ORTHOPEDICS
LORT133 L8 Surgery 0 47265 56270 65270
REPLACEMENT (ORT) # L8 SURGERY
REVISION TOTAL KNEE ORTHOPEDICS
LORT134 L8 Surgery 0 47265 56270 65270
PALSY - SUPRA INCLUDING CAST
ORTHOPEDICS
LORT135 APPLICATION (COMBINED BONY L8 Surgery 0 47265 56270 65270
SURGERY
AND SOFT TISSUE PROCEDURE
WITH FIXATI
TELESCOPIC NAILING IN
ORTHOPEDICS
LORT136 OSTEOGENESIS IMPERFECTA (ORT) L8 Surgery 0 47265 56270 65270
SURGERY
# L8
REVERSE SHOULDER ORTHOPEDICS
LORT137 L9 Surgery 0 56710 67515 78315
77
Department of
Renal Sciences
78
Nephrology
79
Nephrology
NEPHROLOGY
KNEP005 KIDNEY BIOPSY (N) Package 0 30550 36370 42190
PACKAGE
RENAL TRANSPLANT RECIPIENT NEPHROLOGY
KKNEP002 Package 0 554250 659820 765390
PACKAGE PACKAGE
NEPHROLOGY
KKNEP001 RENAL TRANSPLANT DONOR PACKAGE Package 0 1 1 1
PACKAGE
RENAL TRANSPLANT RECIPIENT NEPHROLOGY
KKNEP009 Package 0 717260 853880 990500
SUBSIDIES PACKAGE PACKAGE
LIVER
LIVER TRANSPLANT ? DONOR
KKLTP005 Package TRANSPLANT 0 1 1 1
PACKAGE
PACKAGE
LIVER
kidney &Pancreas TRANSPLANT
KKLTP006 Package TRANSPLANT 0 1158000 1378570 1599140
RECIPIENT PACKAGE
PACKAGE
Bed / Nursing Charges for less than
PNEP044 Procedure NEPHROLOGY 560 580 690 810
2 Hrs
OBSERVATION AND MINOR
PROCEDURE
Bed / Nursing Charges for more than
2 Hrs
SCREENING ULTRASOUND CHARGES
- RICU
RENAL-IV DRUG THERAPY CHARGES
PNEP054 ( IV Cyclophosphamide / IV Rituximab Procedure NEPHROLOGY 3420 3590 4270 4960
Infusion )
PNEP076 CENTRAL LINE WITH USG Procedure NEPHROLOGY 4100 4300 5120 5940
NEW DIALYSIS INITIATION &
TREATMENT PLANNING
ULTRASOUND SCREENING AND
PNEP049 GUIDANCE FOR CENTRAL VENOUS Procedure NEPHROLOGY 4100 4300 5120 5940
CATHETER(CVC) INSERTION
POST TRANSPLANT PLANNING - FIRST
VISIT
PRE - TRANSPLANT COUNSELLING
PNEP051 FOR RENAL TRANSPLANT (RECIPIENT Procedure NEPHROLOGY 8200 8610 10250 11890
/ DONOR)
IMMUNOSUPRESSIVE DRUG THERAPY
PLANNING
PNEP029 KIDNEY BIOPSY Procedure NEPHROLOGY 12020 12620 15030 17430
ABOi Compatible Kidney Transplant
Management
ABOi Compatible Kidney Transplant
Preparation
PNEP063 Post Kidney Transplant Desensitization Procedure NEPHROLOGY 13670 14350 17080 19810
PNEP062 Pre Kidney Transplant Desensitization Procedure NEPHROLOGY 13670 14350 17080 19810
NEPHROLOGY
PNEP055 ACT (Activated Clotting Time) TEST Procedure 280 290 350 410
DIALYSIS
80
Nephrology
NEPHROLOGY
PNEP060 BIO SCAN ANALYSIS - FULL TEST Procedure 630 660 780 910
DIALYSIS
BIO SCAN ANALYSIS - SEGAMENTAL NEPHROLOGY
PNEP061 Procedure 760 800 950 1110
TEST DIALYSIS
NEPHROLOGY
PNEP047 MAINTENANCE DIALYSIS (BSHT) Procedure 820 860 1030 1190
DIALYSIS
NEPHROLOGY
PNEP036 PLEURAL/ ASCITIC TAPPING Procedure 2050 2150 2560 2970
DIALYSIS
MAINTENANCE DIALYSIS ( Above 15 NEPHROLOGY
PNEP077 Procedure 2210 2320 2760 3210
years ) DIALYSIS
NEPHROLOGY
PNEP073 SDHD - Short Daily Hemo Dialysis Procedure 2470 2590 3080 3570
DIALYSIS
PNEP040 Procedure 2520 2650 3150 3660
years ) DIALYSIS
PNEP039 Procedure 2680 2820 3350 3890
years ) DIALYSIS
PNEP038 Procedure 2830 2980 3540 4110
years ) DIALYSIS
NEPHROLOGY
PNEP008 DIALYSIS - GC - 10% Procedure 3140 3300 3930 4560
DIALYSIS
NEPHROLOGY
DIALYSIS
NEPHROLOGY
DIALYSIS
NEPHROLOGY
PNEP016 MAINTENANCE DIALYSIS Procedure 3140 3300 3930 4560
DIALYSIS
DIALYSIS NOCTURNAL - ( Above 12 NEPHROLOGY
PNEP043 Procedure 3280 3450 4100 4760
years ) DIALYSIS
PNEP042 Procedure 3700 3880 4620 5360
years ) DIALYSIS
NEPHROLOGY
PNEP056 SINGLE USE DIALYSIS Procedure 3700 3880 4620 5360
DIALYSIS
PNEP041 Procedure 3900 4100 4880 5660
years ) DIALYSIS
NEPHROLOGY
PNEP037 CAPD -TRANSFER SET CHANGE Procedure 4100 4300 5120 5940
DIALYSIS
NEPHROLOGY
PNEP022 DIALYSIS NOCTURNAL Procedure 4100 4300 5120 5940
DIALYSIS
NEPHROLOGY
PNEP023 DIALYSIS NOCTURNAL - GC - 20% Procedure 4100 4300 5120 5940
DIALYSIS
NEPHROLOGY
PNEP011 DIALYSIS - HEPARIN FREE Procedure 4460 4680 5570 6460
DIALYSIS
NEPHROLOGY
PNEP034 NO REUSE DIALYSIS Procedure 4700 4930 5870 6810
DIALYSIS
NEPHROLOGY
PNEP033 PLASMAPHERESIS (SUBSEQUENT) Procedure 5470 5740 6830 7930
DIALYSIS
81
Nephrology
NEPHROLOGY
PNEP048 PERMCATH REMOVAL / REPOSITION Procedure 6160 6470 7700 8930
DIALYSIS
NEPHROLOGY
PNEP078 DIALYSIS 1ST Procedure 7390 7760 9230 10710
DIALYSIS
NEPHROLOGY
PNEP079 DIALYSIS EMERGENCY Procedure 7390 7760 9230 10710
DIALYSIS
NEPHROLOGY
PNEP072 DIALYSIS OP DELUX Procedure 7510 7890 9390 10890
DIALYSIS
NEPHROLOGY
PNEP007 DIALYSIS - CYCLED PERITONEAL Procedure 8200 8610 10250 11890
DIALYSIS
NEPHROLOGY
PNEP017 DIALYSIS MOBILE - A Procedure 8200 8610 10250 11890
DIALYSIS
DIALYSIS - SUSTAINED LOW NEPHROLOGY
PNEP013 Procedure 8200 8610 10250 11890
EFFICIENCY DIALYSIS
NEPHROLOGY
PNEP003 CATHETERISATION - FEMORAL Procedure 8880 9330 11100 12880
DIALYSIS
NEPHROLOGY
PNEP068 Endotoxin quantitative test Dialysate Procedure 9020 9470 11270 13080
DIALYSIS
NEPHROLOGY
PNEP066 Endotoxin quantitative test R.O water Procedure 9020 9470 11270 13080
DIALYSIS
Endotoxin quantitative test Sterile NEPHROLOGY
PNEP069 Procedure 9020 9470 11270 13080
water DIALYSIS
NEPHROLOGY
PNEP067 Endotoxin quantitative test UF water Procedure 9020 9470 11270 13080
DIALYSIS
NEPHROLOGY
PNEP024 DIALYSIS PERITONEAL - NEP Procedure 9370 9830 11710 13580
DIALYSIS
NEPHROLOGY
PNEP018 DIALYSIS MOBILE - B Procedure 9570 10050 11960 13880
DIALYSIS
NEPHROLOGY
PNEP019 DIALYSIS MOBILE - C Procedure 10930 11480 13660 15850
DIALYSIS
NEPHROLOGY
PNEP002 CATHETERISATION - DOUBLE LUMEN IJ Procedure 11620 12200 14520 16850
DIALYSIS
CONTINUOUS RENAL REPLACEMENT NEPHROLOGY
PNEP070 Procedure 11900 12490 14870 17250
THERAPY - ONLINE DIALYSIS
NEPHROLOGY
PNEP006 CVVH - MULTIFILTERATE Procedure 13390 14060 16740 19410
DIALYSIS
CONTINUOUS RENAL REPLACEMENT NEPHROLOGY
PNEP071 Procedure 20500 21520 25620 29720
THERAPY - OFFLINE DIALYSIS
NEPHROLOGY
PNEP001 CAPD TRAINING /COUNSELING Procedure 24590 25820 30740 35660
DIALYSIS
NEPHROLOGY
PNEP005 CVVH - PRISMA Procedure 24590 25820 30740 35660
DIALYSIS
NEPHROLOGY
PNEP035 PERM CATH MATERIAL CHARGES Procedure 25960 27260 32450 37640
DIALYSIS
NEPHROLOGY
PNEP032 PLASMAPHERESIS (1ST) Procedure 35530 37300 44410 51510
DIALYSIS
82
Nephrology
NEPHROLOGY
PNEP031 PERM CATH Procedure 39620 41600 49530 57450
DIALYSIS
DFPP - DOUBLE DFPP - DOUBLE
NEPHROLOGY
PNEP075 FILTRATION PLASMA PHERESIS Procedure 45080 47340 56350 65370
DIALYSIS
(SUBSEQUENT)
PLASMAPHERESIS WITH GLYCOSORB NEPHROLOGY
PNEP058 Procedure 50560 53090 63200 73310
COLUMN DIALYSIS
PLASMAPHERESIS WITH DIALYSIS AND NEPHROLOGY
PNEP057 Procedure 57390 60260 71740 83210
GLYCOSORB COLUMN DIALYSIS
DFPP - DOUBLE FILTRATION PLASMA NEPHROLOGY
PNEP074 Procedure 65580 68860 81970 95090
PHERESIS DIALYSIS
83
Urology
84
Urology
Surgery Billing
Level Group
ROBOTIC SURGERY PACKAGE - 1 UROLOGY
KRKURO001 Package 0 293430 349320 405210
- URO PACKAGE
PURO286 OXYGEN HOURLY - PURO Procedure UROLOGY 70 80 90 110
PURO283 INJECTION IM - PURO Procedure UROLOGY 100 100 120 140
PURO282 INJECTION IV-PURO Procedure UROLOGY 100 100 120 140
PURO281 INJECTION S/C - PURO Procedure UROLOGY 100 100 120 140
PURO284 IV CANULIZATION - PURO Procedure UROLOGY 100 100 120 140
PURO301 GRBS - PURO Procedure UROLOGY 110 110 130 160
FOLEY'S CATHETER CHANGING -
PURO291 Procedure UROLOGY 200 210 250 290
PURO
PURO290 FOLEY'S CATHETERIZATION - PURO Procedure UROLOGY 200 210 250 290
PURO287 NEBULIZATION - PURO Procedure UROLOGY 200 210 250 290
PURO295 BCG(INJECTION) - PURO Procedure UROLOGY 260 270 320 370
PURO302 BLADDER WASH - PURO Procedure UROLOGY 260 270 320 370
PURO296 CALIBRATION - PURO Procedure UROLOGY 260 270 320 370
CIC( CLEAN INTERMITENT
CATHETER) - PURO
PURO298 SUTURING MINOR - PURO Procedure UROLOGY 260 270 320 370
PURO292 WOUND DRESSING MINOR - PURO Procedure UROLOGY 260 270 320 370
PURO285 ECG - PURO Procedure UROLOGY 380 400 480 560
BED / NURSING CHARGES FOR
LESS THAN 2HRS - PURO
SPC(SUPRAPUBIC CATHETER) -
PURO
PURO299 SUTURING MEDIUM - PURO Procedure UROLOGY 480 500 590 690
WOUND DRESSING MEDIUM -
PURO
PURO300 SUTURING MAJOR - PURO Procedure UROLOGY 760 800 950 1110
PURO294 WOUND DRESSING MAJOR - PURO Procedure UROLOGY 760 800 950 1110
BED/ NURSING CHARGES FOR
MORE THAN 2HRS - PURO
PURO015 UROFLOWMETRY Procedure UROLOGY 960 1010 1200 1390
PURO012 ELECTROMYGRAPHY Procedure UROLOGY 1300 1370 1630 1890
PURO014 URETHRAL PRESSURE PROFILE Procedure UROLOGY 1300 1370 1630 1890
PURO009 CYSTOMETRY Procedure UROLOGY 3700 3880 4620 5360
PURO016 AVF - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO008 CAVEMOSOMETRY Procedure UROLOGY 4510 4740 5640 6540
PURO052 CIRCUMCISSION - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO011 CYSTOGRAM Procedure UROLOGY 4510 4740 5640 6540
85
Urology
Surgery Billing
Level Group
DJ STENT REMOVAL/CYSTOSCOPY
WITH GA
PURO078 EPIDIDYMECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO090 FRENEULOPLASTY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO096 HYDROCELECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO108 MEATOPLASTY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO120 ORCHIDECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO145 PENILE BIOPSY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO184 TESTICULAR BIOPSY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO196 TROCAR CYCTOSTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO203 TROCAR CYSTOSCOPY Procedure UROLOGY 4510 4740 5640 6540
PURO245 VARICOCELE LIGATION DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO257 VASECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540
PURO013 PRESSURE FLOW METER Procedure UROLOGY 4650 4880 5810 6740
PURO017 AVF - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO079 EPIDIDYMECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO097 HYDROCELECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO109 MEATOPLASTY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO121 ORCHIDECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO146 PENILE BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO159 PROSTATE BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO185 TESTICULAR BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO197 TROCAR CYCTOSTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO246 VARICOCELE LIGATION DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO258 VASECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940
PURO158 PROSTATE BIOPSY - DCOS1 Procedure UROLOGY 5060 5320 6330 7340
PURO076 DJ STENT REMOVAL/CYSTOSCOPY Procedure UROLOGY 5330 5600 6660 7730
PURO053 CIRCUMCISSION - DCOS1A Procedure UROLOGY 5470 5740 6830 7930
PURO010 CYSTOMETRY WITH PF STUDY Procedure UROLOGY 5610 5890 7010 8130
86
Urology
Surgery Billing
Level Group
PURO204 TROCAR CYSTOSTOMY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130
PROSTATE BIOPSY - DCOS2 WITH
GA
PURO144 PENILE BIOPSY - PURO Procedure UROLOGY 6700 7030 8370 9710
PURO157 PENILE BIOPSY WITH GA Procedure UROLOGY 6700 7030 8370 9710
PURO170 PROSTATE NEEDLE BIOPSY Procedure UROLOGY 6700 7030 8370 9710
PROSTATE NEEDLE BIOPSY WITH
GA
87
Urology
Surgery Billing
Level Group
PURO028 BLADDER BIOPSY - DCEP1 Procedure UROLOGY 9020 9470 11270 13080
PURO040 BNI - DCEP1 Procedure UROLOGY 9020 9470 11270 13080
PURO132 PCN - DCEP1 Procedure UROLOGY 9020 9470 11270 13080
PURO209 URETERIC MEATOTOMY - DCEP1 Procedure UROLOGY 9020 9470 11270 13080
PURO244 URS + STENTING DECP1 Procedure UROLOGY 9020 9470 11270 13080
PURO269 VIU - DCEP1 Procedure UROLOGY 9020 9470 11270 13080
PURO029 BLADDER BIOPSY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880
PURO041 BNI - DCEP1A Procedure UROLOGY 9570 10050 11960 13880
PURO065 CYSTOLITHOPAXY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880
PURO133 PCN - DCEP1A Procedure UROLOGY 9570 10050 11960 13880
PURO210 URETERIC MEATOTOMY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880
PURO228 URS - DCEP51A Procedure UROLOGY 9570 10050 11960 13880
PURO064 CYSTOLITHOPAXY - DCEP1 Procedure UROLOGY 10110 10620 12640 14660
PURO172 STENTING - DCEP1 Procedure UROLOGY 10110 10620 12640 14660
PURO231 URS - DECP1 Procedure UROLOGY 10110 10620 12640 14660
88
Urology
Surgery Billing
Level Group
PURO173 STENTING - DCEP1A Procedure UROLOGY 10930 11480 13660 15850
PURO233 URS + STENTING DCEP1A Procedure UROLOGY 10930 11480 13660 15850
PURO270 VIU - DCEP1A Procedure UROLOGY 10930 11480 13660 15850
PURO051 BNI - DECP2 Procedure UROLOGY 13390 14060 16740 19410
89
Urology
Surgery Billing
Level Group
PURO234 URS + STENTING DCEP2 Procedure UROLOGY 13390 14060 16740 19410
PURO089 EPIDIDYMECTOMY - DOCS6 Procedure UROLOGY 14350 15060 17930 20800
PURO221 URS - DCEP2 Procedure UROLOGY 15040 15790 18790 21800
90
Urology
Surgery Billing
Level Group
91
Urology
Surgery Billing
Level Group
PURO232 URS - DECP6 Procedure UROLOGY 24590 25820 30740 35660
92
Urology
Surgery Billing
Level Group
UROLOGY
PURO001 LITHOTRIPSY / ESWL - PURO1 Procedure 14350 15060 17930 20800
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LITHOTRIPSY
UROLOGY
LURO001 CLOSURE OF S P C (URO) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
CYSTOSCOPY SAME AS PANENDOS UROLOGY
LURO002 L1 Surgery 4290 4500 5360 6220
(URO) # L1 SURGERY
'J' STENTING OF URETER UROLOGY
LURO003 L1 Surgery 4290 4500 5360 6220
UNILATERAL (URO) # L1 SURGERY
PROSTALIC NEEDLE BIOPSY (URO) UROLOGY
LURO004 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
RETROGRADE CATHETERISATION UROLOGY
LURO005 L1 Surgery 4290 4500 5360 6220
OR BULB URETE (URO) # L1 SURGERY
UROLOGY
LURO006 STENT REMOVAL (URO) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
URETERIC CATHETERISATION UROLOGY
LURO007 L1 Surgery 4290 4500 5360 6220
(UNILATERAL) (URO) # L1 SURGERY
UROLOGY
LURO008 VASOGRAM (URO) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
UROLOGY
LURO009 CIRCUMCISION (URO) (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
DILATATION OF URETHRA (URO) UROLOGY
LURO010 L2 Surgery 0 8240 9810 11380
(URO) # L2 SURGERY
93
Urology
Surgery Billing
Level Group
UROLOGY
LURO011 EPIDIDYMAL BIOPSY (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
UROLOGY
LURO012 FRENULOPLASTY (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
MEATOTOMY URETHRAL) (URO) UROLOGY
LURO013 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
UROLOGY
LURO014 PCN (UNILATERAL) (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
UROLOGY
LURO015 PENILE BIOPSY (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
SUPRAPUBIC CYSTOSTOMY (URO) UROLOGY
LURO016 L2 Surgery 0 8240 9810 11380
(URO) # L2 SURGERY
TESTICULAR BIOPSY (URO) (URO) UROLOGY
LURO017 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
UROLOGY
LURO018 TROCAR CYSTOSTOMY (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
URETERIC CATHETERISATION UROLOGY
LURO019 L2 Surgery 0 8240 9810 11380
(BILATERAL) (URO) # L2 SURGERY
UROLOGY
LURO020 VASECTOMY (URO) (URO) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
CYSTOLITHALOPAXY MANUAL
UROLOGY
LURO064 INCLUDING CYSTOSCOPY (URO) L5 Surgery 0 8370 9200 10040
SURGERY
# L5
OPEN BLADDER NECK SUSPENSION
UROLOGY
SURGERY
# L5
UROLOGY
LURO021 A.V.FISTULA (URO) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
BIOPSY OF BLADDER TUMOUR
UROLOGY
LURO022 INCLUDING ENDOSCOPIC L3 Surgery 0 10820 12880 14940
SURGERY
EXAMINATION (URO) # L3
ENDOSCOPIC TEFLON PASTE INJE UROLOGY
LURO024 L3 Surgery 0 10820 12880 14940
(URO) # L3 SURGERY
ENDOSCOPIC URETERIC UROLOGY
LURO025 L3 Surgery 0 10820 12880 14940
MEATOTOMY (URO) # L3 SURGERY
EPIDIDYMAL CYST EXCISION (URO) UROLOGY
LURO026 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
EPIDIDYMECTOMY - UNILATERAL UROLOGY
LURO027 L3 Surgery 0 10820 12880 14940
(URO) # L3 SURGERY
EPIDIDYMO VASOSTOMY UROLOGY
LURO028 L3 Surgery 0 10820 12880 14940
FOURNIER'S GANGRENE UROLOGY
LURO029 L3 Surgery 0 10820 12880 14940
DEBRIDEMENT (URO) (URO) # L3 SURGERY
HYDROCELECTOMY UNILATERAL UROLOGY
LURO030 L3 Surgery 0 10820 12880 14940
(URO) (URO) # L3 SURGERY
'J' STENTING OF URETER UROLOGY
LURO031 L3 Surgery 0 10820 12880 14940
BILATERAL (URO) # L3 SURGERY
94
Urology
Surgery Billing
Level Group
UROLOGY
LURO032 MEATOPLASTY (LURO) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
UROLOGY
LURO033 PCN (BILATERAL) (URO) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
POST TURP CLOT EVACUATION UROLOGY
LURO034 L3 Surgery 0 10820 12880 14940
(URO) # L3 SURGERY
PROSTATE BIOPSY (ENDOSCOPIC
UROLOGY
LURO035 BIOPSY INCLUDING CYSTOSCOPY) L3 Surgery 0 10820 12880 14940
SURGERY
(URO) # L3
UROLOGY
LURO036 RELOOK PCNL (URO) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
STENTING FOR UROSEPSIS (URO) UROLOGY
LURO023 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
URETERORENOSCOPY DIAGNOSTIC UROLOGY
LURO037 L3 Surgery 0 10820 12880 14940
(URO) # L3 SURGERY
URETHRAL CARUNCLE EXCISION UROLOGY
LURO038 L3 Surgery 0 10820 12880 14940
(URO) # L3 SURGERY
VISUAL OPTICAL/INTERNAL URET UROLOGY
LURO039 L3 Surgery 0 10820 12880 14940
MILD STRUCT (URO) # L3 SURGERY
UROLOGY
LURO040 A.V.GRAFT (URO) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
BLADDER INJURY REPAIR (URO) UROLOGY
LURO041 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
BLADDER NECK INCISION
UROLOGY
LURO042 WITH CYSTOSCOPY (AS SOLE L4 Surgery 0 14790 17610 20420
SURGERY
PROCEDURE) (URO) # L4
DIAGNOSTIC UROLOGY
LURO043 L4 Surgery 0 14790 17610 20420
RETROPERITONOSCOPY (URO) # L4 SURGERY
DRAINAGE OF PERINEPHRIC /
UROLOGY
LURO044 RETROPERITONEAL ABSCESS L4 Surgery 0 14790 17610 20420
SURGERY
(URO) # L4
EPIDIDYMECTOMY - BILATERAL UROLOGY
LURO045 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
EPIDIDYMO VASOSTOMY UROLOGY
LURO046 L4 Surgery 0 14790 17610 20420
ILEO-INGUINAL NODE DISSECTION UROLOGY
LURO047 L4 Surgery 0 14790 17610 20420
- UNILATERAL (URO) # L4 SURGERY
INGUINAL/ FEMORAL HERNIA MESH UROLOGY
LURO059 L4 Surgery 0 14790 17610 20420
REPAIR UNILATERAL (URO) # L4 SURGERY
INGUINAL NODE DISSECTION - UROLOGY
LURO048 L4 Surgery 0 14790 17610 20420
LAPAROSCOPIC DEROOFING OF UROLOGY
LURO049 L4 Surgery 0 14790 17610 20420
CYST (URO) # L4 SURGERY
UROLOGY
LURO050 NEPHROSTOMY PCN) (URO) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
ORCHIDECTOMY RADICAL (URO) UROLOGY
LURO051 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
95
Urology
Surgery Billing
Level Group
ORCHIDOPEXY UNILATERAL (URO) UROLOGY
LURO052 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
ORCHIDUCTOMY UNILATERAL UROLOGY
LURO053 L4 Surgery 0 14790 17610 20420
PERINEAL DRAINAGE OF UROLOGY
LURO054 L4 Surgery 0 14790 17610 20420
PROSTATESS (URO) # L4 SURGERY
RACANALISATION OF VAS - UROLOGY
LURO055 L4 Surgery 0 14790 17610 20420
SUPRAPUBIC CYSTOLITHOTOMY
UROLOGY
SURGERY
(URO) # L4
URETERIC CALCULI BASKETING UROLOGY
LURO057 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
VARICOCELE LIGATION UNILATERAL UROLOGY
LURO058 L4 Surgery 0 14790 17610 20420
(URO) # L4 SURGERY
AMPUTATION OF PENIS - PARTIAL UROLOGY
LURO060 L5 Surgery 0 18010 21440 24870
UROLOGY
LURO061 BRACHIAL FISTULA (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
CAPD CATHETER INSERTIONS UROLOGY
LURO062 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
CUTANEOUS URETEROSTOMY UROLOGY
LURO063 L5 Surgery 0 18010 21440 24870
UNILATERAL (URO) (URO) # L5 SURGERY
UROLOGY
LURO065 DIVERTICULECTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
UROLOGY
LURO066 ENDO PYELOTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
ENDOSCOPIC BLADDER NECK UROLOGY
LURO067 L5 Surgery 0 18010 21440 24870
SUSP (URO) # L5 SURGERY
ENDOSCOPIC RAIL ROADING OF UROLOGY
LURO068 L5 Surgery 0 18010 21440 24870
URETHRA (URO) # L5 SURGERY
ENDOSCOPIC REALIGNMENT OF UROLOGY
LURO069 L5 Surgery 0 18010 21440 24870
URETHRA (URO) # L5 SURGERY
HYDROCELECTOMY BILATERAL UROLOGY
LURO070 L5 Surgery 0 18010 21440 24870
INGUINAL HERNIA - MESH REPAIR
UROLOGY
LURO106 UNDER LA - UNILATERAL (URO) L5 Surgery 0 18010 21440 24870
SURGERY
# L5
LAPAROSCOPIC BLADDER NECK UROLOGY
LURO071 L5 Surgery 0 18010 21440 24870
SUSPENSION (URO) # L5 SURGERY
LAPAROSCOPIC CAPD INSERTION UROLOGY
LURO072 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
LAPAROSCOPIC ORCHIDOPEXY - UROLOGY
LURO073 L5 Surgery 0 18010 21440 24870
UNILATERAL (URO) (URO) # L5 SURGERY
LAPARSCOPIC UROLOGY
LURO074 L5 Surgery 0 18010 21440 24870
URETEROLITHOTOMY (URO) # L5 SURGERY
96
Urology
Surgery Billing
Level Group
LASER PROSTATECTOMY (URO) UROLOGY
LURO075 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
UROLOGY
LURO076 LASER URS (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
UROLOGY
LURO077 NEPHROPEXY (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPEN RAIL ROADING OF URETHRA UROLOGY
LURO079 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
UROLOGY
LURO080 OPEN RENAL BIOPSY (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
ORCHIDECTOMY UNILATERAL -
UROLOGY
LURO081 OPEN/LAPAROSCOPIC (URO) (URO) L5 Surgery 0 18010 21440 24870
SURGERY
# L5
ORCHIDOPEXY BILATERAL (URO) UROLOGY
LURO082 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
PEYRONIES PLAQUE EXCISION & UROLOGY
LURO083 L5 Surgery 0 18010 21440 24870
RUCTI (URO) # L5 SURGERY
POSTERIOR UETHRAL VALVE FULN UROLOGY
LURO084 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
PSOAS HITCH WITH
UROLOGY
LURO085 URETERONEOCYSTOSTOMY (URO) L5 Surgery 0 18010 21440 24870
SURGERY
# L5
UROLOGY
LURO086 RIRS - UNILATERAL (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
SURGERY FOR PRIAPSIM (URO) UROLOGY
LURO087 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
THERAPEUTIC UROLOGY
LURO088 L5 Surgery 0 18010 21440 24870
RETROPERITONOSCOPY (URO) # L5 SURGERY
UROLOGY
LURO089 TORTION TESTIS (URO) (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
UROLOGY
LURO090 TOT SLING PROCEDURE (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
TRANSANAL EXCISION OF TUMOUR UROLOGY
LURO105 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
UROLOGY
LURO091 TRANSPLANT STENTING (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
TRANS URETHRAL RESECTION OF UROLOGY
LURO092 L5 Surgery 0 18010 21440 24870
BL TUMOUR & FULG (URO) # L5 SURGERY
UROLOGY
LURO093 TVT SLING PROCEDURE (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
URETEROLITHOTOMY (URO) (URO) UROLOGY
LURO095 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
URETERO RENOSCOPY CALCULOUS UROLOGY
LURO094 L5 Surgery 0 18010 21440 24870
AL (URO) # L5 SURGERY
URETHRAL DIVERTECULUM
UROLOGY
LURO096 EXCISION INCLUDING CYSTOSCOPY L5 Surgery 0 18010 21440 24870
SURGERY
(URO) # L5
97
Urology
Surgery Billing
Level Group
URETHRAL FISTULA CLOSURE UROLOGY
LURO097 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
UROLOGY
LURO098 URETHROLITHOTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
UROLOGY
LURO099 URETHROLYSIS (URO) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
URETHROPLASTY 2ND STAGE REPA UROLOGY
LURO100 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
URETHROPLASTY I STAGE REPAIR UROLOGY
LURO101 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
VARICOCELE LEGATION BILATERAL UROLOGY
LURO102 L5 Surgery 0 18010 21440 24870
(URO) # L5 SURGERY
VENOUS LEGATION FOR UROLOGY
LURO103 L5 Surgery 0 18010 21440 24870
IMPOTENCY (URO) (URO) # L5 SURGERY
VISUAL OPTICAL/INTERNAL URET UROLOGY
LURO104 L5 Surgery 0 18010 21440 24870
CORETHRO UR (URO) # L5 SURGERY
ADRENALECTOMY UNILATERAL UROLOGY
LURO159 L6 Surgery 0 27010 32150 37290
ADRENELECTOMY UNILATERAL UROLOGY
LURO107 L6 Surgery 0 27010 32150 37290
AMPUTATION TOTAL OF PENIS & UROLOGY
LURO108 L6 Surgery 0 27010 32150 37290
GUINAL BLOCK (URO) # L6 SURGERY
ARTIFICAL URINARY SPHINCTER UROLOGY
LURO109 L6 Surgery 0 27010 32150 37290
PLACEMENT (URO) # L6 SURGERY
BAORI FLAP WITH UROLOGY
LURO110 L6 Surgery 0 27010 32150 37290
URETERONEOCYY (URO) # L6 SURGERY
BLOCK DISSECTION INGUINAL UROLOGY
LURO111 L6 Surgery 0 27010 32150 37290
UNLATERAL (URO) (URO) # L6 SURGERY
CUTANEOUS URETEROSTOMY UROLOGY
LURO112 L6 Surgery 0 27010 32150 37290
BILATERAL (URO) (URO) # L6 SURGERY
CYSTECTOMY PARTIAL INCLUDING UROLOGY
LURO113 L6 Surgery 0 27010 32150 37290
CYSTOSCOPY (URO) # L6 SURGERY
CYSTOCELE MESH REPAIR (URO) UROLOGY
LURO114 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
EXTROPHY BLADDER REPAIR (URO) UROLOGY
LURO115 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
HYPOSPADIAS REPAIR STAGE II UROLOGY
LURO117 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
HYPOSPADIAS REPAIR STAGE I UROLOGY
LURO116 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
ILEO-INGUINAL NODE DISSECTION UROLOGY
LURO118 L6 Surgery 0 27010 32150 37290
- BILATERAL (URO) # L6 SURGERY
INFERIOR CALYCO URETEROSTOMY UROLOGY
LURO119 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
INGUINAL/ FEMORAL HERNIA MESH UROLOGY
LURO160 L6 Surgery 0 27010 32150 37290
REPAIR BILATERAL (URO) # L6 SURGERY
98
Urology
Surgery Billing
Level Group
INGUINAL NODE DISSECTION - UROLOGY
LURO120 L6 Surgery 0 27010 32150 37290
LAPAROSCOPIC LYMPHOCELE UROLOGY
LURO121 L6 Surgery 0 27010 32150 37290
DRAINAGE (URO) # L6 SURGERY
LAPAROSCOPIC NEPHRECTOMY UROLOGY
LURO122 L6 Surgery 0 27010 32150 37290
SIMPLE (URO) (URO) # L6 SURGERY
LAPAROSCOPIC
UROLOGY
LURO123 NEPHROURETERECTOMY SIMPLE L6 Surgery 0 27010 32150 37290
SURGERY
(URO) # L6
LAPAROSCOPIC ORCHIDOPEXY - UROLOGY
LURO124 L6 Surgery 0 27010 32150 37290
BILATERAL (URO) (URO) # L6 SURGERY
LAPAROSCOPIC PYELOLYMPHATIC UROLOGY
LURO125 L6 Surgery 0 27010 32150 37290
DISCONNECTION (URO) # L6 SURGERY
LAPAROSCOPIC URETEROLYSIS UROLOGY
LURO126 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
LAPAROSCOPIC VVF REPAIR (URO) UROLOGY
LURO127 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
LAPAROTOMY FRACTURE PELVIS & UROLOGY
LURO128 L6 Surgery 0 27010 32150 37290
RUPTURE URETHRA (URO) # L6 SURGERY
LAPARSCOPIC PYELOLITHOTOMY UROLOGY
LURO129 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
NEPHRECTOMY SIMPLE/BENIGN - UROLOGY
LURO130 L6 Surgery 0 27010 32150 37290
NEPHROLITHOTOMY INCLUDING
UROLOGY
LURO132 CYSTOSCOPY AND RETROGRADE L6 Surgery 0 27010 32150 37290
SURGERY
CATHETERISATION (URO) # L6
NEPHRO URETERECTOMY SIMPLE) UROLOGY
LURO131 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
OPEN SURGERY FOR FRACTURE
UROLOGY
LURO133 PELVIS WITH BLADDER AND L6 Surgery 0 27010 32150 37290
SURGERY
URETHRAL INJURY (URO) # L6
ORCHIDECTOMY BILATERAL -
UROLOGY
LURO134 OPEN/LAPAROSCOPIC (URO) (URO) L6 Surgery 0 27010 32150 37290
SURGERY
# L6
PENILE PROSTHESIS UROLOGY
LURO136 L6 Surgery 0 27010 32150 37290
IMPLANTATIONS (URO) # L6 SURGERY
PENILE PROSTHESIS UROLOGY
LURO135 L6 Surgery 0 27010 32150 37290
IMPLANTATION (URO) # L6 SURGERY
PENILE/URETHRA INJURY REPAIR UROLOGY
LURO137 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
PERCUEAREOUS UROLOGY
LURO138 L6 Surgery 0 27010 32150 37290
NEPHROSTOLITHOTCNL (URO) # L6 SURGERY
PERINEAL URETHROSTOMY (URO) UROLOGY
LURO139 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
PROSTATECTOMY RETROPUBIC UROLOGY
LURO140 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
99
Urology
Surgery Billing
Level Group
PROSTATECTOMY
UROLOGY
LURO141 TRANSURETHRAL (TURP) (URO) L6 Surgery 0 27010 32150 37290
SURGERY
# L6
UROLOGY
LURO142 PUBOVAGINAL SLING (URO) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
UROLOGY
LURO143 PYELOLITHOTOMY (UROLOGY) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
UROLOGY
LURO144 PYELOPLASTY (UROLOGY) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
RACANALISATION OF VAS - UROLOGY
LURO145 L6 Surgery 0 27010 32150 37290
RECTOCELE MESH REPAIR (URO) UROLOGY
LURO146 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
REIMPLANTATION OF URETER UROLOGY
LURO147 L6 Surgery 0 27010 32150 37290
SACROCOLPOPEXY - OPEN (URO) UROLOGY
LURO158 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
TOTAL AMPUTATION OF PENIS UROLOGY
LURO148 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
UROLOGY
LURO150 TRANSPLANT PCN (URO) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
TRANSPLANT RE-EXPLORATION UROLOGY
LURO151 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
TRANSPLANT URETERIC UROLOGY
LURO152 L6 Surgery 0 27010 32150 37290
REIMPLANTATION (URO) # L6 SURGERY
TRANSURETERO URETEROSTOMY UROLOGY
LURO153 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
URETERIC INJURY REPAIR (URO) UROLOGY
LURO154 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
VVF REPAIR TRANSVESICAL REPA UROLOGY
LURO155 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
VVF REPAIR VAGINAL APPROACH UROLOGY
LURO156 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
YV PLASTY OF BLADDER NECK UROLOGY
LURO157 L6 Surgery 0 27010 32150 37290
(URO) # L6 SURGERY
ADRENELECTOMY UNILATERAL UROLOGY
LURO004RS LR Surgery 0 29590 35220 40850
(LURO) [RS 5 days Package] # LR SURGERY
AUGMENTATION CYSTOPLASTY UROLOGY
BAORI FLAP WITH
UROLOGY
LURO009RS URETERONEOCYY (LURO) [RS 5 LR Surgery 0 29590 35220 40850
SURGERY
days Package] # LR
CYSTECTOMY RADICAL WITH DIVE UROLOGY
HEMINEPHRECTOMY (LURO) [RS 5 UROLOGY
100
Urology
Surgery Billing
Level Group
NEPHRECTOMY PARTIAL (LURO) UROLOGY
[RS 5 days Package] # LR SURGERY
NEPHRECTOMY RADICAL (LURO) UROLOGY
NEPHRECTOMY SIMPLE/BENIGN - UROLOGY
LURO [RS 5 days Package] # LR SURGERY
NEPHRO URETERECTOMY RADICAL UROLOGY
NEPHRO URETERECTOMY SIMPLE) UROLOGY
PROSTATECTOMY RADICAL (LURO) UROLOGY
PROSTATECTOMY RETROPUBIC UROLOGY
PSOAS HITCH WITH
UROLOGY
LURO086RS URETERONEOCMY (LURO) [RS 5 LR Surgery 0 29590 35220 40850
SURGERY
days Package] # LR
PYELOPLASTY (LURO) [RS 5 days UROLOGY
Package] # LR SURGERY
REIMPLANTATION OF URETER
UROLOGY
LURO093RS BILATERAL (LURO) [RS 5 days LR Surgery 0 29590 35220 40850
SURGERY
Package] # LR
REIMPLANTATION OF URETER
UROLOGY
LURO094RS UNILATERAL (LURO) [RS 5 days LR Surgery 0 29590 35220 40850
SURGERY
Package] # LR
SACROCOLPOPEXY (LURO) [RS 5 UROLOGY
VVF REPAIR TRANSVESICAL REPA UROLOGY
AUGMENTATION CYSTOPLASTY
UROLOGY
SURGERY
# L7
AUTO TRANSPLANTATION OF UROLOGY
LURO162 L7 Surgery 0 36010 42870 49730
KIDNEY (URO) # L7 SURGERY
CYSTECTOMY RADICAL WITH DIVE UROLOGY
LURO163 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
EPISPADIAS REPAIR STAGE II (URO) UROLOGY
LURO164 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
EPISPADIUS REPAIR STAGE I (URO) UROLOGY
LURO165 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
UROLOGY
LURO166 ILEAL CONDUIT (URO) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
UROLOGY
LURO167 ILEAL NEOBLADDER (URO) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
ILEAL REPLACEMENT OF URETER UROLOGY
LURO168 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
101
Urology
Surgery Billing
Level Group
INGUINAL HERNIA - MESH REPAIR UROLOGY
LURO189 L7 Surgery 0 36010 42870 49730
UNDER LA - BILATERAL (URO) # L7 SURGERY
LAPAROSCOPIC ADRENALECTOMY UROLOGY
LURO169 L7 Surgery 0 36010 42870 49730
- UNILATERAL (URO) (URO) # L7 SURGERY
LAPAROSCOPIC REIMPLANTATION
UROLOGY
LURO170 OF URETER (UNILATERAL) (URO) L7 Surgery 0 36010 42870 49730
SURGERY
# L7
LAPAROSCOPIC RETROPERITONEAL UROLOGY
LURO171 L7 Surgery 0 36010 42870 49730
NODE DISSECTION (URO) # L7 SURGERY
NEPHRECTOMY RADICAL (URO) UROLOGY
LURO172 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
NEPHRO URETERECTOMY RADICAL UROLOGY
LURO173 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
PROSTATECTOMY RADICAL (URO) UROLOGY
LURO174 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
RECTAL BLADDER WITH PELVIC CY UROLOGY
LURO175 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
RECTAL NEOBLADDER (MAINZ UROLOGY
LURO176 L7 Surgery 0 36010 42870 49730
POUCH) (URO) # L7 SURGERY
REDUCTION CYSTOPLASTY (URO) UROLOGY
LURO177 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
REIMPLANTATION OF URETER UROLOGY
LURO178 L7 Surgery 0 36010 42870 49730
RETROPERITONEAL TUMER EXCISIK UROLOGY
LURO179 L7 Surgery 0 36010 42870 49730
DISSECTION (URO) # L7 SURGERY
UROLOGY
LURO180 RIRS - BILATERAL (URO) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
SACROCOLPOPEXY - UROLOGY
LURO188 L7 Surgery 0 36010 42870 49730
LAPAROSCOPIC (URO) (URO) # L7 SURGERY
TOTAL VAULT PROLPASE MESH UROLOGY
LURO181 L7 Surgery 0 36010 42870 49730
REPAIR (URO) # L7 SURGERY
URETEROSIGMOIDOSTOMY (URO) UROLOGY
LURO182 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
URETHROPLASTY (BUCCAL UROLOGY
LURO183 L7 Surgery 0 36010 42870 49730
MUCOSA) (URO) # L7 SURGERY
URETHROPLASTY
UROLOGY
LURO184 (BULBOPROSTATIC ANASTOMOTIC) L7 Surgery 0 36010 42870 49730
SURGERY
(URO) # L7
URETHROPLASTY (PENILE SKIN UROLOGY
LURO185 L7 Surgery 0 36010 42870 49730
FLAP) (URO) # L7 SURGERY
URETHROPLASTY SINGLE STAGE UROLOGY
LURO187 L7 Surgery 0 36010 42870 49730
URETHROPLASTY (TRANSPUBIC) UROLOGY
LURO186 L7 Surgery 0 36010 42870 49730
(URO) # L7 SURGERY
ADRENALECTOMY BILATERAL UROLOGY
LURO190 L8 Surgery 0 45010 53580 62150
102
Urology
Surgery Billing
Level Group
LAPAROSCOPIC ADRENALECTOMY UROLOGY
LURO191 L8 Surgery 0 45010 53580 62150
- BILATERAL (URO) (URO) # L8 SURGERY
LAPAROSCOPIC DONOR UROLOGY
LURO192 L8 Surgery 0 45010 53580 62150
NEPHRECTOMY (URO) # L8 SURGERY
LURO193 L8 Surgery 0 45010 53580 62150
PARTIAL (URO) # L8 SURGERY
LURO194 L8 Surgery 0 45010 53580 62150
RADICAL (URO) # L8 SURGERY
LAPAROSCOPIC
UROLOGY
LURO195 NEPHROURETERECTOMY RADICAL L8 Surgery 0 45010 53580 62150
SURGERY
(URO) # L8
LAPAROSCOPIC PYELOPLASTY UROLOGY
LURO196 L8 Surgery 0 45010 53580 62150
(URO) # L8 SURGERY
LAPAROSCOPIC REIMPLANTATION UROLOGY
LURO197 L8 Surgery 0 45010 53580 62150
OF URETER (BILATERAL) (URO) # L8 SURGERY
NEPHRECTOMY PARTIAL (URO) UROLOGY
LURO198 L8 Surgery 0 45010 53580 62150
(URO) # L8 SURGERY
TRANSPLANT NEPHRECTOMY UROLOGY
LURO149 L6 Surgery 0 45050 49560 54060
(URO) # L6 SURGERY
ROBOTIC PACKAGE SURGERY - 2 - UROLOGY
5 Days - URO # LR SURGERY
CONDUIT OPERATIONS (OPEN
TOTAL CYSTECTOMY (WITH UROLOGY
LURO204 L9 Surgery 0 54020 64300 74590
CONSTRUCTION OF INTESTINAL SURGERY
CONDUIT OF BLADDER) (URO) # L9
LAPAROSCOPIC RADICAL
UROLOGY
LURO200 CYSTECTOMY + ILEAL CONDUIT L9 Surgery 0 54020 64300 74590
SURGERY
(URO) # L9
UROLOGY
LURO201 CYSTECTOMY + NEOBLADDER L9 Surgery 0 54020 64300 74590
SURGERY
(URO) # L9
UROLOGY
LURO202 CYTSTECTOMY + MAINZ II POUCH L9 Surgery 0 54020 64300 74590
SURGERY
(URO) # L9
LAPAROSCOPIC RADICAL UROLOGY
LURO199 L9 Surgery 0 54020 64300 74590
PROSTATECTOMY (URO) # L9 SURGERY
RENAL TRANSPLANTATION (URO) UROLOGY
LURO203 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
103
Department of
Oncology Sciences
104
Medical Oncology
105
Medical Oncology
PONM053 DRESSING MINOR - ONM Procedure ONCOLOGY MEDICAL 200 210 250 290
PONM052 DRESSING MEDIUM - ONM Procedure ONCOLOGY MEDICAL 220 230 280 320
PONM024 INJ. VIT/IRON - 1 DAY Procedure ONCOLOGY MEDICAL 480 500 590 690
PONM025 INJ. VIT/IRON - 5 DAY Procedure ONCOLOGY MEDICAL 640 670 800 920
PONM002 BIOPSY - PUNCH Procedure ONCOLOGY MEDICAL 1910 2010 2390 2770
PONM003 BIOPSY - TRU CUT Procedure ONCOLOGY MEDICAL 1910 2010 2390 2770
TRANS-
PONM046 THORACICLUNG,PLEURAL,MEDBIO Procedure ONCOLOGY MEDICAL 2470 2590 3080 3570
OFLESI UN CT(B)
CHEMOTHERAPY PROCEDURE -
PONM050 Procedure ONCOLOGY MEDICAL 2730 2730 3000 3280
WEEKLY
PONM001 ASCITIC TAPPING (A) Procedure ONCOLOGY MEDICAL 3420 3590 4270 4960
CHEMOTHERAPY PROCEDURES-
INTRA ARTERIAL
PONM037 PLEURAL TAPPING (A) Procedure ONCOLOGY MEDICAL 5190 5450 6490 7530
BONE MARROW ASPIRATION BIOPSY
(A) - PONM
INTRA CAVITARY
HEMOSTASIS & THROMROPHILIA
EVALUATION & PLAN
CHEMOTHERAPY PROCEDURE -
MINOR
SINGLE DAY
REPLACEMENT THERAPY FACTOR /
PLASMA
PONM023 IMMUNOTHERAPY - ONM Procedure ONCOLOGY MEDICAL 9660 10150 12080 14010
PONM036 PIC - PERIPHERAL LINE Procedure ONCOLOGY MEDICAL 10390 10910 12990 15060
MULTIPLE DAY
PONM047 BIOLOGICAL Procedure ONCOLOGY MEDICAL 13670 14350 17080 19810
PONM055 ALLOGENIC STEM CELL HARVESTING Procedure ONCOLOGY MEDICAL 38250 40170 47820 55470
AUTOLOGOUS STEM CELL
HARVESTING
CRYO PRESERVATION & STORAGE OF
STEM CELLS
CHEMOTHERAPY CONTINUOUS
INFUSIONAL
106
Medical Oncology
PONM044 STEM CELL MOBILIZATION (7 DAYS) Procedure ONCOLOGY MEDICAL 66950 70290 83680 97070
PONM005 BONE MARROW RE-INFUSION Procedure ONCOLOGY MEDICAL 87440 91810 109300 126790
PONM043 STEM CELL COLLECTION Procedure ONCOLOGY MEDICAL 106560 111890 133200 154520
GVHD PROPHYLAXIS FOR ALLOGENIC
TRANSPLANTS ONLY
CONDITIONING THERAPY FOR
TRANSPLANT
POST TRANSPLANT CARE FOR 30
DAYS
ONCOLOGY MEDICAL
KONR018 BMT Donor Package -II Package 0 1 1 1
PACKAGE
ONCOLOGY MEDICAL
KONR019 BMT Donor Package -III Package 0 1 1 1
PACKAGE
ONCOLOGY MEDICAL
KONR012 BMT Subsidies Recipient Package -II Package 0 1207500 1437500 1667500
PACKAGE
ONCOLOGY MEDICAL
KONM006 BMT RECIPIENT PACKAGE (MIPC) Package 0 2948720 3510380 4072040
PACKAGE
PSTM001 ALLOGENIC STEM CELL INJ Procedure STEMPUTICS 142090 149190 177610 206020
PSTM002 AUTOLOGUS STEMCELL INJ Procedure STEMPUTICS 162580 170710 203220 235740
107
Onco Surgery
108
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
POMS001 SKIN TRACTION - POMS Procedure MUSCULOSKELETAL 280 290 350 410
PROCEDURE
ONCOLOGY
POMS003 MINOR DRESSING - POMS Procedure MUSCULOSKELETAL 420 440 520 610
PROCEDURE
ONCOLOGY
OTHER MINOR PROCEDURE -
POMS005 Procedure MUSCULOSKELETAL 420 440 520 610
POMS
PROCEDURE
ONCOLOGY
POMS002 SLAB REMOVAL - POMS Procedure MUSCULOSKELETAL 420 440 520 610
PROCEDURE
ONCOLOGY
POMS004 SUTURE REMOVAL - POMS Procedure MUSCULOSKELETAL 420 440 520 610
PROCEDURE
ONCOLOGY
POMS006 BELOW ELBOW SLAB - POMS Procedure MUSCULOSKELETAL 560 580 690 810
PROCEDURE
ONCOLOGY
POMS007 CAST REMOVAL - POMS Procedure MUSCULOSKELETAL 560 580 690 810
PROCEDURE
ONCOLOGY
K-WIRE REMOVAL & DRESSING -
POMS
PROCEDURE
ONCOLOGY
POMS008 MAJOR DRESSING - POMS Procedure MUSCULOSKELETAL 680 720 850 990
PROCEDURE
ONCOLOGY
POMS010 BELOW KNEE SLAB - POMS Procedure MUSCULOSKELETAL 820 860 1030 1190
PROCEDURE
ONCOLOGY
POMS011 JOINT ASPIRATION - POMS Procedure MUSCULOSKELETAL 820 860 1030 1190
PROCEDURE
ONCOLOGY
POMS012 ABOVE KNEE SLAB - POMS Procedure MUSCULOSKELETAL 960 1010 1200 1390
PROCEDURE
ONCOLOGY
POMS013 ABOVE ELBOW SLAB - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590
PROCEDURE
ONCOLOGY
POMS014 BELOW ELBOW CAST - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590
PROCEDURE
ONCOLOGY
POMS015 STRAPPING - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590
PROCEDURE
ONCOLOGY
POMS016 ABOVE ELBOW CAST - POMS Procedure MUSCULOSKELETAL 1650 1730 2060 2390
PROCEDURE
ONCOLOGY
POMS017 BELOW KNEE CAST - POMS Procedure MUSCULOSKELETAL 1650 1730 2060 2390
PROCEDURE
109
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
POMS018 ABOVE KNEE CAST - POMS Procedure MUSCULOSKELETAL 1910 2010 2390 2770
PROCEDURE
ONCOLOGY
POMS020 NEEDLE BIOPSY - POMS Procedure MUSCULOSKELETAL 2050 2150 2560 2970
PROCEDURE
ONCOLOGY
SKELETAL TRACTION (CALCANEUS/
TIBIA/FEMUR) IN ER - POMS
PROCEDURE
ONCOLOGY
POMS021 TRUCUT BIOPSY - POMS Procedure MUSCULOSKELETAL 2050 2150 2560 2970
PROCEDURE
ONCOLOGY
BONE MARROW ASPIRATION -
POMS
PROCEDURE
ONCOLOGY
LOMS001 Aspiration-MSONCO # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
Bone Marrow Aspiration-MSONCO
LOMS003 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
# L1
SURGERY
ONCOLOGY
LOMS002 Closed Reduction-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS004 Hip Spica POP Cast # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS005 Implant Removal- Minor MSONCO Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS006 Inision & Drainage-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS007 K-Wire Fixation-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS008 Major Wound Dressing # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
Manipulation Under Anasthesia
(MUA)- Minor # L1
SURGERY
ONCOLOGY
LOMS010 Minor Amputation-Upper Limb # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
Minor Tumor Excision-Upper Limb
# L1
SURGERY
110
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LOMS012 Skeletal Traction # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS013 Skin Grafting-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS014 Trucut Bone Biospy # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS015 Wound Debridement-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220
SURGERY
ONCOLOGY
LOMS016 Implant Removal- MSONCO # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS017 Incision & Drainage-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS018 K-Wire Fixation-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
Manipulation Under Anasthesia
(MUA)-Major # L2
SURGERY
ONCOLOGY
LOMS020 Minor Amputation-Lower limb # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
Minor Tumor Excision-Lower Limb
# L2
SURGERY
ONCOLOGY
LOMS022 Nerve Surgery-Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS023 Open Biopsy # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS024 Osteotomy-Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS029 Pedicled Flaps - Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS025 Skin Grafting # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS026 Spinal Biopsy # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
111
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LOMS027 Tendon Transfer # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS028 Wound Debridement-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380
SURGERY
ONCOLOGY
LOMS038 Arthrodesis-Small Joint # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
LOMS030 Bone Grafting-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
LOMS033 Curettage - Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
External Fixator Application-Minor
# L3
SURGERY
ONCOLOGY
LOMS034 K-Nail # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
Limb salvage with Modular
Megaprosthesis - Minor # L3
SURGERY
ONCOLOGY
Nerve Surgery-Major MSONCO
# L3
SURGERY
ONCOLOGY
LOMS036 Plate Osteosynthesis-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
LOMS037 Skin Grafting-Major # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
LOMS031 Tumor Excision-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940
SURGERY
ONCOLOGY
LOMS043 Arthrodesis - Wrist - Minor # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420
SURGERY
ONCOLOGY
LOMS040 Axillary Clearance # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420
SURGERY
ONCOLOGY
LOMS042 Curettage - Major # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420
SURGERY
ONCOLOGY
Excision of Bone segment - Major
# L4
SURGERY
ONCOLOGY
LOMS041 Groin Node Dissection # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420
SURGERY
112
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
Limb Salvage with custom made
Megaprosthesis - Minor # L4
SURGERY
ONCOLOGY
Megaprosthesis Reconstruction
# L4
SURGERY
ONCOLOGY
LOMS049 Above Elbow Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS050 Above Knee Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS059 AMP Hemiarthroplasty # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS060 Arthrodesis-Ankle # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS063 Arthrodesisc- Wrist - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS062 Arthrodesis-Hip # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS061 Arthrodesis - Knee - Minor # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS047 Below Elbow Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS048 Below Knee Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
Bipolar Hemiarthroplasty - Minor
# L5
SURGERY
ONCOLOGY
LOMS054 Extended Curettage # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
Forequarter Amputation - Minor
# L5
SURGERY
ONCOLOGY
Humerus Hemiarthroplasty - Minor
# L5
SURGERY
ONCOLOGY
Implant Removal - Major MSONCO
# L5
SURGERY
113
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LOMS056 Interlocking Nail # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS057 Nail Cement Spacer # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS066 Osteotomy - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
Pedicled Fibula Transfer - Minor
# L5
SURGERY
ONCOLOGY
LOMS067 Pedicled Flaps - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS065 Plate Osteosynthesis - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS069 TKR Megaprosthesis - Minor # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS064 Tumor Excision - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
LOMS058 Vertebroplasty MSONCO # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870
SURGERY
ONCOLOGY
Allograft + Vascularised Fibula
Reconstruction - Major # L6
SURGERY
ONCOLOGY
LOMS071 Arthrodesis - Knee - Major # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290
SURGERY
ONCOLOGY
LOMS070 Balloon Kyphoplasty-MSONCO # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290
SURGERY
ONCOLOGY
Bipolar Hemiarthroplasty-
Megaprosthesis # L6
SURGERY
ONCOLOGY
Bone Allograft Reconstruction -
Minor # L6
SURGERY
ONCOLOGY
ECRT (Extra-corporeal Radiation &
Reimplantation) - Minor # L6
SURGERY
ONCOLOGY
Extended Curettage + Bone
Grafting - Major # L6
SURGERY
114
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
Extended Curettage + Cementing
# L6
SURGERY
ONCOLOGY
External Fixator Application-Major
# L6
SURGERY
ONCOLOGY
Forequarter Amputation - Major
# L6
SURGERY
ONCOLOGY
LOMS081 Free Vascularised Fibula Graft # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290
SURGERY
ONCOLOGY
Humerus Hemiarthroplasty - Major
# L6
SURGERY
ONCOLOGY
Ilizarov External Fixator (IEF)/ LRS
Application # L6
SURGERY
ONCOLOGY
Internal hemipelvectomy Type II +
III - Minor # L6
SURGERY
ONCOLOGY
Internal Hemipelvectomy Type I -
Minor # L6
SURGERY
ONCOLOGY
LOMS086 Partial Sacrectomy - Minor # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290
SURGERY
ONCOLOGY
Total Elbow Replacement - Minor
# L6
SURGERY
ONCOLOGY
LOMS079 Tumor Excision - Supra major # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290
SURGERY
ONCOLOGY
Allograft Prosthetic Composite
(APC) - Minor # L7
SURGERY
Anterior Spinal Cord ONCOLOGY
LOMS098 Decompression & Instrumentation L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730
- Minor # L7 SURGERY
ONCOLOGY
Anterior Spinal Cord
LOMS097 T7 Surgery MUSCULOSKELETAL 0 36010 42870 49730
Decompression - Minor # T7
SURGERY
ONCOLOGY
Arthrodesis Knee - Supra Major
# L7
SURGERY
ONCOLOGY
Arthrodesis Wrist - Supra Major
# L7
SURGERY
115
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
Bipolar Hemiarthroplasty-
Megaprosthesis - Major # L7
SURGERY
ONCOLOGY
Bone Allograft + Free Vascularised
Fibula Reconstruction # L7
SURGERY
ONCOLOGY
Major # L7
SURGERY
ONCOLOGY
Reimplantation) # L7
SURGERY
ONCOLOGY
Reimplantation) - Major UL # L7
SURGERY
ONCOLOGY
Excision of Bone Segment - Supra
Major # L7
SURGERY
ONCOLOGY
Extended Curettage - Supra Major
# L7
SURGERY
ONCOLOGY
Free Vascularised Fibula Graft
-Major # L7
SURGERY
ONCOLOGY
Internal Hemipelvectomy Type I + II
+ III/I +II+ IV - Minor # L7
SURGERY
ONCOLOGY
III - Major # L7
SURGERY
ONCOLOGY
Internal Hemipelvectomy Type I -
Major # L7
SURGERY
ONCOLOGY
Pedicled Fibula Transfer - Major
# L7
SURGERY
ONCOLOGY
LOMS107 Rotationplasty - Minor # L7 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730
SURGERY
ONCOLOGY
LOMS091 TKR Megaprosthesis # L7 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730
SURGERY
ONCOLOGY
Total Elbow Replacement - Major
# L7
SURGERY
Anterior Spinal Cord ONCOLOGY
LOMS113 Decompression & Instrumentation L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
- Supra Major # L8 SURGERY
116
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
Bone Allograft + Free Vascularised
Fibula Reconstruction - Major # L8
SURGERY
ONCOLOGY
Supra Major # L8
SURGERY
ONCOLOGY
Reimplantation) - Pelvis # L8
SURGERY
ONCOLOGY
+ III/I +II+ IV - Major # L8
SURGERY
ONCOLOGY
III - Supra Major # L8
SURGERY
ONCOLOGY
LOMS118 Partial Sacrectomy - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
SURGERY
ONCOLOGY
Pedicled Fibula Transfer - Supra
Major # L8
SURGERY
ONCOLOGY
LOMS122 Rotationplasty - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
SURGERY
ONCOLOGY
LOMS110 THR Megaprosthesis - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
SURGERY
ONCOLOGY
LOMS109 TKR Megaprosthesis - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
SURGERY
ONCOLOGY
Total Elbow Replacement - Supra
Major # L8
SURGERY
ONCOLOGY
Total Femur Replacement - Major
# L8
SURGERY
ONCOLOGY
Total Humerus Replacement -
Supra Major # L8
SURGERY
ONCOLOGY
LOMS119 Total Sacrectomy - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150
SURGERY
Bone Allograft + Free Vascularised ONCOLOGY
LOMS123 Fibula Reconstruction - Supra L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590
Major # L9 SURGERY
ONCOLOGY
Reimplantation) - Supra Major # L9
SURGERY
117
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
+ III/I +II+ IV - Supra Major # L9
SURGERY
ONCOLOGY
Limb Salvage with custom made
Megaprosthesis - Major # L9
SURGERY
ONCOLOGY
Limb salvage with Modular
Megaprosthesis # L9
SURGERY
ONCOLOGY
LOMS129 Rotationplasty - Supra Major # L9 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590
SURGERY
ONCOLOGY
TKR Megaprosthesis - Supra Major
# L9
SURGERY
ONCOLOGY
Total Femur Replacement - Supra
Major # L9
SURGERY
ONCOLOGY
Total Sacrectomy - Supra Major
# L9
SURGERY
D & C FRACTIONAL CURATTAGE ONCOLOGY
LONS001 L1 Surgery 4505 4730 5630 6530
(ONS) # L1 SURGERY
ONCOLOGY
LONS003 DRESSING SIMPLE (ONS) # L1 L1 Surgery 4505 4730 5630 6530
SURGERY
ONCOLOGY
LONS004 EUA (LONS) # L1 L1 Surgery 4505 4730 5630 6530
SURGERY
ONCOLOGY
LONS005 FNAC (LONS) # L1 L1 Surgery 4505 4730 5630 6530
SURGERY
INCISIONAL + DRAINAGE (ONS) ONCOLOGY
LONS006 L1 Surgery 4505 4730 5630 6530
# L1 SURGERY
ONCOLOGY
LONS007 PUNCH BIOPSY (LONS) # L1 L1 Surgery 4505 4730 5630 6530
SURGERY
RE-EXPLORATION FOR BLEEDING ONCOLOGY
LONS002 L1 Surgery 4505 4730 5630 6530
(ONS) # L1 SURGERY
SIGMOIDOSCOPY - RIGID (LONS) ONCOLOGY
LONS008 L1 Surgery 4505 4730 5630 6530
# L1 SURGERY
TRANS-RECTAL/TRANSPERINEAL ONCOLOGY
LONS009 L1 Surgery 4505 4730 5630 6530
BIOPSY OF PROSTATE (ONS) # L1 SURGERY
BRONCHOSCOPY A) - RIGID (ONS) ONCOLOGY
LONS010 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
CERVICAL POLYPECTOMY (ONS) ONCOLOGY
LONS011 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
ONCOLOGY
LONS012 CHEMOPORT REMOVAL (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
CORE BIOPSY /TRUCUT BIOPSY ONCOLOGY
LONS013 L2 Surgery 0 8655 10305 11955
(ONS) # L2 SURGERY
118
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LONS014 CYSTOSCOPY (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
DIRECT LARYNGOSCOPY (ONS) ONCOLOGY
LONS015 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
ONCOLOGY
LONS016 DL-SCOPY (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
ONCOLOGY
LONS017 DRESSING EXTENSIVE (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
EXCISION OF MELANOMA (LONS) ONCOLOGY
LONS018 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
EXCISION OF MUCOSAL ONCOLOGY
LONS019 L2 Surgery 0 8655 10305 11955
MELANOMA (ONS) # L2 SURGERY
EXCISION OF SKIN LESION (ONS) ONCOLOGY
LONS020 L2 Surgery 0 8655 10305 11955
# L2 SURGERY
EXPLORATORY CERVICOTOMY ONCOLOGY
LONS021 L2 Surgery 0 8655 10305 11955
(ONS) # L2 SURGERY
ONCOLOGY
LONS022 ICD - PLACEMENT (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
INTRA PERITONEAL - CHEMOPORT ONCOLOGY
LONS023 L2 Surgery 0 8655 10305 11955
REMOVAL (ONS) # L2 SURGERY
ONCOLOGY
LONS024 LOCAL ROTATION FLAP (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
LYMPHNODE BIOPSY EXCISION - ONCOLOGY
LONS025 L2 Surgery 0 8655 10305 11955
SONS (ONS) # L2 SURGERY
NASOPHARYNGOSCOPY INCLUDING ONCOLOGY
LONS026 L2 Surgery 0 8655 10305 11955
BIOPSY (ONS) # L2 SURGERY
ONCOLOGY
LONS027 SECONDARY SUTURING (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
ONCOLOGY
LONS028 SPLIT SKIN GRAFTING (ONS) # L2 L2 Surgery 0 8655 10305 11955
SURGERY
CIRCUMCISSION FOR PREPUCIAL ONCOLOGY
LONS029 L3 Surgery 0 11365 13530 15695
MALIGNANCY (ONS) # L3 SURGERY
ONCOLOGY
LONS030 CONISATION (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
ONCOLOGY
LONS032 CORDECTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
ONCOLOGY
LONS031 CORD STRIPPING (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
DIAGNOSTIC CALDWELL-LUC ONCOLOGY
LONS033 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
ONCOLOGY
LONS034 DIVISION OF FLAPS (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
EXCISION OF BASAL CELL CARCI) ONCOLOGY
LONS035 L3 Surgery 0 11365 13530 15695
(LONS) # L3 SURGERY
EXCISION OF PREMALIGNANT LES ONCOLOGY
LONS036 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
119
Onco Surgery
Surgery Billing
Level Group
EXCISION OF SUBCUTANEOUS ONCOLOGY
LONS037 L3 Surgery 0 11365 13530 15695
LESION (ONS) # L3 SURGERY
FRACTIONAL CURRATAGE (ONS) ONCOLOGY
LONS038 L3 Surgery 0 11365 13530 15695
# L3 SURGERY
HICKMAN CATHETER INSERTION ONCOLOGY
LONS039 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
HYSTEROSCOPY INCLUDING
BIOPSY, DILATATION, CURETTAGE
ONCOLOGY
LONS040 AND POLYPECTOMY WITH/ L3 Surgery 0 11365 13530 15695
SURGERY
WITHOUT MERINA INSERTION
(ONS) # L3
ONCOLOGY
LONS041 LATERAL RHINOTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
LOCAL EXCISION OF LIP LESION ONCOLOGY
LONS042 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
ONCOLOGY
LONS043 MICRODOCHECTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
ONCOLOGY
LONS044 MOURES OPERATION (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
MUCOSAL SHAVE OF LIP LESION ONCOLOGY
LONS045 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
OESOPHAGOSCOPY - RIGID ONCOLOGY
LONS046 L3 Surgery 0 11365 13530 15695
INCLUDING BIOPSY (ONS) # L3 SURGERY
ONCOLOGY
LONS047 OPEN BONE BIOPSY (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
PALATAL FENESTRATION (ONS) ONCOLOGY
LONS048 L3 Surgery 0 11365 13530 15695
# L3 SURGERY
SUSPENSION LARYNGOSCOPY ONCOLOGY
LONS049 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
ONCOLOGY
LONS050 TARSORRAPHY - SONS (ONS) # L3 L3 Surgery 0 11365 13530 15695
SURGERY
TRACHEO OESOPHAGEAL ONCOLOGY
LONS051 L3 Surgery 0 11365 13530 15695
PUNCTURE (ONS) # L3 SURGERY
WIDE EXCISION OF SCALP TUMOR ONCOLOGY
LONS052 L3 Surgery 0 11365 13530 15695
(ONS) # L3 SURGERY
ONCOLOGY
LONS053 ALVEOLECTOMY (ONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
CHEMOPORT INSERTION (LONS) ONCOLOGY
LONS054 L4 Surgery 0 15535 18495 21455
# L4 SURGERY
DIAGNOSTIC THORACOSCOPY +/- ONCOLOGY
LONS055 L4 Surgery 0 15535 18495 21455
EXCISION BENIGN TUMOR NECK ONCOLOGY
LONS056 L4 Surgery 0 15535 18495 21455
(LONS) # L4 SURGERY
EXCISION OF BASAL CELL CARCITH ONCOLOGY
LONS057 L4 Surgery 0 15535 18495 21455
RECONSTRUCTION (ONS) # L4 SURGERY
120
Onco Surgery
Surgery Billing
Level Group
EXCISION OF LACRIMAL GLAND TB) ONCOLOGY
LONS058 L4 Surgery 0 15535 18495 21455
(ONS) # L4 SURGERY
EXCISION OF MUCOSAL
ONCOLOGY
LONS059 MELANOMAECONSTRUCTION L4 Surgery 0 15535 18495 21455
SURGERY
(ONS) # L4
EXCISION OF PARATHYROID ONCOLOGY
LONS060 L4 Surgery 0 15535 18495 21455
ADENOMA/CARCINOMA (ONS) # L4 SURGERY
FEEDING ENTEROSTOMY (ONS) ONCOLOGY
LONS061 L4 Surgery 0 15535 18495 21455
# L4 SURGERY
ONCOLOGY
LONS062 GASTROSTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
INTRA PERITONEAL - CHEMOPORT ONCOLOGY
LONS063 L4 Surgery 0 15535 18495 21455
INSERTION (ONS) # L4 SURGERY
LAPAROSCOPIC OMENTAL / ONCOLOGY
LONS064 L4 Surgery 0 15535 18495 21455
PERITONEAL BIOPSY (ONS) # L4 SURGERY
ONCOLOGY
LONS065 LEEP (ONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
LID EXCISION WITH ONCOLOGY
LONS066 L4 Surgery 0 15535 18495 21455
RECONSTRUCION (ONS) # L4 SURGERY
ONCOLOGY
LONS067 LUMPECTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
ONCOLOGY
LONS068 MLS (ONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
NARROW FIELD LARYNGECTOMY ONCOLOGY
LONS069 L4 Surgery 0 15535 18495 21455
(ONS) # L4 SURGERY
ONCOLOGY
LONS070 PDT (ONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
RADICAL ORCHIDECTOMY (LONS) ONCOLOGY
LONS071 L4 Surgery 0 15535 18495 21455
# L4 SURGERY
SCELENE TRIANGLE DISSECTION ONCOLOGY
LONS072 L4 Surgery 0 15535 18495 21455
(LONS) # L4 SURGERY
ONCOLOGY
LONS073 SIMPLE MASTECTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
SUBMANDIBULAR GLAND ONCOLOGY
LONS074 L4 Surgery 0 15535 18495 21455
EXCISION (LONS) # L4 SURGERY
THEREPEUTIC CALDWELL-LUC ONCOLOGY
LONS075 L4 Surgery 0 15535 18495 21455
(ONS) # L4 SURGERY
ONCOLOGY
LONS076 TRACHEOSTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455
SURGERY
WIDE EXCISION OF CARCINOMA ONCOLOGY
LONS077 L4 Surgery 0 15535 18495 21455
BUCOSA (ONS) # L4 SURGERY
WIDE EXCISION OF FLOOR MOUTH ONCOLOGY
LONS078 L4 Surgery 0 15535 18495 21455
(ONS) # L4 SURGERY
AMPUTATION OF PENIS - PARTIAL ONCOLOGY
LONS079 L5 Surgery 0 18910 22515 26115
(LONS) # L5 SURGERY
121
Onco Surgery
Surgery Billing
Level Group
BILATERAL OOPHRECTOMY (LONS) ONCOLOGY
LONS080 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
BILATERAL ORCHIDECTOMY (LONS) ONCOLOGY
LONS081 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
BREAST LESION EXCISION (ONS) ONCOLOGY
LONS082 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
CENTRAL COMPARTMENT NECK ONCOLOGY
LONS083 L5 Surgery 0 18910 22515 26115
DISSECTION (ONS) # L5 SURGERY
ONCOLOGY
LONS085 COLOSTOMY -END (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS084 COLOSTOMY - LOOP (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
DEFUNCTIONING COLOSTOMY ONCOLOGY
LONS086 L5 Surgery 0 18910 22515 26115
(LONS) # L5 SURGERY
ONCOLOGY
LONS087 DIAPHRAGM STRIPPING (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS088 DISTAL FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS089 DOUBLE FLAP (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
EXCISION OF MALIGNANT LESION
ONCOLOGY
LONS090 (NOT OTHERWISE SPECIFIED) L5 Surgery 0 18910 22515 26115
SURGERY
(ONS) # L5
EXCISION OF MELANOMA WITH ONCOLOGY
LONS091 L5 Surgery 0 18910 22515 26115
ONCOLOGY
LONS092 EXCISION OF PINNA (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
EXCISION OF UNILATERAL ONCOLOGY
LONS093 L5 Surgery 0 18910 22515 26115
PULMOTASTASIS (ONS) # L5 SURGERY
EXCISION THYROGLOSSAL CYST/ ONCOLOGY
LONS094 L5 Surgery 0 18910 22515 26115
TRACT (ONS) # L5 SURGERY
EXPLORATORY THOROCOTOMY ONCOLOGY
LONS095 L5 Surgery 0 18910 22515 26115
(LONS) # L5 SURGERY
EXTERNAL AUDITORY CANAL EXCI) ONCOLOGY
LONS096 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
FEEDING JEJUNOSTOMY (LONS) ONCOLOGY
LONS097 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
GLOMUS TUMOR EXCISION (ONS) ONCOLOGY
LONS098 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
ONCOLOGY
LONS099 GLOSSECTOMY HEMI (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
HEPATIC RESECTION - WEDGE ONCOLOGY
LONS100 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
HYSTEROSCOPY WITH RESECTION ONCOLOGY
LONS101 L5 Surgery 0 18910 22515 26115
OF FIBROID (ONS) # L5 SURGERY
122
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LONS102 ILEOSTOMY END (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS103 ILEOSTOMY LOOP (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
INCISIONAL HERNIA MESH REPAIR
ONCOLOGY
LONS104 WITH/WITHOUT ADHESIOLYSIS L5 Surgery 0 18910 22515 26115
SURGERY
(ONS) # L5
ONCOLOGY
LONS105 LAPAROSCOPIC BSO (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
LAPAROSCOPIC VENTRAL HERNIA ONCOLOGY
LONS106 L5 Surgery 0 18910 22515 26115
MESH REPAIR (ONS) # L5 SURGERY
ONCOLOGY
LONS107 LARYNGO FISSURE (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS109 MEDIAN STERNOTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
MEDIASTINAL LYMPHADUCTOMY ONCOLOGY
LONS110 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
ONCOLOGY
LONS111 MEDIASTINOSCOPY (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
MIRP - MINIMALLY INVASIVE RADIO ONCOLOGY
LONS112 L5 Surgery 0 18910 22515 26115
GUIDED PARATHYROID (ONS) # L5 SURGERY
ONCOLOGY
LONS113 MUSCLE FLAP (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS114 OMENTECTOMY (LONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS115 PALATECTOMY PARTIAL (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
PAN ENDOSCOPY - SONS (ONS) ONCOLOGY
LONS116 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
ONCOLOGY
LONS117 PEDICLE FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
RECONCOTRUCTION OF GASTRIC ONCOLOGY
LONS119 L5 Surgery 0 18910 22515 26115
RES (LONS) # L5 SURGERY
ONCOLOGY
LONS120 REGIONAL FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
RETROPERITONEAL LYMPHNODE ONCOLOGY
LONS121 L5 Surgery 0 18910 22515 26115
ONCOLOGY
LONS122 REVISION COLOSTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS123 RFA (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ROLL - RADIO GUIDED OCCULT ONCOLOGY
LONS124 L5 Surgery 0 18910 22515 26115
LESION LOCALIZATION (ONS) # L5 SURGERY
SENTINEL NODE BIOPSY (LONS) ONCOLOGY
LONS125 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
123
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LONS126 SIMPLE HYSTRECTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS127 SINGLE FLAP (LONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
ONCOLOGY
LONS128 SPLEENECTOMY (LONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
SUPERIOR MEDIASTINAL CLEARAN ONCOLOGY
LONS129 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
TENDON LENGTHENING /TENDOM ONCOLOGY
LONS130 L5 Surgery 0 18910 22515 26115
SUTURES (ONS) # L5 SURGERY
TENSION SUTURING OF BURST ONCOLOGY
LONS131 L5 Surgery 0 18910 22515 26115
ABDOMEN (ONS) # L5 SURGERY
THERAPEUTIC LAPAROSCOPY ONCOLOGY
LONS132 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
THERAPEUTIC THORACOSCOPY ONCOLOGY
LONS133 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
THEREPEUTIC ENDOSCOPY (LONS) ONCOLOGY
LONS134 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
TICKHOFF LINBERG PROCEDURE ONCOLOGY
LONS135 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
ONCOLOGY
LONS136 TOTAL MASTECTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115
SURGERY
TRACHEO-OESOPHAGEAL SHUNT ONCOLOGY
LONS137 L5 Surgery 0 18910 22515 26115
(ONS) # L5 SURGERY
WIDE EXCISION OF PALATE (ONS) ONCOLOGY
LONS138 L5 Surgery 0 18910 22515 26115
# L5 SURGERY
WIDE EXCISION OF SOFT TISSUE ONCOLOGY
LONS139 L5 Surgery 0 18910 22515 26115
TUMOR (ONS) # L5 SURGERY
AMPUTATION ABOVE KNEE (LONS) ONCOLOGY
LONS140 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
AMPUTATION BELOW KNEE (LONS) ONCOLOGY
LONS141 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
AMPUTATION OF TOTAL PENIS ONCOLOGY
LONS142 L6 Surgery 0 28355 33755 39155
(LONS) # L6 SURGERY
AXILLARY CLEARANCE LEVEL I & II ONCOLOGY
LONS143 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
BREAST LOCAL ONCOPLASTY ONCOLOGY
LONS145 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
BYPASS PROCEDURES (INTESTINE ONCOLOGY
LONS146 L6 Surgery 0 28355 33755 39155
FOR TUMORS) (ONS) # L6 SURGERY
CIRCULAR PHARYNGECTOMY (ONS) ONCOLOGY
LONS147 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
ONCOLOGY
LONS148 COLOSTOMY -CLOSURE (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
D2 LYMPHADENECTOMY (ONS) ONCOLOGY
LONS149 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
124
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
LONS150 ENUCLEATION OF EYE (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
ETHMOIDO-SPHENOIDECTOMY ONCOLOGY
LONS151 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
EXCISION BRACHIAL FISTULA ONCOLOGY
LONS152 L6 Surgery 0 28355 33755 39155
(LONS) # L6 SURGERY
EXCISION OF ADRENAL TUMORS ONCOLOGY
LONS153 L6 Surgery 0 28355 33755 39155
(LONS) # L6 SURGERY
EXCISION OF CARCINOID TUMORS ONCOLOGY
LONS154 L6 Surgery 0 28355 33755 39155
(LONS) # L6 SURGERY
EXCISION OF INSULINOMAS (LONS) ONCOLOGY
LONS155 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
EXCISION OF ORAL TUMORS VIA ONCOLOGY
LONS156 L6 Surgery 0 28355 33755 39155
ROUGH APPROACH (ONS) # L6 SURGERY
GASTROJEJUNOSTOMY & ONCOLOGY
LONS157 L6 Surgery 0 28355 33755 39155
VAGOTOMY (LONS) # L6 SURGERY
GLOSSECTOMY PARTIAL (ONS) ONCOLOGY
LONS158 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
HEPATIC RESECTION ONCOLOGY
LONS159 L6 Surgery 0 28355 33755 39155
SEGMENTECTOMY (ONS) # L6 SURGERY
ONCOLOGY
LONS160 ILEOSTOMY CLOSURE (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
INFRASTRUCTURAL ONCOLOGY
LONS161 L6 Surgery 0 28355 33755 39155
MAXILLECTOMY (ONS) # L6 SURGERY
INTERNAL ILIAC ARTERY LIGATION ONCOLOGY
LONS144 L6 Surgery 0 28355 33755 39155
B/L (ONS) # L6 SURGERY
LAPAROTOMY & ADHESIOLYSIS (AS ONCOLOGY
LONS162 L6 Surgery 0 28355 33755 39155
SOLE PROCEDURE) (ONS) # L6 SURGERY
LARYNGECTOMY - FRONTO ONCOLOGY
LONS163 L6 Surgery 0 28355 33755 39155
LATERAL (ONS) # L6 SURGERY
LYMPHADENECTOMY (NOT ONCOLOGY
LONS108 L6 Surgery 0 28355 33755 39155
OTHERWISE SPECIFIED) (ONS) # L6 SURGERY
MANDIBULOTOMY WITH ONCOLOGY
LONS164 L6 Surgery 0 28355 33755 39155
MANDIBULAR SWING (ONS) # L6 SURGERY
MARGINAL MANDIBULECTOMY ONCOLOGY
LONS165 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
MAXILLECTOMY - PARTIAL (ONS) ONCOLOGY
LONS166 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
MESORECTAL EXCISION (TME) ONCOLOGY
LONS167 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
MUSCLE GROUP EXCISION (ONS) ONCOLOGY
LONS168 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
ONCOLOGY
LONS169 MYOCUTANEOUS FLAP (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
ONCOLOGY
LONS170 NERVE GRAFTING (LONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
125
Onco Surgery
Surgery Billing
Level Group
ORBITAL EXENTERATION (ONS) ONCOLOGY
LONS171 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
PAN HYSTERECTOMY/TOTAL
ONCOLOGY
LONS172 HYSTERECTOMY + B/L BSO (ONS) L6 Surgery 0 28355 33755 39155
SURGERY
# L6
PARA AORTIC LYMPHADECTOMY ONCOLOGY
LONS173 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
PARTIAL PHARYNGECTOMY (LONS) ONCOLOGY
LONS174 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
PLND - PELVIC LYMPHADECTOMY ONCOLOGY
LONS175 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
ONCOLOGY
LONS118 PORT-A-CATH (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
PTERYGO PALATINE FOSSA ONCOLOGY
LONS176 L6 Surgery 0 28355 33755 39155
DISSED) (ONS) # L6 SURGERY
ONCOLOGY
LONS177 QUADRANTECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
RADICAL CHOLECYSTECTOMY AND ONCOLOGY
LONS178 L6 Surgery 0 28355 33755 39155
LYMPHADENECTOMY (ONS) # L6 SURGERY
RESECTION ANASTAMOSIS BOWEL ONCOLOGY
LONS179 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
SACRECTOMY - PARTIAL (ONS) ONCOLOGY
LONS180 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
SEGMENTAL MANDIBULECTOMY ONCOLOGY
LONS181 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
ONCOLOGY
LONS182 SHOELACE REPAIR (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
SUBTOTAL GLOSSECTOMY (ONS) ONCOLOGY
LONS183 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
THYROID ISTHMECTOMY (ONS) ONCOLOGY
LONS184 L6 Surgery 0 28355 33755 39155
# L6 SURGERY
ONCOLOGY
LONS185 THYROID LOBECTOMY (LONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
TOTAL MASTECTOMY + SLNB ONCOLOGY
LONS186 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
TOTAL PALATATECTOMY (ONS) # ONCOLOGY
LONS187 L6 Surgery 0 28355 33755 39155
L6 SURGERY
ONCOLOGY
LONS188 TRACHELECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
TRANSANAL ENDOSCPIC ONCOLOGY
LONS189 L6 Surgery 0 28355 33755 39155
MICROSURGERY (TEM) (ONS) # L6 SURGERY
TRUP & TUR BLADDER TUMOUR ONCOLOGY
LONS190 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
ONCOLOGY
LONS191 TUR-BT (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
126
Onco Surgery
Surgery Billing
Level Group
TWO FIELD LYMPHADENECTOMY ONCOLOGY
LONS192 L6 Surgery 0 28355 33755 39155
(LONS) # L6 SURGERY
UNILATERAL ILEO-INGUINAL ONCOLOGY
LONS193 L6 Surgery 0 28355 33755 39155
BLOCK DISSECTION (ONS) # L6 SURGERY
URINARY DIVERSION PROCEDURES ONCOLOGY
LONS194 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
ONCOLOGY
LONS195 VULVECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155
SURGERY
WEDGE RESECTION OF LUNG ONCOLOGY
LONS196 L6 Surgery 0 28355 33755 39155
(ONS) # L6 SURGERY
WIDE EXCISION OF SCALP TUMOR ONCOLOGY
LONS197 L6 Surgery 0 28355 33755 39155
ABDOMINO-PERINEAL RESECTION ONCOLOGY
LONS001RS LR Surgery 0 31070 36990 42905
(LONS) [RS 10 days Package] # LR SURGERY
ANTERIOR RESECTION (LONS) [RS ONCOLOGY
BYPASS PROCEDURES (LONS) [RS ONCOLOGY
CLOSURE OF COLOSTOMY (LONS) ONCOLOGY
D2 LYMPHADENECTOMY (LONS) ONCOLOGY
DEFUNCTIONING COLOSTOMY ONCOLOGY
DIAGNOSTIC LAPAROSCOPY - ONCOLOGY
DIAGNOSTIC THORACOSCOPY ONCOLOGY
DISTAL PANCREATECTOMY (LONS) ONCOLOGY
EXCISION OF ADRENAL TUMORS ONCOLOGY
EXCISION OF BILATERAL
ONCOLOGY
LONS053RS PULMONASTASIS (LONS) [RS 5 LR Surgery 0 31070 36990 42905
SURGERY
days Package] # LR
EXCISION OF CARCINOID TUMORS ONCOLOGY
EXCISION OF INSULINOMAS (LONS) ONCOLOGY
EXCISION OF PARA PHARYNGEAL ONCOLOGY
EXCISION OF PARATHYROID
ONCOLOGY
LONS066RS ADENOMA/CARCINOMA (LONS) [RS LR Surgery 0 31070 36990 42905
SURGERY
5 days Package] # LR
EXCISION OF UNILATERAL
ONCOLOGY
LONS074RS PULMOTASTASIS (LONS) [RS 5 LR Surgery 0 31070 36990 42905
SURGERY
days Package] # LR
127
Onco Surgery
Surgery Billing
Level Group
EXPLORATORY THOROCOTOMY ONCOLOGY
FEEDING ENTEROSTOMY (LONS) ONCOLOGY
GLOMUS TUMOR EXCISION (LONS) ONCOLOGY
HARTMANN'S PROCEDURE (LONS) ONCOLOGY
HEMICOLECTOMY (LONS) [RS 10 ONCOLOGY
HEPATATECTOMY (LONS) [RS 5 ONCOLOGY
IVOR LEWIS ESOPHAGECTOMY ONCOLOGY
LAPAROSCOPIC OMENTAL /
ONCOLOGY
LONS252RS PERITONEAL BIOPSY (LONS) [RS 5 LR Surgery 0 31070 36990 42905
SURGERY
days Package] # LR
LOBECTOMY - LUNG (LONS) [RS 5 ONCOLOGY
LYMPHADENECTOMY (LONS) [RS 5 ONCOLOGY
MEDIASTINAL / THORACIC TUMOR
ONCOLOGY
LONS058RS RESECTION (LONS) [RS 5 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
MESORECTAL EXCISION (TME) ONCOLOGY
OESOPHAGECTOMY TOTAL-
ONCOLOGY
LONS134RS ORRINGRGAN TRANPOSITION LR Surgery 0 31070 36990 42905
SURGERY
(LONS) [RS 10 days Package] # LR
OESOPHAGO GASTRECTOMY IVOR- ONCOLOGY
PAN HYSTERECTOMY (LONS) [RS 5 ONCOLOGY
PARA AORTIC LYMPHADECTOMY ONCOLOGY
PARTIAL/SUBTAOTAL GASTRO FOR
ONCOLOGY
LONS150RS CARCINNOMA (LONS) [RS 10 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
PELVIC EXENTRATION (LONS) [RS ONCOLOGY
PLND - PELVIC LYMPHADECTOMY ONCOLOGY
POUCHES FOR URINARY RESERVIO ONCOLOGY
PULMONARY METASTATECTOMY
ONCOLOGY
LONS266RS UNILATERAL (LONS) [RS 5 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
128
Onco Surgery
Surgery Billing
Level Group
RADICAL CYSTECTOMY (LONS) [RS ONCOLOGY
RADICAL GASTRECTOMY R0-R4
ONCOLOGY
LONS161RS RNS) (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905
SURGERY
# LR
RADICAL NEPHRECTOMY (LONS) ONCOLOGY
RADICAL NEPHRECTOMY WITH
ONCOLOGY
LONS167RS CAVE) (LONS) [RS 5 days Package] LR Surgery 0 31070 36990 42905
SURGERY
# LR
RADICAL PLEURO-
ONCOLOGY
LONS170RS PNEUMONECTOMY (LONS) [RS 5 LR Surgery 0 31070 36990 42905
SURGERY
days Package] # LR
RECONSTRUCTION OF GASTRIC
ONCOLOGY
LONS173RS RES (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905
SURGERY
# LR
RESECTION ANASTAMOSIS BOWEL ONCOLOGY
RESECTION OF HEPATO-BILIARY
ONCOLOGY
LONS178RS NCIES (LONS) [RS 10 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
RESECTION OF
ONCOLOGY
LONS179RS RETROPERITONEALE) TUMOR LR Surgery 0 31070 36990 42905
SURGERY
RESECTION OF
RETROPERITONEALINTRASPINAL ONCOLOGY
EXT (LONS) [RS 5 days Package] SURGERY
# LR
RETROPERITONEAL LYMPH NODE
ONCOLOGY
LONS181RS DN RPLND) (LONS) [RS 5 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
REVISION THYROIDECTOMY /
ONCOLOGY
LONS274RS COMPLETION THYROIDECTOMY LR Surgery 0 31070 36990 42905
SURGERY
SEGMENTAL RESECTION - LUNG ONCOLOGY
SPLEENECTOMY (LONS) [RS 5 days ONCOLOGY
Package] # LR SURGERY
STAGING LAPROTOMY FOR
ONCOLOGY
LONS197RS CARCINRY (LONS) [RS 10 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
STAGING LAPROTOMY (LONS) [RS ONCOLOGY
SUBTOTAL GASTRECTOMY (LONS) ONCOLOGY
SURGERY FOR APUDOMAS (LONS) ONCOLOGY
129
Onco Surgery
Surgery Billing
Level Group
SURGERY FOR CARCINOMA OVARY ONCOLOGY
THERAPEUTIC LAPAROSCOPY ONCOLOGY
THERAPEUTIC THORACOSCOPY ONCOLOGY
THREE FIELD LYMPHADENECTOMY ONCOLOGY
THREE STAGE OESOPHAGECTOMY ONCOLOGY
THYROIDECTOMY (LONS) [RS 5 ONCOLOGY
THYROID ISTHMECTOMY (LONS) ONCOLOGY
THYROID LOBECTOMY (LONS) [RS ONCOLOGY
TOTAL PROCTO-COLECTOMY WITH
ONCOLOGY
LONS226RS AL ANASTOMOSIS (LONS) [RS 10 LR Surgery 0 31070 36990 42905
SURGERY
days Package] # LR
TOTAL PROCTO-COLECTOMY WITH
ONCOLOGY
LONS227RS MY (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905
SURGERY
# LR
TOTAL PROCTOCOLECTOMY WITH
ONCOLOGY
LONS228RS POCH AND ANASTOMOSIS (LONS) LR Surgery 0 31070 36990 42905
SURGERY
[RS 10 days Package] # LR
TOTAL THYROIDECTOMY FOR
LARGE MULTINODULAR GOITRE/ ONCOLOGY
RETROSTERNAL EXTENSION SURGERY
TOTAL THYROIDECTOMY (LONS) ONCOLOGY
TRIPPLE BYPASS SURGERY (FOR
ONCOLOGY
LONS270RS OBSTRUCTIVE JAUNDICE) (LONS) LR Surgery 0 31070 36990 42905
SURGERY
TWO FIELD LYMPHADENECTOMY ONCOLOGY
URINARY DIVERSION PROCEDURES ONCOLOGY
VATS VIDEO ASSISTED
ONCOLOGY
LONS240RS THORACOSCOPY SURGERY (LONS) LR Surgery 0 31070 36990 42905
SURGERY
WERTHIM'S HYSTRECTOMY RADIC ONCOLOGY
WHIPPLE'S PANCRETO-
ONCOLOGY
LONS242RS DUODENECT (LONS) [RS 10 days LR Surgery 0 31070 36990 42905
SURGERY
Package] # LR
AXILLARY CLEARANCE LEVEL I,II,III ONCOLOGY
LONS198 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
130
Onco Surgery
Surgery Billing
Level Group
BCT/PARTIAL MASTECTOMY /WIDE
ONCOLOGY
LONS200 EXCISION FOR BREAST CANCER L7 Surgery 0 37815 45020 52220
SURGERY
(ONS) # L7
CAROTID BODY TUMOR EXCISION ONCOLOGY
LONS201 L7 Surgery 0 37815 45020 52220
(LONS) # L7 SURGERY
CHEST WALL RESECTION AND ONCOLOGY
LONS202 L7 Surgery 0 37815 45020 52220
ONCOLOGY
LONS203 COMPOSITE FLAP (ONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
COMPOSITE RESECTION (ONS) # ONCOLOGY
LONS204 L7 Surgery 0 37815 45020 52220
L7 SURGERY
ONCOLOGY
LONS205 CRICO-HYOIDOPEXY (ONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
EXCISION OF BILATERAL ONCOLOGY
LONS206 L7 Surgery 0 37815 45020 52220
PULMONASTASIS (ONS) # L7 SURGERY
EXCISION OF MEDIASTINAL TUMO ONCOLOGY
LONS207 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
EXCISION OF PARA PHARYNGEAL ONCOLOGY
LONS208 L7 Surgery 0 37815 45020 52220
TUMOUR (ONS) # L7 SURGERY
EXCISION OF RETRO RECTAL ONCOLOGY
LONS209 L7 Surgery 0 37815 45020 52220
EXCISION OF SOFT TISSUE ONCOLOGY
LONS210 L7 Surgery 0 37815 45020 52220
SARCOMA NECK (ONS) # L7 SURGERY
EXPLORATORY LAPAROTOMY
ONCOLOGY
LONS211 FOR MALIGNANT INTESTINAL L7 Surgery 0 37815 45020 52220
SURGERY
OBSTRUCTION (ONS) # L7
FREE MICRO-VASCULAR FLAP ONCOLOGY
LONS212 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
HARTMANN'S PROCEDURE (ONS) ONCOLOGY
LONS213 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
ONCOLOGY
LONS214 HEMICOLECTOMY (LONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
ONCOLOGY
LONS215 HIP DISARTICULATION (ONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
ILEO INGUINAL BLOCK DISSECTION ONCOLOGY
LONS199 L7 Surgery 0 37815 45020 52220
BILATERAL (ONS) # L7 SURGERY
MODIFIED RADICAL
MASTATECTOMY (EXCLUDING ONCOLOGY
LONS216 L7 Surgery 0 37815 45020 52220
LYMPH NODE SAMPLING) (ONS) SURGERY
# L7
PARTIAL/SUBTAOTAL GASTRO FOR ONCOLOGY
LONS217 L7 Surgery 0 37815 45020 52220
CARCINNOMA (LONS) # L7 SURGERY
ONCOLOGY
LONS218 PERITONECTOMY (ONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
POSTERIOR PHARYNGEAL WALL RE ONCOLOGY
LONS219 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
131
Onco Surgery
Surgery Billing
Level Group
POST-MASTECTOMY ONCOLOGY
LONS220 L7 Surgery 0 37815 45020 52220
PULMONARY METASTATECTOMY ONCOLOGY
LONS221 L7 Surgery 0 37815 45020 52220
BILATERAL (ONS) # L7 SURGERY
RADICAL HEMICOLECTOMY WITH ONCOLOGY
LONS222 L7 Surgery 0 37815 45020 52220
RADICAL MASTOIDECTOMY
ONCOLOGY
LONS223 INCLUDING MEATOPLASTY (ONS) L7 Surgery 0 37815 45020 52220
SURGERY
# L7
RADICAL NECK DISSECTION (ONS) ONCOLOGY
LONS224 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
RADICAL NEPHRECTOMY (ONS) ONCOLOGY
LONS225 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
RADICAL PROSTATECTOMY (ONS) ONCOLOGY
LONS226 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
RADICAL TRACHELECTOMY (ONS) ONCOLOGY
LONS227 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
RADICAL VULVECTOMY + SLNB ONCOLOGY
LONS228 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
RESECTION OF HEPATO-BILIARY ONCOLOGY
LONS229 L7 Surgery 0 37815 45020 52220
MALIGNENCIES (ONS) # L7 SURGERY
RESECTION OF
ONCOLOGY
LONS230 RETROPERITONEALINTRASPINAL L7 Surgery 0 37815 45020 52220
SURGERY
EXT (ONS) # L7
RETROPERITONEAL LYMPH NODE ONCOLOGY
LONS231 L7 Surgery 0 37815 45020 52220
DISSECTION (RPLND) (ONS) # L7 SURGERY
REVISION RADICAL NECK ONCOLOGY
LONS232 L7 Surgery 0 37815 45020 52220
SECOND LOOK LAPROTOMY ONCOLOGY
LONS233 L7 Surgery 0 37815 45020 52220
(LONS) # L7 SURGERY
SEGMENTAL RESECTION - LUNG ONCOLOGY
LONS234 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
SELECTIVE NECK DISSECTION ONCOLOGY
LONS235 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
SLEEVE RESECTION OF TRACHEAL ONCOLOGY
LONS236 L7 Surgery 0 37815 45020 52220
(ONS) # L7 SURGERY
SUBCUTANEOUS MASTECTOMY ONCOLOGY
LONS237 L7 Surgery 0 37815 45020 52220
(LONS) # L7 SURGERY
SUBTOTAL GASTRECTOMY (LONS) ONCOLOGY
LONS238 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
SUBTOTAL TEMPORAL BONE ONCOLOGY
LONS239 L7 Surgery 0 37815 45020 52220
EXCISION (ONS) # L7 SURGERY
SUPERFICIAL PAROTIDECTOMY ONCOLOGY
LONS240 L7 Surgery 0 37815 45020 52220
(LONS) # L7 SURGERY
SUPRA OMOHYOID NECK ONCOLOGY
LONS241 L7 Surgery 0 37815 45020 52220
132
Onco Surgery
Surgery Billing
Level Group
SURGERY FOR APUDOMAS (LONS) ONCOLOGY
LONS242 L7 Surgery 0 37815 45020 52220
# L7 SURGERY
SURGERY FOR OVARIAN CYST AND ONCOLOGY
LONS243 L7 Surgery 0 37815 45020 52220
SURGERY FOR SALIVARY GLAND ONCOLOGY
LONS244 L7 Surgery 0 37815 45020 52220
TUMOURS (ONS) # L7 SURGERY
THREE FIELD LYMPHADENECTOMY ONCOLOGY
LONS245 L7 Surgery 0 37815 45020 52220
(LONS) # L7 SURGERY
ONCOLOGY
LONS246 THYMECTOMY (ONS) # L7 L7 Surgery 0 37815 45020 52220
SURGERY
TOTAL MANDIBULECTOMY WITH ONCOLOGY
LONS247 L7 Surgery 0 37815 45020 52220
RECTION (ONS) # L7 SURGERY
TOTAL MASTECTOMY FOR
BREAST CANCER WITH LEVEL ONCOLOGY
LONS248 L7 Surgery 0 37815 45020 52220
1 & 2 AXILLARY LYMPHNODE SURGERY
CLEARANCE (ONS) # L7
TOTAL THYROIDECTOMY FOR ONCOLOGY
LONS249 L7 Surgery 0 37815 45020 52220
TUMORS (ONS) # L7 SURGERY
TRIPPLE BYPASS SURGERY (FOR
ONCOLOGY
LONS250 OBSTRUCTIVE JAUNDICE) (ONS) L7 Surgery 0 37815 45020 52220
SURGERY
# L7
TYPE -I MODIFIED RADICAL ONCOLOGY
LONS251 L7 Surgery 0 37815 45020 52220
HYSTERECTOMY (ONS) # L7 SURGERY
VATS VIDEO ASSISTED
ONCOLOGY
LONS252 THORACOSCOPY SURGERY (LONS) L7 Surgery 0 37815 45020 52220
SURGERY
# L7
AMPUTATION FORE-QUARTER ONCOLOGY
LONS253 L8 Surgery 0 47265 56270 65270
(LONS) # L8 SURGERY
ANTERIOR MEDIASTINAL TUMOUR ONCOLOGY
LONS254 L8 Surgery 0 47265 56270 65270
RESECTION (ONS) # L8 SURGERY
BUCCO-PHARYNGECTOMY (ONS) ONCOLOGY
LONS255 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
COMPARTMENTAL EXCISION FOR ONCOLOGY
LONS256 L8 Surgery 0 47265 56270 65270
STS (ONS) # L8 SURGERY
COMPOSITE RESECTION WITH ONCOLOGY
LONS257 L8 Surgery 0 47265 56270 65270
RECTION (ONS) # L8 SURGERY
DISTAL PANCREATECTOMY (LONS) ONCOLOGY
LONS258 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
EXCISION OF CHEST WALL TUMOR ONCOLOGY
LONS259 L8 Surgery 0 47265 56270 65270
AND RECONSTRUCTION (ONS) # L8 SURGERY
EXCISION OF MESENTERIC MASS ONCOLOGY
LONS260 L8 Surgery 0 47265 56270 65270
(LONS) # L8 SURGERY
EXCISION OF SOFT TISSUE TUMOG ONCOLOGY
LONS261 L8 Surgery 0 47265 56270 65270
VASCULAR GRAFTS (ONS) # L8 SURGERY
EXTRAPLEURAL PNEUMONECTOMY ONCOLOGY
LONS262 L8 Surgery 0 47265 56270 65270
(ONS) # L8 SURGERY
133
Onco Surgery
Surgery Billing
Level Group
FOREQUARTER AMPUTATION (ONS) ONCOLOGY
LONS263 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
FUNCTIONAL NECK DISSECTION ONCOLOGY
LONS264 L8 Surgery 0 47265 56270 65270
(LONS) # L8 SURGERY
ONCOLOGY
LONS265 HEMI PELVECTOMY (ONS) # L8 L8 Surgery 0 47265 56270 65270
SURGERY
INFRATEMPORAL FOSSA RESECTIO ONCOLOGY
LONS266 L8 Surgery 0 47265 56270 65270
(ONS) # L8 SURGERY
INTERNAL HEMIPELVECTOMY ONCOLOGY
LONS267 L8 Surgery 0 47265 56270 65270
(ONS) # L8 SURGERY
LARYNGECTOMY - HEMI (LONS) ONCOLOGY
LONS268 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
LARYNGECTOMY - NEAR TOTAL ONCOLOGY
LONS269 L8 Surgery 0 47265 56270 65270
FOR MALIGNANCY (ONS) # L8 SURGERY
LARYNGECTOMY - SUPRACRICOID ONCOLOGY
LONS270 L8 Surgery 0 47265 56270 65270
LARYNGECTOMY - SUPRAGLOTTIC ONCOLOGY
LONS271 L8 Surgery 0 47265 56270 65270
(ONS) # L8 SURGERY
LARYNGO PHARYNGO ONCOLOGY
LONS272 L8 Surgery 0 47265 56270 65270
OESOPHAGECTOMY (ONS) # L8 SURGERY
LATERAL CRANIOFACIAL ONCOLOGY
LONS273 L8 Surgery 0 47265 56270 65270
MAXILLECTOMY RADICAL (ONS) ONCOLOGY
LONS275 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
MAXILLECTOMY - TOTAL (ONS) ONCOLOGY
LONS274 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
MODIFIED NECK DISSECTION I & II ONCOLOGY
LONS276 L8 Surgery 0 47265 56270 65270
(LONS) # L8 SURGERY
MUSCLE GROUP EXCISION WITH ONCOLOGY
LONS277 L8 Surgery 0 47265 56270 65270
TRANSFER PROCEDURE (ONS) # L8 SURGERY
PARTIAL CRICOTRACHEAL ONCOLOGY
LONS278 L8 Surgery 0 47265 56270 65270
PARTIAL NEPHRECTOMY (ONS) ONCOLOGY
LONS279 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
POUCHES FOR URINARY RESERVIO ONCOLOGY
LONS280 L8 Surgery 0 47265 56270 65270
(LONS) # L8 SURGERY
RADICAL CYSTECTOMY WITH OUT ONCOLOGY
LONS281 L8 Surgery 0 47265 56270 65270
CONDUIT (ONS) # L8 SURGERY
RADICAL MASTATECTOMY (LONS) ONCOLOGY
LONS282 L8 Surgery 0 47265 56270 65270
# L8 SURGERY
RADICAL MAXILLECTOMY FOR ONCOLOGY
LONS283 L8 Surgery 0 47265 56270 65270
RADICAL
ONCOLOGY
LONS284 MAXILLOETHMOIDECTOMY (LONS) L8 Surgery 0 47265 56270 65270
SURGERY
# L8
134
Onco Surgery
Surgery Billing
Level Group
RADICAL NEPHRECTOMY WITH ONCOLOGY
LONS285 L8 Surgery 0 47265 56270 65270
CAVE) (ONS) # L8 SURGERY
RADICAL NEPHRECTOMY WITH ONCOLOGY
LONS286 L8 Surgery 0 47265 56270 65270
RADICAL VULVECTOMY WITH ONCOLOGY
LONS287 L8 Surgery 0 47265 56270 65270
RESECTION OF BONE TUMOR ONCOLOGY
LONS288 L8 Surgery 0 47265 56270 65270
WITHONSERVATION (ONS) # L8 SURGERY
RESECTION OF RETROPERITONEAL ONCOLOGY
LONS289 L8 Surgery 0 47265 56270 65270
REVERSAL OF HARTMANS ONCOLOGY
LONS290 L8 Surgery 0 47265 56270 65270
PROCEDURE (ONS) # L8 SURGERY
REVISION SURGERY FOR PAROTID ONCOLOGY
LONS291 L8 Surgery 0 47265 56270 65270
ONCOLOGY
LONS292 COMPLETION THYROIDECTOMY L8 Surgery 0 47265 56270 65270
SURGERY
(ONS) # L8
ONCOLOGY
LONS293 SACRECTOMY - TOTAL (ONS) # L8 L8 Surgery 0 47265 56270 65270
SURGERY
ONCOLOGY
LONS294 SCAPULECTOMY (ONS) # L8 L8 Surgery 0 47265 56270 65270
SURGERY
SKIN SPARING/NAC SPARING
ONCOLOGY
LONS295 MASTECTOMY FOR BREAST L8 Surgery 0 47265 56270 65270
SURGERY
CANCER (ONS) # L8
STAGING LAPROTOMY FOR ONCOLOGY
LONS296 L8 Surgery 0 47265 56270 65270
CARCINOMA (ONS) # L8 SURGERY
LONS297 L8 Surgery 0 47265 56270 65270
PELVIC CONFINED (ONS) # L8 SURGERY
SURGERY FOR CHOLONGIO
ONCOLOGY
LONS298 CA WITH HJ WITHOUT LIVER L8 Surgery 0 47265 56270 65270
SURGERY
RESECTION (ONS) # L8
TEMPORAL BONE EXCISION - ONCOLOGY
LONS299 L8 Surgery 0 47265 56270 65270
SONS (ONS) # L8 SURGERY
ONCOLOGY
LONS300 THORACOPLASTY (ONS) # L8 L8 Surgery 0 47265 56270 65270
SURGERY
THYROIDECTOMY FOR
ONCOLOGY
LONS301 RETROSTERNAL EXTENSION (ONS) L8 Surgery 0 47265 56270 65270
SURGERY
# L8
TOTAL GLOSSECTOMY WITH ONCOLOGY
LONS302 L8 Surgery 0 47265 56270 65270
RECONON (ONS) # L8 SURGERY
TOTAL MASTECTOMY FOR BREAST
ONCOLOGY
LONS303 CANCER WITH LEVEL 1,2,3 L8 Surgery 0 47265 56270 65270
SURGERY
AXILLARY CLEARANCE (ONS) # L8
MALIGNANCY + CENTRAL ONCOLOGY
LONS304 L8 Surgery 0 47265 56270 65270
COMPARTMENT LYMPHNODE SURGERY
DISSECTION (ONS) # L8
135
Onco Surgery
Surgery Billing
Level Group
TYPE II MODIFIED RADICAL ONCOLOGY
LONS305 L8 Surgery 0 47265 56270 65270
HYSTRECTOMY (ONS) # L8 SURGERY
WERTHIM'S HYSTRECTOMY ONCOLOGY
LONS307 L8 Surgery 0 47265 56270 65270
RADICAL (ONS) # L8 SURGERY
WIDE FIELD LARYNGECTOMY &
ONCOLOGY
LONS306 PARTIAL PHARYNGECTOMY (ONS) L8 Surgery 0 47265 56270 65270
SURGERY
# L8
ABDOMINO-PERINEAL RESECTION
ONCOLOGY
LONS308 WITH TME +ANP+STOMA (ONS) L9 Surgery 0 56710 67515 78315
SURGERY
# L9
ANTERIOR CRANIOFACIAL ONCOLOGY
LONS309 L9 Surgery 0 56710 67515 78315
ANTERIOR RESECTION - LOW
ONCOLOGY
LONS310 ANTERIOR RESECTION LAR +TME L9 Surgery 0 56710 67515 78315
SURGERY
+ ANP (ONS) # L9
EXCISION FOR BREAST CANCER ONCOLOGY
LONS356 L9 Surgery 0 56710 67515 78315
+ SENTINEL NODE BIOPSY (LONS) SURGERY
# L9
COMPOSITE RESECTION WITH
ONCOLOGY
LONS311 UNILATERAL MOD RADICAL NECK L9 Surgery 0 56710 67515 78315
SURGERY
EXTENDED CRICOTRACHEAL
ONCOLOGY
LONS312 RESECTION & ANASTOMOSIS L9 Surgery 0 56710 67515 78315
SURGERY
(ONS) # L9
HEPATATECTOMY MAJOR (ONS) ONCOLOGY
LONS313 L9 Surgery 0 56710 67515 78315
# L9 SURGERY
IVOR LEWIS ESOPHAGECTOMY FOR ONCOLOGY
LONS314 L9 Surgery 0 56710 67515 78315
LOBECTOMY - LUNG -RADICAL ONCOLOGY
LONS315 L9 Surgery 0 56710 67515 78315
(ONS) # L9 SURGERY
MAJOR SARCOMA RESECTION ONCOLOGY
LONS316 L9 Surgery 0 56710 67515 78315
(ONS) # L9 SURGERY
MAXILLECTOMY + ORBITAL ONCOLOGY
LONS317 L9 Surgery 0 56710 67515 78315
EXENTERATION (ONS) # L9 SURGERY
ONCOLOGY
LONS318 ORRINGER TRANPOSITION FOR L9 Surgery 0 56710 67515 78315
SURGERY
MALIGNANCY (ONS) # L9
OESOPHAGO GASTRECTOMY IVOR- ONCOLOGY
LONS319 L9 Surgery 0 56710 67515 78315
PARAPHARYNGEAL TUMOUR ONCOLOGY
LONS320 L9 Surgery 0 56710 67515 78315
EXCISION (ONS) # L9 SURGERY
ONCOLOGY
LONS321 PELVIC EXENTRATION (ONS) # L9 L9 Surgery 0 56710 67515 78315
SURGERY
PERITONECTOMY + HIPEC (ONS) ONCOLOGY
LONS322 L9 Surgery 0 56710 67515 78315
# L9 SURGERY
RADICAL CYSTECTOMY WITH ONCOLOGY
LONS323 L9 Surgery 0 56710 67515 78315
CONDUIT (ONS) # L9 SURGERY
RADICAL GASTRECTOMY D2-D4 ONCOLOGY
LONS324 L9 Surgery 0 56710 67515 78315
136 LYMPHADENECTOMY (ONS) # L9 SURGERY
Onco Surgery
Surgery Billing
Level Group
RADICAL PAROTIDECTOMY (LONS) ONCOLOGY
LONS325 L9 Surgery 0 56710 67515 78315
# L9 SURGERY
RADICAL PLEURO-
ONCOLOGY
LONS326 PNEUMONECTOMY WITH L9 Surgery 0 56710 67515 78315
SURGERY
LYMPHADENECTOMY (ONS) # L9
RADICAL VULVECTOMY + BLOCK ONCOLOGY
LONS327 L9 Surgery 0 56710 67515 78315
RESECTION OF ANTERIOR
ONCOLOGY
LONS328 ABDOMIL TUMOR & RECON. (LONS) L9 Surgery 0 56710 67515 78315
SURGERY
# L9
ONCOLOGY
LONS329 ROBOTIC SURGERY (ONS) # L9 L9 Surgery 0 56710 67515 78315
SURGERY
LONS330 L9 Surgery 0 56710 67515 78315
- EXTENSIVE (ONS) # L9 SURGERY
SURGERY FOR HILAR CHOLONGIO ONCOLOGY
LONS331 L9 Surgery 0 56710 67515 78315
WITH LIVER RESECTION (ONS) # L9 SURGERY
THREE STAGE OESOPHAGECTOMY ONCOLOGY
LONS332 L9 Surgery 0 56710 67515 78315
TOAL LARYNGECTOMY WITH
ONCOLOGY
LONS333 PARTIAL PHARYNGECTOMY (ONS) L9 Surgery 0 56710 67515 78315
SURGERY
# L9
TOTAL LARYNGECTOMY+PARTIAL
PHARYNGECTOMY + UNILATERAL ONCOLOGY
LONS341 L9 Surgery 0 56710 67515 78315
MODIFIED RADICAL NECK SURGERY
TOTAL PAROTIDECTOMY WITH ONCOLOGY
LONS334 L9 Surgery 0 56710 67515 78315
CONON FACIAL NERVE (ONS) # L9 SURGERY
TOTAL PROCTO-COLECTOMY WITH ONCOLOGY
LONS335 L9 Surgery 0 56710 67515 78315
AL ANASTOMOSIS (LONS) # L9 SURGERY
TOTAL PROCTO-COLECTOMY WITH ONCOLOGY
LONS336 L9 Surgery 0 56710 67515 78315
MY (LONS) # L9 SURGERY
ONCOLOGY
LONS337 POCH AND ANASTOMOSIS (LONS) L9 Surgery 0 56710 67515 78315
SURGERY
# L9
MALIGNANCY + UNILATERAL ONCOLOGY
LONS338 L9 Surgery 0 56710 67515 78315
FUNCTIONAL NECK DISSECTION SURGERY
(ONS) # L9
TYPE - III EXTENDED RADICAL ONCOLOGY
LONS339 L9 Surgery 0 56710 67515 78315
HYSTERECTOMY (ONS) # L9 SURGERY
WHIPPLE'S PANCRETO- ONCOLOGY
LONS340 L9 Surgery 0 56710 67515 78315
DUODENECTOMY (ONS) # L9 SURGERY
EXCISION FOR BREAST CANCER
ONCOLOGY
LONS357 + SENTINEL NODE BIOPSY + L9 Surgery 0 66160 78765 91365
SURGERY
AXILLARY CLEARANCE LEVEL I,II,III
(LONS
137
Onco Surgery
Surgery Billing
Level Group
COMPOSITE RESECTION WITH NECK
ONCOLOGY
LONS347 DISSECTION WITH ITF CLEARANCE L9 Surgery 0 66160 78765 91365
SURGERY
(ONS) # L9
MAJOR LUNG RESECTION
ONCOLOGY
LONS350 SURGERY WITH MEDIASTINAL L9 Surgery 0 66160 78765 91365
SURGERY
LYMPHADENECTOMY (ONS) # L9
PELVIC EXENTRATION WITH
ONCOLOGY
LONS343 CONDUIT/COMPLEX STOMAS (ONS) L9 Surgery 0 66160 78765 91365
SURGERY
# L9
BILATERAL CA - BREAST SURGERY
ONCOLOGY
LONS351 WITH LYMPHADENECTOMY (ONS) L9 Surgery 0 75620 90025 104430
SURGERY
# L9
COMPOSITE RESECTION WITH
ONCOLOGY
LONS346 BILATERAL NECK DISSECTION (ONS) L9 Surgery 0 75620 90025 104430
SURGERY
# L9
EXTENSIVE CA OVARY SURGERY
ONCOLOGY
LONS344 WITH BOWEL RESECTION (ONS) L9 Surgery 0 75620 90025 104430
SURGERY
# L9
EXTENSIVE CA OVARY SURGERY ONCOLOGY
LONS345 L9 Surgery 0 75620 90025 104430
WITH IP CHEMOPORT (ONS) # L9 SURGERY
RADICAL GASTRECTOMY FOR
MALIGNANCY + D2 EXTENDED
LYMPHADENECTOMY + ONCOLOGY
LONS354 L9 Surgery 0 75620 90025 104430
FEEDING JEJUNOSTOMY + SURGERY
RECONSTRUCTION OF GASTRIC
REMNANT CON
RADICAL HYSTERECTOMY FOR
MALIGNANCY+BILATERAL PELVIC
ONCOLOGY
LONS353 LYMPHADENECTOMY+PARA-AORTIC L9 Surgery 0 75620 90025 104430
SURGERY
SYSTEMATIC LYMPHADENECTOMY
(ONS) # L9
RADICAL PAROTIDECTOMY WITH ONCOLOGY
LONS348 L9 Surgery 0 75620 90025 104430
NECK DISSECTION (ONS) # L9 SURGERY
THREE STAGE OESOPHAGECTOMY
+ TWO FIELD LYMPHADENECTOMY ONCOLOGY
LONS349 L9 Surgery 0 75620 90025 104430
+ FEEDING JEJUNOSTOMY + SURGERY
PYLOROPLASTY (ONS) # L9
TOTAL THYROIDECTOMY
ONCOLOGY
LONS342 FOR TUMUORS + CENTRAL L9 Surgery 0 75620 90025 104430
SURGERY
COMPARTMENT + FND (ONS) # L9
DRESSING CHARGE - MINOR - ONCOLOGY
PONS001 Procedure 210 220 265 305
PONS SURGICAL
DRESSING CHARGE - MEDIUM - ONCOLOGY
PONS002 Procedure 275 290 345 400
PONS SURGICAL
DRESSING CHARGE - MAJOR - ONCOLOGY
PONS003 Procedure 355 375 445 515
PONS SURGICAL
ONCOLOGY
PONS029 SUTURING - PONS Procedure 440 460 550 640
SURGICAL
ONCOLOGY
PONS011 EUA (A) - PONS Procedure 620 650 775 900
SURGICAL
ONCOLOGY
PONS010 DRESSING MAJOR - PONS Procedure 670 705 840 970
SURGICAL
ONCOLOGY
PONS012 FNAC - PONS Procedure 670 705 840 970
SURGICAL
138
Onco Surgery
Surgery Billing
Level Group
ONCOLOGY
PONS028 SMEAR CYTOLOGY - PONS Procedure 1155 1215 1445 1675
SURGICAL
ONCOLOGY
PONS009 DIRECT LARYNGOSCOPY (A) - PONS Procedure 1300 1365 1625 1885
SURGICAL
ONCOLOGY
PONS014 ICD INSERTION - PONS Procedure 1365 1435 1705 1980
SURGICAL
ONCOLOGY
PONS013 HYPO PHARYNGOSCOPY (A) - PONS Procedure 1585 1665 1980 2300
SURGICAL
ONCOLOGY
PONS015 J-NEEDLE BIOPSY (A) - PONS Procedure 1585 1665 1980 2300
SURGICAL
OESOPHAGO-GASTRO- ONCOLOGY
PONS021 Procedure 1585 1665 1980 2300
DUODENOSCOPY (A) - PONS SURGICAL
OESOPHAGOSCOPY RIGID (A) - ONCOLOGY
PONS022 Procedure 1585 1665 1980 2300
PONS SURGICAL
PARANASAL SINUS ENDOSCOPY ONCOLOGY
PONS024 Procedure 1585 1665 1980 2300
(A) - PONS SURGICAL
COLONOSCOPY (LIMITED) (A) - ONCOLOGY
PONS006 Procedure 1735 1820 2170 2515
PONS SURGICAL
ONCOLOGY
PONS020 NASOPHARYNGOSCOPY (A) - PONS Procedure 1735 1820 2170 2515
SURGICAL
PLEURODESIS & ICD INSERTION - ONCOLOGY
PONS025 Procedure 1735 1820 2170 2515
PONS SURGICAL
ONCOLOGY
PONS019 MICRO LARYNGOSCOPY (A) - PONS Procedure 1870 1965 2340 2710
SURGICAL
ONCOLOGY
PONS004 BIOPSY - TRU CUT - PONS Procedure 2005 2105 2505 2905
SURGICAL
BRONCHOSCOPY (A) - FLEXIBLE - ONCOLOGY
PONS005 Procedure 2005 2105 2505 2905
PONS SURGICAL
ONCOLOGY
PONS027 PROCEDURE MINOR - PONS Procedure 2005 2105 2505 2905
SURGICAL
ONCOLOGY
PONS007 CYSTOSCOPY (A) - PONS Procedure 3160 3320 3950 4580
SURGICAL
ONCOLOGY
PONS016 LASERISATION (B) - PONS Procedure 3160 3320 3950 4580
SURGICAL
MICRO LARYNGEAL SURGERY (B) ONCOLOGY
PONS018 Procedure 3445 3615 4305 4995
- PONS SURGICAL
ONCOLOGY
PONS017 MEDIASTINOSCOPY (B) - PONS Procedure 3740 3925 4675 5425
SURGICAL
DIAGNOSTIC LAPAROSCOPY (B) - ONCOLOGY
PONS008 Procedure 3885 4080 4855 5635
PONS SURGICAL
ONCOLOGY
PONS023 PAN-ENDOSCOPY (B) - PONS Procedure 4170 4380 5215 6045
SURGICAL
ONCOLOGY
PONS026 PROCEDURE INTERMEDIATE - PONS Procedure 5745 6030 7180 8330
SURGICAL
ONCOLOGY
PONS030 COLPOSCOPY (PONS) Procedure 6470 6795 8090 9380
SURGICAL
ROBOTIC SURGERY PACKAGE - 1 - SURGICAL
KRKONS001 Package 0 293430 349320 405210
SUR ONCO ONCOLOGY PACKAGE
ROBOTIC SURGERY PACKAGE - 2 - SURGICAL
KKONS002 Package 0 374930 446350 517760
SUR ONCO ONCOLOGY PACKAGE
139
Radiation Onco
140
Radiation Onco
Billing
Group
ONCOLOGY
PONR042 IRRADIATION CHARGES - BLOOD - PONR Procedure 450 480 570 660
RADIATION
ONCOLOGY
PONR024 RADIOLOGIST PROFESSIONAL CHARGES Procedure 1040 1090 1300 1510
RADIATION
ONCOLOGY
PONR038 BRACHYTHERAPY Procedure 5190 5450 6490 7530
RADIATION
ONCOLOGY
PONR040 BRACHYTHERAPY SUBSEQUENT Procedure 5190 5450 6490 7530
RADIATION
ONCOLOGY
PONR041 NIMTLY - GILOMA STUDY Procedure 31420 32990 39280 45560
RADIATION
ONCOLOGY
PONR014 IMRT Procedure 27000 45930 56430 62580
RADIATION
ONCOLOGY
PONR039 LINAC Procedure 11480 12060 14350 16650
RADIATION LINAC
141
Department of
Gastroenterology
142
Medical Gastroenterology
143
Billing
Group
MEDICAL
KGAM001 CAPSULE ENDOSCOPY PACKAGE Package GASTROENTEROLOGY 0 54100 64400 74710
PACKAGE
GASTROENTEROLOGY
PLGAM047 ASCITIC TAPPING - DIAGNOSTIC Procedure 2330 2440 2910 3370
MEDICAL
GASTROENTEROLOGY
PLGAM005 COLONOSCOPY (LIMITED) Procedure 3970 4170 4960 5760
MEDICAL
OGD (OESAPHGO GASTRO GASTROENTEROLOGY
PLGAM034 Procedure 3970 4170 4960 5760
DUODENOSCOPY) MEDICAL
GASTROENTEROLOGY
PLGAM002 ASCITIC TAPPING - THERAPEUTIC Procedure 5470 5740 6830 7930
MEDICAL
GASTROENTEROLOGY
PLGAM008 COLONOSCOPY WITH BIOPSY - LTD Procedure 5470 5740 6830 7930
MEDICAL
GASTROENTEROLOGY
PLGAM048 OGD STENT REMOVAL Procedure 5470 5740 6830 7930
MEDICAL
GASTROENTEROLOGY
PLGAM093 PEG REMOVAL Procedure 5470 5740 6830 7930
MEDICAL
GASTROENTEROLOGY
PLGAM037 OGD WITH BIOPSY Procedure 5740 6030 7180 8330
MEDICAL
GASTROENTEROLOGY
PLGAM092 HYDROGEN BREATH TEST Procedure 6840 7180 8540 9910
MEDICAL
GASTROENTEROLOGY
PLGAM091 UREA BREATH TEST Procedure 6840 7180 8540 9910
MEDICAL
GASTROENTEROLOGY
PLGAM097 OGD NG TUBE PLACEMENT Procedure 7390 7760 9230 10710
MEDICAL
GASTROENTEROLOGY
PLGAM006 COLONOSCOPY FULL Procedure 7840 7840 8630 9410
MEDICAL
INTRA-OPERATIVE OGD (WITH OR GASTROENTEROLOGY
PLGAM098 Procedure 9020 9470 11270 13080
WITHOUT BIOPSY) MEDICAL
NJ TUBE PLACEMENT (SINGLE MODALITY GASTROENTEROLOGY
PLGAM095 Procedure 9020 9470 11270 13080
USED) MEDICAL
GASTROENTEROLOGY
PLGAM094 COLONOSCOPY FULL WITH BIOPSY Procedure 9300 9760 11620 13480
MEDICAL
GASTROENTEROLOGY
PLGAM089 MANOMETRY Procedure 9300 9760 11620 13480
MEDICAL
GASTROENTEROLOGY
PLGAM090 MANOMETRY - OESOPHAGAL Procedure 9300 9760 11620 13480
MEDICAL
GASTROENTEROLOGY
PLGAM088 PH METRY Procedure 12020 12620 15030 17430
MEDICAL
GASTROENTEROLOGY
PLGAM010 ENDOSCOPIC BOUGIE DILATATION Procedure 12300 12910 15370 17830
MEDICAL
GASTROENTEROLOGY
PLGAM033 LIVER BIOPSY Procedure 12300 12910 15370 17830
MEDICAL
GASTROENTEROLOGY
PLGAM043 PILES BANDING Procedure 12300 12910 15370 17830
MEDICAL
144
Billing
Group
NJ TUBE PLACEMENT (MULTIPLE GASTROENTEROLOGY
PLGAM087 Procedure 12570 13200 15720 18230
MODALITY USED) MEDICAL
GASTROENTEROLOGY
PLGAM020 ENDOSCOPIC ULTRASOUND / GI TRACT Procedure 12850 13490 16060 18630
MEDICAL
GASTROENTEROLOGY
PLGAM024 ERCP DIAGNOSTIC Procedure 12850 13490 16060 18630
MEDICAL
GASTROENTEROLOGY
PLGAM067 PEG REPLACEMENT Procedure 12850 13490 16060 18630
MEDICAL
GASTROENTEROLOGY
PLGAM082 ENTEROSCOPY DIAGNOSTIC Procedure 13110 13770 16390 19010
MEDICAL
GASTROENTEROLOGY
PLGAM077 FIBRO SCAN Procedure 13110 13770 16390 19010
MEDICAL
GASTROENTEROLOGY
PLGAM035 OGD FOREIGN BODY REMOVAL - SIMPLE Procedure 13110 13770 16390 19010
MEDICAL
GASTROENTEROLOGY
PLGAM054 COLONIC DECOMPRESSION Procedure 13670 14350 17080 19810
MEDICAL
GASTROENTEROLOGY
PLGAM083 ENTEROSCOPY + BIOPSY Procedure 15040 15790 18790 21800
MEDICAL
INTRA-OPERATIVE COLONOSCOPY (WITH GASTROENTEROLOGY
PLGAM099 Procedure 15040 15790 18790 21800
OR WITHOUT BIOPSY) MEDICAL
GASTROENTEROLOGY
PLGAM069 REPEAT APC Procedure 15710 16500 19640 22780
MEDICAL
GASTROENTEROLOGY
PLGAM068 REPEAT EVL Procedure 15710 16500 19640 22780
MEDICAL
GASTROENTEROLOGY
PLGAM066 ENDOSCOPIC BALLOON DILATATION Procedure 18450 19370 23060 26750
MEDICAL
ENDOSCOPIC ULTRASOUND PANCREATO GASTROENTEROLOGY
PLGAM021 Procedure 18450 19370 23060 26750
BILIARY MEDICAL
GASTROENTEROLOGY
PLGAM096 ENDOSCOPIC VARICEAL LIGATION Procedure 18450 19370 23060 26750
MEDICAL
OGD PEG (PERCUTANEOUS ENDOSCOPIC GASTROENTEROLOGY
PLGAM036 Procedure 18450 19370 23060 26750
GASTROSTOMY) MEDICAL
GASTROENTEROLOGY
PLGAM041 PAPILLOTOMY ACCESS Procedure 19130 20090 23910 27740
MEDICAL
GASTROENTEROLOGY
PLGAM051 ENDOSCOPIC APC Procedure 23230 24400 29040 33690
MEDICAL
GASTROENTEROLOGY
PLGAM052 EUS - LYMPHNODE BIOPSY Procedure 23230 24400 29040 33690
MEDICAL
GASTROENTEROLOGY
PLGAM071 ERCP THERAPEUTIC (SIMPLE) Procedure 23910 25110 29890 34670
MEDICAL
GASTROENTEROLOGY
PLGAM044 POLYPECTOMY COLON / GI TRACT Procedure 23910 25110 29890 34670
MEDICAL
OGD - FOREIGN BODY REMOVAL - GASTROENTEROLOGY
PLGAM049 Procedure 27330 28700 34160 39620
DIFFICULT MEDICAL
145
Billing
Group
ENDOSCOPIC HAEMOSTASIS (GI GASTROENTEROLOGY
PLGAM011 Procedure 28700 30130 35870 41610
HAEMOSTASIS) MEDICAL
GASTROENTEROLOGY
PLGAM012 ENDOSCOPIC METAL STENTING Procedure 28700 30130 35870 41610
MEDICAL
GASTROENTEROLOGY
PLGAM084 ENTEROSCOPY THERAPEUTIC Procedure 28700 30130 35870 41610
MEDICAL
GASTROENTEROLOGY
PLGAM046 EUS - CELIAC GANGLION BLOCK Procedure 28700 30130 35870 41610
MEDICAL
GASTROENTEROLOGY
PLGAM038 OGD(ACHALASIA DILATATION) Procedure 28700 30130 35870 41610
MEDICAL
GASTROENTEROLOGY
PLGAM100 Intragastric ballon placement Procedure 28750 30190 35940 41690
MEDICAL
GASTROENTEROLOGY
PLGAM085 EMR Procedure 31420 32990 39280 45560
MEDICAL
ERCP - ACCESS PAPILLOTOMY, STONE GASTROENTEROLOGY
PLGAM057 Procedure 31420 32990 39280 45560
EXTRACTION/STENTING MEDICAL
GASTROENTEROLOGY
PLGAM055 EUS + PANCREATIC BIOPSY Procedure 31420 32990 39280 45560
MEDICAL
POLYPECTOMY+HAEMOCLIP GASTROENTEROLOGY
PLGAM073 Procedure 31420 32990 39280 45560
APPLICATION MEDICAL
ACCESSORY PAPILLA SPHINCTEROTOMY GASTROENTEROLOGY
PLGAM075 Procedure 36900 38740 46120 53500
+STENT MEDICAL
GASTROENTEROLOGY
PLGAM076 ENDOSCOPIC AMPULECTOMY Procedure 36900 38740 46120 53500
MEDICAL
GASTROENTEROLOGY
PLGAM056 ENDOSCOPIC PANCREATIC THERAPY Procedure 36900 38740 46120 53500
MEDICAL
GASTROENTEROLOGY
PLGAM014 ENDOSCOPIC PSEUDO CYST DRAINAGE Procedure 36900 38740 46120 53500
MEDICAL
GASTROENTEROLOGY
PLGAM026 ERCP MECHANICAL LITHOTRIPSY Procedure 36900 38740 46120 53500
MEDICAL
GASTROENTEROLOGY
PLGAM086 ESD Procedure 36900 38740 46120 53500
MEDICAL
ERCP +BILIARY STRICTURE DILATATION GASTROENTEROLOGY
PLGAM074 Procedure 38250 40170 47820 55470
+STENTING MEDICAL
GASTROENTEROLOGY
PLGAM102 Redo POEM Procedure 46000 48300 57500 66700
MEDICAL
GASTROENTEROLOGY
PLGAM079 ERCP AND DIAGNOSTIC SPYGLASS Procedure 54650 57390 68310 79240
MEDICAL
GASTROENTEROLOGY
PLGAM080 ERCP AND SPYGLASS BIOPSY Procedure 58750 61680 73430 85180
MEDICAL
GASTROENTEROLOGY
PLGAM081 ERCP AND SPYGLASS LITHOTRIPSY Procedure 62850 65990 78560 91130
MEDICAL
GASTROENTEROLOGY
PLGAM101 POEM Procedure 69000 72450 86250 100050
MEDICAL
146
Other departments
and services
147
GI General
Surgery Sciences
148
GI General Surgery Sciences
Surgery Billing
Level Group
SURGICAL
KKGAS007 Whipples Surgery package (KMC) Package GASTROENTEROLOGY 0 195620 232880 270140
PACKAGE
SURGICAL
BARIATRIC SURGERY PACKAGE -
KKGAS008 Package GASTROENTEROLOGY 0 350180 416880 483580
SLEEVE
PACKAGE
SURGICAL
BARIATRIC SURGERY PACKAGE -
KKGAS009 Package GASTROENTEROLOGY 0 392440 467190 541940
BYPASS
PACKAGE
GENERAL SURGERY
PGEN011 DRESSING - MINOR - 5CM Procedure 120 130 150 170
PROCEDURE
GENERAL SURGERY
PGEN012 DRESSING - MEDIUM - 5-10 CM Procedure 260 270 320 370
PROCEDURE
DRESSING MAJOR - 10 CM 2-3 GENERAL SURGERY
PGEN013 Procedure 520 550 650 760
WOUNDS PROCEDURE
GENERAL SURGERY
PGEN010 COMPRESSION BANDAGE Procedure 1040 1090 1300 1510
PROCEDURE
GENERAL SURGERY
PGEN001 SUTURING - PGEN Procedure 1040 1090 1300 1510
PROCEDURE
GENERAL SURGERY
PGEN009 FNAC - PGEN Procedure 1650 1730 2060 2390
PROCEDURE
INCISION & DRAINAGE - MINOR - GENERAL SURGERY
PGEN005 Procedure 1780 1860 2220 2570
PGEN PROCEDURE
DEBRIDEMENT - MINOR (INCL GENERAL SURGERY
PGEN002 Procedure 2050 2150 2560 2970
DRESSING) PROCEDURE
INCISION & DRINAGAE - MAJOR - GENERAL SURGERY
PGEN006 Procedure 2050 2150 2560 2970
PGEN PROCEDURE
GENERAL SURGERY
PGEN007 NAIL EXCISION - TOTAL AVULSION Procedure 2050 2150 2560 2970
PROCEDURE
DEBRIDEMENT - MAJOR (INCL GENERAL SURGERY
PGEN003 Procedure 4100 4300 5120 5940
DRESSING) PROCEDURE
GENERAL SURGERY
PGEN008 NAIL EXCISION - WIDGE EXCISION Procedure 6280 6600 7850 9110
PROCEDURE
EXCISION LESION (CYST,LIPOMA GENERAL SURGERY
PGEN004 Procedure 6840 7180 8540 9910
ETC) PROCEDURE
GASTROENTEROLOGY
LGAS001 EUA (LGAS) # L1 L1 Surgery 0 4500 5360 6220
SURGERY
GASTROENTEROLOGY
LGAS002 I & D MINOR (LGAS) # L1 L1 Surgery 0 4500 5360 6220
SURGERY
LYMPHNODE BIOPSY EXCISION - GASTROENTEROLOGY
LGAS006 L2 Surgery 0 8240 9810 11380
(LGAS) # L2 SURGERY
GASTROENTEROLOGY
LGAS003 TRU - CUT BIOPSY (LGAS) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
WOUND DEBRIDEMENT MEDIUM GASTROENTEROLOGY
LGAS004 L2 Surgery 0 8240 9810 11380
(LGAS) # L2 SURGERY
WOUND DEBRIDEMENT MINOR GASTROENTEROLOGY
LGAS005 L2 Surgery 0 8240 9810 11380
(LGAS) # L2 SURGERY
149
Surgery Billing
Level Group
GASTROENTEROLOGY
LGAS007 EUA/FISTULA - LOW (LGAS) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
HAEMORHOIDECTOMY WITH EUA GASTROENTEROLOGY
LGAS011 L3 Surgery 0 10820 12880 14940
(LGAS) # L3 SURGERY
HERNIA FEMORAL/INGUINAL GASTROENTEROLOGY
LGAS008 L3 Surgery 0 10820 12880 14940
UNILATERAL (LGAS) # L3 SURGERY
HERNIA SIMPLE UMBLICAL, EPI) GASTROENTEROLOGY
LGAS009 L3 Surgery 0 10820 12880 14940
(LGAS) # L3 SURGERY
GASTROENTEROLOGY
LGAS010 I & D MAJOR (LGAS) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
ADHESIOLYSIS WITH OR WITHOUT
GASTROENTEROLOGY
LGAS012 BOPSY OPEN (AS SOLE PROCEDURE) L4 Surgery 0 14790 17610 20420
SURGERY
(LGAS) # L4
APPENDICECTOMY OPEN (LGAS) GASTROENTEROLOGY
LGAS013 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
GASTROENTEROLOGY
LGAS014 CHEMOPORT INSERTION (LGAS) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
GASTROENTEROLOGY
LGAS015 EUA/FISTULA - HIGH (LGAS) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
FEEDING JEJUNOSTOMY (LGAS) # GASTROENTEROLOGY
LGAS024 L4 Surgery 0 14790 17610 20420
L4 SURGERY
GASTROENTEROLOGY
LGAS016 GASTROSTOMY (LGAS) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
INCISIONAL HERNIA - MESH REPAIR GASTROENTEROLOGY
LGAS017 L4 Surgery 0 14790 17610 20420
(LGAS) # L4 SURGERY
INGUINAL HERNIA MESH REPAIR - GASTROENTEROLOGY
LGAS018 L4 Surgery 0 14790 17610 20420
UNILATERAL (LGAS) # L4 SURGERY
INTRAOPERATIVE BOWEL GASTROENTEROLOGY
LGAS019 L4 Surgery 0 14790 17610 20420
PREPARATION (LGAS) # L4 SURGERY
INTRAOPERATIVE GASTROENTEROLOGY
LGAS020 L4 Surgery 0 14790 17610 20420
CHOLANGIOGRAPHY (LGAS) # L4 SURGERY
LAPAROSCOPIC CHOLECYSTOSTOMY
- BILE DRAINAGE TO OUTSIDE GASTROENTEROLOGY
LGAS173 L4 Surgery 0 14790 17610 20420
IN SITUATIONS OF SEVERE SURGERY
INFLAMMATION [LGAS] # L4
LAPAROTOMY AND PERITONEAL
GASTROENTEROLOGY
LGAS026 LAVAGE (AS SOLE PROCEDURE) L4 Surgery 0 14790 17610 20420
SURGERY
(LGAS) # L4
LAPROSCOPIC HERNIA OPERATION GASTROENTEROLOGY
LGAS021 L4 Surgery 0 14790 17610 20420
(LGAS) # L4 SURGERY
LAPROSCOPY DIAGNOSTIC
GASTROENTEROLOGY
LGAS022 INCLUDING BIOPSY (AS SOLE L4 Surgery 0 14790 17610 20420
SURGERY
PROCEDURE) (LGAS) # L4
MECKLE'S DIVERTICULECTOMY GASTROENTEROLOGY
LGAS027 L4 Surgery 0 14790 17610 20420
OPEN (LGAS) # L4 SURGERY
STAPLER HAEMORHOIDECTOMY GASTROENTEROLOGY
LGAS025 L4 Surgery 0 14790 17610 20420
(LGAS) # L4 SURGERY
150
Surgery Billing
Level Group
GASTROENTEROLOGY
LGAS023 SUTURING MAJOR (LGAS) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
DEFUNCTIONING COLOSTOMY GASTROENTEROLOGY
LGAS030 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
DUODENOJEJUNOSTOMY - OPEN GASTROENTEROLOGY
LGAS043 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
GASTROJEJUNOSTOMY & GASTROENTEROLOGY
LGAS041 L5 Surgery 0 18010 21440 24870
VAGOTOMY - OPEN (LGAS) # L5 SURGERY
GASTROSTOMY LAPAROSCOPIC GASTROENTEROLOGY
LGAS045 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
GRACILOPLASTY (UNILATERAL) GASTROENTEROLOGY
LGAS031 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
HERNIA FEMORAL/INGUINAL GASTROENTEROLOGY
LGAS032 L5 Surgery 0 18010 21440 24870
BILATERAL (LGAS) # L5 SURGERY
GASTROENTEROLOGY
LGAS033 ILEOSTOMY (LGAS) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
LAPAROSCOPIC SINGLE INCISION
GASTROENTEROLOGY
LGAS034 PARAUMBILICAL HERNIA REPAIR L5 Surgery 0 18010 21440 24870
SURGERY
(LGAS) # L5
LAPAROTOMY RE-EXPLORATION GASTROENTEROLOGY
LGAS046 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
LAPROSCOPIC ADHESIOLYSIS
GASTROENTEROLOGY
LGAS028 INCLUDING BIOPSY (AS SOLE L5 Surgery 0 18010 21440 24870
SURGERY
PROCEDURE) (LGAS) # L5
LAPROSCOPIC APPENDICECTOMY GASTROENTEROLOGY
LGAS035 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
LAPROSCOPIC CHOLECYSTECTOMY GASTROENTEROLOGY
LGAS042 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
LAPROSCOPIC INCISIONAL HERNIA GASTROENTEROLOGY
LGAS036 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
LAPROSCOPIC L.N.BIOPSY (LGAS) GASTROENTEROLOGY
LGAS037 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
LYMPH NODE BIOPSY -
GASTROENTEROLOGY
LGAS047 INTRAPERITONIAL - OPEN (LGAS) L5 Surgery 0 18010 21440 24870
SURGERY
# L5
MECKLE'S DIVERTICULECTOMY GASTROENTEROLOGY
LGAS048 L5 Surgery 0 18010 21440 24870
LAPAROSCOPIC (LGAS) # L5 SURGERY
GASTROENTEROLOGY
LGAS038 OMENTECTOMY (LGAS) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPEN LIVER ABSESS DRAINAGE GASTROENTEROLOGY
LGAS029 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
PYLOROPLASTY/PYLOROMYOTOMY GASTROENTEROLOGY
LGAS044 L5 Surgery 0 18010 21440 24870
(LGAS) # L5 SURGERY
SINGLE INCISION LAPAROSCOPIC GASTROENTEROLOGY
LGAS039 L5 Surgery 0 18010 21440 24870
APPENDECTOMY (LGAS) # L5 SURGERY
SMALL BOWEL STRICTUROPLASTY GASTROENTEROLOGY
LGAS040 L5 Surgery 0 18010 21440 24870
(SINGLE) (LGAS) # L5 SURGERY
151
Surgery Billing
Level Group
GASTROENTEROLOGY
LGAS054 ANOPROCTOPLASTY (LGAS) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
CBD EXPLORATION & SPHINCTERO GASTROENTEROLOGY
LGAS055 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
CHOLECYSTECTOMY + CBD GASTROENTEROLOGY
LGAS056 L6 Surgery 0 27010 32150 37290
EXPLORATION (LGAS) # L6 SURGERY
CHOLECYSTECTOMY - OPEN (LGAS) GASTROENTEROLOGY
LGAS049 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
CLOSURE OF DUODENAL SMALL GASTROENTEROLOGY
LGAS057 L6 Surgery 0 27010 32150 37290
BOWEL FISTULA (LGAS) # L6 SURGERY
COLOSTOMY CLOSURE/REVISION GASTROENTEROLOGY
LGAS050 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
EMERGENCY LAPAROSCOPIC
APPENDECTOMY (LAPAROSCOPIC GASTROENTEROLOGY
LGAS051 L6 Surgery 0 27010 32150 37290
ACUTE ABDOMEN + LAPAROSCOPIC SURGERY
APPENDECTOMY) (LGAS) # L6
GASTROENTEROLOGY
LGAS071 FUNDOPLICATION (LGAS) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
GASTRIC - SLEEVE RESECTION GASTROENTEROLOGY
LGAS058 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
GASTROENTEROLOGY
LGAS052 ILEOSTOMY CLOSURE (LGAS) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
INGUINAL HERNIA MESH REPAIR - GASTROENTEROLOGY
LGAS059 L6 Surgery 0 27010 32150 37290
BILATERIAL (LGAS) # L6 SURGERY
GASTROENTEROLOGY
LGAS200 INLAY MESH HERNIOPLASTY # L6 L6 Surgery 0 27010 32150 37290
SURGERY
LAPAROSCOPIC CHOLECYSTECTOMY
GASTROENTEROLOGY
LGAS060 FOR ACUTE CHOLECYSTITIS (LGAS) L6 Surgery 0 27010 32150 37290
SURGERY
# L6
GASTROENTEROLOGY
LGAS061 FOR COMPLICATED GALLSTONE L6 Surgery 0 27010 32150 37290
SURGERY
DISEASE (LGAS) # L6
LAPAROSCOPIC
GASTROENTEROLOGY
LGAS072 DUODENOJEJUNOSTOMY (LGAS) L6 Surgery 0 27010 32150 37290
SURGERY
# L6
LAPROSCOPIC PERFORATION GASTROENTEROLOGY
LGAS062 L6 Surgery 0 27010 32150 37290
CLOSURE (LGAS) # L6 SURGERY
LARGE BOWEL RESECTION AND GASTROENTEROLOGY
LGAS073 L6 Surgery 0 27010 32150 37290
ANASTOMOSIS (LGAS) # L6 SURGERY
MUCOSAL ADVANCEMENT FLAP GASTROENTEROLOGY
LGAS063 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
RE-EXPLORATION FOR INTRA- GASTROENTEROLOGY
LGAS064 L6 Surgery 0 27010 32150 37290
ABDOMINAL BLEEDING (LGAS) # L6 SURGERY
ROUX Y LOOP CONSTRUCTION GASTROENTEROLOGY
LGAS065 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
SINGLE INCISION LAPAROSCOPIC GASTROENTEROLOGY
LGAS066 L6 Surgery 0 27010 32150 37290
CHOLECYSTECTOMY (LGAS) # L6 SURGERY
152
Surgery Billing
Level Group
SMALL BOWEL RESECTION AND GASTROENTEROLOGY
LGAS067 L6 Surgery 0 27010 32150 37290
ANASTOMOSIS (LGAS) # L6 SURGERY
SMALL BOWEL STRICTUROPLASTY GASTROENTEROLOGY
LGAS068 L6 Surgery 0 27010 32150 37290
(MULTIPLE) (LGAS) # L6 SURGERY
GASTROENTEROLOGY
LGAS053 SPLENECTOMY - OPEN (LGAS) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
TRANSDUODENAL GASTROENTEROLOGY
LGAS069 L6 Surgery 0 27010 32150 37290
SPHINCTEROPLASTY (LGAS) # L6 SURGERY
TRASNANAL EXCISION OF TUMOR GASTROENTEROLOGY
LGAS070 L6 Surgery 0 27010 32150 37290
(LGAS) # L6 SURGERY
LAPROSCOPIC COLECTOMY (LGAS) GASTROENTEROLOGY
LGAS129 L8 Surgery 0 34550 38000 41460
# L8 SURGERY
ABDOMINO-PERINEAL RESECTION GASTROENTEROLOGY
LGAS098 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
CHOLEDOCHODUDENOSTOMY GASTROENTEROLOGY
LGAS081 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
CYSTOGASTROSTOMY / GASTROENTEROLOGY
LGAS082 L7 Surgery 0 36010 42870 49730
CYSTOJEJUNOSTOMY (LGAS) # L7 SURGERY
DUODENAL DIVERTICULIZATION GASTROENTEROLOGY
LGAS095 L7 Surgery 0 36010 42870 49730
PROCEDURE (LGAS) # L7 SURGERY
DUODENAL DIVERTICULUM GASTROENTEROLOGY
LGAS105 L7 Surgery 0 36010 42870 49730
EXCISION (LGAS) # L7 SURGERY
EMERGENCY LAPAROTOMY FOR
GASTROENTEROLOGY
LGAS077 INTESTINAL OBSTRUCTION (LGAS) L7 Surgery 0 36010 42870 49730
SURGERY
# L7
EXCISION OF INSULINOMAS (LGAS) GASTROENTEROLOGY
LGAS078 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
GASTROENTEROLOGY
LGAS104 FISTULOJEJUNOSTOMY (LGAS) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
GASTROENTEROLOGY
LGAS083 GASTRECTOMY PARTIAL (LGAS) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
GRACILOPLASTY (BILATERAL) (LGAS) GASTROENTEROLOGY
LGAS074 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
HYDATID CYST - GASTROENTEROLOGY
LGAS084 L7 Surgery 0 36010 42870 49730
CYSTOPERIYSTECTOMY (LGAS) # L7 SURGERY
GASTROENTEROLOGY
LGAS174 LADDS PRACEDURE (LGAS) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
LAPAROSCOPIC CBD EXPLORATION GASTROENTEROLOGY
LGAS079 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
LAPAROSCOPIC
GASTROENTEROLOGY
LGAS110 CYSTOGASTROSTOMY / L7 Surgery 0 36010 42870 49730
SURGERY
CYSTOJEJUNOSTOMY (LGAS) # L7
LAPAROSCOPIC LARGE BOWEL
GASTROENTEROLOGY
LGAS108 RESECTION AND ANASTOMOSIS L7 Surgery 0 36010 42870 49730
SURGERY
(LGAS) # L7
LAPAROSCOPIC LIVER ABSCESS GASTROENTEROLOGY
LGAS085 L7 Surgery 0 36010 42870 49730
DRAINAGE (LGAS) # L7 SURGERY
153
Surgery Billing
Level Group
LAPAROSCOPIC REPAIR PROLAPSE GASTROENTEROLOGY
LGAS109 L7 Surgery 0 36010 42870 49730
RECTUM MESH REPAIR (LGAS) # L7 SURGERY
LAPROSCOPIC ANTE REFLUX GASTROENTEROLOGY
LGAS096 L7 Surgery 0 36010 42870 49730
OPERATION (LGAS) # L7 SURGERY
LAPROSCOPIC HYDATID CYST GASTROENTEROLOGY
LGAS086 L7 Surgery 0 36010 42870 49730
LAPROSCOPIC RECTOPEXY (LGAS) GASTROENTEROLOGY
LGAS080 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
LAPROSCOPIC SMALL BOWEL GASTROENTEROLOGY
LGAS087 L7 Surgery 0 36010 42870 49730
RESECTION (LGAS) # L7 SURGERY
LAPROSCOPIC SPLENECTOMY GASTROENTEROLOGY
LGAS075 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
LAPROSCOPIC TV + GASTROENTEROLOGY
LGAS088 L7 Surgery 0 36010 42870 49730
GASTROJEJUNOSTOMY (LGAS) # L7 SURGERY
LATERAL PANCREATICO GASTROENTEROLOGY
LGAS097 L7 Surgery 0 36010 42870 49730
JEJUNOSTOMY (LGAS) # L7 SURGERY
GASTROENTEROLOGY
LGAS175 LeVEEN SHUNT # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPEN ACHALASIA CARDIA GASTROENTEROLOGY
LGAS100 L7 Surgery 0 36010 42870 49730
OPEN RIGHT/LEFT HEMICOLECTOMY GASTROENTEROLOGY
LGAS089 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
PARTIAL/SUBTAOTAL GASTRECTOMY GASTROENTEROLOGY
LGAS090 L7 Surgery 0 36010 42870 49730
FOR CARCINOMA (LGAS) # L7 SURGERY
GASTROENTEROLOGY
LGAS102 PERITONECTOMY (LGAS) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
RADICAL SMALL BOWEL RESECTION GASTROENTEROLOGY
LGAS103 L7 Surgery 0 36010 42870 49730
FOR TUMOR (LGAS) # L7 SURGERY
RECTOVAGINAL FISTULA REPAIR GASTROENTEROLOGY
LGAS107 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
REPAIR PROLAPSE RECTUM (LGAS) GASTROENTEROLOGY
LGAS076 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
RETROPERITONEAL TUMOR GASTROENTEROLOGY
LGAS091 L7 Surgery 0 36010 42870 49730
RF ABLATION OF LIVER LESION GASTROENTEROLOGY
LGAS092 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
GASTROENTEROLOGY
LGAS093 SPLENORRAPHY (LGAS) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
SUBTOTAL GASTRECTOMY (LGAS) GASTROENTEROLOGY
LGAS094 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
SURGERY FOR ANAL INCONTINENCE GASTROENTEROLOGY
LGAS106 L7 Surgery 0 36010 42870 49730
(LGAS) # L7 SURGERY
SURGERY FOR ENTEROCUTANEOUS GASTROENTEROLOGY
LGAS099 L7 Surgery 0 36010 42870 49730
FISTULA (LGAS) # L7 SURGERY
VASCULAR RESECTION AND GASTROENTEROLOGY
LGAS101 L7 Surgery 0 36010 42870 49730
RECONSTRUCTION (LGAS) # L7 SURGERY
154
Surgery Billing
Level Group
LAPAROSCOPIC
GASTROENTEROLOGY
LGAS179 CHOLEDOCHODUODENOSTOMY L8 Surgery 0 38580 45930 53280
SURGERY
(LGAS) : L8 # L8
GASTROENTEROLOGY
LGAS144 AMPULLECTOMY (LGAS) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
GASTROENTEROLOGY
LGAS118 ANTERIOR RESECTION (LGAS) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
CHOLEDOCHEL CYST
EXCISION + ROUX-EN-Y GASTROENTEROLOGY
LGAS114 L8 Surgery 0 45010 53580 62150
HEPATICOJEJUNOSTOMY (LGAS) SURGERY
# L8
DISTAL PANCREATECTOMY (LGAS) GASTROENTEROLOGY
LGAS119 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
DISTAL SPLENORENAL SHUNT GASTROENTEROLOGY
LGAS120 L8 Surgery 0 45010 53580 62150
(LGAS) # L8 SURGERY
EMERGENCY LAPAROTOMY FOR GI GASTROENTEROLOGY
LGAS116 L8 Surgery 0 45010 53580 62150
BLEED (LGAS) # L8 SURGERY
EMERGENCY LAPAROTOMY FOR GASTROENTEROLOGY
LGAS121 L8 Surgery 0 45010 53580 62150
MESENTERIC ISCHEMIA (LGAS) # L8 SURGERY
ESOPHAGEAL
GASTROENTEROLOGY
LGAS122 REPLACEMENT(GASTRIC PULL UP) L8 Surgery 0 45010 53580 62150
SURGERY
(LGAS) # L8
ESOPHAGO-GASTRIC
GASTROENTEROLOGY
LGAS123 DEVASCULARIZATION + L8 Surgery 0 45010 53580 62150
SURGERY
SPLENECTOMY (LGAS) # L8
EXCISION OF MESENTERIC MASS GASTROENTEROLOGY
LGAS124 L8 Surgery 0 45010 53580 62150
(LGAS) # L8 SURGERY
GASTROENTEROLOGY
LGAS125 FREYS PROCEDURE (LGAS) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
HEPATODUODENAL LIGAMENT GASTROENTEROLOGY
LGAS126 L8 Surgery 0 45010 53580 62150
LYMPHADENECTOMY (LGAS) # L8 SURGERY
INTERPOSITION PORTACAVAL SHUNT GASTROENTEROLOGY
LGAS127 L8 Surgery 0 45010 53580 62150
(LGAS) # L8 SURGERY
GASTROENTEROLOGY
LGAS142 LAPAROSCOPIC APR (LGAS) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
LAPAROSCOPIC CHOLEDOCHEL
CYST EXCISION + ROUX-EN-Y GASTROENTEROLOGY
LGAS115 L8 Surgery 0 45010 53580 62150
HEPATICOJEJUNOSTOMY (LGAS) SURGERY
# L8
LAPAROSCOPIC GASTRIC BYPASS
GASTROENTEROLOGY
LGAS149 PROCEDURE FOR OBESITY (LGAS) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
LAPAROSCOPIC LIVER RESECTION GASTROENTEROLOGY
LGAS128 L8 Surgery 0 45010 53580 62150
NONANATOMICAL (LGAS) # L8 SURGERY
LAPAROSCOPIC REPAIR PROLAPSE
RECTUM MESH REPAIR + GASTROENTEROLOGY
LGAS148 L8 Surgery 0 45010 53580 62150
RESECTION ANASTOMOSIS (LGAS) SURGERY
# L8
155
Surgery Billing
Level Group
LAPAROSCOPIC VAGOTOMY/ GASTROENTEROLOGY
LGAS146 L8 Surgery 0 45010 53580 62150
GASTRIC BYPASS (LGAS) # L8 SURGERY
LAPAROTOMY WITH MULTIPLE
GASTROENTEROLOGY
LGAS147 PROCEDURES (BLUNT AND L8 Surgery 0 45010 53580 62150
SURGERY
PENETRATING INJURIES) (LGAS) # L8
LAPROSCOPIC ACHALRIA CARDIA GASTROENTEROLOGY
LGAS111 L8 Surgery 0 45010 53580 62150
LIVER TRAUMA (DEBRIDEMENT/ GASTROENTEROLOGY
LGAS130 L8 Surgery 0 45010 53580 62150
RESECTION) (LGAS) # L8 SURGERY
LOW ANTERIOR RESECTION WITH GASTROENTEROLOGY
LGAS131 L8 Surgery 0 45010 53580 62150
ILEOSTOMY (LGAS) # L8 SURGERY
MODULAR ANTEGRADE DISTAL GASTROENTEROLOGY
LGAS132 L8 Surgery 0 45010 53580 62150
PANCREATECTOMY (LGAS) # L8 SURGERY
NONANATOMICAL LIVER RESECTION
GASTROENTEROLOGY
LGAS133 / LATERAL SEGMENTECTOMY (LGAS) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
PANCREAS PRESERVING GASTROENTEROLOGY
LGAS145 L8 Surgery 0 45010 53580 62150
DUODENECTOMY (LGAS) # L8 SURGERY
PANCREATIC NECROSECTOMY/
GASTROENTEROLOGY
LGAS112 ABSCESS DRAINAGE OPEN/ L8 Surgery 0 45010 53580 62150
SURGERY
LAPAROSCOPIC (LGAS) # L8
PANCREATIC TRAUMA
GASTROENTEROLOGY
LGAS134 (DEBRIDEMENT/RESECTION) L8 Surgery 0 45010 53580 62150
SURGERY
(LGAS) # L8
PORTA SYSTEMIC SHUNT (LGAS) GASTROENTEROLOGY
LGAS140 L8 Surgery 0 45010 53580 62150
# L8 SURGERY
RADICAL SUBTOTAL GASTRECTOMY GASTROENTEROLOGY
LGAS135 L8 Surgery 0 45010 53580 62150
R0-R4 RNS) (LGAS) # L8 SURGERY
GASTROENTEROLOGY
LGAS136 ABDOMINAL TUMOR & RECON. L8 Surgery 0 45010 53580 62150
SURGERY
(LGAS) # L8
ROUX-EN-Y
GASTROENTEROLOGY
LGAS137 HEPATICOJEJUNOSTOMY (LGAS) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
SILS ADVANCED PROCEDURES
GASTROENTEROLOGY
LGAS138 (COLECTOMY / CARDIOMYOTOMY / L8 Surgery 0 45010 53580 62150
SURGERY
FUNDOPLICATION) (LGAS) # L8
SPLEEN PRESERVING DISTAL GASTROENTEROLOGY
LGAS139 L8 Surgery 0 45010 53580 62150
SPLENORENAL SHUNT +/- GASTROENTEROLOGY
LGAS117 L8 Surgery 0 45010 53580 62150
SPLENECTOMY (LGAS) # L8 SURGERY
SUBTOTAL COLECTOMY WITH
GASTROENTEROLOGY
LGAS143 ILEORECTAL ANASTOMOSIS (LGAS) L8 Surgery 0 45010 53580 62150
SURGERY
# L8
TOTAL PROCTO-COLECTOMY WITH GASTROENTEROLOGY
LGAS141 L8 Surgery 0 45010 53580 62150
ILEOSTOMY (LGAS) # L8 SURGERY
VIDEO ASSISTED RETROPERITONEAL GASTROENTEROLOGY
LGAS113 L8 Surgery 0 45010 53580 62150
DEBRIDEMENT (VARD) (LGAS) # L8 SURGERY
156
Surgery Billing
Level Group
3-STAGE TRANSTHORACIC GASTROENTEROLOGY
LGAS155 L9 Surgery 0 54020 64300 74590
OESOPHAGECTOMY (LGAS) # L9 SURGERY
GASTROENTEROLOGY
LGAS170 ANTERIOR RESECTION LAR +TME + L9 Surgery 0 54020 64300 74590
SURGERY
ANP Laparoscopic (LGAS) # L9
DUODENUM PRESERVING
GASTROENTEROLOGY
LGAS169 PANCREATECTOMY / TOTAL L9 Surgery 0 54020 64300 74590
SURGERY
PANCREATECTOMY (LGAS) # L9
EXCISION OF VISCERAL ARTERY GASTROENTEROLOGY
LGAS176 L9 Surgery 0 54020 64300 74590
ANEURYSM # L9 SURGERY
EXTENDED CHOLECYSTECTOMY
GASTROENTEROLOGY
LGAS150 (LYMPADENECTOMY + LIVER L9 Surgery 0 54020 64300 74590
SURGERY
RESECTION) (LGAS) # L9
INTESTINAL VAGINOPLASTY (LGAS) GASTROENTEROLOGY
LGAS180 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
LAPAROSCOPIC DISTAL GASTROENTEROLOGY
LGAS151 L9 Surgery 0 54020 64300 74590
LAPAROSCOPIC HEPATECTOMY- GASTROENTEROLOGY
LGAS156 L9 Surgery 0 54020 64300 74590
ANATOMICAL (LGAS) # L9 SURGERY
LAPAROSCOPIC SPLEEN-
GASTROENTEROLOGY
LGAS152 PRESERVING DISTAL L9 Surgery 0 54020 64300 74590
SURGERY
PANCREATECTOMY (LGAS) # L9
Laparoscopic subtotal/total GASTROENTEROLOGY
LGAS178 L9 Surgery 0 54020 64300 74590
colectomy(LGAS):L9 # L9 SURGERY
LAPROSCOPIC APR / ANT GASTROENTEROLOGY
LGAS157 L9 Surgery 0 54020 64300 74590
RESECTION (LGAS) # L9 SURGERY
LAPROSCOPIC GASTRECTOMY GASTROENTEROLOGY
LGAS153 L9 Surgery 0 54020 64300 74590
(LGAS) # L9 SURGERY
MAJOR HEPATATECTOMY (LGAS) GASTROENTEROLOGY
LGAS158 L9 Surgery 0 54020 64300 74590
# L9 SURGERY
MEDIAN PANCREATECTOMY WITH GASTROENTEROLOGY
LGAS159 L9 Surgery 0 54020 64300 74590
RECONSTRUCTION (LGAS) # L9 SURGERY
GASTROENTEROLOGY
LGAS160 ORRINGER TRANPOSITION (LGAS) L9 Surgery 0 54020 64300 74590
SURGERY
# L9
OESOPHAGO GASTRECTOMY IVOR- GASTROENTEROLOGY
LGAS161 L9 Surgery 0 54020 64300 74590
LEWIS (LGAS) # L9 SURGERY
RADICAL EXCISION OF BILE DUCT GASTROENTEROLOGY
LGAS177 L9 Surgery 0 54020 64300 74590
(LGAS) :L9 # L9 SURGERY
RADICAL TOTAL GASTRECTOMY
GASTROENTEROLOGY
LGAS154 (R0-R4 RNS) +/- RECONSTRUCTION L9 Surgery 0 54020 64300 74590
SURGERY
POUCH (LGAS) # L9
REDO-HEPATICOJEJUNOSTOMY GASTROENTEROLOGY
LGAS168 L9 Surgery 0 54020 64300 74590
(LGAS) # L9 SURGERY
REPAIR OF COMPLICATED BILIARY GASTROENTEROLOGY
LGAS162 L9 Surgery 0 54020 64300 74590
STRICTURE (LGAS) # L9 SURGERY
RETROSTERNAL COLONIC BYPASS GASTROENTEROLOGY
LGAS163 L9 Surgery 0 54020 64300 74590
(LGAS) # L9 SURGERY
157
Surgery Billing
Level Group
ROUX Y HEPATICOJEJUNOSTOMY
GASTROENTEROLOGY
LGAS164 FOR PORTAL BILIOPATHY (LGAS) # L9 Surgery 0 54020 64300 74590
SURGERY
L9
SILS SUPRAMAJOR (DISTAL
PANCREATECTOMY/
GASTROENTEROLOGY
LGAS171 CYSTOGASTRECTOMY/TOTAL L9 Surgery 0 54020 64300 74590
SURGERY
PROCTOCOLECTOMY ETC (LGAS)
# L9
PANCREATECTOMY/
GASTROENTEROLOGY
LGAS165 CYSTOGASTROSCTOMY/TOTAL L9 Surgery 0 54020 64300 74590
SURGERY
PROCTOCOLECTOMY COLECTOMY)
(LGAS) # L9
GASTROENTEROLOGY
LGAS166 POUCH ANAL ANASTOMOSIS (LGAS) L9 Surgery 0 54020 64300 74590
SURGERY
# L9
WHIPPLE'S PANCRETO- GASTROENTEROLOGY
LGAS167 L9 Surgery 0 54020 64300 74590
DUODENECTOMY (LGAS) # L9 SURGERY
DS0017 Diagnostic laproscopy Surgery GENERAL SURGERY 0 1110 1320 1530
ANAL DILATATION (AS SOLE
LGEN001 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
PROCEDURE) (GEN) # L1
BANDING / INJECTION OF PILES
(GEN) # L1
LGEN003 CORN EXCISION (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
LGEN008 DRESSING - MINOR (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
EAR LOBE REPAIR UNILATERAL
(LGEN) # L1
EUA (AS SOLE PROCEDURE) (GEN)
# L1
LGEN006 FNAC (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
LGEN007 I & D MINOR (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
LGEN012 MOLE EXCISION (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
LGEN013 PUNCH BIOPSY (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
SIGMOIDOSCOPY - RIGID (LGEN)
# L1
LGEN009 SKIN BIOPSY (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220
WOUND DEBRIDEMENT MINOR
(LGEN) # L1
WOUND SUTURING MINOR (GEN)
# L1
LGEN015 AMPUTATION OF TOE (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
CAPD CATHETER REMOVAL-(GEN):L2
# L2
CHEMOPORT/ HICKMAN CATHETER
REMOVAL (GEN) # L2
158
Surgery Billing
Level Group
LGEN016 CIRCUMCISION (LGEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
CORE BIOPSY /TRUCUT BIOPSY
(GEN) # L2
CYSTOSCOPY SAME AS
PANENDOSOPY (GEN) # L2
EAR LOBE REPAIR BILATERAL (GEN)
# L2
EUA/ ANAL SPHINCTEROTOMY (GEN)
# L2
EXCISION OF SKIN LESION (GEN)
# L2
LGEN031 FASCIOTOMY MINOR (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN030 FRENULOPLASTY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN019 GANGLION EXCISION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN032 ICD - PLACEMENT (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
INTRA PERITONEAL - CHEMOPORT
REMOVAL (GEN) # L2
LIPOMA EXCISION - SMALL (GEN)
# L2
LOCAL EXCISION OF LIP LESION
(GEN) # L2
LYMPHNODE BIOPSY EXCISION (GEN)
# L2
LGEN021 MUSCLE BIOPSY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN022 NAIL EXCISION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
SEBACEOUS CYST EXCISION (GEN)
# L2
LGEN035 SECONDARY SUTURING (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN024 SINUS EXPLORATION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN038 SKIN GRAFT MINOR (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN037 SPLIT SKIN GRAFTING (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
SUCTION BANDING/ INFRA RED
COAGULATION (GEN) # L2
SUPRAPUBIC CYSTOSTOMY (GEN)
# L2
LGEN040 TESTICULAR BIOPSY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
LGEN026 VASECTOMY (LGEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380
WOUND SUTURING INTERMEDIATE
(GEN) # L2
Axillary Lymph Node Biopsy (LGEN)
L3 # L3
CARPAL TUNNEL DECOMPRESSION -
UNILATERAL (GEN) # L3
159
Surgery Billing
Level Group
Cervical Lymph Node Biopsy (LGEN)
L3 # L3
CIRCUMCISSION UNDER LA (GEN):L3
# L3
LGEN043 DERMOID CYST EXCISION (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
LGEN051 DRESSING - MAJOR (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
EPIDIDYMAL CYST EXCISION (GEN)
# L3
EPIDIDYMECTOMY - UNILATERAL
(GEN) # L3
EPIDIDYMO VASOSTOMY
LGEN044 EUA/ LOW FISTULA (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
EXCISION OF SUBCUTANEOUS
LESION (GEN) # L3
FOURNIER'S GANGRENE
DEBRIDEMENT (GEN) # L3
HAEMORHOIDECTOMY WITH EUA +
SIGMOIDOSCOPY (GEN) # L3
HAEMORRHOIDECTOMY WITH EUA
(GEN) # L3
HYDROCELECTOMY UNILATERAL
(LGEN) # L3
LGEN047 I & D MAJOR (LGEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
LGEN048 MICRODOCHECTOMY (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
MUCOSAL SHAVE OF LIP LESION
(GEN) # L3
LGEN062 OPEN BONE BIOPSY (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
PAROTID DUCT CALCULI REMOVAL
(GEN) # L3
PILONIDAL SINUS EXCISION (GEN)
# L3
SEBACEOUS CYST EXCISION
MULTIPLE (GEN) # L3
SFJ LIGATION STRIPPING -
SIMPLE INGUINAL/FEMORAL HERNIA
REPAIR - UNILATERAL (GEN) # L3
SIMPLE UMBLICAL HERNIA /
LGEN412 EPIGASTRIC HERNIA REPAIR - (GEN) L3 Surgery GENERAL SURGERY 0 10820 12880 14940
: L3 # L3
SKIN GRAFT INTERMEDIATE (GEN)
# L3
SUBMANDIBULAR SALIVARY DUCT
CALCULUS REMOVAL (GEN) # L3
160
Surgery Billing
Level Group
VASECTOMY UNDER LA (GEN):L3
# L3
WIDE EXCISION OF SCALP TUMOR
(GEN) # L3
LGEN053 WIDE LOCAL EXCISION (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940
WOUND DEBRIDEMENT MAJOR
(GEN) # L3
WOUND SUTURING MAJOR (GEN)
# L3
ADHESIOLYSIS WITH OR WITHOUT
LGEN102 BOPSY OPEN (AS SOLE PROCEDURE) L4 Surgery GENERAL SURGERY 0 14790 17610 20420
(GEN) # L4
AMPUTATIONS FOOT/HAND (GEN)
# L4
LGEN071 APPENDICECTOMY OPEN (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
CHEMOPORT/ HICKMAN CATHETER
INSERTION (GEN) # L4
DIAGNOSTIC THORACOSCOPY +/-
BIOPSY (GEN) # L4
EPIDIDYMECTOMY - BILATERAL
(GEN) # L4
EPIDIDYMO VASOSTOMY BILATERAL
(GEN) # L4
EPIGASTRIC HERNIA ?MESH REPAIR-
(GEN):L4 # L4
LGEN074 EUA/ HIGH FISTULA (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
EXCISION BENIGN TUMOR NECK
(GEN) # L4
EXCISION OF PARATHYROID
ADENOMA/CARCINOMA (GEN) # L4
LGEN097 FASCIOTOMY MAJOR (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
FEEDING JEJUNOSTOMY (LGEN) #
L4
LGEN095 GASTROSTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
GYNAECOMASTIA UNILATERAL (GEN)
# L4
HADFIELDS PROCEDURE (GEN) #
L4
INGUINAL/ FEMORAL HERNIA MESH
REPAIR UNILATERAL (GEN) # L4
INTRAOPERATIVE
CHOLANGIOGRAPHY (GEN) # L4
161
Surgery Billing
Level Group
INTRA PERITONEAL - CHEMOPORT
INSERTION (GEN) # L4
LAPAROTOMY AND PERITONEAL
LGEN103 LAVAGE (AS SOLE PROCEDURE) L4 Surgery GENERAL SURGERY 0 14790 17610 20420
(GEN) # L4
LIPOMA EXCISION - LARGE (GEN)
# L4
LGEN104 LOCAL ROTATION FLAPS (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
LUMBAR SYMPATHECTOMY (GEN)
# L4
LGEN081 LUMPECTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
MECKLE'S DIVERTICULECTOMY
OPEN (GEN) # L4
OOPHERECTOMY - UNILATERAL
(GEN) # L4
ORCHIDOPEXY - UNILATERAL (LGEN)
# L4
PARATHYROID HYPERPLASIA
EXCISION (GEN) # L4
PARAUMBILICAL HERNIA MESH
REPAIR (GEN) # L4
PILONIDAL SUNUS EXCISON WITH
PRIMARY CLOSURE (GEN) # L4
RADICAL ORCHIDECTOMY (LGEN)
# L4
SCALENE TRIANGLE DISSECTION
(GEN) # L4
SFJ LIGATION STRIPPING PERF
LIGATION - UNILATERAL (GEN) # L4
SIMPLE MASTECTOMY WITH/
LGEN085 WITHOUT AXILLARY LYMPHNODE L4 Surgery GENERAL SURGERY 0 14790 17610 20420
BIOPSY - UNILATERAL (GEN) # L4
LGEN107 SKIN GRAFT MAJOR (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
STAPLER HAEMORHOIDECTOMY+
SIGMOIDOSCOPY (GEN) # L4
STAPLER HAEMORRHOIDECTOMY
(GEN) # L4
TENDON LENGTHENING/SUTURING
(GEN) # L4
LGEN087 TRACHEOSTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420
UMBILICAL HERNIA MESH REPAIR
(GEN) # L4
URINARY BLADDER REPAIR (GEN)
# L4
VAGOTOMY WITH OUT GASTRIC
BYPASS -OPEN (GEN) # L4
162
Surgery Billing
Level Group
VARICOCELE LIGATION UNILATERAL
(GEN) # L4
WIDE EXCISION OF CARCINOMA -
BUCCAL MUCOSA (GEN) # L4
WIDE LOCAL EXCISION + MESH
REPAIR (GEN) # L4
AMPUTATION BELOW KNEE (LGEN)
# L5
AMPUTATION OF PENIS - PARTIAL
(LGEN) # L5
AMPUTATIONS BELOW ELBOW (GEN)
# L5
AVULSION OF VENOUS
LGEN118 PERFORATORS UNILATERAL (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870
# L5
BILATERAL (GEN) # L5
COMPLICATED INGUINAL HERNIA-
(GEN:)L5 # L5
DEFUNCTIONING COLOSTOMY (GEN)
# L5
DIAGNOSTIC LAPAROSCOPY (WITH
LGEN119 OR WITHOUT BIOPSY/LAVAGE)(AS L5 Surgery GENERAL SURGERY 0 18010 21440 24870
SOLE PROCEDURE) (GEN) # L5
DUODENOJEJUNOSTOMY - OPEN
(GEN) # L5
EUA/ HIGH FISTULA WITH DIVERSION
(GEN) # L5
EXCISION OF MALIGNANT LESION
LGEN157 (NOT OTHERWISE SPECIFIED) (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870
# L5
GASTROJEJUNOSTOMY &
VAGOTOMY - OPEN (GEN) # L5
GASTROSTOMY LAPAROSCOPIC
(GEN) # L5
GLOMUS TUMOR EXCISION (GEN)
# L5
LGEN145 GLOSSECTOMY HEMI (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
HYDROCELECTOMY BILATERAL
(LGEN) # L5
ILEO INGUINAL BLOCK DISSECTION -
LGEN122 WITH/WITHOUT ADHESIOLYSIS (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870
# L5
UNDER LA - UNILATERAL (GEN) # L5
163
Surgery Billing
Level Group
LAPAROSCOPIC ADHESIOLYSIS
LGEN124 (INCLUDING BIOPSY) AS SOLE L5 Surgery GENERAL SURGERY 0 18010 21440 24870
PROCEDURE (GEN) # L5
LAPAROSCOPIC APPENDICECTOMY
(GEN) # L5
(GEN) # L5
LAPAROSCOPIC ECTOPIC
UNRUPTURED/RUPTURED (GEN) # L5
LAPAROSCOPIC HERNIA REPAIR
(GEN) # L5
LAPAROSCOPIC INGUINAL/ FEMORAL
LGEN127 HERNIA MESH REPAIR UNILATERAL L5 Surgery GENERAL SURGERY 0 18010 21440 24870
(GEN) # L5
LAPAROSCOPIC OVARIAN
LGEN155 CYSTECTOMY UNILATERAL (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870
# L5
LAPAROSCOPIC VARICOCELE
OPERATION (GEN) # L5
LAPAROSCOPIC VENTRAL HERNIA
MESH REPAIR (GEN) # L5
LAPAROSCOPIY AND PACKING OF
LGEN151 LIVER WITH PERITONEAL LAVAGE L5 Surgery GENERAL SURGERY 0 18010 21440 24870
(GEN) # L5
LAPAROTOMY AND PACKING OF
LGEN150 LIVER WITH PERITONEAL LAVAGE L5 Surgery GENERAL SURGERY 0 18010 21440 24870
(GEN) # L5
LIPOMA EXCISION - MULTIPLE (GEN)
# L5
LYMPH NODE BIOPSY -
LGEN149 INTRAPERITONIAL - OPEN (GEN) # L5 Surgery GENERAL SURGERY 0 18010 21440 24870
L5
MECKLE'S DIVERTICULECTOMY
LAPAROSCOPIC (GEN) # L5
MIRP - MINIMALLY INVASIVE RADIO
GUIDED PARATHYROID (GEN) # L5
LGEN158 OMENTECTOMY (LGEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
OOPHERECTOMY - BILATERAL (GEN)
# L5
OPEN LIVER ABSESS DRAINAGE
(GEN) # L5
ORCHIDECTOMY UNILATERAL -
OPEN/LAPAROSCOPIC (GEN) # L5
ORCHIDOPEXY - BILATERAL (LGEN)
# L5
PILONIDAL SINUS EXCISION WITH
FLAP (GEN) # L5
164
Surgery Billing
Level Group
LGEN160 PORT-A-CATH (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
RECONSTRUCTION OF GASTRIC RES
(LGEN) # L5
RECURRENT INGUINAL HERNIA-
(GEN):L5 # L5
LGEN162 REGIONAL FLAPS (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
RETROPERITONEAL LYMPHNODE
BIOPSY (GEN) # L5
LGEN163 REVISION COLOSTOMY (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
LGEN166 RFA (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
ROLL - RADIO GUIDED OCCULT
LGEN164 LESION LOCALIZATION AND L5 Surgery GENERAL SURGERY 0 18010 21440 24870
EXCISION (GEN) # L5
LGEN167 SENTINEL NODE BIOPSY (LGEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870
BILATERAL (GEN) # L5
SILS INCISIONAL HERNIA REPAIR
(GEN) # L5
SILS OF ANY SIMPLE
LGEN170 PROCEDURE (APPENDICECTOMY/ L5 Surgery GENERAL SURGERY 0 18010 21440 24870
CHLECYSTECTOMY ETC) (GEN) # L5
SILS VENTRAL HERNIA REPAIR (GEN)
# L5
SIMPLE INGUINAL/FEMORAL HERNIA
REPAIR - BILATERAL (GEN) # L5
SMALL BOWEL STRICTUROPLASTY
(SINGLE) (GEN) # L5
SUBMANDIBULAR GLAND EXCISION
(LGEN) # L5
SYMPETHECTOMY-CERVICAL/
THORACIC (GEN) # L5
THERAPEUTIC LAPAROSCOPY (GEN)
# L5
THERAPEUTIC THORACOSCOPY
(GEN) # L5
THERAPEUTIC THORACOSCOPY
(LGEN) # L5
THYROGLOSSAL / BRANCHIAL CYST
OR FISTULA (GEN) # L5
TORTION TESTIS BILATERAL
FIXATION (GEN) # L5
UNDER LA (GEN) # L5
VARICOCELE LEGATION BILATERAL
(GEN) # L5
165
Surgery Billing
Level Group
Wide excision of abdominal wall
with mesh repair (LGEN) L5 # L5
WIDE EXCISION OF SOFT TISSUE
TUMOR (GEN) # L5
ADRENALECTOMY UNILATERAL (SS)
(GEN) # L6
AMPUTATION ABOVE KNEE (SS)
(GEN) # L6
AMPUTATION OF TOTAL PENIS (SS)
(GEN) # L6
LGEN179 ANOPROCTOPLASTY (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980
AVULSION OF VENOUS
LGEN180 PERFORATORS - BILATERAL (SS) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
(GEN) # L6
AXILLARY CLEARANCE LEVEL I & II
(SS) (GEN) # L6
CHOLECYSTECTOMY + CBD
EXPLORATION (SS) (GEN) # L6
CHOLECYSTECTOMY - OPEN (SS)
(GEN) # L6
CLOSURE OF DUODENAL SMALL
BOWEL FISTULA (SS) (GEN) # L6
COMPLICATED APPENDICECTOMY-
(GEN):L6 # L6
EXCISION OF CARCINOID TUMORS
(SS) (GEN) # L6
LGEN213 FUNDOPLICATION (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980
GASTRIC - SLEEVE RESECTION (SS)
(GEN) # L6
GLOSSECTOMY PARTIAL (SS) (GEN)
# L6
GYNAECOMASTIA BILATERAL (SS)
(GEN) # L6
BILATERAL (SS) (GEN) # L6
LAPAROSCOPIC CARDIOMYOTOMY
(SS) (GEN) # L6
LAPAROSCOPIC CBD EXPLORATION
LGEN184 AND SPHINCTROTOMY (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
LGEN191 FOR ACUTE CHOLECYSTITIS (SS) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
(GEN) # L6
LGEN192 FOR COMPLICATED GALLSTONE L6 Surgery GENERAL SURGERY 0 23160 27570 31980
DISEASE (SS) (GEN) # L6
166
Surgery Billing
Level Group
LAPAROSCOPIC
LGEN211 DUODENOJEJUNOSTOMY (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
LAPAROSCOPIC NEPHRECTOMY
SIMPLE (SS) (GEN) # L6
LAPAROSCOPIC ORCHIDOPEXY -
LAPAROSCOPIC PERFORATION
CLOSURE (SS) (GEN) # L6
LAPROSCOPIC CHOLECYSTECTOMY
LGEN183 + CBD EXPLORATION (SS) (GEN) # L6 Surgery GENERAL SURGERY 0 23160 27570 31980
L6
LARGE BOWEL RESECTION AND
ANASTOMOSIS (SS) (GEN) # L6
MELANOMA EXCISSION (SS) (GEN)
# L6
MUSCLE FLAP SINGLE (SS) (GEN)
# L6
MYOCUTANEOUS FLAP (SS) (GEN)
# L6
OPEN SPLENECTOMY (SS) (GEN)
# L6
ORCHIDECTOMY BILATERAL - OPEN/
LAPAROSCOPIC (SS) (GEN) # L6
PARTIAL PAROTIDECTOMY WITH
LGEN199 FACIAL NERVE EXCISION (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
PLND - PELVIC LYMPHADECTOMY
(SS) (GEN) # L6
UNILATERAL (SS) (GEN) # L6
RADICAL CHOLECYSTECTOMY AND
LGEN234 LYMPHADENECTOMY (SS) (GEN) # L6 Surgery GENERAL SURGERY 0 23160 27570 31980
L6
LGEN246 LIGATION - BILATERAL (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
SIMPLE MASTECTOMY WITH/
LGEN196 WITHOUT AXILLARY LYMPHNODE L6 Surgery GENERAL SURGERY 0 23160 27570 31980
BIOPSY - BILATERAL (SS) (GEN) # L6
SINGLE INCISION LAPAROSCOPIC
CHOLECYSTECTOMY (SS) (GEN) # L6
SMALL BOWEL RESECTION AND
ANASTOMOSIS (SS) (GEN) # L6
(MULTIPLE) (LGEN) # L6
167
Surgery Billing
Level Group
(MULTIPLE) (SS) (GEN) # L6
SUBTOTAL GLOSSECTOMY (SS)
(GEN) # L6
SUPERFICIAL PAROTIDECTOMY WITH
LGEN198 FACIAL NERVE EXCISION (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
THYROID ISTHMECTOMY (SS) (GEN)
# L6
THYROID LOBECTOMY (SS) (GEN)
# L6
TOTAL MASTECTOMY + SLNB (SS)
(GEN) # L6
TRANSANAL ENDOSCPIC
LGEN239 MICROSURGERY (TEM) (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980
# L6
TRANSDUODENAL
SPHINCTEROPLASTY (LGEN) # L6
TRANSDUODENAL
SPHINCTEROPLASTY (SS) (GEN) # L6
URINARY DIVERSION PROCEDURES
(SS) (GEN) # L6
VARICOSE VEINS UNILATERAL (open
/ laser) + AVULSION (SS) (GEN) # L6
VARICSOE VEINS UNILATERAL (open
/ laser) + AVULSION (SS) (GEN) # L6
LGEN242 VVF REPAIR (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980
WEDGE RESECTION OF LUNG (SS)
(GEN) # L6
WIDE EXCISION OF SCALP TUMOR
RECONSTRUCTION (SS) (GEN) # L6
COLOSTOMY/ILEOSTOMY CLOSURE/
REVISION (GEN) # L6
EMERGENCY LAPAROSCOPIC
APPENDECTOMY (LAPAROSCOPIC
ACUTE ABDOMEN + LAPAROSCOPIC
APPENDECTOMY) (GEN) # L6
EXCISION OF ABDOMINAL WALL
LGEN185 LESION WITH MESH REPAIR (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290
# L6
HYSTERECTOMY WITH SALPHINGO
LGEN216 - OPHERECTOMY - BILATERAL (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290
# L6
HYSTERECTOMY WITH SALPHINGO -
LGEN215 OPHERECTOMY - UNILATERAL (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290
# L6
INGUINAL/ FEMORAL HERNIA MESH
REPAIR BILATERAL (GEN) # L6
168
Surgery Billing
Level Group
Laparoscopic Appendicectomy for
Abscess/Mass (LGEN) L6 # L6
LAPAROSCOPIC HYSTERECTOMY
LGEN218 WITH SALPHINGO - OPHERECTOMY L6 Surgery GENERAL SURGERY 0 27010 32150 37290
- BILATERAL (GEN) # L6
LGEN217 WITH SALPHINGO - OPHERECTOMY L6 Surgery GENERAL SURGERY 0 27010 32150 37290
- UNILATERAL (GEN) # L6
LAPAROSCOPIC INCISIONAL HERNIA
LGEN188 MESH REPAIR WITH/WITHOUT L6 Surgery GENERAL SURGERY 0 27010 32150 37290
ADHESIOLYSIS (GEN) # L6
LAPAROSCOPIC OVARIAN
CYSTECTOMY BILATERAL (GEN) # L6
LAPAROSCOPIC UMBILICAL HERNIA
LGEN203 MESH REPAIR WITH/WITHOUT L6 Surgery GENERAL SURGERY 0 27010 32150 37290
Laparoscopic ventral hernia repair
with adhesiolysis (LGEN) L6 # L6
LAP HYSTERECTOMY WITH/WITHOUT
LGEN194 LUMPECTOMY MULTIPLE (GEN) # L6 L6 Surgery GENERAL SURGERY 0 27010 32150 37290
RE-EXPLORATION FOR INTRA-
ABDOMINAL BLEEDING (GEN) # L6
THYROIDECTOMY FOR LARGE
MULTINODULAR GOITRE (GEN) # L6
AXILLARY CLEARANCE LEVEL I,II,III
(SS) (GEN) # L7
LGEN247 EXCISION FOR BREAST CANCER (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
CHEST WALL RESECTION AND
CHOLEDOCHODUDENOSTOMY (SS)
(GEN) # L7
CYSTOGASTROSTOMY /
LGEN248 CYSTOJEJUNOSTOMY (SS) (GEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
# L7
DUODENAL DIVERTICULIZATION
PROCEDURE (SS) (GEN) # L7
DUODENAL DIVERTICULUM
EXCISION (SS) (GEN) # L7
EXCISION OF INSULINOMAS (SS)
(GEN) # L7
EXCISION OF RETRO RECTAL TUMOR
(SS) (GEN) # L7
EXCISION OF SOFT TISSUE
SARCOMA NECK (SS) (GEN) # L7
169
Surgery Billing
Level Group
GASTRECTOMY PARTIAL (SS) (GEN)
# L7
HARTMANS PROCEDURE - OPEN
(SS) (GEN) # L7
HYDATID CYST -
LGEN270 CYSTOPERIYSTECTOMY (SS) (GEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
# L7
HYSTERECTOMY RADICAL (SS) (GEN)
# L7
ILEO INGUINAL BLOCK DISSECTION -
LAPAROSCOPIC ADRENALECTOMY -
UNILATERAL (SS) (GEN) # L7
LAPAROSCOPIC
LGEN283 CHOLEDOCHODUDENOSTOMY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
LAPAROSCOPIC
CYSTOGASTROSTOMY /
CYSTOJEJUNOSTOMY (SS) (GEN)
# L7
LAPAROSCOPIC HYDATID CYST
EXCISION (SS) (GEN) # L7
RADICAL (SS) (GEN) # L7
LAPAROSCOPIC LARGE BOWEL
LGEN276 RESECTION AND ANASTOMOSIS (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
LAPAROSCOPIC LATERAL
LGEN286 PANCREATICO JEJUNOSTOMY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
LAPAROSCOPIC LIVER ABSCESS
DRAINAGE (SS) (GEN) # L7
LAPAROSCOPIC SPLENECTOMY (SS)
(GEN) # L7
LATERAL PANCREATICO
JEJUNOSTOMY (SS) (GEN) # L7
LGEN288 LOBECTOMY LUNG (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620
MELANOMA EXCISION WITH
MODIFIED RADICAL MASTATECTOMY
LGEN317 (EXCLUDING LYMPH NODE L7 Surgery GENERAL SURGERY 0 30860 36740 42620
SAMPLING) (SS) (GEN) # L7
MUSCLE FLAP MULTIPLE (SS) (GEN)
# L7
OPEN ACHALASIA CARDIA
OPERATION (SS) (GEN) # L7
OPEN PANCREATICO JEJUNOSTOMY
(SS) (GEN) # L7
170
Surgery Billing
Level Group
OPEN RIGHT/LEFT HEMICOLECTOMY
(SS) (GEN) # L7
PARTIAL PAROTIDECTOMY WITH
LGEN259 FACIAL NERVE PRESERVATION (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
LGEN292 PERITONECTOMY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620
POST-MASTECTOMY
RADICAL HEMICOLECTOMY WITH
L7
RADICAL NECK DISSECTION (SS)
(GEN) # L7
RADICAL SMALL BOWEL RESECTION
FOR TUMOR (SS) (GEN) # L7
RESECTION OF HEPATO-BILIARY
MALIGNACIES (SS) (GEN) # L7
RETROPERITONEAL LYMPH NODE
LGEN298 DISSECTION (RPLND) (SS) (GEN) # L7 Surgery GENERAL SURGERY 0 30860 36740 42620
L7
REVISION RADICAL NECK
DISSECTION (SS) (GEN) # L7
RF ABLATION OF LIVER LESION (SS)
(GEN) # L7
SECOND LOOK LAPROTOMY (SS)
(GEN) # L7
SEGMENTAL RESECTION - LUNG
(SS) (GEN) # L7
SELECTIVE NECK DISSECTION (SS)
(GEN) # L7
LGEN265 SPLENORRAPHY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620
SUBCUTANEOUS MASTECTOMY (SS)
(GEN) # L7
SUBTOTAL GASTRECTOMY (SS)
(GEN) # L7
SUPERFICIAL PAROTIDECTOMY WITH
LGEN258 FACIAL NERVE PRESERVATION (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
SUPRA OMOHYOID NECK
SURGERY FOR ANAL INCONTINENCE
(SS) (GEN) # L7
SURGERY FOR APUDOMAS (SS)
(GEN) # L7
171
Surgery Billing
Level Group
SURGERY FOR ENTEROCUTANEOUS
FISTULA (SS) (GEN) # L7
SURGERY FOR OVARIAN CYST AND
TUMOUR (SS) (GEN) # L7
SURGERY FOR SALIVARY GLAND
TUMOURS (SS) (GEN) # L7
LGEN314 THYMECTOMY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620
CANCER WITH LEVEL 1 & 2
AXILLARY LYMPHNODE CLEARANCE
(SS) (GEN) # L7
TUMORS (SS) (GEN) # L7
VASCULAR RESECTION AND
VATS VIDEO ASSISTED
LGEN315 THORACOSCOPY SURGERY (LGEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
# L7
VATS VIDEO ASSISTED
LGEN264 THORACOSCOPY SURGERY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620
(GEN) # L7
LGEN268 INTESTINAL OBSTRUCTION (GEN) L7 Surgery GENERAL SURGERY 0 36010 42870 49730
# L7
UNDER LA - BILATERAL (GEN) # L7
LAPAROSCOPIC INGUINAL/ FEMORAL
LGEN253 HERNIA MESH REPAIR BILATERAL L7 Surgery GENERAL SURGERY 0 36010 42870 49730
(GEN) # L7
LAPAROSCOPIC RECTOPEXY (GEN)
# L7
RECTUM MESH REPAIR (GEN) # L7
PROLAPSE RECTUM REPAIR -
DELORME'S PROCEDURE (GEN) # L7
PROLAPSE RECTUM REPAIR WITH/
WITHOUT MESH (GEN) # L7
LGEN256 RECTOPEXY - OPEN (GEN) # L7 L7 Surgery GENERAL SURGERY 0 36010 42870 49730
RECTOVAGINAL FISTULA REPAIR
(GEN) # L7
ADRENALECTOMY BILATERAL (SS)
(GEN) # L8
CHOLEDOCHEL CYST
EXCISION + ROUX-EN-Y
HEPATICOJEJUNOSTOMY (SS) (GEN)
# L8
172
Surgery Billing
Level Group
DISTAL PANCREATECTOMY (SS)
(GEN) # L8
DISTAL SPLENORENAL SHUNT (SS)
(GEN) # L8
EMERGENCY LAPAROTOMY FOR GI
BLEED (SS) (GEN) # L8
LGEN341 MESENTERIC ISCHEMIA (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
# L8
ESOPHAGEAL
LGEN342 REPLACEMENT(GASTRIC PULL UP) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(SS) (GEN) # L8
ESOPHAGO-GASTRIC
LGEN343 DEVASCULARIZATION + L8 Surgery GENERAL SURGERY 0 38580 45930 53280
SPLENECTOMY (SS) (GEN) # L8
EXCISION OF CHEST WALL TUMO
LGEN336 AND RECONSTRUCTION (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
# L8
LGEN345 FREYS PROCEDURE (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280
FUNCTIONAL NECK DISSECTION (SS)
(GEN) # L8
# L8
Incision Hernia repair-open
component separation # L8
INTERPOSITION PORTACAVAL SHUNT
(SS) (GEN) # L8
LAPAROSCOPIC ACHALASIA CARDIA
OPERATION (SS) (GEN) # L8
LAPAROSCOPIC ADRENALECTOMY -
LAPAROSCOPIC APR/ANT
RESECTION (SS) (GEN) # L8
LAPAROSCOPIC CHOLEDOCHEL
CYST EXCISION + ROUX-EN-Y
# L8
LAPAROSCOPIC COLECTOMY (SS)
(GEN) # L8
LAPAROSCOPIC FUNDOPLICATION
(SS) (GEN) # L8
LAPAROSCOPIC GASTRIC BYPASS
LGEN356 PROCEDURE FOR OBESITY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
LAPAROSCOPIC LIVER RESECTION
NONANATOMICAL (SS) (GEN) # L8
173
Surgery Billing
Level Group
LAPAROSCOPIC TV AND
LGEN326 GASTROJEJUNOSTOMY (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
# L8
LAPAROSCOPIC VAGOTOMY/
GASTRIC BYPASS (SS) (GEN) # L8
LAPAROTOMY WITH MULTIPLE
PROCEDURES (BLUNT AND
PENETRATING INJURIES) (SS) (GEN)
# L8
LIVER TRAUMA (DEBRIDEMENT/
RESECTION) (LGEN) # L8
LIVER TRAUMA (DEBRIDEMENT/
RESECTION) (SS) (GEN) # L8
MODIFIED NECK DISSECTION I & II
(SS) (GEN) # L8
NEPHRECTOMY PARTIAL (SS) (GEN)
# L8
NONANATOMICAL LIVER RESECTION
LGEN347 / LATERAL SEGMENTECTOMY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
LGEN363 OESOPHAGECTOMY (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280
PANCREAS PRESERVING
DUODENECTOMY (SS) (GEN) # L8
PANCREATIC NECROSECTOMY/
LGEN355 ABSCESS DRAINAGE OPEN/ L8 Surgery GENERAL SURGERY 0 38580 45930 53280
LAPAROSCOPIC (SS) (GEN) # L8
PARTIAL PANCREATECTOMY (SS)
(GEN) # L8
PORTA SYSTEMIC SHUNT (SS) (GEN)
# L8
RADICAL SUBTOTAL GASTRECTOMY
(R0-R4 RNS) (SS) (GEN) # L8
LGEN369 ABDOMINAL TUMOR & RECON. (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
RESECTION OF RETROPERITONEAL
TUMOR (SS) (GEN) # L8
REVERSAL OF HARTMANS
PROCEDURE (SS) (GEN) # L8
REVISION SURGERY FOR PAROTID
TUMOUR (SS) (GEN) # L8
LGEN329 COMPLETION THYROIDECTOMY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
ROUX-EN-Y
LGEN371 HEPATICOJEJUNOSTOMY (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
# L8
174
Surgery Billing
Level Group
SILS ADVANCED PROCEDURES
LGEN346 (COLECTOMY / CARDIOMYOTOMY / L8 Surgery GENERAL SURGERY 0 38580 45930 53280
FUNDOPLICATION) (SS) (GEN) # L8
SKIN SPARING/NAC SAPRING
LGEN330 MASTECTOMY FOR BREAST CANCER L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(SS) (GEN) # L8
SPLENORENAL SHUNT +/-
SPLENECTOMY (SS) (GEN) # L8
STAGING LAPROTOMY FOR
CARCINOMA (SS) (GEN) # L8
SUBTOTAL COLECTOMY WITH
LGEN375 ILEORECTAL ANASTOMOSIS (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
SURGERY FOR CARCINOMA OVARY
PELVIC CONFINED (SS) (GEN) # L8
SURGERY FOR CHOLONGIO CA WITH
LGEN374 HJ WITHOUT LIVER RESECTION (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
THYROIDECTOMY FOR
LGEN331 RETROSTERNAL EXTENSION (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
(GEN) # L8
LGEN332 TOTAL COLECTOMY (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280
LGEN333 CANCER WITH LEVEL 1,2,3 AXILLARY L8 Surgery GENERAL SURGERY 0 38580 45930 53280
CLEARANCE (SS) (GEN) # L8
MALIGNANCY + CENTRAL
COMPARTMENT LYMPHNODE
VARICSOE VEINS BILATERAL (open /
laser) + AVULSION (SS) (GEN) # L8
VIDEO ASSISTED RETROPERITONEAL
LGEN376 DEBRIDEMENT (VARD) (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280
# L8
DIAPHRAGMATIC HERNIA
LGEN319 REPAIR WITH/WITHOUT MESH - L8 Surgery GENERAL SURGERY 0 45010 53580 62150
LAPAROSCOPIC (GEN) # L8
DIAPHRAGMATIC HERNIA REPAIR
LGEN320 WITH/WITHOUT MESH - OPEN (GEN) L8 Surgery GENERAL SURGERY 0 45010 53580 62150
# L8
High anterior resection (LGEN) L8
# L8
WITH ABDOMINOPLASTY (GEN) # L8
Laparoscopic assisted
Hemicolectomy (LGEN) L8 # L8
175
Surgery Billing
Level Group
RECTUM MESH REPAIR +
RESECTION ANASTOMOSIS (GEN)
# L8
PROLAPSE RECTUM REPAIR WITH/
WITHOUT MESH WITH RESECTION
ANASTOMOSIS WITH BOWEL (GEN)
# L8
ABDOMINO-PERINEAL RESECTION
LGEN383 WITH TME +ANP+STOMA (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
# L9
LGEN385 ANTERIOR RESECTION LAR +TME + L9 Surgery GENERAL SURGERY 0 46300 55120 63930
ANP Laparoscopic (SS) (GEN) # L9
LGEN384 ANTERIOR RESECTION LAR +TME + L9 Surgery GENERAL SURGERY 0 46300 55120 63930
ANP (SS) (GEN) # L9
DUODENUM PRESERVING
LGEN388 PANCREATECTOMY / TOTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930
PANCREATECTOMY (SS) (GEN) # L9
EXTENDED CHOLECYSTECTOMY
LGEN377 (LYMPADENECTOMY + LIVER L9 Surgery GENERAL SURGERY 0 46300 55120 63930
RESECTION) (SS) (GEN) # L9
Incision Hernia repair- laparoscopy
LGEN428 Surgery GENERAL SURGERY 0 46300 55120 63930
component separation
LAPAROSCOPIC DISTAL
LAPAROSCOPIC GASTRECTOMY (SS)
(GEN) # L9
LAPAROSCOPIC HEPATECTOMY-
ANATOMICAL (SS) (GEN) # L9
LAPAROSCOPIC OESOPHAGO
LGEN390 GASTRECTOMY IVOR- LEWIS (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
(GEN) # L9
LAPAROSCOPIC SPLEEN-
LGEN392 PRESERVING DISTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930
MAJOR HEPATATECTOMY (SS) (GEN)
# L9
MAJOR SARCOMA RESECTION (SS)
(GEN) # L9
MEDIAN PANCREATECTOMY WITH
LGEN396 ORRINGER TRANPOSITION (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
(GEN) # L9
OESOPHAGO GASTRECTOMY IVOR-
LEWIS (SS) (GEN) # L9
176
Surgery Billing
Level Group
RADICAL GASTRECTOMY D2-D4
L9
RADICAL PAROTIDECTOMY (SS)
(GEN) # L9
RADICAL TOTAL GASTRECTOMY
LGEN379 (R0-R4 RNS) +/- RECONSTRUCTION L9 Surgery GENERAL SURGERY 0 46300 55120 63930
POUCH (SS) (GEN) # L9
REDO-HEPATICOJEJUNOSTOMY (SS)
(GEN) # L9
REPAIR OF COMPLICATED BILIARY
STRICTURE (SS) (GEN) # L9
RETROSTERNAL COLONIC BYPASS
(SS) (GEN) # L9
ROUX Y HEPATICOJEJUNOSTOMY
LGEN402 FOR PORTAL BILIOPATHY (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
# L9
PANCREATECTOMY/
LGEN406 CYSTOGASTRECTOMY/TOTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930
PROCTOCOLECTOMY ETC (SS) (GEN)
# L9
SURGERY FOR CARCINOMA OVARY -
EXTENSIVE (SS) (GEN) # L9
SURGERY FOR HILAR CHOLONGIO
LGEN405 WITH LIVER RESECTION (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
# L9
THREE STAGE OESOPHAGECTOMY
FOR MALIGNANCY (SS) (GEN) # L9
TOTAL PAROTIDECTOMY (SS) (GEN)
# L9
ILEOSTOMY/ POUCH (SS) (GEN) # L9
LGEN408 POUCH ANAL ANASTOMOSIS (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930
(GEN) # L9
MALIGNANCY + UNILATERAL
(GEN) # L9
VASCULAR TRAUMA EXPLORATION
(SS) (GEN) # L9
WERTHIM'S HYSTRECTOMY
RADICAL (SS) (GEN) # L9
WHIPPLE'S PANCRETO-
DUODENECTOMY (SS) (GEN) # L9
LGEN399 ROBOTIC SURGERY (GEN) # L9 L9 Surgery GENERAL SURGERY 0 54020 64300 74590
177
Vascular Surgery
178
Vascular Surgery
Surgery Billing
Level Group
VASCULAR SURGERY
PVAS009 FOOT WEAR SUGGESTION Procedure 360 380 450 520
PROCEDURE
VASCULAR SURGERY
PVAS011 HALF YEARLY REVIEW Procedure 360 380 450 520
PROCEDURE
VASCULAR SURGERY
PVAS015 MONTHLY REVIEW Procedure 360 380 450 520
PROCEDURE
VASCULAR SURGERY
PVAS001 ANNUAL REVIEW Procedure 680 720 850 990
PROCEDURE
VASCULAR SURGERY
PVAS014 HYPERKERATOSIS Procedure 680 720 850 990
PROCEDURE
VASCULAR SURGERY
PVAS016 NAIL CARE Procedure 680 720 850 990
PROCEDURE
VASCULAR SURGERY
PVAS020 NEW PATIENT ASSESSMENT Procedure 680 720 850 990
PROCEDURE
VASCULAR SURGERY
PVAS003 CALLUS EXCISION Procedure 960 1010 1200 1390
PROCEDURE
VASCULAR SURGERY
PVAS007 DEBRIDEMENT - MINOR - PVAS Procedure 960 1010 1200 1390
PROCEDURE
VASCULAR SURGERY
PVAS006 DEBRIDEMENT - MAJOR Procedure 1370 1440 1720 1990
PROCEDURE
VASCULAR SURGERY
PVAS018 NAIL EXCISION - PARTIAL Procedure 2330 2440 2910 3370
PROCEDURE
VASCULAR SURGERY
PVAS002 BURSITIS Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS005 CORN EXCISION - PVAS Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS010 GANGLION EXCISION - PVAS Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS017 NAIL EXCISION - COMPLETE Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS019 NEUROMA EXCISION Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS021 SINUS EXCISION Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS022 SOFT TISSUE CYSTS Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS023 TOE AMPUTATION Procedure 4510 4740 5640 6540
PROCEDURE
VASCULAR SURGERY
PVAS024 STENT GRAFTING Procedure 18300 19220 22880 26530
PROCEDURE
VASCULAR SURGERY
PVAS004 CLAW TOE Procedure 22540 23670 28180 32690
PROCEDURE
VASCULAR SURGERY
PVAS008 EXOSTOSIS Procedure 22540 23670 28180 32690
PROCEDURE
VASCULAR SURGERY
PVAS013 HAMMER TOE Procedure 22540 23670 28180 32690
PROCEDURE
179
Vascular Surgery
Surgery Billing
Level Group
VASCULAR SURGERY
PVAS012 HALLUX VALGUS Procedure 26650 27980 33310 38640
PROCEDURE
LVAS001 CALLUS EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220
LVAS002 CORN EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220
LVAS003 DEBRIDEMENT-MINOR (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220
LVAS004 I & D MINOR (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220
LVAS005 NAIL EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220
LVAS006 AMPUTATIONS TOE/DIGIT (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380
LVAS007 AV FISTULA CLOSURE (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380
DEBRIDEMENT-INTERMEDIATE (VAS)
LVAS008 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380
# L2
EXCISION OF BURSA FOR BURSITIS
(VAS) # L2
LVAS010 GANGLION EXCISION (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380
LVAS011 SKIN GRAFT MINOR (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380
AMPUTATIONS TOE/DIGIT -
MULTIPLE (VAS) # L3
AV FISTULA MINOR (SINGLE) (VAS)
# L3
LVAS014 DEBRIDEMENT-MAJOR (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940
EMBOLECTOMY-BRACHIAL (VAS)
# L3
LVAS016 FASCIOTOMY (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940
LVAS017 I & D MAJOR (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940
UNILATERAL (VAS) # L3
LVAS019 SKIN GRAFT INTER (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940
AMPUTATIONS FOOT/HAND (VAS)
# L4
LUMBAR SYMPATHECTOMY (VAS)
# L4
LIGATION - UNILATERAL (VAS) # L4
AMPUTATION BELOW ELBOW (VAS)
# L5
AMPUTATION BELOW KNEE (LVAS)
# L5
ARTERIO-VENOUS MALFORMATION
MINOR (< 5 CM DIA) (VAS) # L5
AV FISTULA/GRAFT EXPLORATION
(VAS) # L5
180
Vascular Surgery
Surgery Billing
Level Group
AV FISTULA MAJOR (REDO
LVAS026 SURGERIES AND MULTIPLE) (VAS) L5 Surgery VASCULAR SURGERY 0 18010 21440 24870
# L5
AVULSION OF VENOUS
LVAS028 PERFORATORS- UNILATERAL (VAS) L5 Surgery VASCULAR SURGERY 0 18010 21440 24870
# L5
LVAS029 ELVT UNILATERAL (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870
EMBOLECTOMY - FEMORAL (VAS)
# L5
EMBOLECTOMY-POPLITEAL (VAS)
# L5
LVAS032 GRAFT THROMBECTOMY (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870
PATCH GRAFT ANGIOPLASTY (VAS)
# L5
BILATERAL (VAS) # L5
LVAS035 SKIN GRAFT MAJOR (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870
STRIPPING PERF LIGATION-
AVULSIONS - UNILATERAL (VAS) # L5
THORACOSCOPIC SYMPATHECTOMY
(VAS) # L5
AMPUTATION ABOVE KNEE (LVAS)
# L6
INTER (5-10 CM DIA) (VAS) # L6
LVAS040 AVGRAFT FOR DIALYSIS (VAS) # L6 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290
AVULSION OF VENOUS
LVAS041 PERFORATORS- BILATERAL (VAS) L6 Surgery VASCULAR SURGERY 0 27010 32150 37290
# L6
CERVICAL RIB & RELATED
PROCEDURE (VAS) # L6
EMBOLECTOMY + FASCIOTOMY
(VAS) # L6
LIGATION - BILATERAL (VAS) # L6
VARICOSE VEINS UNILATERAL (open
/ laser) + AVULSION (VAS) # L6
AORTO ILIAC ENDARTERECTOMY
(VAS) # L7
MAJOR (> 10 CM DIA) (VAS) # L7
BYPASS TO UPPER LIMB ARTERIES
(VAS) # L7
CAROTID ENDARTERECTOMY (LVAS)
# L7
181
Vascular Surgery
Surgery Billing
Level Group
LVAS050 ELVT BILATERAL (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730
LVAS051 FEMORO DISTAL BYPASS (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730
FEMORO POPLITUL BYPASS (VAS)
# L7
LVAS70 IVC Filter (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 36010 42870 49730
STRIPPING PERF LIGATION
AVULSIONS - BILATERAL (VAS) # L7
SYMPETHECTOMY-CERVICAL/THO
(VAS) # L7
LVAS68 Tibial Vessel Angioplasty (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730
VASCULAR BYPASS/
RECONSTRUCTION (VAS) # L7
VASCULAR TRAUMA EXPLORATION
E/ANGIO (VAS) # L7
AORTIC ANEURYSM ABDOMINAL
(VAS) # L8
BASILIC VEIN TRANSPOSITION (VAS)
# L8
LVAS059 CAROTID BODY TUMOUR (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150
Multiple Vessels Angioplasty
(ballooning)(VAS) # L8
LVAS060 RE DO BYPASS (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150
Single Vessel angioplasty & stenting
(VAS) # L8
VARICOSE VEIN BILATERAL (open /
laser) + AVULSION (VAS) # L8
AORTIC ANEURYSM ABDOMINO
THORACIC (VAS) # L9
AORTIC ANUERYSM COMPLICATED
(RUPTURED/LEAKING) (VAS) # L9
Multiple Vessel Angioplasty &
stenting (VAS) # L9
SEQUENTIAL / COMPOSITE GRAFT
(VAS) # L9
182
Plastic Surgery
183
Plastic Surgery
Surgery Billing
Level Group
PLASTIC SURGERY
PPLS524 Dressing Small - A - PLS Procedure 130 140 160 190
PROCEDURE
PLASTIC SURGERY
PPLS525 Dressing Medium - B - PLS Procedure 220 230 280 320
PROCEDURE
Dressing Multiple/Small-Medium PLASTIC SURGERY
PPLS526 Procedure 260 270 320 370
- PLS PROCEDURE
PLASTIC SURGERY
PPLS527 Dressing Intermediate - PLS Procedure 380 400 480 560
PROCEDURE
PLASTIC SURGERY
PPLS528 Dressing Large - PLS Procedure 760 800 950 1110
PROCEDURE
PLASTIC SURGERY
PPLS529 Dressing Extra Large - PLS Procedure 960 1010 1200 1390
PROCEDURE
PLASTIC RECONSTRUCTIVE PLASTIC SURGERY
PPLS391 Procedure 1100 1150 1370 1590
SRUGERY - CAT 1 - PPLS PROCEDURE
ABDOMINAL FLAP - 2ND STAGE PLASTIC SURGERY
PPLS002 Procedure 1370 1440 1720 1990
DELAY OF FLAP - PPLS PROCEDURE
PLASTIC SURGERY
PPLS122 DEBRIDEMENT - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS133 DRESSING CHARGES - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
D & S FINGER INJURIES EACH - PLASTIC SURGERY
PPLS120 Procedure 1370 1440 1720 1990
PPLS PROCEDURE
PLASTIC SURGERY
PPLS228 INCISION BIOPSY - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS229 INGROWING NAIL EXCISION - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS230 INJECTION SCLEROTHERAPY - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS231 INJECTION THERAPY KELOID - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS236 ISLET WIRING - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS239 JESS FRAME REMOVAL - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
PLASTIC SURGERY
PPLS455 SERIAL EXCISION - MINOR - PPLS Procedure 1370 1440 1720 1990
PROCEDURE
SUTURE OF WOUNDS - MINOR - PLASTIC SURGERY
PPLS465 Procedure 1370 1440 1720 1990
PPLS PROCEDURE
PLASTIC SURGERY
PPLS521 PRS 001 Procedure 1780 1860 2220 2570
PROCEDURE
PLASTIC SURGERY
PPLS530 I & D - Plastic Surgery - Minor - PLS Procedure 1910 2010 2390 2770
PROCEDURE
PLASTIC SURGERY
PPLS532 Suturing - Minor - PLS Procedure 1910 2010 2390 2770
PROCEDURE
PLASTIC SURGERY
PPLS241 K WIRE EACH-PPLS Procedure 2330 2440 2910 3370
PROCEDURE
184
Plastic Surgery
Surgery Billing
Level Group
PLASTIC SURGERY
PPLS270 LOCAL ANASTHESIA - PPLS Procedure 2330 2440 2910 3370
PROCEDURE
PLASTIC SURGERY
PPLS346 NERVE BLOCK - PPLS Procedure 2330 2440 2910 3370
PROCEDURE
PPLS392 Procedure 2330 2440 2910 3370
SURGERY - CAT 2 - PPLS PROCEDURE
ALOPOECIA CORR. SCALP PLASTIC SURGERY
PPLS013 Procedure 2470 2590 3080 3570
REDUCTION - PPLS PROCEDURE
PLASTIC SURGERY
PPLS022 ARCH BAR REMOVAL - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
CARPAL TUNNEL DECOMPRESSION - PLASTIC SURGERY
PPLS072 Procedure 2470 2590 3080 3570
MINOR - PPLS PROCEDURE
CHANGE OF DRESSING - MINOR - PLASTIC SURGERY
PPLS076 Procedure 2470 2590 3080 3570
PPLS PROCEDURE
CORRECTION MALLET FINGER PLASTIC SURGERY
PPLS107 Procedure 2470 2590 3080 3570
CONSERVATIVE - PPLS PROCEDURE
PLASTIC SURGERY
PPLS127 DERMABRASIONS - MINOR - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
PLASTIC SURGERY
PPLS121 D & S MULTIPLE - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
PLASTIC SURGERY
PPLS143 EXCISION BIOPSY - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
PLASTIC SURGERY
PPLS174 FIELD BLOCK - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
PLASTIC SURGERY
PPLS226 IMF & ARCH BARS - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
PLASTIC SURGERY
PPLS436 REVISION AMPUTAION - PPLS Procedure 2470 2590 3080 3570
PROCEDURE
SUTURE OF WOUNDS - MEDIUM - PLASTIC SURGERY
PPLS464 Procedure 2470 2590 3080 3570
PPLS PROCEDURE
PLASTIC SURGERY
PROCEDURE
PLASTIC SURGERY
PROCEDURE
PPLS393 Procedure 3420 3590 4270 4960
SURGERY - CAT 3 - PPLS PROCEDURE
PLASTIC SURGERY
PPLS531 I & D - Plastic Surgery - Major - PLS Procedure 3700 3880 4620 5360
PROCEDURE
PLASTIC SURGERY
PPLS533 Suturing - Major - PLS Procedure 3700 3880 4620 5360
PROCEDURE
PLASTIC SURGERY
PPLS323 MINIPLATE REMOVAL - PPLS Procedure 3830 4030 4790 5560
PROCEDURE
PLASTIC SURGERY
PPLS437 REVISION AMPUTATION SSG - PPLS Procedure 3830 4030 4790 5560
PROCEDURE
PLASTIC SURGERY
PPLS498 TRIGGER FINGER - PPLS Procedure 3830 4030 4790 5560
PROCEDURE
185
Plastic Surgery
Surgery Billing
Level Group
PLASTIC SURGERY
PPLS070 CAPSULOTOMY - PPLS Procedure 4510 4740 5640 6540
PROCEDURE
PLASTIC SURGERY
PPLS106 CORN EXCISSION - PPLS Procedure 4510 4740 5640 6540
PROCEDURE
PLASTIC SURGERY
PPLS173 FAT GRAFTS - PPLS Procedure 4510 4740 5640 6540
PROCEDURE
KOLLAGEN APPLICATION MINOR - PLASTIC SURGERY
PPLS246 Procedure 4510 4740 5640 6540
PPLS PROCEDURE
LAGOPHTHALMOUS CORRECTION PLASTIC SURGERY
PPLS249 Procedure 4510 4740 5640 6540
- PPLS PROCEDURE
PLASTIC SURGERY
PPLS476 TENOSINOVITIS EXCISSION - PPLS Procedure 4510 4740 5640 6540
PROCEDURE
PLASTIC SURGERY
PPLS514 WOUND DRESSING MINOR Procedure 4510 4740 5640 6540
PROCEDURE
ARTHRODESIS EACH FINGER JOINT PLASTIC SURGERY
PPLS028 Procedure 4930 5170 6160 7140
- PPLS PROCEDURE
HAIR TRANSPLANT EACH SITTING PLASTIC SURGERY
PPLS210 Procedure 4930 5170 6160 7140
- PPLS PROCEDURE
PLASTIC SURGERY
PPLS329 NAIL GRAFTING - PPLS Procedure 4930 5170 6160 7140
PROCEDURE
PTOSIS CORRECTION - MINOR - PLASTIC SURGERY
PPLS421 Procedure 4930 5170 6160 7140
PPLS PROCEDURE
SUTURE OF WOUNDS - MAJOR - PLASTIC SURGERY
PPLS463 Procedure 4930 5170 6160 7140
PPLS PROCEDURE
PLASTIC SURGERY
PPLS454 SERIAL EXCISION - MAJOR - PPLS Procedure 5190 5450 6490 7530
PROCEDURE
PLASTIC SURGERY
PPLS265 LIPO INJECTION MINOR - PPLS Procedure 5610 5890 7010 8130
PROCEDURE
PLASTIC SURGERY
PPLS362 NEUROLYSIS MINOR - PPLS Procedure 5610 5890 7010 8130
PROCEDURE
PLASTIC SURGERY
PPLS172 FASCIOTOMY MINOR - PPLS Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS197 GANGLION EXCISSION - PPLS Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS302 MEATOPLASTY Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS469 TATOOING - PPLS Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS513 WOUND DRESSING MAJOR - PPLS Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS517 Z-PLASTY MINOR - PPLS Procedure 6700 7030 8370 9710
PROCEDURE
PLASTIC SURGERY
PPLS115 CROSS FINGER FLAP - PPLS Procedure 7390 7760 9230 10710
PROCEDURE
EARLOBE SEPARATION REPAIRS - PLASTIC SURGERY
PPLS137 Procedure 7650 8030 9560 11090
PPLS PROCEDURE
186
Plastic Surgery
Surgery Billing
Level Group
PLASTIC SURGERY
PPLS001 ABBE FLAP - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
ALOPECIA (BALDNESS/SCALP) HAIR PLASTIC SURGERY
PPLS010 Procedure 7930 8320 9910 11490
TSPT-INTER - PPLS PROCEDURE
PLASTIC SURGERY
PPLS017 AMPUTATIONS (EACH DIGIT) Procedure 7930 8320 9910 11490
PROCEDURE
PLASTIC SURGERY
PPLS023 ARCHBAR - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
ARCHBAR WIRING (SEC PLASTIC SURGERY
PPLS024 Procedure 7930 8320 9910 11490
MANDIBULAR) - PPLS PROCEDURE
CARPAL TUNNEL DECOMPRESSION - PLASTIC SURGERY
PPLS071 Procedure 7930 8320 9910 11490
INTER - PPLS PROCEDURE
CHANGE OF DRESSING - INTER - PLASTIC SURGERY
PPLS075 Procedure 7930 8320 9910 11490
PPLS PROCEDURE
PLASTIC SURGERY
PPLS098 COLUMELLA LENGTHENING - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
COMMISSUROTOMY PLASTIC SURGERY
PPLS099 Procedure 7930 8320 9910 11490
RECONSTRCTION - PPLS PROCEDURE
EYELID REPAIR ECTROPION - INTER PLASTIC SURGERY
PPLS152 Procedure 7930 8320 9910 11490
- PPLS PROCEDURE
FACIAL INJURIES SOFT TISSUE - PLASTIC SURGERY
PPLS158 Procedure 7930 8320 9910 11490
INTER - PPLS PROCEDURE
PLASTIC SURGERY
PPLS242 KELOID/HYPER EX WITH SSG - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
PLASTIC SURGERY
PPLS459 SSG SMALL - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
PLASTIC SURGERY
PPLS494 TRACHEOSTOMY - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
PLASTIC SURGERY
PPLS520 Z-PLASTY SINGLE - PPLS Procedure 7930 8320 9910 11490
PROCEDURE
PLASTIC SURGERY
PPLS148 EXCISSIONAL DEBREDIMENT - PPLS Procedure 8740 9180 10930 12680
PROCEDURE
PLASTIC SURGERY
PPLS444 ROTATION FLAP - PPLS Procedure 8740 9180 10930 12680
PROCEDURE
PLASTIC SURGERY
PPLS097 COLOBOMA - PPLS Procedure 9020 9470 11270 13080
PROCEDURE
PLASTIC SURGERY
PPLS128 DERMAL GRAFT - PPLS Procedure 9020 9470 11270 13080
PROCEDURE
PLASTIC SURGERY
PPLS511 W PLASTY-PPLS Procedure 9020 9470 11270 13080
PROCEDURE
PLASTIC SURGERY
PPLS449 SCAR EXCISION - PPLS Procedure 9300 9760 11620 13480
PROCEDURE
CHELIOPLASTY AUGMENTATION - PLASTIC SURGERY
PPLS079 Procedure 11210 11770 14010 16250
PPLS PROCEDURE
PLASTIC SURGERY
PPLS171 FASCIOTOMY MAJOR - PPLS Procedure 11210 11770 14010 16250
PROCEDURE
187
Plastic Surgery
Surgery Billing
Level Group
GLOMOUS TUMOUR EXCISSION - PLASTIC SURGERY
PPLS201 Procedure 11210 11770 14010 16250
PPLS PROCEDURE
PLASTIC SURGERY
PPLS518 Z-PLASTY MODERATE - PPLS Procedure 11210 11770 14010 16250
PROCEDURE
PTOSIS CORRECTION - MAJOR - PLASTIC SURGERY
PPLS420 Procedure 12020 12620 15030 17430
PPLS PROCEDURE
PLASTIC SURGERY
PPLS060 BROW LIFT - PPLS Procedure 12300 12910 15370 17830
PROCEDURE
PLASTIC SURGERY
PPLS258 LIP AUGMENTATION - PPLS Procedure 13390 14060 16740 19410
PROCEDURE
PLASTIC SURGERY
PPLS260 LIP LIFT - PPLS Procedure 13390 14060 16740 19410
PROCEDURE
PLASTIC SURGERY
PPLS361 NEUROLYSIS MAJOR - PPLS Procedure 13390 14060 16740 19410
PROCEDURE
PLASTIC SURGERY
PPLS386 PERFORATOR FLAP - PPLS Procedure 13390 14060 16740 19410
PROCEDURE
CHEEK RECONSTRUCTION MINOR PLASTIC SURGERY
PPLS078 Procedure 14350 15060 17930 20800
- PPLS PROCEDURE
PPLS011 Procedure 15710 16500 19640 22780
TSPT-MAJOR - PPLS PROCEDURE
PLASTIC SURGERY
PPLS069 CANTHOPLASTY - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS080 CHELIOPLASTY REDUCTION - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
CHIN AUGMENTATION IMPLANT - PLASTIC SURGERY
PPLS084 Procedure 15710 16500 19640 22780
PPLS PROCEDURE
DEGLOVING INJURIES OF LIMBS & PLASTIC SURGERY
PPLS123 Procedure 15710 16500 19640 22780
RECONS. MAJOR - PPLS PROCEDURE
PLASTIC SURGERY
PPLS151 EYELID MINOR REPAIR - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
EYELID REPAIR ENTROPION - MAJOR PLASTIC SURGERY
PPLS153 Procedure 15710 16500 19640 22780
- PPLS PROCEDURE
PLASTIC SURGERY
PPLS238 JESS FRAME APPLICATION - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS259 LIP DOUBLE - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
MILLARDS PROCEDURE UNILATERAL PLASTIC SURGERY
PPLS322 Procedure 15710 16500 19640 22780
- PPLS PROCEDURE
SCAR EXCISION & CONTRACTURE PLASTIC SURGERY
PPLS450 Procedure 15710 16500 19640 22780
SSG - PPLS PROCEDURE
SCARS DERMABRASION - MINOR PLASTIC SURGERY
PPLS453 Procedure 15710 16500 19640 22780
- PPLS PROCEDURE
PLASTIC SURGERY
PPLS458 SSG MOD - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS471 TENDON - REPAIR - PRIMARY - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
188
Plastic Surgery
Surgery Billing
Level Group
PLASTIC SURGERY
PPLS487 TISSUE EXPANDOR REMOVAL - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS510 V-Y-FLAP - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS515 Y-V PLASTY - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS516 Z-PLASTY MAJOR - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS519 Z-PLASTY MULTIPLE - PPLS Procedure 15710 16500 19640 22780
PROCEDURE
PLASTIC SURGERY
PPLS055 BRACHIOPLASTY - PPLS Procedure 17760 18650 22200 25750
PROCEDURE
BLEPHAROPLASTY (SEC EYELIDS) PLASTIC SURGERY
PPLS040 Procedure 18450 19370 23060 26750
UNILATERAL - PPLS PROCEDURE
PLASTIC SURGERY
PPLS451 SCAR MAJOR - PPLS Procedure 18450 19370 23060 26750
PROCEDURE
PLASTIC SURGERY
PPLS452 SCAR REVISION - PPLS Procedure 18450 19370 23060 26750
PROCEDURE
PLASTIC SURGERY
PPLS264 LIPO INJECTION MAJOR - PPLS Procedure 22540 23670 28180 32690
PROCEDURE
CHEEK RECONSTRUCTION MAJOR PLASTIC SURGERY
PPLS077 Procedure 27330 28700 34160 39620
- PPLS PROCEDURE
ALARBASE RECONSTRUCTIONS - PLASTIC SURGERY
PPLS007 Procedure 31420 32990 39280 45560
BILATERAL - PPLS PROCEDURE
PPLS012 Procedure 31420 32990 39280 45560
TSPT-SUPRA - PPLS PROCEDURE
AUGMENTATION WITH IMPLANT PLASTIC SURGERY
PPLS031 Procedure 31420 32990 39280 45560
BICOST OF IMPLANT ETC - PPLS PROCEDURE
BLEPHAROPLASTY (SEC EYELIDS) PLASTIC SURGERY
PPLS039 Procedure 31420 32990 39280 45560
BILATERAL - PPLS PROCEDURE
PLASTIC SURGERY
PPLS088 CLEFT LIP & PALATE - PPLS Procedure 31420 32990 39280 45560
PROCEDURE
F.T.GRAFT FULL THICKNESS GRAFT PLASTIC SURGERY
PPLS156 Procedure 31420 32990 39280 45560
- PPLS PROCEDURE
MILLARDS PROCEDURE BILATERAL PLASTIC SURGERY
PPLS321 Procedure 31420 32990 39280 45560
- PPLS PROCEDURE
PLASTIC SURGERY
PPLS267 LIPO SCULPTION MINOR - PPLS Procedure 34160 35870 42700 49530
PROCEDURE
PLASTIC SURGERY
PPLS266 LIPO SCULPTION MAJOR - PPLS Procedure 45080 47340 56350 65370
PROCEDURE
LPLS001 ARCH BAR REMOVAL (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
LPLS002 CORN EXCISSION (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
CORRECTION MALLET FINGER
LPLS003 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
CONSERVATIVE (LPLS) # L1
LPLS004 DEBRIDEMENT (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
189
Plastic Surgery
Surgery Billing
Level Group
DEBRIDEMENT & SUTURING - ONE
FINGER (LPLS) # L1
DERMABRASIONS - MINOR (LPLS)
# L1
EAR LOBE REPAIR UNILATERAL
(LPLS) # L1
LPLS008 I & D MINOR (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
LPLS009 INCISION BIOPSY (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
INGROWING NAIL EXCISION (LPLS)
# L1
INJECTION SCLEROTHERAPY (LPLS)
# L1
INJECTION THERAPY KELOID -
SINGLE AREA (LPLS) # L1
LPLS013 LOCAL ANASTHESIA (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
LPLS014 NERVER BIOPSY (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220
SUTURE OF WOUNDS - MINOR
(LPLS) # L1
WOUND DRESSING - MINOR (LPLS)
# L1
ABDOMINAL FLAP - 2ND STAGE
DELAY OF FLAP (LPLS) # L2
ARCHBAR WIRING - SINGLE JAW
(LPLS) # L2
ARTERY/NERVE/MUSCLE BIOPSY
(LPLS) # L2
DEBRIDEMENT AND SUTURRING -
SMALL (LPLS) # L2
DEBRIDEMENT & SUTURING - TWO
FINGERS (LPLS) # L2
DERMABRASIONS - INTER (LPLS)
# L2
DIGITAL NERVE REPAIR SINGLE
(LPLS) # L2
EAR LOBE REPAIR BILATERAL (LPLS)
# L2
LPLS025 ESCHARECTOMY MINOR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
EXCISION WITH PRIMARY SUTURING
(LPLS) # L2
FACIAL INJURIES SOFT TISSUE -
MINOR (LPLS) # L2
LPLS028 FASCIOTOMY MINOR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
LPLS029 FAT GRAFTS (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
190
Plastic Surgery
Surgery Billing
Level Group
FINGER TIP INJURY - SINGLE (LPLS)
# L2
FOREIGN BODY REMOVAL (LPLS)
# L2
LPLS032 FRENULOPLASTY (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
HEMATOMA EVACUATION (LPLS) #
L2
IMPLANT REMOVAL SINGLE (LPLS)
# L2
INJECTION THERAPY KELOID -
MULTIPLE AREAS (LPLS) # L2
INTR. FIX .METACARPAL PHALANX K
WIRE - SINGLE (LPLS) # L2
LPLS037 ISLET WIRING (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
LPLS038 JESS FRAME REMOVAL (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
KOLLAGEN APPLICATION MINOR
(LPLS) # L2
LPLS040 NAIL BED REPAIR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
LPLS041 NERVE BLOCK (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380
PRESSURE SORE EXCISION
EXCLUDING REPAIR (LPLS) # L2
REVISION AMPUTAION - SINGLE
(LPLS) # L2
SERIAL EXCISION - MINOR (LPLS)
# L2
SUTURE OF WOUNDS - MEDIUM
(LPLS) # L2
TENOSINOVITIS EXCISSION (LPLS)
# L2
WOUND DRESSING - INTERMEDIATE
(LPLS) # L2
ALOPOECIA CORRECTION BY SCALP
REDUCTION (LPLS) # L3
ARCHBAR WIRING - DOUBLE JAW
(LPLS) # L3
LPLS050 ARTHRODESIS MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
ARTHRODESIS SINGLE FINGER
JOINT (LPLS) # L3
BONE GRAFTS (AS ADJUVANT
PROCEDURE) - SMALL (LPLS) # L3
UNILATERAL (LPLS) # L3
LPLS054 CARTILAGE GRAFTS (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
191
Plastic Surgery
Surgery Billing
Level Group
CORRECTIVE OSTEOTOMY EACH
FINGER (LPLS) # L3
LPLS056 CYST/FISTULA EXCISION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
EXCISION WITH GRAFTING (LPLS)
# L3
LPLS058 EYELID REPAIR MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
FIXATION OF FRACTURE
LPLS059 METACARPAL AND PHALYNGES - L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
SINGLE (LPLS) # L3
FOREIGN BODY GRANULOMA
EXCISSION (LPLS) # L3
LPLS061 GANGLION EXCISSION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS062 I & D MAJOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
INTR. FIX .METACARPAL PHALANX K
WIRE - TWO FINGERS (LPLS) # L3
JESS FRAME APPLICATION MINOR
(LPLS) # L3
KELOID/HYPERTROPHIC SCAR
EXCISION WITH SSG (LPLS) # L3
K WIRE INCLUDING CLOSED
LPLS065 REDUCTION AND CAST APPLICATION L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
(LPLS) # L3
LPLS067 MEATOPLASTY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
MEDIAN NERVE DECOMPRESSION
(LPLS) # L3
LPLS069 NAIL BED GRAFTING (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
NASAL BONE FRACTURE REDUCTION
(LPLS) # L3
NECROTISING FASCIATIS MINOR
(LPLS) # L3
NERVE ENTRAPMENT RELEASE
(LPLS) # L3
LPLS073 NERVE REPAIR SINGLE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS074 NEUROMA EXCISSION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS075 OTOPLASTY STAGE III (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS076 POLYDACTYLY SIMPLE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
POST MASTECTOMY
LPLS077 RECONSTRUCTION - NIPPLE (LPLS) L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
# L3
PRESSURE SORES
LPLS078 RECONSTRUCTION MINOR (LPLS) L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
# L3
LPLS079 REGIONAL BLOCK (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
192
Plastic Surgery
Surgery Billing
Level Group
REVISION AMPUTATION SSG -
SINGLE (LPLS) # L3
LPLS081 SCAR EXCISION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS082 SSG SMALL (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS083 TARSORRAPHY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LCOS001 TATOOING (LCOS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
TISSUE EXPANDERS INSERTION -
SMALL (LPLS) # L3
LPLS089 TRIGGER FINGER (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS085 VERRUCAE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS086 Y-V PLASTY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
LPLS087 Z-PLASTY MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940
ZYGOMA CLOSED REDUCTION
(LPLS) # L3
LPLS090 ABBE FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS091 AMPUTATION FOOT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS092 AMPUTATION HAND (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS093 APPROACH OSTEOTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
AREOLA NIPPLE RECONSTRUCTION
(LPLS) # L4
LPLS095 A-V FISTILA (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
BOUTENIERE DEFORMITY
CORRECTION (LPLS) # L4
CAMPTODACTYLY UNILATERAL
(LPLS) # L4
LPLS098 CANTHOPLASTY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS099 CAPSULOTOMY - JOINT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
CHEEK RECONSTRUCTION MINOR
(LPLS) # L4
CLEFT LIP NASAL DEFORMITY
PRIMARY CORRECTION (LPLS) # L4
CLEFT PALATE - ANTERIOR (LPLS)
# L4
COLUMELLA LENGTHENING (LPLS)
# L4
COMMISSURE RECONSTRUCTION
(LPLS) # L4
LPLS105 CONJUNCTIVAL FLAPS (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS106 CROSS FINGER FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
INTERMEDIATE (LPLS) # L4
193
Plastic Surgery
Surgery Billing
Level Group
DEBRIDEMENT & SUTURING -
MULTIPLE FINGERS (LPLS) # L4
DERMABRASIONS - MAJOR (LPLS)
# L4
LPLS110 DERMAL GRAFT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS111 DERMOID EXCISION (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
DISTRACTION OSTEOTOMIES MINOR
(LPLS) # L4
DUPUYTRENS UNILATERAL (LPLS)
# L4
EARLOBE SEPARATION REPAIRS
(LPLS) # L4
LPLS115 ESCHARECTOMY MAJOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
EXCISION WITH LOCAL FLAP (LPLS)
# L4
EXCISSIONAL DEBREDIMENT (LPLS)
# L4
EYELID REPAIR ECTROPION -
INCLUDING GRAFT/FLAP (LPLS) # L4
INTER (LPLS) # L4
LPLS120 FASCIOTOMY MAJOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
FINGER JOINT REPLACEMENT
SINGLE (LPLS) # L4
FINGER TIP INJURY - MULTI (LPLS)
# L4
LPLS123 FLAPS LOCAL FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
FTG UPTO 9 SQUARE CENTIMETER
IN AREA (LPLS) # L4
GYNAECOMASTIA UNILATERAL
LCOS002 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
(LCOS) # L4
LPLS125 HEMANGIOMAS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
HYMEN RECONSTRUCTION (LPLS)
# L4
HYPOSPADIAS CORRECTION STAGE I
(LPLS) # L4
IMPLANT REMOVAL MULTIPLE
(LPLS) # L4
INTERPHALANGEAL JOINT
LPLS129 RECONSTRUCTION EACH (LPLS) # L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
L4
INTR. FIX .METACARPAL PHALANX
LPLS130 K WIRE - MULTIPLE FINGERS (LPLS) L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
# L4
194
Plastic Surgery
Surgery Billing
Level Group
KELOID/HYPERTROPHIC SCAR -
LPLS131 INTRA LESIONAL EXCISION (LPLS) L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
# L4
KOLLAGEN APPLICATION MAJOR
(LPLS) # L4
LAGOPHTHALMOUS CORRECTION
(LPLS) # L4
LPLS134 LATERAL RHINOTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS135 LUMPECTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
MANDIBLE FRACTURE FIXATION
WIRE/SCREW (LPLS) # L4
MAXILLA # RECONSTRUCTION LE-
FORT - I -UNILATERAL (LPLS) # L4
MELANOCYTE GRAFT - SMALL
(LPLS) # L4
MENNGOCOELE CORRECTIVE
SURGERY (LPLS) # L4
METCARPOPHALENGEAL JOINT ORIF
(LPLS) # L4
NERVE REPAIR DIGITAL MULTIPLE
(LPLS) # L4
LPLS142 NERVE TRANSPOSITION (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS143 NEUROLYSIS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
ORAL COMMISSURE
COMMISUROPLASTY (LPLS) # L4
LPLS145 OTOPLASTY STAGE II (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS146 PERIOSTEOPLASTY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS147 PLATE REMOVAL (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
POLYDACTYLY EXCISION - MINOR
(LPLS) # L4
PTOSIS CORRECTION - UNILATERAL
(LPLS) # L4
RECONSTRUCTION OF LIP LOCAL
FLAP (LPLS) # L4
RE-EXPLORATION OF FLAPS (LPLS)
# L4
REVISION AMPUTATION MULTI (LPLS)
# L4
SKIN GRAFTS AS ADJUVANT
PROCEDURE (LPLS) # L4
SUBMANDIBULAR GLAND EXCISION
(LPLS) # L4
LPLS156 TENDON GRAFT EACH (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
195
Plastic Surgery
Surgery Billing
Level Group
TENDON - REPAIR - PRIMARY (LPLS)
# L4
TENDON TRANSFER SINGLE (LPLS)
# L4
TISSUE EXPANDOR INSERTION -
FINAL INSET - SMALL (LPLS) # L4
LPLS159 TRACHEOSTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS160 TRANSNASAL WIRING (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
LPLS161 TUBE FLAPS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
(LPLS) # L4
LPLS163 VOMER FLAPS (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
WEBBING CORRCTION SURGERIES
(LPLS) # L4
WOUND DRESSING - MAJOR (LPLS)
# L4
LPLS164 W PLASTY - MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420
ALARBASE RECONSTRUCTIONS -
ALARBASE RESECTIONS CLEFT LIP
DEFORMITY (LPLS) # L5
ALOPECIA HAIR TSPT-MINOR (LPLS)
# L5
ALVEOLUS ANTERIOR PALATE
REPAIR - UNILATERAL (LPLS) # L5
LPLS171 AMPUTATION FOREARM (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
ANGLE FRACTURE UNILATERAL
(LPLS) # L5
LPLS173 ANKYLOSIS HAND (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
ARTHRODESIS MULTI FINGER JOINT
(LPLS) # L5
ARTHROPLASTY SINGLE JOINT
(LPLS) # L5
BELOW ELBOW/ ABOVE ELBOW
AMPUTATION (LPLS) # L5
BONE GRAFTS (AS ADJUVANT
PROCEDURE) - LARGE (LPLS) # L5
LPLS178 CABLE GRAFTS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
BILATERAL (LPLS) # L5
CLEFT LIP - INCOMPLETE (LPLS)
# L5
CLEFT PALATE - FISTULA (LPLS) #
L5
196
Plastic Surgery
Surgery Billing
Level Group
LPLS182 COLOBOMA REPAIR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
COMPOSITE GRAFTS MINOR (LPLS)
# L5
CORRECTIVE OSTEOTOMY MULTI
FINGER (LPLS) # L5
CROSS FACIAL NERVE GRAFT (LPLS)
# L5
CROSS NERVE TRANSFER (LPLS)
# L5
CUP EAR CORRECTIONS UNILATERAL
(LPLS) # L5
DEGLOVING INJIRIES DEBRIDEMENT
(LPLS) # L5
DISTRACTION OSTEOTOMIES
MAJOR (LPLS) # L5
DOUBLE LIP CORRECTION (LCOS)
# L5
DOUBLE OPPOSING ZEEPLASTY
(LPLS) # L5
DUPUYTRENS CORRECTION WITH
GRAFT (LPLS) # L5
EARLOBE RECONSTRUCTIONS WITH
FLAP (LPLS) # L5
EXCISION OF MALIGNENT LESION
(LPLS) # L5
EXCISION WITH REGIONAL FLAP
(LPLS) # L5
EXTERNAL AUDITORY CANAL
LPLS195 RECONSTRUCTION SSG FLAP (LPLS) L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
# L5
EYELID REPAIR ENTROPION -
INCLUDING GRAFT/FLAP (LPLS) # L5
LPLS197 EYELID REPAIR MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS198 EYELID REPAIR TUMORS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS199 FASCIAL FLAPS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
FOOT FLAPS MUSCLE FLAPS (LPLS)
# L5
FRACTURE MAXILLA - INTERNAL
FIXATION (LPLS) # L5
LPLS202 FRONTALIS SLING (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS203 GALEAL FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LCOS004 GENIOPLASTY IMPLANT (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
GILLIES ELEVATION OF ARCH (LPLS)
# L5
197
Plastic Surgery
Surgery Billing
Level Group
GYNAECOMASTIA LIPOEXCISION
UNILATERAL (LCOS) # L5
HAND DEFORMITY CORRECTION
MINOR (LPLS) # L5
HAND INJURY ONE SURFACE (LPLS)
# L5
HYPOSPADIAS CORRECTION STAGE
III (LPLS) # L5
LPLS208 IMF & ARCH BARS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
JESS FRAME APPLICATION
INTERMEDIATE (LPLS) # L5
LCOS006 LIP AUGMENTATION (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LCOS007 LIPO INJECTION MINOR (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LOCAL ONCOPLASTY LEVEL I (UPTO
LPLS210 20 % VOLUME OF BREAST) (LPLS) L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
# L5
MALLET FINGER CORRECTION
(LPLS) # L5
FORT - I -BILATERAL (LPLS) # L5
MAXILLA RECONSTRUCTION MINOR
(LPLS) # L5
LCOS008 MELANOCYTE GRAFT (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
MELANOMA-EX-CLOSURE SSG
(LPLS) # L5
LPLS215 MENINGO MYELOCELE (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
METCARPOPHALENGEAL JOINT
ORTHOPLASTY SINGLE (LPLS) # L5
REPLACEMENT SINGLE (LPLS) # L5
NASAL BONE #/RECONSTRUCTION
(LPLS) # L5
NASAL RECONSTRUCTION MINOR
(LPLS) # L5
NECROTISING FASCITIS MAJOR
(LPLS) # L5
LPLS221 NEO-URETHRA I (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
NERVE REPAIR INCLUDING
GRAFTING (LPLS) # L5
NERVE REPAIR MULTIPLE (LPLS) #
L5
NIPPLE AREOLA RECONSTRUCTION
MAJOR (LPLS) # L5
LPLS225 ORO NASAL FISTULA (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
198
Plastic Surgery
Surgery Billing
Level Group
PAROTID GLAND - EXCISION (LPLS)
# L5
LPLS227 PERFORATOR FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS228 PERICRANIL FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
PILONIDAL SURGERY WITH Z PLASTY
(LPLS) # L5
POLYDACTYLY EXCISION - MAJOR
(LPLS) # L5
PRESSURE SORES
LPLS231 RECONSTRUCTION MODERATE L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
(LPLS) # L5
REVASCULIRAZATION FINGER MINOR
(LPLS) # L5
REVISION AMPUTATION SSG - MULTI
(LPLS) # L5
LPLS234 RHINOPHYMA (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
SAGITAL SPLIT OSTEOTOMY
SCALP FLAPS JURI FLAPS (LPLS)
# L5
LCOS025 SCAR REVISION (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
SERIAL EXCISION - MAJOR (LPLS)
# L5
LPLS238 SPASTICITY RELEASE (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS239 SSG MOD (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
SUTURE OF WOUNDS - LARGE
(LPLS) # L5
SWAN NECK DEFORMITY
SYNDACTYLY - SIMPLE (SINGLE)
(LPLS) # L5
THUMB RECONSTRUCTION MINOR
(LPLS) # L5
TISSUE EXPANDER INSERTION -
LARGE (LPLS) # L5
LPLS245 TONGUE FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS246 TORTICOLLIS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS247 TRANSPOSITION FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS248 V-Y-FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS249 W PLASTY - MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
LPLS250 Z-PLASTY MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870
ZYGOMA FRACTURE ORIF (LPLS)
# L5
199
Plastic Surgery
Surgery Billing
Level Group
ALVEOLUS ANTERIOR PALATE
REPAIR - BILATERAL (LPLS) # L6
ANGLE FRACTURE BILATERAL (LPLS)
# L6
MINOR (LPLS) # L6
LPLS255 ARTHRODESIS MOJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
AUGMENTATION MAMMOPLASTY
UNILATERAL (LCOS) # L6
LPLS256 AXIAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
BELOW KNEE/ABOVE KNEE
AMPUTATIONS (LPLS) # L6
BLEPHAROPLASTY UNILATERAL
(LCOS) # L6
BOUTINERRE DEFORMITY
BRACHIOPLASTY - UNILATERAL
(LCOS) # L6
BREAST RECONSTRUCTION MINOR
(LPLS) # L6
CARPAL TUNNEL RELEASE WITH
NEUROLYSIS (LPLS) # L6
CERVICAL RIB OPERATION (LPLS)
# L6
CHEEK RECONSTRUCTION MAJOR
(LPLS) # L6
CHELIOPLASTY AUGMENTATION
(LPLS) # L6
CHELIOPLASTY REDUCTION (LCOS)
# L6
CHIN AUGMENTATION IMPLANT
(LCOS) # L6
CHIN AUGMENTATION WITH
CARTILAGE (LCOS) # L6
LCOS015 CHIN REDUCTION (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
CLEFT LIP SCAR REVISIONS (LPLS)
# L6
LPLS264 CLEFT LIP - UNILATERAL (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS266 CLEFT OF SOFT PALATE (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
CLEFT PALATE - SECONDARY (LPLS)
# L6
CLEFT PALATE - UNILATERAL (LPLS)
# L6
CONTRACTURES RELEASE WITH SSG
(LPLS) # L6
200
Plastic Surgery
Surgery Billing
Level Group
CUT FISTULA HYPOSPADIAS
CYSTIC HYGROMA EXCISION -
SMALL (LPLS) # L6
LARGE (LPLS) # L6
DEGLOVING INJURIES OF LIMBS &
RECONS. MAJOR (LPLS) # L6
LPLS274 DELTOPECTORAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS275 DISTANT FLAP - DELAY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
DISTRACTION OSTEOGENESIS (LPLS)
# L6
DUPUYTRENS BOTH HANDS (LPLS)
# L6
FACIAL NERVE PRIMARY REPAIR
(LPLS) # L6
FINGER REPLANTATION NAIL BED
(LPLS) # L6
FIXATION OF FRACTURE
LPLS280 METACARPAL AND PHALYNGES - L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
MULTIPLE (LPLS) # L6
FOOT FLAPS FASCIOCUTANEOUS
(LPLS) # L6
LPLS282 FORE HEAD FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
FORE HEAD RECONSTRUCTION
(LPLS) # L6
FRACTURE MANDIBLE OPEN
LPLS284 REDUCTION/INTERNAL FIATION L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
(LPLS) # L6
FTG OVER 9 SQUARE CM IN AREA
(LPLS) # L6
GASTRONEMIOUS MUSCLE FLAP
(LPLS) # L6
GLOMOUS TUMOUR EXCISSION
(LPLS) # L6
'GLUTEAL LATERAL ,MEDIAL, THIGH
PLASTY MINOR (LCOS) ' # L6
LPLS288 GROIN FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
GYNAECOMASTIA BILATERAL (LCOS)
# L6
HAIR TRANSPLANT EACH SITTING
(LPLS) # L6
HAND INJURY TWO SURFACES
(LPLS) # L6
HAND RECONSTRUCTION + SSG
(LPLS) # L6
201
Plastic Surgery
Surgery Billing
Level Group
HEMIFACIAL ATROPHY CORRECTION
(LPLS) # L6
HYPOGLOSSAL NERVE TRANSFER
(LPLS) # L6
HYPOSPADIAS CORRECTION STAGE
II (LPLS) # L6
LPLS295 ISLAND FLAPS (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
KELOID/HYPER EXCISION / SSG
(LPLS) # L6
LIP AUGMENTATION BOTH LIPS
(LCOS) # L6
LCOS019 LIP MACROCHELIA (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS298 LIPO FILL SMALL AREA (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LCOS060 LIPOSCULPTURE MINOR (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LIPOSUCTION MINOR (UPTO 2 LTS)
(LPLS) # L6
LPLS297 LIP RECONSTRUCTION (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LOWER LIP RECONSTRUCTION
(LPLS) # L6
LYMPHOEDEMA SURGERY MAJOR
(LPLS) # L6
MACRODACTYLY CORRECTION
(LPLS) # L6
LCOS020 MALLAR IMPLANT (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
FORT - II - UNILATERAL (LPLS) # L6
MELANOCYTE GRAFT - LARGE
(LPLS) # L6
LPLS305 MELANOMA EXCISSION (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS306 MID FACE OSTEOTOMY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
MILLARDS PROCEDURE UNILATERAL
(LPLS) # L6
MUSCLE FLAP SINGLE (LPLS) (LPLS)
# L6
MYOCUTANEOUS FLAP (LPLS) (LPLS)
# L6
NASAL RECONSTRUCTION - MAJOR
(LPLS) # L6
LPLS311 NASO ETHMOID # (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
NECK BURN CONTRACTURE WITH
SSG (LPLS) # L6
LPLS313 NEO-URETHRA II (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS314 NERVE GRAFT SINGLE (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
202
Plastic Surgery
Surgery Billing
Level Group
NERVES SECONDARY REPAIR (LPLS)
# L6
LPLS316 NEUROLYSIS MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS317 ORBITAL OSTEOTOMY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LPLS318 PALATAL FISTULA (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LCOS021 PANNICULECTOMY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
PENILE DYSFUNCTION - IMPLANT
INSERTION (LPLS) # L6
LPLS320 PHARYGEAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
PLATYSMA BAND CORRECTION
(LPLS) # L6
LPLS322 POLYDACTELY COMPLEX (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LCOS022 PROFILOPLASTY MINOR (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
PTOSIS CORRECTION - BILATERAL
(LPLS) # L6
LPLS324 REANIMATION - MINOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LCOS023 RHINOPLASTY PRIMARY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
ROMBERG'S DISEASE CORRECTIVE
SURGERIES (LPLS) # L6
SAGITAL SPLIT OSTEOTOMY
SCAR EXCISION & CONTRACTURE
SSG (LCOS) # L6
LPLS327 SSG MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
SUBCONDYLAR FRACTURE
LPLS329 SURAL ATERY FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
SWAN NECK DEFORMITY
SYNDACTYLY - COMPLEX (SINGLE)
(LPLS) # L6
SYNDACTYLY - SIMPLE (MULTIPLE)
(LPLS) # L6
TEMPOROMANDIBULAR JOINT
LPLS333 ANKYLOSIS RELEASE - UNILATERAL L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
(LPLS) # L6
TENDON TRANSFER MULTIPLE
(LPLS) # L6
THREADLIFT (UPTO 2 THREADS)
(LCOS) # L6
THUMB / FINGER IMPLANT (LPLS)
# L6
THUMB RECONSTRUCTION
MODERATE (LPLS) # L6
203
Plastic Surgery
Surgery Billing
Level Group
TISSUE EXPANDOR INSERTION -
FINAL INSET - LARGE (LPLS) # L6
TRUNK RECONSTRUCTION MINOR
(LPLS) # L6
LPLS339 TUBE FLAPS MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
LCOS027 UMBULICOPLASTY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290
V-Y REPAIR PHARYNGOPLASTY
(LPLS) # L6
ZONE II FLEXOR TENDON REPAIR
(LPLS) # L6
ABDOMINAL WALL
RECONSTRUCTION (LPLS) # L7
LCOS028 ABDOMINOPLASTY MINI (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
ALARBASE RECONSTRUCTIONS -
AUGMENTATION MAMMOPLASTY
LPLS345 BLOW OUT # OF ORBIT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
LPLS346 BONE FLAP (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
BRACHIAL PLEXUS INJURY NERVE
LPLS347 EXPLORATION & NEUROLYSIS (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
# L7
BREAST AUGMENTATION WITH
IMPLANT UNLATERAL (LCOS) # L7
CAMPTODACTYLY FINGER-
BILATERAL/ MULTIPLE (LPLS) # L7
CHEST WALL RECONSTRUCTION
(LPLS) # L7
CHIN AUGMENTATION INCLUDING
LCOS030 BONE GRAFT / OSTEOTOMY (LCOS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
# L7
LPLS350 CLEFT LIP - BILATERAL (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
CLEFT LIP NASAL DEFORMITY
LPLS352 SECONDARY CORRECTION (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
# L7
LPLS351 CLEFT LIP - SECONDARY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
CLEFT PALATE - BILATERAL (LPLS)
# L7
COMPOSITE GRAFTS MAJOR (LPLS)
# L7
CONTRACTURES POST BURN WITH
NECK FLAP (LPLS) # L7
CRANIOSTENOSIS CORRECTION -
SINGLE SUTURE (LPLS) # L7
204
Plastic Surgery
Surgery Billing
Level Group
CUP EAR CORRECTIONS BILATERAL
(LPLS) # L7
CYSTIC HYGROMA EXCISION -
LARGE (LPLS) # L7
DEBRIDEMENT WITH SUTURING AND
KOLLAGEN APPLICATION (LPLS) # L7
DERMOID CYST COMPLEX (LPLS)
# L7
DISTANT FLAP - DIVISION/INSET
(LPLS) # L7
DISTRACTION OSTEOGENESIS
LIMBS (LPLS) # L7
DUPUYTRENS CORRECTION WITH
FLAPS (LPLS) # L7
EPISPADIAS EXTROPHY REPAIR
(LPLS) # L7
LPLS365 EXSTROPHY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
MAJOR (LPLS) # L7
LPLS367 FACIAL NERVE GRAFT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
FACIAL NERVE SECONDARY
FACIAL RECONSTRUCTION (MINOR/
SINGLE FLAP) (LPLS) # L7
LCOS031 FACIAL RESURFACING (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
FASCIO CUTANEOUS FLAPS (LPLS)
# L7
FINGER JOINT REPLACEMENT MULTI
(LPLS) # L7
FINGER REPLANTATION EACH (LPLS)
# L7
FINGER REPLANTATIONS TIP (LPLS)
# L7
FRONTO ORBITAL OSTEOTOMY
(LPLS) # L7
GENIOPLASTY WITH GRAFTS (LCOS)
# L7
GRACELLIS FLAP TRANSFER (LPLS)
# L7
GYNAECOMASTIA LIPOEXCISION
BILATERAL (LCOS) # L7
HAND DEFORMITY CORRECTION
MAJOR (LPLS) # L7
HAND RECONSTRUCTION + GRAFT
(LPLS) # L7
205
Plastic Surgery
Surgery Billing
Level Group
LPLS378 HEMANGIOMAS MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
HYPOPHARYNGEAL
JAW TUMORS LE-FORT OSTEOTOMY
(LPLS) # L7
JESS FRAME APPLICATION MAJOR
(LPLS) # L7
KRUKENBERG OPERATION (LPLS)
# L7
LEVATOR APONEURESIS
CORRECTION SURGERY (LPLS) # L7
LIMB RECONSTRUCTION + SSG
(LPLS) # L7
LPLS385 LIP LIFT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
LIPOBRACHIOPLASTY - UNILATERAL
(LCOS) # L7
LPLS386 LIPO INJECTION MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
LIPOSUCTION (< 4 LTRS) (LCOS) #
L7
LIPOSUCTION INTER (2-4 LTS) (LPLS)
# L7
LOCAL ONCOPLASTY LEVEL II (UPTO
# L7
LOWER LIMB RECONSTRUCTION
CROSS LEG FLAP (LPLS) # L7
LYMPHEDEMA REDUCTION (LPLS)
# L7
LPLS390 LYMPHEDEMA - SHUNT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
MALOCCLUSION CORRECTION
SURGERY (LPLS) # L7
MANDIBLE SPLITING PROCEDURE
(LPLS) # L7
MANDIBULAR OSTEOTOMY (LPLS)
# L7
MANGLED FOOT RECONSTRUCTION
(LPLS) # L7
MASTOPEXY UNILATERAL (LPLS)
# L7
FORT - II - BILATERAL (LPLS) # L7
FORT - III - UNILATERAL (LPLS) # L7
LPLS399 MAXILLARY SWING (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
206
Plastic Surgery
Surgery Billing
Level Group
MEDIAL PLANTAR ARTERY FLAP
(LPLS) # L7
MELANOMA EXCISION WITH
LPLS402 REPLACEMENT MULTIPLE (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
# L7
MICROTIA RECONSTRUCTION (LPLS)
# L7
MID FACE RECONSTRUCTION (LPLS)
# L7
MUSCLE FLAP MULTIPLE (LPLS)
(LPLS) # L7
NASOETHMOID FRACTURES ORIF
(LPLS) # L7
LPLS407 NECK CONTOURING (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
NERVE PRSERVING PAROTIDECTOMY
(LPLS) # L7
LCOS035 NOSE TIP CORRECTION (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
OBESITY - LIPECTOMY - ANTERIOR
OR POSTERIOR (LCOS) # L7
ORAL CAVITY RECONSTRUCTION
(LPLS) # L7
LPLS410 OTOPLASTY STAGE I (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
LPLS411 PALATOPLASTY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
PECTORALIS MAJOR MYOCUTANEOS
FLAP (LPLS) # L7
LPLS413 PHARYNGOPLASTY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
PROFILOPLASTY MODERATE (LPLS)
# L7
LPLS415 REANIMATION - MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
REDUCTION MAMMOPLASTY
REVASCULARIZATION MAJOR (LPLS)
# L7
REVASCULIRAZATION FINGER
MAJOR (LPLS) # L7
RHINO-PLASTY COSMETIC PRIMARY
(LPLS) # L7
SCALP RECONSTRUCTION MAJOR
(LPLS) # L7
LPLS421 SSG EXT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
SYNDACTYLY - COMPLEX (MULTIPLE)
(LPLS) # L7
207
Plastic Surgery
Surgery Billing
Level Group
ARTHROPLASTY (LPLS) # L7
TENDON - REPAIR - SECONDARY
(LPLS) # L7
LCOS037 THIGH LIFT (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
THUMB RECONSTRUCTION MAJOR
(LPLS) # L7
LPLS426 TRAPEZIOUS FLAP (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
UNICORONAL CRANIOISTENOSIS
VAGINAL RECONSTRUCTION (LPLS)
# L7
LPLS429 VAGINAL REJUVINATION (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730
ZYGOMA WITH ORBITAL FLOOR ORIF
(LPLS) # L7
LCOS038 ABDOMINOPLASTY (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
ALOPECIA HAIR TSPT-MAJOR (LPLS)
# L8
ANAL SPINCHTER RECONSTRUCTION
(LPLS) # L8
ANEURYSMAL BONE CYST EXCISION
LPLS433 AND RECONOSTRUCTION (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
# L8
ANGIOFIBROMA EXCISION (LPLS)
# L8
AQUIRED CRANIAL DEFECT
MAJOR (LPLS) # L8
ARTHROPLASTY MULTIPLE JOINTS
(LPLS) # L8
AUGMENTATION RHINOPLASTY WITH
BONE GRAFT (LCOS) # L8
AURICLE TOTAL LOSS
LPLS438 RECONSTRUCTION LONG (LPLS) # L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
L8
BLEPHAROPLASTY BILATERAL
(LCOS) # L8
BONE GRAFT VASCULARISED (LPLS)
# L8
BRACHIAL PLEXUS NERVE REPAIR
(LPLS) # L8
BRACHIAL PLEXUS TRANSFER -
MUSCLE (LPLS) # L8
BRACHIOPLASTY - BILATERAL
(LCOS) # L8
208
Plastic Surgery
Surgery Billing
Level Group
BREAST RECONSTRUCTION MAJOR
(LPLS) # L8
LPLS443 BROW LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS444 CLEFT LIP & PALATE (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
CRANIAL VAULT REMODELLING
(LPLS) # L8
CRANIOFACIAL CLEFTS
LPLS446 MICROSOMIA CORRECTION (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
# L8
LPLS448 CRANIOPLASTY ACRYLIC (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
CRANIOPLASTY WITH BONE GRAFT
(LPLS) # L8
CRITICAL REVASCULARISATION
(LPLS) # L8
DEGLOVING INJURIES OF LIMBS &
RECONS. SUPRA (LPLS) # L8
DISTRACTION OSTEOGENESIS FACE
(LPLS) # L8
ENCEPHACOCELE SURGERY (LPLS)
# L8
LCOS043 FACE LIFT REGULAR (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
FACIAL RECONSTRUCTION
LPLS453 (MODERATE/DOUBLE FLAP) (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
# L8
LPLS454 FOREHEAD LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS455 FREE FLAPS MINOR (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
FRONTO ORBITAL ADVANCEMENT
(LPLS) # L8
FUNCTIONAL MUSCLE TRANSFER
(LPLS) # L8
GENIOPLASTY WITH OSTEOTOMY
(LPLS) # L8
GLOBAL PLEXES NEUOLYSIS (LPLS)
# L8
GLUTEAL LATERAL & MED. THIGH
PLASTY MAJOR (LPLS) # L8
LPLS461 HAND INJURY COMPLEX (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
HAND RECONSTRUCTION + FLAP
(LPLS) # L8
INTRAVELARVELOPLASTY (LPLS)
# L8
LPLS464 KARAPANDZIC FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS465 LATERAL ARM FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS466 LATERAL THIGH FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
209
Plastic Surgery
Surgery Billing
Level Group
LATTISMUSS DORSI FLAP (LPLS)
# L8
LIMB RECONSTRUCTION + GRAFT
(LPLS) # L8
LIMB REVASCULIRAZATION (LPLS)
# L8
LPLS470 LIPO FILL LARGE AREA (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LIPOSCULPTURE MAJOR (LCOS) #
L8
LIPOSUCTION MAJOR (4-6 LTS)
(LPLS) # L8
LOCAL ONCOPLASTY BILATERAL
(LPLS) # L8
LOCAL ONCOPLASTY LEVEL III (OVER
# L8
LOWER LIMB RECONSTRUCTION
BONE TRANSFER/FC FLAPS WITH
SSG/MUSCLE FLAPS WITH SSG
(LPLS) # L8
LYMPHOEDEMA SURGERY SUPRA
(LPLS) # L8
LCOS044 MASTOPEXY BILATERAL (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
FORT - III - BILATERAL (LPLS) # L8
MAXILLA RECONSTRUCTION MAJOR
(LPLS) # L8
LPLS478 ORTHOPLASTY MULTIPLE (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
# L8
MICROVASCULAR FLAP - MINOR
(LPLS) # L8
LPLS480 MID FACE LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
MILLARDS PROCEDURE BILATERAL
(LPLS) # L8
MUCOPERIOSTEAL FLAP FOR
SECONDARY PALATE (LPLS) # L8
MULTIPLE/ COMMUNITED MANDIBLE
FRACTURE (LPLS) # L8
MULTIPLE TENDON/ NERVE/ ARTERY
REPAIR (LPLS) # L8
NASAL RECONSTRUCTION SUPRA
(LPLS) # L8
NECK CONTRACTURE RELEASE WITH
FLAP (LPLS) # L8
LCOS064 NECK LIFT (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
210
Plastic Surgery
Surgery Billing
Level Group
LPLS487 NERVE GRAFT MULTIPLE (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
ORBITAL EXPANSION SURGERY
(LPLS) # L8
OSTEOTOMY ASSYMETRY
PECTORALIS MAJOR MYOCUTANEOS
FLAP WITH SSG (LPLS) # L8
LPLS491 POLANDS SYNDROME (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS492 POLLICIZATION (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
PRESSURE SORES
LPLS493 RECONSTRUCTION MAJOR (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
# L8
LPLS494 RADIAL FOREARM FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
RECONSTRUCTION OF BREAST WITH
LPLS495 AUTOGENOUS FLAPS - UNILATERAL L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
(LPLS) # L8
RECTUS ABDOMINUS FLAP (TRAM)
(LPLS) # L8
REDUCTION MAMMOPLASTY
LCOS046 RHYTIDECTOMY (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
SECONDARY CLEFT LIP AND NOSE
STERNUM RECONSTRUCTION (LPLS)
# L8
SUBCONDYLAR FRACTURE
SYNDACTYLY. COMPLICATED (LPLS)
# L8
LPLS502 TEMPORALIS FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
LPLS503 ANKYLOSIS RELEASE - BILATERAL L8 Surgery PLASTIC SURGERY 0 45010 53580 62150
(LPLS) # L8
THREADLIFT (3 OR MORE THREADS)
(LCOS) # L8
TOE TRANSFER COMPLETE (LPLS)
# L8
TONGUE RECONSTRUCTION (LPLS)
# L8
TRUNK RECONSTRUCTION MAJOR
(LPLS) # L8
VAGINAL RECONSTUCTION (LPLS)
# L8
VELO PHARYNGEAL INCOMPETANCE
211
Plastic Surgery
Surgery Billing
Level Group
VOLKMAN'S CONTRACTURE
AUGMENTATION MASTOPEXY (LCOS)
# L9
BLEPHAROPLASTY FOUR LIDS
(LCOS) # L9
LCOS050 BODY CONTOURING (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
BRACHIAL PLEXUS NERVE GRAFTING
(LPLS) # L9
BRACHIAL PLEXUS TRANSFER (LPLS)
# L9
BREAST AUGMENTATION WITH
IMPLANT BILATERAL (LCOS) # L9
CLEFT LIP COMPOSITE SECONDARY
NOSE CORRECTION (LPLS) # L9
CLEFT REPAIR - ALL IN ONE (LPLS)
# L9
LCOS052 COMPOSITE FACE LIFT (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
CORRECTIVE RHINOPLASTY (LCOS)
# L9
CRANIOFACIAL CLEFTS SYNOSTOSIS
(LPLS) # L9
CRANIOSTENOSIS CORRECTION -
MULTIPLE SUTURES (LPLS) # L9
LPLS516 DIEP FLAP (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
LCOS053 ENDOSCOPIC LIFT (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
LPLS517 FACIAL BIPARTITION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
FACIAL RECONSTRUCTION (MAJOR/
DOUBLE FLAP+SSG) (LPLS) # L9
FOREARM REPLANTATION (LPLS)
# L9
FOUR LID BLEPHEROPLASTY (LPLS)
# L9
FUNCTIONAL MUSCLE TRASFER
LPLS521 INCLUDING CLOSURE OF L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
SECONDARY DEFECT (LPLS) # L9
GENDER CHANGE SURGERY (LPLS)
# L9
HAND RECONSTRUCTION + GRAFT
+ FLAP (LPLS) # L9
LPLS524 HAND REPLANTATION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
HYPERTELORISM CORRECTION
(LPLS) # L9
LIMB RECONSTRUCTION + GRAFT +
FLAP (LPLS) # L9
212
Plastic Surgery
Surgery Billing
Level Group
LIPOABDOMINOPLASTY MAJOR
(LCOS) # L9
LIPOABDOMINOPLASTY MINI (LCOS)
# L9
LIPOABDOMINOPLASTY MINOR
(LCOS) # L9
LIPOBRACHIOPLASTY - BILATERAL
(LCOS) # L9
LIPOSUCTION (4 to 6 LTRS) (LCOS)
# L9
MANDIBLE RECONSTRUCTION
(LPLS) # L9
MEGA LIPOSUCTION ( > 6 LTRS)
(LCOS) # L9
MICROGNATHIA CORRECTION (LCOS)
# L9
MICROVASCULAR FLAP - MAJOR
(LPLS) # L9
OBESITY - LIPECTOMY - ANTERIOR
& POSTERIOR (LCOS) # L9
PAN FACIAL FRACTURE CORRECTION
(LPLS) # L9
PANFACIAL FRACTURE WITH SOFT
TISSUE CORRECTION (LPLS) # L9
PLAGIOCEPHALY COMPOSITE
LCOS059 PROFILOPLASTY MAJOR (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
REIMPLANTATION /
LPLS532 REVASCULARISATION MAJOR (LPLS) L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
# L9
RHINOPLASTY COMPOSITE (LCOS)
# L9
RHINOPLASTY SECONDARY (LCOS)
# L9
LPLS533 THUMB REPLANTATION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590
TOE TRANSFER SEGMENTAL (LPLS)
# L9
UPPER LIMB REPLANTATION (LPLS)
# L9
HAND RECONSTRUCTION
LPLS540 COMPOSITE (GRAFT+FLAP+SSG) L9 Surgery PLASTIC SURGERY 0 63010 75010 87020
(LPLS) # L9
PENILE RECONSTRUCTION (LPLS)
# L9
TRANSSEXUAL SURGERY (LPLS) #
L9
213
Plastic Surgery
Surgery Billing
Level Group
BREAST RECONSTRUCTION SUPRA
(LPLS) # L9
EXCISION WITH FREE FLAP (LPLS)
# L9
FACIAL RECONSTRUCTION COMPLEX
(LPLS) # L9
LPLS539 FREE FLAPS MAJOR (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450
LIMB RECONSTRUCTION
LPLS541 COMPOSITE (GRAFT+FLAP+SSG) L9 Surgery PLASTIC SURGERY 0 72020 85740 99450
(LPLS) # L9
MULTIPLE TOE TRANSFER (LPLS)
# L9
RECONSTRUCTION OF BREAST WITH
LPLS544 AUTOGENOUS FLAPS - BILATERAL L9 Surgery PLASTIC SURGERY 0 72020 85740 99450
(LPLS) # L9
214
ENT
215
ENT
Surgery Billing
Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL
Level Subgroup
FOLLOW UP CONSULTATION AFTER
PENT019 Procedure ENT 70 80 90 110
SPEECH THERAPY/VISIT
PENT035 PAEDIATRIC FREE FIELD ASSESSMENT Procedure ENT 110 110 130 160
PENT042 PURE TONE SCREENING TEST Procedure ENT 110 110 130 160
FOLLOWING UP FOR REHABILITATION &
ADVISE
HEARING AND ORIENTATION AND
COUNSELLING
PENT039 PROFESSIONAL HEARING AID TRIAL Procedure ENT 130 140 160 190
SPECIAL TEST FOR DIFFERENTIAL
DIAGNOSIS
PENT051 SPEECH DISCRIMINATION SCORE 3.7 Procedure ENT 130 140 160 190
SPEECH DISORDERS DIAGNOSIS &
CONSULTATION
PENT041 PURE TONE AUDIOLOGICAL EVALUATION Procedure ENT 200 210 250 290
PENT050 SPEECH ASSESSMENT 3.8 Procedure ENT 200 210 250 290
PENT053 SPEECH THERAPY FOR ADULT Procedure ENT 200 210 250 290
SPEECH THERAPY FOR CHILDREN (FIRST
5 SES
PENT056 STUD CHARGES Procedure ENT 200 210 250 290
PENT059 TRACHEOSTOMY TUBE CHANGE - ENT Procedure ENT 200 210 250 290
PENT011 DRESSING - MEDIUM - PENT Procedure ENT 220 230 280 320
PENT012 DRESSING - MINOR - PENT Procedure ENT 220 230 280 320
PENT040 PURE TONE AUDIOGRAM Procedure ENT 220 230 280 320
PENT047 SISI AND TONE DECAY Procedure ENT 220 230 280 320
SPEECH THERAPY PER SESSION OF 30-
40 MINUTES 3.9
PENT006 CAUTERISATION - PENT Procedure ENT 260 270 320 370
PENT057 SYRINGING 3.13 Procedure ENT 260 270 320 370
PENT016 EAR SYRINGE FOR ONE SIDE Procedure ENT 280 290 350 410
PENT028 IMMITANCE TESTING Procedure ENT 280 290 350 410
PENT060 ULTRASONIC SINOSCOPY Procedure ENT 280 290 350 410
PENT007 CHEMICAL CAUTERY OF THE NOSE Procedure ENT 340 360 420 490
PENT048 SPECIAL AUDIOLOGICAL TESTS Procedure ENT 340 360 420 490
PENT061 WASONCE SYNOSCOPY Procedure ENT 360 380 450 520
PENT068 Allergy Test Single Antigen Procedure ENT 370 390 460 540
PENT002 ANT NASAL PACKING Procedure ENT 420 440 520 610
PENT010 DRESSING - MAJOR Procedure ENT 420 440 520 610
PENT014 EAR LOBE REPAIR UNILATERAL Procedure ENT 420 440 520 610
PENT021 FOREIGN BODIES EAR - PENT Procedure ENT 420 440 520 610
216
ENT
Surgery Billing
Level Subgroup
PENT022 FOREIGN BODIES NOSE - PENT Procedure ENT 420 440 520 610
PENT044 REMOVAL OF FOREIGN BODY EAR Procedure ENT 420 440 520 610
PENT045 REMOVAL OF FOREIGN BODY NOSE Procedure ENT 420 440 520 610
MULTIPLE HEARING ASSESSMENT TEST
FOR ADULTS
PENT003 BILATERAL ANTRAL WASHOUT Procedure ENT 480 500 590 690
PENT023 HEARING AID ANALYSIS 3.6 Procedure ENT 480 500 590 690
PENT024 HEARING AID SELECTION 3.5 Procedure ENT 480 500 590 690
PENT029 IMPEDENCE AND OTHER TESTS Procedure ENT 480 500 590 690
INTRALESIONAL INJECTIONS FOR
KELOIDS
EXAMINATION AND SUCTION TOILET OF
EAR
PENT030 IMPEDENCE AUDIOMETRY Procedure ENT 500 520 620 720
PENT032 MYRINGOTOMY WITH GROMMET Procedure ENT 610 640 770 890
PENT017 ENG Procedure ENT 640 670 800 920
PENT026 HEARING SCREENING TEST Procedure ENT 640 670 800 920
PENT027 HOPKINGS Procedure ENT 640 670 800 920
PENT033 NASAL ENDOSCOPY Procedure ENT 640 670 800 920
PENT013 EAR LOBE REPAIR BILATERAL - PENT Procedure ENT 660 690 820 960
PENT015 EAR PIERCING Procedure ENT 660 690 820 960
PENT009 DIAGNOSTIC NASAL ENDOSCOPY - PENT Procedure ENT 680 720 850 990
PENT043 QUINSY DRAINAGE - I + D Procedure ENT 680 720 850 990
BRAINSTEM EVOKED RESPONSE
AUDIOMETER
BRAINSTEM EVOKED RESPONSE
AUDIOMETRY (BERA)
PENT038 POST NASAL PACKING Procedure ENT 1040 1090 1300 1510
PENT046 REPAIR EAR LOBE 3.12 Procedure ENT 1100 1150 1370 1590
PENT037 POLYP REMOVAL UNDER LA 3.14 Procedure ENT 1370 1440 1720 1990
PENT008 DIAGNOSTIC CAUTERY OF THE NOSE Procedure ENT 1510 1590 1890 2190
PENT034 NASOPHARYNGOSCOPY (FIBRE OPTIC) Procedure ENT 1510 1590 1890 2190
PERITONSILLAR ABSCESS DRAINAGE
UNDER LA
PENT067 VIDEONYSTAGMOGRAPHY - (VNG) Procedure ENT 2740 2880 3430 3970
PENT069 Allergy Test Package 10 Antigens Procedure ENT 3480 3650 4350 5040
PENT058 THYROPLASTY Procedure ENT 4100 4300 5120 5940
PENT126 Surflink Remote Procedure ENT 10240 10750 12800 14850
PENT070 Allergy Test Package 35 Antigens Procedure ENT 12170 12780 15210 17650
217
ENT
Surgery Billing
Level Subgroup
PENT119 Aries -4 Procedure ENT 15300 16060 19120 22180
PENT123 Aries PRO-4 Procedure ENT 17600 18480 22000 25520
PENT127 Surflink Remote microphone Procedure ENT 20700 21740 25880 30020
PENT072 Audibel A4 Gold Procedure ENT 27030 28380 33790 39190
PENT125 Surflink Media Procedure ENT 31630 33210 39540 45860
PENT112 Start 5 Procedure ENT 36230 38040 45290 52530
PENT124 Surflink Mobile 2 Procedure ENT 36230 38040 45290 52530
PENT071 Audibel A4 Platinum Procedure ENT 38530 40460 48160 55870
PENT115 Start 7 Tinnitus Procedure ENT 40250 42270 50320 58370
PENT114 Start 8 Tinnitus Procedure ENT 46000 48300 57500 66700
PENT087 Start 5-A Procedure ENT 48300 50720 60380 70040
PENT080 Start 9 wireless Procedure ENT 70150 73660 87690 101720
PENT086 Start 6-A Procedure ENT 74750 78490 93440 108390
PENT085 Start i1000 Procedure ENT 80500 84530 100630 116730
PENT075 Start wireless 1000 Procedure ENT 80500 84530 100630 116730
PENT110 Anthem XT Silver Procedure ENT 103500 108680 129380 150080
PENT113 Audibel A2 gold tinnitus Procedure ENT 113850 119550 142320 165090
PENT105 Audibel A2 Silver Procedure ENT 115000 120750 143750 166750
PENT097 Anthem XT Silver-3 Procedure ENT 120750 126790 150940 175090
PENT084 Start i1200 Procedure ENT 120750 126790 150940 175090
PENT074 Start wireless 1200 Procedure ENT 120750 126790 150940 175090
PENT100 Audibel A4 Silver-1 Procedure ENT 132250 138870 165320 191770
PENT078 Audibel A3 wireless Silver Procedure ENT 138000 144900 172500 200100
PENT094 Audibel A2 Silver-3 Procedure ENT 144900 152150 181130 210110
PENT091 Pro-1 Procedure ENT 163300 171470 204130 236790
PENT083 Audibel A4i Silver Procedure ENT 166750 175090 208440 241790
218
ENT
Surgery Billing
Level Subgroup
PENT073 Audibel A4 Silver Procedure ENT 166750 175090 208440 241790
PENT109 Anthem XT Gold Procedure ENT 181700 190790 227130 263470
PENT104 Audibel A2 Gold Procedure ENT 201250 211320 251570 291820
PENT096 Anthem XT Gold-2 Procedure ENT 218500 229430 273130 316830
PENT099 Audibel A4 Gold-1 Procedure ENT 224250 235470 280320 325170
PENT077 Audibel A3 wireless Gold Procedure ENT 235750 247540 294690 341840
PENT093 Audibel A2 Gold-2 Procedure ENT 241500 253580 301880 350180
PENT082 Audibel A4i Gold Procedure ENT 270250 283770 337820 391870
PENT108 Anthem XT Platinum Procedure ENT 272550 286180 340690 395200
PENT090 Pro Procedure ENT 276000 289800 345000 400200
PENT103 Audibel A2 Platinum Procedure ENT 302450 317580 378070 438560
PENT095 Anthem XT Platinum-1 Procedure ENT 304750 319990 380940 441890
PENT098 Audibel A4 Platinum-1 Procedure ENT 322000 338100 402500 466900
PENT092 Audibel A2 Platinum -1 Procedure ENT 339250 356220 424070 491920
PENT076 Audibel A3 wireless Platinum Procedure ENT 345000 362250 431250 500250
PENT089 Premium-1 Procedure ENT 362250 380370 452820 525270
PENT081 Audibel A4i Platinum Procedure ENT 385250 404520 481570 558620
PENT088 Premium Procedure ENT 419750 440740 524690 608640
LENT001 ANTERIOR NASAL PACKING (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
LENT002 BIOPSY LESION EAR (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
LENT003 BIOPSY LESION NOSE (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
LENT004 BIOPSY LESION THROAT (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
EAR LOBE REPAIR UNILATERAL (SENT)
LENT005 L1 Surgery ENT SURGERY 4290 4500 5360 6220
# L1
EUM EARS & SUCTION CLEARANCE OF
WAX (ENT) # L1
LENT008 I & D FURUNCLE : EAR / NOSE (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
LENT007 I & D NECK ABSCESS (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220
I & D PERITONSILLAR ABSCESS (ENT)
# L1
MYRINGOTOMY - UNILATERAL (ENT) #
L1
POST NASAL SURGERY BLEEDING
LENT012 FOLLOWING INHOUSE NASAL SURGERY L1 Surgery ENT SURGERY 4290 4500 5360 6220
(ENT) # L1
POST TONSILLECTOMY BLEEDING
LENT011 FOLLOWING INHOUSE TONSILLECTOMY/ L1 Surgery ENT SURGERY 4290 4500 5360 6220
ADENOIDECTOMY (ENT) # L1
DIAGNOSTIC NASAL ENDOSCOPY AS
SOLE PROCEDURE (ENT) # L1
219
ENT
Surgery Billing
Level Subgroup
ADENOIDECTOMY CURETTAGE (ENT) #
L2
ANTERIOR & POSTERIOR NASAL
PACKING (ENT) # L2
LENT015 ANTRAL WASH OUT (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
LENT016 AURAL POLYPECTOMY (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
DIRECT LARYNGOSCOPY /
LENT018 PHARYNGOSCOPY WITH/WITHOUT L2 Surgery ENT SURGERY 0 8240 9810 11380
BIOPSY (ENT) # L2
LENT019 EAR LOBE REPAIR: BILATERAL (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
ENDOSCOPIC CAUTERY FOR EPISTAXIS
(ENT) # L2
EUM & CLEARANCE OF KERATOSIS
OBTURANS (ENT) # L2
EXCISION BIOPSY CERVICAL LYMPH
NODE (ENT) # L2
LENT031 FOREIGN BODY EAR (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
LENT030 FOREIGN BODY NOSE (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
LENT022 I & D HAEMATOMA AURIS (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
I & D MASTOID ABSCESS /
PREAURICULAR ABSCESS (ENT) # L2
I & D SEPTAL HAEMATOMA / ABSCESS
(ENT) # L2
INTRATYMPANIC GENTAMICIN / STEROID
INJECTION (ENT) # L2
LENT026 MYRINGOTOMY - BILATERAL (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
LENT032 NASOLABIAL CYST EXCISION (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
NASOPHARYNGOSCOPY (ENDOSCOPIC)
& BIOPSY (ENT) # L2
PARTIAL TRIMMING TURBINATES (ENT)
# L2
RADIOFREQUENCY TURBINOPLASTY
(ENT) # L2
LENT029 TONGUE TIE RELEASE (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380
ADENOIDECTOMY MICRODEBRIDER /
COBLATION ASSISSTED (ENT) # L3
DIAGNOSTIC BRONCHOSCOPY (ENT) #
L3
EUM MYRINGOTOMY & GROMMET
INSERTION (ENT) # L3
LENT037 EXCISION LESION PINNA (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940
FESS : MINOR ( UNCINECTOMY, MMA,
ANT ETHMOIDECTOMY) (ENT) # L3
220
ENT
Surgery Billing
Level Subgroup
LENT038 FOREIGN BODY PHARYNX (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940
FRACTURE NASAL BONES REDUCTION
(ENT) # L3
LENT040 I & D LUDWIGS ANGINA (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940
I & D PARAPHARYNGEAL /
LENT041 RETROPHARYNGEAL ABSCESS (ENT) # L3 Surgery ENT SURGERY 0 10820 12880 14940
L3
INTRANASAL ANTROSTOMY INCLUDING
ENDOSCOPIC AND BILATERAL (ENT) # L3
MICROLARYNGOSCOPY & BIOPSY (ENT)
# L3
NASAL POLYPECTOMY - BILATERAL
(INCLUDING ENDOSCOPIC) (ENT) # L3
LENT051 OESOPHAGEAL DILATATION (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940
OESOPHAGOSCOPY DIAGNOSTIC
INCLUDING BIOPSY (ENT) # L3
REVISION LARYNGOTRACHEOPLASTY
(ENT) # L3
SUBMANDIBULAR SALIVARY DUCT
CALCULUS REMOVAL (ENT) # L3
UVULOPLASTY / RADIOFREQ TO PALATE
& OROPHARYNX (ENT) # L3
ADENOIDECTOMY + GROMMET
LENT074 ADENOTONSILLECTOMY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
BRONCHOSCOPY FOR REMOVAL OF
FOREIGN BODY (ENT) # L4
LENT052 CALDWELL LUC OPERATION (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
CLOSURE OROANTRAL FISTULA (ENT)
# L4
CRICOPHARYNGEAL MYOTOMY (ENT)
# L4
EXCISION BENIGN TUMOUR NECK (ENT)
# L4
EXCISION LESION BUCCAL MUCOSA
(ENT) # L4
EXCISION PREAURICULAR SINUS (ENT)
# L4
LENT059 EXCISION RANULA (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
FESS : INTER (MINOR + POLYPECTOMY
+ POST ETHMOIDECTOMY) (ENT) # L4
FRACTURE REDUCTION MAXILLA/
ZYGOMA (ENT) # L4
LENT062 FRONTAL SINUS TREPHINE (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
221
ENT
Surgery Billing
Level Subgroup
MEATOPLASTY: BONY AND
CARTILAGINOUS (ENT) # L4
MICROLARYNGOSCOPY & EXCISION
LESION (ENT) # L4
MICROLARYNGOSCOPY & STRIPPING
(ENT) # L4
LENT066 MYRINGOPLASTY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
NASAL POLYPECTOMY + ANTRAL WASH
OUT (BILATERAL) (ENT) # L4
OESOPHAGOSCOPY DIAGNOSTIC
LENT055 INCLUDING FOREIGN BODY REMOVAL L4 Surgery ENT SURGERY 0 14790 17610 20420
(ENT) # L4
LENT076 SEPTOPLASTY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
SUBMUCOUS RESECTION OF NASAL
SEPTUM (ENT) # L4
TONSILLECTOMY : COBLATION
ASSISSTED (ENT) # L4
TONSILLECTOMY : DISSECTION TECH
(ENT) # L4
LENT071 TRACHEOSTOMY (SENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
LENT077 TYMPANOPLASTY : TYPE 1 (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
LENT072 TYMPANOTOMY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420
ADENOTONSILLECTOMY + GROMMET
LENT078 BALOON SINUPLASTY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
BRANCHIAL CYST/FISTULA EXCISION
(ENT) # L5
LENT101 CHOANAL ATRESIA REPAIR (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
LENT080 CORTICAL MASTOIDECTOMY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
FACIAL NERVE DECOMPRESSION (ENT)
# L5
LENT103 FESS + ADENOIDECTOMY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
FESS: MAJOR (INTER + SPHENOID &
FRONTAL SINUS SURGERY) (ENT) # L5
FESS + TURBINATE REDUCTION (ENT)
# L5
GLOMUS TYMPANICUM EXCISION (ENT)
# L5
I & D LUDWIGS ANGINA +
TRACHEOSTOMY (ENT) # L5
INJECTION FOR VOCAL CORD
MEDIALIZATION (ENT) # L5
LARYNGOFISSURE & EXCISION LESION
(ENT) # L5
222
ENT
Surgery Billing
Level Subgroup
LENT083 LARYNGOMALACIA SURGERY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
LARYNGOTRACHEOPLASTY & T - TUBE
LASER ARYTENOIDECTOMY / PARTIAL
CORDECTOMY (ENT) # L5
LASER LARYNGEAL AND TRACHEAL
SURGERIES (ENT) # L5
MICROLARYNGOSCOPY & KEEL
MICROLARYNGOSCOPY & LASER
SURGERY (ENT) # L5
PANENDOSCOPY & BIOPSY (ONS) (ENT)
# L5
POST NASAL SURGERY BLEEDING RE-
EXPLORATION (ENT) # L5
POST TONSILLECTOMY/
LENT090 ADENOIDECTOMY BLEEDING RE- L5 Surgery ENT SURGERY 0 18010 21440 24870
EXPLORATION (ENT) # L5
LENT092 RHINOPHYMA EXCISION (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
SEPTOPLASTY + TURBINATE REDUCTION
(ENT) # L5
SPHENOPALATINE ARTERY CLIPPING /
CAUTERY (ENT) # L5
SUBMANDIBULAR SALIVARY GLAND
EXCISION (ENT) # L5
SUTURE LATERALISATION OF VOCAL
CORD (ENT) # L5
THYROGLOSSAL CYST/FISTULA
EXCISION (ENT) # L5
LENT084 TONSILLECTOMY LASER (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
TRACHEO OESOPHAGEAL PUNCTURE &
VOICE PROSTHESIS (ENT) # L5
TRACHEOSTOMY FOR STRIDOR (ENT)
# L5
LENT099 YOUNGS OPERATION (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870
LENT113 GLOSSECTOMY PARTIAL (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980
LENT120 PARTIAL GLOSSECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980
LENT128 THYROID ISTHMECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980
LENT129 THYROID LOBECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980
BALOON DILATATION OF AIRWAY
LENT110 STENOSIS INCLUDING BRONCHOSCOPY L6 Surgery ENT SURGERY 0 27010 32150 37290
(ENT) # L6
223
ENT
Surgery Billing
Level Subgroup
BONE ANCHORED HEARING AID (BAHA)
(ENT) # L6
ENDOSCOPIC
DACRYOCYSTORHINOSTOMY INCLUDING
INSERTION AND LATER REMOVAL OF
TUBE (ENT) # L6
ENDOSCOPIC FRONTO SPHENO
ETHMOIDECTOMY (ENT) # L6
LENT130 FESS + CALDWELL LUC OP (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
LENT131 FESS + SEPTOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
LATERAL PHARYNGOTOMY AND
PROCEED (ENT) # L6
LATERAL RHINOTOMY AND MEDIAL
MAXILLECTOMY (ENT) # L6
MANDIBULECTOMY: SEGMENTAL / HEMI
(ENT) # L6
LENT118 MASTOID TYMPANOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
LENT119 OPEN RHINOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
LENT132 OSSICULOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
PHARYNGEAL POUCH EXCISION (ENT)
# L6
LENT122 PINNAPLASTY / OTOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
RHINOPLASTY : REDUCTION /
AUGMENTATION (ENT) # L6
LENT133 SEPTORHINOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
SPHENOPALATINE + ETHMOIDAL
ARTERY CLIPPING (ENT) # L6
LENT125 STAPEDECTOMY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
LENT126 STYLOID PROCESS EXCISION (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290
THYROPLASTY TECHNIQUES (1-4) (ENT)
# L6
UVULO PALATO
LENT127 PHARYNGOPLASTY(UVP3) + L6 Surgery ENT SURGERY 0 27010 32150 37290
TONSILLECTOMY (ENT) # L6
ENDOSCOPIC PITUITARY SURGERY (SS)
(ENT) # L7
FACIAL NERVE DECOMPRESSION
INCLUDING GRAFTING (SS) (ENT) # L7
SUPERFICIAL PAROTIDECTOMY (SS)
(ENT) # L7
TEMPORAL BONE RESECTION: PARTIAL
(SS) (ENT) # L7
TEMPORAL BONE RESECTION :
SUBTOTAL (SS) (ENT) # L7
224
ENT
Surgery Billing
Level Subgroup
TOTAL THYROIDECTOMY FOR TUMORS
(SS) (ENT) # L7
COMBINED APPROACH TYMPANOPLASTY
LENT143 - INTACT CANAL WALL TYMPANOPLASTY L7 Surgery ENT SURGERY 0 36010 42870 49730
(ENT) # L7
ENDOLYMPHATIC SAC SURGERY (ENT)
# L7
ENDOSCOPIC ORBITAL DECOMPRESSION
(ENT) # L7
FRONTAL SINUS OSTEOPLASTIC /
OBLITERATION SURGERY (ENT) # L7
GLOMUS JUGULARE EXCISION (ENT) #
L7
LENT137 LABYRINTHECTOMY (ENT) # L7 L7 Surgery ENT SURGERY 0 36010 42870 49730
MODIFIED RADICAL MASTOIDECTOMY
INCLUDING MEATOPLASTY (ENT) # L7
RADICAL MASTOIDECTOMY INCLUDING
MEATOPLASTY (ENT) # L7
SURGERY FOR SLEEP APNOEA: NASAL
SURGERY + UVP3 (ENT) # L7
(ENT) # L8
PARTIAL CRICOTRACHEAL RESECTION
(SS) (ENT) # L8
PARTIAL LARYNGECTOMY (HORIZONTAL
/ VERTICAL) (SS) (ENT) # L8
RADICAL MAXILLECTOMY (SS) (ENT) #
L8
RADICAL / MODIFIED RADICAL NECK
DISSECTION (SS) (ENT) # L8
LENT162 COMPLETION THYROIDECTOMY (SS) L8 Surgery ENT SURGERY 0 38580 45930 53280
(ENT) # L8
THYROIDECTOMY FOR RETROSTERNAL
EXTENSION (SS) (ENT) # L8
LENT159 TOTAL LARYNGECTOMY (SS) (ENT) # L8 L8 Surgery ENT SURGERY 0 38580 45930 53280
LENT160 TOTAL MAXILLECTOMY (SS) (ENT) # L8 L8 Surgery ENT SURGERY 0 38580 45930 53280
MALIGNANCY + CENTRAL
COMPARTMENT LYMPHNODE
TRACHEAL RESECTION & ANASTOMOSIS
(SS) (ENT) # L8
COCHLEAR IMPLANT SURGERY (ENT)
# L8
LENT150 CSF OTORRHOEA REPAIR (ENT) # L8 L8 Surgery ENT SURGERY 0 45010 53580 62150
225
ENT
Surgery Billing
Level Subgroup
LENT151 CSF RHINORRHOEA REPAIR (ENT) # L8 L8 Surgery ENT SURGERY 0 45010 53580 62150
ENDOSCOPIC OPTIC NERVE
DECOMPRESSION (ENT) # L8
LARYNGOTRACHEOPLASTY WITH RIB
GRAFT (ENT) # L8
LENT167 COMMANDO OPERATION (SS) (ENT) # L9 L9 Surgery ENT SURGERY 0 46300 55120 63930
CRANIOFACIAL RESECTION (SS) (ENT)
# L9
EXTENDED CRICOTRACHEAL RESECTION
& ANASTOMOSIS (SS) (ENT) # L9
GLOSSECTOMY TOTAL + NECK
LARYNGOPHARYNGECTOMY + NECK
MAXILLECTOMY + ORBITAL
EXENTERATION (SS) (ENT) # L9
PARAPHARYNGEAL TUMOUR EXCISION
(SS) (ENT) # L9
PAROTIDECTOMY + NECK DISSECTION
(SS) (ENT) # L9
RADICAL PAROTIDECTOMY (SS) (ENT)
# L9
MALIGNANCY + UNILATERAL
(ENT) # L9
ACOUSTIC NEUROMA EXCISION (ENT)
# L9
ENDOSCOPIC LOTHROP OP/ DRAF 111
(ENT) # L9
NASOPHARYNGEAL ANGIOFIBROMA
EXCISION (ENT) # L9
226
Ophthalmology
227
Ophthalmology
Surgery
Level
OPTHALMOLOGY
KOPT012 VITRECTOMY - A - PKG - DC Package 0 23430 27890 32350
PACKAGE
OPTHALMOLOGY
KOPT051 ECCE + PC IOL - PACKAGE - IP Package 0 35260 41980 48700
PACKAGE
OPTHALMOLOGY
KOPT049 SICS + PC IOL - PACKAGE - IP Package 0 35260 41980 48700
PACKAGE
DAY CARE CATARACT- REVISED OPTHALMOLOGY
KOPT058 Package 0 39130 46580 54030
PACKAGE PACKAGE
OPTHALMOLOGY
KOPT037 ECCE + PC IOL - PACKAGE - DC Package 0 40460 48160 55870
PACKAGE
OPTHALMOLOGY
KOPT013 VITRECTOMY - B - PKG - DC Package 0 41060 48880 56700
PACKAGE
PHOTODYNAMIC ONE EYE without DYE OPTHALMOLOGY
KOPT027 Package 0 41780 49740 57700
- PACKAGE PACKAGE
OPTHALMOLOGY
KOPT035 SICS + PC IOL - PACKAGE - DC Package 0 41910 49890 57870
PACKAGE
OPTHALMOLOGY
KOPT039 PHACO SURGERY - PACKAGE - IP Package 0 42990 51180 59370
PACKAGE
OPTHALMOLOGY
KOPT043 MICS CATARACT PACKAGE - IP Package 0 47580 56640 65700
PACKAGE
OPTHALMOLOGY
KOPT014 VITRECTOMY - C - PKG - DC Package 0 47580 56640 65700
PACKAGE
OPTHALMOLOGY
KOPT011 DAY CARE CATARACT- PACKAGE - DC Package 0 52290 62250 72210
PACKAGE
OPTHALMOLOGY
KOPT047 ICL SPHERICAL - PACKAGE - IP Package 0 52770 62820 72870
PACKAGE
TRABECULECTOMY AND PHACO OPTHALMOLOGY
KOPT042 Package 0 52770 62820 72870
PACKAGE - IP PACKAGE
OPTHALMOLOGY
KOPT048 ICL TORIC - PACKAGE - IP Package 0 56760 67570 78380
PACKAGE
OPTHALMOLOGY
KOPT034 INTRAVITREOUS LUCENTIS INJECTION Package 0 56760 67570 78380
PACKAGE
OPTHALMOLOGY
KOPT015 VITRECTOMY - D - PKG - DC Package 0 57360 68290 79210
PACKAGE
OPTHALMOLOGY
KOPT017 TORIC CATARACT PACKAGE - DC Package 0 60020 71450 82880
PACKAGE
OPTHALMOLOGY
KOPT021 VITRECTOMY & CATARACT PACKAGE Package 0 61350 73030 84710
PACKAGE
TRABECULECTOMY AND PHACO OPTHALMOLOGY
KOPT018 Package 0 63520 75620 87720
PACKAGE - DC PACKAGE
OPTHALMOLOGY
KOPT056 VITRECTOMY - D - PKG - IP Package 0 63880 76050 88220
PACKAGE
OPTHALMOLOGY
KOPT016 MFL CATARACT PACKAGE - DC Package 0 67020 79790 92550
PACKAGE
OZURDEX INJECTION PROCEDURE - PKG OPTHALMOLOGY
KOPT023 Package 0 86940 103500 120060
- DC PACKAGE
228
Ophthalmology
Surgery
Level
OPTHALMOLOGY
KOPT059 Intravitreal Eylea Package 0 99540 118500 137460
PACKAGE
CHALAZION OPERATION DRESSING -
POPT009 Procedure OPTHALMOLOGY 110 110 130 160
OPT
POPT025 IOP ONLY Procedure OPTHALMOLOGY 130 140 160 190
POPT026 LACRIMAL SAC SYRINGING Procedure OPTHALMOLOGY 140 150 180 210
POPT039 ORTHO-OPTIC CHECK UP 4.7 Procedure OPTHALMOLOGY 140 150 180 210
POPT049 PLEPOPTIC EXERCISES 4.9 Procedure OPTHALMOLOGY 140 150 180 210
POPT052 REFRACTION/FUNDOSCOPY 4.6 Procedure OPTHALMOLOGY 140 150 180 210
SUB CONJUNCTIVAL/SUB TENON'S
RETROBULBEA
POPT066 SUCTION CUP Procedure OPTHALMOLOGY 200 210 250 290
CAUTERISATION OF ULCER / ONE EYE
4.1.1
GONIOSCOPY OR 3 MIRROR
EXAMINATION
POPT040 ORTHO-OPTIC EXERCISES 4.8 Procedure OPTHALMOLOGY 220 230 280 320
POPT059 SUTURE REMOVAL & DRESSING - OPT Procedure OPTHALMOLOGY 220 230 280 320
SYRINGING OF LACRIMAL SAC ONE EYE
4.3.1
POPT019 FOREIGN BODY REMOVAL 4.5 Procedure OPTHALMOLOGY 260 270 320 370
POPT051 REFRACTION ONLY Procedure OPTHALMOLOGY 280 290 350 410
DS0010 Fundus fluorescence angiography Procedure OPTHALMOLOGY 290 310 360 420
POPT043 PERIMETRY FIELD TEST 4.10 Procedure OPTHALMOLOGY 320 330 390 460
POPT053 REMOVAL OF CORNEAL FOREIGN BODY Procedure OPTHALMOLOGY 320 330 390 460
POPT055 RETROBULAR INJECTION ONE EYE 4.2 Procedure OPTHALMOLOGY 320 330 390 460
CAUTERISATION OF ULCER BOTH EYES
4.1.2
POPT020 FUNDUS PHOTOGRAPHS Procedure OPTHALMOLOGY 340 360 420 490
SYRINGING OF LACRIMAL SAC BOTH
EYES 4.3.2
POPT018 FOLLOW-UP EXAMINATION Procedure OPTHALMOLOGY 420 440 520 610
POPT056 SPECULAR MICROSCOPY Procedure OPTHALMOLOGY 420 440 520 610
POPT012 CONTACT LENS FOLLOW-UP Procedure OPTHALMOLOGY 450 480 570 660
POPT041 PACHYMETRY Procedure OPTHALMOLOGY 450 480 570 660
RETROBULAR INJECTION BOTH EYES
4.2.2
POPT042 PARACENTESIS 4.4 Procedure OPTHALMOLOGY 520 550 650 760
POPT050 POST OPERATIVE OPTHAL KIT Procedure OPTHALMOLOGY 590 620 740 860
POPT064 WART EXCISION Procedure OPTHALMOLOGY 590 620 740 860
229
Ophthalmology
Surgery
Level
CHALAZION OPERATION BOTH EYES
4.11.2
POPT013 CORNEAL TOPOGRAPHY Procedure OPTHALMOLOGY 680 720 850 990
POPT082 DRESSING (OPTHAL) Procedure OPTHALMOLOGY 690 730 870 1010
POPT010 CHALAZION OPERATION ONE EYE 4.11 Procedure OPTHALMOLOGY 760 800 950 1110
POPT014 ELECTROLYSIS Procedure OPTHALMOLOGY 760 800 950 1110
POPT057 SQUINT INVESTIGATION Procedure OPTHALMOLOGY 760 800 950 1110
POPT011 CONTACT LENS FITTING & REFRACTION Procedure OPTHALMOLOGY 820 860 1030 1190
POPT001 A SCAN BIOMETRY Procedure OPTHALMOLOGY 960 1010 1200 1390
POPT063 VISUAL FIELD PERIMETRY (PER EYE) Procedure OPTHALMOLOGY 1100 1150 1370 1590
POPT002 ABERROMETRY Procedure OPTHALMOLOGY 1180 1240 1470 1710
POPT004 B SCAN ULTRA SONOGRAPHY Procedure OPTHALMOLOGY 1180 1240 1470 1710
ARTIFICIAL EYE PROSTHESIS (INCLUDING
PROSTHESIS)
POPT083 WOUND DEBRIDEMENT (OPTHAL) Procedure OPTHALMOLOGY 1270 1330 1590 1840
POPT072 OP TRICORT PROCEDURE Procedure OPTHALMOLOGY 1370 1440 1720 1990
POPT007 CHALAZION I & C Procedure OPTHALMOLOGY 1650 1730 2060 2390
OPTICAL COHERENCE TOMOGRAPHY-
(F/U SCAN)
ARTIFICAL EYE PROSTHESIS FITTING/
CONFORMER
POPT031 LASIK DIAGNOSTIC TEST Procedure OPTHALMOLOGY 2190 2300 2740 3170
POPT065 YAG LASER PROCEDURE Procedure OPTHALMOLOGY 2190 2300 2740 3170
(1-EYE)
POPT035 LIO FOCAL Procedure OPTHALMOLOGY 2470 2590 3080 3570
POPT015 EQUIPMENT CHRGES FOR PHACO Procedure OPTHALMOLOGY 2870 3010 3580 4160
POPT081 Botox injetion (one side) Procedure OPTHALMOLOGY 2880 3020 3600 4170
POPT077 EPILATION / INJECTIONS/ FB REMOVAL Procedure OPTHALMOLOGY 2880 3020 3600 4170
POPT076 EXCISION/I & D OF EYE LID LESION Procedure OPTHALMOLOGY 2880 3020 3600 4170
POPT075 SUTURING/ CRYO /CAUTERY Procedure OPTHALMOLOGY 2880 3020 3600 4170
POPT078 TUBE /IMPLANT REMOVAL Procedure OPTHALMOLOGY 2880 3020 3600 4170
POPT017 FFA Procedure OPTHALMOLOGY 3140 3300 3930 4560
POPT027 LASER (PER EYE/PER SITTING) Procedure OPTHALMOLOGY 3970 4170 4960 5760
POPT079 CANTHOTOMY Procedure OPTHALMOLOGY 4030 4230 5040 5840
POPT016 EQUIPMENT CHRGES FOR VITRECTOMY Procedure OPTHALMOLOGY 4240 4450 5290 6140
(2-EYES)
POPT029 LASER ROP FOR Procedure OPTHALMOLOGY 4510 4740 5640 6540
230
Ophthalmology
Surgery
Level
POPT044 PHACOEMULSIFICATION Procedure OPTHALMOLOGY 5610 5890 7010 8130
CT / MR DCG (Includes injecting the dye
in the Radiology Department)
POPT030 LASER ROP PACKAGE (PER EYE) Procedure OPTHALMOLOGY 6700 7030 8370 9710
POPT073 ICG ANGIOGRAPHY Procedure OPTHALMOLOGY 7460 7830 9320 10810
INTRAVITREAL TRIAMCINOLONE
INJECTION - POPT
POPT028 LASER PACKAGE (PER EYE) Procedure OPTHALMOLOGY 11210 11770 14010 16250
POPT068 INTRAVITREAL AVASTIN INJECTION - C Procedure OPTHALMOLOGY 12850 13490 16060 18630
POPT062 TRANSPUPILLARY THERMOTHERAPY Procedure OPTHALMOLOGY 12850 13490 16060 18630
POPT067 INTRAVITREAL AVASTIN INJECTION - B Procedure OPTHALMOLOGY 17760 18650 22200 25750
POPT024 INTRAVITREAL AVASTIN INJECTION (A) Procedure OPTHALMOLOGY 22540 23670 28180 32690
POPT022 INTRAVITREAL LUCENTIS INJECTION Procedure OPTHALMOLOGY 23910 25110 29890 34670
LASIK SURGERY SPECIAL SCHEME (ONE OPTHALMOLOGY
POPT033 Procedure 23230 24400 29040 33690
EYES) LASIK
OPTHALMOLOGY
POPT071 LASIK SURGERY STANDARD (ONE EYE) Procedure 31420 32990 39280 45560
LASIK
LASIK TREATMENT CUSTOMISED (ONE OPTHALMOLOGY
POPT070 Procedure 36900 38740 46120 53500
EYE) LASIK
LASIK SURGERY SPECIAL SCHEME OPTHALMOLOGY
POPT032 Procedure 46450 48780 58070 67360
(BOTH EYES) LASIK
OPTHALMOLOGY
POPT034 LASIK SURGERY (BOTH EYES) Procedure 54650 57390 68310 79240
LASIK
LASIK TREATMENT CUSTOMISED (BOTH OPTHALMOLOGY
POPT069 Procedure 65580 68860 81970 95090
EYES) LASIK
Cauterisation including cryotherapy to OPTHALMOLOGY
LOPT001 L1 Surgery 4290 4500 5360 6220
conjunctival lesion (OPT) # L1 SURGERY
OPTHALMOLOGY
LOPT002 Chalazion - Single (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Conformer/ shell fitting under GA (OPT) OPTHALMOLOGY
LOPT003 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
OPTHALMOLOGY
LOPT004 Corneal scraping for culture (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
OPTHALMOLOGY
LOPT005 Drainage of conjunctival cyst (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
OPTHALMOLOGY
LOPT006 Drainage of lesion of eyelid (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Electro epilation (Single eyelid) (OPT) OPTHALMOLOGY
LOPT016 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
OPTHALMOLOGY
LOPT007 Endoscopic Evaluation (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
EXAMINATION UNDER ANESTHESIA (OPT) OPTHALMOLOGY
LOPT019 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
231
Ophthalmology
Surgery
Level
Excision of lesion of eyelid - small (< 5 OPTHALMOLOGY
LOPT008 L1 Surgery 4290 4500 5360 6220
MM) (OPT) # L1 SURGERY
Exploration of conjunctiva (including OPTHALMOLOGY
LOPT017 L1 Surgery 4290 4500 5360 6220
removal of foreign body) (OPT) # L1 SURGERY
OPTHALMOLOGY
LOPT020 FORCED DUCTION TEST (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Injection into anterior chamber (OPT) OPTHALMOLOGY
LOPT018 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
OPTHALMOLOGY
LOPT009 Injection into eyelid (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Injection of botulinum toxin into
OPTHALMOLOGY
LOPT010 extraocular or periocular muscles (OPT) L1 Surgery 4290 4500 5360 6220
SURGERY
# L1
OPTHALMOLOGY
LOPT021 LIO (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
OPTHALMOLOGY
LOPT011 Removal of corneal suture (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Removal of superficial corneal foreign OPTHALMOLOGY
LOPT012 L1 Surgery 4290 4500 5360 6220
body (OPT) # L1 SURGERY
OPTHALMOLOGY
LOPT022 RETINAL CRYO (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
OPTHALMOLOGY
LOPT013 Subconjunctival injection (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
Suture of conjunctiva - 5 and less (OPT) OPTHALMOLOGY
LOPT014 L1 Surgery 4290 4500 5360 6220
# L1 SURGERY
OPTHALMOLOGY
LOPT015 Tube Removal (OPT) # L1 L1 Surgery 4290 4500 5360 6220
SURGERY
OPTHALMOLOGY
LOPT040 Canthotomy (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Chalazion - Multiple (UNILATERAL) (OPT) OPTHALMOLOGY
LOPT048 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
contour correction of lid - minor (OPT) OPTHALMOLOGY
LOPT023 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
Correction of trichiasis by electrolysis/ OPTHALMOLOGY
LOPT041 L2 Surgery 0 8240 9810 11380
diathermy/cryotherapy/laser (OPT) # L2 SURGERY
OPTHALMOLOGY
LOPT024 Cryotherapy of eye lid (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Curettage/cryotherapy of lesion of eyelid OPTHALMOLOGY
LOPT042 L2 Surgery 0 8240 9810 11380
(OPT) # L2 SURGERY
CYCLOCRYOPHOTOCOAGULATION (OPT) OPTHALMOLOGY
LOPT049 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT050 DIODE CPC (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT043 Drainage of conjuctival Cyst (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
232
Ophthalmology
Surgery
Level
Electro epilation (Multiple eyelids) (OPT) OPTHALMOLOGY
LOPT051 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT044 Endo DCR (ophthal stand by) (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Endoscopic Evaluation with Currettege OPTHALMOLOGY
LOPT025 L2 Surgery 0 8240 9810 11380
(OPT) # L2 SURGERY
Endoscopic tube Insertion/removal OPTHALMOLOGY
LOPT026 L2 Surgery 0 8240 9810 11380
without DCR (OPT) # L2 SURGERY
OPTHALMOLOGY
LOPT052 EUA + LIO (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Excision/biopsy of conjunctival lesion OPTHALMOLOGY
LOPT031 L2 Surgery 0 8240 9810 11380
(OPT) # L2 SURGERY
OPTHALMOLOGY
LOPT027 Excision of lesion of cornea (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Excision of lesion of eyelid - large (> 5 OPTHALMOLOGY
LOPT028 L2 Surgery 0 8240 9810 11380
MM) /multiple (OPT) # L2 SURGERY
OPTHALMOLOGY
LOPT029 Excision of lesion of sclera (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT030 Excision of pterygium (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT047 Eyelid Repair (Unilateral) (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Incisional biopsy - Extra occulor (OPT) OPTHALMOLOGY
LOPT032 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT033 Infracture of Inferior turbinate (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
INJECTION INTO ANTERIOR CHAMBER/ OPTHALMOLOGY
LOPT053 L2 Surgery 0 8240 9810 11380
AC WASH (OPT) # L2 SURGERY
Intralessional sclerosing agents (OPT) OPTHALMOLOGY
LOPT045 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT054 INTRAVITREAL INJECTION (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT034 Multiple Injections into eye lid (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT035 Paracentesis (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Probing and syringing (unilateral) (OPT) OPTHALMOLOGY
LOPT036 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT037 Punctal Surgery (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Radiotherapy to conjunctival lesion (OPT) OPTHALMOLOGY
LOPT038 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
OPTHALMOLOGY
LOPT055 socket impression under GA (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Suture of conjunctiva - 6 and more (OPT) OPTHALMOLOGY
LOPT056 L2 Surgery 0 8240 9810 11380
# L2 SURGERY
233
Ophthalmology
Surgery
Level
OPTHALMOLOGY
LOPT039 Tarsorrhaphy (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
OPTHALMOLOGY
LOPT046 Wound detridement - minor (OPT) # L2 L2 Surgery 0 8240 9810 11380
SURGERY
Amniotic membrane Transplant (OPT) OPTHALMOLOGY
LOPT057 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
OPTHALMOLOGY
LOPT058 Bilateral Probing / Syringing (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
C3R TREATMENT FOR KERATOCONUS - OPTHALMOLOGY
LOPT085 L3 Surgery 0 10820 12880 14940
UNILATERAL (OPT) # L3 SURGERY
Chalizion - Multiple (BILATERAL) (OPT) OPTHALMOLOGY
LOPT080 L3 Surgery 0 10820 12880 14940
# L3 SURGERY
Ciliary body ablation with cryo/laser OPTHALMOLOGY
LOPT060 L3 Surgery 0 10820 12880 14940
(OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT081 Excision of lesion of eyebrow (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
Excision of lession of canthus/ eyelid < 5 OPTHALMOLOGY
LOPT061 L3 Surgery 0 10820 12880 14940
MM (OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT082 Exploration of eyelid (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
Extracapsular extraction with implant - OPTHALMOLOGY
LOPT062 L3 Surgery 0 10820 12880 14940
unilateral (OPT) # L3 SURGERY
Extracapsular extraction without implant OPTHALMOLOGY
LOPT063 L3 Surgery 0 10820 12880 14940
- unilateral (OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT059 Filler injection (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
Goniosynechialysis or goniopuncture OPTHALMOLOGY
LOPT064 L3 Surgery 0 10820 12880 14940
(with laser or operatively) (OPT) # L3 SURGERY
Implantation of synthetic corneal rings
OPTHALMOLOGY
LOPT065 for keratoconus (including INTACS) (OPT) L3 Surgery 0 10820 12880 14940
SURGERY
# L3
OPTHALMOLOGY
LOPT066 Incision of lacrimal Sac (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT067 Iridocyclectomy (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT086 LENSECTOMY (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT068 Mucosal graft to conjunctiva (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
PNEUMORETINOPEXY + CRYO/LASER OPTHALMOLOGY
LOPT087 L3 Surgery 0 10820 12880 14940
(OPT) # L3 SURGERY
PTERYGIUM EXCISION WITH AUTOGRAFT OPTHALMOLOGY
LOPT088 L3 Surgery 0 10820 12880 14940
(OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT069 Puncto-canaliculoplasty (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
234
Ophthalmology
Surgery
Level
Removal of foreign body from anterior OPTHALMOLOGY
LOPT070 L3 Surgery 0 10820 12880 14940
chamber (OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT071 Removal of lens IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT072 Repair of corneal wound (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT073 Repair of scleral laceration (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT074 Scar Revision - minor (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT075 Secondary insertion of IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT089 SICS WITH PC IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT090 SILICON OIL REMOVAL (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
Surgical correction of squint horizontal OPTHALMOLOGY
LOPT076 L3 Surgery 0 10820 12880 14940
1 muscle (OPT) # L3 SURGERY
Surgical correction of squint inferior OPTHALMOLOGY
LOPT077 L3 Surgery 0 10820 12880 14940
oblique muscle (OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT083 Suture of eyebrow (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
Suturring of eyelid laceration (as sole OPTHALMOLOGY
LOPT084 L3 Surgery 0 10820 12880 14940
procedure) (OPT) # L3 SURGERY
OPTHALMOLOGY
LOPT078 Symblepharon release (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT079 Tarsorrhaphy (McLAUGHLEN) (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT091 VITRECTOMY (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT092 VITREOUS BIOPSY (OPT) # L3 L3 Surgery 0 10820 12880 14940
SURGERY
OPTHALMOLOGY
LOPT125 Anterior Orbitotomy (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT126 Blepharaplasty- one eyelid (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
CORNEO-SCLERAL TEAR REPAIR (OPT) OPTHALMOLOGY
LOPT093 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
Correction of entropion - lower lid - OPTHALMOLOGY
LOPT127 L4 Surgery 0 14790 17610 20420
Weiss procedure (OPT) # L4 SURGERY
Correction of entropion - upper lid (OPT) OPTHALMOLOGY
LOPT128 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
OPTHALMOLOGY
LOPT094 Correction of epicanthus (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Cyclodialysis (separation of ciliary body) OPTHALMOLOGY
LOPT095 L4 Surgery 0 14790 17610 20420
(OPT) # L4 SURGERY
235
Ophthalmology
Surgery
Level
OPTHALMOLOGY
LOPT096 DCT (Dacryo cystectomy) (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT097 Drainage of orbit (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT098 Ectropion Surgery (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT099 Entropion (simple) (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT100 Excision of lesion of iris (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Excision of lession of canthus/ eyelid > 5 OPTHALMOLOGY
LOPT130 L4 Surgery 0 14790 17610 20420
MM (SOPT) # L4 SURGERY
Excission / Biopsy of lacrimal gland OPTHALMOLOGY
LOPT101 L4 Surgery 0 14790 17610 20420
(OPT) # L4 SURGERY
Excission Conj/ Corneal lession with OPTHALMOLOGY
LOPT102 L4 Surgery 0 14790 17610 20420
cryotherapy (OPT) # L4 SURGERY
Excission of Extensive warts (growth) OPTHALMOLOGY
LOPT103 L4 Surgery 0 14790 17610 20420
(OPT) # L4 SURGERY
OPTHALMOLOGY
LOPT104 Exploration of orbit (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Eye Lid Reconstruction without graft OPTHALMOLOGY
LOPT105 L4 Surgery 0 14790 17610 20420
(OPT) # L4 SURGERY
OPTHALMOLOGY
LOPT129 Eyelid Repair (bilateral) (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT106 Flap division (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Frontalis sling surgery (unilateral) (OPT) OPTHALMOLOGY
LOPT107 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
OPTHALMOLOGY
LOPT108 gold weight implantaion (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Goniotomy (surgical treatment of OPTHALMOLOGY
LOPT109 L4 Surgery 0 14790 17610 20420
glaucoma) (OPT) # L4 SURGERY
OPTHALMOLOGY
LOPT110 Lateral Tarsal strip (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT111 Lid split with cryotherapy (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT112 MMG (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Phakoemulsification of lens with implant OPTHALMOLOGY
LOPT113 L4 Surgery 0 14790 17610 20420
- unilateral (OPT) # L4 SURGERY
Phakoemulsification of lens without OPTHALMOLOGY
LOPT114 L4 Surgery 0 14790 17610 20420
implant unilateral (OPT) # L4 SURGERY
Punctal suturing with 10-0 nylon (OPT) OPTHALMOLOGY
LOPT115 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
Removal of foreign body from iris (OPT) OPTHALMOLOGY
LOPT116 L4 Surgery 0 14790 17610 20420
# L4 SURGERY
236
Ophthalmology
Surgery
Level
OPTHALMOLOGY
LOPT117 Revision of squint surgery (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
SCELAR FIXATED IOL IMPLANT WITH OPTHALMOLOGY
LOPT131 L4 Surgery 0 14790 17610 20420
VITRECTOMY (OPT) # L4 SURGERY
OPTHALMOLOGY
LOPT132 scleral buckle (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT118 Scleral graft (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
Surgical correction of squint with OPTHALMOLOGY
LOPT121 L4 Surgery 0 14790 17610 20420
adjustable sutures (OPT) # L4 SURGERY
Surgical correction of squint horizontal
OPTHALMOLOGY
LOPT119 2 muscles (in one eye, or one muscle in L4 Surgery 0 14790 17610 20420
SURGERY
each of two eyes) (OPT) # L4
Surgical correction of squint other OPTHALMOLOGY
LOPT120 L4 Surgery 0 14790 17610 20420
vertical muscles (OPT) # L4 SURGERY
Surgical trabeculectomy or other
OPTHALMOLOGY
LOPT122 penetrating glaucoma procedures (OPT) L4 Surgery 0 14790 17610 20420
SURGERY
# L4
OPTHALMOLOGY
LOPT123 Tarsorrhaphy (bilateral) (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT133 vitrectomy + ERM peeling (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT136 vitrectomy + IOL removal (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT134 vitrectomy + lensectomy (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT135 Vitrectomy + SFIOL (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
OPTHALMOLOGY
LOPT124 Wound debridement (major) (OPT) # L4 L4 Surgery 0 14790 17610 20420
SURGERY
C3R TREATMENT FOR KERATOCONUS - OPTHALMOLOGY
LOPT164 L5 Surgery 0 18010 21440 24870
BILATERAL (OPT) # L5 SURGERY
Complex glaucoma surgery (including
OPTHALMOLOGY
LOPT138 anti-metabolites/insertion of seton (OPT) L5 Surgery 0 18010 21440 24870
SURGERY
# L5
CORNEO-SCLERAL TEAR AND IRIS OPTHALMOLOGY
LOPT165 L5 Surgery 0 18010 21440 24870
PROPLAPSE REPAIR (OPT) # L5 SURGERY
Correction of entropion lower lid or OPTHALMOLOGY
LOPT160 L5 Surgery 0 18010 21440 24870
upper lid, including graft/flap (OPT) # L5 SURGERY
Correction of lower lid or upper lid OPTHALMOLOGY
LOPT161 L5 Surgery 0 18010 21440 24870
ectropion with graft/flap (OPT) # L5 SURGERY
Correction of Ptosis of eyelid - Simple/ OPTHALMOLOGY
LOPT139 L5 Surgery 0 18010 21440 24870
unilateral (OPT) # L5 SURGERY
Cosmetic Procedure (Moderate) (OPT) OPTHALMOLOGY
LOPT140 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
Debulking of lesion tumour (simple) OPTHALMOLOGY
LOPT141 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
237
Ophthalmology
Surgery
Level
Descemets stripping endothelial OPTHALMOLOGY
LOPT142 L5 Surgery 0 18010 21440 24870
keratoplasty (DSEK) (OPT) # L5 SURGERY
Enucleation / Eviseratiobn of eye ball OPTHALMOLOGY
LOPT143 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
Excision of lession of orbit- medical OPTHALMOLOGY
LOPT162 L5 Surgery 0 18010 21440 24870
approach (OPT) # L5 SURGERY
excission of extensive eyelid lesions =/- OPTHALMOLOGY
LOPT137 L5 Surgery 0 18010 21440 24870
frozen section (OPT) # L5 SURGERY
Excission of lesion of orbit- anterior OPTHALMOLOGY
LOPT144 L5 Surgery 0 18010 21440 24870
Exploration of orbit (as sole procedure) OPTHALMOLOGY
LOPT145 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
Extensive Repair of eyelid (unilateral ) OPTHALMOLOGY
LOPT146 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
External Dacryocysto- OPTHALMOLOGY
LOPT147 L5 Surgery 0 18010 21440 24870
rhinostomy(External DCR) (OPT) # L5 SURGERY
OPTHALMOLOGY
LOPT148 FTSG (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT166 ICL - UNILATERAL (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT149 Inferior Orbitotomy (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
Lamellar graft (keratoplasty) to cornea OPTHALMOLOGY
LOPT150 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
Lateral Canthal Reconstruction (OPT) OPTHALMOLOGY
LOPT151 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
OPTHALMOLOGY
LOPT152 Lens implant/exchange (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
Lid split with cryotherapy(bilateral) (OPT) OPTHALMOLOGY
LOPT153 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
Limbal Stem Cell Allograft Transplant OPTHALMOLOGY
LOPT154 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
MFL IMPALNT WITH PHACO - OPTHALMOLOGY
LOPT167 L5 Surgery 0 18010 21440 24870
MICS with PCIOL - UNILATERAL (OPT) OPTHALMOLOGY
LOPT168 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
OPTHALMOLOGY
LOPT163 Mucous membrane graft (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
Perforating graft (keratoplasty) to cornea OPTHALMOLOGY
LOPT155 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
PHACO WITH IOL AND OPTHALMOLOGY
LOPT169 L5 Surgery 0 18010 21440 24870
TRABECULECTOMY (OPT) # L5 SURGERY
Revision of previous glaucoma surgery OPTHALMOLOGY
LOPT156 L5 Surgery 0 18010 21440 24870
(OPT) # L5 SURGERY
SB + CRYO/LASER+DRAINAGE (OPT) OPTHALMOLOGY
LOPT170 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
238
Ophthalmology
Surgery
Level
OPTHALMOLOGY
LOPT157 Scar Revision - Major (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
Simple Reconstruction of socket(not OPTHALMOLOGY
LOPT158 L5 Surgery 0 18010 21440 24870
including implant or graft) (OPT) # L5 SURGERY
OPTHALMOLOGY
LOPT159 Split skin graft (SSG) (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
TORIC IOL IMPLANT WITH PHACO - OPTHALMOLOGY
LOPT171 L5 Surgery 0 18010 21440 24870
OPTHALMOLOGY
LOPT173 VIT + EL + BB (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT172 VIT + EL (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT174 VIT + ERM +ILM (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT175 VIT + MP + EL (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
VIT + MP + LASER + SOI +/- BB (OPT) OPTHALMOLOGY
LOPT176 L5 Surgery 0 18010 21440 24870
# L5 SURGERY
OPTHALMOLOGY
LOPT177 VIT + PFCL + LASER + SOI (OPT) # L5 L5 Surgery 0 18010 21440 24870
SURGERY
OPTHALMOLOGY
LOPT179 Blepharoplasty two eyelids (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
Correction of ptosis of eyelid- complex/ OPTHALMOLOGY
LOPT195 L6 Surgery 0 27010 32150 37290
uinlateral (OPT) # L6 SURGERY
Correction of Ptosis of eyelid - Simple/ OPTHALMOLOGY
LOPT178 L6 Surgery 0 27010 32150 37290
Bilateral (OPT) # L6 SURGERY
Correction of ptosis of eyelid with OPTHALMOLOGY
LOPT196 L6 Surgery 0 27010 32150 37290
autologous fascia lata (OPT) # L6 SURGERY
Cosmetic Procedure (Eextensive) (OPT) OPTHALMOLOGY
LOPT180 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
Dacryocysto-rhinostomy, including OPTHALMOLOGY
LOPT181 L6 Surgery 0 27010 32150 37290
insertion of tube (OPT) # L6 SURGERY
Debulking of lession (complex) (OPT) OPTHALMOLOGY
LOPT182 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
OPTHALMOLOGY
LOPT183 Endonasal DCR (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
Enucleation / Eviseration of Eyeball with OPTHALMOLOGY
LOPT184 L6 Surgery 0 27010 32150 37290
implant (OPT) # L6 SURGERY
Excission of lession orbit- Endoscopic OPTHALMOLOGY
LOPT185 L6 Surgery 0 27010 32150 37290
Extensive repair of Eyelids- bialteral OPTHALMOLOGY
LOPT197 L6 Surgery 0 27010 32150 37290
(OPT) # L6 SURGERY
Eyelid Reconstruction - unilateral / OPTHALMOLOGY
LOPT186 L6 Surgery 0 27010 32150 37290
complex (OPT) # L6 SURGERY
Frontalis sling surgery (bilateral) (OPT) OPTHALMOLOGY
LOPT187 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
239
Ophthalmology
Surgery
Level
Grafts to eyelid/socket from other sites OPTHALMOLOGY
LOPT189 L6 Surgery 0 27010 32150 37290
(OPT) # L6 SURGERY
Insertion of valve into anterior chamber OPTHALMOLOGY
LOPT188 L6 Surgery 0 27010 32150 37290
of eye (OPT) # L6 SURGERY
MICS + PCIOL + TRABECULECTOMY OPTHALMOLOGY
LOPT199 L6 Surgery 0 27010 32150 37290
(OPT) # L6 SURGERY
OPTHALMOLOGY
LOPT198 Orbital Exploration (complex) (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
Reconstruction of socket with implant or OPTHALMOLOGY
LOPT190 L6 Surgery 0 27010 32150 37290
graft (Simple) (OPT) # L6 SURGERY
Removal of foreign body from orbit (OPT) OPTHALMOLOGY
LOPT191 L6 Surgery 0 27010 32150 37290
# L6 SURGERY
OPTHALMOLOGY
LOPT192 Revision of corneal graft (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT193 Secondary Ball Implantation (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT194 Superior Orbitotomy (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT200 VIT + ILM + FGE + GAS/SOI (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT201 VIT + IOFB +/- SOI +/- LASER (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT203 VIT + MP + EL +/- BB (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
OPTHALMOLOGY
LOPT202 VIT + MP + EL + SOI (OPT) # L6 L6 Surgery 0 27010 32150 37290
SURGERY
VIT + SB + LASER + GAS/SOI +/- PFCL OPTHALMOLOGY
LOPT204 L6 Surgery 0 27010 32150 37290
(OPT) # L6 SURGERY
Correction of ptosis of eyelid- complex/ OPTHALMOLOGY
LOPT206 L7 Surgery 0 36010 42870 49730
Bilateral (OPT) # L7 SURGERY
OPTHALMOLOGY
LOPT207 Correction of tele canthus (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
Corretion of ptossi of eye lid- bilateral OPTHALMOLOGY
LOPT208 L7 Surgery 0 36010 42870 49730
(OPT) # L7 SURGERY
OPTHALMOLOGY
LOPT209 Debulking (MAJOR) (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT210 DFG (Dermis fat graft) (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
Excission of lesion of orbit- lateral OPTHALMOLOGY
LOPT211 L7 Surgery 0 36010 42870 49730
orbitotomy (OPT) # L7 SURGERY
Eyelid Reconstruction - Bilateral / OPTHALMOLOGY
LOPT205 L7 Surgery 0 36010 42870 49730
complex (OPT) # L7 SURGERY
OPTHALMOLOGY
LOPT218 ICL - BILATERAL (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
240
Ophthalmology
Surgery
Level
OPTHALMOLOGY
LOPT212 Lateral Orbitotomy (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT213 Orbital decompression (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT214 Orbital fracture repair (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
Reconstruction of socket with implant OPTHALMOLOGY
LOPT215 L7 Surgery 0 36010 42870 49730
and graft (complex) (OPT) # L7 SURGERY
OPTHALMOLOGY
LOPT219 ROP SURGERY (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT216 Temporalis fascia transfer (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT217 Trans Nasal wiring (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
OPTHALMOLOGY
LOPT220 VIT + IOFB + EL + SOI +/- BB (OPT) # L7 L7 Surgery 0 36010 42870 49730
SURGERY
VIT + MP + EL + SOI/GAS +/- BB (OPT) OPTHALMOLOGY
LOPT221 L7 Surgery 0 36010 42870 49730
# L7 SURGERY
VIT + PFCL + EL + SOI +/- BB (OPT) # OPTHALMOLOGY
LOPT222 L7 Surgery 0 36010 42870 49730
L7 SURGERY
OPTHALMOLOGY
LOPT223 Exenteration of the Orbit (OPT) # L8 L8 Surgery 0 45010 53580 62150
SURGERY
241
Ophthal
Critical Care
242
Critical Care
PCRC012 DRESSING MINOR - CRC Procedure CRITICAL CARE 70 80 90 110

PCRC053 ECG -CRC Procedure CRITICAL CARE 110 110 130 160
PCRC030 SUTURING MINOR - CRC Procedure CRITICAL CARE 120 130 150 170
PCRC020 NEBULIZATION - CRC Procedure CRITICAL CARE 140 150 180 210
PHYSIOTHERAPY CHEST / BREATHING
PCRC024 Procedure CRITICAL CARE 140 150 180 210
EXERCISE
PCRC054 NG TUBE PLACEMENT - CRC Procedure CRITICAL CARE 180 190 220 260
PCRC001 ALPHA BED - ALPHA Procedure CRITICAL CARE 190 200 230 270
PCRC011 DRESSING MAJOR - CRC Procedure CRITICAL CARE 190 200 230 270
PCRC019 MISCELLANEOUS PROCEDURE - CRC Procedure CRITICAL CARE 200 210 250 290
PCRC029 SUTURING MAJOR - CRC Procedure CRITICAL CARE 220 230 280 320
PCRC056 TRACHEOSTOMY TUBE CHANGE PER - CRC Procedure CRITICAL CARE 320 330 390 460
PCRC002 ALPHA BED - ALPHATRANCELL Procedure CRITICAL CARE 370 390 460 540
PCRC016 LUMBAR PUNCTURE - CRC Procedure CRITICAL CARE 440 460 550 640
PCRC035 ICU Screening Ultrasound Procedure CRITICAL CARE 480 500 590 690
lmology
PCRC018 MISC PROCEDURE IN ICU Procedure CRITICAL CARE 480 500 590 690
PCRC006 ASCITIC TAP - CRC Procedure CRITICAL CARE 490 510 610 710
PCRC003 ALPHA BED - ALPHAXCELL Procedure CRITICAL CARE 610 640 770 890
PCRC050 INTRA HOSPITAL TRANSPORT - CRC Procedure CRITICAL CARE 640 670 800 920
PCRC055 SEDATION MAJOR - CRC Procedure CRITICAL CARE 640 670 800 920
PCRC039 APEX BED - PM100 - B4 Procedure CRITICAL CARE 650 680 810 940
PCRC023 PFT - SPIROMETRY Procedure CRITICAL CARE 660 690 820 960
PCRC021 NIGHT OXIMETRY Procedure CRITICAL CARE 680 720 850 990
PCRC026 PLEURAL TAPPING - CRC Procedure CRITICAL CARE 680 720 850 990
PCRC038 APEX BED - DYNAFLOW Procedure CRITICAL CARE 780 810 970 1120
PCRC027 POP CHARGES Procedure CRITICAL CARE 820 860 1030 1190
PCRC004 ALPHA BED - NIMBUS Procedure CRITICAL CARE 920 970 1150 1340
PCRC037 ALPHA BED - FLOWTRON Procedure CRITICAL CARE 940 980 1170 1360
PCRC034 TRANSPORT Procedure CRITICAL CARE 1040 1090 1300 1510
PCRC005 ARTERIAL LINE - CRC Procedure CRITICAL CARE 1060 1120 1330 1540
PCRC052 CPR - CRC Procedure CRITICAL CARE 1060 1120 1330 1540
PCRC017 MINITRACHEOSTOMY Procedure CRITICAL CARE 1090 1140 1360 1570
PCRC033 TRACHEOSTOMY MINI - PCRC Procedure CRITICAL CARE 1090 1140 1360 1570
PCRC015 LARGE VOLUME AND PARACENTESIS Procedure CRITICAL CARE 1180 1240 1470 1710
BONE MARROW/PLEURAL/LIVER/LUNG/
TISSUE BI
PCRC010 CENTRAL LINE - CRC Procedure CRITICAL CARE 1240 1300 1540 1790
PCRC028 REUSCITATION (ACTIVE) Procedure CRITICAL CARE 1240 1300 1540 1790
243
Critical Care
PCRC014 INTERCOSTAL DRAINAGE - CRC Procedure CRITICAL CARE 1260 1320 1570 1820
PCRC040 ENDOTRACHEAL INTUBATION - CRC Procedure CRITICAL CARE 1570 1650 1960 2270
PCRC051 INTER HOSPITAL TRANSPORT - CRC Procedure CRITICAL CARE 1570 1650 1960 2270
PCRC031 TPN PLANNING Procedure CRITICAL CARE 1630 1710 2030 2360
PCRC032 TRACHEOSTOMY - PCRC Procedure CRITICAL CARE 1630 1710 2030 2360
PCRC025 PLEURAL BIOPSY - CRC Procedure CRITICAL CARE 1740 1830 2180 2520
PCRC008 BRONCHOSCOPIC PROCEDURE - CRC Procedure CRITICAL CARE 1780 1860 2220 2570
PCRC047 TCD - CRC Procedure CRITICAL CARE 1880 1970 2350 2720
PCRC009 BRONCHOSCOPY - CRC Procedure CRITICAL CARE 1980 2080 2480 2870
PCRC058 BIPAP INITIATION CHARGES Procedure CRITICAL CARE 3000 3000 3000 3000
PCRC057 VENTILLATION INITIATION CHARGES Procedure CRITICAL CARE 3000 3000 3000 3000
HD CATHETER INSERTION TRIPLE/DOUBLE
LUMEN-CRC
PCRC044 INITIATION OF DIALYSIS -CRC Procedure CRITICAL CARE 4100 4300 5120 5940
PLEURAL DRAIN USG GUIDED
(THERAPEUTIC) - CRC
ASCITIC TAP USG GUIDED-THERAPEUTIC
-CRC
PCRC045 INITIATION OF INOTROPES - CRC Procedure CRITICAL CARE 6230 6540 7780 9030
PCRC046 PRONE VENTILATION - CRC Procedure CRITICAL CARE 6230 6540 7780 9030
PPIC019 OXYGEN HOURLY Procedure PAEDIATRIC ICU 70 80 90 110
PPIC018 NEBULIZATION FOR ASTHMA Procedure PAEDIATRIC ICU 130 140 160 190
PPIC017 NEBULIZATION - PIC Procedure PAEDIATRIC ICU 130 140 160 190
PPIC020 PICU HOURLY CHARGE Procedure PAEDIATRIC ICU 190 200 230 270
PPIC009 ENDOTRACHEAL INTUBATION Procedure PAEDIATRIC ICU 330 340 410 470
PPIC024 SEDATION CHARGE - PIC Procedure PAEDIATRIC ICU 330 340 410 470
PPIC011 INFUSION OF VASOACTIVE DRUGS - PIC Procedure PAEDIATRIC ICU 420 440 520 610
PPIC012 INITIAL STABILIZATION Procedure PAEDIATRIC ICU 480 500 590 690
PPIC002 ASCITIC TAP - PIC Procedure PAEDIATRIC ICU 560 580 690 810
PPIC015 LUMBAR PUNCTURE - PIC Procedure PAEDIATRIC ICU 560 580 690 810
PPIC026 SUPRAPUBIC BLADDER TAP - PIC Procedure PAEDIATRIC ICU 560 580 690 810
PPIC016 MISCELLANEOUS PROCEDURE - PIC Procedure PAEDIATRIC ICU 610 640 770 890
PPIC028 ULTRASOUND CRANIAL Procedure PAEDIATRIC ICU 760 800 950 1110
PPIC029 VENESECTION - PIC Procedure PAEDIATRIC ICU 760 800 950 1110
PPIC001 ARTERIAL LINE - PERIPHERAL - PIC Procedure PAEDIATRIC ICU 840 890 1050 1220
PPIC025 SPIROMETRY - PIC Procedure PAEDIATRIC ICU 950 1000 1180 1370
244
Critical Care
PLEURAL PERICARDIAL / SUBDULAR /

PPIC022 Procedure PAEDIATRIC ICU 1050 1100 1310 1520
VENTRICULAR TAP
PPIC014 INTERCOASTAL DRAINAGE Procedure PAEDIATRIC ICU 1150 1210 1440 1670
PPIC003 BIOPSY - BONE MARROW AND ASPIRATION Procedure PAEDIATRIC ICU 1180 1240 1470 1710
PPIC004 BIOPSY - LIVER KIDNEY Procedure PAEDIATRIC ICU 1180 1240 1470 1710
PPIC006 CENTRAL LINE - PIC Procedure PAEDIATRIC ICU 1360 1430 1700 1970
PPIC023 RESUSCITATION ACTIVE - PIC Procedure PAEDIATRIC ICU 1370 1440 1720 1990
CONTINUOUS ARTERIO-VENOUS HAEMO
PPIC007 Procedure PAEDIATRIC ICU 1510 1590 1890 2190
FILTRATION
PPIC027 TOTAL PARENTAL NUTRITION PLANNING Procedure PAEDIATRIC ICU 1820 1910 2280 2640
PPIC021 PLASMA PHRESIS Procedure PAEDIATRIC ICU 2050 2150 2560 2970
PPIC010 EXCHANGE TRANFUSION Procedure PAEDIATRIC ICU 2550 2670 3180 3690
PPIC005 BRONCHOSCOPY FLEXIABLE Procedure PAEDIATRIC ICU 3800 3990 4750 5510
PPIC008 DIALYSIS - PERITONEAL Procedure PAEDIATRIC ICU 5610 5890 7010 8130
245
Pulmonology
246
Pulmonology
Surgery Billing
Level Group
INTERVENTIONAL
KIPM045 Sleep lab-titration study procedure Package PULMONOLOGY 0 12080 14380 16680
MEDICINE PACKAGE
INTERVENTIONAL
KIPM044 EBUS grade 2 with OT Package PULMONOLOGY 0 27780 33070 38360
MEDICINE PACKAGE
INTERVENTIONAL
KIPM043 Thoracoscopy and pleural BX Package PULMONOLOGY 0 27780 33070 38360
MEDICINE PACKAGE
PAEDIATRIC
PPUL003 SPIROMETRY - PEP Procedure 1100 1150 1370 1590
PULMONOLOGY
PAEDIATRIC
PPUL001 BRONCHOSCOPY FLEXIBLE - PEP Procedure 4370 4590 5470 6340
PULMONOLOGY
PAEDIATRIC
PPUL002 SLEEP STUDY Procedure 7930 8320 9910 11490
PULMONOLOGY
RESPIRATORY
PRES006 PLEURAL TAPPING - RES Procedure MEDICINE 820 860 1030 1190
PULMNOLOGY
RESPIRATORY
PRES007 PULMONARY FUNCTION TEST Procedure MEDICINE 820 860 1030 1190
PULMNOLOGY
RESPIRATORY
PRES014 SIX MINUTE WALK TEST Procedure MEDICINE 820 860 1030 1190
PULMNOLOGY
RESPIRATORY
PRES003 FNAC LUNG Procedure MEDICINE 1910 2010 2390 2770
PULMNOLOGY
RESPIRATORY
PRES005 PLEURAL BIOPSY - RES Procedure MEDICINE 2190 2300 2740 3170
PULMNOLOGY
RESPIRATORY
PRES010 PLEURAL THROMBOLYSIS Procedure MEDICINE 3010 3160 3760 4360
PULMNOLOGY
RESPIRATORY
PRES002 BRONCHOSCOPY FIBREOPTIC - RES Procedure MEDICINE 3280 3450 4100 4760
PULMNOLOGY
RESPIRATORY
PRES012 PLEURODESIS Procedure MEDICINE 3420 3590 4270 4960
PULMNOLOGY
RESPIRATORY
PRES009 DIFFUSION STUDY Procedure MEDICINE 4100 4300 5120 5940
PULMNOLOGY
RESPIRATORY
TBNA (TRANS BRONCHIAL NEEDLE
PRES013 Procedure MEDICINE 4790 5030 5980 6940
ASPIRATION)
PULMNOLOGY
RESPIRATORY
PRES008 TITRATION SLEEP STUDY Procedure MEDICINE 5060 5320 6330 7340
PULMNOLOGY
247
Pulmonology
Surgery Billing
Level Group
RESPIRATORY
PRES004 ICD INSERTION Procedure MEDICINE 6700 7030 8370 9710
PULMNOLOGY
RESPIRATORY
PRES017 Sleep study procedure Procedure MEDICINE 8050 8460 10070 11680
PULMNOLOGY
RESPIRATORY
PRES011 VIDEO BRONCHOSCOPY Procedure MEDICINE 9840 10330 12300 14260
PULMNOLOGY
RESPIRATORY
PRES001 BASELINE SLEEP STUDY Procedure MEDICINE 10930 11480 13660 15850
PULMNOLOGY
RESPIRATORY
TRANS BRONCHIAL LUNG BIOPSY
(TBLB
PULMNOLOGY
RESPIRATORY
PRES019 Lab sleep study Procedure MEDICINE 19730 20710 24660 28600
PULMNOLOGY
RESPIRATORY
Bronchoscopy closure of
bronchopleural fistula
PULMNOLOGY
RESPIRATORY
PRES020 Pleuroscopy Procedure MEDICINE 34500 36230 43130 50030
PULMNOLOGY
RESPIRATORY
PRES023 EBUS procedure Procedure MEDICINE 40250 42270 50320 58370
PULMNOLOGY
EBUS Linear staging & Biopsy RESPIRATORY
LRES001 L3 Surgery 0 10820 12880 14940
under GA -OT procedure # L3 MEDICINE SURGERY
248
Anaesthesia
& Pain Management
249
Anaesthesia & Pain Management
ANAESTHESIA
PANA023 Interventional - Level 1 Procedure 360 380 450 520
PROCEDURES
ANAESTHESIA
PANA017 CT Scan (Simple) Procedure 480 500 590 690
PROCEDURES
ANAESTHESIA
PROCEDURES
ANAESTHESIA
PANA008 LUMBAR PUNCTURE Procedure 590 620 740 860
PROCEDURES
ANAESTHESIA
PANA018 CT Scan (Complex) Procedure 680 720 850 990
PROCEDURES
ANAESTHESIA
PANA032 Difficult IV Cannulation - ANA Procedure 690 730 870 1010
PROCEDURES
ANAESTHESIA
PANA019 MRI Scan (Simple) Procedure 740 780 920 1070
PROCEDURES
ANAESTHESIA
PANA001 PATIENT CONTROLLED ANALGESIA Procedure 960 1010 1200 1390
PROCEDURES
ANAESTHESIA
PANA020 MRI Scan (Complex) Procedure 1090 1140 1360 1570
PROCEDURES
ANAESTHESIA
PANA035 Monitored Anaesthesia Consul(MAC) Procedure 1150 1210 1440 1670
PROCEDURES
ANAESTHESIA
PANA021 CT Guided Procedure Procedure 1180 1240 1470 1710
PROCEDURES
ANAESTHESIA
PANA002 RECORDING AND CD-A (Upto 1/2Hour) Procedure 1180 1240 1470 1710
PROCEDURES
ANAESTHESIA
PANA022 US Guided Procedure Procedure 1180 1240 1470 1710
PROCEDURES
ANAESTHESIA
PROCEDURES
ANAESTHESIA
PANA006 ARTERIAL LINE Procedure 1300 1370 1630 1890
PROCEDURES
ANAESTHESIA
PANA010 REUSCITATION (ACTIVE) - ANA Procedure 1300 1370 1630 1890
PROCEDURES
ANAESTHESIA
PANA004 ENTANOX FOR LABOUR ANALGESIA Procedure 1370 1440 1720 1990
PROCEDURES
ANAESTHESIA
PANA007 CENTRAL LINE Procedure 1510 1590 1890 2190
PROCEDURES
Anesthesia Administration Charges - ANAESTHESIA
PANA033 Procedure 1540 1620 1920 2230
ANA PROCEDURES
ANAESTHESIA
PROCEDURES
ANAESTHESIA
PANA013 OBSTETRIC ANALGESIA Procedure 2330 2440 2910 3370
PROCEDURES
ANAESTHESIA
PANA012 POST OPERATIVE EPIDURAL ANALGESIA Procedure 2330 2440 2910 3370
PROCEDURES
RECORDING AND CD-B (More than ANAESTHESIA
PANA003 Procedure 2330 2440 2910 3370
1/2Hour) PROCEDURES
250
ANAESTHESIA
PANA015 EPIDURAL INJECTION - ANA Procedure 2600 2730 3250 3770
PROCEDURES
ANAESTHESIA
PANA005 BRACHY ANAESTHESIA Procedure 2740 2880 3430 3970
PROCEDURES
ANAESTHESIA
PANA031 Caudal Epidural Anesthesia - ANA Procedure 2760 2900 3450 4010
PROCEDURES
ANAESTHESIA
PANA029 Unilateral Minor Block - ANA Procedure 2760 2900 3450 4010
PROCEDURES
ANAESTHESIA
PANA014 LUMBAR DRAIN PLACEMENT - ANA Procedure 3140 3300 3930 4560
PROCEDURES
ANAESTHESIA
PANA009 BRONCHOSCOPY FIBREOPTIC Procedure 3420 3590 4270 4960
PROCEDURES
ANAESTHESIA
PROCEDURES
ANAESTHESIA
PANA034 Unilateral Major Block - ANA Procedure 4140 4350 5180 6010
PROCEDURES
SEDATION CHARGES (INTERVENTIONAL INTERVENTIONAL PAIN
PIPM014 Procedure 6840 7180 8540 9910
PAIN MEDICINE) MEDICINE
INTERVENTIONAL PAIN
KIPM010 CONTINOUS PLEXUS BLOCK PACKAGE Package 0 16910 20130 23350
MEDICINE PACKAGE
DIFFERENTIAL DIAGNOSTIC BLOCK INTERVENTIONAL PAIN
KIPM011 Package 0 16910 20130 23350
PACKAGE MEDICINE PACKAGE
INTER SCALENE BLOCK/SUPRA INTERVENTIONAL PAIN
KIPM014 Package 0 16910 20130 23350
CLAVICULAR/LUM WITH STIM PACKAGE MEDICINE PACKAGE
INTERVENTIONAL PAIN
KIPM001 Genicular nerve block of knees Package 0 30920 36800 42690
MEDICINE PACKAGE
LUMBAR FACET BLOCK PER INTERVENTIONAL PAIN
KIPM003 Package 0 30920 36800 42690
SITEUNDER FLUOROSCOPY PACKAGE MEDICINE PACKAGE
LUMBAR MEDIAN NERVE INJECTION
INTERVENTIONAL PAIN
KIPM004 PER SITE UNDER FLUOROSCOPY Package 0 30920 36800 42690
MEDICINE PACKAGE
PACKAGE
LUMBAR ROOT INJECTION UNDER INTERVENTIONAL PAIN
KIPM005 Package 0 30920 36800 42690
FLUOROSCOPY PACKAGE MEDICINE PACKAGE
INTERVENTIONAL PAIN
KIPM029 LUMBAR FACET BILATERAL PACKAGE Package 0 32610 38820 45030
MEDICINE PACKAGE
SACROILIAC INJECTION UNDER INTERVENTIONAL PAIN
KIPM027 Package 0 32610 38820 45030
FLUOROSCOPY-BILATERAL PACKAGE MEDICINE PACKAGE
PAIN PALLIATIVE
PPPS013 GROUP THERAPHY Procedure 340 360 420 490
MEDICINE
PAIN PALLIATIVE
PPPS001 BIO-FEEDBACK Procedure 420 440 520 610
MEDICINE
PAIN PALLIATIVE
PPPS015 INDIVIDUAL COUNSELLING Procedure 420 440 520 610
MEDICINE
PAIN PALLIATIVE
PPPS030 PSYCHOANALYSIS Procedure 420 440 520 610
MEDICINE
251
PAIN PALLIATIVE
PPPS032 PSYCHOTHERAPHY Procedure 420 440 520 610
MEDICINE
PAIN PALLIATIVE
PPPS008 COGNITIVE-BEHAVIORAL THERAPY Procedure 560 580 690 810
MEDICINE
PAIN PALLIATIVE
PPPS007 COGNITIVE BEHAVIOURAL THERAPHY Procedure 560 580 690 810
MEDICINE
PAIN PALLIATIVE
PPPS017 INITIAL SCREENING AND COUNSELLING Procedure 560 580 690 810
MEDICINE
INITIAL SCREENING & COUNSELLING PAIN PALLIATIVE
PPPS016 Procedure 560 580 690 810
- PPS MEDICINE
PAIN PALLIATIVE
PPPS012 FAMILY COUNSELLING Procedure 590 620 740 860
MEDICINE
PAIN PALLIATIVE
PPPS014 GROUP THERAPY Procedure 590 620 740 860
MEDICINE
PAIN PALLIATIVE
PPPS033 RELAXATION THERAPY Procedure 610 640 770 890
MEDICINE
PAIN PALLIATIVE
PPPS031 PSYCHOMETRIC TESTS Procedure 640 670 800 920
MEDICINE
PAIN PALLIATIVE
PPPS018 INTER COSTAL BLOCK PER SITE Procedure 1040 1090 1300 1510
MEDICINE
PAIN PALLIATIVE
PPPS041 TRIGGER POINT INJECTIONS Procedure 1040 1090 1300 1510
MEDICINE
PAIN PALLIATIVE
PPPS009 CONTINOUS PLEXUS BLOCK Procedure 3140 3300 3930 4560
MEDICINE
PAIN PALLIATIVE
PPPS021 INTRA PLEURAL CATHETER BLOCK Procedure 3700 3880 4620 5360
MEDICINE
PAIN PALLIATIVE
PPPS029 PARAVERTEBRAL CATHETER BLOCK Procedure 3700 3880 4620 5360
MEDICINE
PAIN PALLIATIVE
PPPS035 SPHENOPALATINE BLOCK 1 Procedure 3700 3880 4620 5360
MEDICINE
INTER SCALENE BLOCK/SUPRA PAIN PALLIATIVE
PPPS020 Procedure 4650 4880 5810 6740
CLAVICULAR/LUM WITH STIM MEDICINE
INTER SCALENE BLOCK/SUPRA PAIN PALLIATIVE
PPPS019 Procedure 4650 4880 5810 6740
CLAVICU/LUM WITHOUT STIM MEDICINE
PAIN PALLIATIVE
PPPS037 STELLATE BLOCK Procedure 4650 4880 5810 6740
MEDICINE
PAIN PALLIATIVE
PPPS004 CERVICAL EPIDURAL STEROIDS Procedure 5740 6030 7180 8330
MEDICINE
PAIN PALLIATIVE
PPPS022 LIDOCAINE INFUSION TESTS Procedure 5740 6030 7180 8330
MEDICINE
PAIN PALLIATIVE
PPPS023 LUMBAR EPIDURAL STEROIDS Procedure 5740 6030 7180 8330
MEDICINE
PAIN PALLIATIVE
PPPS039 THORACIC EPIDURAL STEROIDS Procedure 5740 6030 7180 8330
MEDICINE
252
PAIN PALLIATIVE
PPPS010 DIFFERENTIAL DIAGNOSTIC BLOCK Procedure 7650 8030 9560 11090
MEDICINE
LUMBAR SYMPATHETIC BLOCK UNDER PAIN PALLIATIVE
PPPS028 Procedure 7650 8030 9560 11090
FLUOROSCOPY MEDICINE
SACROILIAC INJECTION UNDER PAIN PALLIATIVE
PPPS034 Procedure 8740 9180 10930 12680
LUMBAR FACET BLOCK PER PAIN PALLIATIVE
PPPS025 Procedure 9020 9470 11270 13080
SITEUNDER FLUOROSCOPY MEDICINE
PAIN PALLIATIVE
PPPS011 DREZ LESION UNDER FLUOROSCOPY Procedure 9570 10050 11960 13880
MEDICINE
LUMBAR ROOT INJECTION UNDER PAIN PALLIATIVE
PPPS027 Procedure 9570 10050 11960 13880
THORACIC GANGLIOLYSIS UNDER PAIN PALLIATIVE
PPPS040 Procedure 9570 10050 11960 13880
FLUOROSCOPY OR CT MEDICINE
CELIAC PLEXUS BLOCK UNDER PAIN PALLIATIVE
PPPS003 Procedure 9840 10330 12300 14260
CERVICAL FACET BLOCK PER SITE PAIN PALLIATIVE
PPPS006 Procedure 9840 10330 12300 14260
UNDER FLUOROSCOPY MEDICINE
LUMBAR MEDIAN NERVE INJECTION PAIN PALLIATIVE
PPPS026 Procedure 9840 10330 12300 14260
PER SITE UNDER FLUOR MEDICINE
PAIN PALLIATIVE
PPPS036 SPHENOPALATINE BLOCK 2 Procedure 9840 10330 12300 14260
MEDICINE
SUPERIOR HYPOGASTRIC PLEXUS PAIN PALLIATIVE
PPPS038 Procedure 9840 10330 12300 14260
BLOCK UNDER FLUOROSCOP MEDICINE
CERVICAL EPIDURAL STEROIDS UNDER PAIN PALLIATIVE
PPPS005 Procedure 10390 10910 12990 15060
LUMBAR EPIDURAL STEROIDS UNDER PAIN PALLIATIVE
PPPS024 Procedure 10390 10910 12990 15060
CAUDAL BLOCK WITH NEUROLYSIS PAIN PALLIATIVE
PPPS002 Procedure 10930 11480 13660 15850
UNDER FLUORO MEDICINE
PRHU002 CBT Procedure RHEUMATOLOGY 360 380 450 520
INTRA ARTICULAR INJECTION - MINOR
PRHU007 Procedure RHEUMATOLOGY 360 380 450 520
- RHE
PRHU001 ASPIRATION (DASP-RHE) Procedure RHEUMATOLOGY 590 620 740 860
PRHU008 REHAB Procedure RHEUMATOLOGY 590 620 740 860
INTRA ARTICULAR INJECTION -
MEDIUM - RHE
INTRA ARTICULAR INJECTION - MAJOR
- RHE
PRHU003 INFUSION - TYPE 1 LESS RISK Procedure RHEUMATOLOGY 1370 1440 1720 1990
PRHU004 INFUSION - TYPE 2 DIFFICULT Procedure RHEUMATOLOGY 3830 4030 4790 5560
253
IVF
254
IVF
Surgery Billing
Level Group
VASOGRAPHY - MICROSURG (LAND)
LAND001 L2 Surgery IVF ART SURGERY 0 8240 9810 11380
L2 # L2
LAND002 FRENULOPLASTY (LAND) L3 # L3 L3 Surgery IVF ART SURGERY 0 10820 12880 14940
LAND003 TESA (LAND) L3 # L3 L3 Surgery IVF ART SURGERY 0 10820 12880 14940
CYSTSCOPY AND DILATATION OF
URETHRA UNDER GA (LAND) L4 # L4
PESA - MICROSURG PERC EPI
SPERM ASP (LAND) L4 # L4
CIRCUMCISION UNDER GA (LAND)
L5 # L5
ELECTRO EJACULATION (LAND) L5
# L5
LAND008 EVERSION SAC (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
LAND009 ORCHIDECTOMY U/L (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
LAND010 MESA (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
LAND011 ORCHIDECTOMY B/L (LAND) L6 # L6 L6 Surgery IVF ART SURGERY 0 27010 32150 37290
ORCHIDOPEXY - MICROSURG (U/L)
(LAND) L6 # L6
TUR - EJACULATORY DUCT (LAND)
L6 # L6
LAND014 MICRO TESE (LAND) L6 # L6 L6 Surgery IVF ART SURGERY 0 27010 32150 37290
Micro Surgical VARICOCELE(UL)
(LAND) L6 # L6
ORCHIDOPEXY - MICROSURGERY
(B/L) (LAND) L7 # L7
SURGERY FOR PRIAPISM (LAND) L7
# L7
SUSPENSORY LIGAMENT SURGERY
(LAND) L7 # L7
Micro Surgical VARICOCELE(BL)
(LAND) L7 # L7
LAND020 VVA (LAND) L7 # L7 L7 Surgery IVF ART SURGERY 0 36010 42870 49730
LAND021 VEA (LAND) L7 # L7 L7 Surgery IVF ART SURGERY 0 36010 42870 49730
VENOUS LEAK SURGERY (LAND) L8
# L8
PLAQUE /CURVATURE Surgery
(LAND) L8 # L8
Lengheing Procedure (LAND) L9 #
L9
LAND025 Penile prosthesis (LAND) L9 # L9 L9 Surgery IVF ART SURGERY 0 54020 64300 74590
CORPOROPLICATION Surgery (LAND)
L8 # L8
LAND027 TVT Sling Procedure (IVF ) # L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
255
IVF
Surgery Billing
Level Group
LAND028 TOT Sling Procedure (IVF ) # L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
LAND029 Bilateral Hydrocoelectomy L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870
Diagnostic Hysteroscopy (ANR) L2
LANR001 L2 Surgery IVF ART SURGERY 0 8240 9810 11380
# L2
IVF ART
PAND001 ACROSIN PROACROSIN ASSAY Procedure 1040 1090 1300 1510
PROCEDURES
ADDITIONAL EMPRO TRANFER IN IVF ART
PAND002 Procedure 34160 35870 42700 49530
SAME CYCLE PROCEDURES
IVF ART
PAND003 AID Procedure 20500 21520 25620 29720
PROCEDURES
IVF ART
PAND004 AID-CANCEL CYCLE REFUND Procedure 11210 11770 14010 16250
PROCEDURES
IVF ART
PAND005 AIH Procedure 17760 18650 22200 25750
PROCEDURES
IVF ART
PAND006 AIH-CANCEL CYCLE REFUND Procedure 8480 8900 10600 12290
PROCEDURES
IVF ART
PAND007 ANTISPERM ANTIBODY SPERM TEST Procedure 1650 1730 2060 2390
PROCEDURES
ASSESSMENT OF REACTIVE OXYGEN IVF ART
PAND008 Procedure 2050 2150 2560 2970
SPECIES PROCEDURES
ASSESSMENT OF THE INTEGRITY OF IVF ART
PAND009 Procedure 2050 2150 2560 2970
SPERM CHROMATIN ST PROCEDURES
IVF ART
PAND010 CIRCUMCISION Procedure 20500 21520 25620 29720
PROCEDURES
CIS TEST - COMBINED INJECTION & IVF ART
PAND011 Procedure 3140 3300 3930 4560
STIMULATION PROCEDURES
IVF ART
PAND012 CYST ASPIRATION - USG GUIDED Procedure 6160 6470 7700 8930
PROCEDURES
IVF ART
PAND013 CYST ASPIRATION - B - AND Procedure 5190 5450 6490 7530
PROCEDURES
IVF ART
PAND014 DONOR SAMPLE PROCESSING Procedure 9840 10330 12300 14260
PROCEDURES
DONOR SEMEN SAMPLE WITHOUT IVF ART
PAND015 Procedure 6160 6470 7700 8930
PROCESSING PROCEDURES
IVF ART
PAND016 DONOR SPERM FOR IVF/ICSI Procedure 12300 12910 15370 17830
PROCEDURES
IVF ART
PAND017 EGG DONATION (DLX) THIRD PARTY Procedure 194010 203710 242510 281310
PROCEDURES
IVF ART
PAND018 EGG DONATION (NOR) THIRD PARTY Procedure 184440 193660 230550 267440
PROCEDURES
EGG SHARING (DLX) SELF CYCLE- IVF ART
PAND019 Procedure 194010 203710 242510 281310
SEC.RECIPIENT PROCEDURES
EGG SHARING (NOR) SELF CYCLE- IVF ART
PAND020 Procedure 169410 177880 211760 245640
SEC.RECIPIENT PROCEDURES
256
IVF
Surgery Billing
Level Group
EIPDIDYMAL - TESTIS SPERM IVF ART
PAND021 Procedure 31420 32990 39280 45560
ASPIRATION PROCEDURES
IVF ART
PAND022 ELECTRO EJACULATION Procedure 10670 11200 13330 15460
PROCEDURES
EMBRYO DONATION CYCLING - IVF ART
PAND023 Procedure 194010 203710 242510 281310
(DLX) PROCEDURES
PAND024 Procedure 184440 193660 230550 267440
(NOR) PROCEDURES
EMBRYO DONATION NON-CYCLING IVF ART
PAND025 Procedure 169410 177880 211760 245640
(DLX) PROCEDURES
EMBRYO DONATION NON-CYCLING IVF ART
PAND026 Procedure 143460 150630 179320 208010
(NOR) PROCEDURES
IVF ART
PAND028 ENDOMETRIAL BIOPSY Procedure 3140 3300 3930 4560
PROCEDURES
IVF ART
PAND029 ESTIMATION OF DNA CONTENT Procedure 2050 2150 2560 2970
PROCEDURES
IVF ART
PAND030 FOLLICULAR SCAN Procedure 1510 1590 1890 2190
PROCEDURES
IVF ART
PAND031 FRENULOPLASTY - PAND Procedure 20500 21520 25620 29720
PROCEDURES
IVF ART
PAND032 HEMI ZONA BINDING ASSAY Procedure 8200 8610 10250 11890
PROCEDURES
IN-VITRO CERVICAL MUCUS IVF ART
PAND033 Procedure 1040 1090 1300 1510
PENETRATION TEST PROCEDURES
IVF ART
PAND034 IUCD INSERTION - AND Procedure 5190 5450 6490 7530
PROCEDURES
IVF ART
PAND035 IUCD REMOVAL - AND Procedure 3140 3300 3930 4560
PROCEDURES
IVF ART
PAND036 IUI ONLY Procedure 8740 9180 10930 12680
PROCEDURES
IVF ART
PAND037 IVF CANCEL - TOTAL CYCLE Procedure 12850 13490 16060 18630
PROCEDURES
IVF ART
PAND038 IVF COUNSELLING Procedure 560 580 690 810
PROCEDURES
IVF ART
PAND039 IVF/ICSI-(DLX) 3 CYCLE PACKAGE Procedure 398940 418890 498670 578460
PROCEDURES
IVF ART
PAND040 IVF/ICSI-(NOR) 3 CYCLE PACKAGE Procedure 330630 347160 413290 479410
PROCEDURES
IVF ART
PAND041 IVF/ICSI-DELUXE Procedure 177610 186490 222010 257530
PROCEDURES
IVF ART
PAND042 IVF/ICSI-NORMAL Procedure 146190 153500 182740 211980
PROCEDURES
IVF-ICSI CANCEL CYCLE AFTER EGG IVF ART
PAND043 Procedure 73780 77470 92220 106980
ASPIRATION PROCEDURES
IVF-ICSI CANCEL CYCLE BEFORE IVF ART
PAND044 Procedure 31420 32990 39280 45560
EGG ASPIRATION PROCEDURES
257
IVF
Surgery Billing
Level Group
IVF ART
PAND045 MESA Procedure 23230 24400 29040 33690
PROCEDURES
IVF ART
PAND046 PESA Procedure 17760 18650 22200 25750
PROCEDURES
IVF ART
PAND047 POLYPECTOMY Procedure 4100 4300 5120 5940
PROCEDURES
SELF FROZEN (DLX) EMBRYO IVF ART
PAND048 Procedure 98380 103290 122970 142640
TRANSFER PROCEDURES
SELF FROZEN (NOR) EMPRYO IVF ART
PAND049 Procedure 81980 86080 102470 118860
TRANSFER PROCEDURES
SELF FROZEN EMBRYO TR-CANCEL IVF ART
PAND050 Procedure 42360 44480 52950 61420
- DLX PROCEDURES
SELF FROZEN EMBRYO TR-CANCEL IVF ART
PAND051 Procedure 68310 71730 85390 99050
- NOR PROCEDURES
IVF ART
PAND052 SEMEN ANALYSIS (IVF) Procedure 560 580 690 810
PROCEDURES
IVF ART
PAND053 SEMEN PROCESSING - HUSBAND Procedure 3970 4170 4960 5760
PROCEDURES
IVF ART
PAND054 SEXUAL COUNSELING Procedure 560 580 690 810
PROCEDURES
IVF ART
PAND055 SINGLE SCAN Procedure 820 860 1030 1190
PROCEDURES
SLIDE FOR SPERM - POST IVF ART
PAND056 Procedure 220 230 280 320
EJACULATORY URINE PROCEDURES
IVF ART
PAND057 SONOSALPHINGOGRAM Procedure 3140 3300 3930 4560
PROCEDURES
IVF ART
PAND058 SPERM FUNCTION TEST Procedure 760 800 950 1110
PROCEDURES
IVF ART
PAND059 SURROGACY-FOR MARRIED COUPLE Procedure 422160 443270 527700 612130
PROCEDURES
IVF ART
PAND060 SURROGACY-FOR SINGLE PARENT Procedure 422160 443270 527700 612130
PROCEDURES
IVF ART
PAND061 TESA Procedure 20500 21520 25620 29720
PROCEDURES
IVF ART
PAND062 TESE Procedure 31420 32990 39280 45560
PROCEDURES
TESTICULAR SPERM/EPIDIDYMAL IVF ART
PAND063 Procedure 12300 12910 15370 17830
SPERM - CRYO PROCEDURES
TISSUE - TESTICULAR/OVARIAN IVF ART
PAND064 Procedure 20500 21520 25620 29720
CYRO PRESERVAT PROCEDURES
IVF ART
PAND065 TISSUE FOR SPERM Procedure 1040 1090 1300 1510
PROCEDURES
IVF ART
PAND066 USG ASPIRATION OF CYST - A Procedure 3140 3300 3930 4560
PROCEDURES
IVF ART
PAND067 USG ASPIRATION OF CYST - B Procedure 2470 2590 3080 3570
PROCEDURES
258
IVF
Surgery Billing
Level Group
IVF ART
PAND068 VAGINAL SWAB - AND Procedure 560 580 690 810
PROCEDURES
IVF ART
PAND069 VASECTOMY Procedure 24590 25820 30740 35660
PROCEDURES
INFECTIOUS SAMPLE IVF ART
PAND070 Procedure 7390 7760 9230 10710
CYROFREEZING PROCEDURES
IVF ART
PAND071 DNA FRAGMENTATION INDEX Procedure 2870 3010 3580 4160
PROCEDURES
TEMPORARY CRYO FREEZING + DFI IVF ART
PAND072 Procedure 6160 6470 7700 8930
FOR A MONTH PROCEDURES
IVF-ICSI CANCEL CYCLE AFTER EGG IVF ART
PAND073 Procedure 106560 111890 133200 154520
ASPIRATION - DELUXE PROCEDURES
IVF-ICSI CANCEL CYCLE BEFORE IVF ART
PAND074 Procedure 42360 44480 52950 61420
EGG ASPIRATION - DELUXE PROCEDURES
IVF ART
PAND075 Surrogate FET Repeat cycle Procedure 146190 153500 182740 211980
PROCEDURES
IVF ART
PAND076 Surrogate FET Fresh cycle Procedure 230890 242430 288610 334790
PROCEDURES
IVF ART
PAND077 EMBRYO FREEZING SINGLE STRAW Procedure 31420 32990 39280 45560
PROCEDURES
EMBRYO FREEZING ADDITIONAL IVF ART
PAND078 Procedure 15710 16500 19640 22780
STRAW PROCEDURES
IVF ART
PAND079 OVARIAN TISSUE CRYOFREEZING Procedure 61480 64560 76850 89150
PROCEDURES
RENEWAL OF OVARIAN TISSUE IVF ART
PAND080 Procedure 31420 32990 39280 45560
CRYOFREEZING PROCEDURES
IVF ART
PAND081 AID - REF Procedure 17080 17940 21350 24770
PROCEDURES
IVF ART
PAND082 AIH - REF Procedure 15040 15790 18790 21800
PROCEDURES
EGG DONATION (DLX) THIRD PARTY IVF ART
PAND083 Procedure 194010 203710 242510 281310
- REF PROCEDURES
EGG DONATION (NOR) THIRD PARTY IVF ART
PAND084 Procedure 184440 193660 230550 267440
- REF PROCEDURES
PAND085 Procedure 194010 203710 242510 281310
(DLX) - REF PROCEDURES
PAND086 Procedure 184440 193660 230550 267440
(NOR) - REF PROCEDURES
IVF ART
PAND087 IVF/ICSI-NORMAL - REF Procedure 146190 153500 182740 211980
PROCEDURES
IVF ART
PAND088 IVF/ICSI-DELUXE - REF Procedure 177610 186490 222010 257530
PROCEDURES
IVF ART
PAND089 Annexin V Binding Procedure 420 440 520 610
PROCEDURES
IVF ART
PAND090 Caspase 3 activity Procedure 760 800 950 1110
PROCEDURES
259
IVF
Surgery Billing
Level Group
IVF ART
PAND091 Acrosin Proteolytic activity Procedure 760 800 950 1110
PROCEDURES
IVF ART
PAND092 Alfa neutral glucosidase Procedure 480 500 590 690
PROCEDURES
IVF ART
PAND093 ROS Estimation Procedure 1180 1240 1470 1710
PROCEDURES
ADDITIONAL MEDIA & DISPOSABLE IVF ART
PAND094 Procedure 15710 16500 19640 22780
COST IN IVF PROCEDURES
CASA - COMPUTER ASSISTED IVF ART
PAND095 Procedure 1650 1730 2060 2390
SEMEN ANALYSIS PROCEDURES
CASA + DFI (DNA FRAGMENTATION IVF ART
PAND096 Procedure 3420 3590 4270 4960
INDEX) PROCEDURES
IVF ART
PAND097 CASA + DFI + ROS 1 Procedure 4930 5170 6160 7140
PROCEDURES
IVF ART
PAND098 CASA + DFI + TRIAL WASH Procedure 7650 8030 9560 11090
PROCEDURES
IVF ART
PAND099 CASA + TRIAL WASH Procedure 6020 6320 7520 8730
PROCEDURES
IVF ART
PAND100 CRYO FREEZING - 1 YEAR Procedure 16400 17220 20500 23780
PROCEDURES
IVF ART
PAND101 CRYO FREEZING - 1 YEAR RENEWAL Procedure 16400 17220 20500 23780
PROCEDURES
IVF ART
PAND102 CRYO FREEZING - 3 MONTHS Procedure 7650 8030 9560 11090
PROCEDURES
CRYO FREEZING - 3 MONTHS IVF ART
PAND103 Procedure 7650 8030 9560 11090
RENEWAL PROCEDURES
CRYO FREEZING - 45 days (NON - IVF ART
PAND104 Procedure 6020 6320 7520 8730
RENEWAL) PROCEDURES
CRYO FREEZING - INFECTIOUS IVF ART
PAND105 Procedure 15040 15790 18790 21800
SAMPLE - 3 MONTHS PROCEDURES
CRYO FREEZING - INFECTIOUS IVF ART
PAND106 Procedure 18450 19370 23060 26750
SAMPLE -1 YEAR PROCEDURES
IVF ART
PAND107 CRYO FROZEN SAMPLE DISPATCH Procedure 8480 8900 10600 12290
PROCEDURES
IVF ART
PAND108 ROS - REACTIVE OXYGEN SPECIES Procedure 2600 2730 3250 3770
PROCEDURES
IVF ART
PAND109 SEMEN PCR Procedure 4930 5170 6160 7140
PROCEDURES
IVF ART
PAND110 SEMEN TRIAL PROCESSING Procedure 4930 5170 6160 7140
PROCEDURES
IVF ART
PAND111 TESTICULAR BIOPSY HPE Procedure 3420 3590 4270 4960
PROCEDURES
TESTICULAR TISSUE EXAMINATION IVF ART
PAND112 Procedure 2600 2730 3250 3770
(TESE) PROCEDURES
EMBRYO CRYO FREEZING - IVF ART
PAND113 Procedure 15710 16500 19640 22780
ADDITIONAL STRAW PROCEDURES
260
IVF
Surgery Billing
Level Group
EMBRYO CRYO FREEZING - IVF ART
PAND114 Procedure 36900 38740 46120 53500
RENEUAL 1 YEAR (PER STRAW) PROCEDURES
EMBRYO CRYO FREEZING -
IVF ART
PAND115 RENEUAL 1 YEAR (PER STRAW) Procedure 49190 51650 61490 71320
PROCEDURES
(INFECTIOUS SAMPLE)
EMBRYO CRYO FREEZING - SINGLE IVF ART
PAND116 Procedure 36900 38740 46120 53500
STRAW PROCEDURES
EMBRYO CRYO FREEZING - SINGLE IVF ART
PAND117 Procedure 49190 51650 61490 71320
STRAW (INFECTIOUS SAMPLE) PROCEDURES
IVF ART
PAND118 EMBRYOSCOPE CHARGES Procedure 72410 76030 90510 104990
PROCEDURES
IVF ART
PAND119 FET - CANCELLATION Procedure 9020 9470 11270 13080
PROCEDURES
IUI - PROCEDURE CHARGES IVF ART
PAND120 Procedure 27330 28700 34160 39620
INFECTIOUS (AIH/ AID) PROCEDURES
IVF ART
PAND121 IVF / ICSI - OOCYTE DONATION Procedure 323800 339990 404750 469510
PROCEDURES
IVF ART
PAND122 MOCK TRANSFER CHARGES Procedure 6420 6740 8030 9310
PROCEDURES
OOCYTE VITRIFICATION - IVF ART
PAND123 Procedure 31420 32990 39280 45560
ADDITIONAL STRAW PROCEDURES
OOCYTE VITRIFICATION - SINGLE IVF ART
PAND124 Procedure 54650 57390 68310 79240
STRAW PROCEDURES
IVF ART
PAND125 SEQUENTIAL ET Procedure 10930 11480 13660 15850
PROCEDURES
IVF ART
PAND126 SURROGATE ET CHARGES Procedure 248660 261090 310820 360550
PROCEDURES
IVF ART
PAND127 IVF Additional Drug Package Procedure 392110 411710 490130 568560
PROCEDURES
IVF ART
PAND128 IVF visiting consultant Procedure 214500 225230 268130 311030
PROCEDURES
IVF ART
PAND129 IVF ART PROCEDURES Procedure 28750 30190 35940 41690
PROCEDURES
261
Psychiatry
262
Psychiatry
Billing
Group
PPSY001 ALCOHOL AVERSION THERAPY Procedure PSYCHIATRY 820 860 1030 1190
PPSY002 BEHAVIOUR ASSESMENT Procedure PSYCHIATRY 560 580 690 810
PPSY003 BEHAVIOUR THERAPY Procedure PSYCHIATRY 340 360 420 490
PPSY004 COGNITIVE BEHAVIOURAL THERAPY Procedure PSYCHIATRY 640 670 800 920
COGNITIVE FUNCTIONS ASSESSMENT
PPSY005 Procedure PSYCHIATRY 1240 1300 1540 1790
- PSY
PPSY006 COGNITIVE RETRAINING - PSY Procedure PSYCHIATRY 640 670 800 920
PPSY007 COGNITIVE STIMULATION - PSY Procedure PSYCHIATRY 420 440 520 610
PPSY008 COUNSELLING - PSY Procedure PSYCHIATRY 500 520 620 720
PPSY009 COUNSELLING-N Procedure PSYCHIATRY 520 550 650 760
PPSY010 DIAGNOSTICS Procedure PSYCHIATRY 1040 1090 1300 1510
PPSY011 ECT (PER SITTING) Procedure PSYCHIATRY 760 800 950 1110
PPSY012 ECT PER SITTING WITH ANA Procedure PSYCHIATRY 820 860 1030 1190
PPSY013 FULL ASSESSMENT Procedure PSYCHIATRY 1650 1730 2060 2390
GENERAL PSYCHOLOGICAL
ASSESSMENT
PPSY015 INFANT ASSESMENT Procedure PSYCHIATRY 640 670 800 920
INITIAL SCREENING & COUNSELLING
- PSY
PPSY017 IQ ASSESSMENT Procedure PSYCHIATRY 560 580 690 810
PPSY018 LEARNING DISABILITY ASSESSMENT Procedure PSYCHIATRY 760 800 950 1110
PPSY019 NALOXONE TEST Procedure PSYCHIATRY 2870 3010 3580 4160
PPSY020 NARCO ANALYSIS Procedure PSYCHIATRY 820 860 1030 1190
PPSY021 NEUROPSYCHOLOGICAL ASSESSMENT Procedure PSYCHIATRY 3700 3880 4620 5360
PERSONALITY & INTERPERSONAL
RELATIONS - PSY
PPSY023 PSYCHOLOGICAL ASSESSMENT-MISC Procedure PSYCHIATRY 560 580 690 810
PPSY024 PSYCHOTHERAPHY & CONSULTATION Procedure PSYCHIATRY 640 670 800 920
PPSY025 PSYCHOTHERAPY (PER SESSION) Procedure PSYCHIATRY 340 360 420 490
SPECIFIC PSYCHOLOGICAL FUNCTIONS-
ASSESSMENT
263
Internal medicine
& Diabetes
264
Internal medicine & Diabetes
Billing
Group
DIABETES
PDIB003 ENDOCRINE-GRBS Procedure 100 100 120 140
ENDOCRINOLOGY
DIABETES
PDIB002 ENDOCRINE DYNAMIC TEST - MINOR Procedure 820 860 1030 1190
ENDOCRINOLOGY
DIABETES
PDIB001 ENDOCRINE DYNAMIC TEST - MAJOR Procedure 1650 1730 2060 2390
ENDOCRINOLOGY
GASTRIC LAVAGE ROUTINE - GERIATRIC
PGER011 Procedure GERIATRIC MEDICINE 70 80 90 110
MEDICINE
PGER008 ENEMA - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 100 100 120 140
SPOT GLUCOSE CHECK - GERIATRIC
MEDICINE
DECOMPRESSION OF PNEUMOTHORAX
- GERIATRIC MEDICINE
STEAM INHALATION - GERIATRIC
MEDICINE
DIABETIC EDUCATION - GERIATRIC
MEDICINE
GASTRIC LAVAGE POISONING -
GERIATRIC MEDICINE
MEDIUM - GERIATRIC MEDICINE
VENESECTION/CUT DOWN - GERIATRIC
MEDICINE
ACTH STIMULATION TEST (SHORT &
LONG) - GERIATRIC MEDICINE
FNA OF THYROID - GERIATRIC
MEDICINE
INSULIN TOLERANCE TEST - GERIATRIC
MEDICINE
PROLONGED HYPOGLYCAEMIC TEST -
GERIATRIC MEDICINE
TEST FOR DIABETES INSIPIDUS -
GERIATRIC MEDICINE
TRH STIMULATION TEST - GERIATRIC
MEDICINE
BONE MARROW PROCEDURE -
GERIATRIC MEDICINE
BRONCHOSCOPIC PROCEDURE -
GERIATRIC MEDICINE
BRONCHOSCOPY - GERIATRIC
MEDICINE
265
Billing
Group
ABDOMINAL TAPPING - GERIATRIC
MEDICINE
INTER COSTAL DRAINAGE PLUS
PGER031 THERAPEUTIC PROCEDURE - GERIATRIC Procedure GERIATRIC MEDICINE 2600 2730 3250 3770
MEDICINE
CENTRAL LINE PLACEMENT -
GERIATRIC MEDICINE
INTER COSTAL TUBE INSERTION -
GERIATRIC MEDICINE
PLEURAL ASPIRATION - GERIATRIC
MEDICINE
PLEURAL BIOPSY - GERIATRIC
MEDICINE
PGER025 FNAC MED - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 3560 3740 4450 5160
LUMBAR PUNCTURES - GERIATRIC
MEDICINE
BONE MARROW ASPIRATION & BIOPSY
ABDOMEN TAPPINGS THERAPEUTIC -
GERIATRIC MEDICINE
PGER016 LIVER BIOPSY - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 11210 11770 14010 16250
PINT011 GASTRIC LAVAGE ROUTINE Procedure INTERNAL MEDICINE 70 80 90 110
PINT008 ENEMA - INT Procedure INTERNAL MEDICINE 100 100 120 140
PINT019 SPOT GLUCOSE CHECK Procedure INTERNAL MEDICINE 100 100 120 140
PINT006 DECOMPRESSION OF PNEUMOTHORAX Procedure INTERNAL MEDICINE 110 110 130 160
PINT020 STEAM INHALATION Procedure INTERNAL MEDICINE 110 110 130 160
PINT007 DIABETIC EDUCATION Procedure INTERNAL MEDICINE 130 140 160 190
PINT010 GASTRIC LAVAGE POISONING Procedure INTERNAL MEDICINE 200 210 250 290
PINT015 Procedure INTERNAL MEDICINE 260 270 320 370
- INT
MEDIUM - INT
- INT
PINT023 VENESECTION/CUT DOWN Procedure INTERNAL MEDICINE 680 720 850 990
ACTH STIMULATION TEST (SHORT &
LONG)
PINT009 FNA OF THYROID Procedure INTERNAL MEDICINE 820 860 1030 1190
PINT012 INSULIN TOLERANCE TEST Procedure INTERNAL MEDICINE 820 860 1030 1190
PINT018 PROLONGED HYPOGLYCAEMIC TEST Procedure INTERNAL MEDICINE 820 860 1030 1190
PINT021 TEST FOR DIABETES INSIPIDUS Procedure INTERNAL MEDICINE 820 860 1030 1190
266
Billing
Group
PINT022 TRH STIMULATION TEST Procedure INTERNAL MEDICINE 820 860 1030 1190
PINT003 BONE MARROW PROCEDURE Procedure INTERNAL MEDICINE 1040 1090 1300 1510
PINT004 BRONCHOSCOPIC PROCEDURE - INT Procedure INTERNAL MEDICINE 1510 1590 1890 2190
PINT005 BRONCHOSCOPY - INT Procedure INTERNAL MEDICINE 2190 2300 2740 3170
PINT001 ABDOMINAL TAPPING - INT.MED Procedure INTERNAL MEDICINE 2600 2730 3250 3770
INTER COSTAL DRAINAGE PLUS
THERAPEUTIC PROCEDURE
PINT029 CENTRAL LINE PLACEMENT Procedure INTERNAL MEDICINE 3140 3300 3930 4560
PINT028 INTER COSTAL TUBE INSERTION Procedure INTERNAL MEDICINE 3140 3300 3930 4560
PINT024 PLEURAL ASPIRATION Procedure INTERNAL MEDICINE 3140 3300 3930 4560
PINT027 PLEURAL BIOPSY Procedure INTERNAL MEDICINE 3140 3300 3930 4560
PINT025 FNAC - INT MED Procedure INTERNAL MEDICINE 3560 3740 4450 5160
PINT017 LUMBAR PUNCTURES Procedure INTERNAL MEDICINE 3700 3880 4620 5360
PINT026 BONE MARROW ASPIRATION & BIOPSY Procedure INTERNAL MEDICINE 5060 5320 6330 7340
PINT030 ABDOMEN TAPPINGS THERAPEUTIC Procedure INTERNAL MEDICINE 5610 5890 7010 8130
PINT016 LIVER BIOPSY - INT Procedure INTERNAL MEDICINE 11210 11770 14010 16250
267
Dermatology
268
Dermatology
Billing
Group
PDER001 ABDOMEN Procedure DERMATOLOGY 14350 15060 17930 20800
PDER002 ACNE SCAR RESURFACING Procedure DERMATOLOGY 35530 37300 44410 51510
PDER003 ANTERIOR NECK Procedure DERMATOLOGY 5470 5740 6830 7930
PDER004 ARMS+HANDS+AXILLA Procedure DERMATOLOGY 25280 26550 31600 36660
PDER005 AUTOLOGOUS MINIGRAFTING Procedure DERMATOLOGY 760 800 950 1110
AUTOLOGOUS MINIGRAFTING - ERBIUM
PDER006 Procedure DERMATOLOGY 1240 1300 1540 1790
YAG LASER
PDER007 AXILLA Procedure DERMATOLOGY 5190 5450 6490 7530
PDER008 BACK Procedure DERMATOLOGY 23230 24400 29040 33690
PDER009 BEARDED FACE Procedure DERMATOLOGY 6420 6740 8030 9310
PDER010 BENIGN SKIN LESIONS REMOVAL - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER011 BENIGN SKIN LESIONS REMOVAL - B Procedure DERMATOLOGY 9570 10050 11960 13880
PDER012 BENIGN SKIN LESIONS REMOVAL - C Procedure DERMATOLOGY 11760 12350 14700 17050
PDER013 BETWEEN EYEBROWS Procedure DERMATOLOGY 2470 2590 3080 3570
PDER014 BIKINI LINE Procedure DERMATOLOGY 5880 6180 7350 8530
PDER015 BLISTER GRAFTING Procedure DERMATOLOGY 3280 3450 4100 4760
PDER016 BOTOX PER UNIT Procedure DERMATOLOGY 760 800 950 1110
PDER017 BUTTOCKS Procedure DERMATOLOGY 6420 6740 8030 9310
PDER018 CHEEKS Procedure DERMATOLOGY 5470 5740 6830 7930
PDER019 CHEMICAL CAUTERY - A Procedure DERMATOLOGY 500 520 620 720
PDER020 CHEMICAL CAUTERY - B Procedure DERMATOLOGY 960 1010 1200 1390
PDER021 CHEMICAL CAUTERY - C Procedure DERMATOLOGY 1300 1370 1630 1890
PDER022 CHEMICAL CAUTERY - D Procedure DERMATOLOGY 1780 1860 2220 2570
CHEMOTHERAPHY PROCEDURE
MAINTANENCE
PDER024 CHEST Procedure DERMATOLOGY 10670 11200 13330 15460
PDER025 CHIN Procedure DERMATOLOGY 5330 5600 6660 7730
PDER026 COMEDO EXTRACTION Procedure DERMATOLOGY 560 580 690 810
PDER027 CRYO - A Procedure DERMATOLOGY 560 580 690 810
PDER028 CRYO - B Procedure DERMATOLOGY 1100 1150 1370 1590
PDER029 CRYO - C Procedure DERMATOLOGY 1910 2010 2390 2770
PDER030 CRYO - D Procedure DERMATOLOGY 3970 4170 4960 5760
PDER031 CURETTAGE Procedure DERMATOLOGY 1510 1590 1890 2190
PDER032 CUTANEOUS RESURFACING - A Procedure DERMATOLOGY 4650 4880 5810 6740
PDER033 CUTANEOUS RESURFACING - B Procedure DERMATOLOGY 6160 6470 7700 8930
PDER034 CUTANEOUS RESURFACING - C Procedure DERMATOLOGY 7650 8030 9560 11090
PDER035 CUTANEOUS RESURFACING - D Procedure DERMATOLOGY 15710 16500 19640 22780
269
Dermatology
Billing
Group
PDER036 CUTANEOUS RESURFACING - E Procedure DERMATOLOGY 31420 32990 39280 45560
PDER037 DEEP PEEL Procedure DERMATOLOGY 23910 25110 29890 34670
PDER038 DERMABRASION ( A ) PER SQ.CM Procedure DERMATOLOGY 640 670 800 920
PDER039 DERMABRASION ( B ) PER SQ.CM Procedure DERMATOLOGY 1510 1590 1890 2190
PDER040 DERMABRASION ( C ) PER SQ.CM Procedure DERMATOLOGY 2050 2150 2560 2970
PDER041 DERMABRASION ( D ) PER SQ.CM Procedure DERMATOLOGY 2600 2730 3250 3770
PDER042 DERMAROLLER Procedure DERMATOLOGY 28700 30130 35870 41610
PDER043 EAR & NOSE PIERCING Procedure DERMATOLOGY 760 800 950 1110
PDER044 EARS Procedure DERMATOLOGY 4370 4590 5470 6340
PDER045 ELECTROCAUTERY - A Procedure DERMATOLOGY 820 860 1030 1190
PDER046 ELECTROCAUTERY - B Procedure DERMATOLOGY 1510 1590 1890 2190
PDER047 ELECTROCAUTERY - C Procedure DERMATOLOGY 2050 2150 2560 2970
PDER048 ELECTROCAUTERY - D Procedure DERMATOLOGY 3280 3450 4100 4760
PDER049 ELECTROLYSIS OF HAIR (PER HAIR) Procedure DERMATOLOGY 70 80 90 110
ELECTROLYSIS OF HAIR FULL FACE
(PACKAGE)
PDER051 ENTIRE ARMS Procedure DERMATOLOGY 12850 13490 16060 18630
PDER052 ENTIRE LEGS Procedure DERMATOLOGY 32790 34430 40990 47550
EXPRESSION OF MOLLOSCUM BODIES
(A)
EXPRESSION OF MOLLOSCUM BODIES
(B)
PDER055 FACIAL REJUVINATION Procedure DERMATOLOGY 16400 17220 20500 23780
PDER056 FEET Procedure DERMATOLOGY 4370 4590 5470 6340
PDER057 FILLERS RESTYLANE 0.5 ML Procedure DERMATOLOGY 31420 32990 39280 45560
PDER058 FILLERS RESTYLANE 1.0 ML Procedure DERMATOLOGY 47820 50210 59780 69340
PDER059 FOREARMS Procedure DERMATOLOGY 7650 8030 9560 11090
PDER060 FOREHEAD Procedure DERMATOLOGY 5470 5740 6830 7930
PDER061 FULL ARMS WITH HANDS Procedure DERMATOLOGY 25960 27260 32450 37640
FULL FACE RESURFACING FOR
RHYTIDES B
PDER063 HANDS Procedure DERMATOLOGY 4370 4590 5470 6340
PDER064 HIPS Procedure DERMATOLOGY 7650 8030 9560 11090
PDER065 HYPERTROPHIC SCARS - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER066 HYPERTROPHIC SCARS - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER067 HYPERTROPHIC SCARS - C Procedure DERMATOLOGY 23910 25110 29890 34670
PDER068 I & D MINOR Procedure DERMATOLOGY 1240 1300 1540 1790
PDER069 IM INJECTION Procedure DERMATOLOGY 140 150 180 210
270
Dermatology
Billing
Group
PDER070 INNER THIGHS Procedure DERMATOLOGY 10930 11480 13660 15850
PDER071 INNER THIGHS AND BIKINI Procedure DERMATOLOGY 13110 13770 16390 19010
PDER072 INTRA LESS IONAL INJECTION Procedure DERMATOLOGY 1300 1370 1630 1890
PDER073 IONTOPHORESIS PER SITTING Procedure DERMATOLOGY 760 800 950 1110
PDER074 KNEE AND LOWER LEGS Procedure DERMATOLOGY 13670 14350 17080 19810
PDER075 LASER THERAPY CO2 MAJOR Procedure DERMATOLOGY 10930 11480 13660 15850
PDER076 LASER THERAPY CO2 MEDIUM Procedure DERMATOLOGY 6560 6890 8200 9510
PDER077 LASER THERAPY CO2 MINOR Procedure DERMATOLOGY 3280 3450 4100 4760
PDER078 LASER THERAPY CO2 SUPRA MAJOR Procedure DERMATOLOGY 15040 15790 18790 21800
PDER079 LEGS BELOW KNEE Procedure DERMATOLOGY 12850 13490 16060 18630
PDER080 LIGHT PEEL Procedure DERMATOLOGY 11760 12350 14700 17050
LITE LASER PEEL - FULL FACE SKIN
RESURFACI
PDER082 MICRODERMA - 1 Procedure DERMATOLOGY 3140 3300 3930 4560
PDER083 MICRODERMA - 2 Procedure DERMATOLOGY 2190 2300 2740 3170
PDER084 MILIA EXTRACTION ( A ) Procedure DERMATOLOGY 900 950 1130 1310
PDER085 MILIA EXTRACTION ( B ) Procedure DERMATOLOGY 560 580 690 810
PDER086 MINOR PROCEDURE Procedure DERMATOLOGY 1510 1590 1890 2190
PDER087 NAIL EXCISION - PDER Procedure DERMATOLOGY 590 620 740 860
PDER088 NAIL EXCISION (MAJOR) Procedure DERMATOLOGY 8200 8610 10250 11890
PDER089 NAIL EXCISION (MINOR) Procedure DERMATOLOGY 2470 2590 3080 3570
PDER090 NARROW HOLE EXTENSION TECHNIQUE Procedure DERMATOLOGY 4240 4450 5290 6140
PDER091 NIPPLE / CLEAVAGE Procedure DERMATOLOGY 4370 4590 5470 6340
NON-ABLATIVE PULSED RADIO
FREQUENCY
PDER093 PARING Procedure DERMATOLOGY 1240 1300 1540 1790
PDER094 PATCH TEST PER PATCH (IMPORTED) Procedure DERMATOLOGY 220 230 280 320
PDER095 PATCH TEST PER PATCH (INDIAN) Procedure DERMATOLOGY 220 230 280 320
PDER096 PEEL DEEP PER SQ.INCH Procedure DERMATOLOGY 1780 1860 2220 2570
PDER097 PEEL INTERMEDIATE PER SQ.INCH Procedure DERMATOLOGY 1240 1300 1540 1790
PDER098 PEEL NEO STRATA FULL Procedure DERMATOLOGY 3700 3880 4620 5360
PDER099 PEEL NEO STRATA INTERMEDIATE Procedure DERMATOLOGY 3280 3450 4100 4760
PDER100 PEEL NEO STRATA LIMITED Procedure DERMATOLOGY 2190 2300 2740 3170
PDER101 PEEL SUPERFICIAL PER SQ.INCH Procedure DERMATOLOGY 900 950 1130 1310
PDER102 PEEL TCA EASY CLASSIC Procedure DERMATOLOGY 5880 6180 7350 8530
PDER103 PERINEURAL INJECTION Procedure DERMATOLOGY 1240 1300 1540 1790
PDER104 PHOTOTEST Procedure DERMATOLOGY 2470 2590 3080 3570
271
Dermatology
Billing
Group
PDER105 PHOTOTHERAPY - A Procedure DERMATOLOGY 520 550 650 760
PODOPHYLLUM APPLICATION (PER
SETTING)
PDER107 POSTERIOR NECK Procedure DERMATOLOGY 5470 5740 6830 7930
PDER109 PROVOCATION TEST Procedure DERMATOLOGY 200 210 250 290
PDER110 PUNCH EVACUATION OF CYST Procedure DERMATOLOGY 4370 4590 5470 6340
RESURFACING OF PERIOCULAR AND
PERIORAL REG
PDER112 SCLEROTHERAPY Procedure DERMATOLOGY 3560 3740 4450 5160
PDER113 SIDE BURNS Procedure DERMATOLOGY 4370 4590 5470 6340
PDER114 SKIN BIOPSY Procedure DERMATOLOGY 5470 5740 6830 7930
PDER115 SKIN BIOPSY (FIRST TIME) Procedure DERMATOLOGY 3280 3450 4100 4760
SKIN BIOPSY (SUBSEQUENT BIOPSY ON
SAME PATIENT)
PDER117 SKIN BIOPSY FROM FACE Procedure DERMATOLOGY 5880 6180 7350 8530
PDER118 SKIN SMEAR FOR AFB Procedure DERMATOLOGY 500 520 620 720
PDER119 SOAKS Procedure DERMATOLOGY 200 210 250 290
PDER120 SOFT LASER - A Procedure DERMATOLOGY 2470 2590 3080 3570
PDER121 SOFT LASER - B Procedure DERMATOLOGY 3560 3740 4450 5160
PDER122 TATOOING PER SQ. CM Procedure DERMATOLOGY 960 1010 1200 1390
PDER123 TZANCK TEST Procedure DERMATOLOGY 760 800 950 1110
PDER124 UMBILICUS TO PUBIS Procedure DERMATOLOGY 5880 6180 7350 8530
PDER125 UPPER ARMS Procedure DERMATOLOGY 6420 6740 8030 9310
PDER126 UPPER LIP Procedure DERMATOLOGY 5330 5600 6660 7730
PDER127 WOODS LAMP Procedure DERMATOLOGY 1240 1300 1540 1790
PDER128 AUTOLOGOUS SERUM SKIN TEST Procedure DERMATOLOGY 4240 4450 5290 6140
PDER129 TRICHOGRAM Procedure DERMATOLOGY 3560 3740 4450 5160
PDER130 MICRODERMA III Procedure DERMATOLOGY 3560 3740 4450 5160
PDER131 ELECTRO PHONOPHERESIS Procedure DERMATOLOGY 2870 3010 3580 4160
MICRODERMA & ELECTRO
PHONOPHERESIS
PDER133 DRESSING - PDER Procedure DERMATOLOGY 480 500 590 690
PDER134 DRESSING - MAJOR - PDER Procedure DERMATOLOGY 260 270 320 370
PDER135 DRESSING - INTER - PDER Procedure DERMATOLOGY 200 210 250 290
PDER136 DRESSING - MINOR - PDER Procedure DERMATOLOGY 130 140 160 190
PDER137 FUNGUS IDENTIFICATION - DERM Procedure DERMATOLOGY 1370 1440 1720 1990
PDER138 DERMAROLLER - A (PER SESSION) Procedure DERMATOLOGY 11760 12350 14700 17050
ERBIUM YAG RECIPIENT SITE LASER -
SMALL
272
Dermatology
Billing
Group
MEDIUM
LARGE
EXTENSIVE
PDER143 Q SWITCH HEAD - A Procedure DERMATOLOGY 11760 12350 14700 17050
PDER144 Q SWITCH HEAD - B Procedure DERMATOLOGY 23910 25110 29890 34670
PDER145 Q SWITCH HEAD - C Procedure DERMATOLOGY 35530 37300 44410 51510
PDER146 Q SWITCH HEAD - D Procedure DERMATOLOGY 58750 61680 73430 85180
PDER147 TATOOS - A Procedure DERMATOLOGY 3560 3740 4450 5160
PDER148 TATOOS - B Procedure DERMATOLOGY 7110 7470 8890 10310
PDER149 TATOOS - C Procedure DERMATOLOGY 11760 12350 14700 17050
PDER150 NEVUS OF OTA - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER151 NEVUS OF OTA - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER152 NEVUS OF OTA - C Procedure DERMATOLOGY 19130 20090 23910 27740
ER PIXEL HEAD (SKIN REJUVENATION)
-A
PDER154 ER PIXEL HEAD (ACNE SCARS) - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER155 ER PIXEL HEAD - C Procedure DERMATOLOGY 17080 17940 21350 24770
PDER156 SIDE LOCKS Procedure DERMATOLOGY 4370 4590 5470 6340
PDER157 FULL FACE Procedure DERMATOLOGY 14350 15060 17930 20800
PDER158 FULL LEGS Procedure DERMATOLOGY 25960 27260 32450 37640
PDER159 FULL HAND Procedure DERMATOLOGY 21870 22960 27330 31700
PDER160 BELOW ELBOW HANDS Procedure DERMATOLOGY 11760 12350 14700 17050
PDER161 UNDER ARMS Procedure DERMATOLOGY 5190 5450 6490 7530
PDER162 CHEST FRONT Procedure DERMATOLOGY 23910 25110 29890 34670
PDER163 BIKINI Procedure DERMATOLOGY 8740 9180 10930 12680
PDER164 FULL BODY Procedure DERMATOLOGY 86070 90370 107590 124800
PDER165 SR (570-950) SKIN REJUVENATION - A Procedure DERMATOLOGY 8480 8900 10600 12290
PDER166 SR (570-950) SKIN REJUVENATION - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER167 SR (570-950) SKIN REJUVENATION - C Procedure DERMATOLOGY 19130 20090 23910 27740
PDER168 ST SKIN TIGHTENING - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER169 ST SKIN TIGHTENING - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER170 420-950 - A Procedure DERMATOLOGY 11760 12350 14700 17050
PDER171 420-950 - B Procedure DERMATOLOGY 19130 20090 23910 27740
PDER172 SKIN TIGHTENING - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER173 SKIN TIGHTENING - B Procedure DERMATOLOGY 11760 12350 14700 17050
273
Dermatology
Billing
Group
PDER174 ACTIVE ACNE VULGARIS Procedure DERMATOLOGY 4650 4880 5810 6740
PDER175 ACNE CONGLOBATA Procedure DERMATOLOGY 11760 12350 14700 17050
PDER176 ACNE SCAR REVISION Procedure DERMATOLOGY 11760 12350 14700 17050
POST ACNE HYPER PIGMENTATION
FACE
POST INFLAMMATORY HYPER
PIGMENTATION - A
PIGMENTATION - B
PIGMENTATION - C
PDER181 NEVUS OF OTA Procedure DERMATOLOGY 11760 12350 14700 17050
PDER182 EPILIDES LONG Procedure DERMATOLOGY 7110 7470 8890 10310
PDER183 EPILIDES VERY LONG Procedure DERMATOLOGY 19130 20090 23910 27740
PDER184 TATOO REMOVAL - RED Procedure DERMATOLOGY 11760 12350 14700 17050
PDER185 TATOO REMOVAL - GREEN Procedure DERMATOLOGY 4790 5030 5980 6940
PDER186 TATOO REMOVAL - BLACK Procedure DERMATOLOGY 7110 7470 8890 10310
PDER187 CAFE AU LAIT MACULES-PER LESION Procedure DERMATOLOGY 3560 3740 4450 5160
PDER188 LENTIGINES - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER189 LENTIGINES - B Procedure DERMATOLOGY 19130 20090 23910 27740
PDER190 DYSCHROMIA Procedure DERMATOLOGY 7110 7470 8890 10310
PDER191 MELASMA Procedure DERMATOLOGY 7110 7470 8890 10310
PDER192 FACIAL FINE LINES - A Procedure DERMATOLOGY 7110 7470 8890 10310
PDER193 FACIAL FINE LINES - B Procedure DERMATOLOGY 11760 12350 14700 17050
PDER194 STRIAE SHORT Procedure DERMATOLOGY 11760 12350 14700 17050
PDER195 STRIAE LONG Procedure DERMATOLOGY 19130 20090 23910 27740
PDER196 BECKERS NEVUS - A Procedure DERMATOLOGY 11760 12350 14700 17050
PDER197 BECKERS NEVUS - B Procedure DERMATOLOGY 19130 20090 23910 27740
PDER198 PERI ORBITAL PIGMENTATION Procedure DERMATOLOGY 8480 8900 10600 12290
PDER199 NEVUS SPILUS Procedure DERMATOLOGY 11760 12350 14700 17050
PDER200 MONGOLIAN SPOT - A Procedure DERMATOLOGY 11760 12350 14700 17050
PDER201 MONGOLIAN SPOT - B Procedure DERMATOLOGY 7110 7470 8890 10310
PDER202 PIGMENTED DEMARCATION LINE Procedure DERMATOLOGY 8480 8900 10600 12290
POST ACNE HYPER PIGMENTATION
TRUNK
PDER204 TRAMATIC SCAR - TRUNK Procedure DERMATOLOGY 11760 12350 14700 17050
PDER205 TRAMATIC SCAR - LIMBS Procedure DERMATOLOGY 7110 7470 8890 10310
274
Dermatology
Billing
Group
PDER206 DIFFUSE FACIAL PIGMENTATION Procedure DERMATOLOGY 11760 12350 14700 17050
PDER207 ROSACEA Procedure DERMATOLOGY 5880 6180 7350 8530
PDER208 FLAT SEB KERATOSIS Procedure DERMATOLOGY 7110 7470 8890 10310
PDER209 HYPERTROPHIC SCAR Procedure DERMATOLOGY 11760 12350 14700 17050
PDER210 KELOID Procedure DERMATOLOGY 11760 12350 14700 17050
PDER211 LAX ABDOMEN WITH STRIAE Procedure DERMATOLOGY 58750 61680 73430 85180
PDER212 LASER 360 Procedure DERMATOLOGY 83350 87510 104180 120850
PDER213 SUBCISION Procedure DERMATOLOGY 1240 1300 1540 1790
PDER216 ABLATIVE RADIO FREQUENCY - A Procedure DERMATOLOGY 7650 8030 9560 11090
PDER217 ABLATIVE RADIO FREQUENCY - B Procedure DERMATOLOGY 10930 11480 13660 15850
PDER218 ABLATIVE RADIO FREQUENCY - C Procedure DERMATOLOGY 21870 22960 27330 31700
PDER219 TATOO REMOVAL BLACK 5*5 CMS Procedure DERMATOLOGY 9840 10330 12300 14260
PDER220 Prick Test Single Antigen Procedure DERMATOLOGY 370 390 460 540
PDER221 Prick Test Package 10 Antigens Procedure DERMATOLOGY 3480 3650 4350 5040
PDER224 TGTPHOTOTHERAPY per session Procedure DERMATOLOGY 1500 1570 1870 2170
PDER225 TGTPHOTOTHERAPY 3 session Procedure DERMATOLOGY 3450 3630 4320 5010
PDER226 TGTPHOTOTHERAPY - 6 session Procedure DERMATOLOGY 7480 7850 9350 10840
PDER227 TGTPHOTOTHERAPY - 12 session Procedure DERMATOLOGY 16450 17270 20560 23850
275
Dental
276
Dental
Root canal treatment with Single Por

KDEN005 Package DENTAL PACKAGE 0 20650 24590 28520
crown(per )
KDEN007 BlueSky Implant with SinglePor crown Package DENTAL PACKAGE 0 78510 93470 108420
PDEN001 BITE RAISING APPLIANCE Procedure DENTAL MEDICINE 3560 3740 4450 5160
PDEN002 BLEACHING PROCEDURE (IN-CLINIC) Procedure DENTAL MEDICINE 3560 3740 4450 5160
PDEN003 BLEACHING TRAY - SINGLE Procedure DENTAL MEDICINE 2470 2590 3080 3570
PDEN004 CATLANS APPLIANCE Procedure DENTAL MEDICINE 3560 3740 4450 5160
PDEN005 CERAMIC INLAY Procedure DENTAL MEDICINE 17760 18650 22200 25750
PDEN006 CLEFT LIP Procedure DENTAL MEDICINE 19130 20090 23910 27740
PDEN007 CLEFT PALATE - PDEN Procedure DENTAL MEDICINE 14350 15060 17930 20800
PDEN008 COMPLETE DENTURES (SINGLE ARCH) Procedure DENTAL MEDICINE 10670 11200 13330 15460
CROWN - E-MAX SAME DAY (LAMINATES/
PDEN009 Procedure DENTAL MEDICINE 13110 13770 16390 19010
INLAY/ONLAY)
CROWN - FULL CERAMIC (ZIRCONA/
CERCON)
PDEN011 CROWN AND BRIDGE CERAMIC EU STD Procedure DENTAL MEDICINE 9840 10330 12300 14260
CROWN AND BRIDGE CERAMIC FULL
TERACOM
CROWN AND BRIDGE CROWN-SINGLE UNIT
CAST
INCERAM
MET
NOBLE
POR
TEMPO
CROWN AND BRIDGE SINGLE UNIT
COMPOSITE W
PDEN020 EXTRACTION SURGICAL Procedure DENTAL MEDICINE 1300 1370 1630 1890
PDEN021 EXTRACTIONS CHILD MILK TOOTH Procedure DENTAL MEDICINE 420 440 520 610
FLEXIBLE DENTURE (UNILATERAL &
BILATERAL) PER ARCH
PDEN023 GLASS FIBER POST Procedure DENTAL MEDICINE 4240 4450 5290 6140
PDEN024 IMPLACTED MOLAR INCLUDING LA 7.7 Procedure DENTAL MEDICINE 1300 1370 1630 1890
PDEN025 IMPLANT BIOCARE NOBEL Procedure DENTAL MEDICINE 48200 50610 60250 69890
IMPLANT ENDO-S PER DALLABONA -
METAL
277
Dental
IMPLANT ENDO-S PER DALLABONA -

METAL FEMALE COMPONENT
PDEN028 IMPLANT E-Z-A - DEN Procedure DENTAL MEDICINE 20500 21520 25620 29720
PDEN029 IMPLANT E-Z-S - DEN Procedure DENTAL MEDICINE 17760 18650 22200 25750
PDEN030 IMPLANT E-Z-U - DEN Procedure DENTAL MEDICINE 19130 20090 23910 27740
PDEN031 IMPLANT INTERVENTIONAL PROCEDURE Procedure DENTAL MEDICINE 2330 2440 2910 3370
PDEN032 IMPLANT MIS SEVEN Procedure DENTAL MEDICINE 19130 20090 23910 27740
PDEN033 IMPLANT TRI-D - PDEN Procedure DENTAL MEDICINE 14350 15060 17930 20800
PDEN034 IMPLANT TRI-N - PDEN Procedure DENTAL MEDICINE 17080 17940 21350 24770
IMPLANT TRI PER DALLABONA - RUBBER
COMPONENT
PDEN036 INLAY - METAL Procedure DENTAL MEDICINE 4370 4590 5470 6340
PDEN037 INTRA ORAL X-RAY Procedure DENTAL MEDICINE 340 360 420 490
PDEN038 METAL CAST POST Procedure DENTAL MEDICINE 3700 3880 4620 5360
PDEN039 OCCLUSAL ADJUSTMENT FULL Procedure DENTAL MEDICINE 1650 1730 2060 2390
PDEN040 OCCLUSAL ADJUSTMENT LIMITED Procedure DENTAL MEDICINE 1180 1240 1470 1710
PDEN041 OCCLUSAL NIGHT GUARD/SPLINT HARD Procedure DENTAL MEDICINE 1910 2010 2390 2770
PDEN042 OCCLUSAL NIGHT GUARD/SPLINT SOFT Procedure DENTAL MEDICINE 3560 3740 4450 5160
PDEN043 OPTURATOR Procedure DENTAL MEDICINE 12020 12620 15030 17430
PDEN044 ORAL CANCER SCREENING Procedure DENTAL MEDICINE 2470 2590 3080 3570
PDEN045 ORAL MUCOSAL BIOPSY Procedure DENTAL MEDICINE 2330 2440 2910 3370
PDEN046 ORAL MUCOSAL LESION MANAGEMENT Procedure DENTAL MEDICINE 1780 1860 2220 2570
PDEN047 ORAL PROPHYLAXIS (SCALING / SITTING) Procedure DENTAL MEDICINE 1300 1370 1630 1890
PDEN048 OROFACIAL PAIN MANAGEMENT Procedure DENTAL MEDICINE 2330 2440 2910 3370
PDEN049 OSMF MANAGEMENT Procedure DENTAL MEDICINE 7110 7470 8890 10310
PDEN050 PIT AND FISSURE SEALANT APPLICATION Procedure DENTAL MEDICINE 900 950 1130 1310
PROHYLACTIC TOPICAL FLUORIDE
APPLICATION
PDEN052 PROSTHETICS DENTURE RELINING Procedure DENTAL MEDICINE 2740 2880 3430 3970
PDEN053 PROSTHETICS DENTURE REPAIR Procedure DENTAL MEDICINE 1510 1590 1890 2190
PDEN054 PROSTHETICS FULL DENTURE (U/L) Procedure DENTAL MEDICINE 16400 17220 20500 23780
PROSTHETICS FULL DENTURE U/L CROSS
LINKED
PROSTHETICS IMMEDIATE DENTURE -
PARTIAL
PDEN057 PROSTHETICS OVER DENTURES Procedure DENTAL MEDICINE 19130 20090 23910 27740
PROSTHETICS PARTIAL DENTURE -
ACRYLIC
PDEN059 PROSTHETICS PARTIAL DENTURE - CAST Procedure DENTAL MEDICINE 19820 20810 24770 28740
278
Dental
PDEN060 PROSTHETICS REPLACE ONE TOOTH Procedure DENTAL MEDICINE 590 620 740 860
PDEN061 PULP CAPPING Procedure DENTAL MEDICINE 760 800 950 1110
PDEN062 PULPECTOMY Procedure DENTAL MEDICINE 1780 1860 2220 2570
PDEN063 RADIOGRAPHS BITE WING Procedure DENTAL MEDICINE 260 270 320 370
PDEN064 RADIOGRAPHS CEPHALOGRAM Procedure DENTAL MEDICINE 960 1010 1200 1390
PDEN065 R. V. G INTRA ORAL PERIAPICAL X- Ray Procedure DENTAL MEDICINE 340 360 420 490
PDEN066 RADIOGRAPHS OCCLUSAL Procedure DENTAL MEDICINE 340 360 420 490
PDEN067 RADIOGRAPHS ORTHOPANTOGRAM (OPG) Procedure DENTAL MEDICINE 610 640 770 890
PDEN068 RECEMENTING BRIDGE Procedure DENTAL MEDICINE 610 640 770 890
PDEN069 RECEMENTING CROWN Procedure DENTAL MEDICINE 360 380 450 520
REMOVABLE ORTHODONTICS - MINOR -
PDEN
RESTORATIONS AMALGAM/SILVER
PRIMARY TOOT
RESTORATIONS/FILLINGS AMALGAM/
SILVER PER
PDEN073 RESTORATIONS/FILLINGS COMPOMER Procedure DENTAL MEDICINE 1300 1370 1630 1890
RESTORATIONS/FILLINGS COMPOSITE
RESIN AN
RESTORATIONS/FILLINGS COMPOSITE
RESIN PO
PDEN076 RESTORATIONS/FILLINGS DYCAL/CA(OH)2 Procedure DENTAL MEDICINE 340 360 420 490
PDEN077 RESTORATIONS/FILLINGS GLASS IONOMER Procedure DENTAL MEDICINE 900 950 1130 1310
PDEN078 RESTORATIONS/FILLINGS MIRACLE MIX Procedure DENTAL MEDICINE 610 640 770 890
PDEN079 RESTORATIONS/FILLINGS ONLAY Procedure DENTAL MEDICINE 680 720 850 990
RESTORATIONS/FILLINGS PRIMARY TOOTH
CLAS
RESTORATIONS/FILLINGS TEMPORARY /
SEDATI
PDEN082 ROOT CANAL TREATMENT ANTERIOR Procedure DENTAL MEDICINE 3280 3450 4100 4760
PDEN083 ROOT CANAL TREATMENT BICUSPID Procedure DENTAL MEDICINE 4370 4590 5470 6340
PDEN084 ROOT CANAL TREATMENT MOLAR Procedure DENTAL MEDICINE 4790 5030 5980 6940
PDEN085 ROOT PLANNING Procedure DENTAL MEDICINE 760 800 950 1110
PDEN086 SCAR REVISION OF SUTURING Procedure DENTAL MEDICINE 11760 12350 14700 17050
PDEN087 SPACE MAINTAINER Procedure DENTAL MEDICINE 1240 1300 1540 1790
PDEN088 STAGE - 1 - DEN Procedure DENTAL MEDICINE 11210 11770 14010 16250
PDEN091 THERAPEUTIC PULPOTOMY Procedure DENTAL MEDICINE 1510 1590 1890 2190
279
Dental
PDEN092 WOUND DEBRIDEMENT Procedure DENTAL MEDICINE 8480 8900 10600 12290
PDEN093 ZIMMER DENTAL IMPLANT WITH CROWN Procedure DENTAL MEDICINE 46450 48780 58070 67360
ZIMMER DENTAL IMPLANT WITHOUT
CROWN
PDEN095 LAVA CROWN & BRIDGES Procedure DENTAL MEDICINE 25280 26550 31600 36660
PDEN096 SS II & SIII WITH SOLID ABUTMENT Procedure DENTAL MEDICINE 19130 20090 23910 27740
PDEN097 MS NARROW RIDGE Procedure DENTAL MEDICINE 17080 17940 21350 24770
PDEN098 MS OVERDENTURES WITH RETAINER CAP Procedure DENTAL MEDICINE 17080 17940 21350 24770
PDEN099 3M ESSENTIAL CROWN Procedure DENTAL MEDICINE 18450 19370 23060 26750
PDEN100 FIBRE POST Procedure DENTAL MEDICINE 1240 1300 1540 1790
PDEN101 VICRYL Procedure DENTAL MEDICINE 590 620 740 860
PDEN102 CERAMIC REPAIR Procedure DENTAL MEDICINE 820 860 1030 1190
PDEN103 SURGICEL Procedure DENTAL MEDICINE 2050 2150 2560 2970
PDEN104 BLUE SKY IMPLANT Procedure DENTAL MEDICINE 34160 35870 42700 49530
PDEN105 S S CROWN Procedure DENTAL MEDICINE 4370 4590 5470 6340
PDEN106 STRIP CROWN Procedure DENTAL MEDICINE 3280 3450 4100 4760
PDEN107 CHAIR SIDE RELINING Procedure DENTAL MEDICINE 1780 1860 2220 2570
PDEN108 ANTERIOR DIRECT VENEER (Per Tooth) Procedure DENTAL MEDICINE 3560 3740 4450 5160
POSTERIOR COMPOSITE FILLING (Per
Tooth)
PDEN110 DIASTEMA CLOSURE ( Per Unit) Procedure DENTAL MEDICINE 3700 3880 4620 5360
PDEN111 BLEACHING (Per Tooth) Procedure DENTAL MEDICINE 960 1010 1200 1390
PDEN112 CERAMIC LAMINATE (Per Tooth) Procedure DENTAL MEDICINE 15710 16500 19640 22780
PDEN113 CERAMIC VENEER (Per Tooth) Procedure DENTAL MEDICINE 18450 19370 23060 26750
PDEN114 THINEER (Per Tooth) Procedure DENTAL MEDICINE 14350 15060 17930 20800
HOME BLEACH / OFFICE BLEACH U/L
(Excluding Material)
PDEN116 DEPIGMENTATION OF GUMS (Per Segment) Procedure DENTAL MEDICINE 3700 3880 4620 5360
PDEN117 CROWN LENGTHENING ( Per Tooth) Procedure DENTAL MEDICINE 1910 2010 2390 2770
IVOCLAR COMPLETE DENTURE ( UPPER /
LOWER )
PDEN119 WALPLAST ( FLEXIBLE DENTURE ) Procedure DENTAL MEDICINE 15040 15790 18790 21800
Nobel Active Implant Package (without
crown)
MULTIUNIT ABUTMENT STRAIGHT/
ANGULATED PER UNIT
MULTIUNIT ABATMENT SCREW RETAINED
RESTORATION
PDEN123 CERAMIC SINGLE ARCH DENTURES Procedure DENTAL MEDICINE 27330 28700 34160 39620
PDEN124 Re-TREATMENT ROOT CANAL Procedure DENTAL MEDICINE 6420 6740 8030 9310
280
Dental
PDEN125 SINUS LIFT (Cost for the Graft extra) Procedure DENTAL MEDICINE 18450 19370 23060 26750
PDEN126 RANDOM GLUCOSE (Checking) - Dental Procedure DENTAL MEDICINE 110 110 130 160
RADIOGRAPHS ORTHOPANTOGRAM (OPG
- R)
PDEN128 Crown Zirconia Ziecon (10 Yrs) Procedure DENTAL MEDICINE 10390 10910 12990 15060
PDEN129 Bridge Zirconia Ziecon (10 Yrs) Procedure DENTAL MEDICINE 10390 10910 12990 15060
PDEN130 Crown Zirconia Orodent Italya (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810
PDEN131 Bridge Zirconia Orodent Italya (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810
PDEN132 Crown PFM CAD/CAM Procedure DENTAL MEDICINE 5190 5450 6490 7530
PDEN133 Noritake Zirconia Katana (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810
PDEN134 Zirconia Amman Girrbach (5 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810
PDEN135 Crown PFZ Procedure DENTAL MEDICINE 5190 5450 6490 7530
PDEN136 Sky Fast & Fixed (Single Arch) All On Four Procedure DENTAL MEDICINE 225430 236700 281780 326870
PDEN137 Sky Fast & Fixed (Single Arch) All On Six Procedure DENTAL MEDICINE 330630 347160 413290 479410
PDEN138 Fast & Fixed Analogue Procedure DENTAL MEDICINE 5190 5450 6490 7530
PDEN139 3M Translucent Crown and Bridges Procedure DENTAL MEDICINE 12420 13050 15530 18010
PDEN140 3M Monolith Crown and Bridges Procedure DENTAL MEDICINE 11180 11740 13980 16210
3M Porcelain Fused Metal CAD CAM Crown
and Bridge
PDEN142 Osstem Implant with abutment Procedure DENTAL MEDICINE 19880 20870 24840 28820
PDEN143 Osstem Implant impression coping (per) Procedure DENTAL MEDICINE 4350 4570 5440 6310
PDEN144 Osstem Implant analog(per) Procedure DENTAL MEDICINE 1060 1120 1330 1540
PDEN145 Osstem Implant tube cylinder (per) Procedure DENTAL MEDICINE 3910 4110 4890 5670
PDEN146 PRP-procedure Procedure DENTAL MEDICINE 2880 3020 3600 4170
PDEN147 Soft tissue laser Treatment (per quadrant) Procedure DENTAL MEDICINE 8050 8460 10070 11680
ADJUNCTIVE ORTHODONTICS ON FIXING DENTAL
PDOD001 Procedure 22540 23670 28180 32690
STG-1 ORTHODONTICS
PDOD002 Procedure 4370 4590 5470 6340
STG-2 ORTHODONTICS
PDOD003 Procedure 2870 3010 3580 4160
STG-3 ORTHODONTICS
ANCHORAGE APPLIANCES IMPLANT DENTAL
PDOD004 Procedure 7110 7470 8890 10310
ANCHORAGE ORTHODONTICS
DENTAL
PDOD005 ANCHORAGE APPLIANCES LINGUAL ARCH Procedure 3830 4030 4790 5560
ORTHODONTICS
ANCHORAGE APPLIANCES NANCE HOLDING DENTAL
PDOD006 Procedure 3830 4030 4790 5560
ARCH/TPA ORTHODONTICS
DENTAL
PDOD007 APPLIANCE REPAIR Procedure 1300 1370 1630 1890
ORTHODONTICS
ARCH EXPANSION APPLIANCE HYRAX DENTAL
PDOD008 Procedure 14350 15060 17930 20800
APPLIANCES ORTHODONTICS
281
Dental
ARCH EXPANSION APPLIANCE DENTAL

PDOD009 Procedure 14350 15060 17930 20800
HYRAX+REVER-PULLHEADGEAR STG-1 ORTHODONTICS
ARCH EXPANSION APPLIANCE DENTAL
PDOD010 Procedure 4790 5030 5980 6940
HYRAX+REVER-PULLHEADGEAR STG-2 ORTHODONTICS
ARCH EXPANSION APPLIANCE QUAD HELIX DENTAL
PDOD011 Procedure 11760 12350 14700 17050
ARCH EXPANSION APPLIANCE REMOVABLE DENTAL
PDOD012 Procedure 9570 10050 11960 13880
EXPANSION APPL ORTHODONTICS
DENTAL
PDOD013 ARCHWIRE REPLACEMENT Procedure 1300 1370 1630 1890
ORTHODONTICS
DENTAL
PDOD014 BEGGS TECHNIQUE ON FIXIING STG-1 Procedure 23910 25110 29890 34670
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
PDOD017 BONDED RETAINERS: EACH ARCH Procedure 3420 3590 4270 4960
ORTHODONTICS
DENTAL
PDOD018 BRACKET REPAIR Procedure 900 950 1130 1310
ORTHODONTICS
DENTAL
PDOD019 BRACKET REPLACEMENT Procedure 820 860 1030 1190
ORTHODONTICS
DENTAL
PDOD020 DISTAL ZIG I STAGE Procedure 16400 17220 20500 23780
ORTHODONTICS
DENTAL
PDOD021 DISTALIZATION APPLIANCE STG-1 Procedure 14350 15060 17930 20800
ORTHODONTICS
DENTAL
PDOD022 DISTALIZATION APPLIANCE STG-2 Procedure 4790 5030 5980 6940
ORTHODONTICS
DENTAL
PDOD023 DISTULISATION APPLIANCE K LOOP Procedure 16400 17220 20500 23780
ORTHODONTICS
FIXED PEA (CERAMIC BRACKETS) ON DENTAL
PDOD024 Procedure 47820 50210 59780 69340
FIXING STG-1 ORTHODONTICS
PDOD025 Procedure 13110 13770 16390 19010
PDOD026 Procedure 13110 13770 16390 19010
PDOD027 Procedure 7930 8320 9910 11490
FIXED PEA (STAINLESS STEEL) ON FIXING DENTAL
PDOD028 Procedure 36900 38740 46120 53500
STG-1 ORTHODONTICS
PDOD029 Procedure 6420 6740 8030 9310
STG-2 ORTHODONTICS
PDOD030 Procedure 6560 6890 8200 9510
STG-3 ORTHODONTICS
PDOD031 Procedure 5190 5450 6490 7530
STG-4 ORTHODONTICS
282
Dental
FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL

PDOD032 Procedure 40990 43040 51240 59430
PDOD033 Procedure 11760 12350 14700 17050
PDOD034 Procedure 11760 12350 14700 17050
PDOD035 Procedure 7110 7470 8890 10310
PDOD036 Procedure 2600 2730 3250 3770
DENTAL
PDOD037 FIXED PEA(S.STEEL) ON FIXING V STAGE Procedure 2600 2730 3250 3770
ORTHODONTICS
FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL
PDOD038 Procedure 34160 35870 42700 49530
CASE) STG-1 ORTHODONTICS
PDOD039 Procedure 6420 6740 8030 9310
PDOD040 Procedure 6840 7180 8540 9910
PDOD041 Procedure 4790 5030 5980 6940
PDOD042 Procedure 2600 2730 3250 3770
FIXED PEA(SIMPLE CAS/SINGLE ARCH) ON DENTAL
PDOD043 Procedure 23230 24400 29040 33690
PDOD044 Procedure 5880 6180 7350 8530
PDOD045 Procedure 5880 6180 7350 8530
PDOD046 Procedure 3560 3740 4450 5160
FUNCTIONAL APPLIANCE REMOVABLE ON DENTAL
PDOD047 Procedure 10390 10910 12990 15060
FUNCTIONAL APPLIANCE REMOVABLE ON DENTAL
PDOD048 Procedure 5190 5450 6490 7530
FUNCTIONAL APPLIANCES FIXED ON FIXING DENTAL
PDOD049 Procedure 9570 10050 11960 13880
STG-1 ORTHODONTICS
FUNCTIONAL APPLIANCES FIXED ON FIXING DENTAL
PDOD050 Procedure 5190 5450 6490 7530
STG-2 ORTHODONTICS
GROWTH MODULATION APPLIANCE ON DENTAL
PDOD051 Procedure 18450 19370 23060 26750
GROWTH MODULATION APPLIANCE ON DENTAL
PDOD052 Procedure 4790 5030 5980 6940
GROWTH MODULATION FUNC+HEADGEAR DENTAL
PDOD053 Procedure 14350 15060 17930 20800
STG-1 ORTHODONTICS
PDOD054 Procedure 4790 5030 5980 6940
STG-2 ORTHODONTICS
283
Dental

PDOD055 Procedure 4790 5030 5980 6940
STG-3 ORTHODONTICS
DENTAL
PDOD056 GROWTH MODULATION HEAD GEAR STG-1 Procedure 17760 18650 22200 25750
ORTHODONTICS
DENTAL
PDOD057 GROWTH MODULATION HEADGEAR STG-2 Procedure 5880 6180 7350 8530
ORTHODONTICS
DENTAL
PDOD058 HYRAX APPLIANCES Procedure 18450 19370 23060 26750
ORTHODONTICS
DENTAL
PDOD059 INDIRECT BONDING(EXTRA) Procedure 5880 6180 7350 8530
ORTHODONTICS
DENTAL
PDOD060 LINGUAL HOLDING ARCH Procedure 4790 5030 5980 6940
ORTHODONTICS
DENTAL
PDOD061 NANCE HOLDING ARCH Procedure 4790 5030 5980 6940
ORTHODONTICS
DENTAL
PDOD062 PENDULUM STG Procedure 5060 5320 6330 7340
ORTHODONTICS
DENTAL
PDOD063 POST SURGICAL ORTHODONTICS Procedure 11760 12350 14700 17050
ORTHODONTICS
DENTAL
PDOD064 QUAD HELIX APPLIANCES Procedure 7650 8030 9560 11090
ORTHODONTICS
DENTAL
PDOD065 REMOVABLE APPLIANCE REPAIR Procedure 1300 1370 1630 1890
ORTHODONTICS
REMOVABLE APPLIANCE UPP/LOW PLATES DENTAL
PDOD066 Procedure 7650 8030 9560 11090
REMOVABLE STG-1 ORTHODONTICS
DENTAL
PDOD067 REMOVABLE APPLIANCES ON FIXING STG-1 Procedure 7110 7470 8890 10310
ORTHODONTICS
DENTAL
PDOD068 REMOVABLE APPLIANCES ON FIXING STG-2 Procedure 4790 5030 5980 6940
ORTHODONTICS
REMOVABLE APPLIANCES SINGLE ARCH DENTAL
PDOD069 Procedure 4790 5030 5980 6940
STG-1 ORTHODONTICS
REMOVABLE APPLIANCES SINGLE ARCH DENTAL
PDOD070 Procedure 1300 1370 1630 1890
STG-2 ORTHODONTICS
DENTAL
PDOD071 REMOVABLE EXPANSION APPLIANCES Procedure 7110 7470 8890 10310
ORTHODONTICS
REMOVABLE ORTHODONTICS - MINOR - DENTAL
PDOD072 Procedure 9300 9760 11620 13480
PDOD ORTHODONTICS
RETENTION APPLIANCE REMOVABLE EACH DENTAL
PDOD073 Procedure 1910 2010 2390 2770
ARCH ORTHODONTICS
DENTAL
PDOD074 RETENTIVE PHASE Procedure 3830 4030 4790 5560
ORTHODONTICS
DENTAL
PDOD075 SINGLE ARCH ON FIXING STG-1 Procedure 8200 8610 10250 11890
ORTHODONTICS
DENTAL
PDOD076 SINGLE ARCH ON FIXING STG-2 Procedure 2600 2730 3250 3770
ORTHODONTICS
DENTAL
PDOD077 SS-ARCH-EXPANSION-HYRAX APPLIANCES Procedure 15040 15790 18790 21800
ORTHODONTICS
284
Dental
SS-ARCH-EXPANSION-QUAD HELIX DENTAL

PDOD078 Procedure 7650 8030 9560 11090
SS-ARCH-EXPANSION-REMOVABLE DENTAL
PDOD079 Procedure 7110 7470 8890 10310
EXPANSION APPLIANCES ORTHODONTICS
DENTAL
PDOD080 SS-BONDED RETAINERS:EACH ARCH Procedure 2870 3010 3580 4160
ORTHODONTICS
DENTAL
PDOD081 SS-BRACKET REPAIR Procedure 900 950 1130 1310
ORTHODONTICS
DENTAL
PDOD082 SS-DISTULISATION APPL-K.LOOP Procedure 16400 17220 20500 23780
ORTHODONTICS
DENTAL
PDOD083 SS-DISTULISATION APPL-STG-1 Procedure 14350 15060 17930 20800
ORTHODONTICS
DENTAL
PDOD084 SS-DISTULISATION APPL-STG-2 Procedure 4790 5030 5980 6940
ORTHODONTICS
DENTAL
PDOD085 SS-FIXED APPLIANCE-BEG-FIXED-STG-1 Procedure 23910 25110 29890 34670
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
PDOD088 SS-FIXED-PEA-CERAMICBRACKET-STG-1 Procedure 47820 50210 59780 69340
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
ORTHODONTICS
DENTAL
PDOD092 SS-FUNCTIONAL APPLIANCE STG-1 Procedure 10390 10910 12990 15060
ORTHODONTICS
DENTAL
PDOD093 SS-FUNCTIONAL APPLIANCE STG-2 Procedure 5190 5450 6490 7530
ORTHODONTICS
DENTAL
PDOD094 SS-FUNCTIONAL APPLIANCE-FIXED STG-2 Procedure 5190 5450 6490 7530
ORTHODONTICS
DENTAL
PDOD095 SS-FUNCTIONAL APPLIANCE-FIXED-STG-1 Procedure 9570 10050 11960 13880
ORTHODONTICS
SS-GROWTH-MODULATION-HEADGEAR- DENTAL
PDOD096 Procedure 14350 15060 17930 20800
STG-1 ORTHODONTICS
SS-GROWTH-MODULATION-HEADGEAR- DENTAL
PDOD097 Procedure 14350 15060 17930 20800
STG-2 ORTHODONTICS
DENTAL
PDOD098 SS-LINGUAL HOLDING ARCH Procedure 3830 4030 4790 5560
ORTHODONTICS
DENTAL
PDOD099 SS-NANCE HOLDING ARCH Procedure 3830 4030 4790 5560
ORTHODONTICS
DENTAL
PDOD100 SS-REMOVABLE APPLIANCE REPAIR Procedure 1300 1370 1630 1890
ORTHODONTICS
285
Dental
SS-REMOVABLE-APPLIANCES-UPP/LOW- DENTAL
PDOD101 Procedure 7650 8030 9560 11090
PLATES-STG-1 ORTHODONTICS
SS-RETENTION APPLIANCE REMOVABLE DENTAL
PDOD102 Procedure 1510 1590 1890 2190
EACH ARCH ORTHODONTICS
SS-STRAIGHTWIRE-TECHNIQUE-FIXED- DENTAL
PDOD103 Procedure 43730 45910 54660 63400
STG-1 ORTHODONTICS
PDOD104 Procedure 6420 6740 8030 9310
STG-2 ORTHODONTICS
PDOD105 Procedure 6420 6740 8030 9310
STG-3 ORTHODONTICS
PDOD106 Procedure 5190 5450 6490 7530
STG-4 ORTHODONTICS
SURGICAL ORTHODONTICS FACE BOW DENTAL
PDOD107 Procedure 2600 2730 3250 3770
TRANSFER ORTHODONTICS
SURGICAL ORTHODONTICS PRE-SURGICAL DENTAL
PDOD108 Procedure 35530 37300 44410 51510
ORTHODONTICS ORTHODONTICS
SURGICAL ORTHODONTICS SURGICAL DENTAL
PDOD109 Procedure 2600 2730 3250 3770
SPLINT(DOUBLE ARCH) ORTHODONTICS
SURGICAL ORTHODONTICS SURGICAL DENTAL
PDOD110 Procedure 1300 1370 1630 1890
SPLINT(SINGLE ARCH) ORTHODONTICS
DENTAL
PDOD111 MINOR REMOVABLE ORTHODONTICS Procedure 10390 10910 12990 15060
ORTHODONTICS
DENTAL ORAL
PDOX001 ABSCESS DRAINAGE EXTRA ORAL Procedure 2470 2590 3080 3570
MAXILLOFACIAL
DENTAL ORAL
PDOX002 ABSCESS DRAINAGE INTRA ORAL Procedure 760 800 950 1110
MAXILLOFACIAL
DENTAL ORAL
PDOX003 ADDITIONAL TOOTH APICETOMY Procedure 1510 1590 1890 2190
MAXILLOFACIAL
DENTAL ORAL
PDOX004 ADDITIONAL TOOTH IN GA Procedure 450 480 570 660
MAXILLOFACIAL
ADDITIONAL TOOTH IN MEDICALY DENTAL ORAL
PDOX005 Procedure 340 360 420 490
COMPROMISED MAXILLOFACIAL
DENTAL ORAL
PDOX006 ALVEOLECTOMY/PLASTY Procedure 2870 3010 3580 4160
MAXILLOFACIAL
DENTAL ORAL
PDOX007 ANKYLOSIS TMJ (BILATERAL) Procedure 4370 4590 5470 6340
MAXILLOFACIAL
DENTAL ORAL
PDOX008 ANKYLOSIS TMJ (UNILATERAL) Procedure 3420 3590 4270 4960
MAXILLOFACIAL
DENTAL ORAL
PDOX009 APICOECTOMY Procedure 4100 4300 5120 5940
MAXILLOFACIAL
DENTAL ORAL
PDOX010 BELOW KNEE FULL PLASTER Procedure 1370 1440 1720 1990
MAXILLOFACIAL
DENTAL ORAL
PDOX011 BIMAXILLARY OSTEOTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX012 BLEEDING SOCKET Procedure 450 480 570 660
MAXILLOFACIAL
286
Dental
DENTAL ORAL
PDOX015 CALDWEL-LUC PROCEDURE Procedure 1910 2010 2390 2770
MAXILLOFACIAL
DENTAL ORAL
PDOX016 CARTILAGE GRAFTING Procedure 2870 3010 3580 4160
MAXILLOFACIAL
DENTAL ORAL
PDOX017 CYST ENUCLEATION Procedure 4240 4450 5290 6140
MAXILLOFACIAL
DENTAL ORAL
PDOX018 CYST ESCISION - G.A. Procedure 7110 7470 8890 10310
MAXILLOFACIAL
DENTAL ORAL
PDOX019 DENTAL CLEARANCE UNDER GA Procedure 4790 5030 5980 6940
MAXILLOFACIAL
DENTAL ORAL
PDOX021 DRY SOCKET DRESSING Procedure 320 330 390 460
MAXILLOFACIAL
DENTAL ORAL
PDOX022 EXCISIONAL BIOPSY Procedure 1510 1590 1890 2190
MAXILLOFACIAL
EXTRACTION ADDITIONAL TOOTH SAME DENTAL ORAL
PDOX023 Procedure 340 360 420 490
SITTIN MAXILLOFACIAL
DENTAL ORAL
PDOX024 EXTRACTION ADULT / TOOTH Procedure 610 640 770 890
MAXILLOFACIAL
DENTAL ORAL
PDOX025 EXTRACTION GROSSLY DECAYED Procedure 1180 1240 1470 1710
MAXILLOFACIAL
EXTRACTION MEDICALLY COMPROMISED DENTAL ORAL
PDOX026 Procedure 900 950 1130 1310
PATIENT MAXILLOFACIAL
DENTAL ORAL
PDOX027 EXTRACTION OF SINGLE TOOTH / GA Procedure 1300 1370 1630 1890
MAXILLOFACIAL
DENTAL ORAL
PDOX028 FAT PAD GRAFT (BILATERAL) Procedure 3830 4030 4790 5560
MAXILLOFACIAL
DENTAL ORAL
PDOX029 FAT PAD GRAFT (UNILATERAL) Procedure 2870 3010 3580 4160
MAXILLOFACIAL
DENTAL ORAL
PDOX030 FNAC - DEM Procedure 320 330 390 460
MAXILLOFACIAL
DENTAL ORAL
PDOX031 FOCAL ALVEOLECTOMY Procedure 760 800 950 1110
MAXILLOFACIAL
DENTAL ORAL
PDOX032 FRACTURE ALVEOLOUS Procedure 2470 2590 3080 3570
MAXILLOFACIAL
DENTAL ORAL
PDOX033 FRACTURE BILATERAL ORRIF Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX034 FRACTURE JAW Procedure 9570 10050 11960 13880
MAXILLOFACIAL
DENTAL ORAL
PDOX035 FRACTURE MALAR CLOSED REDUCTION Procedure 9570 10050 11960 13880
MAXILLOFACIAL
DENTAL ORAL
PDOX036 FRACTURE MALAR ORIF Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX037 FRACTURE MANDIBLE - ARCH BARS Procedure 7110 7470 8890 10310
MAXILLOFACIAL
DENTAL ORAL
PDOX038 FRACTURE MAXILLA ORRIF LE FORTE 1 Procedure 14350 15060 17930 20800
MAXILLOFACIAL
287
Dental
DENTAL ORAL
MAXILLOFACIAL
DENTAL ORAL
MAXILLOFACIAL
DENTAL ORAL
PDOX041 FRACTURE MAXILLA WITH SPLIT PALATE Procedure 23910 25110 29890 34670
MAXILLOFACIAL
DENTAL ORAL
PDOX042 FRACTURE MULTIPLE - ORRIF Procedure 14350 15060 17930 20800
MAXILLOFACIAL
DENTAL ORAL
PDOX043 FRACTURE UNILATERAL ORRIF Procedure 11760 12350 14700 17050
MAXILLOFACIAL
DENTAL ORAL
PDOX044 FRENECTOMY Procedure 2470 2590 3080 3570
MAXILLOFACIAL
DENTAL ORAL
PDOX045 GENIOPLASTY Procedure 17080 17940 21350 24770
MAXILLOFACIAL
DENTAL ORAL
PDOX046 GINGIVAL/SOFT TISSUE GRAFTING Procedure 4790 5030 5980 6940
MAXILLOFACIAL
DENTAL ORAL
PDOX047 GINGIVECTOMY/PLASTY/QUADRANT Procedure 2600 2730 3250 3770
MAXILLOFACIAL
DENTAL ORAL
PDOX048 HEMIMANDIBULECTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX049 IMPACTION BONY Procedure 5880 6180 7350 8530
MAXILLOFACIAL
DENTAL ORAL
PDOX050 IMPACTION SOFT TISSUE Procedure 3560 3740 4450 5160
MAXILLOFACIAL
DENTAL ORAL
PDOX051 IMPLANT ENDO-A Procedure 32790 34430 40990 47550
MAXILLOFACIAL
DENTAL ORAL
PDOX052 IMPLANT ENDO-S Procedure 28700 30130 35870 41610
MAXILLOFACIAL
DENTAL ORAL
PDOX053 IMPLANT ENDO-U Procedure 27330 28700 34160 39620
MAXILLOFACIAL
DENTAL ORAL
PDOX054 IMPLANT E-Z-A - DEM Procedure 20500 21520 25620 29720
MAXILLOFACIAL
DENTAL ORAL
PDOX055 IMPLANT E-Z-S - DEM Procedure 17760 18650 22200 25750
MAXILLOFACIAL
DENTAL ORAL
PDOX056 IMPLANT E-Z-U - DEM Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX057 IMPLANT TRI-D - PDOX Procedure 14350 15060 17930 20800
MAXILLOFACIAL
DENTAL ORAL
PDOX058 IMPLANT TRI-N - PDOX Procedure 17080 17940 21350 24770
MAXILLOFACIAL
DENTAL ORAL
PDOX059 INCISION BIOPSY - PDOX Procedure 610 640 770 890
MAXILLOFACIAL
DENTAL ORAL
PDOX060 INTRA ARTICULAR INJECTION - (MAJOR) Procedure 590 620 740 860
MAXILLOFACIAL
DENTAL ORAL
PDOX061 INTRA ARTICULAR INJECTION - (MEDIUM) Procedure 450 480 570 660
MAXILLOFACIAL
288
Dental
DENTAL ORAL
PDOX062 INTRA ARTICULAR INJECTION - (MINOR) Procedure 340 360 420 490
MAXILLOFACIAL
INTRA ARTICULAR INJECTION - (SUPRA DENTAL ORAL
PDOX063 Procedure 560 580 690 810
MAJOR) MAXILLOFACIAL
DENTAL ORAL
PDOX064 INTRA ORAL FLAPS Procedure 2600 2730 3250 3770
MAXILLOFACIAL
DENTAL ORAL
PDOX065 LEPORT I OSTEOTOMY Procedure 23910 25110 29890 34670
MAXILLOFACIAL
DENTAL ORAL
PDOX066 MALAR AUGMENTATION Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX067 MANDIBLE BODY OSTEOTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX068 MANDIBLE DISLOCATION Procedure 1650 1730 2060 2390
MAXILLOFACIAL
DENTAL ORAL
PDOX069 MANDIBLE RAMUS OSTEOTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX070 MANDIBLE SEGMENTAL OSTEOTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX071 MAXILLA SEGMENTAL OSTEOTOMY Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX072 MAXILLECTOMY Procedure 14350 15060 17930 20800
MAXILLOFACIAL
DENTAL ORAL
PDOX073 NASO ETHMOID FRACTURE Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX074 ORBITAL BLOW OUT FRACTURE Procedure 19130 20090 23910 27740
MAXILLOFACIAL
DENTAL ORAL
PDOX075 ORO ANTRAL FISTULA Procedure 9570 10050 11960 13880
MAXILLOFACIAL
DENTAL ORAL
PDOX076 ORO NASAL FISTULA - PDOX Procedure 9570 10050 11960 13880
MAXILLOFACIAL
DENTAL ORAL
PDOX077 ORTHOGNATHIC MODEL SURGERY Procedure 2470 2590 3080 3570
MAXILLOFACIAL
DENTAL ORAL
PDOX078 OSSEOUS SURGERY Procedure 5610 5890 7010 8130
MAXILLOFACIAL
DENTAL ORAL
PDOX079 PT BRACING - PDOX Procedure 320 330 390 460
MAXILLOFACIAL
DENTAL ORAL
PDOX080 PALATEL FENESTRATION Procedure 3420 3590 4270 4960
MAXILLOFACIAL
DENTAL ORAL
PDOX081 PAN FACIAL FRACTURES Procedure 23910 25110 29890 34670
MAXILLOFACIAL
DENTAL ORAL
PDOX082 PERICORONAL FLAP EXCISION Procedure 1370 1440 1720 1990
MAXILLOFACIAL
PERIODONTAL FLAP SURGERY (COST OF DENTAL ORAL
PDOX083 Procedure 3970 4170 4960 5760
GRAFT MAXILLOFACIAL
PLASTER OF PARIS APPLICATION - MAJOR DENTAL ORAL
PDOX084 Procedure 1510 1590 1890 2190
- DEM MAXILLOFACIAL
289
Dental
PLASTER OF PARIS APPLICATION - MEDIUM DENTAL ORAL

PDOX085 Procedure 1180 1240 1470 1710
- DEM MAXILLOFACIAL
PLASTER OF PARIS APPLICATION - MINOR DENTAL ORAL
PDOX086 Procedure 760 800 950 1110
- DEM MAXILLOFACIAL
DENTAL ORAL
PDOX087 REIMPLANTATION OF TOOTH Procedure 1910 2010 2390 2770
MAXILLOFACIAL
DENTAL ORAL
PDOX088 REPAIR OF HARD / SOFT PALATE Procedure 4790 5030 5980 6940
MAXILLOFACIAL
DENTAL ORAL
PDOX089 ROOT RESECTION Procedure 2470 2590 3080 3570
MAXILLOFACIAL
DENTAL ORAL
PDOX090 SEGMENTAL RESECTION Procedure 3830 4030 4790 5560
MAXILLOFACIAL
DENTAL ORAL
PDOX091 SIAL OLITH EXCISION Procedure 4790 5030 5980 6940
MAXILLOFACIAL
DENTAL ORAL
PDOX092 SKIN GRAFTS Procedure 960 1010 1200 1390
MAXILLOFACIAL
DENTAL ORAL
PDOX093 SOFT TISSUE REPAIR INTRAORAL / LA Procedure 1300 1370 1630 1890
MAXILLOFACIAL
DENTAL ORAL
PDOX094 STAGE - 1 - DEM Procedure 9840 10330 12300 14260
MAXILLOFACIAL
DENTAL ORAL
PDOX095 STAGE - 1 TRI Procedure 4650 4880 5810 6740
MAXILLOFACIAL
DENTAL ORAL
MAXILLOFACIAL
DENTAL ORAL
MAXILLOFACIAL
DENTAL ORAL
PDOX098 SUBMANDIBULAR GLAND EXCISION Procedure 7110 7470 8890 10310
MAXILLOFACIAL
DENTAL ORAL
PDOX099 SURGICAL EXISION - CYST TUMOR Procedure 3970 4170 4960 5760
MAXILLOFACIAL
SURGICAL REMOVAL IN MEDICALY DENTAL ORAL
PDOX100 Procedure 1910 2010 2390 2770
COMPROMISED MAXILLOFACIAL
DENTAL ORAL
PDOX101 SURGICAL REMOVAL WITH CURETTAGE Procedure 1300 1370 1630 1890
MAXILLOFACIAL
DENTAL ORAL
PDOX102 SURGICAL SPLINTING Procedure 1910 2010 2390 2770
MAXILLOFACIAL
DENTAL ORAL
PDOX103 SUTURE REMOVAL (MAJOR) Procedure 220 230 280 320
MAXILLOFACIAL
DENTAL ORAL
PDOX104 SUTURE REMOVAL (MEDIUM) Procedure 200 210 250 290
MAXILLOFACIAL
DENTAL ORAL
PDOX105 TONGUE TIE RELEASE - PDOX Procedure 3560 3740 4450 5160
MAXILLOFACIAL
DENTAL ORAL
PDOX106 TRANSPLANTATION Procedure 1240 1300 1540 1790
MAXILLOFACIAL
DENTAL ORAL
PDOX107 VESTIBULAR EXTENSION Procedure 2600 2730 3250 3770
MAXILLOFACIAL
DENTAL ORAL
PDOX108 VESTIBULOPLASTY Procedure 1240 1300 1540 1790
MAXILLOFACIAL
290
Emergency
291
Emergency
Billing
Group
ACCIDENT
PAEA001 BLOOD PRESSURE CHECK - AEA Emergency 50 50 60 70
EMERGENCY ADULT
ACCIDENT
PAEA009 GRBS - BLOOD SUGAR - AEA Emergency 50 50 60 70
EMERGENCY ADULT
ACCIDENT
PAEA020 OXYGEN INHALATION PER HOUR - AEA Emergency 50 50 60 70
EMERGENCY ADULT
ACCIDENT
PAEA012 INJECTION -IM - AEA Emergency 70 70 80 100
EMERGENCY ADULT
ACCIDENT
PAEA010 INJECTION - IV - AEA Emergency 70 70 80 100
EMERGENCY ADULT
ACCIDENT
PAEA011 INJECTION - SC - AEA Emergency 70 70 80 100
EMERGENCY ADULT
ACCIDENT
PAEA014 IV CANNULATION - AEA Emergency 70 70 80 100
EMERGENCY ADULT
ACCIDENT
PAEA007 ENEMA - AEA Emergency 80 80 100 110
EMERGENCY ADULT
ACCIDENT
PAEA018 NEBULISATION - PER EPISODE - AEA Emergency 80 80 100 110
EMERGENCY ADULT
ACCIDENT
PAEA029 TUBE INSERTION - NG - AEA Emergency 80 80 100 110
EMERGENCY ADULT
ACCIDENT
PAEA005 DRESSING - MINOR - AEA Emergency 100 100 120 140
EMERGENCY ADULT
ACCIDENT
PAEA026 SUTURE REMOVAL - MINOR - AEA Emergency 120 130 150 170
EMERGENCY ADULT
ACCIDENT
PAEA002 CATHETERIZATION - AEA Emergency 140 150 180 200
EMERGENCY ADULT
ACCIDENT
PAEA006 ECG - AEA Emergency 150 160 190 220
EMERGENCY ADULT
OBSERVATION CHARGE - 3 TO 6 HRS ACCIDENT
PAEA019 Emergency 160 170 200 230
- AEA EMERGENCY ADULT
ACCIDENT
PAEA004 DRESSING - MEDIUM - AEA Emergency 180 190 230 260
EMERGENCY ADULT
ACCIDENT
PAEA025 SUTURE REMOVAL - MEDIUM - AEA Emergency 180 190 230 260
EMERGENCY ADULT
ACCIDENT
PAEA028 SUTURING MINOR - AEA Emergency 180 190 230 260
EMERGENCY ADULT
ACCIDENT
PAEA015 IV INFUSION - AEA Emergency 280 290 350 400
EMERGENCY ADULT
EMERGENCY SCREENING CHARGES - ACCIDENT
PAEA034 Emergency 350 370 440 510
AEA EMERGENCY ADULT
ACCIDENT
PAEA008 GASTRIC LAVAGE - AEA Emergency 350 370 440 510
EMERGENCY ADULT
ACCIDENT
PAEA038 PROTHROMBIN (INSTANT) - AEA Emergency 350 370 440 510
EMERGENCY ADULT
ACCIDENT
PAEA027 SUTURING MEDIUM - AEA Emergency 350 370 440 510
EMERGENCY ADULT
292
Emergency
Billing
Group
ACCIDENT
PAEA023 POP MINOR - AEA Emergency 420 450 530 610
EMERGENCY ADULT
ACCIDENT
PAEA040 DRESSING MAJOR - AEA Emergency 470 490 580 670
EMERGENCY ADULT
EMERGENCY ROOM RENT PER HOUR ACCIDENT
PAEA056 Emergency 500 500 500 500
(AEA) EMERGENCY ADULT
ACCIDENT
PAEA039 SUTURING MAJOR - AEA Emergency 580 610 730 840
EMERGENCY ADULT
ACCIDENT
PAEA022 POP MEDIUM - AEA Emergency 630 670 790 920
EMERGENCY ADULT
ACCIDENT
PAEA036 QUICK MALARIA PARASITE TEST - AEA Emergency 690 720 860 990
EMERGENCY ADULT
ACCIDENT
PAEA046 FAST SCAN - AEA Emergency 700 730 870 1010
EMERGENCY ADULT
ACCIDENT
PAEA043 LUMBAR PUNCTURE - AEA Emergency 700 730 870 1010
EMERGENCY ADULT
ACCIDENT
PAEA055 Regional Analgesia - AEA Emergency 740 780 920 1070
EMERGENCY ADULT
ACCIDENT
PAEA021 POP MAJOR - AEA Emergency 760 800 950 1100
EMERGENCY ADULT
ACCIDENT
PAEA016 MEDICO LEGAL CHARGES - AEA Emergency 1000 1000 1000 1000
EMERGENCY ADULT
ACCIDENT
PAEA049 PLEURAL TAPPING - AEA Emergency 1050 1110 1320 1530
EMERGENCY ADULT
ACCIDENT
PAEA041 ARTERIAL LINE - AEA Emergency 1160 1220 1450 1680
EMERGENCY ADULT
ACCIDENT
PAEA035 STAT CARDIAC ENZYMES - AEA Emergency 1390 1460 1740 2010
EMERGENCY ADULT
ACCIDENT
PAEA037 SHORTNESS OF BREATH PANEL - AEA Emergency 1630 1710 2040 2360
EMERGENCY ADULT
ACCIDENT
PAEA003 CPR - AEA Emergency 1740 1820 2170 2520
EMERGENCY ADULT
ACCIDENT
PAEA044 ICD INSERTION - AEA Emergency 1740 1820 2170 2520
EMERGENCY ADULT
ACCIDENT
PAEA052 NONINVASIVE VENTILATION - AEA Emergency 1740 1820 2170 2520
EMERGENCY ADULT
CLOSED REDUCTION OF DISLOCATION ACCIDENT
PAEA047 Emergency 2310 2430 2890 3350
- AEA EMERGENCY ADULT
ACCIDENT
PAEA048 PROCEDURAL SEDATION - AEA Emergency 2310 2430 2890 3350
EMERGENCY ADULT
ACCIDENT
PAEA053 TRANSCUTANEOUS PACING - AEA Emergency 2310 2430 2890 3350
EMERGENCY ADULT
ACCIDENT
PAEA013 INTUBATION - AEA Emergency 2890 3040 3610 4190
EMERGENCY ADULT
ACCIDENT
PAEA051 CARDIOVERSION - AEA Emergency 3470 3640 4340 5030
EMERGENCY ADULT
293
Emergency
Billing
Group
ACCIDENT
PAEA050 THROMBOLYSIS - AEA Emergency 3470 3640 4340 5030
EMERGENCY ADULT
ACCIDENT
PAEA042 ASCITIC TAPPING - AEA Emergency 3890 4080 4860 5640
EMERGENCY ADULT
ACCIDENT
PAEA045 CENTRAL LINE PLACEMENT - AEA Emergency 4050 4250 5060 5870
EMERGENCY ADULT
PAEDIATRIC
PPER018 INJECTION -IM - PPER Emergency 60 60 70 80
EMERGENCY
PAEDIATRIC
PPER019 INJECTION - IV - PER Emergency 60 60 70 80
EMERGENCY
PAEDIATRIC
PPER020 INJECTION - SC - PER Emergency 60 60 70 80
EMERGENCY
PAEDIATRIC
PPER023 IV CANNULATION - PER Emergency 80 80 100 110
EMERGENCY
PAEDIATRIC
PPER029 OXYGEN INHALATION PER HOUR - PER Emergency 80 80 100 110
EMERGENCY
PAEDIATRIC
PPER028 NG TUBE PLACEMENT Emergency 110 120 140 160
EMERGENCY
PAEDIATRIC
PPER007 DRESSING - PPER Emergency 130 140 160 190
EMERGENCY
PAEDIATRIC
PPER009 ECG - PPER Emergency 130 140 160 190
EMERGENCY
PAEDIATRIC
PPER027 NEBULISATION - PER EPISODE Emergency 130 140 160 190
EMERGENCY
PAEDIATRIC
PPER024 IV INFUSION - PER INFUSION Emergency 140 150 180 200
EMERGENCY
PAEDIATRIC
PPER051 WARMER Emergency 140 150 180 200
EMERGENCY
PAEDIATRIC
PPER012 ENEMA - PER Emergency 160 170 200 230
EMERGENCY
PAEDIATRIC
PPER041 SUTURE REMOVAL - PER Emergency 180 190 230 260
EMERGENCY
PAEDIATRIC
PPER044 SUTURE REMOVAL & DRESSING - PER Emergency 210 230 270 310
EMERGENCY
PAEDIATRIC
PPER052 SUTURING INTERMEDIATE - PER Emergency 210 230 270 310
EMERGENCY
PAEDIATRIC
PPER056 HAEMOGLOBIN ( AUTOMATED - EC 4+ ) Emergency 230 240 280 320
EMERGENCY
PAEDIATRIC
PPER003 CATHETERIZATION - PER Emergency 240 250 290 340
EMERGENCY
PAEDIATRIC
PPER067 IV INFUSION - WITH MOINTORING Emergency 270 280 330 390
EMERGENCY
PAEDIATRIC
PPER048 TRACHEOSTOMY TUBE CHANGE - PER Emergency 270 280 330 390
EMERGENCY
INFUSION OF VASOACTIVE DRUGS - PAEDIATRIC
PPER017 Emergency 350 370 440 510
PER EMERGENCY
294
Emergency
Billing
Group
PAEDIATRIC
PPER036 POP MINOR - PER Emergency 390 410 490 570
EMERGENCY
PAEDIATRIC
PPER040 SUPRAPUBIC ASPIRATION Emergency 420 450 530 610
EMERGENCY
PAEDIATRIC
PPER005 CONTINUOUS NEBULISATION Emergency 450 470 560 640
EMERGENCY
PAEDIATRIC
PPER013 GASTRIC LAVAGE - PER Emergency 460 480 570 660
EMERGENCY
PAEDIATRIC
PPER047 SUTURING MINOR - PER Emergency 470 490 580 670
EMERGENCY
EMERGENCY ROOM RENT GENERAL PAEDIATRIC
PPER011 Emergency 500 500 500 500
PER HOUR EMERGENCY
PAEDIATRIC
PPER010 EMERGENCY ROOM RENT - PER HOUR Emergency 500 500 500 500
EMERGENCY
PAEDIATRIC
PPER001 ASCITIC TAP - PER Emergency 530 560 660 770
EMERGENCY
PAEDIATRIC
PPER054 DRESSING BURNS - MINOR Emergency 530 560 660 770
EMERGENCY
PAEDIATRIC
PPER026 LUMBAR PUNCTURE - PER Emergency 530 560 660 770
EMERGENCY
PAEDIATRIC
PPER049 TRANSFUSION - PER Emergency 630 670 790 920
EMERGENCY
PAEDIATRIC
PPER050 VENESECTION - PER Emergency 630 670 790 920
EMERGENCY
PAEDIATRIC
PPER035 POP MEDIUM - PER Emergency 660 690 820 950
EMERGENCY
PAEDIATRIC
PPER032 PERIPHERAL ARTERIAL LINE Emergency 690 720 860 990
EMERGENCY
PROTHROMBIN TIME -PT (
PAEDIATRIC
PPER057 AUTOMATED/ CLOTTING ASSAY - PT/ Emergency 690 720 860 990
EMERGENCY
INR)
RENAL PANEL - III - FASTING (CHEM PAEDIATRIC
PPER058 Emergency 690 720 860 990
8+) EMERGENCY
GROWTH HARMONE STIMULATION PAEDIATRIC
PPER014 Emergency 700 730 870 1010
TEST EMERGENCY
PAEDIATRIC
PPER016 INCISSION & DRAINAGE - PPER Emergency 700 730 870 1010
EMERGENCY
PAEDIATRIC
PPER030 PAEDIATRIC ER STABILIZATION Emergency 700 730 870 1010
EMERGENCY
PAEDIATRIC
PPER034 POP MAJOR - PER Emergency 770 810 960 1120
EMERGENCY
PAEDIATRIC
PPER022 INTUBATION - PER Emergency 790 830 990 1150
EMERGENCY
PAEDIATRIC
PPER033 PLEURAL TAP Emergency 790 830 990 1150
EMERGENCY
295
Emergency
Billing
Group
PAEDIATRIC
PPER031 PERICARDIAL TAP Emergency 840 890 1050 1220
EMERGENCY
PAEDIATRIC
PPER021 INTERCOSTAL DRAINAGE - PER Emergency 900 940 1120 1300
EMERGENCY
PAEDIATRIC
PPER025 LIVER BIOPSY - PER Emergency 900 940 1120 1300
EMERGENCY
PAEDIATRIC
PPER037 SEDATION MAJOR Emergency 910 950 1130 1310
EMERGENCY
PAEDIATRIC
PPER045 SUTURING MAJOR - PER Emergency 960 1010 1200 1390
EMERGENCY
BONE MARROW ASPIRATION AND PAEDIATRIC
PPER002 Emergency 1050 1110 1320 1530
BIOPSY EMERGENCY
PAEDIATRIC
PPER004 CENTRAL LINE - PER Emergency 1050 1110 1320 1530
EMERGENCY
PAEDIATRIC
PPER008 DRESSING BURNS - MAJOR Emergency 1050 1110 1320 1530
EMERGENCY
PAEDIATRIC
PPER060 EMERGENCY ROOM RENT - 12 HOURS Emergency 1050 1110 1320 1530
EMERGENCY
INCISSION & DRAINAGE - PPER- PAEDIATRIC
PPER065 Emergency 1050 1110 1320 1530
(MAJOR) EMERGENCY
PAEDIATRIC
PPER066 SEDATION FOR BRONCHOSCOPY Emergency 1050 1110 1320 1530
EMERGENCY
SEDATION FOR INTRAARTICULAR PAEDIATRIC
PPER061 Emergency 1050 1110 1320 1530
INJECTION(less than 3joints) EMERGENCY
PAEDIATRIC
PPER068 SEDATION MINOR -PER Emergency 1050 1110 1320 1530
EMERGENCY
PAEDIATRIC
PPER059 BLOOD GAS ANALYSIS (CG 4+ ) Emergency 1220 1280 1530 1770
EMERGENCY
PAEDIATRIC
PPER006 CPR - PER Emergency 1320 1380 1650 1910
EMERGENCY
PAEDIATRIC
PPER015 HICKMAN REMOVAL - PER Emergency 1370 1440 1710 1980
EMERGENCY
BLOOD GAS ANALYSIS WITH PAEDIATRIC
PPER055 Emergency 1400 1470 1750 2030
ELECTROLYTES (EG 7+ ) EMERGENCY
SEDATION FOR INTRAARTICULAR PAEDIATRIC
PPER062 Emergency 2100 2210 2630 3050
INJECTION( greater than 3joints) EMERGENCY
PAEDIATRIC
PPER063 SEDATION FOR SKIN LESION Emergency 2630 2760 3290 3810
EMERGENCY
SEDATION FOR GI FOREIGN BODY PAEDIATRIC
PPER064 Emergency 5250 5520 6570 7620
REMOVAL EMERGENCY
296
Consultation
297
Consultation
CAEA001 CONSULTATION EMERGENCY - ADULT Consultation CONSULTATION OP 900 900 900 900
CONSULTATION EMERGENCY
CAEA003 Consultation CONSULTATION OP 700 700 700 700
SUPERSPECIALITY DAY - ADULT
CONSULTATION EMERGENCY
CAEA005 Consultation CONSULTATION OP 700 700 700 700
SUPERSPECIALITY NIGHT - ADULT
CAEA006 CONSULTATION EMERGENCY Consultation CONSULTATION OP 750 750 750 750
CANA001 CONSULTATION ANAESTHESIA Consultation CONSULTATION OP 700 0 0 0
CAND001 CONSULTATION ANDROLOGY - IVF Consultation CONSULTATION OP 700 0 0 0
CONSULTATION CARDIOLOGY
CCAN001 Consultation CONSULTATION OP 900 0 0 0
ANAESTHESIA
CCAP001 CONSULTATION CARDIOLOGY PAEDIATRIC Consultation CONSULTATION OP 900 0 0 0
CCAR001 CONSULTATION CARDIOLOGY Consultation CONSULTATION OP 900 0 0 0
CCPSY01 CONSULTATION CHILD PSYCHOLOGY Consultation CONSULTATION OP 900 0 0 0
CONSULTATION CARDIOTHORACIC
CCTS001 Consultation CONSULTATION OP 900 0 0 0
SURGERY
CCYT001 CONSULTATION CYTOGENETICS Consultation CONSULTATION OP 900 0 0 0
CDEN001 CONSULTATION DENTAL - MEDICINE Consultation CONSULTATION OP 700 0 0 0
CDER001 CONSULTATION DERMATOLOGY Consultation CONSULTATION OP 700 0 0 0
CONSULTATION DIABETES AND
CDIB001 Consultation CONSULTATION OP 900 0 0 0
ENDOCRINOLOGY
CDIE001 CONSULTATION DIETARY Consultation CONSULTATION OP 500
CDIE002 HEALTHY DIET PACKAGE Consultation CONSULTATION OP 580 0 0 0
CDOD001 CONSULTATION DENTAL - ORTHODONTICS Consultation CONSULTATION OP 700 0 0 0
CDOM001 CONSULTATION DENTAL - ORAL MEDICINE Consultation CONSULTATION OP 700 0 0 0
CDOX001 CONSULTATION DENTAL - ORAL MAX Consultation CONSULTATION OP 700 0 0 0
CENT001 CONSULTATION ENT Consultation CONSULTATION OP 700 0 0 0
CFET001 CONSULTATION FETAL MEDICINE Consultation CONSULTATION OP 700 0 0 0
CGAM001 CONSULTATION GASTRO MEDICAL Consultation CONSULTATION OP 900 0 0 0
CGAS001 CONSULTATION GASTRO SURGICAL Consultation CONSULTATION OP 900 0 0 0
CGEN001 CONSULTATION GENERAL SURGERY Consultation CONSULTATION OP 700 0 0 0
CGEN003 Discounted consultation (Bariatric surgery) Consultation CONSULTATION OP 420 420 420 420
CGER001 CONSULTATION GERIATRICS Consultation CONSULTATION OP 700 0 0 0
CHOMC01 HOME CARE CONSULTATION Consultation CONSULTATION OP 1020 0 0 0
CINF001 CONSULTATION INFECTIOUS DISEASES Consultation CONSULTATION OP 900 0 0 0
CINT001 CONSULTATION INTERNAL MEDICINE Consultation CONSULTATION OP 700 0 0 0
CONSULTATION INTERVENTIONAL PAIN
CIPM001 Consultation CONSULTATION OP 900 0 0 0
MEDICINE
CONSULTATION INTERVENTIONAL
CIRAD01 Consultation CONSULTATION OP 900 0 0 0
RADIOLOGY
CLTS001 CONSULTATION LIVER TRANSPLANT Consultation CONSULTATION OP 900 0 0 0
298
Consultation
CONSULTATION GEN.SUR - MINIMAL

CMAS001 Consultation CONSULTATION OP 700 0 0 0
ACCESS SURGERY
CMHC001 CONSULTATION HEALTH CHECK Consultation CONSULTATION OP 100 0 0 0
CNEP001 CONSULTATION NEPHROLOGY Consultation CONSULTATION OP 900 0 0 0
CNEU001 CONSULTATION NEUROLOGY Consultation CONSULTATION OP 900 0 0 0
CNPSY01 CONSULTATION NEUROPSYCHOLOGY Consultation CONSULTATION OP 900 0 0 0
CNSR001 CONSULTATION NEUROSURGERY Consultation CONSULTATION OP 900 0 0 0
CNUC001 CONSULTATION NUCLEAR MEDICINE Consultation CONSULTATION OP 900 0 0 0
COBG001 CONSULTATION O. B. G. Consultation CONSULTATION OP 700 0 0 0
CONSULTATION OPTHALMOLOGY -
COCU001 Consultation CONSULTATION OP 700 0 0 0
OCCUPLASTY
CONM001 CONSULTATION ONCOLOGY - MEDICAL Consultation CONSULTATION OP 900 0 0 0
CONR001 CONSULTATION ONCOLOGY - RADIATION Consultation CONSULTATION OP 900 0 0 0
CONS001 CONSULTATION ONCOLOGY - SURGICAL Consultation CONSULTATION OP 900 0 0 0
COPT001 CONSULTATION OPTHALMOLOGY Consultation CONSULTATION OP 700 0 0 0
CORT001 CONSULTATION ORTHOPAEDICS Consultation CONSULTATION OP 700 0 0 0
CORTS01 CONSULTATION ORTHOSPINE Consultation CONSULTATION OP 900 0 0 0
CPAL001 CONSULTATION PAEDIATRIC ALLERGIST Consultation CONSULTATION OP 900 0 0 0
CONSULTATION PAEDIATRIC
CPDR001 Consultation CONSULTATION OP 900 0 0 0
DERMATOLOGY
CPDS001 Consultation CONSULTATION OP 900 0 0 0
DEVELOPMENTAL SPECIALIST
CPED001 CONSULTATION PAEDIATRIC Consultation CONSULTATION OP 700 0 0 0
CPED002 CONSULTATION NEW BORN Consultation CONSULTATION OP 900 0 0 0
CPED003 CONSULTATION NEONATOLOGY Consultation CONSULTATION OP 900 0 0 0
CPEN001 Consultation CONSULTATION OP 900 0 0 0
ENDOCRINOLOGY
CPER001 PAEDIATRIC EMERGENCY-CONSULTATION Consultation CONSULTATION OP 900 0 0 0
CPER002 CONSULTATION SPECIALITY Consultation CONSULTATION OP 700 0 0 0
CPER003 CONSULTATION SUPER SPECIALITY Consultation CONSULTATION OP 900 0 0 0
CPIC001 CONSULTATION PAEDIATRIC ICU Consultation CONSULTATION OP 700 0 0 0
CPLC001 CONSULTATION PAEDIATRIC LACTATION Consultation CONSULTATION OP 900 0 0 0
CPLS001 CONSULTATION PLASTIC SURGERY Consultation CONSULTATION OP 900 0 0 0
CONSULTATION PHYSICAL MEDICINE -
CPMR001 Consultation CONSULTATION OP 700 0 0 0
REHAB
CPNN001 Consultation CONSULTATION OP 900 0 0 0
NEONATOLOGY
CPNU001 CONSULTATION PAEDIATRIC NEUROLOGY Consultation CONSULTATION OP 900 0 0 0
CPORT001 Consultation CONSULTATION OP 900 0 0 0
ORTHOPAEDICS
299
Consultation
CONSULTATION PAIN & PALLIATIVE

CPPS001 Consultation CONSULTATION OP 700 0 0 0
SERVICES
CPRC001 CONSULTATION PAIN RELIEF Consultation CONSULTATION OP 700 0 0 0
CPRHE01 Consultation CONSULTATION OP 900 0 0 0
RHEUMATOLOGY
CPSR001 CONSULTATION PAEDIATRIC SURGERY Consultation CONSULTATION OP 900 0 0 0
CPSY001 CONSULTATION PSYCHIATRY Consultation CONSULTATION OP 900 0 0 0
CPUL001 Consultation CONSULTATION OP 900 0 0 0
PULMONOLOGY
CRAD01 CONSULTATION Radiology & Imaging Consultation CONSULTATION OP 900 0 0 0
CRES001 CONSULTATION RESPIRATORY MEDICINE Consultation CONSULTATION OP 900 0 0 0
CRHU001 CONSULTATION RHEUMATOLOGY Consultation CONSULTATION OP 900 0 0 0
CSCC001 CONSULTATION SPINE CARE Consultation CONSULTATION OP 900 0 0 0
CONSULTATION SPORTS & EXERCISE
CSPO001 Consultation CONSULTATION OP 700 0 0 0
MEDICINE
CURO001 CONSULTATION UROLOGY Consultation CONSULTATION OP 900 0 0 0
CVAS001 CONSULTATION VASCULAR SURGERY Consultation CONSULTATION OP 900 0 0 0
CYOG001 CONSULTATION YOGATHERAPY Consultation CONSULTATION OP 700 0 0 0
Body Composition Analysis and Diet
DIET544 Consultation CONSULTATION OP 580 0 0 0
Consultation
DIET549 NEPHROLOGY DIET CONSULTATION Consultation CONSULTATION OP 390 0 0 0
ECON003 E CONSULTATION & WATSON charges Consultation CONSULTATION OP 9980 0 0 0
E CONSULTATION ONCOLOGY SECOND
ECON004 Consultation CONSULTATION OP 2100 0 0 0
OPINION SERVICES
REFOrder Referral Order Consultation CONSULTATION OP 0
Inpatient
CIPD007 DIETARY WARDS- CONSULTATION CONSULTATION IP 0 500 600 800
Services
Inpatient
CIPANA01 ANAESTHESIA - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPAND01 ANDROLOGY IVF - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPCAR02 CARDIOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPCNI02 CARDIOLOGY(NI) - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
CARDIOTHORACIC SURGERY - Inpatient
CIPCTS01 CONSULTATION IP 0 1100 1300 1700
CONSULTATION IP Services
Inpatient
CIPD008 CONSULTATION - IPD CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPCRC02 CRITICAL CARE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPCYT02 CYTOGENETICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
300
Consultation
Inpatient
CIPDEN01 DENTAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPDER02 DERMATOLOGY-CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
DIABETES AND ENDOCRINOLOGY - Inpatient
CIPDIB02 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPENT01 ENT - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPFET02 FETAL MEDICINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPGAM02 GASTRO MEDICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPGAS01 GASTRO SURGICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPGEN01 GENERAL SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPGER02 GERIATRICS- CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPIND02 INFECTIOUS DISEASES - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPINT02 INTERNAL MEDICINE- CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
INTERVENTIONAL PAIN MEDICINE- Inpatient
CIPIPM03 CONSULTATION IP 0 1100 1300 1700
INTERVENTIONAL RADIOLOGY - Inpatient
CIPIR001 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPLTS01 LIVER TRANSPLANT - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPMLC01 MEDICO LEGAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPPED05 NEONATOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPNEP02 NEPHROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPNEU02 NEUROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPNPSY2 NEUROPSYCHOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPNSR01 NEUROSURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPPED04 NEW BORN - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPNUC02 NUCLEAR MEDICINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPOBG01 OBS & GYNAECOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
301
Consultation
Inpatient
CIPONM02 ONCOLOGY MEDICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
ONCOLOGY RADIATION - CONSULTATION Inpatient
CIPONR02 CONSULTATION IP 0 1100 1300 1700
IP Services
Inpatient
CIPONS01 ONCOLOGY SURGICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPOPT01 OPTHALMOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPORT01 ORTHOPAEDICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPORTS1 ORTHO SPINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPPED02 PAEDIATRICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
PAEDIATRICS DEVELOPMENT - Inpatient
CIPPDS02 CONSULTATION IP 0 1100 1300 1700
PAEDIATRICS ENDOCRINOLOGY - Inpatient
CIPEN002 CONSULTATION IP 0 1100 1300 1700
PAEDIATRICS NEUROLOGY - Inpatient
CIPPNEU2 CONSULTATION IP 0 1100 1300 1700
PAEDIATRICS PULMONOLOGY - Inpatient
CIPPUL02 CONSULTATION IP 0 1100 1300 1700
PAEDIATRICS RHEUMATOLOGY - Inpatient
CIPPRHE2 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPPSR01 PAEDIATRIC SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
PAIN & PALLIATIVE SERVICES - Inpatient
CIPPPS02 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPPR002 PAIN RELIEF - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
PHYSICAL MEDICINE REHABILITATION - Inpatient
CIPPMR02 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPPLS01 PLASTIC SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPPSY02 PSYCHIATRY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
RESPIRATORY MEDICINE - CONSULTATION Inpatient
CIPRES02 CONSULTATION IP 0 1100 1300 1700
IP Services
Inpatient
CIPRHU02 RHEUMATOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPSCC01 SPINE CARE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
SPORTS & EXERCISE MEDICINE- Inpatient
CIPSPO02 CONSULTATION IP 0 1100 1300 1700
Inpatient
CIPURO01 UROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
302
Consultation
Inpatient
CIPVAS01 VASCULAR SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPYOG02 YOGATHERAPY -CONSULTATION IP CONSULTATION IP 0 1100 1300 1700
Services
Inpatient
CIPICU08 ICU CROSS CONSULTATION PER DAY CONSULTATION IP 0 1250 1250 1250
Services
HIGH DEPENDENCY CONSULTATION Inpatient
CIPHDU01 CONSULTATION IP 0 1300 1300 1300
CHARGES Services
ANDROLOGY IVF - CONSULTATION IP- Inpatient
CIPAND02 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
Inpatient
CIPCAR03 CARDIOLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
CARDIOLOGY(NI) - CONSULTATION IP- Inpatient
CIPCNI03 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
CARDIOTHORACIC SURGERY - Inpatient
CIPCTS02 CONSULTATION IP 0 2200 2600 3400
CONSULTATION IP-NIGHT Services
CRITICAL CARE - CONSULTATION IP - Inpatient
CIPCRC03 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
Inpatient
CIPCYT03 CYTOGENETICS - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
Inpatient
CIPDEN02 DENTAL - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
Inpatient
CIPDER03 DERMATOLOGY- CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
DIABETES AND ENDOCRINOLOGY - Inpatient
CIPDIB03 CONSULTATION IP 0 2200 2600 3400
Inpatient
CIPENT02 ENT - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
FETAL MEDICINE - CONSULTATION IP- Inpatient
CIPFET03 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
GASTRO MEDICAL - CONSULTATION IP- Inpatient
CIPGAM03 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
GASTRO SURGICAL - CONSULTATION Inpatient
CIPGAS02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
GENERAL SURGERY - CONSULTATION Inpatient
CIPGEN02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
Inpatient
CIPGER03 GERIATRICS- CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
INFECTIOUS DISEASES - CONSULTATION Inpatient
CIPIND03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
INTERNAL MEDICINE- CONSULTATION Inpatient
CIPINT03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
INTERVENTIONAL PAIN MEDICINE - Inpatient
CIPIPM02 CONSULTATION IP 0 2200 2600 3400
INTERVENTIONAL RADIOLOGY - Inpatient
CIPIR002 CONSULTATION IP 0 2200 2600 3400
303
Consultation
LIVER TRANSPLANT - CONSULTATION Inpatient

CIPLTS02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
NEONATOLOGY - CONSULTATION IP - Inpatient
CIPPED07 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
Inpatient
CIPNEP03 NEPHROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
Inpatient
CIPNEU03 NEUROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
NEUROPSYCHOLOGY - CONSULTATION Inpatient
CIPNPSY3 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
NEUROSURGERY - CONSULTATION IP- Inpatient
CIPNSR02 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
NUCLEAR MEDICINE - CONSULTATION Inpatient
CIPNUC03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
OBS & GYNAECOLOGY - CONSULTATION Inpatient
CIPOBG02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
ONCOLOGY MEDICAL - CONSULTATION Inpatient
CIPONM03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
ONCOLOGY RADIATION - CONSULTATION Inpatient
CIPONR03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
ONCOLOGY SURGICAL - CONSULTATION Inpatient
CIPONS02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
OPTHALMOLOGY - CONSULTATION IP- Inpatient
CIPOPT02 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
ORTHOPAEDICS - CONSULTATION IP- Inpatient
CIPORT02 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
Inpatient
CIPORTS2 ORTHO SPINE - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
Inpatient
CIPPED03 PAEDIATRICS - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
PAEDIATRICS DEVELOPMENT - Inpatient
CIPPDS03 CONSULTATION IP 0 2200 2600 3400
PAEDIATRICS ENDOCRINOLOGY - Inpatient
CIPEN003 CONSULTATION IP 0 2200 2600 3400
PAEDIATRICS NEUROLOGY - Inpatient
CIPPNEU3 CONSULTATION IP 0 2200 2600 3400
PAEDIATRICS PULMONOLOGY - Inpatient
CIPPUL03 CONSULTATION IP 0 2200 2600 3400
PAEDIATRICS RHEUMATOLOGY - Inpatient
CIPPRHE3 CONSULTATION IP 0 2200 2600 3400
PAEDIATRIC SURGERY - CONSULTATION Inpatient
CIPPSR02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
PAIN & PALLIATIVE SERVICES - Inpatient
CIPPPS03 CONSULTATION IP 0 2200 2600 3400
304
Consultation
Inpatient
CIPPR003 PAIN RELIEF - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
PHYSICAL MEDICINE REHABILITATION - Inpatient
CIPPMR03 CONSULTATION IP 0 2200 2600 3400
PLASTIC SURGERY - CONSULTATION Inpatient
CIPPLS02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
Inpatient
CIPPSY03 PSYCHIATRY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
RESPIRATORY MEDICINE - CONSULTATION Inpatient
CIPRES03 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
RHEUMATOLOGY - CONSULTATION IP- Inpatient
CIPRHU03 CONSULTATION IP 0 2200 2600 3400
NIGHT Services
Inpatient
CIPSCC02 SPINE CARE - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
SPORTS & EXERCISE MEDICINE- Inpatient
CIPSPO03 CONSULTATION IP 0 2200 2600 3400
Inpatient
CIPURO02 UROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
VASCULAR SURGERY - CONSULTATION Inpatient
CIPVAS02 CONSULTATION IP 0 2200 2600 3400
IP-NIGHT Services
Inpatient
CIPYOG03 YOGATHERAPY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400
Services
Inpatient
CIPICU07 ICU CONSULTATION PER DAY CONSULTATION IP 0 2500 2500 2500
Services
305
Lab diagnostics
306
Lab diagnostics
C0492 Creatinine- Serum (Nephro camp) Lab Diagnostic Services BIOCHEMISTRY 60 60 70 90

C0168 Glucose - Fasting Lab Diagnostic Services BIOCHEMISTRY 120 120 140 160
C0171 Glucose - Random Lab Diagnostic Services BIOCHEMISTRY 120 120 140 160
C0170 Glucose (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 140 150 170 200
C0370 Urine PH Lab Diagnostic Services BIOCHEMISTRY 140 150 170 200
C0059 Bun (Blood Urea Nitrogen) Lab Diagnostic Services BIOCHEMISTRY 160 160 190 210
C0014 Albumin - Serum Lab Diagnostic Services BIOCHEMISTRY 170 170 200 230
C0034 Ascitic Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0029 Ascitic Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0031 Ascitic Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0491 Cardio HS - CRP(Thesis study) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0115 CSF - Sugar Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0127 Drain Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0476 Glucose 1 Hour Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0169 Glucose - Post Prandial (Ppbs) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0172 Glucose ( Spot ) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0173 Glucose (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0251 Pd Fluid - PH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0462 Plasma/Blood pH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0283 Pleural Fluid - PH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250
C0290 Potassium - Serum Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250
C0315 Sodium - Serum Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250
C0314 Sodium (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250
C0403 Ascitic Fluid - pH Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0042 Bilirubin - Direct Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0122 Dialysis Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0128 Drain Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0390 Drain Fluid - pH Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0391 Drain Fluid - Phosphorus Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0135 Drain Fluid - Total Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0244 Pd Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0253 Pd Fluid - Total Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0258 Peritonial Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0260 Peritonial Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0273 Pleural Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0281 Pleural Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0287 Pleural Fluid- Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
307
Lab diagnostics
C0311 SGOT ( Ast ) Lab Diagnostic Services BIOCHEMISTRY 200 200 230 260
C0312 SGPT ( Alt ) Lab Diagnostic Services BIOCHEMISTRY 200 200 230 260
C0318 Synovial Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0319 Synovial Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280
C0263 Phosphorus - Serum Lab Diagnostic Services BIOCHEMISTRY 220 220 260 290
C0080 Cholesterol - Total Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0114 CSF - Protein Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0394 Drain Fluid - Bicarbonate Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0130 Drain Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0131 Drain Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0133 Drain Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0134 Drain Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0408 Drain Fluid - Uric Acid Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0265 Phosphorus - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0373 Urine Protein - Random Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310
C0105 Creatinine- Serum Lab Diagnostic Services BIOCHEMISTRY 240 240 280 320
C0028 Ascitic Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0404 Ascitic Fluid - Phosphorus Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0405 Ascitic Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0406 Ascitic Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0077 Chloride - Serum Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0078 Chloride - Urine ( 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0076 Chloride (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0110 CSF - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0249 Pd Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0252 Pd Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0255 Pd Fuild - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0264 Phosphorus - Urine (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0277 Pleural Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0284 Pleural Fluid - PHosphorus Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0285 Pleural Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0288 Pleural Fluie - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0289 Potassium (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0291 Potassium (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0313 Sodium (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0317 Synovial Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360
C0398 Ascitic Fluid - BUN Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
308
Lab diagnostics
C0400 Ascitic Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0401 Ascitic Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0040 Bicarbonate - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0041 Bicarbonate - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0102 Creatinine (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0103 Creatinine - (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0106 Cryoglobulins (Qual.) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0121 Dialysis Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0123 Dialysis Fluid - Urea Nitrogen Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0392 Drain Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0136 Drain Fluid - Urea Nitrogen Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0247 Pd Fluid - Bun Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0254 Pd Fluid - Uric Acid Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0256 Pd Fulid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0275 Pleural Fluid - Bun Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0278 Pleural Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0280 Pleural Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0420 Post HD Blood Urea Nitrogen (BUN) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0421 Post HD Creatinine - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0418 Pre HD Blood Urea Nitrogen (BUN) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0419 Pre HD Creatinine - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
Total Protein/ Albumin / Globulin
C0332 Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
/A:G
C0339 Urea Nitrogen (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0340 Urea Nitrogen (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0341 Uric Acid - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0342 Uric Acid - Urine ( 24 Hrs ) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0343 Uric Acid - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390
C0043 Bilirubin -Total Lab Diagnostic Services BIOCHEMISTRY 300 300 350 390
C0297 Protein Total Lab Diagnostic Services BIOCHEMISTRY 300 300 350 390
C0044 Bilirubin Total/Direct Lab Diagnostic Services BIOCHEMISTRY 310 310 360 410
C0079 Cholesterol - Hdl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480
C0081 Cholesterol - Vldl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480
C0082 Cholestrol - Ldl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480
C0335 Triglycerides Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480
C0399 Ascitic Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0032 Ascitic Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
309
Lab diagnostics
C0459 Breast Milk Sodium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0393 Drain Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0407 Drain Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0461 Fluid for chyle(triglycerides) Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0386 Magnesium - Urine (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0248 Pd Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0270 Plerural Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0276 Pleural Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0368 Urine Mucopolysaccharides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0372 Urine Protein - 24 Hrs Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
C0350 Urine - Protein Creatinine Ratio Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510
GGT (Gamma Glutamyl
Transpeptidase)
C0338 TSH (Thyroid Stimulating Hormone) Lab Diagnostic Services BIOCHEMISTRY 450 450 520 590
C0009 Acid PHosphatase - Total Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640
C0030 Ascitic Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640
C0203 Iron Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640
C0286 Pleural Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640
C0460 Stool for Electrolytes Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640
C0101 Creatine PHosphokinase (Cpk) Lab Diagnostic Services BIOCHEMISTRY 480 480 560 630
C0219 Magnesium - Serum Lab Diagnostic Services BIOCHEMISTRY 480 480 560 630
C0018 Alp (Alkaline PHosphatase) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0066 Calcium - Total Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0064 Calcium (Urine - 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0067 Calcium - Urine(Random) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0426 Sweat Chloride Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0320 T.Chol/Hdl.Chol Ratio Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670
C0021 Amylase - Serum Lab Diagnostic Services BIOCHEMISTRY 500 500 580 650
C0107 CSF (Protein , Sugar, Chloride) Lab Diagnostic Services BIOCHEMISTRY 500 500 580 650
C0402 Ascitic Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0065 Calcium - Ionised Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0104 Creatinine Clearance Test Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0113 CSF - Ldh Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0132 Drain Fluid - L D H Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0389 Drain Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
Haemoglobin Variant Analysis (
JMC)
C0208 LDH Total Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
310
Lab diagnostics
C0220 Magnesium - Urine (Rand) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0250 Pd Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0259 Peritonial Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0282 Pleural Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0322 T4 (Thyroxine - Total) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0367 Urine Micro Albumin (24Hrs) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740
C0154 Free T3 Lab Diagnostic Services BIOCHEMISTRY 540 540 630 710
C0271 Pleural Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780
C0321 T3 (Triiodothyronine) Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780
C0366 Urine Micro Albumin (Random) Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780
C0434 Renal Panel - III - Random Lab Diagnostic Services BIOCHEMISTRY 580 600 720 830
C0475 Glucose Tolerance Test GDM Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0176 Glucose Tolerance Test (GTT ) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0194 Immunoglobulin - A (Iga) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0196 Immunoglobulin - G (Igg) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0197 Immunoglobulin - M (Igm) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0431 Renal Panel - III - Fasting Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900
C0424 Cystatin - C Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930
C0205 Iron With TIBC Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930
Qualitative Screening For
Aminoaciduria
C0334 Transferrin Saturation Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930
Acid PHosphatase - Total &
Prostatic
C0279 Pleural Fluid - Cpk Lab Diagnostic Services BIOCHEMISTRY 670 700 830 960
Urine Electrolytes - Na, K & Cl
(Random)
C0143 Electrolytes (Na, K, Cl and Bicarb) Lab Diagnostic Services BIOCHEMISTRY 710 710 820 930
C0422 Cardio HS - CRP Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080
C0142 Electrolytes (Na, K & Cl) Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080
C0423 sTfr - Soluble Transferrin Receptor Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080
C0348 Urinary Microalb & Creatinine Ratio Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080
Urine Electrolytes - Na, K & Cl (24
Hrs)
C0027 Ascitic Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0083 Cholinesterase(Pseudo) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0129 Drain Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0146 Everolimus (Certican) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
311
Lab diagnostics
C0158 FSH ( Follicle Stimulating Hormone ) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0212 LH ( Lutenizing Hormone ) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0217 Lithium Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0240 Osmolality - Serum Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0239 Osmolality - Urine (Rand) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0274 Pleural Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160
C0214 Lipid Profile Lab Diagnostic Services BIOCHEMISTRY 850 850 980 1110
C0148 Ferritin Lab Diagnostic Services BIOCHEMISTRY 900 900 1040 1170
C0425 Retinol Binding Protein (RBP) Lab Diagnostic Services BIOCHEMISTRY 880 920 1100 1270
C0020 Ammonia Lab Diagnostic Services BIOCHEMISTRY 950 950 1100 1240
C0213 Lipase- Serum Lab Diagnostic Services BIOCHEMISTRY 950 950 1100 1240
C0155 Freet4 (Thyroxin-Free) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0156 Fructosamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0207 Kidney Profile Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0216 Lipoprotein (A) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
Protein Electrophoresis With T.P &
Alb
C0351 Urine Drug - Amphetamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0353 Urine Drug - Cocaine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0354 Urine Drug - Metamphetamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0355 Urine Drug - Methadone Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0358 Urine Drug-Methaquolone Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0356 Urine Drug - Morphine (Opiates) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0357 Urine Drug - PHencyclidine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0359 Urine Drug-Propoxyphene Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0360 Urine Durg - Barbiturates Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0361 Urine Durg - Benzodiazepines Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350
C0052 Blood Gas Analysis Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0089 Complement 3 (C3) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0112 CSF - Lactate Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0447 Custic Fibrosis - Blood Spot Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0234 Neonatal TSH Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0242 Osmolality - Urine (24Hrs) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0480 PKU (Phenyl Ketone Uria) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0267 Plasma Lactate ( Lactic Acid ) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0294 Prolactin Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
C0345 Urinary Calculi Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470
312
Lab diagnostics
Urine Drug - Marijuana

(Cannabinoids)
C0153 Free PSA Lab Diagnostic Services BIOCHEMISTRY 1070 1070 1240 1400
C0013 AFP (Alpha Feto Protein) Lab Diagnostic Services BIOCHEMISTRY 1080 1080 1250 1410
C0177 Glycated Hemoglobin ( Hba1C ) Lab Diagnostic Services BIOCHEMISTRY 1090 1090 1260 1420
C0053 Blood Gas Analysis With Electrolytes Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550
C0090 Complement 4 (C4) Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550
C0100 Creatine Kinase With Ck-Mb Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550
G 6 Pd (Glucose 6 PHos
Dehydrogenase)
C0195 Immunoglobulin - E (Ige) Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550
C0293 Progesterone Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550
C0218 Liver Function Test Lab Diagnostic Services BIOCHEMISTRY 1190 1190 1370 1550
C0024 Apoplipoprotein - A1 & B Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0429 Renal Panel - I - Fasting Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0432 Renal Panel - I - Random Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0301 R. O Water Analysis Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0326 Testosterone (Total) Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0371 Urine Porphobilinogen (Quan) Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660
C0330 Thyroid Profile (T3 T4 Tsh) Lab Diagnostic Services BIOCHEMISTRY 1250 1250 1440 1630
C0438 90 min post glucose Insulin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0096 Cortisol 4 Pm Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0097 Cortisol 8 Am Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0095 Cortisol - Midnight Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0093 Cortisol ( Random ) Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0144 Estradiol ( E2 ) Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0186 Hhc Screening Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0200 Insulin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
Neonatal Screening - Cystic
Fibrosis
C0333 Transferrin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0374 Urine Protein Electrophoresis Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740
C0033 Ascitic Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1270 1330 1590 1840
C0011 Adenosine Deaminase (Ada) Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0109 CSF - Ada Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
313
Lab diagnostics
C0395 Drain Fluid - ADA Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0446 Inhibin A Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0257 Pericaridal Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0383 Synovial Fluid - ADA Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0364 Urine Fluoride Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940
C0337 Troponin - I (Qual) Lab Diagnostic Services BIOCHEMISTRY 1430 1430 1650 1860
C0070 Carbamazepine(Tegretol) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0075 Ceruloplasmin Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0092 Copper (Serum) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0179 Growth Hormone ( H Gh ) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0181 Haemoglobin Variant Analysis Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0182 Haptoglobin Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0272 Pleural Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0298 PSA (Prostatic Specific Antigen) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130
C0074 CEA (Carcino Embryonic Antigen) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0091 Copper (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0098 Cortisol- Free (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0125 Digoxin Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0164 Galactosemia Screening Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0165 Gall Stone Analysis Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0188 Homocystine (Plasma) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0232 Neonatal Galactose Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0261 Phenobarbital Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0349 Urinary Xylose Excretion ( 5 Hrs ) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0375 Valproic Acid Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330
C0048 Blood Alcohol / Salivary-Alcohol Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0474 Bone Specific Alkaline Phosphatase Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0108 CSF For Oligoclonal Band Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0157 FSH & LH Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0215 Lipid Tetrad Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0262 Phenytoin Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0328 Theophylline ( Aminophylline ) Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0329 Thyroglobulin Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0379 Xylose Absorption Test - Blood Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510
C0484 Bilirubin And Hb variant Analysis Lab Diagnostic Services BIOCHEMISTRY 1820 1910 2270 2640
C0004 17(Oh)P-Neonatal (Heel Prick) Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700
C0099 C-Peptide Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700
314
Lab diagnostics
C0111 CSF - IGG Index Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700
C0376 Vitamin B12 Lab Diagnostic Services BIOCHEMISTRY 2020 2020 2330 2630
C0026 Arsenic ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0035 Benzodiazepines and Metabolites Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0038 Beta Crosslaps Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0039 Beta Crosslaps (Ctx1) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0124 Dialysis Fluid Analysis Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0145 Estriol - E3 (Unconjugated) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0149 Fluoride - Urine Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0151 Folic Acid (Folate) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0190 Hypertension Profile Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0441 Nicotine(Cotinine) - Urine Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0473 Osteocalcin Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0243 P1Np Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0458 Urinary Aluminium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0457 Urinary Berrylium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
Urinary Delta Amino Levulinic
Acid(Ala)
C0455 Urinary Manganese Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
C0456 Urinary Vanadium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900
17-Oh P (17 Alpha Hydroxy
Progesterone)
C0025 Arsenic ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090
C0119 Dhea -Sulphate Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090
Immunoglobulins ( IGA, IGG, IGM,
Ige )
C0209 Lead ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090
C0331 Tissue Transglutaminase (TTG-A) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090
C0380 Zinc ( Serum ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090
C0488 Bile-Acids Lab Diagnostic Services BIOCHEMISTRY 2240 2360 2800 3250
C0428 Adiponectin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0037 Beta 2 Microglobulin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0047 Bismuth (Blood) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0046 Bismuth ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0086 Citrate, 24 Hour Urine Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0159 FSH, LH & Prolactin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0210 Lead ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0221 Manganese - Blood Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
315
Lab diagnostics
C0222 Mercury - Blood Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0223 Mercury - Urine Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0235 Nickel ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0236 Nickel ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0440 Nicotine(Cotinine) - Serum Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0306 Selenium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0307 Selenium ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
Sex Hormone Binding
Globulin(SHBG)
C0463 Urinary Gold Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0344 Urinary V M A (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
C0449 Urine B2 Microglobulin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290
Ace (Angiotensin Converting
Enzyme)
C0019 Alpha 1 Antitrypsin Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0085 Chromium (Urine) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0088 Cobalt ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0120 Diabetic Profile Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0152 Free Androgen Index (Clia/Elisa) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0347 Urinary Metanephrines Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480
C0397 Blood Gold Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0485 Blood Silver (Ag) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0486 Blood Tin (Sn) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0061 Cadmium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0062 Cadmium ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0068 Cancer Antigen - CA 15-3 Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0084 Chromium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
C0087 Cobalt ( Serum ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680
Heavy Metals Analysis-Blood(Lead/
Arsenic/Mercury)
C0010 Acth , Plasma Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0060 CA - 125 Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0069 Cancer Antigen - CA 19-9 Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0427 HOMA Score Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0224 Methotrexate Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0487 NT- ProBNP Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0299 Pth Intact With Total Calcium Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060
C0192 IGF-1 (Somatomedin- C) Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240
316
Lab diagnostics
C0191 IGF Bp-3 Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240
C0325 Testosterone (Free) Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240
C0369 Urine Oxalate Excretion Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240
C0467 Brain Natriuretic Peptide Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440
C0160 FSH, LH, Prolactin & Progesterone Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440
C0430 Renal Panel - II - Fasting Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440
C0433 Renal Panel - II - Random Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440
C0465 Total Vitamin D Lab Diagnostic Services BIOCHEMISTRY 3080 3240 3850 4470
C0016 Aldolase Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630
C0454 Aryl Sulphatase A Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630
C0451 Islet Cell Antibody Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630
C0003 17 Ketosteroids ( 24 Hrs Urine ) Lab Diagnostic Services BIOCHEMISTRY 3330 3500 4160 4830
5-Hiaa (5-Hydroxy Indole Acetic
Acid)
C0063 Calcitonin Lab Diagnostic Services BIOCHEMISTRY 3330 3500 4160 4830
C0126 Dihydrotestosterone ( Dht) Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020
C0161 FSH, LH, Prolactin & Testosterone Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020
C0327 Testosterone, Free & Total Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020
C0022 Androstenedione Lab Diagnostic Services BIOCHEMISTRY 3600 3780 4500 5220
C0118 CYFRA 21-1, Lung Cancer Marker Lab Diagnostic Services BIOCHEMISTRY 3730 3920 4670 5410
C0202 Insulin Antibodies Lab Diagnostic Services BIOCHEMISTRY 3730 3920 4670 5410
C0482 Cyclosporine A ( W B ) (LCMS) Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610
C0483 Cyclosporine C2 Assay (LCMS) Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610
C0167 Glucode Insulin Package Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610
C0302 Red Cell Folate Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610
C0469 Urine for Free Light chains Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610
C0481 Inhalant Allergans Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790
Neutrophil gelatinase-associated
lipocalin (NGAL)
C0308 Serum Gastrin Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790
C0323 Tacrolimus Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790
C0058 Blood Spot-Amino Acids Lab Diagnostic Services BIOCHEMISTRY 4130 4330 5160 5980
C0479 ROMA Index Lab Diagnostic Services BIOCHEMISTRY 4130 4330 5160 5980
C0435 Anti Mullerian Hormone(AMH) Lab Diagnostic Services BIOCHEMISTRY 4530 4760 5660 6570
C0472 IGG4 Lab Diagnostic Services BIOCHEMISTRY 4800 5040 6000 6960
C0206 Kappa & Lambda Light Chains Lab Diagnostic Services BIOCHEMISTRY 5190 5450 6490 7520
C0001 1,25 Dihydroxy Vitamin Lab Diagnostic Services BIOCHEMISTRY 5860 6160 7330 8500
C0178 GNRH-Stimulation Test Lab Diagnostic Services BIOCHEMISTRY 5860 6160 7330 8500
317
Lab diagnostics
C0002 1,25 Dihydroxy Vitamin D Lab Diagnostic Services BIOCHEMISTRY 6000 6300 7490 8690
C0141 Drugs of Abuse - Urine Lab Diagnostic Services BIOCHEMISTRY 6000 6300 7490 8690
C0138 Drug of Abuse - (Company) Lab Diagnostic Services BIOCHEMISTRY 6130 6440 7660 8890
Drugs of Abuse - 9 Drugs
(Company)
C0137 Drug of Abuse - (Company-10 Drug) Lab Diagnostic Services BIOCHEMISTRY 7450 7830 9310 10800
C0365 Urine Immunofixation Lab Diagnostic Services BIOCHEMISTRY 7720 8110 9650 11190
C0072 Catecholamines - Urine(24Hrs) Lab Diagnostic Services BIOCHEMISTRY 7990 8390 9990 11580
C0193 Immunofixation Electrophoresis Lab Diagnostic Services BIOCHEMISTRY 7990 8390 9990 11580
C0180 Growth Hormone - Stimulation Test Lab Diagnostic Services BIOCHEMISTRY 8520 8940 10640 12350
C0309 Serum Immunofixation Lab Diagnostic Services BIOCHEMISTRY 8520 8940 10640 12350
C0448 Amiodarone Lab Diagnostic Services BIOCHEMISTRY 8790 9220 10980 12740
C0268 Plasma Renin Activity Lab Diagnostic Services BIOCHEMISTRY 8790 9220 10980 12740
C0324 Tandem Mass Spectrometry Lab Diagnostic Services BIOCHEMISTRY 9580 10060 11970 13890
C0409 Chromogranin A Lab Diagnostic Services BIOCHEMISTRY 10390 10910 12980 15060
C0163 Gad Antibodies-Igg Lab Diagnostic Services BIOCHEMISTRY 10910 11460 13640 15820
C0452 LDL Subfractions Lab Diagnostic Services BIOCHEMISTRY 10910 11460 13640 15820
C0453 Urine for PNS 100+ Lab Diagnostic Services BIOCHEMISTRY 11450 12020 14310 16600
C0387 Inhibin-B Lab Diagnostic Services BIOCHEMISTRY 11980 12580 14970 17370
CPP(Cryopoor plasma) - Reserve/
B0018 Lab Diagnostic Services BLOOD BANK 60 60 70 90
Crossmatch
Cryoprecipitate(CRYO) - Reserve/
Crossmatch
RDP/PC (Platelets) - Reserve/
Crossmatch
B0047 Rh - Du Test /Weak - D Test Lab Diagnostic Services BLOOD BANK 140 150 170 200
Pooled Platelet Concentrate(PPC) -
Reserve / Crossmatch - Paediatric
B0007 Blood Grouping & Rh Typing Lab Diagnostic Services BLOOD BANK 270 290 340 390
B0024 FFP (Plasma) - Reserve/Crossmatch Lab Diagnostic Services BLOOD BANK 320 330 400 460
Neonatal Unit - FFP/CPP - Reserve/
Crossmatch
Neonatal Unit - PRBC - Reserve/
Crossmatch
Packed RBC/RCC - Reserve/
Crossmatch
Blood Screening and Compatibility
Report
Sickle Cell Test For Blood Bags/
Donors
318
Lab diagnostics
Whole Blood(WB) - Reserve/

Crossmatch
Pooled Platelet Concentrate(PPC) -
Reserve / Crossmatch
B0054 Theraupetic Phlebotomy Lab Diagnostic Services BLOOD BANK 440 460 550 640
Platelet Pheresi Blood Grouping
and CBC
B0012 Coombs Test Direct (DCT Or DAT) Lab Diagnostic Services BLOOD BANK 560 590 700 820
B0013 Coombs Test Indirect (ICT Or IAT) Lab Diagnostic Services BLOOD BANK 560 590 700 820
B0155 Donath Landsteiner test Lab Diagnostic Services BLOOD BANK 560 590 700 820
B0046 Rh Antibody Titre /Anti - D Titre. Lab Diagnostic Services BLOOD BANK 580 600 720 830
Blood Grouping, Rh Type and
Antibody Screen
B0022 Day Care Charges Lab Diagnostic Services BLOOD BANK 640 680 800 930
Neonatal Blood Grouping & AB
Screening
B0015 Coombs Test - DAT (Mono Specific) Lab Diagnostic Services BLOOD BANK 720 760 900 1040
B0003 Antibody Titer Lab Diagnostic Services BLOOD BANK 740 780 930 1080
B0002 Antibody Screening Lab Diagnostic Services BLOOD BANK 760 790 940 1090
Cryo Precipitates - Reserve/
Crossmatch & Issue
Fresh Frozen Plasma - Reserve/
Crossmatch & Issue
B0068 Antenatal Antibody Screening Lab Diagnostic Services BLOOD BANK 1010 1060 1260 1470
B0014 Coombs Test(Direct and Indirect) Lab Diagnostic Services BLOOD BANK 1010 1060 1260 1470
B0001 Antibody Identification Lab Diagnostic Services BLOOD BANK 1040 1090 1290 1500
Platelet Phereisis - Screening For
TTD
Neonatal Single donor Platelets
(SDP) ?Reserve/ cross Match
Paediatric Single donor Platelets
(SDP) ?Reserve/ cross Match
SDP- Apheresis Platelets - Reserve/
Crossmatch
Granulocyte Concentrate Reserve /
Cross match & Issue
Platelet Rich Concentrates (PRC) -
Reserve/Crossmatch & Issue
B0139 ABO Antibody Titer Lab Diagnostic Services BLOOD BANK 1460 1530 1820 2120
B0065 Antigen Phenotyping - Red Cell Lab Diagnostic Services BLOOD BANK 1610 1690 2010 2330
B0004 Antigen Phenotyping - Red Cells. Lab Diagnostic Services BLOOD BANK 1610 1690 2010 2330
319
Lab diagnostics
HIT (Heparin Induced

Thrombocytopenia)
B0028 Intrauterine Transfusion Lab Diagnostic Services BLOOD BANK 1850 1950 2310 2680
B0067 PNH Test for CD55/CD59 Lab Diagnostic Services BLOOD BANK 1860 1960 2330 2700
Therapetic Red Cell Exchange -
Manual
Packed Red Cells - Reserve/
Crossmatch & Issue (Basic+
B0110 4th Gen NAT-P+Donor AB Lab Diagnostic Services BLOOD BANK 1960 2060 2450 2850
screen+SAGM+AUTO BG/CM/
Hb+MP.Syp ELISA)
Blood Transfusion Package 1 ( Day
care+CBC+ RC Filter-1)
B0093 Transfusion Workup Lab Diagnostic Services BLOOD BANK 2540 2660 3170 3680
B0023 DMSO(5Ml) Lab Diagnostic Services BLOOD BANK 2670 2800 3340 3870
Stem Cell Storage(Liquid N2) Per
Day
Blood Transfusion Package 2 ( Day
care+CBC+ RC Filter-2)
PRP XMatch & Issue((Basic+
B0146 4thGen HIV+NAT+Donor AB Lab Diagnostic Services BLOOD BANK 2800 2940 3500 4060
screen+BCbag)
B0059 NAT Tests Lab Diagnostic Services BLOOD BANK 3330 3500 4160 4830
Platelet Antibody SCREEN/CROSS
MATCH
B0151 VEGF ?Quantitative Lab Diagnostic Services BLOOD BANK 5600 5880 7000 8120
B0021 Cryopreservation Bag(Each) Lab Diagnostic Services BLOOD BANK 9320 9790 11650 13520
B0152 Bone Marrow Processing ( Manual ) Lab Diagnostic Services BLOOD BANK 11200 11760 14000 16240
Single donor platelets(SDP) -
Reserve Crossmatch & Issue
(Basic+4th Gen+NAT-P+Donor AB
screen + Auto BG / Hb,MP.Syp ELIS
B0038 Plasmapheresis Lab Diagnostic Services BLOOD BANK 16640 17470 20790 24120
B0145 Apheresis Granulocyte Concentrate Lab Diagnostic Services BLOOD BANK 16800 17640 21000 24360
B0010 BMP/MNC Processing - Trials Lab Diagnostic Services BLOOD BANK 19300 20270 24130 27990
B0027 LEUKAPHERESIS Lab Diagnostic Services BLOOD BANK 19300 20270 24130 27990
Stem Cell Cryopreservation
Procedure Per Patient
Bone Marrow Processing
Automated
B0039 Platelet Depletion Procedure Lab Diagnostic Services BLOOD BANK 24620 25850 30780 35700
B0050 Stem Cell PHeresis(Each Collection) Lab Diagnostic Services BLOOD BANK 31940 33530 39920 46310
320
Lab diagnostics
B0070 Blood Bank Procedural Charges Lab Diagnostic Services BLOOD BANK 42340 44460 52920 61390
B0069 Allogenic Leukapheresis Lab Diagnostic Services BLOOD BANK 113710 119390 142130 164870
B0094 Autologous Leukapheresis Lab Diagnostic Services BLOOD BANK 248820 261270 311030 360790
BLOOD PACK
B0123 Irradiation Charges-PRBC/RDP Lab Diagnostic Services 230 240 280 330
(PRODUCTS)
BLOOD PACK
B0124 Irradiation Charges -SDP Lab Diagnostic Services 230 240 280 330
(PRODUCTS)
Cryopoorplasma - Issue (Basic+
BLOOD PACK
B0119 4th Gen HIV+NAT+Donor AB Lab Diagnostic Services 840 890 1050 1220
(PRODUCTS)
screen+Buffy coat bags)
Cryoprecipitate - Issue (Basic+
BLOOD PACK
B0118 4th Gen HIV+NAT+Donor AB Lab Diagnostic Services 840 890 1050 1220
(PRODUCTS)
Neonatal Unit - FFP/CPP
(Basic+NAT+Miscl)- Issue (Basic+ BLOOD PACK
B0121 Lab Diagnostic Services 870 910 1080 1260
4th Gen HIV+NAT+Donor AB (PRODUCTS)
Fresh Frozen Plasma (FFP) -
Issue (Basic+ 4th Gen+ NAT-
BLOOD PACK
B0117 P+Leukoreduction+Donor AB Lab Diagnostic Services 920 970 1150 1340
(PRODUCTS)
screen+SAGM+AUTO BG/Hb +MP.
Syp ELISA)
BLOOD PACK
B0125 Leukoreduction charges-PRBC Lab Diagnostic Services 980 1030 1230 1430
(PRODUCTS)
Leukoreduction charges-1 Set of BLOOD PACK
RDP/1 SDP (PRODUCTS)
BLOOD PACK
B0056 Whole Blood - Issue Lab Diagnostic Services 1180 1240 1470 1710
(PRODUCTS)
Platelet concentrate (RDP)
- Issue (Basic+ 4th Gen +NAT-
BLOOD PACK
B0115 P+Leukoreduction+Donor Lab Diagnostic Services 1240 1300 1540 1790
(PRODUCTS)
AB screen+SAGM+ BUFFY
COAT+AUTO BG/Hb +MP
Neonatal Unit - PRBC - Issue
(Basic+ 4th Gen +NAT-
BLOOD PACK
(PRODUCTS)
Syp ELISA)
Neonatal Single donor Platelets BLOOD PACK
(SDP) ? Issue (PRODUCTS)
Packed Red Blood Cells(PRBC)
- Issue (Basic+ 4th Gen NAT-
BLOOD PACK
(PRODUCTS)
Syp ELISA)
Pooled Platelet Concentrate(PPC)
- Issue Paediatric (Basic+ 4th Gen BLOOD PACK
+NAT-P+Leukoreduction+Donor AB (PRODUCTS)
screen+SAGM+ BUFFY C
321
Lab diagnostics
Paediatric Single donor Platelets BLOOD PACK

(SDP) ? Issue (PRODUCTS)
Pooled Platelet Concentrate(PPC)
-Issue (Basic+ 4th Gen +NAT-
BLOOD PACK
B0142 P+Leukoreduction+Donor Lab Diagnostic Services 8400 8820 10500 12180
(PRODUCTS)
AB screen+SAGM+ BUFFY
COAT+AUTO BG/H
Single donor platelets(SDP) -
Issue (Basic+4th Gen+NAT-P+ BLOOD PACK
Leukoreduction+ Donor AB screen (PRODUCTS)
+ Auto BG / Hb,MP.Syp ELISA))
Tumour markers Beta Hcg &Alpha
DS0005 Lab Diagnostic Services CYTOGENETICS 260 270 320 370
Feto protein
PCYT50 PROCESSING FEE - CYT Lab Diagnostic Services CYTOGENETICS 800 840 1000 1160
PCYT28 GENETIC COUNSELLING-A - CYT Lab Diagnostic Services CYTOGENETICS 1200 1260 1500 1740
DNA-ISOLATION & STORAGE FOR 2
PCYT12 Lab Diagnostic Services CYTOGENETICS 1470 1550 1840 2130
YEARS - CYT(2 years)
DS0012
Karyotyping Aminiotic Fluid Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440
B
DS0012
Karyotyping Blood Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440
C
DS0012
Karyotyping Bone Marrow Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440
D
DS0012
Karyotyping Chorion Villus Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440
A
PCYT29 GENETIC COUNSELLING-B - CYT Lab Diagnostic Services CYTOGENETICS 1860 1960 2330 2700
Genetic Counselling /
Documentation
BIOCHEMICAL SCREENING - CYT(7
Days)
PCYT53 New Born screenings - CYT(7 Days) Lab Diagnostic Services CYTOGENETICS 3030 3180 3780 4390
CULTURE-PERIPHERAL BLOOD -
CYT(14Days)
PCYT38 MOLECULAR TEST-A - CYT Lab Diagnostic Services CYTOGENETICS 3470 3640 4330 5020
Pre-eclampsia Screening (PAPP-
A+PLGF)
1ST TRIMESTER SCREENING
PCYT01 DOUBLE TEST -( BETA HCG + PAPP Lab Diagnostic Services CYTOGENETICS 4130 4330 5160 5980
-A) - CYT(7 Days)
PCYT39 MOLECULAR TEST-B - CYT Lab Diagnostic Services CYTOGENETICS 4260 4470 5320 6180
Double test with Pre-eclampsia
screening (?-hCG+PAPP-A+PLGF)
2ND TRIMESTER SCREENING
QUADRUPLE TEST - ( BETA HCG +
AFP + UE3 + INHIBIN -A) - CYT(7
Days)
322
Lab diagnostics
KARYOTYPING-BONE MARROW (LC)

- CYT(10 Days)
KARYOTYPING-PERIPHERAL BLOOD
- CYT(14 Days)
KARYOTYPING-CORD BLOOD -
CYT(10 Days)
PCYT40 MOLECULAR TEST-C - CYT Lab Diagnostic Services CYTOGENETICS 6000 6300 7490 8690
FANCONI'S ANEMIA/STRESS
PCYT13 CYTOGENETICS OR BREAKAGE Lab Diagnostic Services CYTOGENETICS 6660 6990 8320 9650
STUDY - CYT
KARYOTYPING-BONE MARROW -
CYT(10 Days)
PCYT41 MOLECULAR TEST-D - CYT Lab Diagnostic Services CYTOGENETICS 6660 6990 8320 9650
PCYT24 FISH-5q or 7q - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430
FISH STUDY AML1/ETO - CYT(4
Days)
PCYT19 FISH STUDY-CHR-18 - CYT(3 Days) Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430
FISH STUDY-PML/RARA - CYT(3
Days)
PCYT17 FISH STUDY-BCR/ABL - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800
FISH STUDY-CHR-13,21 - CYT(3
Days)
FISH STUDY-CHR-X & Y - CYT(4
Days)
FISH STUDY-DIGEORGE SYNDROME
(DGS) - CYT(8 Days)
FISH STUDY -PRADER WILLIAM
SYNDROME - CYT(8 Days)
FISH STUDY-WILLIAM SYNDROME
(NEW CODE) - CYT(8 Days)
KARYOTYPING-AMNIOTIC FLUID/
CHORINIC VILLI (LC) - CYT(20 Days)
PCYT26 FISH-CBFB - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7720 8110 9650 11190
FISH-MLL(11Q23DEL) - CYT(4
Days)
PCYT42 MOLECULAR TEST-E - CYT Lab Diagnostic Services CYTOGENETICS 8520 8940 10640 12350
Y-MICRODELETION STUDY - CYT(14
Days)
KARYO TYPING - OTHERS - CYT(14
Days)
KARYOTYPING AMNIOTIC FLUID/
CHORIONIC VILLI - CYT(20 Days)
PCYT43 MOLECULAR TEST-F - CYT Lab Diagnostic Services CYTOGENETICS 10390 10910 12980 15060
323
Lab diagnostics
BLOOD PANEL (KARYO+FISH) -

CYT(14 Days)
PCYT44 MOLECULAR TEST-G - CYT Lab Diagnostic Services CYTOGENETICS 11980 12580 14970 17370
FISH STUDY - CHR-13,18,21 -
CYT(4 Days)
ATAXIA TELENGIECTASIS
(BLEOMYCIN ASSAY) - CYT
BONE MARROW PANEL
(KARYO+FISH) - CYT
PCYT22 FISH STUDY-HER2 - CYT(7 Days) Lab Diagnostic Services CYTOGENETICS 13040 13690 16300 18910
PCYT03 ABORTUS SAMPLE - CYT(1 Month) Lab Diagnostic Services CYTOGENETICS 13310 13980 16640 19300
PCYT45 MOLECULAR TEST-H - CYT Lab Diagnostic Services CYTOGENETICS 15300 16070 19130 22190
MDS PANEL (KARYO+FISH 5Q-7Q) -
CYT(10 Days)
AML PANEL
PCYT04 (KARYO+AML1ETO+CBFB+MLL) - Lab Diagnostic Services CYTOGENETICS 21300 22360 26620 30880
CYT(10 Days)
PCYT46 MOLECULAR TEST-I - CYT Lab Diagnostic Services CYTOGENETICS 21960 23050 27440 31840
PCYT47 MOLECULAR TEST-J - CYT Lab Diagnostic Services CYTOGENETICS 30600 32130 38250 44370
PCYT48 MOLECULAR TEST-K - CYT Lab Diagnostic Services CYTOGENETICS 33270 34930 41580 48240
PCYT07 BCRA 1& 2 - CYT(3-4 weeks) Lab Diagnostic Services CYTOGENETICS 39920 41920 49900 57880
PCYT49 NIFTY (T21,18,13) - CYT Lab Diagnostic Services CYTOGENETICS 42340 44460 52920 61390
PCYT54 NIPT (MEDGENOME) Lab Diagnostic Services CYTOGENETICS 42340 44460 52920 61390
PCYT06 AUTISM PANEL - CYT(4-6 weeks) Lab Diagnostic Services CYTOGENETICS 50560 53090 63200 73310
H0135 Platelet + IPF Lab Diagnostic Services HAEMATOLOGY 50 50 50 50
H0071 Stool Routine ( Qualitative Method ) Lab Diagnostic Services HAEMATOLOGY 150 150 180 200
Absolute Eosinophil Count (
H0001 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
Automated )
Differential Count( Automated Cell
Counter )
H0047 Nasal Smear For Eosinophils Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0054 PH (Urine/Body Fluids/Blood) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0065 Specific Gravity (Urine/Body Fluids) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
Stool Complete(Includes Routine
With Occult Blood)
Stool For Reducing Sugar (
Qualitative Method )
H0070 Stool Occult Blood ( Benzidine ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0074 TC (Total Count)( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
Urine Analysis Glucose and
Ketones( Automated )
324
Lab diagnostics
Urine Analysis Protein and Glucose(

Automated )
Urine Analysis Sp.Gr., PH, Proteins
and Glucose
H0080 Urine Fat ( Qualitaitve ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0079 Urine For Bile Salt and Bile Pigment Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0082 Urine For Eosinophilia Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0084 Urine For Ketone ( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0085 Urine For Protein( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
Urine For Reducing Substane(
Benzidine )
H0087 Urine For Sugar ( Benedict ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0089 Urine Occult Blood( Benzidine ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
H0091 Urine Urobilinogen Lab Diagnostic Services HAEMATOLOGY 170 180 210 250
Absolute Lymphocyte Count (
Automated )
Absolute Neutrophil Count(
Automated )
CLOT Retraction Test ( Clotting
Assay )
Fibrinogen Degradation Products-
Qualitative
H0029 Haemoglobin ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
H0115 Immature Granulocytes Count Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
H0060 RBC Count ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
H0098 Stool Fat Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
H0092 Urine/Nasal Smear For Eosinophils Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
H0093 Urobilinogen (Urine) ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280
Urine Routine and Microscopy (
Qualitative Method)
APT and Downey Test( Alkali
Denaturation)
H0028 Gastric Aspirate For Polymorphs Lab Diagnostic Services HAEMATOLOGY 270 290 340 390
H0035 Heinz Bodies Lab Diagnostic Services HAEMATOLOGY 270 290 340 390
H0132 I/T ration for neonate Lab Diagnostic Services HAEMATOLOGY 270 290 340 390
H0063 Sickle Cell Test Lab Diagnostic Services HAEMATOLOGY 270 290 340 390
H0134 Smear for Malaria Parasite (MP) Lab Diagnostic Services HAEMATOLOGY 270 290 340 390
DS0008 Bone marrow study Lab Diagnostic Services HAEMATOLOGY 280 300 350 410
Bence Jones Protein Qualitative (
Thermal Method )
325
Lab diagnostics
H0008 Bleeding Time Lab Diagnostic Services HAEMATOLOGY 330 350 410 480
H0019 ESR ( Automated ) Lab Diagnostic Services HAEMATOLOGY 350 350 410 460
PCV (Packed Cell Volume) (
Automated )
Synovial Fluid For Crystals (
Polarised Light )
Urine For Chylhria ( Qualitative
Method )
CLOT Solubility Test ( Clotting
Assay )
Concentration Method For Fecal
Parasites( Formal S
H0051 PAS Stain Lab Diagnostic Services HAEMATOLOGY 350 370 440 510
H0056 Pregnancy test Lab Diagnostic Services HAEMATOLOGY 350 370 440 510
H0083 Urine For Haemoglobin Lab Diagnostic Services HAEMATOLOGY 350 370 440 510
Urine Myoglobin( Qualitative
Method )
H0034 Hb,TLC, DLC ( Automated ) Lab Diagnostic Services HAEMATOLOGY 390 400 480 560
H0014 Complete Blood Counts (Automated) Lab Diagnostic Services HAEMATOLOGY 420 420 490 550
H0106 Ascetic fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0009 Body Fluid Cell Count/Type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0016 CSF Cell Count and Cell Type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0111 Gastric Fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
Haemosiderinuria ( Perls Prussian
Blue )
Immunoflorescence Method For
Malaria
H0037 Iron Stain ( Perls Prussian Blue ) Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0110 Liver abscess cell count & Cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0044 Microfilaria Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
Pericardial Fluid cell count & cell
type
H0107 Pleural Fluid cell count & Cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
H0112 Synovial fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640
Other Fluids - Cell Count and Cell
Type
Peritoneal fluid cell count & cell
type
H0061 Reticulocyte Count ( Automated ) Lab Diagnostic Services HAEMATOLOGY 540 540 630 710
H0053 Peripheral Smear Examination(P.S) Lab Diagnostic Services HAEMATOLOGY 550 550 640 720
Prothrombin Time -PT ( Automated/
Clotting Assay )
326
Lab diagnostics
H0033 Hb, TLC, DLC, ESR ( Automated ) Lab Diagnostic Services HAEMATOLOGY 540 570 680 780
H0032 Hams Test ( Acidified Serum Test ) Lab Diagnostic Services HAEMATOLOGY 580 600 720 830
H0026 Foetal Erythrocytes Lab Diagnostic Services HAEMATOLOGY 620 650 770 900
H0043 Methemoglobin ( Evelyn & Malloy ) Lab Diagnostic Services HAEMATOLOGY 670 700 830 960
Activated Partial Thromboplastin
Time(1:1mix)
Osmotic Fragility Test ( Calorimetric
Method )
H0039 LE Cell Test ( Qualitative Method ) Lab Diagnostic Services HAEMATOLOGY 800 840 1000 1160
H0045 Myeloperoxidase (Mpo) Lab Diagnostic Services HAEMATOLOGY 800 840 1000 1160
Sucrose Lysis Test ( Qualitative
Method )
H0006 APTT ( Automated / Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270
H0038 LAP Score Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270
H0064 Smear For Review Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270
Stool For Trypsin ( Proteolytic
Enzyme Activity )
FDP-Semiquantitative-Thrombo
Wellco Test
H0113 Bone Marrow Review Slide Lab Diagnostic Services HAEMATOLOGY 1200 1260 1500 1740
H0105 Bone Marrow Smear Examination Lab Diagnostic Services HAEMATOLOGY 1200 1260 1500 1740
H0046 NAE Lab Diagnostic Services HAEMATOLOGY 1270 1330 1590 1840
D-Dimer Test (Immunometri Flow
Through)
Fibrinogen Level ( Automated /
Clotting Assay )
Thrombin Time ( Automated /
Clotting Assay )
Lymphoma - Leukemia Markers
(FC)
H0099 Factor V Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680
H0100 Factor VII Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680
H0022 Factor VIII Assay ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680
H0102 Factor X Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680
H0136 CD 20 Lab Diagnostic Services HAEMATOLOGY 2670 2800 3340 3870
H0020 Factor IX Assay ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 2670 2800 3340 3870
Lupus Anti Coagulant (Russells
Viper Venom)
H0133 CD 19 Lab Diagnostic Services HAEMATOLOGY 3470 3640 4330 5020
H0139 Factor (X III) Quantitative Lab Diagnostic Services HAEMATOLOGY 4480 4710 5600 6500
H0131 Factor II Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 4530 4760 5660 6570
327
Lab diagnostics
H0137 CD 19 & 20 Lab Diagnostic Services HAEMATOLOGY 4660 4900 5830 6760
H0140 VWF Antigen Assay Lab Diagnostic Services HAEMATOLOGY 4840 5090 6050 7020
H0141 HIT Antibody Lab Diagnostic Services HAEMATOLOGY 5450 5720 6810 7900
H0130 FLAER test for PNH Lab Diagnostic Services HAEMATOLOGY 5730 6010 7160 8300
H0101 Factor XI Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 5860 6160 7330 8500
H0097 Platelet Aggregation Test Lab Diagnostic Services HAEMATOLOGY 6390 6710 7980 9260
Protein C ( Automated / Clotting
Assay )
Protein S ( Automated / Clotting
Assay )
H0004 Antithrombin III ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 6660 6990 8320 9650
H0142 Factor V Leiden Mutation Lab Diagnostic Services HAEMATOLOGY 7260 7630 9080 10530
H0123 FISH for BCR/ABL Lab Diagnostic Services HAEMATOLOGY 7450 7830 9310 10800
H0120 PML-RARA Qualitative Lab Diagnostic Services HAEMATOLOGY 7720 8110 9650 11190
Factor V Leiden ( Automated /
Clotting Assay )
H0103 Ristocetin Co Factor Activity Lab Diagnostic Services HAEMATOLOGY 7990 8390 9990 11580
H0117 FISH for AML-ETO(8-21) Lab Diagnostic Services HAEMATOLOGY 8260 8670 10320 11970
H0027 FV-APA Resistance Lab Diagnostic Services HAEMATOLOGY 8520 8940 10640 12350
H0129 BCR / ABL Qualitative Analysis Lab Diagnostic Services HAEMATOLOGY 9050 9510 11320 13130
Lymphoma - Leukemia 4 Markers
(Fc)
H0122 PCR for PDGER Mutation Lab Diagnostic Services HAEMATOLOGY 9050 9510 11320 13130
H0118 FISH for 11q23 Lab Diagnostic Services HAEMATOLOGY 10910 11460 13640 15820
H0119 PCR for JAK 2 mutation Lab Diagnostic Services HAEMATOLOGY 10910 11460 13640 15820
H0138 MRD (ALL) Lab Diagnostic Services HAEMATOLOGY 12100 12710 15120 17540
H0114 Stem Cell Enumeration (FC) Lab Diagnostic Services HAEMATOLOGY 12780 13420 15980 18530
H0128 BCR / ABL Quantitative Analysis Lab Diagnostic Services HAEMATOLOGY 15980 16770 19970 23160
Flowcytometry for Acute Leukemia
Panel
H0124 CML IRMA Mutation Lab Diagnostic Services HAEMATOLOGY 17300 18160 21620 25080
H0125 MDS Panel Lab Diagnostic Services HAEMATOLOGY 17970 18870 22460 26050
P0008 Duplicate Slide Charges Lab Diagnostic Services HISTOPATHOLOGY 170 180 210 250
DS0019 Immuno-histo Chemistry Lab Diagnostic Services HISTOPATHOLOGY 170 180 210 250
P0113 Kidney biopsy ? slide review Lab Diagnostic Services HISTOPATHOLOGY 560 590 700 820
P0002 Aspiration Fluid Cytology (1 - 3) Lab Diagnostic Services HISTOPATHOLOGY 580 600 720 830
P0075 PAP Smear Lab Diagnostic Services HISTOPATHOLOGY 640 680 800 930
P0057 Slide Review Lab Diagnostic Services HISTOPATHOLOGY 740 780 930 1080
P0003 Aspiration Fluid Cytology (4 - 7) Lab Diagnostic Services HISTOPATHOLOGY 1070 1120 1330 1550
328
Lab diagnostics
P0004 Block Review Lab Diagnostic Services HISTOPATHOLOGY 1070 1120 1330 1550
P0015 Histopathology (Medium Size) Lab Diagnostic Services HISTOPATHOLOGY 1120 1180 1400 1630
P0058 Slide Review With Blocks Lab Diagnostic Services HISTOPATHOLOGY 1200 1260 1500 1740
P0016 Histopathology (Small Specimen) Lab Diagnostic Services HISTOPATHOLOGY 1370 1370 1580 1790
P0080 Kidney biopsy - Light microscopy Lab Diagnostic Services HISTOPATHOLOGY 1340 1400 1670 1940
P0001 Aspiration Fluid Cytology (> 8) Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330
P0093 Immuno histochemistry BcL-6 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330
P0089 Immuno histochemistry CD -23 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330
P0090 Immuno histochemistry CD -43 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330
P0091 Immuno histochemistry CD -X2 Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510
P0092 Immuno histochemistry WT-1 Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510
P0053 Indirect IF Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510
P0108 IHC-IgG4 Lab Diagnostic Services HISTOPATHOLOGY 1820 1910 2270 2640
P0011 Frozen Section Lab Diagnostic Services HISTOPATHOLOGY 2000 2100 2500 2900
P0033 Immunofluorescence Panel Lab Diagnostic Services HISTOPATHOLOGY 2000 2100 2500 2900
P0068 Immunohistochemistry C4d Lab Diagnostic Services HISTOPATHOLOGY 2130 2240 2660 3090
P0112 IHC-PLA2R Lab Diagnostic Services HISTOPATHOLOGY 2240 2360 2800 3250
Histopath & Immunoflorescence
P0012 Lab Diagnostic Services HISTOPATHOLOGY 2270 2380 2830 3290
Kidney
Bone marrow biopsy with special
stain
P0088 Immunohistochemistry - 79a Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0102 Immunohistochemistry Arginase-1 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0038 Immunohisto Chemistry BCL - 2 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0105 Immunohistochemistry CA 19.9 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0069 Immunohistochemistry Cd10 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0035 Immunohisto Chemistry CD117 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0026 Immuno Histochemistry CD 15 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0020 Immuno Histo Chemistry - (Cd20) Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0028 Immuno Histochemistry Cd34 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0039 Immunohisto Chemistry Cd5 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0043 Immunohistochemistry Cyclic DI Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0024 Immuno Histo Chemistry - Desmin Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0104 Immunohistochemistry DOG-1 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0099 Immunohistochemistry GCDFP-15 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0101 Immunohistochemistry Glypican -3 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
Immunohistochemistry Inhibin-
Alpha
329
Lab diagnostics
P0067 Immunohistochemistry Ki-67 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
IMMUNOHISTOCHEMISTRY
MYELOPEROXIDASE (MPO)
P0097 Immunohistochemistry Napsin A Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0098 Immunohistochemistry P40 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0103 Immunohistochemistry Pax-8 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0052 Immunohistochemistry SMA Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0094 Immunohistochemistry - SV40 TAg Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480
P0017 HMB 45 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0029 Immunochemistry CD68 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0040 Immunohistochemistry A F P Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0086 Immunohistochemistry - ALK 1 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0077 Immunohistochemistry - AMACR Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
Immunohistochemistry - Amyloid
AA
P0034 Immunohisto Chemistry Calretinin Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0087 Immunohistochemistry - CD1a Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0036 Immunohisto Chemistry CD31 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0085 Immunohistochemistry - CMV Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0074 Immuno Histo Chemistry D1 clone Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0045 Immunohistochemistry GFAP Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0078 Immunohistochemistry - HMWCK Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0047 Immunohistochemistry LCA (CD 45) Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0072 Immuno histochemistry myoD1 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0049 Immunohistochemistry PGR Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0050 Immunohistochemistry PSA Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
Immunohistochemistry S - 100
Protein
P0071 Immuno histochemistry TTF Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
P0023 Immuno Histo Chemistry Vimentin Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680
Kidney biopsy-
Immunofluorescence
P0014 Histopathology (Large Size) Lab Diagnostic Services HISTOPATHOLOGY 2730 2730 3140 3550
P0030 Immunochemistry CD99 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0031 Immunochemistry Chromogranin Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0032 Immunochemistry Synaptophysin Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
330
Lab diagnostics
P0041 Immunohistochemistry CK20 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0042 Immunohistochemistry CK7 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0044 Immunohistochemistry E M A Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0046 Immunohistochemistry HMB45 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0048 Immunohistochemistry PAN C K Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0073 Immuno Histo Chemistry Tdt Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0066 Immuno histochemistry TTF-1 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870
P0019 Immuno Histo Chemistry - (Cd3) Lab Diagnostic Services HISTOPATHOLOGY 2800 2940 3500 4060
P0021 Immuno Histo Chemistry E R Lab Diagnostic Services HISTOPATHOLOGY 2930 3070 3660 4240
P0022 Immuno Histo Chemistry P R Lab Diagnostic Services HISTOPATHOLOGY 2930 3070 3660 4240
Immunohisto Chemistry C - Erb
(Her2Neu)
P0055 Perinatal Specimen Lab Diagnostic Services HISTOPATHOLOGY 3060 3220 3830 4440
Immuno Florescence & Light
Microscopy
P0009 EGFR IHC Lab Diagnostic Services HISTOPATHOLOGY 3330 3500 4160 4830
P0013 Histopathology (Extra Large) Lab Diagnostic Services HISTOPATHOLOGY 3930 3930 4520 5110
Kidney, transplant biopsy - Light
microscopy & C4d IHC
Immunohistochemistry - HMWCK
& AMACR
Kidney biopsy-
P0082 Immunofluorescence & light Lab Diagnostic Services HISTOPATHOLOGY 4260 4470 5320 6180
microscopy
Immuno histochemistry Kappa &
Lamda light cha
P0056 Second Opinion Charges Lab Diagnostic Services HISTOPATHOLOGY 5860 6160 7330 8500
P0010 Electron Microscopy Lab Diagnostic Services HISTOPATHOLOGY 8260 8670 10320 11970
Immunohistochemistry 2 to 5
markers
Immunohistochemistry 6 to 8
markers
Immunohistochemistry more than
8 markers
P0106 Clinical Fetal Autopsy Lab Diagnostic Services HISTOPATHOLOGY 26620 27950 33270 38590
P0095 Electron Microscope (out source) Lab Diagnostic Services HISTOPATHOLOGY 36290 38110 45360 52620
BRCA - 1/Brca - 2 (Addl Family
Member)
P0006 BRCA - 1 / Brca - 2 Lab Diagnostic Services HISTOPATHOLOGY 102460 107590 128080 148570
LABORATORY
LMISC02 Home collection charge (0 - 2 km) Lab Diagnostic Services 170 180 210 250
MISC CHARGES
331
Lab diagnostics
LABORATORY
MISC CHARGES
LABORATORY
MISC CHARGES
LABORATORY
LMISC05 Home collection charge (10 -15 km) Lab Diagnostic Services 440 460 550 640
MISC CHARGES
Home collection charge (15 - 20 LABORATORY
LMISC06 Lab Diagnostic Services 580 600 720 830
km) MISC CHARGES
Home Collection Charges More than LABORATORY
LMISC07 Lab Diagnostic Services 740 780 930 1080
20 Kms MISC CHARGES
LABORATORY
LMISC09 Pecaso Analysis Lab Diagnostic Services 217730 228620 272160 315710
MISC CHARGES
M0188 Wet Mount Microscopy Lab Diagnostic Services MICROBIOLOGY 220 230 270 310
M0085 Grams Stain Smear Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
M0088 Hanging Drop Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
India Ink Preparation For
M0130 Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
Cryptococcus
Scraping/Smear For Fungus (Koh
Preparation)
Skin Clipping For AFB (M. Leprae)
Smear
M0164 Smear For Actinomyces Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
M0165 Smear For Diphtheria Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
M0166 Smear For Nocardia Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
M0183 VDRL Test (Quantitative) - RPR Lab Diagnostic Services MICROBIOLOGY 270 290 340 390
Dark Ground Microscopy For
Spirochoetes
M0191 H-Pylori Rapid Urease Test Lab Diagnostic Services MICROBIOLOGY 330 350 410 480
M0001 AFB Smear/Z.N.Staining Lab Diagnostic Services MICROBIOLOGY 350 370 440 510
M0226 Flow cytometry collection Lab Diagnostic Services MICROBIOLOGY 350 370 440 510
M0171 Sterility Test Lab Diagnostic Services MICROBIOLOGY 440 460 550 640
M0053 Cold Agglutination Test Lab Diagnostic Services MICROBIOLOGY 510 530 630 740
Special Stain (Modified Kinyoun
Stain)
M0239 HP camp HBsag Lab Diagnostic Services MICROBIOLOGY 550 580 690 800
M0232 Chikungunya IgM ELISA Lab Diagnostic Services MICROBIOLOGY 600 600 600 600
M0267 Dengue IGG Lab Diagnostic Services MICROBIOLOGY 600 600 600 600
M0268 Dengue IGM Lab Diagnostic Services MICROBIOLOGY 600 600 600 600
M0207 Dengue NS1 antigen (ELISA) Lab Diagnostic Services MICROBIOLOGY 600 600 600 600
M0189 Widal Test Lab Diagnostic Services MICROBIOLOGY 660 660 760 860
M0213 Viral Assay Lab Diagnostic Services MICROBIOLOGY 640 680 800 930
332
Lab diagnostics
M0193 Stool for Rota and Adenovirus Lab Diagnostic Services MICROBIOLOGY 670 700 830 960
M0020 Anti Streptolysin 0 Titre Lab Diagnostic Services MICROBIOLOGY 740 780 930 1080
M0035 Brucella Agglutination Test Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160
M0077 Extra Antibiotic Sens (Each) Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160
M0157 Rheumatoid Factor Assay Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160
M0136 Malaria Antigen Lab Diagnostic Services MICROBIOLOGY 870 870 1010 1140
Hepatitis B Surface Antigen (Hbsag)
- Elisa
M0038 C-Reactive Protein Lab Diagnostic Services MICROBIOLOGY 880 920 1100 1270
Water Analysis (For Bacterial
Contamination)
Human Immuno Virus (HIV I + II)
- Elisa
M0032 Bile For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0043 Cervical Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0066 Ear Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0078 Eye Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0083 Fungus Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0212 HIV P24 Antigen Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0129 I/V Fluid For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0151 Nasal Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
Salmonella Vi Antibody (Tube
Agglutination)
M0162 Semen Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0168 Sputum Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0174 Throat Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0176 Tissue For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0184 Vitreous Fluid Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470
M0069 Endotracheal Suction Culture Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550
M0115 HIV I & II (Rapid Test) Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550
M0179 TPHA Test Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550
M0180 Urine Culture Lab Diagnostic Services MICROBIOLOGY 1170 1170 1350 1530
M0052 CMV-IGM Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
M0056 CSF E.Coli K1/N. Meningitidis B Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
CSF Haemophilus Influenzae B
Antigen
CSF Meningococcal Antigen (A, C,
Y, W-135)
M0059 CSF Pneumococcal Antigen Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
333
Lab diagnostics
M0060 CSF Streptococcus Group B Antigen Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
M0063 Dengue IGG & IGM Lab Diagnostic Services MICROBIOLOGY 1200 1200 1200 1200
M0079 Faeces Culture (Stool Culture) Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
M0112 Herpes Simplex Virus-1 IGG Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
Herpes Simplex Virus-2 IGG
Antibody (Elisa)
M0114 HICC Screening Test Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
M0142 Miscellaneous Culture Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
Paul Bunnel Test (For Infectious
Mononucleosis)
M0186 Weil Felix Test Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660
M0051 CMV-IGG Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740
M0087 H.Pylori IGG Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740
M0156 PUS Culture Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740
M0177 Toxoplasma IGG Test Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740
M0178 Toxoplasma IGM Test Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740
Cytomegalovirus (CMV) IgG avidity
(Outsourced)
M0241 Cytomegalovirus IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1240 1300 1540 1790
M0109 Hepatits D Virus (Antibody) Elisa Lab Diagnostic Services MICROBIOLOGY 1270 1330 1590 1840
M0141 Microfilarial Antibody Lab Diagnostic Services MICROBIOLOGY 1270 1330 1590 1840
M0089 HBSAG (Rapid Test) Lab Diagnostic Services MICROBIOLOGY 1340 1340 1550 1750
Chlamydia trachomatis IgG
antibodies (Outsourced)
Chlamydia trachomatis IgM
M0005 Anaerobic Culture Lab Diagnostic Services MICROBIOLOGY 1430 1430 1650 1860
M0235 Chikungunya PCR Lab Diagnostic Services MICROBIOLOGY 1500 1500 1500 1500
M0064 Dengue Virus Rt - Pcr Lab Diagnostic Services MICROBIOLOGY 1500 1500 1500 1500
M0103 Hepatitis C Virus Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1540 1540 1780 2010
M0009 Anti Cardiolipin - IGA Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
M0036 Brucella IGG Antibody Test Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
M0037 Brucella IGM Antibody Test Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
M0055 CSF Culture Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
M0080 Fluids Culture Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
M0097 Hepatitis B Core IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
Herpes Simplex Virus (1+2) IGM
(Elisa)
M0158 Rubella IGG Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
334
Lab diagnostics
M0159 Rubella IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130
Anti Beta 2 Glycoprotein 1 Antibody
Screening
M0010 Anti Cardiolipin - IGG Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0011 Anti Cardiolipin - IGM Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0034 Bone Marrow Culture Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0054 Cryptococcus Antigen - Latex Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0098 Hepatitis B Core Total Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0099 Hepatitis B E Antibody Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0100 Hepatitis B E Antigen Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330
M0221 Dengue Panel Lab Diagnostic Services MICROBIOLOGY 1800 1800 1800 1800
M0013 Anti Hbs Ag Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510
M0017 Anti Nuclear Antibody (Ana) - IF Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510
Hepatitis A Virus -Total (Igg+Igm)
Antibodies
M0137 Malaria IgG Antibodies Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510
M0242 Rubella IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1850 1950 2310 2680
M0095 Hepatitis A Virus - IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1860 1960 2330 2700
M0243 Toxoplasma IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1910 2000 2380 2770
M0228 HAIN'S TEST Lab Diagnostic Services MICROBIOLOGY 1940 2040 2430 2810
M0012 Anti Ds-DNA Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900
M0033 Blood Culture and Sensitivity Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900
M0134 Leptospira IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900
M0140 Measles IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900
Anti-Glomerular Basement
M0255 Membrane IgG Antibodies (anti- Lab Diagnostic Services MICROBIOLOGY 2080 2180 2590 3010
GBM) (Outsourced)
M0245 Anti GBM IgG antibodies Lab Diagnostic Services MICROBIOLOGY 2240 2360 2800 3250
M0046 Chlamydia IGA Lab Diagnostic Services MICROBIOLOGY 2270 2380 2830 3290
M0061 Cytomegalovirus (If) Lab Diagnostic Services MICROBIOLOGY 2270 2380 2830 3290
M0006 Anca IF Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480
M0042 CD4/CD8Counts Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480
M0139 Measles IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480
Mycobacterial culture - Automated
(MGIT)
Chlamydia pneumonia IgA
Chlamydia pneumonia IgG
335
Lab diagnostics
Chlamydia pneumonia IgM

M0231 Xpert MTB/RIF assay (GeneXpert) Lab Diagnostic Services MICROBIOLOGY 2470 2590 3080 3580
M0028 Antisperm Antibody Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680
M0200 Aspergillus galactomannan antigen Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680
M0144 Mumps IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680
M0181 Varicella Zoster IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680
M0224 Procalcitonin /CRP Lab Diagnostic Services MICROBIOLOGY 2670 2800 3340 3870
M0182 Varicella Zoster IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 2670 2800 3340 3870
M0067 Echinococcus Antibodies IGG Lab Diagnostic Services MICROBIOLOGY 2800 2940 3500 4060
M0122 HLA B27 (Flowcytometry) Lab Diagnostic Services MICROBIOLOGY 2800 2940 3500 4060
Thyroid Antibody -Thyroglobulin/
Microsomal
M0236 ANCA profile ELISA Lab Diagnostic Services MICROBIOLOGY 3030 3180 3780 4390
M0133 Leptospira - Rapid - IGM Lab Diagnostic Services MICROBIOLOGY 3060 3220 3830 4440
M0155 Procalcitonin Lab Diagnostic Services MICROBIOLOGY 3060 3220 3830 4440
M0048 Chlamydia IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630
M0049 Clostridium Difficile Toxin Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630
M0223 Endotoxin test (Qualitative) Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630
M0123 HLA Cross Match With Dtt Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630
M0146 Mumps IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630
Parvo virus B19 DNA PCR
(Outsourced)
M0025 Anticysticercal Antibody Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830
M0070 Entamoeba Histolytica Antibodies Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830
Mycoplasma Pneumoniae IGG
Antibodies
Mycoplasma Pneumoniae IGM
Antibodies
M0190 Yersenia Culture Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830
Anti-Parietal Cell Antibody
(Outsourced)
M0234 TB FERON Lab Diagnostic Services MICROBIOLOGY 3450 3630 4320 5010
M0015 Anti Mitochondrial Antibodies, AMA Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020
Epstein Barr Virus (Early Antigen
IGG)
Epstein Barr Virus (Nuclear Antigen)
IGG
M0074 Epstein Barr Virus (Vca) IGG Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020
336
Lab diagnostics
M0075 Epstein Barr Virus (Vca) IGM Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020
M0107 Hepatitis E Virus IGM Antibody Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020
M0263 Parvovirus B19 IgG (Outsourced) Lab Diagnostic Services MICROBIOLOGY 3480 3650 4340 5040
M0076 Erythropoietin Lab Diagnostic Services MICROBIOLOGY 3600 3780 4500 5220
M0201 Parvovirus IgM antibodies Lab Diagnostic Services MICROBIOLOGY 3730 3920 4670 5410
M0196 Auto Immune Hepatitis Panel Lab Diagnostic Services MICROBIOLOGY 3870 4060 4830 5610
Anti Smooth Muscle Antibodies-
Immunofluresence
M0094 Helicobacter Pylori IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3990 4190 4990 5790
M0024 Anti-Ccp Antibodies Lab Diagnostic Services MICROBIOLOGY 4130 4330 5160 5980
M0154 Pneumocystis Carinii (LF) Lab Diagnostic Services MICROBIOLOGY 4130 4330 5160 5980
M0237 Anti phospholipase 2 receptor IIF Lab Diagnostic Services MICROBIOLOGY 4240 4450 5300 6140
M0093 Helicobacter Pylori IGA Antibodies Lab Diagnostic Services MICROBIOLOGY 4260 4470 5320 6180
HEPATITIS B REAL TIME PCR
QUALITATIVE
M0214 H1N1 - Test Lab Diagnostic Services MICROBIOLOGY 4500 4500 4500 4500
M0225 HPV -Hybrid Digene Lab Diagnostic Services MICROBIOLOGY 4420 4640 5520 6400
M0187 Western Blot Report Lab Diagnostic Services MICROBIOLOGY 4530 4760 5660 6570
Epstein Barr virus (EBV) DNA PCR
(Outsourced)
M0218 Anti- Desmoglein antibody Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960
M0068 Endomysial IGA Antibodies Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960
M0197 HLA B27 - PCR Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960
M0222 DSA (Donor Specific Antibody) Lab Diagnostic Services MICROBIOLOGY 5190 5450 6490 7520
Japanese Encephalitis Virus Rt -
PCR (Qualitative)
M0026 Antigliadin IGA Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690
M0027 Antigliadin IGG Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690
M0050 CMV-DNA PCR Qualitative Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690
HIV-1 RNA Quantitative RT PCR
(viral load)
M0264 Galactomannan (Outsourced) Lab Diagnostic Services MICROBIOLOGY 6160 6470 7700 8940
M0211 HSV 1 & 2- Real Time PCR Lab Diagnostic Services MICROBIOLOGY 6250 6570 7820 9070
M0003 AFB Susceptibility:Custom Lab Diagnostic Services MICROBIOLOGY 6390 6710 7980 9260
M0047 Chlamydia IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 6390 6710 7980 9260
M0244 AFB susceptibility, SIREP Panel Lab Diagnostic Services MICROBIOLOGY 6720 7060 8400 9750
Food Allergy Panel
(Immunochromatography)
Hepatitis C Virus Real Time PCR
(Qualitative)
337
Lab diagnostics
M0018 Anti Nuclear Antibody (Ana) Profile Lab Diagnostic Services MICROBIOLOGY 7200 7550 8990 10430
AFB speciation- Common
(Outsourced)
Fungal Susceptinility Mic Panel (4
Drugs)
Hepatitis C Virus Genotyping
(Outsourced)
M0209 JC/BK DNA PCR Lab Diagnostic Services MICROBIOLOGY 9320 9790 11650 13520
Anti Acetylcholine Receptor
Antibody
M0203 Auto Immune hepatitis profile Lab Diagnostic Services MICROBIOLOGY 11180 11740 13980 16210
M0227 HLA Flowcytometry Cross Match Lab Diagnostic Services MICROBIOLOGY 11180 11740 13980 16210
M0246 Hepatitis B virus DNA Quantitative Lab Diagnostic Services MICROBIOLOGY 11200 11760 14000 16240
MIC test for Non-Tuberculosis
Mycobacteria (NTM) (Outsourced)
M0065 Dengue Virus Typing Strains 1,2,3,4 Lab Diagnostic Services MICROBIOLOGY 12520 13140 15640 18150
M0102 Hepatitis B Virus Ymdd Mutation Lab Diagnostic Services MICROBIOLOGY 12520 13140 15640 18150
Hepatitis C Virus PCR Quantitative
(Viral Load)
HIV-1 Genotypic Resistance
(Outsourced)
CMV DNA Realtime PCR
(Quantitative)
M0121 HLA Ab&Dr Lab Diagnostic Services MICROBIOLOGY 23290 24450 29110 33770
338
Radiology
339
Radiology
DEXA Single Site bone Radiology

DRAD227 BMD 2330 2440 2910 3370
densitometry Diagnostic Services
DEXA Hip And Spine bone Radiology
DRAD228 BMD 3850 4050 4820 5590
DEXA Three Site bone Radiology
DRAD229 BMD 5260 5530 6580 7630
Radiology
DRAD230 DEXA Whole Body BMD 5260 5530 6580 7630
Diagnostic Services
Radiology
DRAD084 Imaging Services CT 440 440 510 570
Diagnostic Services
Computed tomogram (CT scan) Radiology
DS0013 C CT 500 500 580 650
OTHERS - PLAIN Diagnostic Services
Radiology
DRAD373 CT Radiotherapy plan - 8 cuts(N) CT 890 890 1020 1150
Diagnostic Services
CT SCANNOGARAM LOWER Radiology
DRAD149 CT 950 950 1090 1230
LIMBS Diagnostic Services
Radiology
DRAD423 CT JOINT Limited study CT 1640 1640 1890 2130
Diagnostic Services
Radiology
DRAD202 CT JOINTS WITH 3D CT 1770 1770 2030 2290
Diagnostic Services
Radiology
DRAD367 CT 3D surface rendering CT 1890 1890 2170 2450
Diagnostic Services
Radiology
DRAD398 CT spine (3 vertebral levels) plain CT 2080 2080 2400 2710
Diagnostic Services
Radiology
DRAD447 CT PNS coronal CT 2140 2140 2460 2780
Diagnostic Services
Radiology
DRAD441 CT sella / pituitary CT 2330 2330 2680 3030
Diagnostic Services
Radiology
DRAD374 CT Brachy planning - 1(N) CT 2400 2400 2750 3110
Diagnostic Services
Radiology
DRAD436 CT Head & Brain(N) CT 2520 2520 2900 3270
Diagnostic Services
Stroke 1 CT Brain with MRI Radiology
DRAD1129 CT 2620 2620 3010 3410
Diffusion Diagnostic Services
Radiology
DRAD450 CT Brain & IAM(N) CT 2770 2770 3190 3600
Diagnostic Services
Radiology
DRAD041 CT Kub Plain CT 2770 2770 3190 3600
Diagnostic Services
Radiology
DRAD408 CT wrist both sides CT 2770 2770 3190 3600
Diagnostic Services
Radiology
DRAD409 CT wrist left side CT 2770 2770 3190 3600
Diagnostic Services
Radiology
DRAD410 CT wrist right side CT 2770 2770 3190 3600
Diagnostic Services
Radiology
DRAD425 CT lower abdomen CT 2830 2830 3260 3680
Diagnostic Services
340
Radiology
Radiology
DRAD437 CT Brain & Coronals CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD399 CT cervical spine CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD420 CT foot both sides CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD421 CT foot left side CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD422 CT foot right side CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD411 CT hand both sides CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD412 CT hand left side CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD413 CT hand right side CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD439 CT head (bone window) CT 3030 3030 3480 3930
Diagnostic Services
CT IAM / Temporal bone high Radiology
DRAD446 CT 3030 3030 3480 3930
resolution Diagnostic Services
Radiology
DRAD417 CT Joint both ankle CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD405 CT Joint both Elbow CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD414 CT Joint both knees CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD402 CT Joint Both Shoulder CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD418 CT Joint left ankle CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD406 CT Joint left elbow CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD415 CT Joint left knee CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD403 CT Joint left shoulder CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD419 CT Joint right ankle CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD407 CT Joint right elbow CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD416 CT Joint right knee CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD404 CT Joint right shoulder CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD438 CT Maxillo fascial CT 3030 3030 3480 3930
Diagnostic Services
341
Radiology
Radiology
DRAD427 CT sacro iliac joints CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD400 CT Thoracic spine CT 3030 3030 3480 3930
Diagnostic Services
Radiology
DRAD043 CT Orbits CT 3080 3080 3550 4010
Diagnostic Services
Radiology
DRAD434 CT Thorax High Resolution lungs CT 3080 3080 3550 4010
Diagnostic Services
Radiology
DRAD449 CT sterotactic localization CT 3270 3270 3760 4250
Diagnostic Services
Radiology
DRAD045 CT Pelvis CT 3400 3400 3910 4420
Diagnostic Services
Radiology
DRAD424 CT upper abdomen CT 3520 3520 4050 4580
Diagnostic Services
Radiology
DRAD375 CT Brachy planning - 2 (N) CT 3650 3650 4200 4740
Diagnostic Services
Radiology
DRAD201 CT EXTREMITIES WITH 3D CT 3650 3650 4200 4740
Diagnostic Services
Radiology
DRAD401 CT Lumbar spine CT 3650 3650 4200 4740
Diagnostic Services
Radiology
DRAD432 CT Thorax CT 3650 3650 4200 4740
Diagnostic Services
Radiology
DRAD435 CT neck(N) CT 3770 3770 4340 4900
Diagnostic Services
Radiology
DRAD366 CT Brain with PNS(N) CT 3900 3900 4490 5070
Diagnostic Services
Radiology
DRAD440 CT head with 3D scan CT 3900 3900 4490 5070
Diagnostic Services
Radiology
DRAD426 CT hip joint both sides CT 3900 3900 4490 5070
Diagnostic Services
Stroke 2 CT Brain with MRI Radiology
DRAD1130 CT 4370 4370 5020 5670
Diffusion with MRA Intracranial Diagnostic Services
CT Thorax & High Resolution Radiology
DRAD433 CT 4780 4780 5500 6210
study Diagnostic Services
Radiology
DRAD428 CT abdomen and pelvis CT 5790 5790 6660 7520
Diagnostic Services
DS0013 B CT SPECIAL 550 580 690 800
BRAIN/SPINE - CONTRAST Diagnostic Services
Radiology
DRAD1137 CT NAVIGATION PROTOCOL CT SPECIAL 2570 2700 3210 3720
Diagnostic Services
Radiology
DRAD358 CT Virtual Endoscopy CT SPECIAL 4370 4590 5460 6340
Diagnostic Services
Radiology
DRAD369 CT Denta scan CT SPECIAL 5260 5530 6580 7630
Diagnostic Services
Radiology
DRAD059 CT-Calcium Scoring CT SPECIAL 6300 6610 7870 9130
Diagnostic Services
342
Radiology
Radiology
DRAD161 CT-TRAUMA BRAIN & C SPINE CT SPECIAL 7190 7550 8980 10420
Diagnostic Services
Radiology
DRAD371 CT Perfusion (N) CT SPECIAL 8740 9180 10920 12670
Diagnostic Services
Radiology
DRAD200 CT ANGIO PAEDIATRIC CT SPECIAL 10010 10520 12520 14520
Diagnostic Services
Radiology
DRAD370 CT Bronchoscopy(N) CT SPECIAL 10530 11060 13160 15270
Diagnostic Services
Radiology
DRAD368 CT Colonography(N) CT SPECIAL 13480 14150 16850 19540
Diagnostic Services
Radiology
DRAD052 CT-Angio Coronary CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD378 CT Angiography intracranial CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD379 CT Angiography neck CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD386 CT Angiography - Renal CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD215 CT TRPHASE LIVER VOLUME CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD377 CT Urogram(N) CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD393 CT venography intracranial CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD394 CT venography neck CT SPECIAL 16040 16840 20050 23260
Diagnostic Services
Radiology
DRAD050 CT-Angio (One Region) CT SPECIAL 17330 18200 21660 25130
Diagnostic Services
Radiology
DRAD1108 CT Chest Angio CT SPECIAL 17330 18200 21660 25130
Diagnostic Services
CT Angiography neck & Radiology
DRAD380 CT SPECIAL 17970 18870 22460 26050
intracranial Diagnostic Services
Radiology
DRAD055 CT-Angio Head & Neck CT SPECIAL 17970 18870 22460 26050
Diagnostic Services
CT venography neck & Radiology
DRAD395 CT SPECIAL 17970 18870 22460 26050
intracranial Diagnostic Services
Radiology
DRAD396 CT venography thorax CT SPECIAL 17970 18870 22460 26050
Diagnostic Services
Radiology
DRAD051 CT-Angio Aortic CT SPECIAL 19250 20220 24070 27920
Diagnostic Services
Radiology
DRAD382 CT Angiography abdominal aorta CT SPECIAL 19250 20220 24070 27920
Diagnostic Services
Radiology
DRAD381 CT Angiography thoracic aorta CT SPECIAL 19250 20220 24070 27920
Diagnostic Services
CT-POLYTRAUMA HEMIBODY
Radiology
DRAD203 (BRAIN, C-SPINE & THROAX WITH CT SPECIAL 19890 20890 24860 28840
Diagnostic Services
CONTRAST)
343
Radiology
Radiology
DRAD058 CT-Cabg Evaluation CT SPECIAL 21180 22240 26470 30710
Diagnostic Services
Radiology
DRAD150 CT TRIPHASE ABDOMEN & PELVIS CT SPECIAL 21180 22240 26470 30710
Diagnostic Services
Radiology
DRAD397 CT venography whole abdomen CT SPECIAL 21180 22240 26470 30710
Diagnostic Services
Radiology
DRAD389 CT Angiography lower limbs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD388 CT Angiography thighs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD387 CT Angiography upper limbs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD056 CT-Angio Peripheral CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD392 CT Venography lower limbs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD391 CT Venography thighs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD390 CT Venography upper limbs CT SPECIAL 21820 22910 27270 31630
Diagnostic Services
Radiology
DRAD384 CT Angiography abdomen CT SPECIAL 23100 24260 28880 33500
Diagnostic Services
Radiology
DRAD383 CT Angiography abdomen & chest CT SPECIAL 24380 25600 30470 35350
Diagnostic Services
Radiology
DRAD385 CT Angiography whole abdomen CT SPECIAL 24380 25600 30470 35350
Diagnostic Services
CT ANGIOGRAPHY AORTA & Radiology
DRAD1136 CT SPECIAL 25670 26950 32080 37220
PERIPHERAL Diagnostic Services
CT-POLYTRAUMA WHOLEBODY
(BRAIN, C-SPINE, THROAX Radiology
DRAD204 CT SPECIAL 28230 29640 35290 40930
ABDOMEN, PELVIS WITH Diagnostic Services
CONTRAST)
CT-Angiography Coronary & Radiology
DRAD362 CT SPECIAL 29520 30990 36900 42800
Renal Diagnostic Services
CT-Tripple Rule Out (Pulm, Aorta Radiology
DRAD365 CT SPECIAL 35930 37730 44910 52100
& Coronary)(N) Diagnostic Services
DOPPLER VEIN MARKING LSV Radiology
DRAD164 DOPPLER 1230 1290 1530 1780
FOR BYPASS GRAFT Diagnostic Services
Radiology
DRAD254 Doppler & Ultrasound scrotum DOPPLER 1680 1760 2090 2430
Diagnostic Services
Radiology
DRAD238 Doppler left arm arterial DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD241 Doppler left arm venous DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD244 Doppler left leg arterial DOPPLER 2460 2580 3070 3560
Diagnostic Services
344
Radiology
Radiology
DRAD247 Doppler left leg venous DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD237 Doppler right arm arterial DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD240 Doppler right arm venous DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD243 Doppler right leg arterial DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD246 Doppler right leg venous DOPPLER 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD234 Doppler of Renal artery DOPPLER 2830 2970 3540 4100
Diagnostic Services
Radiology
DRAD235 Doppler penile DOPPLER 2830 2970 3540 4100
Diagnostic Services
Doppler Vein Marking / Mapping Radiology
DRAD255 DOPPLER 2830 2970 3540 4100
varicose veins single limb Diagnostic Services
Doppler carotid & Vertebral Radiology
DRAD231 DOPPLER 3220 3380 4020 4660
vessels Diagnostic Services
Radiology
DRAD1156 Doppler Petrous Artery DOPPLER 3220 3380 4020 4660
Diagnostic Services
Radiology
DRAD232 Doppler Abdomen(N) DOPPLER 3350 3520 4180 4850
Diagnostic Services
Radiology
DRAD233 Doppler of transplanted kidney DOPPLER 3350 3520 4180 4850
Diagnostic Services
Radiology
DRAD245 Doppler both legs venous DOPPLER 3600 3780 4500 5220
Diagnostic Services
Radiology
DRAD239 Doppler both arms venous DOPPLER 4250 4460 5310 6160
Diagnostic Services
Radiology
DRAD250 Doppler left arm venous & arterial DOPPLER 4490 4720 5610 6510
Diagnostic Services
Doppler left lower limb venous & Radiology
DRAD253 DOPPLER 4490 4720 5610 6510
arterial Diagnostic Services
Doppler right arm venous & Radiology
DRAD249 DOPPLER 4490 4720 5610 6510
arterial Diagnostic Services
Doppler right lower limb venous Radiology
DRAD252 DOPPLER 4490 4720 5610 6510
& arterial Diagnostic Services
Radiology
DRAD236 Doppler both arms arterial DOPPLER 4890 5130 6110 7090
Diagnostic Services
Radiology
DRAD242 Doppler both legs arterial DOPPLER 4890 5130 6110 7090
Diagnostic Services
Doppler Vein Marking / Mapping Radiology
DRAD256 DOPPLER 4890 5130 6110 7090
varicose veins both limbs Diagnostic Services
Doppler both upper limbs venous Radiology
DRAD248 DOPPLER 5390 5660 6740 7820
Doppler both lower limbs venous Radiology
DRAD251 DOPPLER 6300 6610 7870 9130
345
Radiology
Radiology
DS0003 Mamogram MAMMOGRAM 330 350 420 480
Diagnostic Services
Radiology
DRAD454 Mammography Extra view MAMMOGRAM 770 810 970 1120
Diagnostic Services
Radiology
DRAD451 Mammography (L) MAMMOGRAM 1810 1900 2260 2620
Diagnostic Services
Radiology
DRAD452 Mammography (R) MAMMOGRAM 1810 1900 2260 2620
Diagnostic Services
Radiology
DRAD087 Mammogram Both Breasts MAMMOGRAM 2460 2580 3070 3560
Diagnostic Services
Mammographic Localization Or Radiology
DRAD206 MAMMOGRAM 8220 8630 10280 11920
Biopsy Diagnostic Services
Magnetic resonance imaging Radiology
DS0014 A MR 580 580 670 750
(MRI) BRAIN/SPINE - PLAIN Diagnostic Services
DS0014 C MR 580 580 670 750
(MRI) OTHERS - PLAIN Diagnostic Services
Radiology
DRAD1135 MRI NAVIGATION PROTOCOL MR 1800 1800 2070 2330
Diagnostic Services
Radiology
DRAD350 MRI Diffusion(N) MR 3060 3060 3520 3970
Diagnostic Services
Radiology
DRAD1132 MRI LIVER-IRON ESTIMATE MR 3680 3680 4230 4780
Diagnostic Services
Radiology
DRAD208 MR ANGIOGRAPHY INTRACRANIAL MR 4270 4270 4910 5540
Diagnostic Services
MR ANGIOGRAPHY NECK Radiology
DRAD166 MR 4270 4270 4910 5540
VESSELS Diagnostic Services
MRI Angiography intracranial Radiology
DRAD281 MR 4270 4270 4910 5540
without contrast Diagnostic Services
MRI Angiography neck vessels Radiology
DRAD284 MR 4270 4270 4910 5540
Radiology
DRAD165 MR VENOGRAPHY INTRACRANIAL MR 4270 4270 4910 5540
Diagnostic Services
MR Venography intracranial Radiology
DRAD283 MR 4270 4270 4910 5540
Radiology
DRAD352 MRI Limited(N) MR 4990 4990 5740 6480
Diagnostic Services
MR ANGIO & VENOGRAM Radiology
DRAD167 MR 5480 5480 6300 7120
INTRACRANIAL Diagnostic Services
MR Angio & Venogram Radiology
DRAD285 MR 5480 5480 6300 7120
intracranial without contrast Diagnostic Services
MRI Angiography neck & Radiology
DRAD282 MR 5480 5480 6300 7120
intracranial without contrast Diagnostic Services
Stroke 3 MRI Limited with MRA Radiology
DRAD1131 MR 5820 5820 6690 7560
Intracranial Diagnostic Services
Radiology
DRAD279 MRCP(N) MR 6110 6110 7030 7940
Diagnostic Services
346
Radiology
MR ANGIOGRAPHY INTRACRANIAL Radiology

DRAD209 MR 6740 6740 7750 8750
& NECK VESSELS Diagnostic Services
Radiology
DRAD098 MR Joints MR 7550 7550 8680 9810
Diagnostic Services
Radiology
DRAD295 MRI angiography both thighs MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD290 MRI angiography left forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD288 MRI angiography left upper arm MR 8270 8270 9510 10740
Diagnostic Services
MRI angiography lower abdomen Radiology
DRAD294 MR 8270 8270 9510 10740
/ pelvis Diagnostic Services
Radiology
DRAD289 MRI angiography right forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD287 MRI angiography right upper arm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD291 MRI angiography thorax MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD293 MRI angiography upper abdomen MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD308 MRI brachial plexus MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD344 MRI brain MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD354 MRI Brain & IAM MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD306 MRI cervical spine MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD335 MRI foot MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD338 MRI hip joints MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD334 MRI left ankle MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD320 MRI left elbow MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD322 MRI left forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD326 MRI left hand MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD330 MRI left knee joint MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD316 MRI left shoulder MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD318 MRI left upper arm MR 8270 8270 9510 10740
Diagnostic Services
347
Radiology
Radiology
DRAD324 MRI left wrist MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD309 MRI lumbar plexus MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD310 MRI lumbo-sacral spine MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD343 MRI neck MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD286 MRI neck & carotid angiography MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD105 MRI One Region MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD347 MRI orbit MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD346 MRI Para nasal sinuses ( PNS ) MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD336 MRI pelvis MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD339 MRI perineum MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD345 MRI Pituitary fossa/sella MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD292 MRI renal angiography MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD333 MRI right ankle MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD319 MRI right elbow MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD321 MRI right forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD325 MRI right hand MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD329 MRI right knee joint MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD315 MRI right shoulder MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD317 MRI right upper arm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD323 MRI right wrist MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD337 MRI sacro-iliac joints MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD327 MRI thigh MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD307 MRI thoracic spine MR 8270 8270 9510 10740
Diagnostic Services
348
Radiology
Radiology
DRAD342 MRI thorax MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD348 MRI TM joint MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD340 MRI upper abdomen MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD305 MRI venography both lower legs MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD304 MRI venography both thighs MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD300 MRI venography left forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD298 MRI venography left upper arm MR 8270 8270 9510 10740
Diagnostic Services
MRI venography lower abdomen Radiology
DRAD303 MR 8270 8270 9510 10740
/ pelvis Diagnostic Services
Radiology
DRAD299 MRI venography right forearm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD297 MRI venography right upper arm MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD301 MRI venography thorax MR 8270 8270 9510 10740
Diagnostic Services
Radiology
DRAD302 MRI venography upper abdomen MR 8270 8270 9510 10740
Diagnostic Services
MRI Angio abdomen with both Radiology
DRAD355 MR 9160 9160 10530 11900
lower limbs Diagnostic Services
Radiology
DRAD278 MRI Mammography MR 9160 9160 10530 11900
Diagnostic Services
Radiology
DRAD1134 MRI BRAIN & FMR MR 9430 9430 10840 12250
Diagnostic Services
Radiology
DRAD1133 MRI BRAIN & SPECTROSCOPY MR 9430 9430 10840 12250
Diagnostic Services
Radiology
DRAD351 MRI Brain Plus(N) MR 9870 9870 11350 12830
Diagnostic Services
Radiology
DRAD314 MRI Spine plus(N) MR 9970 9970 11460 12950
Diagnostic Services
Radiology
DRAD099 MR Joints (Both) MR 12120 12120 13940 15750
Diagnostic Services
Radiology
DRAD331 MRI lower legs MR 14580 14580 16770 18950
Diagnostic Services
Radiology
DRAD341 MRI whole abdomen MR 14580 14580 16770 18950
Diagnostic Services
Radiology
DRAD146 MRI ABDOMEN & PELVIS MR 14640 14640 16830 19020
Diagnostic Services
Radiology
DRAD332 MRI both ankles MR 15800 15800 18170 20530
Diagnostic Services
349
Radiology
Radiology
DRAD328 MRI both knee joints MR 15800 15800 18170 20530
Diagnostic Services
Radiology
DRAD349 MRI Both TM joint MR 15800 15800 18170 20530
Diagnostic Services
Radiology
DRAD311 MRI spine MR 15800 15800 18170 20530
Diagnostic Services
Radiology RADIOLOGY INVASIVE
DS0006 Ultrasound guided biopsyt 550 580 690 800
Diagnostic Services PROCEDURES
DRAD1066 T - Tube cholangiogram OT(N) 2570 2700 3210 3720
JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE
DRAD1115 3150 3310 3940 4570
INJECTION-SINGLE Diagnostic Services PROCEDURES
DRAD1119 4310 4520 5380 6240
INJECTION Diagnostic Services PROCEDURES
U/S GUIDED FNA / DIAGNOSTIC Radiology RADIOLOGY INVASIVE
DRAD1123 4440 4660 5550 6430
ASPIRATION Diagnostic Services PROCEDURES
DRAD1061 CT guided aspiration 5340 5610 6670 7740
CT GUIDED FNA / DIAGNOSTIC Radiology RADIOLOGY INVASIVE
DRAD1124 5340 5610 6670 7740
ASPIRATION Diagnostic Services PROCEDURES
DRAD1056 Ultrasound guided breast biopsy 5340 5610 6670 7740
DRAD1054 Ultrasound guided aspiration(N) 6230 6540 7790 9030
DRAD170 Nasogastric Tube Insertion 6360 6680 7950 9220
DRAD1071 Xray Nasogastric Tube Insertion 6360 6680 7950 9220
DRAD1141 Paed Central Line 6420 6740 8020 9300
DRAD1069 Xray myelogram ( Dorsal ) 6420 6740 8020 9300
DRAD1140 PERM CATH PROCEDURE CHARGE 7070 7420 8830 10240
DRAD1060 CT guided FNAC 7390 7760 9230 10710
DRAD1058 CT Guided Joint Injection 7390 7760 9230 10710
DRAD1116 7390 7760 9230 10710
INJECTION-UPTO 3 JOINTS Diagnostic Services PROCEDURES
DRAD1126 PICK LINE INSERTION 7390 7760 9230 10710
DRAD1053 Ultrasound guided FNAC 7390 7760 9230 10710
DRAD1068 Xray myelogram ( cervical ) 7390 7760 9230 10710
350
Radiology

DRAD1070 Xray myelogram ( Lumbar) 7390 7760 9230 10710
Mammographic biopsy / Radiology RADIOLOGY INVASIVE
DRAD1065 8020 8420 10030 11630
localization Diagnostic Services PROCEDURES
DRAD1055 Ultrasound Guided Drainage 8020 8420 10030 11630
DRAD1139 BILIARY STENT Deployment 8340 8760 10430 12100
DRAD1112 PYLORIC DILATATION - PKG 8610 9040 10760 12480
DRAD173 Nasojejunal Tube Insertion 9510 9980 11880 13790
DRAD172 US/CT Guided Biopsy 9510 9980 11880 13790
DRAD1072 Xray Nasojejunal Tube Insertion 9510 9980 11880 13790
DRAD1117 10660 11200 13330 15460
DRAD1127 TUNNEL LINE INSERTION 10660 11200 13330 15460
HD Catheter Double Lumen - Radiology RADIOLOGY INVASIVE
DRAD1138 10910 11450 13630 15810
Radiology Diagnostic Services PROCEDURES
DRAD1063 CT guided Biopsy 10980 11530 13730 15920
DRAD1062 CT guided drainage 10980 11530 13730 15920
DRAD1064 CT myelogram 10980 11530 13730 15920
DRAD1057 Ultrasound Guided Biopsy 10980 11530 13730 15920
DRAD442 CT cisternography 12460 13080 15570 18060
DRAD1118 17010 17860 21260 24660
DRAD1125 CELIAC PLEXUS BLOCK 19190 20150 23980 27820
DRAD1121 PTBD STEP 2 19190 20150 23980 27820
DRAD196 Angio Cerebral 23620 24800 29530 34250
DRAD174 Angiogram Mesenteric 23620 24800 29530 34250
DRAD197 Angiogram Peripheral 23620 24800 29530 34250
DRAD198 Angiogram Renal 23620 24800 29530 34250
351
Radiology

DRAD1120 PTBD STEP 1 23620 24800 29530 34250
DRAD1067 Tubal Recanalization(N) 23620 24800 29530 34250
DRAD1122 URETRIC STENTING 23620 24800 29530 34250
DRAD140 Venogram 23620 24800 29530 34250
DRAD1114 SCLEROTHERAPHY - PKG 25870 27160 32330 37500
VARICOCELE EMBOLIZATION - Radiology RADIOLOGY INVASIVE
DRAD1113 33950 35650 42440 49230
PKG Diagnostic Services PROCEDURES
DRAD199 Angioplasty 42790 44930 53490 62050
DRAD183 IVC Filter placement 42790 44930 53490 62050
DRAD182 Nephrostomy 42790 44930 53490 62050
Percutaneous Biliary Drainage/ Radiology RADIOLOGY INVASIVE
DRAD176 42790 44930 53490 62050
Stenting Diagnostic Services PROCEDURES
DRAD179 Percutaneous Cholesystostomy 42790 44930 53490 62050
DRAD180 Percutaneous Gastrostomy 42790 44930 53490 62050
DRAD178 Radiofrequency Ablation (RFA) 42790 44930 53490 62050
Transarterial Chemoembolisation Radiology RADIOLOGY INVASIVE
DRAD177 42790 44930 53490 62050
(TACE) Diagnostic Services PROCEDURES
DRAD181 Transjugular biopsy 42790 44930 53490 62050
DRAD175 Venoplasty 42790 44930 53490 62050
DRAD1142 Hepatic Venous / IVC stenting 44910 47150 56130 65110
DRAD186 Therasphere Treatment 64160 67360 80190 93030
DRAD184 Arterial/Venous Embolisation 73780 77470 92230 106980
DRAD1143 Mesentric Angiogram for Y 90 73780 77470 92230 106980
DRAD185 TIPSS 73780 77470 92230 106980
DRAD188 Uterine Fibroid Embolisation 73780 77470 92230 106980
Vascular stent/stent graft Radiology RADIOLOGY INVASIVE
DRAD187 73780 77470 92230 106980
Insertion Diagnostic Services PROCEDURES
352
Radiology
Radiology
DRAD1094 Second Opinion - Single X-Ray RADIOLOGY MISC 60 60 70 80
Diagnostic Services
Second Opinion - multiple Radiology
DRAD1095 RADIOLOGY MISC 110 120 140 160
X-Rays(N) Diagnostic Services
Radiology
DRAD1092 Ultrasound extra film charges(N) RADIOLOGY MISC 160 170 200 230
Diagnostic Services
Radiology
DRAD1087 CD 1 Soft copy X-Ray RADIOLOGY MISC 170 180 210 240
Diagnostic Services
Radiology
DRAD1091 X-ray Extra film charges RADIOLOGY MISC 200 210 250 290
Diagnostic Services
Radiology
DRAD1093 CT //MRI Extra film charges(N) RADIOLOGY MISC 220 240 280 320
Diagnostic Services
Radiology
DRAD1082 Ionic contrast (20 ml) RADIOLOGY MISC 240 250 290 340
Diagnostic Services
Radiology
DRAD1083 Rectal contrast (20ml ionic)(N) RADIOLOGY MISC 240 250 290 340
Diagnostic Services
CD 2 Soft copy X-Rays'/ Radiology
Ultrasound Diagnostic Services
Radiology
DRAD1073 Non-ionic contrast 300mg(10 ml) RADIOLOGY MISC 430 460 540 630
Diagnostic Services
Second Opinion - Radiology
Investigations(N) Diagnostic Services
Second Opinion - Radiology
Mammogram(N) Diagnostic Services
DS0013 D RADIOLOGY MISC 550 580 690 800
OTHERS - CONTRAST Diagnostic Services
Radiology
DRAD1096 Second Opinion - Single CT RADIOLOGY MISC 580 610 720 830
Diagnostic Services
Radiology
DRAD1074 Non-ionic contrast 300mg (20 ml) RADIOLOGY MISC 590 620 730 850
Diagnostic Services
Radiology
DRAD1089 CD 3 Soft copy CT scan / MRI RADIOLOGY MISC 720 760 900 1040
Diagnostic Services
Radiology
DRAD1098 Second Opinion - MRI(N) RADIOLOGY MISC 770 810 970 1120
Diagnostic Services
DS0014 B RADIOLOGY MISC 830 870 1040 1200
(MRI) BRAIN/SPINE - CONTRAST Diagnostic Services
DS0014 D RADIOLOGY MISC 830 870 1040 1200
(MRI) OTHERS - CONTRAST Diagnostic Services
Radiology
DRAD1161 MRI/CT ANAESTHESIA CARE RADIOLOGY MISC 1000 1000 1000 1000
Diagnostic Services
Second Opinion - Serial Radiology
Mammogram(N) Diagnostic Services
Radiology
DRAD1090 DVD soft copy CT scan / MRI(N) RADIOLOGY MISC 990 1040 1240 1440
Diagnostic Services
Radiology
DRAD1075 non-ionic contrast 300mg (40 ml) RADIOLOGY MISC 990 1040 1240 1440
Diagnostic Services
353
Radiology
Second Opinion - Serial CT Radiology

Studies(N) Diagnostic Services
Radiology
DRAD1081 Oral contrast (100 ml)(N) RADIOLOGY MISC 1100 1160 1380 1600
Diagnostic Services
Radiology
Diagnostic Services
Radiology
Diagnostic Services
RADIOLOGIST ASSISTANCE FEE Radiology
-1 Diagnostic Services
Second Opinion - Serial MRI Radiology
Studies(N) Diagnostic Services
Non-ionic contrast 300mg (80 Radiology
ml)(N) Diagnostic Services
ml) Diagnostic Services
ml) Diagnostic Services
Radiology
DRAD103 MRI Contrast 10Ml RADIOLOGY MISC 3030 3180 3790 4390
Diagnostic Services
Radiology
DRAD1085 MRI Contrast 20Ml(N) RADIOLOGY MISC 6050 6360 7570 8780
Diagnostic Services
Radiology
DRAD097 MR Bolus Contrast RADIOLOGY MISC 8470 8900 10590 12290
Diagnostic Services
Radiology
DRAD1086 MRI double dose contrast(N) RADIOLOGY MISC 8470 8900 10590 12290
Diagnostic Services
USG as an emergency procedures Radiology
DS0004 ULTRASOUND 220 240 280 320
if facility not available at GH Diagnostic Services
Radiology
DRAD258 Ultrasound portable ( Eqp)(N) ULTRASOUND 1230 1290 1530 1780
Diagnostic Services
Radiology
DRAD266 Ultrasound endorectal(N) ULTRASOUND 1290 1360 1610 1870
Diagnostic Services
Radiology
DRAD265 Ultrasound endovaginal(N) ULTRASOUND 1290 1360 1610 1870
Diagnostic Services
Radiology
DRAD269 Ultrasound Pelvis(N) ULTRASOUND 1290 1360 1610 1870
Diagnostic Services
Radiology
DRAD276 Ultrasound small parts(N) ULTRASOUND 1290 1360 1610 1870
Diagnostic Services
Radiology
DRAD261 Ultrasound breast ULTRASOUND 1540 1620 1930 2240
Diagnostic Services
ULTRASOUND FOR EARLY Radiology
DRAD262 ULTRASOUND 1540 1620 1930 2240
PREGNANCY Diagnostic Services
354
Radiology
Ultrasound for undescended Radiology

DRAD263 ULTRASOUND 1540 1620 1930 2240
testis Diagnostic Services
Radiology
DRAD259 Ultrasound joint ULTRASOUND 1540 1620 1930 2240
Diagnostic Services
Radiology
DRAD128 Ultra Sound (Nicu) - Portable ULTRASOUND 1540 1620 1930 2240
Diagnostic Services
Radiology
DRAD274 Ultrasound salivary gland ULTRASOUND 1540 1620 1930 2240
Diagnostic Services
Radiology
DRAD129 Ultrasound Abdomen ULTRASOUND 1680 1760 2090 2430
Diagnostic Services
Radiology
DRAD268 Ultrasound abdomen n pelvis ULTRASOUND 1680 1760 2090 2430
Diagnostic Services
Radiology
DRAD270 Ultrasound KUB ULTRASOUND 1680 1760 2090 2430
Diagnostic Services
Ultrasound scrotum with colour Radiology
DRAD264 ULTRASOUND 1680 1760 2090 2430
doppler Diagnostic Services
Ultrasound musculoskeletal Radiology
DRAD260 ULTRASOUND 1810 1900 2260 2620
system Diagnostic Services
Radiology
DRAD273 Ultrasound neck ULTRASOUND 1810 1900 2260 2620
Diagnostic Services
Ultrasound neurosonography ( Radiology
DRAD275 ULTRASOUND 1810 1900 2260 2620
cranial ultrasound ) Diagnostic Services
Radiology
DRAD271 Ultrasound thorax ULTRASOUND 1810 1900 2260 2620
Diagnostic Services
Radiology
DRAD272 Ultrasound thyroid ULTRASOUND 1810 1900 2260 2620
Diagnostic Services
Radiology
DRAD257 Ultrasound (Gen) - Portable(N) ULTRASOUND 2060 2160 2580 2990
Diagnostic Services
Radiology
DRAD267 Ultrasound transplant kidney ULTRASOUND 2330 2440 2910 3370
Diagnostic Services
Radiology
DRAD277 Ultra Sound Follicular Study(N) ULTRASOUND 2460 2580 3070 3560
Diagnostic Services
Radiology
DRAD1128 ULTRASOUND (EMERGENCY) ULTRASOUND 3470 3640 4340 5030
Diagnostic Services
Radiology
DRAD168 INTRAOPERATIVE ULTRASOUND ULTRASOUND 7700 8090 9630 11170
Diagnostic Services
Radiology
DRAD119 Radiology Services XRAY 110 120 140 160
Diagnostic Services
Radiology
DRAD114 Plain Xray Dept XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD487 Xray acromio clavicular joint (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD488 Xray acromio clavicular joint (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD495 Xray ankle AP (bilateral) XRAY 420 440 530 610
Diagnostic Services
355
Radiology
Radiology
DRAD496 Xray ankle AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD497 Xray ankle AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD499 Xray ankle lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD500 Xray ankle lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD502 Xray ankle oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD503 Xray ankle oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD505 Xray ankle stress view (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD506 Xray ankle stress view (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD513 Xray arm / humerus AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD514 Xray arm / humerus AP (R) XRAY 420 440 530 610
Diagnostic Services
Xray arm / humerus AP with Radiology
DRAD515 XRAY 420 440 530 610
elbow (L) Diagnostic Services
DRAD516 XRAY 420 440 530 610
elbow (R) Diagnostic Services
DRAD517 XRAY 420 440 530 610
shoulder (L) Diagnostic Services
DRAD518 XRAY 420 440 530 610
shoulder (R) Diagnostic Services
Radiology
DRAD519 Xray arm / humerus lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD520 Xray arm / humerus lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray arm / humerus lateral with Radiology
DRAD521 XRAY 420 440 530 610
elbow (L) Diagnostic Services
Xray arm / humerus lateral with Radiology
DRAD522 XRAY 420 440 530 610
elbow (R) Diagnostic Services
Radiology
DRAD528 Xray calcaneum axial (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD529 Xray calcaneum axial (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD531 Xray calcaneum lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD532 Xray calcaneum lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD1153 X-ray Caldwell View XRAY 420 440 530 610
Diagnostic Services
356
Radiology
Radiology
DRAD537 Xray cervical spine AP view XRAY 420 440 530 610
Diagnostic Services
Xray cervical spine lateral for Radiology
DRAD539 XRAY 420 440 530 610
cranio-vertebrae junction Diagnostic Services
Xray cervical spine (lateral) in Radiology
DRAD534 XRAY 420 440 530 610
extension Diagnostic Services
Xray cervical spine (lateral) in Radiology
DRAD535 XRAY 420 440 530 610
flexion Diagnostic Services
Radiology
DRAD540 Xray cervical spine lateral view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD542 Xray cervical spine oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD543 Xray cervical spine oblique (R) XRAY 420 440 530 610
Diagnostic Services
Xray cervical spine open mouth Radiology
DRAD544 XRAY 420 440 530 610
for CV junction Diagnostic Services
Radiology
DRAD547 Xray cervico-dorsal spine AP view XRAY 420 440 530 610
Diagnostic Services
Xray cervico-dorsal spine lateral Radiology
DRAD548 XRAY 420 440 530 610
view Diagnostic Services
Xray cervico-dorsal spine Radiology
DRAD549 XRAY 420 440 530 610
swimmers view Diagnostic Services
Radiology
DRAD550 Xray chest AP XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD551 Xray chest AP for ribs bucky film XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD552 Xray chest apicogram XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD553 Xray chest decubitus (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD554 Xray chest decubitus (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD555 Xray chest lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD556 Xray chest lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD557 Xray chest oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD558 Xray chest oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD561 Xray chest PA (CXR) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD562 Xray chest PA penetrating XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD564 Xray clavicle AP view (L) XRAY 420 440 530 610
Diagnostic Services
357
Radiology
Radiology
DRAD566 Xray coccyx AP XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD570 Xray dorsal lumbar spine AP view XRAY 420 440 530 610
Diagnostic Services
Xray dorsal lumbar spine lateral Radiology
DRAD571 XRAY 420 440 530 610
Radiology
DRAD573 Xray dorsal spine AP view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD574 Xray dorsal spine lateral view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD575 Xray dorsal spine oblique view (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD576 Xray dorsal spine oblique view (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD577 Xray ear pinna - soft tissue (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD578 Xray ear pinna - soft tissue (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD581 Xray elbow AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD582 Xray elbow AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD583 Xray elbow lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD584 Xray elbow lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD586 Xray ethmoid sinus (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD587 Xray ethmoid sinus (R) XRAY 420 440 530 610
Diagnostic Services
Xray femur (including hip joint) Radiology
DRAD596 XRAY 420 440 530 610
AP (L) Diagnostic Services
DRAD597 XRAY 420 440 530 610
AP (R) Diagnostic Services
DRAD598 XRAY 420 440 530 610
lateral (L) Diagnostic Services
Xray femur (including knee joint) Radiology
DRAD604 XRAY 420 440 530 610
AP (L) Diagnostic Services
DRAD605 XRAY 420 440 530 610
AP (R) Diagnostic Services
DRAD607 XRAY 420 440 530 610
DRAD608 XRAY 420 440 530 610
lateral (R) Diagnostic Services
Radiology
DRAD616 Xray femur lateral (L) XRAY 420 440 530 610
Diagnostic Services
358
Radiology
Radiology
DRAD617 Xray femur lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray first carpo metacarpal joint Radiology
DRAD619 XRAY 420 440 530 610
(L) Diagnostic Services
DRAD620 XRAY 420 440 530 610
(R) Diagnostic Services
Radiology
DRAD629 Xray foot AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD633 Xray foot for arch lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD634 Xray foot for arch lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD635 Xray foot lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD636 Xray foot lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD638 Xray foot oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD643 Xray forearm AP (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD644 Xray forearm AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD645 Xray forearm AP (R) XRAY 420 440 530 610
Diagnostic Services
Xray forearm for foreign body Radiology
DRAD646 XRAY 420 440 530 610
localisation (L) Diagnostic Services
Xray forearm for foreign body Radiology
DRAD647 XRAY 420 440 530 610
localisation (R) Diagnostic Services
Radiology
DRAD663 Xray hand AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD664 Xray hand AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD655 Xray hand ( ball catcher's view ) XRAY 420 440 530 610
Diagnostic Services
Xray hand for foreign body Radiology
DRAD668 XRAY 420 440 530 610
Xray hand for foreign body Radiology
DRAD669 XRAY 420 440 530 610
Radiology
DRAD670 Xray hand lateral (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD671 Xray hand lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD672 Xray hand lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD673 Xray hand oblique (bilateral) XRAY 420 440 530 610
Diagnostic Services
359
Radiology
Radiology
DRAD674 Xray hand oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD675 Xray hand oblique (R) XRAY 420 440 530 610
Diagnostic Services
Xray hand - soft tissue AP view Radiology
DRAD652 XRAY 420 440 530 610
(bilateral) Diagnostic Services
DRAD653 XRAY 420 440 530 610
DRAD654 XRAY 420 440 530 610
Radiology
DRAD682 Xray heel axial (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD683 Xray heel axial (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD688 Xray heel lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD689 Xray heel lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD693 Xray hip AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD694 Xray hip AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD696 Xray hip lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD697 Xray hip lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray iliac crest for bone age ( Radiology
DRAD700 XRAY 420 440 530 610
pelvis AP view ) Diagnostic Services
Radiology
DRAD712 Xray knee AP (erect) (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD713 Xray knee AP (erect) (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD714 Xray knee AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD715 Xray knee AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD718 Xray knee lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD723 Xray knee tunnel / axial view (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD724 Xray knee tunnel / axial view (R) XRAY 420 440 530 610
Diagnostic Services
Xray left hand for bone age (PA Radiology
DRAD727 XRAY 420 440 530 610
view) Diagnostic Services
Radiology
DRAD738 Xray leg AP (L) XRAY 420 440 530 610
Diagnostic Services
360
Radiology
Radiology
DRAD739 Xray leg AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD741 Xray leg AP with ankle (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD742 Xray leg AP with ankle (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD744 Xray leg AP with knee (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD745 Xray leg AP with knee (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD747 Xray leg lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD748 Xray leg lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD750 Xray leg lateral with ankle (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD751 Xray leg lateral with ankle (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD753 Xray leg lateral with knee (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD754 Xray leg lateral with knee (R) XRAY 420 440 530 610
Diagnostic Services
Xray lower leg for foreign body Radiology
DRAD758 XRAY 420 440 530 610
DRAD759 XRAY 420 440 530 610
Xray lumbar spine AP erect (Lt Radiology
DRAD762 XRAY 420 440 530 610
bending) Diagnostic Services
Xray lumbar spine lateral erect Radiology
DRAD765 XRAY 420 440 530 610
DRAD766 XRAY 420 440 530 610
flexion Diagnostic Services
Radiology
DRAD770 Xray lumbar spine oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD771 Xray lumbar spine oblique (R) XRAY 420 440 530 610
Diagnostic Services
Xray lumbosacral spine AP erect Radiology
DRAD774 XRAY 420 440 530 610
(Lt bending) Diagnostic Services
DRAD775 XRAY 420 440 530 610
(Rt bending) Diagnostic Services
Xray lumbosacral spine lateral Radiology
DRAD777 XRAY 420 440 530 610
erect extension Diagnostic Services
DRAD778 XRAY 420 440 530 610
erect flexion Diagnostic Services
DRAD780 XRAY 420 440 530 610
361
Radiology
Radiology
DRAD785 Xray lunate (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD786 Xray lunate (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD789 Xray mandible oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD790 Xray mandible oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD792 Xray mastoid lateral oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD793 Xray mastoid lateral oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD795 Xray mastoid stenver's view (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD796 Xray mastoid stenver's view (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD797 Xray mastoid towne's view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD799 Xray mastoid view schuller (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD800 Xray mastoid view schuller (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD801 Xray middle finger AP & lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD802 Xray middle finger AP & lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray modified stenver's view for Radiology
DRAD803 XRAY 420 440 530 610
cochlear implant ) (L) Diagnostic Services
Xray modified stenver's view for Radiology
DRAD804 XRAY 420 440 530 610
cochlear implant ) (R) Diagnostic Services
Radiology
DRAD806 Xray nasal bone lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD807 Xray nasal bone lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray nasopharyn Lateral for Radiology
DRAD808 XRAY 420 440 530 610
adenoids Diagnostic Services
Radiology
DRAD810 Xray optic foramen (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD811 Xray optic foramen (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD815 Xray orbit AP (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD816 Xray orbit AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD817 Xray orbit AP (R) XRAY 420 440 530 610
Diagnostic Services
362
Radiology
Radiology
DRAD818 Xray orbit caldwel (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD819 Xray orbit caldwel (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD820 Xray orbit caldwel (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD621 Xray orbit for floor (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD622 Xray orbit for floor (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD623 Xray orbit for floor (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD639 Xray orbit for foreign body (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD640 Xray orbit for foreign body (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD844 Xray orbit for roof (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD845 Xray orbit for roof (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD846 Xray orbit for roof(R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD705 Xray orbit inferior fissure (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD706 Xray orbit inferior fissure(R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD825 Xray orbit lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD826 Xray orbit lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD827 Xray orbit PA (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD828 Xray orbit PA (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD829 Xray orbit PA (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD925 Xray orbit superior fissure (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD926 Xray orbit superior fissure (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD835 Xray patella tangential (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD836 Xray patella tangential (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD1154 X-ray Pelvis PA XRAY 420 440 530 610
Diagnostic Services
363
Radiology
Radiology
DRAD838 Xray penis ( soft tissue ) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD840 Xray pisiform (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD841 Xray pisiform (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD978 Xray plain department XRAY 420 440 530 610
Diagnostic Services
Xray sacro coccyx spine / Radiology
DRAD848 XRAY 420 440 530 610
junction - AP Diagnostic Services
Radiology
DRAD854 Xray sacroiliac joint oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD855 Xray sacroiliac joint oblique (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD851 Xray sacroiliac joint PA (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD852 Xray sacroiliac joint PA ( R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD856 Xray sacrum AP XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD858 Xray sacrum lateral XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD863 Xray scapula AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD866 Xray scapula axial (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD867 Xray scapula axial (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD869 Xray scapula lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD870 Xray scapula lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD872 Xray scapula Y - view (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD873 Xray scapula Y - view (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD881 Xray shoulder axial (axillary) (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD882 Xray shoulder axial (axillary) (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD884 Xray shoulder lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD885 Xray shoulder lateral (R) XRAY 420 440 530 610
Diagnostic Services
Xray shoulder lateral Radiology
DRAD887 XRAY 420 440 530 610
transthoracic (L) Diagnostic Services
364
Radiology

DRAD888 XRAY 420 440 530 610
transthoracic (R) Diagnostic Services
Radiology
DRAD889 Xray skull AP XRAY 420 440 530 610
Diagnostic Services
Xray skull base / basal view / Radiology
DRAD892 XRAY 420 440 530 610
submento-vertebral view Diagnostic Services
Xray skull cone down lateral for Radiology
DRAD893 XRAY 420 440 530 610
sella ( pitutary fossa ) Diagnostic Services
Radiology
DRAD894 Xray skull for jugular foramen XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD896 Xray skull lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD897 Xray skull lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD898 Xray skull maxilla XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD899 Xray skull occipito-frontal view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD900 Xray skull per orbital view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD901 Xray skull tangential view XRAY 420 440 530 610
Diagnostic Services
Xray skull Towne's / fronto- Radiology
DRAD902 XRAY 420 440 530 610
occipital 15 deg Diagnostic Services
DRAD903 XRAY 420 440 530 610
DRAD904 XRAY 420 440 530 610
Radiology
DRAD908 Xray sphenoid sinus (lateral) XRAY 420 440 530 610
Diagnostic Services
Xray sterno clacicular joint AP Radiology
DRAD909 XRAY 420 440 530 610
Radiology
DRAD911 Xray sterno clavicular joint AP (R) XRAY 420 440 530 610
Diagnostic Services
Xray sterno clavicular joint Radiology
DRAD913 XRAY 420 440 530 610
oblique (L) Diagnostic Services
DRAD914 XRAY 420 440 530 610
oblique (R) Diagnostic Services
Radiology
DRAD915 Xray sternum AP XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD916 Xray sternum lateral XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD917 Xray sternum oblique (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD918 Xray sternum oblique (R) XRAY 420 440 530 610
Diagnostic Services
365
Radiology
Xray submandibular gland area Radiology

DRAD919 XRAY 420 440 530 610
Xray submandibular gland area Radiology
DRAD920 XRAY 420 440 530 610
Radiology
DRAD922 Xray subtalar joint (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD923 Xray subtalar joint (R) XRAY 420 440 530 610
Diagnostic Services
Xray temporo mandibular joints Radiology
DRAD928 XRAY 420 440 530 610
(closed mouth) (L) Diagnostic Services
DRAD929 XRAY 420 440 530 610
(closed mouth) (R) Diagnostic Services
DRAD934 XRAY 420 440 530 610
(open mouth) (L) Diagnostic Services
DRAD935 XRAY 420 440 530 610
(open mouth) (R) Diagnostic Services
Radiology
DRAD943 Xray thigh for soft tissue AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD944 Xray thigh for soft tissue AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD945 Xray thoracic inlet view XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD951 Xray trapezium (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD952 Xray trapezium (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD953 Xray wrist and hand for bone age XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD960 Xray wrist AP (bilateral) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD961 Xray wrist AP (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD962 Xray wrist AP (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD967 Xray wrist carpal tunnel (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD968 Xray wrist carpal tunnel (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD970 Xray wrist lateral (L) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD971 Xray wrist lateral (R) XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD972 Xray zygomatic arch base XRAY 420 440 530 610
Diagnostic Services
Xray zygomatic arch oblique Radiology
DRAD973 XRAY 420 440 530 610
tangential Diagnostic Services
366
Radiology
Radiology
DRAD974 Xray zygomatic arch Towne's XRAY 420 440 530 610
Diagnostic Services
Radiology
DRAD1110 AVP X-ray - (BCCI) XRAY 440 470 550 640
Diagnostic Services
Radiology
DRAD1111 AVP X-ray - Interpretation (BCCI) XRAY 440 470 550 640
Diagnostic Services
Radiology
DRAD478 Xray abdomen AP supine XRAY 500 520 620 720
Diagnostic Services
Xray abdomen for foreign body Radiology
DRAD479 XRAY 500 520 620 720
localisation Diagnostic Services
Radiology
DRAD480 Xray abdomen lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD481 Xray abdomen lateral (R) XRAY 500 520 620 720
Diagnostic Services
Xray abdomen left lateral Radiology
DRAD483 XRAY 500 520 620 720
decubitus Diagnostic Services
Xray abdomen oblique for GB Radiology
DRAD484 XRAY 500 520 620 720
area Diagnostic Services
Xray abdomen right lateral Radiology
DRAD482 XRAY 500 520 620 720
decubitus Diagnostic Services
Xray abdomen urinary bladder Radiology
DRAD485 XRAY 500 520 620 720
area supine ( KUBU) Diagnostic Services
Radiology
DRAD490 Xray ankle AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD491 Xray ankle AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD493 Xray ankle AP & stress view (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD494 Xray ankle AP & stress view (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD498 Xray ankle lateral (bilateral) XRAY 500 520 620 720
Diagnostic Services
Xray arm / humerus AP & lateral Radiology
DRAD507 XRAY 500 520 620 720
DRAD508 XRAY 500 520 620 720
DRAD509 XRAY 500 520 620 720
with elbow (L) Diagnostic Services
Radiology
DRAD527 Xray calcaneum axial (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD533 Xray cephalogram XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD565 Xray clavicle AP view (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD568 Xray coccyx lateral XRAY 500 520 620 720
Diagnostic Services
367
Radiology
Radiology
DRAD579 Xray elbow AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD580 Xray elbow AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD585 Xray ethmoid sinus (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD588 Xray feet (bilateral) AP XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD613 Xray femur AP (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD614 Xray femur AP (R) XRAY 500 520 620 720
Diagnostic Services
DRAD599 XRAY 500 520 620 720
Radiology
DRAD626 Xray foot AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD627 Xray foot AP & oblique (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD628 Xray foot AP & oblique (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD630 Xray foot AP (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD637 Xray foot oblique (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD641 Xray forearm AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD642 Xray forearm AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Xray forearm with elbow AP & Radiology
DRAD648 XRAY 500 520 620 720
Xray forearm with wrist AP & Radiology
DRAD650 XRAY 500 520 620 720
Xray forearm with wrist AP & Radiology
DRAD651 XRAY 500 520 620 720
Radiology
DRAD662 Xray hand AP (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD657 Xray hand AP & Lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD661 Xray hand AP & oblique (R) XRAY 500 520 620 720
Diagnostic Services
Xray hand ulnar deviation (for Radiology
DRAD677 XRAY 500 520 620 720
scaphoid) (L) Diagnostic Services
DRAD678 XRAY 500 520 620 720
scaphoid) (R) Diagnostic Services
Radiology
DRAD681 Xray heel axial (bilateral) XRAY 500 520 620 720
Diagnostic Services
368
Radiology
Radiology
DRAD686 Xray heel lateral & axial (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD702 Xray index finger AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD711 Xray knee AP (erect) (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD717 Xray knee lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD720 Xray knee skyline (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD721 Xray knee skyline (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD725 Xray KUB XRAY 500 520 620 720
Diagnostic Services
Xray left elbow for bone age (AP Radiology
DRAD726 XRAY 500 520 620 720
& lateral view) Diagnostic Services
Radiology
DRAD737 Xray leg AP (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD729 Xray leg AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD730 Xray leg AP & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Xray leg AP & lateral with ankle Radiology
DRAD732 XRAY 500 520 620 720
Radiology
DRAD740 Xray leg AP with ankle (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD743 Xray leg AP with knee (bilateral) XRAY 500 520 620 720
Diagnostic Services
Xray leg lateral with ankle Radiology
DRAD749 XRAY 500 520 620 720
Xray leg lateral with knee Radiology
DRAD752 XRAY 500 520 620 720
Radiology
DRAD755 Xray little finger AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Xray lumbar spine AP erect (Rt Radiology
DRAD763 XRAY 500 520 620 720
bending) Diagnostic Services
Radiology
DRAD764 Xray lumbar spine AP view XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD768 Xray lumbar spine lateral view XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD776 Xray lumbosacral spine AP view XRAY 500 520 620 720
Diagnostic Services
Xray lumbosacral spine oblique Radiology
DRAD782 XRAY 500 520 620 720
DRAD783 XRAY 500 520 620 720
369
Radiology
Radiology
DRAD784 Xray lunate (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD787 Xray mandible AP XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD805 Xray nasal bone lateral (bilateral) XRAY 500 520 620 720
Diagnostic Services
Xray orbit superior fissure Radiology
DRAD924 XRAY 500 520 620 720
Xray paranasal sinus Water's Radiology
DRAD830 XRAY 500 520 620 720
Radiology
DRAD832 Xray patella PA & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD833 Xray patella PA & lateral (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD834 Xray patella tangential (bilateral) XRAY 500 520 620 720
Diagnostic Services
Xray pelvis AP (including both Radiology
DRAD837 XRAY 500 520 620 720
hips) Diagnostic Services
Radiology
DRAD839 Xray pisiform (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD842 Xray ring finger AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Xray sacro coccyx spine / junction Radiology
DRAD849 XRAY 500 520 620 720
- lateral Diagnostic Services
Radiology
DRAD850 Xray sacroiliac joint PA (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD864 Xray scapula AP (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD878 Xray shoulder AP (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD879 Xray shoulder AP (R) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD891 Xray skull AP for styloid process XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD905 Xray soft tissue neck AP XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD907 Xray soft tissue neck lateral XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD910 Xray sterno clavicular joint AP (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD921 Xray subtalar joint (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD949 Xray Thumb AP (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD950 Xray trapezium (bilateral) XRAY 500 520 620 720
Diagnostic Services
370
Radiology
Radiology
DRAD955 Xray wrist AP & lateral (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD958 Xray wrist AP & oblique (L) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD966 Xray wrist carpal tunnel (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD969 Xray wrist lateral (bilateral) XRAY 500 520 620 720
Diagnostic Services
Radiology
DRAD530 Xray calcaneum lateral (bilateral) XRAY 530 560 660 770
Diagnostic Services
Radiology
DRAD476 Xray abdomen AP erect XRAY 600 630 750 870
Diagnostic Services
DRAD510 XRAY 600 630 750 870
with elbow (R) Diagnostic Services
Radiology
DRAD525 Xray calcaneum axial & lateral (L) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD526 Xray calcaneum axial & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD625 Xray foot AP & lateral (L) XRAY 600 630 750 870
Diagnostic Services
Xray forearm with elbow AP & Radiology
DRAD649 XRAY 600 630 750 870
Radiology
DRAD658 Xray hand AP & Lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD660 Xray hand AP & oblique (L) XRAY 600 630 750 870
Diagnostic Services
DRAD676 XRAY 600 630 750 870
scaphoid) (bilateral) Diagnostic Services
Radiology
DRAD685 Xray heel lateral & axial (L) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD687 Xray heel lateral (bilateral) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD701 Xray index finger AP & lateral (L) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD710 Xray knee AP (bilateral) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD708 Xray knee AP & lateral (L) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD709 Xray knee AP & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Xray leg AP and lateral with knee Radiology
DRAD736 XRAY 600 630 750 870
DRAD733 XRAY 600 630 750 870
Radiology
DRAD735 Xray leg AP & lateral with knee (L) XRAY 600 630 750 870
Diagnostic Services
371
Radiology
Radiology
DRAD746 Xray leg lateral (bilateral) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD756 Xray little finger AP & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD976 Xray Orthopantomogram XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD843 Xray ring finger AP & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD947 Xray thumb AP & lateral (L) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD948 Xray thumb AP & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD956 Xray wrist AP & lateral (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD959 Xray wrist AP & oblique (R) XRAY 600 630 750 870
Diagnostic Services
Radiology
DRAD115 Plain Xray-Portable XRAY 640 670 800 930
Diagnostic Services
Radiology
DRAD591 Xray feet (bilateral) lateral XRAY 640 670 800 930
Diagnostic Services
Radiology
DRAD612 Xray femur AP (bilateral) XRAY 640 670 800 930
Diagnostic Services
Xray hand AP, LAT,ulnar deviation Radiology
DRAD679 XRAY 640 670 800 930
(for scaphoid) (L) Diagnostic Services
Xray hand AP , Lateral & oblique Radiology
DRAD666 XRAY 640 670 800 930
Radiology
DRAD592 Xray feet (bilateral) oblique XRAY 770 810 970 1120
Diagnostic Services
DRAD667 XRAY 770 810 970 1120
Xray hand AP.LAT.ulnar deviation Radiology
DRAD680 XRAY 770 810 970 1120
(for scaphoid) (R) Diagnostic Services
Xray orbit inferior fissure Radiology
DRAD704 XRAY 770 810 970 1120
Radiology
DRAD1150 X-ray Whole Lower limb AP XRAY 770 810 970 1120
Diagnostic Services
Radiology
DRAD1151 X-ray Whole Lower limb LAT XRAY 770 810 970 1120
Diagnostic Services
Radiology
DRAD1144 X-ray Whole spine AP XRAY 770 810 970 1120
Diagnostic Services
Radiology
DRAD1147 X-ray Whole spine AP LT Bending XRAY 770 810 970 1120
Diagnostic Services
Radiology
DRAD1146 X-ray Whole spine AP RT Bending XRAY 770 810 970 1120
Diagnostic Services
Xray acromio clavicular joint Radiology
DRAD486 XRAY 850 890 1060 1230
372
Radiology
Xray ankle AP & stress view Radiology

DRAD492 XRAY 850 890 1060 1230
Radiology
DRAD501 Xray ankle oblique (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD504 Xray ankle stress view (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
DRAD511 XRAY 850 890 1060 1230
with shoulder (L) Diagnostic Services
Xray cervical spine AP & lateral Radiology
DRAD536 XRAY 850 890 1060 1230
Xray cervical spine in flexion & Radiology
DRAD975 XRAY 850 890 1060 1230
Xray cervical spine oblique Radiology
DRAD541 XRAY 850 890 1060 1230
Xray cervico-dorsal spine AP & Radiology
DRAD545 XRAY 850 890 1060 1230
lateral view Diagnostic Services
Xray cervico-dorsal spine AP & Radiology
DRAD546 XRAY 850 890 1060 1230
swimmers view Diagnostic Services
Radiology
DRAD559 Xray chest PA & lateral (L) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD560 Xray chest PA & lateral (R) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD563 Xray clavicle AP view (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD590 Xray feet (bilateral) AP & oblique XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD610 Xray femur AP & lateral (L) XRAY 850 890 1060 1230
Diagnostic Services
Xray femur (including hip joint) AP Radiology
DRAD595 XRAY 850 890 1060 1230
DRAD603 XRAY 850 890 1060 1230
AP (bilateral) Diagnostic Services
DRAD601 XRAY 850 890 1060 1230
AP & lateral (L) Diagnostic Services
DRAD606 XRAY 850 890 1060 1230
lateral (bilateral) Diagnostic Services
Radiology
DRAD615 Xray femur lateral (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
DRAD618 XRAY 850 890 1060 1230
(bilateral)AP & lateral Diagnostic Services
Radiology
DRAD624 Xray Foetogram XRAY 850 890 1060 1230
Diagnostic Services
Xray foot AP , Lateral & oblique Radiology
DRAD631 XRAY 850 890 1060 1230
Xray foot AP , Lateral & oblique Radiology
DRAD632 XRAY 850 890 1060 1230
373
Radiology
Radiology
DRAD684 Xray heel lateral & axial (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD691 Xray hip AP & lateral (L) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD692 Xray hip AP & lateral (R) XRAY 850 890 1060 1230
Diagnostic Services
Xray hips including thighs
Radiology
DRAD699 (AP view for hip dislocation) - XRAY 850 890 1060 1230
Diagnostic Services
bilateral
Radiology
DRAD703 Xray infantogram XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD716 Xray knee lateral (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Xray knee tunnel / axial view Radiology
DRAD722 XRAY 850 890 1060 1230
Xray lumbar spine AP erect (Lt & Radiology
DRAD761 XRAY 850 890 1060 1230
Rt bending) Diagnostic Services
Xray lumbar spine oblique Radiology
DRAD769 XRAY 850 890 1060 1230
DRAD773 XRAY 850 890 1060 1230
(Lt & Rt bending) Diagnostic Services
Xray mastoid lateral oblique Radiology
DRAD791 XRAY 850 890 1060 1230
Xray mastoid view schuller Radiology
DRAD798 XRAY 850 890 1060 1230
Radiology
DRAD809 Xray optic foramen (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD814 Xray orbit AP & lateral (R) XRAY 850 890 1060 1230
Diagnostic Services
Xray orbit for foreign body Radiology
DRAD822 XRAY 850 890 1060 1230
Xray orbit for foreign body Radiology
DRAD823 XRAY 850 890 1060 1230
Radiology
DRAD824 Xray orbit lateral (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Xray sacro coccyx spine / junction Radiology
DRAD847 XRAY 850 890 1060 1230
- AP & Lateral Diagnostic Services
Radiology
DRAD857 Xray sacrum AP & lateral XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD1155 X-ray Scaphoid view XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD862 Xray scapula AP (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD860 Xray scapula AP & lateral (L) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD865 Xray scapula axial (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
374
Radiology
Radiology
DRAD868 Xray scapula lateral (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD871 Xray scapula Y - view (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD875 Xray shoulder AP & lateral (L) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD883 Xray shoulder lateral (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
DRAD886 XRAY 850 890 1060 1230
transthoracic (bilateral) Diagnostic Services
Radiology
DRAD890 Xray skull AP & lateral XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD906 Xray soft tissue neck AP & lateral XRAY 850 890 1060 1230
Diagnostic Services
DRAD912 XRAY 850 890 1060 1230
oblique (bilateral) Diagnostic Services
DRAD927 XRAY 850 890 1060 1230
(closed mouth) (bilateral) Diagnostic Services
DRAD933 XRAY 850 890 1060 1230
(open mouth) (bilateral) Diagnostic Services
Xray thigh for foreign body Radiology
DRAD937 XRAY 850 890 1060 1230
Xray thigh for foreign body Radiology
DRAD938 XRAY 850 890 1060 1230
Xray thigh for soft tissue AP Radiology
DRAD942 XRAY 850 890 1060 1230
Xray thigh for soft tissue AP & Radiology
DRAD940 XRAY 850 890 1060 1230
Xray thigh for soft tissue AP & Radiology
DRAD941 XRAY 850 890 1060 1230
Radiology
DRAD964 Xray wrist AP, lateral & oblique (L) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD957 Xray wrist AP & oblique (bilateral) XRAY 850 890 1060 1230
Diagnostic Services
Radiology
DRAD719 Xray knee skyline (bilateral) XRAY 910 950 1130 1310
Diagnostic Services
Radiology
DRAD477 Xray abdomen AP erect & supine XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD489 Xray ankle AP & lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
DRAD512 XRAY 970 1020 1210 1410
with shoulder (R) Diagnostic Services
Radiology
DRAD567 Xray coccyx AP & lateral XRAY 970 1020 1210 1410
Diagnostic Services
Xray dorsal spine AP & lateral Radiology
DRAD572 XRAY 970 1020 1210 1410
375
Radiology
Xray dorso-lumbar spine AP & Radiology

DRAD569 XRAY 970 1020 1210 1410
Radiology
DRAD589 Xray feet (bilateral) AP & lateral XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD611 Xray femur AP & lateral (R) XRAY 970 1020 1210 1410
Diagnostic Services
DRAD593 XRAY 970 1020 1210 1410
& lateral (L) Diagnostic Services
DRAD594 XRAY 970 1020 1210 1410
& lateral (R) Diagnostic Services
DRAD602 XRAY 970 1020 1210 1410
AP & lateral (R) Diagnostic Services
Radiology
DRAD656 Xray hand AP & Lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD659 Xray hand AP & oblique (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD695 Xray hip lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD707 Xray knee AP & lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD728 Xray leg AP & lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Xray lumbar spine AP & lateral Radiology
DRAD760 XRAY 970 1020 1210 1410
DRAD767 XRAY 970 1020 1210 1410
flexion & extension Diagnostic Services
Xray lumbosacral spine AP & Radiology
DRAD772 XRAY 970 1020 1210 1410
DRAD779 XRAY 970 1020 1210 1410
erect flexion & extension Diagnostic Services
DRAD781 XRAY 970 1020 1210 1410
Radiology
DRAD788 Xray mandible oblique (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Xray mastoid stenver's view Radiology
DRAD794 XRAY 970 1020 1210 1410
Radiology
DRAD813 Xray orbit AP & lateral (L) XRAY 970 1020 1210 1410
Diagnostic Services
Xray sacroiliac joint oblique Radiology
DRAD853 XRAY 970 1020 1210 1410
Radiology
DRAD861 Xray scapula AP & lateral (R) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD877 Xray shoulder AP (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD876 Xray shoulder AP & lateral (R) XRAY 970 1020 1210 1410
Diagnostic Services
376
Radiology
Xray shoulder axial (axillary) Radiology

DRAD880 XRAY 970 1020 1210 1410
Radiology
DRAD895 Xray skull lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
DRAD931 XRAY 970 1020 1210 1410
(open & closed mouth) (L) Diagnostic Services
DRAD932 XRAY 970 1020 1210 1410
(open & closed mouth) (R) Diagnostic Services
Xray Thoraco Lumber Spine AP Radiology
DRAD946 XRAY 970 1020 1210 1410
Latral Diagnostic Services
Radiology
DRAD965 Xray wrist AP, lateral & oblique (R) XRAY 970 1020 1210 1410
Diagnostic Services
Radiology
DRAD954 Xray wrist AP & lateral (bilateral) XRAY 970 1020 1210 1410
Diagnostic Services
Xray calcaneum axial & lateral Radiology
DRAD524 XRAY 1170 1230 1460 1700
Xray cervical spine in flexion, Radiology
DRAD538 XRAY 1170 1230 1460 1700
extension & neutral Diagnostic Services
DRAD665 XRAY 1170 1230 1460 1700
Xray leg AP & lateral with knee Radiology
DRAD734 XRAY 1170 1230 1460 1700
DRAD757 XRAY 1170 1230 1460 1700
localisation (bilateral) Diagnostic Services
Xray both lower limbs complete Radiology
DRAD523 XRAY 1420 1490 1780 2060
(bilateral) - children Diagnostic Services
DRAD731 XRAY 1420 1490 1780 2060
DRAD930 XRAY 1540 1620 1930 2240
(open & closed mouth) (bilateral) Diagnostic Services
Radiology
DRAD1152 X-ray Whole Lower limb AP & LAT XRAY 1540 1620 1930 2240
Diagnostic Services
Radiology
DRAD1145 X-ray Whole spine AP & LAT XRAY 1540 1620 1930 2240
Diagnostic Services
X-ray Whole spine AP RT & LT Radiology
DRAD1148 XRAY 1540 1620 1930 2240
Bending Diagnostic Services
X-ray Whole spine LAT Flexion & Radiology
DRAD1149 XRAY 1540 1620 1930 2240
Extension Diagnostic Services
Radiology
DRAD609 Xray femur AP & lateral (bilateral) XRAY 1680 1760 2090 2430
Diagnostic Services
Radiology
DRAD690 Xray hip AP & lateral (bilateral) XRAY 1680 1760 2090 2430
Diagnostic Services
Xray shoulder AP & lateral Radiology
DRAD874 XRAY 1810 1900 2260 2620
Radiology
DRAD698 X-ray Skeletal survey XRAY 4890 5130 6110 7090
Diagnostic Services
377
Radiology
Xray abdomen lateral decubitus Radiology Diagnostic

DRAD981 XRAY PORTABLE 720 760 900 1040
( L) (Port) Services
Xray abdomen lateral decubitus Radiology Diagnostic
( R) (Port) Services
Radiology Diagnostic
DRAD980 Xray abdomen sitting AP (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD979 Xray abdomen supine AP (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD983 Xray ankle AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD984 Xray ankle AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD985 Xray ankle AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD986 Xray ankle AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD987 Xray ankle AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD988 Xray ankle lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD989 Xray ankle lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD991 Xray arm / humerus AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD992 Xray arm / humerus AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
Xray arm / humerus lateral (L) Radiology Diagnostic
(Port) Services
Xray arm / humerus lateral (R) Radiology Diagnostic
(Port) Services
DRAD995 Xray cervical spine (lateral) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD996 Xray chest AP (Port) XRAY PORTABLE 720 760 900 1040
Services
Xray chest lateral decubitus (L) Radiology Diagnostic
(Port) Services
Xray chest lateral decubitus (R) Radiology Diagnostic
(Port) Services
DRAD999 Xray elbow AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1000 Xray elbow AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1001 Xray elbow AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1002 Xray elbow AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1003 Xray elbow lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
378
Radiology
DRAD1004 Xray elbow lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1005 Xray feet (bilateral) AP (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1007 Xray femur AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1008 Xray femur AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1009 Xray foot AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1011 Xray foot AP / oblique ( L ) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1012 Xray foot AP / oblique (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1010 Xray foot AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1013 Xray foot oblique (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1014 Xray foot oblique (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1015 Xray forearm AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
Xray forearm AP & lateral (R) Radiology Diagnostic
(Port) Services
DRAD1017 Xray forearm AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1018 Xray forearm AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1019 Xray forearm lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1020 Xray forearm lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1023 Xray hand AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1021 Xray hand AP & oblique (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1022 Xray hand AP & oblique (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1024 Xray hand AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1025 Xray hand lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1026 Xray hand lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1027 Xray hand oblique (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1028 Xray hand oblique (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
379
Radiology
DRAD1030 Xray hip AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1031 Xray hip AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1034 Xray knee AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1032 Xray knee AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1033 Xray knee AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1035 Xray knee AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1036 Xray knee AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1037 Xray knee lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1038 Xray knee lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1041 Xray leg AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1039 Xray leg AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1040 Xray leg AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1042 Xray leg AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1043 Xray leg AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1044 Xray leg lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1045 Xray leg lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1029 Xray pelvis with both hip (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1046 Xray skull lateral (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1047 Xray wrist AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1048 Xray wrist AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1049 Xray wrist AP (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1050 Xray wrist AP (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD1051 Xray wrist lateral (L) (Port) XRAY PORTABLE 720 760 900 1040
Services
380
Radiology
DRAD1052 Xray wrist lateral (R) (Port) XRAY PORTABLE 720 760 900 1040
Services
DRAD468 Xray screening fluoroscopy XRAY SPECIAL 420 440 530 610
Services
DRAD207 MICTURATING CYSTOURETHGRAM XRAY SPECIAL 1540 1620 1930 2240
Services
DRAD472 Xray Fluroscopic Procedure - 1 XRAY SPECIAL 1540 1620 1930 2240
Services
DRAD470 X-ray Distal Loopogram XRAY SPECIAL 1930 2030 2410 2800
Services
DRAD460 Xray Barium swallow XRAY SPECIAL 2190 2300 2740 3180
Services
DRAD471 X-ray Dacrocystogram XRAY SPECIAL 2460 2580 3070 3560
Services
DRAD473 Xray Fluroscopic Procedure - II XRAY SPECIAL 2460 2580 3070 3560
Services
DRAD456 Xray Barium enema infant XRAY SPECIAL 2700 2830 3370 3910
Services
Xray Ascending uretherogram ( Radiology Diagnostic
DRAD474 XRAY SPECIAL 2830 2970 3540 4100
ASU ) Services
DRAD463 Xray ERCP XRAY SPECIAL 2830 2970 3540 4100
Services
DRAD464 Xray Fistulogram/ Sinogram XRAY SPECIAL 2830 2970 3540 4100
Services
DRAD475 Xray Sailogram XRAY SPECIAL 2830 2970 3540 4100
Services
DRAD461 Xray T - tube cholangiogram XRAY SPECIAL 2830 2970 3540 4100
Services
DRAD459 Xray Barium meal upper GI XRAY SPECIAL 3350 3520 4180 4850
Services
DRAD469 Xray hysterosalpingogram ( HSG ) XRAY SPECIAL 3470 3640 4340 5030
Services
Xray Micturating Radiology Diagnostic
cystouretherogram ( MCU ) Services
Xray Barium enema infant- Radiology Diagnostic
Reduction Services
DRAD125 Tilt Table Test XRAY SPECIAL 4120 4320 5150 5970
Services
DRAD455 Xray Barium enema XRAY SPECIAL 4120 4320 5150 5970
Services
DRAD466 Xray IVU Routine XRAY SPECIAL 4490 4720 5610 6510
Services
DRAD458 Xray Barium meal follow through XRAY SPECIAL 4890 5130 6110 7090
Services
Xray small bowel barium enema ( Radiology Diagnostic
enteroclysis ) Services
381
Nuclear Medicine
382
Nuclear Medicine
Billing
Group
NUCLEAR MEDICINE
KNUM005 YTTRIUM THERASPHERES THERAPY-1 Package 0 92620 110260 127900
PACKAGE
NUCLEAR MEDICINE
KNUM017 RADIOEMBOLISATION Package 0 301880 359380 416880
PACKAGE
NUCLEAR MEDICINE
KNUM013 Rhenium PACKAGE Package 0 326030 388130 450230
PACKAGE
NUCLEAR MEDICINE
KNUM014 Lu DOTA PRRT PACKAGE Package 0 391230 465750 540270
PACKAGE
NUCLEAR MEDICINE
KNUM016 TARE with RHENIUM LIPIODOC Package 0 423840 504570 585300
PACKAGE
NUCLEAR MEDICINE
KNUM006 YTTRIUM THERASPHERES THERAPY-2 Package 0 1036160 1233520 1430890
PACKAGE
PNUC134 SECOND OPINION - (NUCLEAR MEDICINE) - I Procedure NUCLEAR MEDICINE 820 860 1030 1190
PNUC135 SECOND OPINION - (NUCLEAR MEDICINE) - II Procedure NUCLEAR MEDICINE 1510 1590 1890 2190
PNUC136 DAT - SCAN Procedure NUCLEAR MEDICINE 11480 12060 14350 16650
Pfizer Study - Vascular Surgery-Lung
PNUC133 Procedure NUCLEAR MEDICINE 12080 12680 15100 17510
Perfusion Scan
PNUC137 PET CT - 1 Procedure NUCLEAR MEDICINE 24590 25820 30740 35660
PNUC138 PET CT - 2 Procedure NUCLEAR MEDICINE 28700 30130 35870 41610
PNUC129 SAMARIUM - 153 EDTMP Procedure NUCLEAR MEDICINE 34160 35870 42700 49530
PNUC132 HYNIC - TOC - 3 PATIENT Procedure NUCLEAR MEDICINE 45080 47340 56350 65370
NUCLEAR MEDICINE -
DS0009 B Cardiac Thallium Scan Procedure 580 610 720 840
GAMMA
NUCLEAR MEDICINE -
DS0009 A Renal Radioisotope scan Procedure 580 610 720 840
GAMMA
NUCLEAR MEDICINE -
DS0009 C Thyroid Radio Iodine Scan Procedure 580 610 720 840
GAMMA
NUCLEAR MEDICINE -
DS0007 Nuclear bone scan Procedure 1150 1210 1440 1670
GAMMA
NUCLEAR MEDICINE -
PNUC007 GAMMA CAMERA WITH LOW DOSE CT Procedure 3420 3590 4270 4960
GAMMA
NUCLEAR MEDICINE -
PNUC013 LIVER SCAN Procedure 3420 3590 4270 4960
GAMMA
NUCLEAR MEDICINE -
PNUC050 TESTICULAR SCAN Procedure 3420 3590 4270 4960
GAMMA
NUCLEAR MEDICINE -
PNUC056 THYROID SCAN Procedure 3970 4170 4960 5760
GAMMA
NUCLEAR MEDICINE -
PNUC023 MUGA SCAN (REST) Procedure 4510 4740 5640 6540
GAMMA
NUCLEAR MEDICINE -
PNUC005 ESOPHAGIAL TRANSIT TIME Procedure 5060 5320 6330 7340
GAMMA
383
Nuclear Medicine
Billing
Group
NUCLEAR MEDICINE -
PNUC008 GASTRIC EMPTYING TIME Procedure 5060 5320 6330 7340
GAMMA
NUCLEAR MEDICINE -
PNUC040 RENAL SCAN - DMSA Procedure 5060 5320 6330 7340
GAMMA
NUCLEAR MEDICINE -
PNUC041 RENAL SCAN - DTPA Procedure 5060 5320 6330 7340
GAMMA
NUCLEAR MEDICINE -
PNUC045 SALIVARY SCAN Procedure 5060 5320 6330 7340
GAMMA
NUCLEAR MEDICINE -
PNUC047 SENTINEL LYMPH NODE BIOPSY Procedure 5610 5890 7010 8130
GAMMA
NUCLEAR MEDICINE -
PNUC010 HEPATOBILIARY SCAN Procedure 6020 6320 7520 8730
GAMMA
NUCLEAR MEDICINE -
PNUC044 RENAL SCAN-EC Procedure 6020 6320 7520 8730
GAMMA
NUCLEAR MEDICINE -
PNUC002 BONE SCAN Procedure 6560 6890 8200 9510
GAMMA
NUCLEAR MEDICINE -
PNUC001 BONE MARROW SCAN Procedure 6700 7030 8370 9710
GAMMA
NUCLEAR MEDICINE -
PNUC015 LUNG V/Q Procedure 6700 7030 8370 9710
GAMMA
NUCLEAR MEDICINE -
PNUC018 MECKELS SCAN Procedure 7110 7470 8890 10310
GAMMA
NUCLEAR MEDICINE -
PNUC059 WHOLE BODY IODINE SCAN Procedure 7110 7470 8890 10310
GAMMA
NUCLEAR MEDICINE -
PNUC009 GI BLEED STUDY Procedure 7390 7760 9230 10710
GAMMA
NUCLEAR MEDICINE -
PNUC017 LYMPHOSCINTIGRAPHY Procedure 7390 7760 9230 10710
GAMMA
NUCLEAR MEDICINE -
PNUC024 MUGA SCAN (STRESS) Procedure 7390 7760 9230 10710
GAMMA
NUCLEAR MEDICINE -
PNUC057 VUR STUDY Procedure 7390 7760 9230 10710
GAMMA
NUCLEAR MEDICINE -
PNUC014 LUNG PERFUSION SCAN Procedure 7650 8030 9560 11090
GAMMA
NUCLEAR MEDICINE -
PNUC016 LUNG VENTILATION SCAN Procedure 7650 8030 9560 11090
GAMMA
NMCFP001 CARDIAC FITNESS PERFUSION NUCLEAR MEDICINE -
PNUC027 Procedure 7650 8030 9560 11090
SCAN GAMMA
NUCLEAR MEDICINE -
PNUC022 MILK SCAN (GE REFLUX SCAN) Procedure 7930 8320 9910 11490
GAMMA
NUCLEAR MEDICINE -
PNUC004 DENATURED RBC SCAN Procedure 9020 9470 11270 13080
GAMMA
NUCLEAR MEDICINE -
PNUC003 BRAIN SPECT Procedure 10930 11480 13660 15850
GAMMA
NUCLEAR MEDICINE -
PNUC046 SCINTIMAMMOGRAPHY Procedure 10930 11480 13660 15850
GAMMA
384
Nuclear Medicine
Billing
Group
NUCLEAR MEDICINE -
PNUC029 PARATHYROID SCAN Procedure 12020 12620 15030 17430
GAMMA
NUCLEAR MEDICINE -
PNUC025 MYOCARDIAL PERFUSION SCAN Procedure 14350 15060 17930 20800
GAMMA
MYOCARDIAL PERFUSION SCAN - NUCLEAR MEDICINE -
PNUC026 Procedure 15710 16500 19640 22780
DOBUTAMINE GAMMA
NUCLEAR MEDICINE -
PNUC058 WB TETROFOSMIN/SESTAL MIBI SCAN Procedure 17760 18650 22200 25750
GAMMA
NUCLEAR MEDICINE -
PNUC006 GALLIUM SCAN Procedure 19820 20810 24770 28740
GAMMA
NUCLEAR MEDICINE -
PNUC020 MIBG SCAN Procedure 20500 21520 25620 29720
GAMMA
NUCLEAR MEDICINE -
PNUC140 Ga DOTANOC Procedure 26680 28020 33350 38690
GAMMA
NUCLEAR MEDICINE -
PNUC141 Ga PSMA Procedure 26680 28020 33350 38690
GAMMA
NUCLEAR MEDICINE -
PNUC048 STRONTIUM 89 - METASTATIC BONE PAIN Procedure 109300 114770 136620 158480
GAMMA
NUCLEAR MEDICINE -
PNUC028 OCTREOTIDE SCAN Procedure 143460 150630 179320 208010
GAMMA
NUCLEAR MEDICINE -
PNUC021 MIBG THERAPY . I. 131 Procedure 165320 173580 206650 239710
GAMMA
NUCLEAR MEDICINE
PNUC101 KIT-BONE MARROW SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC102 KIT-BONE SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC104 KIT-ESOPHAGEAL TRANSIT TIME Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC106 KIT-GASTRIC EMPTYING TIME Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC108 KIT-HEPATOBILIARY SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC109 KIT-LIVER SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC110 KIT-LUNG PERFUSION SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC113 KIT-MECKELS Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC114 KIT-MIBG Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC119 KIT-OCTREOTIDE SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC123 KIT-RENAL SCAN(ADULT) Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC122 KIT-RENAL SCAN EC Procedure 130 140 160 190
- KITS
385
Nuclear Medicine
Billing
Group
NUCLEAR MEDICINE
PNUC125 KIT-STRONTIUM THERAPY Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC126 KIT-THYROID SCAN Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC127 KIT-VUR SCAN(ADULT) Procedure 130 140 160 190
- KITS
NUCLEAR MEDICINE
PNUC105 KIT-GALLIUM Procedure 220 230 280 320
- KITS
NUCLEAR MEDICINE
PNUC111 KIT-LUNG VENTILATION SCAN Procedure 220 230 280 320
- KITS
NUCLEAR MEDICINE
PNUC112 KIT-LYMPHOSCINTIGRAPHY Procedure 220 230 280 320
- KITS
NUCLEAR MEDICINE
PNUC103 KIT-BRAIN SPECT Procedure 260 270 320 370
- KITS
NUCLEAR MEDICINE
PNUC107 KIT-GI BLEED Procedure 260 270 320 370
- KITS
NUCLEAR MEDICINE
PNUC120 KIT-PARATHYROID SCAN Procedure 260 270 320 370
- KITS
NUCLEAR MEDICINE
PNUC124 KIT-SCINTIMAMMOGRAPHY Procedure 260 270 320 370
- KITS
NUCLEAR MEDICINE
PNUC128 KIT-VUR SCAN(PEDIATRIC) Procedure 260 270 320 370
- KITS
NUCLEAR MEDICINE
PNUC116 KIT-MUGA Procedure 320 330 390 460
- KITS
KIT-MYOCARDIAL PERFUSION NUCLEAR MEDICINE
PNUC118 Procedure 320 330 390 460
SCAN(REGULAR) - KITS
NUCLEAR MEDICINE
PNUC115 KIT-MILK SCAN Procedure 360 380 450 520
- KITS
NUCLEAR MEDICINE
PNUC121 KIT-RENAL SCAN (PEDIATRIC) Procedure 360 380 450 520
- KITS
KIT-MYOCARDIAL PERFUSION SCAN (DOB/ NUCLEAR MEDICINE
PNUC117 Procedure 450 480 570 660
ADENOSINE) - KITS
NUCLEAR MEDICINE
PNUC030 PET CT-BONE SCAN Procedure 11210 11770 14010 16250
- PET CT
NUCLEAR MEDICINE
PNUC031 PET CT-CARDIAC VIABILITY Procedure 18450 19370 23060 26750
- PET CT
NUCLEAR MEDICINE
PNUC032 PET CT-FDG BRAIN Procedure 19130 20090 23910 27740
- PET CT
NUCLEAR MEDICINE
PNUC139 PET CT LIMITED STUDY Procedure 24590 25820 30740 35660
- PET CT
NUCLEAR MEDICINE
PNUC033 PET CT-WHOLE BODY Procedure 34160 35870 42700 49530
- PET CT
RADIOIODINE THERAPY WHOLE - BODY NUCLEAR MEDICINE -
PNUC037 Procedure 2740 2880 3430 3970
SURGERY THERAPY
NUCLEAR MEDICINE -
PNUC012 IODINE THERAPY FOR TOXICOSIS (5 MCI) Procedure 6700 7030 8370 9710
THERAPY
386
Nuclear Medicine
Billing
Group
NUCLEAR MEDICINE -
PNUC011 IODINE THERAPY FOR TOXICOSIS (10 MCI) Procedure 8740 9180 10930 12680
THERAPY
NUCLEAR MEDICINE -
PNUC053 THYROID CANCER TREATMENT (< 50mCi) Procedure 26650 27980 33310 38640
THERAPY
NUCLEAR MEDICINE -
PNUC038 RADIONUCLIDE THERAPY - PKG Procedure 34160 35870 42700 49530
THERAPY
NUCLEAR MEDICINE -
PNUC055 THYROID CANCER TREATMENT (50-100mCi) Procedure 50560 53090 63200 73310
THERAPY
NUCLEAR MEDICINE -
PNUC054 THYROID CANCER TREATMENT (>100mCi) Procedure 60120 63120 75140 87170
THERAPY
NUCLEAR MEDICINE -
PNUC049 STRONTIUM THERAPY FOR BONE METS Procedure 165320 173580 206650 239710
THERAPY
NUCLEAR MEDICINE
LNUC001 CO-OPTED SURGEON'S FEE (LNUC) Surgery 0 6430 7660 8880
SURGERY
387
Physiotherapy
388
Physiotherapy
PHYSICAL MEDICINE
PPHY016 CRUTCHES (LEND CHARGES PER DAY) Physiotheraphy 70 70 90 100
GYM
PHYSICAL MEDICINE
PPHY090 WALKERS (LENDING CHARGES) Physiotheraphy 70 70 90 100
GYM
PHYSICAL MEDICINE
PPHY091 WAX AND SIMPLE EXCERCISE Physiotheraphy 80 90 100 120
GYM
PHYSICAL MEDICINE
PPHY006 ASSESSMENT CHARGES Physiotheraphy 100 110 130 150
GYM
PHYSICAL MEDICINE
PPHY018 EVALUATION - PPHY Physiotheraphy 100 110 130 150
GYM
PHYSICAL MEDICINE
PPHY054 INFRA RED RAYS Physiotheraphy 100 110 130 150
GYM
PHYSICAL MEDICINE
PPHY021 EXERCISE HIP MOBILISATION Physiotheraphy 130 130 160 180
GYM
PHYSICAL MEDICINE
PPHY108 KINESIOTAPING Physiotheraphy 160 170 200 230
GYM
PHYSICAL MEDICINE
PPHY080 SPLINTING(MAKING) Physiotheraphy 160 170 200 230
GYM
MC-GS-PHYSIOTHERAPY ADDITIONAL PHYSICAL MEDICINE
PPMR040 Physiotheraphy 170 180 210 240
MODALITY GYM
PHYSICAL MEDICINE
PPHY013 COLD PACK Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY041 GAIT TRAINING Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY053 INFANT STIMULATION Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY058 MOIST HEAT Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY081 SUSPENSION THERAPY Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY084 TENS Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY087 ULTRASOUND THERAPY Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY093 WHEEL CHAIR MOBILISATION Physiotheraphy 200 210 250 290
GYM
PHYSICAL MEDICINE
PPHY079 SPEECH+SWALLOWING COMBINED Physiotheraphy 220 240 280 320
GYM
PHYSICAL MEDICINE
PPHY082 SWALLOWING ASSESMENT Physiotheraphy 220 240 280 320
GYM
PHYSICAL MEDICINE
PPHY088 VOICE ASSESMENT Physiotheraphy 220 240 280 320
GYM
PHYSICAL MEDICINE
PPHY026 EXERCISES - GENERAL BODY 1 Physiotheraphy 280 290 350 400
GYM
FALLS PREVENTION/JOINT PROTECTION PHYSICAL MEDICINE
PPHY032 Physiotheraphy 280 290 350 400
TECHNIQUES/ENERGY CNSN GYM
389
Physiotherapy
PHYSICAL MEDICINE
PPHY042 GB I STRETCHING/STRENGTHENING Physiotheraphy 280 290 350 400
GYM
PHYSICAL MEDICINE
PPHY055 INTERFERENTIAL THERAPY Physiotheraphy 280 290 350 400
GYM
PHYSICAL MEDICINE
PPHY056 LASER THERAPY / INTER X Physiotheraphy 280 290 350 400
GYM
MICROWAVE/SHORTWAVE DIATHERMY PHYSICAL MEDICINE
PER SESSION GYM
PHYSICAL MEDICINE
PPHY083 SWALLOWING THERAPY Physiotheraphy 280 290 350 400
GYM
PHYSICAL MEDICINE
PPHY089 VOICE THERAPY Physiotheraphy 280 290 350 400
GYM
PHYSICAL MEDICINE
PPHY092 WAX BATH Physiotheraphy 280 290 350 400
GYM
PHYSICAL MEDICINE
PPHY009 CERVICAL/LUMBAR TRACTION Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY010 CHEST MANIPULATION Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY014 COMA STIMULATION Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY099 ELECTRICAL STIMULATION- GROUP Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY030 EXERCISES & AMBULATION 1 Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY043 GB II STRETCHING+STRENGTHENING Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY045 HAND REHABILITATION CLINIC Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY060 NEURODEVELOPMENTAL TRAINING Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY059 NEURODEVELOPMENT & ROODS Physiotheraphy 300 320 380 440
GYM
NEUROLOGICAL BIO-FEED PHYSICAL MEDICINE
BACK(AUDITORY) GYM
BACK(SENSORY) GYM
BACK(VISUAL) GYM
PHYSICAL MEDICINE
PPHY075 Sensory Integration Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY086 TILT TABLE Physiotheraphy 300 320 380 440
GYM
PHYSICAL MEDICINE
PPHY111 MAT EXERCISES Physiotheraphy 310 330 390 450
GYM
PHYSICAL MEDICINE
PPHY113 MOTOMED- EXERCISES Physiotheraphy 310 330 390 450
GYM
390
Physiotherapy
PHYSICAL MEDICINE
PPHY123 Yoga therapy One session Physiotheraphy 330 350 420 480
GYM
PHYSICAL MEDICINE
PPMR038 TRIGGER POINT/ MYOFASCIAL RELEASE Physiotheraphy 350 360 430 500
GYM
PHYSICAL MEDICINE
PPHY130 NICU Physiotherapy Physiotheraphy 360 370 440 520
GYM
PHYSICAL MEDICINE
PPHY008 BREATHINGEXCERCISES Physiotheraphy 370 390 460 530
GYM
BREATHING EXERCISES AND POSTURAL PHYSICAL MEDICINE
DRAINAGE GYM
PHYSICAL MEDICINE
PPHY012 COGNITIVE/PERCEPTUAL RE-TRAINING Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY020 EXERCISE ELBOW MOBILISATION Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY096 EXERCISE-FACE Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY025 EXERCISES - BACK Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY095 EXERCISE SHOLDER MOBILISATION - I Physiotheraphy 370 390 460 530
GYM
EXERCISE SHOLDER MOBILISATION - PHYSICAL MEDICINE
I(with modalities) GYM
PHYSICAL MEDICINE
PPHY028 EXERCISES - KNEE Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY029 EXERCISES - NECK Physiotheraphy 370 390 460 530
GYM
EXERCISE WRIST AND FINGER PHYSICAL MEDICINE
MOBILISATION GYM
PHYSICAL MEDICINE
PPHY106 GAIT TRAINING II Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY064 PAEDIATRIC REHAB EXS Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPHY067 POST-NATAL EXS Physiotheraphy 370 390 460 530
GYM
PHYSICAL MEDICINE
PPMR039 MC-GS-PHYSIOTHERAPY 1 SESSION Physiotheraphy 390 410 490 560
GYM
PHYSICAL MEDICINE
PPHY019 EXERCISE ANKLE MOBILISATION Physiotheraphy 400 420 500 580
GYM
PHYSICAL MEDICINE
PPMR037 GAIT TRAINING - REHAB Physiotheraphy 400 420 500 580
GYM
PHYSICAL MEDICINE
PPMR030 INFANT STIMULATION PROGRAM - I Physiotheraphy 400 420 500 580
GYM
PHYSICAL MEDICINE
PPHY001 ADL TRAINING Physiotheraphy 440 470 550 640
GYM
PHYSICAL MEDICINE
PPMR041 Balance & Coordination Activity Physiotheraphy 440 470 550 640
GYM
391
Physiotherapy
Dry Needling technique for Trigger PHYSICAL MEDICINE

Points GYM
PHYSICAL MEDICINE
PPHY027 EXERCISES - GENERAL BODY 2 Physiotheraphy 440 470 550 640
GYM
PHYSICAL MEDICINE
PPHY040 FUNCTIONAL ABILITY TRAINING Physiotheraphy 440 470 550 640
GYM
PHYSICAL MEDICINE
PPHY046 HAND REHABILITATION(MOTOR) Physiotheraphy 440 470 550 640
GYM
HAND REHABILITATION (SENSORY RE- PHYSICAL MEDICINE
EDUCATION) GYM
LYMPHOEDEMA REDUCTION PHYSICAL MEDICINE
(UNILATERAL) GYM
PHYSICAL MEDICINE
PPHY110 OBG PHYSIOTHERAPY CONSULTATION Physiotheraphy 440 470 550 640
GYM
PHYSICAL MEDICINE
PPHY076 Shoulder Package Physiotheraphy 440 470 550 640
GYM
PHYSICAL MEDICINE
PPHY017 ELECTRICAL STIMULATION Physiotheraphy 470 490 580 670
GYM
PERSONALISED EXERCISE PROGRAM PHYSICAL MEDICINE
BASIC GYM
PHYSICAL MEDICINE
PPHY085 TETRA/PARAPLEGIA PACKAGE Physiotheraphy 470 490 580 670
GYM
PHYSICAL MEDICINE
PPHY119 Fine Motor Activity Physiotheraphy 500 520 620 720
GYM
PHYSICAL MEDICINE
PPHY115 ICU physiotherapy Physiotheraphy 500 520 620 720
GYM
PHYSICAL MEDICINE
PPHY121 Clinical Pilates (One Session) Physiotheraphy 540 570 680 790
GYM
PHYSICAL MEDICINE
PPHY068 ERGONOMIC CONSULTATION Physiotheraphy 540 570 680 790
GYM
PHYSICAL MEDICINE
PPHY022 EXERCISE KNEE MOBILISATION Physiotheraphy 540 570 680 790
GYM
PHYSICAL MEDICINE
PPHY035 FITNESS PROGRAM - OP/ HALF HOUR Physiotheraphy 540 570 680 790
GYM
PHYSICAL MEDICINE
PPHY118 Sensory Integration Intervention Physiotheraphy 550 580 690 800
GYM
PHYSICAL MEDICINE
PPHY124 Yoga therapy Two session Physiotheraphy 550 580 690 800
GYM
PHYSICAL MEDICINE
PPHY002 ADVANCED NEUROLOGICAL DISORDERS Physiotheraphy 570 590 710 820
GYM
PHYSICAL MEDICINE
PPHY011 CHEST PHYSIO + ROM EXERCISES Physiotheraphy 570 590 710 820
GYM
CONTINUOUS PASSIVE MOTION DEVICE PHYSICAL MEDICINE
(CPMD) GYM
PHYSICAL MEDICINE
PPHY031 EXERCISES & AMBULATION 2 Physiotheraphy 570 590 710 820
GYM
392
Physiotherapy
PHYSICAL MEDICINE
PPHY023 EXERCISE SHOLDER MOBILISATION Physiotheraphy 570 590 710 820
GYM
PHYSICAL MEDICINE
PPHY047 HEMIPLEGIA PACKAGE Physiotheraphy 570 590 710 820
GYM
LYMPHOEDEMA REDUCTION PHYSICAL MEDICINE
(BILATERAL) GYM
PHYSICAL MEDICINE
PPHY072 Rehab EXS I Physiotheraphy 570 590 710 820
GYM
PHYSICAL MEDICINE
PPHY074 Rom Activities Physiotheraphy 570 590 710 820
GYM
PHYSICAL MEDICINE
PPHY114 NDT- ADULT HEMIPLEGIA Physiotheraphy 610 640 760 880
GYM
PERSONALISED EXERCISE PROGRAM PHYSICAL MEDICINE
ADVANCED GYM
PHYSICAL MEDICINE
PPHY048 HOME CARE MANAGEMENT - < 1 KM Physiotheraphy 680 710 840 980
GYM
PHYSICAL MEDICINE
PPHY097 P & E EXERCISES Physiotheraphy 680 710 840 980
GYM
PHYSICAL MEDICINE
PPHY104 ASPIRATION Physiotheraphy 730 770 910 1060
GYM
PHYSICAL MEDICINE
PPHY102 BACLOFEN PROGRAMMING Physiotheraphy 730 770 910 1060
GYM
PHYSICAL MEDICINE
PPHY103 DRESSING Physiotheraphy 730 770 910 1060
GYM
PLASTER APPLICATION/SERIAL PHYSICAL MEDICINE
CASTING GYM
PHYSICAL MEDICINE
PPHY073 Rehab EXS II + Gait Physiotheraphy 730 770 910 1060
GYM
PHYSICAL MEDICINE
PPHY120 Hand Writing Assessment & Training Physiotheraphy 830 870 1040 1200
GYM
PHYSICAL MEDICINE
PPHY125 Yoga Therapy Three Session Physiotheraphy 830 870 1040 1200
GYM
PHYSICAL MEDICINE
PPHY112 BWSTT- BIODEX GAIT TRAINING Physiotheraphy 850 890 1060 1230
GYM
PHYSICAL MEDICINE
PPHY049 HOME CARE MANAGEMENT 3-4KMS Physiotheraphy 850 890 1060 1230
GYM
PHYSICAL MEDICINE
PPHY003 ANTE-NATAL EXERCISE Physiotheraphy 920 960 1150 1330
GYM
PHYSICAL MEDICINE
PPHY070 COMPREHENSIVE P & E SOLUTIONS - 1 Physiotheraphy 920 960 1150 1330
GYM
PHYSICAL MEDICINE
PPMR029 HOME PHYSIOTHERAPY Physiotheraphy 920 960 1150 1330
GYM
PHYSICAL MEDICINE
PPHY131 Lamaze Session Physiotheraphy 920 960 1150 1330
GYM
PHYSICAL MEDICINE
PPHY126 Yoga Therapy Four Session Physiotheraphy 990 1040 1240 1440
GYM
393
Physiotherapy
PHYSICAL MEDICINE
GYM
PHYSICAL MEDICINE
PPMR023 REHAB HOME CARE 3-4KMS Physiotheraphy 1090 1150 1370 1580
GYM
PHYSICAL MEDICINE
PPHY127 Yoga Therapy Five Session Physiotheraphy 1100 1160 1380 1600
GYM
PHYSICAL MEDICINE
GYM
PHYSICAL MEDICINE
GYM
COMPREHENSIVE P and E SOLUTIONS PHYSICAL MEDICINE
-2 GYM
PHYSICAL MEDICINE
GYM
PHYSICAL MEDICINE
PPHY128 Yoga Therapy Group Session( 15 Days) Physiotheraphy 1650 1740 2070 2400
GYM
PHYSICAL MEDICINE
PPHY109 ERGONOMIC CONSULTATION - ON SITE Physiotheraphy 2060 2160 2580 2990
GYM
PHYSICAL MEDICINE
GYM
Sensory Integration Assessment / Home PHYSICAL MEDICINE
Exercise Program GYM
PHYSICAL MEDICINE
GYM
PHYSICAL MEDICINE
PPHY132 Lamaze Session ( 4 sessions) Physiotheraphy 2640 2780 3300 3830
GYM
PHYSICAL MEDICINE
PPHY039 FITNESS PROGRAM (PM) Physiotheraphy 2670 2800 3330 3860
GYM
PHYSICAL MEDICINE
PPHY129 Yoga Therapy Group Session( 30 days) Physiotheraphy 2750 2890 3440 3990
GYM
PHYSICAL MEDICINE
PPHY133 Lamaze Session(5 Sessions) Physiotheraphy 3300 3470 4130 4790
GYM
PHYSICAL MEDICINE
PPHY005 ANTE-NATAL PACKAGE MEDICARE Physiotheraphy 3630 3820 4540 5270
GYM
PHYSIO PACKAGES FOR CARDIAC PHYSICAL MEDICINE
CASES(10 DAYS IN WARD) GYM
PHYSIO PACKAGES FOR CARDIAC PHYSICAL MEDICINE
CASES (5 DAYS IN ITU) GYM
PHYSICAL MEDICINE
PPHY134 Lamaze Session( 6 sessions) Physiotheraphy 3960 4160 4950 5750
GYM
PHYSICAL MEDICINE
PPHY122 Clinical Pilates (10 Sessions) Physiotheraphy 4400 4620 5500 6380
GYM
CORE STRENGTHENING PHYSICAL MEDICINE
SOLUTIONS(7DAYS) GYM
PHYSICAL MEDICINE
PPHY004 ANTE-NATAL PACKAGE Physiotheraphy 7260 7630 9080 10530
GYM
394
Physiotherapy
PHYSICAL MEDICINE
PPHY037 FITNESS PROGRAM (3 MTHS) Physiotheraphy 7260 7630 9080 10530
GYM
ERGONOMIC AWARNESS CLINIC - PHYSICAL MEDICINE
PACKAGE GYM
PHYSICAL MEDICINE
PPHY038 FITNESS PROGRAM (6 MTHS) Physiotheraphy 12710 13350 15890 18430
GYM
PHYSICAL MEDICINE
PPHY036 FITNESS PROGRAM (1YEAR) Physiotheraphy 21180 22240 26470 30710
GYM
PHYSICAL MEDICINE
KPHY002 Rehabilitation package - 10 DAYS Package 0 148040 176240 204440
GYM PACKAGE
PHYSICAL MEDICINE
PPMR031 INFANT STIMULATION PROGRAM - II Physiotheraphy 370 390 460 530
REHAB INTERVENTION
PPMR015 POP REMOVAL Physiotheraphy PHYSIOTHERAPHY 70 70 90 100
PPMR028 PPMR028 SPEECH II Physiotheraphy PHYSIOTHERAPHY 300 320 380 440
PPMR020 SUTURE REMOVAL - PPMR Physiotheraphy PHYSIOTHERAPHY 300 320 380 440
PPMR027 PPMR027 SPEECH I Physiotheraphy PHYSIOTHERAPHY 370 390 460 530
PPMR007 DRESSING - PPMR Physiotheraphy PHYSIOTHERAPHY 400 420 500 580
PPHY078 SPEECH THERAPY Physiotheraphy PHYSIOTHERAPHY 440 470 550 640
PPMR032 INFANT STIMULATION PROGRAM - NICU Physiotheraphy PHYSIOTHERAPHY 570 590 710 820
PPMR012 ORTHOTICCHECK-UP/MODIFICATION Physiotheraphy PHYSIOTHERAPHY 570 590 710 820
PPMR016 REHAB 1 Physiotheraphy PHYSIOTHERAPHY 570 590 710 820
PPMR021 TRACHEOSTOMY TUBE CHANGE Physiotheraphy PHYSIOTHERAPHY 570 590 710 820
PPHY077 SPEECH ASSESMENT & COUNSELLING Physiotheraphy PHYSIOTHERAPHY 590 620 730 850
PPMR001 ASPIRATION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR002 BACLOFFEN PUMP PROGRAM Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR004 BOTULINUM INJECTION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
CLEAN INTERMITTENT
PPMR005 Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
CATHETERIZATION
PPMR006 DEBRIDEMENT - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR008 EVALUATION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR009 INCISSION & DRAINAGE - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR010 INJECTION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR011 INTRA ARTICULAR INJECTION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR014 PLASTER APPLICATION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR017 REHAB 2 Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR018 SERIAL CASTING Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR019 SHUNT PROGRAM Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR022 TRIGGER POINT INJECTION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060
PPMR003 BACLOFFEN REFILLING Physiotheraphy PHYSIOTHERAPHY 1820 1910 2270 2640
PPMR013 PHENOL BLOCK Physiotheraphy PHYSIOTHERAPHY 2670 2800 3330 3860
395
Physiotherapy
PSPO099 ASSISTED STRETCHING Procedure SPORTS MEDICINE 360 380 450 520
PSPO004 CRYOTHERAPY SESSION Procedure SPORTS MEDICINE 450 480 570 660
PSPO096 KINESIO TAPING - PSPO Procedure SPORTS MEDICINE 450 480 570 660
PSPO087 BACK PAIN EXERCISE ( 1 SESSION ) Procedure SPORTS MEDICINE 520 550 650 760
PSPO071 WEIGHT MANAGEMENT ( 1 SESSION ) Procedure SPORTS MEDICINE 520 550 650 760
PSPO094 BODY COMPOSITION ANALYSIS Procedure SPORTS MEDICINE 590 620 740 860
PSPO029 SPORTS MASSAGE Procedure SPORTS MEDICINE 590 620 740 860
CORE STABILITY EXCERCISES (1
PSPO102 Procedure SPORTS MEDICINE 610 640 770 890
SESSION)
RESPIRATORY REHABILITATION (
ASTHMA / COPD ) - SINGLE SESSION
PSPO091 FITNESS PROGRAM STAFF Procedure SPORTS MEDICINE 660 690 820 960
PSPO039 FUNCTIONAL FASCIAL TAPING Procedure SPORTS MEDICINE 680 720 850 990
MUSCULO-SKELETAL TREATMENT
(MANUAL)
PREVENTIVE STRENGTHENING -
MEDICARE OTHER STAFF
RHEUMATOID ARTHRITIS EXERCISES ( 1
SESSION )
OSTEOPOROSIS EXERCISES ( 1
SESSION )
PSPO097 2D SCAN Procedure SPORTS MEDICINE 900 950 1130 1310
PHYSIOTHERAPY EXERCISE SESSION -
PSPO016 THERABAND / GYM BALL / STABILITY Procedure SPORTS MEDICINE 900 950 1130 1310
TRAINING
MEDICAL BACK & NECK
REHABILITATION
PSPO086 NUTRITIONAL COUNSELING Procedure SPORTS MEDICINE 960 1010 1200 1390
PSPO054 VIBROGYM - 1 Procedure SPORTS MEDICINE 960 1010 1200 1390
PRIMUS TREATMENT WITHOUT MSC /
PSC
PSPO041 HEEL RAISE Procedure SPORTS MEDICINE 1180 1240 1470 1710
PERI-MENOPAUSAL EXERCISE ( SINGLE
SESSION )
FITNESS ASSESSMENT - BASIC
PACKAGE
FITNESS EVALUATION / PRE-
PSPO085 PARTICIPATION SCREENING ( 1 SESSION Procedure SPORTS MEDICINE 1240 1300 1540 1790
)
PREVENTIVE STRENGTHENING -
MEDICARE HOD'S
PSPO025 PRIMUS TREATMENT - ASSESSMENT Procedure SPORTS MEDICINE 1240 1300 1540 1790
PSPO060 Gait Analysis Procedure SPORTS MEDICINE 1300 1370 1630 1890
396
Physiotherapy
EXECUTIVE EXERCISE PROGRAM (

PSPO075 SINGLE SESSION ) + NUTRITIONAL Procedure SPORTS MEDICINE 1510 1590 1890 2190
GUIDANCE
PRIMUS TREATMENT WITH MSC / PSC
6 SESSIONS
PSPO077 CARDIAC SESSION ( 3 SESSIONS ) Procedure SPORTS MEDICINE 1910 2010 2390 2770
OBESITY AND DIABETES EXERCISE ( 3
SESSIONS )
PSPO074 RMR Procedure SPORTS MEDICINE 2050 2150 2560 2970
MEDICAL BACK & NECK
PSPO093 REHABILITATION AND PREVENTIVE Procedure SPORTS MEDICINE 2330 2440 2910 3370
STRENGTHENING & CONDITIONING
PSPO045 TEST - LACTATE THRESHOLD Procedure SPORTS MEDICINE 2330 2440 2910 3370
PSPO063 Weight Management Programme Procedure SPORTS MEDICINE 2330 2440 2910 3370
POST - PARTUM EXERCISES (2
SESSIONS)
PSPO064 PREGNANCY EXERCISES (3 SESSIONS) Procedure SPORTS MEDICINE 2600 2730 3250 3770
WEIGHT MANAGEMENT ( 5 SESSIONS )
+ DIET MANAGEMENT ( 1 SESSION )
PSPO040 HEEL PAIN REL. Procedure SPORTS MEDICINE 2740 2880 3430 3970
PSPO061 Musculoskeletal Assessement Procedure SPORTS MEDICINE 3420 3590 4270 4960
PSPO046 TEST - METABOLIC Procedure SPORTS MEDICINE 3420 3590 4270 4960
PREVENTIVE STRENGTHENING &
CONDITIONING - 1 MEMBERSHIP
EXECUTIVE EXERCISE PROGRAM ( 3
SESSION ) + NUTRITIONAL GUIDANCE
PSPO047 TEST - VO2 Procedure SPORTS MEDICINE 4510 4740 5640 6540
RESPIRATORY REHABILITATION (
ASTHMA / COPD ) - 8 SESSIONS
CONDITIONING - 6 ASSISTED SESSIONS
RHEUMATOID ARTHRITIS EXERCISES ( 8
SESSION )
FITNESS ASSESSMENT - ADVANCED
PACKAGE
PSPO088 BACK PAIN EXERCISE ( 12 SESSION ) Procedure SPORTS MEDICINE 6020 6320 7520 8730
OSTEOPOROSIS EXERCISES ( 8
SESSION )
PSPO078 CARDIAC SESSION ( 12 SESSIONS ) Procedure SPORTS MEDICINE 7110 7470 8890 10310
OBESITY AND DIABETES EXERCISE ( 12
SESSIONS )
PSPO098 CUSTOMIZED INSOLE AND 2D SCAN Procedure SPORTS MEDICINE 7650 8030 9560 11090
397
Physiotherapy
CUSTOMIZED INSOLE & 2D SCAN FOR

GOLFERS
HIGH ALTITUDE TRAINING (12
SESSIONS)
PSPO020 CONDITIONING - 12 ASSISTED Procedure SPORTS MEDICINE 8740 9180 10930 12680
SESSIONS
PSPO022 CONDITIONING - 3 ASSISTED SESSIONS Procedure SPORTS MEDICINE 8740 9180 10930 12680
& MEMBERSHIP
SESSIONS)
PSPO065 PREGNANCY EXERCISES (12 SESSIONS) Procedure SPORTS MEDICINE 9840 10330 12300 14260
MEDICAL BACK & NECK
REHABILITATION* - 6
PSPO024 CONDITIONING - 6 ASSISTED SESSIONS Procedure SPORTS MEDICINE 15710 16500 19640 22780
& MEMBERSHIP
HIGH ALTITUDE TRAINING (24
SESSIONS)
SESSIONS)
MEDICAL BACK & NECK
REHABILITATION* - 12
PSPO021 CONDITIONING - 12 ASSISTED Procedure SPORTS MEDICINE 26650 27980 33310 38640
SESSIONS & MEMBERSHIP
MEDICAL BACK & NECK
MEDICAL BACK & NECK
398
Administration
399
Administration
PADM042 ACLS / BLS / OTHERS Administration ADMINISTRATION 10 10 10 10

PADM075 WAITING LOUNGE KIT Administration ADMINISTRATION 40 40 40 40
PADM058 SC INJECTION Administration ADMINISTRATION 80 80 80 80
PADM055 IM INJECTIONS Administration ADMINISTRATION 100 100 100 100
PADM056 IM INJECTIONS (SHOT) Administration ADMINISTRATION 100 100 100 100
PADM028 NEBULIZATION Administration ADMINISTRATION 110 110 110 110
PADM046 DUPLICATE DISCHARGE SUMMARY Administration ADMINISTRATION 130 130 130 130
PADM043 DUPLICATE HOSPITAL CARD Administration ADMINISTRATION 130 130 130 130
PADM057 IV INJECTION (SHOT) Administration ADMINISTRATION 130 130 130 130
PADM060 IV INJECTION SLOW PUSH Administration ADMINISTRATION 210 210 210 210
PADM003 CERTIFICATE OF BIRTH Administration ADMINISTRATION 230 230 230 230
PADM061 IV INFUSION 1 HOUR Administration ADMINISTRATION 280 280 280 280
PADM038 WAITING LOUNGE-12 Hrs Administration ADMINISTRATION 370 370 370 370
PADM039 WAITING LOUNGE-24 Hrs Administration ADMINISTRATION 480 480 480 480
PADM040 Documentation Processing Fee Administration ADMINISTRATION 500 500 500 500
PADM082 GUEST HOUSE -24 Hrs Administration ADMINISTRATION 1260 1260 1260 1260
PADM083 GUEST HOUSE (SPL) -24 Hrs Administration ADMINISTRATION 1580 1580 1580 1580
PADM051 MEDICAL SUPPORT TEAM CHARGES Administration ADMINISTRATION 2000 2000 2000 2000
PADM077 INTERNATIONAL ASSISTANCE CHARGES Administration ADMINISTRATION 12080 12080 12080 12080
IENT008 Agil Family - Oticon Administration ADMINISTRATION 194250 194250 194250 194250
PADM086 HEALTHIFYME GOLD Administration ADMINISTRATION 2999
PADM087 HEALTHIFYME GOLD PLUS Administration ADMINISTRATION 5499
PADM089 HEALTHIFYME PLATINUM PLUS Administration ADMINISTRATION 13999
PADM084 HEALTHIFYME SILVER Administration ADMINISTRATION 2199
PADM085 HEALTHIFYME SILVER PLUS Administration ADMINISTRATION 4099
PADM090 HEALTHIFYME ULTIMATE Administration ADMINISTRATION 19999
PADM091 HEALTHIFYME ULTIMATE PLUS Administration ADMINISTRATION 24999
PADM100 MORTUARY ROOM CHARGES Miscellaneous MISCELLANEOUS 1000 1000 1000 1000
400
In Patient Services
401
In Patient Services
AREG001 Registration Registration REGISTRATION CHARGES 150 150 150 150
IPBEDC1 Admission Charges Inpatient Services ADMISSION CHARGES 1000 1000 1000 1000
IPBEDC206 BED CHARGES - MICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300
IPBEDC210 BED CHARGES - CCU Inpatient Services ICU BED CHARGES 0 13300 13300 13300
IPBEDC211 BED CHARGES - CTICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300
IPBEDC212 BED CHARGES - DAYCARE Inpatient Services IP BED CHARGES 0 3000 3000 3000
IPBEDC215 BED CHARGES - PICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300
IPBEDC300 BED CHARGES - SINGLE Inpatient Services IP BED CHARGES 0 3700 5900 9800
IPBEDC301 BED CHARGES - DOUBLE Inpatient Services IP BED CHARGES 0 3700 5900 5900
IPBEDC302 BED CHARGES - TRIPLE Inpatient Services IP BED CHARGES 0 3700 3700 3700
BED CHARGES - MICU

IPBEDC303 Inpatient Services ICU BED CHARGES 0 13300 13300 13300
ISOLATION
BED CHARGES - PICU

ISOLATION
BED CHARGES - NICU

HIGH INTENSIVE
BED CHARGES - NICU

LOW INTENSIVE
BED CHARGES - DUAL

IPBEDC308 Inpatient Services IP DUAL BED CHARGES 0 3700 5900 9800
OCCUPANCY SINGLE
BED CHARGES - DUAL

OCCUPANCY DOUBLE
BED CHARGES - DUAL

OCCUPANCY TRIPLE
402
Medical Equipment
403
Medical Equipment
AMED001 CARDIAC MONITOR - PER DAY Inpatient Services MEDICAL EQUIPMENT 390 410 490 570
AMED002 C-ARM CHARGES PER HOUR Inpatient Services MEDICAL EQUIPMENT 0 3780 6860 9610
AMED003 HARMONIC SCALPEL Inpatient Services MEDICAL EQUIPMENT 2480 3620 6860 10210
AMED004 INFUSION PUMP - PER DAY Inpatient Services MEDICAL EQUIPMENT 370 440 530 630
AMED005 LAPROSCOPIC INSTRUMENT Inpatient Services MEDICAL EQUIPMENT 3130 4480 7290 10580
AMED007 OXYGEN CHARGES PER HOUR Inpatient Services MEDICAL EQUIPMENT 350 350 350 350
AMED010 OXYGEN CHARGES Inpatient Services MEDICAL EQUIPMENT 0 5000 5000 5000
AMED011 VENTILATION CHARGES Inpatient Services MEDICAL EQUIPMENT 0 3000 3000 3000
AMED012 VENTILATION CHARGES - BIPAP Inpatient Services MEDICAL EQUIPMENT 0 2750 2750 2750
VENTILATION CHARGES WITH OXYGEN

AMED013 Inpatient Services MEDICAL EQUIPMENT 10500 10500 10500 10500
- PER DAY
VENTILATION CHARGES (Bi Pap) WITH

OXYGEN - PER DAY
AMED015 CUSA MACHINE Inpatient Services MEDICAL EQUIPMENT 2610 2740 3260 3780
AMED016 LIGASURE Inpatient Services MEDICAL EQUIPMENT 2480 4100 7070 9500
AMED017 COMPUTER NAVIGATION Inpatient Services MEDICAL EQUIPMENT 3290 3460 4110 4770
AMED018 ERBE BICLAMP Inpatient Services MEDICAL EQUIPMENT 1940 2030 2420 2810
AMED019 MICROSCOPE - Other Departments Inpatient Services MEDICAL EQUIPMENT 3860 4050 4820 5590
AMED020 MICROSCOPE - ENT, OPTHAL Inpatient Services MEDICAL EQUIPMENT 1590 1670 1990 2300
AMED021 SAP - THERAPY MACHINE CHARGES Inpatient Services MEDICAL EQUIPMENT 2610 2740 3260 3780
INTRA-OP NERVE MONITORING

SYSTEM
AMED023 C-ARM ( SINGLE SHOT - SURGEON) Inpatient Services MEDICAL EQUIPMENT 690 720 860 990
AMED024 C-ARM SINGLE SHOT (ANESTHESIA) Inpatient Services MEDICAL EQUIPMENT 690 720 860 990
AMED026 NIM ECLIPSE MACHINE CHARGES Inpatient Services MEDICAL EQUIPMENT 3740 3930 4680 5430
AMED027 MICROSCOPE - ENT, OPTHAL (Minor) Inpatient Services MEDICAL EQUIPMENT 460 480 570 660
VENTILATION CHARGES (NIV

PORTABLE)
VENTILATION CHARGES (NIV

PORTABLE) WITH OXYGEN - PER DAY
NEURO NAVIGATION SYSTEM

CHARGES
SURGICAL BONE DRILL - Short

duration Use
404
Medical Equipment
SURGICAL BONE DRILL - Long

duration Use
AMED033 LUMINAS LASER - CHARGES Inpatient Services MEDICAL EQUIPMENT 9720 11610 13230 14850
AMED036 URETROSCOPE - CHARGES Inpatient Services MEDICAL EQUIPMENT 19280 20250 24100 27960
AMED037 FLEXIBLE URETEROSCOPE CHARGES Inpatient Services MEDICAL EQUIPMENT 3740 3930 4680 5430
AMED038 I -DRIVE STAPLER Inpatient Services MEDICAL EQUIPMENT 4100 4320 4320 4320
BIOLITEC LASER CHARGES -

UNILATERAL
BIOLITEC LASER CHARGES -

BILATERAL
AMED041 CO2 LASER ?LUMENIS Inpatient Services MEDICAL EQUIPMENT 39690 41680 49620 57560
AMED042 FIBRE ENDURE CO2 Inpatient Services MEDICAL EQUIPMENT 51910 54500 64880 75260
AMED043 HFNC WITH OXYGEN PER DAY Inpatient Services MEDICAL EQUIPMENT 2160 2160 2160 2160
AMED044 HFNC Nasal Prongs Inpatient Services MEDICAL EQUIPMENT 2700 2700 2700 2700
AMED045 HFNC Tubings Inpatient Services MEDICAL EQUIPMENT 2270 2390 2840 3290
ARTHROSCOPE INSTRUMENT
CHARGES
PEDME01 Nitric Oxide Therapy Charges Per Day Inpatient Services MEDICAL EQUIPMENT 10890 11440 13620 15790
PEDME02 NITRIC OXIDE CHARGE up to 6 HOURS Inpatient Services MEDICAL EQUIPMENT 3290 3460 4110 4770
NITRIC OXIDE CHARGE for 6 Hrs to

PEDME03 Inpatient Services MEDICAL EQUIPMENT 5910 6200 7380 8560
12 Hrs

18 Hrs

24 Hrs
405
Yoga
406
Yoga
PYOG006 M-SPECIAL TECHNIQUES (PER SESSION) Procedure YOGA THERAPY 360 380 450 520
PYOG010 SPECIAL TECHNIQUES (PER SESSION) Procedure YOGA THERAPY 360 380 450 520
PYOG009 RELAXATION THERAPY (PER SESSION) Procedure YOGA THERAPY 450 480 570 660
PYOG005 M-RELAXATION THERAPY (PER SESSION) Procedure YOGA THERAPY 480 500 590 690
PYOG008 M-YOGATHERAPY (PER SESSION) Procedure YOGA THERAPY 640 670 800 920
PYOG002 GROUP POSITIVE HEALTH PACKAGE Procedure YOGA THERAPY 680 720 850 990
PYOG004 M-GROUP POSITIVE HEALTH PACKAGE Procedure YOGA THERAPY 680 720 850 990
PYOG011 YOGA THERAPY (PER SESSION) Procedure YOGA THERAPY 680 720 850 990
GROUP INTEGRATED YOGIC PRACTICS (12

PYOG001 Procedure YOGA THERAPY 2330 2440 2910 3370
SESSION)
M-GROUP INTEGRATED YOGIC PRACTICS

PYOG003 Procedure YOGA THERAPY 2330 2440 2910 3370
(12 SESSION)
PYOG007 M-YOGATHERAPY PACKAGE (12 SESSION) Procedure YOGA THERAPY 5610 5890 7010 8130
PYOG012 YOGA THERAPY PACKAGE (12 SESSION) Procedure YOGA THERAPY 5610 5890 7010 8130
407
Home Care
408
Home Care
Billing Billing
Group Subgroup
PHOM123 Suture removal (each suture) additional service Procedure HOME CARE 30 30 30 40
PHOM076 BP check additional service Procedure HOME CARE 40 40 50 60
PHOM124 Staple removal (each staple) additional service Procedure HOME CARE 40 40 50 60
PHOM059 Suture removal (each suture) Procedure HOME CARE 40 40 50 60
PHOM006 BP check Procedure HOME CARE 50 50 60 70
PHOM060 Staple removal (each staple) Procedure HOME CARE 50 50 60 70
Baby Nail cutting / weighing the baby additional
PHOM072 Procedure HOME CARE 60 70 80 90
service
PHOM097 GRBS Check additional service Procedure HOME CARE 60 70 80 90
PHOM117 Sample Collection additional service Procedure HOME CARE 60 70 80 90
PHOM120 SpO2 Check additional service Procedure HOME CARE 60 70 80 90
PHOM002 Baby Nail cutting / weighing the baby Procedure HOME CARE 70 80 90 110
PHOM027 GRBS Check Procedure HOME CARE 70 80 90 110
PHOM046 Sample Collection Procedure HOME CARE 70 80 90 110
PHOM049 SpO2 Check Procedure HOME CARE 70 80 90 110
PHOM070 HOME LAB SAMPLE COLLECTION CHARGES Procedure HOME CARE 120 120 150 170
PHOM082 Colostomy care / bag change additional service Procedure HOME CARE 130 140 160 190
PHOM083 Counselling for breast feeding additional service Procedure HOME CARE 130 140 160 190
Hot formentation (Breast Engorgment) additional
service
PHOM099 IM injection (Shot) [Homecare] additional service Procedure HOME CARE 130 140 160 190
PHOM103 IV injection (Shot) [Homecare] additional service Procedure HOME CARE 130 140 160 190
PHOM104 IV injection slow push [Homecare] additional service Procedure HOME CARE 130 140 160 190
PHOM110 Nail Cutting additional service Procedure HOME CARE 130 140 160 190
PHOM112 Perineal Care additional service Procedure HOME CARE 130 140 160 190
PHOM118 SC injection [Homecare] additional service Procedure HOME CARE 130 140 160 190
PHOM119 Sitz bath additional service Procedure HOME CARE 130 140 160 190
PHOM122 Suppository / Tablet insertion additional service Procedure HOME CARE 130 140 160 190
PHOM125 Urobag change additional service Procedure HOME CARE 130 140 160 190
PHOM012 Colostomy care / bag change Procedure HOME CARE 150 160 190 220
PHOM013 Counselling for breast feeding Procedure HOME CARE 150 160 190 220
PHOM008 Hot formentation (Breast Engorgment) Procedure HOME CARE 150 160 190 220
PHOM029 IM injection (Shot) [Homecare] Procedure HOME CARE 150 160 190 220
PHOM032 IV injection (Shot) [Homecare] Procedure HOME CARE 150 160 190 220
PHOM033 IV injection slow push [Homecare] Procedure HOME CARE 150 160 190 220
PHOM039 Nail Cutting Procedure HOME CARE 150 160 190 220
PHOM041 Perineal Care Procedure HOME CARE 150 160 190 220
409
Home Care
Billing Billing
Group Subgroup
PHOM047 SC injection [Homecare] Procedure HOME CARE 150 160 190 220
PHOM048 Sitz bath Procedure HOME CARE 150 160 190 220
PHOM052 Suppository / Tablet insertion Procedure HOME CARE 150 160 190 220
PHOM053 Urobag change Procedure HOME CARE 150 160 190 220
PHOM071 Baby Bath & Massage additional service Procedure HOME CARE 190 200 230 270
Bladder Training (Clamping and releasing) additional
service
PHOM080 Catheter care additional service Procedure HOME CARE 190 200 230 270
Chemoport access needle (Insertion / Removal)
additional service
PHOM088 Chest Physiotherpay additional service Procedure HOME CARE 190 200 230 270
PHOM090 Drain Care additional service Procedure HOME CARE 190 200 230 270
Dressing (Bed sores, surgical, diabetic) - Minor
additional service
General Visitation (BP/GRBS/PR/RR/SpO2/Temp. check)
additional service
PHOM098 Hair wash additional service Procedure HOME CARE 190 200 230 270
I.V. Drip Administration (each hour) additional charge
additional service
PHOM105 IV line insertion / removal additional service Procedure HOME CARE 190 200 230 270
PHOM108 Mouth Care additional service Procedure HOME CARE 190 200 230 270
PHOM109 Nebulisation additional service Procedure HOME CARE 190 200 230 270
PHOM113 Post natal exercises (After Delivery) additional service Procedure HOME CARE 190 200 230 270
PHOM116 Ryle's Tube Feeding additional service Procedure HOME CARE 190 200 230 270
PHOM021 Dressing (Bed sores, surgical, diabetic) - Minor Procedure HOME CARE 200 210 250 290
PHOM038 Nebulisation Procedure HOME CARE 200 210 250 290
PHOM001 Baby Bath & Massage Procedure HOME CARE 220 230 280 320
PHOM007 Bladder Training (Clamping and releasing) Procedure HOME CARE 220 230 280 320
PHOM010 Catheter care Procedure HOME CARE 220 230 280 320
PHOM016 Chemoport access needle (Insertion / Removal) Procedure HOME CARE 220 230 280 320
PHOM018 Chest Physiotherpay Procedure HOME CARE 220 230 280 320
PHOM020 Drain Care Procedure HOME CARE 220 230 280 320
PHOM026 General Visitation (BP/GRBS/PR/RR/SpO2/Temp. check) Procedure HOME CARE 220 230 280 320
PHOM028 Hair wash Procedure HOME CARE 220 230 280 320
PHOM061 I.V. Drip Administration (each hour) additional charge Procedure HOME CARE 220 230 280 320
PHOM034 IV line insertion / removal Procedure HOME CARE 220 230 280 320
PHOM037 Mouth Care Procedure HOME CARE 220 230 280 320
PHOM042 Post natal exercises (After Delivery) Procedure HOME CARE 220 230 280 320
PHOM045 Ryle's Tube Feeding Procedure HOME CARE 220 230 280 320
410
Home Care
Billing Billing
Group Subgroup
PHOM0128 Humidifier-Daily Procedure HOME CARE 230 250 290 340
PHOM079 Catheter removal additional service Procedure HOME CARE 260 270 320 370
PHOM085 Chemoport flushing additional service Procedure HOME CARE 260 270 320 370
PHOM095 Enema (Proctoclysis / Entofoam) additional service Procedure HOME CARE 260 270 320 370
PHOM106 Intermittent Catheterisation additional service Procedure HOME CARE 260 270 320 370
PHOM107 Manual Evacuation additional service Procedure HOME CARE 260 270 320 370
PHOM121 Suctioning (oral) additional service Procedure HOME CARE 260 270 320 370
PHOM009 Catheter removal Procedure HOME CARE 280 290 350 410
PHOM015 Chemoport flushing Procedure HOME CARE 280 290 350 410
PHOM025 Enema (Proctoclysis / Entofoam) Procedure HOME CARE 280 290 350 410
PHOM035 Intermittent Catheterisation Procedure HOME CARE 280 290 350 410
PHOM036 Manual Evacuation Procedure HOME CARE 280 290 350 410
PHOM050 Suctioning (oral) Procedure HOME CARE 280 290 350 410
PHOM054 Visit Charges 0 - 2 KMS Procedure HOME CARE 300 320 380 440
PHOM089 Death Care additional service Procedure HOME CARE 320 330 390 460
Dressing (Bed sores, surgical, diabetic) - Medium
additional service
PHOM114 Range of Motion (ROM) additional service Procedure HOME CARE 320 330 390 460
PHOM019 Death Care Procedure HOME CARE 350 370 440 510
PHOM022 Dressing (Bed sores, surgical, diabetic) - Medium Procedure HOME CARE 350 370 440 510
PHOM043 Range of Motion (ROM) Procedure HOME CARE 350 370 440 510
PHOM073 Bath / Back Care / Bed Making additional service Procedure HOME CARE 370 390 460 540
PHOM094 ECG additional service Procedure HOME CARE 370 390 460 540
PHOM111 Oxygen Administration per hour additional service Procedure HOME CARE 370 390 460 540
PHOM003 Bath / Back Care / Bed Making Procedure HOME CARE 410 430 510 590
PHOM024 ECG Procedure HOME CARE 410 430 510 590
PHOM040 Oxygen Administration per hour Procedure HOME CARE 430 450 540 620
PHOM063 Visit Charges 2.1 - 4 KMS Procedure HOME CARE 430 450 540 620
PHOM075 Bladder Irrigation additional service Procedure HOME CARE 440 460 550 640
PHOM074 Bladder Wash additional service Procedure HOME CARE 440 460 550 640
PHOM081 Catheterisation additional service Procedure HOME CARE 440 460 550 640
PHOM087 Chemo Medicine Infusion additional service Procedure HOME CARE 440 460 550 640
PHOM084 Colostomy Irrigation additional service Procedure HOME CARE 440 460 550 640
Dressing (Bed sores, surgical, diabetic) - Major
additional service
PHOM100 I.V. Drip Administration additional service Procedure HOME CARE 440 460 550 640
PHOM102 IV infusion (Injection with Saline) additional service Procedure HOME CARE 440 460 550 640
411
Home Care
Billing Billing
Group Subgroup
PHOM115 Ryle's Tube Insertion additional service Procedure HOME CARE 440 460 550 640
PHOM005 Bladder Irrigation Procedure HOME CARE 480 500 590 690
PHOM004 Bladder Wash Procedure HOME CARE 480 500 590 690
PHOM011 Catheterisation Procedure HOME CARE 480 500 590 690
PHOM017 Chemo Medicine Infusion Procedure HOME CARE 480 500 590 690
PHOM014 Colostomy Irrigation Procedure HOME CARE 480 500 590 690
PHOM023 Dressing (Bed sores, surgical, diabetic) - Major Procedure HOME CARE 480 500 590 690
PHOM030 I.V. Drip Administration for 1st Hour Procedure HOME CARE 480 500 590 690
PHOM031 IV infusion (Injection with Saline) Procedure HOME CARE 480 500 590 690
PHOM044 Ryle's Tube Insertion Procedure HOME CARE 480 500 590 690
PHOM0130 Pulse Oxymeter (15 day package) Procedure HOME CARE 610 640 760 880
PHOM0126 NIV / BiPAP Procedure HOME CARE 710 740 880 1020
PHOM135 IP Attender Service Homecare - 12 Hrs/day Procedure HOME CARE 750 790 940 1090
PHOM126 Western Airbed Procedure HOME CARE 1040 1090 1300 1510
PHOM0131 Pulse Oxymeter (30 day package) Procedure HOME CARE 1210 1270 1510 1760
PHOM138 Homecare Subscription Procedure HOME CARE 1250 1310 1560 1810
PHOM0129 Humidifier (15 Days ) Procedure HOME CARE 2300 2420 2880 3340
PHOM0132 Airbed (Sale) Procedure HOME CARE 4260 4470 5320 6170
PHOM0133 Humidifier ( 30 Days ) Procedure HOME CARE 4600 4830 5750 6670
PHOM0127 NIV / BiPAP 15 day package Procedure HOME CARE 6040 6340 7550 8760
PHOM0134 C-Pap ( 30 days) Procedure HOME CARE 6900 7250 8630 10010
PHOM136 IP Attender Service Homecare - 12 Hrs/day for 15 days Procedure HOME CARE 7460 7830 9320 10810
PHOM137 IP Attender Service Homecare - 24 Hrs/day for 15 days Procedure HOME CARE 18630 19570 23290 27020
412
413
HUMAN CARE MEDICAL CHARITABLE TRUST
Adjoining MTNL Building, Main Road,
Sector 6, Dwarka, New Delhi - 110 075
Mail id: mailus@manipalhospitals.com
www.manipalhospitals.com | www.hcmct.in
414
1800 3001 4000 / 011 4967 4967

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EMERGENCY

Sl No Bed Category Bed Charges Consultant Charges

16. Refund Policy:

Annexure: 1 b Investigation: New Born

KCTS003 CABG + VALVE SURGERY PACKAGE 3,35,210 3,99,050 4,62,900

KCTS045 CABG PACKAGE 2,74,810 3,02,320 3,29,780

KCTS004 CLOSURE OF ASD PACKAGE 3,26,030 3,88,130 4,50,230

KCTS005 CLOSURE OF PDA PACKAGE 2,30,880 2,74,850 3,18,830

KCTS014 HEART SURGERY - (CLOSED) PACKAGE 2,51,650 2,99,580 3,47,510

KCTS015 HEART SURGERY - (OPEN) PACKAGE 4,14,660 4,93,640 5,72,620

KCTS032 VALVE MULTIPLE PACKAGE 3,59,240 4,27,660 4,96,090

KCTS034 VALVE SINGLE PACKAGE 2,93,430 3,49,320 4,05,210

KCAR002 ANGIOGRAM CORONARY PACKAGE 17,080 18,790 20,500

KCAR006 ANGIOGRAM PERIPHERAL PACKAGE 16,670 19,840 23,020

KCAR007 ANGIOGRAM RENAL/CAROTID PACKAGE 16,670 19,840 23,020

KCAR012 ANGIOPLASTY PTCA - SINGLE VESSEL PACKAGE 1,06,950 1,17,650 1,28,340

KCAR011 ANGIOPLASTY PTCA - MULTIPLE VESSEL PACKAGE 2,03,950 2,42,800 2,81,650

KCAR010 ANGIOPLASTY PRIMARY - SINGLE VESSEL PACKAGE 2,02,860 2,41,500 2,80,140

KCAR008 ANGIOPLASTY PERIPHERAL PACKAGE 1,03,850 1,23,630 1,43,410

KCAR014 BIVENTRICULAR PACING PACKAGE 2,03,470 2,42,220 2,80,980

KCAR021 EPS DIAGNOSTIC PACKAGE 54,830 65,270 75,710

KCAR026 RF ABLATION SIMPLE PACKAGE 81,510 97,040 1,12,560

KCAR029 RF ABLATION COMPLEX PACKAGE 1,18,700 1,41,310 1,63,920

KCAR018 DEVICE CLOSURE - PDA PACKAGE 73,060 86,970 1,00,890

KCAR017 DEVICE CLOSURE - ASD PACKAGE 1,06,990 1,27,370 1,47,750

KCAR013 BALLON SEPTOSTOMY PACKAGE 74,990 89,270 1,03,560

KCAR015 BPV/BAV PACKAGE 78,850 93,870 1,08,890

INVESTIGATION ANNEXURES: (Any of the investigation from the below mentioned)

Subgroup Service Name Service Code

ANGIOGRAM CORONARY + PERIPHERAL CARDIOLOGY ANGIO

ANGIOPLASTY PRIMARY - SINGLE CARDIOLOGY PLASTY

ANGIOPLASTY PTCA - SINGLE VESSEL CARDIOLOGY PLASTY

ANGIOPLASTY PTCA - MULTIPLE VESSEL CARDIOLOGY PLASTY

DIAGNOSTIC PAEDIATRIC CARDIOLOGY ANGIO

KCAR035 IVUS-Cath Procedure Package CARDIOLOGY PACKAGE 0 36230 43130 50030

KCAR015 BPV/BAV PACKAGE Package CARDIOLOGY PACKAGE 0 78850 93870 108890

KCAR025 PTSMA PACKAGE Package CARDIOLOGY PACKAGE 0 152630 181700 210780

DCAR001 ECG- Adult Procedure CARDIOLOGY 360 360 400 440

PCAR011 PACEMAKER ANALYSIS Procedure CARDIOLOGY 960 1010 1200 1390

DCAR003 Echo-Cardiogram Procedure CARDIOLOGY 3000 3000 3300 3600

DCAR002 Echo-Cardiogram - Paediatrics Procedure CARDIOLOGY 2600 2730 3250 3770

PCAR006 ECHO-SCREENING Procedure CARDIOLOGY 960 1010 1200 1390

DCAR023 3D - ECHO Procedure CARDIOLOGY 3560 3740 4450 5160

PCAR009 HOLTER Procedure CARDIOLOGY 2740 2880 3430 3970

DCAR022 STRESS ECHO Procedure CARDIOLOGY 3560 3740 4450 5160

DCAR021 ANGIODEFENDER Procedure CARDIOLOGY 3140 3300 3930 4560

DCAR016 EXTENDED HOLTER Procedure CARDIOLOGY 3420 3590 4270 4960

DCAR017 AMBULATORY BP RECORDER Procedure CARDIOLOGY 3560 3740 4450 5160

PCAR013 PERICARDIAL ASPIRATION Procedure CARDIOLOGY 11480 12060 14350 16650

PCAR014 T P I (TEMPORARY PACING) Procedure CARDIOLOGY 11480 12060 14350 16650

PCAR015 IABP Procedure CARDIOLOGY 39620 41600 49530 57450

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Surgery Billing Billing

Unification procedure for septate uterus

VAULT PROLAPSE OPERATION -