| Specialty code |
Package Code |
Site |
Package name |
Package Amount |
Preauth Required or Not (Y/N) |
Mandatory investigations for pre-auth |
Post-Op investigations for claims submission |
Average length of Stay (Including Days in intensive care units) |
Govt Reserved Procedure (Y/N) |
Medical (M) or Surgical (S) |
| M5 |
0001 |
Lymphoma, Non-Hodgkin’s |
Lymphoma, Non-Hodgkin’s: Cyclophosphamide - Doxorubicin Vincristine - Prednisone (CHOP)- max 8 cycles (Per cycle) |
R CHOP Regimen-25000 per cycle x6 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0002 |
Multiple Myeloma |
Vincristine, Adriamycin,Dexamethasone(VAD) -cycle max 6 cycles |
Bortezomib+ lenalidomide+ dexamethasone 20,000/ per cycle x6
Bortezomib+ cyclophosphamide+ dexamethasone 10000/per cycle x6
MPT melphalan, thalidomide and prednisolone 6000/per cycle x9
Bortezomib + dexamethasone 6000/per cycle x9 |
Y |
Bone Marrow Aspiration Report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| M5 |
0003 |
Multiple Myeloma |
Thalidomide+Dexamethasone(Oral)/ month - max 12 months |
3000 |
Y |
Bone Marrow Aspiration Report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| M5 |
0004 |
Colon Rectum |
5-Fluorouracil-Oxaliplatin - Leucovorin (FOLFOX) - Max. 6 cycles (Per cycle) |
10000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0005 |
Bone Tumors/Osteosarcoma/ Hepatoblastoma -Operable |
Cisplatin/carboplatin - Adriamycin- max 6 cycles (Per cycle) |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0006 |
Lymphoma, Hodgkin'S |
Adriamycin Bleomycin VinblastinDacarbazine (ABVD) - max 8 cycles (Per cycle) (Day 1 & Day 15) |
ABVD (day 1 and 15) 5000x2=10,000 per cycle x 6 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0007 |
Cervix |
Cisplatin/Carboplatin (AUC2) along with RT- max 6 cycles (Per cycle) |
chemo radiation 5000/per week x 6 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0008 |
Neuroblastoma Stage I –III |
Variable Regimen – Neuroblastoma - max 1 year (Per cycle) |
9000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0009 |
Wilm'sTumor |
SIOP/National Wilms Tumour Study Group (NWTS) regimen(Stages I - V)- max 6 months (Per month) - Wilm's tumour |
7000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0010 |
Colon - rectum |
Monthly 5-FU |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0011 |
Breast |
Paclitaxel weekly x 12 weeks |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0012 |
Breast |
Cyclophosphamide/Methotrexate/5Fluorouracil (CMF) (Per cycle) |
1500 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0013 |
Breast |
Tamoxifen tabs - maximum 12 cycles (Per month) |
100 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0014 |
Breast |
Adriamycin/Cyclophosphamide (AC) – per cycle (Maximum 4 cycles) |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0015 |
Breast |
5- Fluorouracil A-C (FAC) – per cycle (Maximum 6 cycles) |
3100 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0016 |
Breast |
AC (AC Then Taxol) |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0017 |
Small Cell Lung Cancer |
Cisplastin/Etoposide (IIIB) – per cycle (Max. 6 cycles only) |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0018 |
Oncology oesophagus |
Cisplatin + 5 FU(Neoadjuvant Chemotherapy)/Adjuvant (ADJ)- per cycle (Max. of 6 cycles only) |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0019 |
Stomach |
Docetaxel +Oxaliplatin+5FU
20,000 per cycle for 4 cycles
CapOX- 10,000 per cycle for 8 cycles |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0020 |
Breast |
Aromatase Inhibitors (Anastazole/Letrozole/Exemestane) - maximum 12 cycles (Per month) |
900 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0021 |
Urinary Bladder |
Weekly Cisplatin/Carboplatin- max 6 cycles with RT (Per week) |
2000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0022 |
Urinary Bladder |
MethotraxateVinblastin Adriamycin Cyclophosphamide (MVAC) |
5000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0023 |
Retinoblastoma |
Carbo/Etoposide/Vincristine-max 6 cycles (Per cycle) |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0024 |
Febrile Neutropenia |
IV antibiotics and other supportive therapy (Per episode) |
30000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0025 |
Vaginal/ Vulval Cancer |
Cisplastin/5-FU |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0026 |
Ovary |
Carboplatin/Paclitaxel-max 6 cycles (Per cycle) |
Taxol+carboplatin 15000/percyclex6
BEP regimen for germ cell tumor 10000/per cyclex4 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0027 |
Multiple Myeloma |
Melphalan -Prednisone (oral) – per month (max 12 months) - Ovarian CA, Bone CA |
1500 |
Y |
Bone Marrow Aspiration Report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| M5 |
0028 |
Rectal Cancer Stage 2 And 3 |
Gemcitabine +capecitabine-15,000 per cycle for 6 cycles |
4000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0029 |
Multiple Myeloma |
Zoledronic acid - Max 12 cycles (Per month) |
2000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0030 |
Gestational Trophoblast Ds. High Risk |
Etoposide-Methotrexate-Actinomycin / Cyclophosphamide -Vincristine (EMA-CO)-max 6 cycles (Per cycle) |
10000 |
Y |
Beta - HCG report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0031 |
Gestational Trophoblast Ds. Low Risk |
Actinomycin- max 10 cycles (Per cycle) |
1000 |
Y |
Beta - HCG report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0032 |
Gestational Trophoblast Ds. Low Risk |
Weekly Methotrexate (Per week) max. 10 cycles |
1000 |
Y |
Beta - HCG report |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0033 |
Ovary Germ Cell Tumour |
Bleomycin-Etoposide-Cisplatin (BEP) - max cycles 4 (Per cycle) |
6000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0034 |
Prostate |
Hormonal Therapy - Per month |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0035 |
Testis |
Bleomycin-Etoposide-Cisplatin (BEP)- max cycles 4 (Per cycle) |
BEP regimen for germ cell tumour 10000/per cyclex4 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0036 |
Acute Myeloid Leukemia |
Induction Phase, up to |
Daunomycin and cytosine arabinoside (3:7) 100,000 |
Y |
Hematology |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| Bone Marrow Aspiration Report |
|
| M5 |
0037 |
Acute Myeloid Leukemia |
Consolidation Phase, up to |
High dose cytosine arabinoside 75000 x 3-4 cycles |
Y |
Hematology |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| Bone Marrow Aspiration Report |
|
| M5 |
0038 |
Histocytosis |
Variable Regimen-Histocyosis-max 1 year (Per month) |
8000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0039 |
Rhabdomyosarcoma |
Vincristine-Actinomycin-Cyclophosphamide (VACTC) based chemo - max 1 year (Per month) - Rhabdomyosarcoma |
6000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0040 |
Ewing’s Sarcoma |
Variable Regimen Inv - Hematology, Biopsy – Payable |
6000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0041 |
Unlisted Regimen |
Palliative CT- Max 6 cycles (Per cycle) |
5000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0042 |
Terminally Ill |
Palliative And Supportive Therapy - Per month |
3000 |
Y |
|
|
|
N |
M |
| M5 |
0043 |
Acute Lymphatic Leukemia |
Maintenance Phase - Per month |
5000 per month x 24 |
Y |
Hematology |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| Bone Marrow Aspiration Report |
|
| M5 |
0044 |
Acute Lymphatic Leukemia |
Induction |
50000 |
Y |
Hematology |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| Bone Marrow Aspiration Report |
|
| M5 |
0045 |
Acute Lymphatic Leukemia |
Consolidation Phase |
50000 |
Y |
Hematology |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| Bone Marrow Aspiration Report |
|
| M5 |
0046 |
Head and Neck |
Tab Geftinib/Erlotinib-Max 1 Year (Per month) |
3000 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0047 |
Renal cell carcinoma |
Sunitinib/ Pazopanib (per day) |
2500 |
Y |
Biopsy |
Chemotherapy drug
batch number with bar code |
|
N |
M |
| CT |
|
| M5 |
0048 |
chronic myeloid leukemia |
Imatinib |
6000/per month x 5 years |
Y |
|
Chemotherapy drug
batch number with bar code |
|
N |
M |
| M5 |
0049 |
Gall Bladder Cancer |
Gemcitabine + cisplatin |
10,000 per cycle for 6 cycle |
Y |
|
Chemotherapy drug
batch number with bar code |
|
N |
M |