| Specialty code |
Package Code |
Package name |
Package Amount |
Preauth Required or Not (Y/N) |
Mandatory investigations for pre-auth |
Post-Op investigations for claims submission |
Average length of Stay (Including Days in intensive care units) |
Govt Reserved Procedure (Y/N) |
Medical (M) or Surgical (S) |
| S16 |
0001 |
Fixation of fracture of jaw with closed reduction (1 jaw) using wires - under LA |
5,000 |
Y |
X ray |
|
|
N |
S |
| S16 |
0002 |
Fixation of fracture of jaw with open reduction (1 jaw) and fixing of plates/ wire – under GA |
12,000 |
Y |
X ray |
|
|
N |
S |
| S16 |
0003 |
Sequestrectomy |
1,500 |
Y |
Clinical Record |
|
|
N |
S |
| S16 |
0004 |
TM joint ankylosis of both jaws - under GA |
15,000 |
Y |
X ray |
|
|
N |
S |
| S16 |
0005 |
Release of fibrous bands & grafting -in (OSMF) treatment under GA |
3,000 |
Y |
Clinical Record |
|
|
N |
S |
| S16 |
0006 |
Extraction of impacted tooth under LA |
500 |
Y |
X ray |
|
|
N |
S |
| S16 |
0007 |
Cyst & tumour of Maxilla/mandible by enucleation/excision/marsupialization under LA |
2,500 |
Y |
X ray |
|
|
N |
S |
| S16 |
0008 |
Mandible Tumour Resection and reconstruction/Cancer surgery |
6,000 |
Y |
X ray |
|
|
N |
S |
| S16 |
0009 |
Cleft lip and palate surgery (each stage) |
15,000 |
Y |
Clinical Picture |
|
|
N |
S |
| S16 |
0010 |
Fistulectomy |
8500 |
Y |
Clinical record |
|
|
N |
S |
| S16 |
0011 |
Tumour excision |
7500 |
Y |
Clinical record |
|
|
N |
S |
| S16 |
0012 |
Apisectomy including LA |
550 |
|
|
|
|
N |
S |
| S16 |
0013 |
Flap operation per tooth |
350 |
|
|
|
|
N |
S |
| S16 |
0014 |
Fracture wiring including LA |
600 |
|
|
|
|
N |
S |
| S16 |
0015 |
Gingivectomy per tooth |
250 |
|
|
|
|
N |
S |
| S16 |
0016 |
Impacted molar including LA |
550 |
|
|
|
|
N |
S |
| S16 |
0017 |
Drainage of parotid abscess |
7000 |
|
|
|
|
N |
S |
| S16 |
0018 |
Exicision of mandible |
12000 |
|
|
|
|
N |
S |
| S16 |
0019 |
Repair of parotid duct |
15000 |
Y |
Clinical Record |
|
|
N |
S |
| S16 |
0020 |
Abscess incision |
250 |
|
|
|
|
N |
S |
| S16 |
0021 |
All extrction in one jaw |
300 |
|
|
|
|
N |
S |
| S16 |
0022 |
Alveolectomy per tooth |
250 |
|
|
|
|
N |
S |
| S16 |
0023 |
Apical curettage per tooth |
250 |
|
|
|
|
N |
S |
| S16 |
0024 |
condylectomy |
1500 |
|
|
|
|
N |
S |
| S16 |
0025 |
Fistula claosure |
350 |
|
|
|
|
N |
S |
| S16 |
0026 |
Gingivectomy full mouth |
1500 |
|
|
|
|
N |
S |
| S16 |
0027 |
Frenectomy |
150 |
|
|
|
|
N |
S |
| S16 |
0028 |
Growth removal |
250 |
|
|
|
|
N |
S |
| S16 |
0029 |
Osteotomy |
1000 |
|
|
|
|
N |
S |
| S16 |
0030 |
Pericoronotomy |
200 |
|
|
|
|
N |
S |
| S16 |
0031 |
Pulpotomy |
250 |
|
|
|
|
N |
S |
| S16 |
0032 |
Removal of impaction |
250 |
|
|
|
|
N |
S |
| S16 |
0033 |
Segmental resection of jae |
1500 |
|
|
|
|
N |
S |
| S16 |
0036 |
Complete denture |
1500 |
|
|
|
|
N |
S |
| S16 |
0037 |
Removable partial denture |
150 |
|
|
|
|
N |
S |
| S16 |
0038 |
Restoration of teeth per tooth |
200 |
|
|
|
|
N |
S |
| S16 |
0040 |
Root canal treatment per tooth |
500 |
|
|
|
|
N |
S |
| S16 |
0041 |
Metal crown per cap |
200 |
|
|
|
|
N |
S |
| S16 |
0042 |
Ceramic crown per cap |
600 |
|
|
|
|
N |
S |