51
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008 (Notification No. 796-F (MED) dated 31-01-2011) 1 01 – PROCEDURES CODE NAME OF TREATMENT PROCEDURE Maximum Approved Rate (INR) (Rupees) 001 General 01001001 Consultation by Medical Officer (OPD) 150/- 01001002 Consultation by Specialists (OPD) 200/- 01001003 Visit/ Revisit/ Consultation by Specialists (Indoor) (Maximum two visits per day admissible) 200/- 01001004 Consultation by Super- Specialists (OPD) 250/- 01001005 Visit/ Revisit/ Consultation by Super-Specialists (Indoor) (Maximum two visits per day admissible) 250/- 01001006 Pre-operative Anaesthetic Consultation 200/- 01001007 Paramedical Consultation 75/- 01001008 Special Nursing Charge (per shift of 12 hrs.) 150/- 01001009 Aya/ Attendant Charge (per shift of 12 hrs.) 75/- 01001010 Delayed primary suture 1700/- 01001011 Dressings Large 160/- 01001012 Suturing without local anesthesia 400/- 01001013 Suturing of wounds with local anesthesia 500/- 01001014 Debridement of wounds 1200/- 01001015 Removal of Benign Tumor 1100/- 01001016 Aspiration Plural Effusion - Therapeutic 1000/- 01001017 Abdominal Aspiration - Therapeutic 1300/- 01001018 Removal of F.B. Superficial 1200/- 01001019 Bone Marrow Aspiration 1500/- 01001020 Joints Aspiration 1500/- 01001021 Strapping 100/- 01001022 Removal of Stitches 60/- 01001023 Venesection 300/- 01001024 Phimosis Under LA 1500/- CODE NAME OF TREATMENT PROCEDURE Maximum Approved Rate (INR) (Rupees) 01001025 Lumbar puncture 700/- 01001026 Sternal puncture 1500/- 01001027 Injection for Haemorrhoids 1000/- 01001028 Injection for Varicose Veins 1300/- 01001029 Catheterisation 120/- 01001030 Dilatation of Urethra 1100/- 01001031 Incision & Drainage 600/- 01001032 Intercostal Drainage 1500/- 01001033 Peritoneal dialysis 1800/- 01001034 Removal of soft tissue or regional block under general anaesthesia 2400/- 01001035 Dressing Small 100/- 01001036 Secondary suture of wounds 1200/- 002 Skin 01002001 Excision of Moles 600/- 01002002 Excision of Warts 600/- 01002003 Excision of Molluscum contagiosum 600/- 01002004 Excision of Veneral Warts 600/- 01002005 Excision of Corns 550/- 01002006 I/D Injection Keloid of Acne 300/- 01002007 Chemical Cautery (per sittings) 120/- 01002008 Excision of Sebaceous Cysts 1700/- 01002009 Excision of Superficial Liipoma 2400/- 01002010 Excision of Dermoid Cysts 2450/- 003 E.N.T. 01003001 Speech therapy per session of 30-40 minutes 200/- 01003002 Removal of foreign body From Nose/ Ear/ Throat (Day care package) 1500/- 01003003 Swallowing Therapy 250/- 01003004 Syringing 300/- 01003005 Polyp removal under LA 800/- 01003006 Peritonsillar abscess drainage under LA 1600/- 01003007 Tinnitus Retraining Therapy 250/-

13.Revised Rate List

  • Upload
    aicbal

  • View
    8.938

  • Download
    0

Embed Size (px)

DESCRIPTION

West Bengal Health Scheme 2008

Citation preview

Page 1: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

1

01 – PROCEDURES

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

001 General

01001001

Consultation by Medical Officer (OPD) 150/-

01001002 Consultation by

Specialists (OPD) 200/-

01001003

Visit/ Revisit/ Consultation by Specialists (Indoor)

(Maximum two visits per day admissible) 200/-

01001004 Consultation by Super-

Specialists (OPD) 250/-

01001005

Visit/ Revisit/ Consultation by Super-Specialists

(Indoor) (Maximum two visits per

day admissible) 250/-

01001006 Pre-operative Anaesthetic

Consultation 200/-

01001007 Paramedical Consultation 75/-

01001008 Special Nursing Charge

(per shift of 12 hrs.) 150/-

01001009 Aya/ Attendant Charge

(per shift of 12 hrs.) 75/-

01001010 Delayed primary suture 1700/-

01001011 Dressings Large 160/-

01001012 Suturing without local

anesthesia 400/-

01001013 Suturing of wounds with

local anesthesia 500/-

01001014 Debridement of wounds 1200/-

01001015 Removal of Benign Tumor 1100/-

01001016 Aspiration Plural Effusion -

Therapeutic 1000/-

01001017 Abdominal Aspiration -

Therapeutic 1300/-

01001018 Removal of F.B.

Superficial 1200/-

01001019 Bone Marrow Aspiration 1500/-

01001020 Joints Aspiration 1500/-

01001021 Strapping 100/-

01001022 Removal of Stitches 60/-

01001023 Venesection 300/-

01001024 Phimosis Under LA 1500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01001025 Lumbar puncture 700/-

01001026 Sternal puncture 1500/-

01001027 Injection for Haemorrhoids 1000/-

01001028 Injection for Varicose

Veins 1300/-

01001029 Catheterisation 120/-

01001030 Dilatation of Urethra 1100/-

01001031 Incision & Drainage 600/-

01001032 Intercostal Drainage 1500/-

01001033 Peritoneal dialysis 1800/-

01001034

Removal of soft tissue or regional block under general anaesthesia

2400/-

01001035 Dressing Small 100/-

01001036 Secondary suture of

wounds 1200/-

002 Skin

01002001 Excision of Moles 600/-

01002002 Excision of Warts 600/-

01002003 Excision of Molluscum

contagiosum 600/-

01002004 Excision of Veneral Warts 600/-

01002005 Excision of Corns 550/-

01002006 I/D Injection Keloid of

Acne 300/-

01002007 Chemical Cautery (per

sittings) 120/-

01002008 Excision of Sebaceous

Cysts 1700/-

01002009 Excision of Superficial

Liipoma 2400/-

01002010 Excision of Dermoid Cysts 2450/-

003 E.N.T.

01003001 Speech therapy per

session of 30-40 minutes 200/-

01003002

Removal of foreign body From Nose/ Ear/ Throat

(Day care package) 1500/-

01003003 Swallowing Therapy 250/-

01003004 Syringing 300/-

01003005 Polyp removal under LA 800/-

01003006 Peritonsillar abscess drainage under LA 1600/-

01003007 Tinnitus Retraining

Therapy 250/-

Page 2: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

2

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01003008 Myringoplasty 10700/-

01003009 Staepedectomy 12000/-

01003010 Myringotomy with Grommet insertion 6000/-

01003011 Endoscopic Removal of

Fish Bone 1000/-

01003012 Tympanotomy 8000/-

01003013 Paracentesis 4300/-

01003014 Tympanoplasty 14000/-

01003015 Mastoidectomy 15600/-

01003016 Otoplasty 16500/-

01003017 Labyrinthectomy 15600/-

01003018 Skull Base surgery 50000/-

01003019 Facial Nerve

Decompression 20000/-

01003020 Septoplasty 10200/-

01003021 Submucous Resection 10800/-

01003022 Septo-rhinoplasty 15000/-

01003023 Rhinoplasty (non-

cosmetic) 12000/-

01003024 Fracture Reduction 9000/-

01003025 Intra Nasal Diathermy 6000/-

01003026 Turbinectomy 9600/-

01003027 Endoscopic DCR 13000/-

01003028 Endoscopic Surgery 15000/-

01003029 Septal Perf. Repair 15000/-

01003030 Antrum Puncture 3000/-

01003031 Lateral Rhinotomy 1350/-

01003032 Cranio-facial resection 28000/-

01003033 Ethamoidectomy 17600/-

01003034 Caldwell Luc Surgery 12000/-

01003035 Angiofibroma Excision 18000/-

01003036 Endoscopic

Hypophysectomy 25000/-

01003037 Endoscopic Optic Nerve

Decompression 32000/-

01003038 Decompression of Orbit 30000/-

01003039 Ranula Excision 9600/-

01003040 Tongue Tie excision 8100/-

01003041 Sub Mandibular Duct

Lithotomy 9700/-

01003042 Adenoidectomy 8000/-

01003043 Palatopharyngoplasty 15100/-

01003044 Cleft Palate repair 16000/-

01003045 Pharyngoplasty 18000/-

01003046 Styloidectomy 11500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01003047 Uvulo-palatoplasty 20000/-

01003048 Tympanomastoidectomy 15600/-

01003049 Dacunisation 7000/-

01003050 Tonsillectomy 11200/-

01003051 Adenotonsillectomy 13500/-

01003052 Synichiolysis 4200/-

01003053 Submucosal Diathermy 4000/-

01003054 Nasal Mass Excision-

Simple 11200/-

01003055 Nasal Mass Excision- Endoscopic Removal 13500/-

01003056 FESS 11200/-

01003057 Anterior Nasal Packing 4000/-

01003058 Post Nasal Packing 5000/-

01003059 Nasal Bone Reduction 6000/-

004 Opthalmology

01004001

Cauterisation of ulcer/subconjuctival injection - One eye 200/-

01004002

Cauterisation of ulcer/subconjuctival injection - Both eyes 300/-

01004003 Retrobular Injection - One

Eye 200/-

01004004 Retrobular Injection - Both

Eyes 300/-

01004005 Syringing of Lacrimal Sac

-For one eye 200/-

01004006 Syringing of Lacrimal Sac

- For both eyes 300/-

01004007 Paracentesis 800/-

01004008 Foreign body removal 300/-

01004009 Refraction/Fundoscopy 90/-

01004010 Ortho-optic exercises 100/-

01004011 Plepoptic Exercises 100/-

01004012 Chalazion operation -One

Eye 800/-

01004013 Chalazion operation -

Both Eyes 1000/-

01004014 Dressing (Eye) 100/-

01004015 Clinical Photography 100/-

01004016 Pterygium 2200/-

01004017 Orbitotomy 9000/-

01004018 Ptosis correction. 6500/-

01004019 Ectropion Correction 3600/-

01004020 Xenon Arc Laser 700/-

Page 3: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

3

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01004021 D C R (Dacryo custo-

rhinostomy) 5700/-

01004022 ECCE/ICCE 6000/-

01004023 Epicanthus correction. 2100/-

01004024 Squint Correction (one

eye) 4000/-

01004025 Squint Correction (both

eyes) 6000/-

01004026 Keratoplasty 14000/-

01004027 Trabeculotomy 5700/-

01004028 Iridectomy 2400/-

01004029 Goniotomy 2400/-

01004030 Scleral Bukling (Retinal Detachment Surgery) 14000/-

01004031 Syringing & Probing 1100/-

01004032 Vitrectomy 11000/-

01004033 Enucleation 4000/-

01004034 Eviseration 3800/-

01004035 Entropion correction 3000/-

01004036 Cataract with IOL(Cost of

lens extra) 7500/-

01004037 Fistulectomy 5700/-

01004038 Glucoma surgery with

Glucoma valves 5000/-

01004039 Caliculoplasty 3000/-

01004040 Dacryocystectomy 3000/-

01004041 Ptosis surgery with LPS

resection 7000/-

01004042 Ptosis surgery with Sling

surgery 7000/-

01004043 Ectropion surgery- one lid 3000/-

01004044 Ectropion surgery- both

lids 4000/-

01004045 Cheek rotation flap for lid

tumors 8000/-

01004046 Telecanthus correction 4000/-

01004047 Fracture orbital repair 9000/-

01004048 Lasik 18000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01004049 TTT- Transpupillary

thermal therapy 4000/-

01004050 PTK- Phototherapeutic

keratectomy 9000/-

01004051 Iris cyst removal 1000/-

01004052 Lid Abscess incision and

drainage 3000/-

01004053 Orbital Abscess incision

and drainage 4000/-

01004054 Cyclodiathermy 2000/-

01004055 Perforating injury repair 4000/-

01004056

Phaco + IOL (inclusive of Foldable & Non-foldable

lens) Package 14500/-

01004057 YAG Laser Capsulotomy

per sitting 600/-

01004058 YAG Laser Iridectomy per

sitting 600/-

01004059

Argon Laser Trabeculoplasty (ALT)

(per sitting) 1000/-

01004060 HVF 500/-

01004061 Cryopexy 1200/-

01004062 ICG including Medicine 2000/-

01004063 ICG- Double including

Medicine 3600/-

01004064 Electrolysis (Per sitting) 150/-

01004065 Cyclocryo/

Cyclodiathermy 500/-

01004066 D.C.T. (OPD) 800/-

01004067 Silicone Oil (1000) 4000/-

01004068 Silicone Oil (C5) 4000/-

01004069 Silicone Oil Removal 3500/-

01004070 Pneumo Retinopexy 2400/-

Page 4: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

4

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01004071 FGE/ FAE 1500/-

01004072 Indirect Laser 1000/-

01004073 Endo Laser 2400/-

01004074 SF6 Gas 2400/-

01004075 C3F8 Gas 2400/-

01004076 PFCL 2400/-

01004077

Photodynamic Therapy procedure charges- single

eye 15000/-

01004078

Photodynamic Therapy procedure charges- both

eyes 25000/-

01004079 Photodynamic Therapy

(single eye) 85000/-

01004080 Photodynamic Therapy

(both eyes) 100000/-

01004081

Intravitreal Avastin (including cost of injection-

single) 6000/-

01004082

Intravitreal Lucentis (excluding cost of injection-single) 4000/-

01004083

Intravitreal Macugen (excluding cost of injection-single) 4000/-

01004084

Intravitreal injections of antibiotics (cost of medicines extra) 2000/-

01004085 Retinal Foreign Body

Removal 4000/-

01004086 PPV/ Victerectomy 6500/-

01004087 Endo Diathermy 1600/-

01004088 Belt Buckle 3200/-

01004089 IVTCA 800/-

01004090 Membrane Peeling 2400/-

01004091 Anterior Vitrectomy 5000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01004092 Lensectomy 7500/-

01004093 Orbitotomy (Multiple Wall) 16000/-

01004094 ERM (Epi Retinal

Membrane) 3600/-

01004095 Reti Blue 2400/-

01004096 Corneal Collagen Cross-

linking 15000/-

005

Biopsies including Histopathological report

(Package)

01005001 Biopsy procedure under

Local Anaesthesia 4000/-

01005002 Biopsy procedure under

General Anaesthesia 6000/-

01005003 Biopsy procedure under

Endoscopy 8000/-

01005004 FNAC 3500/-

006 Strapping (including Bandage & materials)

01006001 Strapping of Finger 200/-

01006002 Strapping of Toes 200/-

01006003 Strapping of Wrist 360/-

01006004 Strapping of Elbow 400/-

01006005 Strapping of Knee 400/-

01006006 Strapping of Ankle 400/-

01006007 Strapping of Chest 500/-

01006008 Strapping of Shoulder 450/-

01006009 Nasal bone fracture 450/-

01006010 Figure of 8 bandage 450/-

01006011 Colar and cuff sling 450/-

01006012 Ball bandage 450/-

007 Physiotheraphy &

Traction

01007001 Ultrasonic therapy (per

sitting) 70/-

01007002 S.W. Diathermy (per

sitting) 90/-

01007003 Electrical stimulation

(therapeutic) (per sitting) 70/-

01007004 Infra red (per sitting) 90/-

01007005 U.V. Therapeutic dose

(per sitting) 90/-

01007006 Electric vibrator (per

sitting) 90/-

Page 5: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

5

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01007007 Vibrator belt massage

(per sitting) 90/-

01007008 Intra Lumbar Traction

(per sitting) 90/-

01007009 Intermittent Cervical traction (per sitting) 70/-

01007010

Combined Lumbar & Cervical traction (per

sitting) 70/-

01007011 Wax bath (per sitting) 50/-

01007012 Hot pack (per sitting) 70/-

01007013 Whirl pool bath (per

sitting) 90/-

01007014 Obesity Exercises (per

sitting) 60/-

01007015

Breathing Exercises & Postural Drainage (per

sitting) 70/-

01007016 Cerebral Palsy – Massage

(per sitting) 90/-

01007017 Post – polio exercise (per

sitting) 60/-

01007018 Basic Gait Training (Per

Session) 80/-

01007019 Traction + IFT 150/-

01007020 Traction + Stimulation 100/-

01007021 Traction + SWD 100/-

01007022 Traction + SWD + IFT 200/-

01007023 Traction + US 140/-

01007024 Traction + US + IFT 200/-

01007025 Traction + US + IFT +

Exercises 260/-

01007026 Traction + US + IFT +

SWD 260/-

01007027 IFT + PWB 150/-

01007028 Exercise- per sitting 60/-

01007029 PWB + Knee Joint Spad

Fraction 100/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01007030 SWD + IFT 100/-

01007031 US + IFT 100/-

01007032 US + IFT + Stimulation 200/-

01007033 US + Knee Joint + Spad

Fraction 100/-

01007034 US + PWB 100/-

01007035 US + SW + Traction 200/-

01007036 US + Tens 100/-

01007037 US + Stimulation 100/-

01007038 Knee Joints Spad Fraction 100/-

01007039 Electronic Tilt Training-

Per Session 100/-

01007040 Interferential Therapy 100/-

01007041 Laser Treatment- Per

Session 150/-

01007042 Microwave Diathermy- Per

Session 150/-

01007043 Quadriceps Chair Training

(Per Session) 100/-

01007044 Tens 80/-

008 Dental

01008001 Extraction of tooth

including LA 120/-

01008002 Complicated Ext. per Tooth including LA 250/-

01008003 Flap Operation per Tooth 500/-

01008004 Gingivectomy per tooth 300/-

01008005 Cyst under LA (small) 300/-

01008006 Cyst under LA (large) 500/-

01008007 Impacted Molar including

LA 800/-

01008008 Apisectomy including LA 1000/-

01008009 Fracture wiring including

LA 80/-

01008010

Reduction & immobilisation of fracture-

Maxilla under LA 1400/-

Page 6: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

6

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01008011

Reduction & immobilisation of fracture-

Mandible under LA 3000/-

01008012

Splints/ Circum mandibular wiring under

GA 2000/-

01008013

Internal wire fixation/ plate fixation of Maxilla under

LA 4000/-

01008014

Internal wire fixation/ plate fixation of Maxilla under

GA 6000/-

01008015

Internal wire fixation/ plate fixation of Mandible under

LA/GA 6000/-

01008016

Cyst & Tumour of Maxilla/ mandible by enucleation/

excision (package) 2000/-

01008017 TM joint ankylosis- under

GA (package) 11000/-

01008018 Hemi-mandibulectomy

with graft (package) 7000/-

01008019 Hemi-mandibulectomy without graft (package) 4000/-

01008020

Segmental- mandibulectomy with graft

(package) 6000/-

01008021

Segmental- mandibulectomy without

graft (package) 2000/-

01008022 Maxillectomy- partial with

graft (package) 5000/-

01008023 Maxillectomy- partial

without graft (package) 4000/-

01008024

Maxillo-facial prosthesis (sal/ auricular/ orbital/

facial lost part) (package) 5000/-

01008025 Alvelolectomy,

Frenectomy per Quadrant 1150/-

01008026 Alvelolectomy (minor) 380/-

01008027 Amalgam Filling/tooth

(compound) 450/-

01008028 Amalgam Filling/tooth

(regular) 380/-

01008029 Apicoectomy Molar Tooth 2250/-

01008030 Arch Bar Removal 380/-

01008031 Bite Plate/ Retainers 1150/- 01008032 Cast Rpd (per Tooth) 380/-

01008033 Davis Crown/ radicular

Screw supported 1900/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01008034 De Sensitising per sitting 200/-

01008035 Dento Alveolar Fracture

Reduction & Splinting/l.a. 1500/-

01008036 Denture Repair

(category1) 230/-

01008037 Dialation of Whartons

Duct under L.A. 1150/-

01008038 Direct/ indirect Pulp

Capping 230/-

01008039 Drain. of Dento Alveolar

Absce. (ex. Oral) 950/-

01008040 Enucleation of Cyst of

Oral Cavity 2000/-

01008041 Fibre Post Based Post &

Core 1900/-

01008042 Floride Application (per

sitting) 400/-

01008043 Extraction of Impacted

Tooth By Operation 400/-

01008044 Extraction of MISP Tooth by Operation (Open Meth) 1150/-

01008045 GTR (Guided Tissue

Regeneration) 1900/-

01008046 Gingivectomy per

Quadrant 750/-

01008047 Glass Ionomer Filling 400/-

01008048 Glass Ionomes Filling 450/-

01008049 Interdental Wiring 1150/-

01008050 Intra Articular Inj. of

Steroids in TMJ 900/-

01008051 Jacket Crown Acrylic 1500/-

01008052

Minor Dento-alveolar Tracture Reduction &

Splinting/la 950/-

01008053

Post Core/ tooth (cast Post) lab Metal Chgs.

Extra 1150/-

01008054 Post Core/ tooth (pin Retained.comp.core) 750/-

01008055

Post Core/ tooth Screw/pin Retain.

amalgm. 550/-

01008056 Preformed Carbonate

Jacket Crown 750/-

Page 7: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

7

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01008057 Preformed Steel Crown 1150/-

01008058 Pulpotomy 750/-

01008059 Reduction of Dislocation

of Tmj (Under LA.) 1400/-

01008060 Reimplantation (per

Tooth) 3400/-

01008061 Removal Partial Denture

(1st Tooth) 400/-

01008062 Removable Partial

Denture (Additional Tooth) 230/-

01008063

Removable Partial Denture per Tooth (Palatal

Bar) 750/-

01008064 Repair of Facial Soft

Tissue Laceration 1150/-

01008065 Repair of Facial Soft

Tissue Laceration (minor) 750/-

01008066 Root Canal Treatment

(Upto 4 Sitting) 1150/-

01008067 Root Canal Treatment

(Extra Sitting) 400/-

01008068

Root Canal Treatment with Filling and Crown

(package) (Lab. Charges extra) 3600/-

01008069 Scaling per Sitting 400/-

01008070 Sialolithotomy for Small

Stones 115/-

01008071

Surgical Extraction or Surgical Removal of

Impact (package) 1150/-

01008072

Surgical Removal of Benin Reoplasm of Oral

(package) 1500/-

01008073 Surgical Removal of Soft Tissue Lesion (package) 1150/-

01008074

Surgical Removal of Impact Mesiod.tuber

(package) 1150/-

009 ITU/CCU CHARGES

(Special Care Cases)

01009001

ICU/ITU/CCU/NICU/PICU (including:- Oxygen; ECG/SPO2/NIBP/IBP

monitoring; 1:2 Nursing ë GNM Nursing; Round the Clock Doctor (Resident on spot); Diet; Syringe Pump) 2400/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01009002

Ventilator charge (including accessories)

per day 1000/-

01009003 Pneupack Ventilator in

Nursery (per day) 800/-

01009004 High Definition Unit/ Step Down (including Oxygen) 1500/-

01009005 Exchange Transfusion 1200/-

01009006 O.T. Charges for

Exchange transfusion 400/-

010 Oxygen Charges

01010001 Private/ Semi-private/

General Ward per hour 60/-

011 Burn Cases

01011001

upto 30% Burns 1st Dressing (excluding

dressing materials and medicines) 700/-

01011002

upto 30% Burns Subsequent Dressing (excluding dressing

materials and medicines) 700/-

01011003

30% to 50% Burns 1st Dressing (excluding

dressing materials and medicines) 700/-

01011004

30% to 50% Burns Subsequent Dressing (excluding dressing

materials and medicines) 700/-

01011005

Extensive Burn above 50% Frist Dressing (excluding dressing

materials and medicines) 1500/-

01011006

Extensive Burn above 50% Subsequent dressing

(excluding dressing materials and medicines) 1500/-

01011007 Burn Unit Bed (including

Oxygen) 1500/-

012 Obstetric &

Gynaecology Cases

01012001 Normal delivery or with Episiotomy & P. repair 12000/-

01012002 Low Forceps 12000/-

01012003 Low midcavity forceps 14000/-

01012004 Cesarean Section 20000/-

01012005 Cesarean Hysterectomy 22000/-

Page 8: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

8

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01012006 Rupture Uterus- closure & repair with Tubal Ligation 22000/-

01012007

Perforation of Uterus after D/E Laparotomy &

Closure 18000/-

01012008 Laparotomy-peritonitis Lavage and Drainage 16000/-

01012009 Laparotomy-failed

laparoscopy to explore 6100/-

01012010 Salphingectomy 14000/-

01012011 Salphingo-Oophorectomy 18000/-

01012012 Ovarean Cystectomy 18000/-

01012013 Oopherctomy 15000/-

01012014 Broad Ligment

Haemotoma Drainage 12000/-

01012015

Exploration of perineal Haematoma & Resuturing

of Episiotomy 12000/-

01012016

Exploration of abdominal Haematoma (after

laparotomy + LUCS) 12000/-

01012017 Internal podalic version

and extraction 12000/-

01012018 Manual Removal of

Placenta 3700/-

01012019

3rd stage Complication MRP for outside delivery

etc 4900/-

01012020 Examination under

anaesthesia 2500/-

01012021 Burst-abdomen Repair 3300/-

01012022 Gaping Pareneal Wound

Secondary Suturing 2500/-

01012023 Gaping abdominal wound

Secondary Suturing 3700/-

01012024 Complete perineal tear-

repair 2500/-

01012025 Exploration of PPH-tear

repair 4200/-

01012026 Destructive Operation 12000/-

01012027

Suction evacuation vesicular mole, Missed

abortion D/E 5900/-

01012028 Colpotomy-drainage P/V

needling EUA 4200/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01012029 Repair of post-coital tear,

perineal injury 4200/-

01012030 Excision of urethral

caruncle 4000/-

01012031 Laparoscopy (Gynae) 6100/-

01012032 Shirodhkar, Mc. Donalds

stich 3700/-

01012033 Laparotomy 20000/-

01012034 Abdominal Hysterectomy 22000/-

01012035 Vaginal Hysterectomy 22000/-

01012036 Myomectomy 22000/-

01012037 Vaginoplasty 22000/-

01012038 Vulvectomy

(Simple/Radical) 25000/-

01012039 RVF Repair 25000/-

01012040 Other Major Operations 25000/-

01012041 Manchester Operations 20000/-

01012042 Perineorrhaphy 14700/-

01012043 Colporraphy 14400/-

01012044 Modified Gilliam 16900/-

01012045 Shirodkar’s Operation 10200/-

01012046 Diagnostic Curettage 2700/-

01012047 Fractional Curettage 3400/-

01012048 D & C and Cervical Biopsy 3400/-

01012049 Polypectomy 3600/-

01012050 Other-Minor Operation 3600/-

01012051 Excision Vaginal

Cyst/Burtholin Cyst 3900/-

Page 9: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

9

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01012052 Excision Vaginal Septum 5900/-

01012053 Laparoscopy Diagnostic 6000/-

01012054 Laparoscopy Sterilisation 7300/-

01012055 Laparoscopy Operative 12000/-

01012056 Laparoscopy LAVH 25000/-

01012057 Drilling of Ovary 10800/-

01012058 Adhesiolysis 17400/-

01012059 Management of Ectopic

pregnancy 20000/-

01012060 Hysteroscopy TCRE 11500/-

01012061 Hysteroscopy Removal of

IUCD 5500/-

01012062 Hysteroscopy Removal of

Septum 11500/-

01012063 Hysteroscopy Diagnostic 7300/-

01012064 Werthimas Hystrectomy

for Cancer cervix 30000/-

01012065 Sterilisation Post Pertum 4700/-

01012066 Sterilisation Intravaginal 6000/-

01012067 Abortion- D & C 3900/-

01012068 Abortion- Evacuation 4200/-

01012069 MTP- 1st Trimester 3200/-

01012070 MTP - 2nd Trimester 4800/-

01012071 Extended Hysterectomy 28000/-

013 General Surgery

01013001 Drainage of Abscess 2000/-

01013002 Dressing under G.A. 2400/-

01013003 Aspiration of cold Abscess

of Lymphnode 3100/-

01013004 Aspiration of Empyema 2400/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01013005 Aspiration of Liver

Abscess 3000/-

01013006 Open Drainage of Liver

Abscess 10000/-

01013007 Drainage of Pelvic

Abscess 10000/-

01013008 Drainage of Ischiorectal

Abscess 8000/-

01013009

Drainage of Subdiaphragmatic

Abscess 14000/-

01013010 Open Drainage of

Perinepheric Abscess 14000/-

01013011 Drainage of Perigastric

Abscess 12000/-

01013012 Drainage of Perotid

Abscess 8000/-

01013013 Drainage of

Retropharyngeal Abscess 8000/-

01013014 Open Drainage of Psoas

Abscess 8000/-

01013015 Open Drainage of

Perivertebral Abscess 10000/-

01013016

Fissurectomy/ Haemorroidectomy/ Correction of Piles 16000/-

01013017

Haemorroidectomy/ Correction of Piles with Stapler Gun

(cost of Gun extra) 16000/-

01013018 Excision of Superficial

Neurofibroma 2800/-

01013019 Varicose Veins 25000/-

01013020 Excision of Carbuncle 4000/-

014 Injury Of Superficial Soft

Tissues

015 Interestical (Implant)

01015001 Head & Neck 9700/-

01015002 Breast 9600/-

01015003 Soft Tissue Sarcome 12000/-

016 GASTROENTROLOGY

01016001 Capsule Endoscopy 30000/-

Page 10: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

10

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01016002 Complete Double Baloon

Enteroscopy 18000/-

01016003 Complete Small Bowel

Evaluation 30000/-

01016004 Argan Plasma Coa

(Major) 5000/-

01016005 Argan Plasma Coa

(Major) (BS) 6500/-

01016006 Argan Plasma Coa

(Minor) 2200/-

01016007 Argan Plasma Coa

(Minor) (BS) 3000/-

01016008 Band Ligation 3500/-

01016009 Band Ligation (BS) 5500/-

01016010 Biliary Brushing 1000/-

01016011 Biliary Brushing (BS) 1600/-

01016012 Biliary Pancreatic (M) 16000/-

01016013 Biliary Pancreatic (M) (BS) 23000/-

01016014 Biliary Pancreatic (P) 13300/-

01016015 Biliary Pancreatic (P) (BS) 18000/-

01016016 Cre Ballon Dilatation (BS) 15000/-

01016017 Cre Balloon Dilatation 9000/-

01016018 Dilatation (Stricture) 3000/-

01016019 Dilatation (Stricture) (BS) 4200/-

01016020 EMG Charge (Large) 3500/-

01016021 EMG Charge (Small) 1500/-

01016022 Endoscopic Tube Place 3000/-

01016023 Endoscopic Tube Place

(BS) 4200/-

01016024 Oesophageal Transit 1200/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01016025 Gastrostomy (PEG) 7000/-

01016026 Gastrostomy (PEG) (BS) 11000/-

01016027 Glue Injection 4500/-

01016028 Glue Injection (BS) 7000/-

01016029 Hemosta by Glod Probe 7000/-

01016030 Hemostatic Clip 7000/-

01016031 Hemostatic Clip (BS) 10000/-

01016032 Hepatonorm 700/-

01016033 Injection Hemostasis 4000/-

01016034 Injection Hemostasis (BS) 6000/-

01016035 LGI Manometry 4000/-

01016036 LGI Manometry (BS) 6000/-

01016037 UGI Manometry 3200/-

01016038 UGI Manometry (BS) 4500/-

01016039 Nasobiliary Drainage 12000/-

01016040 Nasobiliary Drainage (BS) 18000/-

01016041 Nasojejunal Tube Plac 3000/-

01016042 Nasojejunal Tube Plac

(BS) 4200/-

01016043 Papilla Cannu Minor 6500/-

01016044 Papilla Cannu Minor (BS) 8200/-

01016045 Pappu Stnt Spingt (M) 12000/-

01016046 Pappu Stnt Spingt (M)

(BS) 17500/-

01016047 Polypectomy (Colonic) 3200/-

Page 11: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

11

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01016048 Polypectomy (Colonic)

(BS) 4800/-

01016049 Polypectomy (Upper GI) 3000/-

01016050 Polypectomy (Upper GI)

(BS) 4500/-

01016051 Pre Cutting 4500/-

01016052 Pre Cutting (BS) 7500/-

01016053 Pseudocyst Drainage 9000/-

01016054 Pseudocyst Drainage (BS) 16000/-

01016055 Sclerotherapy 3000/-

01016056 Sclerotherapy (BS) 3800/-

01016057 Small Bowel Enteroscp 14000/-

01016058 Sphincterotomy 10500/-

01016059 Sphincterotomy (BS) 16000/-

01016060 Stone Extraction 12000/-

01016061 Stone Extraction (BS) 17000/-

01016062 Gastric Emptying 2500/-

01016063 Mechanical Lithotripsy 25000/-

01016064 ERCP (Stenting) 10000/-

017 Head & Neck

01017001 Ear Lobe Repair one side 600/-

01017002

Excision of Pinna for Growth (Squamous/Basal/

Injuries) Skin Only 4500/-

01017003

Excision of Pinna for Growth (Squamous/Basal/

Injuries) Skin and Cartilage 6000/-

01017004 Partial Amputation of

Pinna 6000/-

01017005 Total Amputation of Pinna 7500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01017006

Total Amputation & Excision of External

Auditory Meatus 10250/-

01017007 Excision of Cystic Hygroma Minor 5500/-

01017008 Excision of Cystic Hygroma Major 8000/-

01017009 Excision of Cystic

Hygroma Extensive 12300/-

01017010 Excision of Branchial Cyst 11000/-

01017011 Excision of Branchial

Sinus 11000/-

01017012 Excision of Pharyngeal

Diverticulum 12200/-

01017013 Mandibulectomy

25000/-

01017014 Operation for Cervical Rib 30000/-

01017015 Pharyngectomy 35000/-

01017016 Stenosis Excision 17000/-

01017017 Commando Operation 27000/-

01017018 Block Dissection of

Cervical Lymph Nodes 20300/-

01017019 Pharyngectomy &

Reconstruction 40000/-

01017020 Operation for Carcinoma

Lip - Wedge Excision 10000/-

01017021 Operation for Carcinoma

Lip - Vermilionectomy 10000/-

01017022

Operation for Carcinoma Lip - Wedge Excision and

Vermilonectomy 12000/-

01017023 Estlander Operation 9700/-

01017024 Abbe Operation 12000/-

01017025 Cheek Advancement 10200/-

01017026 Excision of the Maxilla 23300/-

01017027 Excision of the Mandible -

Segmental 18100/-

01017028 Hemimandibulectomy 27200/-

01017029 Partial Glossectomy 6100/-

01017030 Hemiglossectomy 13500-

01017031 Total Glossectomy 25000/-

01017032 Parotidectomy -

Superficial 24000/-

Page 12: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

12

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01017033 Parotidectomy -

Conservative 19700/-

01017034 Parotidectomy - Radical 22000/-

01017035 Parotidectomy - Total 15000/-

01017036 Repair of Parotid Duct 20400/-

01017037

Removal of Submandibular Salivary

gland 10000/-

01017038 Hemithyroidectomy 15000/-

01017039 Partial Thyroidectomy 16000/-

01017040 Subtotal Thyroidectomy

(Toxic Goitre) 22000/-

01017041 Total Thyroidectomy 23000/-

01017042 Resection Enucleation of

Adenoma 12500/-

01017043 Isthmectomy 12600/-

01017044 Total Thyroidectomy and

Block Dissection 31400/-

01017045 Excision of Lingual

Thyroid 25650/-

01017046 Excision of Thyroglossal

Cyst/Fistula 15000/-

01017047 Excision of Parathyroid Adenoma/Carcinoma 25600/-

01017048 Laryngectomy 37150/-

01017049 Laryngo Pharyngectomy 43500/-

01017050 Sinus & Fistula repair 14000/-

01017051 Lymph Node Excision 8000/-

01017052 Hyoid Suspension 12000/-

01017053 Genioplasty 12000/-

01017054 Direct Laryngoscopy 5400/-

01017055 Phonosurgery 15400/-

01017056 Fibroptic Laryngoscopy 3000/-

01017057 Microlaryngeal Surgery 11000/-

01017058 Laryngofissure 17500/-

018 Head & Neck Cancer

01018001 Benign Tumour Excisions 11000/-

01018002 Temporal Bone resection 27600/-

01018003 Radical Neck Dissection 28500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01018004 Carotid Body Excision

(cost of Graft extra) 36000/-

01018005 Total Laryngectomy 39050/-

01018006 Flap Reconstructive

Surgery 42800/-

01018007 Parapharyngeal Tumour

Excision 32000/-

01018008 Total Thyroidectomy 30000/-

019 Breast

01019001 Drainage of Abscess 7000/-

01019002 Excision of Lumps 10000/-

01019003 Local Mastectomy

(Simple) 13500/-

01019004 Radical Mastectomy (Formal or Modified) 28000/-

01019005 Excision of Mammary

Fistula 16000/-

01019006 Segmental Resection of

Breast 18300/-

01019007 Breast Cancer (Tumour

excision) 30000/-

020

Cardio Respiratory Procedures

01020001 Tracheostomy 3700/-

01020002 Thoracotomy (Penetrating

Wounds) 17500/-

01020003 Intercostal Drainage of

empyema 5400/-

01020004 Decortication (Pleurectomy) 37000/-

01020005 Thoracoplasty 37000/-

01020006 Pneumonectomy 37000/-

01020007 Lobectomy 37000/-

01020008 Segmental Resection 37000/-

01020009 Hydatid Cyst- Removal 37000/-

01020010

Video-assisted thoracoscopic lung

Surgeries 37000/-

01020011

Lung volume reduction surgery (Unilateral/

Bilateral) 37000/-

01020012 Thoracoscopic Decortication 37000/-

01020013 Thoracoscopic

Pneumonectomy 37000/-

01020014 Thoracoscopic Lobectomy 37000/-

Page 13: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

13

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01020015 Thoracoscopic Segmental

Resection 37000/-

01020016 Thoracoscopic Cyst excision 37000/-

01020017 Thoracoscopic

Sympathectomy 37000/-

01020018

Chest Wall Tumor Excision with

Reconstruction 37000/-

01020019 Repair of Congenital

Chest Wall Defermities 37000/-

01020020 Multiple Lobectomy 37000/-

01020021 Decortication + Thoracoplasty 37000/-

01020022

Decortication + Lung Resection +

Thoracoplasty 37000/-

01020023 Open Lung Biopsy 18000/-

01020024 Medicistinoscopy(cervical) 15000/-

01020025

Video-assisted thoracoscopy (VATS)

36960/-

01020026 Thoracotomy for BPF 37000/-

01020027 Surgery for Destroyed

Lung 37000/-

01020028 Sleeve Resection with

Lobectomy 37000/-

01020029 Extrapleural

Pneumonectomy 37000/-

01020030 Tracheal Stenosis Surgery 37000/-

01020031 Repair of Tracheo Innuminete Fistula 37000/-

01020032 Tracheal Resection for

Tracheal Tumour 37000/-

01020033 Segmentectomy 37000/-

01020034 Wedge Resection 37000/-

01020035

Lung Resection with Paratracheal L. Node

Resection 37000/-

01020036 Lung Resection with Chest Wall Invasion 37000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01020037

Lung Resection with Dissection of Lymph Node

Stations 37000/-

01020038 Surgery for Recurrent

Pnemothoraxic 37000/-

01020039 Surgery for Aspergillosis

(Lung Cavities) 37000/-

01020040 Bronchotomy 37000/-

01020041 Mediostonoscopy 15000/-

021 Cardiac / Cardio

Thoracic Procedures

01021001

Coronary Bypass Surgery (including Pre-Surgery

Profile) 150000/-

01021002

Coronary Bypass Surgery-post Angioplasty

(including Pre-Surgery Profile) 150000/-

01021003

Coronary Balloon Angioplasty

(Excluding Cost of Stents) (including Pre-Surgery

Profile) (4 days’ package) 66000/-

01021004

Balloon angioplasty with Valvotomy (including Pre-

Surgery Profile) 90000/-

01021005

Open Heart Procedures (including Pre-Surgery

Profile) 150000/-

01021006

Total Correction of Tetralogy of Fallot

(including Pre-Surgery Profile) 150000/-

01021007

RSUV Correction (including Pre-Surgery

Profile) 150000/-

01021008

TAPVC Correction (including Pre-Surgery

Profile) 150000/-

01021009 Open ASD VSD (including

Pre-Surgery Profile) 150000/-

01021010

Open Pulmonary Valvotomy (including Pre-

Surgery Profile) 150000/-

01021011

Open Aortic Valvotomy (including Pre-Surgery

Profile) 150000/-

01021012 Blalock Taussig Operation 72000/-

Page 14: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

14

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

(including Pre-Surgery Profile)

01021013

Mitral Valvotomy (including Pre-Surgery

Profile) 72000/-

01021014

Mitral Valve Replacement (Excluding Cost of Valve)

(including Pre-Surgery Profile) 150000/-

01021015

Aortic Valve Replacement (Excluding Cost of Valve)

(including Pre-Surgery Profile) 150000/-

01021016

Double Valve Replacement (Excluding Cost of Valves) (including

Pre-Surgery Profile) 160000/-

01021017

Thoraco-Abdomi Aorta Replacement (including

Pre-Surgery Profile) 150000/-

01021018

Coarctation-Arota Repair of Block Taussing Shunt (including Pre-Surgery

Profile) 96000/-

01021019

Patent Ductus Arteriousus (including Pre-Surgery

Profile) 72000/-

01021020

Mitral Valvotomy (Open) (including Pre-Surgery

Profile) 150000/-

01021021 Pericardiostomy (including

Pre-Surgery Profile) 54000/-

01021022 Pericardiectomy (including

Pre-Surgery Profile) 72000/-

01021023 Pericardio Centesis 3900/-

01021024

Permanent Pacemaker Implantation (Excluding

Cost of Pacemaker) (4 days’ package) 19400/-

01021025

Temporary Pacing Lead Implantation (Including

use of Temporary Pacemaker) 12600/-

01021026 Embolectomy 19800/-

01021027

Aneurysm- Resection & Grafting (cost of Graft

extra) 96000/-

01021028 Thoracocentesis 2000/-

01021029 Thorachostomy 5400/-

01021030 Exploratory Thorocotomy 37000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01021031

Unifocalization with Shunt (including Pre-Surgery

Profile) 150000/-

01021032

Removal of Foreign Body from Trachea or

Oesophagus 6000/-

01021033 Rib Resection & Drainage 11500/-

01021034 Mediastinal Tumour 35000/-

01021035 Thymectomy 35000/-

01021036 ASD Device Closure

(Excluding Cost of Device) 40000/-

01021037 PDA Device Closure

(Excluding Cost of Device) 32000/-

01021038 DSA 5400/-

01021039 EP STUDY 8400/-

01021040 3D RF Ablation 40000/-

01021041 Mini EP Study 5000/-

01021042 Coronary Angiography

(1 day’s package) 11700/-

01021043 Fonten 170000/-

01021044 Gunshot injury 52000/-

01021045 Heart transplant 277000/-

01021046 Intra coronary stenting 58000/-

01021047 Directiol atherectomy 98000/-

01021048

Permanent Pacemaker Implantation (DDD)

(Pacemaker Cost extra) (4 days’ package) 25000/-

01021049

Permanent Pacemaker Implantation

(Biventricular) (Pacemaker Cost extra) (4

days’ package) 30000/-

01021050 Femoral Poplitial Bypass 75000/-

01021051 Iliacfemoral Bypass 75000/-

01021052 Aorto Bifemoral Bypass 75000/-

01021053 Carotid Subclavian

Bypass 75000/-

01021054 PA Banding 55000/-

01021055 BD Glen 55000/-

01021056

Thoracic Aorta/ Arch Replacement (including

Pre-Surgery Profile) 150000/-

Note:- CABG if done along with other Heart Surgeries like Valve Replacement etc. will attract the same rate as

CABG.

022 Oesophagus

Page 15: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

15

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01022001

Atresia of Oesophagus and Tracheo

Oesophageal Fistula 29700/-

01022002

Operations for Replacement of

Oesophagus by Colon 38000/-

01022003 Oesophagectomy for

Carcinoma Easophagus 38000/-

01022004 Oesophageal Intubation (Mausseau Barbin Tube) 15500/-

01022005 Achalasia Carida

Transthoracic 29700/-

01022006 Achalasia Carida

Abdominal 14600/-

01022007 Oesophago Gastrectomy

for mid 1/3 lesion 38000/-

01022008 Oesophagus Dilatation of

Stricture- per visit 1500/-

01022009

Colon-Inter position or Replacement of

Oesophagus 38000/-

01022010

Oesophago Gastrectomy – Lower Corringers

procedure 38000/-

01022011 Esophageal Perforation

Surgery 38000/-

01022012 Installation of Ryles Tube

in Ca Esophagus 5000/-

01022013 Esophageal Directiculum

Surgery 38000/-

023 Abdomen

01023001 Gastroscopy 1300/-

01023002 Gastric & Duodenal Biopsy (Endoscopic) 1700/-

01023003 Pyleromyotomy 10000/-

01023004 Gastrostomy 12000/-

01023005 Simple Closure of

Perforated peptic Ulcer 15000/-

01023006 Vagotomy Pyleroplasty /

Gastro Jejunostomy 30000/-

01023007 Duodenojejunostomy 25000/-

01023008

Partial/Subtotal Gastrectomy for

Carcinoma 30000/-

01023009 Partial/Subtotal

Gastrectomy for Ulcer 30000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01023010 Operation for Bleeding

Peptic Ulcer 25000/-

01023011 Gastrojejunostomy &

Vagotomy 27000/-

01023012 Operation for

Gastrojejunal Ulcer 25000/-

01023013 Total Gastrectomy for

Cancer 35000/-

01023014 Highly Selective

Vagotomy 25000/-

01023015 Selective Vagotomy &

Drainage 25000/-

01023016 Congenital Diaphragmatic

Hernia 30000/-

01023017 Hiatus Hernia Repair

Abdominal 30000/-

01023018 Hiatus Hernia Repair

Transthoracic 30000/-

01023019 Exploratory Laparotomy 12900/-

01023020 Epigastric Hernia Repair 15000/-

01023021 Umbilical Hernia Repair 15000/-

01023022 Ventral and Scar Hernia

Repair 18000/-

01023023 Inguinal Hernia

Herniorraphy- unilateral 15000/-

01023024

Inguinal Hernia – Hernioplasty- with mesh-

unilateral 22000/-

01023025 Femoral Hernia Repair 22000/-

01023026

Rare Hernias - Repair (Spigalion, Obturator,

Lumbar, Sciatic) 25000/-

01023027 Splenectomy - For

Trauma 25000/-

01023028 Splenectomy - For

Hypersplenism 25000/-

01023029 Splenorenal Anastomosis 40000/-

01023030 Portocaval Anastomosis 40000/-

01023031

Direct Operation on Oesophagus for Portal

Hypertension 30000/-

01023032 Mesentericocaval

Anastomosis 35000/-

01023033 Warren Shunt 35000/-

01023034 Pancerato Duodenectomy 36000/-

Page 16: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

16

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01023035

By Pass Procedure for Inoperable Carcinoma of

Pancreas 30000/-

01023036 Cystojejunostomy or Cystogastrostomy 30000/-

01023037 Cholecystectomy 18000/-

01023038 Cholecystectomy & Exploration of CBD 22000/-

01023039 Repair of Common Bile

Duct 20000/-

01023040 Operation for Hydatid Cyst

of Liver 25000/-

01023041 Cholecystostomy 14200/-

01023042 Hepatic Resections

(Lobectomy Hepatectomy) 28000/-

01023043 Operation on Adrenal

Glands - Bilateral 35000/-

01023044

Operation on Adrenal Glands - Unilateral for

Tumour 20000/-

01023045 Appendicectomy for Acute

Appendicitis 20000/-

01023046 Appendicectomy for Chronic Appendicitis 18000/-

01023047 Appendicular Abscess –

Drainage 12000/-

01023048 Mesenteric Cyst- Excision 18000/-

01023049 Peritonioscopy/ Laparoscopy 5100/-

01023050 Jejunostomy 18000/-

01023051 Ileostomy 18000/-

01023052 Congenital Atresia &

Stenosis of Small Intestine 25000/-

01023053 Muconium ileus 20000/-

01023054 Mal-rotation & Volvulus of

the Midgut 20000/-

01023055 Resection & Anastomosis

of Small Intestine 22000/-

01023056 Excision of Meckle’s

Deverticulum 22000/-

01023057 Duodenal Diverticulum 18000/-

01023058 Operation for Intestinal

Obstruction 25000/-

01023059 Operation for Intestinal

perforation 25000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01023060 Benign Tumours of Small

Intestine 25000/-

01023061 Excision of Small Intestine

Fistula 25000/-

01023062

Operations for Haemorrhage of the Small

Intestines 25000/-

01023063

Operations of the Duplication of the

Intestines 32000/-

01023064

Operations for Recurrent Intestinal Obstruction

(Noble Plication & Other Operations for the

Adhesions) 28000/-

01023065 Ilieosigmoidostomy 22000/-

01023066 Ilieotransverse Colostomy 22000/-

01023067 Caecostomy 10000/-

01023068 Loop Colostomy

Transverse Sigmoid 20000/-

01023069 Terminal Colostomy 24000/-

01023070 Closure of Colostomy 24000/-

01023071 Right Hemi-Colectomy 24000/-

01023072 Left Hemi-Colectomy 24000/-

01023073 Total Colectomy 39000/-

01023074 Operations for Volvulus of

Large Bowel 25200/-

01023075 Operations for Sigmoid

Diverticulitis 22000/-

01023076 Fissure in Ano - Dilatation 6800/-

01023077 Fissure in Ano - Fissurectomy 16000/-

01023078 Rectal Polyp-Excision 8000/-

01023079

Operation of Haemorrhoids -Lords

procedure 10000/-

01023080 Fistula in Ano - High

Fistulectomy 20000/-

01023081 Fistula in Ano - Low

Fistulectomy 12000/-

01023082 Imperforat Anus -

Colostomy 16000/-

01023083 Imperforate Anus - Pull

Through Operation 22000/-

01023084 Prolapse Rectum -

Theirch Wiring 15000/-

Page 17: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

17

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01023085 Prolapse Rectum -

Rectopexy 10000/-

01023086 Prolapse Rectum - Grahams Operation 22000/-

01023087 Operations for

Hirschsprungs Disease 22000/-

01023088 Excision of Pilonidal Sinus 12300/-

01023089 Abdomino-Perineal Excision of Rectum 26700/-

01023090 Anterior Resection of

rectum 26300/-

01023091 Pull Through Abdominal

Resection 22000/-

01023092 Operations for Neuroblastoma 22000/-

01023093 Fistula/ Fistulotomy 12000/-

01023094 Hernioctomy 21000/-

024 Nephrology / Genitourinary

01024001 Partial Nephrectomy 25000/-

01024002 Nephrolithotomy 25000/-

01024003 Pyelolithotomy 25000/-

01024004 Operations for

Hydronephrosis 25000/-

01024005 Open Drainage of

Perinephric Abscess 15000/-

01024006 Cavernostomy 20400/-

01024007 Operations for Cyst of the

Kidney 25000/-

01024008 Ureterolithotomy 20000/-

01024009 Nephroureterectomy 20000/-

01024010 Operations for Ureter for -

Double Ureters 30000/-

01024011 Operations for Ureter -for Ectopia of Single Ureter 27000/-

01024012 Operations for Vesico-

ureteric Reflux 28000/-

01024013 Ureterostomy - Cutaneous 20000/-

01024014 Uretero-Colic anastomosis 20000/-

01024015 Formation of an Ileal

Conduit 22000/-

01024016 Ureteric Catheterisation 5000/-

01024017 Dormia Extraction of

Calculus 6000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01024018 Biopsy of Bladder

(Cystoscopic) 6000/-

01024019 Diathermy Destruction of

Bladder Neoplasm 15000/-

01024020 Litholapexy 15000/-

01024021 Operations for Injuries of

the Bladder 30000/-

01024022

Suprapubic Drainage (Cystostomy/ Vesicostomy) 12000/-

01024023 Total Cystectomy 35000/-

01024024 Diverticulectomy 32000/-

01024025 Open Resection of the

Bladder Neck 25000/-

01024026 Y-V Plasty of the Bladder

Neck 25000/-

01024027 Cystoplasty 28000/-

01024028 Operations for Extrophy of

the Bladder 40000/-

01024029 Repair of Ureterocoel 25000/-

01024030 Suprapubic Prostatectomy 25000/-

01024031 Retropubic Prostatectomy 25000/-

01024032

Transurethral Resection of Prostate (TURP)/ TUR

Bladder Tumour 25000/-

01024033

Intravesical BCG instillation (Cost of BCG

extra) 500/-

01024034 Operations for Injury to

Urethra 30000/-

01024035 Internal urethrotomy 15000/-

01024036 Urethral Reconstruction 32000/-

01024037 Operation for Congenital

Valves of Urethra 16000/-

01024038

Operations for Incontinence of Urine -

Male 25000/-

01024039

Operations for Incontinence of Urine -

Female 25000/-

01024040 Reduction of Paraphimosis 2450/-

01024041 Circumcision (under

General Anaesthesia) 6000/-

01024042 Meatotomy 3500/-

01024043 Meatoplasty 6800/-

01024044 Operations for

Hypospadias - Chordee 15000/-

Page 18: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

18

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

Correction

01024045

Operations for Hypospadias - Second

Stage or One Stage Repair 24000/-

01024046 Operations for Epispadias 22000/-

01024047 Partial Amputation of the

Penis 14000/-

01024048 Total amputation of the

Penis 20000/-

01024049 Orchidectomy- Simple 14000/-

01024050 Orchidectomy- Radical 20000/-

01024051

Adreneclectomy Unilateral/Bilateral for

Tumour/For Carcinoma 30000/-

01024052 Operations for Hydrocele -

Unilateral 8000/-

01024053 Operations for Hydrocele -

Bilateral 12000/-

01024054 Operation for Torsion of

Testis 15000/-

01024055 Vasovasostomy 18000/-

01024056 Operations for Varicocele 15000/-

01024057 Block Dissection of

Inguinal Nodes - One Side 25000/-

01024058

Block Dissection of Inguinal Nodes - Both

Sides 32000/-

01024059 Excision of Filarial

Scrotum 16000/-

01024060 Emergency Dialysis Femoral Puncture 1200/-

01024061 Emergency Dialysis Subclavian Puncture 1800/-

01024062 Fistula/Shunt 8000/-

01024063 Dialysis Femoral

Catheterisation Bilateral 1500/-

01024064 Haemo Dialysis (All

Inclusive) 1500/-

01024065 Double Lumen Sub Clavian Catheter 3000/-

01024066

Continuous Arterio Venus Haemofiltration (CAVH)/

CAVD 17000/-

01024067 Subclavian Access 1850/-

01024068 Femoral Access 1750/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01024069 Plasma Exchange 2500/-

01024070 Donor Nephrectomy 50000/-

01024071 Renal Transplantation 250000/-

01024072 Ureteric Reimplant 4200/-

01024073 Lymphocoel 4300/-

01024074 Transplant Nephrectomy 35000/-

01024075 Nephrouretectomy 35000/-

01024076 Vascular Prosthetic Graft 35000/-

01024077 CAPD (insertion &

removal) 8000/-

01024078 PCNL - Unilateral 30000/-

01024079 PCNL – Bilateral/

PCNL-III 46000/-

01024080 Palomo’s Unilateral 7300/-

01024081 Palomo’s Bilateral 12600/-

01024082 Endoscopic Teflon Inject 5100/-

01024083 Testicular Biopsy 4350/-

01024084 Gil-Verner’s Extended

Pyelolithotomy 22000/-

01024085

Radical Nephrectomy Complicated Tumour or

Adhesions 50000/-

01024086 Anderson Hynes

Pyeloroplasty 25000/-

01024087 Vasico Vaginal Fistula

Repair 30000/-

01024088 Radical Cystectomy 44000/-

01024089 Caeco Cystoplasty 26000/-

01024090 Nephrectomy Simple 25000/-

01024091 Nephrostomy 22000/-

01024092 Ureteric Reimplant 25000/-

01024093 Partial Cystectomy 28000/-

01024094 Epididymectomy 12000/-

01024095 TURP Cystolithotripsy 30000/-

01024096 Open Prostatectomy 28000/-

01024097 Closure of Urethral Fistula 28000/-

01024098 Orchidopexy - Unilateral 15000/-

01024099 Orchidopexy - Bilateral 20000/-

01024100 Cystolithotomy -

Suprapubic 15000/-

01024101 Endoscopic Removal of

Stone in Bladder 18000/-

01024102 Resection Bladder Neck

Endoscopic 18000/-

Page 19: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

19

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01024103 Ureteroscopic Removal-

with LASER 40000/-

01024104 Ureteroscopic Removal-

without LASER 18000/-

01024105 Urethroplasty 1st Stage 14000/-

01024106 Optical Urethrotomy 18000/-

01024107 Exploratory Scrototomy 10000/-

01024108 Perineal Urethrostomy 15000/-

01024109 Dilatation of Stricture Urethra under G.A. 4000/-

01024110

Dilatation of Stricture Urethra without

Anesthesia 2200/-

01024111 Retroperitoneoscopy

Nephrectomy 40000/-

01024112 Retroperitoneoscopy partial Nephrectomy 35000/-

01024113 Retroperitoneoscopic

nephrolithotomy 35000/-

01024114 Retroperitoneoscopic

pyelolithotomy 35000/-

01024115

Retroperitoneoscopic operation for

Hyderonephrosis 35000/-

01024116 Retroperitoneoscopic surgery for Renal cyst 35000/-

01024117 Retroperitoneoscopic

ureterolithotomy 35000/-

01024118 Retroperitoneoscopic Nephroureteroectomy 35000/-

01024119 Laproscopy aassisted

orchidopexy 22000/-

01024120 Laproscopic operation for

varicocele 20000/-

01024121 Cystoscopic Basketing of

Urethra 12000/-

01024122 Lithotripsy/ ESWL

(Complete) 30000/-

01024123 Lithotripsy-1/ SMSL (Day

Care) 18000/-

01024124 Lithotripsy-2/3/ SMSL

(Day Care) 23000/-

01024125 Slow Efficiency Dialysis

(SLED) 4000/-

01024126 Prosthetic Surgery for urinary incontinence 40000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01024127

Hilioum Laser Prostrate surgery/ Optical Internal

urethrotomy/ C 30000/-

01024128

High Intensity Focus Ultrasound (HIFU) Robotic

for Carcinoma 150000/-

01024129 CRRT Procedure 11000/-

01024130 TURP with LASER 32000/-

01024131 Lithoclast (Day Care) 16000/-

025 Plastic Surgery

01025001 Primary Suture of Wound 3200/-

01025002 Injection of Keloids -

Ganglion 2700/-

01025003 Injection of Keloids -

Haemangioma 6100/-

01025004 Free Grafts - Wolfe Grafts 18000/-

01025005 Free Grafts - Theirech -

Small Area 5% 18500/-

01025006 Free Grafts - Large Area

10% 30000/-

01025007 Free Grafts - Very Large

Area 20% 32400/-

01025008 Skin Flaps - Rotation

Flaps 28750/-

01025009 Skin Flaps -

Advancement Flaps 31650/-

01025010

Skin Flaps - Direct- cross Leg Flaps- Cross Arm

Flap 35500/-

01025011 Skin Flaps - Cross

Finger 35500/-

01025012 Skin Flaps - Abdominal 35500/-

01025013 Skin Flaps - Thoracic 34400/-

01025014 Skin Flaps - Arm Etc. 35500/-

01025015 Subcutaneous Pedicle

Flaps Raising 28500/-

01025016 Subcutaneous Pedicle

Flaps Delay 27750/-

01025017 Subcutaneous Pedicle

Flaps Transfer 28500/-

01025018 Cartilage Grafting 29700/-

01025019 Reduction of Facial Fractures of Nose 9000/-

01025020 Reduction of Facial Fractures of Maxilla 13800/-

Page 20: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

20

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01025021

Reduction of Fractures of Mandible & Maxilla - Eye

Let Splinting 27000/-

01025022

Reduction of Fractures of Mandible & Maxilla - Cast

Netal Splints 27000/-

01025023

Reduction of Fractures of Mandible & Maxilla -

Gumming Splints 27000/-

01025024 Internal Wire Fixation of

Mandible & Maxilla 32000/-

01025025 Cleft Lip - repair. 32400/-

01025026 Cleft Palate Repair

Severe Degree 33800/-

01025027 Primary Bone Grafting of

Cleft Lip Palate 34550/-

01025028 Secondary Surgery for

Cleft Lip Deformity 32600/-

01025029 Secondary Surgery for

Cleft Palate 31350/-

01025030 Reconstruction of Eyelid

Defects - Minor 17550/-

01025031 Reconstruction of Eyelid

Defects - Major 30000/-

01025032

Plastic Surgery of Different Regions of the

Ear - Minor 10000/-

01025033

Plastic Surgery of Different Regions of the

Ear - Major 20000/-

01025034 Plastic Surgery of the

Nose - Minor 10000/-

01025035 Plastic Surgery of the

Nose - Major 20000/-

01025036

Plastic Surgery for Facial Paralysis (Support with

Reanimation) 32000/-

01025037 Pendulous Breast -

Mammoplasty 22550/-

026 Orthopaedic Surgery

Procedure

01026001 Application of P.O.P Casts for Upper & Lower Limbs 7500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01026002 Application of Functional

Cast Brace 7500/-

01026003 Application of Skin

Traction 1650/-

01026004 Application of Skeletal

Tractions 4450/-

01026005 Bandage & Strappings for

Fractures 1150/-

01026006 Aspiration & Intra Articular

Injections 950/-

01026007 Application of P.O.P

Spices & Jackets 6000/-

01026008 Close Reduction of

Fractures of Limb & P.O.P 7500/-

01026009 Reduction of Compound

Fractures 10000/-

01026010 Open Reduction & Internal Fixation of Fingurs & Toes 18000/-

01026011

Open Reduction of fracture of Long Bones of

Upper / Lower Limb -Nailing & External Fixation 28000/-

01026012

Open Reduction of fracture of Long Bones of Upper / Lower Limb -AO

Procedures 27000/-

01026013 Tension Band Wirings 6000/-

01026014 Bone Grafting 18000/-

01026015 Excision of Bone Tumours

-Superficial 28000/-

01026016 Excision of Bone Tumours

-Deep 40000/-

01026017 Excision of Ganglion 10000/-

01026018

Excision or other Operations for Scaphoid

Fractures 25000/-

01026019

Sequestrectomy & Saucerizations -

Superficial 20000/-

01026020 Sequestrectomy &

Saucerizations -Deep 30000/-

01026021

Sequestrectomy & Saucerizations -

Arthrotomy 35000/-

Page 21: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

21

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01026022 S.P.Nailing for Fracture

Neck Femur 35000/-

01026023 Multiple Pinning Fracture

Neck Femur 35000/-

01026024 Nail Plate Fixations for Fracture Neck Femur 35000/-

01026025

A.O.Compression Procedures for Fracture

Neck Femur 35000/-

01026026

Open Reduction of Fracture Neck Femur

Muscle Pedicle Graft and Internal Fixations 35000/-

01026027 Closed Reduction of

Dislocations 10000/-

01026028 Open Reduction of

Dislocations - Superficial 20000/-

01026029 Open Reduction of

Dislocations - Deep 30000/-

01026030

Open Reduction of Fracture Dislocation &

Internal Fixation 35000/-

01026031 Neurolysis/Nerve Suture 25000/-

01026032 Nerve Repair with Grafting 32000/-

01026033 Tendon with Transplant or

Graft 35000/-

01026034

Tendon Lengthening/Tendon

Sutures 25000/-

01026035 Tendon Transfer 35000/-

01026036 Laminectomy, Excision Disc (Prosthesis extra) 40000/-

01026037

Laminectomy, Excision Disc and Tumours (Prosthesis extra) 60000/-

01026038 Anterolateral Clearance

for tuberculosis 32000/-

01026039

Antereolateral Decompression and

Spinal Fusion 45000/-

01026040 Costo Transversectomy 30000/-

01026041 Corrective Ostectomy & Internal Fixation - Minor 15000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01026042 Corrective Ostectomy & Internal Fixation - Major 30000/-

01026043 Arthrodisis of - Minor

Joints 15000/-

01026044 Arthrodisis of - Major

Joints 30400/-

01026045 Soft Tissue Operations for

C.T.E.V. 25000/-

01026046

Soft Tissue Operations for Polio (instrumentation

extra) 25000/-

01026047 Partial Hip Replacement (Cost of Prosthesis extra) 40000/-

01026048 Operations for Brachial Plexus & Cervical Rib 32000/-

01026049

Amputations - Below

Knee Rs 25000/-

01026050

Amputations - Below

Elbow 25000/-

01026051

Amputations - Above

Knee 35000/-

01026052 Amputations - Above

Elbow 30000/-

01026053 Amputations - Forequarter 40000/-

01026054

Amputations -Hind Quarter and

Hemipelvectomy 44000/-

01026055 Disarticulations - Major 30000/-

01026056 Disarticulations - Minor 20000/-

01026057 Arthrography &

Osteomedullography 10450/-

01026058 Spinal Ostectomy and

Internal Fixations 40200/-

01026059 Arthroscopy - Operative 24250/-

01026060 Soft Tissue Operation on

Knee 24000/-

01026061

Myocutaneous and Fasciocutaneous Flat Procedures for Limbs 24000/-

01026062 Removal of Nails, Wires &

Screw 10000/-

01026063 Removal of Plates 15000/-

01026064 Total Hip Replacement-

Unilateral (Excluding 60000/-

Page 22: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

22

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

Implants)

01026065

Total Finger Joint Replacement-Unilateral

(Excluding Implants) 23000/-

01026066

Total Knee Joint Replacement-Unilateral

(Excluding Implants) 55000/-

01026067

Any Other Joint Replacement (e.g. elbow, shoulder, etc.)- Unilateral (Cost of Implants extra) 55000/-

01026068

Multiple fractures repair (excluding peripheral limb

injuries)-major (above three fractures) (cost of

implants extra) 100000/-

01026069

Multiple fractures repair (excluding peripheral limb injuries)-medium (above two fractures) (cost of

implants extra) 60000/-

01026070 Sternal Dehisences

Repair 25000/-

01026071 Sternal Dehisences

Reconstruction 55000/-

01026072 Fingers (post, slab) 300/-

01026073 Fingers full plaster 300/-

01026074 Colles Fracture - Below

elbow 1200/-

01026075 Colles Fracture - Full

plaster 2000/-

01026076 Colles fracture Ant. Or

post. slab 1000/-

01026077 Above elbow full plaster 1000/-

01026078 Above Knee post-slab 700/-

01026079 Below Knee full plaster 1000/-

01026080 Below Knee post-slab 750/-

01026081 Tube Plaster (or plaster

cylinder) 1450/-

01026082 Above knee full plaster 2400/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01026083 Above knee full slab 2200/-

01026084 Minerva Jacket 4000/-

01026085 Plaster Jacket 3050/-

01026086 Shoulder spica 3350/-

01026087 Single Hip spica 3100/-

01026088 Double Hip spica 3800/-

01026089 Resection of First Rib 45000/-

01026090 Resection of Cerical Rib 35000/-

01026091 Rib Resection 12500/-

01026092 Ligament Reconstruction 22000/-

027 Neuro-Surgery

01027001

Craniotomy and Evacuation of Haematoma

-Subdural 70000/-

01027002

Craniotomy and Evacuation of Haematoma

-Extradural 70000/-

01027003 Evacuation of Brain

Abscess 80000/-

01027004

Excision of Lobe (Frontal, Temporal, Cerebelium

etc.) 80000/-

01027005 Excision of Brain Tumours

-Supratentotial 80000/-

01027006 Excision of Brain Tumours

-Subtentorial 80000/-

01027007 Surgery of Cord Tumours 60000/-

01027008

Ventriculoatrial /Ventriculoperitoneal

Shunt 40000/-

01027009 Excision of Cervical Inter-

Vertebral Discs 50000/-

01027010 Sympathetectomy -

Lumbar 18000/-

01027011 Sympathetectomy -

Cervical 18000/-

Page 23: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

23

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01027012 Twist Drill Craniostomy 30000/-

01027013 Subdural Tapping 15000/-

01027014 Ventricular Tapping 12000/-

01027015 Abscess Tapping 15000/-

01027016 Placement of ICP Monitor

- 15000/-

01027017 Urokinase Therepy for

ICH - 15000/-

01027018 Skull Traction Application 3400/-

01027019 Lumber Pressure

Monitoring 10000/-

01027020 Vascular Malformations 100000/-

01027021 Peritoneal Shunt 15000/-

01027022 Atrial Shunt 15000/-

01027023 Meningo Encephalocoel 52000/-

01027024 Meningomyelocoel 42000/-

01027025 C.S.F. Rhinorrhaea 55000/-

01027026 Cranioplasty 55000/-

01027027 Posterior Cervical

Dissectomy 50000/-

01027028 Anterior Cervical

Dissectomy 50000/-

01027029 Brachial Plexus

Exploration Microsuturing 50000/-

01027030 Median Nerve

Decompression 40000/-

01027031 Peripheral Neurectomy

(Tirgeminal) 45000/-

01027032 Trigeminal Rhiotomy 35000/-

01027033 Cranial Nerve Astomosis 60000/-

01027034 Meningocoele Excision 45000/-

01027035 Peripheral Nerve Surgery

– Major 50000/-

01027036 Peripheral Nerve Surgery

Minor 40000/-

01027037 Ventriculo-Atrial Shunt (Exclud. Cost of valve) 100000/-

01027038 Nerve Biopsy (Procedure

+ Investigation) 15000/-

01027039 Brain Biopsy (Procedure +

Investigation) 18000/-

01027040 Anterior Cervical Spine

Surgery with fusion 60000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01027041 Anterior Lateral Decompression 60000/-

01027042 Brain Mapping 2400/-

01027043 Cervical or Dorsal

Laminectomy 45000/-

01027044

Combined Trans-oral Surgery & CV Junction

Fusion 110000/-

01027045 C.V. Junction Fusion 80000/-

01027046 Depressed Fracture 40000/-

01027047 Discectomy 45000/-

01027048 Endarterectomy 50000/-

01027049 R.F. Lesion for Trigeminal

Neuralgia - 30000/-

01027050 Spasticity Surgery - 90000/-

01027051 Spinal Fusion Procedure 65000/-

01027052 Spinal Intra Medullary

Tumours 65000/-

01027053 Spinal Bifida Surgery

Major 65000/-

01027054 Spina/ Bifida Surgery

Minor 55000/-

01027055 Stereotaxic Procedures-

biopsy/ aspiration 22000/-

01027056 Trans Sphenoidal Surgery 65000/-

01027057 Trans Oral Surgery 110000/-

01027058 Implantation of DBS- one

Electrode 100000/-

01027059 Implantation of DBS- two

Electrodes 100000/-

01027060 Endoscopic

Adueductoplasty 100000/-

01027061 Facial nerve

reconstruction 50000/-

01027062 Recanelisation of venous

sinuses 80000/-

01027063 Carotid stenting 75000/-

01027064 Cervical disc arthroplasty 35000/-

01027065 Lumbar disc arthroplasty

30000/-

01027066 Corpus Callosectomy 60000/-

01027067 Hemishpherectomy 80000/-

Page 24: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

24

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01027068 Endoscopic CSF rhinorrhea repair 50000/-

01027069 Microsurgical excision of

Acoustic tumour 60000/-

01027070 Microsurgical excision of

meningomas 60000/-

01027071 Epilepsy surgery 80000/-

01027072 RF lesion for facet pain

syndrome 40000/-

01027073 Cervical laminoplasty 40000/-

01027074 Lateral mass C1-C2 screw

fixation 60000/-

01027075

Microsurgical decompression for

Trigemil nerve 60000/-

01027076 Cerebellar stimulation for

hemifacial spasm 80000/-

01027077

Cerebellar stimulation for other cranial nerve

neuralgia 80000/-

01027078 IC EC bypass procedures 70000/-

01027079 Stereotactic guided

craniotomy 70000/-

01027080

Baclofen pump implantation lesioning for

movement disorder including Parkinsonism 60000/-

01027081 Programmable shunt 40000/-

01027082 Endoscopic

sympathectomy 18000/-

01027083 External ventricular

drainage 12000/-

01027084 Image guided surgery Excision of tethored 60000/-

01027085 Endoscopic 3rd ventriculostomy 60000/-

01027086

Endoscopic cranial surgery/Biopsy/aspiration/

aneurysm coiling 60000/-

01027087 Endoscopic discectomy 60000/-

01027088 Aneurysm coiling 80000/-

01027089 Endoscopic spil

procedure- aneurysm 80000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

coiling

01027090

Surgery for grooving skull fractures- aneurysm

coiling 80000/-

01027091 Carpel Tunnel decompression 40000/-

01027092 Clipping of intracranial

aneurysm with use of clip 90000/-

01027093

Endoscopic aspiration of intracerebellar haematoma 60000/-

01027094

Stereotactic Radiosurgery for brain pathology (X

knife/ Gamma) 120000/-

01027095 Foramen magnum

decompression 60000/-

01027096

Foramen magnum decompression with syringosubarachnoid

shunt 60000/-

01027097

Dorsal column stimulation for bachache in failed

back syndrome 50000/-

01027098 Surgery for recurrent disc prolapse/ epidural fibrosis 60000/-

01027099 Surgery for brain stem

tumours 100000/-

01027100

Decompressive cranectomy for

hemishpherical acute subdural 70000/-

01027101

Intra arterial thrombolysis with RTPA for ischemic

stroket RTPA-acute 100000/-

01027102 Stereotactic aspiration of intracerebral haematoma 50000/-

01027103 Complex Brain Surgery 130000/-

01027104 Complex Spine Surgery 110000/-

01027105 Dorsal Sympathectomy 50000/-

01027106

Neuro rehabilitisation- package for 25 sittings

(bed charges extra) 15000/-

028 Vascular Surgery

Page 25: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

25

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01028001 Patch Graft Angioplasty 50000/-

01028002 Operations for Stenosis of

Renal Arteries 50000/-

01028003 Thrombendarterectomy 50000/-

01028004 Operations for Acquired

Arteriovenous Fistula 50000/-

01028005 Congenital Arterio Venous

Fistula 27700/-

01028006 Surgery for Arterial

Aneursysm -Vertebral 80000/-

01028007 Surgery for Arterial Aneursysm Carotid 42500/-

01028008

Surgery for Arterial Aneursysm Main Arteries

of the Limb 50000/-

01028009 Dissecting Aneurysms +

Implant 150000/-

01028010 Stripping of Short or Long

Sephenous Veins 30000/-

01028011 Ligation of Ankle

Perforators 17400/-

01028012 Excision and Skin Graft of

Venous Ulcer 15500/-

01028013 Venous Thromoectomy 22100/-

01028014

Lymphatics Excision of Subcutaneous Tissues In

Lymphoedema 30000/-

01028015 Trendelenburg Operations 30000/-

01028016 Vascular Procedure –

Minor 16800/-

01028017 Surgery for Arterial

Aneursysm Spleen Artery 40200/-

01028018 Surgery for Arterial

Aneursysm Renal Artery 40200/-

029 Paediatric Surgery

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01029001 Excision of thyroglossal

Duct/Cyst 30000/-

01029002

Diaphragmatic Hernia Repair (Thoracic or

Abdominal Approach) 35000/-

01029003

Tracheo Oesophageal Fistula (Correction

Surgery) 40000/-

01029004 Colon Replacement of

Oesophagus 40000/-

01029005 Omphalo Mesenteric Cyst

Excision 30000/-

01029006 Omphalo Mesenteric

Duct- Excision 30000/-

01029007 Meckels Diverticulectomy 30000/-

01029008 Omphalocele 1st Stage

(Hernia Repair) 28000/-

01029009 Omphalocele 2nd Stge

(Hernia Repair) 30000/-

01029010 Gastrochisis Repair 24000/-

01029011 Inguinal Herniotomy 24000/-

01029012 Congenital Hydrocele 24000/-

01029013 Hydrocele of Cord 22000/-

01029014 Torsion Testis Operation 25000/-

01029015 Congenital Pyloric Stenosis- operation 27000/-

01029016 Duodenal- Atresia

Operation 35000/-

01029017 Pancreatic Ring Operation 45000/-

01029018 Meconium Ileus Operation 30000/-

01029019 Malrotation of Intestines

Operation 32000/-

01029020 Rectal Biopsy (Megacolon) 25000/-

01029021 Colostomy Transverse 28000/-

01029022 Colostomy Left Iliac 28000/-

01029023

Abdominal Perineal Pull Through (Hirschaprugis

Disease) 35000/-

01029024 Imperforate Anus Low 22000/-

Page 26: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

26

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

Anomaly -Cut Back Operation

01029025

Imperforate Anus Low Anomaly - Perineal

Anoplasty 28000/-

01029026

Inperforate Anus High Anomaly -Sacroabdomino

Perineal Pull Through 25000/-

01029027

Inperforate Anus High Anomaly - Closure of

Colostomy 21000/-

01029028 Intususception Operation 35000/-

01029029

Choledochoduodenostomy for Atresia of Extra Hepatic Billiary Duct 35000/-

01029030 Operation of Choledochal

Cyst 35000/-

01029031 Nephrectomy for -

Pyonephrosis 35000/-

01029032 Nephrectomy for - Hydronephrosis 35000/-

01029033 Nephrectomy for -Wilms

Tumour 35000/-

01029034

Paraortic Lymphadenoctomy with Nephrectomy for Wilms

Tumour 40000/-

01029035 Sacro- Coccygeal Teratoma Excision 30000/-

01029036 Neuroblastoma Debulking 32000/-

01029037 Neuroblastoma Total

Excision 36000/-

01029038 Rhabdomyosarcoma wide

Excision 40000/-

01029039

Colon Transplant/ Conduit Management following

Acid Structure Oesophagus 65000/-

01029040 Umbilical Line 500/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01029041 Peripheral Long Line 800/-

01029042 LP 300/-

01029043 Peritoneal Tapping 500/-

01029044 Chest Drainage 800/-

01029045

General Nursery Care (including Nursing Care

etc.) 600/-

01029046 Phototherapy per day 400/-

01029047

Neonate Rooming in with mother per day (inclusive

of Nursing care) 600/-

01029048 SNCU (Sick New Born

Care Unit) 1600/-

030

Laproscopic/ Endoscopic Operations

In Gen. Surgery / Gastrohepatic / Nephro-

01030001 Diagnostic Laproscopy 6600/-

01030002 Laproscopic

Pyloromyotomy 18000/-

01030003 Laproscopic Gastrostomy 21000/-

01030004 Laproscopic Closure of Perforated peptic ulcer 25000/-

01030005

Laproscopic Vagotomy Pyleroplasty/ gastro

jejunostomy 24000/-

01030006 Laproscopic umbilical

hernia repair 20000/-

01030007 Laproscopic ventral hernia

repair 25000/-

01030008 Laproscopic

cystogastrostomy 30000/-

01030009 Lap. Cholecystectomy &

CBD exploration 26000/-

01030010 Lap. Hydatid of liver

surgery 28000/-

01030011 Lap. Hepatic resection 28000/-

01030012 Lap. Assisted small bowel

resection 30000/-

01030013 Lap. For intestinal

obstruction 30000/-

Page 27: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

27

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01030014 Lap. For intestinal

perforation 28000/-

01030015 Lap. Assisted Right

Hemicolectomy 32000/-

01030016 Lap. Assisted left Hemicolectomy 32000/-

01030017 Lap. Assisted Total

Colectomy 37000/-

01030018 Laproscopic Rectopexy 32000/-

01030019

Lap. Asisted Abdominoperineal

Resection of rectum 37000/-

01030020 Lap. Assisted anterior

resection 37000/-

01030021 Laproscopic

Cholecystectomy 25000/-

01030022 Laproscopic

Appendicectomy 21000/-

01030023 Laaproscopic Hernia

Repair 21000/-

01030024 Laproscopic Hiatus Hernia

Repair 30000/-

01030025 Laproscopic Adhesiolysis Rs 18000/-

01030026 Laproscopic

Adrenalectomy 32000/-

01030027 Laproscopic

Thyroidectomy 32000/-

01030028 Laproscopic

Spleenectomy 32000/-

01030029 Laproscopic Colectomy 35000/-

01030030 Laproscopic Nephrectomy 40000/-

01030031 Inguinal Hernia (Laproscopic) 20000/-

01030032 Laproscopic

Pyelolithotomy 30000/-

01030033 Ureterolithotomy 22000/-

01030034 Lap Ovarian Cystectomy 22000/-

01030035 Laparoscopic Hysterectomy 25000/-

01030036 Laparoscopic Ectopic 22000/-

01030037 Foreign body removal 4000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01030038 Nephrolithotomy 35000/-

01030039

Operations for Hydronephrosis-

Pyeloplasty 35000/-

01030040

Operations for Hydronephrosis-

Endopyelotomy antegrade 35000/-

01030041 Operations for Cyst of the

Kidney 40000/-

01030042 URSL 25000/-

01030043 Nephroureterectomy 50000/-

01030044 Operations for Vesico-

ureteric Reflux 40000/-

01030045 Diverticulectomy 22000/-

01030046 Repair of Ureterocoel 35000/-

01030047 Operations for Varicocele

Palomo’s- Unilateral 20000/-

01030048 Operations for Varicocele

Palomo’s- Bilateral 30000/-

01030049 Nephrostomy 16000/-

01030050 Orchidopexy- Unilateral 25000/-

01030051 Orchidopexy- Bilateral 30000/-

01030052 Prostratectomy 45000/-

01030053 Laparoscopic Uro stone 30000/-

01030054 Incisional Hernioplasty 35000/-

Radiotherapy & Chemotherapy

(packages)

031 Nuclear Medicines-

Radio Isotope Therapy

01031001 131- Iodine Therapy <

15mCi 5200/-

01031002 131- Iodine Therapy 15-50

mCi 16900/-

01031003 131- Iodine Therapy 51-

100 mCi 16900/-

Page 28: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

28

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01031004 131- Iodine Therapy >

100mCi 19500/-

01031005

Strontium therapy for metastatic bone pain

palliation 7200/-

01031006

Samarium-153 therapy for metastatic bone pain

palliation 10700/-

032 Cobalt 60 Therapy

01032001 Radical Therapy 70000/-

01032002 Adjustment Therapy-

Immobilisation technique 16000/-

01032003 Palliative Therapy (less

than 10 fractions) 15000/-

01032004 Palliative Therapy (10-25

fractions) 25000/-

01032005 Palliative Therapy (single

fraction) 5000/-

033 Linear Accelerators

01033001 3-D Planning (L. Acc. or

Cobalt-60) 6000/-

01033002 2-D Planning (L. Acc. or

Cobalt-60) 5000/-

01033003 Intensity Modulated Radio

Therapy (IMRT) 105000/-

01033004 Image Guided Radio

Therapy (IGRT) 150000/-

01033005 IGRT Single Fraction 7000/-

01033006 3D-CRT (Confirmal Radio

Therapy) 65000/-

01033007 3D-CRT with IGRT 75000/-

01033008 4D-CRT with IGRT 90000/-

01033009 Stereotactic Radio

Surgery (SRS) 85000/-

01033010 Stereotactic Radio

Therapy (SRT) 70000/-

01033011 Rapid Arc with IMRT rate 100000/-

01033012 Palliative Radiation

Therapy upto 15 fractions 25000/-

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01033013 Palliative Radiation

Therapy upto 25 fractions 35000/-

01033014 Palliative Radiation single

fraction 10000/-

01033015 Conventional Radiation

Therapy with CT 35000/-

01033016 Conventional Radiation

Therapy CBCT 45000/-

01033017

SRS/ SRT Neuro interventional charge/

case 10000/-

01033018 Electron Beam (>10

Fractions) 40500/-

01033019 Electron Beam (<10

Fractions) 9000/-

01033020 Pre-radiation profile 2500/-

034 Brachy Therapy

01034001

Intra Cavitary Brachytherapy- 1st

insertion 5500/-

01034002

Intra Cavitary/ Intra Luminal Brachytherapy-

2nd and subsequent insertion 3000/-

01034003 Interstitial Brachy

Therapy- 1st insertion 15000/-

01034004 Interstitial Brachy

Therapy- 2nd insertion 10000/-

035 Chemotherapy

01035001 Neoadjuvant 1000/-

01035002 Adjuvant 1000/-

01035003 Infusional Chemotherapy 1000/-

01035004 Chemotherapy wafers for malignant brain tumours 20000/-

01035005 Multiple drug therapy per

day 900/-

01035006 Targeted therapy 1000/-

01035007 Chemoport facility 1000/-

Page 29: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

29

CODE NAME OF TREATMENT

PROCEDURE

Maximum Approved Rate (INR) (Rupees)

01035008

PICC line (Peripherally Inserted Central

Canulisation) 1000/-

036 Room Rent (Per day)

01036001 General Ward 600/-

01036002 Semi-Private Ward 1200/-

01036003 Private Ward 1800/-

01036004 Day Care/ Minor (OPD)

Surgeries (all categories) 600/-

Admissible Blood

Charges

037 For treatment in

Government Hospitals

01037001 General Beds 50/-

01037002 Paying Beds 100/-

01037003 Cabin 140/-

038

For treatment in recognised Private Hospitals/ Nursing

Homes/ Aided Institurions

01038001 Whole Blood 500/-

01038002 F.F.P. 400/-

01038003 Platelet Concentrate 400/-

01038004 Platelet Rich Plasma 400/-

01038005 Packed Cell 400/-

01038006 Frozen Plasma 350/-

01038007 Crypoprecipitate 300/-

01038008 Washed RBC 400/-

Page 30: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

30

RATES OF INVESTIGATIONS :

02 – INVESTIGATIONS

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

001 General

02001001

Aspiration Plural Effusion - Diagnostic 750/-

02001002 Abdominal Aspiration -

Diagnostic 900/-

02001003 Pericardial Aspiration 1200/-

02001004 Bone Marrow Aspiration 800/-

02001005 Joints Aspiration 750/-

02001006 E.C.G. 140/-

02001007 E.E.G. 800/-

02001008 Stress test (TMT) 850/-

02001009 Lumbar puncture 1000/-

02001010 Sternal puncture 800/-

002 E.N.T.

02002001 Pure Tone Audiogram 300/-

02002002 Impedence & other tests 300/-

02002003 SISI, Tone Decay &

Difference times 250/-

02002004

Multiple hearing assessment test to Adults

450/-

02002005 Hearing Aid Selection 100/-

02002006 Hearing Aid Analysis 400/-

02002007 Speech Discrimination

Score 200/-

02002008 Speech Assessment 200/-

02002009 Cold Calorie Test for Vestibular function

180/-

02002010 Audiometry (MHC) 250/-

02002011 ABR (Threshold Est.) 650/-

02002012 Acoustic Reflex Decay 100/-

02002013 Eustachian Tube Func 100/-

02002014 IMP Audiometry 300/-

02002015 Otoacoustic Est. (OAE) 550/-

02002016 PEAD Audio Assessment 200/-

02002017 SRT & SDS 150/-

02002018 Swallowing Assest 30/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02002019 Tympanometry 150/-

02002020 Voice Assest 250/-

02002021 Endo Laryngoscopy 850/-

02002022 ENG 1300/-

02002023 Nasal Endoscopy 600/-

02002024 Nasopharyngoscopy 600/-

02002025 LV Dyssynchrony Study 1400/-

003 Eye

02003001 Refraction/Fundoscopy 150/-

02003002 Ortho-optic check up 150/-

02003003 Perimetry/field test 400/-

02003004 Clinical Photography 100/-

02003005 Electrooculogram 500/-

02003006 ERG 400/-

02003007 Flourescein Angioraphy 800/-

02003008 A-Scan 200/-

02003009 Tono Graphy 450/-

02003010 VER 300/-

02003011 Goldmen Perimetry 150/-

02003012 Specular microsopy 200/-

02003013 Indo cyaningreen

Angiography of Retina 1000/-

02003014 Indo cyaningreen

Angiography - IRIS 1000/-

02003015 Automated Perimetry 450/-

02003016 Corneal endothelial cell

count 200/-

02003017 Corneal topography 200/-

02003018 Corneal pachymetry 200/-

02003019 Retinal nerve film analyzer

studies 100/-

02003020 Auto Refrectemetry 60/-

02003021 Biometry 180/-

02003022 Ultrasound studies - A

Scan 600/-

02003023 Ultrasound studies -- B

Scan 600/-

02003024 Retinal/Meter function

studies 150/-

02003025 PAN ACUITY METER 200/-

Page 31: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

31

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02003026 Laser interferometry 1000/-

02003027 EKG, EOG 500/-

02003028 Dacryocystography (DGC) 500/-

02003029 Orbital Angio studies 500/-

02003030 Digital Biometry Reading

(Single) 180/-

02003031 Biometry (Both Eye) 350/-

02003032 Biometry-corp (Both) 400/-

02003033 Biometry-corp-Single 300/-

02003034 Pachymetry (Both Eye) 400/-

02003035 Pachymetry (Single) 200/-

02003036 Multifocal ERG (One Eye) 800/-

02003037 NCT 160/-

02003038 OCT- NFL Analyser 1600/-

02003039 Schiotz Tonometer 250/-

02003040 TTT 2500/-

02003041 VEP 600/-

02003042 Anterior Segment (Fundus)

Photography 300/-

02003043 USG 550/-

004 Physiotheraphy

02004001 Muscle testing and

diagnostic 100/-

005 Dental

02005001 Intra oral X-ray (Digital) 80/-

02005002 Opg Cephalogram 210/-

02005003 Opg Standard View 210/-

02005004 Radio Visiograph (per

Image) 110/-

006 Genetics

02006001 Fragile X Decet & Karyo of

Peri Bld Cell 3500/-

007 X-Ray (Digital X Ray)

02007001 Fluroscopy chest 120/-

02007002 Occlusal 130/-

02007003 Abdomen AP or Erect (one

film) 130/-

02007004 Abdomen Lateral view (one

film) 130/-

02007005 Abdomen for Pregnancy 130/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02007006 Chest PA view (one film) 130/-

02007007 Chest Oblique or Lateral

(One film) 130/-

02007008 Mastoids (one film) 150/-

02007009 Extremities, bones & Joints

(one film) 140/-

02007010 Pelvis (One film) 140/-

02007011 Paranasal sinuses (One

film) 140/-

02007012 T.M. Joints (One film) 140/-

02007013 Abdomen & pelvis for

K.U.B. 250/-

02007014 Skull A.P. & Lateral 250/-

02007015 Spine A.P. & Lateral 250/-

02007016 Barium Swallow 700/-

02007017 Sinography/ Sialography 750/-

02007018 Cystography/ Urethrography

1120/-

02007019 Hystero-Salpaingography 1110/-

02007020 Arthrography 840/-

02007021 Retrograde Pyelography 1080/-

02007022 Oral or I.V.

Cholecystography 720/-

02007023 Barium Enema 1160/-

02007024 Barium Meal Upper or

Lower 960/-

02007025 Bronchography 1260/-

02007026 I.V. Urography/ I.V.P. 1350/-

02007027 Myelography 1500/-

02007028 Pneumo Encephalography 1120/-

02007029 Barium meal Complete 1230/-

02007030 Cerebral/Femoral

Angiography 2000/-

02007031 Periapical X-Ray 100/-

02007032 Barium Enema (Double

Cont.) 1300/-

02007033 Barium IC Junction 750/-

02007034 Gastro Conray Meal 750/-

02007035 Intravenous Pyelogram 1400/-

02007036 T-Tube Cholangiogram 700/-

02007037 PTBD Gram 700/-

02007038 Micturating 750/-

Page 32: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

32

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

Cystourethrogram (MCU)

02007039 VUR/ Cystourethrography

2600/-

02007040 Small Bowel Enema 1150/-

02007041

Any XRAY using portable machine-addl handling

charge 300/-

02007042

Any other XRAY- single Film (Small)

130/-

02007043

Any other XRAY- single Film (Large)

160/-

008 Conventional X-Ray (70%

of Digital X-Ray rates)

02008001 Fluroscopy chest 90/-

02008002 Occlusal 90/-

02008003 Abdomen AP or Erect (one

film) 90/-

02008004 Abdomen Lateral view (one

film) 90/-

02008005 Abdomen for Pregnancy 90/-

02008006 Chest PA view (one film) 90/-

02008007 Chest Oblique or Lateral

(One film) 90/-

02008008 Mastoids (one film) 100/-

02008009 Extremities, bones & Joints

(one film) 90/-

02008010 Pelvis (One film) 90/-

02008011 Paranasal sinuses (One

film) 90/-

02008012 T.M. Joints (One film) 90/-

02008013 Abdomen & pelvis for

K.U.B. 170/-

02008014 Skull A.P. & Lateral 160/-

02008015 Spine A.P. & Lateral 170/-

02008016 Barium Swallow 490/-

02008017 Sinography/ Sialography 520/-

02008018 Cystography/ Urethrography

780/-

02008019 Hystero-Salpaingography Rs 780/-

02008020 Arthrography 590/-

02008021 Retrograde Pyelography 760/-

02008022 Oral or I.V.

Cholecystography 510/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02008023 Barium Enema 810/-

02008024 Barium Meal Upper or

Lower 670/-

02008025 Bronchography 880/-

02008026 I.V. Urography/ I.V.P. Rs 950/-

02008027 Myelography Rs 1050/-

02008028 Pneumo Encephalography 780/-

02008029 Barium meal Complete 860/-

02008030 Cerebral/Femoral

Angiography 1180/-

02008031 Periapical X-Ray 70/-

02008032 Barium Enema (Double

Cont.) 910/-

02008033 Barium IC Junction 530/-

02008034 Gastro Conray Meal 530/-

02008035 Intravenous Pyelogram 980/-

02008036 T-Tube Cholangiogram 490/-

02008037 PTBD Gram 490/-

02008038 Micturating

Cystourethrogram (MCU) 530/-

02008039 VUR/ Cystourethrography 1820/-

02008040 Small Bowel Enema 810/-

02008041

Any XRAY using portable machine-addl handling

charge 300/-

02008042

Any other XRAY- single Film (Small)

90/-

02008043

Any other XRAY- single Film (Large)

110/-

009 Ultrasound

Investigations

02009001 Obstetric First Scan/

Follow up 500/-

02009002 USG: Lower Abdomen/

Pelvis 800/-

02009003 Upper abdomen First

Scan/ Follow up 600/-

02009004 Ultrasound-

Neurosonogram 900/-

02009005

USG- Neurosonogram- Screening

350/-

Page 33: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

33

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02009006

Total Abdominal survey or Multiple organ study

950/-

02009007 Special procedures &

Aspiration etc. 1230/-

02009008 Image Intensifiers 700/-

02009009 USG: Neck 850/-

02009010 USG: KUB 800/-

02009011 USG: Whole Abdomen 950/-

02009012 USG: Whole Abdomen +

Transrectal 1500/-

02009013 USG: Scrotum 900/-

02009014 USG: Testis 600/-

02009015 Ultrasound Bladder 600/-

02009016 Ultrasound Kidney/ Renal 600/-

02009017 USG: Pregnancy + Doppler 2200/-

02009018 USG: Joint (Unilateral) 900/-

02009019 USG: Joint (Bilateral) 1800/-

02009020 USG: Musculoskeletal 800/-

02009021 USG: Transrectal 800/-

02009022 USG: Breast Unilateral 700/-

02009023 USG: Breast Bilateral 1050/-

02009024 USG: Thyroid 800/-

02009025 USG: Chest 700/-

02009026 USG: Prostate 550/-

02009027 USG: Single Organ 550/-

02009028 USG: Follicular Study 1250/-

02009029 USG: Guided Procedure 600/-

02009030 USG: FNAC 900/-

02009031 USG: Follow-up Ovulation 600/-

02009032 USG: For Congenital

Anomaly 1800/-

02009033 Ultrasound Parotid 800/-

02009034 Ultrasound Thigh 800/-

02009035 Any USG using portable

machine- handling charge 200/-

010 Clinical Pathology

02010001 Urine routine 60/-

02010002 Quantitative Albumin/Sugar 50/-

02010003 Urine Bile Pigment and 50/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

Salt

02010004 Urine Urobilinogen 50/-

02010005 Urine Ketones 50/-

02010006 Urine Occult Blood 50/-

02010007 Urine total proteins 100/-

02010008 Urine Sodium 100/-

02010009 Urine Chloride 100/-

02010010 Bence Jones protein 90/-

02010011 Stool routine 60/-

02010012 Stool occult blood 60/-

02010013 Post coital smear

examination 100/-

02010014 Smear analysis 100/-

02010015

Body fluid (CSF/Ascitic Fluid etc.) Chemistry,

Sugar, Protein etc. 240/-

02010016 Body fluid for Malignant

cells 200/-

02010017 Urinary Porphobilinogen 110/-

02010018 Urinary Myoglobin 400/-

02010019 Urine for

Immunoelectrophoresis 3500/-

02010020 Urine for Protein Electrophoresis

2800/-

02010021 CRK ISO Enzyme Electrophoresis

5000/-

02010022 Hb Electrophoresis 600/-

02010023 Chyle Test 100/-

02010024 Semen Analysis 280/-

02010025 IVF Semen Analysis 250/-

02010026 Stool Reducing Substance 60/-

02010027 Stool for OVA, Parasite 70/-

02010028 Stool for Parasite 60/-

02010029 Stool Culture & Sensitivity 200/-

02010030 Urine for Culture &

Sensitivity 250/-

02010031 Karyotype Chromosome

Analysis 2400/-

02010032 Genotyping 5000/-

02010033 Glucotyping 5000/-

02010034 Urine for Electrolytes 200/-

Page 34: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

34

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02010035 Urine Amino-aciduria 150/-

02010036 Urine for Phosphorus 220/-

02010037 Urine for Z-N Stain 60/-

02010038 Urine Protein/Creatinine

Ratio 250/-

02010039 Opiates Serum Random

Urine 450/-

02010040 Opiates Random Urine 450/-

02010041 Urine Ammino Acid,

Qualitative, 2 Dimensional 700/-

02010042 Pre/Post-Dialysis

Creatinine 100/-

02010043 Pre/Post-Dialysis

Potassium 100/-

02010044 Pre/Post-Dialysis Sodium 100/-

02010045 Pre/Post-Dialysis Urea 80/-

011 Haematology

02011001 Haemoglobin (Hb) 50/-

02011002 Total Leucocytic Count

(TLC) 50/-

02011003 Differential Leucocytic

Count (DLC) 50/-

02011004 E.S.R. 50/-

02011005 Total Red Cell count 60/-

02011006 Platelet count 80/-

02011007 Reticulocyte count 70/-

02011008 Absolute Eosinophil count 60/-

02011009 Packed Cell Volume (PCV) 50/-

02011010 Peripheral Smear

Examination 70/-

02011011 Smear for Malaria parasite 70/-

02011012 Bleeding & Clotting Time 60/-

02011013 Clot Retraction Time 50/-

02011014 R.B.C. Fragility Test 100/-

02011015 L.E. Cell 120/-

02011016 Foetal Haemoglobin (Hb-F) 250/-

02011017 Prothrombin Time (P.T.) 150/-

02011018 Complete Haemogram 180/-

02011019 Bone Marrow Smear

Exmination 400/-

02011020 Partial Thromboplastin 200/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02011021

Glucose 6 Phosphate Dehydrogenase (G, 6PD)

220/-

02011022 P.C.V. Haematocrit 50/-

02011023 RBC Folate 1350/-

02011024 Whole Blood Folate 1350/-

02011025 Sickling Test 120/-

02011026 Bleeding Time 40/-

02011027 Clotting Time 40/-

02011028 D-Dimer Semi Quantitative 900/-

02011029 Scurose Lysis Test 280/-

02011030

Red Cell Osmotic Frag. with Incubato

280/-

02011031 Heinz Body Test 120/-

02011032 Fibrinogen 400/-

02011033 FDP 150/-

02011034 Plasma Haemoglobin 190/-

02011035 Factor VIII Studies 1000/-

02011036 Factor IX Functional 1200/-

02011037 Factor V Functional 2500/-

02011038

Factor V Lieden Mutation Analysis

4000/-

Page 35: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

35

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02011039 TC, DC, ESR 120/-

02011040

Absolute Lymphocytes Count

80/-

02011041

HB, TC, DC 120/-

02011042 Bone Marrow [Perls Stain] 750/-

02011043 Cell Type & Cell Count 320/-

02011044

Nasal Smear for Eosinophils

90/-

02011045 CSF Cell Counts [TC/DC] 170/-

02011046

Complete Blood Picture [CBP]

180/-

02011047 MCV MCH MCHC 180/-

02011048 Investigation of ABO/RH 360/-

02011049 Sinovial Fluid for Analysis 400/-

02011050 Blood Parasites 70/-

02011051 Malaria Parasite 70/-

02011052 Malarial Antigen Detection 320/-

02011053 Filaria Antigen W. Bancrofti 560/-

02011054 Lap Score 400/-

02011055 BAL Cell Count 100/-

02011056 Cold Agglutination 150/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02011057 AT III 650/-

02011058 AT III Anti Thrombin 650/-

02011059 Absolute Neutrophil Count 50/-

02011060 Osmotic Fragility 120/-

02011061 HLA Typing 10000/-

02011062 T-Cell Cross Matching 5000/-

02011063

Karyotyping for Bone Marrow Cancer (REL

6000/-

02011064 Sucrose Lysis Test 120/-

02011065 APTT (50:50) 200/-

02011066

Immunofixation Electroporesis

7200/-

012 Blood Bank

02012001 Blood Group & RHO Type 140/-

02012002 Cross match 50/-

02012003 Packed Cells- Proc.

Charges 450/-

02012004 Saline Washed Packed

Cells: Proc. Charges 450/-

02012005 Coomb’s Test Direct/

Indirect 200/-

02012006 Australia Antigen 200/-

02012007 RHO, Antibody titer 250/-

02012008 Platelet rich Plasma-Proc.

Charges 450/-

02012009 Whole Human Blood-I.P.-

Proc. Charges 450/-

02012010 Fresh frozen Plasma: Proc.

Charges 450/-

02012011 Cryoprecipitate: Proc.

Charges 450/-

02012012 Platelet Concent- Proc.

Charges 450/-

02012013 Therapeutic Phlebotomy:

Proc. Charges 450/-

Page 36: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

36

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02012014 Granulocyte Conc.: Proc.

Charges 450/-

013 Bio-Chemistry

02013001 Glucose blood- Fasting/

PP/ Random 70/-

02013002 Blood Urea Nitrogen/ Blood

Urea 80/-

02013003 Serum Creatinine 100/-

02013004 Serum Uric Acid 110/-

02013005 Serum Bilirubin total/ direct 130/-

02013006 Serum Iron 220/-

02013007 Serum Cholesterol 120/-

02013008 Total Iron Binding Capacity 300/-

02013009 CK MB 390/-

02013010 Serum Calcium 120/-

02013011 Serum Phosphorus 120/-

02013012 Total Protein Alb/Glo Ratio 140/-

02013013 S.G.P.T. 120/-

02013014 S.G.O.T. 120/-

02013015 Serum amylase 250/-

02013016 Serum Electrolyte 250/-

02013017 Triglyceride 220/-

02013018 Glucose Tolerance Test

(GTT) 300/-

02013019 C.P.K. 270/-

02013020 L.D.H. 210/-

02013021 L.D.-1 320/-

02013022 LDH & LD-1 470/-

02013023 T3 300/-

02013024 T4 300/-

02013025 TSH 300/-

02013026 T3, T4, TSH 700/-

02013027 FSH 420/-

02013028 LH 410/-

02013029 FSH & LH 670/-

02013030 Prolactin 470/-

02013031 Blood gas analysis 400/-

02013032 Blood gas analysis with

electrolytes 500/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02013033 Cortisol 650/-

02013034 HDL Cholestrol 200/-

02013035 VLDL Cholesterol 170/-

02013036 ALDL 480/-

02013037 Lipid Profile 700/-

02013038 LFT [Liver Function Test] 750/-

02013039 Alkaline Phosphatase 150/-

02013040 Acid Phosphatase 300/-

02013041 Leucocyte Alkaline Phosphatase Score

600/-

02013042 Serum Magnesium 170/-

02013043 Serum Copper 500/-

02013044 Serum Lithium 250/-

02013045 Serum Lipase 250/-

02013046 Serum Chloride 150/-

02013047 Serum Inorganic

Phosphorous 160/-

02013048 Serum Ceruloplasmin 750/-

02013049 Serum

Carbamazepine/Tegretol 1400/-

02013050 Carbamazepine 600/-

02013051 Serum Calcitonin 1400/-

02013052 Calcitonin 1200/-

02013053 Myoglobin Serum 2400/-

02013054 Serum C Peptide 800/-

02013055 Serum C Peptide (PP) 500/-

02013057 Serum Eption/Phenytoin 700/-

02013058 Albumin (Serum) 120/-

02013059 Serum Ferritin 720/-

02013060 Serum B12 Level 600/-

02013061 Serum Sodium 240/-

02013062 Serum Folate 720/-

02013063 Folate & Vitamin 12 Serum 1100/-

02013064 Serum Aldolase 400/-

02013065 Serum Acetaminophen 650/-

02013066 Serum Growth Hormone 550/-

02013067 Parathyroid Hormone

(PTH), Intact 1200/-

02013068 Serum Osmolality 250/-

Page 37: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

37

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02013069 Serum Potassium 150/-

02013070 Serum TIBC 280/-

02013071 Serum Parathormone

Level 900/-

02013072

Serum Homocystine/ Homocystine/ Homocystine

Level 750/-

02013073 Serum Individual Phospolipids-TLC

450/-

02013074 Serum/Plasma Bicarbonate 350/-

02013075 Serum Haptoglobin 850/-

02013076 Serum Testosterone 500/-

02013077 Serum Thyroglobulin 1360/-

02013078 Lactate Plasma 550/-

02013079 CA-19-9 1000/-

02013080 CA 125 800/-

02013081 CA 15.3 160/-

02013082 CA 72.4 Gastric Cancer

Marker 1050/-

02013083 CSF Sugar 100/-

02013084 CSF Protein 100/-

02013085 Lactate (CSF) 400/-

02013086 CSF Protein

Electropherisis 800/-

02013087 CSF-Oligoclinal Band

Analysis 2000/-

02013088 CSF for Biochemical

Analysis 280/-

02013089 CSF Chloride 150/-

02013090 CSF Profile 3200/-

02013091 Sodium Bicarbonate 100/-

02013092 Mucopolysaccharidoses

(MPS) Screening U 500/-

02013093 Renin Activity Plasma,

PRA 4000/-

02013094 Plasma Ammonia 400/-

02013095 Fructosamine 200/-

02013096 GGT-Gamma Glutamyl

Transaminase 320/-

02013097 Globulin 120/-

02013098 Estradiol 520/-

02013099 Estradiol (E2) 420/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02013100 Glycosylated Haemoglobin

[HBA1C] 520/-

02013101 Alpha I Anti Trypsin Assay 1200/-

02013102 Insulin-P.P./ Fasting/

Random 650/-

02013103 Lactose Tolerance Test 550/-

02013104 DHEA-S (Sulphate) 800/-

02013105 Serum Digoxin/ Serum

Digoxin Level 700/-

02013106 Serum Gastrin 900/-

02013107 Progesterone 450/-

02013108 Beta HCG (B-HCG) 650/-

02013109

Beta HCG Quantitative Trophoblastic Cancer

Marker 600/-

02013110 Cardiac Enzymes 450/-

02013111 LDH Heat Stable Fraction 640/-

02013112 LDH Isoenzymes 1430/-

02013113 Antiphospolipid Antibody

IGG & IGM 1050/-

02013114

Antiphospolipid Antibody IGM

750/-

02013115 Anti-Sperm Antibody/ ABS 550/-

02013116 Alpha-Feto Protein (AFP)

Cancer Marker 650/-

02013117 Carcino Embryonic Antigen

[CEA] 600/-

02013118 Anti-Thyroid Antibodies 950/-

02013119 Anti-Thyroid Antibodies-TG

Ab 900/-

02013120 Bicarbonate 150/-

02013121 Anti Cardiolipin Antibody-

IgG/ IgM 650/-

02013122 Anti Cardiolipin Antibody

Profile 1700/-

02013123 C_Peptide Assay 350/-

02013124 Cyst Fluid for Analysis 350/-

02013125 Trop-T 820/-

02013126 Troponin T-Qualitative 400/-

02013127 Intracellular Calcium 120/-

02013128 Pleural/ Peritoneal Fluid for

Sugar 80/-

02013129 Peritoneal Dialysis Fluid for

Sugar & Urea 220/-

Page 38: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

38

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02013130 Apolipo Proteins 500/-

02013131 Free Testosterone 600/-

02013132 Blood Acetone/Ketone 240/-

02013133 Pleural Fluid for Protein 80/-

02013134 Pleural Fluid for LDH 200/-

02013135 Pleural Fluid for Amylase 180/-

02013136 Fluid for LDH 160/-

02013137 Fluid for Amylase 130/-

02013138 Fluid for Creatinine 110/-

02013139 Fluid for Lipase 130/-

02013140 Fluid for Cholesterol 150/-

02013141 Phenytoin Level 720/-

02013142 24 H Ketosteroid & Ketogenic Steroid

1700/-

02013143 Angio Tension Converting

Enzyme (ACE) 780/-

02013144 Phenobarbitone 720/-

02013145 Anti Thyroid Antibodies

TPO Ab 900/-

02013146 Anti TG 550/-

02013147 ACTH 960/-

02013148 ACTH Plasma 960/-

02013149 Intact PTH 700/-

02013150 IGFI 350/-

02013151 IGF-I (Somatomedin-C) 2800/-

02013152 B-2 Microglobulin 960/-

02013153 Valproic Acid 520/-

02013154 Valproate 520/-

02013155 Sex Hormone Binding 1200/-

02013156 Vitamine B-12 Level 800/-

02013157 Vitamin D 25 Hydroxy 1400/-

02013158 17 Hydroxy Corticostiroids 580/-

02013159 Lipoprotein (a) 400/-

02013160 Synovial Fluid for

Biochemistry 480/-

02013161 Plasma Catecholamines 5500/-

02013162 Serum IgA 220/-

02013163 Serum IgG 220/-

02013164 Serum IgM 400/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02013165 Pericardial Fluid for

Biochemistry 360/-

02013166 Pericardial Fluid Test 100/-

02013167 Peritoneal Fluid-

Biochemistry 450/-

02013168 Aldosterone 1150/-

02013169 Galactosemia Profile 1800/-

02013170 FISH (NH) 2800/-

02013171 FISH for BCR/ ABL 3200/-

02013172 Fluid for TVPCR 1400/-

02013173 Serum Cortisone 380/-

02013174 Transferrin 780/-

02013175 Chromogranin A 5000/-

02013176 Cryo Globulin Screening 780/-

02013177 Cocaine Metabolite Screen 500/-

02013178 Cyclosporine CO 1600/-

02013179 Cytokeratin/ Erythropoietin 1200/-

02013180 Protein C/ S, Functional 2800/-

014 Histopathology

02014001 Pap Smear 240/-

02014002 Histopathology exam per

tissue type 250/-

015 Bactriology & Serology

02015001 Smear gram-strain

examination 100/-

02015002 Sputum smear A.F.B. stain 100/-

02015003 Vaginal Smear Examination

100/-

02015004 V.D.R.L. 120/-

02015005 Widal test 180/-

02015006 Rheumatoid Factor test 300/-

02015007 Culture & Sensitivity (other

specimens) 250/-

02015008 Urine pregnancy test 200/-

02015009 C.R.P. 220/-

02015010 ASO Titer 250/-

02015011 Quantitative H.C.G. 400/-

02015012 Blood culture & sensitivity 250/-

02015013 Vibro cholera culture 250/-

02015014 CAPD Fluid for Culture & 350/-

Page 39: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

39

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

Sensitivity

02015015 CAPD Fluid for Fungal

Stain/ Gram Stain 100/-

02015016 CAPD Fluid-Cytology 200/-

02015017 Rapid Urease Test 250/-

02015018 ASO (Antistreptoysin “O”) 360/-

02015019 High Sensitivity-CRP 400/-

02015020 PUS for Fungal Culture 250/-

02015021 PUS for Fungal Stain 100/-

02015022 PUS for Gram Stain 100/-

02015023 PUS for Z-N Stain 100/-

02015024 Culture & Sensitivity [PUS] 250/-

02015025 Culture & Sensitivity [CSF] 250/-

02015026 Culture & Sensitivity

[Semen] 250/-

02015027 Culture & Sensitivity [Fluid] 250/-

02015028 Culture & Sensitivity

[Sputum] 250/-

02015029 Culture & Sensitivity

[Throat Swab] 250/-

02015030 Culture & Sensitivity for

Vaginal Swab 250/-

02015031 Culture & Sensitivity for

Aspirated Fluid 250/-

02015032 Culture & Sensitivity

[Wound Swab] 250/-

02015033 Wound Swab for Fungal

Stain 100/-

02015034 Wound Swab for Gram

Stain 100/-

02015035 Wound Swab for Z-N Stain 100/-

02015036 Culture & Sensitivity

[Rectal Swab] 250/-

02015037 Nail for Fungal Culture 200/-

02015038 Nail Clipping for KOH

preparation 100/-

02015039 Blood Culture & Sensitivity-

Anaerobic 600/-

02015040 Blood for Culture &

Sensitivity (Paediatric) 600/-

02015041 Tissue for Culture &

Sensitivity 250/-

02015042 Mitral Valve Tissue for Culture & Sensitivity 250/-

02015043 Aortic Valve Tissue for 250/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02015044 Arterial Line Tip for Culture

& Sensitivity 250/-

02015045 Ascitic Fluid for Culture &

Sensitivity 600/-

02015046 AC Tap for Culture &

Sensitivity 250/-

02015047 Sputum for AFB Culture 500/-

02015048 Sputum for Fungal Culture 150/-

02015049 Sputum for Fungal Stain 100/-

02015050 Sputum for Z-N Stain 100/-

02015051 Sputum for Grams Stain 100/-

02015052 Esophageal Smear for

Candida 150/-

02015053 Urine for AFB Culture 500/-

02015054 Pleural Fluid for AFB

Culture 500/-

02015055 Pleural Fluid- TBPCR 1200/-

02015056 Culture AFB Antibiotic

Sensitivity- 5 Drug Panel 3000/-

02015057 Urine for Gram Stain 100/-

02015058 Throat Swab for KLB 100/-

02015059 Fungus Culture 150/-

02015060 Clostridium Difficile Toxin A

& B 1200/-

02015061 Yeast Identification and

Susceptibility 350/-

02015062 Non Fermenter

Identification 300/-

02015063 Serology for Mumps

IGM/IGG 1000/-

02015064 Torch Profile 1500/-

02015065 Serum Angitens. Conv.

Enzy. Assay 400/-

02015066 P-ANCA 800/-

02015067 C-ANCA 800/-

02015068 Aldehyde Serum Test 80/-

02015069 Elisa Test for Ecinococcus

Antibody Detec 600/-

02015070 Ascitic Fluid Cell Count 200/-

02015071 Anti HBS (Antibody to

Australia-Antigen) 400/-

02015072 Hepatitis B Surface

Antibody 400/-

Page 40: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

40

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02015073 Anti-HBC Core Antibody

IgM 550/-

02015074 Serum Immunoglobulin 600/-

02015075 Immunoglobulin IGE 500/-

02015076 IGE Allergy Individual 600/-

02015077 Immunoglobulin-IGA 600/-

02015078 Immunoglobulin IGM 600/-

02015079 Immunoglobulin IGG 600/-

02015080 Anti-HAV-IGM-Antibody 1000/-

02015081 Compliment C3 350/-

02015082 Compliment C4 350/-

02015083 Toxoplasma- IgG 370/-

02015084 Toxoplasma- IgG 370/-

02015085 Toxoplasma- IgG + IgM 700/-

02015086 Cysticercosis Antibody/

Antibody IgG 600/-

02015087 Cytomegalovirus, PCR 2000/-

02015088 PCR for AFB 1350/-

02015089 Herpes I(IgG)(HSV Type I) 300/-

02015090 Herpes I(IgM)(HSV Type I) 300/-

02015091 Herpes II (IgG)(HSV Type

II) 300/-

02015092 Herpes II (IgM)(HSV Type

II) 300/-

02015093 Herpes I + II (IgG) 300/-

02015094 Herpes I + II (IgM) 300/-

02015095

TPHA (Treponema Pallidum Haemagglutinat

340/-

02015096 HBsAg 420/-

02015097 Hydatid Cyst for IgG Elisa 600/-

02015098 Aspergillus Antibody

(IGG/IGM) 1000/-

02015099 Anti HCV IgG/IgM 820/-

02015100 Anti HEV IgG/IgM 840/-

02015101 Allergy Screening- Adult 1200/-

02015102 Dengue Elisa 1000/-

02015103 Dengue Antibodies IgG +

IgM 600/-

02015104 Dengue NS1 Ag Test 600/-

02015105 Screening for C-Pylori 200/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

[RUT]

02015106 Elisa for Tuberculosis

[IGG/IGM/IGA] 350/-

02015107 Febrile Agglutinins

[Widal.Weli-FEl 400/-

02015108 HBe Antigen Detection

(HBe Ag) 550/-

02015109 CMV (Cytomegalo Virus

)Antibody [IGM] 350/-

02015110 Brucella Antibody 420/-

02015111 Breast Cancer ERPR and

HER2/NEU 2400/-

02015112 Anti HCV IIIrd Generation

Elisa 350/-

02015113 Epstein Bar Virus IGM

[VCA Elisa] 600/-

02015114 HEV IgM Elisa 700/-

02015115 Legionella Pneumophila-

Elisa 600/-

02015116 Elisa for Pregnancy 630/-

02015117 Elisa for Mumps (IgG

Antibody) 450/-

02015118 Elisa for Measles (IgG

Antibody) 450/-

02015119 Mumps Elisa (IgM

Antibody) 520/-

02015120 HIV P24 Antigen 600/-

02015121 Vivax Antigen 350/-

02015122 Anti Smooth Muscle

Antibody (ASMA) 500/-

02015123 Anti-Mitochondrial

Antibody-M2 (AMA-M2) 750/-

02015124 Anti-Nuclear Antibody/

ANF/ ANA 450/-

02015125 ANA IFA (HEP-2) Method 960/-

02015126

Anti-Native Deoxyribonucleic Acid (Ds-

DNA) 700/-

02015127 Antismith Antibody 650/-

02015128 Rubella IgG/IgM Antibody 360/-

02015129 Rubella IgG & IgM 650/-

02015130 Rubeola IgG/IgM Antibody 1000/-

02015131 Rubeola Antibodies IgG &

IgM 1400/-

02015132 Leptospira Antibody

IGM/IGG 840/-

Page 41: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

41

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02015133 Leptospira Antibody IGG &

IGM 1650/-

02015134 Cryptococcus Antigen-Latex Detection (CSF)

1300/-

02015135 Falciparum Antigen 360/-

02015136 ADA (Adenosine

Deaminase- Body Fluid) 450/-

02015137 Mantoux Test 150/-

02015138 Anti HAV-Total (IGG &

IGM) 720/-

02015139 Cytomegalo Virus (CMV

)Antibody [IGG] 320/-

02015140 CMV IgM + IgG 600/-

02015141 Chopra Aldehyde Test 100/-

02015142 Amniotic Fluid-Lecithin

Spingomyl 400/-

02015143 Amoebiais Antibodies [IHA]

Screening 280/-

02015144 Amoebic Serology 800/-

02015145 KOH Mount for Fungal

Elements Detection 100/-

02015146 Campylobacter Jejieni

Antigen Detection I 360/-

02015147 HIV Test (1 & 2) 450/-

02015148 Typhi DOT-M 160/-

02015149 Hepatitis B-Core, total

(HBC total, IGG + IGM) 720/-

02015150 Anti HBC Antibody (IgM) 720/

02015151 Anti HBC Antibody (Total) 720/

02015152 Anti HBE 550/-

02015153 Hepatitis Be Antibody 550/-

02015154 Hepatitis D Virus Antibody 1450/-

02015155 HLA B27 CHN 920/-

02015156

HLA-B27, Disease Association, Flow

Cytometry 1500/-

02015157 HLA-ABC & DR Tissue

Crossmatch 2000/-

02015158 HCV RNA PCR Qualitative 2500/-

02015159 Hepatitis C Viral RNA

Genotype, LIPA 9500/-

02015160 Varicella- Zoster Virus IGG

Titres 520/-

02015161 Varcilla Zoster IgM 720/-

02015162 Varcilla Zoster IgG & IgM 1400/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02015163 Anti LKM-1 (Liver Kidney

Microsomal-1) Antibo 820/-

02015164 Viable MTB Detection-

PCR 1500/-

02015165 HIV Qualitative (Window

Period Detection) 1200/-

02015166 Anti Sclero 70/ SCL 70 1300/-

02015167 Comprehensive CNS Panel- (Molecular Dia

6800/-

02015168 HIV Proviral DNA Detector

Qualitative 1100/-

02015169 Hepatitis B PCR

Quantitative 1900/-

02015170 Hepatitis B Virus PCR

Qualitative 3000/-

02015171 Anti GBM Antibody+

900/-

02015172 HSV DNA PCR 1500/-

02015173 Anti RNP-Sm Antibody 1000/-

02015174 Antibody to Ribonucleo

Protein IgG 1100/-

02015175 NBT Reduction Test 720/-

02015176 Anti Jo Antibody 520/-

02015177 Anti Jo-1 Antibodies 840/-

02015178 Antibody to SSA/SSB 2000/-

02015179 Antibody to SSB/LA 720/-

02015180 Japanese Encepahilits Virus PCR (JE Virus P

1500/-

02015181

HIV-1 RNS Quantitative RT-PCR with CD-3, CD-4,

CD 3800/-

02015182 RNS Study/ Decrement 350/-

02015183 HIV Viral Load CD4 & CD8 3200/-

02015184 Anti RNP- Sm IgG 1100/-

02015185 Anti Endomysial Antibody

IgA 720/-

02015186 CD-4, CD-8 700/-

02015187 CD 10 1200/-

02015188 CD 20 920/-

02015189 CD 3 920/-

02015190 CD 30 920/-

02015191 HCV RNA Quantitative/

Viral Load 6000/-

02015192 HBV Quantitative 5500/-

Page 42: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

42

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02015193 HBV DNA Qualitative 1900/-

02015194 Mycobacterium

IgA/IgG/IgM 600/-

02015195 Mycobacterium Serology

IgG/IgM 500/-

02015196 Mycobacterium

Tuberculosis Serology EL 1900/-

02015197 TB PCR (Mycobacterium

tuberculosis PCR) 850/-

02015198 Treponema Pallidum Antibody Detection

300/-

02015199 Treponemal Pallisum,

FTPA-ABF 2000/-

02015200 Autoimmune Hepatitis

Panel 900/-

02015201 Antinuclear antibody Panel

(14 antibody panel) 1100/-

02015202 Anti CCP Antibody 450/-

02015203 Anti Centromere Antibody 800/-

02015204 Serum Procalcitonin 2000/-

02015205 Serum Prealbumin 550/-

02015206 HSV (1+2) IgG/IgM

Antibodies 280/-

02015207 HSV (1+2) IgG and HSV

(1+2) IgM 550/-

02015208 Chikungunya Test 500/-

02015209 ANA/ ANF in Dilution 1000/-

02015210 Bronchial Aspiration for

Culture & Sensitivity 300/-

02015211 Bronchial Aspiration for

AFB Culture 500/-

02015212 Bronchial Aspiration for

Fungal Stain 100/-

02015213 Bronchial Aspiration for

Gram Stain 100/-

02015214 Bronchial Aspiration for

TBPCR 1400/-

02015215 CVP Tip for Culture &

Sensitivity 300/-

02015216 Dialysis Catheter Tip for

C/S 300/-

02015217

Ear/ Eye/ Nasal/ Tongue Swab for Culture &

Sensitivity 300/-

02015218 Prostatic Secretion for

Microscopy 150/-

02015219 Prostrate Specific Antigen

(PSA) 500/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

016 Obstetric Cases

02016001 Examination under

anaesthesia 2430/-

02016002 Laparoscopy (Gynae) 6060/-

02016003 Lap. Dye Test with removal

of adhesions 8000/-

017 Biopsies (Specimen

processing per tissue type)

02017001 Biopsy [Large] 600/-

02017002 Biopsy [Medium] 500/-

02017003 Biopsy [Small] 350/-

02017004 Biopsy [Extra Large] 800/-

018 Head & Neck Cancer

019 Cardio Respiratory

Procedures

02019001 Direct Laryngoscopy 4380/-

02019002 Bronchoscopy 2400/-

02019003 Mediastinoscopy 2880/-

02019004 Pleural Biopsy 3630/-

02019005 Thoracoscopy 6600/-

02019006 Pulmonary function test

BMR 700/-

02019007 Spirometry 700/-

02019008 Spirometry with Helium

Dilution 1620/-

02019009

Spirometry with Helium Dilution with diffusion

capacity studies 1620/-

02019010 Pulmonery exercise testing 940/-

02019011 Punctal Cautery 100/-

02019012 NT Pro BNP 1000/-

02019013 Cardioversion 1400/-

02019014 Cardiac Troponin I 400/-

Page 43: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

43

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02019015 TEE with Anesthesia 2500/-

02019016 Testicular 800/-

02019017

Flexible Bronchoscopy- Diagnostic- TBNA

10000/-

02019018

Flexible Bronchoscopy- Therapeutic

2500/-

02019019

Flexible Bronchoscopy- Glue

4000/-

02019020

Flexible Bronchoscopy- Baloon Tampete

4000/-

02019021

Flexible Bronchoscopy- Toileting

2600/-

02019022

Rigid Bronchoscopy- Diagnostic

5000/-

02019023

Rigid Bronchoscopy- Massive Haemoplysis

6200/-

02019024 Fibroptic bronchoscopy 2100/-

02019025 Fibroptic Bronchoscopy

with Washing/Biopsy 2500/-

020 Cardiac / Cardio Thoracic

Procedures

02020001 Test of Pacemaker 580/-

02020002 Stress Myocardial Study

(MBI/ TR) 7200/-

02020003 Echo Screening 720/-

02020004 Stress Echo/ Dobutamine

Echo 1950/-

02020005 Foetal Echocardiography 1320/-

02020006 Cardio Tocography 360/-

02020007

2 D Echo with colour Doppler/ 2D Echo

Cardiography 1320/-

02020008 Trans Oesophaedral Echo

(TEE) 840/-

02020009

Holter Analysis & Holter Report (with Prd.

Specification) 1470/-

02020010 Cardiac Cath Angiography

(Without Coronary 13200/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

Angioplasty)

02020011 Aortogram 3900/-

02020012

Package charges for Cardiovascular investigation 410/-

02020013 Stress Thallium 3600/-

02020014 Muga (Resting) 1440/-

02020015 Muga (Stress) 1800/-

02020016

Echo Colour Doppler

1440/-

02020017 Check Angio 7000/-

021 Abdomen/

Gastroentrology

02021001 Gastroscopy 1170/-

02021002

Gastric & Duodenal Biopsy (Endoscopic)

1560/-

02021003 ERCP 4000/-

02021004 ERCP Fluroscopy 2200/-

02021005

Upper G.I. Endoscopy 1100/-

02021006

Upper G.I. Endoscopy with Biopsy

1300/-

02021007 Sigmoidoscopy (rigid) 1400/-

02021008

Sigmoidoscopy (flexible) 1200/-

02021009

Oesophagoscopy 1100/-

Page 44: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

44

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02021010

Colonoscopy 1800/-

02021011

Colonoscopy-Full (GAS-PKG)

2000/-

02021012

24 H PH Metry 4000/-

02021013

24 H PH Metry (BS) 5500/-

022 Nephrology / Genitourinary

02022001 Biopsy of Bladder

(Cystoscopic) 8000/-

02022002 Urethroscopy 6000/-

02022003 Glomerular Filtration Rate 500/-

02022004 Urethral dialatation-

Diagnostics 1000/-

02022005 Visually Evoked Potential 500/-

02022006 Uroflow Study (Micturometry) 600/-

02022007 Urodynamic Study

(Cystometry) 1200/-

02022008

Cystoscopy with Retrograde Catheter

Unilateral 4000/-

02022009

Cystoscopy with Retrograde Catheter

Bilateral 6000/-

02022010 Cystoscopy Diagnostic 5000/-

02022011 Cortisol-blood 240/-

02022012 Voiding-cysto-urethrogram 360/-

02022013 Renal Transplant

Evaluation 1500/-

023 Orthopaedic Surgery

Procedure

02023001 Arthrography &

Osteomedullography 11000/-

02023002 Arthroscopy - Diagnostic 11000/-

024 Neurology

02024001 Placement of ICP Monitor - 6000/-

02024002 Lumber Pressure

Monitoring 6100/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02024003 Nerve Biopsy 8500/-

02024004 Brain Biopsy 8500/-

02024005 Brain Mapping 3000/-

02024006 Ambulatory Electro Ence 5000/-

02024007 Blink Reflex 500/-

02024008 Decrement Test 650/-

02024009 EMG Four Limbs 900/-

02024010 EMG Two Limbs 480/-

02024011 NCV Four Limbs 900/-

02024012 NCV Two Limbs 500/-

02024013 EMG-Facial 500/-

02024014 NCV-Facial 500/-

02024015 NCV+EMG-Facial 950/-

02024016 Spincter-EMG 550/-

02024017 H Reflex 500/-

02024018 SSEP (Lower Limbs) 550/-

02024019 SSEP (Upper Limbs) 550/-

02024020 SSEP-UL/LL 1000/-

02024021 VEP (Flash) 550/-

02024022 VEP (PR) 550/-

02024023 Counsl of INH Patient 200/-

02024024 Spl Edu Assessment 250/-

02024025 Baer Study 550/-

02024026 Baer/ Threshold 1000/-

02024027 Councelling & Therapy 200/-

02024028 IQ Assessment 300/-

02024029 Neuro Psychological T 850/-

02024030 Personality & IQ Child 450/-

02024031 Personality Development T 650/-

02024032 SSR 700/-

02024033 Lumbar puncture with CSF

Monitoring 1500/-

02024034 HER-2/ NEU 1200/-

025 Breast

02025001 Mammography (Single

side) 800/-

02025002 Mammography (Both

sides) 1500/-

Page 45: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

45

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

026 Gynae, Operation

Charges

02026001 Diagnostic Curettage 3000/-

02026002 Fractional Curettage 3400/-

02026003 Hysteroscopy Diagnostic 7500/-

027 Laproscopic Operations

In Gen. Surgery / Gastrohepatic / Nephro-

02027001 Diagnostic Laproscopy 7000/-

028 Specialised Procedures / Investigations/ C.T. Scan

02028001 Cat Scan (C.T.) Head 1600/-

02028002 C.T. Head Scan Involv.

Spl. Investigation 2300/-

02028003 C.T. Scan Brain 1600/-

02028004 HRCT Chest Thorax 6000/-

02028005 C.T. Chest (HRCT) 4000/-

02028006 C.T. Scan Chest 3500/-

02028007

C.T. Spine (Cervical,Dorsal, Lumbar,Sacral) 3500/-

02028008 CT Angiogram of Cervical

and Intra 7200/-

02028009 C.T. Cervical C.T. 3D Reconstruction only -- 1200/-

02028010 C.T. Guided Biopsy 2000/-

02028011 C.T. Guided percutaneous

cath drainage 2500/-

02028012 C.T. Myelogram (Cervical Spine) 3500/-

02028013 C.T. Myelogram

(Lumbar Spine or D/S) 3500/-

02028014 CT Pelvis with Hip Joints 3000/-

02028015 CT KUB (Plain) 3500/-

02028016 CT Sacro Iliac Joint 2500/-

02028017 CT Pituitary/ Sella 2500/-

02028018 CT Cisternography 1600/-

02028019 CT Petrous Temporal Bone 3000/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02028020 CT Sacrum & Coccyx 3500/-

02028021 C.T. Scan Upper Abdomen 3000/-

02028022 C.T. Scan Lower Abdomen 3000/-

02028023 C.T. Scan Whole Abdomen 5000/-

02028024

C.T. Shoulder Joint/ Knee Joint/ Elbow Joint/ Any

Other Joint (Plain) 3500/-

02028025 CT Base of Neck 2000/-

02028026 C.T. Scan Neck (Thyroid

Soft Tissue) 3000/-

02028027 CT Ankle with Foot 2000/-

02028028 C.T. Scan Orbits/Eye 3000/-

02028029

CT Arm/ Humerus/ Forearm/ Radius-Ulna/

Leg/ Tibia-Fibula/ Thigh/ Femur (Single) Plain 4500/-

02028030 C.T. Scan Limbs 2500/-

02028031 CT Both Thigh 2000/-

02028032 C.T. Scan Whole Body 10000/-

02028033 CT Extremities 2000/-

02028034 C.T. Scan of Para Nasal

Sinus 3000/-

02028035 CT guided FNAC 2500/-

02028036 CT Angiography of Brain/

Carotid/ Thorax/ Neck 5400/-

02028037 CT 64 Coronary

Angiography 10000/-

02028038

CT Angiography of Brain/ Carotid/ Thorax/ Neck/ Abdomen/ Extremities/ Renal area/ Peripheral

area/ Pulmonary area with Visipaque 6500/-

02028039 CT Renal Angiography 5000/-

02028040 CT Angio Both Lower

Limbs 10000/-

02028041 CT Angiography of Neck

Vessels 5000/-

02028042

CT Angiography of Abdomen/ Extremities/ Renal area/ Peripheral 6000/-

Page 46: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

46

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

area/ Pulmonary area

02028043

PET CT Scan (Whole Body)

(including Flurodeoxy Glucose) 20000/-

02028044 Therapeutic Aspiration- CT 3000/-

02028045 Diagnostic Aspiration- CT 1600/-

02028046 Ionic Contrast (20 C.C.) 270/-

02028047 Ionic Contrast (50 C.C.) 675/-

02028048 Non-ionic Contrast (10

C.C.) 500/-

02028049 Non-ionic Contrast (25

C.C.) 750/-

02028050 Non-ionic Contrast (50

C.C.) 1250/-

02028051 Non-ionic Contrast (100

C.C.) 2100/-

02028052 3D Reconstruction charge 1200/-

029 MRI

02029001

MRI Brain/ Brain with Protocol/ CSF Study/

Internal Ear 6000/-

02029002 MRI Base of Skull 5400/-

02029003 MRI Orbits 6000/-

02029004 MRI Face 5400/-

02029005 MRI Nasopharynx and

PNS 6000/-

02029006 MRI Pharynx 5400/-

02029007 MRI Neck 6000/-

02029008 MRI Pituitary 5400/-

02029009 MRI Thyroid/ Cranio-

Vertebral (C.V.) Junction/ 5000/-

02029010 MRI Temporal Bones

(Unilateral) 6000/-

02029011 MRI Venography/

Angiography 5400/-

02029012 MRI Arm/ Fore Arm/ Thigh/

Femur/ Leg/ Foot 5400/-

02029013 MRI Arm (Humerus) (Left/ 5400/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02029014 MRI- Single Joint 5400/-

02029015 MRI- Both Joints 9000/-

02029016 MRI Sacro Iliac Joints 5400/-

02029017

MRI Spine (Cervical/ Dorsal/ Lumbar/ Cervico-Dorsal/ Dorso-Lumbar/

Lumbo-Sacral) 5400/-

02029018 MRI Lumbar Spine &

Sacroiliac Joint 6000/-

02029019 Double Region Plain (Brain

& Spine) 9000/-

02029020 Tripple Region Plain (Brain

& Spine) 13000/-

02029021 MRI CSF Flow Study 1500/-

02029022 MRI Spectroscopy 1500/-

02029023 MRI Diffusion Tensor

Imaging (DTI) 1500/-

02029024 MRI SWI (Susceptibility

Weighted Image) 1500/-

02029025 MRI Hip 6000/-

02029026 MRI Urogram 5400/-

02029027 MRI Pelvis 6000/-

02029028 MRCP 5000/-

02029029 MRI Extremities 6000/-

02029030 MRI Upper Abdomen with

MRCP 6000/-

02029031 MRI Temporomandibular

Single Joint 5000/-

02029032 MRI Temporomandibular

Double Joints 6000/-

02029033 MRI Upper Abdomen 5400/-

02029034 MRI Upper Thigh & Lower

Abdomen 7000/-

02029035 MRI Whole Abdomen 9000/-

02029036 MRI Lower Abdomen/

Pelvis 5400/-

02029037 MRI Breast 6000/-

02029038 MRI Thoracic Outlet 5400/-

02029039 MRI Spine Screening 5400/-

02029040 MRI Brachial Plexus 5400/-

02029041 MRI Chest 5400/-

Page 47: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

47

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02029042 MRI Brain with Spectroscopy 6000/-

02029043 MRI Brain with Perfusion 7300/-

02029044 MRI Brain with Orbit/ PNS/

Angio/ Neck Angio 6500/-

02029045

MRI Brain with DTI (Diffusion Tensor Imaging)/

SWI (Susceptibility Weighted Image)/ Cranial

Nerve Evaluation 6000/-

02029046 MRI Perfusion Study 3500/-

02029047 MRI Screening 5400/-

02029048 Screening Single Area with

Films 1500/-

02029049 Screening Double Area

with Films 3000/-

02029050 MRI Small Part 4000/-

02029051 MRI Other Region 5400/-

02029052 Contrast (Ionic/ Non-ionic) 2500/-

030 Other Investigations

02030001 Fluoroscopic Screening 120/-

02030002 Oxygen Saturation 120/-

02030003 Bone Densitometry Single

site 800/-

02030004 Bone Densitometry Two

sites 1200/-

02030005

Bone Densitometry Three sites ( Spine , Hip & one

extremity) 1600/-

02030006 Bone Densitometry Whole

body 2200/-

02030007 A.V. Fistula 3000/-

031 Immunology

02031001 Hepatitis B DNA 5200/-

02031002 HBV DNA Quantitative/

Viral Load 6000/-

032 Nuclear Medicines

02032001 Isotope Venography 3500/-

02032002 Gallium-67 Scan/Ghallium

Scan 8500/-

02032003 Thyroid Scan 1800/-

02032004 Iodine-131 Thyroid Scan 2500/-

02032005 Thyroid (Tc99m) Scan 1800/-

02032006 Para Thyroid Scan 6000/-

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

02032007 Thallium Scan 9000/-

02032008 Spect Myocardial Perfusion

Scan (Thalium/ Tetro) 11000/-

02032009 Spect Myo Perfusion Rest Scan (Thalium/ Tero/ Mie 5500/-

02032010 Nuclear Blood Pool Scan 2000/-

02032011 Radio-Isotope Ureteric

Reflux (Indirect) 3000/-

02032012 Whole Body Tc-V-DMSA

Scan 3500/-

02032013 Brain Spect (Tumour

Imaging) 2500/-

02032014 Tumour Immagery 5000/-

02032015 Bone Scan Spect (Single

Region) 1800/-

02032016 Bone Scan- three phase

(Single Region) 2700/-

02032017 Bone Scan Spect (whole

body) 3000/-

02032018 Tc 99m DMSA Renal Scan 2000/-

033 Profiles

02033001 Lipid Profile 700/-

02033002 Thyroid Profile 1200/-

02033003 Total Diabetic Profile 1000/-

02033004 Pre Cath Profile 850/-

02033005 Coagulation Profile 550/-

02033006 LFT [Liver Function Test] 750/-

02033007 Pre Dialysis Serology 600/-

02033008 Dialysis Profile 500/-

02033009 Hepatitis B Profile 3000/-

02033010 Hepatitis Panel 1800/-

02033011 Neuro Profile 2000/-

02033012 Septic Profile 900/-

02033013 Paediatric Septic Profile 1800/-

02033014 Basic Metabolic Panel

(BMP) 320/-

02033015 Comprehensive Metabolic

Panel (CMP) 500/-

02033016 Anaemia Screen (HAEM1) 2800/-

02033017 Thrombocytopenia Screen

(HAEM2) 3400/-

02033018 Mycloma Screen (HAEM3) 2700/-

02033019 Lymphoma Screen 2000/-

Page 48: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

48

CODE NAME OF

INVESTIGATION

Maximum Approved Rate (INR) (Rupees)

(HAEM4)

02033020 Polycythaemia (HAEM5) 1800/-

02033021 Thallasaemia Patient

Screen (HAEM6) 3000/-

02033022 Thallasaemia Counselling

Serum (HAEM7) 1200/-

02033023 CRBSI 550/-

02033024 ACTH Stim 1900/-

02033025 Growth Hormone Stim 2000/-

02033026 Male GnRH Stim 3500/-

02033027 Female GnRH Stim 3300/-

02033028 Bone Marrow Profile 550/-

02033029 EP Screening Profile 1100/-

02033030 Torch Profile 1500/-

02033031 Renal Profile 330/-

Page 49: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

49

RATES FOR IMPLANTS

03- IMPLANTS

CODE NAME OF THE ITEM Maximum Approved Rate (INR)

(Rupees)

001 Cardiology Implantation Devices

03001001 Pacemaker (Single Chamber)- Ordinary (SSI Autocapture)

45,000/- or the actual cost, whichever is less

03001002 Pacemaker (Single Chamber)- With rate modulation (SSIR)

68,000/- + VAT or the actual cost, whichever is less

03001003

Pacemaker (Dual Chamber) (DDD/DDDR/VDDR) 1,20,000/- + VAT or the actual

cost, whichever is less

03001004 CRT (Cardiac Resynchronization Therapy)

2,50,000/- or the actual cost, whichever is less

03001005 AICD (Automatic Implantable Cardioverter Defibrillater)

3,50,000/- or the actual cost, whichever is less

03001006 CRT + AICD combination

5,00,000/- or the actual cost, whichever is less

03001007 BMS (Bare Metal Stent)(made of Steel)

30,000/- + VAT or the actual cost, whichever is less

03001008 BMS (Bare Metal Stent)(made of alloy e.g. Cobalt, Chromium,

etc.) 40,000/- + VAT or the actual

cost, whichever is less

03001009 DES (Drug Eluting Stent)- Sirolimus-eluting e.g. Cypher, etc.

95,000/- + VAT or the actual cost, whichever is less

03001010

DES (Drug Eluting Stent)- Higher Sirolimus derivatives e.g. Endeavour, Promus, Xcience, etc.

1,05,000/- + VAT or the actual cost, whichever is less

03001011 DES (Drug Eluting Stent)- Paclitaxel-eluting e.g. Taxus, etc.

80,000/- + VAT or the actual cost, whichever is less

03001012 PDA- closure device

50,000/- + VAT or the actual cost, whichever is less

03001013 ASD/ VSD- closure device

80,000/- + VAT or the actual cost, whichever is less

03001014 Mitral Baloon, e.g. Inoue Baloon

40,000/- + VAT or the actual cost, whichever is less

03001015 Pulmonary Valvoplasty Baloon

20,000/- + VAT or the actual cost, whichever is less

03001016 Mitral/ Aortic Heart Valve

50,000 + VAT or the actual cost, whichever is less

03001017 TTK Chitra (Mitral/ Aortic Heart Valve)

30,000 + VAT or the actual cost, whichever is less

03001018 Heart Valves- Annuloplasty Ring

24,000/- + VAT or the actual cost, whichever is less

002 Opthalmology

03002001 Hydrophobic Foldable IOL 5,000/-

03002002 Silicon Foldable IOL 4,000 /-

Page 50: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

50

CODE NAME OF THE ITEM Maximum Approved Rate (INR)

(Rupees)

03002003 Hydrophilic Acrylic Lens 6,000 /-

03002004 PMMA IOL 500/-

003 ENT

03003001

One-sided Hearing Aid (Body worn/Pocket/Behind the ear type or in the canal type (conventional)

10,000/-

03003002 Bilateral Hearing Aid 20,000/-

03003003

Digital Hearing Aid (to be purchased with the permission of the West Bengal Health Scheme Authority)

30,000/-

004 Neuro Implants

Type of Neuro-implant Prescribing Authority

Ceiling

Rate

Life of

Battery

Cost of

Battery

03004001 DBS Implants

Neurologist of a recognised

hospital 3,60,000/-

3-5

years 2,50,000/-

03004002 Intra-thecal Pumps 2,62,000/- 7 years 2,25,000/-

03004003

Spinal Cord Stimulators

Any two specialists of

concerned speciality/ HoD

of Neurology/

Neurosurgery/

Anaesthesiology of

recognized hospital

2,62,000/- 3-5

years 2,00,000/-

03004004 CPAP Machine 50,000/-

03004005 BIPAP Machine 1,00,000/-

005 Orthopaedic implants

Maximum Ceiling Rates

(Rupees)

03005001 Depuy (TKR) Knee 75,000/-

03005002 Zimmer (USA) Knee 74,880/-

03005003 Cemented Bipolar Hip (Zimmer) 41,080/-

03005004 Uncemented Total Hip (Zimmer) 69,992/-

03005005 Cemented Bipolar Hip (Depuy) 38,500/-

03005006 Uncemented Total Hip (Depuy) 77,000/-

03005007 Cemented Total Hip (Depuy) 46,500/-

03005008 DHS Plate Screw 3,500/-

03005009 Proximal Femur Nail 5,720/-

03005010 Locking Plate & Screw- for Humerous 5,500/-

03005011 Locking Plate & Screw- for Distal Tibia 6,500/-

03005012 Locking Plate & Screw- for Proximal Tibia 5,500/-

03005013 Locking Plate & Screw- for Proximal Femur 6,500/-

03005014 Locking Plate & Screw- for Shaft Femur 9,000/-

03005015 Locking Plate & Screw- for Radius Ulna 2,500/-

03005016

Locking Plate & Screw- for Distal Humerous & Elbow

Joint 4,500/-

03005017 Locking Plate & Screw- for Shaft Humerous 5,500/-

Page 51: 13.Revised Rate List

Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008

(Notification No. 796-F (MED) dated 31-01-2011)

51

CODE NAME OF THE ITEM Maximum Approved Rate (INR)

(Rupees)

03005018 Locking Plate & Screw- for Buttress Plate & Screw 5,500/-

03005019 ISO-Elastic Nail (Per Piece) 2,500/-

03005020 Interlocking Nail for Tibia & Femur 3,500/-

03005021 PFN Nail for Proximal Femur 8,000/-

03005022 DHS Plate Screw for Trochanteric Fracture 3,500/-

03005023 Humerous Plate 3,500/-

03005024 Humerous locking Plate & Screw 5,500/-

03005025 Humerous locking T- Buttress Plates & Screw 4,500/-

03005026 Elbow Joint- fixation by locking Plate & Screw 3,500/-

03005027 Replacement of Elbow Joint 20,000/-

03005028 Radius Ulna- Locking Plates & Screw 4,500/-

03005029 Wrist joint with locking Plate & Screw 2,500/-

03005030 Soldier Joint- With Jess Fixator 6,500/-

03005031 External & ILLIZAROV- Femur 7,000/-

03005032 External & ILLIZAROV- Tibia 7,000/-

03005033 External & ILLIZAROV- Pelvis 7,000/-