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Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
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/- 01001025 Lumbar puncture 700/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
01001037 Bone Marrow
Transplantation (inclusive of all)
1000000/-
01001038 Central Line 800/- 01001039 Intubation Charge 400/-
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/-
01002011 Surgery of Infected Corn
(Day Care) 2800/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01003005 Polyp removal under LA 800/-
01003006 Peritonsillar abscess drainage under LA
1600/-
01003007 Tinnitus Retraining
Therapy 250/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01003043 Palatopharyngoplasty 15100/- 01003044 Cleft Palate repair 16000/- 01003045 Pharyngoplasty 18000/- 01003046 Styloidectomy 11500/- 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/-
01003060 Excision of Lesion Base of Tongue- per Oral Approach
6400/-
01003061 Unilateral Pre-Auricular
Sinus Operation 23400/-
01003062
Cochlear Implantation [including Pre-operative
investigation & evaluation, cost of implant, cost of
surgical procedure & post-op follow-up (one year
mapping, Speech Therapy on different sitting)]
670000/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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)/ Diod Laser (per sitting)
1000/-
01004060 HVF 500/-
01004061 Cryopexy 1200/-
01004062 ICG including Medicine 2000/-
01004063 ICG- Double including
Medicine 3600/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/- 01005005 Visceral Biopsy 5000/- 01005006 Aspiration Biopsy 1500/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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 5000/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
(sal/ auricular/ orbital/ facial lost part) (package)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01008073 Surgical Removal of Soft Tissue Lesion (package)
1150/-
01008074 Surgical Removal of Impact Mesiod.tuber
(package) 1150/-
01008075 Disto-impacted teeth (two)
under GA 30000/-
009 ITU/CCU CHARGES
(Special Care Cases)
01009001
ICU/ITU/CCU/NICU/PICU (including:- Oxygen; ECG/SPO2/NIBP/IBP
monitoring; 1:2 Nursing ċ GNM Nursing; Round the Clock Doctor (Resident on spot); Diet; Syringe Pump)
2400/-
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/-
01009007 CRIB (Critical Ward Bed) 800/-
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% First Dressing 1500/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
(excluding dressing materials and medicines)
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/-
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 Oophorectomy 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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
01012029 Repair of post-coital tear,
perineal injury 4200/-
01012030 Excision of urethral
carbuncle 4000/-
01012031 Laparoscopy (Gynae) 6100/-
01012032 Shirodkar, 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01012068 Abortion- Evacuation 4200/-
01012069 MTP- 1st Trimester 3200/-
01012070 MTP - 2nd Trimester 4800/-
01012071 Extended Hysterectomy 28000/-
01012072 Hydrotubation 1000/-
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/-
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 Psoras
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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 Deformities 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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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 150000/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
Profile)
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
(including Pre-Surgery Profile)
72000/-
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-Aorta 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) 19400/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
(4 days’ package)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
01021057 AICD/ICD Implantation
procedure charges (cost of implants extra)
60000/-
01021058 C-PAP/ Bi-PAP 500/- per day Note:- CABG if done along with other Heart Surgeries
like Valve Replacement etc. will attract the same rate as CABG.
022 Oesophagus
01022001 Atresia of Oesophagus
and Tracheo Oesophageal Fistula
29700/-
01022002 Operations for
Replacement of Oesophagus by Colon
38000/-
01022003 Oesophagectomy for
Carcinoma Esophagus 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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01023052 Congenital Atresia &
Stenosis of Small Intestine25000/-
01023053 Muconium ileus 20000/-
01023054 Mal-rotation & Volvulus of
the Midgut 20000/-
01023055 Resection & Anastomosis
of Small Intestine 22000/-
01023056 Excision of Meckle’s
Diverticulum 22000/-
01023057 Duodenal Diverticulum 18000/-
01023058 Operation for Intestinal
Obstruction 25000/-
01023059 Operation for Intestinal
perforation 25000/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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 Correction
15000/-
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 Side25000/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/- 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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 assisted
orchidopexy 22000/-
01024120 Laproscopic operation for
varicocele 20000/-
01024121 Cystoscopic Basketing of
Urethra 12000/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
01024127 Helium Laser Prostrate surgery/ Optical Internal
urethrotomy 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/- 01024132 Vasectomy 2500/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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
32000/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
Reanimation)
01025037 Pendulous Breast -
Mammoplasty 22550/-
026 Orthopaedic Surgery
Procedure
01026001 Application of P.O.P Casts for Upper & Lower Limbs
7500/-
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 Fingers & 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01026018 Excision or other
Operations for Scaphoid Fractures
25000/-
01026019 Sequestrectomy & Saucerizations -
Superficial 20000/-
01026020 Sequestrectomy &
Saucerizations -Deep 30000/-
01026021 Sequestrectomy & Saucerizations -
Arthrotomy 35000/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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 Implants)
60000/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01027008 Ventriculoatrial
/Ventriculoperitoneal Shunt
40000/-
01027009 Excision of Cervical Inter-
Vertebral Discs 50000/-
01027010 Sympathetectomy -
Lumbar 18000/-
01027011 Sympathetectomy -
Cervical 18000/-
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
(Trigeminal) 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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
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/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01027064 Cervical disc arthroplasty 35000/-
01027065 Lumbar disc arthroplasty
30000/-
01027066 Corpus Callosectomy 60000/-
01027067 Hemishpherectomy 80000/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01027087 Endoscopic discectomy 60000/-
01027088 Aneurysm coiling 80000/-
01027089 Endoscopic spil
procedure- aneurysm coiling
80000/-
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 backache 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
15000/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
(bed charges extra)
028 Vascular Surgery
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
Aneurysm -Vertebral 80000/-
01028007 Surgery for Arterial Aneurysm Carotid
42500/-
01028008 Surgery for Arterial
Aneurysm 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
Aneurysm Spleen Artery 40200/-
01028018 Surgery for Arterial
Aneurysm Renal Artery 40200/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
029 Paediatric Surgery
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 35000/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
Through (Hirschaprugis Disease)
01029024 Imperforate Anus Low
Anomaly -Cut Back Operation
22000/-
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 Choledochoduodenostom
y 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/-
01029049 Operation of Trigger
Finger of children under G.A.
10000/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01030013 Lap. For intestinal
obstruction 30000/-
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. Assisted
Abdominoperineal Resection of rectum
37000/-
01030020 Lap. Assisted anterior
resection 37000/-
01030021 Laproscopic
Cholecystectomy 25000/-
01030022 Laproscopic
Appendicectomy 21000/-
01030023 Laproscopic 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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01030037 Foreign body removal 4000/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01031003 131- Iodine Therapy 51-
100 mCi 16900/-
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01033012 Palliative Radiation
Therapy upto 15 fractions 25000/-
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 1500/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01035008 PICC line (Peripherally
Inserted Central Canulisation)
1000/-
01035009 R-CHOP Chemotherapy
per pulse 45000/-
01035010
Cost of preparation, pushing & supportive
treatment per pulse of R-CHOP Chemotherapy
12000/-
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 Institutions
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/-
CODE NAME OF TREATMENT
PROCEDURE
Maximum Approved Rate (INR) (Rupees)
01038008 Washed RBC 400/-
01038009 Human Albumin
(20% 100 ml) 3000/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
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/-
02002026 Stroboscopy 700/-
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 Angiography 800/-
02003008 A-Scan 200/-
02003009 Tono Graphy 450/-
02003010 VER 300/-
02003011 Goldmen Perimetry 150/-
02003012 Specular microscopy 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
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 Eyes) 350/-
02003032 Biometry-corp (Both) 400/-
02003033 Biometry-corp-Single 300/-
02003034 Pachymetry (Both Eyes) 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 Physiotherapy
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/-
02007006 Chest PA view (one film) 130/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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
Cystourethrogram (MCU) 750/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 KUB 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 780/-
02008020 Arthrography 590/-
02008021 Retrograde Pyelography 760/-
02008022 Oral or I.V.
Cholecystography 510/-
02008023 Barium Enema 810/-
02008024 Barium Meal Upper or
Lower 670/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02008025 Bronchography 880/-
02008026 I.V. Urography/ I.V.P. 950/-
02008027 Myelography 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/-
02009006 Total Abdominal survey or
Multiple organ study 950/-
02009007 Special procedures &
Aspiration etc. 1230/-
02009008 Image Intensifiers 700/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02009036 Transvaginal Sonography 800/-
010 Clinical Pathology
02010001 Urine routine 60/-
02010002 Quantitative Albumin/Sugar 50/-
02010003 Urine Bile Pigment and
Salt 50/-
02010004 Urine Urobilinogen 50/-
02010005 Urine Ketones 50/-
02010006 Urine Occult Blood 50/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02010035 Urine Amino-aciduria 150/-
02010036 Urine for Phosphorus 220/-
02010037 Urine for Z-N Stain 60/-
02010038 Urine Protein/Creatinine
Ratio 250/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02010046 Urine for Microalbumin
Creatinine 520/-
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
Examination 400/-
02011020 Partial Thromboplastin 200/-
02011021 Glucose 6 Phosphate
Dehydrogenase (G, 6PD) 220/-
02011022 P.C.V. Haematocrit 50/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 Sucrose 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/-
02011039 TC, DC, ESR 120/-
02011040 Absolute Lymphocytes
Count 80/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02011057 AT III 650/-
02011058 AT III Anti Thrombin 650/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 280/-
02011065 APTT (50:50) 200/-
02011066 Immunofixation Electroporesis
7200/-
02011067 Malarial Antigen Detection 450
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/-
02012014 Granulocyte Conc.: Proc.
Charges 450/-
013 Bio-Chemistry
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02013033 Cortisol 650/-
02013034 HDL Cholesterol 200/-
02013035 VLDL Cholesterol 170/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02013036 ALDL/ LDL Cholesterol 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/-
02013069 Serum Potassium 150/-
02013070 Serum TIBC 280/-
02013071 Serum Parathormone
Level 900/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02013100 Glycosylated Haemoglobin
[HBA1C] 520/-
02013101 Alpha I Anti Trypsin Assay 1200/-
02013102 Insulin-P.P./ Fasting/
Random 650/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02013130 Apolipo Proteins 500/-
02013131 Free Testosterone 600/-
02013132 Blood Acetone/Ketone 240/-
02013133 Pleural Fluid for Protein 80/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 Vitamin 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/-
02013165 Pericardial Fluid for
Biochemistry 360/-
02013166 Pericardial Fluid Test 100/-
02013167 Peritoneal Fluid-
Biochemistry 450/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02013181 Free T3 350/-
02013182 Free T4 500/-
014 Histopathology
02014001 Pap Smear 240/-
02014002 Histopathology exam per
tissue type 250/-
015 Bacteriology & Serology
02015001 Smear gram-stain
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 &
Sensitivity 350/-
02015015 CAPD Fluid for Fungal 100/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
Stain/ Gram Stain
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 Culture & Sensitivity
250/-
02015044 Arterial Line Tip for Culture
& Sensitivity 250/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 Antigens 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/-
02015073 Anti-HBC Core Antibody
IgM 550/-
02015074 Serum Immunoglobulin 600/-
02015075 Immunoglobulin IGE 500/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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- IgM 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
[RUT] 200/-
02015106 Elisa for Tuberculosis
[IGG/IGM/IGA] 350/-
02015107 Febrile Agglutinins
[Widal.Weli-FEl 400/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02015133 Leptospira Antibody IGG &
IGM 1650/-
02015134 Cryptococcus Antigen-Latex Detection (CSF)
1300/-
02015135 Falciparum Antigen 360/-
02015136 ADA (Adenosine 450/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
Deaminase- Body Fluid)
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/-
02015163 Anti LKM-1 (Liver Kidney Microsomal-1) Antibody
820/-
02015164 Viable MTB Detection-
PCR 1500/-
02015165 HIV Qualitative (Window
Period Detection) 1200/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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 Encephalitis 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/-
02015193 HBV DNA Qualitative 1900/-
02015194 Mycobacterium
IgA/IgG/IgM 600/-
02015195 Mycobacterium Serology
IgG/IgM 500/-
02015196 Mycobacterium
Tuberculosis Serology EL 1900/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02015220 BCR abl transcript
quantification 4000/-
02015221 Aerobic by Bactec 900/-
02015222 Dengue Serology IgG &
IgM 1200/-
02015223 Rapid Blood/Body Fluid
Culture (Bact-Alert/ Bactec)930/-
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/-
02019015 TEE with Anesthesia 2500/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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)/ Tilt Table Test
1470/-
02020010 Cardiac Cath Angiography
(Without Coronary Angioplasty)
13200/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/-
02020018 Doppler Carotid Artery 1700/-
02020019 Flowtron Excel (DVT) 500/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02021009 Oesophagoscopy 1100/-
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/-
02022014 Cystoscopy & Stent
Removal (Outdoor procedure)
5000/-
023 Orthopaedic Surgery
Procedure
02023001 Arthrography &
Osteomedullography 11000/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02023002 Arthroscopy - Diagnostic 11000/-
024 Neurology
02024001 Placement of ICP Monitor - 6000/-
02024002 Lumber Pressure
Monitoring 6100/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
025 Breast
02025001 Mammography (Single
side) 800/-
02025002 Mammography (Both
sides) 1500/-
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/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02028017 CT Pituitary/ Sella 2500/-
02028018 CT Cisternography 1600/-
02028019 CT Petrous Temporal Bone 3000/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02028042
CT Angiography of Abdomen/ Extremities/ Renal area/ Peripheral area/ Pulmonary area
6000/-
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/-
02028053 CT Dual Phase Study-
Liver 5000/-
02028054 Fibroscan 3500/-
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/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
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/
Right) 5400/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02029038 MRI Thoracic Outlet 5400/-
02029039 MRI Spine Screening 5400/-
02029040 MRI Brachial Plexus 5400/-
02029041 MRI Chest 5400/-
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/Gallium
Scan 8500/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02032003 Thyroid Scan 1800/-
02032004 Iodine-131 Thyroid Scan 2500/-
02032005 Thyroid (Tc99m) Scan 1800/-
02032006 Para Thyroid Scan 6000/-
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/-
02032019 Myocardial Perfusion Scan 7800/-
02032020 HIDA Scan 1750/-
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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02033015 Comprehensive Metabolic
Panel (CMP) 500/-
02033016 Anaemia Screen (HAEM1) 2800/-
02033017 Thrombocytopenia Screen
(HAEM2) 3400/-
02033018 Mycloma Screen (HAEM3) 2700/-
02033019 Lymphoma Screen
(HAEM4) 2000/-
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/-
CODE NAME OF
INVESTIGATION
Maximum Approved Rate (INR) (Rupees)
02033030 Torch Profile 1500/-
02033031 Renal Profile 330/-
02033032
Septic Profile (Hb, TC, DC, Platelets, ESR, P. Smear, Toxic Granules, Band Cell,
CRP)
780/-
___________________________________________________________________
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
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 /-
03002003 Hydrophilic Acrylic Lens 6,000 /-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF THE ITEM Maximum Approved Rate (INR)
(Rupees)
03002004 PMMA IOL 500/- 03002005 Cost of Injection Lucentis 45000/-
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/- 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/-
Annexure-I Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011) As on: 19-09-2013
CODE NAME OF THE ITEM Maximum Approved Rate (INR)
(Rupees)
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/-
03005034 TA-ALP-6-40 Alpha Lock Poly Axial Pedicle Screw with Inny 6 ×
40 mm Titanium Light Blue 5,750/-
03005035 TA-TR-5-5-50 Alpha Lock Connecting Rod 5.5 × 50 mm length
Titanium Light Blue 2,250/-
03005036 DFN 451.823 12 CANN L240 13,780/- 03005037 DFN 450.864 6 Locking SC L60 1,200/- 03005038 DFN 451.895 E/CAP S/B Pink 1,520/- 03005039 DFN 450.886 S/Blade L70 5,850/- 03005040 4.9 Locking Bolt 459.340 LB 4.9x3.4 800/- 03005041 4.9 Locking Bolt 459.360 LB 4.9x3.6 800/-
006 Surgical implants Maximum Ceiling Rates
(Rupees)
03006001 Prolene Mesh
Size 6ʺ × 6ʺ 6ʺ × 3ʺ
11.81ʺ × 11.81ʺ (30cm × 30cm)
3,145/- 1,650/- 5,341/-