Healthcare Financial Services IG Edition 1
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CodeSystem: MOH Category

Official URL: http://nphies.sa/terminology/CodeSystem/moh-category Version: 0.3.0
Active as of 2025-06-23 Computable Name: MOH_Category

Copyright/Legal: Ministry of Health Saudi Arabia (https://www.moh.gov.sa)

These are MOH-specific billing codes.

This Code system is referenced in the content logical definition of the following value sets:

Generated Narrative: CodeSystem moh-category

version: 1; Last updated: 2022-08-08 13:04:40+0300

This case-sensitive code system http://nphies.sa/terminology/CodeSystem/moh-category provides a fragment that includes following codes:

CodeDisplay
650426 Release Of Carpal Tunnel Syndrom General Anaesthesia
506060 C & S Prostrate
650424 Release Of Carpal Tunnel Syndrome Regional Anaesthesia
75-34.50 Pleurectomy
K57200 Suturing of Vaginal Tear
650422 Release Of Carpal Tunnel Syndrome Local Anaesthesia
518046 Vasopressin (Adh)
650420 Theco-Peritoneal Shunt
518048 5-Hiaa
U80172 Gold
T76020 Skeletal Survey
U80170 Gentamycin
518044 17-Ketosteriods, Urine
518086 Oestradiol
750906 Telengiectasia Treatment, Legs, Medium Area -Per Session (Skincare)
518088 Digoxin
650428 Release Of Ulnar Nerve Entrapment At Wrist
800026 Socket Reconstruction
518082 Ft3
U80168 Ethosuximide
518040 17-Hydroxycortisoteriods, Urine
518084 T B G
U80166 Doxepin
750908 Telengiectasia Treatment, Legs, Large Area -Per Session (Skincare)
U80164 Depakine Level (Valproic Acid)
518080 Chromosomal Analysis
800024 Thyroid Orbital Decompression (Both Eyes)
U84520 Bun
750902 Laser Facial Rejuvenation - Per Session (Skincare)
650430 Release Of Cubital Tunnel Syndrome
750904 Telengiectasia Treatment, Legs, Small Area -Per Session (Skincare)
E42420 Parotidectomy total
650416 Repair Of Meningomyelocele Major
800028 Enucl. With Hydroxy. Orbital
650414 Repair Of Meningomyelocele, Minor Defect
506068 C & S Swine Flu (H1N1)
506066 C & S Semen
75-34.02 Thoracotomy, exploratory
U82784 IGA/IGM/IGD/IGG
U82785 IGE
K57210 Colpo Perineorraphy
800022 Thyroid Orbital Decompression (One Eye)
650412 Posterior Fusion And Stabilization
202080 Long Term Care (Ltc) - Per Day Package
650410 Anterior Or Anterolateral Verteb, Resection And Stabilization
506062 Fern Test
U80162 Digoxin - Lanoxin
800020 Optic Nerve Sheath Fenes – Onsf
D92250 Fundus Photography with interpretation
518074 Insulin, Serum
506050 C & S Umbilical
650418 Repair Of Occult Spinal Dysraphism
518038 Cortisol
518076 C-Peptide, Serum
518034 Vitamine D
518070 Vitamine B12, Serum
U80156 Tegretol Level - Carbamazipene
518036 Acth
518072 Haptoglobin
518030 Free T4
U80152 Amitriptyline
518032 Calcitonin
U84512 Triponin Qualitiative
750096 Patch Test (Skincare)
800034 Drill Of Hyder. Imp. With Artif.
750094 Dermabrasion (Skincare)
506058 C & S Conjunctiva
U84550 Uric Acid
750910 Telengiectasia Treatment, Face, Few Area -Per Session (Skincare)
650442 Old Perineural Nerve Repair
E49080 Peritoneal lavage
506056 C & S Axilla
U80194 Quinidine
750912 Telengiectasia Treatment, Face, Multiple Area -Per Session (Skincare)
U80192 N-Acetylprocainamide
800032 Impl. Of Hydr. Orb. In Enucl.
U80190 Procainamide
202090 Icu/Nicu/Picu Per Day Package
750092 Comedon Extraction - Large Area (Skincare)
U82775 Galactose-1-Phosphate-Uridyltransferase
750090 Comedon Extraction - Medium Area (Skincare)
U80188 Primidone
506054 C & S Skin
U80186 Phenytoin - Free
U82776 Galactose-1-Phosphate
U80185 Phenytoin - Epanutin Level Total
U84545 Urea Clearance
800030 Implan. Of Reg. In Enuc. Evisc.
650438 Interfasicular Repair
650436 Nerve Neurolysis
506052 C & S Rectal
650434 Surgery For Unusual Nerve Entrapment Or Injury
U84540 Urine Urea Nitrogen
650404 Excision Of Lesions Intraspinal Intradural – Lumbar
650432 Brachial Plexus Decompression
U80184 Phenobarbital - Gardinal Level
650402 Excision Of Lesions Intraspinal Extradural – Cervical
518096 Trypsin
650400 Excision Of Lesions Intraspinal Extradural – Dorsal
518098 Carbamazepine (Tegretol)
518068 Folic Acid, Serum
518092 Dibucaine Inhibition Of Pseudocholinesterase
U80150 Amikacin
D92235 Flouroscene Angiography
518064 Tranferritin, Serum
U80178 Lithium level
650408 Excision Of Lesions Intraspinal Intradural – Cervical
U80176 Lidocaine
518066 Ferritin, Serum
U80174 Imipramine
650406 Excision Of Lesions Intraspinal Intradural – Dorsal
518090 Cystic Fibrosis
518060 Alpha-Fetoprotein
650440 Direct Perineural Nerve Repair
800004 Orbital Tumour Biopsy+Histopathology Analysis
518062 Carcinembryonic Antigen (Cea)
800002 Orbital Exploration
800008 Reconstruction Of Orbital Base Fracture
800006 Orbital Tumour Excision+Histopathology Analysis
710002 Polishing Of Teeth (Prophylaxis)
704098 Periodontal Root Planning (Less Than 6 Teeth)
710006 Oral Prophylaxis: With Flouride (2 Visits-Children
710004 Scaling & Polishing
704096 Periodontal Root Planning (Entire Mouth)
T74290 Oral Cholecystogram/Gall Bladder
716084 Adding Tooth To Partial Denture To Replace Extracted Tooth-Each Tooth(Not Involv
518056 Metanephrines, Urine
518058 Catecholanines, 24 Hours Urine
460298 Dp-Oto-Ecuastic Emission
716082 Repair Of Broken Complete Or Partial Denture - No Teeth Damaged
518052 Vanillymandelic Acid (Vma), Urine
460296 Follow Up Tympanometry
518054 Homovanillic Acid Urine
716080 Paratial Denture Adjustment
800014 Enucleation Or Evisceration=Prosth.Implant
825246 Penile Prosthesis With Implant (Malleable)
108-35.50 Repair, septa, atrial and ventricular, with prosthesis
800012 Enucleation Or Evisceration Of Eye Ball
825248 Penilse Prosthesis With Implant (Inflatable)
518050 Human Growth Hormone
308-58.93 Implantation, artificial urinary sphincter
800018 Posterior Orbital Tumour
716088 Chair - Side Relining (Complete Denture)Chair - Side Relining (Complete Denture)
716086 Adding Tooth To Partial Denture To Replace Extracted Tooth(Involving Clasp Or Ab
800016 Posterior Orbital Exploration
704094 Membrane / Bone Grafts - Per Tooth
800010 Exentration
704092 Gingivectomy And Treatment (Fewer Than 5 Teeth)
825240 Diverticulectomy
704090 Gingivectomy Or Gingioplasty - Per Quadrant
825242 Urs & Stone Extraction
825244 Cystoscopy + Removal Of Djs Under G.A.
G29870 Arthroscopy (Diagnostic) Knee
E43621 Subtotal gastrectomy
716072 Upper Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)
704058 Vestibuloplasty/Sulcus Deepening (Per Jaw)
716070 Acrylic Partial Denture (4-7 Teeth)
704056 Removal Of Lorus Palatinus Or Mandibularis
518196 Galactose 1 Phosphate Uridyltrasferase (Quantative
810102 Microlaryngoscopy
518198 Ionized Calcium
704054 Post Extraction Complication:Dressing (Opd)
518192 Galactosemia Screening
810104 Microlaryngosurgery
825236 Epididymectomy
704052 Post Surgical Extraction:Drsyspicules Removal
716078 Complete Denture Adjustment
518194 Amino Acid Screening
810106 Larynx Laser Surgery
825238 Cystoscopy And Lithlapexy
716040 Chrome Cobalt Partial 4-7 Teeth
716076 Bite Guard (Bite Raising Appliance)
108-35.42 Creation, septal defect, in heart
108-35.91 Transposition, interatrial, venous return
716074 Upper Chrome Cobalt Partial Denture (3 Or More Teeth Bilateral)
108-35.92 Creation, conduit, between right ventricle,
501-81.22 Arthrodesis,knee
U84630 Zinc
108-35.93 Creation, conduit, between left ventricle,
825230 Vasal Reversal
825232 Vasoepididymostomy
716048 Porcelain Set For Complete Dentures (Additional)
825234 Vasovasostomy
108-35.94 Creation, conduit, between atrium,
460276 Foreign Body Removal L.A. (Throat)
460274 Incision + Drainage Of Quinzy (L.A)
H94240 Lung Volume - Helium Dilution
460278 Fine Needle Aspiration Cytology
108-35.95 Revision, corrective procedure, heart
460280 Somnoplasty Tounge - Clinic (1St Stage)
716046 Other Corrective Procedures (Per 1/4 Hour)
825224 Repair Of Urethral Injuries
716044 Ceka Attachment Per Piece
U82009 Acetone Total
825226 Urethroplasty One Stage
500004 Glucose (Serum) Random
460284 Pure Tone Audiometry (Air & Bone)
825228 Urethroplasty Two Stages
716042 Chrome Cobalt Partial 8-12 Teeth
108-35.31 Operation, papillary muscle
500002 Glucose (Serum) Fasting
108-35.32 Operation, Chordae tendinae
460282 Somnoplasty Tounge - Clinic (2Nd Stage)
704050 Alveolectomy (Per Quadrant)
L90810 Psychotheraphy Interactive
810110 Laser Tonsillectomy
137202 Child Anxiety Manifest Level
704068 Surgical Exposure Of Impacted Or Unerrupted Tooth
825220 Radical Prostatectomy
810112 Tonsillectomy
825222 Repair Of Hypospadias Two Stages
704066 Tooth Extraction Additional Each + L.A..
137208 Mmpi Sub Scale
36-14.27 Destruction, chorioretinal lesion, adiation sources
137204 Child Behaviour Check List
G29894 Arthroscopy (Diagnostic) Ankle
810114 Pan-Endoscopy (Triple Procedure)
137206 Middle Sex Scale
36-14.26 Destruction, chorioretinal lesion, by radiation therapy
716094 Laboratory Relining (Partial Denture)
704064 Alveolar Ridge Grafting Per Jaw
460288 Tone Decay Test
810116 Hypopharyngoscopy & Foreign Body Removal
716092 Laboratory Relining (Complete Denture)
704062 Other Undefined Surgical Procedures Per 15 Minutes
460286 Follow Up Pure Tone Audiometry (Air & Bone)
T76770 Ultra Sound - Retroperitoneal
L96100 Psychological Test
108-35.80 Repair, total, certain congenital cardiac anomalies
716036 Chrome Cobalt Full Denture: Upper And Lower
716090 Chair - Side Relining (Partial Denture)
716034 Rebasing (Upper Or Lower)
X1005 Ventilator Per Day
460290 Ablb
716032 Changing Teeth In Old Chrome - Partial
825214 Iliocystoplasty
X1004 Oxy Hood Per Day
L90804 Individual psycho therapy insight oriented
X1003 Mist Tent Per Day
716030 Splints/Guards
U80299 Amphotericin B Level
X1002 Oxygen Inhalation Per Day
X1001 Oxygen Inhalation - Per Hour X1001
825216 Insertion Of Penile Prothesis
704060 Apicoectomy (Per Tooth Excluding Rct)
716098 Lower Chrome Cobalt Partial Denture (3 Or More Teeth / Bilateral)
810108 Adenoidectomy
460294 Audiological Assessment
716038 Chrome Cobalt Partial 1-3 Teeth
825218 Radical Cystectomy
148-46.92 Myotomy, colon, other parts
716096 Lower Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)
460292 Strenger Test
512002 Hemoglobin Electrophoresis
137212 Beck Depression Inventory
704078 Ridge Extension (Augmentation Per Arch)
137214 Performance Anxiety Scale
825210 Excision Of Ureterocele And Reimplantation Of Ureter
704076 Biopsy Of Extra Oral Tissues
137210 Self Esteem Inventory
704074 Biopsy Of Oral Tissue (Soft)
825212 Ileal Ureter
512004 Protein Electrophoresis (Serum, Csf, Urine)
716062 Denture - Complete Lower (Chrome Cobbalt)
128100 Schanz Screw
500018 Creatinine Urine (Random)
128102 Malleolar Screw
716060 Denture - Complete Upper (Chrome Cobbalt)
I92590 Hearing Aid adjustment & Evaluation Unilateral
800758 Laser Trabeculoplasty
128104 Partial Hip - Thomson Hip Prothesis
108-35.70 Repair, septa, atrial, ventricular, unspecified
I92591 Hearing aid Adjustment & Evaluation Bilateral
800762 Photo. Kera. Astigm - Pak Vizx
128106 Penning Mini External Fixator
500022 Uric Acid (Serum)
850240 Laparascopic Salpingo-Oophorectomy (Bilateral)
800760 Phototherapeutic Keratectomy (P.T.K.) One Eye
850242 Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Unilateral)
716068 Acrylic Partial Denture (1-3 Teeth)
850244 Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Bilateral)
T73700 CT LO EXT without Contrast
500020 Creatinine Clearance
500027 Globulin
716066 Denture - Immediate Lower Complete
500026 Albumin
716064 Denture - Immediate Uper Complete
640020 Ptca (Per.Tr.Coronory Angioplasty) - Sv +2 Stents
500024 Total Protein, Serum
K59025 CTG less than an hour
704072 Biopsy Of Oral Tissue (Hard)
T73701 CT Scan Knee Lower Ext with Contrast
850236 Laparascopic Checking Of Tubal Patency
K57240 Anterior Colporrhapy & Repair Cystocele
850238 Laparascopic Salpingo-Oophorectomy (Unilateral)
H43450 Oesophageal Dilation
110-37.12 Pericardiotomy
810220 Labyrinthectomy
640022 Ptca (Per.Tr.Coronory Angioplasty) - Dv + Stent
650018C Microguide Wire
U85384 Fibrinogen
750074 Electro Cautery - Multiple Lesion (Skincare)
750232 Brow Lift (Skincare)
810222 Vestibular Neurectomy
750072 Electro Cautery - Few Lesion (Skincare)
810224 Facial Nerve Surgery
110014 Orthofix Rental (Per Day)
810226 Ossiculoplasty
300226 Thyroid Imaging
110012 Orthofix
650018A Each Additional : Coil
I69210 Ear Wash
650018B Microcatheter
300224 X-Ray Film Copy Cash (Nett) Each
38-12.14 Subtotal or complete iridectomy for melanoma
704014 Surgical Extraction - Complex (Bone Removal)
D92283 Color vision exam
750070 Electrolysis Per Session (Skincare)
650026A Each Additional : Coil
202004 Private Room Per Day
202002 Suite Room Per Day
650026B Microcatheter
704012 Surgical Extraction - Simple
304032 Colour Doppler Sonography Breast (Two)
650026C Microguide Wire
704010 Removal Of Teeth (Soft Tissue) + La
304030 Colour Doppler Sonography Breast (One)
524008 Anti Sperm Antibody
704018 Removal Of Teeth (Completely Bony) + L.A.
810140 Cleft Palate Repair
704016 Removal Of Teeth (Partially Bony) + L.A.
710018 Topical Application Of Flouride -2 Vis (Ex Prophylaxis)
524012 Osteocalcin
U80202 Vancomycin
716004 Partial Denture 1-3 Teeth
500044 Sgpt (Alt)
137018 Psychological Assessment- Category 2 - Anxiety
U80200 Tobramycin
716002 Complete Dentures
500042 Sgot (Ast)
524016 Hydroxproline Total
500048 Alkaline Phosphatase
500046 Ggt
716008 Partial Denture 8-12 Teeth
500040 Total And Direct Biliburin
524010 Thyroid Uptake
716006 Partial Denture 4-7 Teeth
704024 Cyst Operation
704022 Suturing - Large Area
704020 Suturing - Small Area (2-3 Sutures)
500028 Osmolarity, Serum / Urine
U88162 Cytology ( Fine Needle Aspiration )
T74150 CT Scan Abdomen
704028 Incision And Drainage Of Abscess - Extraoral
704026 Incision And Drainage Of Abscess - Intraoral
500034 Total Bilirubin
500032 Albumin/Globumin Ratio
500038 Direct Bilirubin
500036 Total Biliburin, Neonatal
500030 Plasma Globumin
650024B Microcatheter
650024C Microguide Wire
524020 Factor Viii
704036 Pericoronal Flap Removal - Simple
650028B Microguide Wire
810122 Plastic Surgery Of Throat
704034 Closure Of Oro-Antral Fistula
810124 Tumor Surgery Of Throat
I30400 Rhinoplasty
704032 Wiring Fractured Jaw - Complex
U84560 Urine Uric Acid
704070 Surgical Removal Of Suprenumerary Tooth
850246 Diagnostic Laparascopy + Canalization Of Tube
36-14.41 Scleral buckling with implant, f vitreous substitute
U80198 Theophyline
704088 Excision Of Hyperplastic Tissue (Per Arch)
U80196 Acetylsalicylic Acid
36-14.49 Scleral buckling with vitrectomy, membranectomy, ion
640024 Ptca (Per.Tr.Coronory Angioplasty) - Dv + 2 Stents
704086 Release Of Tounge Tie
750230 Otoplasty - Ear Reshaping (Skincare)
704084 Excision Of Bengin Tumour - Lesion Diameter Over 1 Cm
303-56.92 Implantation, electronic uteral stimulator
716050 Isosit Injection Moulded Denture
218-78.37 Lengthening bone, tibia and fibula
353-40.53 Excision, lymph node - iliac, radical
353-40.52 Excision, lymph node - periaortic, radical
500008 Glucose Tolerance Test
173030 Activated Clotting Time
500006 Glucose (Serum) 2Hpp
300228 Chest Pa / Erect
650474 Microscopic Brain Excision Of Epileptic Focus
353-40.54 Dissection, groin, radical
716058 Denture - Complere Lower (Acrylic)
1099700 Ang cor1ca 107-88.55 Angiocardiogram- coronary, 1 catheter
500012 Bun
640062 E.T.Suction
640064 Infusion Syringe Pump
304036 Colour Doppler Sonography Brain(Through Fontanell)
108-35.60 Repair, septa, atrial, ventricular, with tissue graft
800146 Unilat. Ptosis Repair+Fresh
810218 Endolymphatic Shunt
716056 Denture - Complete Upper (Acrylic)
650472 Ct Guided Aspiration Of Intra-Cerebral
518126 Fructose Test
500010 Glucose ( Glucometer) Test
304034 Colour Doppler Sonography Testicular W/Out Doppler - T
800144 Bilateral Sim. Ptosis Repair
716054 Tissue Conditioning Material
I30300 Removal of foreign body- Nose
191-50.40 Hepatectomy, total
500016 Creatinine, Serum
300192 Forearm (Ulna/Radius) 2 Views
716052 Refixing Tooth In Denture Or Hairline Cracks
800148 Bil. Ptosis Repair+Fresh Fasc.
518128 Mast (Allergy Screen)
300190 Forearm (Ulna/Radius) 1 View
518122 Prostate Specific Antigen
300196 Scaphoid - 1 View
460218 Sinsus Puncture
518124 Lithium
D68520 Dacryocystectomy
710020 Follow-Up (Period)
710024 Flap Operation
460216 Cryoturbinectomy
U86430 Rheumatoid Factor
130504 Occupational Therapy (One Part)
460210 Foreign Body Removal
130502 Occupational Therapy (More Than One Part)
M15780 Dermabrasion Face
460214 Electrical Cautry
130506 Occupational Therapy & Physiotherapy (One Sitting)
460212 Chemical Cautry
T73620 Foot Oscalcis - 2 Views
N97116 GAIT training
106002 Ambulance Fee Less Than 50 Kms
H91105 Gastric Lavage
460228 Somnoplasty Turbinate - Clinic
825190 Repair Of Ureteral Injuries
810126 Tracheostomy
106006 Ambulance Fee More Than 100 Kms Less Than 250 Kms
825192 Retropubic Prostatectomy
106004 Ambulance Fee More Than 50 Kms Less Than 100 Kms
460222 Epistaxis Nasal Pack
I69405 Eustachian Catheterization
825274 Trans Obturator Tape Insertion
110-37.24 Biopsy, pericardium
825278 Trans Vaginal Tape Insertion (Tot)
518108 Trop T.
U84590 Vitamin A (Retinol)
518106 Microalbuminuria
104-35.20 Replacement,heart valve
U84585 Vanillyl Mandelic Acid (NMA, Urine)
110-37.31 Pericardiectomy
104-35.33 Annulopasty
110-37.40 Repair, heart and pericardium
U84578 Urine Urobilinogen
40-14.60 Removal of surgically implanted material from posterior, separate procedure)
U85060 Peripheral Smear
304072 Colour Doppler Femoral Artery (Unilateral)
T76856 Ultra Sound - Pelvis
304070 Colour Doppler Brachial Artery (Bilateral)
304076 Colour Doppler Peripheral Veins (One Limb)
304074 Colour Doppler Femoral Artery (Bilateral)
K56740 Excision of Bartholin Cyst
304078 Colour Doppler Peripheral Veins (Two Limbs)
840004 Closed Reduction Of Dislocation And P.O.P
840002 Excision Of Ganglion
115-37.85 Replacement any type pacemaker,single chamber device
840008 Tendon Release Of Wrist
115-37.83 Insertion dual chamber device, initial
840006 Tendon Release Of Fingers
115-37.82 Insertion, single chamber device, initial rate responsive
115-37.80 Insertion, permanent pacemaker, initial
U85048 White Blood Cell Count Only
F54640 Orchipexy, bilateral
840012 Closed Reduction Of Fracture Dislocation
115-37.87 Replacement any type pacemaker,dual chamber device
840018 Closed Fracture Small Bones Of Hand Or Foot
840016 Menisectomy Or Excisin Of Cyst Of The Knee Joint
E40701 Repair cleft lip
800836 Ch- Draniage ( Outside Hospital)
800834 Ch-Drainage ( Inside Hospita )
117-37.74 Insertion or replacement epicardial pacemaker, -37.74
117-37.75 Revision,pacemaker lead,electrode
117-37.76 Replacement,transvenous atrial/ventr pacemaker lead
800838 Graft Replacment (Inhospital)
117-37.77 Removal ,pacemaker leads/electrodes w/o replacement
304050 Colour Doppler Renal Artery
202102 Disposables I.C.U.
800840 Balloon Dacyoplasty
U82803 U82803 Blood Gases
304054 Colour Doppler Portal System
800844 Collagen Plug
T76830 Ultra Sound - Transvaginal
304052 Colour Doppler Hepatic Artery
800842 Amniotic Membrane Graft
304058 Colour Doppler Iliac Vessels
840022 Reconstruction Of Amputated Finger W/O Grafting
304056 Colour Doppler Aortic
840020 Pop To Simple Fracture Without Displacement
840026 Correction Of Hallux Valgus
840024 Closed Reduction Of Dislocated Phalanges
840028 Arthrodesis Of The Big Toe
117-37.89 Revision or removal pacemaker device
800848 Anterior Chamber Reformation Post Operative (Inside Hospital)
202108 Cardiac Care Unit (Ccu)
800846 Unilateral Punctural Occlusion
202106 Disposables Nicu
202104 Isolation Disposables Per Day
800850 Anterior Chamber Reformation Post Operative (Outside Hospital)
304060 Colour Doppler Testicular Artery
304064 Colour Doppler Carotid Artery (Unilateral)
202110 Pediatric Icu (Picu)
T71134 Chest 4 Views with Fluroscopy
304062 Colour Doppler Veins (Varices)
304068 Colour Doppler Brachial Artery (Unilateral)
840030 Pop For Correction Of Foot Deformity
304066 Colour Doppler Carotid Artery (Bilateral)
840036 Fracture Of Coles
840034 Excision Of Olecranon Bursa
U85260 Factor 10
L90871 Electro convulsive therapy (ECT) multiple seizures
U86592 VDRL/RPR
U86593 RPR TITER
208062 Narrow Band Nb-Uvb
137216 Self Assessment Scale
704134 Reduction Of Complicated Middle/Upper Face Fracture
G24130 Excision of radial head
652004 Cabg & Tissue Aortic Valve Replacement
137218 Eating Disorder Scale
L90870 Electro Convulsive Therapy (ECT) Single seizure
201-39.26 Bypass, vascular, intra-abdominal
652006 Cabg & Mechanical Aortic Valve
825202 Turp
518006 Progesterone
825204 Ureteroscope
U86674 Giardia Lamblia ABS.
112-35.96 Valvuloplasty, percutaneous
518008 Pregnandiol
825208 Boari Flap
L90875 Bio Feedback Therapy
137222 Anorexia Nervosa Scale
H85095 Bone Marrow - Aspiration
137224 Bender Gestalat Scale
U84600 Alcohol Isopropanol
173028 Sodium Profiling
825200 Tuna
U86622 Brucella Agglutination Test
173024 Surgical Revision Of Fistula
300230 Chest Ap / Supine
173026 Bone Biopsy
173020 Creation Of A V Fistula
300234 Chest Lat. Decubitus
173022 Insertion Of Central Vascular Catheter(Femoral/Subclavian/Jugular)
U84490 Stool for Trypsin Activity
300232 Chest. Lat. View
I69200 Removal FB Impacted Ear
128022 Spoon Plate 6 Holes Each
300238 Ribs Ap
704030 Wiring Fractured Jaw - Simple
128024 Cancelleus Bone Screws
300236 Chest Pa / Lat. View
T76090 Mamography ( 1 Breast )
128026 Cortex Bone Screws
K56810 Perineoplasty
128028 Malleable Bone Screws
173018 Plasma Pheresis / Exchange Per Session
P-211 Stapedectomy
300240 Ribs Ap / Oblique
P-212 P-212 Adenoidectomy
173014 Haemodiafilteration 4 To 12 Hours - Per Session
T70360 NECK - Soft Tissue
U83586 17-Ketosteroids
128020 Broad Dynamic Comp Plate 14 Holes Each
173016 Continous Arteriovenous Haemofiltration 12 To 24 Hours Per Session
U86615 Pertussis Bordetella
300244 Shoulder Ap / Lat.
173010 Permicath
300242 Shoulder Ap
173012 Subclavian Double Lumen
300204 Skeletal Survey
173050 Acid Concentrate ( Litre)
300202 Pattela - 1 View
T76080 Fistulogram/Sinogram
173052 Insertion Of Perma Cath Tunnel Line
300208 Mcu (Along With Ivp)
300206 Intra-Operative Choloangiogram (I.O.C)
212002 Operation Fine Major - Doctor Fees
300207 Mcu (Micuratug Urethrogram)
506008 T.B.Culture
K56800 Plastic Repair of Introitus
506006 Anaerobic Culture
506004 Routine Culture, Mycology
640066 Intubation
810302 Thyroidectomy
840038 Amputation Of Finger Or Toe
640140 Mitral Balloon Valuloplasty
49-25.30 Glossectomy - complete
116-37.87 Replacement any type pacemaker,dual chamber device
750112 Punch Graft - Medium Area (Skincare)
304038 Colour Doppler Sonography Neck Lesions
640142 Bronchial Artery Angiography
K57250 Posterior Colporrhaphy & Repair Eectocele
750110 Punch Graft - Small Area (Skincare)
750086 Excision Of Mole - Large (Skincare)
810232 Laser Ear Surgery
110008 Wheel Chair - Rental (Per Day)
750084 Excision Of Mole - Medium (Skincare)
810234 Mastoid Abscess Drainage Under G.A.
110006 Wheel Chair - Deposit
810236 Ear Foreign Body Removal Under G.A.
110004 Crutches - Rental (Per Day)
750088 Comedon Extraction - Small Area (Skincare)
810238 Suction Clearance Under G.A.
110002 Crutches Deposit
202007 Semi-Suite Room Per Day
750082 Excision Of Mole - Small (Skincare)
202008 Paediatric Ward
810230 Implantable Hearing Aid
202006 Semi-Private Room Per Day
202014 Special Nurse 24 Hours
202012 Nursery
202010 Infant Incubator
304042 Colour Doppler Vaginal Ultrasound With Doppler Study
304040 Colour Doppler Vaginal Ultrasound Exam W/Out Dopp.Study
810228 Second Stage Of Two Stage Tympanoplasty
110010 Walking Stick
54-20.92 Revision, Mastoidectomy
304044 Colour Doppler Pregnancy Umbilical Artery Placental Flow Ovarian & Uterian
K57260 Combined Antero Posterior Colporraphy
304008 Colour Doppler Hip Joint (Two)
750050 Puva Per Session (Skincare)
810202 Unilateral Myringatomy (G.A.)
810204 Bilateral Myringatomy (G.A.)
750054 Eye Brow Transplant (Skincare)
D92260 Ophthalmodynametry
202018 Isolation Room
202016 Intensive Care Unit (Icu)
202026 Head Box(Neo-Natal Care)
U82725 Fatty Acids Nonesterified
202024 Observation Room Er / Or Recovery More Than 6 Hour
304010 Colour Doppler Knee Joint (One)
U82728 Ferritin
202022 Observation Room Er / Or Recovery Less Than 6 Hour
202020 Guest Board & Lodging
304014 Colour Doppler Wrist J - Carpal T (One)
304012 Colour Doppler Knee Joint (Two)
304018 Colour Doppler Muscles (One Limb)
304016 Colour Doppler Wrist J - Carpal T (Two)
750064 Trichogram (Skincare)
214014 Operation Room Charges Simple
810210 Myringoplasty
750062 Skin Biopsy (Skincare)
810212 Tympanoplasty + Mastoidectomy
650478 Craniectomy, Brain Dissection & Haematoma Evaucation
750068 Cryo Cautery - Multiple Lesion (Skincare)
214010 Operation Room Charges Medium
810214 Radical Mastoidectomy
650476 Microscopic Total Suprasellar Tumour Excision Through Subfrontal Approach With F
750066 Cryo Cautery - Few Lesion (Skincare)
214012 Operation Room Charges Minor
E60280 Thyro glossal cyst excision
810216 Stapedectomy
T76872 Ultra Sound Trans Rectal
T76870 Ultra Sound - Scrotum and Content
750060 Facial Cleansing Skin Care (Skincare)
202034 Companion Charges With Child Per Day
202032 Extra Lunch/Dinner Tray
304020 Colour Doppler Muscles (Two Limbs)
202030 Nursing Care Per Day
810206 Unilateral Myringatomy & Grommet (G.A.)
304024 Colour Doppler Tendons (Two)
810208 Bilateral Myringatomy & Grommet (G.A.)
304022 Colour Doppler Tendons (One)
49-25.40 Glossectomy - radical
304028 Colour Doppler Bones (Two Limbs)
214006 Operation Room Charges Fine Major
304026 Colour Doppler Bones (One Limb)
214008 Operation Room Charges Major
650038A Each Additional : Coil
650038B Microcatheter
650038C Microguide Wire
650268 Repair Of Scalp Injury Under General Anaesthesia
650266 Excision Of Scalp Swelling Or Tumour
526308 Phenol
7-86.06 Insertion - infusion pump, totally implantable
526312 Adrenal Cortex Abs
526310 Ccp
526316 C-1 Esterase Inhibitor
526314 Anti Ccp Abs
112002 Mortuary Rent Per Day
650276 Repair Of Skull Fracture With Damaged Brain Tissue
U82980 Glutethimide
650274 Repair Of Compound Skull Fracture
650272 Repair Of Simple Skull Fracture
I30100 Nose, EUA, Biopsy
650270 Excision Of Skull Vault Tumour
650258 Craniotomy And Excision Of Clival Tumour
650256 Craniotomy And Excision Of C P Angle Tumour
526318 Aldolase
U82977 GGT (Gamma G.T.)
U82979 Glutathione Reductase
650262 Craniotomy And Evacuation Of Acute Subdural Hematoma
650036C Microguide Wire
500014 Ammonia
303222 Ct Cardiac Angiography
H47000 Liver Biopsy
704082 Excision Of Bengin Tumour - Lesion Diameter Upto 1Cm
704080 Bone Grafting (Synthetic / Pop)
300194 T.Tube Cholanglogram
800142 Exci. Of Lid Tum=Rec. Us Flao
303226 Ct Virtual Colonography & Polyp Detection
137024 Psychological Assessment- Category 2 - Personality
303224 Ct Brain Perfusion Studies
800140 Exci. Of Lid Tumour With Com. Re
300198 Heel - 1 View
1099699 Ang R&L-H 107-88.54 Angiocardiogram- right and & heart
460220 Intra Nasal Mucosal Allergy T.
710022 Other Preventive Procedures: Per 15 Minutes
I92553 Speech audiometry air & bone
710028 Pit & Fissure Sealant - Per Tooth
208064 Removal Of Skin Tag 1 To 3
460226 Follow Up-Sinus Endoscopy (One Year )
750030 Hair Transplantation (300-400) Graft (Skincare)
460224 Follow Up Sinus Endoscopy (One Time)
N97124 N97124 Massage Therapy
T73610 Ankle - 3 Views
T71250 CT Thorax without Contrast
U82055 Alcohol, Ethyl
825194 Simple Cystectomy
825196 Simple Nephrectomy
652008 Cabg & Tissue Mitral Valve
825198 Transvesical Prostatectomy
652010 Cabg & Mechanical Mitral Valve
T73615 Ankle Arthrography
840160 Amputations : Upper Limbs
302008 Antenatal Scan
652012 Cabg & Double Tissue Valve
652014 Cabg & Double Mechanical Valve
840164 Arthroclesis, Shoulder
750226 Complete Cleft Lip (Skincare)
518002 Estrogen
640014 Ptca (Per.Tr.Coronory Angioplasty) - Dv
840162 Arthrodesis 1 Big Joint – Hip, Knee (Subtalar:Ankle), Foot : Triple
518004 Estradiol
750224 In-Complete Cleft Lip (Skincare)
506028 Haemoglobin H (For Alpha Thalassemia)
137220 Bulimia Nervosa Scale
506026 Food Testing For Coliforms
506024 Water Testing: Routine Bacteriological Analysis
U86664 Epstein BARR Nuclear AG.
506022 Skin Scrapping Microscopy For Herpes
ICU ICU Services Adult/Pediatric Incl cost Provide ICU Services, Adult/Pediatric (after 2 to 4 weeks of admission in ICU,if no active interventions patient will be converted to long term condition -definition will be applicable) * Medication above 350 SR per day as per SFDA price list, Blood & blood products, MRI, CT, ECHO, Doppler , CRRT , Surgical and endoscopic procedure are an excluded services. To get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist
810128 Incision & Drainage Of Quinsy Under G.A.
G29830 Arthroscopy (Diagnostic) Elbow
137226 A D H D Scale
137228 Brief Psychotherapy 6 Sessions
506020 Direct Fungal Wet Mount
518150 Beta Hcg
P-210 Tympanoplasty
650028A Each Additional: Microcatheter
G29800 Arthroscopy (Diagnostic) TM joint
704038 Pericoronal Flap Removal - Complex
810120 Bronchoscopy
T74710 Pelvimetry - 2 Views
353-71.50 Vulvectomy, radical
U86644 Cytomegalo Virus Screening-IGG
156-42.84 Repair, fistula, esophageal, other
156-42.85 Repair, esophageal, stricture
173046 Dialyser
640068 Intubasion - Elective
506002 C & S (Culture & Sensitivity)
U86645 Cytomegalo Virus Screening-IGM
173048 Sodium Bicarbonate ( Litre)
U86648 Diptheria Antitoxin
800814 Gluocoma Cyclo Photo – Coagulation ( Cbc)
173042 Permanent Peritoneal Cathetor
173044 Acute Peritoneal Cathetor
840100 Fracture Vetebrae
800812 Conjunctival Revision (Inside Hospital)
650260 Craniotomy And Excision Of Foramen Mangum Tumour
840106 Removal K-Wires Without Incision Under G.A.
K57160 Insertion of Pessary
T76070 CT Bone Density Study
173040 Central Venous Pressure Monitoring
840108 Application Of Hip Spica Muga + Uii
1099698 Ang L-H 107-88.53 Angiocardiogram- left heart
303228 Ct Virtual Bronchoscopy
1099697 Ang R-H 107-88.52 Angiocardiogram- right heart
1099696 Cath R&L-H 107-37.23 Catheterization cardiac, combined right and left heart
650228 Endoscopy For The Management Of Hydrocephalus
U86308 Monotest (Paul Bunnel Test)
1099695 Cath L-H 107-37.22 Catheterization cardiac, left heart
830072 Cervical Polypectomy
1099694 Cath R-H 107-37.21 Catheterization cardiac, right heart
650226 Ventriculo-Peritoneal Shunt Insertion
L95881 Developmental testing
830074 Oophrectomy
650224 Brachial Plexus Repair
750354 Erbium Laser - Single Treatment (Skincare)
650222 Release Of Carpal Tunnel Syndrome
208066 Removal Of Skin Tag 4 To 10
704132 Reduction Of Simple / Middle Face Fractures + Plating
L95883 Neuro Psychological Testing Battery
750352 Laser Test (Skincare)
K57288 Sling Operation
208068 Removal Of Skin Tag More Than 10
704130 Reduction Of Fractured Zygomatic Arch
712080 Treatment Plan - C
750034 Hair Transplantation (500-600) Graft (Skincare)
140070 Ercp - With Placement Of Stent
140072 Ercp - With Nasobilliary Drainage Tube
140074 Ercp - With Mechanical Lithotripsy
N97034 Contrast bath, each 15 minutes
140066 Ercp - With Sphincterotomy With Or Without Removal Of Stone
N97035 Ultrasound, each 15 minutes
140068 Ercp - With Use Of Retrieval Ballon
H94760 Pulse Oximetry
712082 Treatment Plan - D
712084 Treatment Plan - E
U86588 Smart Test (Strep A)
208060 Testicular Puncture
E36450 Exchange transfusion
750360 Erbium Laser - More Than Ten Pcs (Skincare)
U85250 Factor 9
750364 Dye Laser Per Session Medium Area 5-10 Cm (Skincare)
WD9215 Local Anaesthesia
750362 Dye Laser Per Session Small Area 2-5 Cm (Skincare)
WD9210 Dental Anaesthesia w/o Surgery
WD9211 Regional Block Anaesthesia
712074 Space Retainer Removable - Follow Up
712076 Treatment Plan - A
T75710 Angiography - Extremity Unilateral
712070 Space Retainer - Fixed
712072 Space Retainer - Removable
U85246 Factor 8 Associated AG.
750358 Erbium Laser - More Than Five Pcs (Skincare)
U85245 Factor 8 Ristocetin Cofactor
750356 Erbium Laser - Less Than Three Pcs (Skincare)
712078 Treatment Plan - B
T75716 Angiography - Extremity Bilateral
750332 Liposuction Upper Back (Skincare)
750330 Liposuction Lower Back (Skincare)
U85280 Factor 12
N97014 Electrical Stimulation (Unattended)
N97012 Traction, Mechanical
N97010 Application of modality to 1or more area;hot/cold pack
U88305 Gross and Micro Exam Level IV
750324 Liposuction Gynocomastia - Large (Skincare)
U88304 Gross and Micro Exam Level III
750322 Liposuction Gynocomastia - Medium (Skincare)
N97018 Paraffin Bath
750328 Liposuction Buttock (Skincare)
U88309 Gross and Micro Exam Level VI
N97016 Vasopneumatic Devices
U88307 Gross and Micro Exam Level V
750326 Liposuction Flanks (Skincare)
U85270 Factor 11
U88302 Gross and Micro Exam Level II
750342 Full Abdominoplasty - Large (Skincare)
U88300 Histopathology (Frozen Section)
750340 Full Abdominoplasty - Small (Skincare)
E39502 Paraesophageal hiatus hernia repair trans abdominal
N97026 Infra Red
N97024 Diathermy
N97022 Whirlpool
N97020 Microwave
750336 Liposuction Chin (Skincare)
750334 Liposuction Arms (Skincare)
750338 Mini Abdominoplasty (Skincare)
N97028 Ultra Violet
840238 Application Of Splints, Slabs, Pop Without Reduction
840236 Removal Of F.B. Superficial
830030 Polypectomy Fract. Curretage
750310 Liposuction Lateral Thighs (Small-Medium) (Skincare)
T74440 Vasography
T73110 Wrist - 3 Views
830036 Posterior Colpoperineorrhaphy
830038 Anterior Colpoperineorrhaphy
830032 Douglas Pouch Abscess Drainage
140030 Sclerotherapy (Oesophagus)
140020 Laryngo-Bronoscopy/Diagnostic
140022 Laryngo-Bronoscopy/Diagnostic + Biopsy
750308 Liposuction Abdomen -Large (Skincare)
140024 Laryngo-Bronoscopy/Diagnostic + Film
830028 Laparascopy (Not For Infertility Investigations) Diagnostic
T73100 Wrist - 2 Views
140026 Colonoscopy
140028 Endoscopy Under L.A.
840242 Terminalisation
750302 Liposuction (Skincare)
840240 C.R. Of Fractures Or Dislocations Without Anaesthesia + Application Of Pop
840246 O.R. + If Of Single Bone Except Fracture Neck, Femur, Torch, Fracture And Fractu
750306 Liposuction Abdomen - Medium (Skincare)
712048 Expansion Of Lower Mandible, Crozat Appliance
840244 Wound Toilet & Debridment
750304 Liposuction Abdomen - Small (Skincare)
840248 Cervical Disc Prolapse- Desectomy + Decompression
750320 Liposuction Gynocomastia - Small (Skincare)
825180 Pyeloplasty
830024 Caesarian Delivery (With Normal Baby)
T74430 Cystography
G23410 Repair of rotator cuff
830026 Shirodkar Suture
825182 Removal Of Penile Prosthesis
302007 Ultrasound Obstetric Level Iii
I69436 Gromet Sheppard vent tube, fluoroplastic
T73600 Ankle - 2 Views
640016 Ptca (Per.Tr.Coronory Angioplasty) - Tv
U82088 Aldosterone
136006 Air Mist Therapy
840168 Benign Bone Tumours : Curretage Bone Grafting
U86668 Francisella Tularensis ABS.
T76938 Ultra Sound Guided Aspiration Cyst
640018 Ptca (Per.Tr.Coronory Angioplasty - Sv + Stent
840166 Arthroscopy Diagnostic + Proceed
750228 Forehead Lift (Skincare)
U86663 EB Virus(Epstein Barr Virus) IGM IFA
650020B Microcatheter
506018 Glemsa Staining
506016 Methylene Blue Staining
506014 Acid Fast Staining
500067 Electrolytes (Na, K, C1) Urine
P-208 Septoplasty
716026 Relining Upper Or Lower Denture
P-209 Polypectomy
500066 Sodium, Serum Or Urine
128012 Broad Dynamic Comp Plate 7 Holes Each
716024 Immediate Complete Dentures (Requiring Relining)
U84481 T3 (Free T3)
500064 Total Co2
U84480 T3
128014 Broad Dynamic Comp Plate 8 Holes Each
716022 Additional Casted Clasp-Gold Or Metal
P-204 Sinus washout - Bilateral
716020 Tooth Additional (Each)
500068 Total Cholesterol
P-205 Removal of nasal foreign body
810118 Esophagoscopy
500063 Electrolytes (Na, K, C1) Serum
128016 Broad Dynamic Comp Plate 9 Holes Each
500062 Lipase
P-206 Tonsillectomy
P-207 Tonsillectomy & Adenoidectomy
810304 Total Laryngectomy
U84484 CDT ( Cardiac Troponin )
128018 Broad Dynamic Comp Plate 12 Holes Each
800818 Iol Repositioning ( Inside Hospital)
P-200 Laryngoscopy + Biopsy
800816 Gluocoma Ext+ Drang Implant
P-201 Myringotomy and insertion of Gromet - Unilateral
110-37.91 Massage, cardiac, open chest
P-202 Myringotomy and insertion of Gromet - Bilateral
P-203 Sinus washout - Unilateral
650036D Detachable Balloon
128010 Broad Dynamic Comp. Plate 6 Holes Each
N.2 NICU Second week (SR/Day) N.2 Exlusion as above
E38100 Splenectomy
830096 Removal Of Circulage / Shirodkar Suture
N.1 NICU First week (SR/Day) N.1 * Medication above 350 SR per day as per SFDA price list, Blood & blood products, MRI, CT, ECHO, Doppler , CRRT , Surgical and endoscopic procedure are an excluded service To get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist
640000 Catheterization Left Heart
497-81.08 Fusion,posterior,lumbar/lumbosacral
T93882 U/S Doppler Carotid Unilateral
N.4 NICU Fourth week (SR/Day) N.4 Exlusion as above
U83505 Hydroxyproline, Total
800158 Unilateral Tarsal Strip With Graft
800156 Bilateral Tarsal Strip
800150 Unil. Levator Mus. Recession
303232 Ct Carotid & Vertebral Arteries Angiography
303230 Ct Cerebral Arteries Angiography
137020 Psychological Assessment- Category 2 - Ocd
U83500 Hydroxyproline, Free
800154 Unilateral Tarsal Strip
303236 Ct Pulmonary Arteries Angiography
800152 Bil. Levator Mus. Recession
303234 Ct Aorta & Mesenteric Arteries Angiography
710026 Periodontal Bone Grafting Implant/Bony Detect
T73090 ULNA Radius (Forearm) - 2 Views
830070 Abdominal Sling For Congenital Prolapse
800124 Eye Plastic Surgery
800122 Trichiasis Repair (Both Eyes)
800128 Repair Of Simple Lid+Explora
830076 Removal Of Iucd Under Ga
750032 Hair Transplantation (400-500) Graft (Skincare)
830078 Salpingectomy / Salpingostomy
U82943 Glucagon (P)
U82947 Glucose Quantitative Blood /CSF
137022 Psychological Assessment- Category 2 - Panic & Phobia
650232 Spinal Stenosis : Inter Laminar Decompression / Laminectomy With Discectomy
I92562 ABLB-Alternate Binaural Loudness Balance
710008 Gingival Currettage - Per Quadrant
I92563 Tone decay test
830020 Vacuum Delivery (With Normal Baby)
825184 Repair Of Fracture Penis
830022 Breech Delivery (With Normal Baby)
U85290 Factor 13
825186 Repair Of Renal Injuries
825188 Repair Of Ruptured Urethra Or Bladder
136008 Breathing Exercise