Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2025-07-30 |
{
"resourceType" : "CodeSystem",
"id" : "moh-category",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2022-08-08T13:04:40.59+03:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem moh-category</b></p><a name=\"moh-category\"> </a><a name=\"hcmoh-category\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 1; Last updated: 2022-08-08 13:04:40+0300</p></div><p>This case-sensitive code system <code>http://nphies.sa/terminology/CodeSystem/moh-category</code> provides <b>a fragment</b> that includes following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td style=\"white-space:nowrap\">650426<a name=\"moh-category-650426\"> </a></td><td>Release Of Carpal Tunnel Syndrom General Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">506060<a name=\"moh-category-506060\"> </a></td><td>C & S Prostrate</td></tr><tr><td style=\"white-space:nowrap\">650424<a name=\"moh-category-650424\"> </a></td><td>Release Of Carpal Tunnel Syndrome Regional Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">75-34.50<a name=\"moh-category-75-34.4650\"> </a></td><td>Pleurectomy</td></tr><tr><td style=\"white-space:nowrap\">K57200<a name=\"moh-category-K57200\"> </a></td><td>Suturing of Vaginal Tear</td></tr><tr><td style=\"white-space:nowrap\">650422<a name=\"moh-category-650422\"> </a></td><td>Release Of Carpal Tunnel Syndrome Local Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">518046<a name=\"moh-category-518046\"> </a></td><td>Vasopressin (Adh)</td></tr><tr><td style=\"white-space:nowrap\">650420<a name=\"moh-category-650420\"> </a></td><td>Theco-Peritoneal Shunt</td></tr><tr><td style=\"white-space:nowrap\">518048<a name=\"moh-category-518048\"> </a></td><td>5-Hiaa</td></tr><tr><td style=\"white-space:nowrap\">U80172<a name=\"moh-category-U80172\"> </a></td><td>Gold</td></tr><tr><td style=\"white-space:nowrap\">T76020<a name=\"moh-category-T76020\"> </a></td><td>Skeletal Survey</td></tr><tr><td style=\"white-space:nowrap\">U80170<a name=\"moh-category-U80170\"> </a></td><td>Gentamycin</td></tr><tr><td style=\"white-space:nowrap\">518044<a name=\"moh-category-518044\"> </a></td><td>17-Ketosteriods, Urine</td></tr><tr><td style=\"white-space:nowrap\">518086<a name=\"moh-category-518086\"> </a></td><td>Oestradiol</td></tr><tr><td style=\"white-space:nowrap\">750906<a name=\"moh-category-750906\"> </a></td><td>Telengiectasia Treatment, Legs, Medium Area -Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">518088<a name=\"moh-category-518088\"> </a></td><td>Digoxin</td></tr><tr><td style=\"white-space:nowrap\">650428<a name=\"moh-category-650428\"> </a></td><td>Release Of Ulnar Nerve Entrapment At Wrist</td></tr><tr><td style=\"white-space:nowrap\">800026<a name=\"moh-category-800026\"> </a></td><td>Socket Reconstruction</td></tr><tr><td style=\"white-space:nowrap\">518082<a name=\"moh-category-518082\"> </a></td><td>Ft3</td></tr><tr><td style=\"white-space:nowrap\">U80168<a name=\"moh-category-U80168\"> </a></td><td>Ethosuximide</td></tr><tr><td style=\"white-space:nowrap\">518040<a name=\"moh-category-518040\"> </a></td><td>17-Hydroxycortisoteriods, Urine</td></tr><tr><td style=\"white-space:nowrap\">518084<a name=\"moh-category-518084\"> </a></td><td>T B G</td></tr><tr><td style=\"white-space:nowrap\">U80166<a name=\"moh-category-U80166\"> </a></td><td>Doxepin</td></tr><tr><td style=\"white-space:nowrap\">750908<a name=\"moh-category-750908\"> </a></td><td>Telengiectasia Treatment, Legs, Large Area -Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U80164<a name=\"moh-category-U80164\"> </a></td><td>Depakine Level (Valproic Acid)</td></tr><tr><td style=\"white-space:nowrap\">518080<a name=\"moh-category-518080\"> </a></td><td>Chromosomal Analysis</td></tr><tr><td style=\"white-space:nowrap\">800024<a name=\"moh-category-800024\"> </a></td><td>Thyroid Orbital Decompression (Both Eyes)</td></tr><tr><td style=\"white-space:nowrap\">U84520<a name=\"moh-category-U84520\"> </a></td><td>Bun</td></tr><tr><td style=\"white-space:nowrap\">750902<a name=\"moh-category-750902\"> </a></td><td>Laser Facial Rejuvenation - Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">650430<a name=\"moh-category-650430\"> </a></td><td>Release Of Cubital Tunnel Syndrome</td></tr><tr><td style=\"white-space:nowrap\">750904<a name=\"moh-category-750904\"> </a></td><td>Telengiectasia Treatment, Legs, Small Area -Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">E42420<a name=\"moh-category-E42420\"> </a></td><td>Parotidectomy total</td></tr><tr><td style=\"white-space:nowrap\">650416<a name=\"moh-category-650416\"> </a></td><td>Repair Of Meningomyelocele Major</td></tr><tr><td style=\"white-space:nowrap\">800028<a name=\"moh-category-800028\"> </a></td><td>Enucl. With Hydroxy. Orbital</td></tr><tr><td style=\"white-space:nowrap\">650414<a name=\"moh-category-650414\"> </a></td><td>Repair Of Meningomyelocele, Minor Defect</td></tr><tr><td style=\"white-space:nowrap\">506068<a name=\"moh-category-506068\"> </a></td><td>C & S Swine Flu (H1N1)</td></tr><tr><td style=\"white-space:nowrap\">506066<a name=\"moh-category-506066\"> </a></td><td>C & S Semen</td></tr><tr><td style=\"white-space:nowrap\">75-34.02<a name=\"moh-category-75-34.4602\"> </a></td><td>Thoracotomy, exploratory</td></tr><tr><td style=\"white-space:nowrap\">U82784<a name=\"moh-category-U82784\"> </a></td><td>IGA/IGM/IGD/IGG</td></tr><tr><td style=\"white-space:nowrap\">U82785<a name=\"moh-category-U82785\"> </a></td><td>IGE</td></tr><tr><td style=\"white-space:nowrap\">K57210<a name=\"moh-category-K57210\"> </a></td><td>Colpo Perineorraphy</td></tr><tr><td style=\"white-space:nowrap\">800022<a name=\"moh-category-800022\"> </a></td><td>Thyroid Orbital Decompression (One Eye)</td></tr><tr><td style=\"white-space:nowrap\">650412<a name=\"moh-category-650412\"> </a></td><td>Posterior Fusion And Stabilization</td></tr><tr><td style=\"white-space:nowrap\">202080<a name=\"moh-category-202080\"> </a></td><td>Long Term Care (Ltc) - Per Day Package</td></tr><tr><td style=\"white-space:nowrap\">650410<a name=\"moh-category-650410\"> </a></td><td>Anterior Or Anterolateral Verteb, Resection And Stabilization</td></tr><tr><td style=\"white-space:nowrap\">506062<a name=\"moh-category-506062\"> </a></td><td>Fern Test</td></tr><tr><td style=\"white-space:nowrap\">U80162<a name=\"moh-category-U80162\"> </a></td><td>Digoxin - Lanoxin</td></tr><tr><td style=\"white-space:nowrap\">800020<a name=\"moh-category-800020\"> </a></td><td>Optic Nerve Sheath Fenes – Onsf</td></tr><tr><td style=\"white-space:nowrap\">D92250<a name=\"moh-category-D92250\"> </a></td><td>Fundus Photography with interpretation</td></tr><tr><td style=\"white-space:nowrap\">518074<a name=\"moh-category-518074\"> </a></td><td>Insulin, Serum</td></tr><tr><td style=\"white-space:nowrap\">506050<a name=\"moh-category-506050\"> </a></td><td>C & S Umbilical</td></tr><tr><td style=\"white-space:nowrap\">650418<a name=\"moh-category-650418\"> </a></td><td>Repair Of Occult Spinal Dysraphism</td></tr><tr><td style=\"white-space:nowrap\">518038<a name=\"moh-category-518038\"> </a></td><td>Cortisol</td></tr><tr><td style=\"white-space:nowrap\">518076<a name=\"moh-category-518076\"> </a></td><td>C-Peptide, Serum</td></tr><tr><td style=\"white-space:nowrap\">518034<a name=\"moh-category-518034\"> </a></td><td>Vitamine D</td></tr><tr><td style=\"white-space:nowrap\">518070<a name=\"moh-category-518070\"> </a></td><td>Vitamine B12, Serum</td></tr><tr><td style=\"white-space:nowrap\">U80156<a name=\"moh-category-U80156\"> </a></td><td>Tegretol Level - Carbamazipene</td></tr><tr><td style=\"white-space:nowrap\">518036<a name=\"moh-category-518036\"> </a></td><td>Acth</td></tr><tr><td style=\"white-space:nowrap\">518072<a name=\"moh-category-518072\"> </a></td><td>Haptoglobin</td></tr><tr><td style=\"white-space:nowrap\">518030<a name=\"moh-category-518030\"> </a></td><td>Free T4</td></tr><tr><td style=\"white-space:nowrap\">U80152<a name=\"moh-category-U80152\"> </a></td><td>Amitriptyline</td></tr><tr><td style=\"white-space:nowrap\">518032<a name=\"moh-category-518032\"> </a></td><td>Calcitonin</td></tr><tr><td style=\"white-space:nowrap\">U84512<a name=\"moh-category-U84512\"> </a></td><td>Triponin Qualitiative</td></tr><tr><td style=\"white-space:nowrap\">750096<a name=\"moh-category-750096\"> </a></td><td>Patch Test (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">800034<a name=\"moh-category-800034\"> </a></td><td>Drill Of Hyder. Imp. With Artif.</td></tr><tr><td style=\"white-space:nowrap\">750094<a name=\"moh-category-750094\"> </a></td><td>Dermabrasion (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">506058<a name=\"moh-category-506058\"> </a></td><td>C & S Conjunctiva</td></tr><tr><td style=\"white-space:nowrap\">U84550<a name=\"moh-category-U84550\"> </a></td><td>Uric Acid</td></tr><tr><td style=\"white-space:nowrap\">750910<a name=\"moh-category-750910\"> </a></td><td>Telengiectasia Treatment, Face, Few Area -Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">650442<a name=\"moh-category-650442\"> </a></td><td>Old Perineural Nerve Repair</td></tr><tr><td style=\"white-space:nowrap\">E49080<a name=\"moh-category-E49080\"> </a></td><td>Peritoneal lavage</td></tr><tr><td style=\"white-space:nowrap\">506056<a name=\"moh-category-506056\"> </a></td><td>C & S Axilla</td></tr><tr><td style=\"white-space:nowrap\">U80194<a name=\"moh-category-U80194\"> </a></td><td>Quinidine</td></tr><tr><td style=\"white-space:nowrap\">750912<a name=\"moh-category-750912\"> </a></td><td>Telengiectasia Treatment, Face, Multiple Area -Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U80192<a name=\"moh-category-U80192\"> </a></td><td>N-Acetylprocainamide</td></tr><tr><td style=\"white-space:nowrap\">800032<a name=\"moh-category-800032\"> </a></td><td>Impl. Of Hydr. Orb. In Enucl.</td></tr><tr><td style=\"white-space:nowrap\">U80190<a name=\"moh-category-U80190\"> </a></td><td>Procainamide</td></tr><tr><td style=\"white-space:nowrap\">202090<a name=\"moh-category-202090\"> </a></td><td>Icu/Nicu/Picu Per Day Package</td></tr><tr><td style=\"white-space:nowrap\">750092<a name=\"moh-category-750092\"> </a></td><td>Comedon Extraction - Large Area (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U82775<a name=\"moh-category-U82775\"> </a></td><td>Galactose-1-Phosphate-Uridyltransferase</td></tr><tr><td style=\"white-space:nowrap\">750090<a name=\"moh-category-750090\"> </a></td><td>Comedon Extraction - Medium Area (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U80188<a name=\"moh-category-U80188\"> </a></td><td>Primidone</td></tr><tr><td style=\"white-space:nowrap\">506054<a name=\"moh-category-506054\"> </a></td><td>C & S Skin</td></tr><tr><td style=\"white-space:nowrap\">U80186<a name=\"moh-category-U80186\"> </a></td><td>Phenytoin - Free</td></tr><tr><td style=\"white-space:nowrap\">U82776<a name=\"moh-category-U82776\"> </a></td><td>Galactose-1-Phosphate</td></tr><tr><td style=\"white-space:nowrap\">U80185<a name=\"moh-category-U80185\"> </a></td><td>Phenytoin - Epanutin Level Total</td></tr><tr><td style=\"white-space:nowrap\">U84545<a name=\"moh-category-U84545\"> </a></td><td>Urea Clearance</td></tr><tr><td style=\"white-space:nowrap\">800030<a name=\"moh-category-800030\"> </a></td><td>Implan. Of Reg. In Enuc. Evisc.</td></tr><tr><td style=\"white-space:nowrap\">650438<a name=\"moh-category-650438\"> </a></td><td>Interfasicular Repair</td></tr><tr><td style=\"white-space:nowrap\">650436<a name=\"moh-category-650436\"> </a></td><td>Nerve Neurolysis</td></tr><tr><td style=\"white-space:nowrap\">506052<a name=\"moh-category-506052\"> </a></td><td>C & S Rectal</td></tr><tr><td style=\"white-space:nowrap\">650434<a name=\"moh-category-650434\"> </a></td><td>Surgery For Unusual Nerve Entrapment Or Injury</td></tr><tr><td style=\"white-space:nowrap\">U84540<a name=\"moh-category-U84540\"> </a></td><td>Urine Urea Nitrogen</td></tr><tr><td style=\"white-space:nowrap\">650404<a name=\"moh-category-650404\"> </a></td><td>Excision Of Lesions Intraspinal Intradural – Lumbar</td></tr><tr><td style=\"white-space:nowrap\">650432<a name=\"moh-category-650432\"> </a></td><td>Brachial Plexus Decompression</td></tr><tr><td style=\"white-space:nowrap\">U80184<a name=\"moh-category-U80184\"> </a></td><td>Phenobarbital - Gardinal Level</td></tr><tr><td style=\"white-space:nowrap\">650402<a name=\"moh-category-650402\"> </a></td><td>Excision Of Lesions Intraspinal Extradural – Cervical</td></tr><tr><td style=\"white-space:nowrap\">518096<a name=\"moh-category-518096\"> </a></td><td>Trypsin</td></tr><tr><td style=\"white-space:nowrap\">650400<a name=\"moh-category-650400\"> </a></td><td>Excision Of Lesions Intraspinal Extradural – Dorsal</td></tr><tr><td style=\"white-space:nowrap\">518098<a name=\"moh-category-518098\"> </a></td><td>Carbamazepine (Tegretol)</td></tr><tr><td style=\"white-space:nowrap\">518068<a name=\"moh-category-518068\"> </a></td><td>Folic Acid, Serum</td></tr><tr><td style=\"white-space:nowrap\">518092<a name=\"moh-category-518092\"> </a></td><td>Dibucaine Inhibition Of Pseudocholinesterase</td></tr><tr><td style=\"white-space:nowrap\">U80150<a name=\"moh-category-U80150\"> </a></td><td>Amikacin</td></tr><tr><td style=\"white-space:nowrap\">D92235<a name=\"moh-category-D92235\"> </a></td><td>Flouroscene Angiography</td></tr><tr><td style=\"white-space:nowrap\">518064<a name=\"moh-category-518064\"> </a></td><td>Tranferritin, Serum</td></tr><tr><td style=\"white-space:nowrap\">U80178<a name=\"moh-category-U80178\"> </a></td><td>Lithium level</td></tr><tr><td style=\"white-space:nowrap\">650408<a name=\"moh-category-650408\"> </a></td><td>Excision Of Lesions Intraspinal Intradural – Cervical</td></tr><tr><td style=\"white-space:nowrap\">U80176<a name=\"moh-category-U80176\"> </a></td><td>Lidocaine</td></tr><tr><td style=\"white-space:nowrap\">518066<a name=\"moh-category-518066\"> </a></td><td>Ferritin, Serum</td></tr><tr><td style=\"white-space:nowrap\">U80174<a name=\"moh-category-U80174\"> </a></td><td>Imipramine</td></tr><tr><td style=\"white-space:nowrap\">650406<a name=\"moh-category-650406\"> </a></td><td>Excision Of Lesions Intraspinal Intradural – Dorsal</td></tr><tr><td style=\"white-space:nowrap\">518090<a name=\"moh-category-518090\"> </a></td><td>Cystic Fibrosis</td></tr><tr><td style=\"white-space:nowrap\">518060<a name=\"moh-category-518060\"> </a></td><td>Alpha-Fetoprotein</td></tr><tr><td style=\"white-space:nowrap\">650440<a name=\"moh-category-650440\"> </a></td><td>Direct Perineural Nerve Repair</td></tr><tr><td style=\"white-space:nowrap\">800004<a name=\"moh-category-800004\"> </a></td><td>Orbital Tumour Biopsy+Histopathology Analysis</td></tr><tr><td style=\"white-space:nowrap\">518062<a name=\"moh-category-518062\"> </a></td><td>Carcinembryonic Antigen (Cea)</td></tr><tr><td style=\"white-space:nowrap\">800002<a name=\"moh-category-800002\"> </a></td><td>Orbital Exploration</td></tr><tr><td style=\"white-space:nowrap\">800008<a name=\"moh-category-800008\"> </a></td><td>Reconstruction Of Orbital Base Fracture</td></tr><tr><td style=\"white-space:nowrap\">800006<a name=\"moh-category-800006\"> </a></td><td>Orbital Tumour Excision+Histopathology Analysis</td></tr><tr><td style=\"white-space:nowrap\">710002<a name=\"moh-category-710002\"> </a></td><td>Polishing Of Teeth (Prophylaxis)</td></tr><tr><td style=\"white-space:nowrap\">704098<a name=\"moh-category-704098\"> </a></td><td>Periodontal Root Planning (Less Than 6 Teeth)</td></tr><tr><td style=\"white-space:nowrap\">710006<a name=\"moh-category-710006\"> </a></td><td>Oral Prophylaxis: With Flouride (2 Visits-Children</td></tr><tr><td style=\"white-space:nowrap\">710004<a name=\"moh-category-710004\"> </a></td><td>Scaling & Polishing</td></tr><tr><td style=\"white-space:nowrap\">704096<a name=\"moh-category-704096\"> </a></td><td>Periodontal Root Planning (Entire Mouth)</td></tr><tr><td style=\"white-space:nowrap\">T74290<a name=\"moh-category-T74290\"> </a></td><td>Oral Cholecystogram/Gall Bladder</td></tr><tr><td style=\"white-space:nowrap\">716084<a name=\"moh-category-716084\"> </a></td><td>Adding Tooth To Partial Denture To Replace Extracted Tooth-Each Tooth(Not Involv</td></tr><tr><td style=\"white-space:nowrap\">518056<a name=\"moh-category-518056\"> </a></td><td>Metanephrines, Urine</td></tr><tr><td style=\"white-space:nowrap\">518058<a name=\"moh-category-518058\"> </a></td><td>Catecholanines, 24 Hours Urine</td></tr><tr><td style=\"white-space:nowrap\">460298<a name=\"moh-category-460298\"> </a></td><td>Dp-Oto-Ecuastic Emission</td></tr><tr><td style=\"white-space:nowrap\">716082<a name=\"moh-category-716082\"> </a></td><td>Repair Of Broken Complete Or Partial Denture - No Teeth Damaged</td></tr><tr><td style=\"white-space:nowrap\">518052<a name=\"moh-category-518052\"> </a></td><td>Vanillymandelic Acid (Vma), Urine</td></tr><tr><td style=\"white-space:nowrap\">460296<a name=\"moh-category-460296\"> </a></td><td>Follow Up Tympanometry</td></tr><tr><td style=\"white-space:nowrap\">518054<a name=\"moh-category-518054\"> </a></td><td>Homovanillic Acid Urine</td></tr><tr><td style=\"white-space:nowrap\">716080<a name=\"moh-category-716080\"> </a></td><td>Paratial Denture Adjustment</td></tr><tr><td style=\"white-space:nowrap\">800014<a name=\"moh-category-800014\"> </a></td><td>Enucleation Or Evisceration=Prosth.Implant</td></tr><tr><td style=\"white-space:nowrap\">825246<a name=\"moh-category-825246\"> </a></td><td>Penile Prosthesis With Implant (Malleable)</td></tr><tr><td style=\"white-space:nowrap\">108-35.50<a name=\"moh-category-108-35.4650\"> </a></td><td>Repair, septa, atrial and ventricular, with prosthesis</td></tr><tr><td style=\"white-space:nowrap\">800012<a name=\"moh-category-800012\"> </a></td><td>Enucleation Or Evisceration Of Eye Ball</td></tr><tr><td style=\"white-space:nowrap\">825248<a name=\"moh-category-825248\"> </a></td><td>Penilse Prosthesis With Implant (Inflatable)</td></tr><tr><td style=\"white-space:nowrap\">518050<a name=\"moh-category-518050\"> </a></td><td>Human Growth Hormone</td></tr><tr><td style=\"white-space:nowrap\">308-58.93<a name=\"moh-category-308-58.4693\"> </a></td><td>Implantation, artificial urinary sphincter</td></tr><tr><td style=\"white-space:nowrap\">800018<a name=\"moh-category-800018\"> </a></td><td>Posterior Orbital Tumour</td></tr><tr><td style=\"white-space:nowrap\">716088<a name=\"moh-category-716088\"> </a></td><td>Chair - Side Relining (Complete Denture)Chair - Side Relining (Complete Denture)</td></tr><tr><td style=\"white-space:nowrap\">716086<a name=\"moh-category-716086\"> </a></td><td>Adding Tooth To Partial Denture To Replace Extracted Tooth(Involving Clasp Or Ab</td></tr><tr><td style=\"white-space:nowrap\">800016<a name=\"moh-category-800016\"> </a></td><td>Posterior Orbital Exploration</td></tr><tr><td style=\"white-space:nowrap\">704094<a name=\"moh-category-704094\"> </a></td><td>Membrane / Bone Grafts - Per Tooth</td></tr><tr><td style=\"white-space:nowrap\">800010<a name=\"moh-category-800010\"> </a></td><td>Exentration</td></tr><tr><td style=\"white-space:nowrap\">704092<a name=\"moh-category-704092\"> </a></td><td>Gingivectomy And Treatment (Fewer Than 5 Teeth)</td></tr><tr><td style=\"white-space:nowrap\">825240<a name=\"moh-category-825240\"> </a></td><td>Diverticulectomy</td></tr><tr><td style=\"white-space:nowrap\">704090<a name=\"moh-category-704090\"> </a></td><td>Gingivectomy Or Gingioplasty - Per Quadrant</td></tr><tr><td style=\"white-space:nowrap\">825242<a name=\"moh-category-825242\"> </a></td><td>Urs & Stone Extraction</td></tr><tr><td style=\"white-space:nowrap\">825244<a name=\"moh-category-825244\"> </a></td><td>Cystoscopy + Removal Of Djs Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">G29870<a name=\"moh-category-G29870\"> </a></td><td>Arthroscopy (Diagnostic) Knee</td></tr><tr><td style=\"white-space:nowrap\">E43621<a name=\"moh-category-E43621\"> </a></td><td>Subtotal gastrectomy</td></tr><tr><td style=\"white-space:nowrap\">716072<a name=\"moh-category-716072\"> </a></td><td>Upper Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">704058<a name=\"moh-category-704058\"> </a></td><td>Vestibuloplasty/Sulcus Deepening (Per Jaw)</td></tr><tr><td style=\"white-space:nowrap\">716070<a name=\"moh-category-716070\"> </a></td><td>Acrylic Partial Denture (4-7 Teeth)</td></tr><tr><td style=\"white-space:nowrap\">704056<a name=\"moh-category-704056\"> </a></td><td>Removal Of Lorus Palatinus Or Mandibularis</td></tr><tr><td style=\"white-space:nowrap\">518196<a name=\"moh-category-518196\"> </a></td><td>Galactose 1 Phosphate Uridyltrasferase (Quantative</td></tr><tr><td style=\"white-space:nowrap\">810102<a name=\"moh-category-810102\"> </a></td><td>Microlaryngoscopy</td></tr><tr><td style=\"white-space:nowrap\">518198<a name=\"moh-category-518198\"> </a></td><td>Ionized Calcium</td></tr><tr><td style=\"white-space:nowrap\">704054<a name=\"moh-category-704054\"> </a></td><td>Post Extraction Complication:Dressing (Opd)</td></tr><tr><td style=\"white-space:nowrap\">518192<a name=\"moh-category-518192\"> </a></td><td>Galactosemia Screening</td></tr><tr><td style=\"white-space:nowrap\">810104<a name=\"moh-category-810104\"> </a></td><td>Microlaryngosurgery</td></tr><tr><td style=\"white-space:nowrap\">825236<a name=\"moh-category-825236\"> </a></td><td>Epididymectomy</td></tr><tr><td style=\"white-space:nowrap\">704052<a name=\"moh-category-704052\"> </a></td><td>Post Surgical Extraction:Drsyspicules Removal</td></tr><tr><td style=\"white-space:nowrap\">716078<a name=\"moh-category-716078\"> </a></td><td>Complete Denture Adjustment</td></tr><tr><td style=\"white-space:nowrap\">518194<a name=\"moh-category-518194\"> </a></td><td>Amino Acid Screening</td></tr><tr><td style=\"white-space:nowrap\">810106<a name=\"moh-category-810106\"> </a></td><td>Larynx Laser Surgery</td></tr><tr><td style=\"white-space:nowrap\">825238<a name=\"moh-category-825238\"> </a></td><td>Cystoscopy And Lithlapexy</td></tr><tr><td style=\"white-space:nowrap\">716040<a name=\"moh-category-716040\"> </a></td><td>Chrome Cobalt Partial 4-7 Teeth</td></tr><tr><td style=\"white-space:nowrap\">716076<a name=\"moh-category-716076\"> </a></td><td>Bite Guard (Bite Raising Appliance)</td></tr><tr><td style=\"white-space:nowrap\">108-35.42<a name=\"moh-category-108-35.4642\"> </a></td><td>Creation, septal defect, in heart</td></tr><tr><td style=\"white-space:nowrap\">108-35.91<a name=\"moh-category-108-35.4691\"> </a></td><td>Transposition, interatrial, venous return</td></tr><tr><td style=\"white-space:nowrap\">716074<a name=\"moh-category-716074\"> </a></td><td>Upper Chrome Cobalt Partial Denture (3 Or More Teeth Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">108-35.92<a name=\"moh-category-108-35.4692\"> </a></td><td>Creation, conduit, between right ventricle,</td></tr><tr><td style=\"white-space:nowrap\">501-81.22<a name=\"moh-category-501-81.4622\"> </a></td><td>Arthrodesis,knee</td></tr><tr><td style=\"white-space:nowrap\">U84630<a name=\"moh-category-U84630\"> </a></td><td>Zinc</td></tr><tr><td style=\"white-space:nowrap\">108-35.93<a name=\"moh-category-108-35.4693\"> </a></td><td>Creation, conduit, between left ventricle,</td></tr><tr><td style=\"white-space:nowrap\">825230<a name=\"moh-category-825230\"> </a></td><td>Vasal Reversal</td></tr><tr><td style=\"white-space:nowrap\">825232<a name=\"moh-category-825232\"> </a></td><td>Vasoepididymostomy</td></tr><tr><td style=\"white-space:nowrap\">716048<a name=\"moh-category-716048\"> </a></td><td>Porcelain Set For Complete Dentures (Additional)</td></tr><tr><td style=\"white-space:nowrap\">825234<a name=\"moh-category-825234\"> </a></td><td>Vasovasostomy</td></tr><tr><td style=\"white-space:nowrap\">108-35.94<a name=\"moh-category-108-35.4694\"> </a></td><td>Creation, conduit, between atrium,</td></tr><tr><td style=\"white-space:nowrap\">460276<a name=\"moh-category-460276\"> </a></td><td>Foreign Body Removal L.A. (Throat)</td></tr><tr><td style=\"white-space:nowrap\">460274<a name=\"moh-category-460274\"> </a></td><td>Incision + Drainage Of Quinzy (L.A)</td></tr><tr><td style=\"white-space:nowrap\">H94240<a name=\"moh-category-H94240\"> </a></td><td>Lung Volume - Helium Dilution</td></tr><tr><td style=\"white-space:nowrap\">460278<a name=\"moh-category-460278\"> </a></td><td>Fine Needle Aspiration Cytology</td></tr><tr><td style=\"white-space:nowrap\">108-35.95<a name=\"moh-category-108-35.4695\"> </a></td><td>Revision, corrective procedure, heart</td></tr><tr><td style=\"white-space:nowrap\">460280<a name=\"moh-category-460280\"> </a></td><td>Somnoplasty Tounge - Clinic (1St Stage)</td></tr><tr><td style=\"white-space:nowrap\">716046<a name=\"moh-category-716046\"> </a></td><td>Other Corrective Procedures (Per 1/4 Hour)</td></tr><tr><td style=\"white-space:nowrap\">825224<a name=\"moh-category-825224\"> </a></td><td>Repair Of Urethral Injuries</td></tr><tr><td style=\"white-space:nowrap\">716044<a name=\"moh-category-716044\"> </a></td><td>Ceka Attachment Per Piece</td></tr><tr><td style=\"white-space:nowrap\">U82009<a name=\"moh-category-U82009\"> </a></td><td>Acetone Total</td></tr><tr><td style=\"white-space:nowrap\">825226<a name=\"moh-category-825226\"> </a></td><td>Urethroplasty One Stage</td></tr><tr><td style=\"white-space:nowrap\">500004<a name=\"moh-category-500004\"> </a></td><td>Glucose (Serum) Random</td></tr><tr><td style=\"white-space:nowrap\">460284<a name=\"moh-category-460284\"> </a></td><td>Pure Tone Audiometry (Air & Bone)</td></tr><tr><td style=\"white-space:nowrap\">825228<a name=\"moh-category-825228\"> </a></td><td>Urethroplasty Two Stages</td></tr><tr><td style=\"white-space:nowrap\">716042<a name=\"moh-category-716042\"> </a></td><td>Chrome Cobalt Partial 8-12 Teeth</td></tr><tr><td style=\"white-space:nowrap\">108-35.31<a name=\"moh-category-108-35.4631\"> </a></td><td>Operation, papillary muscle</td></tr><tr><td style=\"white-space:nowrap\">500002<a name=\"moh-category-500002\"> </a></td><td>Glucose (Serum) Fasting</td></tr><tr><td style=\"white-space:nowrap\">108-35.32<a name=\"moh-category-108-35.4632\"> </a></td><td>Operation, Chordae tendinae</td></tr><tr><td style=\"white-space:nowrap\">460282<a name=\"moh-category-460282\"> </a></td><td>Somnoplasty Tounge - Clinic (2Nd Stage)</td></tr><tr><td style=\"white-space:nowrap\">704050<a name=\"moh-category-704050\"> </a></td><td>Alveolectomy (Per Quadrant)</td></tr><tr><td style=\"white-space:nowrap\">L90810<a name=\"moh-category-L90810\"> </a></td><td>Psychotheraphy Interactive</td></tr><tr><td style=\"white-space:nowrap\">810110<a name=\"moh-category-810110\"> </a></td><td>Laser Tonsillectomy</td></tr><tr><td style=\"white-space:nowrap\">137202<a name=\"moh-category-137202\"> </a></td><td>Child Anxiety Manifest Level</td></tr><tr><td style=\"white-space:nowrap\">704068<a name=\"moh-category-704068\"> </a></td><td>Surgical Exposure Of Impacted Or Unerrupted Tooth</td></tr><tr><td style=\"white-space:nowrap\">825220<a name=\"moh-category-825220\"> </a></td><td>Radical Prostatectomy</td></tr><tr><td style=\"white-space:nowrap\">810112<a name=\"moh-category-810112\"> </a></td><td>Tonsillectomy</td></tr><tr><td style=\"white-space:nowrap\">825222<a name=\"moh-category-825222\"> </a></td><td>Repair Of Hypospadias Two Stages</td></tr><tr><td style=\"white-space:nowrap\">704066<a name=\"moh-category-704066\"> </a></td><td>Tooth Extraction Additional Each + L.A..</td></tr><tr><td style=\"white-space:nowrap\">137208<a name=\"moh-category-137208\"> </a></td><td>Mmpi Sub Scale</td></tr><tr><td style=\"white-space:nowrap\">36-14.27<a name=\"moh-category-36-14.4627\"> </a></td><td>Destruction, chorioretinal lesion, adiation sources</td></tr><tr><td style=\"white-space:nowrap\">137204<a name=\"moh-category-137204\"> </a></td><td>Child Behaviour Check List</td></tr><tr><td style=\"white-space:nowrap\">G29894<a name=\"moh-category-G29894\"> </a></td><td>Arthroscopy (Diagnostic) Ankle</td></tr><tr><td style=\"white-space:nowrap\">810114<a name=\"moh-category-810114\"> </a></td><td>Pan-Endoscopy (Triple Procedure)</td></tr><tr><td style=\"white-space:nowrap\">137206<a name=\"moh-category-137206\"> </a></td><td>Middle Sex Scale</td></tr><tr><td style=\"white-space:nowrap\">36-14.26<a name=\"moh-category-36-14.4626\"> </a></td><td>Destruction, chorioretinal lesion, by radiation therapy</td></tr><tr><td style=\"white-space:nowrap\">716094<a name=\"moh-category-716094\"> </a></td><td>Laboratory Relining (Partial Denture)</td></tr><tr><td style=\"white-space:nowrap\">704064<a name=\"moh-category-704064\"> </a></td><td>Alveolar Ridge Grafting Per Jaw</td></tr><tr><td style=\"white-space:nowrap\">460288<a name=\"moh-category-460288\"> </a></td><td>Tone Decay Test</td></tr><tr><td style=\"white-space:nowrap\">810116<a name=\"moh-category-810116\"> </a></td><td>Hypopharyngoscopy & Foreign Body Removal</td></tr><tr><td style=\"white-space:nowrap\">716092<a name=\"moh-category-716092\"> </a></td><td>Laboratory Relining (Complete Denture)</td></tr><tr><td style=\"white-space:nowrap\">704062<a name=\"moh-category-704062\"> </a></td><td>Other Undefined Surgical Procedures Per 15 Minutes</td></tr><tr><td style=\"white-space:nowrap\">460286<a name=\"moh-category-460286\"> </a></td><td>Follow Up Pure Tone Audiometry (Air & Bone)</td></tr><tr><td style=\"white-space:nowrap\">T76770<a name=\"moh-category-T76770\"> </a></td><td>Ultra Sound - Retroperitoneal</td></tr><tr><td style=\"white-space:nowrap\">L96100<a name=\"moh-category-L96100\"> </a></td><td>Psychological Test</td></tr><tr><td style=\"white-space:nowrap\">108-35.80<a name=\"moh-category-108-35.4680\"> </a></td><td>Repair, total, certain congenital cardiac anomalies</td></tr><tr><td style=\"white-space:nowrap\">716036<a name=\"moh-category-716036\"> </a></td><td>Chrome Cobalt Full Denture: Upper And Lower</td></tr><tr><td style=\"white-space:nowrap\">716090<a name=\"moh-category-716090\"> </a></td><td>Chair - Side Relining (Partial Denture)</td></tr><tr><td style=\"white-space:nowrap\">716034<a name=\"moh-category-716034\"> </a></td><td>Rebasing (Upper Or Lower)</td></tr><tr><td style=\"white-space:nowrap\">X1005<a name=\"moh-category-X1005\"> </a></td><td>Ventilator Per Day</td></tr><tr><td style=\"white-space:nowrap\">460290<a name=\"moh-category-460290\"> </a></td><td>Ablb</td></tr><tr><td style=\"white-space:nowrap\">716032<a name=\"moh-category-716032\"> </a></td><td>Changing Teeth In Old Chrome - Partial</td></tr><tr><td style=\"white-space:nowrap\">825214<a name=\"moh-category-825214\"> </a></td><td>Iliocystoplasty</td></tr><tr><td style=\"white-space:nowrap\">X1004<a name=\"moh-category-X1004\"> </a></td><td>Oxy Hood Per Day</td></tr><tr><td style=\"white-space:nowrap\">L90804<a name=\"moh-category-L90804\"> </a></td><td>Individual psycho therapy insight oriented</td></tr><tr><td style=\"white-space:nowrap\">X1003<a name=\"moh-category-X1003\"> </a></td><td>Mist Tent Per Day</td></tr><tr><td style=\"white-space:nowrap\">716030<a name=\"moh-category-716030\"> </a></td><td>Splints/Guards</td></tr><tr><td style=\"white-space:nowrap\">U80299<a name=\"moh-category-U80299\"> </a></td><td>Amphotericin B Level</td></tr><tr><td style=\"white-space:nowrap\">X1002<a name=\"moh-category-X1002\"> </a></td><td>Oxygen Inhalation Per Day</td></tr><tr><td style=\"white-space:nowrap\">X1001<a name=\"moh-category-X1001\"> </a></td><td>Oxygen Inhalation - Per Hour X1001</td></tr><tr><td style=\"white-space:nowrap\">825216<a name=\"moh-category-825216\"> </a></td><td>Insertion Of Penile Prothesis</td></tr><tr><td style=\"white-space:nowrap\">704060<a name=\"moh-category-704060\"> </a></td><td>Apicoectomy (Per Tooth Excluding Rct)</td></tr><tr><td style=\"white-space:nowrap\">716098<a name=\"moh-category-716098\"> </a></td><td>Lower Chrome Cobalt Partial Denture (3 Or More Teeth / Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">810108<a name=\"moh-category-810108\"> </a></td><td>Adenoidectomy</td></tr><tr><td style=\"white-space:nowrap\">460294<a name=\"moh-category-460294\"> </a></td><td>Audiological Assessment</td></tr><tr><td style=\"white-space:nowrap\">716038<a name=\"moh-category-716038\"> </a></td><td>Chrome Cobalt Partial 1-3 Teeth</td></tr><tr><td style=\"white-space:nowrap\">825218<a name=\"moh-category-825218\"> </a></td><td>Radical Cystectomy</td></tr><tr><td style=\"white-space:nowrap\">148-46.92<a name=\"moh-category-148-46.4692\"> </a></td><td>Myotomy, colon, other parts</td></tr><tr><td style=\"white-space:nowrap\">716096<a name=\"moh-category-716096\"> </a></td><td>Lower Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">460292<a name=\"moh-category-460292\"> </a></td><td>Strenger Test</td></tr><tr><td style=\"white-space:nowrap\">512002<a name=\"moh-category-512002\"> </a></td><td>Hemoglobin Electrophoresis</td></tr><tr><td style=\"white-space:nowrap\">137212<a name=\"moh-category-137212\"> </a></td><td>Beck Depression Inventory</td></tr><tr><td style=\"white-space:nowrap\">704078<a name=\"moh-category-704078\"> </a></td><td>Ridge Extension (Augmentation Per Arch)</td></tr><tr><td style=\"white-space:nowrap\">137214<a name=\"moh-category-137214\"> </a></td><td>Performance Anxiety Scale</td></tr><tr><td style=\"white-space:nowrap\">825210<a name=\"moh-category-825210\"> </a></td><td>Excision Of Ureterocele And Reimplantation Of Ureter</td></tr><tr><td style=\"white-space:nowrap\">704076<a name=\"moh-category-704076\"> </a></td><td>Biopsy Of Extra Oral Tissues</td></tr><tr><td style=\"white-space:nowrap\">137210<a name=\"moh-category-137210\"> </a></td><td>Self Esteem Inventory</td></tr><tr><td style=\"white-space:nowrap\">704074<a name=\"moh-category-704074\"> </a></td><td>Biopsy Of Oral Tissue (Soft)</td></tr><tr><td style=\"white-space:nowrap\">825212<a name=\"moh-category-825212\"> </a></td><td>Ileal Ureter</td></tr><tr><td style=\"white-space:nowrap\">512004<a name=\"moh-category-512004\"> </a></td><td>Protein Electrophoresis (Serum, Csf, Urine)</td></tr><tr><td style=\"white-space:nowrap\">716062<a name=\"moh-category-716062\"> </a></td><td>Denture - Complete Lower (Chrome Cobbalt)</td></tr><tr><td style=\"white-space:nowrap\">128100<a name=\"moh-category-128100\"> </a></td><td>Schanz Screw</td></tr><tr><td style=\"white-space:nowrap\">500018<a name=\"moh-category-500018\"> </a></td><td>Creatinine Urine (Random)</td></tr><tr><td style=\"white-space:nowrap\">128102<a name=\"moh-category-128102\"> </a></td><td>Malleolar Screw</td></tr><tr><td style=\"white-space:nowrap\">716060<a name=\"moh-category-716060\"> </a></td><td>Denture - Complete Upper (Chrome Cobbalt)</td></tr><tr><td style=\"white-space:nowrap\">I92590<a name=\"moh-category-I92590\"> </a></td><td>Hearing Aid adjustment & Evaluation Unilateral</td></tr><tr><td style=\"white-space:nowrap\">800758<a name=\"moh-category-800758\"> </a></td><td>Laser Trabeculoplasty</td></tr><tr><td style=\"white-space:nowrap\">128104<a name=\"moh-category-128104\"> </a></td><td>Partial Hip - Thomson Hip Prothesis</td></tr><tr><td style=\"white-space:nowrap\">108-35.70<a name=\"moh-category-108-35.4670\"> </a></td><td>Repair, septa, atrial, ventricular, unspecified</td></tr><tr><td style=\"white-space:nowrap\">I92591<a name=\"moh-category-I92591\"> </a></td><td>Hearing aid Adjustment & Evaluation Bilateral</td></tr><tr><td style=\"white-space:nowrap\">800762<a name=\"moh-category-800762\"> </a></td><td>Photo. Kera. Astigm - Pak Vizx</td></tr><tr><td style=\"white-space:nowrap\">128106<a name=\"moh-category-128106\"> </a></td><td>Penning Mini External Fixator</td></tr><tr><td style=\"white-space:nowrap\">500022<a name=\"moh-category-500022\"> </a></td><td>Uric Acid (Serum)</td></tr><tr><td style=\"white-space:nowrap\">850240<a name=\"moh-category-850240\"> </a></td><td>Laparascopic Salpingo-Oophorectomy (Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">800760<a name=\"moh-category-800760\"> </a></td><td>Phototherapeutic Keratectomy (P.T.K.) One Eye</td></tr><tr><td style=\"white-space:nowrap\">850242<a name=\"moh-category-850242\"> </a></td><td>Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">716068<a name=\"moh-category-716068\"> </a></td><td>Acrylic Partial Denture (1-3 Teeth)</td></tr><tr><td style=\"white-space:nowrap\">850244<a name=\"moh-category-850244\"> </a></td><td>Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">T73700<a name=\"moh-category-T73700\"> </a></td><td>CT LO EXT without Contrast</td></tr><tr><td style=\"white-space:nowrap\">500020<a name=\"moh-category-500020\"> </a></td><td>Creatinine Clearance</td></tr><tr><td style=\"white-space:nowrap\">500027<a name=\"moh-category-500027\"> </a></td><td>Globulin</td></tr><tr><td style=\"white-space:nowrap\">716066<a name=\"moh-category-716066\"> </a></td><td>Denture - Immediate Lower Complete</td></tr><tr><td style=\"white-space:nowrap\">500026<a name=\"moh-category-500026\"> </a></td><td>Albumin</td></tr><tr><td style=\"white-space:nowrap\">716064<a name=\"moh-category-716064\"> </a></td><td>Denture - Immediate Uper Complete</td></tr><tr><td style=\"white-space:nowrap\">640020<a name=\"moh-category-640020\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty) - Sv +2 Stents</td></tr><tr><td style=\"white-space:nowrap\">500024<a name=\"moh-category-500024\"> </a></td><td>Total Protein, Serum</td></tr><tr><td style=\"white-space:nowrap\">K59025<a name=\"moh-category-K59025\"> </a></td><td>CTG less than an hour</td></tr><tr><td style=\"white-space:nowrap\">704072<a name=\"moh-category-704072\"> </a></td><td>Biopsy Of Oral Tissue (Hard)</td></tr><tr><td style=\"white-space:nowrap\">T73701<a name=\"moh-category-T73701\"> </a></td><td>CT Scan Knee Lower Ext with Contrast</td></tr><tr><td style=\"white-space:nowrap\">850236<a name=\"moh-category-850236\"> </a></td><td>Laparascopic Checking Of Tubal Patency</td></tr><tr><td style=\"white-space:nowrap\">K57240<a name=\"moh-category-K57240\"> </a></td><td>Anterior Colporrhapy & Repair Cystocele</td></tr><tr><td style=\"white-space:nowrap\">850238<a name=\"moh-category-850238\"> </a></td><td>Laparascopic Salpingo-Oophorectomy (Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">H43450<a name=\"moh-category-H43450\"> </a></td><td>Oesophageal Dilation</td></tr><tr><td style=\"white-space:nowrap\">110-37.12<a name=\"moh-category-110-37.4612\"> </a></td><td>Pericardiotomy</td></tr><tr><td style=\"white-space:nowrap\">810220<a name=\"moh-category-810220\"> </a></td><td>Labyrinthectomy</td></tr><tr><td style=\"white-space:nowrap\">640022<a name=\"moh-category-640022\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty) - Dv + Stent</td></tr><tr><td style=\"white-space:nowrap\">650018C<a name=\"moh-category-650018C\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">U85384<a name=\"moh-category-U85384\"> </a></td><td>Fibrinogen</td></tr><tr><td style=\"white-space:nowrap\">750074<a name=\"moh-category-750074\"> </a></td><td>Electro Cautery - Multiple Lesion (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">750232<a name=\"moh-category-750232\"> </a></td><td>Brow Lift (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810222<a name=\"moh-category-810222\"> </a></td><td>Vestibular Neurectomy</td></tr><tr><td style=\"white-space:nowrap\">750072<a name=\"moh-category-750072\"> </a></td><td>Electro Cautery - Few Lesion (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810224<a name=\"moh-category-810224\"> </a></td><td>Facial Nerve Surgery</td></tr><tr><td style=\"white-space:nowrap\">110014<a name=\"moh-category-110014\"> </a></td><td>Orthofix Rental (Per Day)</td></tr><tr><td style=\"white-space:nowrap\">810226<a name=\"moh-category-810226\"> </a></td><td>Ossiculoplasty</td></tr><tr><td style=\"white-space:nowrap\">300226<a name=\"moh-category-300226\"> </a></td><td>Thyroid Imaging</td></tr><tr><td style=\"white-space:nowrap\">110012<a name=\"moh-category-110012\"> </a></td><td>Orthofix</td></tr><tr><td style=\"white-space:nowrap\">650018A<a name=\"moh-category-650018A\"> </a></td><td>Each Additional : Coil</td></tr><tr><td style=\"white-space:nowrap\">I69210<a name=\"moh-category-I69210\"> </a></td><td>Ear Wash</td></tr><tr><td style=\"white-space:nowrap\">650018B<a name=\"moh-category-650018B\"> </a></td><td>Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">300224<a name=\"moh-category-300224\"> </a></td><td>X-Ray Film Copy Cash (Nett) Each</td></tr><tr><td style=\"white-space:nowrap\">38-12.14<a name=\"moh-category-38-12.4614\"> </a></td><td>Subtotal or complete iridectomy for melanoma</td></tr><tr><td style=\"white-space:nowrap\">704014<a name=\"moh-category-704014\"> </a></td><td>Surgical Extraction - Complex (Bone Removal)</td></tr><tr><td style=\"white-space:nowrap\">D92283<a name=\"moh-category-D92283\"> </a></td><td>Color vision exam</td></tr><tr><td style=\"white-space:nowrap\">750070<a name=\"moh-category-750070\"> </a></td><td>Electrolysis Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">650026A<a name=\"moh-category-650026A\"> </a></td><td>Each Additional : Coil</td></tr><tr><td style=\"white-space:nowrap\">202004<a name=\"moh-category-202004\"> </a></td><td>Private Room Per Day</td></tr><tr><td style=\"white-space:nowrap\">202002<a name=\"moh-category-202002\"> </a></td><td>Suite Room Per Day</td></tr><tr><td style=\"white-space:nowrap\">650026B<a name=\"moh-category-650026B\"> </a></td><td>Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">704012<a name=\"moh-category-704012\"> </a></td><td>Surgical Extraction - Simple</td></tr><tr><td style=\"white-space:nowrap\">304032<a name=\"moh-category-304032\"> </a></td><td>Colour Doppler Sonography Breast (Two)</td></tr><tr><td style=\"white-space:nowrap\">650026C<a name=\"moh-category-650026C\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">704010<a name=\"moh-category-704010\"> </a></td><td>Removal Of Teeth (Soft Tissue) + La</td></tr><tr><td style=\"white-space:nowrap\">304030<a name=\"moh-category-304030\"> </a></td><td>Colour Doppler Sonography Breast (One)</td></tr><tr><td style=\"white-space:nowrap\">524008<a name=\"moh-category-524008\"> </a></td><td>Anti Sperm Antibody</td></tr><tr><td style=\"white-space:nowrap\">704018<a name=\"moh-category-704018\"> </a></td><td>Removal Of Teeth (Completely Bony) + L.A.</td></tr><tr><td style=\"white-space:nowrap\">810140<a name=\"moh-category-810140\"> </a></td><td>Cleft Palate Repair</td></tr><tr><td style=\"white-space:nowrap\">704016<a name=\"moh-category-704016\"> </a></td><td>Removal Of Teeth (Partially Bony) + L.A.</td></tr><tr><td style=\"white-space:nowrap\">710018<a name=\"moh-category-710018\"> </a></td><td>Topical Application Of Flouride -2 Vis (Ex Prophylaxis)</td></tr><tr><td style=\"white-space:nowrap\">524012<a name=\"moh-category-524012\"> </a></td><td>Osteocalcin</td></tr><tr><td style=\"white-space:nowrap\">U80202<a name=\"moh-category-U80202\"> </a></td><td>Vancomycin</td></tr><tr><td style=\"white-space:nowrap\">716004<a name=\"moh-category-716004\"> </a></td><td>Partial Denture 1-3 Teeth</td></tr><tr><td style=\"white-space:nowrap\">500044<a name=\"moh-category-500044\"> </a></td><td>Sgpt (Alt)</td></tr><tr><td style=\"white-space:nowrap\">137018<a name=\"moh-category-137018\"> </a></td><td>Psychological Assessment- Category 2 - Anxiety</td></tr><tr><td style=\"white-space:nowrap\">U80200<a name=\"moh-category-U80200\"> </a></td><td>Tobramycin</td></tr><tr><td style=\"white-space:nowrap\">716002<a name=\"moh-category-716002\"> </a></td><td>Complete Dentures</td></tr><tr><td style=\"white-space:nowrap\">500042<a name=\"moh-category-500042\"> </a></td><td>Sgot (Ast)</td></tr><tr><td style=\"white-space:nowrap\">524016<a name=\"moh-category-524016\"> </a></td><td>Hydroxproline Total</td></tr><tr><td style=\"white-space:nowrap\">500048<a name=\"moh-category-500048\"> </a></td><td>Alkaline Phosphatase</td></tr><tr><td style=\"white-space:nowrap\">500046<a name=\"moh-category-500046\"> </a></td><td>Ggt</td></tr><tr><td style=\"white-space:nowrap\">716008<a name=\"moh-category-716008\"> </a></td><td>Partial Denture 8-12 Teeth</td></tr><tr><td style=\"white-space:nowrap\">500040<a name=\"moh-category-500040\"> </a></td><td>Total And Direct Biliburin</td></tr><tr><td style=\"white-space:nowrap\">524010<a name=\"moh-category-524010\"> </a></td><td>Thyroid Uptake</td></tr><tr><td style=\"white-space:nowrap\">716006<a name=\"moh-category-716006\"> </a></td><td>Partial Denture 4-7 Teeth</td></tr><tr><td style=\"white-space:nowrap\">704024<a name=\"moh-category-704024\"> </a></td><td>Cyst Operation</td></tr><tr><td style=\"white-space:nowrap\">704022<a name=\"moh-category-704022\"> </a></td><td>Suturing - Large Area</td></tr><tr><td style=\"white-space:nowrap\">704020<a name=\"moh-category-704020\"> </a></td><td>Suturing - Small Area (2-3 Sutures)</td></tr><tr><td style=\"white-space:nowrap\">500028<a name=\"moh-category-500028\"> </a></td><td>Osmolarity, Serum / Urine</td></tr><tr><td style=\"white-space:nowrap\">U88162<a name=\"moh-category-U88162\"> </a></td><td>Cytology ( Fine Needle Aspiration )</td></tr><tr><td style=\"white-space:nowrap\">T74150<a name=\"moh-category-T74150\"> </a></td><td>CT Scan Abdomen</td></tr><tr><td style=\"white-space:nowrap\">704028<a name=\"moh-category-704028\"> </a></td><td>Incision And Drainage Of Abscess - Extraoral</td></tr><tr><td style=\"white-space:nowrap\">704026<a name=\"moh-category-704026\"> </a></td><td>Incision And Drainage Of Abscess - Intraoral</td></tr><tr><td style=\"white-space:nowrap\">500034<a name=\"moh-category-500034\"> </a></td><td>Total Bilirubin</td></tr><tr><td style=\"white-space:nowrap\">500032<a name=\"moh-category-500032\"> </a></td><td>Albumin/Globumin Ratio</td></tr><tr><td style=\"white-space:nowrap\">500038<a name=\"moh-category-500038\"> </a></td><td>Direct Bilirubin</td></tr><tr><td style=\"white-space:nowrap\">500036<a name=\"moh-category-500036\"> </a></td><td>Total Biliburin, Neonatal</td></tr><tr><td style=\"white-space:nowrap\">500030<a name=\"moh-category-500030\"> </a></td><td>Plasma Globumin</td></tr><tr><td style=\"white-space:nowrap\">650024B<a name=\"moh-category-650024B\"> </a></td><td>Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">650024C<a name=\"moh-category-650024C\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">524020<a name=\"moh-category-524020\"> </a></td><td>Factor Viii</td></tr><tr><td style=\"white-space:nowrap\">704036<a name=\"moh-category-704036\"> </a></td><td>Pericoronal Flap Removal - Simple</td></tr><tr><td style=\"white-space:nowrap\">650028B<a name=\"moh-category-650028B\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">810122<a name=\"moh-category-810122\"> </a></td><td>Plastic Surgery Of Throat</td></tr><tr><td style=\"white-space:nowrap\">704034<a name=\"moh-category-704034\"> </a></td><td>Closure Of Oro-Antral Fistula</td></tr><tr><td style=\"white-space:nowrap\">810124<a name=\"moh-category-810124\"> </a></td><td>Tumor Surgery Of Throat</td></tr><tr><td style=\"white-space:nowrap\">I30400<a name=\"moh-category-I30400\"> </a></td><td>Rhinoplasty</td></tr><tr><td style=\"white-space:nowrap\">704032<a name=\"moh-category-704032\"> </a></td><td>Wiring Fractured Jaw - Complex</td></tr><tr><td style=\"white-space:nowrap\">U84560<a name=\"moh-category-U84560\"> </a></td><td>Urine Uric Acid</td></tr><tr><td style=\"white-space:nowrap\">704070<a name=\"moh-category-704070\"> </a></td><td>Surgical Removal Of Suprenumerary Tooth</td></tr><tr><td style=\"white-space:nowrap\">850246<a name=\"moh-category-850246\"> </a></td><td>Diagnostic Laparascopy + Canalization Of Tube</td></tr><tr><td style=\"white-space:nowrap\">36-14.41<a name=\"moh-category-36-14.4641\"> </a></td><td>Scleral buckling with implant, f vitreous substitute</td></tr><tr><td style=\"white-space:nowrap\">U80198<a name=\"moh-category-U80198\"> </a></td><td>Theophyline</td></tr><tr><td style=\"white-space:nowrap\">704088<a name=\"moh-category-704088\"> </a></td><td>Excision Of Hyperplastic Tissue (Per Arch)</td></tr><tr><td style=\"white-space:nowrap\">U80196<a name=\"moh-category-U80196\"> </a></td><td>Acetylsalicylic Acid</td></tr><tr><td style=\"white-space:nowrap\">36-14.49<a name=\"moh-category-36-14.4649\"> </a></td><td>Scleral buckling with vitrectomy, membranectomy, ion</td></tr><tr><td style=\"white-space:nowrap\">640024<a name=\"moh-category-640024\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty) - Dv + 2 Stents</td></tr><tr><td style=\"white-space:nowrap\">704086<a name=\"moh-category-704086\"> </a></td><td>Release Of Tounge Tie</td></tr><tr><td style=\"white-space:nowrap\">750230<a name=\"moh-category-750230\"> </a></td><td>Otoplasty - Ear Reshaping (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">704084<a name=\"moh-category-704084\"> </a></td><td>Excision Of Bengin Tumour - Lesion Diameter Over 1 Cm</td></tr><tr><td style=\"white-space:nowrap\">303-56.92<a name=\"moh-category-303-56.4692\"> </a></td><td>Implantation, electronic uteral stimulator</td></tr><tr><td style=\"white-space:nowrap\">716050<a name=\"moh-category-716050\"> </a></td><td>Isosit Injection Moulded Denture</td></tr><tr><td style=\"white-space:nowrap\">218-78.37<a name=\"moh-category-218-78.4637\"> </a></td><td>Lengthening bone, tibia and fibula</td></tr><tr><td style=\"white-space:nowrap\">353-40.53<a name=\"moh-category-353-40.4653\"> </a></td><td>Excision, lymph node - iliac, radical</td></tr><tr><td style=\"white-space:nowrap\">353-40.52<a name=\"moh-category-353-40.4652\"> </a></td><td>Excision, lymph node - periaortic, radical</td></tr><tr><td style=\"white-space:nowrap\">500008<a name=\"moh-category-500008\"> </a></td><td>Glucose Tolerance Test</td></tr><tr><td style=\"white-space:nowrap\">173030<a name=\"moh-category-173030\"> </a></td><td>Activated Clotting Time</td></tr><tr><td style=\"white-space:nowrap\">500006<a name=\"moh-category-500006\"> </a></td><td>Glucose (Serum) 2Hpp</td></tr><tr><td style=\"white-space:nowrap\">300228<a name=\"moh-category-300228\"> </a></td><td>Chest Pa / Erect</td></tr><tr><td style=\"white-space:nowrap\">650474<a name=\"moh-category-650474\"> </a></td><td>Microscopic Brain Excision Of Epileptic Focus</td></tr><tr><td style=\"white-space:nowrap\">353-40.54<a name=\"moh-category-353-40.4654\"> </a></td><td>Dissection, groin, radical</td></tr><tr><td style=\"white-space:nowrap\">716058<a name=\"moh-category-716058\"> </a></td><td>Denture - Complere Lower (Acrylic)</td></tr><tr><td style=\"white-space:nowrap\">1099700<a name=\"moh-category-1099700\"> </a></td><td>Ang cor1ca 107-88.55 Angiocardiogram- coronary, 1 catheter</td></tr><tr><td style=\"white-space:nowrap\">500012<a name=\"moh-category-500012\"> </a></td><td>Bun</td></tr><tr><td style=\"white-space:nowrap\">640062<a name=\"moh-category-640062\"> </a></td><td>E.T.Suction</td></tr><tr><td style=\"white-space:nowrap\">640064<a name=\"moh-category-640064\"> </a></td><td>Infusion Syringe Pump</td></tr><tr><td style=\"white-space:nowrap\">304036<a name=\"moh-category-304036\"> </a></td><td>Colour Doppler Sonography Brain(Through Fontanell)</td></tr><tr><td style=\"white-space:nowrap\">108-35.60<a name=\"moh-category-108-35.4660\"> </a></td><td>Repair, septa, atrial, ventricular, with tissue graft</td></tr><tr><td style=\"white-space:nowrap\">800146<a name=\"moh-category-800146\"> </a></td><td>Unilat. Ptosis Repair+Fresh</td></tr><tr><td style=\"white-space:nowrap\">810218<a name=\"moh-category-810218\"> </a></td><td>Endolymphatic Shunt</td></tr><tr><td style=\"white-space:nowrap\">716056<a name=\"moh-category-716056\"> </a></td><td>Denture - Complete Upper (Acrylic)</td></tr><tr><td style=\"white-space:nowrap\">650472<a name=\"moh-category-650472\"> </a></td><td>Ct Guided Aspiration Of Intra-Cerebral</td></tr><tr><td style=\"white-space:nowrap\">518126<a name=\"moh-category-518126\"> </a></td><td>Fructose Test</td></tr><tr><td style=\"white-space:nowrap\">500010<a name=\"moh-category-500010\"> </a></td><td>Glucose ( Glucometer) Test</td></tr><tr><td style=\"white-space:nowrap\">304034<a name=\"moh-category-304034\"> </a></td><td>Colour Doppler Sonography Testicular W/Out Doppler - T</td></tr><tr><td style=\"white-space:nowrap\">800144<a name=\"moh-category-800144\"> </a></td><td>Bilateral Sim. Ptosis Repair</td></tr><tr><td style=\"white-space:nowrap\">716054<a name=\"moh-category-716054\"> </a></td><td>Tissue Conditioning Material</td></tr><tr><td style=\"white-space:nowrap\">I30300<a name=\"moh-category-I30300\"> </a></td><td>Removal of foreign body- Nose</td></tr><tr><td style=\"white-space:nowrap\">191-50.40<a name=\"moh-category-191-50.4640\"> </a></td><td>Hepatectomy, total</td></tr><tr><td style=\"white-space:nowrap\">500016<a name=\"moh-category-500016\"> </a></td><td>Creatinine, Serum</td></tr><tr><td style=\"white-space:nowrap\">300192<a name=\"moh-category-300192\"> </a></td><td>Forearm (Ulna/Radius) 2 Views</td></tr><tr><td style=\"white-space:nowrap\">716052<a name=\"moh-category-716052\"> </a></td><td>Refixing Tooth In Denture Or Hairline Cracks</td></tr><tr><td style=\"white-space:nowrap\">800148<a name=\"moh-category-800148\"> </a></td><td>Bil. Ptosis Repair+Fresh Fasc.</td></tr><tr><td style=\"white-space:nowrap\">518128<a name=\"moh-category-518128\"> </a></td><td>Mast (Allergy Screen)</td></tr><tr><td style=\"white-space:nowrap\">300190<a name=\"moh-category-300190\"> </a></td><td>Forearm (Ulna/Radius) 1 View</td></tr><tr><td style=\"white-space:nowrap\">518122<a name=\"moh-category-518122\"> </a></td><td>Prostate Specific Antigen</td></tr><tr><td style=\"white-space:nowrap\">300196<a name=\"moh-category-300196\"> </a></td><td>Scaphoid - 1 View</td></tr><tr><td style=\"white-space:nowrap\">460218<a name=\"moh-category-460218\"> </a></td><td>Sinsus Puncture</td></tr><tr><td style=\"white-space:nowrap\">518124<a name=\"moh-category-518124\"> </a></td><td>Lithium</td></tr><tr><td style=\"white-space:nowrap\">D68520<a name=\"moh-category-D68520\"> </a></td><td>Dacryocystectomy</td></tr><tr><td style=\"white-space:nowrap\">710020<a name=\"moh-category-710020\"> </a></td><td>Follow-Up (Period)</td></tr><tr><td style=\"white-space:nowrap\">710024<a name=\"moh-category-710024\"> </a></td><td>Flap Operation</td></tr><tr><td style=\"white-space:nowrap\">460216<a name=\"moh-category-460216\"> </a></td><td>Cryoturbinectomy</td></tr><tr><td style=\"white-space:nowrap\">U86430<a name=\"moh-category-U86430\"> </a></td><td>Rheumatoid Factor</td></tr><tr><td style=\"white-space:nowrap\">130504<a name=\"moh-category-130504\"> </a></td><td>Occupational Therapy (One Part)</td></tr><tr><td style=\"white-space:nowrap\">460210<a name=\"moh-category-460210\"> </a></td><td>Foreign Body Removal</td></tr><tr><td style=\"white-space:nowrap\">130502<a name=\"moh-category-130502\"> </a></td><td>Occupational Therapy (More Than One Part)</td></tr><tr><td style=\"white-space:nowrap\">M15780<a name=\"moh-category-M15780\"> </a></td><td>Dermabrasion Face</td></tr><tr><td style=\"white-space:nowrap\">460214<a name=\"moh-category-460214\"> </a></td><td>Electrical Cautry</td></tr><tr><td style=\"white-space:nowrap\">130506<a name=\"moh-category-130506\"> </a></td><td>Occupational Therapy & Physiotherapy (One Sitting)</td></tr><tr><td style=\"white-space:nowrap\">460212<a name=\"moh-category-460212\"> </a></td><td>Chemical Cautry</td></tr><tr><td style=\"white-space:nowrap\">T73620<a name=\"moh-category-T73620\"> </a></td><td>Foot Oscalcis - 2 Views</td></tr><tr><td style=\"white-space:nowrap\">N97116<a name=\"moh-category-N97116\"> </a></td><td>GAIT training</td></tr><tr><td style=\"white-space:nowrap\">106002<a name=\"moh-category-106002\"> </a></td><td>Ambulance Fee Less Than 50 Kms</td></tr><tr><td style=\"white-space:nowrap\">H91105<a name=\"moh-category-H91105\"> </a></td><td>Gastric Lavage</td></tr><tr><td style=\"white-space:nowrap\">460228<a name=\"moh-category-460228\"> </a></td><td>Somnoplasty Turbinate - Clinic</td></tr><tr><td style=\"white-space:nowrap\">825190<a name=\"moh-category-825190\"> </a></td><td>Repair Of Ureteral Injuries</td></tr><tr><td style=\"white-space:nowrap\">810126<a name=\"moh-category-810126\"> </a></td><td>Tracheostomy</td></tr><tr><td style=\"white-space:nowrap\">106006<a name=\"moh-category-106006\"> </a></td><td>Ambulance Fee More Than 100 Kms Less Than 250 Kms</td></tr><tr><td style=\"white-space:nowrap\">825192<a name=\"moh-category-825192\"> </a></td><td>Retropubic Prostatectomy</td></tr><tr><td style=\"white-space:nowrap\">106004<a name=\"moh-category-106004\"> </a></td><td>Ambulance Fee More Than 50 Kms Less Than 100 Kms</td></tr><tr><td style=\"white-space:nowrap\">460222<a name=\"moh-category-460222\"> </a></td><td>Epistaxis Nasal Pack</td></tr><tr><td style=\"white-space:nowrap\">I69405<a name=\"moh-category-I69405\"> </a></td><td>Eustachian Catheterization</td></tr><tr><td style=\"white-space:nowrap\">825274<a name=\"moh-category-825274\"> </a></td><td>Trans Obturator Tape Insertion</td></tr><tr><td style=\"white-space:nowrap\">110-37.24<a name=\"moh-category-110-37.4624\"> </a></td><td>Biopsy, pericardium</td></tr><tr><td style=\"white-space:nowrap\">825278<a name=\"moh-category-825278\"> </a></td><td>Trans Vaginal Tape Insertion (Tot)</td></tr><tr><td style=\"white-space:nowrap\">518108<a name=\"moh-category-518108\"> </a></td><td>Trop T.</td></tr><tr><td style=\"white-space:nowrap\">U84590<a name=\"moh-category-U84590\"> </a></td><td>Vitamin A (Retinol)</td></tr><tr><td style=\"white-space:nowrap\">518106<a name=\"moh-category-518106\"> </a></td><td>Microalbuminuria</td></tr><tr><td style=\"white-space:nowrap\">104-35.20<a name=\"moh-category-104-35.4620\"> </a></td><td>Replacement,heart valve</td></tr><tr><td style=\"white-space:nowrap\">U84585<a name=\"moh-category-U84585\"> </a></td><td>Vanillyl Mandelic Acid (NMA, Urine)</td></tr><tr><td style=\"white-space:nowrap\">110-37.31<a name=\"moh-category-110-37.4631\"> </a></td><td>Pericardiectomy</td></tr><tr><td style=\"white-space:nowrap\">104-35.33<a name=\"moh-category-104-35.4633\"> </a></td><td>Annulopasty</td></tr><tr><td style=\"white-space:nowrap\">110-37.40<a name=\"moh-category-110-37.4640\"> </a></td><td>Repair, heart and pericardium</td></tr><tr><td style=\"white-space:nowrap\">U84578<a name=\"moh-category-U84578\"> </a></td><td>Urine Urobilinogen</td></tr><tr><td style=\"white-space:nowrap\">40-14.60<a name=\"moh-category-40-14.4660\"> </a></td><td>Removal of surgically implanted material from posterior, separate procedure)</td></tr><tr><td style=\"white-space:nowrap\">U85060<a name=\"moh-category-U85060\"> </a></td><td>Peripheral Smear</td></tr><tr><td style=\"white-space:nowrap\">304072<a name=\"moh-category-304072\"> </a></td><td>Colour Doppler Femoral Artery (Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">T76856<a name=\"moh-category-T76856\"> </a></td><td>Ultra Sound - Pelvis</td></tr><tr><td style=\"white-space:nowrap\">304070<a name=\"moh-category-304070\"> </a></td><td>Colour Doppler Brachial Artery (Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">304076<a name=\"moh-category-304076\"> </a></td><td>Colour Doppler Peripheral Veins (One Limb)</td></tr><tr><td style=\"white-space:nowrap\">304074<a name=\"moh-category-304074\"> </a></td><td>Colour Doppler Femoral Artery (Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">K56740<a name=\"moh-category-K56740\"> </a></td><td>Excision of Bartholin Cyst</td></tr><tr><td style=\"white-space:nowrap\">304078<a name=\"moh-category-304078\"> </a></td><td>Colour Doppler Peripheral Veins (Two Limbs)</td></tr><tr><td style=\"white-space:nowrap\">840004<a name=\"moh-category-840004\"> </a></td><td>Closed Reduction Of Dislocation And P.O.P</td></tr><tr><td style=\"white-space:nowrap\">840002<a name=\"moh-category-840002\"> </a></td><td>Excision Of Ganglion</td></tr><tr><td style=\"white-space:nowrap\">115-37.85<a name=\"moh-category-115-37.4685\"> </a></td><td>Replacement any type pacemaker,single chamber device</td></tr><tr><td style=\"white-space:nowrap\">840008<a name=\"moh-category-840008\"> </a></td><td>Tendon Release Of Wrist</td></tr><tr><td style=\"white-space:nowrap\">115-37.83<a name=\"moh-category-115-37.4683\"> </a></td><td>Insertion dual chamber device, initial</td></tr><tr><td style=\"white-space:nowrap\">840006<a name=\"moh-category-840006\"> </a></td><td>Tendon Release Of Fingers</td></tr><tr><td style=\"white-space:nowrap\">115-37.82<a name=\"moh-category-115-37.4682\"> </a></td><td>Insertion, single chamber device, initial rate responsive</td></tr><tr><td style=\"white-space:nowrap\">115-37.80<a name=\"moh-category-115-37.4680\"> </a></td><td>Insertion, permanent pacemaker, initial</td></tr><tr><td style=\"white-space:nowrap\">U85048<a name=\"moh-category-U85048\"> </a></td><td>White Blood Cell Count Only</td></tr><tr><td style=\"white-space:nowrap\">F54640<a name=\"moh-category-F54640\"> </a></td><td>Orchipexy, bilateral</td></tr><tr><td style=\"white-space:nowrap\">840012<a name=\"moh-category-840012\"> </a></td><td>Closed Reduction Of Fracture Dislocation</td></tr><tr><td style=\"white-space:nowrap\">115-37.87<a name=\"moh-category-115-37.4687\"> </a></td><td>Replacement any type pacemaker,dual chamber device</td></tr><tr><td style=\"white-space:nowrap\">840018<a name=\"moh-category-840018\"> </a></td><td>Closed Fracture Small Bones Of Hand Or Foot</td></tr><tr><td style=\"white-space:nowrap\">840016<a name=\"moh-category-840016\"> </a></td><td>Menisectomy Or Excisin Of Cyst Of The Knee Joint</td></tr><tr><td style=\"white-space:nowrap\">E40701<a name=\"moh-category-E40701\"> </a></td><td>Repair cleft lip</td></tr><tr><td style=\"white-space:nowrap\">800836<a name=\"moh-category-800836\"> </a></td><td>Ch- Draniage ( Outside Hospital)</td></tr><tr><td style=\"white-space:nowrap\">800834<a name=\"moh-category-800834\"> </a></td><td>Ch-Drainage ( Inside Hospita )</td></tr><tr><td style=\"white-space:nowrap\">117-37.74<a name=\"moh-category-117-37.4674\"> </a></td><td>Insertion or replacement epicardial pacemaker, -37.74</td></tr><tr><td style=\"white-space:nowrap\">117-37.75<a name=\"moh-category-117-37.4675\"> </a></td><td>Revision,pacemaker lead,electrode</td></tr><tr><td style=\"white-space:nowrap\">117-37.76<a name=\"moh-category-117-37.4676\"> </a></td><td>Replacement,transvenous atrial/ventr pacemaker lead</td></tr><tr><td style=\"white-space:nowrap\">800838<a name=\"moh-category-800838\"> </a></td><td>Graft Replacment (Inhospital)</td></tr><tr><td style=\"white-space:nowrap\">117-37.77<a name=\"moh-category-117-37.4677\"> </a></td><td>Removal ,pacemaker leads/electrodes w/o replacement</td></tr><tr><td style=\"white-space:nowrap\">304050<a name=\"moh-category-304050\"> </a></td><td>Colour Doppler Renal Artery</td></tr><tr><td style=\"white-space:nowrap\">202102<a name=\"moh-category-202102\"> </a></td><td>Disposables I.C.U.</td></tr><tr><td style=\"white-space:nowrap\">800840<a name=\"moh-category-800840\"> </a></td><td>Balloon Dacyoplasty</td></tr><tr><td style=\"white-space:nowrap\">U82803<a name=\"moh-category-U82803\"> </a></td><td>U82803 Blood Gases</td></tr><tr><td style=\"white-space:nowrap\">304054<a name=\"moh-category-304054\"> </a></td><td>Colour Doppler Portal System</td></tr><tr><td style=\"white-space:nowrap\">800844<a name=\"moh-category-800844\"> </a></td><td>Collagen Plug</td></tr><tr><td style=\"white-space:nowrap\">T76830<a name=\"moh-category-T76830\"> </a></td><td>Ultra Sound - Transvaginal</td></tr><tr><td style=\"white-space:nowrap\">304052<a name=\"moh-category-304052\"> </a></td><td>Colour Doppler Hepatic Artery</td></tr><tr><td style=\"white-space:nowrap\">800842<a name=\"moh-category-800842\"> </a></td><td>Amniotic Membrane Graft</td></tr><tr><td style=\"white-space:nowrap\">304058<a name=\"moh-category-304058\"> </a></td><td>Colour Doppler Iliac Vessels</td></tr><tr><td style=\"white-space:nowrap\">840022<a name=\"moh-category-840022\"> </a></td><td>Reconstruction Of Amputated Finger W/O Grafting</td></tr><tr><td style=\"white-space:nowrap\">304056<a name=\"moh-category-304056\"> </a></td><td>Colour Doppler Aortic</td></tr><tr><td style=\"white-space:nowrap\">840020<a name=\"moh-category-840020\"> </a></td><td>Pop To Simple Fracture Without Displacement</td></tr><tr><td style=\"white-space:nowrap\">840026<a name=\"moh-category-840026\"> </a></td><td>Correction Of Hallux Valgus</td></tr><tr><td style=\"white-space:nowrap\">840024<a name=\"moh-category-840024\"> </a></td><td>Closed Reduction Of Dislocated Phalanges</td></tr><tr><td style=\"white-space:nowrap\">840028<a name=\"moh-category-840028\"> </a></td><td>Arthrodesis Of The Big Toe</td></tr><tr><td style=\"white-space:nowrap\">117-37.89<a name=\"moh-category-117-37.4689\"> </a></td><td>Revision or removal pacemaker device</td></tr><tr><td style=\"white-space:nowrap\">800848<a name=\"moh-category-800848\"> </a></td><td>Anterior Chamber Reformation Post Operative (Inside Hospital)</td></tr><tr><td style=\"white-space:nowrap\">202108<a name=\"moh-category-202108\"> </a></td><td>Cardiac Care Unit (Ccu)</td></tr><tr><td style=\"white-space:nowrap\">800846<a name=\"moh-category-800846\"> </a></td><td>Unilateral Punctural Occlusion</td></tr><tr><td style=\"white-space:nowrap\">202106<a name=\"moh-category-202106\"> </a></td><td>Disposables Nicu</td></tr><tr><td style=\"white-space:nowrap\">202104<a name=\"moh-category-202104\"> </a></td><td>Isolation Disposables Per Day</td></tr><tr><td style=\"white-space:nowrap\">800850<a name=\"moh-category-800850\"> </a></td><td>Anterior Chamber Reformation Post Operative (Outside Hospital)</td></tr><tr><td style=\"white-space:nowrap\">304060<a name=\"moh-category-304060\"> </a></td><td>Colour Doppler Testicular Artery</td></tr><tr><td style=\"white-space:nowrap\">304064<a name=\"moh-category-304064\"> </a></td><td>Colour Doppler Carotid Artery (Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">202110<a name=\"moh-category-202110\"> </a></td><td>Pediatric Icu (Picu)</td></tr><tr><td style=\"white-space:nowrap\">T71134<a name=\"moh-category-T71134\"> </a></td><td>Chest 4 Views with Fluroscopy</td></tr><tr><td style=\"white-space:nowrap\">304062<a name=\"moh-category-304062\"> </a></td><td>Colour Doppler Veins (Varices)</td></tr><tr><td style=\"white-space:nowrap\">304068<a name=\"moh-category-304068\"> </a></td><td>Colour Doppler Brachial Artery (Unilateral)</td></tr><tr><td style=\"white-space:nowrap\">840030<a name=\"moh-category-840030\"> </a></td><td>Pop For Correction Of Foot Deformity</td></tr><tr><td style=\"white-space:nowrap\">304066<a name=\"moh-category-304066\"> </a></td><td>Colour Doppler Carotid Artery (Bilateral)</td></tr><tr><td style=\"white-space:nowrap\">840036<a name=\"moh-category-840036\"> </a></td><td>Fracture Of Coles</td></tr><tr><td style=\"white-space:nowrap\">840034<a name=\"moh-category-840034\"> </a></td><td>Excision Of Olecranon Bursa</td></tr><tr><td style=\"white-space:nowrap\">U85260<a name=\"moh-category-U85260\"> </a></td><td>Factor 10</td></tr><tr><td style=\"white-space:nowrap\">L90871<a name=\"moh-category-L90871\"> </a></td><td>Electro convulsive therapy (ECT) multiple seizures</td></tr><tr><td style=\"white-space:nowrap\">U86592<a name=\"moh-category-U86592\"> </a></td><td>VDRL/RPR</td></tr><tr><td style=\"white-space:nowrap\">U86593<a name=\"moh-category-U86593\"> </a></td><td>RPR TITER</td></tr><tr><td style=\"white-space:nowrap\">208062<a name=\"moh-category-208062\"> </a></td><td>Narrow Band Nb-Uvb</td></tr><tr><td style=\"white-space:nowrap\">137216<a name=\"moh-category-137216\"> </a></td><td>Self Assessment Scale</td></tr><tr><td style=\"white-space:nowrap\">704134<a name=\"moh-category-704134\"> </a></td><td>Reduction Of Complicated Middle/Upper Face Fracture</td></tr><tr><td style=\"white-space:nowrap\">G24130<a name=\"moh-category-G24130\"> </a></td><td>Excision of radial head</td></tr><tr><td style=\"white-space:nowrap\">652004<a name=\"moh-category-652004\"> </a></td><td>Cabg & Tissue Aortic Valve Replacement</td></tr><tr><td style=\"white-space:nowrap\">137218<a name=\"moh-category-137218\"> </a></td><td>Eating Disorder Scale</td></tr><tr><td style=\"white-space:nowrap\">L90870<a name=\"moh-category-L90870\"> </a></td><td>Electro Convulsive Therapy (ECT) Single seizure</td></tr><tr><td style=\"white-space:nowrap\">201-39.26<a name=\"moh-category-201-39.4626\"> </a></td><td>Bypass, vascular, intra-abdominal</td></tr><tr><td style=\"white-space:nowrap\">652006<a name=\"moh-category-652006\"> </a></td><td>Cabg & Mechanical Aortic Valve</td></tr><tr><td style=\"white-space:nowrap\">825202<a name=\"moh-category-825202\"> </a></td><td>Turp</td></tr><tr><td style=\"white-space:nowrap\">518006<a name=\"moh-category-518006\"> </a></td><td>Progesterone</td></tr><tr><td style=\"white-space:nowrap\">825204<a name=\"moh-category-825204\"> </a></td><td>Ureteroscope</td></tr><tr><td style=\"white-space:nowrap\">U86674<a name=\"moh-category-U86674\"> </a></td><td>Giardia Lamblia ABS.</td></tr><tr><td style=\"white-space:nowrap\">112-35.96<a name=\"moh-category-112-35.4696\"> </a></td><td>Valvuloplasty, percutaneous</td></tr><tr><td style=\"white-space:nowrap\">518008<a name=\"moh-category-518008\"> </a></td><td>Pregnandiol</td></tr><tr><td style=\"white-space:nowrap\">825208<a name=\"moh-category-825208\"> </a></td><td>Boari Flap</td></tr><tr><td style=\"white-space:nowrap\">L90875<a name=\"moh-category-L90875\"> </a></td><td>Bio Feedback Therapy</td></tr><tr><td style=\"white-space:nowrap\">137222<a name=\"moh-category-137222\"> </a></td><td>Anorexia Nervosa Scale</td></tr><tr><td style=\"white-space:nowrap\">H85095<a name=\"moh-category-H85095\"> </a></td><td>Bone Marrow - Aspiration</td></tr><tr><td style=\"white-space:nowrap\">137224<a name=\"moh-category-137224\"> </a></td><td>Bender Gestalat Scale</td></tr><tr><td style=\"white-space:nowrap\">U84600<a name=\"moh-category-U84600\"> </a></td><td>Alcohol Isopropanol</td></tr><tr><td style=\"white-space:nowrap\">173028<a name=\"moh-category-173028\"> </a></td><td>Sodium Profiling</td></tr><tr><td style=\"white-space:nowrap\">825200<a name=\"moh-category-825200\"> </a></td><td>Tuna</td></tr><tr><td style=\"white-space:nowrap\">U86622<a name=\"moh-category-U86622\"> </a></td><td>Brucella Agglutination Test</td></tr><tr><td style=\"white-space:nowrap\">173024<a name=\"moh-category-173024\"> </a></td><td>Surgical Revision Of Fistula</td></tr><tr><td style=\"white-space:nowrap\">300230<a name=\"moh-category-300230\"> </a></td><td>Chest Ap / Supine</td></tr><tr><td style=\"white-space:nowrap\">173026<a name=\"moh-category-173026\"> </a></td><td>Bone Biopsy</td></tr><tr><td style=\"white-space:nowrap\">173020<a name=\"moh-category-173020\"> </a></td><td>Creation Of A V Fistula</td></tr><tr><td style=\"white-space:nowrap\">300234<a name=\"moh-category-300234\"> </a></td><td>Chest Lat. Decubitus</td></tr><tr><td style=\"white-space:nowrap\">173022<a name=\"moh-category-173022\"> </a></td><td>Insertion Of Central Vascular Catheter(Femoral/Subclavian/Jugular)</td></tr><tr><td style=\"white-space:nowrap\">U84490<a name=\"moh-category-U84490\"> </a></td><td>Stool for Trypsin Activity</td></tr><tr><td style=\"white-space:nowrap\">300232<a name=\"moh-category-300232\"> </a></td><td>Chest. Lat. View</td></tr><tr><td style=\"white-space:nowrap\">I69200<a name=\"moh-category-I69200\"> </a></td><td>Removal FB Impacted Ear</td></tr><tr><td style=\"white-space:nowrap\">128022<a name=\"moh-category-128022\"> </a></td><td>Spoon Plate 6 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">300238<a name=\"moh-category-300238\"> </a></td><td>Ribs Ap</td></tr><tr><td style=\"white-space:nowrap\">704030<a name=\"moh-category-704030\"> </a></td><td>Wiring Fractured Jaw - Simple</td></tr><tr><td style=\"white-space:nowrap\">128024<a name=\"moh-category-128024\"> </a></td><td>Cancelleus Bone Screws</td></tr><tr><td style=\"white-space:nowrap\">300236<a name=\"moh-category-300236\"> </a></td><td>Chest Pa / Lat. View</td></tr><tr><td style=\"white-space:nowrap\">T76090<a name=\"moh-category-T76090\"> </a></td><td>Mamography ( 1 Breast )</td></tr><tr><td style=\"white-space:nowrap\">128026<a name=\"moh-category-128026\"> </a></td><td>Cortex Bone Screws</td></tr><tr><td style=\"white-space:nowrap\">K56810<a name=\"moh-category-K56810\"> </a></td><td>Perineoplasty</td></tr><tr><td style=\"white-space:nowrap\">128028<a name=\"moh-category-128028\"> </a></td><td>Malleable Bone Screws</td></tr><tr><td style=\"white-space:nowrap\">173018<a name=\"moh-category-173018\"> </a></td><td>Plasma Pheresis / Exchange Per Session</td></tr><tr><td style=\"white-space:nowrap\">P-211<a name=\"moh-category-P-211\"> </a></td><td>Stapedectomy</td></tr><tr><td style=\"white-space:nowrap\">300240<a name=\"moh-category-300240\"> </a></td><td>Ribs Ap / Oblique</td></tr><tr><td style=\"white-space:nowrap\">P-212<a name=\"moh-category-P-212\"> </a></td><td>P-212 Adenoidectomy</td></tr><tr><td style=\"white-space:nowrap\">173014<a name=\"moh-category-173014\"> </a></td><td>Haemodiafilteration 4 To 12 Hours - Per Session</td></tr><tr><td style=\"white-space:nowrap\">T70360<a name=\"moh-category-T70360\"> </a></td><td>NECK - Soft Tissue</td></tr><tr><td style=\"white-space:nowrap\">U83586<a name=\"moh-category-U83586\"> </a></td><td>17-Ketosteroids</td></tr><tr><td style=\"white-space:nowrap\">128020<a name=\"moh-category-128020\"> </a></td><td>Broad Dynamic Comp Plate 14 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">173016<a name=\"moh-category-173016\"> </a></td><td>Continous Arteriovenous Haemofiltration 12 To 24 Hours Per Session</td></tr><tr><td style=\"white-space:nowrap\">U86615<a name=\"moh-category-U86615\"> </a></td><td>Pertussis Bordetella</td></tr><tr><td style=\"white-space:nowrap\">300244<a name=\"moh-category-300244\"> </a></td><td>Shoulder Ap / Lat.</td></tr><tr><td style=\"white-space:nowrap\">173010<a name=\"moh-category-173010\"> </a></td><td>Permicath</td></tr><tr><td style=\"white-space:nowrap\">300242<a name=\"moh-category-300242\"> </a></td><td>Shoulder Ap</td></tr><tr><td style=\"white-space:nowrap\">173012<a name=\"moh-category-173012\"> </a></td><td>Subclavian Double Lumen</td></tr><tr><td style=\"white-space:nowrap\">300204<a name=\"moh-category-300204\"> </a></td><td>Skeletal Survey</td></tr><tr><td style=\"white-space:nowrap\">173050<a name=\"moh-category-173050\"> </a></td><td>Acid Concentrate ( Litre)</td></tr><tr><td style=\"white-space:nowrap\">300202<a name=\"moh-category-300202\"> </a></td><td>Pattela - 1 View</td></tr><tr><td style=\"white-space:nowrap\">T76080<a name=\"moh-category-T76080\"> </a></td><td>Fistulogram/Sinogram</td></tr><tr><td style=\"white-space:nowrap\">173052<a name=\"moh-category-173052\"> </a></td><td>Insertion Of Perma Cath Tunnel Line</td></tr><tr><td style=\"white-space:nowrap\">300208<a name=\"moh-category-300208\"> </a></td><td>Mcu (Along With Ivp)</td></tr><tr><td style=\"white-space:nowrap\">300206<a name=\"moh-category-300206\"> </a></td><td>Intra-Operative Choloangiogram (I.O.C)</td></tr><tr><td style=\"white-space:nowrap\">212002<a name=\"moh-category-212002\"> </a></td><td>Operation Fine Major - Doctor Fees</td></tr><tr><td style=\"white-space:nowrap\">300207<a name=\"moh-category-300207\"> </a></td><td>Mcu (Micuratug Urethrogram)</td></tr><tr><td style=\"white-space:nowrap\">506008<a name=\"moh-category-506008\"> </a></td><td>T.B.Culture</td></tr><tr><td style=\"white-space:nowrap\">K56800<a name=\"moh-category-K56800\"> </a></td><td>Plastic Repair of Introitus</td></tr><tr><td style=\"white-space:nowrap\">506006<a name=\"moh-category-506006\"> </a></td><td>Anaerobic Culture</td></tr><tr><td style=\"white-space:nowrap\">506004<a name=\"moh-category-506004\"> </a></td><td>Routine Culture, Mycology</td></tr><tr><td style=\"white-space:nowrap\">640066<a name=\"moh-category-640066\"> </a></td><td>Intubation</td></tr><tr><td style=\"white-space:nowrap\">810302<a name=\"moh-category-810302\"> </a></td><td>Thyroidectomy</td></tr><tr><td style=\"white-space:nowrap\">840038<a name=\"moh-category-840038\"> </a></td><td>Amputation Of Finger Or Toe</td></tr><tr><td style=\"white-space:nowrap\">640140<a name=\"moh-category-640140\"> </a></td><td>Mitral Balloon Valuloplasty</td></tr><tr><td style=\"white-space:nowrap\">49-25.30<a name=\"moh-category-49-25.4630\"> </a></td><td>Glossectomy - complete</td></tr><tr><td style=\"white-space:nowrap\">116-37.87<a name=\"moh-category-116-37.4687\"> </a></td><td>Replacement any type pacemaker,dual chamber device</td></tr><tr><td style=\"white-space:nowrap\">750112<a name=\"moh-category-750112\"> </a></td><td>Punch Graft - Medium Area (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">304038<a name=\"moh-category-304038\"> </a></td><td>Colour Doppler Sonography Neck Lesions</td></tr><tr><td style=\"white-space:nowrap\">640142<a name=\"moh-category-640142\"> </a></td><td>Bronchial Artery Angiography</td></tr><tr><td style=\"white-space:nowrap\">K57250<a name=\"moh-category-K57250\"> </a></td><td>Posterior Colporrhaphy & Repair Eectocele</td></tr><tr><td style=\"white-space:nowrap\">750110<a name=\"moh-category-750110\"> </a></td><td>Punch Graft - Small Area (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">750086<a name=\"moh-category-750086\"> </a></td><td>Excision Of Mole - Large (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810232<a name=\"moh-category-810232\"> </a></td><td>Laser Ear Surgery</td></tr><tr><td style=\"white-space:nowrap\">110008<a name=\"moh-category-110008\"> </a></td><td>Wheel Chair - Rental (Per Day)</td></tr><tr><td style=\"white-space:nowrap\">750084<a name=\"moh-category-750084\"> </a></td><td>Excision Of Mole - Medium (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810234<a name=\"moh-category-810234\"> </a></td><td>Mastoid Abscess Drainage Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">110006<a name=\"moh-category-110006\"> </a></td><td>Wheel Chair - Deposit</td></tr><tr><td style=\"white-space:nowrap\">810236<a name=\"moh-category-810236\"> </a></td><td>Ear Foreign Body Removal Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">110004<a name=\"moh-category-110004\"> </a></td><td>Crutches - Rental (Per Day)</td></tr><tr><td style=\"white-space:nowrap\">750088<a name=\"moh-category-750088\"> </a></td><td>Comedon Extraction - Small Area (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810238<a name=\"moh-category-810238\"> </a></td><td>Suction Clearance Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">110002<a name=\"moh-category-110002\"> </a></td><td>Crutches Deposit</td></tr><tr><td style=\"white-space:nowrap\">202007<a name=\"moh-category-202007\"> </a></td><td>Semi-Suite Room Per Day</td></tr><tr><td style=\"white-space:nowrap\">750082<a name=\"moh-category-750082\"> </a></td><td>Excision Of Mole - Small (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">202008<a name=\"moh-category-202008\"> </a></td><td>Paediatric Ward</td></tr><tr><td style=\"white-space:nowrap\">810230<a name=\"moh-category-810230\"> </a></td><td>Implantable Hearing Aid</td></tr><tr><td style=\"white-space:nowrap\">202006<a name=\"moh-category-202006\"> </a></td><td>Semi-Private Room Per Day</td></tr><tr><td style=\"white-space:nowrap\">202014<a name=\"moh-category-202014\"> </a></td><td>Special Nurse 24 Hours</td></tr><tr><td style=\"white-space:nowrap\">202012<a name=\"moh-category-202012\"> </a></td><td>Nursery</td></tr><tr><td style=\"white-space:nowrap\">202010<a name=\"moh-category-202010\"> </a></td><td>Infant Incubator</td></tr><tr><td style=\"white-space:nowrap\">304042<a name=\"moh-category-304042\"> </a></td><td>Colour Doppler Vaginal Ultrasound With Doppler Study</td></tr><tr><td style=\"white-space:nowrap\">304040<a name=\"moh-category-304040\"> </a></td><td>Colour Doppler Vaginal Ultrasound Exam W/Out Dopp.Study</td></tr><tr><td style=\"white-space:nowrap\">810228<a name=\"moh-category-810228\"> </a></td><td>Second Stage Of Two Stage Tympanoplasty</td></tr><tr><td style=\"white-space:nowrap\">110010<a name=\"moh-category-110010\"> </a></td><td>Walking Stick</td></tr><tr><td style=\"white-space:nowrap\">54-20.92<a name=\"moh-category-54-20.4692\"> </a></td><td>Revision, Mastoidectomy</td></tr><tr><td style=\"white-space:nowrap\">304044<a name=\"moh-category-304044\"> </a></td><td>Colour Doppler Pregnancy Umbilical Artery Placental Flow Ovarian & Uterian</td></tr><tr><td style=\"white-space:nowrap\">K57260<a name=\"moh-category-K57260\"> </a></td><td>Combined Antero Posterior Colporraphy</td></tr><tr><td style=\"white-space:nowrap\">304008<a name=\"moh-category-304008\"> </a></td><td>Colour Doppler Hip Joint (Two)</td></tr><tr><td style=\"white-space:nowrap\">750050<a name=\"moh-category-750050\"> </a></td><td>Puva Per Session (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810202<a name=\"moh-category-810202\"> </a></td><td>Unilateral Myringatomy (G.A.)</td></tr><tr><td style=\"white-space:nowrap\">810204<a name=\"moh-category-810204\"> </a></td><td>Bilateral Myringatomy (G.A.)</td></tr><tr><td style=\"white-space:nowrap\">750054<a name=\"moh-category-750054\"> </a></td><td>Eye Brow Transplant (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">D92260<a name=\"moh-category-D92260\"> </a></td><td>Ophthalmodynametry</td></tr><tr><td style=\"white-space:nowrap\">202018<a name=\"moh-category-202018\"> </a></td><td>Isolation Room</td></tr><tr><td style=\"white-space:nowrap\">202016<a name=\"moh-category-202016\"> </a></td><td>Intensive Care Unit (Icu)</td></tr><tr><td style=\"white-space:nowrap\">202026<a name=\"moh-category-202026\"> </a></td><td>Head Box(Neo-Natal Care)</td></tr><tr><td style=\"white-space:nowrap\">U82725<a name=\"moh-category-U82725\"> </a></td><td>Fatty Acids Nonesterified</td></tr><tr><td style=\"white-space:nowrap\">202024<a name=\"moh-category-202024\"> </a></td><td>Observation Room Er / Or Recovery More Than 6 Hour</td></tr><tr><td style=\"white-space:nowrap\">304010<a name=\"moh-category-304010\"> </a></td><td>Colour Doppler Knee Joint (One)</td></tr><tr><td style=\"white-space:nowrap\">U82728<a name=\"moh-category-U82728\"> </a></td><td>Ferritin</td></tr><tr><td style=\"white-space:nowrap\">202022<a name=\"moh-category-202022\"> </a></td><td>Observation Room Er / Or Recovery Less Than 6 Hour</td></tr><tr><td style=\"white-space:nowrap\">202020<a name=\"moh-category-202020\"> </a></td><td>Guest Board & Lodging</td></tr><tr><td style=\"white-space:nowrap\">304014<a name=\"moh-category-304014\"> </a></td><td>Colour Doppler Wrist J - Carpal T (One)</td></tr><tr><td style=\"white-space:nowrap\">304012<a name=\"moh-category-304012\"> </a></td><td>Colour Doppler Knee Joint (Two)</td></tr><tr><td style=\"white-space:nowrap\">304018<a name=\"moh-category-304018\"> </a></td><td>Colour Doppler Muscles (One Limb)</td></tr><tr><td style=\"white-space:nowrap\">304016<a name=\"moh-category-304016\"> </a></td><td>Colour Doppler Wrist J - Carpal T (Two)</td></tr><tr><td style=\"white-space:nowrap\">750064<a name=\"moh-category-750064\"> </a></td><td>Trichogram (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">214014<a name=\"moh-category-214014\"> </a></td><td>Operation Room Charges Simple</td></tr><tr><td style=\"white-space:nowrap\">810210<a name=\"moh-category-810210\"> </a></td><td>Myringoplasty</td></tr><tr><td style=\"white-space:nowrap\">750062<a name=\"moh-category-750062\"> </a></td><td>Skin Biopsy (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">810212<a name=\"moh-category-810212\"> </a></td><td>Tympanoplasty + Mastoidectomy</td></tr><tr><td style=\"white-space:nowrap\">650478<a name=\"moh-category-650478\"> </a></td><td>Craniectomy, Brain Dissection & Haematoma Evaucation</td></tr><tr><td style=\"white-space:nowrap\">750068<a name=\"moh-category-750068\"> </a></td><td>Cryo Cautery - Multiple Lesion (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">214010<a name=\"moh-category-214010\"> </a></td><td>Operation Room Charges Medium</td></tr><tr><td style=\"white-space:nowrap\">810214<a name=\"moh-category-810214\"> </a></td><td>Radical Mastoidectomy</td></tr><tr><td style=\"white-space:nowrap\">650476<a name=\"moh-category-650476\"> </a></td><td>Microscopic Total Suprasellar Tumour Excision Through Subfrontal Approach With F</td></tr><tr><td style=\"white-space:nowrap\">750066<a name=\"moh-category-750066\"> </a></td><td>Cryo Cautery - Few Lesion (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">214012<a name=\"moh-category-214012\"> </a></td><td>Operation Room Charges Minor</td></tr><tr><td style=\"white-space:nowrap\">E60280<a name=\"moh-category-E60280\"> </a></td><td>Thyro glossal cyst excision</td></tr><tr><td style=\"white-space:nowrap\">810216<a name=\"moh-category-810216\"> </a></td><td>Stapedectomy</td></tr><tr><td style=\"white-space:nowrap\">T76872<a name=\"moh-category-T76872\"> </a></td><td>Ultra Sound Trans Rectal</td></tr><tr><td style=\"white-space:nowrap\">T76870<a name=\"moh-category-T76870\"> </a></td><td>Ultra Sound - Scrotum and Content</td></tr><tr><td style=\"white-space:nowrap\">750060<a name=\"moh-category-750060\"> </a></td><td>Facial Cleansing Skin Care (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">202034<a name=\"moh-category-202034\"> </a></td><td>Companion Charges With Child Per Day</td></tr><tr><td style=\"white-space:nowrap\">202032<a name=\"moh-category-202032\"> </a></td><td>Extra Lunch/Dinner Tray</td></tr><tr><td style=\"white-space:nowrap\">304020<a name=\"moh-category-304020\"> </a></td><td>Colour Doppler Muscles (Two Limbs)</td></tr><tr><td style=\"white-space:nowrap\">202030<a name=\"moh-category-202030\"> </a></td><td>Nursing Care Per Day</td></tr><tr><td style=\"white-space:nowrap\">810206<a name=\"moh-category-810206\"> </a></td><td>Unilateral Myringatomy & Grommet (G.A.)</td></tr><tr><td style=\"white-space:nowrap\">304024<a name=\"moh-category-304024\"> </a></td><td>Colour Doppler Tendons (Two)</td></tr><tr><td style=\"white-space:nowrap\">810208<a name=\"moh-category-810208\"> </a></td><td>Bilateral Myringatomy & Grommet (G.A.)</td></tr><tr><td style=\"white-space:nowrap\">304022<a name=\"moh-category-304022\"> </a></td><td>Colour Doppler Tendons (One)</td></tr><tr><td style=\"white-space:nowrap\">49-25.40<a name=\"moh-category-49-25.4640\"> </a></td><td>Glossectomy - radical</td></tr><tr><td style=\"white-space:nowrap\">304028<a name=\"moh-category-304028\"> </a></td><td>Colour Doppler Bones (Two Limbs)</td></tr><tr><td style=\"white-space:nowrap\">214006<a name=\"moh-category-214006\"> </a></td><td>Operation Room Charges Fine Major</td></tr><tr><td style=\"white-space:nowrap\">304026<a name=\"moh-category-304026\"> </a></td><td>Colour Doppler Bones (One Limb)</td></tr><tr><td style=\"white-space:nowrap\">214008<a name=\"moh-category-214008\"> </a></td><td>Operation Room Charges Major</td></tr><tr><td style=\"white-space:nowrap\">650038A<a name=\"moh-category-650038A\"> </a></td><td>Each Additional : Coil</td></tr><tr><td style=\"white-space:nowrap\">650038B<a name=\"moh-category-650038B\"> </a></td><td>Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">650038C<a name=\"moh-category-650038C\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">650268<a name=\"moh-category-650268\"> </a></td><td>Repair Of Scalp Injury Under General Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">650266<a name=\"moh-category-650266\"> </a></td><td>Excision Of Scalp Swelling Or Tumour</td></tr><tr><td style=\"white-space:nowrap\">526308<a name=\"moh-category-526308\"> </a></td><td>Phenol</td></tr><tr><td style=\"white-space:nowrap\">7-86.06<a name=\"moh-category-7-86.4606\"> </a></td><td>Insertion - infusion pump, totally implantable</td></tr><tr><td style=\"white-space:nowrap\">526312<a name=\"moh-category-526312\"> </a></td><td>Adrenal Cortex Abs</td></tr><tr><td style=\"white-space:nowrap\">526310<a name=\"moh-category-526310\"> </a></td><td>Ccp</td></tr><tr><td style=\"white-space:nowrap\">526316<a name=\"moh-category-526316\"> </a></td><td>C-1 Esterase Inhibitor</td></tr><tr><td style=\"white-space:nowrap\">526314<a name=\"moh-category-526314\"> </a></td><td>Anti Ccp Abs</td></tr><tr><td style=\"white-space:nowrap\">112002<a name=\"moh-category-112002\"> </a></td><td>Mortuary Rent Per Day</td></tr><tr><td style=\"white-space:nowrap\">650276<a name=\"moh-category-650276\"> </a></td><td>Repair Of Skull Fracture With Damaged Brain Tissue</td></tr><tr><td style=\"white-space:nowrap\">U82980<a name=\"moh-category-U82980\"> </a></td><td>Glutethimide</td></tr><tr><td style=\"white-space:nowrap\">650274<a name=\"moh-category-650274\"> </a></td><td>Repair Of Compound Skull Fracture</td></tr><tr><td style=\"white-space:nowrap\">650272<a name=\"moh-category-650272\"> </a></td><td>Repair Of Simple Skull Fracture</td></tr><tr><td style=\"white-space:nowrap\">I30100<a name=\"moh-category-I30100\"> </a></td><td>Nose, EUA, Biopsy</td></tr><tr><td style=\"white-space:nowrap\">650270<a name=\"moh-category-650270\"> </a></td><td>Excision Of Skull Vault Tumour</td></tr><tr><td style=\"white-space:nowrap\">650258<a name=\"moh-category-650258\"> </a></td><td>Craniotomy And Excision Of Clival Tumour</td></tr><tr><td style=\"white-space:nowrap\">650256<a name=\"moh-category-650256\"> </a></td><td>Craniotomy And Excision Of C P Angle Tumour</td></tr><tr><td style=\"white-space:nowrap\">526318<a name=\"moh-category-526318\"> </a></td><td>Aldolase</td></tr><tr><td style=\"white-space:nowrap\">U82977<a name=\"moh-category-U82977\"> </a></td><td>GGT (Gamma G.T.)</td></tr><tr><td style=\"white-space:nowrap\">U82979<a name=\"moh-category-U82979\"> </a></td><td>Glutathione Reductase</td></tr><tr><td style=\"white-space:nowrap\">650262<a name=\"moh-category-650262\"> </a></td><td>Craniotomy And Evacuation Of Acute Subdural Hematoma</td></tr><tr><td style=\"white-space:nowrap\">650036C<a name=\"moh-category-650036C\"> </a></td><td>Microguide Wire</td></tr><tr><td style=\"white-space:nowrap\">500014<a name=\"moh-category-500014\"> </a></td><td>Ammonia</td></tr><tr><td style=\"white-space:nowrap\">303222<a name=\"moh-category-303222\"> </a></td><td>Ct Cardiac Angiography</td></tr><tr><td style=\"white-space:nowrap\">H47000<a name=\"moh-category-H47000\"> </a></td><td>Liver Biopsy</td></tr><tr><td style=\"white-space:nowrap\">704082<a name=\"moh-category-704082\"> </a></td><td>Excision Of Bengin Tumour - Lesion Diameter Upto 1Cm</td></tr><tr><td style=\"white-space:nowrap\">704080<a name=\"moh-category-704080\"> </a></td><td>Bone Grafting (Synthetic / Pop)</td></tr><tr><td style=\"white-space:nowrap\">300194<a name=\"moh-category-300194\"> </a></td><td>T.Tube Cholanglogram</td></tr><tr><td style=\"white-space:nowrap\">800142<a name=\"moh-category-800142\"> </a></td><td>Exci. Of Lid Tum=Rec. Us Flao</td></tr><tr><td style=\"white-space:nowrap\">303226<a name=\"moh-category-303226\"> </a></td><td>Ct Virtual Colonography & Polyp Detection</td></tr><tr><td style=\"white-space:nowrap\">137024<a name=\"moh-category-137024\"> </a></td><td>Psychological Assessment- Category 2 - Personality</td></tr><tr><td style=\"white-space:nowrap\">303224<a name=\"moh-category-303224\"> </a></td><td>Ct Brain Perfusion Studies</td></tr><tr><td style=\"white-space:nowrap\">800140<a name=\"moh-category-800140\"> </a></td><td>Exci. Of Lid Tumour With Com. Re</td></tr><tr><td style=\"white-space:nowrap\">300198<a name=\"moh-category-300198\"> </a></td><td>Heel - 1 View</td></tr><tr><td style=\"white-space:nowrap\">1099699<a name=\"moh-category-1099699\"> </a></td><td>Ang R&L-H 107-88.54 Angiocardiogram- right and & heart</td></tr><tr><td style=\"white-space:nowrap\">460220<a name=\"moh-category-460220\"> </a></td><td>Intra Nasal Mucosal Allergy T.</td></tr><tr><td style=\"white-space:nowrap\">710022<a name=\"moh-category-710022\"> </a></td><td>Other Preventive Procedures: Per 15 Minutes</td></tr><tr><td style=\"white-space:nowrap\">I92553<a name=\"moh-category-I92553\"> </a></td><td>Speech audiometry air & bone</td></tr><tr><td style=\"white-space:nowrap\">710028<a name=\"moh-category-710028\"> </a></td><td>Pit & Fissure Sealant - Per Tooth</td></tr><tr><td style=\"white-space:nowrap\">208064<a name=\"moh-category-208064\"> </a></td><td>Removal Of Skin Tag 1 To 3</td></tr><tr><td style=\"white-space:nowrap\">460226<a name=\"moh-category-460226\"> </a></td><td>Follow Up-Sinus Endoscopy (One Year )</td></tr><tr><td style=\"white-space:nowrap\">750030<a name=\"moh-category-750030\"> </a></td><td>Hair Transplantation (300-400) Graft (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">460224<a name=\"moh-category-460224\"> </a></td><td>Follow Up Sinus Endoscopy (One Time)</td></tr><tr><td style=\"white-space:nowrap\">N97124<a name=\"moh-category-N97124\"> </a></td><td>N97124 Massage Therapy</td></tr><tr><td style=\"white-space:nowrap\">T73610<a name=\"moh-category-T73610\"> </a></td><td>Ankle - 3 Views</td></tr><tr><td style=\"white-space:nowrap\">T71250<a name=\"moh-category-T71250\"> </a></td><td>CT Thorax without Contrast</td></tr><tr><td style=\"white-space:nowrap\">U82055<a name=\"moh-category-U82055\"> </a></td><td>Alcohol, Ethyl</td></tr><tr><td style=\"white-space:nowrap\">825194<a name=\"moh-category-825194\"> </a></td><td>Simple Cystectomy</td></tr><tr><td style=\"white-space:nowrap\">825196<a name=\"moh-category-825196\"> </a></td><td>Simple Nephrectomy</td></tr><tr><td style=\"white-space:nowrap\">652008<a name=\"moh-category-652008\"> </a></td><td>Cabg & Tissue Mitral Valve</td></tr><tr><td style=\"white-space:nowrap\">825198<a name=\"moh-category-825198\"> </a></td><td>Transvesical Prostatectomy</td></tr><tr><td style=\"white-space:nowrap\">652010<a name=\"moh-category-652010\"> </a></td><td>Cabg & Mechanical Mitral Valve</td></tr><tr><td style=\"white-space:nowrap\">T73615<a name=\"moh-category-T73615\"> </a></td><td>Ankle Arthrography</td></tr><tr><td style=\"white-space:nowrap\">840160<a name=\"moh-category-840160\"> </a></td><td>Amputations : Upper Limbs</td></tr><tr><td style=\"white-space:nowrap\">302008<a name=\"moh-category-302008\"> </a></td><td>Antenatal Scan</td></tr><tr><td style=\"white-space:nowrap\">652012<a name=\"moh-category-652012\"> </a></td><td>Cabg & Double Tissue Valve</td></tr><tr><td style=\"white-space:nowrap\">652014<a name=\"moh-category-652014\"> </a></td><td>Cabg & Double Mechanical Valve</td></tr><tr><td style=\"white-space:nowrap\">840164<a name=\"moh-category-840164\"> </a></td><td>Arthroclesis, Shoulder</td></tr><tr><td style=\"white-space:nowrap\">750226<a name=\"moh-category-750226\"> </a></td><td>Complete Cleft Lip (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">518002<a name=\"moh-category-518002\"> </a></td><td>Estrogen</td></tr><tr><td style=\"white-space:nowrap\">640014<a name=\"moh-category-640014\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty) - Dv</td></tr><tr><td style=\"white-space:nowrap\">840162<a name=\"moh-category-840162\"> </a></td><td>Arthrodesis 1 Big Joint – Hip, Knee (Subtalar:Ankle), Foot : Triple</td></tr><tr><td style=\"white-space:nowrap\">518004<a name=\"moh-category-518004\"> </a></td><td>Estradiol</td></tr><tr><td style=\"white-space:nowrap\">750224<a name=\"moh-category-750224\"> </a></td><td>In-Complete Cleft Lip (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">506028<a name=\"moh-category-506028\"> </a></td><td>Haemoglobin H (For Alpha Thalassemia)</td></tr><tr><td style=\"white-space:nowrap\">137220<a name=\"moh-category-137220\"> </a></td><td>Bulimia Nervosa Scale</td></tr><tr><td style=\"white-space:nowrap\">506026<a name=\"moh-category-506026\"> </a></td><td>Food Testing For Coliforms</td></tr><tr><td style=\"white-space:nowrap\">506024<a name=\"moh-category-506024\"> </a></td><td>Water Testing: Routine Bacteriological Analysis</td></tr><tr><td style=\"white-space:nowrap\">U86664<a name=\"moh-category-U86664\"> </a></td><td>Epstein BARR Nuclear AG.</td></tr><tr><td style=\"white-space:nowrap\">506022<a name=\"moh-category-506022\"> </a></td><td>Skin Scrapping Microscopy For Herpes</td></tr><tr><td style=\"white-space:nowrap\">ICU<a name=\"moh-category-ICU\"> </a></td><td>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)\n* 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.\nTo get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist</td></tr><tr><td style=\"white-space:nowrap\">810128<a name=\"moh-category-810128\"> </a></td><td>Incision & Drainage Of Quinsy Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">G29830<a name=\"moh-category-G29830\"> </a></td><td>Arthroscopy (Diagnostic) Elbow</td></tr><tr><td style=\"white-space:nowrap\">137226<a name=\"moh-category-137226\"> </a></td><td>A D H D Scale</td></tr><tr><td style=\"white-space:nowrap\">137228<a name=\"moh-category-137228\"> </a></td><td>Brief Psychotherapy 6 Sessions</td></tr><tr><td style=\"white-space:nowrap\">506020<a name=\"moh-category-506020\"> </a></td><td>Direct Fungal Wet Mount</td></tr><tr><td style=\"white-space:nowrap\">518150<a name=\"moh-category-518150\"> </a></td><td>Beta Hcg</td></tr><tr><td style=\"white-space:nowrap\">P-210<a name=\"moh-category-P-210\"> </a></td><td>Tympanoplasty</td></tr><tr><td style=\"white-space:nowrap\">650028A<a name=\"moh-category-650028A\"> </a></td><td>Each Additional: Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">G29800<a name=\"moh-category-G29800\"> </a></td><td>Arthroscopy (Diagnostic) TM joint</td></tr><tr><td style=\"white-space:nowrap\">704038<a name=\"moh-category-704038\"> </a></td><td>Pericoronal Flap Removal - Complex</td></tr><tr><td style=\"white-space:nowrap\">810120<a name=\"moh-category-810120\"> </a></td><td>Bronchoscopy</td></tr><tr><td style=\"white-space:nowrap\">T74710<a name=\"moh-category-T74710\"> </a></td><td>Pelvimetry - 2 Views</td></tr><tr><td style=\"white-space:nowrap\">353-71.50<a name=\"moh-category-353-71.4650\"> </a></td><td>Vulvectomy, radical</td></tr><tr><td style=\"white-space:nowrap\">U86644<a name=\"moh-category-U86644\"> </a></td><td>Cytomegalo Virus Screening-IGG</td></tr><tr><td style=\"white-space:nowrap\">156-42.84<a name=\"moh-category-156-42.4684\"> </a></td><td>Repair, fistula, esophageal, other</td></tr><tr><td style=\"white-space:nowrap\">156-42.85<a name=\"moh-category-156-42.4685\"> </a></td><td>Repair, esophageal, stricture</td></tr><tr><td style=\"white-space:nowrap\">173046<a name=\"moh-category-173046\"> </a></td><td>Dialyser</td></tr><tr><td style=\"white-space:nowrap\">640068<a name=\"moh-category-640068\"> </a></td><td>Intubasion - Elective</td></tr><tr><td style=\"white-space:nowrap\">506002<a name=\"moh-category-506002\"> </a></td><td>C & S (Culture & Sensitivity)</td></tr><tr><td style=\"white-space:nowrap\">U86645<a name=\"moh-category-U86645\"> </a></td><td>Cytomegalo Virus Screening-IGM</td></tr><tr><td style=\"white-space:nowrap\">173048<a name=\"moh-category-173048\"> </a></td><td>Sodium Bicarbonate ( Litre)</td></tr><tr><td style=\"white-space:nowrap\">U86648<a name=\"moh-category-U86648\"> </a></td><td>Diptheria Antitoxin</td></tr><tr><td style=\"white-space:nowrap\">800814<a name=\"moh-category-800814\"> </a></td><td>Gluocoma Cyclo Photo – Coagulation ( Cbc)</td></tr><tr><td style=\"white-space:nowrap\">173042<a name=\"moh-category-173042\"> </a></td><td>Permanent Peritoneal Cathetor</td></tr><tr><td style=\"white-space:nowrap\">173044<a name=\"moh-category-173044\"> </a></td><td>Acute Peritoneal Cathetor</td></tr><tr><td style=\"white-space:nowrap\">840100<a name=\"moh-category-840100\"> </a></td><td>Fracture Vetebrae</td></tr><tr><td style=\"white-space:nowrap\">800812<a name=\"moh-category-800812\"> </a></td><td>Conjunctival Revision (Inside Hospital)</td></tr><tr><td style=\"white-space:nowrap\">650260<a name=\"moh-category-650260\"> </a></td><td>Craniotomy And Excision Of Foramen Mangum Tumour</td></tr><tr><td style=\"white-space:nowrap\">840106<a name=\"moh-category-840106\"> </a></td><td>Removal K-Wires Without Incision Under G.A.</td></tr><tr><td style=\"white-space:nowrap\">K57160<a name=\"moh-category-K57160\"> </a></td><td>Insertion of Pessary</td></tr><tr><td style=\"white-space:nowrap\">T76070<a name=\"moh-category-T76070\"> </a></td><td>CT Bone Density Study</td></tr><tr><td style=\"white-space:nowrap\">173040<a name=\"moh-category-173040\"> </a></td><td>Central Venous Pressure Monitoring</td></tr><tr><td style=\"white-space:nowrap\">840108<a name=\"moh-category-840108\"> </a></td><td>Application Of Hip Spica Muga + Uii</td></tr><tr><td style=\"white-space:nowrap\">1099698<a name=\"moh-category-1099698\"> </a></td><td>Ang L-H 107-88.53 Angiocardiogram- left heart</td></tr><tr><td style=\"white-space:nowrap\">303228<a name=\"moh-category-303228\"> </a></td><td>Ct Virtual Bronchoscopy</td></tr><tr><td style=\"white-space:nowrap\">1099697<a name=\"moh-category-1099697\"> </a></td><td>Ang R-H 107-88.52 Angiocardiogram- right heart</td></tr><tr><td style=\"white-space:nowrap\">1099696<a name=\"moh-category-1099696\"> </a></td><td>Cath R&L-H 107-37.23 Catheterization cardiac, combined right and left heart</td></tr><tr><td style=\"white-space:nowrap\">650228<a name=\"moh-category-650228\"> </a></td><td>Endoscopy For The Management Of Hydrocephalus</td></tr><tr><td style=\"white-space:nowrap\">U86308<a name=\"moh-category-U86308\"> </a></td><td>Monotest (Paul Bunnel Test)</td></tr><tr><td style=\"white-space:nowrap\">1099695<a name=\"moh-category-1099695\"> </a></td><td>Cath L-H 107-37.22 Catheterization cardiac, left heart</td></tr><tr><td style=\"white-space:nowrap\">830072<a name=\"moh-category-830072\"> </a></td><td>Cervical Polypectomy</td></tr><tr><td style=\"white-space:nowrap\">1099694<a name=\"moh-category-1099694\"> </a></td><td>Cath R-H 107-37.21 Catheterization cardiac, right heart</td></tr><tr><td style=\"white-space:nowrap\">650226<a name=\"moh-category-650226\"> </a></td><td>Ventriculo-Peritoneal Shunt Insertion</td></tr><tr><td style=\"white-space:nowrap\">L95881<a name=\"moh-category-L95881\"> </a></td><td>Developmental testing</td></tr><tr><td style=\"white-space:nowrap\">830074<a name=\"moh-category-830074\"> </a></td><td>Oophrectomy</td></tr><tr><td style=\"white-space:nowrap\">650224<a name=\"moh-category-650224\"> </a></td><td>Brachial Plexus Repair</td></tr><tr><td style=\"white-space:nowrap\">750354<a name=\"moh-category-750354\"> </a></td><td>Erbium Laser - Single Treatment (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">650222<a name=\"moh-category-650222\"> </a></td><td>Release Of Carpal Tunnel Syndrome</td></tr><tr><td style=\"white-space:nowrap\">208066<a name=\"moh-category-208066\"> </a></td><td>Removal Of Skin Tag 4 To 10</td></tr><tr><td style=\"white-space:nowrap\">704132<a name=\"moh-category-704132\"> </a></td><td>Reduction Of Simple / Middle Face Fractures + Plating</td></tr><tr><td style=\"white-space:nowrap\">L95883<a name=\"moh-category-L95883\"> </a></td><td>Neuro Psychological Testing Battery</td></tr><tr><td style=\"white-space:nowrap\">750352<a name=\"moh-category-750352\"> </a></td><td>Laser Test (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">K57288<a name=\"moh-category-K57288\"> </a></td><td>Sling Operation</td></tr><tr><td style=\"white-space:nowrap\">208068<a name=\"moh-category-208068\"> </a></td><td>Removal Of Skin Tag More Than 10</td></tr><tr><td style=\"white-space:nowrap\">704130<a name=\"moh-category-704130\"> </a></td><td>Reduction Of Fractured Zygomatic Arch</td></tr><tr><td style=\"white-space:nowrap\">712080<a name=\"moh-category-712080\"> </a></td><td>Treatment Plan - C</td></tr><tr><td style=\"white-space:nowrap\">750034<a name=\"moh-category-750034\"> </a></td><td>Hair Transplantation (500-600) Graft (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">140070<a name=\"moh-category-140070\"> </a></td><td>Ercp - With Placement Of Stent</td></tr><tr><td style=\"white-space:nowrap\">140072<a name=\"moh-category-140072\"> </a></td><td>Ercp - With Nasobilliary Drainage Tube</td></tr><tr><td style=\"white-space:nowrap\">140074<a name=\"moh-category-140074\"> </a></td><td>Ercp - With Mechanical Lithotripsy</td></tr><tr><td style=\"white-space:nowrap\">N97034<a name=\"moh-category-N97034\"> </a></td><td>Contrast bath, each 15 minutes</td></tr><tr><td style=\"white-space:nowrap\">140066<a name=\"moh-category-140066\"> </a></td><td>Ercp - With Sphincterotomy With Or Without Removal Of Stone</td></tr><tr><td style=\"white-space:nowrap\">N97035<a name=\"moh-category-N97035\"> </a></td><td>Ultrasound, each 15 minutes</td></tr><tr><td style=\"white-space:nowrap\">140068<a name=\"moh-category-140068\"> </a></td><td>Ercp - With Use Of Retrieval Ballon</td></tr><tr><td style=\"white-space:nowrap\">H94760<a name=\"moh-category-H94760\"> </a></td><td>Pulse Oximetry</td></tr><tr><td style=\"white-space:nowrap\">712082<a name=\"moh-category-712082\"> </a></td><td>Treatment Plan - D</td></tr><tr><td style=\"white-space:nowrap\">712084<a name=\"moh-category-712084\"> </a></td><td>Treatment Plan - E</td></tr><tr><td style=\"white-space:nowrap\">U86588<a name=\"moh-category-U86588\"> </a></td><td>Smart Test (Strep A)</td></tr><tr><td style=\"white-space:nowrap\">208060<a name=\"moh-category-208060\"> </a></td><td>Testicular Puncture</td></tr><tr><td style=\"white-space:nowrap\">E36450<a name=\"moh-category-E36450\"> </a></td><td>Exchange transfusion</td></tr><tr><td style=\"white-space:nowrap\">750360<a name=\"moh-category-750360\"> </a></td><td>Erbium Laser - More Than Ten Pcs (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U85250<a name=\"moh-category-U85250\"> </a></td><td>Factor 9</td></tr><tr><td style=\"white-space:nowrap\">750364<a name=\"moh-category-750364\"> </a></td><td>Dye Laser Per Session Medium Area 5-10 Cm (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">WD9215<a name=\"moh-category-WD9215\"> </a></td><td>Local Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">750362<a name=\"moh-category-750362\"> </a></td><td>Dye Laser Per Session Small Area 2-5 Cm (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">WD9210<a name=\"moh-category-WD9210\"> </a></td><td>Dental Anaesthesia w/o Surgery</td></tr><tr><td style=\"white-space:nowrap\">WD9211<a name=\"moh-category-WD9211\"> </a></td><td>Regional Block Anaesthesia</td></tr><tr><td style=\"white-space:nowrap\">712074<a name=\"moh-category-712074\"> </a></td><td>Space Retainer Removable - Follow Up</td></tr><tr><td style=\"white-space:nowrap\">712076<a name=\"moh-category-712076\"> </a></td><td>Treatment Plan - A</td></tr><tr><td style=\"white-space:nowrap\">T75710<a name=\"moh-category-T75710\"> </a></td><td>Angiography - Extremity Unilateral</td></tr><tr><td style=\"white-space:nowrap\">712070<a name=\"moh-category-712070\"> </a></td><td>Space Retainer - Fixed</td></tr><tr><td style=\"white-space:nowrap\">712072<a name=\"moh-category-712072\"> </a></td><td>Space Retainer - Removable</td></tr><tr><td style=\"white-space:nowrap\">U85246<a name=\"moh-category-U85246\"> </a></td><td>Factor 8 Associated AG.</td></tr><tr><td style=\"white-space:nowrap\">750358<a name=\"moh-category-750358\"> </a></td><td>Erbium Laser - More Than Five Pcs (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U85245<a name=\"moh-category-U85245\"> </a></td><td>Factor 8 Ristocetin Cofactor</td></tr><tr><td style=\"white-space:nowrap\">750356<a name=\"moh-category-750356\"> </a></td><td>Erbium Laser - Less Than Three Pcs (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">712078<a name=\"moh-category-712078\"> </a></td><td>Treatment Plan - B</td></tr><tr><td style=\"white-space:nowrap\">T75716<a name=\"moh-category-T75716\"> </a></td><td>Angiography - Extremity Bilateral</td></tr><tr><td style=\"white-space:nowrap\">750332<a name=\"moh-category-750332\"> </a></td><td>Liposuction Upper Back (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">750330<a name=\"moh-category-750330\"> </a></td><td>Liposuction Lower Back (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U85280<a name=\"moh-category-U85280\"> </a></td><td>Factor 12</td></tr><tr><td style=\"white-space:nowrap\">N97014<a name=\"moh-category-N97014\"> </a></td><td>Electrical Stimulation (Unattended)</td></tr><tr><td style=\"white-space:nowrap\">N97012<a name=\"moh-category-N97012\"> </a></td><td>Traction, Mechanical</td></tr><tr><td style=\"white-space:nowrap\">N97010<a name=\"moh-category-N97010\"> </a></td><td>Application of modality to 1or more area;hot/cold pack</td></tr><tr><td style=\"white-space:nowrap\">U88305<a name=\"moh-category-U88305\"> </a></td><td>Gross and Micro Exam Level IV</td></tr><tr><td style=\"white-space:nowrap\">750324<a name=\"moh-category-750324\"> </a></td><td>Liposuction Gynocomastia - Large (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U88304<a name=\"moh-category-U88304\"> </a></td><td>Gross and Micro Exam Level III</td></tr><tr><td style=\"white-space:nowrap\">750322<a name=\"moh-category-750322\"> </a></td><td>Liposuction Gynocomastia - Medium (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">N97018<a name=\"moh-category-N97018\"> </a></td><td>Paraffin Bath</td></tr><tr><td style=\"white-space:nowrap\">750328<a name=\"moh-category-750328\"> </a></td><td>Liposuction Buttock (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U88309<a name=\"moh-category-U88309\"> </a></td><td>Gross and Micro Exam Level VI</td></tr><tr><td style=\"white-space:nowrap\">N97016<a name=\"moh-category-N97016\"> </a></td><td>Vasopneumatic Devices</td></tr><tr><td style=\"white-space:nowrap\">U88307<a name=\"moh-category-U88307\"> </a></td><td>Gross and Micro Exam Level V</td></tr><tr><td style=\"white-space:nowrap\">750326<a name=\"moh-category-750326\"> </a></td><td>Liposuction Flanks (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U85270<a name=\"moh-category-U85270\"> </a></td><td>Factor 11</td></tr><tr><td style=\"white-space:nowrap\">U88302<a name=\"moh-category-U88302\"> </a></td><td>Gross and Micro Exam Level II</td></tr><tr><td style=\"white-space:nowrap\">750342<a name=\"moh-category-750342\"> </a></td><td>Full Abdominoplasty - Large (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U88300<a name=\"moh-category-U88300\"> </a></td><td>Histopathology (Frozen Section)</td></tr><tr><td style=\"white-space:nowrap\">750340<a name=\"moh-category-750340\"> </a></td><td>Full Abdominoplasty - Small (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">E39502<a name=\"moh-category-E39502\"> </a></td><td>Paraesophageal hiatus hernia repair trans abdominal</td></tr><tr><td style=\"white-space:nowrap\">N97026<a name=\"moh-category-N97026\"> </a></td><td>Infra Red</td></tr><tr><td style=\"white-space:nowrap\">N97024<a name=\"moh-category-N97024\"> </a></td><td>Diathermy</td></tr><tr><td style=\"white-space:nowrap\">N97022<a name=\"moh-category-N97022\"> </a></td><td>Whirlpool</td></tr><tr><td style=\"white-space:nowrap\">N97020<a name=\"moh-category-N97020\"> </a></td><td>Microwave</td></tr><tr><td style=\"white-space:nowrap\">750336<a name=\"moh-category-750336\"> </a></td><td>Liposuction Chin (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">750334<a name=\"moh-category-750334\"> </a></td><td>Liposuction Arms (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">750338<a name=\"moh-category-750338\"> </a></td><td>Mini Abdominoplasty (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">N97028<a name=\"moh-category-N97028\"> </a></td><td>Ultra Violet</td></tr><tr><td style=\"white-space:nowrap\">840238<a name=\"moh-category-840238\"> </a></td><td>Application Of Splints, Slabs, Pop Without Reduction</td></tr><tr><td style=\"white-space:nowrap\">840236<a name=\"moh-category-840236\"> </a></td><td>Removal Of F.B. Superficial</td></tr><tr><td style=\"white-space:nowrap\">830030<a name=\"moh-category-830030\"> </a></td><td>Polypectomy Fract. Curretage</td></tr><tr><td style=\"white-space:nowrap\">750310<a name=\"moh-category-750310\"> </a></td><td>Liposuction Lateral Thighs (Small-Medium) (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">T74440<a name=\"moh-category-T74440\"> </a></td><td>Vasography</td></tr><tr><td style=\"white-space:nowrap\">T73110<a name=\"moh-category-T73110\"> </a></td><td>Wrist - 3 Views</td></tr><tr><td style=\"white-space:nowrap\">830036<a name=\"moh-category-830036\"> </a></td><td>Posterior Colpoperineorrhaphy</td></tr><tr><td style=\"white-space:nowrap\">830038<a name=\"moh-category-830038\"> </a></td><td>Anterior Colpoperineorrhaphy</td></tr><tr><td style=\"white-space:nowrap\">830032<a name=\"moh-category-830032\"> </a></td><td>Douglas Pouch Abscess Drainage</td></tr><tr><td style=\"white-space:nowrap\">140030<a name=\"moh-category-140030\"> </a></td><td>Sclerotherapy (Oesophagus)</td></tr><tr><td style=\"white-space:nowrap\">140020<a name=\"moh-category-140020\"> </a></td><td>Laryngo-Bronoscopy/Diagnostic</td></tr><tr><td style=\"white-space:nowrap\">140022<a name=\"moh-category-140022\"> </a></td><td>Laryngo-Bronoscopy/Diagnostic + Biopsy</td></tr><tr><td style=\"white-space:nowrap\">750308<a name=\"moh-category-750308\"> </a></td><td>Liposuction Abdomen -Large (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">140024<a name=\"moh-category-140024\"> </a></td><td>Laryngo-Bronoscopy/Diagnostic + Film</td></tr><tr><td style=\"white-space:nowrap\">830028<a name=\"moh-category-830028\"> </a></td><td>Laparascopy (Not For Infertility Investigations) Diagnostic</td></tr><tr><td style=\"white-space:nowrap\">T73100<a name=\"moh-category-T73100\"> </a></td><td>Wrist - 2 Views</td></tr><tr><td style=\"white-space:nowrap\">140026<a name=\"moh-category-140026\"> </a></td><td>Colonoscopy</td></tr><tr><td style=\"white-space:nowrap\">140028<a name=\"moh-category-140028\"> </a></td><td>Endoscopy Under L.A.</td></tr><tr><td style=\"white-space:nowrap\">840242<a name=\"moh-category-840242\"> </a></td><td>Terminalisation</td></tr><tr><td style=\"white-space:nowrap\">750302<a name=\"moh-category-750302\"> </a></td><td>Liposuction (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">840240<a name=\"moh-category-840240\"> </a></td><td>C.R. Of Fractures Or Dislocations Without Anaesthesia + Application Of Pop</td></tr><tr><td style=\"white-space:nowrap\">840246<a name=\"moh-category-840246\"> </a></td><td>O.R. + If Of Single Bone Except Fracture Neck, Femur, Torch, Fracture And Fractu</td></tr><tr><td style=\"white-space:nowrap\">750306<a name=\"moh-category-750306\"> </a></td><td>Liposuction Abdomen - Medium (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">712048<a name=\"moh-category-712048\"> </a></td><td>Expansion Of Lower Mandible, Crozat Appliance</td></tr><tr><td style=\"white-space:nowrap\">840244<a name=\"moh-category-840244\"> </a></td><td>Wound Toilet & Debridment</td></tr><tr><td style=\"white-space:nowrap\">750304<a name=\"moh-category-750304\"> </a></td><td>Liposuction Abdomen - Small (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">840248<a name=\"moh-category-840248\"> </a></td><td>Cervical Disc Prolapse- Desectomy + Decompression</td></tr><tr><td style=\"white-space:nowrap\">750320<a name=\"moh-category-750320\"> </a></td><td>Liposuction Gynocomastia - Small (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">825180<a name=\"moh-category-825180\"> </a></td><td>Pyeloplasty</td></tr><tr><td style=\"white-space:nowrap\">830024<a name=\"moh-category-830024\"> </a></td><td>Caesarian Delivery (With Normal Baby)</td></tr><tr><td style=\"white-space:nowrap\">T74430<a name=\"moh-category-T74430\"> </a></td><td>Cystography</td></tr><tr><td style=\"white-space:nowrap\">G23410<a name=\"moh-category-G23410\"> </a></td><td>Repair of rotator cuff</td></tr><tr><td style=\"white-space:nowrap\">830026<a name=\"moh-category-830026\"> </a></td><td>Shirodkar Suture</td></tr><tr><td style=\"white-space:nowrap\">825182<a name=\"moh-category-825182\"> </a></td><td>Removal Of Penile Prosthesis</td></tr><tr><td style=\"white-space:nowrap\">302007<a name=\"moh-category-302007\"> </a></td><td>Ultrasound Obstetric Level Iii</td></tr><tr><td style=\"white-space:nowrap\">I69436<a name=\"moh-category-I69436\"> </a></td><td>Gromet Sheppard vent tube, fluoroplastic</td></tr><tr><td style=\"white-space:nowrap\">T73600<a name=\"moh-category-T73600\"> </a></td><td>Ankle - 2 Views</td></tr><tr><td style=\"white-space:nowrap\">640016<a name=\"moh-category-640016\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty) - Tv</td></tr><tr><td style=\"white-space:nowrap\">U82088<a name=\"moh-category-U82088\"> </a></td><td>Aldosterone</td></tr><tr><td style=\"white-space:nowrap\">136006<a name=\"moh-category-136006\"> </a></td><td>Air Mist Therapy</td></tr><tr><td style=\"white-space:nowrap\">840168<a name=\"moh-category-840168\"> </a></td><td>Benign Bone Tumours : Curretage Bone Grafting</td></tr><tr><td style=\"white-space:nowrap\">U86668<a name=\"moh-category-U86668\"> </a></td><td>Francisella Tularensis ABS.</td></tr><tr><td style=\"white-space:nowrap\">T76938<a name=\"moh-category-T76938\"> </a></td><td>Ultra Sound Guided Aspiration Cyst</td></tr><tr><td style=\"white-space:nowrap\">640018<a name=\"moh-category-640018\"> </a></td><td>Ptca (Per.Tr.Coronory Angioplasty - Sv + Stent</td></tr><tr><td style=\"white-space:nowrap\">840166<a name=\"moh-category-840166\"> </a></td><td>Arthroscopy Diagnostic + Proceed</td></tr><tr><td style=\"white-space:nowrap\">750228<a name=\"moh-category-750228\"> </a></td><td>Forehead Lift (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">U86663<a name=\"moh-category-U86663\"> </a></td><td>EB Virus(Epstein Barr Virus) IGM IFA</td></tr><tr><td style=\"white-space:nowrap\">650020B<a name=\"moh-category-650020B\"> </a></td><td>Microcatheter</td></tr><tr><td style=\"white-space:nowrap\">506018<a name=\"moh-category-506018\"> </a></td><td>Glemsa Staining</td></tr><tr><td style=\"white-space:nowrap\">506016<a name=\"moh-category-506016\"> </a></td><td>Methylene Blue Staining</td></tr><tr><td style=\"white-space:nowrap\">506014<a name=\"moh-category-506014\"> </a></td><td>Acid Fast Staining</td></tr><tr><td style=\"white-space:nowrap\">500067<a name=\"moh-category-500067\"> </a></td><td>Electrolytes (Na, K, C1) Urine</td></tr><tr><td style=\"white-space:nowrap\">P-208<a name=\"moh-category-P-208\"> </a></td><td>Septoplasty</td></tr><tr><td style=\"white-space:nowrap\">716026<a name=\"moh-category-716026\"> </a></td><td>Relining Upper Or Lower Denture</td></tr><tr><td style=\"white-space:nowrap\">P-209<a name=\"moh-category-P-209\"> </a></td><td>Polypectomy</td></tr><tr><td style=\"white-space:nowrap\">500066<a name=\"moh-category-500066\"> </a></td><td>Sodium, Serum Or Urine</td></tr><tr><td style=\"white-space:nowrap\">128012<a name=\"moh-category-128012\"> </a></td><td>Broad Dynamic Comp Plate 7 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">716024<a name=\"moh-category-716024\"> </a></td><td>Immediate Complete Dentures (Requiring Relining)</td></tr><tr><td style=\"white-space:nowrap\">U84481<a name=\"moh-category-U84481\"> </a></td><td>T3 (Free T3)</td></tr><tr><td style=\"white-space:nowrap\">500064<a name=\"moh-category-500064\"> </a></td><td>Total Co2</td></tr><tr><td style=\"white-space:nowrap\">U84480<a name=\"moh-category-U84480\"> </a></td><td>T3</td></tr><tr><td style=\"white-space:nowrap\">128014<a name=\"moh-category-128014\"> </a></td><td>Broad Dynamic Comp Plate 8 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">716022<a name=\"moh-category-716022\"> </a></td><td>Additional Casted Clasp-Gold Or Metal</td></tr><tr><td style=\"white-space:nowrap\">P-204<a name=\"moh-category-P-204\"> </a></td><td>Sinus washout - Bilateral</td></tr><tr><td style=\"white-space:nowrap\">716020<a name=\"moh-category-716020\"> </a></td><td>Tooth Additional (Each)</td></tr><tr><td style=\"white-space:nowrap\">500068<a name=\"moh-category-500068\"> </a></td><td>Total Cholesterol</td></tr><tr><td style=\"white-space:nowrap\">P-205<a name=\"moh-category-P-205\"> </a></td><td>Removal of nasal foreign body</td></tr><tr><td style=\"white-space:nowrap\">810118<a name=\"moh-category-810118\"> </a></td><td>Esophagoscopy</td></tr><tr><td style=\"white-space:nowrap\">500063<a name=\"moh-category-500063\"> </a></td><td>Electrolytes (Na, K, C1) Serum</td></tr><tr><td style=\"white-space:nowrap\">128016<a name=\"moh-category-128016\"> </a></td><td>Broad Dynamic Comp Plate 9 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">500062<a name=\"moh-category-500062\"> </a></td><td>Lipase</td></tr><tr><td style=\"white-space:nowrap\">P-206<a name=\"moh-category-P-206\"> </a></td><td>Tonsillectomy</td></tr><tr><td style=\"white-space:nowrap\">P-207<a name=\"moh-category-P-207\"> </a></td><td>Tonsillectomy & Adenoidectomy</td></tr><tr><td style=\"white-space:nowrap\">810304<a name=\"moh-category-810304\"> </a></td><td>Total Laryngectomy</td></tr><tr><td style=\"white-space:nowrap\">U84484<a name=\"moh-category-U84484\"> </a></td><td>CDT ( Cardiac Troponin )</td></tr><tr><td style=\"white-space:nowrap\">128018<a name=\"moh-category-128018\"> </a></td><td>Broad Dynamic Comp Plate 12 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">800818<a name=\"moh-category-800818\"> </a></td><td>Iol Repositioning ( Inside Hospital)</td></tr><tr><td style=\"white-space:nowrap\">P-200<a name=\"moh-category-P-200\"> </a></td><td>Laryngoscopy + Biopsy</td></tr><tr><td style=\"white-space:nowrap\">800816<a name=\"moh-category-800816\"> </a></td><td>Gluocoma Ext+ Drang Implant</td></tr><tr><td style=\"white-space:nowrap\">P-201<a name=\"moh-category-P-201\"> </a></td><td>Myringotomy and insertion of Gromet - Unilateral</td></tr><tr><td style=\"white-space:nowrap\">110-37.91<a name=\"moh-category-110-37.4691\"> </a></td><td>Massage, cardiac, open chest</td></tr><tr><td style=\"white-space:nowrap\">P-202<a name=\"moh-category-P-202\"> </a></td><td>Myringotomy and insertion of Gromet - Bilateral</td></tr><tr><td style=\"white-space:nowrap\">P-203<a name=\"moh-category-P-203\"> </a></td><td>Sinus washout - Unilateral</td></tr><tr><td style=\"white-space:nowrap\">650036D<a name=\"moh-category-650036D\"> </a></td><td>Detachable Balloon</td></tr><tr><td style=\"white-space:nowrap\">128010<a name=\"moh-category-128010\"> </a></td><td>Broad Dynamic Comp. Plate 6 Holes Each</td></tr><tr><td style=\"white-space:nowrap\">N.2<a name=\"moh-category-N.462\"> </a></td><td>NICU Second week (SR/Day) N.2 Exlusion as above</td></tr><tr><td style=\"white-space:nowrap\">E38100<a name=\"moh-category-E38100\"> </a></td><td>Splenectomy</td></tr><tr><td style=\"white-space:nowrap\">830096<a name=\"moh-category-830096\"> </a></td><td>Removal Of Circulage / Shirodkar Suture</td></tr><tr><td style=\"white-space:nowrap\">N.1<a name=\"moh-category-N.461\"> </a></td><td>NICU First week (SR/Day) N.1\n* 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\nTo get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist</td></tr><tr><td style=\"white-space:nowrap\">640000<a name=\"moh-category-640000\"> </a></td><td>Catheterization Left Heart</td></tr><tr><td style=\"white-space:nowrap\">497-81.08<a name=\"moh-category-497-81.4608\"> </a></td><td>Fusion,posterior,lumbar/lumbosacral</td></tr><tr><td style=\"white-space:nowrap\">T93882<a name=\"moh-category-T93882\"> </a></td><td>U/S Doppler Carotid Unilateral</td></tr><tr><td style=\"white-space:nowrap\">N.4<a name=\"moh-category-N.464\"> </a></td><td>NICU Fourth week (SR/Day) N.4 Exlusion as above</td></tr><tr><td style=\"white-space:nowrap\">U83505<a name=\"moh-category-U83505\"> </a></td><td>Hydroxyproline, Total</td></tr><tr><td style=\"white-space:nowrap\">800158<a name=\"moh-category-800158\"> </a></td><td>Unilateral Tarsal Strip With Graft</td></tr><tr><td style=\"white-space:nowrap\">800156<a name=\"moh-category-800156\"> </a></td><td>Bilateral Tarsal Strip</td></tr><tr><td style=\"white-space:nowrap\">800150<a name=\"moh-category-800150\"> </a></td><td>Unil. Levator Mus. Recession</td></tr><tr><td style=\"white-space:nowrap\">303232<a name=\"moh-category-303232\"> </a></td><td>Ct Carotid & Vertebral Arteries Angiography</td></tr><tr><td style=\"white-space:nowrap\">303230<a name=\"moh-category-303230\"> </a></td><td>Ct Cerebral Arteries Angiography</td></tr><tr><td style=\"white-space:nowrap\">137020<a name=\"moh-category-137020\"> </a></td><td>Psychological Assessment- Category 2 - Ocd</td></tr><tr><td style=\"white-space:nowrap\">U83500<a name=\"moh-category-U83500\"> </a></td><td>Hydroxyproline, Free</td></tr><tr><td style=\"white-space:nowrap\">800154<a name=\"moh-category-800154\"> </a></td><td>Unilateral Tarsal Strip</td></tr><tr><td style=\"white-space:nowrap\">303236<a name=\"moh-category-303236\"> </a></td><td>Ct Pulmonary Arteries Angiography</td></tr><tr><td style=\"white-space:nowrap\">800152<a name=\"moh-category-800152\"> </a></td><td>Bil. Levator Mus. Recession</td></tr><tr><td style=\"white-space:nowrap\">303234<a name=\"moh-category-303234\"> </a></td><td>Ct Aorta & Mesenteric Arteries Angiography</td></tr><tr><td style=\"white-space:nowrap\">710026<a name=\"moh-category-710026\"> </a></td><td>Periodontal Bone Grafting Implant/Bony Detect</td></tr><tr><td style=\"white-space:nowrap\">T73090<a name=\"moh-category-T73090\"> </a></td><td>ULNA Radius (Forearm) - 2 Views</td></tr><tr><td style=\"white-space:nowrap\">830070<a name=\"moh-category-830070\"> </a></td><td>Abdominal Sling For Congenital Prolapse</td></tr><tr><td style=\"white-space:nowrap\">800124<a name=\"moh-category-800124\"> </a></td><td>Eye Plastic Surgery</td></tr><tr><td style=\"white-space:nowrap\">800122<a name=\"moh-category-800122\"> </a></td><td>Trichiasis Repair (Both Eyes)</td></tr><tr><td style=\"white-space:nowrap\">800128<a name=\"moh-category-800128\"> </a></td><td>Repair Of Simple Lid+Explora</td></tr><tr><td style=\"white-space:nowrap\">830076<a name=\"moh-category-830076\"> </a></td><td>Removal Of Iucd Under Ga</td></tr><tr><td style=\"white-space:nowrap\">750032<a name=\"moh-category-750032\"> </a></td><td>Hair Transplantation (400-500) Graft (Skincare)</td></tr><tr><td style=\"white-space:nowrap\">830078<a name=\"moh-category-830078\"> </a></td><td>Salpingectomy / Salpingostomy</td></tr><tr><td style=\"white-space:nowrap\">U82943<a name=\"moh-category-U82943\"> </a></td><td>Glucagon (P)</td></tr><tr><td style=\"white-space:nowrap\">U82947<a name=\"moh-category-U82947\"> </a></td><td>Glucose Quantitative Blood /CSF</td></tr><tr><td style=\"white-space:nowrap\">137022<a name=\"moh-category-137022\"> </a></td><td>Psychological Assessment- Category 2 - Panic & Phobia</td></tr><tr><td style=\"white-space:nowrap\">650232<a name=\"moh-category-650232\"> </a></td><td>Spinal Stenosis : Inter Laminar Decompression / Laminectomy With Discectomy</td></tr><tr><td style=\"white-space:nowrap\">I92562<a name=\"moh-category-I92562\"> </a></td><td>ABLB-Alternate Binaural Loudness Balance</td></tr><tr><td style=\"white-space:nowrap\">710008<a name=\"moh-category-710008\"> </a></td><td>Gingival Currettage - Per Quadrant</td></tr><tr><td style=\"white-space:nowrap\">I92563<a name=\"moh-category-I92563\"> </a></td><td>Tone decay test</td></tr><tr><td style=\"white-space:nowrap\">830020<a name=\"moh-category-830020\"> </a></td><td>Vacuum Delivery (With Normal Baby)</td></tr><tr><td style=\"white-space:nowrap\">825184<a name=\"moh-category-825184\"> </a></td><td>Repair Of Fracture Penis</td></tr><tr><td style=\"white-space:nowrap\">830022<a name=\"moh-category-830022\"> </a></td><td>Breech Delivery (With Normal Baby)</td></tr><tr><td style=\"white-space:nowrap\">U85290<a name=\"moh-category-U85290\"> </a></td><td>Factor 13</td></tr><tr><td style=\"white-space:nowrap\">825186<a name=\"moh-category-825186\"> </a></td><td>Repair Of Renal Injuries</td></tr><tr><td style=\"white-space:nowrap\">825188<a name=\"moh-category-825188\"> </a></td><td>Repair Of Ruptured Urethra Or Bladder</td></tr><tr><td style=\"white-space:nowrap\">136008<a name=\"moh-category-136008\"> </a></td><td>Breathing Exercise</td></tr></table></div>"
},
"url" : "http://nphies.sa/terminology/CodeSystem/moh-category",
"version" : "0.3.0",
"name" : "MOH_Category",
"title" : "MOH Category",
"status" : "active",
"experimental" : false,
"date" : "2025-07-30T12:41:32+03:00",
"publisher" : "HL7 Saudi Arabia",
"contact" : [
{
"name" : "HL7 Saudi Arabia",
"telecom" : [
{
"system" : "url",
"value" : "http://test-project.org/test-publisher"
}
]
}
],
"description" : "These are MOH-specific billing codes.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "SA",
"display" : "Saudi Arabia"
}
]
}
],
"copyright" : "Ministry of Health Saudi Arabia (https://www.moh.gov.sa)",
"caseSensitive" : true,
"compositional" : false,
"versionNeeded" : false,
"content" : "fragment",
"concept" : [
{
"code" : "650426",
"display" : "Release Of Carpal Tunnel Syndrom General Anaesthesia"
},
{
"code" : "506060",
"display" : "C & S Prostrate"
},
{
"code" : "650424",
"display" : "Release Of Carpal Tunnel Syndrome Regional Anaesthesia"
},
{
"code" : "75-34.50",
"display" : "Pleurectomy"
},
{
"code" : "K57200",
"display" : "Suturing of Vaginal Tear"
},
{
"code" : "650422",
"display" : "Release Of Carpal Tunnel Syndrome Local Anaesthesia"
},
{
"code" : "518046",
"display" : "Vasopressin (Adh)"
},
{
"code" : "650420",
"display" : "Theco-Peritoneal Shunt"
},
{
"code" : "518048",
"display" : "5-Hiaa"
},
{
"code" : "U80172",
"display" : "Gold"
},
{
"code" : "T76020",
"display" : "Skeletal Survey"
},
{
"code" : "U80170",
"display" : "Gentamycin"
},
{
"code" : "518044",
"display" : "17-Ketosteriods, Urine"
},
{
"code" : "518086",
"display" : "Oestradiol"
},
{
"code" : "750906",
"display" : "Telengiectasia Treatment, Legs, Medium Area -Per Session (Skincare)"
},
{
"code" : "518088",
"display" : "Digoxin"
},
{
"code" : "650428",
"display" : "Release Of Ulnar Nerve Entrapment At Wrist"
},
{
"code" : "800026",
"display" : "Socket Reconstruction"
},
{
"code" : "518082",
"display" : "Ft3"
},
{
"code" : "U80168",
"display" : "Ethosuximide"
},
{
"code" : "518040",
"display" : "17-Hydroxycortisoteriods, Urine"
},
{
"code" : "518084",
"display" : "T B G"
},
{
"code" : "U80166",
"display" : "Doxepin"
},
{
"code" : "750908",
"display" : "Telengiectasia Treatment, Legs, Large Area -Per Session (Skincare)"
},
{
"code" : "U80164",
"display" : "Depakine Level (Valproic Acid)"
},
{
"code" : "518080",
"display" : "Chromosomal Analysis"
},
{
"code" : "800024",
"display" : "Thyroid Orbital Decompression (Both Eyes)"
},
{
"code" : "U84520",
"display" : "Bun"
},
{
"code" : "750902",
"display" : "Laser Facial Rejuvenation - Per Session (Skincare)"
},
{
"code" : "650430",
"display" : "Release Of Cubital Tunnel Syndrome"
},
{
"code" : "750904",
"display" : "Telengiectasia Treatment, Legs, Small Area -Per Session (Skincare)"
},
{
"code" : "E42420",
"display" : "Parotidectomy total"
},
{
"code" : "650416",
"display" : "Repair Of Meningomyelocele Major"
},
{
"code" : "800028",
"display" : "Enucl. With Hydroxy. Orbital"
},
{
"code" : "650414",
"display" : "Repair Of Meningomyelocele, Minor Defect"
},
{
"code" : "506068",
"display" : "C & S Swine Flu (H1N1)"
},
{
"code" : "506066",
"display" : "C & S Semen"
},
{
"code" : "75-34.02",
"display" : "Thoracotomy, exploratory"
},
{
"code" : "U82784",
"display" : "IGA/IGM/IGD/IGG"
},
{
"code" : "U82785",
"display" : "IGE"
},
{
"code" : "K57210",
"display" : "Colpo Perineorraphy"
},
{
"code" : "800022",
"display" : "Thyroid Orbital Decompression (One Eye)"
},
{
"code" : "650412",
"display" : "Posterior Fusion And Stabilization"
},
{
"code" : "202080",
"display" : "Long Term Care (Ltc) - Per Day Package"
},
{
"code" : "650410",
"display" : "Anterior Or Anterolateral Verteb, Resection And Stabilization"
},
{
"code" : "506062",
"display" : "Fern Test"
},
{
"code" : "U80162",
"display" : "Digoxin - Lanoxin"
},
{
"code" : "800020",
"display" : "Optic Nerve Sheath Fenes – Onsf"
},
{
"code" : "D92250",
"display" : "Fundus Photography with interpretation"
},
{
"code" : "518074",
"display" : "Insulin, Serum"
},
{
"code" : "506050",
"display" : "C & S Umbilical"
},
{
"code" : "650418",
"display" : "Repair Of Occult Spinal Dysraphism"
},
{
"code" : "518038",
"display" : "Cortisol"
},
{
"code" : "518076",
"display" : "C-Peptide, Serum"
},
{
"code" : "518034",
"display" : "Vitamine D"
},
{
"code" : "518070",
"display" : "Vitamine B12, Serum"
},
{
"code" : "U80156",
"display" : "Tegretol Level - Carbamazipene"
},
{
"code" : "518036",
"display" : "Acth"
},
{
"code" : "518072",
"display" : "Haptoglobin"
},
{
"code" : "518030",
"display" : "Free T4"
},
{
"code" : "U80152",
"display" : "Amitriptyline"
},
{
"code" : "518032",
"display" : "Calcitonin"
},
{
"code" : "U84512",
"display" : "Triponin Qualitiative"
},
{
"code" : "750096",
"display" : "Patch Test (Skincare)"
},
{
"code" : "800034",
"display" : "Drill Of Hyder. Imp. With Artif."
},
{
"code" : "750094",
"display" : "Dermabrasion (Skincare)"
},
{
"code" : "506058",
"display" : "C & S Conjunctiva"
},
{
"code" : "U84550",
"display" : "Uric Acid"
},
{
"code" : "750910",
"display" : "Telengiectasia Treatment, Face, Few Area -Per Session (Skincare)"
},
{
"code" : "650442",
"display" : "Old Perineural Nerve Repair"
},
{
"code" : "E49080",
"display" : "Peritoneal lavage"
},
{
"code" : "506056",
"display" : "C & S Axilla"
},
{
"code" : "U80194",
"display" : "Quinidine"
},
{
"code" : "750912",
"display" : "Telengiectasia Treatment, Face, Multiple Area -Per Session (Skincare)"
},
{
"code" : "U80192",
"display" : "N-Acetylprocainamide"
},
{
"code" : "800032",
"display" : "Impl. Of Hydr. Orb. In Enucl."
},
{
"code" : "U80190",
"display" : "Procainamide"
},
{
"code" : "202090",
"display" : "Icu/Nicu/Picu Per Day Package"
},
{
"code" : "750092",
"display" : "Comedon Extraction - Large Area (Skincare)"
},
{
"code" : "U82775",
"display" : "Galactose-1-Phosphate-Uridyltransferase"
},
{
"code" : "750090",
"display" : "Comedon Extraction - Medium Area (Skincare)"
},
{
"code" : "U80188",
"display" : "Primidone"
},
{
"code" : "506054",
"display" : "C & S Skin"
},
{
"code" : "U80186",
"display" : "Phenytoin - Free"
},
{
"code" : "U82776",
"display" : "Galactose-1-Phosphate"
},
{
"code" : "U80185",
"display" : "Phenytoin - Epanutin Level Total"
},
{
"code" : "U84545",
"display" : "Urea Clearance"
},
{
"code" : "800030",
"display" : "Implan. Of Reg. In Enuc. Evisc."
},
{
"code" : "650438",
"display" : "Interfasicular Repair"
},
{
"code" : "650436",
"display" : "Nerve Neurolysis"
},
{
"code" : "506052",
"display" : "C & S Rectal"
},
{
"code" : "650434",
"display" : "Surgery For Unusual Nerve Entrapment Or Injury"
},
{
"code" : "U84540",
"display" : "Urine Urea Nitrogen"
},
{
"code" : "650404",
"display" : "Excision Of Lesions Intraspinal Intradural – Lumbar"
},
{
"code" : "650432",
"display" : "Brachial Plexus Decompression"
},
{
"code" : "U80184",
"display" : "Phenobarbital - Gardinal Level"
},
{
"code" : "650402",
"display" : "Excision Of Lesions Intraspinal Extradural – Cervical"
},
{
"code" : "518096",
"display" : "Trypsin"
},
{
"code" : "650400",
"display" : "Excision Of Lesions Intraspinal Extradural – Dorsal"
},
{
"code" : "518098",
"display" : "Carbamazepine (Tegretol)"
},
{
"code" : "518068",
"display" : "Folic Acid, Serum"
},
{
"code" : "518092",
"display" : "Dibucaine Inhibition Of Pseudocholinesterase"
},
{
"code" : "U80150",
"display" : "Amikacin"
},
{
"code" : "D92235",
"display" : "Flouroscene Angiography"
},
{
"code" : "518064",
"display" : "Tranferritin, Serum"
},
{
"code" : "U80178",
"display" : "Lithium level"
},
{
"code" : "650408",
"display" : "Excision Of Lesions Intraspinal Intradural – Cervical"
},
{
"code" : "U80176",
"display" : "Lidocaine"
},
{
"code" : "518066",
"display" : "Ferritin, Serum"
},
{
"code" : "U80174",
"display" : "Imipramine"
},
{
"code" : "650406",
"display" : "Excision Of Lesions Intraspinal Intradural – Dorsal"
},
{
"code" : "518090",
"display" : "Cystic Fibrosis"
},
{
"code" : "518060",
"display" : "Alpha-Fetoprotein"
},
{
"code" : "650440",
"display" : "Direct Perineural Nerve Repair"
},
{
"code" : "800004",
"display" : "Orbital Tumour Biopsy+Histopathology Analysis"
},
{
"code" : "518062",
"display" : "Carcinembryonic Antigen (Cea)"
},
{
"code" : "800002",
"display" : "Orbital Exploration"
},
{
"code" : "800008",
"display" : "Reconstruction Of Orbital Base Fracture"
},
{
"code" : "800006",
"display" : "Orbital Tumour Excision+Histopathology Analysis"
},
{
"code" : "710002",
"display" : "Polishing Of Teeth (Prophylaxis)"
},
{
"code" : "704098",
"display" : "Periodontal Root Planning (Less Than 6 Teeth)"
},
{
"code" : "710006",
"display" : "Oral Prophylaxis: With Flouride (2 Visits-Children"
},
{
"code" : "710004",
"display" : "Scaling & Polishing"
},
{
"code" : "704096",
"display" : "Periodontal Root Planning (Entire Mouth)"
},
{
"code" : "T74290",
"display" : "Oral Cholecystogram/Gall Bladder"
},
{
"code" : "716084",
"display" : "Adding Tooth To Partial Denture To Replace Extracted Tooth-Each Tooth(Not Involv"
},
{
"code" : "518056",
"display" : "Metanephrines, Urine"
},
{
"code" : "518058",
"display" : "Catecholanines, 24 Hours Urine"
},
{
"code" : "460298",
"display" : "Dp-Oto-Ecuastic Emission"
},
{
"code" : "716082",
"display" : "Repair Of Broken Complete Or Partial Denture - No Teeth Damaged"
},
{
"code" : "518052",
"display" : "Vanillymandelic Acid (Vma), Urine"
},
{
"code" : "460296",
"display" : "Follow Up Tympanometry"
},
{
"code" : "518054",
"display" : "Homovanillic Acid Urine"
},
{
"code" : "716080",
"display" : "Paratial Denture Adjustment"
},
{
"code" : "800014",
"display" : "Enucleation Or Evisceration=Prosth.Implant"
},
{
"code" : "825246",
"display" : "Penile Prosthesis With Implant (Malleable)"
},
{
"code" : "108-35.50",
"display" : "Repair, septa, atrial and ventricular, with prosthesis"
},
{
"code" : "800012",
"display" : "Enucleation Or Evisceration Of Eye Ball"
},
{
"code" : "825248",
"display" : "Penilse Prosthesis With Implant (Inflatable)"
},
{
"code" : "518050",
"display" : "Human Growth Hormone"
},
{
"code" : "308-58.93",
"display" : "Implantation, artificial urinary sphincter"
},
{
"code" : "800018",
"display" : "Posterior Orbital Tumour"
},
{
"code" : "716088",
"display" : "Chair - Side Relining (Complete Denture)Chair - Side Relining (Complete Denture)"
},
{
"code" : "716086",
"display" : "Adding Tooth To Partial Denture To Replace Extracted Tooth(Involving Clasp Or Ab"
},
{
"code" : "800016",
"display" : "Posterior Orbital Exploration"
},
{
"code" : "704094",
"display" : "Membrane / Bone Grafts - Per Tooth"
},
{
"code" : "800010",
"display" : "Exentration"
},
{
"code" : "704092",
"display" : "Gingivectomy And Treatment (Fewer Than 5 Teeth)"
},
{
"code" : "825240",
"display" : "Diverticulectomy"
},
{
"code" : "704090",
"display" : "Gingivectomy Or Gingioplasty - Per Quadrant"
},
{
"code" : "825242",
"display" : "Urs & Stone Extraction"
},
{
"code" : "825244",
"display" : "Cystoscopy + Removal Of Djs Under G.A."
},
{
"code" : "G29870",
"display" : "Arthroscopy (Diagnostic) Knee"
},
{
"code" : "E43621",
"display" : "Subtotal gastrectomy"
},
{
"code" : "716072",
"display" : "Upper Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)"
},
{
"code" : "704058",
"display" : "Vestibuloplasty/Sulcus Deepening (Per Jaw)"
},
{
"code" : "716070",
"display" : "Acrylic Partial Denture (4-7 Teeth)"
},
{
"code" : "704056",
"display" : "Removal Of Lorus Palatinus Or Mandibularis"
},
{
"code" : "518196",
"display" : "Galactose 1 Phosphate Uridyltrasferase (Quantative"
},
{
"code" : "810102",
"display" : "Microlaryngoscopy"
},
{
"code" : "518198",
"display" : "Ionized Calcium"
},
{
"code" : "704054",
"display" : "Post Extraction Complication:Dressing (Opd)"
},
{
"code" : "518192",
"display" : "Galactosemia Screening"
},
{
"code" : "810104",
"display" : "Microlaryngosurgery"
},
{
"code" : "825236",
"display" : "Epididymectomy"
},
{
"code" : "704052",
"display" : "Post Surgical Extraction:Drsyspicules Removal"
},
{
"code" : "716078",
"display" : "Complete Denture Adjustment"
},
{
"code" : "518194",
"display" : "Amino Acid Screening"
},
{
"code" : "810106",
"display" : "Larynx Laser Surgery"
},
{
"code" : "825238",
"display" : "Cystoscopy And Lithlapexy"
},
{
"code" : "716040",
"display" : "Chrome Cobalt Partial 4-7 Teeth"
},
{
"code" : "716076",
"display" : "Bite Guard (Bite Raising Appliance)"
},
{
"code" : "108-35.42",
"display" : "Creation, septal defect, in heart"
},
{
"code" : "108-35.91",
"display" : "Transposition, interatrial, venous return"
},
{
"code" : "716074",
"display" : "Upper Chrome Cobalt Partial Denture (3 Or More Teeth Bilateral)"
},
{
"code" : "108-35.92",
"display" : "Creation, conduit, between right ventricle,"
},
{
"code" : "501-81.22",
"display" : "Arthrodesis,knee"
},
{
"code" : "U84630",
"display" : "Zinc"
},
{
"code" : "108-35.93",
"display" : "Creation, conduit, between left ventricle,"
},
{
"code" : "825230",
"display" : "Vasal Reversal"
},
{
"code" : "825232",
"display" : "Vasoepididymostomy"
},
{
"code" : "716048",
"display" : "Porcelain Set For Complete Dentures (Additional)"
},
{
"code" : "825234",
"display" : "Vasovasostomy"
},
{
"code" : "108-35.94",
"display" : "Creation, conduit, between atrium,"
},
{
"code" : "460276",
"display" : "Foreign Body Removal L.A. (Throat)"
},
{
"code" : "460274",
"display" : "Incision + Drainage Of Quinzy (L.A)"
},
{
"code" : "H94240",
"display" : "Lung Volume - Helium Dilution"
},
{
"code" : "460278",
"display" : "Fine Needle Aspiration Cytology"
},
{
"code" : "108-35.95",
"display" : "Revision, corrective procedure, heart"
},
{
"code" : "460280",
"display" : "Somnoplasty Tounge - Clinic (1St Stage)"
},
{
"code" : "716046",
"display" : "Other Corrective Procedures (Per 1/4 Hour)"
},
{
"code" : "825224",
"display" : "Repair Of Urethral Injuries"
},
{
"code" : "716044",
"display" : "Ceka Attachment Per Piece"
},
{
"code" : "U82009",
"display" : "Acetone Total"
},
{
"code" : "825226",
"display" : "Urethroplasty One Stage"
},
{
"code" : "500004",
"display" : "Glucose (Serum) Random"
},
{
"code" : "460284",
"display" : "Pure Tone Audiometry (Air & Bone)"
},
{
"code" : "825228",
"display" : "Urethroplasty Two Stages"
},
{
"code" : "716042",
"display" : "Chrome Cobalt Partial 8-12 Teeth"
},
{
"code" : "108-35.31",
"display" : "Operation, papillary muscle"
},
{
"code" : "500002",
"display" : "Glucose (Serum) Fasting"
},
{
"code" : "108-35.32",
"display" : "Operation, Chordae tendinae"
},
{
"code" : "460282",
"display" : "Somnoplasty Tounge - Clinic (2Nd Stage)"
},
{
"code" : "704050",
"display" : "Alveolectomy (Per Quadrant)"
},
{
"code" : "L90810",
"display" : "Psychotheraphy Interactive"
},
{
"code" : "810110",
"display" : "Laser Tonsillectomy"
},
{
"code" : "137202",
"display" : "Child Anxiety Manifest Level"
},
{
"code" : "704068",
"display" : "Surgical Exposure Of Impacted Or Unerrupted Tooth"
},
{
"code" : "825220",
"display" : "Radical Prostatectomy"
},
{
"code" : "810112",
"display" : "Tonsillectomy"
},
{
"code" : "825222",
"display" : "Repair Of Hypospadias Two Stages"
},
{
"code" : "704066",
"display" : "Tooth Extraction Additional Each + L.A.."
},
{
"code" : "137208",
"display" : "Mmpi Sub Scale"
},
{
"code" : "36-14.27",
"display" : "Destruction, chorioretinal lesion, adiation sources"
},
{
"code" : "137204",
"display" : "Child Behaviour Check List"
},
{
"code" : "G29894",
"display" : "Arthroscopy (Diagnostic) Ankle"
},
{
"code" : "810114",
"display" : "Pan-Endoscopy (Triple Procedure)"
},
{
"code" : "137206",
"display" : "Middle Sex Scale"
},
{
"code" : "36-14.26",
"display" : "Destruction, chorioretinal lesion, by radiation therapy"
},
{
"code" : "716094",
"display" : "Laboratory Relining (Partial Denture)"
},
{
"code" : "704064",
"display" : "Alveolar Ridge Grafting Per Jaw"
},
{
"code" : "460288",
"display" : "Tone Decay Test"
},
{
"code" : "810116",
"display" : "Hypopharyngoscopy & Foreign Body Removal"
},
{
"code" : "716092",
"display" : "Laboratory Relining (Complete Denture)"
},
{
"code" : "704062",
"display" : "Other Undefined Surgical Procedures Per 15 Minutes"
},
{
"code" : "460286",
"display" : "Follow Up Pure Tone Audiometry (Air & Bone)"
},
{
"code" : "T76770",
"display" : "Ultra Sound - Retroperitoneal"
},
{
"code" : "L96100",
"display" : "Psychological Test"
},
{
"code" : "108-35.80",
"display" : "Repair, total, certain congenital cardiac anomalies"
},
{
"code" : "716036",
"display" : "Chrome Cobalt Full Denture: Upper And Lower"
},
{
"code" : "716090",
"display" : "Chair - Side Relining (Partial Denture)"
},
{
"code" : "716034",
"display" : "Rebasing (Upper Or Lower)"
},
{
"code" : "X1005",
"display" : "Ventilator Per Day"
},
{
"code" : "460290",
"display" : "Ablb"
},
{
"code" : "716032",
"display" : "Changing Teeth In Old Chrome - Partial"
},
{
"code" : "825214",
"display" : "Iliocystoplasty"
},
{
"code" : "X1004",
"display" : "Oxy Hood Per Day"
},
{
"code" : "L90804",
"display" : "Individual psycho therapy insight oriented"
},
{
"code" : "X1003",
"display" : "Mist Tent Per Day"
},
{
"code" : "716030",
"display" : "Splints/Guards"
},
{
"code" : "U80299",
"display" : "Amphotericin B Level"
},
{
"code" : "X1002",
"display" : "Oxygen Inhalation Per Day"
},
{
"code" : "X1001",
"display" : "Oxygen Inhalation - Per Hour X1001"
},
{
"code" : "825216",
"display" : "Insertion Of Penile Prothesis"
},
{
"code" : "704060",
"display" : "Apicoectomy (Per Tooth Excluding Rct)"
},
{
"code" : "716098",
"display" : "Lower Chrome Cobalt Partial Denture (3 Or More Teeth / Bilateral)"
},
{
"code" : "810108",
"display" : "Adenoidectomy"
},
{
"code" : "460294",
"display" : "Audiological Assessment"
},
{
"code" : "716038",
"display" : "Chrome Cobalt Partial 1-3 Teeth"
},
{
"code" : "825218",
"display" : "Radical Cystectomy"
},
{
"code" : "148-46.92",
"display" : "Myotomy, colon, other parts"
},
{
"code" : "716096",
"display" : "Lower Chrome Cobalt Partial Denture (1-3 Teeth / Unilateral)"
},
{
"code" : "460292",
"display" : "Strenger Test"
},
{
"code" : "512002",
"display" : "Hemoglobin Electrophoresis"
},
{
"code" : "137212",
"display" : "Beck Depression Inventory"
},
{
"code" : "704078",
"display" : "Ridge Extension (Augmentation Per Arch)"
},
{
"code" : "137214",
"display" : "Performance Anxiety Scale"
},
{
"code" : "825210",
"display" : "Excision Of Ureterocele And Reimplantation Of Ureter"
},
{
"code" : "704076",
"display" : "Biopsy Of Extra Oral Tissues"
},
{
"code" : "137210",
"display" : "Self Esteem Inventory"
},
{
"code" : "704074",
"display" : "Biopsy Of Oral Tissue (Soft)"
},
{
"code" : "825212",
"display" : "Ileal Ureter"
},
{
"code" : "512004",
"display" : "Protein Electrophoresis (Serum, Csf, Urine)"
},
{
"code" : "716062",
"display" : "Denture - Complete Lower (Chrome Cobbalt)"
},
{
"code" : "128100",
"display" : "Schanz Screw"
},
{
"code" : "500018",
"display" : "Creatinine Urine (Random)"
},
{
"code" : "128102",
"display" : "Malleolar Screw"
},
{
"code" : "716060",
"display" : "Denture - Complete Upper (Chrome Cobbalt)"
},
{
"code" : "I92590",
"display" : "Hearing Aid adjustment & Evaluation Unilateral"
},
{
"code" : "800758",
"display" : "Laser Trabeculoplasty"
},
{
"code" : "128104",
"display" : "Partial Hip - Thomson Hip Prothesis"
},
{
"code" : "108-35.70",
"display" : "Repair, septa, atrial, ventricular, unspecified"
},
{
"code" : "I92591",
"display" : "Hearing aid Adjustment & Evaluation Bilateral"
},
{
"code" : "800762",
"display" : "Photo. Kera. Astigm - Pak Vizx"
},
{
"code" : "128106",
"display" : "Penning Mini External Fixator"
},
{
"code" : "500022",
"display" : "Uric Acid (Serum)"
},
{
"code" : "850240",
"display" : "Laparascopic Salpingo-Oophorectomy (Bilateral)"
},
{
"code" : "800760",
"display" : "Phototherapeutic Keratectomy (P.T.K.) One Eye"
},
{
"code" : "850242",
"display" : "Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Unilateral)"
},
{
"code" : "716068",
"display" : "Acrylic Partial Denture (1-3 Teeth)"
},
{
"code" : "850244",
"display" : "Diagnostic Laparascopy + New Ostia Of Fallopian Tube (Bilateral)"
},
{
"code" : "T73700",
"display" : "CT LO EXT without Contrast"
},
{
"code" : "500020",
"display" : "Creatinine Clearance"
},
{
"code" : "500027",
"display" : "Globulin"
},
{
"code" : "716066",
"display" : "Denture - Immediate Lower Complete"
},
{
"code" : "500026",
"display" : "Albumin"
},
{
"code" : "716064",
"display" : "Denture - Immediate Uper Complete"
},
{
"code" : "640020",
"display" : "Ptca (Per.Tr.Coronory Angioplasty) - Sv +2 Stents"
},
{
"code" : "500024",
"display" : "Total Protein, Serum"
},
{
"code" : "K59025",
"display" : "CTG less than an hour"
},
{
"code" : "704072",
"display" : "Biopsy Of Oral Tissue (Hard)"
},
{
"code" : "T73701",
"display" : "CT Scan Knee Lower Ext with Contrast"
},
{
"code" : "850236",
"display" : "Laparascopic Checking Of Tubal Patency"
},
{
"code" : "K57240",
"display" : "Anterior Colporrhapy & Repair Cystocele"
},
{
"code" : "850238",
"display" : "Laparascopic Salpingo-Oophorectomy (Unilateral)"
},
{
"code" : "H43450",
"display" : "Oesophageal Dilation"
},
{
"code" : "110-37.12",
"display" : "Pericardiotomy"
},
{
"code" : "810220",
"display" : "Labyrinthectomy"
},
{
"code" : "640022",
"display" : "Ptca (Per.Tr.Coronory Angioplasty) - Dv + Stent"
},
{
"code" : "650018C",
"display" : "Microguide Wire"
},
{
"code" : "U85384",
"display" : "Fibrinogen"
},
{
"code" : "750074",
"display" : "Electro Cautery - Multiple Lesion (Skincare)"
},
{
"code" : "750232",
"display" : "Brow Lift (Skincare)"
},
{
"code" : "810222",
"display" : "Vestibular Neurectomy"
},
{
"code" : "750072",
"display" : "Electro Cautery - Few Lesion (Skincare)"
},
{
"code" : "810224",
"display" : "Facial Nerve Surgery"
},
{
"code" : "110014",
"display" : "Orthofix Rental (Per Day)"
},
{
"code" : "810226",
"display" : "Ossiculoplasty"
},
{
"code" : "300226",
"display" : "Thyroid Imaging"
},
{
"code" : "110012",
"display" : "Orthofix"
},
{
"code" : "650018A",
"display" : "Each Additional : Coil"
},
{
"code" : "I69210",
"display" : "Ear Wash"
},
{
"code" : "650018B",
"display" : "Microcatheter"
},
{
"code" : "300224",
"display" : "X-Ray Film Copy Cash (Nett) Each"
},
{
"code" : "38-12.14",
"display" : "Subtotal or complete iridectomy for melanoma"
},
{
"code" : "704014",
"display" : "Surgical Extraction - Complex (Bone Removal)"
},
{
"code" : "D92283",
"display" : "Color vision exam"
},
{
"code" : "750070",
"display" : "Electrolysis Per Session (Skincare)"
},
{
"code" : "650026A",
"display" : "Each Additional : Coil"
},
{
"code" : "202004",
"display" : "Private Room Per Day"
},
{
"code" : "202002",
"display" : "Suite Room Per Day"
},
{
"code" : "650026B",
"display" : "Microcatheter"
},
{
"code" : "704012",
"display" : "Surgical Extraction - Simple"
},
{
"code" : "304032",
"display" : "Colour Doppler Sonography Breast (Two)"
},
{
"code" : "650026C",
"display" : "Microguide Wire"
},
{
"code" : "704010",
"display" : "Removal Of Teeth (Soft Tissue) + La"
},
{
"code" : "304030",
"display" : "Colour Doppler Sonography Breast (One)"
},
{
"code" : "524008",
"display" : "Anti Sperm Antibody"
},
{
"code" : "704018",
"display" : "Removal Of Teeth (Completely Bony) + L.A."
},
{
"code" : "810140",
"display" : "Cleft Palate Repair"
},
{
"code" : "704016",
"display" : "Removal Of Teeth (Partially Bony) + L.A."
},
{
"code" : "710018",
"display" : "Topical Application Of Flouride -2 Vis (Ex Prophylaxis)"
},
{
"code" : "524012",
"display" : "Osteocalcin"
},
{
"code" : "U80202",
"display" : "Vancomycin"
},
{
"code" : "716004",
"display" : "Partial Denture 1-3 Teeth"
},
{
"code" : "500044",
"display" : "Sgpt (Alt)"
},
{
"code" : "137018",
"display" : "Psychological Assessment- Category 2 - Anxiety"
},
{
"code" : "U80200",
"display" : "Tobramycin"
},
{
"code" : "716002",
"display" : "Complete Dentures"
},
{
"code" : "500042",
"display" : "Sgot (Ast)"
},
{
"code" : "524016",
"display" : "Hydroxproline Total"
},
{
"code" : "500048",
"display" : "Alkaline Phosphatase"
},
{
"code" : "500046",
"display" : "Ggt"
},
{
"code" : "716008",
"display" : "Partial Denture 8-12 Teeth"
},
{
"code" : "500040",
"display" : "Total And Direct Biliburin"
},
{
"code" : "524010",
"display" : "Thyroid Uptake"
},
{
"code" : "716006",
"display" : "Partial Denture 4-7 Teeth"
},
{
"code" : "704024",
"display" : "Cyst Operation"
},
{
"code" : "704022",
"display" : "Suturing - Large Area"
},
{
"code" : "704020",
"display" : "Suturing - Small Area (2-3 Sutures)"
},
{
"code" : "500028",
"display" : "Osmolarity, Serum / Urine"
},
{
"code" : "U88162",
"display" : "Cytology ( Fine Needle Aspiration )"
},
{
"code" : "T74150",
"display" : "CT Scan Abdomen"
},
{
"code" : "704028",
"display" : "Incision And Drainage Of Abscess - Extraoral"
},
{
"code" : "704026",
"display" : "Incision And Drainage Of Abscess - Intraoral"
},
{
"code" : "500034",
"display" : "Total Bilirubin"
},
{
"code" : "500032",
"display" : "Albumin/Globumin Ratio"
},
{
"code" : "500038",
"display" : "Direct Bilirubin"
},
{
"code" : "500036",
"display" : "Total Biliburin, Neonatal"
},
{
"code" : "500030",
"display" : "Plasma Globumin"
},
{
"code" : "650024B",
"display" : "Microcatheter"
},
{
"code" : "650024C",
"display" : "Microguide Wire"
},
{
"code" : "524020",
"display" : "Factor Viii"
},
{
"code" : "704036",
"display" : "Pericoronal Flap Removal - Simple"
},
{
"code" : "650028B",
"display" : "Microguide Wire"
},
{
"code" : "810122",
"display" : "Plastic Surgery Of Throat"
},
{
"code" : "704034",
"display" : "Closure Of Oro-Antral Fistula"
},
{
"code" : "810124",
"display" : "Tumor Surgery Of Throat"
},
{
"code" : "I30400",
"display" : "Rhinoplasty"
},
{
"code" : "704032",
"display" : "Wiring Fractured Jaw - Complex"
},
{
"code" : "U84560",
"display" : "Urine Uric Acid"
},
{
"code" : "704070",
"display" : "Surgical Removal Of Suprenumerary Tooth"
},
{
"code" : "850246",
"display" : "Diagnostic Laparascopy + Canalization Of Tube"
},
{
"code" : "36-14.41",
"display" : "Scleral buckling with implant, f vitreous substitute"
},
{
"code" : "U80198",
"display" : "Theophyline"
},
{
"code" : "704088",
"display" : "Excision Of Hyperplastic Tissue (Per Arch)"
},
{
"code" : "U80196",
"display" : "Acetylsalicylic Acid"
},
{
"code" : "36-14.49",
"display" : "Scleral buckling with vitrectomy, membranectomy, ion"
},
{
"code" : "640024",
"display" : "Ptca (Per.Tr.Coronory Angioplasty) - Dv + 2 Stents"
},
{
"code" : "704086",
"display" : "Release Of Tounge Tie"
},
{
"code" : "750230",
"display" : "Otoplasty - Ear Reshaping (Skincare)"
},
{
"code" : "704084",
"display" : "Excision Of Bengin Tumour - Lesion Diameter Over 1 Cm"
},
{
"code" : "303-56.92",
"display" : "Implantation, electronic uteral stimulator"
},
{
"code" : "716050",
"display" : "Isosit Injection Moulded Denture"
},
{
"code" : "218-78.37",
"display" : "Lengthening bone, tibia and fibula"
},
{
"code" : "353-40.53",
"display" : "Excision, lymph node - iliac, radical"
},
{
"code" : "353-40.52",
"display" : "Excision, lymph node - periaortic, radical"
},
{
"code" : "500008",
"display" : "Glucose Tolerance Test"
},
{
"code" : "173030",
"display" : "Activated Clotting Time"
},
{
"code" : "500006",
"display" : "Glucose (Serum) 2Hpp"
},
{
"code" : "300228",
"display" : "Chest Pa / Erect"
},
{
"code" : "650474",
"display" : "Microscopic Brain Excision Of Epileptic Focus"
},
{
"code" : "353-40.54",
"display" : "Dissection, groin, radical"
},
{
"code" : "716058",
"display" : "Denture - Complere Lower (Acrylic)"
},
{
"code" : "1099700",
"display" : "Ang cor1ca 107-88.55 Angiocardiogram- coronary, 1 catheter"
},
{
"code" : "500012",
"display" : "Bun"
},
{
"code" : "640062",
"display" : "E.T.Suction"
},
{
"code" : "640064",
"display" : "Infusion Syringe Pump"
},
{
"code" : "304036",
"display" : "Colour Doppler Sonography Brain(Through Fontanell)"
},
{
"code" : "108-35.60",
"display" : "Repair, septa, atrial, ventricular, with tissue graft"
},
{
"code" : "800146",
"display" : "Unilat. Ptosis Repair+Fresh"
},
{
"code" : "810218",
"display" : "Endolymphatic Shunt"
},
{
"code" : "716056",
"display" : "Denture - Complete Upper (Acrylic)"
},
{
"code" : "650472",
"display" : "Ct Guided Aspiration Of Intra-Cerebral"
},
{
"code" : "518126",
"display" : "Fructose Test"
},
{
"code" : "500010",
"display" : "Glucose ( Glucometer) Test"
},
{
"code" : "304034",
"display" : "Colour Doppler Sonography Testicular W/Out Doppler - T"
},
{
"code" : "800144",
"display" : "Bilateral Sim. Ptosis Repair"
},
{
"code" : "716054",
"display" : "Tissue Conditioning Material"
},
{
"code" : "I30300",
"display" : "Removal of foreign body- Nose"
},
{
"code" : "191-50.40",
"display" : "Hepatectomy, total"
},
{
"code" : "500016",
"display" : "Creatinine, Serum"
},
{
"code" : "300192",
"display" : "Forearm (Ulna/Radius) 2 Views"
},
{
"code" : "716052",
"display" : "Refixing Tooth In Denture Or Hairline Cracks"
},
{
"code" : "800148",
"display" : "Bil. Ptosis Repair+Fresh Fasc."
},
{
"code" : "518128",
"display" : "Mast (Allergy Screen)"
},
{
"code" : "300190",
"display" : "Forearm (Ulna/Radius) 1 View"
},
{
"code" : "518122",
"display" : "Prostate Specific Antigen"
},
{
"code" : "300196",
"display" : "Scaphoid - 1 View"
},
{
"code" : "460218",
"display" : "Sinsus Puncture"
},
{
"code" : "518124",
"display" : "Lithium"
},
{
"code" : "D68520",
"display" : "Dacryocystectomy"
},
{
"code" : "710020",
"display" : "Follow-Up (Period)"
},
{
"code" : "710024",
"display" : "Flap Operation"
},
{
"code" : "460216",
"display" : "Cryoturbinectomy"
},
{
"code" : "U86430",
"display" : "Rheumatoid Factor"
},
{
"code" : "130504",
"display" : "Occupational Therapy (One Part)"
},
{
"code" : "460210",
"display" : "Foreign Body Removal"
},
{
"code" : "130502",
"display" : "Occupational Therapy (More Than One Part)"
},
{
"code" : "M15780",
"display" : "Dermabrasion Face"
},
{
"code" : "460214",
"display" : "Electrical Cautry"
},
{
"code" : "130506",
"display" : "Occupational Therapy & Physiotherapy (One Sitting)"
},
{
"code" : "460212",
"display" : "Chemical Cautry"
},
{
"code" : "T73620",
"display" : "Foot Oscalcis - 2 Views"
},
{
"code" : "N97116",
"display" : "GAIT training"
},
{
"code" : "106002",
"display" : "Ambulance Fee Less Than 50 Kms"
},
{
"code" : "H91105",
"display" : "Gastric Lavage"
},
{
"code" : "460228",
"display" : "Somnoplasty Turbinate - Clinic"
},
{
"code" : "825190",
"display" : "Repair Of Ureteral Injuries"
},
{
"code" : "810126",
"display" : "Tracheostomy"
},
{
"code" : "106006",
"display" : "Ambulance Fee More Than 100 Kms Less Than 250 Kms"
},
{
"code" : "825192",
"display" : "Retropubic Prostatectomy"
},
{
"code" : "106004",
"display" : "Ambulance Fee More Than 50 Kms Less Than 100 Kms"
},
{
"code" : "460222",
"display" : "Epistaxis Nasal Pack"
},
{
"code" : "I69405",
"display" : "Eustachian Catheterization"
},
{
"code" : "825274",
"display" : "Trans Obturator Tape Insertion"
},
{
"code" : "110-37.24",
"display" : "Biopsy, pericardium"
},
{
"code" : "825278",
"display" : "Trans Vaginal Tape Insertion (Tot)"
},
{
"code" : "518108",
"display" : "Trop T."
},
{
"code" : "U84590",
"display" : "Vitamin A (Retinol)"
},
{
"code" : "518106",
"display" : "Microalbuminuria"
},
{
"code" : "104-35.20",
"display" : "Replacement,heart valve"
},
{
"code" : "U84585",
"display" : "Vanillyl Mandelic Acid (NMA, Urine)"
},
{
"code" : "110-37.31",
"display" : "Pericardiectomy"
},
{
"code" : "104-35.33",
"display" : "Annulopasty"
},
{
"code" : "110-37.40",
"display" : "Repair, heart and pericardium"
},
{
"code" : "U84578",
"display" : "Urine Urobilinogen"
},
{
"code" : "40-14.60",
"display" : "Removal of surgically implanted material from posterior, separate procedure)"
},
{
"code" : "U85060",
"display" : "Peripheral Smear"
},
{
"code" : "304072",
"display" : "Colour Doppler Femoral Artery (Unilateral)"
},
{
"code" : "T76856",
"display" : "Ultra Sound - Pelvis"
},
{
"code" : "304070",
"display" : "Colour Doppler Brachial Artery (Bilateral)"
},
{
"code" : "304076",
"display" : "Colour Doppler Peripheral Veins (One Limb)"
},
{
"code" : "304074",
"display" : "Colour Doppler Femoral Artery (Bilateral)"
},
{
"code" : "K56740",
"display" : "Excision of Bartholin Cyst"
},
{
"code" : "304078",
"display" : "Colour Doppler Peripheral Veins (Two Limbs)"
},
{
"code" : "840004",
"display" : "Closed Reduction Of Dislocation And P.O.P"
},
{
"code" : "840002",
"display" : "Excision Of Ganglion"
},
{
"code" : "115-37.85",
"display" : "Replacement any type pacemaker,single chamber device"
},
{
"code" : "840008",
"display" : "Tendon Release Of Wrist"
},
{
"code" : "115-37.83",
"display" : "Insertion dual chamber device, initial"
},
{
"code" : "840006",
"display" : "Tendon Release Of Fingers"
},
{
"code" : "115-37.82",
"display" : "Insertion, single chamber device, initial rate responsive"
},
{
"code" : "115-37.80",
"display" : "Insertion, permanent pacemaker, initial"
},
{
"code" : "U85048",
"display" : "White Blood Cell Count Only"
},
{
"code" : "F54640",
"display" : "Orchipexy, bilateral"
},
{
"code" : "840012",
"display" : "Closed Reduction Of Fracture Dislocation"
},
{
"code" : "115-37.87",
"display" : "Replacement any type pacemaker,dual chamber device"
},
{
"code" : "840018",
"display" : "Closed Fracture Small Bones Of Hand Or Foot"
},
{
"code" : "840016",
"display" : "Menisectomy Or Excisin Of Cyst Of The Knee Joint"
},
{
"code" : "E40701",
"display" : "Repair cleft lip"
},
{
"code" : "800836",
"display" : "Ch- Draniage ( Outside Hospital)"
},
{
"code" : "800834",
"display" : "Ch-Drainage ( Inside Hospita )"
},
{
"code" : "117-37.74",
"display" : "Insertion or replacement epicardial pacemaker, -37.74"
},
{
"code" : "117-37.75",
"display" : "Revision,pacemaker lead,electrode"
},
{
"code" : "117-37.76",
"display" : "Replacement,transvenous atrial/ventr pacemaker lead"
},
{
"code" : "800838",
"display" : "Graft Replacment (Inhospital)"
},
{
"code" : "117-37.77",
"display" : "Removal ,pacemaker leads/electrodes w/o replacement"
},
{
"code" : "304050",
"display" : "Colour Doppler Renal Artery"
},
{
"code" : "202102",
"display" : "Disposables I.C.U."
},
{
"code" : "800840",
"display" : "Balloon Dacyoplasty"
},
{
"code" : "U82803",
"display" : "U82803 Blood Gases"
},
{
"code" : "304054",
"display" : "Colour Doppler Portal System"
},
{
"code" : "800844",
"display" : "Collagen Plug"
},
{
"code" : "T76830",
"display" : "Ultra Sound - Transvaginal"
},
{
"code" : "304052",
"display" : "Colour Doppler Hepatic Artery"
},
{
"code" : "800842",
"display" : "Amniotic Membrane Graft"
},
{
"code" : "304058",
"display" : "Colour Doppler Iliac Vessels"
},
{
"code" : "840022",
"display" : "Reconstruction Of Amputated Finger W/O Grafting"
},
{
"code" : "304056",
"display" : "Colour Doppler Aortic"
},
{
"code" : "840020",
"display" : "Pop To Simple Fracture Without Displacement"
},
{
"code" : "840026",
"display" : "Correction Of Hallux Valgus"
},
{
"code" : "840024",
"display" : "Closed Reduction Of Dislocated Phalanges"
},
{
"code" : "840028",
"display" : "Arthrodesis Of The Big Toe"
},
{
"code" : "117-37.89",
"display" : "Revision or removal pacemaker device"
},
{
"code" : "800848",
"display" : "Anterior Chamber Reformation Post Operative (Inside Hospital)"
},
{
"code" : "202108",
"display" : "Cardiac Care Unit (Ccu)"
},
{
"code" : "800846",
"display" : "Unilateral Punctural Occlusion"
},
{
"code" : "202106",
"display" : "Disposables Nicu"
},
{
"code" : "202104",
"display" : "Isolation Disposables Per Day"
},
{
"code" : "800850",
"display" : "Anterior Chamber Reformation Post Operative (Outside Hospital)"
},
{
"code" : "304060",
"display" : "Colour Doppler Testicular Artery"
},
{
"code" : "304064",
"display" : "Colour Doppler Carotid Artery (Unilateral)"
},
{
"code" : "202110",
"display" : "Pediatric Icu (Picu)"
},
{
"code" : "T71134",
"display" : "Chest 4 Views with Fluroscopy"
},
{
"code" : "304062",
"display" : "Colour Doppler Veins (Varices)"
},
{
"code" : "304068",
"display" : "Colour Doppler Brachial Artery (Unilateral)"
},
{
"code" : "840030",
"display" : "Pop For Correction Of Foot Deformity"
},
{
"code" : "304066",
"display" : "Colour Doppler Carotid Artery (Bilateral)"
},
{
"code" : "840036",
"display" : "Fracture Of Coles"
},
{
"code" : "840034",
"display" : "Excision Of Olecranon Bursa"
},
{
"code" : "U85260",
"display" : "Factor 10"
},
{
"code" : "L90871",
"display" : "Electro convulsive therapy (ECT) multiple seizures"
},
{
"code" : "U86592",
"display" : "VDRL/RPR"
},
{
"code" : "U86593",
"display" : "RPR TITER"
},
{
"code" : "208062",
"display" : "Narrow Band Nb-Uvb"
},
{
"code" : "137216",
"display" : "Self Assessment Scale"
},
{
"code" : "704134",
"display" : "Reduction Of Complicated Middle/Upper Face Fracture"
},
{
"code" : "G24130",
"display" : "Excision of radial head"
},
{
"code" : "652004",
"display" : "Cabg & Tissue Aortic Valve Replacement"
},
{
"code" : "137218",
"display" : "Eating Disorder Scale"
},
{
"code" : "L90870",
"display" : "Electro Convulsive Therapy (ECT) Single seizure"
},
{
"code" : "201-39.26",
"display" : "Bypass, vascular, intra-abdominal"
},
{
"code" : "652006",
"display" : "Cabg & Mechanical Aortic Valve"
},
{
"code" : "825202",
"display" : "Turp"
},
{
"code" : "518006",
"display" : "Progesterone"
},
{
"code" : "825204",
"display" : "Ureteroscope"
},
{
"code" : "U86674",
"display" : "Giardia Lamblia ABS."
},
{
"code" : "112-35.96",
"display" : "Valvuloplasty, percutaneous"
},
{
"code" : "518008",
"display" : "Pregnandiol"
},
{
"code" : "825208",
"display" : "Boari Flap"
},
{
"code" : "L90875",
"display" : "Bio Feedback Therapy"
},
{
"code" : "137222",
"display" : "Anorexia Nervosa Scale"
},
{
"code" : "H85095",
"display" : "Bone Marrow - Aspiration"
},
{
"code" : "137224",
"display" : "Bender Gestalat Scale"
},
{
"code" : "U84600",
"display" : "Alcohol Isopropanol"
},
{
"code" : "173028",
"display" : "Sodium Profiling"
},
{
"code" : "825200",
"display" : "Tuna"
},
{
"code" : "U86622",
"display" : "Brucella Agglutination Test"
},
{
"code" : "173024",
"display" : "Surgical Revision Of Fistula"
},
{
"code" : "300230",
"display" : "Chest Ap / Supine"
},
{
"code" : "173026",
"display" : "Bone Biopsy"
},
{
"code" : "173020",
"display" : "Creation Of A V Fistula"
},
{
"code" : "300234",
"display" : "Chest Lat. Decubitus"
},
{
"code" : "173022",
"display" : "Insertion Of Central Vascular Catheter(Femoral/Subclavian/Jugular)"
},
{
"code" : "U84490",
"display" : "Stool for Trypsin Activity"
},
{
"code" : "300232",
"display" : "Chest. Lat. View"
},
{
"code" : "I69200",
"display" : "Removal FB Impacted Ear"
},
{
"code" : "128022",
"display" : "Spoon Plate 6 Holes Each"
},
{
"code" : "300238",
"display" : "Ribs Ap"
},
{
"code" : "704030",
"display" : "Wiring Fractured Jaw - Simple"
},
{
"code" : "128024",
"display" : "Cancelleus Bone Screws"
},
{
"code" : "300236",
"display" : "Chest Pa / Lat. View"
},
{
"code" : "T76090",
"display" : "Mamography ( 1 Breast )"
},
{
"code" : "128026",
"display" : "Cortex Bone Screws"
},
{
"code" : "K56810",
"display" : "Perineoplasty"
},
{
"code" : "128028",
"display" : "Malleable Bone Screws"
},
{
"code" : "173018",
"display" : "Plasma Pheresis / Exchange Per Session"
},
{
"code" : "P-211",
"display" : "Stapedectomy"
},
{
"code" : "300240",
"display" : "Ribs Ap / Oblique"
},
{
"code" : "P-212",
"display" : "P-212 Adenoidectomy"
},
{
"code" : "173014",
"display" : "Haemodiafilteration 4 To 12 Hours - Per Session"
},
{
"code" : "T70360",
"display" : "NECK - Soft Tissue"
},
{
"code" : "U83586",
"display" : "17-Ketosteroids"
},
{
"code" : "128020",
"display" : "Broad Dynamic Comp Plate 14 Holes Each"
},
{
"code" : "173016",
"display" : "Continous Arteriovenous Haemofiltration 12 To 24 Hours Per Session"
},
{
"code" : "U86615",
"display" : "Pertussis Bordetella"
},
{
"code" : "300244",
"display" : "Shoulder Ap / Lat."
},
{
"code" : "173010",
"display" : "Permicath"
},
{
"code" : "300242",
"display" : "Shoulder Ap"
},
{
"code" : "173012",
"display" : "Subclavian Double Lumen"
},
{
"code" : "300204",
"display" : "Skeletal Survey"
},
{
"code" : "173050",
"display" : "Acid Concentrate ( Litre)"
},
{
"code" : "300202",
"display" : "Pattela - 1 View"
},
{
"code" : "T76080",
"display" : "Fistulogram/Sinogram"
},
{
"code" : "173052",
"display" : "Insertion Of Perma Cath Tunnel Line"
},
{
"code" : "300208",
"display" : "Mcu (Along With Ivp)"
},
{
"code" : "300206",
"display" : "Intra-Operative Choloangiogram (I.O.C)"
},
{
"code" : "212002",
"display" : "Operation Fine Major - Doctor Fees"
},
{
"code" : "300207",
"display" : "Mcu (Micuratug Urethrogram)"
},
{
"code" : "506008",
"display" : "T.B.Culture"
},
{
"code" : "K56800",
"display" : "Plastic Repair of Introitus"
},
{
"code" : "506006",
"display" : "Anaerobic Culture"
},
{
"code" : "506004",
"display" : "Routine Culture, Mycology"
},
{
"code" : "640066",
"display" : "Intubation"
},
{
"code" : "810302",
"display" : "Thyroidectomy"
},
{
"code" : "840038",
"display" : "Amputation Of Finger Or Toe"
},
{
"code" : "640140",
"display" : "Mitral Balloon Valuloplasty"
},
{
"code" : "49-25.30",
"display" : "Glossectomy - complete"
},
{
"code" : "116-37.87",
"display" : "Replacement any type pacemaker,dual chamber device"
},
{
"code" : "750112",
"display" : "Punch Graft - Medium Area (Skincare)"
},
{
"code" : "304038",
"display" : "Colour Doppler Sonography Neck Lesions"
},
{
"code" : "640142",
"display" : "Bronchial Artery Angiography"
},
{
"code" : "K57250",
"display" : "Posterior Colporrhaphy & Repair Eectocele"
},
{
"code" : "750110",
"display" : "Punch Graft - Small Area (Skincare)"
},
{
"code" : "750086",
"display" : "Excision Of Mole - Large (Skincare)"
},
{
"code" : "810232",
"display" : "Laser Ear Surgery"
},
{
"code" : "110008",
"display" : "Wheel Chair - Rental (Per Day)"
},
{
"code" : "750084",
"display" : "Excision Of Mole - Medium (Skincare)"
},
{
"code" : "810234",
"display" : "Mastoid Abscess Drainage Under G.A."
},
{
"code" : "110006",
"display" : "Wheel Chair - Deposit"
},
{
"code" : "810236",
"display" : "Ear Foreign Body Removal Under G.A."
},
{
"code" : "110004",
"display" : "Crutches - Rental (Per Day)"
},
{
"code" : "750088",
"display" : "Comedon Extraction - Small Area (Skincare)"
},
{
"code" : "810238",
"display" : "Suction Clearance Under G.A."
},
{
"code" : "110002",
"display" : "Crutches Deposit"
},
{
"code" : "202007",
"display" : "Semi-Suite Room Per Day"
},
{
"code" : "750082",
"display" : "Excision Of Mole - Small (Skincare)"
},
{
"code" : "202008",
"display" : "Paediatric Ward"
},
{
"code" : "810230",
"display" : "Implantable Hearing Aid"
},
{
"code" : "202006",
"display" : "Semi-Private Room Per Day"
},
{
"code" : "202014",
"display" : "Special Nurse 24 Hours"
},
{
"code" : "202012",
"display" : "Nursery"
},
{
"code" : "202010",
"display" : "Infant Incubator"
},
{
"code" : "304042",
"display" : "Colour Doppler Vaginal Ultrasound With Doppler Study"
},
{
"code" : "304040",
"display" : "Colour Doppler Vaginal Ultrasound Exam W/Out Dopp.Study"
},
{
"code" : "810228",
"display" : "Second Stage Of Two Stage Tympanoplasty"
},
{
"code" : "110010",
"display" : "Walking Stick"
},
{
"code" : "54-20.92",
"display" : "Revision, Mastoidectomy"
},
{
"code" : "304044",
"display" : "Colour Doppler Pregnancy Umbilical Artery Placental Flow Ovarian & Uterian"
},
{
"code" : "K57260",
"display" : "Combined Antero Posterior Colporraphy"
},
{
"code" : "304008",
"display" : "Colour Doppler Hip Joint (Two)"
},
{
"code" : "750050",
"display" : "Puva Per Session (Skincare)"
},
{
"code" : "810202",
"display" : "Unilateral Myringatomy (G.A.)"
},
{
"code" : "810204",
"display" : "Bilateral Myringatomy (G.A.)"
},
{
"code" : "750054",
"display" : "Eye Brow Transplant (Skincare)"
},
{
"code" : "D92260",
"display" : "Ophthalmodynametry"
},
{
"code" : "202018",
"display" : "Isolation Room"
},
{
"code" : "202016",
"display" : "Intensive Care Unit (Icu)"
},
{
"code" : "202026",
"display" : "Head Box(Neo-Natal Care)"
},
{
"code" : "U82725",
"display" : "Fatty Acids Nonesterified"
},
{
"code" : "202024",
"display" : "Observation Room Er / Or Recovery More Than 6 Hour"
},
{
"code" : "304010",
"display" : "Colour Doppler Knee Joint (One)"
},
{
"code" : "U82728",
"display" : "Ferritin"
},
{
"code" : "202022",
"display" : "Observation Room Er / Or Recovery Less Than 6 Hour"
},
{
"code" : "202020",
"display" : "Guest Board & Lodging"
},
{
"code" : "304014",
"display" : "Colour Doppler Wrist J - Carpal T (One)"
},
{
"code" : "304012",
"display" : "Colour Doppler Knee Joint (Two)"
},
{
"code" : "304018",
"display" : "Colour Doppler Muscles (One Limb)"
},
{
"code" : "304016",
"display" : "Colour Doppler Wrist J - Carpal T (Two)"
},
{
"code" : "750064",
"display" : "Trichogram (Skincare)"
},
{
"code" : "214014",
"display" : "Operation Room Charges Simple"
},
{
"code" : "810210",
"display" : "Myringoplasty"
},
{
"code" : "750062",
"display" : "Skin Biopsy (Skincare)"
},
{
"code" : "810212",
"display" : "Tympanoplasty + Mastoidectomy"
},
{
"code" : "650478",
"display" : "Craniectomy, Brain Dissection & Haematoma Evaucation"
},
{
"code" : "750068",
"display" : "Cryo Cautery - Multiple Lesion (Skincare)"
},
{
"code" : "214010",
"display" : "Operation Room Charges Medium"
},
{
"code" : "810214",
"display" : "Radical Mastoidectomy"
},
{
"code" : "650476",
"display" : "Microscopic Total Suprasellar Tumour Excision Through Subfrontal Approach With F"
},
{
"code" : "750066",
"display" : "Cryo Cautery - Few Lesion (Skincare)"
},
{
"code" : "214012",
"display" : "Operation Room Charges Minor"
},
{
"code" : "E60280",
"display" : "Thyro glossal cyst excision"
},
{
"code" : "810216",
"display" : "Stapedectomy"
},
{
"code" : "T76872",
"display" : "Ultra Sound Trans Rectal"
},
{
"code" : "T76870",
"display" : "Ultra Sound - Scrotum and Content"
},
{
"code" : "750060",
"display" : "Facial Cleansing Skin Care (Skincare)"
},
{
"code" : "202034",
"display" : "Companion Charges With Child Per Day"
},
{
"code" : "202032",
"display" : "Extra Lunch/Dinner Tray"
},
{
"code" : "304020",
"display" : "Colour Doppler Muscles (Two Limbs)"
},
{
"code" : "202030",
"display" : "Nursing Care Per Day"
},
{
"code" : "810206",
"display" : "Unilateral Myringatomy & Grommet (G.A.)"
},
{
"code" : "304024",
"display" : "Colour Doppler Tendons (Two)"
},
{
"code" : "810208",
"display" : "Bilateral Myringatomy & Grommet (G.A.)"
},
{
"code" : "304022",
"display" : "Colour Doppler Tendons (One)"
},
{
"code" : "49-25.40",
"display" : "Glossectomy - radical"
},
{
"code" : "304028",
"display" : "Colour Doppler Bones (Two Limbs)"
},
{
"code" : "214006",
"display" : "Operation Room Charges Fine Major"
},
{
"code" : "304026",
"display" : "Colour Doppler Bones (One Limb)"
},
{
"code" : "214008",
"display" : "Operation Room Charges Major"
},
{
"code" : "650038A",
"display" : "Each Additional : Coil"
},
{
"code" : "650038B",
"display" : "Microcatheter"
},
{
"code" : "650038C",
"display" : "Microguide Wire"
},
{
"code" : "650268",
"display" : "Repair Of Scalp Injury Under General Anaesthesia"
},
{
"code" : "650266",
"display" : "Excision Of Scalp Swelling Or Tumour"
},
{
"code" : "526308",
"display" : "Phenol"
},
{
"code" : "7-86.06",
"display" : "Insertion - infusion pump, totally implantable"
},
{
"code" : "526312",
"display" : "Adrenal Cortex Abs"
},
{
"code" : "526310",
"display" : "Ccp"
},
{
"code" : "526316",
"display" : "C-1 Esterase Inhibitor"
},
{
"code" : "526314",
"display" : "Anti Ccp Abs"
},
{
"code" : "112002",
"display" : "Mortuary Rent Per Day"
},
{
"code" : "650276",
"display" : "Repair Of Skull Fracture With Damaged Brain Tissue"
},
{
"code" : "U82980",
"display" : "Glutethimide"
},
{
"code" : "650274",
"display" : "Repair Of Compound Skull Fracture"
},
{
"code" : "650272",
"display" : "Repair Of Simple Skull Fracture"
},
{
"code" : "I30100",
"display" : "Nose, EUA, Biopsy"
},
{
"code" : "650270",
"display" : "Excision Of Skull Vault Tumour"
},
{
"code" : "650258",
"display" : "Craniotomy And Excision Of Clival Tumour"
},
{
"code" : "650256",
"display" : "Craniotomy And Excision Of C P Angle Tumour"
},
{
"code" : "526318",
"display" : "Aldolase"
},
{
"code" : "U82977",
"display" : "GGT (Gamma G.T.)"
},
{
"code" : "U82979",
"display" : "Glutathione Reductase"
},
{
"code" : "650262",
"display" : "Craniotomy And Evacuation Of Acute Subdural Hematoma"
},
{
"code" : "650036C",
"display" : "Microguide Wire"
},
{
"code" : "500014",
"display" : "Ammonia"
},
{
"code" : "303222",
"display" : "Ct Cardiac Angiography"
},
{
"code" : "H47000",
"display" : "Liver Biopsy"
},
{
"code" : "704082",
"display" : "Excision Of Bengin Tumour - Lesion Diameter Upto 1Cm"
},
{
"code" : "704080",
"display" : "Bone Grafting (Synthetic / Pop)"
},
{
"code" : "300194",
"display" : "T.Tube Cholanglogram"
},
{
"code" : "800142",
"display" : "Exci. Of Lid Tum=Rec. Us Flao"
},
{
"code" : "303226",
"display" : "Ct Virtual Colonography & Polyp Detection"
},
{
"code" : "137024",
"display" : "Psychological Assessment- Category 2 - Personality"
},
{
"code" : "303224",
"display" : "Ct Brain Perfusion Studies"
},
{
"code" : "800140",
"display" : "Exci. Of Lid Tumour With Com. Re"
},
{
"code" : "300198",
"display" : "Heel - 1 View"
},
{
"code" : "1099699",
"display" : "Ang R&L-H 107-88.54 Angiocardiogram- right and & heart"
},
{
"code" : "460220",
"display" : "Intra Nasal Mucosal Allergy T."
},
{
"code" : "710022",
"display" : "Other Preventive Procedures: Per 15 Minutes"
},
{
"code" : "I92553",
"display" : "Speech audiometry air & bone"
},
{
"code" : "710028",
"display" : "Pit & Fissure Sealant - Per Tooth"
},
{
"code" : "208064",
"display" : "Removal Of Skin Tag 1 To 3"
},
{
"code" : "460226",
"display" : "Follow Up-Sinus Endoscopy (One Year )"
},
{
"code" : "750030",
"display" : "Hair Transplantation (300-400) Graft (Skincare)"
},
{
"code" : "460224",
"display" : "Follow Up Sinus Endoscopy (One Time)"
},
{
"code" : "N97124",
"display" : "N97124 Massage Therapy"
},
{
"code" : "T73610",
"display" : "Ankle - 3 Views"
},
{
"code" : "T71250",
"display" : "CT Thorax without Contrast"
},
{
"code" : "U82055",
"display" : "Alcohol, Ethyl"
},
{
"code" : "825194",
"display" : "Simple Cystectomy"
},
{
"code" : "825196",
"display" : "Simple Nephrectomy"
},
{
"code" : "652008",
"display" : "Cabg & Tissue Mitral Valve"
},
{
"code" : "825198",
"display" : "Transvesical Prostatectomy"
},
{
"code" : "652010",
"display" : "Cabg & Mechanical Mitral Valve"
},
{
"code" : "T73615",
"display" : "Ankle Arthrography"
},
{
"code" : "840160",
"display" : "Amputations : Upper Limbs"
},
{
"code" : "302008",
"display" : "Antenatal Scan"
},
{
"code" : "652012",
"display" : "Cabg & Double Tissue Valve"
},
{
"code" : "652014",
"display" : "Cabg & Double Mechanical Valve"
},
{
"code" : "840164",
"display" : "Arthroclesis, Shoulder"
},
{
"code" : "750226",
"display" : "Complete Cleft Lip (Skincare)"
},
{
"code" : "518002",
"display" : "Estrogen"
},
{
"code" : "640014",
"display" : "Ptca (Per.Tr.Coronory Angioplasty) - Dv"
},
{
"code" : "840162",
"display" : "Arthrodesis 1 Big Joint – Hip, Knee (Subtalar:Ankle), Foot : Triple"
},
{
"code" : "518004",
"display" : "Estradiol"
},
{
"code" : "750224",
"display" : "In-Complete Cleft Lip (Skincare)"
},
{
"code" : "506028",
"display" : "Haemoglobin H (For Alpha Thalassemia)"
},
{
"code" : "137220",
"display" : "Bulimia Nervosa Scale"
},
{
"code" : "506026",
"display" : "Food Testing For Coliforms"
},
{
"code" : "506024",
"display" : "Water Testing: Routine Bacteriological Analysis"
},
{
"code" : "U86664",
"display" : "Epstein BARR Nuclear AG."
},
{
"code" : "506022",
"display" : "Skin Scrapping Microscopy For Herpes"
},
{
"code" : "ICU",
"display" : "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)\n* 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.\nTo get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist"
},
{
"code" : "810128",
"display" : "Incision & Drainage Of Quinsy Under G.A."
},
{
"code" : "G29830",
"display" : "Arthroscopy (Diagnostic) Elbow"
},
{
"code" : "137226",
"display" : "A D H D Scale"
},
{
"code" : "137228",
"display" : "Brief Psychotherapy 6 Sessions"
},
{
"code" : "506020",
"display" : "Direct Fungal Wet Mount"
},
{
"code" : "518150",
"display" : "Beta Hcg"
},
{
"code" : "P-210",
"display" : "Tympanoplasty"
},
{
"code" : "650028A",
"display" : "Each Additional: Microcatheter"
},
{
"code" : "G29800",
"display" : "Arthroscopy (Diagnostic) TM joint"
},
{
"code" : "704038",
"display" : "Pericoronal Flap Removal - Complex"
},
{
"code" : "810120",
"display" : "Bronchoscopy"
},
{
"code" : "T74710",
"display" : "Pelvimetry - 2 Views"
},
{
"code" : "353-71.50",
"display" : "Vulvectomy, radical"
},
{
"code" : "U86644",
"display" : "Cytomegalo Virus Screening-IGG"
},
{
"code" : "156-42.84",
"display" : "Repair, fistula, esophageal, other"
},
{
"code" : "156-42.85",
"display" : "Repair, esophageal, stricture"
},
{
"code" : "173046",
"display" : "Dialyser"
},
{
"code" : "640068",
"display" : "Intubasion - Elective"
},
{
"code" : "506002",
"display" : "C & S (Culture & Sensitivity)"
},
{
"code" : "U86645",
"display" : "Cytomegalo Virus Screening-IGM"
},
{
"code" : "173048",
"display" : "Sodium Bicarbonate ( Litre)"
},
{
"code" : "U86648",
"display" : "Diptheria Antitoxin"
},
{
"code" : "800814",
"display" : "Gluocoma Cyclo Photo – Coagulation ( Cbc)"
},
{
"code" : "173042",
"display" : "Permanent Peritoneal Cathetor"
},
{
"code" : "173044",
"display" : "Acute Peritoneal Cathetor"
},
{
"code" : "840100",
"display" : "Fracture Vetebrae"
},
{
"code" : "800812",
"display" : "Conjunctival Revision (Inside Hospital)"
},
{
"code" : "650260",
"display" : "Craniotomy And Excision Of Foramen Mangum Tumour"
},
{
"code" : "840106",
"display" : "Removal K-Wires Without Incision Under G.A."
},
{
"code" : "K57160",
"display" : "Insertion of Pessary"
},
{
"code" : "T76070",
"display" : "CT Bone Density Study"
},
{
"code" : "173040",
"display" : "Central Venous Pressure Monitoring"
},
{
"code" : "840108",
"display" : "Application Of Hip Spica Muga + Uii"
},
{
"code" : "1099698",
"display" : "Ang L-H 107-88.53 Angiocardiogram- left heart"
},
{
"code" : "303228",
"display" : "Ct Virtual Bronchoscopy"
},
{
"code" : "1099697",
"display" : "Ang R-H 107-88.52 Angiocardiogram- right heart"
},
{
"code" : "1099696",
"display" : "Cath R&L-H 107-37.23 Catheterization cardiac, combined right and left heart"
},
{
"code" : "650228",
"display" : "Endoscopy For The Management Of Hydrocephalus"
},
{
"code" : "U86308",
"display" : "Monotest (Paul Bunnel Test)"
},
{
"code" : "1099695",
"display" : "Cath L-H 107-37.22 Catheterization cardiac, left heart"
},
{
"code" : "830072",
"display" : "Cervical Polypectomy"
},
{
"code" : "1099694",
"display" : "Cath R-H 107-37.21 Catheterization cardiac, right heart"
},
{
"code" : "650226",
"display" : "Ventriculo-Peritoneal Shunt Insertion"
},
{
"code" : "L95881",
"display" : "Developmental testing"
},
{
"code" : "830074",
"display" : "Oophrectomy"
},
{
"code" : "650224",
"display" : "Brachial Plexus Repair"
},
{
"code" : "750354",
"display" : "Erbium Laser - Single Treatment (Skincare)"
},
{
"code" : "650222",
"display" : "Release Of Carpal Tunnel Syndrome"
},
{
"code" : "208066",
"display" : "Removal Of Skin Tag 4 To 10"
},
{
"code" : "704132",
"display" : "Reduction Of Simple / Middle Face Fractures + Plating"
},
{
"code" : "L95883",
"display" : "Neuro Psychological Testing Battery"
},
{
"code" : "750352",
"display" : "Laser Test (Skincare)"
},
{
"code" : "K57288",
"display" : "Sling Operation"
},
{
"code" : "208068",
"display" : "Removal Of Skin Tag More Than 10"
},
{
"code" : "704130",
"display" : "Reduction Of Fractured Zygomatic Arch"
},
{
"code" : "712080",
"display" : "Treatment Plan - C"
},
{
"code" : "750034",
"display" : "Hair Transplantation (500-600) Graft (Skincare)"
},
{
"code" : "140070",
"display" : "Ercp - With Placement Of Stent"
},
{
"code" : "140072",
"display" : "Ercp - With Nasobilliary Drainage Tube"
},
{
"code" : "140074",
"display" : "Ercp - With Mechanical Lithotripsy"
},
{
"code" : "N97034",
"display" : "Contrast bath, each 15 minutes"
},
{
"code" : "140066",
"display" : "Ercp - With Sphincterotomy With Or Without Removal Of Stone"
},
{
"code" : "N97035",
"display" : "Ultrasound, each 15 minutes"
},
{
"code" : "140068",
"display" : "Ercp - With Use Of Retrieval Ballon"
},
{
"code" : "H94760",
"display" : "Pulse Oximetry"
},
{
"code" : "712082",
"display" : "Treatment Plan - D"
},
{
"code" : "712084",
"display" : "Treatment Plan - E"
},
{
"code" : "U86588",
"display" : "Smart Test (Strep A)"
},
{
"code" : "208060",
"display" : "Testicular Puncture"
},
{
"code" : "E36450",
"display" : "Exchange transfusion"
},
{
"code" : "750360",
"display" : "Erbium Laser - More Than Ten Pcs (Skincare)"
},
{
"code" : "U85250",
"display" : "Factor 9"
},
{
"code" : "750364",
"display" : "Dye Laser Per Session Medium Area 5-10 Cm (Skincare)"
},
{
"code" : "WD9215",
"display" : "Local Anaesthesia"
},
{
"code" : "750362",
"display" : "Dye Laser Per Session Small Area 2-5 Cm (Skincare)"
},
{
"code" : "WD9210",
"display" : "Dental Anaesthesia w/o Surgery"
},
{
"code" : "WD9211",
"display" : "Regional Block Anaesthesia"
},
{
"code" : "712074",
"display" : "Space Retainer Removable - Follow Up"
},
{
"code" : "712076",
"display" : "Treatment Plan - A"
},
{
"code" : "T75710",
"display" : "Angiography - Extremity Unilateral"
},
{
"code" : "712070",
"display" : "Space Retainer - Fixed"
},
{
"code" : "712072",
"display" : "Space Retainer - Removable"
},
{
"code" : "U85246",
"display" : "Factor 8 Associated AG."
},
{
"code" : "750358",
"display" : "Erbium Laser - More Than Five Pcs (Skincare)"
},
{
"code" : "U85245",
"display" : "Factor 8 Ristocetin Cofactor"
},
{
"code" : "750356",
"display" : "Erbium Laser - Less Than Three Pcs (Skincare)"
},
{
"code" : "712078",
"display" : "Treatment Plan - B"
},
{
"code" : "T75716",
"display" : "Angiography - Extremity Bilateral"
},
{
"code" : "750332",
"display" : "Liposuction Upper Back (Skincare)"
},
{
"code" : "750330",
"display" : "Liposuction Lower Back (Skincare)"
},
{
"code" : "U85280",
"display" : "Factor 12"
},
{
"code" : "N97014",
"display" : "Electrical Stimulation (Unattended)"
},
{
"code" : "N97012",
"display" : "Traction, Mechanical"
},
{
"code" : "N97010",
"display" : "Application of modality to 1or more area;hot/cold pack"
},
{
"code" : "U88305",
"display" : "Gross and Micro Exam Level IV"
},
{
"code" : "750324",
"display" : "Liposuction Gynocomastia - Large (Skincare)"
},
{
"code" : "U88304",
"display" : "Gross and Micro Exam Level III"
},
{
"code" : "750322",
"display" : "Liposuction Gynocomastia - Medium (Skincare)"
},
{
"code" : "N97018",
"display" : "Paraffin Bath"
},
{
"code" : "750328",
"display" : "Liposuction Buttock (Skincare)"
},
{
"code" : "U88309",
"display" : "Gross and Micro Exam Level VI"
},
{
"code" : "N97016",
"display" : "Vasopneumatic Devices"
},
{
"code" : "U88307",
"display" : "Gross and Micro Exam Level V"
},
{
"code" : "750326",
"display" : "Liposuction Flanks (Skincare)"
},
{
"code" : "U85270",
"display" : "Factor 11"
},
{
"code" : "U88302",
"display" : "Gross and Micro Exam Level II"
},
{
"code" : "750342",
"display" : "Full Abdominoplasty - Large (Skincare)"
},
{
"code" : "U88300",
"display" : "Histopathology (Frozen Section)"
},
{
"code" : "750340",
"display" : "Full Abdominoplasty - Small (Skincare)"
},
{
"code" : "E39502",
"display" : "Paraesophageal hiatus hernia repair trans abdominal"
},
{
"code" : "N97026",
"display" : "Infra Red"
},
{
"code" : "N97024",
"display" : "Diathermy"
},
{
"code" : "N97022",
"display" : "Whirlpool"
},
{
"code" : "N97020",
"display" : "Microwave"
},
{
"code" : "750336",
"display" : "Liposuction Chin (Skincare)"
},
{
"code" : "750334",
"display" : "Liposuction Arms (Skincare)"
},
{
"code" : "750338",
"display" : "Mini Abdominoplasty (Skincare)"
},
{
"code" : "N97028",
"display" : "Ultra Violet"
},
{
"code" : "840238",
"display" : "Application Of Splints, Slabs, Pop Without Reduction"
},
{
"code" : "840236",
"display" : "Removal Of F.B. Superficial"
},
{
"code" : "830030",
"display" : "Polypectomy Fract. Curretage"
},
{
"code" : "750310",
"display" : "Liposuction Lateral Thighs (Small-Medium) (Skincare)"
},
{
"code" : "T74440",
"display" : "Vasography"
},
{
"code" : "T73110",
"display" : "Wrist - 3 Views"
},
{
"code" : "830036",
"display" : "Posterior Colpoperineorrhaphy"
},
{
"code" : "830038",
"display" : "Anterior Colpoperineorrhaphy"
},
{
"code" : "830032",
"display" : "Douglas Pouch Abscess Drainage"
},
{
"code" : "140030",
"display" : "Sclerotherapy (Oesophagus)"
},
{
"code" : "140020",
"display" : "Laryngo-Bronoscopy/Diagnostic"
},
{
"code" : "140022",
"display" : "Laryngo-Bronoscopy/Diagnostic + Biopsy"
},
{
"code" : "750308",
"display" : "Liposuction Abdomen -Large (Skincare)"
},
{
"code" : "140024",
"display" : "Laryngo-Bronoscopy/Diagnostic + Film"
},
{
"code" : "830028",
"display" : "Laparascopy (Not For Infertility Investigations) Diagnostic"
},
{
"code" : "T73100",
"display" : "Wrist - 2 Views"
},
{
"code" : "140026",
"display" : "Colonoscopy"
},
{
"code" : "140028",
"display" : "Endoscopy Under L.A."
},
{
"code" : "840242",
"display" : "Terminalisation"
},
{
"code" : "750302",
"display" : "Liposuction (Skincare)"
},
{
"code" : "840240",
"display" : "C.R. Of Fractures Or Dislocations Without Anaesthesia + Application Of Pop"
},
{
"code" : "840246",
"display" : "O.R. + If Of Single Bone Except Fracture Neck, Femur, Torch, Fracture And Fractu"
},
{
"code" : "750306",
"display" : "Liposuction Abdomen - Medium (Skincare)"
},
{
"code" : "712048",
"display" : "Expansion Of Lower Mandible, Crozat Appliance"
},
{
"code" : "840244",
"display" : "Wound Toilet & Debridment"
},
{
"code" : "750304",
"display" : "Liposuction Abdomen - Small (Skincare)"
},
{
"code" : "840248",
"display" : "Cervical Disc Prolapse- Desectomy + Decompression"
},
{
"code" : "750320",
"display" : "Liposuction Gynocomastia - Small (Skincare)"
},
{
"code" : "825180",
"display" : "Pyeloplasty"
},
{
"code" : "830024",
"display" : "Caesarian Delivery (With Normal Baby)"
},
{
"code" : "T74430",
"display" : "Cystography"
},
{
"code" : "G23410",
"display" : "Repair of rotator cuff"
},
{
"code" : "830026",
"display" : "Shirodkar Suture"
},
{
"code" : "825182",
"display" : "Removal Of Penile Prosthesis"
},
{
"code" : "302007",
"display" : "Ultrasound Obstetric Level Iii"
},
{
"code" : "I69436",
"display" : "Gromet Sheppard vent tube, fluoroplastic"
},
{
"code" : "T73600",
"display" : "Ankle - 2 Views"
},
{
"code" : "640016",
"display" : "Ptca (Per.Tr.Coronory Angioplasty) - Tv"
},
{
"code" : "U82088",
"display" : "Aldosterone"
},
{
"code" : "136006",
"display" : "Air Mist Therapy"
},
{
"code" : "840168",
"display" : "Benign Bone Tumours : Curretage Bone Grafting"
},
{
"code" : "U86668",
"display" : "Francisella Tularensis ABS."
},
{
"code" : "T76938",
"display" : "Ultra Sound Guided Aspiration Cyst"
},
{
"code" : "640018",
"display" : "Ptca (Per.Tr.Coronory Angioplasty - Sv + Stent"
},
{
"code" : "840166",
"display" : "Arthroscopy Diagnostic + Proceed"
},
{
"code" : "750228",
"display" : "Forehead Lift (Skincare)"
},
{
"code" : "U86663",
"display" : "EB Virus(Epstein Barr Virus) IGM IFA"
},
{
"code" : "650020B",
"display" : "Microcatheter"
},
{
"code" : "506018",
"display" : "Glemsa Staining"
},
{
"code" : "506016",
"display" : "Methylene Blue Staining"
},
{
"code" : "506014",
"display" : "Acid Fast Staining"
},
{
"code" : "500067",
"display" : "Electrolytes (Na, K, C1) Urine"
},
{
"code" : "P-208",
"display" : "Septoplasty"
},
{
"code" : "716026",
"display" : "Relining Upper Or Lower Denture"
},
{
"code" : "P-209",
"display" : "Polypectomy"
},
{
"code" : "500066",
"display" : "Sodium, Serum Or Urine"
},
{
"code" : "128012",
"display" : "Broad Dynamic Comp Plate 7 Holes Each"
},
{
"code" : "716024",
"display" : "Immediate Complete Dentures (Requiring Relining)"
},
{
"code" : "U84481",
"display" : "T3 (Free T3)"
},
{
"code" : "500064",
"display" : "Total Co2"
},
{
"code" : "U84480",
"display" : "T3"
},
{
"code" : "128014",
"display" : "Broad Dynamic Comp Plate 8 Holes Each"
},
{
"code" : "716022",
"display" : "Additional Casted Clasp-Gold Or Metal"
},
{
"code" : "P-204",
"display" : "Sinus washout - Bilateral"
},
{
"code" : "716020",
"display" : "Tooth Additional (Each)"
},
{
"code" : "500068",
"display" : "Total Cholesterol"
},
{
"code" : "P-205",
"display" : "Removal of nasal foreign body"
},
{
"code" : "810118",
"display" : "Esophagoscopy"
},
{
"code" : "500063",
"display" : "Electrolytes (Na, K, C1) Serum"
},
{
"code" : "128016",
"display" : "Broad Dynamic Comp Plate 9 Holes Each"
},
{
"code" : "500062",
"display" : "Lipase"
},
{
"code" : "P-206",
"display" : "Tonsillectomy"
},
{
"code" : "P-207",
"display" : "Tonsillectomy & Adenoidectomy"
},
{
"code" : "810304",
"display" : "Total Laryngectomy"
},
{
"code" : "U84484",
"display" : "CDT ( Cardiac Troponin )"
},
{
"code" : "128018",
"display" : "Broad Dynamic Comp Plate 12 Holes Each"
},
{
"code" : "800818",
"display" : "Iol Repositioning ( Inside Hospital)"
},
{
"code" : "P-200",
"display" : "Laryngoscopy + Biopsy"
},
{
"code" : "800816",
"display" : "Gluocoma Ext+ Drang Implant"
},
{
"code" : "P-201",
"display" : "Myringotomy and insertion of Gromet - Unilateral"
},
{
"code" : "110-37.91",
"display" : "Massage, cardiac, open chest"
},
{
"code" : "P-202",
"display" : "Myringotomy and insertion of Gromet - Bilateral"
},
{
"code" : "P-203",
"display" : "Sinus washout - Unilateral"
},
{
"code" : "650036D",
"display" : "Detachable Balloon"
},
{
"code" : "128010",
"display" : "Broad Dynamic Comp. Plate 6 Holes Each"
},
{
"code" : "N.2",
"display" : "NICU Second week (SR/Day) N.2 Exlusion as above"
},
{
"code" : "E38100",
"display" : "Splenectomy"
},
{
"code" : "830096",
"display" : "Removal Of Circulage / Shirodkar Suture"
},
{
"code" : "N.1",
"display" : "NICU First week (SR/Day) N.1\n* 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\nTo get re-imbused for medication above the daily limit, submission must include a list of details medications as per SFDA codes and pricelist"
},
{
"code" : "640000",
"display" : "Catheterization Left Heart"
},
{
"code" : "497-81.08",
"display" : "Fusion,posterior,lumbar/lumbosacral"
},
{
"code" : "T93882",
"display" : "U/S Doppler Carotid Unilateral"
},
{
"code" : "N.4",
"display" : "NICU Fourth week (SR/Day) N.4 Exlusion as above"
},
{
"code" : "U83505",
"display" : "Hydroxyproline, Total"
},
{
"code" : "800158",
"display" : "Unilateral Tarsal Strip With Graft"
},
{
"code" : "800156",
"display" : "Bilateral Tarsal Strip"
},
{
"code" : "800150",
"display" : "Unil. Levator Mus. Recession"
},
{
"code" : "303232",
"display" : "Ct Carotid & Vertebral Arteries Angiography"
},
{
"code" : "303230",
"display" : "Ct Cerebral Arteries Angiography"
},
{
"code" : "137020",
"display" : "Psychological Assessment- Category 2 - Ocd"
},
{
"code" : "U83500",
"display" : "Hydroxyproline, Free"
},
{
"code" : "800154",
"display" : "Unilateral Tarsal Strip"
},
{
"code" : "303236",
"display" : "Ct Pulmonary Arteries Angiography"
},
{
"code" : "800152",
"display" : "Bil. Levator Mus. Recession"
},
{
"code" : "303234",
"display" : "Ct Aorta & Mesenteric Arteries Angiography"
},
{
"code" : "710026",
"display" : "Periodontal Bone Grafting Implant/Bony Detect"
},
{
"code" : "T73090",
"display" : "ULNA Radius (Forearm) - 2 Views"
},
{
"code" : "830070",
"display" : "Abdominal Sling For Congenital Prolapse"
},
{
"code" : "800124",
"display" : "Eye Plastic Surgery"
},
{
"code" : "800122",
"display" : "Trichiasis Repair (Both Eyes)"
},
{
"code" : "800128",
"display" : "Repair Of Simple Lid+Explora"
},
{
"code" : "830076",
"display" : "Removal Of Iucd Under Ga"
},
{
"code" : "750032",
"display" : "Hair Transplantation (400-500) Graft (Skincare)"
},
{
"code" : "830078",
"display" : "Salpingectomy / Salpingostomy"
},
{
"code" : "U82943",
"display" : "Glucagon (P)"
},
{
"code" : "U82947",
"display" : "Glucose Quantitative Blood /CSF"
},
{
"code" : "137022",
"display" : "Psychological Assessment- Category 2 - Panic & Phobia"
},
{
"code" : "650232",
"display" : "Spinal Stenosis : Inter Laminar Decompression / Laminectomy With Discectomy"
},
{
"code" : "I92562",
"display" : "ABLB-Alternate Binaural Loudness Balance"
},
{
"code" : "710008",
"display" : "Gingival Currettage - Per Quadrant"
},
{
"code" : "I92563",
"display" : "Tone decay test"
},
{
"code" : "830020",
"display" : "Vacuum Delivery (With Normal Baby)"
},
{
"code" : "825184",
"display" : "Repair Of Fracture Penis"
},
{
"code" : "830022",
"display" : "Breech Delivery (With Normal Baby)"
},
{
"code" : "U85290",
"display" : "Factor 13"
},
{
"code" : "825186",
"display" : "Repair Of Renal Injuries"
},
{
"code" : "825188",
"display" : "Repair Of Ruptured Urethra Or Bladder"
},
{
"code" : "136008",
"display" : "Breathing Exercise"
}
]
}