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Ayushman Codes and Prerequisites
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Spe cia lty Code | Code and Procedure | Rate | Pre-op | Post-op |
| Acute Lymphoblastic Leukemia |
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| M4 | 3A.M4.00004: Acute lymphoblastic leukemia: radiation | 5000 | Haematology, Bone Marrow Aspitation / Flow cytometry | Photo with RT Machine, RT treatment chart |
| M4 | 3A.M4.00001 : Acute lymphoblastic leukemia (chemotherapy including diagnostics): induction | 50000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| M4 | 3A.M4.00002 : Acute lymphoblastic leukemia (chemotherapy including diagnostics):consolidation | 50000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| M4 | 3A.M4.00003 : Acute lymphoblastic leukemia (chemotherapy including diagnostics): maintainence | 5000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| M4 | 3A.M4.00005:Acute lymphoblastic leukemia: Supportive care/ rehabilitation | 20000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| M5 | 3A.M5.00046: Acute Lymphatic Leukemia Maintenance Phase- Per month(x24) | 5000 | Haematology, Bone Marrow Aspitation/ Flowcytometry | Photo with RT Machine, RT treatment Chart |
| M5 | 3A.M5.00047: Acute Lymphatic Leukemia Induction | 50000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Photo with RT Machine, RT treatment Chart |
| M5 | 3A.M5.00048: Acute Lymphatic Leukemia Consolidation Phase | 50000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17182: Adult ALL-Hyper CVAD /BFM-4cycles (Each cycle=A +B) | 36000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17236: Maintenance (Paed and adults)- ALL (Per month) | 3000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| Acute Myeloid Leukemia |
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| M4 | 3A.M4.00006: Acute myeloid leukemia (chemotherapy including diagnostics): induction | 75000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M4 | 3A.M4.00007: Acute myeloid leukemia (chemotherapy including diagnostics): consolidation | 75000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M4 | 3A.M4.00008: Acute myeloid leukemia: Supportive care/ rehabilitation | 30000 | Haematology+ Cyto flowmetry report | Clinical Photograph, chemotherapy drug batch number with bar code, treatment drug details in discharge summary |
| M5 | 3A.M5.00039: Acute Myeloid Leukemia Induction Phase, up to (Daunomycin and cytosine arabinoside (3:7)) | 100000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| M5 | 3A.M5.00040 : Acute Myeloid Leukemia Consolidation Phase, upto (High dose cytosine arabinoside– per cycle, max. of 3 to 4 cycles) | 75000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17181: Consolidation 1to4 phases (per phase)- AML | 33000 | Haematology, Bone Marrow Aspitation/ Flowcytometry | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17233:Induction/ 1stPhase-AML (2nd Induction- permitted in adults only) | 50000 | Haematology, Bone Marrow Aspitation/ Flowcytometry | Clinical Photograph, chemotherapy drug batch number with barcode |
| Hodgkin Lymphoma |
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| M4 | 3A.M4.00010: Hodgkin Lymphoma (Favorable group): radiation | 10000 | Hematology+ Biopsy/ FNAC report | Photo with RT Machine, RT treatment chart |
| M4 | 3A.M4.00013: Hodgkin Lymphoma (unfavorable group): radiation | 15000 | Hematology+ Biopsy/ FNAC report | Photo with RT Machine, RT treatment chart |
| M4 | 3A.M4.00011: Hodgkin Lymphoma (Favourable group): Supportive care/ rehabilitation | 15000 | Biopsy ,CT | Clinical Photograph, chemotherapy drug batch number with bar code |
| M4 | 3A.M4.00014: Hodgkin Lymphoma (unfavourable group): Supportive care /rehabilitation | 25000 | Biopsy, CT | Clinical Photograph, chemotherapy drug batch number with bar code, treatment drug details in discharge Summary |
| M5 | 3A.M5.00009 : Lymphoma, Hodgkin'S Adriamycin Bleomycin Vinblastin Dacarbazine (ABVD)- max 8 cycles (Per cycle) (Day1&Day15) | 10000 | Biopsy, CT | Clinical Photograph, chemotherapy drug batch number with barcode |
| Non-Hodgkin Lymphoma |
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| M4 | 3A.M4.00015:Non-Hodgkin Lymphoma: chemotherapy including diagnostics | 1,50,000 | Lymph node Biopsy, HPE, BMA with biopsy, CT scan | Heamogram, Biochemestry, chestx-ray, chemotherapy drug batch number with Bar code |
| M4 | 3A.M4.00016:Non-Hodgkin Lymphoma: Supportive care/ rehabilitation | 50000 | Biopsy, CT | Clinical Photograph, chemotherapy drug batch number with bar code, treatment drug details in discharge Summary |
| M5 | 3A.M5.00001: Lymphoma, Non-Hodgkin’s R-CHOP Regimen (per cycle)x 6 | 6000 | Biopsy, CT report with film | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17188: Bendamustine-max 6cycles (Per cycle)- CLL | 10000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17189: Bendamustine+ Ritumaxib- 6-8cycles (Per cycle)-CLL (Available only at select centres) | 20000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17190: R-CHOP- max 6cycles (Per cycle) | 20000 | Biopsy, CT report with film | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17191 : Variable Regimen- Non Lymphoblastic NHL, (Per cycle) max. 8cycles. (Amount as per drug cost) | 20000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with bar code |
| Multiple Myeloma |
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| M5 | 3A.M5.00002: Multiple Myeloma Bortezomib+ lenalidomide+ dexamethasone, per cycle x6 | 5000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00003 : Multiple Myeloma Bortezomib + cyclophosphamide + dexamethasone, per cycle x6 | 5000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00004: Multiple Myeloma MPT-melphalan, thalidomide and prednisolone ,per cycle x9 | 5000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00005: Multiple Myeloma Bortezomib +dexamethasone, per cycle x 9 | 5000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00006 : Multiple Myeloma Thalidomide +Dexamethasone (Oral)/ month- Max 12 months | 5000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00030: Multiple Myeloma Melphalan- Prednisone (oral )–per month (max 12 months)- | 1500 | Bone Marrow Aspiration Report, Serum Protein electrophoresis, CRAB criteria | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.00032: Multiple Myeloma Zoledronic acid- Max 12 cycles (Per month) | 2000 | CT/ PET/ Bone scan/ X ray, Biopsy if required | Chemotherapy drug batch number With barcode |
| M5 | 3A.M5.17192: Plasmacell Leukemia/ Multiple Myeloma -Thaladomide, Dexamethasone, Bortezomib- max 6 cycles | 20000 | Bone Marrow Aspiration Report, Serum Protein electrophoresis | Clinical Photograph, chemotherapy drug batch number with barcode |
| Salvage Chemotherapies |
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| M5 | 3A.M5.17184 : Salvage CT - GDP (Gemcitabine - Cisplatin-Dexamethasone)- Maximum 6cycles (Per cycle) | 12000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with bar code |
| M5 | 3A.M5.17185: Salvage CT- ICE (Ifosfamide- Carboplatin- Etoposide)-Maximum 6 cycles (Per cycle) | 15000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with barcode |
| M5 | 3A.M5.17186: Salvage CT-DHAP (cytosine arabinoside- cisplatin- dexamethasone)-Maximum 6 cycles (Per cycle) | 25000 | Hematology +Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with barcode |
| Chronic Myeloid Leukemia |
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| M4 | 3A.M4.00037: Chronic Myeloid Leukemia: Chemotherapy including diagnostics | 6000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Photo with RT Machine, RT treatment Chart |
| M4 | 3A.M4.00038:Chronic Myeloid Leukemia: supportive care/ rehabilitation | 1,00,000 | BMA report and Molecular analysis report | Hemogram, Biochemistry, , treatment drug details in discharge summary |
| M5 | 3A.M5.00051: Chronic myeloid leukemia Imatinib (per month) x5years | 6000 | Haematology, Bone Marrow Aspitation/ Flow cytometry | Photo with RT Machine, RT treatment chart |
| M5 | 3A.M5.17187: Second generation Tab TKI-max 12 cycles per yea r(Per month)-(Failure of Imatinib) | 6000 | Hematology+ FNAC report /Cytogenetics / BCR-ABL | Clinical Photograph, chemotherapy drug batch number with barcode |
| M5 | 3A.M5.17237: Imatinib Min 400mg/day-max 12 cycles per yea r(Per month) -AML, CML | 5000 | Hematology+ FNAC report /Cytogenetics /BCR-ABL | Clinical Photograph, chemotherapy drug batch number with bar code |
| Sickle Cell Anemia |
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M1 | 3A.M1.00042: Sickle cell Anemia-routine ward | 1800 | Clinical notes confirming diagnosis | Clinical notes in relevant reports |
M1 | 3A.M1.00042A: Sickle cell Anemia- HDU | 2700 | Clinical notes confirming diagnosis | Clinical notes in relevant reports |
M1 | 3A.M1.00042B: Sickle cell Anemia-ICU without ventilator | 3600 | Clinical notes confirming diagnosis | Clinical notes in relevant reports |
M1 | 3A.M1.00042C: Sickle cell Anemia-ICU with ventilator | 4500 | Clinical notes confirming diagnosis | Clinical notes in relevant reports |
| Others |
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M1 | 3A.M1.00069: Plasmapheresis- per session | 2000 | Blood examination | Blood examination |
M4 | 3A.M4.00031: Histiocytosis: chemotherapy including diagnostics | 50000 | Skin Biopsy/ Lymph node Biopsy, USG Abdomen pelvis | Heamogram, Biochemestry |
M4 | 3A.M4.00032: Histiocytosis: supportive care/ rehabilitation | 5000 | Hematology+ Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with barcode |
M5 | 3A.M5.00041: Histocytosis Variable Regimen- Histocyosis- max 1year (Per month) | 8000 | Biopsy, CT report with film | Clinical Photograph, chemotherapy drug batch number with barcode |
M5 | 3A.M5.00044: Unlisted Regimen Palliative CT- Max 6 cycles (Per cycle) | 5000 | CT/MRI, HPE report | Chemotherapy drug batch number With barcode |
M5 | 3A.M5.00045: Terminally Ill Palliative And Supportive Therapy- Per month | 3000 | CT/MRI, HPE report | Chemotherapy drug batch number With barcode |
M5 | 3A.M5.17179: High Dose Methotrexate (MTX) –max 6cycles (Per cycle) | 15000 | Biopsy, CT-Scan with film | Clinical Photograph, chemotherapy drug batch number with bar code |
M5 | 3A.M5.17183 : D'angelo's for CNS primary and secondary lymphomas-(Max. 6months) (Per month) | 20000 | Haematology+ Cyto flowmetry report | Clinical Photograph, chemotherapy drug batch |
M5 | 3A.M5.17191 : Variable Regimen-Non Lymphoblastic NHL,(Per cycle) max. 8cycles .(Amount as per drug cost) | 20000 | Hematology +Biopsy/ FNAC report | Clinical Photograph, chemotherapy drug batch number with bar code |
M5 | 3A.M5.17194: Variable Regimen- LCH-max 1 year (Per month) (Amount as per drug cost) | 8000 | Biopsy, IHC, CT report with film | Clinical Photograph, chemotherapy drug batch number with barcode |
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